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Hope!. 2. Outline of Entire Presentation . Part One: Setting the stage for personal growth and Recovery through Hope, Empowerment and Preparation: An OverviewPart Two: Using the Empowerment Scale to plan and monitor treatment aimed at Empowerment and Recovery. Hope!. 3. Part One. Setting the st
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1. 1 Using the Empowerment Scale In Treatment: an Educational Program for Consumers, Clinicians and Supervisors Partnership with psychiatry
Vs. No partnership
Structure it in partnership
Psych services
May 02
Fisher
Conditions for empowermentWhy cons arent always receptive
Emp t trt plnng
Shared Philosophy of empowerment and recovery
Staff empowerment allowed modeling of empowerment to consumer
Focus on EBP DBT on BPD, IMR in groups, RN focus on wellness, Dr. Diane Smith, Motivational interviewing, lets consumers make bad choices and attempt to put in place safety nets.
Using nine recovery principles, using empowerment as targets in scales, self-esteem, self-esteem group
Self-esteem is core theme of almost all mental illness
Consumer involvement in the agency, consumer advisory group under development Examples for
Partnership with psychiatry
Vs. No partnership
Structure it in partnership
Psych services
May 02
Fisher
Conditions for empowermentWhy cons arent always receptive
Emp t trt plnng
Shared Philosophy of empowerment and recovery
Staff empowerment allowed modeling of empowerment to consumer
Focus on EBP DBT on BPD, IMR in groups, RN focus on wellness, Dr. Diane Smith, Motivational interviewing, lets consumers make bad choices and attempt to put in place safety nets.
Using nine recovery principles, using empowerment as targets in scales, self-esteem, self-esteem group
Self-esteem is core theme of almost all mental illness
Consumer involvement in the agency, consumer advisory group under development Examples for
2. Hope! 2 Outline of Entire Presentation Part One: Setting the stage for personal growth and Recovery through Hope, Empowerment and Preparation: An Overview
Part Two: Using the Empowerment Scale to plan and monitor treatment aimed at Empowerment and Recovery
3. Hope! 3 Part One Setting the stage for personal growth and Recovery through Hope, Empowerment and Preparation: An Overview
Review conditions necessary for Empowerment to take place
4. Hope! 4 Learning Objectives:Part One Define Recovery & Empowerment
Describe how Recovery and Empowerment apply to all consumers
Describe the conditions for Empowerment Explain relationship of recoveryand empowermentExplain relationship of recoveryand empowerment
5. Hope! 5 Resilience & Recovery Ideally during youth, people acquire resilience, an innate capacity that when facilitated and nurtured empowers children, youth, and families to successfully meet lifes challenges with a sense of self-determination, mastery and hope From: Resiliency Workgroup
People can build resilience even as adults
If an adult becomes mentally ill, they will use what resilience they have to Recover
One goal of treatment may be to build resilience to avoid future mental health problems
6. Hope! 6 Hope Hope is a desire accompanied by confident expectation. Having a sense of hope is the foundation for ongoing recovery from mental illness. Even the smallest belief that we can get better, as others have, can fuel the recovery process.
Early in the recovery process, it is possible for a treatment provider, friend, and/or family member to carry hope for a consumer. At some point, however, consumers must develop and internalize their own sense of hope
From: MHRecovery.com
7. Hope! 7 Hope and Recovery Without Hope, why would anyone proceed in mental health treatment?
Recovery from Schizophrenia is possible:
55.5% achieved recovery in multiple studies*
With many other less serious disorders there are similar or higher improvement rates
We should offer hope to consumers!
8. Hope! 8 Our Hope: Recovery Refers to the process in which individuals are able to live, work, learn and participate fully in their communities
Recovery is the ability to live a fulfilling and productive life despite a disability
Recovery also implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in an individual's recovery (President's New Freedom Commission on Mental Health)
9. Hope! 9 Another View of Recovery Instead of focusing primarily on symptom relief
recovery casts a much wider spotlight on restoration of self-esteem and identity and on attaining meaningful roles in society. The definitions do not, however, imply full recovery, in which full functioning is restored and no medications are needed. Instead they suggest a journey or process, not a destination or curePatricia Deegan, 1997
10. Hope! 10 People are Labeled with Mental Illness Due to: Many reasons including:
Severe emotional distress
Insufficient social supports/resources/ coping skills to maintain the major social roles expected of them during that phase of their life
Those who have adequate resources to cope with their symptoms may not be labeled as mentally ill
11. Hope! 11 THEREFORE: The goal of treatment here is assisting people in gaining greater control of their lives and assisting them in regaining valued roles in societyDan Fisher, MD
Recovery is made possible through a combination of SUPPORTS needed to re-establish social roles and SELF-MANAGEMENT needed to take control of major decisions
12. Hope! 12 Treatment With Recovery Focus Mental illness is not a life-long process
Builds assets that can help consumers get on with their lives despite potentially continuing symptoms of mental illness
Empowerment is a key asset that can be built in the presence of symptoms
Empowerment is negatively correlated with symptom distress (Stewart & Kopache, 2003 IASPRS Conference Presentation)
13. Hope! 13 Recovery is for Everyone The processes of recovery as described above can happen for everyone despite level of functioning or types of symptoms
14. Hope! 14 What is Empowerment? The process of investing with power
Recovery does not occur without Empowerment
15. Hope! 15 Empowerment Process The process of increasing personal, interpersonal and political power to enable individuals or collectives to improve their life situation. It requires the full participation of people in the formulation, implementation and evaluation of decisions determining the functioning and well-being of the society.http://www.polity.org.za
16. Hope! 16 Empowerment Helps Everyone The components of empowerment are part of the healing process for everyone, not just those with severe mental illness
Empowerment issues (low self-esteem, sense of powerlessness, etc.) are present in almost all cases, regardless of diagnosis
For those with mental illness, empowerment can be a tool to enhance a consumers decision-making capacity
17. Hope! 17 Each Person Must Become Empowered Themselves Empowerment is not something that can be given to a person or that can be done for a person
BUT clinicians can and must aid in establishing the conditions necessary for Empowerment
Empowerment in life cannot be gained without empowerment in treatment
18. Hope! 18 Conditions for Empowerment Managed Psychiatric Symptoms
Participation Skills
Psychological Readiness
Mutual Trust and Respect
Reciprocal Concrete Incentives
Availability of Choices
Participation Structures and Processes
Access to Resources
Supportive Culture
19. Hope! 19 Conditions for Empowerment Empowerment can begin even with a minimum level of these conditions
Clinicians should proceed assuming that empowerment is possible and work to establish the necessary conditions
20. Hope! 20 Condition: Managed Psychiatric Symptoms Consumers can participate in treatment planning even with symptoms present
Symptoms do not impact all areas of decision-making; assume that persons can participate
21. Hope! 21 Condition:Participation Skills People must have some level of participation skills to meaningfully participate in treatment
Many systems have access to Climbing into the Drivers Seat training that helps prepare consumers to take part in treatment planning
Even with symptoms, a person can acquire participation skills needed to take part in treatment planning
Give opportunities for decision making; making even small decisions builds skills
Honoring consumer choices, sometimes even poor ones, fosters a sense of confidence in their ability to make decisions
22. Hope! 22 Condition:Psychological Readiness Hope for change is needed, but hope is fragile
Psychological readiness can be inhibited by past failed attempts to change, feelings of powerlessness, lack of hope, and other reasons
Motivational interviewing (characterized by active listening, empathy, non-argumentative style, open-ended questioning) can be useful in fostering readiness
Small successes build readiness
23. Hope! 23 Condition:Mutual Trust and Respect Consumer believes clinician wants whats best and respects consumers abilities, choices and basic worth as a person
Clinician believes consumer can make good decisions and is willing to cooperate
Mutual trust and respect build the therapeutic alliance, which has been shown to improve treatment outcomes (Crane-Ross, Lutz & Roth, 2005)
24. Hope! 24 Condition:Reciprocal Concrete Incentives Both consumer and clinician must have concrete and meaningful incentives to participate in treatment
Consumers have incentive of better life as a result of successful treatment
Clinicians have the incentive that the consumers they serve will have positive changes in their life
Sometimes the incentives have to be pointed out to be recognized, or put in place if not there already
25. Hope! 25 Condition:Availability of Choices In order for decision-making to be meaningful, valid choices must be available
These choices can be in style of treatment modalities, additional services, or goals of treatment
Even bad choices can be empowering; however, more failurebrought about by not being readymay foster powerlessness rather than empowerment
A decision to defer decision-making is also OKit does not indicate a general inability or unwillingness to make decisions
People make choices all the time; show consumers that everyday choices are evidence of their power
26. Hope! 26 Condition:Participation Structures and Processes Empowerment should be a part of the formal processes in a service setting
Involving families and/or significant othersat the consumers discretionis empowering
Individualized treatment planning implies that the consumer is present and participates
27. Hope! 27 Condition:Access to Resources Ability of consumers to identify and access resources will enhance treatment effectiveness
In order to recover, a consumer must be able to learn to identify and access resources, including:
Peer Support
Mediation
Community events as social opportunities
Educational materials
28. Hope! 28 Condition:Access to Resources Clinicians also need resources:
Training
Time to conduct meaningful engagement (it takes longer to write treatment plans with the consumer taking part)
Tools such as Outcomes reports
Evidence-based practice models
29. Hope! 29 Condition: Supportive Culture Clinicians do not work in isolation: the culture of the agency either supports or inhibits empowerment
A supportive culture:
Has empowered clinicians that instill hope and set an example for consumers
Minimizes stigma
Assumes consumers are self-reliant or can grow into self-reliance
Has Mission and Vision statements that support Empowerment and Recovery
Has leaders that support Empowerment and Recovery
30. Hope! 30 Conditions Only Set the Stage The effectiveness of treatment depends on how much of each condition is present
The conditions provide a structure for nurturing consumer empowerment
To the extent possible, all conditions should be present
31. Hope! 31 Empowerment Requires Actual Change Increasing consumers self-esteem, self-efficacy, and sense of power are necessary but not sufficient conditions for growth
These subjective changes must be accompanied by objective or actual changes in order for progress to be sustained
32. Hope! 32 Part One Summary Hope is the seed that can start and sustain the recovery process
Empowerment is essential to recovery because it enables the consumer to lead their own recovery
Empowerment is up to the consumer, but clinicians can set the stage by fulfilling the conditions of Empowerment
33. Hope! 33 Part Two Using the Empowerment Scale to plan and monitor treatment aimed at Empowerment and Recovery
Review Reports that Incorporate Empowerment Sub-Scales and Items
Review how to use the Reports in the various phases of treatment
34. Hope! 34 Learning Objectives:Part Two Explain the components of the Empowerment Scale
Know which reports incorporating Empowerment can be used in treatment
Give specific suggestions about how to use the Empowerment Scale in treatment Explain relationship of recoveryand empowermentExplain relationship of recoveryand empowerment
35. Hope! 35 The Empowerment Scale The Adult Consumer Survey of the Ohio Outcomes System Includes:
The Boston University Making Decisions Empowerment Scale has 5 components
Self-Esteem
Optimism and Control Over the Future
Community Activism and Autonomy
Power/Powerlessness
Righteous Anger
36. Hope! 36 Empowerment Exercise Complete and score the Empowerment Scale
Special hand-scoring version included--Do not use this version in treatment!
Leave about 15 minutes for this task
Consider what you would like to work on if it were your treatment plan
37. Hope! 37 Finding the Positive The amount of self-esteem, power, righteous anger, community activism and optimism/control over the future can vary in different areas of life
Part of the clinical process must be to find areas of life where empowerment exists
These scales and the individual items can help find areas of strength and find areas where improvement is still needed
38. Hope! 38 About Normative Data
Normative data are usually constructed from scores representative of the population we are measuring; norms provide a standard with reference to a population of interest
Some norming data are included in subsequent slides to provide a general sense of the Empowerment scale scores
39. Hope! 39 About Normative Data
The primary use of the Empowerment data in treatment is to compare the person to themselves over time
Norms are not Targets! These are what exist in a Grade B system (NAMI state ratings, 2006)
If you always do what you always did, you always get what you always got
-Martha Hodge
40. Hope! 40 Self-Esteem/Efficacy
Loss of self-esteem is a major concern for virtually all consumers
Without some sense of self worth, a persons reason to live or participate in treatment may be lost
Every new adjustment is a crisis in self-esteem
-Eric Hoffer
If you put a small value on yourself, rest assured that the world will not raise your price
-Unknown
41. Hope! 41 Self-Esteem/Efficacy Items 38. I have a positive attitude toward myself
39. I am usually confident about the decisions I make
42. I see myself as a capable person
45. I am often able to overcome barriers
47. When I make plans, I am almost certain to make them work
51. I am able to do things as well as most other people
52. I generally accomplish what I set out to do
57. I feel I am a person of worth, at least on an equal basis with others
59. I feel I have a number of good qualities
42. Hope! 42 Self-Esteem/Efficacy Low self-esteem is like driving through life with your hand-break on
-Maxwell Maltz
43. Hope! 43 Optimism and Control Over the Future Sense of the future is a key component of mental health
Without optimism, there is no reason to expect results in treatment
If you think you can, you can. And if you think you can't, you're right
-Mary Kay Ash
44. Hope! 44 Optimism and Control Over the Future Items 34. I can pretty much determine what will happen in my life
35. People are limited only by what they think is possible
46. I am generally optimistic about the future
60. Very often a problem can be solved by taking action
45. Hope! 45 Optimism and Control Over the Future
46. Hope! 46 Community Activism and Autonomy Fulfilling positive roles gives life meaning, an essential component of Recovery
Activism can build safety nets
Being part of a community gives consumers a chance to build social assets outside the mental health system
Never doubt that a small group of thoughtful, committed people can change the world: indeed it's the only thing that ever has!
- Margaret Mead
47. Hope! 47 Community Activism and Autonomy Items 36. People have more power if they join together as a group
44. People working together can have an effect on their community
53. People should try to live their lives the way they want to
58. People have a right to make their own decisions, even if they are bad ones
60. Very often a problem can be solved by taking action
61. Working with others in my community can help to change things for the better
48. Hope! 48 Community Activism and Autonomy
49. Hope! 49 Power/Powerlessness Presence or absence of belief that personal efforts will produce meaningful results
In order to achieve the outcomes of treatment, the consumer needs to have a sense of personal power
Consumer participation in treatment will hinge on the power a consumer has or is given by the clinical team
Power can be taken, but not given. The process of the taking is empowerment in itself
-Gloria Steinem
50. Hope! 50 Power/Powerlessness Items 40. People have no right to get angry just because they dont like something
41. Most of the misfortunes in my life were due to bad luck
43. Making waves never gets you anywhere
49. Usually I feel alone
50. Experts are in the best position to decide what people should do or learn
54. You cant fight city hall (authority)
55. I feel powerless most of the time
56. When I am unsure about something, I usually go along with the rest of the group
51. Hope! 51 Power/Powerlessness
52. Hope! 52 Righteous Anger Anger is OK in the face of an inappropriate action
Knowing when anger is OK and responding appropriately are what makes righteous anger a tool for recovery
Unlike other Empowerment subscales, Righteous Anger positively correlates with Symptom DistressMore Anger, More Distress
HOWEVER, Symptom Distress and Anger are sometimes a sign that the consumer is ready to change
53. Hope! 53 Righteous Anger Items 37. Getting angry about something never helps
40. People have no right to get angry just because they dont like something
43. Making waves never gets you anywhere
48. Getting angry about something is often the first step toward changing it
54. Hope! 54 Righteous Anger
55. Hope! 55 Righteous Anger Don't let justified emotions rob your health and well-being
-Doc Childre and Howard Martin,
There was never an angry man that thought his anger unjust
-St. Francis De Sales
Righteous anger comes easily;
Righteous action is carefully planned
56. Hope! 56 Empowerment Scales While the Overall Empowerment scale can be used as an indicator of progress in treatment, the individual subscales and individual items are more useful in the treatment planning process
57. Hope! 57 Reports Several reports are available that give information about the Empowerment Subscales and items
StrengthsAssets
Red FlagsTargets
Change Over TimeGraphically monitor progress at scale level
ARROWSuggested Activities
Adult Basic ReportOne-page report monitors progress at subscale level and some items
58. Hope! 58 Reports Reports are not essential --you can review the individual items of the Empowerment scale with the consumer
Whatever reports you use, give the consumer a copy!
Find out which reports are available from your system, and if you dont find ones you like, ask your vendor to add them
59. Hope! 59 Strengths Report Lists the positive and very positive responses
Allows consumers and staff to identify strengths that the consumer can use to achieve their treatment goals
Invites consumer participation if consumers are allowed to select the strengths they want to use
Available in the ODMH Data Entry and Report Template Specific result: look at case example
Role playSpecific result: look at case example
Role play
60. Hope! 60
61. Hope! 61 Red Flags Report Lists items with a negative or very negative responses
Invites consumer participation if consumers are allowed to select the targets of treatment
Available in the ODMH Data Entry and Report Template
62. Hope! 62
63. Hope! 63 Change over Time Report Graphic display of how Outcomes scales change over time
Empowerment subscales are included
Invites consumers to consider their progress in treatment
Available in the ODMH Data Entry and Report Template
64. Hope! 64
65. Hope! 65 ARROW Report Achieving Recovery & Resiliency the Outcomes Way (ARROW)
Based on Maslow's hierarchy of needs and consumer's responses to the Adult Consumer instrument
ARROW suggests potential activities for a consumer's treatment and/or recovery plan
The activities suggested in the report can augment treatment by calling on non-agency resources
More at: www.MHRecovery.com
Available in the Reports Generator How technology produces the ARROW. Limited to POV and later implementation in the
What was the goal of the practice adoption
Stage appropriateness
How technology produces the ARROW. Limited to POV and later implementation in the
What was the goal of the practice adoption
Stage appropriateness
66. Hope! 66
67. Hope! 67 Adult Basic Report One-page report to monitor progress on subscales and selected items
Includes Provider Community Functioning scale and summary of victimization items
Empowerment subscales are included
Useful for looking at how much consumers scores have changed, Reliable Change amount noted
Invites consumers to consider their progress in treatment
Available in the ODMH Reports Generator
68. Hope! 68
69. Hope! 69 Getting The Reports Reports come out of two Access databases:
Reports Generator
Data Entry and Reports Template
These tools are at: http://www.mh.state.oh.us/oper/outcomes/data.flow.template.html
70. Hope! 70 Using The Empowerment Scale In Treatment The Empowerment Scale is intended to be used the same way as all Outcomes Scales:
Complements Initial Clinical Assessment
Basis for Treatment Planning
Basis to monitor and track progress
Basis to modify treatment based on progress
71. Hope! 71 Outcomes & Self-Report Reviewing Outcomes with consumers gives a starting point for discussion
Outcomes are not the final word about how consumers feel
Outcomes need to be used collaboratively with the consumer
72. Hope! 72 Initial Clinical Assessment Each subscale reflects a necessary component of successful treatment; therefore, check where consumers are on each
Use these reports:
Strengths
Red Flags
Adult Basic Report
- AND -
Review the Items
73. Hope! 73 Outcomes Use in Treatment Planning The Longitudinal Consumer Outcomes (LCO) Study found that good Outcomes were best predicted by:
Consumers perceptions that their needs are met!
Consumers perceptions of service empowerment (e.g., involvement in treatment planning) was most highly correlated with degree to which they felt their needs were met
Using Outcomes in a collaborative fashion in Treatment Planning helps empower Consumers --they see that their needs are being attended to
74. Hope! 74 Treatment Planning Use Empowerment Items and Scales as targets of treatment
Use Empowerment Items and Scales as strengths in addressing other targets of Treatment
Use these reports:
Strengths
Red Flags
ARROW
75. Hope! 75 Monitor and Track Progress Review the reports with the consumer
Use the:
Change Over Time Report
Adult Basic Report
And:
The ARROW report, if you used in original treatment planning
76. Hope! 76 Modify Treatment Based on Progress Check Empowerment and other Outcomes gains scores against planned goals of treatment
If non-responsive, or if deteriorated, seek consumer input into what course corrections are needed in treatment
If goals are met, acknowledge success, plan next steps
Between formal reviews, take every opportunity to recognize and validate consumer steps toward goals
77. Hope! 77 Documenting Work on Empowerment and Recovery The Empowerment Scale and reports are appropriate material to be used as sources of information in documenting need for work on Empowerment and Recovery aspects of treatment
However, it is outside the scope of this training to explain what constitutes acceptable medical necessity documentation
Therefore, a training on medical necessity is included in the Empowerment training package if it is necessary to have guidance on medical necessity
78. Hope! 78 Summary The Empowerment scale has 5 parts:
Self-Esteem/Efficacy
Power/Powerlessness
Optimism/Control over the future
Community Activism and Autonomy
Righteous Anger
Various Empowerment reports are available
The Empowerment Scale items and subscales can be used during all phases of treatment
79. Hope! 79 Supervision Especially for new clinicians, write comments on Outcomes reports where clinicians need to pay attention
Assign the use of the ARROW report especially with clinicians new to Recovery
Use Outcomes to identify where clinicians may need further training
80. Hope! 80 Supervision Check progress on Outcomes, and
Review consumers who are doing poorly or well in supervision:
What worked?
What didnt?
Review change over time reports with clinicians to identify when consumers are progressing or deteriorating
Review Outcomes to identify what kinds of consumers the clinician effectively serves
81. 81 Contributors Joyce Campian
Janet Galligan
Geoff Grove
Lisa Grubbs
Dana Harlow
James Healy
Kraig Knudsen
Renee Kopache
Michelle Litton-Betts
Wilma Lutz
Sandi Miller
Nancy Nickerson
Rick Shepler
Dora Sterling
Jonas Thom
Kathy Trubisky
Marsha Zabecki
Partnership with psychiatry
Vs. No partnership
Structure it in partnership
Psych services
May 02
Fisher
Conditions for empowermentWhy cons arent always receptive
Emp t trt plnng
Shared Philosophy of empowerment and recovery
Staff empowerment allowed modeling of empowerment to consumer
Focus on EBP DBT on BPD, IMR in groups, RN focus on wellness, Dr. Diane Smith, Motivational interviewing, lets consumers make bad choices and attempt to put in place safety nets.
Using nine recovery principles, using empowerment as targets in scales, self-esteem, self-esteem group
Self-esteem is core theme of almost all mental illness
Consumer involvement in the agency, consumer advisory group under development Partnership with psychiatry
Vs. No partnership
Structure it in partnership
Psych services
May 02
Fisher
Conditions for empowermentWhy cons arent always receptive
Emp t trt plnng
Shared Philosophy of empowerment and recovery
Staff empowerment allowed modeling of empowerment to consumer
Focus on EBP DBT on BPD, IMR in groups, RN focus on wellness, Dr. Diane Smith, Motivational interviewing, lets consumers make bad choices and attempt to put in place safety nets.
Using nine recovery principles, using empowerment as targets in scales, self-esteem, self-esteem group
Self-esteem is core theme of almost all mental illness
Consumer involvement in the agency, consumer advisory group under development