Moving from Side Dish to Main Course

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Moving from Side Dish to Main Course

• The Supported Socialization Approach as a
  Critical Ingredient in Recovery
• Michael F. Seiferling and Joel Brownridge
• 2008 PSR National Conference
• Winnipeg, Manitoba

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Recovery

• a process of restoring a meaningful sense of
  belonging to ones community and positive sense
  of identity apart from ones condition while
  rebuilding a life despite ones limitations
  imposed by that condition

Davidson et al, 2007
3
Barrier to Recovery?

• Social recreation programs on the back burner of
  care
• Considered counterproductive to offer social
  programming during work hours
• Focus on providing social programming rather
  than social integration programs

Pascaris, 1994
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Socialization and Recovery

• Strong evidence showing connection between
  recovery and stable housing, access to
  education and employment
• EQUALLY IMPORTANT is the role that social
  connections play in ones recovery

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Deficit-Based Approach

• we have required people to be remission from the
  symptoms of their illness before they have been
  allowed access to normative adult activitiesto
  have friends, to have their parents be proud of
  them, to have a car or to be allowed to have sex,
  they have to eradicate the visible evidence of
  their disability

Davidson et al, 2001b
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Social Support and Recovery

• Strong evidence that these indeed are
  prerequisites for recovery
• Social factors have a positive impact on
• Employment outcome
• Improved measures for Quality of Life
• Reduced Symptoms/Hospitalization
• Increase in Recovery Measures

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Orange directly facilitated by SS Yellow
indirectly facilitated by SS
Oken, et al 2007
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Person-Centered Elements of Recovery

• Meaning and purpose
• Ability to do so comes from the interaction
  between a persons internal drive and an
  environment which offers support and opportunities

Oken, et al 2007
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Exchange-Centered Elements of Recovery

• Social Functioning and Social Roles
• Active involvement of either the re-establishment
  of previous social roles or the creation of new
  social roles such as intimate partner, employee,
  community member

Oken, et al 2007
10
Community-Centered Elements of Recovery

• Social Connectedness and Relationships
• Support from others in the form of reciprocal
  relationships built on love, patience and trust
  are a requisite to recovery as well as an
  outgrowth of the recovery process

Oken, et al 2007
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Community-Centered Elements of Recovery

• Social Opportunities and Integration
• Environment must include opportunities to
  access alternative therapies and formal supports,
  including medications, mental health providers,
  and peer groups
• Integration is necessary both of the
  psychiatric disability into a sense of self and
  of the individual into a welcoming community

Oken, et al 2007
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Social Inclusion

• Friendship
• Feeling like a worthwhile human being through
  meaningful activity
• Hopefulness though an affirmative stance
• not so much rewards of recovery as the
  prerequisites for recovery

Davidson, et al. 2001b
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Social Programming 101

• Traditional Models
• Clubhouse
• Lodges
• Consumer-run drop in centers
• Social activities/groups

Davidson, et al. 2004
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Limitations

• Primarily institutional settings
• Consumers may stay away for fear of being
  identified as a mental patient
• Non-normalized environments

Davidson, et al. 2004
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Limitations

• Difficulty in transferring skills from artificial
  environments into more natural settings
• Cant prepare consumers to deal with the
  unpredictable
• Cant explore the various subtleties of
  relationships
• Fewer role models of normalized behavior

Davidson, et al. 2004
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Limitations

• Most significant limitation is that a person must
  prove they have the skills prior to being
  allowed supported access to the community

Davidson, et al. 2004
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What is Supported Socialization?

• An alternative to clubhouses, lodges, and
  consumer run drop-ins
• Focus on social integration (pool league vs pool
  outing)
• Socialization in natural settings is the process,
  not the product

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What is Supported Socialization?

• Developed by Larry Davidson and colleges at Yale
• Intended to mirror the success of other
  supported approaches (i.e. employment)
• VERY closely tied to Recovery

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The Study

• Study done in 2004
• Group 1 only
• Group 2 consumer
• Group 3 community
• Conclusionspeople do better when they develop
  supportive caring, reciprocal relationships
  (outside the mental health system)

Davidson, et al. 2004
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Key Elements

• Involves the provision of structured
  opportunities for socialization
• Increase access to on-going social and
  recreational activities
• Marked by the establishment of reciprocal
  relationships with peers based on strengths

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Key Elements

• Takes place in normalized/naturally occurring
  settings, outside of the mental health community
• In-Vitro (in-vivo) supports are provided to
  ensure people overcome/accommodate for the
  disability (direct support)
• Create mediating structures that enable
  participation in community life (barriers)

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What is Supported Socialization?

• Supporting opportunity
• Supporting risk
• Successes
• Failures
• Supporting participation

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RISK!!

• People also have to have a sense that it will be
  worthwhile to take the risks of taking steps
  forward and all steps forward, no matter how
  small, entail risk

Davidson, et al. 2004
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RISK!!

• Recovery is an on-going process, is non-liner
  including both successes (positive changes) and
  set backs (negative changes), and is ecologically
  oriented (lived within the context of self and
  external circumstance
• Minimum risk Minimum reward

Ochocka, Nelson, and Janzen, 2005
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How to

• Other Supported approaches
• Social Skills Training
• Peer Provided Service
• Strong Evidence Base for all Interventions

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The Supported approach

• Service focus on competitive employment no
  pre-vocational programming strong evidence
• Based on consumer choice only requirement is a
  desire to work strong evidence
• Rapid job search place then train strong
  evidence

Bond, 2004
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The Supported approach

• Consumer preference strength and preference
  based moderately strong
• Unlimited and individualized support long term
  supports and follow up are vital weak evidence

Bond, 2004
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Social Skills Training

• Gives shape to place then train
• Role plays used as primary medium
• Small groups or one to one
• Bridge gap between office and community

Bellack, 2004
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Social Skills Training

• Addresses key principles of supported
  socialization
• A type of in vitro support
• Social Skills build relationships
• Office based exercises assist in identifying
  opportunities for participation in community
  activities and build self-efficacy

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Case Managers Role in SS

• Social skills training prior to placement
• So, What if happens?
• Address community access issues (i.e. mediating
  structures)
• Transportation issues
• Social Budget Planning
• Low cost activities
• Identify gatekeepers
• Train the Trainer (i.e. socialization coach)

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Socialization Coaches

• In-direct support
• Preparation activities (activity calendar
  reminders)
• Follow up, post involvement for feedback and
  skill refinement
• Direct support
• Primarily on-site
• Skills training re-enforcement and intervention
• Identify and develop natural support networks

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Peer Provided Service

• Employed as Socialization Coaches
• Should be..
• Stable in their own recovery
• Successfully integrated into normalized settings
• Connected to their own social support networks
  outside of the mental health setting

Solomon, 2004
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Peer Service - Benefits

• Experiential Knowledge
• Specialized information that has been obtained
  through life experience
• Social Learning
• Because of the personal experiences with mental
  illness, role model is more creditable
• Increase sense of self-efficacy on both sides
• Choice
• Professional or Peer Services (empowerment)

Solomon, 2004
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EvaluationHow do we know this is working?

• Social network size
• Social Functioning
• Rates of hospitalization, employment
• Reduction in dependence on professional support
  (longitudinal)
• Recovery measures

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Whats Unique to the SS approach ?

• Principles keep the focus in community
• Offers clear indicators of success
• Increases choices for treatment options
• Developed from Evidence Based Practices
• IPS (supported approaches)
• Social Skills Training
• Peer Support Models

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Whats Unique to the SS approach ?

• Long-Term
• Structures social network development
• Potential for lasting connections to the
  community
• Overall goal is self-sufficiency and decreased
  dependence on the formal system
• Helps to facilitates recovery

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Recovery

• a process of restoring a meaningful sense of
  belonging to ones community and positive sense
  of identity apart from ones condition while
  rebuilding a life despite ones limitations
  imposed by that condition

Davidson et al, 2007
38
Final Thoughts

• Like with an effective sense of self worth, we
  cannot simply give such experiences to someone
  else. At best, we can provide access and
  opportunities, and help others to prepare
  themselves for such experiences

Davidson, et al. 2001b
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Conclusions

• Where do we go from here?
• SSS Regina Chapter
• Peer Provided Service/Peer Support
• What are the limitations of this approach?
• Resources
• Funding
• Stigma
• Old Wine, New Bottle?

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References

• Bond, G. (2004). Supported Employment Evidence
  for an Evidence Based Practice. Psychiatric
  Rehabilitation Journal, 27, 345-357.
• Bellack, A. (2004). Skills Training for People
  with Severe Mental Illness. Psychiatric
  Rehabilitation Journal, 27. 375-389.
• Davidson, L., Haglund, K., Stayner, D., Rakfeldt,
  J., Chinman, M. and Tebes, J. (2001a). It Was
  Just Realizing That Life Isnt One big Horror A
  Qualitative Study of Supported Socialization.
  Psychiatric Rehabilitation Journal, 24, 257-292.
• Davidson, L., Shahar, G., Stayner, D., Chinman,
  M., Rakfelder, J., and Tebes, J.K. (2004).
  Supported Socialization for People with
  Psychiatric Disabilities Lessons From a
  Randomized Controlled Trail. Journal of Community
  Psychology, 32, 453-477.
• Davidson, L., Stayner, R., Nickou, C., Styron,
  T., Rowe, M and Chinman, M. (2001b). Simply to
  be Let In Inclusion as a Basis for Recovery
  from Mental Illness. Psychiatric Rehabilitation
  Journal, 24, 375-388.

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References

• Ochocka, J., Nelson, G., and Janzen R. (2005).
  Moving Forward Negotiating Self and External
  Circumstances in Recovery. Psychiatric
  Rehabilitation Journal, 28, 315-322.
• Oken, S., Craig, C., Ridgway P., Ralph, R. and
  Cook, J. (2007). An Analysis of the Definitions
  and Elements of Recovery A Review of the
  Literature. Psychiatric Rehabilitation Journal,
  31, 9-22.
• Pascaris, A. (1994). Social Recreation A Blind
  Spot in Rehabilitation? In W. Anthony L.
  Spaniol (Eds.), Readings in psychiatric
  rehabilitation (p.205-236). Boston, MA Center
  for Psychiatric Rehabilitation
• Solomon, P. (2004). Peer Support/Peer Provided
  Services Underlying Processes, Benefits, and
  Critical Ingredients. Psychiatric Rehabilitation
  Journal. 27, 392-402.

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• Phoenix Residential Society
• 1770 Halifax St.
• Regina, Sask.
• S4P 1T1
• Phone [phone]
• Executive Director Carole Eaton
• carole.eaton_at_accesscomm.ca
• mseiferling_at_accesscomm.ca
• jbrownridge_at_accesscomm.ca