Olivier Bohuon

1. Olivier Bohuon What are the required competencies of the "effective" psychiatric rehabilitation practitioner? Comparing perspectives of service users, service providers and family members The International Journal of Psychosocial Rehabilitation 2010; 14(2): 81-93

2. Authors David Roe, Ph.DAssociate Professor and Chair, Department of Community Mental HealthFaculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel. Adi Telem, M.A. Graduate student, Department of Community Mental HealthFaculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel. Vered Baloush-Klienman, Ph.D.Ministry of Health, Israel. Marc Gelkopf, Ph.D.Associate Professor, Department of Community Mental HealthFaculty of Social Welfare & Health SciencesUniversity of Haifa, Haifa, Israel.  Abraham Rudnick, M.D., Ph.D., C.P.R.P., F.R.C.P.C. (arudnic2@uwo.ca) Associate Professor, Departments of Psychiatry and Philosophy Chair, Division of Social and Rural Psychiatry, University of Western OntarioPhysician-Leader, Psychosis Program, Regional Mental Health Care, London, Ontario, Canada.

3. Psych rehab services in Israel Legislation- A milestone in the development of psychiatric rehabilitation services (PSRS) was reached with the legislation (2000) concerning the rehabilitation in the community of people with psychiatric disabilities. The legislation specifies a "basket" of PSRS to be provided to service users who meet eligibility requirements. Post- legislation- in the last decade more than half the psychiatric hospital patients in Israel were discharged into the community. Currently, nearly 16,000 persons with psychiatric disabilities are receiving PSRS in the community.

4. Competencies Characterization • In order to improve the training and hopefully the practice of psychiatric rehabilitation practitioners (PRPs), it is important to characterize the competencies - attitudes, skills, knowledge, and values - required from them. • A small number of empirical studies have focused on such efforts: • A 28-member panel of experts was assembled, with varied backgrounds in mental health and rehabilitation. The panel found 12 sets of core competencies required from psychiatric rehabilitation service providers (Coursey, Curtis, Matsh & Campbell (2000). Journal of Psychiatric Rehabilitation, 23(4), 370-384, 2000). • In a study based on interviews and focus groups with key stakehodlers, 37 competencies were found in seven differen t areas (Young, Forquer, Tran, Starzynski &  Shatkin (2000). Journal of Behavioral Health Services & Research, 27(3),  321-333, 2000).

5. IAPSRS - Competencies The International Association of Psychosocial Rehabilitation Services (IAPSRS, 2000) initiated a panel of six experts of the Association to identify and determine the professional, personal, and interpersonal competencies required from graduates of psychiatric rehabilitation programs. A test was devised to examine the areas of responsibility, knowledge, values, and competencies of psychiatric rehabilitation service providers. (IAPSRS, 2000).

6. The importance of competencies Collectively, the reviewed studies emphasize the importance of competencies related to: the relationship between the rehabilitation practitioner and the consumer; the ability to diagnose and evaluate; the ability to advance rehabilitation and facilitate empowerment; the ability to provide therapeutic, family, and supportive interventions; and the ability to advance resources and coordination (Coursey et al, 2000; Young et al, 2000; IAPSRS, 2001).

7. Method - Research design • In order to improve the qualification process of PSR service providers from a recovery (hence, from service users’ and others’) perspective, and consequently, the quality of the services they offer, it is necessary to characterize with greater precision the competencies - approaches, skills, knowledge, and values - required from them • The purpose of our study, therefore, was to identify the skills, knowledge, attitudes, and values required from the effective PSR practitioner considering multiple perspectives of key stakeholders – service users and others.   • This mixed design study combined qualitative focus groups and a quantitative study. In both studies three different groups of stakeholders participated: service users, service providers and family members (of service users)

8. Focus Groups Study sampleFocus groups with three groups of stakeholders were carried out independently Rehabilitation service providers group: Two groups which together included 19 service providers from the field of psychiatric rehabilitation included service providers from various disciplines (social work, psychology, occupational therapy, community mental health workers), from a variety of rehabilitation agencies and organizations.Service user group: This group included 11 service users with serious mental illnesses (SMI) receiving rehabilitation services.  Family members group: This group included 8 family members of service users who were actively involved in their family member's life and in touch with the PSR service providers.

9. Qualitative study results The data obtained from the focus groups answered the first research question: What skills, knowledge, attitudes and values are required from effective PRPs according to the three groups of stakeholders (service users, service providers and family members).   No differences were observed in the competencies suggested by the three groups, and all points could be found in the professional literature and included the following 5 categories.

10. 5 categories of competencies • a) Interpersonal, addressing the modes of communication of the rehabilitation practitioner with the consumer; • (b) professional, relating to knowledge skills addressing mental illness and psychiatric disability, medications and their side effects, and professional ethics; • (c) evaluation and planning, relating to proper resource management and documentation, and evaluation of the consumer's situation; • (d) access to social resources, relating to a holistic approach to the human condition and wide knowledge of existing services being offered to this population; • (e) rehabilitation (or recovery orientation), relating to the optimism of the service providers and their faith in the persons who they serve.

11. Quantitative Study • Study sample: 102 participants from 3 groups of stakeholders: • 34 Rehabilitation service providers • 35 Service users • 33 Family members

12. Method of analysis – Research Tool Evaluation of the importance of competenciesThe “Competencies of the Rehabilitation Practitioner Questionnaire” (CRPQ) was developed based on the results of the qualitative portion of the study and the relevant professional literature . The questionnaire was administered to the 3 stakeholder groups. All participants ranked the items of the CRPQ on a 5-point scale (from 5=most important to 1=least important). After all the questionnaires were completed, the competencies of the effective rehabilitation practitioner were grouped into two categories: more important (ranking of 4-5) and less important (ranking of 1-3).

13. Quantitative Study Results • When assessing the relative importance participants gave to the different competencies, results show that interpersonal, professional, and rehabilitation skills were ranked as more important than planning and evaluation skills and skills for accessing social resources.

14. Ratings of importance of Competencies

15. Discussion • The results indicate that there is broad agreement about the required competencies of psychiatric rehabilitation service providers (this may reflect the fact that psychiatric rehabilitation strives to include as many relevant stakeholders in all forms of planning and implementation of services), but that there are some minor difference in the ranking of the more important competencies, namely rehabilitation practitioners emphasizing the importance of rehabilitation skills. • This difference may suggest that consumers wish to feel safe and well cared for by well trained service providers, emphasizing the need for their qualification and training in the relevant professional disciplines, and that rehabilitation professionals wish to feel that they have the needed basic rehabilitation skills to do their job well. • These results are supported by those of several other studies.

16. Conclusion • The similarities among the three groups of stakeholders regarding the importance of competencies of the rehabilitation practitioner were greater than the differences.  This finding is somewhat surprising, given that many studies report disagreements between service providers and service users. More research is required.

17. Key references • Coursey, R. D., Curtis, L., Matsh, D.T., & Campbell, J. (2000). Competencies for direct service staff members who work with adults with severe mental illnesses in outpatient public mental health managed care systems. Journal of Psychiatric Rehabilitation, 23(4), 370-384. • Gill, K. J. & Kenneth (2005). Experience is not always the best teacher: Lessons from the certified psychiatric rehabilitation practitioner certification program. Journal of American Psychiatric Rehabilitation, 8, 151-164. • Gill, K, J., Pratt, C,W., Barrett, N. (1997). Preparing Psychiatric Rehabilitation specialists through undergraduate education. Journal of Community Mental Health, 33(4), 323-329 • Young, A.S., Forquer, S. L., Tran, A., Starzynski. M., & Shatkin, J. (2000). Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. Journal of Behavioral Health Services & Research, 27(3), 321-333.