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RTP Newsletter Header - Issue No. 10, July, 2012
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 Featured Practice
Spirituality and Recovery by Priscilla Ridgway, Ph.D., MSW. The Center for Community Support and Research (CCSR) at Wichita State University recently facilitated a statewide Summit on Spirituality and Recovery. At the 120-person gathering, Dr. Priscilla Ridgway, CCSR Consumer Initiatives Researcher, provided an overview on spirituality and recovery entitled “Spirituality and Recovery: What Do We Know and How Do We Know It?”

Research on spirituality, religion, health, and mental health is growing and has included large and small studies and first-person accounts. It employs qualitative and quantitative methods and addresses areas such as what helps what hinders recovery, positive coping, alternative and complementary approaches, brain imaging studies on the impact of meditation and prayer, and studies on post-traumatic growth. Some research shows spirituality-based groups demonstrate positive outcomes, thus moving the area of supported spirituality toward becoming an evidence-based practice. For example,
  • Religious participation and feeling close to God are linked to better health and mental health outcomes.
  • Spirituality is a key component to mental health recovery: 60 to 90 percent of people in the U.S. with serious mental health concerns say spirituality and faith are important in their personal recovery. Spiritual practices are a main form of coping for many people with mental health conditions.
  • Ignoring or pathologizing spirituality is wounding. Shame/blame or guilt-based systems of belief are related to poor outcomes.
  • People in mental health recovery may change their faith affiliation or orientation, and/or combine or draw on practices from a number of faith-based or spiritual traditions.
  • Some people experience difficult spiritual awakenings that affect their mental health or have “psychosis with mystic features.” Others in recovery are drawn to being “wounded healers” based on a felt spiritual calling and assist people who are struggling with mental health challenges.
  • Benefits and gifts can result from the struggle with mental health concerns and the transition to spirituality or faith-based communities in recovery. These gifts include a new sense of creativity, greater hope, appreciation of the “little things,” relationships (rather than materialistic values), spiritual growth, sense of belonging, a healthier lifestyle, greater sense of meaning, buffering of stress, sense of forgiveness and peace, and increased compassion for oneself and others.
  • Direct spiritual healing is difficult to measure or understand scientifically, although first-person accounts of recovery are testaments to such experiences.
These findings, along with other work, will be used to flesh out a model of supported spirituality that includes assessment, guidelines for spirituality in strength-based recovery planning, spiritually centered practice models, and efforts promoting inclusion in faith and spiritual communities. A four-page research bibliography and copy of the Summit Report are available upon request from priscilla.ridgway@wichita.edu.

Dr. Ridgway is a researcher at Wichita State University's Center for Community Support and Research, where her work centers on peer recovery education, health self-advocacy, supported spirituality, and healing trauma. She is interested in gathering guidelines, practice models, and efforts to promote inclusion of people in recovery in faith-based or spiritual communities.
 Training and Technical Assistance
Training. RTP’s Webinars address key aspects of implementing recovery-oriented practice. Recordings and presentations for each event are available by download through the following links:

2010
June: Emerging Trends in Program and Workforce Development
September: What Recovery Means in Acute Care
December: Outreach & Engagement

2011
April: Person-Centered Care Planning
July: Promoting Recovery Through Psychological and Social Means
October: Graduation

2012
January: Assessing for and Addressing Trauma in Recovery-Oriented Practice
April: Understanding and Building on Culture and Spirituality in Recovery-Oriented Practice

RTP’s next Webinar, “Evaluating for and Using Medications in Recovery-Oriented Practice,” will discuss approaches for determining the appropriate use of psychiatric medications based on an individual’s situation and condition. The session will include guidelines for safe and effective use of medicine when prescribed and selected as part of a recovery plan. The Webinar is being planned for October 2012. Keep an eye out for more information.

Technical Assistance. RTP Technical Assistance (TA) provides valuable resources that support strategies for implementing recovery-oriented care in practical and sustainable ways.

In the last quarter, we fulfilled requests for resources on recovery-oriented approaches to prescribing and medication management; culturally centered approaches to health care; definitions and benefits of peer support; sample treatment planning formats incorporating resiliency and recovery; alternatives to psychotropic medication; clergy and spiritual counseling; mental health fact sheets for children, seniors, and veterans; and state licensing boards.

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 staff Monday through Friday from 9 a.m. to 5:30 p.m. at 877.584.8535, or email requests to recoverytopractice@dsgonline.com. We will respond to each request within 48 hours, and arrangements for longer consultations can be made on a case-by-case basis. Although behavioral health practitioners are RTP's primary audience, anyone interested in promoting recovery transformation is welcome to access RTP training and TA.
 Project Update
RTP continues to reach out to people with interest and expertise in recovery. Our goal is to advance the implementation of recovery-oriented practice among professional practitioners. With that in mind, our multimedia resources cover a wide range of related topics. In the last quarter, for example, RTP’s Weekly Highlights reflected practitioners’ perspectives on recovery, including "Collaborative Assessment and Management of Suicidality," how peer specialists and their supervisors can work together, recovery and treatment plans, resident recovery training, and using the term ‘mental Illness’. We also shared several personal stories from consumers whose lived experience provides practice-based evidence for behavioral health care transformation. To read archived issues of the Weekly Highlight, visit http://www.dsgonline.com/rtp/resources.html.

RTP’s Steering Committee met in June via teleconference. During the call, the six RTP professional disciplines updated participants on their curricula development. A rich discussion offered everyone the opportunity to consider how training can be effectively designed and delivered to support change. The group discussed how recovery works in interdisciplinary settings (i.e., between social workers and psychiatrists), how interrelated criminal justice issues are being addressed, and to what extent consumer–practitioners are involved in the training design and delivery. We are extremely appreciative of our Steering Committee's dedication to making RTP so successful. The next meeting will be held in December 2012.

On June 29 in Seattle, Washington, representatives from all six professional disciplines and Deputy Project Director Deidra Dain presented “Recovery-Oriented Practice Is a Multidisciplinary Practice” at the National Alliance on Mental Illness National Convention. The innovative session included a role play and open discussion that addressed the importance of collaboration among professions and the inclusion of clients and families in treatment planning and care. Many thanks to everyone who participated in the design and delivery of the workshop: Renee Kopache (American Psychological Association), Antonio Lambert (National Association of Peer Specialists), Mary Moller (American Psychiatric Nurses Association), Annelle Primm (American Psychiatric Association/American Association of Community Psychiatrists), Cynthia Moreno Tuohy (Association for Addiction Professionals), and Seol Han (Council on Social Work Education).

Please note: Weekly Highlights will not be published during the month of August. Watch for our popular series to resume this fall. In the meantime, we offer an extensive library of articles, reports, videos, clinical tools, and case studies, and are happy to help connect you with the resources you need. Contact us at recoverytopractice@dsgonline.com.
 Guest Columnist
Antonio LambertIt Works for Me by Antonio Lambert, CPS, ITE. Some people are really afraid to talk about spirituality and mental health. I used to be one of them. I’d see people eaten alive in meetings and groups for bringing it up and wonder what everyone would say if I spoke my mind. I started questioning why it always went that way until I realized a lot of folks don’t know the difference between spirituality and religion. The confusion goes back so far that I can’t put a date on it, and for goodness’ sake I won’t try. But I will say a certain kind of boldness is needed to use spirituality within your recovery. It’s a declaration that means “I’m going to have a good quality of life.” My spiritual walk is my personal movement to stay well and alive. How I use it in my wellness journey on a daily basis is the heart of this article. I hope it empowers readers in need of spirituality on their recovery walks.

For me, the day is made or broken early in the morning. My morning spirituality session is just as important as taking my medicine and eating breakfast. It’s as if I’m a fighter jet being checked before takeoff. My gear has to be in place to complete my assignment, so I find a space that is entirely silent (front porch, backyard, etc.) and clean out my thoughts. This is when I meditate, which I refer to as “putting on my armor.” After that I read “Bible Promises,” an app on my iPad. It covers everything from addiction, stress, and depression to courage, wisdom, and strength. I call this reading time my “fueling.” Not everyone associates the bible, Quran, prayer books, etc., with their spirituality, but I do. For me, it’s what I need to achieve order in my life.

Spirituality is important to me because it helps me obey. It has given me the wisdom to respect authority, the knowledge to make healthy and conscious decisions, and as the prayer says, the courage to change the things I can. It has also helped me stop playing Superman and taught me to take care of myself. I carry my spirituality wherever I go, but it’s never bulky or heavy. It’s in my heart. These days when I look in the mirror I see a man who is proud of who he is—someone who is becoming free through his spirituality. I’m thankful for my support network and happy to be able to share my experience with people around the world so we can all work on getting well and staying well.

Antonio is a Certified Peer Specialist and RTP specialist for the National Association of Peer Specialists (NAPS). NAPS will host workshops on spirituality and recovery at its sixth annual conference in Philadelphia, Pa., September 6–8, 2012.
 Professional Discipline Training Awards
Over the last 3 months, RTP's professional disciplines have dedicated their efforts to two main activities: progressing through curriculum development and presenting a joint workshop at the National Alliance of Mental Illness (NAMI) National Convention.

NAMI Workshop
On June 29, the six RTP disciplines led the session “Recovery-Oriented Practice Is a Multidisciplinary Practice” at the NAMI National Convention in Seattle, Washington. The group demonstrated how recovery-oriented practice can be an integrative principle for multidisciplinary teams of professional practitioners, including psychiatrists, psychiatric nurses, psychologists, social workers, peer specialists, and addiction counselors. Forgoing more traditional formats, the RTP disciplines designed a role play simulation based on lived experience that provided practice-based evidence of recovery’s efficacy. SAMHSA’s recovery definition, principles, and dimensions were also shared and the standing-room-only audience participated in a stimulating discussion following the performance. Contact Deidra Dain for more information about the session.

Curriculum Development
The American Psychiatric Association (ApA) and American Association of Community Psychiatrists (AACP) have developed six training modules, all of which are currently under review by DSG’s consultants and staff. The ApA/AACP RTP team will continue pilot testing modules with consumers and psychiatrists, who will jointly deliver the training. For more information about the pilot tests, contact Deborah Cohen.

After more than 40 organizations offered to participate in the American Psychiatric Nurses Association’s (APNA’s) first curriculum pilot, the APNA RTP team selected three testing sites and conducted pilots in June and July. Sites included a community hospital, university-based hospital, and private hospital, each with inpatient units and based within an urban, suburban, or rural setting. The next pilot will take place during APNA’s 26th Annual Conference in November, and the second pilot phase will follow. For more information, contact Deborah Hobbs.

Reviews of the American Psychological Association's (APA’s) 13 draft training modules have provided thoughtful insights about how the content of recovery-oriented practice can best be delivered to training directors in clinical, counseling, and professional psychology, who will in turn train doctoral and postdoctoral students. During the APA Annual Convention in early August, the RTP Recovery Advisory Committee will convene to consider curriculum reviews and prepare pilot versions, which will be delivered in two locations starting this September. Contact Urmi Chakrabarti for more information.

The Council on Social Work Education (CSWE) has completed three rounds of draft development and is preparing its pilot for early August. Their curriculum includes pre-Webinar preparation materials, three 90-minute, interactive Webinar presentations, and involvement in post-Webinar learning collaboratives. A comprehensive document that links recovery-oriented competencies for social workers with accreditation standards for the profession will serve as a central guide in the training program. CSWE’s target training audience is field instructors—social work practitioners who supervise students in the field. To learn more about their plans, contact Erin Bascug.

Our newest RTP professional organization, the Association for Addiction Professionals (previously the National Association of Alcohol and Drug Abuse Counselors [NAADAC]), has completed the research and assessment phase of the project. They recently submitted a draft Situational Analysis describing how recovery is currently practiced in substance use and addiction treatment. Following finalization of the Situational Analysis, NAADAC's RTP team will submit a preliminary draft of their training outline. For more information, contact Cynthia Moreno Tuohy.

The National Association of Peer Specialists (NAPS) has submitted all of their proposed modules, including pre-session assessment and preparation, and evaluation and guidance for post-session learning collaboratives. The weeklong curriculum will be pilot tested at three sites, each which employs peer specialists; reflects geographic, cultural, and organizational diversity in type, size, and setting; and demonstrates historical training experience. While developing its curriculum, the NAPS RTP team has considered valuable input from its stakeholders that will enhance in-person pilots as well as the final online version. Contact Antonio Lambert for more information.
 Personal Story
A Personal Story by Jimi Kelley, FSST. Walking along a dark and empty street, dodging puddles of blood that seemed to lie everywhere like a natural part of the landscape, I wandered in a sort of serpentine manner, avoiding the dead birds that fell from the sky. It was a morbid feeling, yet I knew it was a natural part of life.

I knew in a few hours this feeling would pass and I would likely return to the “fast track,”—hours spent in rapture, where so many new ideas would come to me. My world would be full of vibrant color and laden with secret messages only I perceived.

As surely as the occasional car that passed me on the street was not dodging the birds falling from the sky, I felt alone in my awareness of life and death. I wondered if the anomaly was inside of me. Still, without guidance, I could not quiet the part of myself subject to fits of rage. After this anger caused me to cut myself with a knife, I landed in a quiet office with a gentle man who informed me I was sick.

In that moment, I felt relief as I never had before. A well-educated and compassionate man was assuring me I had a medical dysfunction that could be managed with medicine—a scientific, lab-produced remedy.

Born Native American through my mother, I related more closely to her and my grandfather than anyone else in the world. I was too young to realize dominant culture had convinced them, like so many other Native people, that our traditional ways were flawed and that we needed to embrace science as religion. I accepted the diagnosis of rapid cycling bipolar disorder and spent the next 15 years complying with a routine of antipsychotics, mood stabilizers, antidepressants, and prescription amphetamines to treat my deplorable and embarrassing “condition.”

Although the synthetic struggles of man versus nature during those 15 years took me on a more tumultuous roller coaster ride than any mood swing I could ever imagine, I submitted to the belief that this was my lot in life—that feeling like a machine bound to the numb and dreamy state of someone who has taken too much allergy medicine was my good fortune and only path to becoming a worthwhile human being.

I continued with regimens inspired by my providers' experimental curiosities long after I had begun pursuing my own cultural practices and the wisdom of our elder people. I tried to balance the teachings I received over the years with the whims of script-happy doctors who tried to put their signature on my brain by giving me a diagnosis different from doctors I had previously seen, regardless of the outcome.

As I learned to supplant the minimal benefits of therapy with traditional practices of our culture, I experienced a progression of personal development that was more fulfilling than I ever expected.

Programs like the St. Regis Indian Health Service (IHS) in Akwesasne, New York, offer an integral approach to mental health care, providing access to traditional healing as well as clinical recovery. According to IHS regarding Public Law 93-638, Indian Self-Determination Contracting and Compacting, tribes and tribal programs now directly manage more than 50 percent of the mental health budget and programs for Native American communities.

Unfortunately, these services were not available where I was living, and in the midst of a tumultuous divorce, the sudden loss of a long-term job, the pressure of being a single parent to two children, and stress wrought by a contrary work environment, I experienced a collapse of hope, faith, and therapeutic progress that I called “Crashing Through the Medication.” My thoughts, emotions, and sense of self fell into a state of despair that no amount of medication could relieve.

In the absence of chemical support, I decided to surrender to the experience. I cast all prayer and practice aside and entered the dark—naked and raw, angry and anguished.

I would not share the experiences of that time and the issues I encountered in the dark with anyone, but at last I was gifted a glimpse of hope. A caretaker of ceremony whom I had spoken to in an offhand conversation sensed the despair in my voice and traveled several hundred miles to see me.

What emerged from our meeting and the healing prayers that followed can only be described as shaking something loose that had been wrapped too tightly. Within days, my mind became as clear as it was when I was a child, and my body—my limbs—felt relaxed and new. As if this liberation wasn't enough, an elder said to me, “You know in the old days, these things that Western medicine call 'illnesses' were referred to as 'gifts' by our people.”

Like a flash of light, it dawned on me that my struggle for balance was not a struggle between medication and culture—it was a struggle between acceptance and fear. Stepping out on a new path with new understanding, I experienced the one hope I never thought possible: access to my gifts and control over my symptoms.

Eight years after my catalytic depression, I am peacefully free of synthetic stability. I have access to the ingenuity that used to overwhelm me in times of mania, and access to the sadness and anger that held me captive during depression. But now I can identify and choose what’s good for me and what I need to let go.

As Western medicine and science continue to catch up to tradition, I believe the value of cultural practices and teachings will be increasingly integrated, and the wellness movement will truly be an achievable goal.

Jimi Kelley is a consultant on culture, spirituality, and mental health for the First Nations Behavioral Health Association.

References
Harris, A.H., F.M. Luskin, S.V. Benisovich, S. Standard, J. Bruning, S. Evans, and C. Thoresen. (2006). Effects of a Group Forgiveness Intervention on Forgiveness, Perceived Stress and Trait Anger: A Randomized Trial. Journal of Clinical Psychology 62(6):715–733.

Indian Health Service. American Indian/Alaska Native National Behavioral Health Strategic Plan 2011–2015. (2011). Rockville, Md.: IHS National Tribal Advisory Committee on Behavioral Health, IHS Behavioral Health Work Group, and IHS.

Marano, Hara Estroff. (2005). Laughter: The Best Medicine. Psychology Today.
http://www.psychologytoday.com/articles/200504/laughter-the-best-medicine
 Resource Spotlight
Being different is tough for school-aged children, but when kids embrace their personal culture and history, they have the ability to overcome almost any obstacle. “The Role of Culture in Helping Children Recover From a Disaster” is a guide for making the classroom a safe and comfortable space where teachers can help students recover from natural or man-made disasters—earthquakes, hurricanes, wars, school shootings, or terrorist acts, for example.

Showing empathy for a child and his or her situation is crucial, and being sensitive to that child’s background is just as important. Although there are universal signs of grieving (crying, anger, isolation), a person’s culture may encourage or frown upon certain behavior. Some cultures find it inappropriate to talk openly about difficult topics.

It’s essential for teachers to choose their words carefully and acknowledge that language, religion, and cultural customs make each child’s recovery process unique.
 Related Links
The New York Association of Psychiatric Rehabilitation Services is asking people of different races, ethnicities, genders, and ages to participate in a project called Culture Matters in My Life Journey. Practitioners, service providers, and anyone in recovery from a mental health illness and/or co-occurring substance use disorder can share a personal story about the role culture has played in the healing process.

Eating disorders can result from sociocultural, psychological, and biological factors such as low self-esteem, rigid thinking, and the pressures of cultural norms. What happens to a person suffering from a disorder like anorexia or bulimia may be most apparent on the surface, as such illnesses can take a visible toll on the body. Physical damage is a serious consequence, but how does one account for damage to the soul? Incorporating Spirituality in Psychotherapy is Carolyn Costin’s approach to living a soul-centered life—one that encourages awareness of the world around us and all the details that make our days special. Truly caring for the soul can help restore a harmonious mind–body connection.

Turn Toward Life is an interfaith online community for people who connect peace, social justice, and ecology with enlightenment, self-realization, and personal fulfillment. For those who believe these issues are inextricably linked, Turn Toward Life provides a collection of essays, videos, and art that reflects the power and potential of spirituality and encourages compassion, awareness, forgiveness, and creativity.