empowering vulnerable populations
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Empowering vulnerable populations:An example of empowering people with mentalillness through treatment planning
Donald M. Linhorst, PhD, MSWProfessor and Director
School of Social Work
Saint Louis UniversityOctober 2, 2012
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PRESENTATION DERIVED FROM:
My 15 years of experience as asocial worker
My research on empowerment Linhorst, D. M. (2006).Empowering People with SevereMental Illness. New York: Oxford
University Press
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PRESENTATION OVERVIEW
Empowerment and treatmentplanning defined
Components of empowerment Conditions for empowerment
through treatment planning
Guidelines for mental health staffand consumers
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EMPOWERMENT DEFINED
Empowerment is themeaningful participation of
people with mental illness indecision making and activitiesthat give them increasedpower, control, or influenceover important areas of theirlives. (Linhorst, 2006, p. 9)
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TREATMENT PLANNING DEFINED
Treatment planning is the process bywhich the needs, strengths, andproblems of people with mentalillness are assessed, treatment goalsare established, and treatment andrehabilitation activities are identified
to facilitate goal achievement.(Linhorst, 2006, p. 88)
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COMPONENTS OF TREATMENTPLANNING
Strengths, problems and/or obstacles
Long-term and short-term goals
Treatment and rehabilitationinterventions to help meet goals
Reassess, reformulate goals andinterventions, and reassess
Format and components of treatmentplans will vary, often guided bypopulation and accreditation standards
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EMPOWERMENT
COMPONENTS OFEMPOWERMENT
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Empowerment involves holdingpower, control, and influence
Holding final decision making power
is most empowering. However, empowerment exists on a
continuum, and it can occur in someinstances through a sharing of power.
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Empowerment is situational
Empowerment is specific to particular
activities at a specific point in time. Individuals can be empowered in one
activity but not another
Empowerment can increase ordecease as circumstances change.
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Empowerment can refer to aprocess
Any process that prepares people to
participate more effectively in anactivity that increases their power,control, or influence can beconsidered empowering.
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Empowerment can refer to anoutcome
Empowerment outcomes
Are the consequences or results ofempowerment processes
Can be short-term or long-term
Can be subjective or objective
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One cannot empower another
People must empower themselves.
However, others play a critical role inproviding individuals with supportiverelationships, resources, decisionmaking opportunities, and other
things many people need to empowerthemselves.
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EMPOWERMENT
CONDITIONS FOREMPOWERING MENTAL
HEALTH CONSUMERS
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Managed Mental Health Symptoms
The consumers symptoms are managed
to the degree necessary tomeaningfully participate in a specificactivity.
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Managed Mental Health Symptomsand Treatment Planning
Symptoms can limit
insight into the mental illness
ability to focus
ability to process information
ability to consider options
ability to make informed choices
ability to understand consequences
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Managed Mental Health Symptomsand Treatment Planning
Addressing the condition
Treat symptoms and provide consumerswith tools to manage symptoms
Involve consumers in as many treatmentdecisions as possible as it is rare thatsymptoms prevent people from makingany decisions
As symptoms subside, increase the roleconsumers play in treatment planning
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Participation Skills
The consumer possesses the skills
required to meaningfully participatein a particular activity.
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Participation Skills and TreatmentPlanning
Identify and express needs and goals
Weigh options for goals and activities
Cognitively link services andinterventions with goal achievement
Resolve conflicts with staff if theyarise during treatment planning
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Participation Skills and TreatmentPlanning
Addressing the condition
Provide skills training as needed
Promote use of advocates at treatmentplanning sessions if consumers lack theskills to meaningfully participate
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Psychological Readiness
The consumer has the psychological
readiness, that is, confidence,motivation, willingness tomeaningfully participate in aparticular activity.
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Psychological Readiness andTreatment Planning
Lack of psychological readiness canbe associated with
Past failed attempts to improvethemselves
Fear of change
Lack of knowledge of themselves and the
possibilities that exist for them Clinical depression
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Psychological Readiness andTreatment Planning
Addressing the condition
Must first assess the reasons associatedwith the lack of readiness; may need to:
Treat symptoms of depression
Development of supportive relationshipsbetween case managers and consumers
Create opportunities for small successes
Use motivational interviewing
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Mutual Trust and Respect
The consumer and the persons with
whom he or she is interacting havethe necessary level of mutual trustand respect to meaningfullyparticipate together in a particular
activity.
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Mutual Trust and Respect andTreatment Planning
Lack of trust and respect can be reflected inclinician paternalism
Consumers may not want to participate in
treatment planning unless they believeclinicians respect their right to participateand have their best interests in mind
Development can be more difficult with
consumers from cultural, racial, or ethnicbackgrounds different from staff
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Mutual Trust and Respect andTreatment Planning
Addressing the condition
Partnerships based on egalitarian relationshipsthat respect and appreciate the different
strengths each bring to the decision makingprocess
Establish positive relationships, which can carryover to treatment planning
Clinician self-disclosure
Reinforce and celebrate accomplishments
Clarify expectations of both parties in thetreatment planning process
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Reciprocal Concrete Incentives
Concrete incentives exist for both the
consumer and persons with whom heor she is interacting to meaningfullyparticipate together in a particularactivity.
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Reciprocal Concrete Incentives andTreatment Planning
Concrete incentives for consumers tomeaningfully participate
Can lead to subjective feelings of empowerment
Are most likely to have goals and interventionsin the plan that reflect their preferences
Need clinicians expertise to assist them toidentify the most helpful interventions
If coerced into treatment, plan can provide aroadmap to ending coercion
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Reciprocal Concrete Incentives andTreatment Planning
Concrete incentives for clinicians tomeaningfully engage consumers Consumer involvement in treatment
planning increases the likelihood thattheir clients will have favorable outcomes
Consumers possess information abouttheir disability, strengths, and goals that
clinicians need to develop anindividualized treatment plan that ismost appropriate for their clients
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Availability of Choices
The consumer has choices he or shevalues and sufficient informationabout those choices to makeinformed decisions about a particularactivity.
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Availability of Choices andTreatment Planning
Consumers should have a range ofchoices
Across service types (e.g., medication,housing, and employment)
Within service types (e.g., choices oftypes and location of housing)
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Availability of Choices andTreatment Planning
Factors limiting service choices
Under funding of public mental health services
Emphasis on medication at the cost of other
treatment and rehabilitation options Poor coverage of mental health services by
private insurance companies
Not having health insurance or being underinsured
Managed care restrictions on treatment
Legal or informal sources of coercion
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Availability of Choices andTreatment Planning
Addressing the condition
Political advocacy at the local, state, andnational levels to increase mental health
services
Updating staff on service options
Staff and consumers taking the initiativeto create new services to fill gaps
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Participation Structures andProcesses
The consumer has structures andprocesses through which tomeaningfully participate in aparticular activity.
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Participation Structures andProcesses and Treatment Planning
Basic treatment planning structures
Treatment teams
Case managers
Family involvement
Should be involved when they have a
genuine, constructive interest, And when the consumer agrees to it
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Participation Structures andProcesses and Treatment Planning
Key processes
Consumers present when writingtreatment plans
Individualizing treatment goals
Breaking down broad goals into smaller,more concrete goals
Adapting decision making to consumersabilities
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Participation Structures andProcesses and Treatment Planning
Key processes (continued) Having an agreed upon process for
resolving consumer and staff differences
Involving consumer advocates whenneeded to ensure consumerspreferences are identified
Modifying the process when consumers
are experiencing severe symptoms, aredeemed incompetent, or are coerced intotreatment
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Access to Resources
The consumer has access to theresources needed to meaningfullyparticipate in a particular activity.
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Access to Resources and TreatmentPlanning
Client resources
Advocates to participate in the planningprocess when needed
Mediation process for resolvingdifferences between consumers and staff
Logistical resources (e.g., transportation,child care)
Adequate time to participate at a timethat is convenient to the consumer
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Access to Resources and TreatmentPlanning
Staff resources
Staff training
to realize the potential of consumers to direct
their own treatment to understand why some consumers may
choose not to participate and how to address it
to develop the skills to meaningfully engageconsumers in the treatment planning process
Staff time to meaningfully engage consumers inthe treatment planning process
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Supportive Culture
The culture in which the consumer isinteracting in a particular activity issupportive of shared participation.
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Supportive Culture and TreatmentPlanning
A culture is supportive when
Stigma, discrimination, and paternalismare minimized within the mental health
organization Consumers are viewed as capable of
making meaningful decisions and caringfor themselves
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Supportive Culture and TreatmentPlanning
Addressing the condition Mental health organizations adopt
recovery models and psychiatric
rehabilitation approaches Leaders create mission and vision
statements that reflect the recovery andstrengths perspectives
Administrators model these perspectivesfor staff in their interactions withconsumers
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Supportive Culture and TreatmentPlanning
Addressing the condition (continued)
Staff receive extensive training, technicalassistance, and opportunities to discusstreatment planning
Administrators develop systems to evaluateconsumer participation and staff competenciesrelated to treatment planning
Administrators establish caseload sizes at
reasonable levels so that staff have the time tomeaningfully engage their clients in treatmentplanning
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GUIDELINES FOR MENTAL HEALTHSTAFF
Recognize the important contributionsmental health consumers make totreatment planning
Teach skills needed by consumers tomeaningfully participate
Develop trusting and respectfulrelationships to promote meaningfulparticipation
Adapt the treatment planning process forconsumers from diverse backgrounds
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GUIDELINES FOR MENTAL HEALTHSTAFF (continued)
Have mechanisms to resolve conflicts thatinvariably arise during treatment planning
Include consumer advocates in treatment
planning when needed Ensure adequate time for treatmentplanning
Develop an organizational culture thatsupports meaningful participation
Include family members in treatmentplanning when consumers agree to it
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GUIDELINES FOR MENTAL HEALTHCONSUMERS
First and foremost, exercise your right tomeaningfully participate in treatmentplanning
Request, and in some instances demand,meaningful choices
Ask for advocates if you believe they canhelp you make better decisions
Carefully consider the suggestions offeredby staff for goals and treatment activities
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GUIDELINES FOR MENTAL HEALTHCONSUMERS (continued)
If experiencing active symptoms thatinterfere with your ability to participate, askto meet at another time
Ask for more time to complete thetreatment plan if you feel rushed
Seek information that assists you in makingchoices about goals and treatment activities
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CONCLUSIONS
Consciously look for opportunities toempower vulnerable consumers
Be aware of the conditions for
empowerment, and seek ways toensure they are met
The benefits of empowerment areextensive, for consumers, socialservice organizations, and the publicat large.
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CONTACT INFORMATION
Donald M. Linhorst, PhD, MSW
linhorsd@slu.edu 314.977.2745
School of Social Work, Saint LouisUniversity, 3550 Lindell Blvd., St.
Louis, Missouri, 63103
mailto:linhorsd@slu.edumailto:linhorsd@slu.edu
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