alex mabe, ph.d. gareth fenley, m.s.w

Alex Mabe, Ph.D.Gareth Fenley, M.S.W.

Medical College of Georgia –Charlie Norwood Veterans Affairs Medical

Center Psychology Residency

Alex Mabe, Ph.D.Gareth Fenley, M.S.W.

Medical College of Georgia –Charlie Norwood Veterans Affairs Medical

Center Psychology Residency

This presentation is supported in part by an educational grant from U.S. Department of Health Resources and Service Administration (HRSA) Bureau of Health Professions (BHPr)

This presentation is supported in part by an educational grant from U.S. Department of Health Resources and Service Administration (HRSA) Bureau of Health Professions (BHPr)

Health Professions

http://www.hrsa.gov/

1) The participants will learn the fundamental principles of the recovery model of mental health care and be able to apply these principles to clinical practice training.

2) The participants will become familiar with the certified peer specialist as a new and valuable trainer for professional psychologists.

3) The participants will learn key components of a recovery training model that employs educational strategies to teach recovery based knowledge, attitudes, and practice skills.

1) The participants will learn the fundamental principles of the recovery model of mental health care and be able to apply these principles to clinical practice training.

2) The participants will become familiar with the certified peer specialist as a new and valuable trainer for professional psychologists.

3) The participants will learn key components of a recovery training model that employs educational strategies to teach recovery based knowledge, attitudes, and practice skills.

Jeremy is 40 years of age and has carried the diagnosis of schizophrenia since he was 24 years of age. Currently, he lives in a group home

and works in a rehabilitation center earning minimal wage for basic cleaning services.

In the most recent visit with his psychiatrist, he stated that he wanted to open his own checking account so that the group home supervisors would stop stealing his money.

Jeremy is 40 years of age and has carried the diagnosis of schizophrenia since he was 24 years of age. Currently, he lives in a group home

and works in a rehabilitation center earning minimal wage for basic cleaning services.

In the most recent visit with his psychiatrist, he stated that he wanted to open his own checking account so that the group home supervisors would stop stealing his money.

Knowledge of Recovery Model Concepts – 93%

Familiar with the literature – 66% Feel comfortable providing a

definition – 55%

Knowledge of Recovery Model Concepts – 93%

Familiar with the literature – 66% Feel comfortable providing a

definition – 55%

WHO Pilot Study and other Longitudinal Outcome Research on mental illness demonstrated that partial to full recovery (in the traditional sense) is just as common, if not more so, than a chronic, downward, or deteriorating course and enduring disability.

WHO Pilot Study and other Longitudinal Outcome Research on mental illness demonstrated that partial to full recovery (in the traditional sense) is just as common, if not more so, than a chronic, downward, or deteriorating course and enduring disability.

Adapted from and used with permission of Larry Davidson, Ph.D. Davidson, L. (2007, January). Recovery and serious mental illness: What it is and how to promote it. Presentation at the Medical College of Georgia Psychiatry Grand Rounds (January 11, 2007).

Experience of Consumers with Psychologists

Experience of Consumers with Psychologists

“I found psychologists were no help. They wanted to focus too much on my symptoms. It seemed like they were getting some sort of titillation hearing about my delusions. I don't want to talk about my symptoms particularly my delusions. I am trying to forget my delusions since they were so embarrassing. I want to focus on the future. I must be doing something right since I have a MS, almost a second MS, worked for years, and am presently in a PhD program in computer science. All of this without the help of psychologists. If I had listened to psychologists 20 years ago I would have not accomplished any of this since they told me I was being unrealistic about attending grad school.”FROM: email list for job and school networking for people with psychiatric disabilities, maintained by Boston University

“I found psychologists were no help. They wanted to focus too much on my symptoms. It seemed like they were getting some sort of titillation hearing about my delusions. I don't want to talk about my symptoms particularly my delusions. I am trying to forget my delusions since they were so embarrassing. I want to focus on the future. I must be doing something right since I have a MS, almost a second MS, worked for years, and am presently in a PhD program in computer science. All of this without the help of psychologists. If I had listened to psychologists 20 years ago I would have not accomplished any of this since they told me I was being unrealistic about attending grad school.”FROM: email list for job and school networking for people with psychiatric disabilities, maintained by Boston University

Mental Health Consumer / Survivor / Ex-Patient / Ex-Inmate Movement Borrowed idea of being ‘in recovery’ from

addiction self-help community, suggesting that even when mental illness is long-term, a person can—and has the right to—reclaim his or her life outside of institutional settings.

Mental Health Consumer / Survivor / Ex-Patient / Ex-Inmate Movement Borrowed idea of being ‘in recovery’ from

addiction self-help community, suggesting that even when mental illness is long-term, a person can—and has the right to—reclaim his or her life outside of institutional settings.


Recovery from refers to eradicating the symptoms and ameliorating the deficits caused by serious mental illnesses

Recovery in refers to learning how to live a safe, dignified, full, and self-determined life in the face of the enduring disability which may, at times, be associated with serious mental illnesses

Recovery from refers to eradicating the symptoms and ameliorating the deficits caused by serious mental illnesses

Recovery in refers to learning how to live a safe, dignified, full, and self-determined life in the face of the enduring disability which may, at times, be associated with serious mental illnesses


“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

SAMHSA (2006)

“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

SAMHSA (2006)

What is ‘revolutionary’ about Recovery?

What is ‘revolutionary’ about Recovery?

Minimizing illness is not the same as maximizing the opportunity for a meaningful life

Requires role shifts for both the person with the illness/disability and the provider of services

Must broaden focus of care beyond the illness itself – effects of stigma are equally (if not more) damaging than the illness itself

Minimizing illness is not the same as maximizing the opportunity for a meaningful life

Requires role shifts for both the person with the illness/disability and the provider of services

Must broaden focus of care beyond the illness itself – effects of stigma are equally (if not more) damaging than the illness itself


Health care as a collaborative enterprise

Health care as a collaborative enterprise

In recovery-oriented care, it is neither that the doctor is the sole expert nor is it solely self-help.

It is a partnership, more like midwifery than surgery, but perhaps characterized best in the words of The Home Depot:

In recovery-oriented care, it is neither that the doctor is the sole expert nor is it solely self-help.

It is a partnership, more like midwifery than surgery, but perhaps characterized best in the words of The Home Depot:

“You can do it. We can help.”Adapted from and used with permission of Larry Davidson, Ph.D. Davidson, L. (2007, January). Recovery and serious mental illness: What it is and how to promote it. Presentation at the Medical College of Georgia Psychiatry Grand Rounds (January 11, 2007).

New Freedom Commission (2003) and Federal Action Agenda (2005)

June 2007, Psychologist Terry Cline, Ph.D., administrator of the SAMSHA met with APA board of directors

VA Psychology Leadership Conference – April 2008 “VHA mental health services will be recovery oriented…”

Spring 2009 – The Task Force on Serious Mental Illness and Severe Emotional Disturbance

New Freedom Commission (2003) and Federal Action Agenda (2005)

June 2007, Psychologist Terry Cline, Ph.D., administrator of the SAMSHA met with APA board of directors

VA Psychology Leadership Conference – April 2008 “VHA mental health services will be recovery oriented…”

Spring 2009 – The Task Force on Serious Mental Illness and Severe Emotional Disturbance

If it ain’t broke, then don’t fix it!If it ain’t broke, then don’t fix it!

Why should we change our clinical practice approach?Why should we change our clinical practice approach?

Trends in Mental Health ServicesTrends in Mental Health Services

60%-80% do not receive needed services

55% of the individuals with serious mental illness stated that they had not received services because they did not need it.

Significant delays in seeking treatment are common.

Dropping out of treatment prematurely is common.

60%-80% do not receive needed services

55% of the individuals with serious mental illness stated that they had not received services because they did not need it.

Significant delays in seeking treatment are common.

Dropping out of treatment prematurely is common.

Trends in Mental Health Services- continued

Trends in Mental Health Services- continued

Psychiatric practice appears to be drifting toward primarily psychopharmacological management – consumers have less and less “time with the doctor.”

Treatment effect sizes for medication management and psychotherapy are modest.

Stigma continues to be a serious hindrance for good quality care and positive clinical outcomes.

Self-Stigma leads to treatment avoidance

Psychiatric practice appears to be drifting toward primarily psychopharmacological management – consumers have less and less “time with the doctor.”

Treatment effect sizes for medication management and psychotherapy are modest.

Stigma continues to be a serious hindrance for good quality care and positive clinical outcomes.

Self-Stigma leads to treatment avoidance

Our OpinionOur Opinion

“It IS broke and it needs fixin’!”“It IS broke and it needs fixin’!”

Natalie Cole - SingerNatalie Cole - Singer

Clinical Depression

Key Recovery ConceptsKey Recovery ConceptsAs identified by (and adapted from) a

SAMHSA panel of providers, consumers,

administrators, and researchers:

1. Empowerment

2. Person-Centered Care

3. Whole Person Care (Holistic)

4. Focus on Strengths

5. Support (Systemic Treatment Orientation)

6. Recovery as a Journey (Non-linear Process)

7. Hope

As identified by (and adapted from) a SAMHSA panel of providers, consumers,

administrators, and researchers:

1. Empowerment

2. Person-Centered Care

3. Whole Person Care (Holistic)

4. Focus on Strengths

5. Support (Systemic Treatment Orientation)

6. Recovery as a Journey (Non-linear Process)

7. Hope

Adapted from Substance Abuse and Mental Health Services Administration (2006). National consensus statement on mental health recovery. Rockville, MD: US Department of Health and Human Services. Accessed online 12/20/2006. http://download.ncadi.samhsa.gov/ken/pdf/SMA05/trifold.pdf

Defining Empowerment

Defining Empowerment

A sense of authority in making choices, participating in treatment, and engaging in preferred life activities

Composed of four major components:

1. Self Direction2. Respect3. Personal responsibility4. Advocacy

A sense of authority in making choices, participating in treatment, and engaging in preferred life activities

Composed of four major components:

1. Self Direction2. Respect3. Personal responsibility4. Advocacy

Adapted from Substance Abuse and Mental Health Services Administration (2006). National consensus statement on mental health recovery. Rockville, MD: US Department of Health and Human Services. Accessed online 12/20/2006. http://download.ncadi.samhsa.gov/ken/pdf/SMA05/trifold.pdf

How would you characterize your practice model?

How would you characterize your practice model?

Are you taking care of your patients?

Or are you partnering with consumers to help them take

care of themselves?

Are you taking care of your patients?

Or are you partnering with consumers to help them take

care of themselves?

Person First LanguagePerson First Language

No:No: YESYES

The mentally illThe mentally ill People with mental People with mental illnessillness

Mental patientsMental patients People who receive People who receive mental health mental health services: consumerservices: consumer

A schizophrenicA schizophrenic A person with A person with schizophreniaschizophrenia

He’s bipolarHe’s bipolar He has bipolar He has bipolar disorderdisorder

No:No: YESYES

The mentally illThe mentally ill People with mental People with mental illnessillness

Mental patientsMental patients People who receive People who receive mental health mental health services: consumerservices: consumer

A schizophrenicA schizophrenic A person with A person with schizophreniaschizophrenia

He’s bipolarHe’s bipolar He has bipolar He has bipolar disorderdisorder

Earl Campbell – NFL Running BackEarl Campbell – NFL Running Back

Panic Disorder

Person-Centered Care Person-Centered Care

When YOU go to the doctor, how do you want decisions to be made?

When YOU go to the doctor, how do you want decisions to be made?

Beyond Compliance:Shared Decision Making

Beyond Compliance:Shared Decision Making

There are two experts in the room. One knows science and has

clinical experience and technical skills

The other knows his or her personal preferences and subjective experience

There are two experts in the room. One knows science and has

clinical experience and technical skills

The other knows his or her personal preferences and subjective experience

Deegan & Drake (2006) Shared Decision Making and Medication Management in the Recovery Process. PSYCHIATRIC SERVICES, 57, 1636-1639.

Tom Harrell - Jazz MusicianTom Harrell - Jazz Musician

Schizophrenia

Whole Person CareHolistic Treatment

Whole Person CareHolistic Treatment

Collaborative Goal Setting: “Your life to be about something”

Question

Collaborative Goal Setting: “Your life to be about something”

Question

“In a world where you could choose to have your life be about something, what would you have it be about?”

“In a world where you could choose to have your life be about something, what would you have it be about?”

Adapted from and used with permission of Kelly Wilson, Ph.D. (2008, May). Using ACT for your most difficult cases.. Presentation at the Medical College of Georgia Psychiatry Workshop (May 2, 2008).

Adapted from and used with permission of Kelly Wilson, Ph.D. (2008, May). Using ACT for your most difficult cases.. Presentation at the Medical College of Georgia Psychiatry Workshop (May 2, 2008).

Dr. Kay Redfield Jamison - Psychologist, Scientist, and Author

Dr. Kay Redfield Jamison - Psychologist, Scientist, and Author

Bipolar Disorder

Focus on StrengthsFocus on Strengths

“Let’s talk about what you do well.”

Howie Mandell – Comedian/Actor Howie Mandell – Comedian/Actor

Obsessive-Compulsive Disorder

SupportSystemic Treatment Orientation

SupportSystemic Treatment Orientation

A (Not So?) New Part of the TeamA (Not So?) New Part of the Team

Certified Peer Specialist

Certified Peer Specialist

A “Peer Specialist” or “Peer Support Specialist”:

A “Peer Specialist” or “Peer Support Specialist”:

Manages his or her own life with mental illness

Provides mental health services to others with mental illness (peers)

Manages his or her own life with mental illness

Provides mental health services to others with mental illness (peers)

The Peer Specialist’s RoleThe Peer Specialist’s Role

Part of a multidisciplinary team Does not treat symptoms Does provide support, encouragement

and wellness planning Offers role modeling and teaching

about Recovery

Part of a multidisciplinary team Does not treat symptoms Does provide support, encouragement

and wellness planning Offers role modeling and teaching

about Recovery

The Georgia Certified Peer

Specialist (CPS) Program

The Georgia Certified Peer

Specialist (CPS) Program

High school diploma or GED required

Competitive admissions process

Two-week training

Certification exam

Continuing education

High school diploma or GED required

Competitive admissions process

Two-week training

Certification exam

Continuing education

Monica Seles – Tennis ChampionMonica Seles – Tennis Champion

Clinical Depression

Recovery as a Journey

Non-Linear Process

Recovery as a Journey

Non-Linear Process It [Recovery] is not a perfectly linear process. At times, our course is erratic and we falter, slide back, regroup, and start again.”

Dr. Pat Deegan

Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11-19, p. 15.

Prepare the ConsumerPrepare the Consumer

Prepare the consumer for the ups and downs.

Discuss relapses before they happen in terms of learning experiences.

Encourage a balanced outlook on the future.

Work with individuals where they are at.

Prepare the consumer for the ups and downs.

Discuss relapses before they happen in terms of learning experiences.

Encourage a balanced outlook on the future.

Work with individuals where they are at.

Jack Dreyfus – Business LeaderJack Dreyfus – Business Leader

Clinical Depression

Hope Hope

By George Frederick Watts By George Frederick Watts

Hope arises from…Hope arises from…

“The Will” - Convey the message that people with mental illness can recover and can have meaningful lives. Finding an obtainable goal when it seemed like none could be found.

“The Way” - A belief that our actions or the actions of others could help to make the desired outcome come about. Finding an unexpected pathway to achieving a goal and the resources to get there.

“The Will” - Convey the message that people with mental illness can recover and can have meaningful lives. Finding an obtainable goal when it seemed like none could be found.

“The Way” - A belief that our actions or the actions of others could help to make the desired outcome come about. Finding an unexpected pathway to achieving a goal and the resources to get there.

Adapted from: Snyder, C.R., Ilardi S.S., Cheavens J, Michael, S.R., Yamure, L., & Sympson S. (2000). The role of hope in cognitive-behavior therapies. Cognitive Therapy and Research,24, 747-762.

Adapted from: Snyder, C.R., Ilardi S.S., Cheavens J, Michael, S.R., Yamure, L., & Sympson S. (2000). The role of hope in cognitive-behavior therapies. Cognitive Therapy and Research,24, 747-762.

Hope arises from…Hope arises from…

“The Relationship” - Affirm personal worth and hope in the relationship. Responding with affirming words.

“The Stories” - Share your stories of hope…and the stories of others who are role models of recovery.

“The Relationship” - Affirm personal worth and hope in the relationship. Responding with affirming words.

“The Stories” - Share your stories of hope…and the stories of others who are role models of recovery.

Adapted from Snyder, et al. 2000Adapted from Snyder, et al. 2000

John Nash - Mathematician/Nobel Prize Winner

John Nash - Mathematician/Nobel Prize Winner

Schizophrenia

Project G.R.E.A.T.(Georgia Recovery-Based

Educational Approach to Treatment)

Project G.R.E.A.T.(Georgia Recovery-Based

Educational Approach to Treatment) System transformation of an academic

psychiatric department to a Recovery model of care through teaching and dissemination.

To disseminate the Recovery Model to mental health agencies and medical schools throughout Georgia and beyond.

System transformation of an academic psychiatric department to a Recovery model of care through teaching and dissemination.

To disseminate the Recovery Model to mental health agencies and medical schools throughout Georgia and beyond.

Recovery-oriented care requires a fundamentally shift-

Yet Bridges need to be built

Recovery-oriented care requires a fundamentally shift-

Yet Bridges need to be built

Traditional

Care

Traditional

Care

Recovery Oriented Care

The Revolution Requires Providers and Consumers Working TogetherThe Revolution Requires Providers and Consumers Working Together

Providers: Need to be more collaborative Need to be more versed on strengths and

resilience Need to broaden definitions of the “treatment

team” Need to be more aware of the critical nature of

hope Consumers:

Need to develop complementary knowledge and skills in order to be able to work collaboratively with their providers

Providers: Need to be more collaborative Need to be more versed on strengths and

resilience Need to broaden definitions of the “treatment

team” Need to be more aware of the critical nature of

hope Consumers:

Need to develop complementary knowledge and skills in order to be able to work collaboratively with their providers

The Revolution Requires Science and the “Consumer’s Voice”

The Revolution Requires Science and the “Consumer’s Voice”

Science Can provide useful tools for refining ways

recovery principles can be taught and implemented in clinical practice.

Consumer Voice Can direct us toward relevant processes

and outcomes that are founded on lived experience with mental illness

Science Can provide useful tools for refining ways

recovery principles can be taught and implemented in clinical practice.

Consumer Voice Can direct us toward relevant processes

and outcomes that are founded on lived experience with mental illness

Curriculum DesignCurriculum Design

Who: Doctorally trained clinicians and consumers

What: Recovery principles and Practices - Complex material

Outcome: Knowledge, attitudes, skills-practice behavior

Who: Doctorally trained clinicians and consumers

What: Recovery principles and Practices - Complex material

Outcome: Knowledge, attitudes, skills-practice behavior

Curriculum Design - continuedCurriculum Design - continued

Trainers: Doctorally trained clinicians and consumers

Key Outcomes: Key Concepts - Contrasts of traditional and

recovery practice, empirical evidence of recovery principles, practice applications

Key attitudes – respect, empowerment Key behaviors – goal setting, strengths

assessment, collaborative decision making, and hope enhancement strategies

Trainers: Doctorally trained clinicians and consumers

Key Outcomes: Key Concepts - Contrasts of traditional and

recovery practice, empirical evidence of recovery principles, practice applications

Key attitudes – respect, empowerment Key behaviors – goal setting, strengths

assessment, collaborative decision making, and hope enhancement strategies

Project Great: Defining and Refining as we go


Phase I: Bringing in “The Consumer Voice” Hiring Certified Peer

Specialists Forming a Behavioral

Health Advisory Council

Phase I: Bringing in “The Consumer Voice” Hiring Certified Peer

Specialists Forming a Behavioral

Health Advisory Council



Phase II: Developing workshops

to immerse psychology

and psychiatry faculty

and students in the

Recovery Model of

Mental Health Care.

Phase II: Developing workshops

to immerse psychology

and psychiatry faculty

and students in the

Recovery Model of

Mental Health Care.

Workshop DesignWorkshop Design

Connect learning to the participants’ preexisting data bank

Allay fears that recovery would supplant their skills/practices

Include materials in the form of clinical situations or consumer problems/ treatment stories

Provide consumer stories – examples of consumer competence

Connect learning to the participants’ preexisting data bank

Allay fears that recovery would supplant their skills/practices

Include materials in the form of clinical situations or consumer problems/ treatment stories

Provide consumer stories – examples of consumer competence

Workshop Design- continuedWorkshop Design- continued

Introduce person first languageUse active learning strategies –

Socratic questions, case vignettes with discussion, roleplay

Keep science in the forefrontIntroduce practice prompts (tools) Conduct pre-post measurement of

knowledge and attitudes

Introduce person first languageUse active learning strategies –

Socratic questions, case vignettes with discussion, roleplay

Keep science in the forefrontIntroduce practice prompts (tools) Conduct pre-post measurement of

knowledge and attitudes



Phase III: Creating and Disseminating Practice Tools

Phase III: Creating and Disseminating Practice Tools

Documentation Templates Consistent with Recovery

Project GREAT Recovery Assessment Form

I. Person-Centered Treatment Plan (Life Goals and Objectives)Goal 1: ____________________________________________________________________________________________________________________________________________________________________ New Consumer/Family Tasks____________________________________________________________________________________________________________________________________________________________________ New Provider Tasks/Responsibility_______________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________Goal 2: ____________________________________________________________________________________________________________________________________________________________________ New Consumer/Family Tasks____________________________________________________________________________________________________________________________________________________________________

New Provider Tasks/Responsibility____________________________________________________________________________________________________________________________________________________________________

Project GREAT Recovery Assessment Form - continued

II. List Personal Strengths for Consumer related to personal life goals:1.2.3. III. Systems-based Treatment PlanIs this individual/family appropriate for referral for Peer Support Services? (e.g., Peer Support Specialist, Friendship Community Center, AA, NA, NAMI, Parent-to-Parent, Bereaved Parents of America, Health Grandparents Project of Augusta)

YES NOWould the consumer like to participate in Peer Support Services here at MCG?

YES NOWould any of the following community support areas be appropriate for consideration in your treatment planning (Please circle appropriate services): Activities/Hobbies Child Care Financial support Health Care Housing Physical fitness Occupational/job support School/Educational SupportSpiritual/religious support Substance Abuse Program TransportationOther______________________

Project GREAT Recovery Assessment Form - continued

IV. Hope Assessment: Person’s beliefs that they are capable of doing things to make things better: High Medium Low Person’s beliefs that there are pathways toward making things better: High Medium Low

Behavioral Health Planning FormMedical College of Georgia

“Putting Patient/Family Centered Care and Recovery into Practice”



Name: ___________________________ Date: _______________Welcome to our clinic. This form can help you take an active role in your care with us. Please take a few minutes to fill it out at home, bring it back to the clinic, and give it

to your doctor or therapist at your next visit. Tell us what your goals are: Help us make your life goals the focus of your care. Please write down one or two

ways that you want your life to be better. Be specific. Think of something that you would enjoy or something that would give you a sense

of meaning and purpose. Examples: “I want a job.” “I would like to be able to go out with friends.” “I want to

enjoy doing things with my child.” "I want to have more meaningful and fulfilling relationships."

Goal 1: ____________________________________________________________________________________________________________________________Goal 2: ______________________________________________________________________________________________________________________________

Name: ___________________________ Date: _______________Welcome to our clinic. This form can help you take an active role in your care with us. Please take a few minutes to fill it out at home, bring it back to the clinic, and give it

to your doctor or therapist at your next visit. Tell us what your goals are: Help us make your life goals the focus of your care. Please write down one or two

ways that you want your life to be better. Be specific. Think of something that you would enjoy or something that would give you a sense

of meaning and purpose. Examples: “I want a job.” “I would like to be able to go out with friends.” “I want to

enjoy doing things with my child.” "I want to have more meaningful and fulfilling relationships."

Goal 1: ____________________________________________________________________________________________________________________________Goal 2: ______________________________________________________________________________________________________________________________


“Putting Patient/Family Centered Care and Recovery into Practice”Continued


“Putting Patient/Family Centered Care and Recovery into Practice”Continued

Would you have an interest in also meeting with a Peer Specialist?

Yes___ No ____

A peer specialist is a person who has lived with mental health problems and learned skills to live well. The peer specialist can work with you one on one or in a support group.

Would you have an interest in also meeting with a Peer Specialist?

Yes___ No ____

A peer specialist is a person who has lived with mental health problems and learned skills to live well. The peer specialist can work with you one on one or in a support group.

Strengths Assessment FormMedical College of Georgia




Please Complete This Form While You are Waiting and Give to Your Doctor/Therapist as Part of Your Visit Today

Name: ___________________________ Date: _______________Welcome to our clinic. This form can help you take an active role in your care with us. Please take a few minutes to fill it out and give it to your doctor or therapist as a

part of your visit today. Tell us what you believe are your strengths: Because your strengths can play such an important role in your success working

with us, we want to know what you do well. Please answer the questions below.

1. What about you makes you strong and has helped you through difficult times? (e.g., positive attitudes, personal traits such as patience/sense of humor/ strong work ethic, or spiritual faith, etc.) ______________________

_____________________________________________________________________2. What special skills do you have? ___________________________________________________________________________________________________________3. What do you do for fun? __________________________________________________________________________________________________________________

Please Complete This Form While You are Waiting and Give to Your Doctor/Therapist as Part of Your Visit Today

Name: ___________________________ Date: _______________Welcome to our clinic. This form can help you take an active role in your care with us. Please take a few minutes to fill it out and give it to your doctor or therapist as a

part of your visit today. Tell us what you believe are your strengths: Because your strengths can play such an important role in your success working

with us, we want to know what you do well. Please answer the questions below.

1. What about you makes you strong and has helped you through difficult times? (e.g., positive attitudes, personal traits such as patience/sense of humor/ strong work ethic, or spiritual faith, etc.) ______________________

_____________________________________________________________________2. What special skills do you have? ___________________________________________________________________________________________________________3. What do you do for fun? __________________________________________________________________________________________________________________


“Putting Patient/Family Centered Care and Recovery into Practice”CONTINUED


“Putting Patient/Family Centered Care and Recovery into Practice”CONTINUED

4. Which people in your life have been helpful to you?_____________________________________________________________________________

_5. Who helps you keep physically healthy? _________________________________________________________________________________________

_6. What’s good about the home and neighborhood you live in?________________________________________________________________________

7. What gives your life purpose and meaning? ____________________________________________________________________________________

4. Which people in your life have been helpful to you?_____________________________________________________________________________

_5. Who helps you keep physically healthy? _________________________________________________________________________________________

_6. What’s good about the home and neighborhood you live in?________________________________________________________________________

7. What gives your life purpose and meaning? ____________________________________________________________________________________

TAKING FLIGHT: Recurring prompts to “think and do Recovery”

TAKING FLIGHT: Recurring prompts to “think and do Recovery”

Proposed: Goals Scale

Directions: Read each item carefully. Using the scale shown below,please select the number that best describes how you think about

yourself right now and put that number in the blank provided. Please take a few moments to focus on yourself and what is going on in your life at t his moment. Once you have this "here and now" set, go ahead and answer each item according to the following scale:

1 = Definitely False;, 2 = Mostly False;, 3 = Somewhat False;, 4 = Slightly False;, 5 = Slightly True;,6 = Somewhat True;, 7 = Mostly True;, and 8 = Definitely True.

___1. If I should find myself in a jam, I could think of many ways to get out of it.___2. At the present time, I am energetically pursuing my goals.___3. There are lots of ways around any problem that I am facing now.___4. Right now I see myself as being pretty successful.___5. I can think of many ways to reach my current goals.___6. At this time, I am meeting the goals that I have set for myself.

Proposed: Goals Scale

Directions: Read each item carefully. Using the scale shown below,please select the number that best describes how you think about

yourself right now and put that number in the blank provided. Please take a few moments to focus on yourself and what is going on in your life at t his moment. Once you have this "here and now" set, go ahead and answer each item according to the following scale:

1 = Definitely False;, 2 = Mostly False;, 3 = Somewhat False;, 4 = Slightly False;, 5 = Slightly True;,6 = Somewhat True;, 7 = Mostly True;, and 8 = Definitely True.

___1. If I should find myself in a jam, I could think of many ways to get out of it.___2. At the present time, I am energetically pursuing my goals.___3. There are lots of ways around any problem that I am facing now.___4. Right now I see myself as being pretty successful.___5. I can think of many ways to reach my current goals.___6. At this time, I am meeting the goals that I have set for myself.

The State Hope Scale (Goals Scale)

The State Hope Scale (Goals Scale)

Note. When administering the measure, it is labeled the Goals Scale.

The even-numbered items are agency, and the odd-numbered items are pathways. Subscale scores for agency or pathways are derived by adding the three even- and odd-numbered items, and the total State Hope Scale score is the sum of all six items.

Note. When administering the measure, it is labeled the Goals Scale.

The even-numbered items are agency, and the odd-numbered items are pathways. Subscale scores for agency or pathways are derived by adding the three even- and odd-numbered items, and the total State Hope Scale score is the sum of all six items.

Snyder CR. Sympson SC. Ybasco FC. Borders TF. Babyak MA. Higgins RL. (1996) Development and validation of the State Hope Scale. [Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.] Journal of Personality & Social Psychology. 70(2):321-35.

Snyder CR. Sympson SC. Ybasco FC. Borders TF. Babyak MA. Higgins RL. (1996) Development and validation of the State Hope Scale. [Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.] Journal of Personality & Social Psychology. 70(2):321-35.

Phase IV: Educational Outreach Teams-

“See one, Do one.”

Engage Residents in Teaching Recovery 9 Presentations since 2007 involving 15

different psychiatry/psychology residents

Phase IV: Educational Outreach Teams-

“See one, Do one.”

Engage Residents in Teaching Recovery 9 Presentations since 2007 involving 15

different psychiatry/psychology residents



Phase V: Psychology Residency Curriculum Changes

Increasing exposure to the “Consumer’s Voice” – CPS in Team meetings Participation in Behavioral Health Council Observing peer-to-peer support groups

Phase V: Psychology Residency Curriculum Changes

Increasing exposure to the “Consumer’s Voice” – CPS in Team meetings Participation in Behavioral Health Council Observing peer-to-peer support groups



Phase V: Psychology Residency Curriculum Changes-

continued Demonstration of Recovery Skills –

Rotation and Seminar Evaluations Evaluations of Faculty Work Sample

Phase V: Psychology Residency Curriculum Changes-

continued Demonstration of Recovery Skills –

Rotation and Seminar Evaluations Evaluations of Faculty Work Sample



Resident Work Sample Resident Work Sample

“…Ms. B has a number of strengths including her hope and motivation to improve her current difficulties and persistent in achieving her goals. When asked about prominent life goals, Ms. B. identified her desire to participate in more activities that she enjoys including cooking and fishing… to meet this goal [to be a chef] Ms. B. may benefit from a vocational rehabilitation assessment and job skills training… Ms. B may also wish to attend a community college or technical school to pursue a career in the culinary arts.”

“…Ms. B has a number of strengths including her hope and motivation to improve her current difficulties and persistent in achieving her goals. When asked about prominent life goals, Ms. B. identified her desire to participate in more activities that she enjoys including cooking and fishing… to meet this goal [to be a chef] Ms. B. may benefit from a vocational rehabilitation assessment and job skills training… Ms. B may also wish to attend a community college or technical school to pursue a career in the culinary arts.”

Phase VI: Measuring OutcomesPhase VI: Measuring Outcomes



0102030405060708090

100

1980 1990 2000 2006

Line 4

Line 5

Line 6

Recovery Knowledge ChangeRecovery Knowledge Change

Recovery Knowledge

17.4

20.4

14.9

0

5

10

15

20

25

Pre Post

MCG

Control

Recovery Knowledge

17.4

20.4

14.9

0

5

10

15

20

25

Pre Post

MCG

Control

Recovery AttitudesRecovery Attitudes

Recovery Attitudes

111.5

137.7

98.994.8

117108.2

0

20

40

60

80

100

120

140

160

Pre Post AQ-27-Pre AQ-27-Post

MCG

Control

Recovery Attitudes

111.5

137.7

98.994.8

117108.2

0

20

40

60

80

100

120

140

160

Pre Post AQ-27-Pre AQ-27-Post

MCG

Control

Recovery Documentation Chart Audit:Percent of Charts with Consumers’ Life Goals

Recovery Documentation Chart Audit:Percent of Charts with Consumers’ Life Goals

28%

64%

0%

10%

20%

30%

40%

50%

60%

70%

Jul-08 Feb-09

28%

64%

0%

10%

20%

30%

40%

50%

60%

70%

Jul-08 Feb-09

Recovery Related Consumer Satisfaction Press Gainey- Recovery Related Patient Satisfaction Responses

Recovery Related Consumer Satisfaction Press Gainey- Recovery Related Patient Satisfaction Responses

First of Recovery Workshops Completed

Proposed Next Phase:

Shared Decision Making Seminar and Supervision Guidelines

Proposed Next Phase:

Shared Decision Making Seminar and Supervision Guidelines



Shared Decision Making ChecklistMedical College of Georgia




1. Provided information about the health issue at hand in a manner that was understandable to the patient.

strongly disagree disagree undecided agree strongly agree

2. Provided information about treatment options (including options of doing nothing).


3. Identified values relevant to the decision.

a) Described options so that the patient could understand and could imagine what it is like to experience their physical, emotional, social effects.


b) Asked the consumer to consider which positive and negative features matter most.


1. Provided information about the health issue at hand in a manner that was understandable to the patient.


2. Provided information about treatment options (including options of doing nothing).


3. Identified values relevant to the decision.

a) Described options so that the patient could understand and could imagine what it is like to experience their physical, emotional, social effects.


b) Asked the consumer to consider which positive and negative features matter most.



“Putting Patient/Family Centered Care and Recovery into Practice”continued


“Putting Patient/Family Centered Care and Recovery into Practice”continued

4. Identified mutually endorsed and valued outcomes that are the target of intervention.strongly disagree disagree undecided agree strongly agree

5. Identified tasks that were agreed upon, seen as relevant, and in which there is a responsibility to act.strongly disagree disagree undecided agree strongly agree

6. Have established a relationship built on trust, acceptance, and confidence. a) Technical competence.

Thorough evaluation of the problem. Provision of effective treatment options

strongly disagree disagree undecided agree strongly agreeb) Interpersonal Factors

Communication of understanding. Expressions of caring. Communications that are clear and complete. Emphasis on partnership. Demonstrations of honesty and respect.


4. Identified mutually endorsed and valued outcomes that are the target of intervention.strongly disagree disagree undecided agree strongly agree

5. Identified tasks that were agreed upon, seen as relevant, and in which there is a responsibility to act.strongly disagree disagree undecided agree strongly agree

6. Have established a relationship built on trust, acceptance, and confidence. a) Technical competence.

Thorough evaluation of the problem. Provision of effective treatment options

strongly disagree disagree undecided agree strongly agreeb) Interpersonal Factors

Communication of understanding. Expressions of caring. Communications that are clear and complete. Emphasis on partnership. Demonstrations of honesty and respect.


Questions/DiscussionQuestions/Discussion

For additional information: [email protected]

alex mabe, ph.d. gareth fenley, m.s.w

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