Evidence-Based Practices: Shaping Mental Health Services Toward Recovery Illness Management and Recovery

Where We’ve Been: Illness Management Demons, Exorcisms, Death Chains and Isolation Medication Maintenance Treatment and Rehabilitation Recovery

Treatment and Rehabilitation 1. Treatment – Reduces emotional distress by reducing symptoms through diagnosis, medications, treatment planning, and therapy.  Treatment services are done TO ME.

Rehabilitation  Provides skills and supports to maintain and sustain independence and addresses the consequences of the illness and the rebuilding of a positive self image.  This is done through goal setting, skills teaching, resource coordination, and supports development.

Rehabilitation services are done WITH ME Until I can do them for or by myself.

The IMR Toolkit is: A set of materials which shows a practitioner how to provide an EBP that focuses on providing practical information about Treatment and developing Rehabilitation skills that build resilience to facilitate Recovery.

Resilience To strengthen those factors that allow a person to overcome adversity.

In short, IMR Expands your knowledge and Strengthens your mental and physical ability …so that you can regain your life to a usable form and reclaim your personal power from your illness.

IMR is a tool designed to move mental health service delivery from… The Reform outlined in the “President’s New Freedom Commission on Mental Health” to the “wholesale and fundamental Transformation” demanded in “Transforming Mental Health Care in America: The Federal Action Agenda – First Steps”. (Federal Action Agenda p. 18)

Reform states: Mental illnesses and emotional disturbances are treatable

Transformation states that: Recovery is the expectation! Does Kentucky’s mental health care service delivery system expect Recovery?

Will implementation of the IMR toolkit improve Kentucky’s expectation?

2 Key Principles of Transformation 1. Services and treatments “must be consumer - and family-driven –geared to give consumers real and meaning full choices about treatment options and providers; not oriented to the requirements of bureaucracies.” (Federal Action Agenda p.19)

2 Key Principles of Transformation Care must focus on:  Increasing one’s ability to cope with life’s challenges  Facilitating recovery  Building resilience “And NOT just on managing symptoms”. ( Federal Action Agenda p.19)

Does IMR achieve both goals? Let’s look and see…

Development Team

Goals of IMR

Educational Handouts Handout #1 Recovery Strategies Handout #2a Practical Facts About Schizophrenia Handout #2b Practical Facts About Bipolar Disorder Handout #2c Practical Facts About Depression Handout #3 Stress–Vulnerability Model & Treatment Strategies Handout #4 Building Social Support Handout #5 Using Medication Effectively Handout #6 Reducing Relapses Handout #7 Coping with Stress Handout #8 Coping with Problems and Symptoms Handout #9 Getting Needs Met in a Mental Health System

Format: IMR is series of weekly sessions where mental health practitioners help people who have experienced psychiatric symptoms to develop personalized strategies for managing their mental illness and moving forward in their lives.

Structure of the sessions – Predictable Informal socializing and identification of any major problems 1-3 minutes Review previous session(s) 1-3 minutes Review homework 3-5 minutes Follow-up on goals 1-3 minutes Set agenda for current session 1-2 minutes Teach new material or review previously taught material minutes Agree on new homework assignment 3-5 minutes Summarize progress made in current session 3-5 minutes

Significant others can be involved Can share their educational handouts Can request help in practicing specific skills Can invite significant others to participate in some sessions. Are especially helpful in sessions which involve developing a relapse prevention plan

Practitioners are: Social Workers Occupational Therapist Counselors Case Managers Nurses Psychologist All need training and ongoing supervision.

How is it holding up to the “2 Keys” Remember the 2 key principles to successfully Transforming a Mental health Service Delivery System?

1. Services and treatments “must be consumer - and family- driven –geared to give consumers real and meaning full choices about treatment options and providers; not oriented to the requirements of bureaucracies.” (Federal Action Agenda p.19)

2 Key Principles of Transformation 2. Care must focus on:  Increasing one’s ability to cope with life’s challenges  Facilitating recovery  Building resilience “And NOT just on managing symptoms”. ( Federal Action Agenda p.19)

To me… It feels very rigid. The “partnership” between” consumer and provider is missing. No role for Peer Specialist

Other states have Added Peers as team teachers with the practitioners. Some have given the whole program to Peers to run

What’s the problem with that?

Core evidence-based components Psychoeducation behavioral tailoring for medication relapse prevention training Coping skills training.

IMR Fidelity Scale 13 items developed to measure the adequacy of implementation Each item is rated on a 5-point behaviorally- anchored rating scale ranging from 1 (“Not implemented”) to 5 (“Fully implemented”). The “Fully implemented” ratings were determined through expert sources and empirical research.

How the Rating Is Done The assessment is conducted through a site visit. It requires a minimum of 4 hours to complete longer stays allows for collection of more data and hence should result in a more valid assessment.

Data collection procedures include chart review review of educational handouts semi-structured interviews with program leader, IMR practitioners, and IMR consumers. When feasible, fidelity assessors should observe one or more IMR sessions (either live or a videotaped session).

The IMR fidelity assessment is Primarily based on documentation in progress notes. if these notes do not exist or are not easily available, the fidelity assessment will take a very different course. The goal is to examine the charts and 5 most recent progress notes of IMR sessions for each of 5 IMR consumers

Who Does the Ratings? Individuals who: Have experience and training in interviewing and data collection procedures (including chart reviews). Have an understanding of the nature and critical ingredients of IMR. We strongly recommend all fidelity assessments be conducted by at least two assessors.

Do you have enough data? Are Services and Treatments consumer - and family-driven? Are they geared to give consumers real and meaningful choices about treatment options and providers?

Do you have enough data? Does care focus on: Increasing one’s ability to cope with life’s challenges? Facilitating recovery? Building resilience? Just on managing symptoms”.

The ball is in your court… YOU decide!