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Articles2006Below is a list of articles, abstracts, book chapters, or handbooks authored by Center for Psychiatric Rehabilitation staff. Due to copyright laws some articles are not available for full-text download. In most cases, these articles are available for purchase after searching the publisher's web site. Anthony, W. & Ashcraft, L. (2006). Crisis Services in the Living Room. Behavioral Healthcare, 26(7), 12-14. Have you ever noticed the way we behavioral health folks respond when something doesn't work the way we had hoped? One of our most common responses is to do more of it, to try harder, to test it longer. When it still doesn't work, we all too often conclude that this is the best we can expect and settle for mediocrity. This almost happened to META Services, Inc. (a recovery services organization in Phoenix) when it was transforming its crisis services. META's first approach to upgrading the program's quality was to add space and do more of what staff already were doing. This would have improved the service, but was it the right service to begin with? During a lucid moment, the management team remembered that phrase about “doing the right thing versus doing the thing right.” Was doing more of the same program just doing the thing right, rather than doing the right thing? Was there a better approach?
Anthony, W.A. & Ashcraft, L. (2006). Differentiating a Bad Day from a Crisis. Behavioral Healthcare, November. A few days ago, Jenny stopped by META Services to say hello. As we watched her approach the steps leading to our office, we realized something was wrong. Her gait was slow and defeated, her head hanging low. The last time we had seen her she was full of life, chattering a mile a minute, excited about graduating from peer employment training at META Services and looking forward to her first day of work. We had received e-mails from her since then, in which she expressed exuberance about her new job and delight at the chance to make a difference in the lives of others who had similar circumstances. This vibrant Jenny was a sharp contrast to the woman we had met four months earlier. The Jenny back then was broken, both physically and mentally. She barely had survived a suicide attempt that left her in constant pain, with a prognosis that she might never walk again. Mentally she was no better: deflated, depressed, and completely hopeless. Yet she had support. Her family loved and helped her, and gradually her physical injuries began to heal. Her spirit, however, was quite another matter.
Anthony, W. & Ashcraft, L. (2006). Factoring in Structure. Behavioral Healthcare, August. Some of the best minds in the behavioral health field have registered concerns lately about “pretend recovery.” They have noticed that many programs simply are putting a “recovery” sign on their front door yet continuing to do the same things they always have done. This leads to the concern that recovery principles will not be given a fair shake at changing the way we do business because they really aren't being practiced in the first place. Being eternal optimists, we're hoping that programs aren't pretending but perhaps just aren't clear about how to initiate a recovery services transformation. Obviously, a lot more is involved in the transformation process than changing the sign on the front door.
Anthony, W., Ashcraft, L. (2006). From Consumer to Caregiver. Behavioral Healthcare, January. The fastest way we know to transform a mental health agency into a recovery- oriented operation is to involve the people being served in all levels of the program. Perhaps the most talked about consumer role these days is that of “peer support.” Just about any conference you attend has several workshops on this subject. Peer support is a lot more than just the latest buzzword in behavioral health; it is in fact one of the most powerful tools for transformation. The best way to gain an understanding of what peer support is and how it works is to go to the source and talk to people who are actually doing peer-support work. This quote from a peer graduating from the META Services Peer Employment Training program at META Services in Phoenix illustrates the powerful impact that even a brief peer encounter can have:
Anthony, W., Ashcraft, L. (2006). How Recovery Happens. Behavioral Healthcare, September, 2006. The road to recovery looks different for each person—it is a very personal experience. However, some common occurrences often are shared by most people who choose this path. Over the past few years leaders in the recovery movement have identified several common steps along this path. Among them are LeRoy Spaniol, PhD, and his colleagues at Boston University, who have been conducting several qualitative, longitudinal analyses of individuals’ recovery experiences. Dr. Spaniol and colleagues have identified four broad, overlapping phases of recovery that people move between: overwhelmed by the disability, struggling with the disability, living with the disability, and living beyond the disability. Furthermore, they have identified three factors associated with the degree of challenge to recovery: comorbid substance abuse, environmental context, and age of disability onset.
Anthony, W.A. & Ashcraft, L. (2006). Relapse is Different in Recovery. Behavioral Healthcare, October. Relapse, viewed through the lenses of recovery, is framed very differently than it has been in the traditional behavioral health context. In a recovery context, relapse is not seen as a failure that reflects poorly on the person. The person is held accountable, but we also look at system issues that might have contributed to the relapse. This offers an opportunity for the person and the system to partner in reflection, honestly assessing what could have been done to prevent the slippage. In the recovery context, we all make corrections and commitments to move ahead after a relapse, learning from each other's mistakes. A relapse becomes a learning opportunity for both the person (no longer referred to as a “patient” or “client” in a recovery context) and the system. We ask ourselves, What can we do differently? What can we learn from this relapse that will help us strengthen and improve what we have to offer? How can we improve our results next time?
Ashcraft, L., Anthony, W. (2006). Let People Make Their Own Decisions. Behavioral Healthcare, March. One of the common barriers to recovery has been a propensity to control and/or eliminate as many forms of risk as possible. Before the possibility of recovery from mental illness was confirmed by research, we were limited in what we could hope for in terms of the results of our work. Many behavioral health professionals believed that a core competency of their jobs was caretaking, a word that incorporated the idea of protecting people from risk. This belief reached into the zone of making major decisions for people, since it was presumed that mental illness had eroded their ability to make sound decisions.
Ashcraft, L., Anthony, W. (2006). Tools for Transforming Language. Behavioral Healthcare, April. Many of us undoubtedly have thumbed through thousands of medical records and charts. In our more existential moments, we might have asked ourselves, “What is all of this? Does it really mean anything? Is it really necessary?” If we really are committed to service transformation, the way we work needs to be questioned and probably changed.
Ashcraft, L., Anthony, W. (2006). A Treatment Planning Reality Check. Behavioral Healthcare, February. Treatment planning has been an obsession that has haunted behavioral healthcare professionals throughout the field's evolution. Some of us might at times even fall into the trap of judging our professional success based on the number of treatment plans we have completed. But out of all the recovery stories we have heard, we have yet to hear anyone mention that he owes his recovery to the treatment plan.
Ashcraft, L., Anthony, W., Dayan, E. (2006). Moving Recovery into the Classroom. Behavioral Healthcare, May. Until the development of the supported education concept (which helps people with psychiatric disabilities choose and achieve educational goals),1 educational interventions and educational outcomes for people with severe mental illnesses rarely had been considered. It has been implemented in a variety of locations (such as California, Illinois, Massachusetts, and Michigan) during the past two decades.2 In the first nationwide survey of members of the organization now known as the National Alliance on Mental Illness, members reported that while only 5% of their relatives with mental illnesses were working full time, 92% had graduated from high school, 59% had attended college, and 17% had graduated from college.3 Depending on the particular sample taken, 52 to 92% of people with severe mental illnesses are high school graduates, and 15 to 60% of these high school graduates attend college.4 Unfortunately, mental health interventions rarely capitalize on people's interest and success in education.
Ashcraft, L., Anthony, W., & Zeeb, M. (2006). Transformation Can Happen Anywhere. Behavioral Healthcare, July. One of the most interesting things about service transformation is that it can happen anywhere. It can creep into some of the most rigid, highly regulated settings and shift the foundation of what we believe to be unchangeable. Take the concept of recovery, for instance. Themental health system has not been designed to facilitate recovery because recovery from serious mental illness was/nt discussed until recently. Today, conversations about recovery can be overheard in the hallways of nearly any behavioral health organization. Program directors are scrambling to understand and incorporate recovery concepts; researchers are testing recovery practices; accreditation bodies are including recovery principles and practices in their protocols; and program evaluators are measuring recovery outcomes. Now that's transformation!
Ellison, M.L., & Dunn E. (2006). Empowering and demedicalized case management practices: Perspectives of mental health consumer leaders and professionals. Journal of Social Work in Disability and Rehabilitation, 5(2), 1-17. The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twentyfive categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.
Hutchinson, D. S., Anthony, W., Ashcraft, L., Johnson, G., Dunn, E., Lyass, A., & Rogers, E. S. (2006). The personal and vocational impact of training and employing people with psychiatric disabilities as providers. Psychiatric Rehabilitation Journal, 29(3), 205-213. Objective: This study examined the feasibility of a structured peer provider training program and its effect on peer providers with respect to their own personal and vocational recovery. Methods: Sixty-six individuals participated in an evaluation of a 60-hour, 5-week long peer training program. Participants were assessed prior to and after the training on scales to measure recovery, empowerment and self-concept. Analyses of variance were used to examine subjective changes in these measures. Job acquisition and retention data were also examined at posttest. Results: Participants experienced gains in perceived empowerment, attitudes toward recovery and self-concept. Trainees went on to obtain peer provider positions within the mental health agency in which they received the training and 89% of those trained retained employment at 12 months. Twenty-nine percent of the initial jobs into which the peer providers were placed were full-time; 52% were part-time and 19% were hourly. Conclusions: Findings suggest that a standardized program designed to provide peer training was used successfully and participants' recovery and employability were improved. Further studies are recommended to rigorously test peer providers' impact on their clients and to examine the advantages that accrue to the agency when mental health recipients are employed as peer providers.
Hutchinson, D., Ashcraft, L., Anthony, W. (2006). The Role of Recovery Education. Behavioral Healthcare, June. This is the second of two columns focusing on supported education as an important strategy in transforming mental health services. The column in the May issue described an ongoing program at META services in Phoenix. This issue's column describes a supported education initiative at Boston University.
Hutchinson, D.S., Gagne, C., Bowers, A., Russinova, Z., Skrinar, G.S., & Anthony, W.A. (2006). A framework for health promotion services for people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 29 (4), 241 – 250. The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance one's well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now feature, a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).
Rogers, E., Anthony, W., & Farkas, M. (2006). The Choose-Get-Keep Approach to psychiatric rehabilitation. Rehabilitation Psychology, 51(3), 247-256. Objective: Comprehensive review of studies using the choose-get-keep (CGK) process model of psychiatric rehabilitation. Also, other studies are identified that have demonstrated methodologies useful in future research on the CGK model. Intervention Model: The CGK process is conceptualized as the phases through which people with psychiatric disabilities proceed as they engage in psychiatric rehabilitation. Conclusion: The CGK model is a potentially useful psychiatric rehabilitation intervention that can be implemented in a variety of service settings and that focuses on the activities of the practitioner and the service recipient. The CGK model warrants further empirical study to examine its effectiveness. (PsycINFO Database Record (c) 2006 APA, all rights reserved)
Rogers, E., Anthony, W., & Lyass, A. (2006). A randomized clinical trial of psychiatric vocational rehabilitation. Rehabilitation Counseling Bulletin, 49(3), 143-156. In this study, the researchers examined the effectiveness of two vocational rehabilitation interventions in improving employment, educational, clinical, and quality-of-life out-comes for people with psychiatric disabilities. The authors recruited participants in waves over a 2-year period and randomly assigned them to receive either psychiatric vocational rehabilitation (PVR) or enhanced state vocational rehabilitation (ESVR) services. Although both groups improved significantly over time in their vocational and educational outcomes, no differences were found between the two interventions on any outcomes. In this article, the authors explore why ESVR achieved better outcomes than previous research would have suggested.
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