A Look At The
Recovery Model
Luis Lopez MS
Implementation Specialist, Trainer
Center for Practice Innovation
@ Columbia Psychiatry
New York State Psychiatric Institute
[email protected]
Agenda
• The Challenge
• Recovery Informed Practices
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Strength Based Approaches
Peer Supports
Trauma Informed Care
Cultural Competency
Harm Reduction
Stages of Change
WRAP
8 Dimensions of Wellness
Review of the Medical Model
The Medical Model
• Focuses on treating behavioral health
challenges as a physical health challenge.
• Symptoms come from within.
• Symptoms are grouped together and
classified under diagnoses.
• Biological causes, psychopathological
methodology.
Review of the Medical Model
The Medical Model
• Diagnoses are based on judgments.
• Diagnoses sometimes vary from
professional to professional, from doctor
to doctor, from hospital to hospital.
• Adds to the stigma and discrimination felt
by people with behavioral health
challenges.
Words That Can Pathologize
“symptoms”
“borderline” “depressed”
“dissociated”
“decompensating”
“my consumer”
“sick”
“mentally ill”
“chronically ill”
“crazy”
“low functioning”
“psychotic”
“abnormal”
“erratic”
“mental disorders”
Strength Based Approaches
 Assess people’s lives carefully. Look at what
they have accomplished. Their strength comes
from what they have to do to survive.
 You will find strength in the stories of your
consumers –
 People who have struggled with drug use
 People who have encountered and survived abuse.
 People who have experienced homelessness
 Think about the amount of strength that it takes for an
individual to live in the streets for years.
Strength Based Approaches
 Identify as many positive areas as you can.
 Make the strengths part of treatment.
 For example, “Luis wants to work in the area of counseling,”
instead of, “Luis needs a job” or “Luis is unemployed.”
 Be careful with language
• Let’s use strength based language
• Words like denial, non compliance, lazy, and lacks insight
don’t promote recovery.
Strength Based Approaches
 Promote Self Efficacy
 All of us have accomplished things in our lives –
celebrate them!!!
 Acknowledge the efforts, Affirmations
 As simple as - coming to the first appointment, attending the
first group, meeting with the Intake person, etc.
What strength based language you could incorporate
in your work to replace these terms?
Empowering Interactions
promote self-determination
Power Robbing Language
Empowering Language
You should
Can, could
You need
What have you considered?
You must
What are your options
You can’t
What can you do?
No one can do that…
Up till now…
Problem
Challenge, situation, concern
But
And
It only works when…
What other ways might work for you?
The best way is…
Some choices are…
Your only option is…
Options to possibly consider are…
My advice to you is…
What has worked for you in the past?
You can’t do that
Some thins that worked for me are…
Peer Supports
In numerous studies, the involvement of
peer specialists in service delivery led to
consumers experiencing
•
•
•
•
less hospitalizations
shorter hospitalizations
fewer reported life problems
better social functioning
(Paulson et al, 1997-2000; Klein et al, 1998; Felton, et al, 1995; Lyons et al, 1996;
Cook et al, 1995)
Peer Supports
 Peer Providers should be part of every level of
care in our system. Peers could be part of the –



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initial contact with consumers
outreach team
intake process (including the intake interview)
team that welcomes consumers to each appointment
follow up calls for next up appointment
community bridging – contacting housing, job, and
school networks
 overall advocacy
Peer Supports
 Peers could also be part of the –
 group facilitation
 one on one contacts
 family groups
Trauma Informed Care
Trauma could be dehumanizing, shocking or
terrifying, singular or multiple events over time,
and often includes betrayal in the areas of
safety, trust, and the ability to make choices.
Trauma can result from experiences of violence.
Trauma includes physical, sexual and
institutional abuse, neglect, intergenerational
trauma, and disasters that induce
powerlessness, fear, recurrent hopelessness,
and a constant state of alert.
Trauma Informed Care
Trauma impacts one's spirituality and
relationships with self, others,
communities and environment, often
resulting in recurring feelings of shame,
guilt, rage, isolation, and disconnection.
The National Center for Trauma Informed Care (NCTIC)
Trauma Informed Care
• Respect, inform, connect, and promote
hope
• Promote recovery
• Understand and acknowledge the
interrelation between trauma and
symptoms of trauma
• Collaborate with and empower trauma
survivors, as well as family members and
friends (of the trauma survivor)
Cultural Competency
If we are going to develop any relationships
with need to respect and include culture.
The essential components of Cultural
Competency are Cultural
Considerations, Self-reflection and the
Asking Stance.
Cultural Competency
Cultural Considerations
 When you meet consumer for the first time,
establish dialogue that includes primary and
secondary cultural dimensions –
•
•
•
•
language
family
neighborhood
experiences
Let’s see handout
•
Cultural Considerations:
Primary and Secondary Dimensions
Employment
Community
Networks
Geographic
Location
Class
Extended Family
country of origin
Income
sexual
orientation
Economics
Political
Context
Immigration
Status
ethnicity
Marital
Status
RACE
age
Parental
Status
Primary dimensions
influence “who” an
individual is.
Secondary dimensions
influence an individual’s
participation.
Military
Experience
GENDER
perceptions of
physical qualities
Education
Literacy
English
Language
Proficiency
Physical
Abilities
Cultural Competency
Self Reflection
 Clinical providers should continuously assess
where they are with cultural issues.
• Do I believe people can get better?
• Is the reason something is making me
uncomfortable based on personal biases?
•
Cultural Competency
The Asking Stance
• Never assume or second guess anything
• Always ask the question (even if you think that
you know the answer)
• Asking the questions promotes respect and
choice
• Asking the questions empowers the person
• Asking the questions makes you more
knowledgeable
Let’s see handout
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Asking Stance
What is your language of preference?
What would be most helpful to you?
How would you like to be addressed?
Is there anything you would like me to know about you?
Do you want to share anything about your religious
or spiritual upbringing or current practice?
?
Do you have any questions that you would ask me about the
services that our program provides?
- What other questions would you ask? -
Harm Reduction
Harm Reduction
 Respect a person stage of recovery.
•
Provide a safe environment. Don’t judge or
condemn individual.
 A person may be very guarded based what
s/he are experiencing and doing.
•
Develop trust. We should be sensitive to that.
Consumer should establish what boundaries
should be explored.
Harm Reduction
Harm Reduction
 Start the treatment by assessing where the
person at – assess readiness
•
•
What are the person’s immediate needs.
Addressing these needs reduce harm.
Encourage personal choice. What the person
wants to work on.
Stages of Change
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Transcendence
Recurrence
Mary Ellen Copeland’s
Wellness Recovery Action Plan
The Wellness Recovery Action Plan, or
WRAP plan, will help the consumer
develop a wellness plan that includes
preventive actions to address negative
triggers - and the long consequences of
these triggers.
Wellness Recovery Action Plan
Some of the areas reviewed are –
Wellness Toolbox
How do you feel when you feel well?
Triggers: Life events that make you feel bad
How do you feel when you are not feeling well?
What is your breaking point? What happens
right before the crisis?
Wellness Recovery Action Plan
The second part of the WRAP is a behavioral
health Advanced Directive. It in, the
consumer will outlined her/his needs will
experiencing a crisis:
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Who could provide support?
Who should we call?
What medications work?
What treatment to I prefer?
What can the provider do while you are in crisis?
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[email protected]
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Reframing Labels and Perceptions
Lacks Insight
Illness
Patient
Addict
Non-Compliant
Resistant
Relapser
Manipulative
Demanding
Frustrating
Denial
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Reframing Labels and Perceptions
Lacks Insight
Self Protective
Illness
Wellness
Patient
Individual
PTSD
Trauma
Non-Compliant
Independent
Resistant
Cautious
Relapser
Repeating Behaviors
Manipulative
Skillful
Demanding
Assertive
Frustrating
Worried
Denial
Precontemplative