Recovery-oriented Approaches to Treatment and Service Engagement

May 2, 2018

Recovery to PracticeSpring 2018 Webinar Series

The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

Webinar Orientation

Tips for Webinar RoomTech/Topic PodTo request technical assistance (sound,

image, etc.)and

Pose your questions for the presenters there!

Closed CaptionReal-time captioning is available by clicking the link in the pod just below the presenters pics.

Note: a separate window will open.

Chat PodCheck-in, say hello, where you’re from, what you do…Share ideas about the webinar topic with each other.

CEU/CertificateAccess is provided at the end of the webinar.Attendance Certificate is also available, if you do not need formal CEUs.

2

2

The Spring RTP Webinar Series 3

Engagement & Recovery in Behavioral Health Services“Numerous variables may affect level of treatment engagement, including

therapeutic alliance, accessibility of care, and a client's trust that the treatmentwill address his/her own unique goals. As such, we have found that the concept ofrecovery-oriented care, which prioritizes autonomy, empowerment and respectfor the person receiving services, is a helpful framework in which to view toolsand techniques to enhance treatment engagement. Specifically, person-centeredcare, including shared decision making, is a treatment approach that focuses onan individual's unique goals and life circumstances. Use of person-centered carein mental health treatment models has promising outcomes for engagement.”

Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry, 15(1), 13–20. http://doi.org/10.1002/wps.20306

#1: Therapeutic Alliance and Its Impact on Engagement (recording is available)#2: Engagement via a Crisis or Pre-crisis Tool Within a Wellness Recovery Action Plan (WRAP)#3: Social Media/Technology for Outreach and Engagement (May 23, 2018 1:00pm ET)

Engagement via a Crisis or Pre-crisis

Tool Within a Wellness

Recovery Action Plan (WRAP)

Nev Jones, MA, MA, PhDAssistant Professor/ USF

&Matthew Federici, MS, CPRP

Executive Director, Copeland Center for

Wellness and Recovery

4

https://copelandcenter.com

WRAP®

The Wellness Recovery Action Plan (WRAP) was developed by a group of people who had been dealing with difficult feelings and behaviors for many years—people working together to feel better and get on with their lives.

WRAP guides people through the process of identifying their personal wellness resources and how to use those resources as a guide for daily living, dealing with triggers, early warning signs of symptoms, indicators that things are breaking down, and developing advance directive and post crisis plans.

6

WRAP Co-Facilitation

• Delivered in a peer-support group context

• Widely used with people

• Of all ages

• With mental health diagnoses and other disabilities

• From varied economic circumstances

• Diverse cultural backgrounds

7

Based on ME Copeland’s 4-part Study on Mental Health Recovery

1. Key Concepts2. Wellness Toolbox3. Wellness Recovery Action Plan4. Recovery Topics

a) Lifestyle Issuesb) Peer Support c) Trauma Recoveryd) Work-related Issues

8

Key to Engagement: Peer Support and Self-determination

The Copeland Center co-facilitation practices of WRAP are based on a process that evolved out of two fundamental values:

1. People are experts in their own recovery and wellness.

2. People with shared experience can support each other effectively.

9

WRAP Co-Facilitation: Values and Ethics

• Based on self-determination

• Rooted in the belief in equality

• A mutual learning model

• Avoid medical and clinical language

• No limits to recovery

• Focus on person’s strengths and away from perceived deficits

It’s a way of approaching daily living!

10

How Might WRAP Affect Engagement?

11

Conceptual foundation of WRAP = Self Determination Theory

a) Autonomous motivation sustained, long-term behavioral change

b) Provider/service support for a person’s autonomy internalized motivation

Controlled vs Autonomous MotivationTy

pe

“MUSTivation” “WANTivation”

Reas

on External Pressure

Internal Pressure

Usefulness-driven

Values-driven

Effe

ct Little engagement, resentment

Guilt and shame

Sense of volition, gratification

12

Empirical Support

13

Meta-analytic support for Self-Determination Theory model (Ng et al., 2012)

• Type of motivation and sustained behavioral change

• Provider/service autonomy support & development of autonomous motivation

Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-Determination Theory Applied to Health Contexts: A Meta-Analysis. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 7(4), 325–340. https://doi.org/10.1177/1745691612447309

WRAP for Crisis Support

Qualitative Investigation of the Wellness Recovery Action Plan [WRAP] in a UK NHS Crisis Care Setting

This 2017 research suggests that WRAP has potential in supporting recovery from crisis, revealing insights into the nature of crisis which can inform the further development of crisis services.

Michael Ashman, Vanessa Halliday & Joseph G. Cunnane (2017) Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting, Issues in Mental Health Nursing, 38:7, 570-577, DOI: 10.1080/01612840.2017.1300840

Our Research: WRAP for Engagement

Goal: Understand the impact of WRAP on treatment engagement, relationships with providers and medication-related decision making.

Sample: 54 WRAP participants from urban, suburban and rural areas in Illinois

• Diverse ages, race/ethnicity, gender, diagnosis

• Many reported periods of homelessness, involuntary hospitalization, long periods of ‘disengagement’ from services

15

Distinctions: Variations on “Disengagement”

16

WRAP Mechanisms and ImpactM

echa

nism

s

Experiential Knowledge

SharingAwareness Self-

UnderstandingSelf-

Efficacy Activation

Impa

ct Confident Communication

Greater Assertiveness Honesty Autonomous

Motivation

17

WRAP and Self-determination Ty

pe

“MUSTivation” “WANTivation”

Reas

on External Pressure

Internal Pressure

Usefulness-driven

Values-driven

Effe

ct Little engagement, resentment

Guilt and shame

Sense of volition, gratification

WRAP

18

Takeaways

WRAP & other peer-led interventions may

• Increase awareness and self-understanding in an empowering way.

• Facilitate the development of autonomous motivation for treatment/services.

• And lead to…

• Greater honesty and openness with providers.

• Confidence in sharing concerns/opinions.

• Involvement and investment in decision making.

19

Fidelity and Sustainability Based in Values

WRAP engagement works best when people learn the standard curriculum concepts and structure in a co-facilitated peer group environment following core values and practices

20

WRAP Values• Consistently convey message of

hope.

• Facilitate and illustrate ways participants can advocate for themselves.

• Promote personal responsibility via focusing on how WRAP is owned by the individual and helps them to be accountable for their actions and to take manageable risks.

21

WRAP Values (Cont.)

• Promote personal sharing through co-facilitator modeling examples of using WRAP in their own life.

• Keep focus on what people do well and generating ideas from the group.

• Avoid medical, clinical language and comments based on deficits.

• Avoid final giving final answers and explore choices and options via generating group discussions.

22

Fidelity and Sustainability Based in Values

23

Co-facilitation based on training in 15 value domains with observable practices

Scale developed as part of a grant from the National Institute of Mental Health at the National Institute of Health (1R34MH085051-01A1, Judith

Cook Ph.D., Principle Investigator)

Building Capacity for Fidelity to WRAP Engagement

1. Seminar I, Developing WRAP Course: designed to facilitate people to develop their own personalized plan; based on an 8-week, 2.5-hour agenda that is co-facilitated

2. Seminar II, WRAP Facilitator Certificate Program: designed for people who use WRAP to learn the values and ethics in facilitating WRAP with their peers; based on a 5-day agenda co-facilitated by Copeland Center for Wellness and Recovery-trained Advanced Level WRAP Facilitators

3. Advanced Level WRAP Facilitation Certification Course: designed for experienced WRAP Facilitators to learn how to mentor peers in the values and ethic of facilitating WRAP (exclusive Copeland Center course offered 3–4 times annually)

24

Agency and Systems

• Facilitates formal and informal WRAP® group opportunities, i.e. as a part of service offerings, “after hours,”churches,coffee shops, etc.

• Develops and fosters a network of facilitators.

• Focuses on WRAP® as a process, a way to approach daily living and mutual learning, not a document or form to be put into a file.

• All inclusive and creates an atmosphere that is based on our common connections of navigating health and wellness on a daily basis not diagnosis, illness or deficit orientation.

25

Agency and Systems (Cont.)

• Incorporates WRAP® concepts, values and planning process on multiple levels of the organizations, i.e.

• Team WRAP, Creating A Well Workforce

• Maintains the voluntariness and self-direction of WRAP®

• Accommodates a variety of learning styles and settings, i.e.

• Self-taught, groups, online, using arts and crafts, etc.

26

WRAP® = Better Treatment

Engagement

“It was only after developing my WRAP plan, especially figuring out exactly what triggeredmy symptoms, and telling my doctor what I’m like when my symptoms are at their worst --compared to what I’m like when I’m symptom free -- that an accurate mental health diagnosis was finally made for me.”

-- Person who uses WRAP

27

WRAP® = Systems

Transformation

“WRAP Facilitation has really made a change on how we do things here in the State of Tennessee. The 5 key concepts have permeated the culture… We have had a significant decrease the use of inpatient services and we attribute this outcome to WRAP.”

Advanced Level Facilitator Sheryl McCormick Coordinator, Recovery Training Services, Peninsula, a Division of Parkwest Medical Center, Knoxville Tennessee

28

The Way WRAP Works

Research report available at:

https://copelandcenter.com/resources/way-wrap-

works

29

Questions DiscussionComments

30

Thank you to our presenters31

Matthew FedericiNev Jones

SAMHSA’s

10 Principlesand

4 Dimensionsof Recovery in

Behavioral Health

32

HomeHealth

CommunityPurpose

Recovery to Practice

Through education, training, and resources SAMHSA’sRecovery to Practice (RTP) program supports the expansion and integration of recovery-oriented behavioral health care delivered in multiple service settings between multiple disciplines.

33

Want to continue your learning?34

1Ashman, M., Halliday, V., Cunnane, J.G. (2017) Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting, Issues in Mental Health Nursing, 38:7, 570-577, https://doi.org/10.1080/01612840.2017.1300840

2Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer Support Services for Individuals With Serious Mental Illnesses: Assessing the Evidence.Psychiatric Services, 65(4), 429–441. https://doi.org/10.1176/appi.ps.201300244

3 Copeland, ME., (n.d.) Crisis Plan and Working Through Hard Times | MentalHealthRecovery. (n.d.). Retrieved February 28, 2018, from http://mentalhealthrecovery.com/info-center/crisis-plan/

4Fukui, S., Starnino, V. R., Susana, M., Davidson, L. J., Cook, K., Rapp, C. A., & Gowdy, E. A. (2011). Effect of Wellness Recovery Action Plan (WRAP) participation on psychiatric symptoms, sense of hope, and recovery. Psychiatric Rehabilitation Journal, 34(3), 214-222. http://dx.doi.org/10.2975/34.3.2011.214.222

5Jones, N., Corrigan, P. W., James, D., Parker, J., & Larson, N. (2013). Peer support, self-determination, and treatment engagement: A qualitative investigation. Psychiatric Rehabilitation Journal, 36(3), 209-214. http://dx.doi.org/10.1037/prj0000008

RTP Companion Newsletter on

Family Engagement

35

Sign up to receive the RTP quarterly newsletter by visiting our webpage:https://www.samhsa.gov/recovery-to-practice

The final RTP webinar in the series: Engagement and Recovery

Oriented PracticesMay 23rd – Engagement and Technology

Registration is open now!

36

Online Courses Coming Soon:• Integrated Behavioral Health• Peer Support for People

Experiencing Homelessness

37

To receive a Certificate of Attendance or to earn a continuing

education creditfor attending

this RTP webinar click

https://www.surveygizmo.com/s3/4343445/Engagement-via-a-Crisis-or-Pre-crisis-Tool-Within-a-Wellness-Recovery-Action-Plan-WRAP

Thank you for attending!