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The Development of Recovery Competencies for In-patient Mental Health Providers Working with People with Serious Mental Illness. Shu-Ping Chen , Ph. D. Candidate, School of Rehabilitation Therapy, Queen’s University
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Shu-Ping Chen, Ph. D. Candidate, School of Rehabilitation Therapy, Queen’s University
Terry Krupa, PhD, OT Reg (Ont), Professor, School of Rehabilitation Therapy, Queen’s University
The downsizing and/or closures of psychiatric hospitals and the increase of community-based services
Generic Recovery Competency Frameworks
Specific Recovery Competency Framework
The purpose of this study was to:
1. identify the most salient recovery competencies required of in-patient providers to inform the development of an educational program
2. develop a shared understanding of recovery by providers
-- Literature review -- Key informant interviews
Develop a recovery competency framework
for in-patient providers
Key Informants Interviews
Tensions inherent in delivering recovery-oriented services in in-patient context
Personal level tensions
1. Psychotic symptom
2. Behavioral problem
3. Cognitive impairment
4. Emotional distress
5. Lack of motivation
6. Refractory to treatment
7. Side effects of medications
Providers’ own tensions
1. Various recovery competencies
2. Inefficient knowledge transformation
3. Pressure, tension, frustration
4. Low motivation
5. Inadequate colleague support
6. Negative belief toward SMI
Environmental level tensions
1. Poor physical environment
2. Inflexible routines
3. Unsafe atmosphere
4. Limited resources and support
5. Hierarchical power structure
6. Institutionalization
Medical model
Custodial framework
Risk control
Action & Practice
Limited engagement:
segregation, restriction,
constrained communication, passivity of patients
Consequences
Hopeless
Powerless
Compromised relationships
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Challenge 1. The environmental level tensions
Critical tension: Patients perceive the in-patient environment as non-humanistic, inflexible, unsafe, and lacking in stimulation.
a. non humanistic physical environment
b. inflexible ward routines
c. unsafe atmosphere
d. lack of resources
e. hierarchical power structure
f. institutionalization
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Challenge 2. The personal level tensions
Critical tension: Patients may be experiencing acute illness or other experiences of distress which prevents them from engaging in recovery planning.
a. psychotic symptoms
b. behavioral problems
c. cognitive impairment
d. emotional distress
e. lack of motivation
f. treatment-refractory illness
g. side-effects of the medications
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Challenge 3. Providers’ own tensions
Critical tension: Providers do not demonstrate recovery attitudes, knowledge, skills, and behaviors in their daily practice.
a. various recovery competencies (belief in medical model, non recovery-oriented attitude…)
b. Inefficient knowledge transformation
c. feelings of pressure, tension, and frustration as a result of patients’ conditions, as well as apparent conflicts between human rights and some interventions
d. low motivation to change
e. inadequate colleague support
f. negative beliefs toward patients with serious mental illness
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Reduce environmental level tensions
Reduce personal level tensions
Build relationship
Engage patients in setting goals and planning
Provide choices and individualized services
Challenge 4. Setting goals and planning and providing individually tailored services
Critical tension: Intervention and decision making are based on the medical model. Patients are not empowered to take responsibility.
a. stakeholders’ goals are different or don’t support recovery
b. patients insist on goals that appear unrealistic /unfeasible
c. patients depend on hospital care and don’t appear to move forward
d. time challenge 1- patients’ high turnovers. Acute inpatients do not have enough time to implement recovery planning
e. time challenge 2- practitioners’ time constraints. Practitioners do not have enough time to offer time-consuming services or cannot satisfy different patients’ needs at the same time
Engage patients in setting goals and planning
Provide choices and individualized services
Engage patients in setting goals and planning
Provide choices and individualized services
Engage patients in setting goals and planning
Provide choices and individualized services
Challenge 5. Provide choices based on individual needs
Critical tension: It is difficult to address different patients’ needs in a restricted environment.
a. tensions exist between patients’ needs/rights/choices and the structure of the units
b. patients’ decisions may lead to harmful/negative outcomes
Engage patients in setting goals and planning
Provide choices and individualized services
Engage patients in setting goals and planning
Provide choices and individualized services
Challenge 6. Foster a positive recovery cycle
Critical tension: patients can be in a negative cycle of hopelessness, powerlessness, vulnerability, and repeated relapse.
a. patients can be extremely fragile/have extremely low self-esteem
hope
Advocacy
Empower-ment
network
skills
readiness
Foster the positive cycle of hope, empowerment, meaningful life, and personal growth
hope
Advocacy
Empower-ment
network
skills
readiness
Competency 6: Fostering a positive recovery cycle -- know best practice of recovery
hope
Advocacy
Empower-ment
network
skills
readiness
Competency 6: Fostering a positive recovery cycle -- know best practice of recovery
hope
Advocacy
Empower-ment
network
skills
readiness
Challenge 7. Promoting recovery and advocacy
Critical tension: Existing stigmas prevent patients from moving forward.
a. patients’ internalized stigma
b. social stigma
hope
Advocacy
Empower-ment
network
skills
readiness
Take a proactive role in diminishing stigma and promoting recovery in the community
hope
Advocacy
Empower-ment
network
skills
readiness
Competency 7: Promoting recovery and advocacy
hope
Advocacy
Empower-ment
network
skills
readiness
Ensure continuity of recovery process
Challenge 8. Provide transitional services
Critical tension: Moving from the in-patient to community environment can be a complex transition. In-patients may not have access to supports to connect them to resources and opportunities in the community. .
a. insufficient resources and ongoing support in the community
Ensure continuity of recovery process
Ensure continuity of recovery process