Community Support Services Training Session 6 Rutgers, The State University of New Jersey School of Health Professions Department of Psychiatric Rehabilitation and Counseling Professions

Review from Session 5 IRP-agency transition Checklist Red Flags Progress Notes

Progress Note Activity Use DAP checklist to determine if your progress note contains all the key components. If necessary, rewrite your progress notes to reflect what is required.

Learning Objectives Practice writing a progress note that contains the key components for CSS Learn/review skills necessary to facilitate a structured task group Become familiar with characteristics and skills of an effective group facilitator Become familiar with Evidence-Based Practices Learn strategies and content in Illness Management and Recovery (IMR) and its relationship to CSS.

Group Activity-Problem Solving

Discussion Questions What is a group? In what situations are you called on to facilitate a group? How can you support your staff in their efforts to facilitate a group?

What impacts a group? Content- materials brought to group Dynamics-internal issues (interrelationships between members) Forces- external issues (time of day, membership, environment) Leadership- attitude, preparedness

Curative Factors in Groups Installation of Hope Universality Imparting of Information Altruism Corrective Recapturing of Family Group Development of Social Skills Imitative Behavior Interpersonal Learning Group Cohesion (Yalom, 1983)

Types of Groups Counseling Groups – focus on growth and development Psychotherapy Groups – focus on antecedents/diagnosis/links to present Self-Help Groups – peers share, support, and learn from each other Task/structured Groups – skills learning and development (our focus)

Task/Structured Groups Characterized by a central theme Often singular or short-term Include readings, structured exercises and practice opportunities (homework) Don’t require advanced clinical training Serve a variety of purposes: provide information, problem solving, teach skills, share ideas, provide support NOT therapy or counseling groups

Structure of the Group Each group has a lesson plan Plan describes the purpose and direction of the group (the what, why, how) Each session addresses a topic based on the plan Group leader is responsible for maintaining focus on the group’s purpose

Group Planning Process - Forms & Discussion Let’s take a look at a lesson plan form. Is this plan different, or the same, as you would use for meeting with an individual? Can any of these steps be applied to your current preparation for meeting with an individual?

Characteristics of a Productive Group There is a focus on the here and now Goals of members are clear and specific Cohesion is high – a sense of emotional bonding in the group Conflict in the group is recognized and explored Members are willing to make themselves known Trust is increased and there is a sense of safety (Corey, 2002)

The Group Counselor: Person and Professional Courage Modeling Goodwill and caring Openness Non-defensiveness Becoming aware of your own culture Personal power Stamina Willingness to seek new experiences Self Awareness Sense of humor Inventiveness Dedication and commitment

Group Leadership Skills Active Listening Questioning Reflecting Linking Clarifying Confronting Summarizing Supporting Facilitating Blocking Empathizing Evaluating Interpreting Terminating

Round Exercise

What makes IMR an evidenced-based practice? Objective Definition and Description of the Innovation Service Innovation Empirical Research Confirming Results Empirical Research Confirming Results Empirical Research Confirming Results Development of a Fidelity Scale Evidence Based Practice (Pratt, Gill, Barrett & Roberts, 2014)

What are Evidence-Based Practices? Integrated Dual Diagnosis Treatment (IDDT) Assertive Community Treatment (ACT) Pharmacologic Treatment Psycho-Education for Families Supported Employment Illness Management and Recovery (IMR)

Illness Management and Recovery(IMR) IMR is an evidence-based practice that helps people with mental illness: Set meaningful personal goals Acquire skills necessary to cope with and manage their illness Make progress toward their recovery

Core Values of IMR Hope is the key ingredient The person is the expert Personal choice is a must Practitioners of IMR are partners Practitioners demonstrate, not dictate Respect is always present

IMR Modules Recovery Strategies Practical Facts about Mental Illness The Stress-Vulnerability Model Building Social Support Using Medication Effectively Drug and Alcohol Use Reducing Relapses Coping with Stress and Common Problems Coping with Symptoms Getting your Needs Met in the Mental Health System Healthy Lifestyles

IMR: Group Discussion Thinking of services contained in CSS Thinking of expected outcomes of CSS How do we use the tenets of IMR as an impetus to support change?

How does IMR relate to Community Support Services (CSS)? Improved ability to manage one’s illness is a common recovery goal Avoiding relapses and re-hospitalizations gives people greater control over their lives Less time spent dealing with mental illness allows more time to be spent on personal recovery Less distress due to symptoms leads to a better quality of life Increases independence through skill development

Strategies Motivational -Convey confidence and hope -Relate learning to goals -Explore pros and cons of change Educational -Active teaching -Multiple methods -Simple, normalizing language

Strategies, cont’d Cognitive Behavioral Shaping Role Playing Modeling Reinforcement Homework Jointly agreed upon Individualized and goal related Behaviorally specific May involve or be facilitated by others Should be followed up

Anticipated Outcomes Reduce relapses/re-hospitalization Reduced symptom severity Increased knowledge base Increased medication management Improved coping skills Increased hopefulness and optimism Improved social skills Improved collaboration

Small Group Activity - IMR Get in groups Identify a group facilitator Using the module provided, facilitate an IMR group Be prepared to discuss your experience as a participant and facilitator in a larger group

Learning Application Ask a consumer to define recovery. Bring back the consumer’s definition of recovery.

Q&A

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 Brady, K.T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: The neurobiological effects of chronic stress. The American Journal of Psychiatry, 162(8), 1483-1493. Corey, M.S., Corey, G. (2002). Groups: process and practice. Pacific Grove, CA. Wadsworth Group. Jacobs, E. E., Masson, R.L., Harvill, R.L., Schimmel, C.J. (2009). Group counseling strategies and skills. (7th ed.) Belmont, CA: Brooks/Cole. Pratt, C. W., Gill, K. J., N.M, & Roberts, M. M. (2014). Psychiatric Rehabilitation. (3rd ed.) San Diego, CA: Elsevier Inc. Yalom, Irvin D. (1983). Inpatient Group Psychotherapy. Basic Books, NY.