Community Support Services Training Session 3 Rutgers, The State University of New Jersey School of Health Professions Department of Psychiatric Rehabilitation and Counseling Professions

Session 2 Review Olmstead Permanent Supportive Housing Communication Skills Learning Application: changes needed to prepare for CSS?

Learning Objectives Summarize the Supervisory Working Alliance Model Assess the role of clinical supervision at your agency Demonstrate an understanding of Motivational Interviewing principles Demonstrate an understanding of the 8 dimensions of wellness Understand the importance of helping individuals examine all areas of their life

Working Alliance “A working alliance between a supervisor and a [supervisee] in which the counselor can offer an account or recording of their work: reflect on it: receive feedback, and where appropriate, guidance. The object of this alliance is to enable the [supervisee] to gain in ethical competence, confidence and creativity so as to give their best possible service to the clients” (Inskipp & Proctor, 1993)

Supervisory Working Alliance Model Restorative (Supportive) Formative (Educative) Normative (Managerial) (Inskipp & Proctor, 1993)

RESTORATIVE Function Supervision promotes reflection and self care while supporting personal and professional growth. This function creates the “medium” through which good CS occurs and is predominantly interpersonal. Philosophically comes first Historically this is the origin of CS in nursing, support around stress burnout. Promoting reflection / mind-fullness. The absence of this is associated with harmful supervision. Acceptance and change. (Cutcliffe, Butterworth & Proctor, 2001; Inskipp & Proctor, 1993)

FORMATIVE Function Clinical competencies are taught, shared and practiced. The skills, knowledge and values-base of the supervisee are enhanced. The evidence for effective clinical supervision is largely based on audit and feedback (Cutcliffe, Butterworth & Proctor, 2001; Inskipp & Proctor, 1993) CS is easiest when the intervention is clearly defined and measurable. This function has the clearest and best evidence of what works.

NORMATIVE Function Practice is kept in line with professional/ organizational ethics and norms as well as the evidence that exists for effectiveness. A tension exists between the need for “psychological safety” and accountability (Cutcliffe, Butterworth & Proctor, 2001; Inskipp & Proctor, 1993) Restorative function comes first conceptually

(Cutcliffe, Butterworth & Proctor, 2001; Inskipp & Proctor, 1993) J Acceptance and change (Cutcliffe, Butterworth & Proctor, 2001; Inskipp & Proctor, 1993)

Supervision Activity Review the form; reflect, and note how these aspects of supervision appear in your agency -Elements of supervision -Agency policy on supervision -Providing/receiving supervision -Implementing supervision in your agency 2. Share ideas with agency group 3. Recorder will share results of problem solving with the larger group T

You would think… That having had a heart attack would be enough to persuade a man to quit smoking, change his diet, exercise more, and take his medications. That hangovers, damaged relationships, an auto crash, and memory blackouts would be enough to convince a woman to stop drinking. That time spent in the dehumanizing privations of prison would dissuade people from reoffending. The key is that motivation is the key to change. The role the support worker plays in moving people toward motivation for change

What is motivation? Low resistance Openness and collaboration Expressing emotion Adhering to a change plan Changing All of which are strongly influenced by what a support worker does

Motivational Interviewing (MI) An evidence-based treatment that addresses ambivalence to change A conversational approach designed to help people with the following: examine ambivalence expressing the desire to change (in their own words) enhance confidence in taking action elicit and strengthen change talk strengthen commitment to change plan for and begin the conversation for change (Miller & Rollnick, 2013)

Motivational Interviewing Clip MI Video Clip (Fader, 2012)

Stages of Change Pre-contemplation Contemplation Preparation Action Maintenance

Stages of Change Pre-Contemplation-Not seeing a problem behavior or not considering change. Contemplation-Acknowledging that there is a problem but struggling with ambivalence. Weighing pros and cons and the benefits and barriers to change. Preparation-Taking steps and getting ready to change. Action-Making the change and living the new behaviors, which is an all-consuming activity. Maintenance-Maintaining the behavior change that is now integrated into the person's life. (Rosengren, 2009)

How does this translate to interventions Pre-Contemplation Outreach Trusting Relationship Practical Support Assessment Contemplation/Preparation Motivational Interventions Education Action Skill building Social Support Cognitive Behavioral Interventions Maintenance Planning Recovery Lifestyle

Principles of Motivational Interviewing Express empathy Develop discrepancy Avoiding argumentation Roll with resistance Support self efficacy (Miller & Rollnick, 2013)

Change Talk – DARN CAT Desire: I want to… Ability: I can… Reason: It’s important… Need: I should… Commitment: I will… Activation: I am ready… Taking steps: I am doing it tomorrow…

Motivational Interviewing (MI) Resource http://www.motivationalinterviewing.org/

Wellness Definition Wellness involves being aware of ourselves as whole people, including a sense of balance and comfort with our bodies, our lives, and our jobs. It is a sense that things are going well for us today, and can continue to go well for us tomorrow. It is a sense that we have meaningful relationships, love, and a sense of meaning and purpose. Although we have setbacks, or we experience stress and trauma, we are resilient, have emotional strength, material resources, and the support of others to survive and thrive. ---Peggy Swarbrick

Are you familiar with the wellness approach Are you familiar with the wellness approach? If so, how do you incorporate this into your work?

Wellness Wheel Activity Wellness Dimensions Emotional Financial Environmental Social Intellectual Spiritual Physical Occupational

After each area of wellness is identified, consider how you define this domain in your life. Statements will also be read to generate ideas. Fill in the corresponding pie-shaped section of the wheel to the degree of wellness you are achieving in that area of your life For example, emotional wellness: I am able to cope effectively with life and have satisfying relationships If you feel you are 100% satisfied in this area, color the whole area, if you are 30% satisfied, color from the center to the 3rd marker in that pie-shaped section Complete this for all 8 sections of the wheel

Emotional I am able to cope effectively with life and have satisfying relationships I am able to feel and label my emotions

Financial I am satisfied with my current and future financial situations I can manage my finances without difficulty

Social I have a sense of belonging and connectedness I am satisfied with my support system

Spiritual I have a sense of purpose and meaning in life

Occupational I gain personal satisfaction and enrichment in my work

Physical I recognize the need for physical activity, diet, sleep, and nutrition

Intellectual I recognize my creative abilities and find ways to expand knowledge and skills

Environmental My surroundings are pleasant and support well-being

Take a look at your wellness wheel… There is no “right” or “wrong” wheel Responses may vary depending on age and stage in life Did you have any difficulty identifying what each wellness domain means to you? If so, which ones?

8 Dimensions of Wellness

Why are we focusing on wellness dimensions? Health disparities that exist between those who are diagnosed with mental illness and those who are not Life situations that contribute to poor health Mind/Body Connection (Druss & Reisinger, 2011; Schroeder, 2007)

Balancing Act… (Druss & Walker, 2011) (Druss & Reisinger, 2011)

Critical Component of Wellness Assessment 8 Dimensions of Wellness

Wellness Assessment Form / Directions

Group Activity – Wellness Assessment Choose a partner Each person completes the assessment with their partner Identify 2 or 3 areas that they would like to work on for change Provide each other with feedback on conducting the assessment: How did work for you? Facilitators will role play first

Learning Application Practicing using the wellness form with an individual and/or share the wellness form with staff on your team Be prepared to share your experience next session

Q&A and Evaluations

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 Druss, B.G & Reisinger W, E. (2011) Mental disorders and medical comorbidity. Biological Psychiatry, 54(3), 215- 225. Fader, J. (2012, June 13). Dr. jonathan fader demonstrates motivational interviewing skills [Video file]. Retrieved from https://www.youtube.com/watch?v=ZxKZaKFzgF8. Inskipp, F., Proctor, B., & Cascade, T.(1993). The art, craft, and tasks of counseling supervision Part 1-making the most of supervision; professional development for counselors,psychotherapists, supervisors and trainees.

References (continued) Kennymore, J. balancing your wellness wheel. Retrieved from http://www.nwmissouri.edu/wellness/SHIFT resources Miller, W., Rollnick, S. (2013). Motivational interviewing: helping people change. [3rd edition]. New York: Guilford Press. Rosengren, D. B. (2009). Building motivational interviewing skills: a practitioner workbook. New York: Guilford Press.

References (continued) Schroeder, S. (2007). We Can do Better – Improving the Health of the American People. New England Journal of Medicine, 357, 1221-1228. Signpost Coaching Services. (2017). wheel of life. Retrieved fromhttp://www.signpostcoaching.co.uk/uploads/files/w heel-of-life_blank.pdf Swarbrick, M. (2012). Introduction to Wellness Coaching. Freehold, NJ: Collaborative Support Programs of New Jersey Inc., Institute of Wellness and Recovery.