The Center

Psychiatric Rehabilitation – Choosing a Valued Role: Supports

Updated:  June 21, 2006

All of us require skills and supports to function in our lives. Simply stated, skills are something we ourselves do with a level of purpose and proficiency, whereas supports consist of something provided to us, typically by another person or organization. Supports are as crucial to success and satisfaction in our role at work or at home as are skills. For people with psychiatric disabilities, research has confirmed that a strong correlation exists between the skills and supports that are needed and desired by a person and a positive rehabilitation outcome. Preferred choices also correlate strongly with positive outcomes. In the Psychiatric Rehabilitation Approach the systematic process of Choosing a Valued Role (referred to in previous articles) helps the recipient to make an informed selection that is preferred and consistent with personal values. The importance of environmental specificity as it relates to determining skills and support needs in rehabilitation cannot be overstated: a person’s needs, strengths and deficits can only be viewed in the context of a specific environment. This is why, contrary to general statements often made about recipients’ abilities, a person is skilled or unskilled, or high or low functioning, only in relationship to the demands of a particular environment. A thorough understanding of the requirements of the environment and a subsequent assessment of existing skills and supports leads to a series of strategies that can be utilized to develop critical behaviors and resources. This article will describe the process of support development using Resource Coordination as a strategy.

Consistent with psychiatric rehabilitation skill evaluation and development strategies, Achieving a Valued Role through Support Development begins with finding out which supports are required by the recipient to be successful and satisfied in a chosen environment. Two sources of information are explored for this purpose, the environment and the individual. The chosen environment dictates the explicit and implicit supports that are required to get or keep a goal. For example, Medicaid income and medication monitoring are explicit supports required by some environments whereas assistance with transportation is an implicit support required by some individuals to sustain a job. Desired support needs are obtained from the recipient, often drawn from the person’s past unsatisfactory experiences or problem situations. An understanding of what’s personally needed can be obtained by asking: ‘What happened in your past job (for example) that you’d like to handle differently in the future? And ‘What kind of assistance or support could help you resolve such a situation?’ To be of value, all supports need to be both impactful and realistic for the person; they need to have the potential to influence the outcome of a situation and the person needs to be able to imagine them self receiving the support.

Once an initial list of supports is ascertained, a process is undertaken to determine those that are critical and to define in detail precisely what the critical support means for the individual. Not unlike the process of determining critical skills, supports that are most needed are those that have the potential to influence the person’s acquisition and continuance of their chosen role. Defining a support to clearly understand what is seen or heard when it is provided enables the recipient and the practitioner to evaluate the level at which it is currently provided and compare this level with that which is needed. Clarity around exactly what’s needed is particularly helpful when resources need to be sought out and coordinated.

In the Psychiatric Rehabilitation Approach, the objectives of Resource Coordination entail securing an agreement from a resource to provide support to the recipient at the level needed and ensuring the recipient’s successful and satisfactory use of the resource. Resource Coordination is not used to garner support from colleagues or programs within one’s own agency; it is a labor intensive undertaking that is effective when outside persons or organizations are needed. Intervention strategies include ‘resource selection’, ‘clarifying the need’, ‘marketing’ and ‘negotiating’. Once the recipient has chosen a resource, the practitioner or the recipient may need to ‘clarify the need’ and persuasively describe the type of support being requested and the reasons for its selection. In some cases, making inroads with a resource necessitates even more effort. ‘Marketing’ the recipient involves presenting recipient assets and countering resource objections to providing support to the recipient. ‘Negotiating’ is used when problems are encountered with a resource and mutually acceptable and agreed upon ways to overcome barriers to support provision are needed. Many of the activities undertaken in Resource Coordination utilize skills common in case management services. Although staff in a range of programs use some of these skills, this structured and systematic method for developing supports by intimately involving consumers in their own plans for recovery is distinguishable.