VA PSYCHOLOGY LEADERSHIP CONFERENCE May 18, 2007 Psychosocial Rehabilitation and Recovery Oriented Services Robert Grese

1. Department of Veterans Affairs VA PSYCHOLOGY LEADERSHIP CONFERENCEMay 18, 2007Psychosocial Rehabilitation and Recovery Oriented ServicesRobert Gresen, Ph.D.(Robert.Gresen@va.gov)

2. 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

3. Family Services • Family engagement, support, education • Family Psychoeducation • Administrative supports/incentives • Legislation

4. 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 system-wide. (1/4- 1/3)

5. 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

6. 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.

7. 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 …

8. Peer Support Services(continued) PSTs may be placed in mental health clinics, inpatient units, MHICMs, partial hospitalization, homeless programs, work restoration, residential rehabilitation programs ...

9. 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

10. Psychosocial Rehabilitation and Recovery Centers (PRRCs) • Centers where veterans with mental illness can explore and pursue recovery options • Veterans can receive professional and self-help/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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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.

22. 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

23. 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

24. Educational Initiatives(continued) • Web-based anti-stigma training program currently available • Web-based Recovery Oriented mental health services training program expected in 2007*

25. 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

26. 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)

27. 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

28. 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

29. What else do we need to do?

30. Evidence-Based PracticesFamily 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

31. Evidence Based FPE Models • Behavioral Family Management (Ian Fallon et. al.) • Family Psychoeducation (Carol Anderson et. al.) • Psychoeduational Multifamily Groups (William McFarlane et. al.)

32. Psychosocial Rehabilitation (PSR) • Fundamental principle: Recovery is possible for individuals with Serious Mental Illness • Focus: Functional domains to maximize life satisfaction:

33. Consensus Conference on Mental Health RecoverySponsored 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.

34. National Consensus Statement on Mental Health Recovery (SAMHSA)

35. 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

36. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158

37. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158

38. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158