Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

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Evidence-Based Practices Shaping Mental Health
Services Toward Recovery

• Illness Management and
• Recovery

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Where Weve Been Illness
Management

• Demons, Exorcisms, Death
• Chains and Isolation
• Medication Maintenance
• Treatment and Rehabilitation
• Recovery

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Treatment and Rehabilitation

• Treatment
• Reduces emotional distress by reducing symptoms
  through diagnosis, medications, treatment
  planning, and therapy.
• Treatment services are done
• TO ME.

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Rehabilitation

• Provides skills and supports to maintain and
  sustain independence and addresses the
  consequences of the illness and the rebuilding of
  a positive self image.
• This is done through goal setting, skills
  teaching, resource coordination, and supports
  development.

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Rehabilitation services are done WITH ME
Until I can do them for or by myself.
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The IMR Toolkit is
A set of materials which shows a practitioner how
to provide an EBP that focuses on providing
practical information about Treatment and
developing Rehabilitation skills that build
resilience to facilitate Recovery.
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Resilience

• To strengthen those factors that allow a person
  to overcome adversity.

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In short, IMR

• Expands your knowledge and
• Strengthens your mental and physical ability
• so that you can regain your life to a usable
  form and reclaim your personal power from your
  illness.

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IMR is a tool designed to move mental health
service delivery from

• The Reform outlined in the Presidents New
  Freedom Commission on Mental Health
• to
• the wholesale and fundamental Transformation
  demanded in Transforming Mental Health Care in
  America The Federal Action Agenda First
  Steps.
  
• (Federal Action Agenda p. 18)

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Reform states

• Mental illnesses and emotional disturbances are
  treatable

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Transformation states that

• Recovery is the expectation!

Does Kentuckys mental health care service
delivery system expect Recovery?
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Will implementation of the IMR toolkit improve
Kentuckys expectation?
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2 Key Principles of Transformation

• 1. Services and treatments

must be consumer - and family-driven geared to
give consumers real and meaning full choices
about treatment options and providers not
oriented to the requirements of
bureaucracies. (Federal Action Agenda p.19)
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2 Key Principles of Transformation

• Care must focus on
• Increasing ones ability to cope with lifes
  challenges
• Facilitating recovery
• Building resilience
• And NOT just on managing symptoms.
• (Federal Action Agenda p.19)

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Does IMR achieve both goals?

• Lets look and see

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Development Team
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Goals of IMR
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(No Transcript)
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Educational Handouts

• Handout 1 Recovery Strategies
• Handout 2a Practical Facts About Schizophrenia
• Handout 2b Practical Facts About Bipolar
  Disorder
• Handout 2c Practical Facts About Depression
• Handout 3 StressVulnerability Model
  Treatment Strategies
• Handout 4 Building Social Support
• Handout 5 Using Medication Effectively
• Handout 6 Reducing Relapses
• Handout 7 Coping with Stress
• Handout 8 Coping with Problems and Symptoms
• Handout 9 Getting Needs Met in a Mental Health
  System

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Format

• IMR is series of weekly sessions where mental
  health practitioners help people who have
  experienced psychiatric symptoms to develop
  personalized strategies for managing their mental
  
• illness and moving forward in their lives.

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Structure of the sessions Predictable

• Informal socializing and identification of any
  major problems 1-3 minutes
• Review previous session(s) 1-3 minutes
• Review homework 3-5 minutes
• Follow-up on goals 1-3 minutes
• Set agenda for current session 1-2 minutes
• Teach new material or review previously taught
• material 30-40 minutes
• Agree on new homework assignment 3-5 minutes
• Summarize progress made in current session 3-5
  minutes

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Significant others can be involved

• Can share their educational handouts
• Can request help in practicing specific skills
• Can invite significant others to participate in
  some sessions.
• Are especially helpful in sessions which involve
  developing a relapse prevention plan

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Practitioners are

• Social Workers
• Occupational Therapist
• Counselors
• Case Managers
• Nurses
• Psychologist
• All need training and ongoing supervision.

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How is it holding up to the 2 Keys

• Remember the 2 key principles to successfully
  Transforming a Mental health Service Delivery
  System?

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1. Services and treatments
must be consumer - and family-driven geared to
give consumers real and meaning full choices
about treatment options and providers not
oriented to the requirements of
bureaucracies. (Federal Action Agenda p.19)

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2 Key Principles of Transformation

• 2. Care must focus on
• Increasing ones ability to cope with lifes
  challenges
• Facilitating recovery
• Building resilience
• And NOT just on managing symptoms.
• (Federal Action Agenda p.19)

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To me

• It feels very rigid.
• The partnership between consumer and provider
  is missing.
• No role for Peer Specialist

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Other states have

• Added Peers as team teachers with the
  practitioners.
• Some have given the whole program to Peers to run
  

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Whats the problem with that?
Fidelity!
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Core evidence-based components

• Psychoeducation
• behavioral tailoring for medication
• relapse prevention training
• Coping skills training.

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IMR Fidelity Scale

• 13 items developed to measure the adequacy of
  implementation
• Each item is rated on a 5-point
  behaviorally-anchored rating scale ranging from 1
  (Not implemented) to 5 (Fully implemented).
• The Fully implemented ratings were determined
  through expert sources and empirical research.

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How the Rating Is Done

• The assessment is conducted through a site visit.
• It requires a minimum of 4 hours to complete
  longer stays allows for collection of more data
  and hence should result in a more valid
  assessment.

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Data collection procedures include

• chart review
• review of educational handouts
• semi-structured interviews with program leader,
  IMR practitioners, and IMR consumers.
• When feasible, fidelity assessors should observe
  one or more IMR sessions (either live or a
  videotaped session).

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The IMR fidelity assessment is

• Primarily based on documentation in progress
  notes.
• if these notes do not exist or are not easily
  available, the fidelity assessment will take a
  very different course.
• The goal is to examine the charts and 5 most
  recent progress notes of IMR sessions for each of
  5 IMR consumers

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Who Does the Ratings?

• Individuals who
• Have experience and training in interviewing and
  data collection procedures (including chart
  reviews).
• Have an understanding of the nature and critical
  ingredients of IMR.
• We strongly recommend all fidelity assessments be
  conducted by at least two assessors.

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Do you have enough data?

• Are Services and Treatments consumer - and
  family-driven?
• Are they geared to give consumers real and
  meaningful choices about treatment options and
  providers?

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Do you have enough data?

• Does care focus on
• Increasing ones ability to cope with lifes
  challenges?
• Facilitating recovery?
• Building resilience?
• Just on managing symptoms.

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The ball is in your court
YOU decide!