Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

1. Evidence-Based Practices: Shaping Mental Health Services Toward Recovery Illness Management and Recovery

2. Where We’ve Been: Illness Management • Demons, Exorcisms, Death • Chains and Isolation • Medication Maintenance • Treatment and Rehabilitation • Recovery

3. Treatment and Rehabilitation • Treatment – Reduces emotional distress by reducing symptoms through diagnosis, medications, treatment planning, and therapy. • Treatment services are done TO ME.

4. Rehabilitation • Provides skills and supports to maintain and sustain independence and addresses the consequences of the illness and the rebuilding of a positive self image. • This is done through goal setting, skills teaching, resource coordination, and supports development.

5. Rehabilitation services are done WITH ME Until I can do them for or by myself.

6. The IMR Toolkit is: A set of materials which shows a practitioner how to provide an EBP that focuses on providing practical information about Treatment and developing Rehabilitation skills that build resilience to facilitate Recovery.

7. Resilience • To strengthen those factors that allow a person to overcome adversity.

8. Expands your knowledge and Strengthens your mental and physical ability …so that you can regain your life to a usable form and reclaim your personal power from your illness. In short, IMR

9. IMR is a tool designed to move mental health service delivery from… The Reform outlined in the “President’s New Freedom Commission on Mental Health” to the “wholesale and fundamental Transformation” demanded in “Transforming Mental Health Care in America: The Federal Action Agenda – First Steps”. (Federal Action Agenda p. 18)

10. Reform states: • Mental illnesses and emotional disturbances are treatable

11. Transformation states that: • Recovery is the expectation! Does Kentucky’s mental health care service delivery system expect Recovery?

12. Will implementation of the IMR toolkit improve Kentucky’s expectation?

13. 2 Key Principles of Transformation 1. Services and treatments “must be consumer - and family-driven –geared to give consumers real and meaning full choices about treatment options and providers; not oriented to the requirements of bureaucracies.” (Federal Action Agenda p.19)

14. 2 Key Principles of Transformation Care must focus on: • Increasing one’s ability to cope with life’s challenges • Facilitating recovery • Building resilience “And NOT just on managing symptoms”. (Federal Action Agenda p.19)

15. Does IMR achieve both goals? Let’s look and see…

16. Development Team

17. Goals of IMR

19. Educational Handouts • Handout #1 Recovery Strategies • Handout #2a Practical Facts About Schizophrenia • Handout #2b Practical Facts About Bipolar Disorder • Handout #2c Practical Facts About Depression • Handout #3 Stress–Vulnerability Model & Treatment Strategies • Handout #4 Building Social Support • Handout #5 Using Medication Effectively • Handout #6 Reducing Relapses • Handout #7 Coping with Stress • Handout #8 Coping with Problems and Symptoms • Handout #9 Getting Needs Met in a Mental Health System

20. Format: IMR is series of weekly sessions where mental health practitioners help people who have experienced psychiatric symptoms to develop personalized strategies for managing their mental illness and moving forward in their lives.

21. Structure of the sessions – Predictable • Informal socializing and identification of any major problems 1-3 minutes • Review previous session(s) 1-3 minutes • Review homework 3-5 minutes • Follow-up on goals 1-3 minutes • Set agenda for current session 1-2 minutes • Teach new material or review previously taught • material 30-40 minutes • Agree on new homework assignment 3-5 minutes • Summarize progress made in current session 3-5 minutes

22. Significant others can be involved • Can share their educational handouts • Can request help in practicing specific skills • Can invite significant others to participate in some sessions. • Are especially helpful in sessions which involve developing a relapse prevention plan

23. Practitioners are: • Social Workers • Occupational Therapist • Counselors • Case Managers • Nurses • Psychologist All need training and ongoing supervision.

24. How is it holding up to the “2 Keys” Remember the 2 key principles to successfully Transforming a Mental health Service Delivery System?

25. 1. Services and treatments “must be consumer - and family-driven –geared to give consumers real and meaning full choices about treatment options and providers; not oriented to the requirements of bureaucracies.” (Federal Action Agenda p.19)

26. 2 Key Principles of Transformation 2. Care must focus on: • Increasing one’s ability to cope with life’s challenges • Facilitating recovery • Building resilience “And NOT just on managing symptoms”. (Federal Action Agenda p.19)

27. To me… • It feels very rigid. • The “partnership” between” consumer and provider is missing. • No role for Peer Specialist

28. Other states have • Added Peers as team teachers with the practitioners. • Some have given the whole program to Peers to run

29. What’s the problem with that? Fidelity!

30. Core evidence-based components • Psychoeducation • behavioral tailoring for medication • relapse prevention training • Coping skills training.

31. IMR Fidelity Scale • 13 items developed to measure the adequacy of implementation • Each item is rated on a 5-point behaviorally-anchored rating scale ranging from 1 (“Not implemented”) to 5 (“Fully implemented”). • The “Fully implemented” ratings were determined through expert sources and empirical research.

32. How the Rating Is Done • The assessment is conducted through a site visit. • It requires a minimum of 4 hours to complete longer stays allows for collection of more data and hence should result in a more valid assessment.

33. Data collection procedures include • chart review • review of educational handouts • semi-structured interviews with program leader, IMR practitioners, and IMR consumers. • When feasible, fidelity assessors should observe one or more IMR sessions (either live or a videotaped session).

34. The IMR fidelity assessment is • Primarily based on documentation in progress notes. • if these notes do not exist or are not easily available, the fidelity assessment will take a very different course. • The goal is to examine the charts and 5 most recent progress notes of IMR sessions for each of 5 IMR consumers

35. Who Does the Ratings? Individuals who: • Have experience and training in interviewing and data collection procedures (including chart reviews). • Have an understanding of the nature and critical ingredients of IMR. We strongly recommend all fidelity assessments be conducted by at least two assessors.

36. Do you have enough data? • Are Services and Treatments consumer - and family-driven? • Are they geared to give consumers real and meaningful choices about treatment options and providers?

37. Do you have enough data? Does care focus on: • Increasing one’s ability to cope with life’s challenges? • Facilitating recovery? • Building resilience? • Just on managing symptoms”.

38. The ball is in your court… YOU decide!