Transcript Department of Veterans Affairs VA PSYCHOLOGY LEADERSHIP CONFERENCE May 18, 2007 Psychosocial Rehabilitation and Recovery Oriented Services Robert Gresen, Ph.D. ([email protected])

Department of Veterans Affairs
VA PSYCHOLOGY LEADERSHIP CONFERENCE
May 18, 2007
Psychosocial Rehabilitation and Recovery
Oriented Services
Robert Gresen, Ph.D.
([email protected])
Major Program Areas
• Family Services
• Peer Support
• Psychosocial Rehabilitation and Recovery
Centers
• Vocational Rehabilitation
• Other evidence based and best practices
• Anti-Stigma
• Staff, veteran and other stakeholder
education
• Local Recovery Coordinators
Family Services
• Family engagement, support, education
• Family Psychoeducation
• Administrative supports/incentives
• Legislation
Family Psychoeducation (FPE)
Funded FPE Proposals:
• FY’05 – 2 Proposals
• FY’06 - 9 Proposals
• FY’07 – 8 Proposals
This is estimated to address only a small
percentage of the overall need systemwide. (1/4- 1/3)
Peer Support Services
• Provided by a person who has
recovered or has experienced
significant recovery from serious mental
illness
• Utilizes personal experience of being a
consumer of mental health services in
the context of helping others
Peer Support Services (cont)
• Various models
•
•
•
Peer Support Technicians (paid staff)
Peer Support/Education Groups (e.g. Vet to Vet)
Consumer Operated Services
• Need to understand the various models
• Similarities and differences; strengths of each
• Roles, responsibilities, boundaries, etc.
Peer Support Services (cont)
24 sites
• Peers as VHA staff (PSTs ) serve as full
members of the mental health treatment
team
• Document in the medical record
• Assist veterans in skill building, goal
setting, problem solving, outreach …
Peer Support Services
(continued)
PSTs may be placed in mental health
clinics, inpatient units, MHICMs, partial
hospitalization, homeless programs,
work restoration, residential
rehabilitation programs ...
Peer Support Services (cont)
• For those models where peer specialists are
hired
• Insure current staff have sufficiently embraced
recovery beliefs and principles to value an
respect the peer providers role and their unique
contribution to the mental health team
• Insure that proper HR procedures are used
• National training planned – August 2007
Psychosocial Rehabilitation and
Recovery Centers (PRRCs)
• Centers where veterans with mental illness
can explore and pursue recovery options
• Veterans can receive professional and selfhelp/peer support services as well as referral
to other VA or community-based services.
• PRRCs should be developed in the context of
the existing MH continuum of care, available
community resources, etc.
Psychosocial Rehabilitation and
Recovery Centers (PRRCs)
(continued)
Funded FPE Proposals:
• FY’06 - 18 Proposals
• FY’07 – 9 Proposals
Existing Day Treatment Centers: 42
PRRC National Training planned for FY 2007
Vocational Rehabilitation
• 37,792 veterans served 2006
• Primary Clinical Approaches
• Incentive Therapy, Vocational
Assistance, CWT
• 162 CWT programs: All major facilities
•
•
•
•
45 new programs FY05, 06 & 07
13 of 21 Polytrauma program locations
CWT – SCI Research at 5 locations
275 new staff funded FY05, 06 & 07
Compensated Work Therapy
• Three components
• Workshop evaluation
• Transitional Work Experiences
• Supported Employment
• Supported Employment
• Focus on veterans with psychosis
• 4000 served in fy 2006
• “Experiment” in EBP implementation
Other Evidence Based and
Emerging Best Practices
• Existing literature
• Authoritative sources such as the
SAMHSA website
http://www.mentalhealth.samhsa.gov/cmhs/
communitysupport/toolkits/default.asp
• Other emerging best practices
Is there a plan?
National Recovery Coordinator
• Resource to the field
• Oversee implementation of recovery
initiative in VHA MH
• Appoint a NATIONAL RECOVERY
ADVISORY COMMITTEE to provide expert
advice and assistance
Activities of the NRC and the National
Recovery Advisory Committee
• Adopt and promulgate the SAMHSA definition of
Recovery
• Recovery Education program for staff
• Recovery Education for veterans and family
members
• Compile a list of recommended resource
materials
• Develop a peer support system at each facility
Activities of the NRC and the National
Recovery Advisory Committee (continued)
• Facilitate and support the efforts of field based MH
leadership to develop plans for implementing
recovery initiatives at each facility.
• Monitor and facilitate implementation of recovery
oriented care system-wide
• Assess the impact of recovery transformation
• recovery outcomes of consumers
• increased provider competency
Activities of the NRC and the National
Recovery Advisory Committee (continued)
• Identify best practice measures of above
• Encourage and identify resources specifically to
support research to evaluate implementation and
effectiveness of recovery oriented programs.
• Collaborate with OQP and JCAHO to develop
appropriate ORYX measure to track facility
adherence to this process.
Local Recovery Coordinators
(LRCs)
In conjunction with the Mental Health
Director:
• develop a 3-5 year facility plan to
implement recovery oriented services
• develops a facility recovery education
plan to include staff, veterans, family
members and other stakeholders
• develop and conduct evaluations
Local Recovery Coordinators
(continued)
• provide an annual report on
implementation progress
• participates in VISN and national
conference calls
• participates in MH leadership meetings
at the local level
• May serve as VISN POC to NRC/NRAC
• delivers recovery oriented care
Local Recovery Coordinators
(continued)
• Qualifications
• Lived experience in recovery from mental
illness preferred but not required.
• Experience in the recovery model and in
transforming health care systems,
particularly the VA.
• Previous experience as a Mental Health
clinician providing direct care.
Educational Initiatives
• Satellite programs addressing the
general principles of psychosocial
rehabilitation and recovery for all mental
health staff have been broadcast.
• Conferences have been held in
vocational rehabilitation, peer support
and Mental Health Intensive Case
Management
Mental Illness Awareness Week
(MIAW)
• Office of Mental Health Services
developed a “Recognition of Recovery”
package which included a key note
address, sample program, certificates,
etc
• 16 VAMCs hosted MIAW programs the
first week of October, 2006
Educational Initiatives
(continued)
• Web-based anti-stigma training program
currently available
• Web-based Recovery Oriented mental health
services training program expected in 2007*
Educational Initiatives
(continued)
• Interprofessional Fellowship Program
in Psychosocial Rehabilitation for
trainees in mental health professions
funded by OAA
(Bedford, Palo Alto, West Haven, Durham, San
Diego, Waco, Little Rock)
• Clinical supervisor training
Educational Initiatives
(continued)
Presentations at various VISN and national
level meetings:
• VISN 3 MH Recovery Conference (Sept. 2006)
• VISN 23 Annual Mental Health Meeting (May
2007)
• VA Psychology Leadership Conference (May
2007)
• Transforming VHA MH Care (July 2007)
Evaluation/Accoutability
• Tracking allocated dollars and people
• Monitoring will include employees hired
under those dollars and, if they were an
internal or external hire. If internal the
position vacated will be monitored to
assure it is backfilled
• Outcomes
Other Plans for the Immediate Future
• Develop IL on PSR concepts
• Develop IL on peer support: definitions, basic
concepts, models …..
• Develop directive on Peer Support: policy,
procedures, hiring practices, ….
• Consumer Councils
• Consumer Representation on MH Executive
Committees
• New Educational Initiatives
What else do we need to do?
Evidence-Based Practices
Family Psychoeducation (FPE)
Refers to several clinical models having the main focus
of improving the well-being and functioning of the
veteran and meeting the family members' need for
education, guidance and support as they participate
in the on-going care of an ill relative. All evidence
based modes include the following key elements:
• Family support
• Problem-solving skills training
• Crisis intervention
• Duration of at least nine months
• Education about mental illness
Evidence Based FPE Models
• Behavioral Family Management (Ian
Fallon et. al.)
• Family Psychoeducation (Carol
Anderson et. al.)
• Psychoeduational Multifamily Groups
(William McFarlane et. al.)
Psychosocial Rehabilitation
(PSR)
• Fundamental principle: Recovery is possible
for individuals with Serious Mental Illness
• Focus: Functional domains to maximize life
satisfaction:
Employment
Spiritual
Education
Legal
Housing
Family
Relationships
Consensus Conference on Mental
Health Recovery
Sponsored by SAMHSA, December 2004
• Mental health recovery is a journey of healing
and transformation for a person with a mental
health disability to be able to live a
meaningful life in communities of his or her
choice while striving to achieve full human
potential or “personhood.” Recovery is a
multi-faceted concept based on these 10
fundamental elements and guiding principles.
National Consensus Statement on
Mental Health Recovery
(SAMHSA)
Self-direction
Strength-based
Individualized and Peer Support
Person-centered
Empowerment
Respect
Holistic
Responsibility
Non-linear
Hope
Recovery Oriented Program
(Farkas et. al. 2005)
• Values
• Interest in patients as people, consumer
involvement and choice, growth potential
• Structures
• mission, policies, procedures, record
keeping, and quality assurance
• Staffing
• selection, training and supervision
Recovery Practice Standards
Farkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158
Recovery Practice Standards
Farkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158
Recovery Practice Standards
Farkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158
Robert Gresen, Ph.D.
Associate Chief Consultant for
Psychosocial Rehabilitation and
Recovery Services
Anthony Campinell, Ph.D.
Director for
Therapeutic and Supported
Employment Services
Susan McCutcheon, Ed.D.
Program Manager
(Vacant)
Program Manager
(Vacant)
Program Manager
(Vacant)
Health System Specialist
(Vacant)
Health Systems Specialist
Syvonne Carter
Program Assistant
Ralph Zaccheo, MBA
Administrative Officer
Frederick Lee
Rehab Planning Specialist,.
CWT & IT
Charles McGeough
Program Specialist, Marketing
Donna Tasker
Health Systems Specialist
Judith Patten
Program Specialist