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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

Schools of Social Work Deans' Consortium Project
for Evidence-Based Practice in Mental Health
Curriculum Guide

The faculty curriculum guide was designed for faculty use and provides an expanded weekly module format of goals and objectives along with a detailed outline of relevant subject matter to be covered in each presentation. The guide also includes suggested instruction methods and class activities for each module. There are two detailed activities: “the poster session” and “levels of evidence” exercises, which are general in nature and can be applied to most modules, and the “fish bowl” exercise, which can be readily applied to the trauma and mental illness module. It is expected that faculty teaching the course will have expertise in some, but not all, areas covered by the course. In addition to the supplemental required readings for students, some modules have additional or recommended reading sections for faculty.

Week 1 module topic: Recovery, Stigma, and Mental Illness

Goals/Purpose:

  • To introduce students to the key concepts of recovery and stigma as they relate to individuals with a diagnosis of serious mental illness.
  • To provide students with a framework to understand how cultural issues intersect with mental health and illness. These ideas will serve as the conceptual underpinnings for the rest of the seminar.

Objectives:

  1. Define recovery and stigma as they relate to individuals with a diagnosis of serious mental illness;
  2. Describe characteristics of a recovery-oriented approach to working with individuals with a diagnosis of serious mental illness; and,
  3. Describe how culture affects mental illness.

Topic Outline:

  1. Overview of Recovery*
    1. Until recently, severe mental disorders considered destined for lifelong deterioration.
    2. Consumer and family movements began to challenge this in the 1980s and 1990s.
    3. Pioneer consumer, Patricia Deegan, one of the important voices in this movement.
    4. Recovery concept: not a goal or end-state, but “a process, an outlook, a vision, a guiding principle” (Surgeon General, 1999). Focuses on restoring self-esteem and achieving meaningful roles in society.
      1. introduced in consumer writings
      2. encouraged by some research supporting positive long-term outcomes
      3. A recovery framework for intervention involves consumers as full partners in their treatment, setting their own goals for their lives
  2. Stigma: “bias, distrust, stereotyping, fear, embarrassment, anger, and/or avoidance” (Surgeon General) of people with mental illness.*
    1. Labeling theory & symbolic interactionism
      1. Primary deviance
      2. Secondary deviance
    2. The context of mental illness (Rosenhan study)
    3. Impact of stigma
      1. Individual’s self concept and self-esteem
      2. Results in discrimination (housing, employment, school, health insurance, etc.) and, sometimes, abuse
      3. Creates barriers to help-seeking for those who have untreated mental illness
    4. Increased knowledge about mental illness by the American public has NOT resulted in reduced stigma.
  3. Culture & Mental Illness*
    1. Symptoms of mental disorders & culture
      1. Prevalence rates of schizophrenia and bipolar disorder are similar throughout the world.
      2. Culture and social context (e.g., exposure to poverty and violence) play a significant role in depression, and an even greater role in post-traumatic stress disorder.
    2. Culture affects:
      1. How people describe and report their symptoms (including which they report)
      2. Meaning ascribed to symptoms
      3. Responses to symptoms
        1. Coping responses
        2. Help-seeking
      4. Risk and protective factors vary across ethnic groups, however in most research it is difficult to identify whether this is a function of culture, class, or oppression.
    3. While there are some “culture-bound” mental disorders, they are limited, and the knowledge base on these is still relatively new and evolving.

Suggested Session Instruction Methods and Class Activities:

  • Lecture
  • Discussion
  • Suggested In-class Activities:
    • Have students (in small groups) define mental health and mental illness.
    • Have students generate a list of all the words that are used to refer to individuals with a diagnosis of serious mental illness and then discuss what this demonstrates about public attitudes.
    • Have students share reactions to readings by consumers (see consumer website under Additional Readings.
    • Have students (or instructor) role play an approach to a first interview with a consumer (e.g., Mr. Jones case) two ways: 1) illustrating a traditional medical approach; 2) illustrating a recovery-focused approach.

Required Readings:

  • Sands, R.G. (2001). Getting oriented: themes and contexts, chapter 1. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 1-23.
  • Surgeon General (1999). Overview of recovery [in Chp. 2, The fundamentals of mental health and illness]. In Mental health: A report of the Surgeon General. [Electronic version]. Rockville, MD: Office of the Surgeon General, US Public Health Service. Retrieved May 10, 2003 from: http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec10.html Leaving OMH site
  • Surgeon General (1999). The roots of stigma [in Chp. 1, Introduction and themes]. In Mental health: A report of the Surgeon General. [Electronic version]. Rockville, MD: Office of the Surgeon General, US Public Health Service. Retrieved May 10, 2003 from: www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html#roots_stigma Leaving OMH site
  • Onken, S.J., Dumont, J.M, Ridgway, R., Dornan, D.H., & Ralph, R.O. (2002). Mental health recovery: What helps and what hinders? Alexandria, VA: National technical Assistance Center for State Health Planning. Online: http://www.nasmhpd.org/ntac/reports/index.html Leaving OMH site
  • Surgeon General. (2001). Culture counts: The influence of culture and society on mental health. In Mental health, culture, race and ethnicity: A supplement to mental health: A report of the Surgeon General. [Electronic version]. Rockville, MD: Office of the Surgeon General, US Public Health Service. Retrieved May 10, 2003 from: www.mentalhealth.org/cre/toc.asp Leaving OMH site

Recommended Readings:

  • Solomon, A. (1992). Clinical diagnosis among diverse populations: A multicultural perspective. Families in Society, 73(6), 371-377.
  • Labeling theory [in Social Response Theories: Labeling Theory, Marxist Scholarship, & Social Response in the Criminological Tradition] at www.crimetheory.com/Archive/Response/ Leaving OMH site Retrieved May 10, 2003
  • Recovery from Mental Illness, Alaska Consumer Mental Health Web. Includes stories of personal recovery, as well as articles. Online: http://akmhcweb.org/recovery/rec.htm Leaving OMH site

* Signifies Key Components That Require Review

Week 2 module topic: Introduction to Evidence-Based Practice (and Review of Serious Mental Illness if required, will vary with needs of each school)

Goals/Purpose:

  • To introduce students to the concept of evidence-based practice (EBP), the importance of EBP on the national and state levels.
  • To introduce students to the concept of the ethical and professional issues and the skills involved with EBPs.

Objectives:

  1. Describe the importance of using evidence-based practices with individuals with a diagnosis of serious mental illness;
  2. Describe the difference between ”evidenced-based practice” and “best practices;”
  3. Discuss the ethical concerns raised by the failure to offer clients evidence-based practices;
  4. Discuss how EBP should be utilized in developing treatment plans;
  5. Describe the importance of fidelity with EBPs.

Topic Outline:

  1. What is Evidence-Based Practice?
    1. What it is: services or intervention methods that have some research supporting their effectiveness.
    2. What it is not: “Best practice.” This refers to interventions or services based on best clinical or programmatic wisdom--however, no systematic assessment of effectiveness has been conducted (no data).
  2. Why should you care about it?*
    1. Institute of Medicine report (Crossing the Quality Chasm)
    2. National movement toward adopting EBP as policy
    3. Development of practice guidelines
    4. State policy changes
    5. Lawsuits for failure to offer EBP
    6. “Technology Transfer” has become a critical emerging area of policy and practice: how do we bring EBP into practice settings?
  3. Ethical issues*
    1. Not offering EBP: Imagine being diagnosed with cancer.
      1. How would you feel if your doctor:
        1. Didn’t share with you all the available treatment options?
        2. Didn’t know which interventions had the best outcomes for treating your cancer?
        3. Hadn’t kept up to date with the cancer treatment since s/he left school?
        4. Failed to offer you the option to receive a treatment that had demonstrated repeated success in the research?
      2. How often have you seen mental health settings do any of the above?
    2. Problems with limiting intervention options to only EBP
      1. No treatment has demonstrated 100% success, there were always some people who didn’t respond to the intervention. Your client may turn out to be one of the non-responders.
      2. The EBP may be a bad “fit” for your client. For example:
        1. Clients with significant cognitive impairments might have difficulty learning some types of cognitive-behavioral interventions.
        2. A client with bipolar disorder and alcohol dependence may also have a severe social phobia that would limit his/her ability to participate in a group for integrated dual diagnosis treatment
        3. A given EBP may not be a good fit with a given client’s cultural background.
      3. Not all the need or issues confronting clients have EBP interventions developed for them. Consumers and frontline practitioners are often the first ones to identify a newly emerging issue or problem. They need to be free to develop new interventions-these new interventions may well become the next set of best practices, which will hopefully lead to some future controlled research.
      4. Efficacy vs. Effectiveness. Not all EBPs have demonstrated effectiveness, and there may need to be modifications to adequately transport them to real world settings with clients from diverse backgrounds.
      5. Social work ethics & EBP (see activities under Suggested Activities)
  4. Responsible use of EBP*
    1. Understand the nature of the evidence, including it’s limitations, and the fact that the evidence base continues to change.
    2. Consider EBP as the first treatment to be considered, but understand it may be inappropriate, or need modification.
    3. If EBP is inappropriate, document this decision, and the informed consent (for treatment) process.
    4. Importance of fidelity
      1. Studies of the impact of deviation from fidelity. Treatment success decreases as fidelity decreases.
      2. When adapting EBP for a given setting, it’s critical to understand its basic principles, so its active components aren’t changed in the adaptation process.
      3. Measurement of fidelity
    5. Responsible use of EBP requires some understanding of research, so you don’t just take other’s endorsements as “truth,” and can evaluate the adequacy of research support yourself.
      Need for monitoring client progress toward outcomes that are targeted by the EBP, and revising intervention plans if progress is not what is expected.
    6. Need for monitoring client progress toward outcomes that are targeted by the EBP, and revising intervention plans if progress is not what is expected.
  5. Efforts to evaluate and classify interventions based on research support
    1. Multiple systems are being employed by different groups, either by developing classification schemes or practice guidelines based on research and best practices.
    2. Social work is a bit behind on this, just beginning to talk about practice guideline development related to specific types of client problems (although has developed practice guidelines for fields of practice).
  6. One level of evidence system: Agency of Health Care Policy and Research (AHCPR)
    1. Level A: randomized, controlled clinical trials
    2. Level B: well designed clinical studies without randomization or placebo comparison
    3. Level C: service and naturalistic clinical studies, combined with clinical observations, which are sufficiently compelling to warrant use of the treatment technique or follow the specific recommendation
    4. Level D: long-standing and wide-spread clinical practice that has not been subjected to empirical tests
    5. Level E: long-standing practice by circumscribed groups of clinicians that has not been subjected to empirical tests
    6. Level F: recently developed treatment that has not been subjected to clinical or empirical tests
  7. Review/overview of EBPs included in the course*

* Signifies Key Components That Require Review

Suggested Session Instruction Methods and Class Activities:

  • Lecture/PowerPoint
  • Discussion
  • Suggested In-Class Activity:
    • Have students brainstorm the skills and resources that social workers would need in order to use EBPs over the course of their careers.
    • Have students examine the NASW Code of Ethics to identify:
      1. If the scenarios identified in 3-a-i occurred in a mental health agency context, which ethical standards would be violated?
      2. Which ethical standards would come into play when utilizing EBP in an agency? (note, this should be considered broadly, utilizing standards related to competence, informed consent, self-determination, evaluation and research, etc.).

Required Readings:

  • Sands, R.G. (2001). Historical context. A biopsychosocial conceptual framework. Legal and ethical issues, chapters 2, 3 & 7. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 27-44, 47-73, and 138-164.
  • Institute of Medicine (2001). Executive summary. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Online: http://books.nap.edu/books/0309072808/html/1.html#pagetop Leaving OMH site
  • NASW Code of Ethics. Can be obtained from NASW. Also available online at the NASW website: www.socialworkers.org/pubs/code/code.asp Leaving OMH site
  • Thyer, B.A. (2002). Evidence-based practice and social work. Evidence-Based Mental Health, 5, 6-7.
  • Gibbs, L., & Gambrill, E. (2002). Evidence-based practice: Counterarguments to objections. Research on Social Work Practice, 12¸452-477.

Week 3 module topic: PACT—Program for Assertive Community Treatment

Goals/Purpose:

  • To develop an understanding of the PACT model of community mental health service delivery.
  • To develop knowledge about the program components and their effectiveness for individuals with a diagnosis of serious mental illness.

Objectives:

  1. Demonstrate knowledge about the history of Assertive Community Treatment model, its unique characteristics, empirical findings and conclusions;
  2. Describe the target population, admission criteria;
  3. Describe the team composition: staff roles, team size, ratios, and caseloads, hours of operation, administrative requirements;
  4. Describe the PACT team organization and communication flow;
  5. Demonstrate an understanding of the evidence-based-practice interventions such as client-centered and problem-solving approach to individual services;
  6. Describe the model components for fidelity for replication and program standards;
  7. Develop skills in effective teamwork;
  8. Develop skills in comprehensive community assessment using a problem-solving framework.

Topic Outline:

  1. PACT Program fidelity components
    1. Team personnel
    2. Shared staff roles
    3. Team size, ratios, caseload, staff/client ratio
    4. Team operation
    5. Staff scheduling
    6. PACT headquarters
    7. Program budget
    8. Record management
  2. Critical perspective of service delivery
  3. Comprehensive biopsychosocial assessment
    1. Interface of biological, psychological and social factors for SPMI clients
    2. Comprehensive assessment
  4. Treatment planning
    1. Client case review
    2. Client’s individual treatment team
    3. Flexible service intensity
  5. Effective teamwork skills
    1. Team composition
    2. Job Functions
    3. Organization and communication structure
    4. Meetings and scheduling
  6. Client-centered problem solving therapy
    1. Problem Solving Therapy (PST)
    2. Task centered model

Suggested Session Instruction Methods and Class Activities:

  • Lecture and discussion
  • Suggested in-class activities:
    • Video titled “Hospital Without Walls” features a PACT team in action
    • Class visit to a PACT team
    • Identify fidelity components of the PACT model
    • Role play a team meeting
  • Suggested homework assignments:
    • Critical review of the empirical literature on PACT services
    • Complete a treatment plan using a case example

Required Readings:

  • Sands, R.G. (2001). The biopsychosocial assessment. Community care of persons with severe mental illness: case management and community resources, chapters 4 & 11. Clinical social work practice in behavioral mental health. Boston: Allyn &Bacon, pp. 78-98 & 255-340.
  • Bond, G. (2001). Assertive Community Treatment: Best practice. Presented at New York State Office of Mental Health Best Practices Conference, June 11, 2001, Workshop 11: Theory and Practice: Assertive Community Treatment. Retrieved March 23, 2003, from http://www.omh.state.ny.us/omhweb/aboutomh/transcripts/bond.htm.
  • McGrew, J.H., Wilson, R., and Bond, G. (1996). Client perspectives on helpful ingredients of assertive community treatment. Psychiatric Rehabilitation Journal, 19, 13-21.
  • Lehman, A. F., Dixon, L. B., Kernan, E. DeForge, B. R., & Postrado, L. T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 54, 1038-1043.
  • Test, M. A., Knoedler, W. H., Allness, D. J., Burke, S. S., Brown, R. L., & Wallisch, L. S. (1991). Long-term community care through an assertive continuous treatment team. In C. A. Tamminga & S. C. Schulz (Eds.), Advances in neuropsychiatry and psychopharmacology, volume 1: schizophrenia research (239-246).

Week 4 module topic: Motivating for Change and Motivational Interviewing

Goals/Purpose:

  • To develop an understanding of the transtheoretical model of change.
  • To develop skill in using motivational interviewing techniques to help clients change.

Objectives:

Upon completion student will be able to:

  1. Discuss the stages of change outlined in the transtheoretical model;
  2. Identify the stage of change that a client is in;
  3. Discuss the components of motivational interviewing;
  4. Use motivational interviewing to work with mental health clients to attain desired changes.

Topic Outline:

  1. Transtheoretical model and stages of change
    1. Pre-contemplative-person has no clear intention to change.
    2. Contemplative-person recognizes existence of a problem and is considering change.
    3. Preparation-person has made a decision to change and is planning for action.
    4. Action-person is engaged in behavioral change.
    5. Maintenance- person is sustaining and integrating change.
  2. Motivational interviewing
    1. Effectiveness of motivational interviewing.
    2. Definition-directive, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence (Rollnick & Miller, 1995).
    3. Spirit (Rollnick & Miller, 1995)
      1. Motivation to change is elicited from the client, and not imposed from without.
      2. It is the client’s task, not the clinician’s to articulate and resolve his or her own ambivalence.
      3. Direct persuasion is not an effective method for resolving ambivalence.
      4. The counseling style is generally a quiet and eliciting one.
      5. The counselor is directive in helping the client to examine and resolve ambivalence.
      6. Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.
      7. The therapeutic relationship is more like a partnership or companionship than expert/recipient roles.
    4. Techniques-express empathy, develop discrepancy between person’s perceptions of where they are and where they want to be, avoid arguments, roll with resistance, support self-efficacy (Smyth, 1996).
  3. Use of the transtheoretical model and motivational interviewing to address mental health problems (see Smyth, 1996).
    1. Use the assessment process to identify psychiatric symptoms or behaviors in need of change.
    2. Identify the stage of change that the client is in.
    3. Work with the client to identify goals.
    4. Develop interventions that are appropriate to the stage of change that the client is in.
    5. Work with the client to facilitate the change process.

Suggested Session Instruction Methods and Class Activities:

  • Lecture and discussion
  • Suggested in-class activity:
    • Identify the stage of change that a client is in using case examples.
    • View film clips of motivational interviews (Films available for purchase at http://motivationalinterview.org/training/videos.html).
    • Role-play motivational interviews.

Required Readings:

  • Burke, B., Arkowitz, & Dunn, C. (2002). The efficacy of motivational interviewing and its adaptations: What we know so far. In W. Miller & S. Rollnick (Eds.), Motivational interviewing: Preparing people for change (2nd ed.) (pp. 217-250). New York: The Guilford Press.
  • Rollnick, S. & Miller, W. R. (1995). What is motivational interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334.
  • Smyth, N.J. (1996). Motivating clients with dual disorders: A stage approach. Families in Society, 77(10), 605-614.

Week 5 module topic: Wellness Self Management

Goals/Purpose:

  • To learn the most effective means of helping clients learn to self-manage their illness.
  • To understand different management techniques that are related to their symptoms.

Objectives:

  1. Help clients recognize symptoms of their illness that may lead to a relapse;
  2. Help clients learn how to access help and build support systems in the most effective and efficient manner;
  3. Understand the effectiveness of techniques that can help clients self-manage their symptoms.

Topic Outline:

  1. The symptoms of psychosis, depression, and mania are reviewed.
  2. The culture of recovery.
    1. Techniques of instilling hope in clients that recovery is likely and within their reach.
    2. Collaborative work with clients to help them construct realistic recovery goals.
  3. The management of symptoms.
    1. Providing clients with the knowledge about their illness and about their accompanying symptoms.
    2. Helping clients recognize when certain symptoms are “tips” about their wellness or possible relapse.
    3. Helping clients establish a support system that is useful for managing wellness and is in place when needed for possible relapse.
  4. Mutual Aid and its healing components.
    1. The effectiveness of mutual aid for helping clients.
      1. Management of symptoms is discussed.
    2. The role of social workers in supporting mutual aid is discussed.
  5. Interventions and outcomes for the strength-based perspective.
    1. Interventions include:
      1. Helping clients know more about their symptoms.
      2. Helping clients learn coping skills.
      3. Teaching clients behavioral techniques of managing symptoms and helping clients establish a relapse plan.
    2. The design of outcome data based on each client’s goals and objectives is presented.
    3. Evidence-based outcome data from multiple studies are presented.
  6. Trusting relationships and outcome measures.
    1. Outcome data related to trusting relationships are presented.
    2. Innovative ways to create trusting relationships are offered.
    3. Methods of evaluating the effect of trusting relationships are presented.

Suggested Session Instruction Methods and Class Activities

  • Lecture
  • Discussion
  • Suggested Homework Assignments:
    • Students are asked to create a research evaluation design for a study on the effectiveness of using one aspect of the strength perspective for managing symptoms.
    • Using the scenario of Mr. Jones, write a plan for helping the client manage their illness.

Required Readings:

  • Mellman, T.A., Miller, A.L., Weissman, E. M., Crisman, M.L., Essock, S.M. Marder, S.R. (2001). Evidenece-based pharmacologic treatment for people with severe mental illness: A focus on guidelines and algorithms. Psychiatric Services, 52(5), 619-625.
  • Miller, R., & Mason, S.E. (2002). Diagnosis schizophrenia, pp. 95-103, Coping with Positive and Negative Symptoms, (chapter 10), pp. 104-113, Coping with Other Symptoms and Side Effects (chapter 11).
  • Sands, R.G. (2001). Community care of persons with severe mental illness, case management and community resources, chapter 11. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 255-290.

Recommended Readings:

  • Chinman, M.J., Rosenheck, R., & Lam, J.A. (1999). The development of relationships between people who are homeless and have a mental disability and their case managers. Psychiatric Rehabilitation Journal, 23(1), 47-55.
  • Cogan, J.C. (1998). The consumer as expert: Women with serious mental illness and their relationship-based needs. Psychiatric Rehabilitation Journal, 22 (2), 142-154.
  • Dixon, L. (2000). Reflections on recovery. Community Mental Health Journal, 36(4), 443-447.
  • Frese III, F.J., Stanley, J., Kress, K., & Vogel-Scibilia, S. (2001). Integrating evidence-based practices and the recovery model. Psychiatric Services, 52(11), 1462-1468.
  • Kelly, T.B. (1999). Mutual aid groups with mentally ill older adults. Social Work with Groups, 21 (4), 63-80.
  • Mueser, K.T., Corrigan, P.W., Hilton, D.W., Tanzman, B., Schaub, A., Gingerich, S., et al. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53(10), 1272-1284.
  • Mowbray, C.T., Moxley, D.P., & Collins, M.E. (1998). Consumers as mental health providers: First-person accounts of benefits and limitations. The Journal of Behavioral Health Services & Research, 25(4), 397-411.
  • Ridgway, P. (2001). Restoring psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal, 24 (4), 335-343.
  • Russinova, Z. (1999). Providers’ hope-inspiring competence as a factor optimizing psychiatric rehabilitation outcomes. Journal of Rehabilitation, 65 (4), 50-57.
  • Segal, S.P., Gomory, T., & Silverman, C.J. (1998). Health status of homeless and marginally housed users of mental health self-help agencies. Health and Social Work, 23(1), 45-52.
  • Williams, C.C., & Collins, A.A. (1999). Defining new frameworks for psychosocial intervention. Psychiatry, 62(1), 61-78.

Week 6 module topic: Medication Management

Goals/Purpose:

  • To illustrate how evidence-based practice can:
    • help clients make informed choices about medication and manage the undesirable side effects to improve success with their prescribed medication regimen;
    • demonstrate how medication, in conjunction with supportive counseling, can help clients achieve a happier, more productive life style.

Objectives:

  1. Appreciate the importance of the social work role in helping clients manage their prescribed medications;
  2. Differentiate among the medication categories for the various mental illnesses;
  3. Understand how the interaction between supportive counseling and medication management can benefit clients.

Topic Outline:

  1. The social work role in medication management.
    1. The ethics and legal aspects of the social work role in medication management.
    2. Family involvement in medication management, including issues of confidentiality.
    3. The role of self determination and respecting the client’s right to make informed choices about medications.
  2. Psychotropic medications, their use and their limitations.
    1. The classifications of psychotropic medication and their uses.
    2. The risks and benefits associated with psychotropic medication.
    3. The role of social workers in research projects for developing new medications.
  3. Techniques that help consumers manage their medication regimens.
    1. Collaboration with professionals from other disciplines on medication management with clients.
    2. Ways of working with clients who have difficulty adhering to medications as prescribed.
    3. Educating clients about the undesirable side effects of medication and assisting them in making informed medication choices.
    4. Supporting clients in talking with their doctors about side effects and problems with medication.
  4. The effectiveness of supportive counseling in conjunction with medication.
    1. Using individual and group treatment to encourage medication management.
    2. The effectiveness of supportive and behavioral techniques for medication management.
    3. The effectiveness of programs in encouraging medication use.

Suggested Session Instruction Methods and Class Activities:

  • Lecture/discussion

Students are asked to review the section of the Mr. Jones case on not taking his medication in the prescribed manner and use this case in the class discussion on medication management.

Required Readings:

  • Miller, R., & Mason, S.E (2002). Diagnosis schizophrenia. New York: Columbia University Press, pp. 68-81, Medication, (chapter 8).
  • Sands, R.G. (2001). Intervention with persons with severe mental illness: theories, concepts and philosophies, chapter 10. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 231-254.
  • Sands, R.G. (2001). Intervening with individuals affected by severe mental illness, medication, social skills training and family education, chapter 12. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 291-327.

Recommended Readings:

  • Bentley, K.J., & Walsh, J.F. (2001). The social worker and psychotropic medication. Belmont CA: Brooks/Cole, pp. 181-223, Medication Adherence and Refusal, (chapter 7), and Medication Monitoring and Management, (chapter 8).
  • Hogarty, G.E., Kornblith, S.J., Greenwald, D., & DiBarry, A.L., Cooley, S., Flesher, S., et al. (1995). Personal therapy: A disorder-relevant psychotherapy for schizophrenia. Schizophrenia Bulletin, 21, 379-393.
  • Miller, R., & Mason, S.E. (2001). Using group therapy to enhance treatment compliance in first episode schizophrenia. Social Work with Groups, 24(1), 38-51.
  • Ziguras, S.J., Klimidis, S., Lambert, T.J.R., & Jackson, A.C. (2001). Determinants of anti-psychotic medication compliance in a multicultural population. Community Mental Health Journal, 37(3), 273-284.
  • Zygmunt, A., Olfson, M., Boyer, C.A., & Mechanic, D. (2002). Interventions to improve medication adherence in schizophrenia. The American Journal of Psychiatry, 159(10), 1653-1664.

Week 7 module topic: Treatment for Concomitant Mental Health and Substance Abuse Problems

Goals/Purpose:

  • To develop an understanding of the interrelationship between substance abuse and mental health problems.
  • To develop skill in assessing and treating individuals with a diagnosis of concomitant mental health and substance abuse problems.

Objectives:

  1. Articulate an understanding of the biopsychosocial model of addiction and mental health problems;
  2. Discuss controversies in the treatment of co-occurring disorders;
  3. Discuss the nature and effects of drugs of abuse;
  4. Assess mental health clients for substance abuse problems;
  5. Develop treatment plans to address co-occurring mental health and substance use problems;
  6. Use social skills training for relapse prevention.

Topic Outline:

  1. Biopsychosocial model
    1. Interplay of biological, psychological, and social factors in concomitant mental health and substance abuse problems.
    2. Evidence for the contribution of biological, psychological, and social factors.
  2. Controversies in dual diagnosis treatment
    1. Identifying the “primary” disorder.
    2. Should treatment occur in a mental health, substance abuse, or dual track program?
    3. Use of medication.
    4. Use of 12-step program.
  3. Drugs of abuse
    1. Students should use the online resource to update themselves on the various drugs of abuse and their effects.
  4. Assessment
    1. Incorporating assessment of substance use into the biopsychosocial assessment.
    2. Components of a substance use assessment.
    3. Substance abuse screening tools.
    4. Using a functional assessment to ascertain how substances are used in relation to psychiatric symptoms and effects on functioning.
  5. Treatment planning
    1. Developing treatment plans to address co-occurring mental health and substance abuse problems.
  6. Relapse prevention using social skills training
    1. Importance of relapse prevention.
    2. Evidence for the effectiveness of social skills training to prevent relapse.
    3. Using social skills training to enhance self-efficacy and increase relapse prevention skills.

Suggested Session Instruction Methods and Class Activities:

  • Lecture and discussion
  • Suggested Homework Assignments:
    • Assign pairs of students specific drugs of abuse to review on-line. Have the students provide a brief update on the drugs that they reviewed on-line to the class.
    • Develop a treatment plan for a dually diagnosed client. Evaluate and plan interventions using the perspective that the problem is:
      1. A mental health problem.
      2. A substance abuse problem.
      3. Both a mental health and substance abuse problem.
  • Suggested In-Class Activities:
    • Role-play a substance use assessment.
    • Practice social skills training for relapse prevention.
    • Assign pairs of students specific drugs of abuse to review on-line. Have students provide a brief update on the drugs that they reviewed on-line to the class.
    • Develop a treatment plan for a dually diagnosed client.

Evaluate and plan interventions using the perspective that the problem is: (1) a mental health problem, (2) a substance abuse problem, (3) both a mental health and substance abuse problem.

Required Readings:

  • Sands, R.G. (2001). Clinical practice with clients who abuse substances, chapter 13, A biopsychosocial conceptual framework, review of chapter 3. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 328-368 and 47-77.
  • Annis, H.M. & Davis, C. S. (1991). Relapse prevention. Alcohol Health & Research World, 15 (3), 204-212.
  • Drake, R.E., Essock, S.M. Shaner, A., Carey, K.B., Minkoff, K., Kola, L. et al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52, 469-476.
  • Ries, R. et al. (1994). Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse - TIP Series #9 Rockville, MD: U.S. Department of Health and Human Services - Center for Substance Abuse Treatment. (Can be ordered on-line at http://www.health.org Leaving OMH site) (Revised Tip due out in 2003). Available online at: http://ncadi.samhsa.gov/govpubs/bkd134 Leaving OMH site
  • Info Facts on Drugs of Abuse at: http://www.nida.nih.gov/DrugPages/ Leaving OMH site
    (Site provides detailed description of each drug of abuse and its effects.)
  • Miller, R., & Mason, S.E. (2002). Diagnosis schizophrenia, pp. 114-128, Alcohol, Drugs and Safer Sex, (Chapter 12).

Recommended Readings:

  • Watkins, T.R., Lewellen, A., and Barrett, M.C. (2001). Dual diagnosis: An integrated approach to treatment. Thousand Oaks, CA: Sage Publications

Week 8: Free Week

Free week – This week may be used to visit an EBP site, invite a guest speaker, as additional time for specified area not covered, or for more depth in a particular topic area.

Week 9 module topic: Family Psychoeducation Module

Goals/Purpose:

  • To provide students with an overview of psychoeducation as an evidence-based practice that fits with social work perspective and values
  • To provide students with an overview of the theory underlying the approach
  • To sensitize students to the critical role of consumers and families as allies and collaborators in psychoeducational and other evidence-based interventions
  • To provide students with a framework for considering diversity and culture when implementing psychoeducational interventions
  • To relate psychoeducation to the other evidence-based practices

Module Objectives:

  1. Demonstrate knowledge about the unique aspects of psychoeducation and how it complements and enhances other evidence-based practices;
  2. Describe the theoretical underpinnings of psychoeducation and how these affect application, implementation, and policy;
  3. Describe the key components and principles of the psychoeducational model as demonstrated through applied research, and in the context of replication and fidelity to the model.

Topic Outline:

  1. Overview and definition of psychoeducation in the context of evidence-based practice
    1. Rationale and need
    2. Paradigm shift from "medical model" to more collaborative strengths-based model
    3. Synergy of educational and therapeutic techniques
  2. Literature- based examples and applications of psychoeducation as evidence-based practice
    1. Randomized trials
    2. Falloon et al., 1998
    3. McFarlane et al., 1993; 1995
  3. Theoretical and historical overview of psychoeducation
    1. Over arching theory: Ecological systems theory
    2. Social support & group theory
    3. Social learning theory
    4. Cognitive behavioral theory
    5. Approaches to problem solving
  4. History of psychoeducation in relationship to the family and consumer advocacy movements
  5. Structure, content, format, timing, flexibility
    1. Multiple family groups, single family sessions, individual sessions
    2. Length of intervention
    3. Structure and format
    4. Psychoeducation curriculum content
  6. Implications for Practice & Policy
    1. Funding
    2. Reimbursement
    3. Staff and administrative support (i.e. time, attitude, buy-in)
    4. Identifying and bridging cultural differences among families, consumers and providers, and building cultural competency
    5. Staff training and supervision
    6. Constantly changing knowledge base regarding serious mental illness
    7. Challenges regarding confidentiality and ethics

Suggested Session Instruction Methods and Class Activities:

  • Didactic presentation & discussion
  • Suggested in-class activities:
    • Break-out into small groups to plan a culturally sensitive psychoeducational session (different groups focusing on different cultures). Come together for a large group discussion.
    • Students prepare and email questions for discussion (i.e. related to assigned readings) prior to class session small group and/or large group discussion on questions.
    • Video Clip on family issues and severe and persistent mental illness (SPMI) large group discussion regarding potential applications for psychoeducation (suggested video: "Uncertain Journey").

Required Readings:

  • Sands, R.G. (2001). Intervening with individuals affected by severe mental illness: medication, social skills training and family education, chapter 12. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, pp. 320-323.
  • Falloon, I. R., Held, T., Roncone, R., Coverdale, J. H., & Laidlaw, T. M. (1998). Optimal treatment strategies to enhance recovery from schizophrenia. Australia New Zealand Journal of Psychiatry, 32(1), 43-49.
  • Lukens, E. & Thorning, H. Psychoeducation and severe mental illness (1998). In Williams, J. & Ell, K. (eds.) Breakthroughs in mental health research: Implications for social work practice, pp. 343-365. NASW Press: Washington DC.
  • McFarlane, W., Dunne, E., Lukens, E., Newmark, M., McLaughlin-Toran, J., Deakins, S. et al. (1993). From Research to clinical practice: Dissemination of New York State's family psychoeducation project. Hospital & Community Psychiatry 44, 265-270.
  • McFarlane, W., Lukens, E., Link, B., Dushay, R., Deakins, S., Dunne, E., et al (1995). Multiple Family Groups and Psychoeducation in the Treatment of Schizophrenia. Archives of General Psychiatry, 52, 679-687.

Week 10 module topic: Supported Employment

Goals/Purpose:

  • To provide an understanding of the importance of work as treatment and outcome for individuals with a diagnosis of serious mental illness.
  • To provide an understanding of the role of evidence- based supported employment technology as a tool to help consumers reach their vocational goals.

Objectives:

  1. Understand the social policy context for promoting work for consumers;
  2. Acquire knowledge about the range of work options, and programs that offer these options, available to consumers in the New York State provider system;
  3. Describe the key components of a Supported Employment approach;
  4. Understand and identify the evidence for Supported Employment approach;
  5. Identify the implications of Supported Employment for social work practice.

Topic Outline:

  1. Setting the stage
    1. Why are we talking about work for individuals with a diagnosis of serious mental illness?
      1. Social policy shift to support work outcome evidenced through legislation and funding
      2. Factors that make the shift possible
        1. Improvements in treatment and medications
        2. Research that supports positive outcomes as a consequence of working
        3. Consumer demand
  2. What is work?
    1. Agency based options
      1. Prevocational services
        1. Time limited activities that involve preparation for work through skill acquisition (e.g., preparing resumes, interviewing, dressing for work) and exploration of interests and options important to career development
      2. Internships/Volunteer positions
        1. Positions that allow consumers to try out a specific type of job, usually time limited and unpaid or paid a small stipend to cover expenses
      3. Sheltered workshops
        1. Structured, supervised employment usually involving unskilled, repetitive tasks where consumers typically earn below minimum wage
    2. Community based options
      1. Integrated work
        1. Enclaves (groups of consumers working together at a business)
        2. Work crews (mobile teams of consumers who provide services to multiple businesses and where the employer is usually the provider agency
        3. Affirmative businesses (small businesses that provide goods or services to the public where co-workers are others with mental health conditions and the employer is the provider agency)
        4. Transitional employment (part time, temporary placement at an employer)
      2. Competitive work
        1. Compensated labor for which an individual applies, is screened and offered a position
        2. Though the majority of daily contacts are not with paid care givers or other people with disabilities, the recipient can receive some level of support or assistance from a paid care giver (e.g., supported/assisted competitive employment program)
    3. Operationalization of work options
      1. Vocational program types in New York State Personalized Recovery Oriented Services (PROS) including IPRTs, Clubhouses, Psychosocial Clubs, Supportive Employment, and Supported Employment and VESID programs
    4. Discussion questions:
      1. What has been your experience at the agencies where you are placed?
      2. What work-related issues do consumers have?
      3. For example, do consumers want to work?
      4. Are they afraid to work because of the fear that they would lose their benefits?
      5. Are vocational goals part of the treatment plan?
      6. Does the intake assessment include questions about work?
  3. Supported Employment as an approach to promote integrated, competitive employment
    1. Definition of supported employment
    2. History and models
      1. “choose-get-keep” (Boston)
      2. ACT (Madison)
      3. IPS (New Hampshire)
      4. WORC (New York)
    3. Impact on people with mental health conditions
      1. Increased placement
      2. Increased retention
      3. Indirect affect on well-being and QOL through retention
    4. Key supported employment components
      1. Vocational services integrated with other community support services
      2. Strengths perspective and consumer self-determination
      3. Assessment beyond gaps in functional capacity caused by the condition, work history and skill set to include non-vocational barriers to employment
      4. Match between job, skills and interests
      5. Rapid placement into integrated competitive employment
      6. On-going post placement supports that include on-site interventions with employers
    5. Evidence for key components (summarized in Bond, 1998 and Bond, et al., 2001)
      1. Day treatment conversion studies: studies that replaced day treatment programs with supported employment programs and showed large increase in employment rates, no increase in relapse, cost savings
      2. Randomized controlled trials: studies that provide evidence supporting the effectiveness of the IPS model by showing better employment outcomes for people in IPS compared to controls
      3. Correlation studies of fidelity of implementation: studies find that closer implementation of IPS program components results in better employment outcomes
      4. Descriptive studies/ Qualitative studies: studies that describe the role of important components of supported employment, consumer choice, consumer characteristics associated with successful employment, provider operations and organizational and funding structures
    6. Discussion questions:
      1. Who is work ready?
      2. Does diagnosis predict work readiness?
      3. Do people need previous work experience to be considered work ready?
      4. Do people need to be symptom free to be work ready?
  4. Implications for social work practice
    1. Mental health agencies integrate work into policy, practice and culture
      1. Assessment : includes employment-related information such as non-vocational barriers to employment, career interests, vocational skills, and need for accommodation
      2. Service coordination: includes the employment system through negotiation and implementation of post-placement supports with employers as well as coordination of services around potential non-vocational barriers to employment
    2. Vocational services: whose job is it anyway?
    3. Relationship between work and education and training
    4. Employer perceptions and reactions – learning new skills
      1. Disclosure: understanding the risks and benefits, disclosure planning
      2. Entering the workplace: building a partnership with employers, marketing consumers, providing supports to the workplace
    5. Discussion questions:
      1. Is it the job of the social worker to enter the workplace with the consumer?
      2. What are the risks and benefits of disclosure?
      3. Is accommodation a right or a privilege?
      4. Does the mandate for employers to accommodate people with disabilities mean that the consumer does not need to meet job qualifications?

Suggested Session Instruction Methods and Class Activities:

  • Didactic presentation and discussion.

Required Readings:

  • Akabas, S. H. & Gates, L. B. (in preparation). Work Opportunities for Rewarding Careers: An approach to guide practice with mental health consumers.
  • Bond, G. R. (1998). Principles of the individual placement and support model: Empirical support. Psychiatric Rehabilitation Journal, 22 (1), 11 –23.
  • Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A. Meisler, N., Lehman, A. F. et al. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 53 (3) 313- 322.
  • Gates, L. B., Weidberg, S., Akabas, S. H., Myers, R., Schwager, M. & Kailin-Kee, J. (in review). Performance Based Contracting: Turning vocational policy into jobs. Administration and Policy in Mental Health.
  • Marrone, J., Hoff, D. & Gold, M. (1999). Organizational change for community employment. Journal of Rehabilitation, 10 – 19.
Week 11 module topic: Social Skills

Goals/Purpose:

  • To understand the essential mechanics of social skills learning for individuals with a diagnosis of serious mental illnesses.
  • To review the current literature for its efficacy.

Objectives:

  1. Differentiate and utilize the various types of social skills training techniques.
  2. Articulate the current outcome data available for social skills training.

Topic Outline:

  1. Social skills training models.
    1. The different techniques are presented and discussed. They include:
      1. Modeling
      2. Practice and role play
      3. Homework assignments
      4. Cognitive restructuring
    2. The use of the group and individual modes of treatment are compared.
  2. Outcome data for social skills training.
    1. The existing outcome data are presented.
    2. Research methods for procuring this data are discussed.

Suggested Session Instruction Methods and Class Activities:

  • Lecture
  • Discussion
  • Suggested in-class activities:
    • Students are asked to role play a social skills training group session. Students are assigned in groups to role play modeling, practice, and cognitive restructuring.
  • Suggested homework assignments
    • Students are asked to identify 3 skills and create a homework assignment for each skill. Students are asked to role play the evaluation of the assignments.
    • Students are asked to submit an evaluation design for a social skills training group.

Required Readings:

  • Sands, R.G. (2001). Community care of persons with severe mental illness, case management and community resources. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, Chapter 11, pp. 255-290.
  • Sands, R.G. (2001). Social Skills Training. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon, chapter 12, pp. 302-312.

Recommended Readings:

  • Bellack, A.S., Mueser, K.T., Gingerich, S., & Agresta, J. (1997). Social skills training for schizophrenia: A step-by-step guide. New York: Guilford.
  • Bellack, A.S., Gold, J.M., & Buchanan, R.W. (1999). Cognitive rehabilitation for schizophrenia: Problems, prospects, and strategies. Schizophrenia Bulletin, 25(2), 257-
  • Glynn, S.M., Marder, S.R., Liberman, R.P., Blair, K., Wirshing, W.C., Wirshing, D.A., Ross, D., & Mintz, J. (2002). Supplementing clinic-based skills training with manual-based community support sessions: Effects on social adjustment of patients with schizophrenia. American Journal of Psychiatry, 159(5), 829-837.
  • Heinssen, R.K., Liberman, R.P., & Kopelowicz, A. (2000). Psychosocial skills training for schizophrenia: lessons from the laboratory. Schizophrenia Bulletin, 26(1), 21 –
  • Liberman, R.P., Glyn, S., Blair, K.E., Ross, D., & Marder, S.R. (2002). In vivo amplified skills training: Promoting generalization of independent living skills for clients with schizophrenia. Psychiatry, 65(2), 137-155.

Week 12 module topic: Trauma and Serious Mental Illness

Goals/Purpose: The module will present information on trauma exposure and post-traumatic stress disorder (PTSD) in individuals with a diagnosis of serious mental illness, building on students’ knowledge and skills acquired in the foundation year and in previous modules in the course. The module will address trauma and serious mental illness as an emerging research topic.

Objectives: Upon completion, student will be able to:

  1. Demonstrate an understanding of the epidemiology of trauma and PTSD in individuals with a diagnosis of serious mental illness, and relate this understanding to social work’s strengths perspective.
  2. Display a sound grasp of current research about trauma etiology in individuals with a diagnosis of serious mental illness.
  3. Appreciate recent empirically- based psychosocial treatment interventions for individuals with a diagnosis of serious mental illness who have experienced trauma, and exhibit the ability to select and apply these interventions to needy client populations.

Topic Outline:

  1. Epidemiology of trauma and PTSD:
    1. Most people experience at least one traumatic event serious enough to lead to PTSD, but only a few people go on to develop PTSD.
    2. People with PTSD are at higher risk for other psychiatric and substance abuse disorders
    3. Three uniform risk factors for PTSD:
      1. Pre-existing psychiatric disorders;
      2. Family history of PTSD;
      3. Childhood trauma.
  2. Trauma exposure and PTSD individuals with a diagnosis of serious mental illness:
    1. Growing evidence that individuals with a diagnosis of serious mental illness are at elevated risk for trauma exposure and subsequent PTSD.
    2. Intersection between trauma exposure, PTSD and serious mental illness is still unclear.
    3. Multiple models:
      1. Early trauma can be a risk factor for both major depression and PTSD
      2. Serious mental illness may heighten likelihood of trauma exposure through homelessness and substance abuse
      3. Serious mental illness may increase vulnerability to PTSD development at any given level of trauma
      4. Psychosis itself may constitute DSM-IV criterion A trauma
    4. Serious mental illness: nearly 3% of U.S. population.
    5. Rates of trauma exposure and PTSD in individuals with a diagnosis of serious mental illness not yet adequately determined due to nosologic, psychometric and sampling issues.
    6. Emerging evidence about high rates of trauma exposure and PTSD in individuals with a diagnosis of serious mental illness.
    7. Individuals diagnosed with serious mental illness: 34-53% report childhood sexual or physical abuse and 43-81% report some victimization over life course.
    8. PTSD in individuals with a diagnosis of serious mental illness: Seven recent studies report prevalence rate of 28-43% for PTSD in individuals with a diagnosis of serious mental illness, as opposed to 9.2% lifetime prevalence rate in the general population.
  3. Treatment and service delivery implications:
    1. Need to develop effective treatment for this co-morbid condition (PTSD and serious mental illness).
    2. Not yet any empirically validated treatments for individuals with a diagnosis of serious mental illness with PTSD, but efforts beginning to evaluate group and individual models using cognitive behavioral therapy, exposure therapy and cognitive restructuring.
    3. Assessment of individuals with a diagnosis of serious mental illness should always include assessing for trauma exposure and potential PTSD. Both inpatient and outpatient assessment protocols must do so.

Suggested Session Instruction Methods and Class Activities:

  • Class discussion
  • Lecture
  • Suggested in-class activities
  • Online assignments and discussions

Required Readings:

  • Sands, R.G. (2001). Postmodern feminist theory and practice. chapter 6. Clinical social work practice in behavioral mental health. Boston: Allyn & Bacon. pp. 116-133.
  • Breslau, N. (2002). Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Canadian Journal of Psychiatry, 41(10), 923-929.
  • Ell, K.C. and Asenberg, E. (1998). Stress-related disorders, Chapter 8. In Willams and Ell (Eds.). Advances in mental health research, pp. 217-259.
  • Koenen, K.C., Goodwin, R., Struening, E., Hellman, F. and Guardino, M. (2003). Post traumatic stress disorder and treatment seeking in a national screening sample. Journal of Traumatic Stress, 16(1), 5-16.
  • Rosenberg, S., Mueser, K., Jankowski, M.K., and Hamblen, J. (Summer 2002). Trauma exposure in people with severe mental illness. PTSD Research Quarterly, 13(3), 1-7.
  • Tucker, W. M. (2002). How to include the trauma history in the diagnosis and treatment of psychiatric inpatients. Psychiatric Quarterly, 73(2), 135-144.

Recommended Readings:

  • Alexander, M.J.& Muenzenmaier, K. (1998). Trauma, addiction, and recovery: Addressing public health epidemics among women with severe mental illness. In Levin, Blanch et al. (Eds.) (1998). Women's mental health services: A public health perspective. (pp. 215-239). Thousand Oaks, CA, US: Sage.
  • Read, J and Ross, C. (2003). Psychological trauma and psychosis: Another reason why people diagnosed schizophrenic must be offered psychological therapies. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. 31(1), 247-268.

Week 13 module topic: Peer Support & Self-help Module

Goals/Purpose:

  • To provide students with an overview of self-help programs as evidence-based practice that fits with social work perspective and values
  • To provide students with an overview of the theory underlying the approach
  • To sensitize students to the importance of self-help as a means to help individuals and families enhance resiliency, improve quality of life, and move towards recovery and increased community tenure
  • To place self-help programs in the context of other evidence-based practices

Objectives: Upon completion, student will be able to:

  1. Describe and define different forms of peer support in the context of EBP principles;
  2. Describe how peer support programs could enrich and enhance professional services;
  3. Document the advantages and challenges involved in peer support programs.

Topic Outline:

  1. Overview and definition of peer support in the context of evidence-based practice
    1. Peer support is defined as social, emotional and other support provided by persons with a shared condition or challenge (e.g. mental health consumers) to others with a similar challenge
    2. May be paid or voluntary (i.e. self-help)
  2. Mechanisms for consumer provided services and self-help programs
    1. Consumer provided services (defined as services in which consumers or family are paid as providers to deliver mental health services)
      1. Family provided services
      2. Consumer run or operated services are planned, operated, administered, & evaluated by consumers and are free-standing legal entities
      3. Consumer partnership services are services in which consumers deliver services, but control, administration, & governance is shared with non-consumers.
      4. Consumer or family employees within formal mental health service delivery system (positions within agency or service are designated for consumers who support & extend primary professional services)
  3. Self-help groups (examples)
    1. Recovery, Inc.
    2. Double Trouble
    3. Emotions Anonymous
    4. National Alliance for the Mentally Ill (NAMI)
  4. On-line and/or telephone support groups
  5. Peer support/Self-help principles
    1. Social support
    2. Experiential knowledge
    3. Social learning
    4. Helping as therapeutic? increased competence & self-awareness
    5. Learning through others w/common problems
  6. Benefits/outcomes for consumer providers of service
    1. Personal growth
    2. Growth as worker/increased potential for employment
    3. Mutual support
    4. Reduced hospitalization
  7. Benefits/outcomes for family providers of service
    1. Increased knowledge and advocacy skills
    2. Expanded social supports
  8. Review of key outcome studies for consumer recipients of service
    1. Solomon & Draine, 2001
    2. Mowbray, 1998; 2002
  9. Benefits for mental health provider system
    1. Added services
    2. Decreased stigma among providers
    3. Potential to reach/serve treatment refusers
  10. Implications for practice and policy
    1. Within provider system
    2. Staff and administrative awareness and buy-in
    3. On-site peer support personnel
    4. Selection of consumer services and employees
    5. Attitude towards, and willingness to learn from, consumer employees
    6. Volunteer vs. paid positions
    7. Training and supervision
    8. Infusion of cultural competency and sensitivity in consumer provided services
    9. Level of professional involvement
    10. Role of self-help & peer support in relationship to professional providers
  11. External peer support programs
    1. Staff awareness & training
    2. Referral of consumers for services
    3. Bridging/coordinating services between professionals and peers
    4. Attitudes of consumers and advocates towards professional involvement

Suggested Session Instruction Methods and Class Activities:

  • Lecture discussion
  • Suggested in-class activities:
    • Discussion of pros and cons of peer support services
    • Discussion of potential conflicts arising between professionals and consumers in implementation of peer support services & strategies for resolution
    • Small group exercise on planning & integrating peer support services in an existing mental health setting (e.g. community mental health center)

Required Readings:

  • Dixon, L., Stewart, T, Burland, J., Delahanty, J. Lucksted, A. & Hoffman, M (2001). Pilot study of the effectiveness of the family-to-family education program. Psychiatric Services, 5, 965-967.
  • Mowbray, C.T., Moxley, D.P., & Collins, M.E. (1998). Consumers as mental health providers: First-persons accounts of benefits and limitations. The Journal of Behavioral Health Services & Research, 25(4), 397-411.
  • Mowbray, C.T., Robinson, E.A., & Holter, M.C. (2002). Consumer drop-in centers: Operations, services, and consumer involvement. Health and Social Work, 27, 248-261.
  • Solomon, P. & Draine, J. (2001). The state of knowledge of the effectiveness of consumer provided services. Psychiatric Rehabilitation, 25, 20-27.

Week 14 module topic: Acting as an agent for change for “technology transfer”

Goals/Purpose:

  • To expose students to the ideas and strategies involved in changing organizations so that EBPs can be effectively integrated into practice.

Objectives:

  1. Describe principles that enhance the adoption of new interventions in organizations;
  2. Describe how the stages of change model could be applied to an organization or program;
  3. Discuss activities that enhance positive attitudes toward EBP interventions for consumers, staff, and program/organization.

Topic Outline (Key Topics*):

  1. Technology transfer (from ATTC: The Change Book, with additions)*
    1. Technology transfer can address the gap between research and practice by bringing EBP into practice settings.
    2. Technology transfer ≠ training.
    3. Adoption of change requires:
      1. Policies that provide incentives for innovation
      2. System administrators who are knowledgeable and supportive of the new practice
      3. Administrators willing to adapt services to new model
      4. Supervisors skilled in the new practices and knowledgeable about fidelity
      5. Opinion leaders who endorse the new model & accompanying changes
      6. Service providers with the knowledge, skills & attitudes consistent with the new practices
      7. Opportunities for staff input and feedback
      8. Opportunities for consumer input and feedback
  2. Steps for creating a blueprint for change (adapted from ATTC: The Change Book)* [note: one can begin at step a, or step c, depending on whether one is beginning with an identified problem or need, or a desired outcome. See The Change Book, chapters 3-6 for details on each identified step].
    1. Identify the problem or need.
    2. Organize a team for addressing the problem (when possible, include key opinion leaders on this team, as well as input from staff and consumers).
    3. Identify the desired outcome & clear indicators to measure this outcome.
    4. Assess the organization or agency for change readiness and resources.
    5. Assess the specific audience to be targeted.
    6. Identify the approach most likely to achieve the desired outcome.
    7. Design action and maintenance plans for your change initiative.
      1. If new intervention is implemented, identify which components are key for fidelity to the protocol
      2. Design system (e.g., checklists, supervision, etc.) to ensure fidelity
    8. Evaluate the progress of your change initiative.
      1. choose outcomes to monitor that relate directly to the identified problem and the new intervention/practices
      2. solicit input from participants to evaluate the process
      3. choose interval & system for ongoing monitoring of progress toward goals
    9. Revise action and maintenance plans based on evaluation results, return to step g to implement this revised plan.
  3. Applying the stages of change to organizations (adapted from ATTC: The Change Book)*
    1. Pre-contemplation: people and organizations are not thinking about change. They think, “Everything is working like it is supposed to” or “it’s not possible to change, so why bother?”
    2. Contemplation: people and organizations are thinking about change, but often have ambivalent thoughts or feelings. They think, “It might be a good idea to change, but is the situation really that bad?”
    3. Preparation: people and organizations are getting ready to make a change, but they are not yet ready to act. They think, “Something has to change if we are going to fix this problem.” Or, “let’s figure out how to implement this new practice.”
    4. Action: people and organizations are actively changing. They think, “We are changing our practice by _________.”
    5. Maintenance: people and organizations have already made a change and are working to maintain the new behavior. They think, “How is the change working? How could we improve our change plan? How can we ensure this change endures with future staff changes?”
    6. Relapse: people and organizations have returned to old behavior. How the relapse is interpreted and what is learned from it (to help with future change) is critical. If the conclusion is that “change isn’t possible”, then the system can return to pre-contemplation.
  4. Minimizing resistance (adapted from ATTC: The Change Book)*
    1. Apply Motivational Interviewing strategies with staff, team (e.g., empathic reflection, exploring pros & cons of change/no change).
    2. Provide incentives and rewards.
    3. Encourage and listen to full expression of concerns and fears.
    4. Celebrate small victories.
    5. Develop realistic goals.
    6. Actively involve as many people as possible from the start.
    7. Use opinion leaders and early adopters for training and promotion.
    8. Educate and communicate.
  5. Strategies for affecting change (from ATTC: The Change Book, Appendix)
    1. Strategies for affecting attitude change and adoption of innovations at the consumer level:
      1. Provide evidence of how a practice or innovation works
      2. Educate the recipient about the innovation
      3. Refer to effective technologies in other areas or fields
      4. Utilize advertising and marketing plans
    2. Strategies for affecting attitude change and adoption of innovations at the practitioner/clinical staff level:
      1. Provide evidence of how a practice or innovation works
      2. Educate the practitioner about the innovation
      3. Refer to effective technologies in other areas or fields
      4. Provide incentives for clinicians to use an innovation (peer support, financial incentives, outcomes monitoring)
      5. Identify early adopters and allow them to model
      6. Gain single state agency involvement in the adoption of an innovation
      7. Utilize a multifaceted approach to behavior change.
      8. Utilize advertising and marketing plans.
    3. Strategies for affecting attitude change and adoption of innovations at the program/organization level:
      1. Secure single state agency support and/or funding
      2. Educate programs/organizations that financing is important but should not be the “end all”
      3. Provide responses to the concerns or barriers perceived by the programs/organizations
      4. Develop training and diffusion strategies specifically for small stand-alone treatment programs and those with staff in recovery and/or without graduate degrees
  6. Other factors that can affect the adoption of innovations
    1. The size of a program/organization - larger programs are more likely to adopt new innovations.
    2. Type of work setting – community-based treatment program, medical or mental health center program, freestanding clinics.
    3. Staff composition – number of staff in recovery, staff with licenses, staff with master’s or doctoral degrees.
    4. The champion of an innovation or practice affects its adoption.
    5. Different learning styles require different strategies for acceptance and adoption of new innovations.
  7. Planning for the future—staying on top of a changing knowledge base*
    1. Remind students that the knowledge base continually changes.
    2. Brainstorm strategies for staying current about EBPs:
      1. Websites
      2. Membership in key professional organizations
      3. E-Letters

Suggested Session Instruction Methods and Class Activities:

  • Lecture/PowerPoint
  • Discussion
  • Suggested in-class activities:
    • Use case study in The Change Book to implement steps from the Blueprint for Action to the case (there are worksheets in The Change Book).
    • Have student use the worksheets to plan implementation of a specific EBP in specific mental health agencies (perhaps identified from students’ field placements).

Required Readings:

  • Addiction Technology Transfer Centers (2000). The change book: A blueprint for technology transfer. Rockville, MD: Center for Substance Abuse Treatment. [Electronic Version] Accessed on May 10, 2003 at: http://www.nattc.org/resPubs/cbResources.html#cb Leaving OMH site (in Adobe pdf. format, or you can order print copies for minimal cost).
  • Packard, T. (1995). TQM and organizational change and development. In B. Gummer & P. McCallion (Eds.), Total Quality Management in the social services: Theory and practice. Albany, NY: Rockefeller College Press. [Electronic Version]. Accessed on May 10, 2003 at: http://www.improve.org/tqm.html Leaving OMH site

* Signifies Key Components That Require Review

Copyright: © 2004 New York State Office of Mental Health
44 Holland Avenue
Albany, NY 12229
All rights reserved.

Opinions expressed in this course manual are those of the authors and do not necessarily reflect the opinions or official policy of the New York State Office of Mental Health.

Permission is granted for the user to download this course manual in its original format and print a limited number of copies for personal educational purposes only. The manual may not be used for any other purpose, altered from its original format, nor incorporated in any other publications or presentations, including but not limited to commercial programs, other books, databases or any kind of software, without written consent of the New York State Office of Mental Health. Inquiries regarding this manual should be addressed to the attention of Lisa Easterly-Klaas at the address listed above.

Comments or questions about the information on this page can be directed to the Social Work EBP Project.