A StrengthsBased Approach to IPS Supported Employment Learning
A Strengths-Based Approach to IPS Supported Employment: Learning from Strengths Model Case Management Implementation and Impact on Employment Outcomes Rick Goscha, Ph. D California Institute for Behavioral Health Solutions October 3, 2018
What I want to convey Employment is an essential component to helping people build and re-build their lives Employment exploration begins day 1 of service not at the point of IPS referral Being strengths-based doesn’t always come natural in our systems of care IPS staff play an essential role in keeping strengths on the organizational agenda • 2
Goal of the Strengths Model Help people build or re-build lives, beyond our systems of care, that bring meaning, purpose, and valued identity Help increase people’s ability to exercise power related to: * How they view themselves * How they interact with their environment
Entrapping G SM oal CM of Intrapersonal Narratives Empowering Environment al Niches Entrapping Empowering
Examples of Entrapping Narratives I AM JUST…… “I’M NOT WORTH ANYTHING” I DON’T DESERVE BETTER “I AM INCAPABLE OF…. . ” I CAN’T DO IT BECAUSE OF ……
The Strengths Assessment is about creating space For narratives of hope, recovery, and wellness to co-exist
What is the Strengths Model? An evidence-based practice that…. …combines concepts and principles of recovery, empowerment, and person/environment niches… …with practical tools, methods, and practice interventions… …to help people build or re-build lives worth living, beyond formal systems of care, that bring meaning, purpose, and positive identity.
Primary providers of Strengths Best fit: Community-based, direct service workers (i. e care managers, case managers, community support workers) Promising fit: Peer support, supported employment, supported education, supported housing Practical application: outpatient clinicians, crisis services, residential services • 8
9 1 1 / 2 5 / 2 0 The Context of Strengths Model Work Recovery • Meaning • Purpose • Identity
What People Want Safe place to call home Economic stability Role with meaning, purpose, and valued identities Connection to others Connection with the community To love and be loved Feel safe Support to stay well
1 1 / 2 5 / 2 0 The Context of Strengths Model Work Engagement Tools/Methods Recovery • Understanding • Strengths Assessment • Meaning • Hope • Alliance • Personal Plan • Group Supervision • Purpose • Identity
Principles of the Strengths Model 1. People have the capability to recover, reclaim, and transform their lives 2. Focus is on strengths versus deficits 3. The community is viewed as an oasis of potential resources 4. The person is the director of the helping process 5. The relationship with the person is primary and essential 6. The primary setting for our work is in the community 12
Integrative Role of Strengths Outpatient Therapy Medical Services Strengths Model Residential Services Supported Employment/ Education Crisis Services
Compatibility of Strengths with other strengths-based, recovery-oriented approaches Shareddecision making Cognitive Behavioral Therapy Strengths Model Solution focused approaches Motivational Interviewing Dialectical Behavioral Therapy
10 Strengths Model Studies • • • Competitive Employment Psychiatric hospitalization Housing Post-secondary education Symptoms Community involvement Social Support Social Isolation Quality of Life
Fidelity and Outcomes Competitive Employment 50 40 30 20 10 0 1988 2004 Fidelity Outcomes 2016
Types Of Strengths Qualities/Personal Characteristics Talents and Skills Environmental Strengths Interests/ Aspirations
Introducing Dean
Organization of the Strengths Assessment • Seven Life Domains • Three Temporal Orderings • Encompasses both simplicity and complexity
Introducing Elizabeth
Overview of Elizabeth at the beginning of her road to recovery 33 year old, white, heterosexual woman Living with mother and step-father. Mostly isolated from community. Frequent hospitalization (7 times in one year)
Overview of Elizabeth at the beginning of her road to recovery Frequent calls to crisis services (suicidal ideation) History of childhood physical, sexual, and emotional abuse.
Overview of Elizabeth at the beginning of her road to recovery ₋ Only lived once on her own (lasted 5 months) ₋ Evicted from apartment and was homeless for two months ₋ Re-entered the hospital ₋ Returned to living with mom and stepfather
Where Elizabeth is now (five years later) ₋ Own apartment for five years ₋ Sings in a church choir ₋ Helps out occasionally at nursery during Sunday school classes ₋ Has a close friend at her apartment complex ₋ Has a dog
Where Elizabeth is now (five years later) ₋ Has been hospitalized twice in the past five years ₋ Calls the crisis line periodically (3 -4 times a year) ₋ Still struggles at times with depression, disassociation, voices, and suicidal thoughts, although less frequent ₋ Is considering employment
What shifts created the environment to help Elizabeth recover? Elizabeth: “I am not worth anything. Therefore, this is best life will ever be. ” “A better life is possible. ” Worker: “I am not sure she can live on her own. ” “I’mnervousabout it, but butmaybe she shecan cando doit. ”“ it. ” Agency culture: “We have to be careful getting people excited about hopes and dreams that are unrealistic. ” –and– “Taking risk is a liability for the organization. ” “If people do not dream and take risks, there’s no way we can help them recover. ” Hope
What shifts created the environment to help Elizabeth recover? Elizabeth: “I’m just trying to cope. Others are making life difficult for me. ” want my my own I want to prove to “I“Iwant ownplace. I want to prove others to myselfand others can do I Ican dothis. ” Worker: “Once you’re stable, we can try to work on a goal like getting your own place. ” ““I’m not sure what it is going to take “I’m not sure what it’s going to take to to achieve but if it to is you, achieve this goal, this but ifgoal, it’s important to you, it and I willtake help you I’ll help you explore steps to achieve it. ” explore it and take steps “Make sure every goal Agency on the treatment plan Culture: meets the criteria for medical necessity. ” “Make sure every the “Make sure every goal ongoal theon treatment plansomething is clearly something the plan is clearly the person is passionate aboutmake and sure then passionate about and then your role that goal criteria make sureinyour role meets in thatthe goal meets for medical necessity. ” the criteria for medical necessity” Meaningful and Important Goal
What shifts created the environment to help Elizabeth recover? Elizabeth: Worker: Agency Culture: “I am mentally ill. ” “I’maasinger, aa friend, a a “I’m friend, aadaughter, memberof ofaa faith community, also member community, who struggles at times with distressing also struggles at times with thoughts. ” distressing “She is mentally ill. ” “She’s a singer, a afriend, aadaughter, aa “I’m a singer, memberof ofaa faith community, also member community, who struggles at times with distressing also struggles at times with thoughts. ” distressing “We serve people with severe and persistent mental illnesses. ” “We help people with the lived treatment plan is clearly something the experience of mental illness build and/or person is passionate about and then rebuild lives that have meaning make sure your in that goal meets and role purpose. ” “Make sure every goal on the criteria for medical necessity” Identity and Focus
Critical Components of the Strengths Assessment (Content) Written in a context that is meaningful and important to the person “I want my“Iown I wantplace. my own place”to prove tolike myself others “I would moreand friends to do things I can do this. ” with” Hope-inducing for the person ““I’m not sure what it is going to take Theto process of exploring achieve this goal, possibilities but if it is and visualizing tangible strengths created an important to you, I will help you aura of hope explore it and take steps to achieve it. ” Thorough, detailed and specific * Brother (Roy) can take me places if I need anything * Lamictal helps with the depression – “I don’t feel suicidal as much” Written from the person’s perspective and using his/her own words “I want…” “I have…. . ”
Critical Components of the Strengths Assessment (Process) Evolves at the person’s pace Conducted in a conversational manner Occurs in the person’s natural environment whenever possible ` As opposed to a rush to fill out paperwork Most important is that person is engaged As opposed to an interview ““I’m Uses the boxes to record, not guide As opposed to a majority of meeting occurring in the office The nature of the goal will often dictate setting As opposed to a one-time assessment Part of an ongoing process in which information is updated on a regular basis You are creating a portrait or building a narrative, not completing a form
Thank You!
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