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What is WRAP An Introduction to the Concept Co-Facilitated by Gerard Thomas & Jen Padron
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Greetings & Hello everyone my name is Gerard Thomas, I am a Vietnam era veteran honorably discharged from the US Army in 1971. I am a resident of Washington DC & a consumer of services from Pathways to Housing DC. I’m a trained Certified Advance Level WRAP Facilitator. I conduct WRAP groups & workshops that teach about wellness tools & strategies, such as medication management, changing negative thoughts to positive, developing a wellness lifestyle, & motivating people to work toward recovery – feeling the way they want to feel, making their lives the way they want them to be. I’ve also been trained and certified by the DC Dep’t of Behavioral Health as a Certified Peer Specialist. I assist people who have psychiatric symptoms to discover the strengths they have and can use to enhance their recovery, emphasizing the underlying concepts necessary to recovery: hope, personal responsibility, education, self- advocacy, & support. I’m also active with the DC Department of Behavioral Health as a mental health advocate and a WRAP Facilitator. I have been using WRAP since 2006... I know from my own life experience that a duel diagnosis is not the end of the world and that a meaningful and positive life is possible with the correct kind of services and the right kinds of support. When recovery and support are based on mutuality & self-determination people can and do get well, and stay well for long periods of time, and do what they want to do with their lives.
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Jen Padron, M.ed, CPS Associate Director/Principal Investigator/Project Director, DC Recovery Network Jen has consulted with Vanguard Communications, to SAMHSA on wellness and social inclusion initiatives nationwide and for a Stanford University and NASHMPD Expert Q&A on experienced psychosis and cultural attunement. Currently, she’s currently a Consultant to Southern Methodist University on an NIMH and University of Texas at Austin Hogg Foundation funded study of Latina/o youth and early-experienced psychosis. She is a WRAP Facilitator, State of Georgia Certified Peer Specialist and State of Texas Advanced Certified Peer Specialist, and Community Health Worker Promotora. Her passion is working actively to grow a US Peer Leadership and Workforce where a CPS, RC and CHW portfolio of services will drive co-located behavioral and physical health recovery-oriented service care systems. Jen is a PhD Candidate, earning her PhD in Public Health late ’15. She believes in service and is a volunteer board of director member to ACHMA College for Behavioral Health Leadership and sits on committees for peer services | supports national initiatives.
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Mary Ellen Copeland, PhD Mental Health Recovery Including: Wellness Recovery Action Planning ® WRAP ®
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There are Four Parts to the study of Mental Health Recovery: 1. Key Recovery Concepts… 1.Hope 2.Personal Responsibility 3.Education 4.Self Advocacy 5.Support …and Issues That Need Attention: Getting Good Health Care Medication Management 2
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There are Four Parts to the study of Mental Health Recovery: 2. Wellness Toolbox 3. Wellness Recovery Action Planning 4. Recovery Topics: Building Self-Esteem Changing Negative Thoughts to Positive Ones Peer Support Work Related Issues Trauma Recovery Suicide Prevention 3
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Mental Health Recovery Additional Issues: Living Space Lifestyle Motivation This workshop and the concepts, skills and strategies you learn while in this workshop are complementary to your health care treatment program. They are not a replacement for your treatment program. 4
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Key Recovery Concepts 6 Hope Personal Responsibility Education Self-Advocacy Support
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There is Much to Hope For! You can get well and stay well for long periods of time! 7
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There is Much to Hope For! You can work toward and meet your goals! You can lead a happy and productive life! 8
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There is Much to Hope For! You don’t need, nor will you benefit from, dire predictions about your future. 9
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There is Much to Hope For! Your supporters and care providers need to: encourage you, help you to feel better, assist and support you in staying well. 10
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You are the expert on yourself! You know what you want and need! It is up to you to take personal responsibility for your own wellness and your own life! Personal Responsibility 11
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Education Learn all you can about yourself so you can make good decisions about: Treatment Lifestyle Career Relationships Living Space Leisure Time Activities All Aspects of Your Life 13
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16 Education
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Self-Advocacy Become a strong advocate for yourself. This means: “Going for it” with courage, persistence and determination; expressing yourself clearly and calmly until you get what you need for yourself. 17
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Believe in yourself Know your rights and insist that they are respected (see the following Bill of Rights) 18 Self-Advocacy
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Set personal goals and work toward meeting them by: Getting the facts Planning your strategy Gathering support Targeting your efforts 19 Self-Advocacy
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Developing & Keeping a Strong Support System Support from family, friends, and care providers is definitely helpful. Being effectively supported will help you feel better and enrich your life. You will benefit from having at least five good friends or supporters you can call on when you need or want … 27
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Someone to talk to Companionship To have a good time Help in figuring things out and making decisions Someone to take over for you and keep you safe when you can’t take care of yourself 28 Developing & Keeping a Strong Support System
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Health Care Medications 81 Issues that May Need Attention:
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Health Care There may be medical reasons that are causing you to feel badly. Some of the most common include: Hypo- or hyperthyroidism and other endocrine gland problems Various chronic or acute disease processes 82
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Have a Complete Physical Examination At least once a year and whenever your symptoms change or worsen This examination needs to include a complete battery of thyroid tests. 84
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Medication Issues You may choose to take medications for the short or long term to help you feel better. This choice is up to you. 92
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Know the possible side-effects and if they occur, report them to your health care provider. Use medications only as prescribed. Work closely with a competent pharmacist who knows you well. Use a simple system to assure consistent use of medications. 96 Medication:
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Report any lapses in medication treatment to your care provider. Insist on regular blood testing. Pay close attention to lifestyle issues such as diet, exercise, light, rest and stress. Avoid using alcohol or illegal drugs. 97 Medication:
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WRAP ® Wellness Recovery Action Plan ® 219 Mary Ellen Copeland, PhD
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Wellness Toolbox Daily Maintenance Plan Triggers and Action Plan Early Warning Signs and Action Plan When Things are Breaking Down and Action Plan Crisis Planning Post Crisis Planning 220 WRAP Includes:
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Was developed by a group of people who had been dealing with difficult feelings and behaviors for many years People working to feel better and get on with their lives 221 Wellness Recovery Action Plan
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1.Help you stay as well as possible 2.Help you keep track of difficult feelings and behaviors, and develop action plans to help you feel better 222 WRAP Will:
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3.Tell others what to do for you when you feel so badly you can’t make decisions, take care of yourself and keep yourself safe. 223 WRAP Will:
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As a tool to help insure your success if you are planning changes in your life, like: Getting a Job Changing Jobs 224 You Can Use WRAP
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Increasing your Work Hours Taking on More Responsibilities Getting More Education or Training Leaving Supported Housing 225 You Can Use WRAP
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Moving Beginning or Leaving a Relationship Working on Relationship Issues Having a Child You Can Use WRAP 226
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To Address Other Life Issues like: Chronic or Acute Illness Addictions Breaking Bad Habits Losing Weight Trying Out New Interests Caring for Ill or Elderly Family Member You Can Use WRAP 227
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You could develop a separate WRAP to deal with each of these issues or you could include these issues in one WRAP. WRAP 228
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There is only one person who can write your WRAP- YOU! You and only you decide: If you want to write a WRAP How much time it takes you to do it When you want to do it Which parts you want to do WRAP 229
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You and only you decide: Who you want, if anyone, to help you with it How you use it Who you show it to Where you keep it Who, if anyone, has copies of your Crisis Plan WRAP 230
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You may want to develop your WRAP in a three ring binder with filler paper and a set of five tabs. However, you can develop your WRAP using any paper or notebook style. WRAP 231
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You could develop it on your computer or even on a tape recorder. You may want to ask a friend to support you as you work on your WRAP. WRAP 232
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Developing a list of your Wellness Tools These are the things you do to keep yourself well, and the things you do to help yourself feel better when you don’t feel well. Begin a WRAP by: 233
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You may have discovered wellness tools yourself or learned about them from others. Most of them are simple, safe, and free. You will use these tools to develop your WRAP. Begin a WRAP by: 234
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Reaching out to others for support Checking in with a care provider Peer Counseling Focusing Exercises Stress Reduction and Relaxation Techniques Common Wellness Tools 235
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Doing things that divert your attention/Things you enjoy Journal writing Eating or avoiding certain foods Exercise Light Common Wellness Tools 236
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Doing things that help you sleep well Modifying your daily life Taking action to keep yourself safe Daily Planning Spiritual practices 237 Common Wellness Tools
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You will be able to think of many other Wellness Tools that are helpful to you. You can keep your list in the front of your binder, on your computer, or wherever is most convenient for you. 238 Common Wellness Tools
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On the first tab in your binder write “Daily Maintenance List”. Insert it in your binder, followed by several sheets of binder paper. On the first page, describe how you feel when you feel well. Do it in list form. 239 Daily Maintenance List
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Some words that others have used are: BrightHappy OutgoingOptimistic HumorousCompetent AthleticIndustrious ContentResponsible ReasonableWithdrawn 240 Daily Maintenance List
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Some words that others have used are: IntrovertedTalkative ActiveEnergetic CompulsiveDramatic QuietCalm CheerfulCurious BoisterousReserved 241 Daily Maintenance List
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You may also want to include on this page any specific things you want to work on in your WRAP like: Building your self-esteem Going back to work Getting a different job 242 Daily Maintenance List
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Learning new skills Losing or gaining weight Addressing addictions Relieving the effects of trauma 243 Daily Maintenance List
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Healing from an illness, injury or surgery Dealing with a chronic illness like Fibromyalgia or Arthritis 244 Daily Maintenance List
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On the next page make a list of things you need to do for yourself every day to keep feeling well. 245 Daily Maintenance List
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Examples (Be Specific): Get up at 7:00 AM on weekdays so I can get to work on time. Pack a healthy lunch and snacks to take to work. Eat three healthy meals and three healthy snacks. 246 Daily Maintenance List
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Examples (Be Specific): Drink at least six 8-ounce glasses of water Get half an hour exposure to outdoor light. Take medications and vitamins. Exercise for a least half an hour. 247 Daily Maintenance List
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Examples: Relax or meditate for at least 20 minutes. Write in a journal for at least 15 minutes. Spend half an hour enjoying a fun, affirming or creative activity. 248 Daily Maintenance List
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On the next page make a reminder list for things you might choose or need to do on any day. Reading through this list daily and doing those things that need to be done reduces the stress in your life and helps keep you on track. 249 Daily Maintenance List
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Ideas of things that might be on this list include: Setting up an appointment with a care provider Calling your Vocational Rehabilitation Counselor Making some possible employment contacts Signing up for a class 250 Daily Maintenance List
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Studying Spending time with a good friend Being in touch with my family Spending extra time with my partner Peer Counseling 251 Daily Maintenance List
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Getting more sleep Buying groceries Having some personal time Planning something fun for the weekend 252 Daily Maintenance List
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Spending time with children or pets Planning a vacation Taking a hot bubble bath Going to a support group 253 Daily Maintenance List
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External events or circumstances may make you feel very uncomfortable. These are normal reactions to life events - but if you don’t respond to them, they may actually make you feel worse. 254 Triggers
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On the Second Tab write “Triggers” and put in several sheets of binder paper. On the first page write down those things that, if they happened, might make you feel worse. 255 Triggers
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Examples: Problems at work Difficult relationships with co-workers Benefits being questioned or denied Doing work that is hard for you Anniversary of loss or trauma Traumatic news 266 Triggers
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Examples: Being very overtired Work stress Family friction Financial problems 277 Triggers Physical illness Sexual harassment Aggressive sounding noises Feeling left out
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Examples: Reminders of abandonment Intimacy Excessive stress Guilt/Criticism/Put-Downs Spending too much time alone Being teased 258 Triggers
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On the page after your list of Triggers, develop a plan that you feel will keep you from feeling worse if a triggering event occurs 259 Triggers Action Plan
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Sample Plan: If Any of My Triggers Come Up I Will: Make sure I do everything on my Daily Maintenance List If work related, talk to my Vocational Counselor or employer Focus on tasks that are easy for me to do well 260 Triggers Action Plan
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Sample Plan: Get one thing done that I know I can do well Do a reality check Talk to a support person Write in my journal Get some vigorous exercise 261 Triggers Action Plan
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Sample Plan: Peer Counsel with a friend Play my guitar for an hour Do a Deep Breathing or a Relaxation Exercise 262 Triggers Action Plan
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Early Warning Signs are internal and may be unrelated to reactions to stressful situations. They are subtle signs of change that indicate you many need to take some further action. 263 Early Warning Signs
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On the third tab write “Early Warning Signs”. Follow this with several sheets of binder paper. On the first page make a list of Early Warning Signs you have noticed. 264 Early Warning Signs
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Examples: Forgetfulness Anxiety or Nervousness Inability to experience pleasure Lack of motivation Feeling slowed down or speeded up 265 Early Warning Signs
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Examples: Avoiding doing Daily Maintenance items Being uncaring or apathetic Avoiding others or isolating Being obsessed with things Feeling unconnected to my body Increased irritability or negativity 266 Early Warning Signs
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Examples: Increase in smoking Not keeping appointments Spending money impulsively Aches and Pains Feelings of hopelessness Beginning of irrational though patterns 267 Early Warning Signs
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On the next page develop a plan of things to do everyday until you feel better – a plan you think will help you from feeling worse if you notice Early Warning Signs. 268 Early Warning Signs Action Plan
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Sample Plan: Do everything on my Daily Maintenance Plan Tell a supporter how I am feeling Peer Counsel Do a Focusing Exercise 269 Early Warning Signs Action Plan
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Sample Plan: Do three 10 minute Relaxation Exercises Spend at least 1 hour involved in an activity I enjoy Ask others to take over my household responsibilities Early Warning Signs Action Plan 270
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Surround myself with loving, affirming people Take a Mental Health Day Arrange to leave work early Get plenty of rest 271 Early Warning Signs Action Plan
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You may begin to feel even worse – very uncomfortable, like the situation is serious – and even dangerous – but you are still able to take some action in your own behalf. This is a very important time. It is necessary to take immediate, assertive action to prevent a crisis. 272 When Things are Breaking Down or Getting Worse
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On the fourth tab write “When Things are Breaking Down”. Follow this with several sheets of binder paper. Make a list of the feelings and behaviors which, for you, mean that things have worsened and are close to the crisis stage. 273 When Things are Breaking Down or Getting Worse
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Examples: Can’t concentrate at work Losing track of what I’m doing Feeling very oversensitive and fragile Irrational responses to others 274 When Things are Breaking Down or Getting Worse
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Feeling very needy Unable to sleep for (how long?) Sleeping all the time Avoiding eating Racing thoughts 275 When Things are Breaking Down or Getting Worse
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Examples: Substance abuse Obsessed with negative thoughts Unusual behaviors Dissociation (blacking out, losing time) 276 When Things are Breaking Down or Getting Worse
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Examples: Seeing things that aren’t there Risk taking behaviors, like driving too fast Thoughts of self-harm Taking your anger out on others 277 When Things are Breaking Down or Getting Worse
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On the next page, write an action plan to use each day When Things are Breaking Down. The plan now needs to be clear and very directive, with many things you “must” do and fewer choices. 278 When Things are Breaking Down or Getting Worse
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Sample: Call my Doctor or care provider, ask for and follow their advice Arrange for at least three days off from work and any other responsibilities Talk to a supporter Arrange for someone to stay with me 279 When Things are Breaking Down or Getting Worse
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Take action so I can’t hurt myself if things get worse Do everything on my Daily Maintenance List Do two Peer Counseling sessions, three Deep Breathing Relaxation Exercises, two Focusing Exercises Write in my journal for half an hour Get half an hour of exercise When Things are Breaking Down or Getting Worse 280
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The next section of the WRAP is the Crisis Plan. In spite of your best planning and assertive action, you may find yourself in a crisis situation where others will need to take over responsibility for your care. You may feel as though you are totally out of control. 281 Crisis Planning
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Write your Crisis Plan when you are well. Your plan will instruct others about how to care for you when you are not well. It keeps you in control even when it seems like things are out of control. 282 Crisis Planning
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Others will know what to do, saving everyone time and frustration, while insuring that your needs will be met. Develop this plan slowly when you are feeling well. 283 Crisis Planning
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On the fifth tab write “Crisis Plan.” Insert quite a few sheets of lined paper or use a form. This part of WRAP is different from other parts of the plan because you will give it to others so they have it when needed. The Crisis Plan has 9 parts. 284 Crisis Planning
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It Includes: What you are like when you are well Indicators that others need to “take over” Who “takes over” and who doesn’t 285 Crisis Planning
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Information on your Health Care Contacts and Medications Acceptable and Unacceptable Treatments Home/Community Care/Respite Plan 286 Crisis Planning
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Acceptable and Unacceptable Hospital Facilities Things others can do that would help Things other might do that would make you feel worse 287 Crisis Planning
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A list of chores and tasks for others Indicators that the plan is no longer needed Signatures of key people 288 Crisis Planning
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Describe what you are like when you are feeling well, as a reference point for people who may not have met you before. (You can copy this from the first part of the first section of WRAP.) 289 Crisis Planning Part 1: “What I’m Like When I’m Feeling Well”
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Examples: BrightIndustrious OutgoingWithdrawn HumorousActive AthleticTalkative ReasonableEnergetic ResponsibleDramatic 290 Crisis Planning Part 1: “What I’m Like When I’m Feeling Well”
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Examples: IntrovertedContent CompulsiveCalm CheerfulQuiet BoisterousReserved HappyCurious OptimisticCompetent 291 Crisis Planning Part 1: “What I’m Like When I’m Feeling Well”
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List those signs that indicate to others that they need to take over responsibility for your care and make decisions on your behalf. 292 Crisis Planning Part 2: Signs that Supporters Need to Take Over
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Examples: Uncontrollable pacing, unable to stay still Inability to stop compulsive behaviors Catatonic/unmoving for long periods of time Neglecting personal hygiene (# of days?) Not cooking or doing any housework (days?) 293 Crisis Planning Part 2: Signs that Supporters Need to Take Over
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Examples: Not understanding what people are saying Self destructive, abusive or violent behavior Criminal activities Destroying property Substance abuse Threatening suicide or acting suicidal Not getting out of bed at all, refusing to eat 294 Crisis Planning Part 2: Signs that Supporters Need to Take Over
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List at least 5 people you want to take over for you. You can include family members, friends and/or care providers. Ask the people you choose if it is OK for you to include them on this list. Tell them what would be involved. Show them a copy of your plan. 295 Crisis Planning Part 3: Supporters
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If they say they can do it, GREAT! If not, they can still be a good friend. Peers often provide this support for each other. You may want to set up a meeting with your supporters so they know each other and to discuss your plan. 296 Crisis Planning Part 3: Supporters
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Include a list of people you do not want to be involved in decision making or care. You can also write why you do not want them involved. Also describe how you want supporters to settle disputes if they disagree. 297 Crisis Planning Part 3: Supporters
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Provide the following information: Names and Phone Numbers of your Physician and Pharmacy Your Insurance Company Name, Phone Number, and ID Numbers All Allergies Medications and Health Care preparations you are currently using, why you are using them, dosage and when you take them 298 Crisis Planning Part 4: Medication
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Medications you would prefer to use if medications (or additional medications) become necessary and why you would choose them Medications that would be acceptable to you if medications became necessary, and why you would choose them Medications that should be avoided and why 299 Crisis Planning Part 4: Medication
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List those treatments you would like and those that you would want to avoid. Include “alternative” therapies that have helped as well as those that have not been helpful. 300 Crisis Planning Part 5: Treatments
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Hospitalization is often not the best option. Develop a carefully devised plan so that you can stay at home or in the community and still get the care you need. In order to do this, find out what resources are available in your community. 301 Crisis Planning Part 6: Home/Community Care/ Respite Center
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List those treatment facilities where you would prefer to be hospitalized if that became necessary, and those you wish to avoid. 302 Crisis Planning Part 7: Treatment Facilities
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List things others can do for you that would help: Listen without interrupting. Hold me or let me pace. Lead me through a Relaxation Exercise. Peer Counsel with me. Take me for a walk. Provide materials so I can draw or paint 303 Crisis Planning Part 8: Help From Others
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Let me express my feelings. Don’t talk to me (or, do talk to me). Encourage me, reassure me. Feed me good food (be specific). Keep me from hurting myself, even it that means you have to restrain me or get help from others. Keep me from hurting you or others 304 Crisis Planning Part 8: Help From Others
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Include a list of specific tasks you will need others to do for you, and who you would like to take care of these things. 305 Crisis Planning Part 8: Help From Others
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Examples: Paying bills Child and pet care Talking to employers Buying groceries Household chores 306 Crisis Planning Part 8: Help From Others
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List things that others should avoid doing, things that would not help or might make the situation worse. Examples: Using force Spending too much time alone Being teased 307 Crisis Planning Part 8: Help From Others
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Restraint and/or seclusion Getting angry with me Impatience and invalidation Not being heard Trying to entertain me Certain kinds of music and videos 308 Crisis Planning Part 8: Help From Others
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When you feel better, your supporters will no longer need to follow this plan. Develop a list of indicators that your supporters can use to determine when they no longer need to follow this plan. 309 Crisis Planning Part 9: When my Supporters No Longer Need to Use This Plan
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Examples: When I have slept through the night for three nights When I begin cooking for myself When I eat at least two good meals a day When I am taking care of my personal hygiene needs 310 Crisis Planning Part 9: When my Supporters No Longer Need to Use This Plan
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When I can carry on a conversation When I keep my living space organized When I can be in a crowd without being anxious When I return to work When I can sit still for 10 minutes 311 Crisis Planning Part 9: When my Supporters No Longer Need to Use This Plan
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You have now completed your Crisis Plan! Update it when you learn new information or change your mind about things. Give your supporters new copied of your Crisis Plan each time you revise it. You can help assure that your Crisis Plan will be followed by signing it in the presence of two witnesses. 312 Crisis Planning
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It will further increase its potential for use if you appoint and name a supporter with Durable Power of Attorney. Since the legality of these documents varies from state to state, you cannot be absolutely sure the plan will be followed. However, it is your best assurance that your wishes will be honored. 313
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The time when you are healing from a crisis can be very important. Although you feel ready to begin taking care of yourself again, you may still be dealing with difficult feelings as well as the aftermath of the crisis. You may find that you start feeling worse - like you are heading for another crisis. 314 Post Crisis Planning
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Thinking about this time before you even have a crisis, and perhaps giving it more attention when you are starting to feel better after a crisis, may help you have an easier time recovering and moving on. 315 Post Crisis Planning
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Addressing the following issues and creating a Timetable for Resuming Responsibilities may guide you through the process. 316 Post Crisis Planning
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When will you know you are ready to use a Post Crisis Plan? How you would like to feel when you have recovered from the crisis? Who do you want to support you through this time? 317 Post Crisis Planning
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If you have been hospitalized, where will you go when your are discharged? Who you would like to take you there? Who you would like to stay with you? 318 Post Crisis Planning
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Things that will ease your recovery if they are taken care of. Things you can ask someone else to do for you. Things that can wait until you feel better. Things you need to do for yourself everyday 319 Post Crisis Planning
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Things you might need to do everyday. Things and people you need to avoid. Signs that you are beginning to feel worse. 320 Post Crisis Planning
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Wellness Tools you will use if you are starting to feel worse. Things you need to do to prevent further loss. Signs that you can return to using your Daily Maintenance Plan. 321 Post Crisis Planning
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Changes in your Wellness Recovery Action Plan. Changes you want to make in your lifestyle or life goals. What you learned from the crisis. 322 Post Crisis Planning
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People you need to thank. Changes you want to make in your life as a result of what you have learned. What do you need to do to prevent further repercussions from this crisis? 323 Post Crisis Planning
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People you need to apologize to. People with whom you need to make amends. Medical, legal or financial issues that need to be resolved. 324 Post Crisis Planning
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Timetable for Resuming Responsibilities Identify the responsibility, such as work, children, or buying groceries. List who has been taking care of this task, such as your sister, partner or friend. 325 Post Crisis Planning
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Describe what you need while you are resuming this responsibility, for instance, someone to go with you, someone to watch your child in the morning, a half day schedule. 326 Post Crisis Planning
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Create a Step by Step plan for resuming responsibility, for instance, going to work for one day the first week, two days the second week, three days the third week. 327 Post Crisis Planning
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You have now reviewed the Wellness Recovery Action Plan! Perhaps you have started to work on your own plan or are helping someone else develop their plan. 328 Conclusion
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If so, give yourself credit for the work you are doing. You may even want to give yourself a reward from time to time. You can begin using your Wellness Recovery Action Plan as your guide to daily living whenever you want to. 329 WRAP
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At first you may want to review your plan everyday, following your Daily Maintenance Plan, and taking other action as needed. 330 WRAP
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After a while you will notice that you remember your plan and only need to refer to it from time to time, unless you are having a difficult time. 331 WRAP
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You may want to revise your plan when you discover new Wellness Tools and find that some things work better for you than others. 332 WRAP
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Resources 333
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1 Recovery Topics Mary Ellen Copeland, PhD
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Recovery Topics 1. Self-Esteem 2. Changing Negative Thoughts to Positive Ones 3. Peer Support 4. Work-Career 5. Trauma Recovery 6. Suicide Prevention 7. Additional Issues a. Living Space b. Lifestyle c. Motivation 335
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