An Overview of WRAP

1. An Overview of WRAP And The Five Key Concepts of Recovery Presented By Stephen Pocklington, CRE, ITE

2. Copeland Center 2 WRAP stands for… Wellness  Recovery  Action  Planning

3. Copeland Center 3 The Origins of WRAP Mary Ellen’s lived experience A void in the system’s understanding Reaching out to peers with similar experience Hope rekindled in light of others’ recovery Key Concepts distilled from others’ stories Sharing empirical insights through workshops Collective recognition of need for structure The integration of collective wisdom

4. Copeland Center 4 WRAP is all about… Instilling Hope Promoting Personal Responsibility Encouraging Critical Thinking and Ongoing Education Fostering and Facilitating Self-Advocacy Support and Promoting the Development of Networks of Supporters

5. Copeland Center 5 The concepts, skills and strategies of WRAP are complementary to mental health care treatment: WRAP is not a replacement for other treatment programs When used together, WRAP helps people get more out of their current treatment programs

6. Copeland Center 6 WRAP Facilitators do not counsel or give any advice except to say clearly: NEVER stop taking medications without careful consideration and without getting the advice of your physician and other supporters NEVER abruptly stop any medication. There are protocols which must be followed for stopping or changing medications

7. Copeland Center 7 The Key Concepts of Recovery: Hope Personal Responsibility Education Self-Advocacy Support

8. Copeland Center 8 Hope is the key that unlocks the door to unlimited recovery… People don’t need, nor will they benefit from, dire predictions about their future People do need to stay connected (or get reconnected) with sources of hope People need to see clearly that tomorrow can be better than today…

9. Copeland Center 9 Hope isn’t the same as Optimism: Hope isn’t blind to suffering and struggle; it has survived them Hope is rooted in the experienced or witnessed reality of resilience and recovery Hope is the undaunted belief that tomorrow can be better than today despite what the pessimists and so-called “realists” may say

10. Copeland Center 10 Personal Responsibility You are the expert on yourself You know what you need and want Whether you recognize it or not, you are a powerful survivor and you possess tremendous courage and strength You have it within you to take on personal responsibility for your wellness and recovery

11. Copeland Center 11 Personal Responsibility = Taking Charge Personal Responsibility is about tapping into our freedom and power to chart our own course through Life It’s about realizing that, if tomorrow can be better than today, it’s up to me to make it be better It’s knowing that no matter what Life throws at me, I get to choose my response

12. Copeland Center 12 Responsibility & Response-Ability Responsibility may seem like a burden, but to be human is to be Response-able Response-ability is the ability to choose our responses to whatever happens in our lives It’s the birthright of freedom, power and choice that allows us to write our own stories and create our better tomorrows It is proactive rather than reactive…

13. Copeland Center 13 Responsibility and Education: You can’t take charge without knowing what you’re taking charge of… Once in charge, you need to know where you want to go with your life So, there is no more powerful act of personal responsibility than committing to life-long learning, which will impact work, relationships… every aspect of your life

14. Copeland Center 14 Education goes well beyond school, books, workshops, Internet searches, by: Learning from mistakes; turning them into lessons, so you don’t have to repeat them Paying attention to what Life has taught you about what works and what doesn’t work Engaging the support of trusted peers to do some critical learning about our true selves…

15. Copeland Center 15 Critical Learning about Oneself How do I know what I know? What is truly important to me? (as opposed to what others want me to value) What are my dreams? What are my true goals in Life? What is keeping me from realizing my dreams and goals?

16. Copeland Center 16 Self-Advocacy means: Speaking up and speaking out for yourself “Going for it” with courage, persistence and unwavering determination Expressing yourself clearly and calmly until you get what you need for yourself As need be, speaking truth to power

17. Copeland Center 17 Effective Self-Advocacy Involves: Believing in yourself Knowing your rights and insisting that they are respected Having a personal vision and mission, setting goals and working toward them Getting the facts, planning your strategy, gathering support; targeting your efforts Being steadfast and consistent in your commitment

18. Copeland Center 18 Support, in one sense, is about… Developing and maintaining a strong system of informal and formal supporters Natural supports from family, friends Formal supports from providers as needed Having multiple supporters to call on in times of crisis who have agreed to follow your plan Community in all its varied meanings

19. Copeland Center 19 Support, in another sense, is… Whatever a person’s experience has shown to be helpful Negotiated and agreed upon Always in keeping with the person’s stated wishes, choices and self-determined plans Never coercive Respectful of the dignity of risk and the right to learn through trial and error

20. Copeland Center 20 On being a supporter… If you are coming to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together… Anonymous (Australian Aboriginal), 1994

21. Wellness Recovery Action Planning AConcise Overview of the planning process and the format of a plan

22. Copeland Center 22 WRAP is the only truly Person-Centered/Driven Planning Process WRAP is entirely self-directed Every aspect of WRAP is voluntary It is 100% individualized It contains only what the person chooses to put in it The planning process is facilitated by trained peers who are ethically constrained from giving advice It can be changed as often and as much as the person chooses

23. Copeland Center 23 A WRAP is a simple tool that can be used to get well and stay well, or… Make positive lifestyle changes Have greater success with employment Have happier, healthier relationships Successfully navigate Life’s changes Get more of what you want out of Life Whatever else you want it to do…

24. Copeland Center 24 A WRAP Includes: Your personal Wellness Toolbox Your Daily Maintenance Plan A list of your identified Triggers and your Action Plan for responding to your Triggers A list of your identified Early Warning Signs and your Action Plan for responding to those signs

25. Copeland Center 25 A WRAP also includes: A list of your identified Signs that Things Are Breaking Down and your Action Plan for responding to those signs Your personal Crisis Plan for how others can support you through Life’s most challenging and troubling moments Your Post Crisis Plan for gradually getting back on your feet after a very difficult time

26. Copeland Center 26 Wellness Tools Wellness Tools are simply those things you know from experience help you get well, be well and stay well There are lots of common wellness tools that are safe, simple, cheap or free, and easy to access like exercise, nutrition, journaling, peer support, relaxation techniques, etc. Your Wellness Tools are whatever works for you… and they may be unique to you

27. Copeland Center 27 The Wellness Toolbox: A Wellness Toolbox is just a comprehensive listing of your wellness tools It’s kept at the front of your WRAP to serve as a convenient reminder of all the proven resources at your disposal It’s a list that you are constantly revising; adding new tools that prove more helpful and removing tools that prove less helpful Again, it lists only things that work for you

28. Copeland Center 28 Daily Maintenance Plan WRAP is about taking charge of your life by making self-care a part of everyday routine The Daily Maintenance Plan is based on the understanding that there are certain things, which, if I do them each day, generally result in my being well and having a good day A Daily Maintenance Plan simply helps you remember the things that you need to do each day, so you can plan your days around them

29. Copeland Center 29 The Daily Maintenance Plan consists of three interrelated parts: A simple but clear description of What I am like When I am Well, or vision statement of what you want to feel like, or want to be A Daily Maintenance List of those things you know work for you that you can commit to doing everyday to keep yourself well A reminder list of things you might need to do on any given day to stay on track and stay well

30. Copeland Center 30 Part 1: What I Am Like When I Am Well At it’s most basic level, this is simply a reminder of what “being well” feels like It can be a list of words and phrases that describe you when you are feeling well Or, it can be a powerful vision statement that describes how and who you would like to be Whether simple or elaborate, it serves both as a reminder and as a motivator for taking personal responsibility for one’s wellness

31. Copeland Center 31 Part 2: The Daily Maintenance List This is simply a list of things you know you need to do every day to keep yourself well This is a commitment you make to yourself The list needs to be doable, not burdensome Each person’s list is different This is a list things you choose to do for yourself, not things others want you to do…

32. Copeland Center 32 Part 3: The Things You Might Need to Do There are some things we don’t need to do every day, but we know we need to do them regularly or periodically in order to stay on track, e.g., pay bills, laundry, etc. These are things we won’t do every day, but might choose to do if we recognize the need A reminder list helps us recognize important things we might need to do on any given day

33. Copeland Center 33 Triggers Triggers are those external events or circumstances, which, when they occur, predictably produce reactions that are negative and may be very disturbing Knowing that you are susceptible to feeling uncomfortable emotional reactions to particular events and circumstances is the first step to reducing their power over you. A list of known triggers serves as a reminder of your response-ability and a call to action

34. Copeland Center 34 Triggers Action Plan Knowing your Triggers makes you much less susceptible to being “knocked off balance,” but if you don’t respond deliberately when they occur you can still end up reacting negatively Here you list actions that have worked for you in the past, making a plan for heading off or overcoming negative reactions to triggers These are actions you commit to take whenever a trigger is experienced

35. Copeland Center 35 Early Warning Signs Early Warning Signs are internal and may be unrelated to reactions to stressful situations Despite our best efforts at keeping ourselves well, anyone of us may begin to experience subtle indicators that “all is not well” These are simply signs of change that indicate the need to take some further action, beyond daily maintenance, to keep ourselves well

36. Copeland Center 36 Identifying Early Warning Signs Because Early Warning Signs are so subtle, they are very easy to miss or ignore It may be helpful to ask friends or family about early warning signs they may have noticed Make a detailed list of all the Early Warning Signs you can identify and review it regularly As you pay more attention to keeping yourself well, you will begin to notice even subtler warning signs and you will be able to take even earlier action to keep yourself well

37. Copeland Center 37 Early Warning Signs Action Plan By knowing your Early Warning Signs, and by recognizing them early enough, you are empowered to take quick action to prevent things from getting any worse The Early Warning Signs Action Plan is your plan of action, based on what has worked for you in the past, for getting back to being well This is a commitment you make to yourself to do extra things for the sake of wellness, and to keep doing them as needed

38. Copeland Center 38 When Things Are Breaking Down Despite of our best efforts at self-care, any one of us may at times find ourselves feeling like things are breaking down, even like things are getting to the point where we’re in danger of being utterly overwhelmed It is only by identifying signs that things are still just breaking down that you get the opportunity to take protective or restorative action on your own behalf to avert a crisis

39. Copeland Center 39 When Things Are Breaking Down Because there is a very real risk of being overwhelmed, great care must be taken to identify signs that things are merely breaking down as opposed to signs that things have already broken down Because of the stressors and confusion that often accompany such times, it is critically important to be very clear, accurate and specific in describing these signs

40. Copeland Center 40 Action Plan for “When Things Are…” When you see the signs that tell you things are breaking down, you will know you are in a critical time that calls for immediate action The action plan you write for this time has to be very clear, specific and directive, so it gives you clear instructions and few choices In writing this action plan, you are making a commitment to following it to the letter and to keep following it until you are feeling better

41. Copeland Center 41 Crisis Planning Writing any part of a Wellness Recovery Action Plan is a hopeful act of personal responsibility, and this is especially the case when we start thinking proactively about planning for the worst When we think non-clinically about “crisis” we can see that it’s only human and natural to experience times when we are temporarily unable to make good decisions With a good Crisis Plan we can learn and grow through even the worst of times

42. Copeland Center 42 A Crisis Plan Lets You Retain Control It’s difficult to plan for a “crisis,” especially if you associate it with losing control, so it’s helpful to remember that crisis planning is about staying in charge By carefully developing a Crisis Plan through negotiation and collaboration with your supporters, you can create a plan that keeps you in control even when decision-making is temporarily turned over to supporters Your supporters will be following your plan

43. Copeland Center 43 Crisis Plans Apply to Any “Crisis” Although Crisis Plans are often written with past psychiatric crises in mind, they are equally applicable to any situation where we would recognize the need to turn decision-making over (temporarily) to supporters whom we trust to follow our plans Considering other circumstances that might overwhelm you, like medical, financial, or relationship crises, may help you to recognize “crisis” and crisis planning as opportunities to learn, grow and face life more confidently

44. Copeland Center 44 Crisis Planning Takes Time… Your Crisis Plan needs to be developed slowly and deliberately when you are feeling well Consider all sorts of foreseeable situations and the possibility of unforeseeable contingencies, and decide how you would like each to be handled should they arise This sort of careful planning actually supports your supporters, who, because of your plan, will now clearly understand your needs and wishes, and therefore be able to approach supporting you with confidence

45. Copeland Center 45 Part 1: What I am like when I am well Although friends and family know what you are usually like, an emergency room doctor or other crisis worker probably won’t know the baseline “you” Your Crisis Plan begins with a description of what you are like when you are well in order to prevent misinterpretations of behavior This is a different slant on what you put in your Daily Maintenance Plan as it needs to address areas of possible misinterpretation

46. Copeland Center 46 Part 2: Signs That I am in Crisis This section tells supporters when to activate your Crisis Plan and take over decision-making in accordance with the rest of the plan These signs warrant very careful attention and explicit articulation, as the plan will not be inactivated until your supporters see the signs you identify in Part 9: Inactivating the Plan Honesty in completing this section depends both on insight and trust in one’s supporters

47. Copeland Center 47 Part 3: Supporters Identify the people you want to take over for you and support you through a time of crisis Whether friends, family, or health care professionals, identify the people who have earned your trust, have the qualities you value, and who are willing to support you in accordance with this plan We encourage people to identify at least five supporters for their Crisis Plan, which is a challenge for many of us

48. Copeland Center 48 Things to consider about Supporters Identify certain tasks for certain supporters; clarity about different roles makes it easier to support you and may attract more supporters Identify those non-supporters you don’t want to have around you during a difficult time; you can plan for keeping them at a distance Anticipate possible disputes among your supporters and decide how you would want your supporters to resolve them

49. Copeland Center 49 Part 4: Medication Provide current, accurate, and comprehensive information about every medication you take List contact information for all your doctors and pharmacists, including insurance information Address what medications are preferred if a change is needed, those that are acceptable, and those that should be avoided, and why List even any illicit drugs you might have taken

50. Copeland Center 50 Part 5: Treatments Identify those treatments you would like to receive and any you specifically want to avoid It helps your supporters advocate for you if they know how a preferred treatment helped in the past, or why and how one you want to avoid didn’t help Identify “alternative” treatments like massage if they work for you and you prefer them Be explicit: if you must have something or absolutely won’t accept something, say so

51. Copeland Center 51 Part 6: Home, Community and Respite Care The careful planning that goes into a WRAP Crisis Plan makes home and community based options both realistic and beneficial You may decide to set up your entire plan around staying at home with supporters, or in the community, perhaps in crisis respite Or, you may use this section to structure only part of your supports to occur at home or in the community

52. Copeland Center 52 Part 7: Treatment Facilities In spite of their best efforts, your supporters may not be able to provide you with all the care you need at home or in community respite care Presuming that there are options, list those treatment facilities where you would prefer to go if you need to be hospitalized, and list those you specifically wish to avoid

53. Copeland Center 53 Part 8: Help From Others This is the very heart of the Crisis Plan, and it takes a lot of time and thought to develop List and define what would really help you get back to feeling and being well, and what wouldn’t help when you are overwhelmed Everything described here has to be carefully planned and negotiated with supporters: this is nothing less than their instruction manual

54. Copeland Center 54 When Planning Help From Others: Be very clear and explicit about what “help” means to you, explaining not just what to do but how; this is where you define “support” List those mundane things that supporters can do for you so you can focus on recovery (feed pets, care for kids, tend to bills, etc.) List those things that would not be helpful or might actually make things worse for you

55. Copeland Center 55 Part 9: Inactivating the Plan Just as you gave your supporters a clear list of indicators that told them when to activate the plan, it’s equally important to tell them what to look for to know that it’s time to inactivate it To insure the plan is inactivated when you are ready, and only when you are ready, make sure in advance that your supporters understand and can interpret these signs

56. Copeland Center 56 Making a WRAP Crisis Plan Binding Your WRAP Crisis Plan can be incorporated into an Advance Directive Note: The real strength of the WRAP Crisis Plan is the process used to develop it and the strong, trusting relationships it engenders; supporters who are intimately involved in planning process make the best advocates

57. Copeland Center 57 The Post Crisis Plan The Post Crisis Plan provides a structure for stepping down supports and facilitating a gradual resumption of responsibilities It facilitates both planning prior to a crisis and planning (or plan modification) while coming out of a crisis Constructive engagement in such planning can be a sign that it’s time to inactivate the crisis plan