A CBT/DBT/MI, stage-based curriculum designed for the seriously mentally ill population

C. A. P. S.  A CBT/DBT/MI, stage-based curriculum designed for this specific population  Individual lessons, workbooks, MI tools, and other resources for group work and 1-on-1 work  Built on proven-effective Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Motivational Interviewing  Organized around the Prochaska/DiClemente Stages Of Change model

Goals of the Program  Measurable decrease in acting out, violence and self-harm  Reduction in frequency, intensity, and duration of specific problem symptoms  Increase in therapy and med compliance, including the establishment of trust between the client and the treatment provider  Documentation of movement along the Stages of Change and achievement of clinical objectives

Features Of The Curriculum  Two different tracks– one for Psychotic Spectrum and one for Mood Disorders– feature unique symptom- specific material for each.  Each track includes one-hour lessons for a 50-hour group experience, as well as an array of one-on-one tools and supplementary workbooks.  Materials are grouped into three phases roughly corresponding to Pre-Contemplation, Contemplation, and Preparation/Determination stages of change

Features Of The Curriculum The Psychotic Spectrum track takes into account a lower level of cognitive functioning relative to the Mood Disorder track. Specific Psychotic Spectrum symptoms are addressed, including:  Auditory hallucinations  Visual hallucinations  Delusions  Depression  Anxiety  Disorganization

Features Of The Curriculum The Mood Disorder track takes into account a higher level of cognitive functioning relative to the Psychotic Spectrum track. Specific Mood Disorder symptoms are addressed, including:  Self-harm  Mania  Anger and agitation  Depression  Anxiety

Features Of The Curriculum  A Checkpoint appears every 5 lessons to assess progress through the curriculum. Assessment tools are provided.  Each Phase ends with a GO/NO GO decision point. Each participant must have moved sufficiently through the specific stage of change, and have demonstrated appropriate competency and clinical progress before being allowed to move to the next phase.  Checkpoints and GO/NO GO decision points allow you to support the process through clinical supervision and documentation.

ELEMENTS OF THE CURRICULUM

Lessons Individual lessons run 4 to 6 pages and are meant to be done in a single session in group.

Lessons Lessons include:  Self-soothing, distraction, and other key coping/ distress tolerance skills  Interpersonal effectiveness and anti-violence skills  Multiple affect regulation skills for increased self- management  Increased self-efficacy against the highest and most common risk factors and triggers to symptoms and acting out.

Writing Assignments This element can be done in class or as homework, and can then be processed in group. Alternatively, the group leader can read the question and elicit answers.

Skills Cards Skills cards help remind participants of the skill they have learned. The group leader can encourage them to cut out the card and keep it with them.

Scenarios Scenarios are written in the third person, and ask participants to give advice to the person in the scenario.

Likert Scales Likert scales help you probe the thinking of each participant and track their progress through the curriculum.

Checklists Completed checklists may be retained by participants to remind them of the various things they are learning about themselves.

FOOD FOR THOUGHT These short activities attack pre-contemplation and address faulty thinking. They get participants thinking about a variety of key issues and faulty thinking. Typically, these are several pages long and pose questions for participants to respond to.

WHAT DO YOU THINK? These one-page activities, similar to FOOD FOR THOUGHT, focus on a single scenario or story that attacks pre-contemplation and addresses faulty thinking. They are presented in the third person so participants can give advice to the characters in the scenario rather than talking about themselves– a very useful technique for participants in pre- contemplation!

CHOICES & CHANGES These small workbooks are intended for a one hour session. They include writing opportunities, checklists, and action plans– all focused on one key area, Introduction to Treatment for example.

Supplemental Material The model includes overlays of supplementary material you can select for special or intensive needs. They include:  Managing Aggression and Violence, a 50 lesson, scripted interpersonal effectiveness curriculum that teaches anti- violence, communication, and social skills. Lessons include key communication and assertion skills, conflict resolution, coping with peer pressure, and avoiding violence.  Sleep Disturbances, a DSM-IV compatible resource that addresses causes, sleep hygiene, and coping skills.

Supplemental Material  Self-Injury, a workbook-based resource that addresses common issues in self-injury and impulse control, including costs and consequences, handling difficult feelings, and rituals for self-injury.  Extensive symptoms awareness, assessment, and management tools to reduce frequency, intensity, and duration of symptoms.  Tools to assess and assist movement along the Stages of Change, including a Change Talk Tool, MI-Toolkits, and Importance and Confidence scales.

Staff Support Resources A major strength of this model is the inclusion of a wide range of staff support resources. The program is supported by:  Counselor’s Manual  Program Leader’s Guide  Staff Development Manual  Motivational Interviewing Manual  Motivational Interviewing toolkit

About Phoenix/New Freedom Programs Improve the quality of your treatment and gain peace of mind that effective, readily documentable treatment will be taking place! Phoenix/New Freedom Programs offers a force-multiplier for providers of behavioral health services. From workbooks to individual one-hour lessons, we can provide a full range of programming to fit your specific needs and dosage.

About Phoenix/New Freedom Programs  More than 2400 programs in 49 states  Multiple substance abuse, mental health, and dual diagnosis units at Riker’s Island (NYC jails)  Adult Community Corrections/Probation/Parole nationwide  more than 3 dozen state maximum and supermax facilities  more than 100 in-cell study programs nationwide

Riker’s Island uses our materials facility-wide: A Road Not Taken (substance abuse), Beyond The Bridge (mental health), and CAPS (severe and persistent mentally ill). In October of 2012, research data from A Road Not Taken was selected to be presented at the American Public Health Association 140th Annual Meeting and Expo in San Francisco. Among the findings:  41.67% reduction in multiple re-arrests  23% reduction - to 32% - of recidivism for those experiencing a longer length of stay (more than 41 days) in the program.

Beyond the Bridge and its evaluation process was also selected for presentation at the American Public Health Association 140th Annual Meeting and Expo in San Francisco. In the first year of use:  Violent incidents across the facility went down 15%, but violent incidents among the population receiving our curriculum went down 31%.  In an experimental cell unit violence was down 46% while in a mirror cell unit not using the materials violence was up by almost 500%.

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