Tools for SelfAdvocacy

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Tools for Self-Advocacy

• Social Security Administration
• Ticket Partners Summit
• Working Together for Success
• Louisville, Kentucky
• March 11, 2008

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Presenters

• Evelyn Bussema, LMSW, CPRP
• Director of Education and Training
• United States Psychiatric Rehabilitation
  Association (USPRA)
• Linthicum, Maryland
• Lyn Legere, MS, CRC, CPRP
• Director of Education
• The Transformation Center
• Boston, Massachusetts

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Rehabilitation

• Focuses on helping individuals develop skills and
  access resources needed to increase capacity to
  be successful and satisfied in chosen roles.
• Service Recipients Must Lead the Process!!!

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Rehabilitation promotes Recovery

• Full community integration
• Improved quality of life

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A Critical Ingredient of Recovery

• Attaining and Sustaining Employment

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The principles and interventions of psychiatric
rehabilitation were designed for persons with
psychiatric disabilities

• We believe that examining what has resulted in
  positive work and life outcomes for people with
  psychiatric disabilities can be helpful in
  developing best practice approaches for all
  persons with disabilities

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USPRA Principles of Psychiatric Rehabilitation
1975

• Recovery is the ultimate goal... Interventions
  must facilitate the process of recovery.
• PR practices help people (re)establish normal
  roles in the community and their (re)integration
  into community life.
• PR practices facilitate the development of
  personal support networks.
• PR practices facilitate an enhanced quality of
  life for each person receiving services
• All people have the capacity to learn and grow

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Principles of Psychiatric Rehabilitation6-10

• People receiving services have the right to
  direct their own affairs, including those that
  are related to theirdisability.
• All people are to be treated with respect and
  dignity
• PR practitioners make conscious and consistent
  effort to eliminate labeling and discrimination,
  particularly discrimination based upon a
  disabling condition
• Cultural and/or ethnicity play an important role
  in recovery. They are sources of strength and
  enrichment for the persons and the services
• PR interventions build on the strengths of each
  person

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Principles of Psychiatric Rehabilitation11-15

• PR services are to be coordinated, accessible,
  and available as long as needed
• All services are designed to address the unique
  needs of each individual, consistent with the
  individuals cultural values and norms
• PR practices actively encourage and support the
  involvement of persons in normal community
  activitiesthroughout the rehabilitation process
• The involvement and partnership of persons
  receiving services and family members is an
  essential ingredient of the process of
  rehabilitation and recovery
• Psychiatric Rehabilitation practitioners should
  constantly strive to improve the services they
  provide

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Prochaska Stages of Changes

• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance

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5 phases of Rehabilitation

• Assessing Readiness (for Change)
• Developing Readiness (for Change)
• Choosing the Goal
• Achieving the Goal
• Keeping the Goal

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Assessing Readiness

• Process Assess with the person
• Current need and desire for change
• Current willingness to work at change
• What the person already knows about possible
  choices
• What the person knows about self, and the way
  he/she interacts with others.

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As part of the readiness assessment, a person
needs to explore.

• Am I prepared (knowledge, skills attitude) to
  take responsibility for making the change?
• Am I prepared (knowledge, skills attitude) to
  engage in the self-reflection and growth required
  of change?

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Assessing Readiness

• Outcome We (service user provider) identify
• Strengths to build on
• Gaps to be strengthened before beginning the
  choosing phase
• Areas to address later on in the process.
• Benefit Factors critical to long-term
  persistence and success are identified earlier
  rather than later. Saves time money, and
  avoids frustration of all parties.

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To effect meaningful changePeople must

• Be the primary decision makers in their
  rehabilitation plans.
• Believe that they are the lead partner
• Believe that they have the skills and resources
  to effect personal change.

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To effect meaningful changePeople must

• Believe their efforts will result in a positive
  outcome.
• Have the self environmental knowledge to make
  an informed choice
• Have the Need and Desire to change

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Relate all Interventions to the Persons
Identified Need(s)

• Need is generally more than money.
• What will getting a job do for the person?
• Purpose
• Improved standard of living
• Increased self-esteem
• Hope

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Developing Readiness

• Through learning experiences, a person will
• Understand his/her values preferences more
  clearly
• Learn about possible goal choices
• Learn about recovery possibilities
• Develop relationships
• Experience accomplishments

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Developing Readiness

• Outcome. Acquisition of self-confidence,
  self-control, self-reliance, self-esteem, self-
  awareness, hope and readiness for choosing a
  goal.
• Benefits Developing readiness provides the
  person with the knowledge, skills attitudes to
  make an informed choice regarding his or her
  goal.

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Choosing the Goal

• Identify the dream job, home, or place to go to
  school
• Gather information about places that might be
  good options for the individual
• Choose the goal that best matches the person

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Job Preferences Are Important
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Choosing the Goal

• Outcome. A goal statement of where the person
  would like to live, learn or work and when the
  person hopes to accomplish the goal, e.g. I
  intend to be a marketing associate at Global
  Enterprises beginning in September, 2009.
• Benefit. A person is motivated when working
  towards his/her own goal, and needed skills
  supports can be developed to the specific needs
  of the goal.

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Achieving the Goal

• Identify what the goal environment requires
• Identify the strengths that will help a person
  succeed in that environment
• Identify other things the person needs to learn
  or change in order to succeed in the chosen goal
• Identify the supports needed
• Set up and follow a plan for how to make those
  changes (develop skills and supports)

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Achieving Phase Activities

• Functional Assessment - Listing, Describing, and
  Evaluating usage of the skills most critical for
  goal success.
• Generally the most critical skills are not job
  tasks
• Examples Preparing clothes, Estimating time,
  etc.

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Achieving Phase Activities

• Resource Assessment - Identifying supports needed
  for goal achievement
• Natural Supports
• People, places, things activities, e.g. clock,
  transportation, taking a walk on break.

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Achieving the Goal

• Outcome. Having the skills and supports needed
  to succeed in obtaining sustaining the goal
• Benefits. Allows for a concrete plan where
  change can be seen experienced by the person,
  all tasks are related to the goal (motivation),
  and the person can change his/her mind about the
  goal if the tasks are not successful or
  satisfying.

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Achieving Phase Activities

• Planning Develop a work plan for skill and
  support development
• the persons plan, not the service providers
  plan
• Intervention Implement the planSkill teaching
  and support acquisition

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Keeping the Goal

• Evaluate how the person doing in the new
  environment
• Solve problems as they arise.
• Outcome.
• Success and Satisfaction

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Keeping involves so much more that the ability to
perform job tasks

• Keeping is dependent of total life wellness
• Healthy body, mind, and spirit
• Safe place to live
• Social networks
• Supports
• Hope for a bright future

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The provider cannot assure success!

• Providers Role Create an environment that
  supports personal empowerment and communicates
  hope!
• Service Users Role Rise to the level of the
  bar. The person may or may not be able to do
  that at the particular time.

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Outcomes by the Numbers

• One Example
• Hope Haven, Inc. 7/03 6/04
• 43 participants increased employment status
• 41 participants increased earnings
• 85 of graduates achieved their goals
• Measurement tool developed by HSRI evaluation
  center

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Key Barrier The low expectations of
professionals
A vicious circle that erodes hope and reduces
opportunity
Expert professionals say that people with mental
health problems (all disabilities?) are unlikely
to be able to work
People with mental health problems (all
disabilities?) believe that they cannot work and
give up trying to get jobs
Employers believe that people with mental health
problems (all disabilities?) cant work so
dont employ them
Very few people with mental health problems or
other disabilities in employment
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Additional Barriers

• Funding Source Limitations
• Rigid Program Structures
• One Size Fits All
• Rehabilitation Individualized Planning

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Vocational Rehabilitation Psychiatric
Rehabilitation

• Collaboration between PR VR services
• Collaboration between VR other service agencies
• Overcome system differences
• Learn each others system
• Define roles
• Authorize services to help person choose, get
  keep work.
• Serve together

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What might a case manager do?

• Assess Develop Readiness before referring to
  VR
• Collaborate with VR worker to help develop needed
  skills
• Help person determine the skills that will lead
  to satisfaction
• Skills and supports not specific to the job
  requirements that are vital to maintaining health
  wellness.

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Get Creative

• Brainstorm funding mechanisms that might be
  tapped to fund a self-advocacy intervention

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Resources

• Boston University Center for Psychiatric
  Rehabilitation www.bu.edu/cpr
• (BU has a Certificate Program in Psychiatric
  Vocational Rehabilitation)
• US Psychiatric Rehabilitation Association USPRA
  www.uspra.org

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Bibliography

• Becker, D. (2006). Supported Employment
  Improving life through work. Retrieved from the
  worldwideweb at www.dhs.state.or.us/tools/vr/train
  ing/2006/programs_supports/ebse/reese_supp
  emp.ppt on 2/8/08.
• Blankertz, L. Robinson, S. (1996). Adding a
  vocational focus to mental health rehabilitation.
  Psychiatric Services, 47 1216-1222
• Bracke, P. (2004). Boredom in Psychiatric
  Rehabilitation and Vocational Rehabilitation
  Centres. Paper presented at the annual meeting of
  the American Sociological Association, San
  Francisco, CA August 14, 2004. (Retrieved on
  2/5/08 at www.allacademic.com/meta/p108547_index.h
  tml).
• Cook JA. Lehman AF. Drake R, et al. Integration
  of psychiatric and vocational services a
  multisite randomized, controlled trial of
  supported employment. Am J Psychiatry.
  200516219481956
• Cook, Judith A. (1999) Research Based Principles
  of Vocational Rehabilitation for Psychiatric
  Disability. IAPSRS Connection, Issue 4
• Liberman RP., Kopelowicz A. (2002) Teaching
  persons with severe mental disabilities to be
  their own case managers. Psychiatric Services
  5313771379.
• MacDonald-Wilson, K. (2001) Unique Issues in
  Assessing Work Function Among Individuals with
  Psychiatric Disabilities. Journal of Occupational
  Rehabilitation 11(3) 217-232.
• Maronne, J., Gandolfo, C. Gold, M. Hoff, D.
  (2000). If You Think Work Is Bad for People with
  Mental Illness, Then Try Poverty, Unemployment,
  and Social Isolation. Psychiatric Rehabilitation
  Journal 23(2) 187-19.
• Provencher, H.L., Gregg, R., Mean, S. Mueser,
  K.T. (2002). The Role of Work in the Recovery of
  Persons with Psychiatric Disabilities.
  Psychiatric Rehabilitation Journal, (26)2,
  132-144
• Rehabilitation Services Administration, U.S.
  Department of Education, George Washington
  University. (2005) 30th Institute on Recovery
  Issues Innovative Methods for Providing
  Vocational Rehabilitation services to people with
  psychiatric disabilities.

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Contact Information

• Evelyn Bussema, LMSW, CPRP
• USPRA
• 601 Global Way, Suite 106
• Linthicum, Maryland 21090
• Ph. [phone]
• email ebussema_at_uspra.org
• Lyn Legere, MS,CRC,CPRP,CPS
• Director of Education Peer Support
• The Transformation Center
• Roxbury, MA 02118
• email lynlegere_at_yahoo.com