The Empowerment Center: Recovery Mentor Project |
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A Proposal to |
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The Westchester County Department of Community Mental Health |
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Presented on |
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June 10, 2008 |
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Table of Contents |
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Executive Summary |
Page 3 |
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Introduction |
Page 4 |
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A. K. Sen’s Capability Set diagram |
Page 6 |
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Contemporary Practice diagram |
Page 9 |
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Applied Services diagram |
Page 12 |
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Measurements |
Page 13 |
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Timeline and Summary of Services |
Page 14 |
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Additional Supports |
Page 16 |
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Anticipated Conclusion |
Page 16 |
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Executive Summary The Commissioner of New York State Office of Mental Health came to Westchester County and spoke about the failures of the present day mental health system. In an effort to play a role in the improvement lives of people in the present mental health system, we humbly present our Recovery Mentoring Project. We believe there are three rudimentary elements that need to be included when attempting to effect a positive social change:
It is predictable that when a patient is fully engaged in their personal medical treatment the success rate for that practice increases. Therefore, a program designed to work for the expressed interest of the person being served stands to have a higher probability of success. An environment to enable a person to trust and fully participate must be created to maximize the person’s involvement in their treatment. We have chosen A.K. Sen’s Capability Set as our theory behind our proposed Recovery Mentoring Project. Sen explains a person’s capability is dependent on their personal skills, the environment’s structural opportunities, and the person’s motivation for Self-Determination. If one or more of these components become disturbed a person’s capabilities will suffer. However, if these components are brought into “balance” a synergistic result will occur. The components of Sen’s Capability Set includes:
We have identified three general practices that will operationalize the components of Sen’s theory:
Personal skill building is emphasized as the primary effect desired in Care Coordination. Care Coordination is about organizing the right thing to happen at the right time to maximize an individual’s growth and development. The Wraparound approach fits well in answering Sen’s question, “what are the structural opportunities the person may use in their discovery of their recovery?” Person-Centered services place the person at the “hub” of their services. The primary benefit of a Person-Centered practices results in the restoration of hope and self esteem which motivates a person to participate in life and renew an enthusiasm to determine their own destiny, the third leg of Sen’s theory. The practical application of Sen’s theory through best practices is what The Empowerment Center is prepared to carry out when rolling out the Recovery Mentoring Project. The three rudimentary elements are paired in the following manner: Theory – General Practices - Services to be Provided
Motivation to Self-Determination – Person-Centered Practices – Trainings Motivation toward Self-Determination promoted through person centered services will be practically applied through engaging people in various trainings that encourage empowerment and overcoming psychiatric disabilities.
Structural Opportunities – Wraparound Practices – Self-Determination Fund A Self-Determination Fund will provide a practical application of a Wraparound practice providing the resources to enable access to structural opportunities to participants.
Personal Skill Set - Care Coordination Practices – Recovery Mentors The recovery mentor will be the person’s primary friend, comrade, personal assistant. The mentor will provide one to one unconditional support. The mentoring initiative will follow the same format of consumer-directed personal assistance (CDPA). The services to be implemented are the following:
In summary The Empowerment Center will administer the Recovery Mentoring Project by means of three primary services; providing empowerment trainings, working with a Self-Determination Fund and employing a number of part-time, one-to-one, personal assistance to the enrollees.
Through the generosity of the Human Services Resource Institute (HSRI) we have a number of measurement tools that will provide the necessary feedback for the enrollee, helping them in their discovery of recovery.
We will pay $12.00 an hour to a Recovery Mentor. A total of 1,600 hours will be available to enrollees throughout the year. The hours allocated to any one person enrolled in the project will be determined through a collaborative agreement between the person served, Westchester County Department of Community Mental Health and The Empowerment Center. Introduction Theory Motivation to Self-Determination - Personal Skills Set - Structural Opportunities
We introduce our proposal by describing A. K. Sen’s Capability Set theoretical construct. This construct is the foundation and guide we have based the services we will be offering. The Capability Set has been coupled with practices used in many progressive mental health services delivery systems. The common practices that are linked to Sen’s theory are used to derive the actual services we propose to offer as part of our response to the RFP.
It has been hard for psychologist and psychiatrist to find a useful theoretical construct that comprehensively conceptualizes a psychiatric disability. Furthermore, there are not many effective theories that can be used as a guide or direction to overcome a psychiatric disability.
In order for a theory to be successful it must be recognized and understood by many different groups. First and foremost, it has to make sense to the person seeking help. A second group is the scientific community. These are the people responsible for the various labels used to describe individual’s behavior that have been tagged a psychiatric disability. A third group of people that need to understand the theoretical construct are the people who have been hired to assist a person trying to overcome their psychiatric disability.
Economics Nobel Prize winner A.K. Sen’s theoretical framework defining disability is the foundation we have chosen to understand, measure and evaluate people overcoming the struggles associated with psychiatric disabilities. Sen’s Capability Set theory explains a person’s capability set does not constitute the presence of a physical or a mental ability; rather it is understood as a practical opportunity. A person’s capability set is dependent on their personal skills, their structural opportunities, and the person’s motivation for Self-Determination. If one or more of these components are terribly disturbed a person’s capabilities will suffer. If these components are brought into “balance,” a synergistic result will occur.
We have adopted this theoretical construct to provide our proposal with a sound theory. It is our hope that by using Sen’s Capability Set, we will enable the mentor and the person served to accurately identify the areas that people need to concentrates on in overcoming their psychiatric disability. Sen’s three components that make up his Capability Set are:
• Motivation To Self-Determination • Personal Skills Set • Structural Opportunities
Each of the above components, when observed, recorded, measured and evaluated will individually yield important information to utilize in a person’s service plan. It is significantly important to recognize the triangular comparison of the three components as the primary outcome to be evaluated. It is believed this comparison will yield the richest dimensional measurement or their sense of self. This measurement will enable a person to fully recognize their capability and areas to refocus from a disability mind set to a practical opportunity by overcoming the barriers associated with a disability. |
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Practices Motivation to Self-Determination – Person-Centered Practices Person-Centered services is reliant on the person’s motivation toward personal determination.
“A person centered approach is reshaping practices throughout behavioral health care with its emphasis on the individual who has strengths, talents, and interests rather than a person as a case or a diagnostic label (Wisconsin 2000).”
An environment to enable a person to trust and fully participated must be created to maximize the person’s involvement in their treatment. The primary goals of Person-Centered services is engagement and communication. Engagement and communication will only happen in a caring and understanding environment. Many people diagnosed with a psychiatric disability have learned a level of isolation and dependency that is very difficult to change. At The Empowerment Center we see people are able to grow from dependency to independence when they trust another person, identify with that person and then “take after” that person.
Engagement is meeting people in their own world. “In their own world,” is a cherished place that we all have experienced at each end. That is to say, each of us have danced with friends who were in altered realities and have taken the lead in the dance when we have become overcome by unusual realities. A person’s altered state is a natural response to extreme events. Listening to a person, believing and validating their experience leads to the doorway of that person’s world. That doorway is a privileged gift and one should only walk through the door carrying the reciprocal gifts of honor, trust, and respect. To pathologicalize a person’s behavior is to trivialize, euphemize and dehumanize the person’s experience. Respecting, validating and believing a person’s expressions cultivates trust that leads to hope, which, leads to empowerment and Self-Determination.
The switch from being a passive recipient of care to an active partner is a very compelling challenge. It is dependent on trust and connecting with another person. The connection results in the empowerment of a person establishing the courage to take the risk and begin participating in life.
A hero ventures forth from the world of common day into a region of supernatural wonder: fabulous forces are there encountered and a decisive victory is won: the hero comes back from this mysterious adventure with the power to bestow boons on his fellow man. Joseph Campbell
The goal in all service deliveries must be that the person is at the center of all decisions affecting his/her lives. Furthermore, it is the responsibility of the care giver to engage the initial connection and keep the lines of communication open. If communication is lost then person-centered decision making is lost and the opportunity to participate in life is lost.
That he not busy being born Is busy dying. Bob Dylan |
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All services must be delivered in a manner that is considerate, valued, validating, respectful and consistent. Person centered planning must be driven by the person’s strengths, values, culture, beliefs, spirituality and preferences. By recognizing personal values and by consistently being treated with respect and dignity the person becomes skilled at taking risks and gets busy living.
Structural Opportunities – Wraparound Practices Wraparound practices are reliant on finding the structural opportunities in the community that aid in the discovery of recovery. Wraparound is a philosophy of care that wraps the assets of the community around the person seeking help. It is used to build constructive relationships and support networks among people and their community. Wraparound practices are community based, culturally relevant, individualized, strength based, and person and family centered.
Wraparound plans are comprehensive and address multiple life domains across home, school, and community, including living environment; basic needs; safety; and social, emotional, educational, spiritual, and cultural needs.
A defining feature of Wraparound is that it is unconditional; if interventions are not achieving the outcomes desired by the team. The team regroups to rethink the configuration of supports, services, and interventions to ensure success in natural home, school, and community settings. In other words, people do not fail, but plans do. Rather than forcing a person to fit into existing program structures, Wraparound is based on the belief that services and supports should be flexibly arranged to meet and managed the unique needs of the person and their support network structural opportunities.
Personal Skill Set – Care Coordination Practices Care Coordination is reliant upon a person building the coping skills through the coordination of effective care. The skills range from independent living skills, occupation skills, money management skills or any other individual skill that will aid in the person’s recovery. In Care Coordination the person appoints a key person who will keep in close touch with the person, supporting the person and learning with the person what coping skills are needed by the person to fully participate in life.
The principal facet of Wraparound practices is getting people to the right place for the right learning experience at the right time.
Care Coordination primarily works to improve the person’s life skills, the major change takes place within the person. The change may come about from heighted enthusiasm toward Self-Determination due to a personal relationship or a new structural opportunity in the person’s community. At The Empowerment Center we believe there are three major levels of Care Coordination: the person develops skills on his/her own, a person develops skills with the help of others, and at times, a person needs someone else to perform the necessary skill for them.
Care Coordination as it is presently practiced, must be careful not to develop an artificial dependency between care giver and care user. At every opportunity the care giver must allow the people to do for themselves deciding what’s what in their lives. It’s the responsibility of the care giver to teach the person how to fish rather than give the person a fish. |
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Applied Services Motivation to Self-Determination – Person-Centered Practices - Trainings Motivation toward Self-Determination promoted through person centered services will be practically applied through engaging people in various trainings that encourage empowerment and overcoming psychiatric disabilities. The Empowerment Center will sponsor the following trainings but are not limited to: advance directives, mutual support, advocacy training, white paper training, cultural know how, supportline training and self help empowerment training. The training is a creation of an environment that promotes group support for the participants thereby providing them with exposure to peer support group.
These trainings will provide the participants the opportunity to bond with each other which will lead to Self-Determination, skill building support and content that will build personal skills.
Structural Opportunities – Wraparound Practices – Self-Determination Fund A Self-Determination Fund will provide a practical application of a Wraparound practice providing the resources to enable access to structural opportunities to participants. The fund will be used to integrate a person to community supports that they may never be able to access because of the lack of money. This fund will provide people the freedom to purchase things that they choose to help them with their recovery.
Personal Skill Set - Care Coordination Practices – Recovery Mentors The recovery mentor will be the person’s primary friend, comrade, personal assistant. As we know at The Empowerment Center, a private mentor will play a vital role in the individual growth of the person receiving services. The mentor will provide one to one unconditional support. The mentor will chosen by the participant from a list of bios offered to the person. The mentoring initiative will follow the same format of consumer-directed personal assistance (CDPA).
The Brokered Deal The CDPA’s brokered deal is intrinsic to the success of the program. The brokered deal is between the Customer, Employee and Broker (representing sponsoring agency). All participants will benefit, if the triangular relationship has been brokered and maintained. It is in each person’s best interest to achieve a successful working relationship.
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Roles of Each Participant The Customer
(the broker will mentor the enrollee on how to complete the above)Recovery MentorThe Employee· Work hours scheduled by Customer
The Employer of Record Broker- The Sponsoring Agency Employer of Record (The Empowerment Center or agency chosen by participant)
Principally, the deal can only be successful if the Customer is satisfied. The Empowerment Center feels it is paramount to improving the present mental health system by placing the people at the forefront of his/her treatment. All choices need to be based on the most recent state of the art information available. |
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Measurements HSRI - Human Services Resource Institute The Empowerment Center’s statewide initiative, The Coalition, has worked with HSRI to discover new state of the Art measurement tools for peer services. HSRI mission in the fields of developmental disabilities, physical disabilities, mental health and child welfare HSRI works to:
HSRI has graciously given The Empowerment Center Two volumes of measurement scales in mental health human services, Can We Measure Recovery and Measuring the Promise. We reviewed the 600 plus measurements and concluded these following scales would best serve the Recovery Mentoring Project. These measurement tools will provide vital feedback to the participant and Recovery Mentor to evaluate and guide the participants discovery of recovery.
Motivation to Self-Determination – Person-Centered Practices – Trainings Appendix I - MAKING DECISIONS EMPOWERMENT SCALE Appendix II - PERSONAL EMPOWERMENT SCALE
Structural Opportunities – Wraparound Practices – Self-Determination Fund Appendix III - ORGANIZATIONAL EMPOWERMENT SCALE Appendix IV - RECOVERY ENHANCING ENVIRONMENT MEASURE (REE) ALSO KNOWN AS THE DEVELOPING RECOVERY ENHANCING ENVIRONMENT MEASURE (DREEM) Appendix V - EXTRA-ORGANIZATIONAL EMPOWERMENT SCALE Personal Skill Set - Care Coordination Practices – Recovery Mentors Appendix VI - COMMUNITY LIVING SKILLS SCALE Appendix VII – RECOVERY ORIENTED PRACTICES INDEX (ROPI) (not in appendix)
In addition to these measurement tools the Recovery Mentoring Project will use an adaptation of the Western New York Coordination of Care Plan – Appendix VIII. The Plan will act as a tracking tool to help the participant and the mentor track and consolidate vital information to guide the participant to Self-Determination, empowerment and his/her discovery of recovery.
Timeline and Summary of Services
§ Create Recovery Mentoring Team. Eligible candidates will have graduated from The Empowerment Center’s NYWRAC Advocacy Training, Telephone Support Training and be in good standing as an employee of The Empowerment Center or has demonstrated the commitment to fully dedicate themselves to their peers. § The Empowerment Center in collaboration with Westchester County Department of Community Mental Health (WCDCMH) design, schedule and sponsor training for the Recovery Mentors in Person-Centered practices. § The team will schedule, advertise and present The Recovery Mentoring Initiative to all Westchester County community based mental health programs, psychiatric inpatient hospitals, club houses, drop-in center and the local NAMI chapter in Westchester County. Hand outs, literature and applications will be given to the scheduled audiences. § In collaboration with WCDCMH create the structure and policies for a Self-Determination Fund. By the end of Month 2 it must be completely operational.
§ Along with guidance from WCDCMH create a criteria for prioritizing applications § Accept applications for enrollment. § Review Applications and accept people into the program.
§ Organize, schedule and sponsor initial empowerment toward recovery training for chosen applicants. § Organize, schedule and sponsor initial social mixer among 12 accepted applicants and Prospective Recovery Mentors. § Allow applicants to choose their Recovery Mentor. § In collaboration with WCDCMH assign amount of hours assigned to individual applicant.
§ Begin Recovery Mentoring Project. Chosen Recovery Mentors will meet with the person who chose them as their Recovery Mentor. Using the people’s expressed interest as their guide Recovery Mentor will design their work according to the people they are working with. § The Empowerment Center will schedule mutual support training open to all chosen applicants. § Applicants with Recovery Mentor begins writing individual service plan. § Applicants are introduced advance directives by Recovery Mentor.
§ Organize, schedule and sponsor second social mixer among 12 accepted applicants and Prospective Recovery Mentors. § Allow applicants to choose their Recovery Mentor. § In collaboration with WCDCMH assign amount of hours assigned to individual applicant. § Organize, schedule and sponsor initial empowerment toward recovery training for chosen second chosen applicants. § The Empowerment Center will schedule White Paper training open for initial 12 applicants.
§ Begin recovery Mentoring Initiative. Chosen Recovery Mentors will meet with the person who chose them as their Recovery Mentor. Using the person’s expressed interest as their guide Recovery Mentor will design their work according to the person they are working with. § Schedule, organize and sponsor Advocacy Training available to all applicants. § Applicants are introduced advance directives by Recovery Mentor.
§ Offer mutual support training to second class of applicants. § Offer cultural know how and supportline training to all applicants.
§ Organize, schedule and sponsor initial empowerment toward recovery training for chosen applicants. § Organize, schedule and sponsor initial social mixer among 12 accepted applicants and Prospective Recovery Mentors. § Allow applicants to choose their Recovery Mentor. § In collaboration with WCDCMH assign amount of hours assigned to individual applicant.
§ Begin recovery Mentoring Initiative. Chosen Recovery Mentors will meet with the person who chose them as their Recovery Mentor. Using the person’s expressed interest as his/her guide the Recovery Mentor will design his/her work according to the person with whom they may be working. § The Empowerment Center will schedule mutual support training open to all chosen applicants. § Applicants with Recovery Mentor begins writing individual service plan. § Applicants are introduced to advance directives by Recovery Mentor.
§ Organize, schedule and sponsor second social mixer among 12 accepted applicants and Prospective Recovery Mentors. § Allow applicants to choose their Recovery Mentor. § In collaboration with WCDCMH assign number of hours assigned to individual applicant. § Organize, schedule and sponsor initial empowerment toward recovery training for chosen second chosen applicants. § The Empowerment Center will schedule White Paper training open for second 12 applicants.
§ Begin Recovery Mentoring Project with new class. Chosen Recovery Mentors will meet with the person who chose them as their Recovery Mentor. Using the person’s expressed interest as his/her guide Recovery Mentor will design his/her work according to the person they are working with. § Schedule, organize and sponsor Advocacy Training available to all applicants. § Applicants are introduced advance directives by Recovery Mentor
Additional Supports The Empowerment Center’s Sphere of Support
The Empowerment Center (TEC) is on a mission to seek solutions for the people we serve. Through research, networking, education and training the Center is at the forefront of how to help ourselves and our peers manage obstacles associated with psychiatric disabilities. The Empowerment Center is able to identify solutions that work by asking the many people who make up our organization; people we serve, people who we employ, our board of directors, professional providers, people in the community and families. The Empowerment Center has used the information gathered from these groups as the basis to our supports. We describe our services as a sphere of support representing multi-dimensional approach toward meeting the expressed needs of our peers.
Using established highly effective support services we call our Sphere of Support, that has been in place for over 12 years, The Empowerment Center will wrap its Sphere of Support around each successfully brokered team. TEC’s resources and influence will guide each team to success grounded in mutual support and self help.
TEC’s multi-dimensional Sphere of Support includes:
· Peer Advocacy inpatient · Peer Advocacy in the community · Peer-Support Centers · Peer-Support Line · Peer Bridging · Peer Training
Anticipated Conclusion This grant truly addresses the extra mile our employee go for their peers, but don’t get paid to do it. People in the system empathize with their peers and show an enormous loyalty and dedication when working with a peer. At The Empowerment Center we find that the extras we do for our peers, just is not built into the system. This grant incorporates that improvement into the mental health system. It has sound theories, operationalized with reliable practices and applied through practical services. These reasons plus The Empowerment Center’s sphere of support and the empathic connections that bond peers to each other indicates a strong probability that people will benefit greatly from this initiative. A synergistic result will be produced from the three areas motivation, knowledge, and structural opportunities spinning in balance. The barriers affecting this balance can be mental distress, substance abuse and emotional difficulties. Overcoming these barriers and balancing areas of our life will lead to an increase in a person’s discovery of recovery. |
MAKING DECISIONS EMPOWERMENT SCALE