Tools for Self-Advocacy

1. Tools for Self-Advocacy Social Security Administration Ticket Partners Summit: Working Together for Success Louisville, Kentucky March 11, 2008

2. 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

3. 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!!!

4. Rehabilitation promotes Recovery Full community integration Improved quality of life

5. A Critical Ingredient of Recovery Attaining and Sustaining Employment

6. 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

7. 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

8. Principles of Psychiatric Rehabilitation6-10 People receiving services have the right to direct their own affairs, including those that are related to their�disability. 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

9. 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 individual�s cultural values and norms PR practices actively encourage and support the involvement of persons in normal community activities�throughout 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

10. Prochaska: Stages of Changes

11. 5 phases of Rehabilitation Assessing Readiness (for Change) Developing Readiness (for Change) Choosing the Goal Achieving the Goal Keeping the Goal

12. 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.

13. 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?

14. 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.

15. To effect meaningful change�People 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.

16. To effect meaningful change�People 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

17. Relate all Interventions to the Person�s 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

18. 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

19. 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.

21. 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

23. 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.

24. 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)

25. 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.

26. 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.

27. 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.

28. Planning: Develop a work plan for skill and support development the person�s plan, not the service provider�s plan Intervention: Implement the plan�Skill teaching and support acquisition Achieving Phase Activities

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

30. 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

31. The provider cannot assure success! Provider�s Role: Create an environment that supports personal empowerment and communicates hope! Service User�s Role: Rise to the level of the bar. The person may or may not be able to do that at the particular time.

32. 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

34. Additional Barriers Funding Source Limitations Rigid Program Structures �One Size Fits All� Rehabilitation = Individualized Planning

35. Vocational Rehabilitation & Psychiatric Rehabilitation Collaboration between PR & VR services Collaboration between VR & other service agencies Overcome system differences Learn each other�s system Define roles Authorize services to help person choose, get & keep work. Serve together

36. 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.

37. Get Creative Brainstorm funding mechanisms that might be tapped to fund a self-advocacy intervention

38. 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

39. Bibliography Becker, D. (2006). Supported Employment: Improving life through work. Retrieved from the worldwideweb at www.dhs.state.or.us/tools/vr/training/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.html). 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. 2005;162:1948�1956 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 53:1377�1379. 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.

40. Contact Information Evelyn Bussema, LMSW, CPRP USPRA 601 Global Way, Suite 106 Linthicum, Maryland 21090 Ph. (410) 789-7054 email: ebussema@uspra.org Lyn Legere, MS,CRC,CPRP,CPS Director of Education & Peer Support The Transformation Center Roxbury, MA 02118 email: lynlegere@yahoo.com