CFRP and CPRP Exam Study Guide: Best Practices in Psychiatric Rehabilitation

In psychiatric rehabilitation, we define the desired outcome as - Answer- recovery - a life of meaning and purpose for people who live with mental health conditions. To know whether a practice is effective, research and evaluation must: - Answer- Demonstrate that the practice does achieve the outcome desired. When a certain threshold of research evidence is reached, showing that one practice has better outcomes than alternatives, the practice is evidence-based. Evidence-Based Practices: - Answer- Specific interventions and service models that have been shown effective through multiple high-quality research studies by different research teams Best Practices: - Answer- Those approaches, tools, and techniques that are recognized as desirable and effective, but have not yet been studied adequately and so lack evidence. The Four Over-Arching Themes of Psychiatric Rehabilitation: - Answer- 1. Services that are person-centered 2. Services focused on full integration and participation in a person's community of choice. 3. Vigilance and activism to combat prejudice and discrimination. 4. Effective and ongoing training that is relevant to the field and targeted towards developing the attitudes, knowledge, and skill needed to be an effective psychiatric rehabilitation practitioner. Person-Centered Services are Built On: - Answer- Self-determination, choice, and promote individual responsibility. Service Plans in Psychiatric Rehabilitation are Designed to: - Answer- Define and achieve goals that are personally relevant and valuable. Assessment and Interventions in Psychiatric Rehabilitation Target: - Answer- The skills and supports needed to achieve personal goals. Psychiatric Rehabilitation Services focus on: - Answer- the whole of a person and what is needed to promote overall wellness in all life domains. Community is is a comprehensive concept encompassing a - Answer- Physical location as well as a sense of belonging. Psychiatric Rehabilitation have historically done well with creating community within their own walls, but have done less well with helping people - Answer- use their services to build a larger network of natural supports who are not connected to the mental health system. A focus on community integration requires attending to social relationships, recreational activities, and spiritual/religious communities for those who seek them as well as helping people access non-segregated housing, supporting employment, and providing the support/opportunity for further education. Activism is needed on a: - Answer- small scale and a daily basis. It is not only represented in large and organized protests or advocacy campaigns, although such larger efforts are often critical to improving services, increasing opportunity, and influencing policy. Psychiatric Rehabilitation Practitioners need to work on: - Answer- community acceptance and understanding in local neighborhoods, but also on improving the attitudes of service provider colleagues who dwell on symptoms, believe in an overly pessimistic prognosis, and fail to see the person behind the disability. Training requires identifying and addressing the - Answer- knowledge, skills, and attitudes needed for a particular job as well as on the foundational competencies of psychiatric rehabilitation. What are the primary components of the person-centered process? - Answer- - Service planning - Assessment - Interventions What Psychiatric Rehabilitation Specialists do should not be based on: - Answer- instinct or tradition, but should be grounded in what we know for sure works in research. Peer support and peer-run services enrich psychiatric rehabilitation by - Answer- providing concrete evidence that recovery is real by offering role models and relationships of mutuality, and deep understanding that only comes from shared experience. Service providers and service users are shaped by their - Answer- culture of origin, cultures of affinity, and the cultures that surround them, making multicultural competence a key area for life-long education and improvement. Practitioners are not operating in a vacuum, but are affected by - Answer- policies, regulations, legislation, and lack of funding. Addressing system deficits require advocacy, and practitioners need advocacy skills to be a part of the change effort as well as to teach people using services to advocate for the changes they would like to see. First and foremost in everything, including what we say, must be recognition that the people using psychiatric rehabilitation are just that.... - Answer- people, with all the complexities and uniqueness that make each individual and one of a kind with hopes, dreams, and possibilities that are there to discover. For more than 60 years, mental health services have focused on ways to support individuals with psychiatric disabilities. Overwhelmingly psychiatric rehabilitation (psyR) has been established as one approach with demonstrated success in - Answer- supporting individual recovery due to its continued ability to expand, develop, and diversify. PsyR was born out of the need to restore health and well-being among - Answer- individuals with psychiatric disabilities. Burdened by stigma, isolation, and poverty, individuals with mental illness generally languished within institutional treatment settings with little or no hope of ever returning to their homes and communities. In the late 1940's, a small group of individuals with psychiatric disabilities began to meet informally and focused their efforts to organize as a collective. - Answer- Their efforts focused on helping people people in recovery make their way back to live within their home communities, return to meaningful work, and re-establish valuable social relationships. The first PsyR homes were - Fountain House - Philadelphia's Horizon Household - Boston's Center Club - Chicago's Threshold - Miami's Fellowship House - Fairweather Lodge Programs All of these programs focused on themes of - Answer- Service within community-based settings, work and meaningful vocational activities, development of social and recreational networks, skills training, and personal growth/empowerment. What is psyR? - Answer- promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. PsyR services are collaborative, person-directed, and individualized. They are an essential element of the health care and human service spectrum, and should be evidence-based. It focuses on helping develop skills and access resources needed to increase their capacity to be successful and satisfied. PsyR services are also shaped by - Answer- core principles, delivered within ethical guidelines, and support a process based on multicultural diversity and competence. Through the 12 Core Principles and Values, PRA further describes the key elements of psychiatric rehabilitation practice - Answer- Principle 1: Psychiatric rehabilitation practitioners convey hope and respect, and believe that all individuals have the capacity for learning and growth. Principle 2: Psychiatric rehabilitation practitioners recognize that culture is central to recovery, and strive to ensure that all services are culturally relevant to individuals receiving services. Principle 3: Psychiatric rehabilitation practitioners engage in the processes of informed and shared decision‐making and facilitate partnerships with other persons identified by the individual receiving services. Principle 4: Psychiatric rehabilitation practices build on the strengths and capabilities of individuals. Principle 5: Psychiatric rehabilitation practices are person‐centered; they are designed to address the unique needs of individuals, consistent with their values, hopes and aspirations. Principle 6: Psychiatric rehabilitation practices support full integration of people in recovery into their communities where they can exercise their rights of citizenship, as well as to accept the responsibilities and explore the opportunities that come with being a member of a community and a larger society. Principle 7: Psychiatric rehabilitation practices promote self‐determination and empowerment. All individuals have the right to make their own decisions, including decisions about the types of services and supports they receive. Principle 8: Psychiatric rehabilitation practices facilitate the development of personal support networks by utilizing natural supports within communities, peer support initiatives, and self‐ and mutual‐help groups. Principle 9: Psychiatric rehabilitation practices strive to help individuals improve the quality of all aspects of their lives; including social, occupational, educational, residential, intellectual, spiritual and financial. Principle 10: Psychiatric rehabilitation practices promote health and wellness, encouraging individuals to develop and use individualized wellness plans. Principle 11: Psychiatric rehabilitation services emphasize evidence‐based, promising, and emerging best practices that produce outcomes congruent with personal recovery. Programs include structured program evaluation and quality improvement mechanisms that actively involve persons receiving services. Principle 12: Psychiatric rehabilitation services must be readily accessible to all individuals whenever they need them (activism). These services also should be well coordinated and integrated with other psychiatric, medical, and holistic treatments and practices. The Institute of Medicine (IOM) and the Agency for Healthcare Research & Quality (AHRQ) - Answer- both focus on the need for the highest quality mental health services possible. The IOM has focused on core components of PsyR models as "best practices" to be used across professional disciplines, such as better communication among stakeholders, combining knowledge and EPB with individual choice and treatment preferences, and working collaboratively across multiple disciplines The AHRQ recognizes PsyR using a six-level structure for rating scientific evidence - Answer- Level 1a - meta-analysis of multiple randomized control trials (RCT) Level 1b - (At least on RCT) Level 2a - At least one well-designed controlled study without randomization Level 2b - at least one other type of non-controlled quasi-experimental study) Level 3 - Non-experimental descriptive studies, comparative, correlational, & case studies Level 4 - expert committee reports, opinions, and/or clinical experiences of recognized authorities. Six models of PsyR are recognized as using AHRQ structures. PsyR models demonstrate evidence at the highest levels, including level 1a and level 1b - Answer- 1. Collaborative psychopharmacology 2. Supported employment 3. Assertive community treatment 4. family psychoeducation 5. Integrated treatment for mutual diagnosis 6. Skills training For close to 30 years, studies have demonstrated the positive effects of PsyR services provided by people in recovery, such as - Answer- consumer-operated post-hospital social network enhancement programs, supported employment services, consumer-operated intensive case management services, and assertive community treatment services provided by peers. Other services that characterize PsyR have moderate support and have led to major policy shifts in the use of these techniques within the field. They include - Answer- reduction in rates of seclusion and/or restraint, use and support of psychiatric advance directives, self-directed care services, and shared decision making. More recently, the foundations of high-level evidence supporting PsyR service models designed and delivered by individuals in recovery led to the inclusion of Wellness Recovery Action Planning (WRAP). Studies of WRAP have established that - Answer- this peer-designed model at AHRQ level 1b evidence with at least 1 RCT showing PsyR models and services lead the way in person-driven care, shared decision making, and other strategies within a context of EBP's. However, behavioral healthcare services, including PsyR, continue to need improvement and refinement at the personal provider, and organizational levels. The field of PsyR continues to examine and refine the concept of recovery. However, a singular definition of the concept of recovery has been - Answer- elusive. A core goal of PsyR services has been to support individuals with psychiatric disabilities in restoring their lives within community settings, broadly referring to this practice as "promoting recovery." Within the PsyR field discussion continues to focus on a standardized operational definition. Despite ongoing efforts, to define recovery, one general definition remains widely cited in the literature - Answer- Recovery is a deeply personal unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness, Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness. A definition of recovery as it specifically relates to PsyR - Answer- Recovery from mental illness involves much more than recovery from the mental illness itself. People with mental illness may have to recover from the stigma that they incorporated into their very being; from the effects of treatment settings; from the lack of recent opportunities for self-determination; from negative side effects of unemployment; and from crushed dreams. Recovery is a complex, time consuming process. Various other definitions of recovery - Answer- -Hope and empowerment as well as external or social factors; such as recovery-focused service systems and general human rights (Greenley). - 3 Concepts of Recovery: {Hope} {taking personal responsibility} {getting on with life} (Noordsy). - Person-centered recovery reflects a strong focus on sustaining a "fulfilling, meaningful life and positive sense of identity founded on hopefulness and self-determination." (Andresen). He continued to add key components to the process of recovery. {1. developing and sustaining hope} {2. work to re-establish a positive personal identity free of stigmatizing view of mental illness} {3. finding meaning in life as defined by the individual - Self determination} {4. taking responsibility of own life}. Davidson and Roe discuss a "broad heterogeneity in outcomes" for people with psychiatric disabilities. Examining terms related to clinical compared to rehabilitative factors, the authors posit 2 distinct and complementary meanings. - Answer- 1. Recover is characterized by clinical features (improvements in symptoms) of a mental illness. 2. Recovery is evidenced through community inclusion, empowerment, and self-determination despite any ongoing aspects or experience of a clinical illness or disability. Regardless of how recovery is defined, it is essential that people with psychiatric disabilities have the opportunity to participate in service that promote mental/physical health and community integration. There are eight essential features/assumptions of recovery-oriented mental health services (including PsyR) - Answer- 1. Recovery can occur without professional intervention 2. A common denominator of recovery is the presence of individuals who believe in the person in recovery and will stand by them. 3. Recovery as a vision does function as a part of a person's ideas or theories about "mental illness." 4. Recovery occurs despite that mental health symptoms may occur. 5. Recovery changes the frequency and duration of mental health symptoms. 6. Recovery is not necessarily a linear process. 7. The consequences of the illness *aka stigma* often can be harder to overcome than any of its symptoms. 8. Recovery does not suggest that a person never had a mental illness or never experienced mental health symptoms. In response to federal initiatives and the IOM, systems must - Answer- broaden their focus to provide supports that are effective at assisting individuals in achieving recovery and returning to full participation in the community. Key Recovery values drive the development and implementation of PsyR services. In particular, values of recovery-oriented services focus on - Answer- person orientation, person involvement, self determination, and choice, and growth potential. A person orientation ensures that individuals are treated as a person first with a focus on strengths rather than limitations. Person involvement promotes individuals' rights for full partnership and involvement in the planning of PsyR services and how they are received. Self-determination are evident in the right to make individual decisions about services and choices about treatments. Potential for growth suggests that all individuals have the ability to recover, regardless of times of crisis or other disability. Organizations must address their missions, policies, procedures, information management, quality assurance, program setting, and program networks to ensure that they - Answer- reflect the core values of recovery. An organization's recovery mission can be characterized by improvements that allow individuals to live and function in the environment they choose rather than a single focus on treatment with lack of attention to choice and self-determination. PsyR services use quality assurance to examine - Answer- outcomes and milestones of interest to service users, not only those measures required by funders or regulators. Recovery-oriented PsyR services must incorporate measures to train, select, and supervise staff. Staff training must include opportunities for PsyR providers to have regular interaction with people who are living beyond their disability. Certification in PsyR Services - Answer- The Institute of Medicine, the Annapolis Coalition, and others are calling for an increase in knowledge and skills in PsyR. This led to the creation of two certificates from the Psychiatric Rehabilitation Association -CPRP- Certified Psychiatric Rehabilitation Practitioner (adult focus) -CFRP- Child and Family Resiliency Practitioner (PsyR for children and adolescents) These certifications fills a valuable education and training gap within a multidisciplinary workforce. The credential represents a strategy to offer PsyR within the contexts of its principles with attention to ethical conduct and multicultural diversity. It supports standards for ethical behavior in professional relationships and directs PsyR practitioners to adopt the person-first methods that support/promote self-determination. A medical model emphasizes - Answer- psychiatric diagnosis and treatment of symptoms. It also focuses on the injury, illness, disease, or disorder; it examines the pathology or impairment in the body that are affected by the illness, and prescribes treatment interventions to reduce or eliminate the symptoms/signs, discomfort, or distress of an illness to improve psychological functioning. In mental health treatment, the most common interventions are psychotropic medications and psychotherapy. While treatments may be effective in reducing symptoms and distress, they typically do not result in improvements in work functioning, educational achievement, or community integration. The rehabilitation/recovery approach emphasizes - Answer- maximizing functioning and examining the environmental and personal factors that play a role in functioning, disability, and recovery. For the last 30 years the mental health field has been moving away from the - Answer- medical model (focus on reducing symptoms and providing treatments) and moving towards focusing on recovering (challenging negative effects of treatment in public service systems, from discrimination, and exclusions made by society and occasionally public/mental health services). Recovery has a primary aid in - Answer- guiding the development and delivery of mental health services. What is Supporting Recovery according to the SAMHSA? - Answer- partnering with people in recovery from mental and substance use disorders to guide the behavioral health system and promote individual, program, and system level approaches that foster health resilience; increase permanent housing, employment, education, and other necessary supports; and reduce social barriers of inclusion. The Center for Mental Health Services within SAMHSA funded an initiative called - Answer- Recovery to Practice: Aims to advance a recovery-oriented approach to behavioral health care by developing, promoting, and delivering training curricula in the major disciplines on how to translate the concept of recovery into service delivery. Recovery outcomes can include - Answer- improvements in role functioning in work, social, and living situations. Recovery is increasingly being used to - Answer- denote a person's potential for growth, healing, and community integration. It refers to a person's right and ability to live a safe, dignified, and meaningful life in the community of his/her choice despite continuing disability associated with the illness... learning how to live fully in the presence of a disabling condition. SAMHSA - Recovery from Mental Disorders and Substance Use Disorders: A process of - Answer- change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Recovery and Support Strategic Initiative: SAMHSA delignated four major dimensions that support life in recovery - Answer- 1. Health: Overcoming or managing one's diseases as well as living in a physically and emotionally hea