Illness Management and Recovery Program William Anthony defined recovery as: … the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness (Anthony, 1993).

“Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back.” Florence Nightingale

Recovery…. You don't have to control your thoughts; you just have to stop letting them control you. - Dan Millman The disease is progressive. So is recovery Superman's not brave. You can't be brave if you're indestructible. It's every day people, like you and me, that are brave knowing we could easily be defeated but still continue forward. - unknown

Recovery Recovery has a unique meaning to each individual. For every person, recovery is conceptualized in a different manner. Recovery is a continuous state of being Individuals will not be “cured” of mental illness Individuals are powerless over their disease, but NOT their lives

Recovery Instead of CONTROL patients can have the Knowledge to become EMPOWERED More POWER will be gained by taking responsibility for one’s disease process through education, support and unconditional acceptance. Patients DO have a choice They CAN fulfill their dreams They CAN lead healthy, fulfilling lives Practitioners can help to give them the TOOLs to maintain recovery.

Recovery and Practitioners Our role is not to define recovery for patients, but instead help to increase their feelings of hope that accompany them through this process With encouragement, education and skill acquisition, patients can learn how to gain power and control over their disease process.

Recovery & Illness Management and Recovery Program (IM&R) Recovery is the heart of the IM&R program Recovery is not an end goal, but instead, an on-going process Patients are NOT passive recipients, but instead, actively participate in this process As practitioners, we are responsible for providing them with the tools and abilities to participate in their recovery and plan of care.

Illness Management and Recovery Program Developed from Evidence Based Practice which cited 5 psychosocial interventions as effective for mental health recovery Supported employment Family psycho-education Integrated Dual Disorder Treatment Assertive Community Treatment Illness Management and Recovery

Illness Management and Recovery Program Came from National evidence based practice Review of 40 randomized controlled studies: The results: Components Outcomes Psycho-education Improved knowledge of mental illness Behavioral Tailoring Helps people take medications as prescribed Relapse Prevention Reduces symptoms & Hospitalizations Coping Skills Training Cognitive – Behavioral Therapy Reduces severity of distress and symptoms.

Illness Management and Recovery Program : So what then? A structured program Curriculum based approach Help patients to acquire skills and knowledge Assist patients to understand recovery Assist patients to achieve their own, personal recovery

Illness Management and Recovery Program “Illness Management and Recovery (IMR) is an evidence-based psychiatric rehabilitation practice whose primary aim is to empower consumers to manage their illnesses, find their own goals for recovery, and make informed decisions about their treatment by teaching them the necessary knowledge and skills.” (United States Department of Health and Human Services, 2009)

Goals of Illness Management and Recovery • Instill hope that change is possible • Develop a collaborative relationship with the treatment team • Help people establish personally meaningful goals to strive towards • Teach information about mental illness and treatment options • Develop skills for reducing relapses, dealing with stress, and coping with symptoms • Provide information about where to obtain needed resources • Help people develop or enhance their natural supports for managing their illness and pursuing goals

Core Values of IM & R: Hope Hope, participation and coping have been shown to increase one’s quality of life Hope and destiny assist one to believe in their ability to influence their future destiny In order to convey hope, practitioners themselves must HAVE hope and be able to convey this hope to patients. Transmitting hope and belief in and to patients helps them to feel empowered.

Core Values of IM & R: The patient is the expert Every patient experiences their disease process in a unique manner. Every patient knows and understands which treatment strategies work best for them. Patients are experts on their disease process and recovery. Practitioners are experts on technical aspects of mental illness, coping strategies, stress reduction, ect. Through the sharing of expertise, recovery can more efficiently and effectively be achieved.

Core Values of IM & R: Patient’s personal choice It is the practitioner's role to assist and support patients to make their own, personal choices. Instead of force and/or coercion (expect in legal situations), practitioner's should help patients to identify the consequences of their outcomes.

Core Values of IM & R: Practitioners are collaborators Collaboration helps patients to cope with their illness make progress towards their goals Patients and Practitioners work together, in a non-hierarchal, helping relationship

Core Values of IM & R: Practitioners demonstrate respect for individuals living with mental illness Patients as individual As capable decision makers As individuals with rights, goals and dreams Patient’s ability to make decision, take risks and experience consequences

Teaching Methods: Motivation The practitioner’s role is to provide patient’s with the motivation to learn IM & R. It can NEVER be assumed that one already possess the motivation necessary for recovery. Motivation will help patients to achieve short term goals Motivation can change over time and therefore must be consistently addressed throughout the program. It is vital that practitioner's convey their confidence, support and encouragement in patients in order to maintain motivation.

Teaching Methods: Education Disease information, illness management, coping strategies and illness prevention are core educational concepts in IM & R Education should be INTERACTIVE in order to enhance acquisition and cognitive processing. Interactive education also helps to clarify information, understand a patient’s perspective and convey respect for their individuality. Practitioners need to consciously check for understanding and if necessary, break information down into small components Speak in a manner that patient’s understand; “speak their same language”

Teaching Method: Education Patients can actively learn about their disease. With knowledge, patients will be able to actively participate in care Education can lead to empowerment Education can lead to responsibility Response-able

Learning about me and my illness 1. What are some of the symptoms of the disease that I have? (sadness, depression, denial, anger, frustration, ect) 2. What changes have occurred in my physical, social, economic and/or professional life because of my disease? 3. How has my disease affected my relationship with the people I love the most? 4. What are some ways that my disease has caused my life to be unmanageable and/or out of control? 5. Give three reasons for having hope today. What are you looking forward to? What has already started to change for the better in your life?

Teaching Methods: Cognitive Behavioral Strategies Reinforcement: Positive: utilized to increase positive behaviors (i.e. increase praise, rewards, self esteem) Negative: utilized to decrease negative behaviors (i.e. decrease stress, anxiety, ect) Practitioner's role: praise, enthusiasm, positive reinforcement, monitoring achievement of personal goals, encourage utilization of newly acquired skills

Teaching Methods: Shaping This entails successive behaviors/steps to obtain new behaviors/goals Practitioners needs to provide positive reinforcement, encouragement and feedback while also realizing that patients learn at their own rate Practitioners can shape patient’s attitude by acknowledging their efforts, struggles and accomplishments in their own IM & R program

Teaching Methods: Modeling Practitioners demonstrate desirable and appropriate skills for patients to observe Practitioners can enhance learning by explaining the rationale and basis for the skill/behavior before its demonstration Patients can then provide feedback on behavior while also role modeling newly acquired skill What patients observe practitioners completing on a daily basis are ALSO examples of role modeling.

Teaching Methods: Role Playing and Practice Practitioners should support acquisition of new skills inside and outside of the group After completion, patients should be asked about experiences, feelings, obstacles, ect Enthusiastically encourage patients to use skills throughout the day and track their experiences

Teaching Methods: Homework Assist in acquisition of skills Provides individuals with hope and confidence that they will be able to learn and complete new skill Can be modified based on patient’s mental and cognitive status. Can include other peers in the program.

Teaching Methods: Cognitive Restructuring How patients feel about themselves and how the process information influences their understanding of the world and how they respond to events. When one’s cognitive processes are inaccurate, restructuring can assist one to view the world, process information and understand information in a more accurate manner.

Teaching Methods: Cognitive Restructuring Practitioners can participate in cognitive restructuring by: Teaching patients accurate facts about mental illness Exp. Mental illness is influences by environmental, biological and social factors and NOT a due to one’s lack of self will and/or weakness.

Teaching Methods: Behavioral Tailoring Helps build strategies to incorporate medications into one’s daily routine Practitioners can help by providing prompts, reinforcement, rationale for taking medications, benefits of taking medication Practitioners'’ Techniques: Identify daily routine Identify daily activity that will help/prompt individuals to remember to take medication. Role model the plan Assist patient to practice the plan implementation

Teaching Methods: Relapse Prevention Create a plan that identifies signs, symptoms and steps to respond to signs Patients can learn and identify “triggers” Include support persons in plan The practitioner can explain relapse, benefits of relapse prevention, techniques to avoid relapse. Write down plan and role play the plan

When I am feeling Bad OR Good, these are the people that I can call: Friends Phone Number   Family Members Others:

Crisis Plan: I know that things are not going well when I notice these warning signs : (thoughts, feelings, actions, physical symptoms, ect) I know that I need to call for help immediately when I notice the following EMERGENCY warning signs: In order to get help and stay SAFE before help arrives I will:

Natural recovery support systems Define support systems Identify support systems Included support systems in life Share in the recovery process with natural support systems within one’s life.

Teaching Methods: Coping skills Practitioner can help patients to identify troubling behaviors/symptoms and situations in which they frequently occur. Help patient to identify coping strategies that have utilized and their effectiveness The practitioner can help the patient to obtain new coping skills or increase the utilization of currently utilized beneficial and efficient coping skills. Role play new coping skills with patient

Patients who will benefit from IM & R Educational sessions have been written specifically for individuals with schizophrenia, bipolar and depression. However, it is believed that all individuals living with and surviving psychiatric illnesses can benefit from IM & R It is also believed that ALL patients, no matter how long they have been living with their illness can benefit from IM & R

Role of Practitioner Help individuals enhance natural support systems Increase feelings of hope Instill hope Help patients define meaningful goals Personally Have Hope Teach and Educate Provide patients with the tools and skills to participate in their own recovery Initiate a collaborative role with the treatment team Empower and Inspire the Patient

Role of Practitioner: The benefits of the program Give practical clinical tools to work with Creates a partnerships with patients Brings evidence based practice into recovery Better understanding of patients, their struggles, their lives More recovery focused vs. paternalistic

The patients: the benefits Yes, this is what they have really said More confidence Able to try new activities Become involved in more meaningful activities Able to manage their own illness better Feel more hopeful Increase vocational activities

Structure Individual teaching: Allows more individual teaching and dedicated attention to one’s individualized needs Group teaching: Allows patients to receive feedback, form relationships, gain support and identify role models Combination: Allows core material to be taught to individuals while group sessions provide time and opportunity for support and feedback.

Session Time Frame Informal socializing and identification of any major problems 1-3 minutes Review previous session(s) Review Homework 3-5 minutes Follow up on Goals Set agenda for current session 1-2 minutes Teach new material or review previously taught material 30-40 minutes Agree on new homework assignment Summarize progress made in current session

Time Time range of group can vary from 45-60 minutes. However, individuals with shorter attention span may only be able to maintain attention for 30 minutes. If necessary, shorter, more frequent sessions can be completed.

How this all fits in…. Motivational interviewing is how we interact with patients Integrated Dual Disorder treatment is how we ensure that patients' mental illness and chemical abuse is treated simultaneously Illness Management and Recovery is the program we utilize to assist individuals into and through their recovery.

Where are we? Where are we going? 08 is the pilot unit Patients will start setting long term and short term goals Current goals group is a component of this process All staff will know and communicate with each other regarding each patient's current goal OT/TR will work with patients to set long term recovery goals Disciplines will work together to conduct IM & R groups daily.

The rest of it…. Motivational interviewing Every staff member to receive training Eventually tracking the stage of recovery at which patients are at in order to know which techniques to use, how ready that they are to change….i.e. how motivated they are Integrated dual disorder treatment Incorporate assessments and treatment goals for MI & CD together Utilizes motivational interviewing framework GAIN-SS will be utilized to screen, upon admission those who are at risk for a substance abuse These techniques/programs will eventually replace the MICD group that we utilize now.

Illness Management and Recovery Program Integrated Dual Disorder Treatment Motivational interviewing Programming Process Treat MI + CD together Treatment approach How we talk to patients 1:1 and in groups

"...the character of the nurse is as important as the knowledge she possesses." -- Jarvis, 1996 "When you're a nurse you know that every day you will touch a life or a life will touch yours. -- Anonymous “They may forget your name but they will never forget how you made them feel.” Maya Angelou

Work Cited   Flaum, M. & Salyers, M., (2004). Session VII: Illness management and recovery. [PowerPoint slides]. Retrieved from http://www.medicine.uiowa.edu/icmh/recovery/. Hazelden. (2009). Family program. Center City, MN. Minnesota Department of Health and Human services. (2009). Illness management and recovery: Implementation resource kit. Retrieved from http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_028649 Roe, D. P.-H. (2007). Illness management and recovery: Generic issues of group format implementation. American Journal of Psychiatric Rehabilitation, 131-147. United States Department of Health and Human Services – Substance Abuse and Mental Health Services Administration. (2009). Evidence based practices: Shaping mental health services towards recovery. Retrieved from http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/