Implementing Psychiatric Rehabilitation

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Grant Hampton
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1 Implementing Psychiatric Rehabilitation What helps? What hinders? Professor Marianne Farkas Center for Psychiatric Rehabilitation Boston University Rehab 92 Utrecht Netherlands April 1, 2014

2 Just because everything is different doesn't mean anything has changed Irene Peter

3 Vision of services All services focus on one Recovery vision or goal Crisis Intervention Treatment Rehab Services Culture of belief in in person no matter what Rights Protection Person s Recovery Vision Supported Education, Employment, Housing Skills to support person making vision possible Peer Support self help Wellness Case Management Farkas 2011

4 Rehabilitation is a systematic approach, based on recovery values, that contributes to overall recovery by : Developing relationships where the individual is the expert regarding his or her own recovery Facilitating the individual s success in choosing, getting and keeping his or her preferred role With this vision -what is rehabilitation all about? Farkas 2006; Farkas & Anthony 1989

5 Key Rehabilitation Principles Preferred Environment Skills Supports Individual Functioning Environment & Role Focused Functioning Depends Upon Skills & Supports Center for Psychiatric Rehabilitation Boston University, 2007

6 Psychiatric Rehabilitation Process Readiness Keeping Success & Satisfaction Selecting Process Direction Getting Choosing Other services Farkas 2013

7 Additive Selective Transformational Adding particular new techniques (e.g. peer workers, skill building, cognitive remediation) to the existing treatment system Changing some policies or practices in selected parts of the organization (e.g. client choices will be recorded in official dossier in work programs) Cultural, values based change drives practice, community, policy and fiscal changes in all parts and levels of the organization. Three approaches to change Adapted from Evans 2012

8 Psych Rehab and the 3 C s of Transformational Change Culture How we do things around here, values expressed in the organization Commitment Capacity Farkas, Ashcraft, Anthony, 2010 Who is willing to do what ( funding sources; politicians, administrators, providers, community) Do we have the skills to promote achievement of a preferred valued role by people we serve?

9 Nudging people out of comfort zone, through layers of rhetoric, history & antiquated information, respecting existing beliefs & values Preparing people for new experience, moving in the direction of the vision of what can be, to reach hearts and minds What is so hard about transforming culture?

10 Traditional settings Patient role oriented Coercion Compliance, risk management Maintenance, realistic Symptoms & supports Process oriented Focus on one aspect ( ie emotional) & 1 or 2 domains ( eg living, working) Recovery oriented IRB Person orientation Choice Partnership Hope Skills & Supports Outcome orientation Comprehensiveness Culture is based on values

11 Consultant, Program Administrator Family members Users Public, Community resources Front Line workers Government bodies Program Leaders. Supervisors How can commitment be less of a problem?

12 Changing the program infrastructure Changing provider competencies Capacity Mission, Policy, procedures, record keeping, activities, setting, network, staff hiring, promotion, support Ensuring that anyone providing psych rehab can perform skills to: engage users in a partnership, facilitate their goal setting for preferred roles, facilitate their identification of the critical skills and supports needed to reach their goals, person centered planning, teach identified skills; help overcome barriers to skill use; link with identified resources critical to goal; modify or create resources when needed Anthony & Farkas, 2011

13 Delivery Recipient/ Services Supervision Personnel/Staff Development Management Program/Operational Policy Making Organizational/Strategic Aligning Organization Functions Forbess, Kennard & Farkas, 2006

14 Integration of Functions and Components Recipient Service Delivery Staff Supervision Mission Values Process Outcomes Program Management Organization Policy Making Forbess, Kennard & Farkas, 2001 Procedures/Protocols Activity ; Schedules Descriptions/Lesson Plans/ Curricula Job Descriptions Record keeping (Service Plans, Worksheets, etc.) Quality Assurance

15 Change your opinions, keep to your principles, change your leaves, keep intact your roots Victor Hugo

Psychosocial Rehabilitation Workshop

Marianne Farkas Professor, Boston University Sept 17 2012 Brussels Belgium Psychosocial Rehabilitation Workshop Copyright@Boston University,Farkas 2012 What will we do today? What is already clear to you