Integrating Mental Health Recovery into
Social WorkSAMHSA Recovery-to-Practice Project
Council on Social Work Education (CSWE)http://www.cswe.org/recovery
Presentation developed by CSWEContact: Jessica Holmes, [email protected]
Presented by Susan Rogers, CSWE Steering Committee Member and Director, National Mental
Health Consumers’ Self-Help [email protected]
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Recovery to PracticeYear 1 – Situational Analysis (3/2010 – 9/2011)
Year 2 – Develop training outline
Year 3 – Develop training manual and pilot test training
Year 4 – Continue pilot testing and finalize training
Year 5 – Implement training
10/2013 to 9/2014
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Situational Analysis: Methodology Qualitative
Focus groups Interviews Discussion forums Comments from
individuals with lived experience
Syllabi review Review of state
documents and training materials
Literature review Review of professional
organizations Site visits
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QuantitativeCSWE Annual
Survey of Social Work Programs
NASW Workforce Studies
Mental Health, United States
Situational Analysis: Methodology
Situational Analysis: MethodologyStakeholders engaged:
Individuals with lived experience of psychiatric conditions
PractitionersStudentsEducatorsField Education
DirectorsField Instructors
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Social Workers and Mental HealthMore than 100,000
social work students enrolled
Master’s level concentrations:49 programs offered
“mental health”39 offered “health
and mental health”111 offered “direct
practice/clinical”
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Social workers are estimated to provide almost half of all mental health services.
36.8% of licensed social workers identify mental health as primary sector of employment.
Social Workers and Mental Health
Positive Findings Strong theoretical connections Recognition of the term recovery Ready “acceptance” of the idea
of recovery Integration of some recovery
components Longstanding commitment to
cultural competency and social justice
Some programs have begun to infuse trauma-informed practice
Social workers can provide a unique role
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Negative FindingsDissonance between social
work theory and practiceWeak integration of some
recovery components (e.g., hope, peer support)
Confusion about definition of recovery
Wide use of medical model and deficits thinking
Only small number infusing recovery as a whole
Need to enact organizational policy change
Funding uncertainty 9
Recovery-oriented Social Workerso Use hope-inducing behaviors and
practiceso Believe individuals can and do recovero Amplify clients’ voiceso Engage in goal-directed treatmento Facilitate individual choice and self-
determinationo Include family and significant others (with
permission)o Expect life beyond the mental health
system - community and social inclusiono Emphasize natural community supportso Recommend peer support networks and
services 10
Comparing the Two Approaches
Strengths Assessment Problems AssessmentWhat the person wants, desires, aspires to, dreams of; person’s talents, skills and knowledge. A holistic portrait.
Defines diagnosis as the problem. Questions are pursued related to problems; needs, deficits, symptoms.
Is conversational and purposeful. Is an interrogative interview.Strengths assessment is specific and detailed; individualizes person.
Places the person in a diagnostic or problem category using generic, homogeneous language.
Client authority and ownership. Is controlled by the professional.The professional asks, “What can I learn from you?”
The professional dictates, “What I think you need to learn/ work on.”
From The Strengths Model (3rd ed.), Rapp & Goscha, 2012, p. 95) 11
“But we already do that!”Traditional Services Recovery
Relationship with worker
• Client is usually “less than” the worker
• “Us/Them” • Frequently “power
over”
• “Power with”, shared risk, and responsibility.
• Meeting of “equals” with different expertise, experiences
• Negotiated boundariesGoal of service
• Maximize functioning • Skill development • Re-integration into
society
• A meaningful life
Treatment
From Noordsy, et al
• Increase strengths, reduce barriers; skills teaching; Vocational rehab
• Lifestyle changes: grooming, housing, diet, exercise, substance abuse
• Medications can play a vital role
• Consumer driven. Worker as ally, consultant
• Mutual help & self help • Seeing possibility, building hopes,
dreams. • Address issues & consequences
important to consumer. • Taking personal responsibility• Move from passive to active roles.
Risk-taking rather than care-taking • Attention to impact of trauma as well
as substance abuse issues• Medications can play a vital role 12
Pre-Recovery MH System Recovery Enhancing System
Message is: “you’ll never recover” – illness is a life long condition
Message is: “recovery is likely” you can and will attain both symptom relief and social recovery
Staff primarily set treatment plan and goals with minimal input by consumer. Plans often generic and focus on illness/medical necessity of treatment
Personalized recovery plan is mandated based on person’s individual goals and dreams.
Crisis services emphasize coercion and involuntary treatment, often use seclusion and restraint which can be (re)traumatizing
Crisis alternatives such as warm lines and respite are available. Staff has been trained to avoid seclusion and restraint and is skilled in alternative approaches
Families are left out; they are not educated about recovery. Little or no family support or education
Families are educated about recovery as well as about mental illness. Family support and conflict mediation are readily available from Ridgeway (2004)
“But we already do that!”
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Chronic thinkingPractitioner cynicism- It is not enough for the practitioner to engage in a series of empowering practices if the practitioner has no hope that the consumer can achieve recovery (Simon, 1994)- Importance of recognizing the nonlinear aspect of the recovery process
Some Challenges
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Comments from Alternatives 2010 Caucus“In terms of my recovery process, I was in contact with a lot of different professionals – psychologists, psychiatrists, social workers – and I think the person was helpful regardless of their professional standing. The social workers were most helpful because they did offer that hope, that possibility of recovery, whether they knew what that framework was or not.”
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Trauma-Informed Care• Literature clear on
importance of recognizing signs of trauma and trauma-informed care
• Peers said this was an area where social workers are lacking....
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“I felt dismissed, patronized, demeaned and ignored in the system. Everything I was taught as a child in my trauma was reinforced in my journey through the system.”
-Alternatives 2010
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“The biggest thing that was so frustrating was that, even though it was in the record that I had a traumatic brain injury, they had no under-standing whatsoever of the effects of trauma…. It was me educating them about what I needed.”
- Alternatives 2010
Peer Participation in Social Work• Stand-out examples exist
o Via peer supporto Co-teaching of courses or
class guestso Participation in
organizational policy“I’ve learned more from my data collecting of personal stories than from any of my mental health courses” - APM Discussion Participant, 2010
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Peer participation is not the norm.
Culturally Competent Practice“…Recovery cannot take
place outside the context of a person’s culture, sexual orientation, or spiritual beliefs”
- Faculty interviewee, 2010
• Necessity of culturally competent practice has been included in: o Conferences/training
eventso NASW Code of Ethicso CSWE Educational Policy
and Accreditation Standards
• Needs constant attention
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Plan for Social WorkProvide a holistic
trainingBuild on existing
partnerships between schools and field instructors
Training will target:Field instructorsSocial work
programs/faculty
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Structure for the CurriculumTarget audience: Field Instructors• Curriculum components
• 3 webinars (with CEUs)
• Competencies for Recovery-oriented Social Work Practice
• Language for field contracts/assessments
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Structure for the CurriculumSecondary target: Social work education programs • Curriculum components
• Launch at CSWE Annual Program Meeting
• Posted webinars• Competencies document• Model syllabi• Recovery bibliography• Student exercises
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Training Manual Development• Steering Committee• Webinar Presenters• CSWE Director of
Accreditation• SAMHSA and Development
Services Group• Comments from
participants at conferences• CSWE’s Annual Program
Meeting• Alternatives Conference• APA’s Institute
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Structure for the Curriculum
1st webinar: What is
recovery?
2nd webinar: recovery in social
work
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Webinar 1: Introduction to Mental Health Recovery in Social WorkPresenters
o Lauren Spiro (National Coalition for Mental Health Recovery)
o Patrick Sullivan (Indiana University)
o Video Clips • Paolo del Vecchio
(SAMHSA)• MSW with lived
experience
GoalEducate social workers about mental health recovery
Learning Objectives– Define recovery– List 2 milestones in the
evolution of the recovery movement
– List 3 of the 10 components of recovery
– Identify 2 similarities between social work and recovery
– Identify 1 area of social work practice that would change if recovery-oriented practice is implemented
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Webinar 2: Mental Health Recovery Competencies in Social Work
Presenterso Patrick Sullivan
(Indiana University)o Debbie Plotnick (Mental
Health Association of Southeastern Pennsylvania)
o Video Clips• Charles Curie (Curie
Group, LLC & former SAMHSA administrator)
• Richard Goscha (University of Kansas)
GoalTeach competencies needed to integrate mental health recovery into social work practice
Learning Objectives– Identify 2 methods for
involving individuals with lived experience throughout the process
– List 5 competencies for social work practice in a recovery framework
– Identify 2 recovery-oriented practices
– Describe 1 opportunity and 1 challenge in implementing the recovery model
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Webinar 3: Infusing Mental Health Recovery in Social Work Field InstructionPresenters
o Lauren Spiro (National Coalition for Mental Health Recovery)
o Marylou Sudders (Massachusetts Society for the Prevention of Cruelty to Children)
• Video Clipso King Davis (University of
Texas at Austin)o Marvin Southard (LA
County Department of Mental Health)
o MSW student in recovery agency (Recovery Empowerment Network)
GoalInfuse mental health recovery in field instruction
Learning Objectives– List 5 competencies for
social work practice in a recovery framework
– Describe a model recovery-oriented agency
– Identify at least 3 recovery practices essential to the student field experience
– List at least 1 potential example of student assessment measures
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Plan for Piloting Curriculum• Expected pilot participants
(Stakeholder Representatives)• Utilize the already established
network of people (interviews, focus groups, etc.) to solicit pilot participants
• Field instructors, MFP fellows, students, consumers, faculty members
• At least 10 individuals• Initial pilot trainings occured
early September 2012.
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Identify participants
Present webinars
Review/evaluate
(structured & open-ended feedback)
Make changes to
the webinars
Plan for Piloting Curriculum
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