1. Assertive Community Treatment Working with Natural Supports and Community Integration
Oregon Center of Excellence for Assertive Community Treatment
Contact: Heidi Herinckx

2. ACT is recovery oriented
Recovery is defined differently for each person
Recovery is a process and a journey

3. Recovery Focus on wellness
Doesn’t mean absence of symptoms but regaining many things that give a sense of purpose, value and improved quality of life

4. Recovery from what?
In addition to recovering from the mental illness itself, what are some of the other things that individuals you are working with in ACT recovering from?

5. Complex Issues
What are some of the consequences or co-issues that a person is recovering from in addition to mental illness?
Medical issues
Trauma
Substance abuse issues
Stigma
Isolation
Poverty and debt
Criminal justice involvement
Trauma from those who served them in the past
Forced treatment or perceived forced treatment

6. Recovery involves Hope
Restoration of social roles (parent, worker, girlfriend, leader of garden club)
Having a purpose in life
Community integration
Being a respected member of the community
Building and rebuilding social support networks
Having self determination

7. Community Integration
The opportunity to live in the community and be valued for one’s uniqueness and abilities, like everyone else (Mark Salzer, 2006)
This is the core of recovery based services

8. Community Integration
Think about and name the variety of all the places you go in a day

9. Community Based Services
The Community Based Services in ACT are NOT just visiting a person in their home.
The main idea of community based services is to expanding the places in the community where people feel comfortable and confident in their functioning.
Community based services should occur in the grocery store, in churches, in community centers, in parks, places of employment

10. Recovery and Community Integration
The goal of community integration is in many ways inseparable from the goal of recovery. In fact, it has been referred to as “the external, concrete manifestation” of the recovery experience (Bond, 2004)
Community integration involves building a strong natural support system

11. Natural Supports
Natural supports usually involve relationships with family members, friends, co-workers, neighbors and acquaintances, and are of a reciprocal (give-and-take) nature.
Such supports helps one to develop a sense of social belonging, dignity and self-esteem.

12. Consider the relationship
Recovery
Natural Social Supports Community Integration

13. Promoting Recovery
Emphasis is full community integration and improved quality of live
Focus on skill building to increase and improve functioning
Delivered in context of helping relationship in community settings
Restoring/Regaining valued social roles meaningful lives
Focus on personal goals and preferences

14. Community Integration: Natural Supports
Community Integration involves working with natural community supports: (who?)
Housing
Employment
Education
Physical Health
Leisure/Recreation
Spiritual/Religious Community
Friends, family
Civic and Citizenship organizations

15. Promoting Community Integration
Expand the range of opportunities to participate in their community as an equal member
Identify barriers to community integration and target obstacles that prevent people from being full members of their community
Provide supports that bring about meaningful changes in the lives of people with psychiatric disabilities

16. Explore Self and Values
Provide opportunities to explore values, beliefs, cultural identity
This may lead to ideas for involvement in a cultural community, groups that speak a particular language, spiritual community, political group, social activism

17. Help Promote Social Participation
Social isolation is common
Fewer friends, supportive relationships, social activities.
Potential barriers that you may have to address:
Stigma of mental illness
Skill deficits
Lack of supports in the community
Lack of community education (understanding, acceptance, support)

18. Types of social participation
Employment, education, leisure, social activities, parent, neighbor
Civic engagement
Volunteering
Taking up a cause
Educating the community about a topic of interest
Advocating
Voting

19. Goal: I want a new friend
Help a person develop a plan, identify the steps needed and help the person carry out the plan
1) what are the opportunities to make a friend
2) how does the person perceive these opportunities (hopeful, impossible)
3)What are the strengths the person has to accomplish this goal (friendly, outgoing)
4)Needs/ skills to be developed (how to give appropriate eye contact or start and stop a conversation)
How will the team support and provide services (role model, coach, identify resources)
How well is it working (changes in barriers, perceptions, celebrate successes and try new things, take it to the next level)

20. I want a new friend What’s common
Limiting the realm of possibilities to opportunities to meet people within the mental health agency/activities
Focusing on social circles the person already has
What’s needed
Expanding opportunities to mainstream activities in the community based on individual’s interests
Exploring new social opportunities

21. I want a friend In working with the individual in making a new friend:
1) location of the activity – outside of mental health agency- community based and natural setting with others in the community that do not experience a disability
2) self determination- participation reflects individuals choice
3) mainstream interactions with a wide variety of members of the community

22. ACT Services Service category
Description of the content in the process
Consumer outcomes
Mental health treatment/co-occurring TX
Alleviating symptoms and distress (medications, therapy, IDDT, evidenced based practices)
Symptom Relief/Improved mental well-being
Crisis Intervention
Controlling and resolving critical or dangerous problems
Personal safety assured
Case management
Obtaining the services and coordinating care wanted and needed
Service access
REHABILITATION
Developing skills and supports related to individual’s goals
ROLE FUNCTIONING
ENRICHMENT
Engaging individuals in fulfilling and satisfying activities
SELF-DEVELOPMENT/EFFICACY
Rights protection
Advocating to uphold one’s rights
Equal opportunity
Basic support
Providing the people places and things needed to survive (shelter, food, medical care)
Personal survival assured
Self-help
Exercising a voice and choice in one’s life
Empowerment
Wellness/Prevention
Promoting healthy lifestyles
Health status improved

23. Importance of Psychiatric Rehabilitation Processes
If the desired outcome is increased role functioning then psychiatric rehabilitation is the service provided to help develop an individual’s skills and support them to reach their goals

24. Psychiatric Rehabilitation Process
1) evaluation phase:
Set rehabilitation goal (I want a new friend)
Readiness Assessment and Development
Behavioral description of person’s self –determined readiness to work on achieving this goal
This phase may involve helping a person develop readiness to work on developing the skills needed to reach the goal
Functional Assessment
Evaluate current skill level and strengths
Identify needs and deficits
Dig deep and get specific
Resource Assessment
Identify what is needed to be successful

25. Psychiatric Rehabilitation Process
2) Planning Phase
Identify the specific skills and supports needed
Locations in the community to practice skill development
Identify high-priority skills
Resource development objectives

26. Psychiatric Rehabilitation Process
3) Intervention Phase
Identify and work on changes needed to a person’s personal environment to meet goal
Develop personal skills
Environmental supports
Resource acquisition or coordination
4) Monitor skill learning and assess effectiveness

27. I want a new friend Assessment Phase Planning Phase Intervening Phase
Assess communication skills
Formulate a plan
Role model communication skills
Assess eye contact
Provide person with support in preparation and planning of specific activities
Discuss conversation starter topics and personal boundaries
Explore opportunities and locations to meet new people and comfort level with these options
Choose how and where the friendship development activity will take place
Accompany individual to activities and help to identify opportunities to engage in conversation
Explore other skills necessary to make and maintain friendships and learning style
 Helping to build self-efficacy and confidence to get ready to meet people
Provide education on the characteristics of a healthy relationship (friendship)
Identify resources needed (funds for social activity, transportation assistance)
Providing feedback during social interactions to help identify strengths and areas that need development

28. Social Integration Development
ACT teams can use a similar process for identifying opportunities for social integration as employment specialists do for job development
Identify social organizations in the community and work with them to forge the way for incorporating an individual into their community- identifying the strengths and value, unique skills and contributions of the person

29. Working with Natural Supports
Gather information about public and community resources as a compendium of community and natural supports.
Developing trusting relationships
Provide training to natural supports on how to be supportive to ACT clients and provide instruction on how to navigate the service system.
Designing activities in natural settings consistent with individual needs interests, choices

30. Groups run by the MH agency
Groups create great opportunities to prepare individuals for community integration BUT don’t stop there
Help to expand these skills in natural community settings
Demonstrate/model skills used in group in a wide variety of community settings
ACT staff are gradually pulling back their support and letting people fly solo

31. Vision for Recovery Belief that recovery is possible
Uncover abandoned hopes and dreams
Discover self through strengths, values, culture, skills
Reclaim a meaningful live and valued social roles
Full community integration

32. The ultimate goal for an ACT program
The ultimate goal for you as an ACT team is to “work yourself out of a job”
Help someone get to a point of recovery where they don’t need ACT services any longer and are not dependent upon the MH service delivery system
Live, thrive, in the community
Research demonstrates that one of the most important factors to successful transition from ACT services was establishing a strong natural social support system

33. Organizational Assessment
How much focus does your ACT team have on psychiatric rehabilitation?
Teaching skills in the community?
Do all ACT staff serve in this capacity?
Examine your organizational structure: does it promote community integration or does it still continue to segregate individuals by focusing on interactions with only other peers?

34. Discussion
Describe some successes you have had working with/building informal supports and promoting community integration for ACT participants

35. Discussion
What are some of the challenges?

36. Discussion
Do you feel that recovery is attainable for some people more than others?

37. Resources
Boston University Center for Psychiatric Rehabilitation
Anthony, W. A., & Farkas, M. D. (2009). Primer on the psychiatric rehabilitation process. Boston: Boston University Center for Psychiatric Rehabilitation.