Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition Chapter Twenty Facilitating a Meaningful Change and Recovery By Nancy Summers Published by Brooks Cole Cengage Learning 2009

WORKING TOWARD RECOVERY Working toward recovery and a positive change involves: Seeing problems and illness as only a part of who the individual is. Seeing the client as a competent partner in planning. Developing a relationship that is trustworthy. Collaborating on goals that are important to the client. Giving support and encouragement when needed. Workers who believe people can change and recover. Services that the client can use to make changes and sustain them.

DISCOURAGING RECOVERYAND CHANGE People do not recover or make meaningful changes when workers: Make decisions with out consulting them. Set goals without the client’s input. Demean or denigrate clients. Act as if clients are incompetent or less capable than they really are.

WHAT IS CHANGE? Change means different things to different people. Change usually takes commitment and hard work. For some change means Immediate improvements. Long-term alterations that will have far reaching effects on well- being and sense of self worth. Giving up an old habit. Accepting a diagnosis.

WHAT KEEPS PEOPLE FROM MAKING THE CHANGES THEY SAY THEY NEED? Fear Uncertainty Stubbornness Denial there is a problem or that change is needed Lack of confidence Lack of hope An inability to envision the future after change is accomplished

TEN FUNDMENTAL COMPONENTS OF RECOVERY FROM U.S. DEPT OF HEALTH AND HUMAN SERVICES, OFFICE OF SUBSTANCE ABUSE, AND MENTAL HEALTH SERVICES ADMINISTRATION Self-Directed - The consumer takes the lead. Empowerment - Consumers have authority to choose. Non-Linear - There will be setbacks. Individualized and Person Centered - Consumers recover using their unique strengths and resources. Holistic - The plan addresses the whole person. Strengths-based - recovery is built on the person’s strengths. Peer Support/Mutual Support - clients encourage each other and provide knowledge to one another. Responsibility - Clients take personal responsibility for their own recovery. Respect - inclusion, full participation, acceptance and appreciation. Hope - the message of a better future.

BEYOND IMMEDIATE PROBLEMS AND ILLNESS It is important to help clients plan for the future. Help client visualize and articulate their goals and ideas for themselves. Encourage self-determination in where the client would like to go from here. Collaborate with clients on finding pathways to their goals and ideas. Consider the physical health of clients and assist clients in obtaining the health care they need, including physicals.

PEER SUPPORT Peer support is given by peers who have had similar problems and recovered. Peer support can diminish the sense of being alone for clients. Peer support counselors often have tips that workers do not have.

DISCOURAGED When clients are discouraged: The situation seems to overwhelm them. They have low regard for their capabilities. They are unwilling or unable to take responsibility. They describe their circumstances or other people as totally domineering. They are unable to focus on solutions. Their goals seem unrealistic or impossible to them. They set impossible standards for themselves. They use global statements, such as “nobody likes me” or “I never get invited” or “I have no friends”.

HOW CASE MANAGERS MOTIVATE AND ENCOURAGE Begin where the client is - Use reflective listening to listen to where the client is now before going for solutions. See the client’s strengths - clients have strengths and capabilities that will help them change. Accurately assess the client’s ambivalence - Not all reluctance to follow through is resistance. The client may be afraid or overwhelmed. Appreciate every effort - When working toward changes some efforts may fail. Appreciate the effort. Never lose sight of potential - focus on what clients can do and talk about past accomplishments and experiences

STAGES OF CHANGE Stage One: Precontemplation - The client is not ready for change and probably not even thinking about it. Stage Two: Contemplation - The client is ready to explore change but not ready to commit to it. Stage Three: Developing a Plan - The client is ready to change but needs a plan Stage Four: Implementing the Plan - the client may be uncertain but will actually change her habits, behaviors, or thinking. Stage Five: Maintaining Changes - The client wants the changes to be permanent. Sometimes there are still obstacles. Relapse - the client is unable to sustain the change over a long period of time and may return to the old ways.

AMBIVALENCE AND RELUCTANCE People move toward recovery at different rates. Some people are more ambivalent about changing than others. Ambivalence and reluctance are a normal part of changing. Case managers need to accept the ambivalence and reluctance as a normal part of moving toward change and recovery. Some people stay with their ambivalence longer than others and some people never move beyond it.

ROLLING WITH RESISTANCE We sometimes view reluctance and ambivalence as resistant. There may be other reasons a person is not moving quickly You may hear excuses or the person may ignore the plan you constructed together. The client may avoid you or procrastinate. We should see resistance as a signal to do things differently. Resistance tells us that what we have constructed and the support we are giving for change needs to be done differently. Respect where the client is and make it clear that: 1. You want to listen 2. The decision is theirs 3. Ambivalence about change is normal