Community Support Services Training Direct Care Series – Session 4 Rutgers, The State University of New Jersey School of Health Professions Department of Psychiatric Rehabilitation and Counseling Professions

Session 3 Review Motivational Interviewing 8 Dimensions of Wellness Learning Application: What was your experience using the wellness assessment form?

Learning Objectives Describe the impact of person-first language on service delivery Identify the components of a Rehabilitation Needs Assessment (RNA) Explore the importance of breaking a goal down into its critical components Identify critical knowledge, skills, and resources needed to achieve goals Examine the framework of SMART documentation

What is person-first language? Referring to people in a way that emphasizes or focuses attention on the fact of their humanity and personhood, rather than on the existence of a disability, illness, condition, or characteristic. (Psychiatric Rehabilitation Association, 2016)

Why person-first language? Words we choose to use to portray people with mental illness reflect our attitudes and beliefs about the value, dignity, and worth of people with disabilities. (Pratt, Gill, Barrett & Roberts, 2014)

Person-first Language By interacting with people as people first and, through our actions and our words, by using “person-first” language, we educate the public that the people who are assisted through rehabilitation services are people first. Expressing a person-first philosophy and adhering to it are two separate matters. In order to make this philosophy come alive, we must each become acutely aware of the words we commit to paper or to conversation, and equally aware of the manner in which we represent ourselves, both in public and in private interactions. (Psychiatric Rehabilitation Association, 2016)

“If thought corrupts language, language can also corrupt thought” “If thought corrupts language, language can also corrupt thought”. -George Orwell

The Impact of Language Unfortunately, disability diagnoses are often used to define a person’s value and potential, and low expectations and a dismal future may be the predicted norm. A person’s diagnosis is often used to decide how/where the person will be educated, what type of job he will/won’t have, where/how he’ll live, and more including what services he is thought to need. (Snow, 2009)

Activity: Person-first Language

Rehabilitation Needs Assessment (RNA)

Rehabilitation Needs Assessment (RNA) A process – not a form The form documents the process of exploration, discussions, assessment Creates a blueprint for attaining desired goals Forms the basis for the Individual Rehabilitation Plan Comprehensive in scope and depth

Preliminary Rehabilitation Needs Assessment (PRNA) & Comprehensive Rehabilitation Needs Assessment (CRNA)

PRNA and CRNA Timeframes Completed prior to admission Completed by the 14th day of admission, every six months for the first year after the initial assessment, and annually thereafter

RNA Assumes goal attainment is possible Identifies areas of need Is not used to screen out, reject or show inability to attain goal

Balance of Strengths & Needs Med and Psych Sx. Functional limitations Strengths Supports Abilities Preferences

Strengths Real strengths that will support goal attainment Not a generic laundry list that never makes it to the IRP or intervention phases of rehabilitation 2 friends Family in area Likes animals Is kind May not be “packaged” as a strength Non compliant? May indicate self determined and self-advocacy Pays drug dealer regularly? Is able to budget History of homelessness? Resilient and resourceful

How Is a RNA Similar To What I Do Now? Gathers information typically covered in a traditional psychosocial assessment. Provides an assessment of support or assistance needed in various areas of functioning. Is intended to inform the Individual Rehabilitation Plan.

How Is a RNA Similar To What I Do Now? Asks about current and past experiences in areas of psychiatric treatment, employment, education. Can feel very invasive with expectation to reveal personal information that may or may not be relevant to the person’s goals and aspirations AND if not done with interest, compassion and skill.

How is the RNA Dissimilar To What I Do Now? Focus on valued life roles. Incorporates a conversation on the person’s hopes, dreams and aspirations. Explores past and current experiences and interests related to social life, education, employment next. Is followed by a “deeper dive” into the areas that are mutually agreed upon and prioritized. Must tie directly to goals and Individual Rehabilitation Plan.

Hopes, Dreams & Aspirations Not an easy conversation Many don’t know, are afraid to acknowledge, or have given up We’re afraid this will trigger disappointment, anger, sadness Keep a person’s aspirations front and center throughout: assessment, goal setting, planning, and intervention Tie back to goals that are established

RNA Form

RNA Activity Break up into groups of three Identify Counselor (staff completing the RNA) Client (do NOT play a role… just be yourself) Observer The counselor will review and complete 2 to 3 sections of Part 2 of the RNA Client and observe to provide feedback Switch roles

S-M-A-R-T Documentation Specific M Measureable A Attainable R Realistic T Timely

https://youtu.be/1-SvuFIQjK8 S-M-A-R-T Video Clip https://youtu.be/1-SvuFIQjK8

The S-M-A-R-T Framework Documentation should be straight forward and emphasize what you want to happen Specific Measurable Attainable Realistic Timely Measurable progress so you can see the changes over time Provide a clear target to work toward This does not translate into easy, but rather “do-able” Should require some effort, but seem reachable

Open Discussion Do you use SMART documentation? How can the SMART framework improve your work? How would you use the SMART framework to develop rehabilitation plans? Give examples?

SMART Activity Do these goals/interventions follow the SMART framework? Are they rehabilitation oriented? If not, what changes need to be made?

I will Start to build relationships in the community by making 1 friend by 8/15/17

I will reduce the amount of times I visit the hospital by 8/20/17

I will improve my health by losing 80lbs by 8/1/17

I will complete a partial care program

I will enroll as a full time college student by 7/31/17

Activity: Personal Goal Setting Pair back up with your group and use the SMART framework to rewrite the goals you identified from the RNA Share with the larger group: Are these goals really S-M-A-R-T?

Potential Barriers Do you use S-M-A-R-T documentation? Why is documenting in S-M-A-R-T format essential as we move to a fee-for-service model? Implications for the electronic health record?

Exploration Leads To Interventions Knowledge What does the person need to KNOW Skills What does the person need to DO Resources What does the person need to HAVE This follows the CRNA – completed by staff since this leads to IRP and interventions

Example – Making friends Knowledge Skills Resources Qualities you want in a friend Conversational skills Opportunities to meet and interact with other people General role and expectations of a mutual friendship Recognizing positive qualities in someone (as well as potentially harmful qualities) Support to discuss issues that may arise with friends and how to address Personal benefits to having friends Negotiation skills Transportation to get together with friends Self awareness of interests, needs and expectations Expressing interest in someone else’s experiences, etc. Money to do things like go to movies, out for a meal, etc.

Knowledge, Skills, Resources Form

Activity Facilitator role-play Go back to your group Review your goal identified from the RNA Step 1: Utilizing effective communication skills, brainstorm an extensive list of what is needed for success

Activity Facilitator role-play Step 2: Break out the items into the specific categories: knowledge, skill, or resources Use the KSR template, place your list into the appropriate category: Knowledge: What would you need to know Skills: What would you need to do Resources: What would you need to have Step 3: Check off Once in the appropriate categories, identify if the item is something you already have or something you need to work on

Learning Application Review IRP’s in your agency and assess if they follow they SMART framework. Be prepared to share next session. For session 5, please bring a deidentified sample IRP and a corresponding progress note.

Q&A and Evaluations

Zakia Clay, MSW, LCSW, CPRP Anthony Zazzarino MA, LPC, ACS, CPRP Contact Information Zakia Clay, MSW, LCSW, CPRP Zakia.Clay@shp.rutgers.edu Ann Reilly MA, LSW, CPRP Reillya2@shp.rutgers.edu Anthony Zazzarino MA, LPC, ACS, CPRP ASZ28@shp.rutgers.edu

References Larosiliere, V (2011). Community Support Services [memo]. Retrieved from http://www.state.nj.us/humanservices/dmhs/info/CSS_Notice_to_provi ders.pdf Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2014). Psychiatric rehabilitation. (3rd ed.). San Diego, CA: Elsevier Inc. Psychiatric Rehabilitation Association. (2016). PRA Language Guidelines. Retrieved from http://www.uspra.org/pra-language- guidelines Snow, K. (2009). People first language. Retrieved from: http://www.disabilityisnatural.com/explore/people-first-l Swarbrick, M. (2012). Introduction to Wellness Coaching. Freehold, NJ: Collaborative Support Programs of New Jersey Inc. Inc., Institute for Wellness and Recovery.