Department of Veterans Affairs

1. Department of Veterans Affairs VA PSYCHOLOGY LEADERSHIP CONFERENCEMay 18, 2007Psychosocial Rehabilitation and Recovery Oriented ServicesRobert Gresen, Ph.D.(Robert.Gresen@va.gov)

2. Major Program Areas • Family Services • Peer Support • Psychosocial Rehabilitation and Recovery Centers • Vocational Rehabilitation • Other evidence based and best practices • Anti-Stigma • Staff, veteran and other stakeholder education • Local Recovery Coordinators

3. Family Services • Family engagement, support, education • Family Psychoeducation • Administrative supports/incentives • Legislation

4. Family Psychoeducation (FPE) Funded FPE Proposals: • FY’05 – 2 Proposals • FY’06 - 9 Proposals • FY’07 – 8 Proposals This is estimated to address only a small percentage of the overall need system-wide. (1/4- 1/3)

5. Peer Support Services • Provided by a person who has recovered or has experienced significant recovery from serious mental illness • Utilizes personal experience of being a consumer of mental health services in the context of helping others

6. Peer Support Services (cont) • Various models • Peer Support Technicians (paid staff) • Peer Support/Education Groups (e.g. Vet to Vet) • Consumer Operated Services • Need to understand the various models • Similarities and differences; strengths of each • Roles, responsibilities, boundaries, etc.

7. Peer Support Services (cont)24 sites • Peers as VHA staff (PSTs ) serve as full members of the mental health treatment team • Document in the medical record • Assist veterans in skill building, goal setting, problem solving, outreach …

8. Peer Support Services(continued) PSTs may be placed in mental health clinics, inpatient units, MHICMs, partial hospitalization, homeless programs, work restoration, residential rehabilitation programs ...

9. Peer Support Services (cont) • For those models where peer specialists are hired • Insure current staff have sufficiently embraced recovery beliefs and principles to value an respect the peer providers role and their unique contribution to the mental health team • Insure that proper HR procedures are used • National training planned – August 2007

10. Psychosocial Rehabilitation and Recovery Centers (PRRCs) • Centers where veterans with mental illness can explore and pursue recovery options • Veterans can receive professional and self-help/peer support services as well as referral to other VA or community-based services. • PRRCs should be developed in the context of the existing MH continuum of care, available community resources, etc.

11. Psychosocial Rehabilitation and Recovery Centers (PRRCs) (continued) Funded FPE Proposals: • FY’06 - 18 Proposals • FY’07 – 9 Proposals Existing Day Treatment Centers: 42 PRRC National Training planned for FY 2007

12. Vocational Rehabilitation • 37,792 veterans served 2006 • Primary Clinical Approaches • Incentive Therapy, Vocational Assistance, CWT • 162 CWT programs: All major facilities • 45 new programs FY05, 06 & 07 • 13 of 21 Polytrauma program locations • CWT – SCI Research at 5 locations • 275 new staff funded FY05, 06 & 07

13. Compensated Work Therapy • Three components • Workshop evaluation • Transitional Work Experiences • Supported Employment • Supported Employment • Focus on veterans with psychosis • 4000 served in fy 2006 • “Experiment” in EBP implementation

14. Other Evidence Based and Emerging Best Practices • Existing literature • Authoritative sources such as the SAMHSA website http://www.mentalhealth.samhsa.gov/cmhs/ communitysupport/toolkits/default.asp • Other emerging best practices

15. Is there a plan? National Recovery Coordinator • Resource to the field • Oversee implementation of recovery initiative in VHA MH • Appoint a NATIONAL RECOVERY ADVISORY COMMITTEE to provide expert advice and assistance

16. Activities of the NRC and the National Recovery Advisory Committee • Adopt and promulgate the SAMHSA definition of Recovery • Recovery Education program for staff • Recovery Education for veterans and family members • Compile a list of recommended resource materials • Develop a peer support system at each facility

17. Activities of the NRC and the National Recovery Advisory Committee (continued) • Facilitate and support the efforts of field based MH leadership to develop plans for implementing recovery initiatives at each facility. • Monitor and facilitate implementation of recovery oriented care system-wide • Assess the impact of recovery transformation • recovery outcomes of consumers • increased provider competency

18. Activities of the NRC and the National Recovery Advisory Committee (continued) • Identify best practice measures of above • Encourage and identify resources specifically to support research to evaluate implementation and effectiveness of recovery oriented programs. • Collaborate with OQP and JCAHO to develop appropriate ORYX measure to track facility adherence to this process.

19. Local Recovery Coordinators (LRCs) In conjunction with the Mental Health Director: • develop a 3-5 year facility plan to implement recovery oriented services • develops a facility recovery education plan to include staff, veterans, family members and other stakeholders • develop and conduct evaluations

20. Local Recovery Coordinators (continued) • provide an annual report on implementation progress • participates in VISN and national conference calls • participates in MH leadership meetings at the local level • May serve as VISN POC to NRC/NRAC • delivers recovery oriented care

21. Local Recovery Coordinators (continued) • Qualifications • Lived experience in recovery from mental illness preferred but not required. • Experience in the recovery model and in transforming health care systems, particularly the VA. • Previous experience as a Mental Health clinician providing direct care.

22. Educational Initiatives • Satellite programs addressing the general principles of psychosocial rehabilitation and recovery for all mental health staff have been broadcast. • Conferences have been held in vocational rehabilitation, peer support and Mental Health Intensive Case Management

23. Mental Illness Awareness Week(MIAW) • Office of Mental Health Services developed a “Recognition of Recovery” package which included a key note address, sample program, certificates, etc • 16 VAMCs hosted MIAW programs the first week of October, 2006

24. Educational Initiatives(continued) • Web-based anti-stigma training program currently available • Web-based Recovery Oriented mental health services training program expected in 2007*

25. Educational Initiatives(continued) • Interprofessional Fellowship Program in Psychosocial Rehabilitation for trainees in mental health professions funded by OAA (Bedford, Palo Alto, West Haven, Durham, San Diego, Waco, Little Rock) • Clinical supervisor training

26. Educational Initiatives(continued) Presentations at various VISN and national level meetings: • VISN 3 MH Recovery Conference (Sept. 2006) • VISN 23 Annual Mental Health Meeting (May 2007) • VA Psychology Leadership Conference (May 2007) • Transforming VHA MH Care (July 2007)

27. Evaluation/Accoutability • Tracking allocated dollars and people • Monitoring will include employees hired under those dollars and, if they were an internal or external hire. If internal the position vacated will be monitored to assure it is backfilled • Outcomes

28. Other Plans for the Immediate Future • Develop IL on PSR concepts • Develop IL on peer support: definitions, basic concepts, models ….. • Develop directive on Peer Support: policy, procedures, hiring practices, …. • Consumer Councils • Consumer Representation on MH Executive Committees • New Educational Initiatives

29. What else do we need to do?

30. Evidence-Based PracticesFamily Psychoeducation (FPE) Refers to several clinical models having the main focus of improving the well-being and functioning of the veteran and meeting the family members' need for education, guidance and support as they participate in the on-going care of an ill relative. All evidence based modes include the following key elements: • Family support • Problem-solving skills training • Crisis intervention • Duration of at least nine months • Education about mental illness

31. Evidence Based FPE Models • Behavioral Family Management (Ian Fallon et. al.) • Family Psychoeducation (Carol Anderson et. al.) • Psychoeduational Multifamily Groups (William McFarlane et. al.)

32. Psychosocial Rehabilitation (PSR) • Fundamental principle: Recovery is possible for individuals with Serious Mental Illness • Focus: Functional domains to maximize life satisfaction:

33. Consensus Conference on Mental Health RecoverySponsored by SAMHSA, December 2004 • Mental health recovery is a journey of healing and transformation for a person with a mental health disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or “personhood.” Recovery is a multi-faceted concept based on these 10 fundamental elements and guiding principles.

34. National Consensus Statement on Mental Health Recovery (SAMHSA)

35. Recovery Oriented Program(Farkas et. al. 2005) • Values • Interest in patients as people, consumer involvement and choice, growth potential • Structures • mission, policies, procedures, record keeping, and quality assurance • Staffing • selection, training and supervision

36. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158

37. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158

38. Recovery Practice StandardsFarkas et al 2005 Community Mental Health Journal, Vol. 41, No. 2, 141-158