Psychiatric Rehabilitation
.... promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any me... [Show More] ntal health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation services are collaborative, person-directed and individualized. These services are an essential element of the health care and human services spectrum, and should be evidenced-based.
WRAP
Wellness Recovery Action Plan
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Assertive Community Treatment (ACT)
-an evidence-based practice that improves outcomes for people with severe mental illness who are most vulnerable to homelessness and hospitalization.
Principles of Psych Rehab Groupings
1-3= Roles of the Practitioners
4-10= Best Practices in the Field
11-12 PsyR Service Delivery
Evidence-Based Practice (EBP)
- recognizes the importance of understanding and following research recommendations, while taking into account the service provider's clinical expertise and the goals, preferences, interests, values, and characteristics of the people using the service
Empirically Supported Treatment (EST)
-a type of intervention that has been proven effective, such as cognitive behavioral therapy for treatment of depression.
Evidenced-Based Medicine (EBM)
-the process an individual practitioner follows in selecting the appropriate intervention for one individual diagnosed with a particular condition who is experiencing specific symptoms.
Recovery
......a deeply personal unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. it is a way of living a satisfying, hopeful, and contributing life even with limitations cause by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.
Recovery Relating to principles of PsyR
Recovery from mental illness involves much more than recovery from the illness. itself. People with mental illness(es) may have to recover from the stigma that they incorporated into their very being; from the iatrogenic effects of treatment setting; from the lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams. Recover is a complex, time-consuming process.
The Eight Essential Features of recover-oriented mental health services
1. Recovery can occur without professional intervention.
2. A common denominator of recovery is the presence of individuals who believe in the person in recovery and will stand by him/her.
3. Recovery as a vision does function as a part of a person's ideas or theories about "mental illnesses".
4. Recovery occurs despite that mental health symptoms may reoccur.
5. Recovery changes frequency and duration of mental health symptoms.
6. Recovery is not necessarily a linear process.
7. The consequences of the "illness" (eg. stigma) often can be harder to overcome than any of its symptoms.
8. Recovery does not suggest that a person never had a mental illness of never experienced mental health symptoms.
Noordsy et al. definition of recovery is centered around what 3 core concepts:
1. hope 2. taking personal responsibility 3. getting on with life.
Principles of Psychiatric Rehabilitation
1. Psychiatric rehabilitation practitioners (PRP) convey hope and respect and believe that all individuals have the capacity for learning and growth.
2. PRP recognize that culture is central to recovery and strive to ensure that all services are culturally relevant to individuals receiving services.
3. PRP engage in the processes of informed and shared-decision making and facilitate partnerships with other people the individual receiving services has identified
4. PsyR practices build on strengths and capabilities of individuals.
5. PsyR practices are person-centered; they are designed to address the unique needs of individuals, consistent with their values, hopes, and aspirations.
6. PsyR practices support full integration of people in recovery into their communities where they exercise their rights of citizenship as well as to accept the responsibilities and explore the opportunities that come with being a member of a community and a larger society.
7. PsyR practices promote self-determination and empowerment. All individuals have the right to make their own decisions, including decisions about the types of services and support they receive.
8. PsyR practices facilitate the development of personal support networks by utilizing natual supports within communities, peer support initiatives, and self-and mutual-help groups.
9. PsyR practices strive to help individuals improve the quality of all aspects of their lives, including social, occupational, educational, residential, intellectual, spiritual, and financial.
10. PsyR practices promote health and wellness, encouraging individuals to develop and use individualized wellness plans.
11. PsyR Services emphasize evidence-based, promising, and emerging best practices that produce outcomes congruent with personal recovery. Programs include structured program evaluation and quality improvement mechanisms that actively involve persons receiving services.
12. PsyR services must be readily accessible to all individuals whenever they need them. These services also should be well coordinated and integrated with other psychiatric, medical, and holistic treatments and practices.
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SAMHSA's definition of recovery:
A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
SAMHSA's Four Major Dimensions of Recovery
1. HEALTH: Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way;
2. HOME: A stable and safe place to live;
3. PURPOSE: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society;
4. COMMUNITY: Relationships and social networks that provide support, friendship, love, and hope.
The Medical Perspective on Psychiatric Disability
-Focused on treating the mental health condition (the symptoms of the psychiatric illness).
-Use language such as mental impairment, psychiatric disorder, emotional disturbance, or diagnosis.
-Follows the DSM- to be a disorder:
-symptoms must be noticeable (clinically significant)
-must be/or at risk of causing difficulty in role functioning
-must have abnormal/not "culturally-sanctioned"
reactions/behaviors to events
-a faulty way of perceiving or reacting to the world
The Disability Perspective
-psych disabilities occur when a mental health condition interferes with a person's function in living, learning, working, and/or social environments and roles.
Americans with Disabilities Act (ADA) definition for Disability
-a physical or mental impairment that substantially limits one or more major life activities of such individual
Social Security Act (SSA) definition for Disability
-"the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of no less than 12 months."
PRA's definition for Disability
-the concept is seen as more relevant to rehabilitation than is the concept of illness and implies the hope of reacquiring abilities and valued roles.
The Bio-Psycho-Social Perspective
-the health condition is seen as interacting with environmental and personal factors to affect an individual's functioning at the level of body functions and structures, in performance of daily activities, and in participation in values roles and life domains.
Bio-Psycho-Social Perspective Functions related to Symptoms of the Body
ABC
-Affective functions: experience, expression, regulation of affect.
-Behavioral functions: energy and drive, sleep and appetites, and psychomotor functions
-Cognitive functions: experience of self and time, attention/concentration, memory, and executive functions
Positive Symptoms (in regards to Medical Perspective of Psychiatric Disbility)
-additions to typical behaviors (present)
Ex. delusion, hallucinations, bizzare behaviors, etc.
Negative Symptoms (in regards to Medical Perspective of Psychiatric Disbility)
-showing a lack of something (absent)
Ex. social withdrawl, difficulty producing thoughts or speech, blunted of flat affect, etc.
The Social Perspective on Psychiatric Disability
-sees the disability as a product of the social and interpersonal factors.
-"there is no such thing as a mental illness"
-believes that psychiatric symptoms can be a healthy response to a dysfunctional world.
-"what looks like illness often represents a method of surviving difficult times or coping with trauma
-Believes that because the environment helps to define 'disability', disability is a socially constructed concept.
Competency
-the ability to apply or use knowledge, skills, attitudes, and personal characteristics to successfully perform critical work tasks, specific functions, or operate in a given role or position.
KSA
Knowledge, Skills, and Attitudes
KSA's Three competency blocks
Foundational (bottom tier), industry-related (middle tier), and occupation-related (top tier)
KSA's Foundational Block
-can be generalized/are core competencies
-three tiers: basic workplace skills, basic academic skills, and the personal effectiveness skill (soft skills)
Accredidation
the approval of an organization stating that they meet the expected standards and competencies
Certification
granted to an individual by a non-governmental agency
Licensure/Registration
granted to an individual by a government agency
Person-Centered Planning (PCP)
-an ongoing collaborative process between an individual and his or her team members (including clinical and rehabilitation professionals as well as natural supports)
Process Perspective (in regards to PCP)
-how roles, relationships, and planning meetings look different when conducted in a person-centered fashion
Documentation Perspective (in regards to PCP)
-how the person-centered process is reflected in a written plan.
"Dignity of Risk"/"Right to Fail"
-respecting each individual's autonomy and self-determination (or "dignity") to make choices for himself or herself
IAPSRS Plans Should Include:
-person-first language
-diagnosis is not as important as the persons' individuality
-language should be understandable to all involved and if professional terminology is necessary it should be explained to all.
-goals should be written using individuals' own words.
PROS
Personalized Recovery-Oriented Services
A Comprehensive approach to Psychiatric Rehabilitation Assessment includes an assessment of:
1. the person's readiness and preferences for life changes
2. the person's everyday functional strengths and needs
3. the nature of the person's resource supports an barriers
Assessment in PsyR Practice
-an ongoing process that the person in recovery and their psych practitioner engage in mutually to determine the need to and direction of change in the person's daily living skills and living learning, and working domains [Show Less]