Instilling Hope, Confidence and Motivation:

1
Instilling Hope, Confidence and Motivation

• The Boston University
• Psychiatric Rehabilitation Approach to Developing
  Readiness

Workshop W20 Wednesday, October 7 1030 a.m.
1230 p.m. Seasons 2
Jim Womeldorff, MS, CPRP Manager, Recovery
Oriented Services 100 New Salem Road, Suite
116 Uniontown, PA 15401 724 437-0729, ext.
209 jim.womeldorff_at_crcsi.org
Pennsylvania Community Providers Association 2009
Conference
SEVEN SPRINGS MOUNTAIN RESORT Champion, PA
2
The Psychiatric Rehabilitation
Approach to Assessing Readiness Developing
Readiness
as developed by Dr. William Anthony and his
associates at B.U.s Center for Psychiatric
Rehabilitation
3
Mission of the Psychiatric Rehabilitation
Approach
To improve the functioning of persons
with psychiatric disabilities so that they can be
successful and satisfied in the living,
learning, working social roles and
environments of their choice with the most
personal independence possible and the least
amount of intervention needed.

4
Disability Challenges to Practitioners

• Lacks relationship with a helper.
• Lacks the readiness commitment needed to
  participate in rehabilitative process.
• Lacks the direction needed for learning or using
  skills supports.
• Lacks resource supports needed to function in a
  living, learning, working or social environment.
• Lacks skills needed to function in a living,
  learning, working or social environment.

5
Psychiatric Rehabilitation Principle
Skills High Low
Supports High Low
Role Preference
6
Psychiatric Rehabilitation Process
Getting Keeping Leaving
Achieving Valued Roles
Assessing developing skills and supports needed
to function in a preferred environmental role.
Choosing Valued Roles
Providing opportunities and assistance to make an
informed choice about a preferred environmental
role.
Developing Readiness
Increasing hope, interest,
and motivation to be actively involved in
choosing and/or preparing for a valued role.
Engaging
Developing a trusting
relationship.
7
Psychiatric Rehabilitation Interventions
Principle Rehabilitation Interventions are
designed to match the motivational functional
needs of the consumer.

• Engagement
• Connecting with consumers
• Readiness Development
• Connecting with consumers
• Organizing motivational activities
• Demonstrating credible supports

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Psychiatric Rehabilitation Interventions, cont.

• Choosing a Valued Environmental Role
• Identifying Personal Criteria
• Specifying Alternative Environments
• Choosing the Goal

9
Psychiatric Rehabilitation Interventions, cont.

• Achieving Valued Roles
• Direct Skill Teaching
• Skill Use Programming
• Resource Coordination
• Resource Modification

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Importance of Involvement

• Rehabilitation is something that must be done
  with the person. Rehabilitation cannot be done
  to someone.
• Decision to participate in rehabilitation
• Choice of Goals
• Development of Plans
• Modification of Intervention Activities

11
Person Centered Service Planning

• Recovery enhancing activity
• Maximizes consumer involvement in planning
  process
• Plan that consumer understands and agrees with
  without compromising health, safety, and security
• Driven by assessment of rehabilitation readiness
• Organizes all services to accomplish a single
  rehabilitation goal, relative to a living,
  learning, working or social environment

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Role Recovery Critical Pathways
1. Engage
2. Establish the Long-term View
3. Assess Readiness
4. Select the Role Recovery Goal
Engagement
Readiness Development
Choosing Valued Roles
Achieving Valued Roles
5. Plan Deliver Treatment, Rehabilitation,
Peer Support, Enrichment, Other Services
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Assessing Readiness
14
Readiness Assessment Results Leading to
Rehabilitation Phase
Readiness Assessment
5
4
3
2
1

• Environmental Awareness
• Types
• Details
• History

• Need
• Satisfaction
• Success

• Commitment
• Positive Belief
• Desire
• Self-Efficacy
• Support

• Self-Awareness
• Interests
• Values
• Preferences

• Personal Closeness
• To practitioner
• PEIS (preferences)

Engaging establishing a trusting , collaborative
relationship Developing Readiness developing
awareness to increase hope, confidence,
motivation Choosing a Valued Role
systematically using preferences to evaluate
alternatives Achieving a Valued Role developing
skills and supports to increase success and
satisfaction
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Examples of Role Recovery Goals

• Engagement
• Mary will feel trusting enough of staff be an
  active participant in the process
• of assessing readiness and developing her
  service plan by July 1, 20__.
• Carol will be stable enough to participate in
  assessing readiness and
• developing her service plan by May, 20__.
• Readiness Development
• Ellen will feel confident enough to begin
  actively participating in selecting
• a place to live in the community by August,
  20__.
• Gerald will feel hopeful enough about his future
  to begin working with staff
• to choose and prepare for a place to work by
  June, 20__.
• Kim will feel secure enough about her ability to
  stay off drugs to start the
• process of finding a place to live that
  matches her needs by September,
• 20__.
• Carol will feel hopeful enough about supports and
  services in the
• community to select a place shed like to live
  by November 15, 20__.

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Examples of Role Recovery Goals, cont.

• Choosing Valued Roles
• Ray will select a place hed like to live that is
  near his family by October 7,
• 20__.
• Rita will choose a job that she believes is the
  best match for her interests
• and abilities by August 12, 20__.
• Bob will choose a place to go to live where he
  believes he will be safe by
• December 5, 20__.
• Louise will pick a supervised apartment in the
  greater Philadelphia area by
• March 8, 20__.
• Achieving Valued Roles
• Ted intends to live at his parents home in Erie
  by October 20__.
• Betty wants to live in the Green Valley Group
  Home in Johnstown by January,
• 20__.
• Joe intends to live at the Trails End apartments
  in Towanda by August 20__.
• Kathy wants to live at the Oak Tree Lodge
  supervised apartments in
• Altoona by December 1, 20__.

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Developing Readiness
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Developing Readiness Definition
Developing Readiness is creating learning
experiences that, when processed by the
consumer, are likely to develop his/her
commitment to participate in rehabilitation
services.
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
19
Readiness Development Strategies

• Develop Supports
• Credible
• Committed

• Develop Insights
• Self
• Environments
• Recovery
• Psychiatric Rehabilitation
• MH Services/Supports

Increase Hope, Confidence, Commitment to Change
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
20
Developing Readiness Practitioner Skills

• Specifying Readiness Development Focus
• Organizing Motivational Activities
• Clarifying Personal Implications
• Demonstrating Credible Support

Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
21
Developing Readiness Conditions

• Consumer involved in Readiness Assessment

• Readiness Assessment Not Ready or Unsure

• Consumer understands lack of Readiness

• Consumer willing to participate in activities
  designed to
• increase Readiness

Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
22
Example Motivational Activities

• Self-Awareness
• Recording insights from significant experiences
  in a personal journal.
• Clarifying personal values with a group of
  consumers.
• Analyzing past environmental experiences with a
  practitioner.

• Recovery Awareness
• Viewing videotapes about recovery.
• Participating in a series of practitioner
  facilitated small group discussions about
  recovery.
• Attending a presentation by a consumer
  describing her/his recovery experience.

• Environmental Awareness
• Looking at picture albums or videotapes of
  different environments.
• Job shadowing or brief trial in different jobs.
• Visiting different environments.

Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
23
Organizing Motivational Activities Specifying
the Readiness Development Focus Self
Environmental Awareness
Type of Awareness

• Assessed Factor
• Self-Awareness
• Environmental
• Awareness

Self Interests, preferences, values
Environments Types and characteristics of
places that exist in the community
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
24
Organizing Motivational Activities Specifying
the Readiness Development Focus Commitment to
Change

• Assessed Factor
• Lack of Belief change would be beneficial

Type of Awareness
Self Interests, preferences, values
Environments Desirable characteristics of
places that exist Recovery Rehabilitation
Positive personal experiences of others
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
25
Organizing Motivational Activities Specifying
the Readiness Development Focus Commitment to
Change

• Assessed Factor
• Lack of Confidence (Self-Efficacy)

Type of Awareness
Self Abilities, talents, accomplishments Recover
y Rehabilitation That its not uncommon, How
others facilitate, What others did on their
own MH Services/Supports That effective
services supports exist, Positive personal
experiences of others
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
26
Organizing Motivational Activities Specifying
the Readiness Development Focus Commitment to
Change
Type of Awareness

• Assessed Factor
• Lack of Belief
• in Supports

MH Services/Supports That effective services
supports exist, Positive personal experiences of
others Environments Places exist with
support/services
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
27
Organizing Motivational Activities Formats to
Match consumers Preferences
Verbal or Experiential?
11 or Group?
Consumer or Staff Lead?
Self Completion or Staff Assistance?
Reading, Writing Required ?
Male or Female Leader?
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
28
Johns Readiness Development Motivational
Activities

• Personal Accomplishments
• Group (self-awareness
• abilities, strengths)
• Residential Interest Inventory
• activity (self-awareness
• interests, preferences)
• Learning about Living Options
• Group (environmental
• awareness types,
• characteristics)

• Low Commitment
• Lack of Confidence (self-efficacy)

• Low Self-Awareness
• About preferences
• About values

• Low Environmental
• Awareness
• About types of places
• About characteristics of places

29
Clarifying Personal Implications
Insights about Change?
More Ready? Less Ready?
Knowledge
Self Environments Recovery Rehabilitation MH
Services/Supports
Motivational Activity
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
30
Clarifying Personal Implications Johns
Readiness Insights
Personal Learning
Motivational Activity
Impact on Readiness

• Has the ability to be in public places with
  strangers even if nervous (Self)
• Two most important preferences for a place to
  live are close to parents private outside
  space (Self)
• Some affordable places to live have private
  outside space

Personal Accomplishments group Residential
Interest Inventory Learning about
Living Options group

• I can probably handle shopping and going to the
  park alone.
• More Ready
• If I dont live in a place thats close to
  parents and having some private space outside, I
  probably wont like it.
• Less Ready
• I might be able to get a place with private
  outside space.
• More Ready

31
Readiness Development Strategies

• Develop Insights
• Self
• Environments
• Recovery
• Psychiatric
• Rehabilitation
• MH Services/Supports

• Develop Supports
• Credible
• Committed

Increase Hope, Confidence, Commitment to Change
Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
32
Characteristics of Credible Supports

• Credible Supports are People..
• Whom the consumer respects
• From whom the consumer wants support
• Who want to support the consumer
• Who have the capacity to support the consumer

Cohen, M., Forbess, R., Farkas, M. (2000).
Psychiatric Rehabilitation Training Technology
Developing Readiness for Rehabilitation. (Trainer
Package). Boston Boston University, Center for
Psychiatric Rehabilitation, Trustees of Boston
University.
33
Johns Credible Support
Secured commitment from brother to accompany on
recreational/leisure activity ½ day per month
Low Commitment Lack of Belief in Support
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Johns Readiness Insights

• Can count on brother to follow through (Support)

Personal Learning
Credible Support
Impact on Readiness

• I wont need to rely on my parents for support
  in the feature as much as I thought.
• More Ready

Brothers monthly outings
35
Role Recovery / Psychiatric Rehabilitation Process
Note Rehabilitation Planning occurs at the point
when the indicated goal is set (any of the
banner boxes) and the activities in that phase
are chosen and scheduled.
36
Recovery-Missioned Service Delivery System
Overall Outcome Success and Satisfaction in
Valued Roles and Environments Adapted from a
1993 presentation to Technical Assistance
Division Field Associates by William Anthony,
Ph.D., Executive director of the Center for
Psychiatric Rehabilitation at Boston University.