The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.

THE DIRECTOR’S NEW YORK MINUTE 

 “NEVER SAY NEVER” ABOUT HOPES AND DREAMS

By Courtenay M. Harding, PhD 

First of all, that statement is ironical and contradictory, but the idea behind it is important.  In 1982, Stephen Jay Gould, the Harvard paleontologist and diehard Yankees fan was told by his physician that he would never see many more baseball games because he was suffering from a very rare cancer.  He went and looked up the literature and found that research had declared the median length of life after diagnosis was only 8 months. Like many an academic, He figured out that the median, as one statistical measure of the central tendency in data, has a wide range distributed into a bell curve.  He knew, from his own work, that Nature is naturally full of variation, therefore he could live a very short time or a very long time.(1) He also found that the data revealed that people with “positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment… tend to live longer….”(1) Knowing, that there was a range of possibilities, cheered him up immensely and, indeed, he lived another 20 years! 

Erin Elbe was told by her doctor that she would never walk again after a disease in her leg bones yet, later, she became a world champion figure skater.(2) She was preceded in history by many others but, especially by Tenley Albright.  In 1946, Dr. Albright contracted polio and was not expected to walk again. However, she became the first American woman to win a gold medal in ladies figure skating in the 1950s.(3) She later became a surgeon. Han Xiaopeng became China’s first gold medalist in Olympic history in the 2006 Torino games for skiing after a severe knee injury.  His physicians had told him earlier that “he was lucky he hadn't been crippled for life.”(4)   Allison Baver won the Bronze medal in the 2010 Vancouver Olympics as an inline skate racer after her leg was shattered and was told she would be lucky just to walk.(5)    

In fact, if you ask Google to give you articles about people who were once seriously injured or profoundly ill and had been told they could never have their dream, you will find pages and pages of references and stories. (e.g. 6)   People, in all walks of life, seem to defy dire predictions, more often than not, if they are stubborn and persistent.  If they believe something different might happen, they develop compensatory skills by practicing a lot, and fighting back.  In effect, they may be also retraining their body by doing so because Mother Nature is usually trying to correct things gone awry in the body and the brain.

Consumers of psychiatric services, who are disabled and episodic in their symptom course, are often told by clinical staff that he or she will never really get their life back, let alone finish school or go to work or get married and have a family. Yet consumers from across the world are fighting back and reclaiming their lives.  The literature is replete with stories.(e.g. 7 - 8)    Research data also persistently reports these successes. (e.g. 9)   Therefore, we need to stop thinking and saying “You can never expect to do this or that…” but help people learn to fight back. In addition, observations have shown that people, who might be considered to be the biggest pains in the neck in treatment, are the very same people, who already have the energy to get their life back, if rechanneled back into their old dreams and hopes.  After years of discussion, which are still persisting, SAMSHA’s brand new consensus definition of recovery in 2011 is: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”(10)

Recovering consumers have listed the characteristics of programs, such as PROS in New York, which help to reclaim lives: self-direction, individual and person-centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope. These factors are thought to be achieved best through supports such as restoration to health, a stable affordable place to live, purpose and meaning in life, and being part of a community.(10-12)

The people, about whom I worry, are the more passive and accepting people, who agree with our pessimistic prognoses and assume that we know best.  They settle into “patienthood” and a life far different from what they once wanted for themselves.  That is why we have to undo all those messages given to them over the years and help light a fire under them in 2012!

Resources:

1. Gould, S. J. (1985) The Median is not the Message. Discover Magazine. 6(6): 40-42.
2. Elbe, E. (1996) Jewish figure skater hopes to ice spot in  ’98 Olympic Games.  http://www.jweekly.com
3. Albright, T. (2011) http://www.answers.com/topic/tenley-albright
4. Han, X. (2000). China’s Golden Inspiration.  10 Inspirational Stories from the Winter Olympics by tRex  http://www.infobarrel.com/10_Inspirational_Stories_from_the_Winter_Olympics
5. ABC4.com – Salt Lake City, Utah News : Allison Baver  http://www.abc4.com/mostpopular/story/Allison-Baver pub. 12/22
6. Wickert, F.W. (2006) Never Say Can’t.   http://ourecho.com/story-1188-NEVER-SAY-CAN-T.shtml
7. Deegan, P. (1996)  Recovery is a Journey of the Heart. Psychiatric Rehabilitation Journal, 19(3):91-97.
8. Chamberlin, J. (1998). Confessions of a noncompliant    patient. Journal of Psychosocial Nursing and Mental Health Services.    36(4): 49-52.
9. Davidson, L., Harding, C.M., & Spaniol, LR. (2005)     Recovery from Severe Mental Illnesses: Research      Evidence and Implications for Practice. (Vol. 1). Boston, MA. Center for Psychiatric Rehabilitation, Boston University.
10. Substance Abuse and Mental Health Services Administration. (2011). SAMHSA’s Definition and Guiding Principles of Recovery – Answering the Call for Feedback. Rockville, MD.: Dept. of Health and Human Services.  http://blog.samsha.gov/2011/12/22/
11. Substance Abuse and Mental Health Services  Administration. (2011) Recovery Defined – A Unified Working Definition and Set of Principles. Rockville, MD.: Dept. of Health and Human Services.  http://blog.samsha.gov/2011/05/20/recovery-defined-a-unified
12. Bellack, A.S. (2006) Scientific and Consumer Models of Recovery in Schizophrenia:  Concordance, Contrasts, and Implications.  Schizophrenia Bulletin. 32(3):432-442.

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PROGRESS NOTES

Resolving to Be Content

By Susan Blayer, LMSW, MDiv

I will organize my Christmas decorations better this year (tangled tree lights, anyone?).  I will lose the 10 pounds I gained learning how to bake last year.  I will clean out my closet and get rid of anything I haven’t worn since 1989.

My annual resolutions have become old reliable friends who pay me a visit just in time for the post-holiday slump.  For many of us, a new year means renewed commitments to goals that might have gotten a bit dusty since last January.  Some folks may have just plain given up at this point, frustrated by the same list of things of temporarily, partially, or not at all accomplished, year after year.  

Not wanting to fall into that trap, I went looking for research on goal-setting, to increase my odds of actually achieving them some time in 2012. I found a review of studies, covering 35 years of empirical research on goal-setting theory, published in 2002 by Edwin Locke of the University of Maryland, and Gary Latham, of the University of Toronto.(1)

Locke and Latham contend that goals are motivational, and can affect positive outcomes by drawing attention and effort toward activities relevant to the goal.(1)  Here are a few guidelines, based on the four main areas of importance to goal attainment found from their analysis of the data:

• Setting specific, rather than abstract, goals (ie. “I will buy organizing boxes for my decorations”, rather than, “I will organize my decorations better.”)
• A sense of self-efficacy (If I believe I can accomplish the goal, even when I make mistakes or it becomes challenging, I have a higher likelihood of success.)
• Commitment to the goal (dedicating time and resources to their achievement predicts greater success).
• Getting consistent and frequent feedback about progress (through tracking, outside input)  (1)

These seem like common sense, and remind me of the old S.M.A.R.T acronym many of us were taught to follow when setting goals--  that they should be Specific, Measurable, Appropriate, Realistic and Timely.

Concrete, helpful suggestions…. yet, come January 1st, I'm still back at that proverbial square one with the same resolutions. Researchers at Stanford University of Persuasive Technology Lab call these “blue behaviors,” those goal-related activities with which we have had previous experience. (2) (The Stanford Persuasive Technology Lab scholars study the way technology, from websites to Facebook to phone apps, can be designed to change people’s beliefs and behaviors.)

 Using the Fogg Behavior Grid (above, created by the Stanford team’s Project Director, BJ Fogg) is a way to begin creating what they refer to as a “behavior design.” (2)   Blue, or familiar, behaviors, are one of 15 to choose from on the grid.  The colors distinguish the category of behavior one seeks to alter, which then can be lined up with the desired frequency of the behavior change, from a one-time event to lasting over time. 

Their helpful Blue Dot Behavior Guide highlights a key element of the Fogg Behavior Model, upon which the grid was based, “.. three elements must converge at the same moment for a behavior [change] to occur: motivation, ability, triggers.  When a behavior does not occur, at least one of those three elements is missing.” (2)

I was intrigued by their use of triggers, as I generally associate the term to meaning the catalytic forces that lead to unwanted behaviors.  With the Fogg Model, however, triggers are probes to ensuring that the activity is completed.  For example, with my first resolution, to organize my Christmas decorations better, my first specific goal would be to buy organizing boxes. My trigger would be to set my phone calendar alarm to go off on the day and time that I scheduled to go buy them. 

The authors of the model believe that one should “focus on triggers first,” then move on to assessing capability and obstacles to ability.  One would work on increasing motivation last, after crafting triggers and considering ability.  According to Fogg and his team, there are three core motivators—sensation (pleasure/pain), anticipation (hope/fear), and belonging (acceptance/rejection). (2)   It is a thoughtfully and research-based constructed model that I believe might be just as practical and efficient as Prochaska and DiClemente’s Stages and Processes of Change.

It sure is a lot of work though, isn't it?  No wonder it is so hard for people to change behaviors.  Perhaps more effort is needed than I actually have to give at this particular point in the year. So, I decided to approach it from a spiritual perspective—and prayed and meditated on the matter.  My Inner Guide filled me with the possibility that this year I could simply give myself the resolution of being content.  Could I be ok with not making any resolutions this year?

I mean, would it be the worst thing in the world to accept my tangled lights and expanded waistline?

I bristled at the thought.  Resolutions, and the hope of change inherent in them, are good!  What will I be if I don’t strive to be better?

Answer: Just fine.

Then, as spiritually synchronicity would have it, I stumbled upon a post entitled, “Quashing the Self-Improvement Urge” on the Zenhabits.net blog. (3)    The owner of this blog is Leo Babauta, a leading productivity expert and author of the popular 2008 book, The Power of Less: The Fine Art of Limiting Yourself to the Essential...in Business and in Life.

I have condensed and highlighted some of the key points of the post, which was published last month:

It's an incredibly pervasive urge: we are always trying to improve, and if we’re not, that’s something we should improve….. So what’s the problem?   You could say it’s great that people are constantly trying to improve themselves, but where does it end?   When is anyone ever content with who they are?   We are taught that we are not good enough yet, that we must improve, and so … we always feel a little inadequate.  This is true no matter how much you’ve accomplished.  Maybe 2012 will be the year we reach perfection…. What if instead, we learned to be happy with ourselves?... Would that be horrible, if we were just content and didn’t need to better ourselves every minute of every week? Would we be lazy slobs, or would we instead be happy, and in being happy do things that make us happy rather than make us better? (3)    

Maybe this year I will take Babauta’s lead and give myself a break.  I can realize that “better” is not synonymous with “happy.”  As I look into a new year, I can strive to be perfectly satisfied with my messy, flawed, not-working-to-improve-one-bit self.   He calls it a “revolution of contentment”.  I call it a resolution of contentment. 

Hopefully this is one I can keep.

References

1. Latham, G. and Locke, E. (2002)  Building a practically useful theory of goal setting and task motivation. American Psychologist, 57, 705-717.
2. Fogg Blue Dot Behavior Guide (December 2010)
3. Babauta, L (Dec. 13, 2011) “Quashing the Self-Improvement Urge” retrieved from the Zenhabits.net blog: http://zenhabits.net/improve/

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Center News

 The Center Seeks Peer Educators— Two Positions Currently Open!

The Center is looking for two enterprising Peer Educators to help consumers and their families learn about Health Homes. Candidates must be comfortable with public speaking.

Please see the Peer Job Board on our website for more information and to apply:  http://www.coalitionny.org/the_center/jobs/job.php?id=5971

Life Skills Profile Now Available on Center Website

Providers attending the last PROS Learning Collaborative asked for a way to measure the small functional changes in consumer status every three months.   Center Director, Courtenay Harding, suggested that agencies consider the Life Skills Profile (LSP) developed in Australia many years ago by Rosen et al, in 1989. 

This brief instrument is scored on one page, is easy to use, and has undergone substantial psychometric testing repeatedly across many populations.   It was designed to assess people who have severe and episodic disorders and are found primarily in the public mental health system of care.  It comes in three forms, with 16, 20 or 39 questions which produce 5 subscales: communication, social contact, non-turbulence, self-care, and responsibility.  These scales are framed with recovery values but can be scored with either strengths or impairments or in mind.   The longest form (LSP-39) is used primarily in research while the LSP-20 appears to be the best one to use clinically and captures the subtle changes occurring across every three months (see Rosen et al, 2001).  No special training is required and it is free of psychiatric jargon.

The routine use of this short instrument can inform clinicians and the people with whom they work about whether or not progress is being made and in which areas.  In addition, aggregated data will allow the agency to proclaim success with its interventions if shown in the outcome findings.

To access the actual instruments and the Rosen et al, 2001 overview article, please go to the Resource Page of our Center website:  http://www.coalitionny.org/the_center/resources/index.php#ClinicOutcomes

Call to Providers--Post Your Open Peer Position on our Peer Job Board:

http://www.coalitionny.org/the_center/jobs/

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Education and Training

Leading Groups: An Introduction

This full-day training is designed for mental health practitioners who seek to harness the power of groups to support individuals in their recovery. The training may be of particular interest to providers of Personalized Recovery Oriented Services (PROS) since group work is the main service modality in PROS programs. Participants will be introduced to theoretical concepts and fundamental skills essential for leading various types of groups, including knowledge-based, skills-based and therapy groups. The focus will be on developing group dynamics that engage and empower group members, motivate them to achieve personal goals and help the group as a whole recover. Through didactic and experiential learning, participants will acquire the skills they need to plan and lead groups that are meaningful and alive.

Facilitator: Aaron Vieira, LMSW
Date: January 11
Time: 9:30 - 4:30pm            
Location: The Coalition Conference Room
Register now »  Hurry, seats fill quickly!!

Inspiring Stories and Recovery Research: Hope and Resilience for Staff

This half-day training will provide evidence from the eleven long-term studies of serious and persistent psychiatric problems, which revealed that most people can significantly improve and many even recover over time. Participants will hear inspiring stories about how staff participated in helping people reclaim their lives.  Dr. Courtenay Harding will show that hope, temperament, and human resilience of both staff and consumers all play important roles in the recovery process.

Facilitator: Courtenay Harding, Ph.D.
Date: January 13
Time: 9am - 12:30pm
Location: The Coalition Conference Room
Register now »  Reserve your seat!

To register for any Center training or to download our current training schedule, please go to: www.coalitionny.org/the_center/training/

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Other Community Education, Events &  News

 Register for The Coalition’s 2012 Conference

Registration for the Coalition’s 2012 Conference is now open.  Providers will not want to miss this opportunity to explore this year’s theme, “Riding the Roller Coaster of Change: Behavioral Health in Transition.”  Our keynote speaker will be Chuck Ingoglia, Vice President,  Public Policy at the National Council for a national perspective of health care changes.   State representative Gregory Allen, Director, Division of Financial Planning and Policy, New York State Department of Health will talk about new State initiatives.  Representatives from OptumHealth and Community Care Behavioral Health, the NYC and Hudson Valley based Behavioral Health Organizations will discuss their plans to implement BHOs in their areas.

The cost of registration is $175 for Coalition members and $225 for non-members.  Lunch will be provided.  Seats will go quickly, so register online now to reserve your spot.

Date: January 20th
Time:  9:30 am - 4:00 pm                           
Location: The Association of the Bar of the City of New York, 42 West 44th Street
For more information: http://www.coalitionny.org/events/Roller_Coaster_conf/RidingtheRollerCoasterofChange.php

Reserve your seat, register online NOW>>

 Assessing and Addressing Trauma in Recovery-Oriented Practice Webinar

This Recovery to Practice webinar aims to help providers determine how extensively traumatic experiences have affected people with behavioral health conditions and how to incorporate that knowledge into their care-planning approach. Multidisciplinary presenters will describe a range of supports, implementation tools, and interventions to address the role of trauma in recovery.

Date: January 25th
Time: 3:00 – 4:30 pm
Location: Webinar
Register: https://www304.livemeeting.com/lrs/8000963084/Registration.aspx?pageName=k01m8psx1dd71bzn

Webinar- Learn from a New Zealand Model of Integrated Behavioral Health and Recovery

The United Council for Community Behavioral Healthcare offers its Behavioral Health World Series Webinar in New York at the end of January.  In this webinar participants will  learn how Te Pou, non-government organization operating in New Zealand’s mental health sector, works to develop the mental health, addiction and disability workforces in New Zealand.  Te Pou supports an initiative called,  Let’s Get Real,  a New Zealand Ministry of Health program to build a workforce that is recovery-focused, person-centered, culturally capable, and committed to improving the quality of services. 

Date: January 31
Time:  1:00 pm                 
Location: Webinar
Register: https://www2.gotomeeting.com/register/855266802

NAMI and The Good Dog Foundation Provide Monthly Pet Therapy

Feeling the need to snuggle with a puppy??   NAMI NYC Metro provides a free, on-going group which offers peer support and therapeutic interaction with professionally trained pet therapy dogs from the Good Dog Foundation.  It is held every third Saturday of the month.   

Date: Next session, January 21st
Time:  5:30 – 7:00 pm                    
For more information: 212-684-3264 or helpline@naminyc.org
To learn more about The Good Dog Foundation go to:  http://thegooddogfoundation.org/

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Mental Health Articles, Publications and Reports

Guidelines for Affirming and Engaging the LGBT Community

Executive Director of The Rainbow Heights Club, Christian Huygen, Ph.D., shared a resource to guide providers in effective ways to affirm and engage people who identify as Lesbian, Gay, Bi-Sexual and Transgender.  Although the 7-page document was designed for hospitals, the recommendations can be easily applied to a variety of community-based behavioral health programs.  Download the PDF version.

Take Good Care of Yourself and Others in the New Year

Seasonal blues run high this time of year.  The following articles highlight information and resources to help reduce symptoms of depression, increase wellness and prevent self-harm.

Tackling Depression in the Workplace

 A new report entitled, Brain Health + Brain Skills = Brain Capital,  calls for leading corporations in Canada and the U.S. to tackle the issue of depression in the workplace. The report states that, by some estimates, as much as one-quarter of the workforce in Canada and the U.S. suffer from depression, and makes the case that corporations are in the best position to help. The authors claim that finding a cure for depression could save lives from heart attack, stroke, diabetes, and suicide among working families around the world. Among their proposals is that companies should use the workplace to educate employees about suicide prevention and that managers should receive crisis training.

To read the Toronto star article featuring the report, go to:

http://www.thestar.com/business/article/1098869--corporations-best-placed-to-lead-fight-against-depression-report

Facebook Collaboration to Help Prevent Suicide 

Facebook has collaborated with The Substance Abuse and Mental Health Services Administration and the National Suicide Prevention Lifeline to help those in crisis by enabling  users to report a suicidal comment they see posted by a friend to Facebook using either the Report Suicidal Content link or the report links found throughout the site. The person who posted the suicidal comment will then immediately receive an e-mail from Facebook encouraging them to call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or to click on a link to begin a confidential chat session with a crisis worker.

To read more about this first-of-its-kind service, go to: http://www.samhsa.gov/newsroom/advisories/1112125820.aspx

 Smoking and Lack of Mastery Increase Risk of Depression Recurrence

A study published this past November sought to identify the factors associated with a long-term negative prognosis of repeated-episode depression.  The researchers found that people with major depression who were current smokers or had low levels of self-mastery were at an increased risk of recurrence of depression.  Their report recommends that interventions include helping people with depression successfully quit smoking and also finding ways to increase their sense of self-mastery. 

To read more about the findings of this study, go to http://www.cmaj.ca/content/183/17/1969.full

Tool to Increase the 8 Dimensions of Wellness

Peggy Swarbrick and Jay Yudof have designed a tool for the Institute for Wellness and Recovery Initiative to assist people in thinking about each of the 8 dimensions of wellness which may help reduce symptoms of mental illnesses, such as chronic depression.  The resource includes written exercises to explore these 8 aspects of wellness (emotional, financial, environmental, intellectual, physical, social, occupational, and spiritual).

Learn more and find the link to download the booklet here:

http://welltacc.org/wellness/113-wellness/301-8-wellness-dimensions-booklet.html

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