RTP Newsletter Header - Issue No. 6, July, 2011
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 Featured Practice
Crisis Respite. A project of the Georgia Mental Health Consumer Network, the Peer Support and Wellness Center (PSWC) is a peer-run alternative to traditional mental health services. Services include daily Wellness Activities, a 24/7 Warm Line and Respite.

“We are about wellness, not illness,” is their motto.

All staff are Certified Peer Specialists trained in Intentional Peer Support, which was created by Shery Mead.

Daily Wellness Activities are holistic and non-clinical in nature, and include Aroma Therapy, Creative Writing, Art Explorations, bowling, the Wellness Recovery Action Plan, Double Trouble in Recovery, Trauma Informed Peer Support, and Job Readiness. Other activities are held in the community, where events, workshops, and training are taking place.

The 24/7 Warm Line provides peer support over the phone. Through a partnership with the Georgia Crisis and Access Line (GCAL), non-crisis calls from GCAL are transferred to the Warm Line and crisis calls from the Warm Line are transferred to GCAL.

“Talking to a peer every day reminds me I am not alone,” says one caller. “It helps me to stay connected.”

“Respite” is a non-clinical alternative to psychiatric hospitalization. The PSWC has three Respite beds in a residential neighborhood, where individuals can stay for up to 7 nights, free of charge, and receive peer support 24 hours a day. Guests cook and clean for themselves and come and go as they please without any disruption to their daily routines. To be eligible for Respite, a person completes a “Proactive Interview” when he or she is doing well. This dialogue serves to build a relationship with peer staff before a Respite stay is needed.

Peer relationships are built on mutuality and moving toward a life of wellness and recovery. The PSWC is a trauma-informed environment where individuals are treated with dignity and respect.

“We hold the hope for each person who comes to the PSWC,” says Director Jayme Lynch. “We believe recovery is possible for everyone.”

Two new PSWCs opened on June 30, 2011. One is located in Cartersville, Georgia; the other is in Cleveland, Georgia.

—Jayme Lynch, CPS, Director, Peer Support and Wellness Center, Decatur, Ga.
 Training and Technical Assistance
Training and Technical AssistanceTraining. RTP provides quarterly training Webinars on topics related to recovery-oriented practice. Today, July 28, 2011, RTP conducted the third of a four-part series, “Step 3 in the Recovery-Oriented Care Continuum: Promoting Recovery Through Psychosocial and Social Means.”

This Webinar described a few approaches to promoting recovery that involve psychological and social interventions. First, David Kingdon, M.D., updated participants on the state of the art in cognitive-behavioral psychotherapeutic approaches to serious mental illnesses (schizophrenia and bipolar disorder). Next, Larry Davidson, Ph.D., described the key common elements of psychiatric rehabilitation approaches that involve in vivo support (supported employment, education, housing, etc.). Finally, Jayme Lynch, CPS, described the role of consumer-run programs and businesses as they offer alternatives to traditional programs and settings (e.g., clubhouses).

You can conveniently download the presentation slides and the complete recorded session from the RTP Resources Web page at: http://www.dsgonline.com/rtp/resources.html.

The next RTP Webinar will take place in September. The title will be “Step 4 in the Recovery-Oriented Care Continuum: Graduation.” This Webinar will complete the series by looking at the "back door" of the service system—ways to facilitate people in moving on and beyond specialty behavioral health care. The notion of "graduating" from formal services is most effective when engaged early in the process, so the Webinar will begin by addressing ways people can be assisted in making connections to community resources while still receiving formal services. Watch your email for the date, time, and details on where and how to register!

Technical Assistance. RTP Technical Assistance (TA) provides valuable resources that support learning strategies for implementing recovery-oriented care in practical and sustainable ways. We have an extensive library of recovery-oriented articles, personal stories and anecdotes, curricula, videos, and links to relevant publications and professional sources. To access TA, contact RTP TA staff, Monday through Friday, from 9:00 a.m. to 5:30 p.m., at 877.584.8535, or email requests to RecoverytoPractice@dsgonline.com. Each request will be responded to within 48 hours of receipt. Arrangements for longer consultations are available on a case-by-case basis.

Although mental health practitioners are the Resource Center's primary audience, anyone interested in promoting the cause of recovery transformation is welcome to access RTP training and TA.
 Project Update
The summer season continues to be very active for RTP. We are extremely enthusiastic about SAMHSA’s approval of the new RTP Web site design, which fits nicely within SAMHSA’s recently refreshed site. Watch for our announcement and the link soon!

In other news, our Steering Committee met in June and enjoyed a dialogue with the professional discipline awardees about their training outlines, which are now under development. Steering Committee members asked questions and offered guidance on additional strategies for the awardees to consider. Our next Steering Committee meeting will be in December.

SAMHSA has asked RTP to lead a variety of activities that address the use of medications in recovery-oriented practice—a topic that is discussed among many and written about extensively. We are planning a dialogue in the fall to convene stakeholders who will discuss their perspectives on an array of subtopics inherent in the medications conversation, such as efficacy, acceptance in addictions treatment, the role and impact of culture, and use within primary care settings. Following this gathering, a series of briefing papers will be prepared and made available through our Web site. A third venue for promoting conversation about psychopharmacology will be a live Webinar sometime during FY2012. We will announce the date and time in an upcoming issue of our Weekly Highlights.

In addition to working on individual projects, the RTP professional discipline awardees are joining together and participating as a multidisciplinary group to share strategies and practices. In June, Steve Harrington from the National Association of Peer Specialists presented an RTP poster session at the US Psychiatric Rehabilitation Association conference in Boston. This October, representatives from the RTP awardee groups will lead a workshop at the Alternatives Conference. This is a first for the group as a whole. Jessica Holmes, RTP Project Director from the Council on Social Work Education, is coordinating the proposal and arrangements for the group.

The RTP initiative will also be a focus of four sessions at the upcoming Annual Convention of the American Psychological Association (APA) to be held in Washington, D.C., August 4-7. These are:

Thursday 8/4/11

9:00–9:50 a.m. Will Psychology be Relevant in the Era of Health Care Reform: The Need for Recovery-Oriented Care

1:00–1:50 p.m. Treating People with Serious Mental Illness: Development of New Curriculum and Training Modules for Clinical Psychologists

Friday 8/5/11

9:00–9:50 a.m. SAMHSA Priorities and Future Directions (Pam Hyde, J.D., SAMHSA Administrator)

Sunday 8/7/11

9:00–9:50 a.m. Bringing Psychologists into the Revolution of the Recovery Model of Mental Health Care

In addition to Administrator Hyde, presenters and discussants will include RTP Project Director Larry Davidson and members of the APA's RTP Steering and Advisory Committees (Peter Ashenden, Arthur Evans, Mary Jansen, and Bruce Zahn).

Finally, the RTP professional discipline awardees are planning a joint conversation in the near future to discuss how they can participate in SAMHSA’s upcoming National Wellness Week, September 19-23. We are all looking forward to highlighting recovery-oriented practice among professionals as part of a major paradigm shift in behavioral health care.
 Guest Columnist
Charles Rapp PictureStrengths Model and Recovery. One of the major contributions of social work to the Recovery Movement is the Strengths Model. First formulated in the early 1980s by the University of Kansas School of Social Welfare, the Strengths Model was an early harbinger of recovery-oriented practice. It took a rather radical position at that time, which emphasized the talents, competencies, and resources of people and environments rather than the dominant view, which focused on pathology, deficits, and problems. The six principles of the model are
  1. People with psychiatric disabilities can recover, reclaim, and transform their lives.
  2. The focus is on individual strengths, not deficits.
  3. The community is viewed as an oasis of resources.
  4. The client is the director of the helping process.
  5. The worker-client relationship is primary and essential.
  6. The primary setting for work is the community.
The Strengths Model is not just a philosophy or perspective, although it is both of these things. As a whole, it is a set of values and principles, a theory of practice, and the explicit practice methods and tools that, once employed, help clients achieve the goals they set for themselves. The empirical testing of the model includes two experimental studies, two quasi-experimental studies, and five non-experimental studies. Positive results have been found for a wide range of measures, with improved social functioning and a reduction in symptoms being most consistent. The most comprehensive treatment of the model is The Strengths Model: Case Management with People with Psychiatric Disabilities, written by Charles A. Rapp and Richard J. Goscha and published by Oxford University Press.

—Charles A. Rapp, Ph.D., Research Professor, University of Kansas School of Social Welfare, Lawrence, Kan.
 Professional Discipline Training Awards
Over the last three months, since the completion of their Situational Analyses, the RTP professional discipline awardees have taken great strides in developing their training outlines, moving closer to characterizing the actual content of the curriculum. They are currently working closely with their consumer advisors and staff to design learning experiences where an optimal number of participants interact in a variety of hands-on exercises, engage as individuals and in small groups during a dynamic agenda of mixed media, and test their understanding of putting recovery into practice.

Awardees have identified the target audience within their profession that will be eligible for the RTP training based on discoveries revealed and analyses conducted over the last year. By professional discipline, the target audiences are as follows (as described by the organization):

American Psychiatric Association/American Association of Community Psychiatrists:

Receivers of training, including
  • Psychiatry residents, medical students, and fellows;
  • Very early career psychiatrists;
  • Public/community psychiatrists (including National Health Service Corps and VA); and
  • Inpatient psychiatrists and emergency psychiatrists (acute care settings)
and trainers/supervisors, including
  • Residency program supervisors and lecturers, medical student educators;
  • Case conference and grand rounds organizers; and
  • “Early adaptor” local training organizers and training providers
American Psychiatric Nurses Association: Inpatient psychiatric mental health nurses

American Psychological Association: Training directors in clinical, counseling, and school psychology at APA-accredited doctoral programs

Council on Social Work Education: Field instructors—practitioners who are working in the field and serve as supervisors to social work students

National Association of Peer Specialists: Working Peer Specialists

Following their final outlines, which will be completed in September 2011, the professional discipline awardees will develop training manuals. The training manuals will contain the complete curriculum as well as the process for pilot testing, marketing, and implementing recovery-oriented training with their target audiences. A year from now, the first phase of pilot testing will be underway.
 Personal Story
Alice Holstein Picture Tough Grace: Mental Illness as a Spiritual Path. Alice Holstein was the third annual recipient of the “Shooting Star Award” from the Mental Health Coalition of Greater La Crosse, Wis. This article is based on her May 12, 2010, acceptance speech at a reception sponsored by Don and Roxanne Weber.

The speech was dedicated to those who were not in attendance, such as those in our jails, under our bridges, at the Salvation Army, in psychiatric wards, and in one of the four to five households affected by mental illness. The war they fight is often unheralded, unclaimed, and full of sacrifice and pain. We need to honor them and their families for the heroic deeds they undertake just to live.

This version of my story is based on one of my deepest passions—how I have come to view my illness as a spiritual path. Accordingly, the title is “Tough Grace: Mental Illness as a Spiritual Path.” I am taking advantage of my bully pulpit today to create some understanding about mental illness by sharing my story of struggle and triumphs.

Where I’m headed with this subject is to talk first about some of the lemon parts that went into making lemonade, including some examples of the losses that we incur as we battle getting well. Then, how I healed—what transformed me. Finally, three different perspectives on why this has turned out to be a profound spiritual path. But first, what do I mean by the word “spiritual?” I believe that everyone must define it for themselves. To me it means that which guides and supports me, that which provides meaning and purpose all wrapped up in a reverence for life.

My illness has been manic depression, characterized by the high highs of mania followed by the low lows of depression, with periods of normalcy in between. I had a tougher time with this illness than many for a variety of reasons.

You can see some of the symptoms of the illness in the following list of “Ain’t It Awful” experiences. I had 13 to 14 hospitalizations and probably 15 manic episodes over 12 years. I can see, in retrospect, 20 years of symptoms starting in the 1980s—12 of them psychotic. My worst symptom was paranoia; I believed there was a giant drug and vice conspiracy operating everywhere, so there was nowhere to go for help. I was argumentative and disruptive. The police picked me up more than several times. I bought three cars I didn’t need and had eight adverse reactions to various medications. I went on spending sprees that cost thousands and had back-breaking medical bills. I was guilty of reckless driving and had three car accidents in one year. Fear drove me to travel far from home to some 10 states—not exactly the vacations I would have planned. I created unbelievable messes, fouling my financial affairs, packing up my house, giving things away and leaving belongings in various places that then had to be retrieved over long distances. I intruded on other people’s time and property.

To read this article in its entirety, please click here.
 Resource Spotlight
30 Frequently Asked Questions (FAQs) for Recovery to Practice (RTP)

The following RTP FAQs and preliminary answers are available through the RTP Resource Center. To view the complete list of questions and answers, click here for access to the RTP Resources Web page. When the RTP Web site is live, you will be able to access and use this resource as a ready reference.
  1. Do people really recover? And if so, why don’t I see them?
  2. Is recovery evidence based?
  3. How is recovery-oriented care different from simply implementing evidence-based practices?
  4. How is recovery different from psychiatric or psychosocial rehabilitation?
  5. How does recovery-oriented practice relate to the medical model or clinical care?
  6. Is the recovery movement anti-professional?
  7. How do you see mental health recovery interfacing with the substance abuse recovery movement?
  8. How is recovery relevant for inpatient units and/or psychiatric emergency departments?
  9. How is recovery relevant for a justice-involved client population?
  10. Is recovery different for people from different cultural backgrounds?
  11. How is recovery relevant for children and youth? What does “resilience” mean? What does it mean for practices to be resiliency oriented?*
  12. How can I instill hope in those I work with? What if people don’t want care, or don’t have personal goals?
  13. What role do medications play in recovery?
  14. How can consumers self-direct their treatment and their lives if they have a mental illness?
  15. Do you really believe that people with serious mental illnesses should be trusted to make their own decisions?
  16. Why is work an important component of recovery?
  17. Many people living with psychiatric illness are often concerned about losing their benefits if they return to work. How can you address these concerns?
  18. What role does trauma play in recovery?
  19. What role does spirituality play in recovery?
  20. What roles do the body and physical well-being play in recovery?
  21. What is peer support?
  22. Who provides peer support?
  23. How/where can you find funding for peer support services?
  24. What are the various roles that people in recovery can play as service providers?
  25. Should peers work as peer specialists in the same clinic/program where they receive their own mental health care?
  26. How can program directors take a leadership role in motivating their staff to become recovery oriented and develop true partnerships with clients?
  27. How does the relationship between the practitioner and the service user change in recovery-oriented practice?
  28. How can a practitioner adopt recovery-oriented practices within the context of a traditional or conventional mental health program or setting?
  29. What kind of culture change is required to support recovery-oriented practices?
  30. How are recovery-oriented services funded? Are they supported by Medicaid and/or Medicare?
 Related Links
The Georgia Mental Health Consumer Network, Inc. is a non-profit corporation founded in 1991 by consumers of state services for mental health, developmental disabilities, and addictive diseases. Their mission is to "promote recovery through advocacy, education, employment, empowerment, peer support, and self help, and to unite as one voice to support the priorities set each year at the annual convention."

Since its inception in August 2001, the Turn-A-Frown Around Foundation, Inc. (TAFA) has brought love and laughter to folks in nursing homes, psychiatric wards, and partial care programs (mental health day treatment). They offer a friendly ear to support those in need through their outreach phone service, "The Unconditional LoveLive," and make personal visits, phone calls, and email contact with those seeking help. Their role in the community is to assist people living with psychiatric and physical disabilities who have lost hope or feel isolated by linking them with a "forever friend" network. TAFA reaches out to these individuals to help them attain a sense of hope and well-being through the affirmation and recognition of caring others. A staggering 50 percent of nursing home residents and 75 percent of mental hospital patients will die without a friend. TAFA aims to change those statistics by bringing love, laughter, and a listening ear to the lonely and isolated in nursing homes, mental hospitals, children's homes, and more.

SAMHSA’s 10x10 Wellness Campaign launched its free brochures and posters for clinicians, community organizations, consumers/survivors, and peers who want to increase the life expectancy of people with behavioral health challenges by 10 years over the next 10 years. The new resources include
  • Top Three Ways to Promote Wellness poster (SMA10-4569)
  • Eight Dimensions of Wellness poster (SMA10-4568)
  • Informational brochure for primary care providers that provides strategies for talking about wellness and connecting with patients’ behavioral health care providers (SMA10-4566)
  • Motivational brochure for consumers/survivors/peers that describes how to incorporate the Eight Dimensions of Wellness into everyday life (SMA10-4567)
  • Informational brochure to raise awareness about the disparity in early mortality for people with behavioral health problems and gain “champions” for the 10x10 Wellness Campaign (SMA10-4565)
These consumer-centered tools establish a shared language for talking about how wellness can support recovery for individuals with behavioral health challenges. To order or download the free materials, visit