An Overview of the Wellness Recovery Action Plan: WRAP Luis O. Lopez, MS Trainer, Coach Implementation Specialist Center for Practice Innovations

Agenda Mary Ellen Copeland’s WRAP Plan: a grassroots tool for over 15 years An Evidence Based Practice Cook Dixon SAMHSA Values & Ethics of WRAP

Agenda Recovery Concepts of WRAP Sections of the WRAP Plan How to use the WRAP Plan Polling Question Review of the WRAP Plan

Mary Ellen Copeland: WRAP Plan Mary Ellen Copeland’s WRAP plan is a tool for self management, wellness and recovery. Since 1997, the WRAP Plan, a grassroots tool, has helped people reconnect to wellness. For further information, guidance and training, contact Mary Ellen Copeland and the Copeland Center for Wellness and Recovery http://www.mentalhealthrecovery.com/

WRAP: An Evidence-Based Practice There is a great deal of evidence on the effectiveness of WRAP. A couple of studies by Judith Cook are Improving Propensity for Patient Self-Advocacy Through Wellness Recovery Action Planning: Results of a Randomized Controlled Trial  A Randomized Controlled Trial of Effects of Wellness Recovery Action Planning on Depression, Anxiety, and Recovery" 

WRAP: An Evidence-Based Practice In examining the Science of Recovery, researchers looked at WRAP as an important tool to establish wellness and self efficacy. Assessing Recovery in People with Serious Mental Illness: Development of a New Scale. Psychiatric Services. Old Wine in New Bottles? Drapalski, A.L., Medoff, D., Unick, G.J., Velligan,D., Dixon, L., Bellack, A.S. Psychiatr Serv. 2012 Jan;63(1):48-53.

An Evidence-Based Practice In 2011, the Wellness Recovery Action Plan became part of the SAMHSA's National registry of Evidence-Based Programs and Practices. http://nrepp.samhsa.gov/

Values and Ethics Life Is Worth Living I get well and stay well for long periods of time I treat self and others as unique with dignity, compassion mutual respect I am the expert on me - I have strengths and do things well My feelings and behaviors are normal response to traumatic circumstances I use human language to honor my personhood Culture is more than Ethnicity I embrace diversity –including sexual preference “readiness” I live above and beyond expectations: My recovery is unlimited. Life Is Worth Living I can also take this as a handout as a word document – the pyramid is cut down These are Values identified for WRAP groups. Peer to peer recovery values. http://www.mentalhealthrecovery.com/wrap_values_ethics.php Self-determination, personal responsibility, empowerment, and self-advocacy are expected outcomes of  WRAP. There is hope.  People get well, stay well for long periods of time, and do the things they want to do with their lives. Personal Mental Health Recovery Values and Ethics Insist that you be treated as an equal with dignity, compassion, mutual respect, and unconditional high regard, a unique, special individual, including acceptance of diversity with relation to culture, ethnicity, language, religion, race, gender, age, disability, sexual preference, and “readiness” issues, and treat others the same way. Every part of WRAP is totally is voluntary.  You, the person who is developing the WRAP, decide if you want to do it, when you want to do it, how long you will take, what it will include and who assists and supports you. WRAP is based on the premise that there are “no limits” to recovery. Keep the focus on things you do well, and avoid negative self-judgments or the findings of deficit-based assessments. Concentrate on your individual strengths and away from perceived deficits as determined by you or others. It is understood that you as the person who is developing this WRAP,  are  the expert on yourself. If possible, work together and learn with your peers to increase mutual understanding, knowledge and promote wellness. Avoid the use of clinical, medical and diagnostic language.    Difficult feelings and behaviors are normal responses to traumatic circumstances and what is happening in your life and need not be considered symptoms or a diagnosis. Emphasize strategies that are simple and safe.  As a facilitator you must: In order to do mental health recovery and WRAP work, it is essential that you understand and support the following values and ethics. If you don't want to, or cannot adhere to these values and ethics, pleae do not  do this work, Mental Health Recovery Values and Ethics for Group Facilitators honor the participants. accept them as they are and as unique, special individuals, remind them that there are "no-limits" to anyone's recovery. give them a sense hope. validate their experiences. treat them with dignity, compassion, respect and unconditional high regard. give each person choices and options, not final answers. support the concept that each person is the expert on themselves. based on self-determination - it opens the door for individuals, but doesn't dictate their path. In this work, participants learn through their own experience and the experience of others. This work is: rooted in the belief in equality - no one is any better or has higher value than anyone else. a mutual learning model, where both people work together to increase understanding and promote wellness. not necessarily a replacement for other kinds of therapy, but can complement any other therapy. adaptable to anyone's personal philosophy. simple and safe for anyone, regardless of the severity of their symptoms. based on common sense. infinitely do-able. always changing - the body of knowledge is always expanding and is infinite. not based on any philosophy or model, but can incorporate any philosophy or model. not only a program - it is a way of life. There is no room for big egos or "power trips," bigotry, prejudice or hatred. Everyone belongs at the table, no matter what their issues or where they are on their path. There are no predetermined outcomes. Each individual works at their own pace toward their own goals. Follow strict codes of sexual conduct at all times. As a facilitator, do not behave in a manner that might be construed as sexually suggestive, harassing or discriminatory. If anyone in your group or at your presentation does these kind of things, let them know that it is not acceptable. If you are having a hard time with this, discuss it with someone you trust can give you helpful guidance and support in addressing this issue. There is no "political" agenda. (Political discussions need to be saved for the appropriate forum.) Do everything you can to ensure a safe, comfortable and respectful atmosphere for participants.

Personal Responsibility 5 Key Recovery Concepts Hope Personal Responsibility Education Self Advocacy Support   Key Recovery Concepts There are five key recovery concepts that, through her research, Mary Ellen  found to be essential to effective recovery work. I imagine that my recovery is a wheel rim – each recovery concept is a spoke – if one spoke is weak then that is where the rim of my recovery wheel will be vulnerable. They are: Hope - People who experience mental health difficulties get well, stay well and go on to meet their life dreams and goals. Personal Responsibility - It's up to you, with the assistance of others, to take action and do what needs to be done to keep yourself well. Education - Learning all you can about what you are experiencing so you can make good decisions about all aspects of you life. Self Advocacy -Effectively reaching out to others so that you can get what it is that you need, want and deserve to support your wellness and recovery. Support - While working toward your wellness is up to you, receiving support from others, and giving support to others will help you feel better and enhance the quality of your life.

Sections of the WRAP Plan Wellness Toolbox Daily Maintenance Plan Identifying Triggers Identifying Early Warning Signs When Things are Breaking Down Crisis Planning Post Crisis Planning

Sections of the WRAP Plan For every section, the person develops an Action Plan. The Action Plan outlines Tools needed to address daily challenges Tools identified are put in the Wellness Toolbox

Sections of the WRAP Plan Wellness Toolbox The Wellness Toolbox contains a number of ideas, activities, and/or objects that promote wellness. These tools are personal and meaningful to the person working on the WRAP plan.

Sections of the WRAP Plan Short Answer Poll The Wellness Toolbox What things do you do or use to make you feel well?

Sections of the WRAP Plan Daily Maintenance Plan This section asks the person how does s/he feel when s/he feels well. It also establishes what to do to feel well. Daily Maintenance List : How do I feel when I feel well Good Mood Talkative Focus What do I need to do daily to maintain my wellness. Cup of Coffee Listen to Music Exercise

Sections of the WRAP Plan Identifying Triggers This section asks person to identify external events that makes the person feel bad, uncomfortable, anxious, and/or upset. (feelings everyone experiences.) Discuss situations that act as triggers. Triggers Had an argument with my father Things I need to do to feel well Action Plan call a friend work on breathing exercises

Sections of the WRAP Plan Identifying Early Warning Signs This section asks the person to identify those feelings that are sometimes developed by the trigger. Sometimes, critical feelings happen without external triggers. Talk about how do you feel when the trigger is not addressed at the moment. Early Warning Signs: How do I feel when I feel bad? I feel resentment I feel hurt Things I need to do to feel well - Action Plan call my friend talk to a family member

Sections of the WRAP Plan When Things are Breaking Down These signs that may be internal and external - you may begin to feel further away from your wellness.   An important time to focus on specific action steps with clear instructions on how to use your resources and supports.  It is necessary to take immediate action to prevent a crisis. Signs that Things are Breaking Down drug misuse withdrawal feeling angry Things I need to do to feel well Action Plan call a health care provider talk to a friend

Sections of the WRAP Plan Crisis Planning The Crisis Planning is a proactive way to look at potential challenges. The Crisis Planning has 9 parts. What I’m like when I am feeling well. Symptoms Supporters Medication Treatment Home / Community Care Treatment Facilities Help from Others When my supporters no longer need to use this plan

Sections of the WRAP Plan Crisis Planning Chinese symbol for Crisis This is just a way to talk about crisis - 2 pictures -

Resources Copeland, M. E. (1999). Winning against relapse: A workbook of action plans for recurring health and emotional problems. Dummerston, VT: Peach Press. Copeland, M. E. (2001). The depression workbook: A guide for living with depression and manic depression (2nd ed.). Oakland, CA: New Harbinger Publications. Copeland, M. E. (2006). Wellness Recovery Action Planning (WRAP) project: WRAP group facilitator's kit. Copeland, M. E. (2009). Facilitator training manual: Mental health recovery including Wellness Recovery Action Plan curriculum. Dummerston, VT: Peach Press. Copeland, M. E. (2010). WRAP facilitator manual. Copeland, M. E., & Mead, S. (2004). Wellness Recovery Action Plan and peer support: Personal, group, and program development. Dummerston, VT: Peach Press.

Resources lopezlu@nyspi.columbia.edu