Recovery: Are we there yet? A process of learning to approach each - PDF document

9/27/2010 Recovery Recovery: Are we there yet? A process of learning to approach each day’s challenges, overcome our disabilities, learn skills, live independently, and contribute to society. contribute to society Patricia B Nemec PsyD CRC CPRP Patricia B. Nemec, PsyD, CRC, CPRP USPRA-GEORGIA This process is supported by those who October 2010 believe in us and give us hope. Please do not photocopy without permission Separate handouts with references are available Contact: patnemec@patnemec.com http://www.transformation-center.org 3 4 An Experiential Shift Research on Recovery Despair to Hope • Outcome – Research evidence Alienation to Purpose – Longitudinal studies over 20-37 years Isolation to Relationship – 46-84% recovered or significantly improved 46 84% recovered or significantly improved Withdrawal to Involvement • Deegan’s historical research Passive adjustment to Active coping – Worcester State Hospital 1840-1893: 58% – “The treatment has changed dramatically and -Priscilla Ridgway recovery rates are about the same” (2001) http://www.nasmhpd.org/spec_e-report_fall04panel.cfm 5 6 Recovery is Real Changes in Perspective “I had spent over 20 years believing that I Containment Survive had a mental illness, that something was Segregation wrong with my brain. I was told it was Treatment incurable and I would spend the rest of my incurable and I would spend the rest of my Rehabilitation life on psychiatric medication. Now I’ve Recovery come to believe that what I was told was not true. The experts were wrong .” Wellness Thrive -Loren’s Story Firewalkers: Madness, Beauty, & Mystery 7 8 Do not photocopy or distribute without permission USPRA-GA (Oct 2010) patnemec@patnemec.com 1

9/27/2010 Recovery-Oriented Services Person Centered Services • Person-centered • User-friendly, accessible, welcoming • Strengths focus • Service user is source of control • Support development • Coordinated, seamless • Skill development • No wrong door; service users respected • Whole person view, strengths-based • The rehabilitation formula: • Accepting, commitment to engaging Success = Skills + Supports 9 10 Person-Centered Assessment Person Centered Planning • Based on interests, preferences, wishes, • Not just producing a signed service plan! hopes, dreams, goals • A person-centered process – Motivation is discovered, not created – Assessment of goals, needs is the foundation • Focuses on functional needs to achieve • Focuses on functional needs to achieve – Planning identifies strategies to achieve goals Pl i id ifi i hi l personal goals – Intervention creates progress towards goals • Identifies and evaluates skills • Shared Decision Making 11 12 Person-Centered Intervention Motivation • Fits the person’s view of the need/problem • Motivation is discovered, not created • Evidence of effectiveness • Chosen from among options • A person who is motivated shows it by….? • Delivered by provider of choice • In contrast, a person who is unmotivated…? 14 16 Do not photocopy or distribute without permission USPRA-GA (Oct 2010) patnemec@patnemec.com 2

9/27/2010 What is motivation? Facilitators of motivation • Invisible—like an “energy force” • Choice (internal motivation, no coercion) • Motivation to do (or to avoid) • Expectations (Positive outcome, Self-efficacy) • Can only be inferred from actions • Experience • Intrinsic vs. extrinsic motivation • Interest • Maturity • Physical capacity to make change • Relationship(s) • Risk tolerance (see also expectations, maturity) 17 19 Self-determination theory The Ike Powell Formula M = FN x PV x FS x PR Motivation Motivation • Motivation – Felt Need If there s a 0 anywhere, If there's a 0 anywhere, your end result is 0! Autonomy Autonomy Competence Competence Relatedness Relatedness – Practical Vision – First Step It’s my choice I can do it I care about you… – Positive Results …and you care if I do it Deci & Ryan 20 21 Motivation vs. Engagement Who drops out? • Motivation refers to drivers of action • Younger, male, ethnic minority – Drivers toward achieving something • Low social functioning and social isolation – Drivers toward avoiding something – Not married; out of contact with family • Engagement refers to connection E t f t ti • Low SES, education level, unemployment – Consensus regarding purpose of relationship • Co-occurring SMI and substance use – Trust, based on respect, dignity, mutuality • Not accepting, or identified with, diagnosis – Recognition of the value of collaboration • Poor alliance with service provider(s) • Disengaged: drops out, not nec unmotivated – Initial period of tx most likely time for dropout Kreyenbuhl, Nossel, Dixon (2009) 22 23 Do not photocopy or distribute without permission USPRA-GA (Oct 2010) patnemec@patnemec.com 3

9/27/2010 What do the “dropouts” say? Why are they dissatisfied? • Desire to solve problem on one’s own • Treatment/services are not helpful – Feeling a loss of control (meds / effects) • Unsympathetic providers • Already improved, no treatment needed – Who don’t listen – Who don’t encourage or expect active • Treatment unlikely to help Wh d ’ i participation in decision making • Practical constraints – Forgot, moved, lacked transport • Fear of the mental health system • Dissatisfaction with treatment/services Kreyenbuhl, Nossel, Dixon (2009) 24 25 Engagement Why have goals? • Engagement ≠ Compliance • Goals result from commitment – More accepting than rejecting of services • Goals contribute to motivation • Voluntary cooperation • “Be” goals: Who/Where • Accepting of staff presence even when • “Do” goals: Actions to get to the “be” there is a disagreement • Actively setting and pursuing goals/roles Milestones of Recovery Scale 26 28 Readiness Readiness Factors • Assessing and Developing Readiness • Need • Readiness for… • Commitment – Engaging in the rehabilitation process • Awareness – Exploring current environments (domains) E l i i (d i ) – Self – Considering other possible environments – Options (environments) – Choosing to stay/go from current place – Illness/Wellness? • Relationship NOT readiness for achieving a goal (e.g., work) 29 30 Do not photocopy or distribute without permission USPRA-GA (Oct 2010) patnemec@patnemec.com 4

9/27/2010 Factor 1: Need for change Factor 2: Commitment to change • A “push” to change • A “pull” to a new situation – Need to get out of the current situation • Commitment can occur w/any level of need • Motivation: Desire for change • Change is: • Urgency: Pressure to change – Possible – External pressure = currently unsuccessful – Positive – How quickly is change needed or desired? – Likely • Satisfaction • Awareness of process of change – Internal experience of pressure = dissatisfied • Perceived support to make the change 31 32 Factor 3: Awareness Factor 4: Relationship Informed decision making involves • Does the person value your help? • Personal criteria for decision-making: • Is the person sufficiently connected to you, the helper, to weather the ups and downs – Interests Self-awareness Self-awareness of change? of change? – Values V l – Preferences • Knowledge of options (Environments) – Physical characteristics of a setting – Requirements and expectations 33 34 Exploring Readiness Stages of Change • Develop a partnership • Observe and listen • Focus on: Contemplation – Indicators of stage of change Preparation – Readiness factors • Use effective engagement skills Action • Use Motivational Interviewing strategies (relapse) Maintenance 35 36 Do not photocopy or distribute without permission USPRA-GA (Oct 2010) patnemec@patnemec.com 5