Wellness Self-Management

Training

New York State Office of Mental Health

Statewide Initiative

Spring 2008

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Agenda Introductions Overview of Wellness Self-Management (WSM)

Wellness Self-Management Personal Workbook Recovery Concepts Cultural Competence Core competencies

Performance Indicators Educational Supervision including Fidelity Scale

Conducting a WSM Group – Demonstration and Practice

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What is WSM and Why is it Important?

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What is Wellness Self-Management? Curriculum based practice designed to assist

adults to effectively manage serious mental health problems

The topics covered include a number of research informed approaches that are organized into a comprehensive and coordinated set of practices

The WSM program was based on Illness Management & Recovery, a nationally recognized Evidence-Based Practice for adults with serious mental health problems

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Eight Goals of the Program Learning about recovery and what it can

mean for you Making the best use of your mental and

physical health services Learning that mental health and physical

wellness will help you to achieve your goals and support your personal recovery

Staying well by decreasing symptoms of a mental health problem

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Eight Goals of the Program (continued) Learning how to manage day to day

stress and prevent relapse Staying well by connecting with

others Staying well by living a healthy

lifestyle Recognizing and building on your

cultural values and experiences to support your personal recovery

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Details About the WSM Program Participation is voluntary Group or individual format Meets at least once a week Optimally closed group Group size- 8-10 members Ideally, co-led Peer co-leadership encouraged Groups run for 30 to 60 minutes typically Duration of program varies, but usually a year or

more to complete the entire curriculum Use of a Workbook that belongs to the participant

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More Details About the Program Emphasis on “Action Steps”, which promote

continued learning in real life outside the group

Emphasis on involving family/significant others Practitioners use several approaches

Motivational Educational Cognitive-behavioral

These competencies are embedded within the workbook to guide and reinforce skills.

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Expected Benefits

Show Promotional DVD here

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Limitations of Wellness Self -Management

Comprehensive curriculum vs. in depth focus

WSM is not a stand alone service While many individual WSM topics have

research support, this specific combination and format have not been rigorously studied (this project will add to our knowledge base)

Emphasis on verbal learning

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WSM Personal Workbook

(Hand Out and Review Workbook)

Recovery Perspectives

Psychiatric Recovery

“Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (William Anthony, Ph.D.)

“… refers to the lived real life experience of persons as they accept and overcome the challenge of the disability.” (Patricia Deegan, Ph.D.)

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GOOD NEWS“Long-term studies have consistently found

that half to two-thirds of people diagnosed with major mental illness go on to a significant or complete recovery. Data show that even in the second or third decade, a person can still go on to a complete recovery.”

Patricia Deegan, Ph.D.

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Underlying Values of Recovery

Person Orientation Focus on the person first and

foremost: a persons talents, aspirations, interests, strengths and cultural and religious values

A focus on life roles beyond the role of patient

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Underlying Values of RecoveryInvolvement Informed decision making related to the

services and treatments received Identifying the personal goals one wants to

improve Having frequent opportunities to read,

discuss and personalize workbook topics Having a voice in deciding the who,what,

when and where of services. Emphasis on participants learning from

each other

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Underlying Values of RecoveryChoice The opportunity to have options and a

range of possibilities reflecting felt needs and preferences.

Understanding options and evaluating the pros and cons of different choices is emphasized.

Coercion is to be avoided and Informed decision making and not

compliance is the goal.

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Underlying Values of RecoveryHope and Growth Potential Emphasis on positive possibilities Acknowledges negative realities without a

sense of defeat. Recognizes that the process of recovery is

not linear but often characterized by setbacks as well as progress.

Acknowledge the gains made in our understanding of mental health problems, treatment and rehabilitation.

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Effective Communication Matters: One approach to building a recovery supporting relationship

Increases understanding for sender and receiver Doesn’t elicit defensiveness, anger or passive

submission Has the main aim of keeping lines of

communication open Imparts accurate information and builds in check

steps to insure message is understood as intended

Leaves both parties feeling respected, heard and open to the others perspective

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One model of understanding communication patterns: Transactional Analysis ( Eric Berne M.D.)

PARENT

ADULT

CHILD

PARENT

ADULT

CHILD

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PARENT

CRITICALPARENT

NURTURINGPARENT

The “Taught” aspect of life. Early recordings from parental figures.

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CRITICALPARENT

•Automatic responses ( many unquestioned recordings)

•Demanding, critical,prejudgments, rules, rules and more rules, authoritarian, black and white thinking, traditional, generalizes, superior attitude, patronizing, sets limits, exerts power over others, rigid inflexible thinking, biases, doesn’t rely on facts to make judgments)

•Fond of words such as always, never, must, should

•Finger pointing, arms folded, harsh tone of voice, stern facial expressions

                         

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NURTURINGPARENT

Caring, sympathetic, empathic, sensitive, protective warm, loving, comforting, rescuing, and smothering

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HURTCHILD

Shame, guilt, fear, cautiousness, rage, feelings of inferiority, humiliation, embarrassment, avoidant, temper tantrum, impatient, self centered, pouting, feeling sorry for self

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HAPPY CHILD

energy for creativity, spontaneity, and intuition, joy, excitement, feels safe and loved, carefree, laughter, humor, pleasure seeking, wants, desires

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ADULT

Here and now focus, Reality testing, scientific, fact finding, calm, rational, problem solver, calculator, observant, self reflecting, explores assumptions, decides on a course of action based on the situation, fulfills responsibilities, asks what?, how?, when? with whom? Where? keeps an eye on outcomes and adjusts accordingly

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PARENT

ADULT

PARENT

ADULT

CHILD CHILD

In the workplace this pattern of communicating is likely in

situations in which individuals are dependent on others or situations where one group of people have

power over another group of people

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PARENT

ADULT

PARENT

ADULT

CHILD CHILD

WSM is about…

CULTURAL COMPETENCE

MAINTAINING AN ASKING STANCE,QUALITY IMPROVEMENT IN MENTAL HEALTH

SERVICE DELIVERY

We don’t see things as they are,

we see them as we

are.Anais Nin

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MAINTAIN AN ASKING STANCE

Consider all consumers as individuals first.

Never assume a person’s ethnic identity tells you anything about his or her cultural values or patterns of behavior.

Treat all “facts” you have ever heard or read about cultural values and traits as hypotheses, to be tested anew with each client.

TURN FACTS INTO QUESTIONS

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Cultural Competency in the WSM Workbook

The workbook has been designed to appreciate the cultural experience of participantsOne of the expressed goals of WSM

“recognizing and building on your cultural values to support your personal recovery”

A specific lesson is devoted to helping participants explore the influence of cultural values on healthcare decisions.

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Cultural Competency in the WSM Workbook (continued) Many key topic areas highlight the

connection between cultural perspectives and the following:Causes of mental illnessTreatment preferencesCommunity resources and social

support

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Core Clinical Competencies Utilized in Implementing Evidence-Based Practices

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Core Competencies

Connecting and Motivational skills

Educational

Cognitive-Behavioral

Integrating these skills in a group modality

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Connecting and Motivational Teaching

Strategies Help person see how learning information and

skills is related to achieving personal goals Demonstrate Understanding via empathic

responding Share perspective in a non judgmental manner Merge perspectives by emphasizing common

ground and shared goals Convey hope, belief, and confidence that person

can make desired changes and accomplish goals Help person explore costs and benefits of

maintaining the status quo vs. costs and benefits of change

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Educational Teaching Strategies

Interactive teaching, not lecturing Asking questions to review information and check

comprehension Using a variety of methods to present the

handout material, such as summarizing the key points, giving examples, taking turns reading aloud, or asking people to read on their own

Adopting participants’ language to facilitate comprehension of material

Multi-sensory learning approaches (see, speak, write, hear, do)

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Cognitive-Behavioral Teaching Strategies

Reinforcement Shaping Modeling Role playing Cognitive restructuring Programming practice opportunities

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The ABC’s of Conducting a WSM Group

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Conducting Purposeful and Effective Groups is ChallengingTypical Dilemmas

The Meandering Group The Monopolized Group Individual Therapy with an audience Group Multiple individual therapy with an audience

Group The “pulling teeth” group OR group leader

does most of the talking Group The “I just hope to survive this group” Group The “ filler group” I don’t care what we talk

about because we need to “fill in” the time

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The Basics of Teaching: Individual and Group

SettingsThe multi-phasic, temporally

sequential, tri-partite group pedagogical process

(M.P.T.S.T.P.G.P.P)

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The Key Elements of

(M.P.T.S.T.P.G.P.P)Beginning

Middle

End

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R.O.P.E.S.R eview_____

O verview___

P resentation____ Tell Show

E xercise________ Do

S ummary__________ END

BEGINNING

MIDDLE

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BEGINNING Review of main points of previous

lesson Review of Action Steps completed

since last session Review of participants’ experiences

with and feelings about today’s topic Review of why today’s topic is

important Overview of today’s lesson (agenda)

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The Review: An example of statements, questions and inquiries

STATE: The topic and lesson we covered last week was about________________

We discussed what this means and why it is important.

ASK: What was one of the main points you took from last weeks topic?

CHECK: Who chose to learn more about last week’s topic by completing an action step? What did you learn?

STATE: Today we are starting a new topic/lesson called __________________________________.

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The Review: An example of statements, questions and inquiries (continued)

ASK: (sample of questions) Before we begin let’s discuss what group members know about this topic area. What does the topic/lesson _____________________mean?

ASK: Why might this be important to learn about? How can this topic be helpful to you? How may learning about____________ benefit you in accomplishing your goals.

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The OVERVIEW: Sample statements group leader may useSTATE: As usual, we will start out reading

important information about_________ and why it may be important.

We will then complete the personalized worksheet on page___ and then

each group member will be invited to complete an action step plan if you decide this is a topic you want to learn more about or take other actions to support your personal recovery.

The group will last about________

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MIDDLEPresentation utilizes the Workbook’s

Important InformationPersonalized Worksheet and Discussion points

Exercise utilizes the Workbook’sAction Steps planning section

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END Summary of the important points of

today’s lesson Group members’ thoughts and feelings

about today’s lesson Positive feedback is provided to group

participants that focuses on specific aspects of today’s lesson

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REVIEW QUICK GUIDE

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Considerations for Practice Role-Plays No Oscars will be awarded (please be kind,

but realistic – not your most difficult interactions of your career)

Stay in role (until the end of role-play) Keep your same name For the sake of role-play, imagine the

setting for everyone is an outpatient day treatment program

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Practice exercises Exercise #1: Recovery Chapter (pages 52-54)

Topic: Personal strengths and outside resources helps recovery

Lesson: Recognizing and using your cultural and community resources

Exercise #2: Mental Health Wellness Chapter (pages 95-97) Topic: Coping with Stress and Symptoms Lesson: Identifying your personal signs of stress

Exercise #3: Living a healthy Lifestyle and Recovery (pages 159-161) Topic: What is a healthy lifestyle and why is it

important? Lesson: What is connection between healthy

lifestyle and mental health recovery?