Janis Tondora

Recovery in Serious Mental Illness: A New Wine or Just a New Bottle?

The notion of recovery has become a dominant force in mental health policy, evident in reports of the Surgeon General and Presidents New Freedom Commission. In both reports, recovery is stipulated as the overarching goalof care and foundation for reforms at state and local levels. Little consensus exists regarding the nature of recovery in mental illness, however, or about the most effective ways to promote it. The authors offer a conceptual framework for distinguishing between various uses of the term, provide a definition of recovery in mental health. and conclude with a discussion of the implications of this concept for meaningful reform.

From rhetoric to routine: assessing perceptions of recovery-oriented practices in a state mental health and addiction system.

The Recovery Self Assessment (RSA) was developed to gauge perceptions of the degree to which programs implement recovery-oriented practices. Nine hundred and sixty-seven directors, providers, persons in recovery, and significant others from 78 mental health and addiction programs completed the instrument. Factor analysis revealed five factors: Life Goals, Involvement, Diversity of Treatment Options, Choice, and Individually-Tailored Services. Agencies were rated highest on items related to helping people explore their interests and lowest on items regarding service user involvement in services. The RSA is a useful, self-reflective tool to identify strengths and areas for improvement as agencies strive to offer recovery-oriented care.

Creating a recovery-oriented system of behavioral health care: moving from concept to reality.

This article describes challenges and successes seen in the first four years of efforts the state of Connecticut has made to reorient its behavioral health system to promoting recovery. Beginning in 2000, the Connecticut initiative was conceptualized as a multi-year, systemic process that involved the following interrelated steps: a) developing core values and principles based on the input of people in recovery; b) establishing a conceptual and policy framework based on this vision; c) building workforce competencies and skills; d) changing programs and service structures; e) aligning fiscal and administrative policies; and, finally, f) monitoring, evaluating, and adjusting these efforts. Following descriptions of the first four steps, the authors offer a few lessons that might benefit other states engaged in similar processes of transformation.

Strategies for Developing Competency Models

There is an emerging trend within healthcare to introduce competency-based approaches in the training, assessment, and development of the workforce. The trend is evident in various disciplines and specialty areas within the field of behavioral health. This article is designed to inform those eorts by presenting a step-by-step process for developing a competency model. An introductory overview of competencies, competency models, and the legal implications of competency development is followed by a description of the seven steps involved in creating a competency model for a specific function, role, or position. This modeling process is drawn from advanced work on competencies in business and industry.

The fundamentals of workforce competency: implications for behavioral health.

Increasing attention is being directed to the competency of those who deliver healthcare in the United States. In behavioral health, there is growing recognition of the need to define, teach, and assess essential competencies. Since attention to this issue in behavioral health is relatively recent, there is much to be gained by learning from the principles, definitions, and conceptual models of competency that have been developed in other fields. This article outlines the forces that drive the current focus on competency of the healthcare workforce. Relevant history, principles, definitions, and models that have evolved through research and application in business and industry are reviewed. From this analysis, recommendations are offered to guide future work on competencies in behavioral health.

Play, Pleasure, and Other Positive Life Events: "Non-Specific" Factors in Recovery from Mental Illness?

Abstract As part of the emerging recovery paradigm, there is an increasing need for psychiatric treatment and rehabilitation to be strengths—based and to be driven by the desires and preferences of the person with mental illness. Yet if mental illness is a brain disease, it is not at all clear how these characteristics contribute to improvement in the persons condition or influence the course and outcome of the disorder. To avoid these aspects being relegated to the role of nonspecific factors, the field must develop an understanding of the role of strengths and interests in recovery. To contribute to this effort, we review the existing empirical research on the protective and stress—buffering effects of positive life events and qualitative data on the importance of play and pleasure in the lives of people with mental illness. We conclude by considering briefly the implications of this research for clinical practice.

Workforce Competencies in Behavioral Health: An Overview

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

Evidence-Based Teaching Practice: Implications for Behavioral Health

Educational practices and strategies have changed very little over the years, and even emerging advances in technology have become the prisoners of traditional academic norms. Thus, while there is increasing emphasis on evaluating and aligning caregiving processes with the strongest evidence of effectiveness, there is little demonstration or role-modeling of this same expectation in either the formal or continuing educational processes of behavioral healthcare providers. This “disconnect” is a significant problem in the field. This paper addresses the urgent need to inform the education and training of the behavioral health workforce with current theories regarding the teaching–learning process and evidence about the effectiveness of various teaching strategies. The relevant theories and available bodies of evidence are described, and the implications for workforce education and training are identified.

A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos.

Background Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives. Purpose We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers. Methods Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life. Conclusions Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems. Clinical Trials 2010; 7: 368—379. http://ctj.sagepub.com

Training in evidence-based practice.

Controversy surrounds the concept of EBP. Many individuals question whether research is capable of guiding decisions about diagnosis and treatment, or whether it simply gives oversimplified answers to highly complex questions about human behavior. These concerns aside, it is hard to envision a future in which consumers and payers do not demand that the health professions ground their interventions in an evidence base. It is sobering to recognize that training in EBP has been far from the norm in the various behavioral health disciplines. This is just one aspect of a much larger crisis in behavioral health workforce education. Graduate and residency programs have not kept pace with many of the changes in behavioral health care delivery over the past decade. The field continues to use continuing education strategies that are ineffective, and little training is offered to the paraprofessional and bachelor-prepared staff members who comprise a large segment of the workforce in public sector and inpatient settings. Broad strategies are needed to overcome the lethargy in behavioral health education and training programs to make them more relevant to contemporary clinical practice. Incorporating evidence-based approaches to treatment is one critical element of needed reforms. General medicine has laid a foundation that can be built on for teaching the process of EBP. Psychiatry and psychology have taken the lead in identifying those interventions to be taught that are evidence-based or empirically supported. Research on continuing education and adult learning illuminates the educational strategies that are likely effective in teaching evidence-based interventions and an evidence-based process of care. Additionally, the research on changing provider behavior shows the importance of ensuring practice environments that support and reinforce, rather than thwart, the practice of evidence-based treatment. There are many resources to draw on but the task facing educators is substantial.