Tools for Enhancing Self-Determination in the Recovery Process

1. Tools for Enhancing Self-Determination in the Recovery Process Judith A. Cook, Ph.D. University of Illinois at Chicago NYAPRS 29th Annual Conference Kerhonkson, NY, September 16, 2011

2. A Word of Thanks to our Center’s Funders • U.S. Department of Education, National Institute on Disability & Rehabilitation Research • Substance Abuse & Mental Health Services Administration, Center for Mental Health Services Funded by Cooperative Agreement No. H133B050003. The views expressed do not reflect the policy or position of any Federal agency.

3. The pathway to an enriching life can involve risks as well as rewards

4. RISK AVERSION Risk aversion is the reluctance of a person to accept a bargain with an uncertain payoff rather than another bargain with a certain, but lower, expected payoff. LOSS AVERSION Loss aversion refers to people's tendency to strongly prefer avoiding losses to acquiring gains. Studies suggest that losses are twice as powerful, psychologically, as gains. Risk Aversion & Loss AversionConcepts from the psychology of decision-making under risk & uncertainty

5. When people are making transitions to a meaningful life, they need support

6. An all-too-familiar picture for people in recovery

7. How Can We Make the Risks More Manageable?

8. Tools for Building an Enriching Life Shared Decision-Making Financial Literacy Supported Education Peer Support/Self-Help Self-Direction Asset Accumulation

9. Shared Decision-Making A decision making process jointly shared by clients and their providers; clients play an active role; based on the best evidence of the risks and benefits of all the available options

10. What Makes SDM So Hard? Research shows that people want to share decisions; but often don’t.

11. Key Elements of SDM • Create a context in which clients'views about service options are valued & deemed necessary • Share technical information, making sure clients understand the information, & helping them base their preference on the best evidence • Providers share their recommendations, & explicitly acknowledge uncertainty in the decision-making process.

12. Decision Support Tools • Ottawa Personal Decision Guide • Ottawa iShould • Common Ground • UIC NRTC Raising Difficult Issues with your Service Provider

13. Ottawa Personal Decision Guide Helps people assess their decision-making needs, plan for next steps, and track progress • Identify options • List benefits & risks for each option • Rate the importance of each benefit & risk • Choose the option with the most important benefits & the fewest risks • Pending stage of change, plan for next steps: • What is supporting/impeding the decision? • What is the person willing to try? • Specifically, how can providers help?

18. Why not go out on a limb? Isn’t that where the fruit is? Mark Twain

19. Financial Literacy Financial literacy is the ability to understand money and how to manage one’s own personal finances through financial planning.

20. People Feel Financial Planning is Futile “I just sat down the other day and wrote out checks with which to pay my bills and find out I’ve already spent my money before I even have it. There was no fat to trim, nothing to budget.” Woman in Chicago

21. A Fatalistic View Can Get in the Way of Planning “I think when I have money, ‘You know what? I may not be here tomorrow. Look at my friend who passed away suddenly.’ Then I don’t care about the end of the month.” Man from Georgia

22. UIC Financial Education Curriculum • Lesson 1: What’s Important to You? values, needs vs wants; identifying financial goals, budgeting • Lesson 2: Income vs. Expensesdifference between fixed vs. flexible expenses; developing a savings plan • Lesson 3: Managing Your Debtcontrolling debt, how to increase your income, 101 ways to save $ • Lesson 4: Understanding Creditunderstanding your credit report; managing credit/debt problems • Lesson 5: Using Financial Institutionschecking & savings accounts, direct deposit, debit cards, using ATMs, online banking, bank loans • Lesson 6: Building Consumer Skillssmart shopping, spending traps, spotting fraud, consumer rights

23. You are like everyone else… FreeCreditReport.Com Commercial

24. Two roads diverged in a wood, and I... I took the one less traveled by, and that has made all the difference. Robert Frost

25. Asset Accumulation

26. Assets are Key to Transcending Poverty • It is assets, not income, that allow people to move out of poverty and achieve economic independence. • One in 5 Americans does not have sufficient assets (e.g., savings, home equity) to survive at poverty level for three months should they lose their income. -Corporation for Enterprise Development (CFED)

27. Individual Development Accounts (Federal IDA Program) • Individual saves earned income for 1st home, small business capitalization, or post-secondary education (MUST be $ from a job) • Income must be below 200% of poverty level to qualify (<$20,800 family of 1) • Savings not counted against SSI/SSDI check • Individual must receive financial education • Individual’s contribution is matched by federal & non-federal sources • People must save for either: 1) a home; 2) post-secondary education; 3) starting their own business

28. How IDA Asset Accumulation Works Federal Government Matches $20 Person Deposits $20 $20 + $20 + $20 = $60 Person Now Has $60 Local Bank or Philanthropic Organization Matches $20

29. IDA Program Locations in New York State 26 Locations 13 Programs

30. Members & Staff of the UIC Individual Development Account Project Funded by the Consumer Affairs Program of the Center for Mental Health Services of SAMHSA, & the National Institute on Disability & Rehabilitation Research of USDOE

31. Ongoing Assistance for IDA Holders • The project monitors monthly deposits, holding quarterly meetings with participants to review progress, provide support, & celebrate achievements. • If people lose their jobs they are helped to find new ones. If they have financial emergencies they can forego savings for a brief period. • Financial education is provided regarding the IDA goal (low-income home ownership financing, choosing and enrolling in post-secondary school, creating a business plan & budget for a micro-enterprise). • People are helped to make their asset purchase and provided with ongoing support as needed.

32. You'll always miss 100% of the shots you don't take.  Wayne Gretzky

33. Supported Education Services designed to help people choose the kind of post- secondary education to pursue, secure financial aid, enroll, and successfully complete college or vocational/technical courses

34. Why Supported Education? • Many people with psychiatric disabilities have interrupted educations • Many do not have an advanced degree when this is required for many of the fastest growing occupational fields • Without adequate education (such as post-secondary education), people are trapped in entry-level employment

35. Supported Education • Supported Education models consist of a wide variety of service types and combinations • Assistance with college application, financial aid, enrollment, reasonable accommodations • Campus-based support • Remedial education • Tutoring • Student peer support • Case management • Supported employment • Linkage to student counseling

36. Supported Education • Supported Education helps PSR “clients” make the transition to becoming “students” 74% attended 1 or more college courses 61% community college (2 yr) 32% voc/tech school 7% 4-yr university 75% received passing grades in their classes (Wolf & DiPietro, 1992)

37. Supported Education • Supported Education helps clients enhance their employment outcomes • Participants made significantly more money (higher hourly salaries) after receiving SE • Participants worked significantly more hours after receiving SE (Cook & Solomon, 1993)

38. “Faith is taking the first step, even when you don't see the whole staircase.” Martin Luther King Jr.

39. Peer Support & Self-Help

40. Peer-Led Programs Beyond emotional support and advocacy, many programs provide a social network and an economic safety net for their members

41. Peer Programs Help People Manage Risk Taking, Often by Addressing Practical Issues

42. Self-Direction

43. Wellness Recovery Action Plan • Session 1: Key concepts of WRAP & recovery • Session 2-3: Personalized wellness strategies. Exercises to enhance self-esteem, build competence, & explore benefits of peer support. • Session 4: Daily maintenance plan. Plan for recognizing & responding to triggers. • Session 5: Early warning signs and how these signal a need for additional support • Session 6-7: Crisis plan, names of individuals willing to help, & types of assistance preferred. • Session 8: Plan for post-crisis support & retooling WRAP plan after a crisis to avoid relapse. Graduation ceremony

44. Why WRAP? By using these self-management tools and strategies people can achieve a level of wellness, stability and recovery that they always hoped was possible

45. Facilitators in the Ohio WRAP Study

46. WRAP Outcomes • Reduced psychiatric symptoms • Increased hopefulness • Decreased coping through self-blame • Increased quality of life • Increased self-advocacy • Increased recovery • Increased empowerment

47. WRAP is Now an Evidence-Based Practice!Selected for Inclusion in NREPP(National Registry of Evidence-Based Programs & Practices) http://nrepp.samhsa.gov/ViewIntervention.aspx?id=208

48. Tax Preparation Assistance Free tax preparation assistance can lead to tax refunds that provide funds to cover current expenses, or can be used for asset accumulation in a savings account or IDA

49. Real Economic Impact Tour • Partnership between IRS, National Disability Institute, & national partners • Provides free tax preparation and filing assistance • Even if not required to file by IRS, can claim the Earned Income Tax Credit (incomes < $48,000) • People who have never filed before can receive tax credits that are retroactive for 3 years • If the amount returned is >$2000 asset limit, can be deposited in an IDA without penalty in benefits/eligibility • REI also helps people with disabilities become certified tax preparers, establishing a new career line for some • Saves money spent for tax preparation among low-income individuals

50. Micro-EnterpriseDevelopment • Matches person’s dreams & talents to their economic activity • Funding for small businesses is available from numerous sources (PASS, state VR) • One of the few options for growing wealth among people on SSI since a business owner can have unlimited resources in their business account • Reasonable accommodations are virtually unlimited when you are your own boss