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November 3, 2011 Volume 2, Issue 40
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To access RTP's Weekly Highlights, quarterly e-newsletters, Webinar recordings,
and PowerPoint presentations,
please visit http://www.dsgonline.com/rtp/resources.html.
The 2011 "Recovery-Oriented Care Continuum" Webinar series featured four steps:
Step 1: Outreach & Engagement
Step 2: Person-Centered Care Planning
Step 3: Promoting Recovery Through Psychological and Social Means
Step 4: Graduation

Click on the links above to download the PowerPoint presentations and recordings.

Paving the Way for Graduation: Using a Peer-Involved Model
by Neil Harbus, LCSW, CPRP
Pathways to Housing was founded almost 20 years ago based on the belief that housing was a human right, and that the most vulnerable population—those who were homeless with mental health issues—should have immediate access to permanent, independent housing. As originators of the "Housing First" model, Pathways has always been committed to providing services driven by consumer choice and supporting an individual's ability to grow and recover within the community. Over the last few years as more people have "graduated" to less intensive levels of care, a need to improve the graduation process within the agency became apparent. Our aim was to facilitate a fairly seamless transition, placing individuals at the center and involving peers, staff, and others to support them throughout the graduation process.

Designing the Process
We realized many existing facets of Pathways could help support this new graduation process: permanent housing people could retain even after graduation, continuity of care as they moved from more intensive Assertive Community Treatment (ACT) teams to less intensive case management teams, and the ability to retain social connections they had established at Pathways.

Moving forward, we engaged in discussions with former graduates, candidates for graduation, staff working with candidates for graduation, and staff who would work with people after graduation.

Some common recommendations emerged from these discussions:
  • Make graduation a positive experience with a formal graduation ceremony and celebration.
  • Make graduation a gradual process with an individualized time frame varying from 3 to 9 months.
  • Provide a strong peer presence throughout the transition process.
  • Involve peers (who had successfully completed a transition) as mentors to support individuals before, during, and after graduation.
  • Provide specific skills training based on an individual's needs prior to graduation.
  • Ensure effective communication between all parties involved with the individual.

The "Moving On" Program
Recommendations for facilitating the graduation process led to the "Moving On" program. The program team consists of peers and clinicians who assist individuals in all aspects of graduation.

Peer presence is a cornerstone of Moving On, making the program and graduation process so unique. The Moving On program focuses on positive aspects of graduation, but also encourages people to work through fears and anxieties. Graduation is a big step for many, since case management teams only meet with people every 2 weeks and individuals are expected to take on more responsibility. Peers assume two roles, becoming intermediaries and advocates for individuals in the graduation process. They ensure individuals have a "voice" in all that's going on, and that the graduating person remains central to the process. They also make sure the graduation process proceeds at a comfortable pace for the individual. Peers are the bridge between the ACT team an individual is leaving and the new case management team assuming the individual's care.

Graduation Concerns
Peers involved in the Moving On program address individuals' concerns about graduation in a very compassionate yet forthright manner. Common concerns include feeling abandoned and rejected by the treatment team, fearing they will not be able to function independently in the community, and feeling they will not be successful in securing outside providers (psychiatrists and counselors). Also important are the concerns of family members, who may fear the individual will "fall apart" without supportive ACT services after graduation. All interested parties are involved in the Moving On planning process—their fears are taken seriously and addressed. Peers collaborate with individuals to handle these issues and design strategies to overcome fears and concerns.

The "Moving On" Process
The entire Moving On team becomes involved as soon as the graduation process begins. They collaborate with the individual to manage issues and develop skills he or she believes should be addressed prior to graduation. Their assistance includes accompanying people to new provider appointments, shopping for food and household items, maintaining an apartment, and using more community resources. While some of the work occurs at the Pathways offices, much of it happens in the community. Individuals are provided with as much support as they are comfortable receiving and can either meet with members of the team in person or get support by phone. As they work toward graduation, people are encouraged to access the services and supports available at Pathways' peer-run Resource Center, which offers groups, classes, and one-on-one counseling sessions. This is especially emphasized if they have an interest in employment, education, finances, or parenting.

The weekly Moving On group is the centerpiece of the entire process and includes peers from the Moving On program, past graduates, individuals in the process of graduating, and a peer representative from the Pathways Resource Center. The group meeting has evolved into a celebration of wellness to applaud accomplishments, discuss solutions to challenges, and share resources.

Outcomes and Graduation
As for early outcomes, 20 individuals graduated in our first class 1 year ago, and no one has had to return to an ACT team. A number of graduates are now working or pursuing their education, and all report an improved quality of life. After graduation, one individual described the transition: "Leaving the ACT team wasn't as difficult as I thought, especially with the help of the peers, and I can still go back and visit."

Pathways is about to have its second official graduation, with another 20-person class. Graduation has become an event not to be missed. There is music, food, poetry, family, and friends, and everyone at Pathways attends. Each graduate is given a certificate symbolizing the accomplishment. It is truly a special day for all.

Neil Harbus is program director of the Pathways to Housing Peer Wellness Program. The October 6, 2011 RTP Webinar, "Step 4 in the Recovery-Oriented Care Continuum," addressed the important recovery-oriented concept of an individual's "graduation" from formal services.

The New York Times Lives Restored Series
Managing Mental Illness While Building A Successful Career
It has long been thought that people with severe mental illness had limited career opportunities, and many are advised to take simple, low-stress jobs to avoid exacerbating their symptoms. But now researchers are studying people with schizophrenia and its close cousin schizoaffective disorder as they effectively manage demanding, high-stress positions. Keris Myrick, MBA, PhDc, who has been diagnosed with schizoaffective disorder, talked about managing her illness and sticking to a consistent and full schedule. "When I'm well," she said, "I have to continually ask, 'What does it take to be well?' I need some very specific things around me. And if I get spinny—that's what I call it when my brain moves too fast—well, I need to have a plan."

To read the article, visit http://www.nytimes.com/2011/10/23/health/23lives.html?_r=1&ref=us.

National Technical Assistance Center for Children's Mental Health
The National Technical Assistance Center for Children's Mental Health (NTAC) has taken a leadership role in addressing the mental health needs of children and youth at the policy, research, training, consultation, and direct service levels. NTAC has provided a foundation for building comprehensive community service delivery systems for children with mental health and/or substance abuse needs and their families. They work with States, Tribes, communities, and families, offering a range of training and technical assistance, publications, and informational resources. The center promotes services and supports that are
  • community based
  • comprehensive, coordinated, and collaborative across systems and organizations
  • in full partnership with families and youth
  • culturally and linguistically competent
  • individualized, flexible, and coordinated to fit each child and family
  • strength based
  • evidence or practice based
NTAC is committed to preserving a broad view of mental health for people from birth to adulthood. To this end, the center's work supports community systems that provide services for children and youth with emotional disturbances and co-occurring problems such as substance abuse, developmental disabilities, and physical impairments.

NTAC is funded and supported by SAMHSA. Other funding sources include the Administration for Children and Families and the Annie E. Casey Foundation.

New SAMHSA Publication Geared Toward Women and Girls
Addressing the Needs of Women and Girls: Core Competencies for Mental Health and Substance Abuse Service Professionals. This report provides mental health and substance abuse professionals with a comprehensive overview of unique prevention, treatment, and recovery skills and practices—including trauma-informed care—to effectively serve women and girls. Published in October 2011, the report will be useful for the full spectrum of behavioral health professionals.

Audience: educators, program planners, administrators, project managers, public health professionals, professional care providers, and HHS staff

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-
oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other
recovery resources, please contact Stephanie Bernstein, MSW, at 877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
877.584.8535, or email recoverytopractice@dsgonline.com.


The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.