Transcript Illness Management and Recovery Program

Illness Management and
Recovery Program
William Anthony defined recovery as:
… the development of new meaning and purpose in one’s life
as one grows beyond the catastrophic effects of mental illness
(Anthony, 1993).
“Unless we are making
progress in our nursing
every year, every month,
every week, take my word
for it we are going back.”
Florence Nightingale
Recovery….
The disease is
progressive.
So is recovery
You don't
have to
control your
thoughts; you
just have to
stop letting
them control
you.
- Dan Millman
Superman's not brave. You can't be brave if you're
indestructible. It's every day people, like you and me, that
are brave knowing we could easily be defeated but still
continue forward.
- unknown
Recovery
 Recovery has a unique meaning to each individual.
 For every person, recovery is conceptualized in a different
manner.
 Recovery is a continuous state of being
 Individuals will not be “cured” of mental illness
 Individuals are powerless over their disease, but NOT their lives
Recovery
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Instead of CONTROL patients can have the Knowledge to become
EMPOWERED
More POWER will be gained by taking responsibility for one’s
disease process through education, support and unconditional
acceptance.
 Patients DO have a choice
 They CAN fulfill their dreams
 They CAN lead healthy, fulfilling lives
Practitioners can help to give them the TOOLs to maintain recovery.
Recovery and Practitioners
 Our role is not to define recovery for patients, but instead
help to increase their feelings of hope that accompany them
through this process
 With encouragement, education and skill acquisition, patients
can learn how to gain power and control over their disease
process.
Recovery & Illness Management
and Recovery Program (IM&R)
 Recovery is the heart of the IM&R program
 Recovery is not an end goal, but instead, an on-going
process
 Patients are NOT passive recipients, but instead, actively
participate in this process
 As practitioners, we are responsible for providing them with
the tools and abilities to participate in their recovery and plan
of care.
Illness Management and Recovery
Program
 Developed from Evidence Based Practice which cited 5
psychosocial interventions as effective for mental health
recovery
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Supported employment
Family psycho-education
Integrated Dual Disorder Treatment
Assertive Community Treatment
Illness Management and Recovery
Illness Management and Recovery
Program
 Came from National evidence based practice
 Review of 40 randomized controlled studies:
 The
results:
Components
Outcomes
Psycho-education
Improved knowledge of mental
illness
Behavioral Tailoring
Helps people take medications as
prescribed
Relapse Prevention
Reduces symptoms &
Hospitalizations
Coping Skills Training
Cognitive – Behavioral Therapy
Reduces severity of distress and
symptoms.
Illness Management and Recovery
Program : So what then?
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A structured program
Curriculum based approach
Help patients to acquire skills and knowledge
Assist patients to understand recovery
Assist patients to achieve their own, personal recovery
Illness Management and Recovery
Program
 “Illness Management and Recovery (IMR) is an evidencebased psychiatric rehabilitation practice whose primary aim is
to empower consumers to manage their illnesses, find their
own goals for recovery, and make informed decisions about
their treatment by teaching them the necessary knowledge
and skills.” (United States Department of Health and Human
Services, 2009)
Goals of Illness Management and
Recovery
• Instill hope that change is possible
• Develop a collaborative relationship with the treatment team
• Help people establish personally meaningful goals to strive
towards
• Teach information about mental illness and treatment options
• Develop skills for reducing relapses, dealing with stress, and
coping with symptoms
• Provide information about where to obtain needed resources
• Help people develop or enhance their natural supports for
managing their illness and pursuing goals
Core Values of IM & R: Hope
 Hope, participation and coping have been shown to increase
one’s quality of life
 Hope and destiny assist one to believe in their ability to
influence their future destiny
 In order to convey hope, practitioners themselves must
HAVE hope and be able to convey this hope to patients.
 Transmitting hope and belief in and to patients helps them to feel
empowered.
Core Values of IM & R:
The patient is the expert
 Every patient experiences their disease process in a unique
manner.
 Every patient knows and understands which treatment
strategies work best for them.
 Patients are experts on their disease process and recovery.
 Practitioners are experts on technical aspects of mental
illness, coping strategies, stress reduction, ect.
 Through the sharing of expertise, recovery can more
efficiently and effectively be achieved.
Core Values of IM & R:
Patient’s personal choice
 It is the practitioner's role to assist and support patients to
make their own, personal choices.
 Instead of force and/or coercion (expect in legal situations),
practitioner's should help patients to identify the
consequences of their outcomes.
Core Values of IM & R:
Practitioners are collaborators
 Collaboration helps patients to cope with their illness make
progress towards their goals
 Patients and Practitioners work together, in a non-hierarchal,
helping relationship
Core Values of IM & R:
Practitioners demonstrate respect for
individuals living with mental illness
 Respect:
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Patients as individual
As capable decision makers
As individuals with rights, goals and dreams
Patient’s ability to make decision, take risks and experience
consequences
Teaching Methods: Motivation
 The practitioner’s role is to provide patient’s with the
motivation to learn IM & R. It can NEVER be assumed that
one already possess the motivation necessary for recovery.
 Motivation will help patients to achieve short term goals
 Motivation can change over time and therefore must be
consistently addressed throughout the program.
 It is vital that practitioner's convey their confidence, support
and encouragement in patients in order to maintain
motivation.
Teaching Methods: Education
 Disease information, illness management, coping strategies
and illness prevention are core educational concepts in IM & R
 Education should be INTERACTIVE in order to enhance
acquisition and cognitive processing.
 Interactive education also helps to clarify information,
understand a patient’s perspective and convey respect for their
individuality.
 Practitioners need to consciously check for understanding and if
necessary, break information down into small components
 Speak in a manner that patient’s understand; “speak their same
language”
Teaching Method: Education
 Patients can actively learn about their disease.
 With knowledge, patients will be able to actively participate in
care
 Education can lead to empowerment
 Education can lead to responsibility
 Response-able
Learning about me and my illness
1. What are some of the symptoms of the disease that I have? (sadness, depression,
denial, anger, frustration, ect)
2. What changes have occurred in my physical, social, economic and/or professional
life because of my disease?
3. How has my disease affected my relationship with the people I love the most?
4. What are some ways that my disease has caused my life to be unmanageable
and/or out of control?
5. Give three reasons for having hope today. What are you looking forward to? What
has already started to change
for the better in your life?
Teaching Methods:
Cognitive Behavioral Strategies
 Reinforcement:
 Positive: utilized to increase positive behaviors (i.e. increase
praise, rewards, self esteem)
 Negative: utilized to decrease negative behaviors (i.e. decrease
stress, anxiety, ect)
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Practitioner's role: praise, enthusiasm, positive reinforcement,
monitoring achievement of personal goals, encourage utilization
of newly acquired skills
Teaching Methods:
Shaping
 This entails successive behaviors/steps to obtain new
behaviors/goals
 Practitioners needs to provide positive reinforcement,
encouragement and feedback while also realizing that
patients learn at their own rate
 Practitioners can shape patient’s attitude by acknowledging
their efforts, struggles and accomplishments in their own IM
& R program
Teaching Methods:
Modeling
 Practitioners demonstrate desirable and appropriate skills for
patients to observe
 Practitioners can enhance learning by explaining the
rationale and basis for the skill/behavior before its
demonstration
 Patients can then provide feedback on behavior while also
role modeling newly acquired skill
 What patients observe practitioners completing on a daily
basis are ALSO examples of role modeling.
Teaching Methods:
Role Playing and Practice
 Practitioners should support acquisition of new skills inside
and outside of the group
 After completion, patients should be asked about
experiences, feelings, obstacles, ect
 Enthusiastically encourage patients to use skills throughout
the day and track their experiences
Teaching Methods:
Homework
 Assist in acquisition of skills
 Provides individuals with hope and confidence that they will
be able to learn and complete new skill
 Can be modified based on patient’s mental and cognitive
status.
 Can include other peers in the program.
Teaching Methods:
Cognitive Restructuring
 How patients feel about themselves and how the process
information influences their understanding of the world and
how they respond to events.
 When one’s cognitive processes are inaccurate, restructuring
can assist one to view the world, process information and
understand information in a more accurate manner.
Teaching Methods:
Cognitive Restructuring
 Practitioners can participate in cognitive restructuring by:
 Teaching patients accurate facts about mental illness
 Exp. Mental illness is influences by environmental, biological and social
factors and NOT a due to one’s lack of self will and/or weakness.
Teaching Methods:
Behavioral Tailoring
 Helps build strategies to incorporate medications into one’s
daily routine
 Practitioners can help by providing prompts, reinforcement,
rationale for taking medications, benefits of taking medication
 Practitioners'’ Techniques:
 Identify daily routine
 Identify daily activity that will help/prompt individuals to remember
to take medication.
 Role model the plan
 Assist patient to practice the plan implementation
Teaching Methods:
Relapse Prevention
 Create a plan that identifies signs, symptoms and steps to
respond to signs
 Patients can learn and identify “triggers”
 Include support persons in plan
 The practitioner can explain relapse, benefits of relapse
prevention, techniques to avoid relapse.
 Write down plan and role play the plan
When I am feeling Bad OR Good, these are the people that I can call:
Friends
Family Members
Others:
Phone Number
Crisis Plan:
I know that things are not going well when I notice these warning signs :
(thoughts, feelings, actions, physical symptoms, ect)
I know that I need to call for help immediately when I notice the following
EMERGENCY warning signs:
(thoughts, feelings, actions, physical symptoms, ect)
In order to get help and stay SAFE before help arrives I will:
Natural recovery support systems
 Define support systems
 Identify support systems
 Included support systems in life
 Share in the recovery process with natural support systems
within one’s life.
Teaching Methods:
Coping skills
 Practitioner can help patients to identify troubling
behaviors/symptoms and situations in which they frequently
occur.
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 Help patient to identify coping strategies that have utilized and
their effectiveness
 The practitioner can help the patient to obtain new coping skills
or increase the utilization of currently utilized beneficial and
efficient coping skills.
Role play new coping skills with patient
Patients who will benefit from
IM & R
 Educational sessions have been written specifically for
individuals with schizophrenia, bipolar and depression.
 However, it is believed that all individuals living with and
surviving psychiatric illnesses can benefit from IM & R
 It is also believed that ALL patients, no matter how long they
have been living with their illness can benefit from IM & R
Help individuals
enhance natural
support systems
Empower and
Inspire the
Patient
Initiate a
collaborative
role with the
treatment team
Increase
feelings of hope
Role of
Practitioner
Provide patients
with the tools
and skills to
participate in
their own
recovery
Instill hope
Help patients
define
meaningful
goals
Teach and
Educate
Personally Have
Hope
Role of Practitioner: The benefits
of the program
 Give practical clinical tools to work with
 Creates a partnerships with patients
 Brings evidence based practice into recovery
 Better understanding of patients, their struggles, their lives
 More recovery focused vs. paternalistic
The patients: the benefits
Yes, this is what they have really said
 More confidence
 Able to try new activities
 Become involved in more meaningful activities
 Able to manage their own illness better
 Feel more hopeful
 Increase vocational activities
Structure
 Individual teaching: Allows more individual teaching and
dedicated attention to one’s individualized needs
 Group teaching: Allows patients to receive feedback, form
relationships, gain support and identify role models
 Combination: Allows core material to be taught to individuals
while group sessions provide time and opportunity for
support and feedback.
Session Time Frame
Informal socializing and
identification of any major
problems
1-3 minutes
Review previous session(s)
1-3 minutes
Review Homework
3-5 minutes
Follow up on Goals
1-3 minutes
Set agenda for current session
1-2 minutes
Teach new material or review
previously taught material
30-40 minutes
Agree on new homework
assignment
3-5 minutes
Summarize progress made in
current session
3-5 minutes
Time
 Time range of group can vary from 45-60 minutes.
 However, individuals with shorter attention span may only be
able to maintain attention for 30 minutes.
 If necessary, shorter, more frequent sessions can be
completed.
How this all fits in….
Motivational
interviewing is how
we interact with
patients
Integrated Dual
Disorder treatment is
how we ensure that
patients' mental
illness and chemical
abuse is treated
simultaneously
Illness Management
and Recovery is the
program we utilize to
assist individuals into
and through their
recovery.
Where are we? Where are we
going?
 08 is the pilot unit
 Patients will start setting long term and short term goals
 Current goals group is a component of this process
 All staff will know and communicate with each other
regarding each patient's current goal
 OT/TR will work with patients to set long term recovery goals
 Disciplines will work together to conduct IM & R groups daily.
The rest of it….
 Motivational interviewing
 Every staff member to receive training
 Eventually tracking the stage of recovery at which patients are at
in order to know which techniques to use, how ready that they
are to change….i.e. how motivated they are
 Integrated dual disorder treatment
 Incorporate assessments and treatment goals for MI & CD
together
 Utilizes motivational interviewing framework
 GAIN-SS will be utilized to screen, upon admission those who
are at risk for a substance abuse
 These techniques/programs will eventually replace the MICD
group that we utilize now.
Illness
Management and • Programming
Recovery Program
Integrated Dual • Process
MI + CD
Disorder Treatment • Treat
together
Motivational
interviewing
• Treatment approach
• How we talk to
patients 1:1 and in
groups
"...the character of the
nurse is as important as
the knowledge she
possesses."
-- Jarvis, 1996
“They may
forget your
name but they
will never forget
how you made
them feel.” Maya
Angelou
"When you're a
nurse you know
that every day
you will touch a
life or a life will
touch yours.
-- Anonymous
Work Cited
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 Flaum, M. & Salyers, M., (2004). Session VII: Illness management and recovery. [PowerPoint
slides]. Retrieved from http://www.medicine.uiowa.edu/icmh/recovery/.
 Hazelden. (2009). Family program. Center City, MN.
 Minnesota Department of Health and Human services. (2009). Illness management and
recovery: Implementation resource kit. Retrieved from
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&Revisio
nSelectionMethod=LatestReleased&dDocName=id_028649
 Roe, D. P.-H. (2007). Illness management and recovery: Generic issues of group format
implementation. American Journal of Psychiatric Rehabilitation, 131-147.
 United States Department of Health and Human Services – Substance Abuse and Mental
Health Services Administration. (2009). Evidence based practices: Shaping mental health
services towards recovery. Retrieved from
http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/
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