Module 5: Emerging Practices Supporting the Vision

1. Module 5:Emerging Practices Supporting the Vision Preparing the Workforce Employing Consumers and Family Members As Employees in the Mental Health Workforce Working Well Together

2. Welcome

3. Tools For the Vision : Making the Vision Come Alive

4. Change

5. Quote: Change your thoughts and you change your world. - Norman Vincent Peale

6. Learning Objectives • Identify what emerging practices will support the vision • Find resources for emerging practices • Know how to balance the impact of change

7. Methods

8. Methods for Moving Forward Step #1: WHY are we making this change? • Why are we planning to hire and work with consumers and their families?

9. Methods for Moving Forward Step #2: WHAT will this look like? • What will the staff, the agency, the community look like once we attain our vision?

10. Methods for Moving Forward Step #3: • WHEN will I know what to do? • What are the next steps needed to move towards the new vision? Who will inform me? Where will I learn about what to do?

11. Methods for Moving Forward Step #4: • WHAT WILL I BECOME? • What is my new role? What new skills will I need to have? What do I need to know to be able to work side-by-side with consumers and families?

12. The Elements to Address

13. Mitigating Factors Some Solutions • Trauma Trauma-Informed, Peer Support Services • Substance Use Challenges Harm-reduction strategies, Stages of change, Motivational Interviewing, integrated co-occurring treatment • Diverse, multicultural, beliefs Outreach, Employ consumer/family from diverse communities • Overburdened System Mindfulness & Self-care, WRAP, WRAP at Work, NAMI & UACF Education Classes, Consumer and Family Employees

14. What is Trauma & Who has It? • DSM IV-TR: • Personal experience or learning of an event that involves actual threatened death or serious injury to oneself or another person and • the response to the event must involve intense fear, helplessness or horror (for children, disorganized or agitated behavior. • 90% of public mental health clients have been exposed to (and most have actually experienced multiple experiences) of trauma • (Goodman, Rosenburg et al., 1997; Mueser et al., 1998)

15. Effects of Trauma • Nervous System Brain chemistry changes • Adverse Childhood Experiences (ACE) Study • 10 Questions of 17,000 HMO members childhood • 2/3 had at least score of one ACE • More than 1 in 5 reported score of more than 3 ACE • The higher the score the higher risk of illness • Person with score of 4 or more had 12x more likely to attempt suicide & 10x more likely to have used IV drugs • Let’s self-score ourselves. See 10 questions on handout. • More information at: http://www.cdc.gov/ace/index.htm

16. Trauma-Informed Care • Elements • Foster trust, Choice, Collaboration, empowerment • Take trauma into account • Avoid triggering trauma reactions • Create a safe environment, physically and emotionally • Stephanie Covington, 2008 • http://trauma-informed-california.org/home.html • US Center for Mental Health Services(CMHS) National Center Trauma Informed Care • http://www.samhsa.gov/nctic/

17. Trauma-Informed Self Care • “Mindfulness” exercises • Shapiro, S. & Carlson, L., The Art and Science of Mindfulness: Integrating Mindfulness Into Psychology and the Helping Professions. (2009) Pub. by American Psychological Association, Washington, D.C. • "Trauma Stewardship” describes the circle of Trauma Exposure Response and how professionals are impacted • "Following the Five Directions” exercises to help practitioners gain a better understanding of themselves: • North: creating space for inquiry • East: choosing our focus • South: building compassion and community • West: Finding balance • The Fifth Direction: a daily practice of centering ourselves • Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others" van DernootLipsky and Burk (2009)

18. While You are on the Job… • Offer a friendly greeting to others as you arrive • Relaxation and stress reduction techniques: deep breathing • Take a 30 minute lunch break away from the office • Take a short walk during my 15 minute breaks • Use visual images that help you to focus on relaxation and wellness in the workplace

19. Prevalence of Co-occurring D/O • Adults who use drugs are more than twice as likely to have severe mental illness (SMI) as adults who do not use drugs • Conversely, people with SMI have a much higher risk of developing substance use disorder (SUD) (www.samhsa.gov, 2005) • Lifetime prevalence of SUD in people with SMI is reported to be 40-60%. (Mueser, Noordsy, Drake and Fox, 2003)

20. Treatment of Co-occuring Challenges • Expect co-occurring mental health & substance use challenges • Integrate mental health and substance abuse treatments • Use individualized Stages of Change and Motivational Interviewing strategies to help people into recovery • Strengths-based model • Harm Reduction in housing services too

21. Stages of Change http://www.utexas.edu/research/cswr/nida/rdpConceptModel.html

22. Harm-Reduction & Practices • Various strategies for reducing physical and social harms associated with risk-taking behavior • Harm reduction is about • preventing disease, death, incarceration and isolation. • improving and saving lives. • making dangerous behaviors less dangerous. • http://sexworkerswithoutborders.org/101s/harm-reduction-101/harm-reduction-definition/ • Meeting people at their stage of change • Examples: Nicotine Patches and Gum, Needle exchange programs, methadone, admission into programs though person may still be using drugs, use of condoms

23. Outreach to Diverse Communities • Outreach into communities, no expectation community will come to us • Develop relationships, working to address specific, broader challenges within community, let them decide how • Value of Faith-based organizations • Important to understand that traditional healing practices, in addition to or instead of contemporary mental health practices, may be important to some persons with mental illnesses. -SAMSHA, 2004

24. Wellness Recovery Action Plan • by Mary Ellen Copeland • An unique action plan developed by individuals to maintain wellness • Wellness Toolbox • Daily Maintenance Plan • Identifying Triggers & an Action Plan • Identifying Early Warning Signs & an Action Plan • Crisis Plan • Post-crisis plan

25. Plan for Self-Care: Daily Maintenance

26. WRAP Basics • Writing a plan must be done entirely by the individual who plans to use it • Feedback and encouragement can be helpful. Note: Supporters need to avoid telling people what to write in their plan. • It is essential that writing a WRAP is done at the individual’s own pace and in their own style. • WRAP is a structure that allows for individual creativity and personal self-expression.

27. Creates an environment that invites people to step into personal responsibility. Empowers people who experiences symptoms to make choices and discover what works best for each individual. Encourages open communication with co-workers and supporters. Creates the opportunity for people who experience symptoms and their supporters to better understand each other. Using and sharing WRAP allows people who experience symptoms to play leadership roles in their community by teaching, modeling and promoting mental health recovery WRAP Works at Work!

28. NAMI’s Education • Peer to Peer • Family to Family • Instructors: family members, consumers, professionals • 3 Stage Process • Stage One: Dealing with the Catastrophic Event • Stage Two: Learning to Cope • Stage Three: Moving into Advocacy • Mental Health Provider training

29. United Advocates for Children & Families--UACF • 12 Week Training: • Educate, Equip & Support (EES): Building Hope • Navigation of services • Partnership between family members and treatment providers • EES Certification Training • Train the Trainer

30. Consumer/Family Employment A Full Range of Roles Trainers for new and existing workforce Staff in the full range of capacities: Direct service Outreach & engagement Management Policy & Planning Research Evaluation Advisory Groups as the Primary Stakeholders Operating Self-Help Organizations Leaders and role models in the Community

31. Hiring Consumers: Key Issues • Livable Wages • Benefits Counseling and Transition Supports • Career Ladders: opportunities for advancement • Access and support in both peer positions and non-designated positions • Flexible scheduling and other reasonable accommodations

32. Ongoing Supports Workplace Supports Mentoring Proactive Supervision/Evaluation Culture that encourages work/life balance Access to ongoing training Opportunities for advancement Community Supports: Peer Provider Support Networks WRAP/Recovery and other peer support Personal Supports Friendships Exercise Nutrition Spiritual community Relaxation

33. The New Beginning

34. Staff Transformation • Looking Inward and Rebuilding the Passion • Building Inspiration and Belief in Recovery • Changing from Treating Illnesses to Helping People with Illnesses Have Better Lives • Moving from Care-taking to Empowering, Sharing Power &Control • Gaining Comfort with Co-Staff with Mental Illness & Multiple Roles • Valuing the Subjective Experience • Creating Therapeutic Relationships • Lowering Emotional Walls & Becoming a Guiding Partner • Understanding the Process of Recovery • Becoming Involved in the Community • Reaching Out to the Rejected • Living Recovery Values • California Association of Social Rehabilitation Agencies. Developing Systems and Services that Support People In Wellness and Recovery. (2007) Pub. by California Institute of Mental Health, Sacramento, CA

35. Wellness Activities in Workplace • Resilience-Building Activities Against Stress • yoga, tai chi, lunchtime fitness walks • workshops on problem solving, effective communication, conflict resolution • team building activities • Eliminates ‘us’ versus ‘them’

36. Share-Outs to Leaders Of the tools discussed, what strategies do you find important to consider in manifesting the vision to welcome consumer/family partners into the workforce that you want to share with the agency’s leaders? Prepare a single list from the entire class to be given to the administrator.

37. Quote: A journey of a thousand miles begins with one small step. - Lao Tzu

38. Questions?