1. Community Support Services Training Direct Care Series – Session 4
Rutgers, The State University of New Jersey
School of Health Professions
Department of Psychiatric Rehabilitation and Counseling Professions

2. Session 3 Review Motivational Interviewing 8 Dimensions of Wellness
Learning Application: What was your experience using the wellness assessment form?

3. Learning Objectives
Describe the impact of person-first language on service delivery
Identify the components of a Rehabilitation Needs Assessment (RNA)
Explore the importance of breaking a goal down into its critical components
Identify critical knowledge, skills, and resources needed to achieve goals
Examine the framework of SMART documentation

4. What is person-first language?
Referring to people in a way that emphasizes or focuses attention on the fact of their humanity and personhood, rather than on the existence of a disability, illness, condition, or characteristic.
(Psychiatric Rehabilitation Association, 2016)

5. Why person-first language?
Words we choose to use to portray people with mental illness reflect our attitudes and beliefs about the value, dignity, and worth of people with disabilities.
(Pratt, Gill, Barrett & Roberts, 2014)

6. Person-first Language
By interacting with people as people first and, through our actions and our words, by using “person-first” language, we educate the public that the people who are assisted through rehabilitation services are people first.
Expressing a person-first philosophy and adhering to it are two separate matters. In order to make this philosophy come alive, we must each become acutely aware of the words we commit to paper or to conversation, and equally aware of the manner in which we represent ourselves, both in public and in private interactions.
(Psychiatric Rehabilitation Association, 2016)

7. “If thought corrupts language, language can also corrupt thought”
“If thought corrupts language, language can also corrupt thought”. -George Orwell

8. The Impact of Language
Unfortunately, disability diagnoses are often used to define a person’s value and potential, and low expectations and a dismal future may be the predicted norm.
A person’s diagnosis is often used to decide how/where the person will be educated, what type of job he will/won’t have, where/how he’ll live, and more including what services he is thought to need.
(Snow, 2009)

9. Activity: Person-first Language

10. Rehabilitation Needs Assessment (RNA)

11. Rehabilitation Needs Assessment (RNA)
A process – not a form
The form documents the process of exploration, discussions, assessment
Creates a blueprint for attaining desired goals
Forms the basis for the Individual Rehabilitation Plan
Comprehensive in scope and depth

12. Preliminary Rehabilitation Needs Assessment (PRNA) & Comprehensive Rehabilitation Needs Assessment (CRNA)

13. PRNA and CRNA Timeframes
Completed prior to admission
Completed by the 14th day of admission, every six months for the first year after the initial assessment, and annually thereafter

14. RNA Assumes goal attainment is possible Identifies areas of need
Is not used to screen out, reject or show inability to attain goal

15. Balance of Strengths & Needs
Med and Psych Sx.
Functional limitations
Strengths
Supports
Abilities
Preferences

16. Strengths Real strengths that will support goal attainment
Not a generic laundry list that never makes it to the IRP or intervention phases of rehabilitation
2 friends
Family in area
Likes animals
Is kind
May not be “packaged” as a strength
Non compliant? May indicate self determined and self-advocacy
Pays drug dealer regularly? Is able to budget
History of homelessness? Resilient and resourceful

17. How Is a RNA Similar To What I Do Now?
Gathers information typically covered in a traditional psychosocial assessment.
Provides an assessment of support or assistance needed in various areas of functioning.
Is intended to inform the Individual Rehabilitation Plan.

18. How Is a RNA Similar To What I Do Now?
Asks about current and past experiences in areas of psychiatric treatment, employment, education.
Can feel very invasive with expectation to reveal personal information that may or may not be relevant to the person’s goals and aspirations AND if not done with interest, compassion and skill.

19. How is the RNA Dissimilar To What I Do Now?
Focus on valued life roles.
Incorporates a conversation on the person’s hopes, dreams and aspirations.
Explores past and current experiences and interests related to social life, education, employment next.
Is followed by a “deeper dive” into the areas that are mutually agreed upon and prioritized.
Must tie directly to goals and Individual Rehabilitation Plan.

20. Hopes, Dreams & Aspirations
Not an easy conversation
Many don’t know, are afraid to acknowledge, or have given up
We’re afraid this will trigger disappointment, anger, sadness
Keep a person’s aspirations front and center throughout:
assessment, goal setting, planning, and intervention
Tie back to goals that are established

21. RNA Form

22. RNA Activity Break up into groups of three Identify
Counselor (staff completing the RNA)
Client (do NOT play a role… just be yourself)
Observer
The counselor will review and complete 2 to 3 sections of Part 2 of the RNA
Client and observe to provide feedback
Switch roles

23. S-M-A-R-T Documentation
Specific M
Measureable A
Attainable R
Realistic T
Timely

24. https://youtu.be/1-SvuFIQjK8
S-M-A-R-T Video Clip

25. The S-M-A-R-T Framework
Documentation should be straight forward and emphasize what you want to happen
Specific
Measurable
Attainable
Realistic
Timely
Measurable progress so you can see the changes over time
Provide a clear target to work toward
This does not translate into easy, but rather “do-able”
Should require some effort, but seem reachable

26. Open Discussion Do you use SMART documentation?
How can the SMART framework improve your work?
How would you use the SMART framework to develop rehabilitation plans? Give examples?

27. SMART Activity
Do these goals/interventions follow the SMART framework? Are they rehabilitation oriented?
If not, what changes need to be made?

28. I will Start to build relationships in the community by making 1 friend by 8/15/17

29. I will reduce the amount of times I visit the hospital by 8/20/17

30. I will improve my health by losing 80lbs by 8/1/17

31. I will complete a partial care program

32. I will enroll as a full time college student by 7/31/17

33. Activity: Personal Goal Setting
Pair back up with your group and use the SMART framework to rewrite the goals you identified from the RNA
Share with the larger group: Are these goals really S-M-A-R-T?

34. Potential Barriers Do you use S-M-A-R-T documentation?
Why is documenting in S-M-A-R-T format essential as we move to a fee-for-service model?
Implications for the electronic health record?

35. Exploration Leads To Interventions
Knowledge
What does the person need to KNOW
Skills
What does the person need to DO
Resources
What does the person need to HAVE
This follows the CRNA – completed by staff since this leads to IRP and interventions

36. Example – Making friends
Knowledge
Skills
Resources
Qualities you want in a friend
Conversational skills
Opportunities to meet and interact with other people
General role and expectations of a mutual friendship
Recognizing positive qualities in someone (as well as potentially harmful qualities)
Support to discuss issues that may arise with friends and how to address
Personal benefits to having friends
Negotiation skills
Transportation to get together with friends
Self awareness of interests, needs and expectations
Expressing interest in someone else’s experiences, etc.
Money to do things like go to movies, out for a meal, etc.

37. Knowledge, Skills, Resources Form

38. Activity Facilitator role-play Go back to your group
Review your goal identified from the RNA
Step 1: Utilizing effective communication skills, brainstorm an extensive list of what is needed for success

39. Activity Facilitator role-play
Step 2: Break out the items into the specific categories: knowledge, skill, or resources
Use the KSR template, place your list into the appropriate category:
Knowledge: What would you need to know
Skills: What would you need to do
Resources: What would you need to have
Step 3: Check off
Once in the appropriate categories, identify if the item is something you already have or something you need to work on

40. Learning Application
Review IRP’s in your agency and assess if they follow they SMART framework. Be prepared to share next session.
For session 5, please bring a deidentified sample IRP and a corresponding progress note.

41. Q&A and Evaluations

42. Zakia Clay, MSW, LCSW, CPRP Anthony Zazzarino MA, LPC, ACS, CPRP
Contact Information
Zakia Clay, MSW, LCSW, CPRP
Ann Reilly MA, LSW, CPRP
Anthony Zazzarino MA, LPC, ACS, CPRP

43. References
Larosiliere, V (2011). Community Support Services [memo]. Retrieved from ders.pdf Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2014). Psychiatric rehabilitation. (3rd ed.). San Diego, CA: Elsevier Inc. Psychiatric Rehabilitation Association. (2016). PRA Language Guidelines. Retrieved from guidelines Snow, K. (2009). People first language. Retrieved from: Swarbrick, M. (2012). Introduction to Wellness Coaching. Freehold, NJ: Collaborative Support Programs of New Jersey Inc. Inc., Institute for Wellness and Recovery.