RTP Newsletter Header - Issue No. 7, October, 2011
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 Featured Practice
Cognitive Therapy for Psychosis. Over the years, psychological treatments for psychosis have had a mixed response. Until recently, evidence of their effectiveness was questionable. But now there are more than 30 internationally conducted studies that show cognitive therapy has beneficial effects when adapted for people experiencing both positive and negative symptoms. Thus, its use has increased in the past few years. As people have become familiar with cognitive therapy, treatment guidelines (e.g., the Patient Outcomes Research Team recommendations) have incorporated it and the demand has grown.

Cognitive therapy for psychosis (CTP) helps clarify links between beliefs, feelings, and behavior. It enables people to explore their important concerns (beliefs), which often include worries about other people, e.g., conspiracy fears; distress (feelings) resulting from troubling experiences, e.g., voices; and disability (actions) resulting from powerlessness and demoralization, in a way that can improve understanding and coping.

Psychological work involves understanding how and why voices or strong beliefs develop and interfere with people's lives. Exploring these issues can lead to reduced distress and disability, allowing individuals to mobilize personal resources and accept support from behavioral health services. Moving away from beliefs that delay recovery becomes possible and sustainable.

CTP is a common sense approach, normalizing and destigmatizing experiences when appropriate. It uses a structured yet flexible and sensitive process to engage people and work systematically through assessment, formulation ("making sense"), and goal and target setting, with specific techniques for managing voices, delusions, and negative symptoms.

This kind of therapy has proven valuable in a range of settings. In hospitals, it can assist in assessment and productive interaction about risk-related issues, distressing experiences, and medication use. Outside the hospital, it can help engage people whose personal beliefs may clash with the use of behavioral health services and medication. It can also have additional value supplementing medications that only partially relieve symptoms.

CTP is used by clinical psychologists and nurse therapists in certain settings, but it has also been successfully implemented by nursing staff and case managers. Psychiatrists often find CTP techniques valuable in working and negotiating with clients, e.g., regarding attitudes about treatment.

Quite a number of services throughout North America, including Ohio, Wisconsin, and British Columbia, have made progress training staff in CTP. Others will follow as the treatment becomes more generally accepted.

—David Kingdon, M.D., professor of Mental Health Care Delivery, University of Southampton. Dr. Kingdon addressed the use of cognitive-behavioral therapy in the July 28, 2011 RTP Webinar, "Promoting Recovery Through Psychological and Social Means."

 Training and Technical Assistance
Training and Technical AssistanceTraining. Recovery to Practice provides quarterly training Webinars on topics related to recovery-oriented practice. On October 6, 2011, RTP conducted the final Webinar in a four-part series addressing the continuum of recovery-oriented care. The Webinar focused on a relatively new but important concept: an individual's graduation from formal services, which often involves a transition to less formal, community-based supports.

If people can recover from or learn to cope with serious mental illnesses, how can mental health professionals plan for this transition from the very beginning of treatment? During the Webinar, this question was addressed by three experts: Wesley Sowers, M.D., a psychiatrist and Director of the Center for Public Service Psychiatry at Western Psychiatric Institute and Clinic; Lauren Spiro, M.A., Director of the National Coalition for Mental Health Recovery; and Antonio Lambert, CPS, RTP Specialist for the National Association of Peer Specialists. Dr. Sowers approached the issue as a psychiatrist who has accompanied people on recovery journeys and helped them to heal and reclaim full and meaningful lives beyond the boundaries of the mental health system. Ms. Spiro and Mr. Lambert described personal recovery experiences, as well as their work in facilitating the recovery of others, identifying resources and supports that are instrumental in recovery. These included elements of formal treatment, such as healing relationships and medication, and spirituality, friends, and "giving back" by helping others.

The Webinar also discussed options and alternatives for those who wish to move on from formal services, and how we can help ensure that people who have optimally benefited from treatment have a meaningful life to return to.

Download the presentation slides and recorded session from the RTP Resources Web page at http://www.dsgonline.com/rtp/resources.html

The next RTP Webinar is scheduled for December. Watch your email for the topic, date, time, and registration details. 

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

Although behavioral health practitioners are the Resource Center's primary audience, anyone interested in promoting recovery transformation is welcome to access RTP training materials and TA.

 Project Update
As a new fiscal year begins, RTP is enjoying continued momentum for a number of different efforts. Our library of resources on recovery-oriented care has expanded to contain more than 700 items ranging from articles and personal stories to videos and links. If you are looking for a particular piece, or would like us to search a specific topic, please send a request to recoverytopractice@dsgonline.com. When the new RTP Web site is live, you will be able to search the library's many materials directly.  

RTP supported SAMHSA in planning and conducting the Dialogue on Psychopharmaceuticals in Behavioral Healthcare on October 11 and 12, 2011. More than 50 people attended the meeting, including practitioners from the substance use and mental health services fields, consumers, researchers, Federal staff, and program managers. The purpose of the meeting was to share perspectives on a range of topics related to the use of medications for mental health and substance use disorders, and to provide recommendations about those topics. Participants discussed decision making; efficacy; acceptance in addictions treatment; the role and impact of culture, including alternatives; the use of medications throughout the human life span; medication in court-ordered treatment; and medication use within primary care settings. When finalized, the Executive Summary and subsequent report will be publicly available.

During National Wellness Week, September 19–23, 2011, part of National Recovery Month, the RTP professional disciplines planned activities and posted announcements to increase their members' awareness of the link between recovery and wellness.

The American Psychiatric Association (ApA) added informative materials to its Web site, including psychiatrists' essays and testimonials on recovery, a wellness fact sheet with statistics on the physical health of people with mental illness, and a list of recovery sessions to be held at the October 2011 ApA Institute on Psychiatric Services. See more at http://www.psych.org/Share/OMNA/Recovery-to-Practice_1.aspx.

The American Psychiatric Nurses Association posted information about SAMHSA's efforts to promote wellness and increase life expectancies for people with mental health and substance use problems. Special art and recovery initiatives compiled by Gayle Bluebird are also available on their site. Visit their RTP Resources page for more information.

In an effort to promote wellness, demonstrate a commitment to improving mortality rates for people with mental health disorders, and inspire health and wellness in the workplace, the American Psychological Association organized a line dance for its office neighbors. There was a great turnout and participants stepped to the beat of different dances, ate healthy snacks, and enjoyed each other's company. See a clip of their dance.

The Council on Social Work Education (CSWE) featured National Wellness Week in their September 2011 issue of Focus, a member newsletter. In addition to highlighting events on their Web site, CSWE posted one tweet each week in September about National Recovery Month and Wellness Week, the Joint Resolution, and the Eight Dimensions of Wellness.

The National Association of Peer Specialists RTP team posted announcements on SAMHSA activities on their Web site. Visit the site to catch a glimpse of the line dance held during their annual conference in late August.

 Guest Columnist
Miraj Desai PictureCulture and Empowerment. My initial interest in clinical psychology was fostered by early experiences of prejudice and discrimination. These experiences awakened me to the need for greater awareness among practitioners and scholars about issues facing culturally diverse groups. In the post–9/11 environment, my friends and I were subjected to continued harassment and threats, merely because of the way we looked, which left my personal sense of community profoundly altered.

It would take an arduous journey of suffering and healing to regain my lost sense of trust and safety. Writing my undergraduate thesis on everyday prejudice in a post–9/11 world was a major part of the rebuilding work. With the help of mentors and friends, I was able to cultivate my renewed strength and voice. I also found my calling in psychology, which I believe can play an essential role in mitigating the harmful effects of dehumanization.

The recovery movement embodies this humanizing approach, promoting greater respect, appreciation, and empowerment for all members of society. Dr. Larry Davidson and his colleagues fittingly place the recovery movement within a larger civil rights and capabilities perspective, powerfully demonstrating how recovery involves "establishing, reestablishing, or reclaiming a meaningful life in the community" rather than focusing solely on "disorder, deficit, and disability." Strength and voice are central to this view. Instead of locating the pathology in the person, mental health practitioners are journeying along with their clients, examining and questioning the outer world and its relation to their clients' lives and happiness. It evokes what phenomenologist and psychologist Maurice Merleau–Ponty once said: the very notion of the person implicates the outer world, and neither can be understood without the other ("there is no inner man [sic], man is in the world, and only in the world does he know himself").

Having had the opportunity to practice these empowerment principles through the clinical/community psychology internship at Yale University and the Connecticut Mental Health Center, I have already seen and heard how the approach is making a dramatic difference in people's lives. I have also witnessed what a recovery-oriented, community-based mental health system looks like. For instance, I work closely with the Community Services Network, a remarkable group of community-based organizations whose mission is to improve the lives of people in recovery through comprehensive health, housing, and social opportunities.

In our recovery-oriented work, interesting challenges have also emerged. For example, a colleague of mine is contemplating ways to incorporate the cultural values of his bilingual population into person-centered clinical work. We may find a person's centering is his or her family or culture, and that the person-centered goal is also a family-centered one. It is our responsibility as clinicians to welcome and respect such differences without losing sight of our shared humanity.

Significant elements of my graduate training have informed my recovery-oriented work—particularly education in phenomenology, humanistic psychology, community and global mental health, and indigenous and multicultural psychology. I have benefited from the education of amazing mentors and programs, including Professors Frederick Wertz, Vikram Patel, Maureen O'Hara, and Hawthorne Smith; the Bellevue/NYU Program for Survivors of Torture; and the wonderful American Psychological Association Minority Fellowship Program network. Through their example as role models, these mentors have shown me what a humane and humanistic person is, which transcends any particular approach. Last but not least, my family upbringing and study of India's wisdom and spiritual traditions have been integral to my education.

To read this article in its entirety, please click here.

 Professional Discipline Training Awards
The RTP professional discipline awardees have completed their recovery-oriented training outlines and are developing the training manuals they will ultimately disseminate and deliver. Pilot testing of the training with their respective target audiences will occur next summer. Each discipline has an advisory or steering committee that includes consumers and actively participates in all RTP activities.

The target audience for the American Psychiatric Association/American Association of Community Psychiatrists training is two primary groups—direct service providers and trainers/supervisors. Nine modules intend to achieve the following goals:

  1. Understand the concepts of recovery-oriented care and the reasoning behind it.
  2. Create welcoming environments where people in recovery will feel valued and respected in every aspect of the engagement process.
  3. Recognize the value of person-centered planning and individualized care and understand the mechanisms for implementing them.
  4. Understand the concepts of collaborative medication management and their relationship to other therapeutic options and recovery.
  5. Recognize the importance of providing a comprehensive and integrated approach to recovery, including all aspects of a person's well-being (mental, physical, spiritual, social, etc.), and understand ways to incorporate that approach.
  6. Understand the methods for assisting people in recovery to build life skills and undertake productive/creative activities of their choice.
  7. Understand and use elements of culturally competent care and adapt strategies to individual experiences, both past and present.
  8. Understand the importance of peer support and methods to successfully incorporate peer specialists in treatment teams and connect to voluntary peer support resources.
  9. Become familiar with the array of natural supports that can help individuals recover from mental illness and support integration into the community (to the extent they desire).

The American Psychiatric Nurses Association's target audience is inpatient psychiatric mental health nurses. Module 1 will cover the following three topics:

  1. What is recovery, where does it happen, when does it happen, and who does it happen to?
  2. Inpatient hospitalization as an important context for the recovery process—what and how?
  3. You and recovery—how the nurse as a professional and as a person counts in developing and enhancing recovery-oriented practice.

Module 2 will address the following four topics:

  1. The relationship between the recovery approach to care and the Psychiatric Mental Health scope and standards of practice
  2. Recovery-oriented inpatient therapeutic milieu
  3. The recovery approach to care and understanding the importance of trauma-informed care
  4. The recovery-focused approach to care

The target audience for the American Psychological Association (APA) is training directors at APA accredited programs in clinical, counseling, and school psychology who will ultimately train doctoral students. Modules will address the following topics:

  1. What is recovery?
  2. History and evolution
  3. Community inclusion
  4. Scientific Foundations I and II
  5. Clinical assessment
  6. Person-centered planning
  7. Partnership and engagement
  8. Interventions
  9. Health disparities; system administration and policy
  10. Peer support; ethics
  11. Roles of psychologists
  12. Organizational change and management

The Council on Social Work Education's curriculum will target field instructors—practitioners who serve as supervisors for social work students. Three principal goals—each including multiple learning objectives—comprise the breadth of the curriculum across three sessions:

  1. Educate social workers about mental health recovery.
  2. Teach competencies needed to integrate mental health recovery into social work practice.
  3. Infuse mental health recovery in field instruction activities.

The National Association of Peer Specialists is designing their curriculum primarily for working peer specialists. Eight modules aim to fulfill the following goals:

  1. Familiarize peer specialists with basic recovery principles.
  2. Understand the importance and role of trauma-informed care in peer specialist practice.
  3. Understand cultural awareness and introduce relevant practices that facilitate multicultural effectiveness in peer specialist practice.
  4. Ensure workplace inclusion through good communication and conflict management.
  5. Understand ethical standards and boundaries for peer specialists.
  6. Understand why a holistic approach to peer support is important and how holism can be accomplished.
  7. Understand the nature of co-occurring disorders and peer specialist practices that can facilitate dual recovery.
  8. Understand how to develop more supportive relationships for peer specialists and for the lives of those they serve.

Collaboration among the RTP professional disciplines will continue as the groups decide how to incorporate the multidisciplinary practice that occurs in the field. For example, representatives from the RTP awardee groups will lead a workshop titled "Recovery to Practice: Integrating Mental Health Recovery into Behavioral Health Professions" at this week's Alternatives Conference. Also, at this week's Institute for Psychiatric Services, RTP representatives will lead a workshop titled "Recovery-oriented Practice–A Multidisciplinary Perspective."

 Personal Story
Denise Noseworthy Picture My name is Denise. I am not an illness, but a person who has a life worth living and a story to tell. To give you a glimpse of my personal recovery story requires that I share bits and pieces of my illness story as well. I do this because it is important to know that those who will be in your care can and often do get well. When people share their stories in Alcoholics Anonymous (AA), they talk about what it was like, what happened, and how their lives have changed. I will attempt to do the same as I tell you my story.

Let me begin by saying I am most definitely a walking miracle. For all intents and purposes, I should not be standing here today. But before I get to that part of my story, I would like to share 10 things I think are interesting about me:
  1. I attended more than 40 different schools by the time I graduated from high school.
  2. I prefer the mountains to the beach.
  3. I am addicted to Starbucks Hazelnut Iced Coffee—with seven Splendas!
  4. I am owned by two dogs and two cats.
  5. I love to travel.
  6. Clothes shopping is one of my favorite things to do.
  7. I was kissed by Shamu the killer whale when I was 13.
  8. One of my relatives crossed the Potomac with General George Washington.
  9. I love to snorkel in the Bahamas.
  10. I have a dry sense of humor.

Now, here are 10 things I've experienced that I do not like:

  1. Most green vegetables
  2. Hot weather
  3. Driving in the rain
  4. Losing my cell phone signal
  5. Missing a flight connection
  6. Driving in Atlanta traffic
  7. Getting a flat tire on the interstate 15 miles from the next exit, without the right equipment to change the tire
  8. Conflict with others
  9. Being in the hospital
  10. Being labeled mentally ill

My story begins in the late childhood and early teen years of my life. The problems began at about age 10, when I told my mom I wanted to kill myself. Her response was to bring me a knife, telling me if I was going to kill myself, to do it right. Fast forward to the following year, when I was so depressed I swallowed an entire bottle of baby aspirin. At age 12, I was hospitalized for the first time after once again telling my mom I wished I were dead. I began screaming at her for mostly no reason, slamming doors, and cutting my arms. For the next 3 years, this was the norm.

The year I turned 16 was the first of 20 years plagued by bulimia nervosa. At 18, I attempted to go to college, but quit before the first term was over because I couldn't concentrate. I also had periods of time where I could go four or five nights without sleep.

Since I was not going to college, I entered the working world. In my mind, money meant spending. I turned 28 and started experiencing the devastating effects of depression again. It didn't help that my birth mother passed away 2 weeks after I was diagnosed with depression. Two years later, I was on disability due to the depression that prevented me from getting out of bed most days. I also experienced the first of more than 50 psychiatric hospitalizations in my life.

To read this article in its entirety, please click here.

 Resource Spotlight
It has been said that recovery is primarily the responsibility of the person with the behavioral health condition. In addition to developing training and tools for professionals, then, there should be training and tools for people with behavioral health conditions, to support them in their recovery efforts. Such trainings and tools are being developed throughout the country, and as they become available, Recovery to Practice will bring them to your attention.

To begin, two self-help tools already in use—Wellness Recovery Action Plans (WRAP) and Pathways to Recovery—are amassing an impressive evidence base for supporting recovery efforts of people with serious mental illnesses.

WRAP is an increasingly popular structured process developed by Mary Ellen Copeland and based on her collaboration with many people in recovery over a span of several years. The WRAP Web site defines WRAP as "a system that you devise for yourself that helps you work through mental health challenges or life issues. It is adaptable to any situation. Through careful observation, you identify those things you do to help yourself feel better when you are not feeling well, and those things you do to stay well and enjoy your life (Wellness Tools), and then use these wellness tools to develop personal action plans. People all over the world who are working on their recovery and wellness successfully use this planning process."

Pathways to Recovery is a self-help workbook developed by Priscilla Ridgway, Diane McDiarmid, Lori Davidson, Julie Bayes, and Sarah Ratzlaff through the University of Kansas School of Social Welfare. Also based on the input of many people in recovery, this workbook uses a "journey" metaphor to provide guidance for initiating and managing many dimensions of the recovery process, including seldom mentioned issues like spirituality and sexuality.

According to the University of Kansas Web site, Pathways to Recovery is "a tool to help people move forward in mental health recovery. It is an extensive self-help workbook. The workbook orients people to recovery, helps them to identify their personal strengths and dreams, and refocus on reclaiming positive sources of identity and a life beyond being a person with a psychiatric disability or a full-time consumer of mental health services. It helps people think about and plan how to live a full life, despite their psychiatric history or problems."

Readers who discover additional tools can send them to RTP staff by emailing recoverytopractice@dsgonline.com.

 Related Links
Pathways to Housing. This organization's mission is to transform individual lives by ending homelessness and supporting recovery for people with psychiatric disabilities. The program supports the notion that housing is a basic human right, and aspires to change the practice of homeless services by
  • Providing immediate access to permanent independent apartments, without preconditions
  • Setting the standard for services driven by consumer choice that support recovery and community integration
  • Conducting research to identify innovative solutions and best practices for those who suffer from mental illness and homelessness

For further information, visit http://www.pathwaystohousing.org.

Exponents is a minority-led, community-based organization. Their mission is to improve the quality of life for people affected by drug addiction, incarceration, and HIV/AIDS. Programs are designed to support successful life transitions by engaging people in services that ignite hope and promote awareness. Activities gradually mobilize individuals along a progressive path of stabilization while fostering a sense of community and individual responsibility. Exponents Founder and President Howard Josepher, LCSW, wrote an article titled "Advocacy" for the October 13 Weekly Highlight. Click here to read the article.

For further information, visit http://www.exponents.org.

SAMHSA-HRSA Center for Integrated Health Solutions (CIHS). The Center promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions. CIHS provides training and technical assistance to 64 community behavioral health organizations that have collectively received more than $26.2 million in Primary and Behavioral Health Care Integration (PBHCI) grants, as well as community health centers and other primary care and behavioral health organizations. The PBHCI grant program is part of an unprecedented effort led by Congress and the U.S. Health and Human Services Department to help prevent and reduce chronic disease and promote wellness by treating behavioral health needs on equal footing with other health conditions. CIHS aims to advance the integration of primary and behavioral health care by increasing numbers of

  • Individuals trained in specific behavioral health–related practices
  • Organizations using integrated health care service delivery approaches
  • Consumers credentialed to provide behavioral health–related practices
  • Model curriculums developed for bidirectional primary and behavioral health integrated practice
  • Health providers trained in the concepts of wellness and behavioral health recovery

For further information, visit http://www.centerforintegratedhealthsolutions.org.