outline of entire presentation

11

Using the Using the Empowerment Scale Empowerment Scale In Treatment: an In Treatment: an Educational Program Educational Program for for Consumers, Consumers, Clinicians and Clinicians and SupervisorsSupervisors

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Outline of Entire Outline of Entire Presentation Presentation

Part One: Setting the stage for personal Part One: Setting the stage for personal growth and Recovery through Hope, growth and Recovery through Hope, Empowerment and Preparation: An Empowerment and Preparation: An OverviewOverview

Part Two: Using the Empowerment Part Two: Using the Empowerment Scale to plan and monitor treatment Scale to plan and monitor treatment aimed at Empowerment and Recoveryaimed at Empowerment and Recovery

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Part OnePart One

Setting the stage for personal growth and Setting the stage for personal growth and Recovery through Hope, Empowerment Recovery through Hope, Empowerment and Preparation: An Overviewand Preparation: An Overview

Review conditions necessary for Review conditions necessary for Empowerment to take placeEmpowerment to take place

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Learning Objectives:Learning Objectives:Part OnePart One

Define Recovery & EmpowermentDefine Recovery & Empowerment Describe how Recovery and Empowerment Describe how Recovery and Empowerment

apply to all consumersapply to all consumers Describe the conditions for Empowerment Describe the conditions for Empowerment

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Resilience & RecoveryResilience & Recovery Ideally during youth, people acquire resilience, Ideally during youth, people acquire resilience,

“an innate capacity that when facilitated and “an innate capacity that when facilitated and nurtured empowers children, youth, and families nurtured empowers children, youth, and families to successfully meet life’s challenges with a to successfully meet life’s challenges with a sense of self-determination, mastery and hope” sense of self-determination, mastery and hope” From: Resiliency WorkgroupFrom: Resiliency Workgroup

People can build resilience even as adults People can build resilience even as adults If an adult becomes mentally ill, they will use If an adult becomes mentally ill, they will use

what resilience they have to Recover what resilience they have to Recover One goal of treatment may be to build resilience One goal of treatment may be to build resilience

to avoid future mental health problemsto avoid future mental health problems

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HopeHope Hope is a desire accompanied by confident Hope is a desire accompanied by confident

expectation. Having a sense of hope is the expectation. Having a sense of hope is the foundation for ongoing recovery from mental foundation for ongoing recovery from mental illness. Even the smallest belief that we can get illness. Even the smallest belief that we can get better, as others have, can fuel the recovery better, as others have, can fuel the recovery process.process.

Early in the recovery process, it is possible for Early in the recovery process, it is possible for a treatment provider, friend, and/or family a treatment provider, friend, and/or family member to carry hope for a consumer. At member to carry hope for a consumer. At some point, however, consumers must develop some point, however, consumers must develop and internalize their own sense of hopeand internalize their own sense of hope

From: MHRecovery.com From: MHRecovery.com

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Hope and RecoveryHope and Recovery

Without Hope, why would anyone proceed in Without Hope, why would anyone proceed in mental health treatment?mental health treatment?

Recovery from Schizophrenia is possible: Recovery from Schizophrenia is possible: 55.5% achieved recovery in multiple studies* 55.5% achieved recovery in multiple studies* With many other less serious disorders there are With many other less serious disorders there are

similar or higher improvement ratessimilar or higher improvement rates

We should offer hope to consumers!We should offer hope to consumers!

*From Liberman, R.P. & Kopelwicz (2005) Recovery from Schizophrenia:*From Liberman, R.P. & Kopelwicz (2005) Recovery from Schizophrenia:A concept in Search of Research. A concept in Search of Research. Psychiatric Services.Psychiatric Services.

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Our Hope: RecoveryOur Hope: Recovery

Refers to the process in which individuals are Refers to the process in which individuals are able to live, work, learn and participate fully in able to live, work, learn and participate fully in their communitiestheir communities

Recovery is the ability to live a fulfilling and Recovery is the ability to live a fulfilling and productive life despite a disabilityproductive life despite a disability

Recovery also implies the reduction or Recovery also implies the reduction or complete remission of symptoms. Science has complete remission of symptoms. Science has shown that having shown that having hopehope plays an integral role plays an integral role in an individual's recovery in an individual's recovery (President's New (President's New Freedom Commission on Mental Health)Freedom Commission on Mental Health)

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Another View of RecoveryAnother View of Recovery

“ “Instead of focusing primarily on symptom Instead of focusing primarily on symptom relief…recovery casts a much wider relief…recovery casts a much wider spotlight on restoration of spotlight on restoration of self-esteemself-esteem and and identityidentity and on attaining and on attaining meaningful rolesmeaningful roles in in society. The definitions do not, however, society. The definitions do not, however, imply full recovery, in which full functioning imply full recovery, in which full functioning is restored and no medications are needed. is restored and no medications are needed. Instead they suggest a journey or process, Instead they suggest a journey or process, not a destination or cure”not a destination or cure”Patricia Deegan, 1997Patricia Deegan, 1997

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People are Labeled with People are Labeled with Mental Illness Due to:Mental Illness Due to:

Many reasons including:Many reasons including: Severe emotional distressSevere emotional distress

Insufficient social supports/resources/ coping Insufficient social supports/resources/ coping skills to maintain the major social roles expected skills to maintain the major social roles expected of them during that phase of their lifeof them during that phase of their life

Those who have adequate resources to Those who have adequate resources to cope with their symptoms may not be cope with their symptoms may not be labeled as mentally illlabeled as mentally ill

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THEREFORE:THEREFORE:

““The goal of treatment here is assisting people The goal of treatment here is assisting people in gaining greater control of their lives and in gaining greater control of their lives and assisting them in regaining valued roles in assisting them in regaining valued roles in society”society”Dan Fisher, MDDan Fisher, MD

Recovery is made possible through a Recovery is made possible through a combination of combination of SUPPORTSSUPPORTS needed to re- needed to re-establish social roles and establish social roles and SELF-SELF-MANAGEMENTMANAGEMENT needed to take control of needed to take control of major decisionsmajor decisions

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Treatment With Recovery Treatment With Recovery FocusFocus

Mental illness is not a life-long processMental illness is not a life-long process Builds assets that can help consumers get Builds assets that can help consumers get

on with their lives despite potentially on with their lives despite potentially continuing symptoms of mental illnesscontinuing symptoms of mental illness

Empowerment is a key asset that can be Empowerment is a key asset that can be built in the presence of symptomsbuilt in the presence of symptoms

Empowerment is negatively correlated with Empowerment is negatively correlated with symptom distress symptom distress (Stewart & Kopache, 2003 IASPRS (Stewart & Kopache, 2003 IASPRS Conference Presentation)Conference Presentation)

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Recovery is for EveryoneRecovery is for Everyone

The processes of recovery The processes of recovery as described above can as described above can happen for everyone despite happen for everyone despite level of functioning or types level of functioning or types of symptomsof symptoms

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What is Empowerment?What is Empowerment?

The process of investing with powerThe process of investing with power Recovery does not occur without Recovery does not occur without

EmpowermentEmpowerment

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Empowerment ProcessEmpowerment Process

The process of increasing personal, The process of increasing personal, interpersonal and political power to interpersonal and political power to enable individuals or collectives to enable individuals or collectives to improve their life situation. It requires the improve their life situation. It requires the full participation of people in the full participation of people in the formulation, implementation and formulation, implementation and evaluation of decisions determining the evaluation of decisions determining the functioning and well-being of the society.functioning and well-being of the society.http://www.polity.org.zahttp://www.polity.org.za

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Empowerment Helps Empowerment Helps EveryoneEveryone

The components of empowerment are part of The components of empowerment are part of the healing process for everyone, not just the healing process for everyone, not just those with severe mental illnessthose with severe mental illness

Empowerment issues (low self-esteem, sense Empowerment issues (low self-esteem, sense of powerlessness, etc.) are present in almost of powerlessness, etc.) are present in almost all cases, regardless of diagnosisall cases, regardless of diagnosis

For those with mental illness, empowerment For those with mental illness, empowerment can be a tool to enhance a consumer’s can be a tool to enhance a consumer’s decision-making capacitydecision-making capacity

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Each Person Must Each Person Must Become Empowered Become Empowered ThemselvesThemselves

Empowerment is not something that can Empowerment is not something that can be given to a person or that can be done be given to a person or that can be done for a personfor a person

BUT clinicians can and must aid in BUT clinicians can and must aid in establishing the conditions necessary for establishing the conditions necessary for EmpowermentEmpowerment

Empowerment in life cannot be gained Empowerment in life cannot be gained without empowerment in treatmentwithout empowerment in treatment

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Conditions for Conditions for EmpowermentEmpowerment

Managed Psychiatric SymptomsManaged Psychiatric Symptoms Participation SkillsParticipation Skills Psychological ReadinessPsychological Readiness Mutual Trust and RespectMutual Trust and Respect Reciprocal Concrete IncentivesReciprocal Concrete Incentives Availability of ChoicesAvailability of Choices Participation Structures and ProcessesParticipation Structures and Processes Access to ResourcesAccess to Resources Supportive CultureSupportive Culture

David Linhorst, 2006, Empowering People with Severe Mental Illness: A Practical Guide

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Conditions for Conditions for EmpowermentEmpowerment

Empowerment can begin even with a minimum Empowerment can begin even with a minimum level of these conditionslevel of these conditions

Clinicians should proceed assuming that Clinicians should proceed assuming that empowerment is possible and work to establish empowerment is possible and work to establish the necessary conditionsthe necessary conditions

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Condition: Condition: Managed Psychiatric Managed Psychiatric SymptomsSymptoms

Consumers can participate in treatment Consumers can participate in treatment planning even with symptoms presentplanning even with symptoms present

Symptoms do not impact all areas of Symptoms do not impact all areas of decision-making; assume that persons decision-making; assume that persons can participatecan participate

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Condition:Condition:Participation SkillsParticipation Skills

People must have some level of participation People must have some level of participation skills to meaningfully participate in treatmentskills to meaningfully participate in treatment

Many systems have access to Many systems have access to Climbing into Climbing into the Driver’s Seatthe Driver’s Seat training that helps prepare training that helps prepare consumers to take part in treatment planningconsumers to take part in treatment planning

Even with symptoms, a person can acquire Even with symptoms, a person can acquire participation skills needed to take part in participation skills needed to take part in treatment planningtreatment planning

Give opportunities for decision making; making Give opportunities for decision making; making even small decisions builds skillseven small decisions builds skills

Honoring consumer choices, sometimes even Honoring consumer choices, sometimes even poor ones, fosters a sense of confidence in poor ones, fosters a sense of confidence in their ability to make decisionstheir ability to make decisions

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Condition:Condition:Psychological ReadinessPsychological Readiness

Hope for change is needed, but hope is fragileHope for change is needed, but hope is fragile Psychological readiness can be inhibited by Psychological readiness can be inhibited by

past failed attempts to change, feelings of past failed attempts to change, feelings of powerlessness, lack of hope, and other powerlessness, lack of hope, and other reasonsreasons

Motivational interviewing (characterized by Motivational interviewing (characterized by active listening, empathy, non-argumentative active listening, empathy, non-argumentative style, open-ended questioning) can be useful in style, open-ended questioning) can be useful in fostering readinessfostering readiness

Small successes build readinessSmall successes build readiness

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Condition:Condition:Mutual Trust and RespectMutual Trust and Respect

Consumer believes clinician wants what’s best Consumer believes clinician wants what’s best and respects consumer’s abilities, choices and and respects consumer’s abilities, choices and basic worth as a personbasic worth as a person

Clinician believes consumer can make good Clinician believes consumer can make good decisions and is willing to cooperate decisions and is willing to cooperate

Mutual trust and respect build the therapeutic Mutual trust and respect build the therapeutic alliance, which has been shown to improve alliance, which has been shown to improve treatment outcomes treatment outcomes (Crane-Ross, Lutz & Roth, (Crane-Ross, Lutz & Roth, 2005)2005)

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Condition:Condition:Reciprocal Concrete IncentivesReciprocal Concrete Incentives Both consumer and clinician must have concrete Both consumer and clinician must have concrete

and meaningful incentives to participate in and meaningful incentives to participate in treatmenttreatment

Consumers have incentive of better life as a Consumers have incentive of better life as a result of successful treatmentresult of successful treatment

Clinicians have the incentive that the consumers Clinicians have the incentive that the consumers they serve will have positive changes in their lifethey serve will have positive changes in their life

Sometimes the incentives have to be pointed out Sometimes the incentives have to be pointed out to be recognized, or put in place if not there to be recognized, or put in place if not there alreadyalready

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Condition:Condition:Availability of ChoicesAvailability of Choices

In order for decision-making to be meaningful, valid In order for decision-making to be meaningful, valid choices must be availablechoices must be available

These choices can be in style of treatment modalities, These choices can be in style of treatment modalities, additional services, or goals of treatmentadditional services, or goals of treatment

Even bad choices can be empowering; Even bad choices can be empowering; howeverhowever, more , more failure—brought about by not being ready—may foster failure—brought about by not being ready—may foster powerlessness rather than empowermentpowerlessness rather than empowerment

A decision to defer decision-making is also OK—it does A decision to defer decision-making is also OK—it does not indicate a general inability or unwillingness to make not indicate a general inability or unwillingness to make decisionsdecisions

People make choices all the time; show consumers People make choices all the time; show consumers that everyday choices are evidence of their powerthat everyday choices are evidence of their power

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Condition:Condition:Participation Structures and Participation Structures and ProcessesProcesses

Empowerment should be a part of the Empowerment should be a part of the formal processes in a service settingformal processes in a service setting

Involving families and/or significant Involving families and/or significant others—at the consumer’s discretion—is others—at the consumer’s discretion—is empoweringempowering

Individualized treatment planning implies Individualized treatment planning implies that the consumer is present and that the consumer is present and participatesparticipates

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Condition:Condition:Access to ResourcesAccess to Resources

Ability of consumers to identify and access Ability of consumers to identify and access resources will enhance treatment effectivenessresources will enhance treatment effectiveness

In order to recover, a consumer must be able In order to recover, a consumer must be able to learn to identify and access resources, to learn to identify and access resources, including:including: Peer SupportPeer Support MediationMediation Community events as social opportunitiesCommunity events as social opportunities Educational materialsEducational materials

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Condition:Condition:Access to ResourcesAccess to Resources

Clinicians also need resources:Clinicians also need resources: TrainingTraining Time to conduct meaningful engagement (it Time to conduct meaningful engagement (it

takes longer to write treatment plans with the takes longer to write treatment plans with the consumer taking part)consumer taking part)

Tools such as Outcomes reportsTools such as Outcomes reports Evidence-based practice modelsEvidence-based practice models

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Condition: Condition: Supportive CultureSupportive Culture

Clinicians do not work in isolation: the culture of the Clinicians do not work in isolation: the culture of the agency either supports or inhibits empowermentagency either supports or inhibits empowerment

A supportive culture:A supportive culture: Has empowered clinicians that instill hope and set Has empowered clinicians that instill hope and set

an example for consumersan example for consumers Minimizes stigmaMinimizes stigma Assumes consumers are self-reliant or can grow Assumes consumers are self-reliant or can grow

into self-relianceinto self-reliance Has Mission and Vision statements that support Has Mission and Vision statements that support

Empowerment and RecoveryEmpowerment and Recovery Has leaders that support Empowerment and Has leaders that support Empowerment and

RecoveryRecovery

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Conditions Only Set the Conditions Only Set the StageStage

The effectiveness of treatment depends The effectiveness of treatment depends on how much of each condition is presenton how much of each condition is present

The conditions provide a structure for The conditions provide a structure for nurturing consumer empowermentnurturing consumer empowerment

To the extent possible, all conditions To the extent possible, all conditions should be presentshould be present

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Empowerment Requires Empowerment Requires Actual ChangeActual Change

Increasing consumer’s self-esteem, self-Increasing consumer’s self-esteem, self-efficacy, and sense of power are efficacy, and sense of power are necessary but not sufficient conditions for necessary but not sufficient conditions for growthgrowth

These subjective changes must be These subjective changes must be accompanied by objective or actual accompanied by objective or actual changes in order for progress to be changes in order for progress to be sustainedsustained

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Part One SummaryPart One Summary

Hope is the seed that can start and sustain the recovery process

Empowerment is essential to recovery because it enables the consumer to lead their own recovery

Empowerment is up to the consumer, but clinicians can set the stage by fulfilling the conditions of Empowerment

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Part TwoPart Two

Using the Empowerment Scale to plan Using the Empowerment Scale to plan and monitor treatment aimed at and monitor treatment aimed at Empowerment and RecoveryEmpowerment and Recovery

Review Reports that Incorporate Review Reports that Incorporate Empowerment Sub-Scales and ItemsEmpowerment Sub-Scales and Items

Review how to use the Reports in the Review how to use the Reports in the various phases of treatmentvarious phases of treatment

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Learning Objectives:Learning Objectives:Part TwoPart Two

Explain the components of the Explain the components of the Empowerment ScaleEmpowerment Scale

Know which reports incorporating Know which reports incorporating Empowerment can be used in treatmentEmpowerment can be used in treatment

Give specific suggestions about how to use Give specific suggestions about how to use the Empowerment Scale in treatmentthe Empowerment Scale in treatment

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The Empowerment ScaleThe Empowerment Scale

The Adult Consumer Survey of the The Adult Consumer Survey of the Ohio Outcomes System Includes:Ohio Outcomes System Includes:

The Boston University “Making The Boston University “Making Decisions” Empowerment Scale has Decisions” Empowerment Scale has 5 components5 components Self-Esteem Self-Esteem Optimism and Control Over the FutureOptimism and Control Over the Future Community Activism and AutonomyCommunity Activism and Autonomy Power/PowerlessnessPower/Powerlessness Righteous AngerRighteous Anger

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Empowerment ExerciseEmpowerment Exercise

Complete and score the Empowerment Complete and score the Empowerment ScaleScale

Special hand-scoring version included--Special hand-scoring version included--Do not use this version in treatment!Do not use this version in treatment!

Leave about 15 minutes for this taskLeave about 15 minutes for this task Consider what you would like to work on Consider what you would like to work on

if it were your treatment planif it were your treatment plan

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Finding the PositiveFinding the Positive

The amount of self-esteem, power, righteous The amount of self-esteem, power, righteous anger, community activism and anger, community activism and optimism/control over the future can vary in optimism/control over the future can vary in different areas of lifedifferent areas of life

Part of the clinical process must be to find Part of the clinical process must be to find areas of life where empowerment existsareas of life where empowerment exists

These scales and the individual items can help These scales and the individual items can help find areas of strength and find areas where find areas of strength and find areas where improvement is still neededimprovement is still needed

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About Normative Data…About Normative Data…

Normative data are Normative data are usually constructed from scores representative of the population we are measuring; norms provide a standard with reference to a population of interest

Some norming data are included in Some norming data are included in subsequent slides to provide a general subsequent slides to provide a general sense of the Empowerment scale scoressense of the Empowerment scale scores

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About Normative Data…About Normative Data…

The primary use of the Empowerment The primary use of the Empowerment data in treatment is to compare the data in treatment is to compare the person to themselves over timeperson to themselves over time

Norms are not Targets! These are what Norms are not Targets! These are what exist in a Grade B system (NAMI state exist in a Grade B system (NAMI state ratings, 2006)ratings, 2006)

““If you always do what you always did, If you always do what you always did, you always get what you always got”you always get what you always got”

-Martha Hodge-Martha Hodge

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Self-Esteem/EfficacySelf-Esteem/Efficacy

Loss of self-esteem is a major concern for virtually all Loss of self-esteem is a major concern for virtually all

consumersconsumers Without some sense of self worth, a person’s reason to Without some sense of self worth, a person’s reason to

live or participate in treatment may be lostlive or participate in treatment may be lost “ “Every new adjustment is a crisis in self-esteem”Every new adjustment is a crisis in self-esteem” -Eric Hoffer-Eric Hoffer “ “If you put a small value on yourself, rest assured that If you put a small value on yourself, rest assured that

the world will not raise your price”the world will not raise your price” -Unknown-Unknown

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Self-Esteem/Efficacy Self-Esteem/Efficacy ItemsItems

38. I have a positive attitude toward myself38. I have a positive attitude toward myself 39. I am usually confident about the decisions I make39. I am usually confident about the decisions I make 42. I see myself as a capable person42. I see myself as a capable person 45. I am often able to overcome barriers45. I am often able to overcome barriers 47. When I make plans, I am almost certain to make 47. When I make plans, I am almost certain to make

them workthem work 51. I am able to do things as well as most other people51. I am able to do things as well as most other people 52. I generally accomplish what I set out to do52. I generally accomplish what I set out to do 57. I feel I am a person of worth, at least on an equal 57. I feel I am a person of worth, at least on an equal

basis with othersbasis with others 59. I feel I have a number of good qualities 59. I feel I have a number of good qualities

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Self-Esteem/EfficacySelf-Esteem/Efficacy

““Low self-esteem is like driving through life with your Low self-esteem is like driving through life with your hand-break on”hand-break on”

-Maxwell Maltz-Maxwell Maltz

Normative data:Normative data: Intake 180 Days 1 Year

Overall MeanOverall Mean 2.62 2.74 2.78

Schiz. or other PsychoticSchiz. or other Psychotic 2.81 2.89 2.97

AnxietyAnxiety 2.53 2.65 2.68

DepressionDepression 2.50 2.64 2.65

BipolarBipolar 2.54 2.67 2.71

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Optimism and Control Optimism and Control Over the FutureOver the Future

Sense of the future is a key component Sense of the future is a key component of mental healthof mental health

Without optimism, there is no reason to Without optimism, there is no reason to expect results in treatmentexpect results in treatment

“ “If you think you can, you can. And if you If you think you can, you can. And if you think you can't, you're right”think you can't, you're right”

--Mary Kay AshMary Kay Ash

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Optimism and Control Optimism and Control Over the Future ItemsOver the Future Items

34. I can pretty much determine what 34. I can pretty much determine what will happen in my lifewill happen in my life

35. People are limited only by what they 35. People are limited only by what they think is possible think is possible

46. I am generally optimistic about the 46. I am generally optimistic about the futurefuture

60. Very often a problem can be solved 60. Very often a problem can be solved by taking actionby taking action

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Optimism and Control Optimism and Control Over the FutureOver the Future

Normative data Normative data Intake 180 Days 1 Year


Schiz. Or other PsychoticSchiz. Or other Psychotic 2.71 2.89 2.97




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Community Activism and Community Activism and AutonomyAutonomy

Fulfilling positive roles gives life meaning, an Fulfilling positive roles gives life meaning, an essential component of Recoveryessential component of Recovery

Activism can build safety nets Activism can build safety nets Being part of a community gives consumers a Being part of a community gives consumers a

chance to build social assets outside the chance to build social assets outside the mental health systemmental health system

““Never doubt that a small group of thoughtful, Never doubt that a small group of thoughtful, committed people can change the world: indeed it's committed people can change the world: indeed it's the only thing that ever has!”the only thing that ever has!”

- Margaret Mead- Margaret Mead

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Community Activism and Community Activism and Autonomy ItemsAutonomy Items36. People have more power if they join together as a 36. People have more power if they join together as a

groupgroup44. People working together can have an effect on their 44. People working together can have an effect on their

communitycommunity53. People should try to live their lives the way they 53. People should try to live their lives the way they

want towant to58. People have a right to make their own decisions, 58. People have a right to make their own decisions,

even if they are bad oneseven if they are bad ones60. Very often a problem can be solved by taking action60. Very often a problem can be solved by taking action61. Working with others in my community can help to 61. Working with others in my community can help to

change things for the betterchange things for the better

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Community Activism and Community Activism and AutonomyAutonomy

Normative data Normative data Intak

e 180 Days 1 Year






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Power/PowerlessnessPower/Powerlessness Presence or absence of belief that Presence or absence of belief that

personal efforts will produce meaningful personal efforts will produce meaningful results results

In order to achieve the outcomes of In order to achieve the outcomes of treatment, the consumer needs to have a treatment, the consumer needs to have a sense of personal powersense of personal power

Consumer participation in treatment will Consumer participation in treatment will hinge on the power a consumer has or is hinge on the power a consumer has or is given by the clinical teamgiven by the clinical team

““Power can be taken, but not given. The Power can be taken, but not given. The process of the taking is empowerment in itself”process of the taking is empowerment in itself”

-Gloria Steinem-Gloria Steinem

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Power/Powerlessness Power/Powerlessness ItemsItems

40. People have no right to get angry just because they 40. People have no right to get angry just because they don’t like somethingdon’t like something

41. Most of the misfortunes in my life were due to bad luck41. Most of the misfortunes in my life were due to bad luck

43. Making waves never gets you anywhere 43. Making waves never gets you anywhere

49. Usually I feel alone49. Usually I feel alone

50. Experts are in the best position to decide what people 50. Experts are in the best position to decide what people should do or learnshould do or learn

54. You can’t fight city hall (authority)54. You can’t fight city hall (authority)

55. I feel powerless most of the time55. I feel powerless most of the time

56. When I am unsure about something, I usually go along 56. When I am unsure about something, I usually go along with the rest of the groupwith the rest of the group

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Power/PowerlessnessPower/Powerlessness

Normative data Normative data Intake 180Days 1 Year






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Righteous AngerRighteous Anger

Anger is OK in the face of an inappropriate actionAnger is OK in the face of an inappropriate action Knowing when anger is OK and responding Knowing when anger is OK and responding

appropriately are what makes righteous anger a appropriately are what makes righteous anger a tool for recoverytool for recovery

Unlike other Empowerment subscales, Righteous Unlike other Empowerment subscales, Righteous Anger positively correlates with Symptom Anger positively correlates with Symptom Distress—More Anger, More DistressDistress—More Anger, More Distress

HOWEVER, Symptom Distress and Anger are HOWEVER, Symptom Distress and Anger are sometimes a sign that the consumer is ready to sometimes a sign that the consumer is ready to changechange

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Righteous Anger ItemsRighteous Anger Items

37. Getting angry about something never 37. Getting angry about something never helpshelps

40. People have no right to get angry just 40. People have no right to get angry just because they don’t like somethingbecause they don’t like something

43. Making waves never gets you 43. Making waves never gets you anywhere anywhere

48. Getting angry about something is often 48. Getting angry about something is often the first step toward changing itthe first step toward changing it

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Normative Data:Normative Data: Intake180Days 1 Year


Schizo. or other PsychoticSchizo. or other Psychotic 2.42 2.43 2.42




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“ “Don't let justified emotions rob your health Don't let justified emotions rob your health and well-being” and well-being”

-Doc Childre and Howard Martin, -Doc Childre and Howard Martin, “ “There was never an angry man that There was never an angry man that

thought his anger unjust”thought his anger unjust” -St. Francis De Sales-St. Francis De Sales “ “Righteous anger comes easily; Righteous anger comes easily; Righteous action is carefully planned”Righteous action is carefully planned”

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Empowerment ScalesEmpowerment Scales

While the Overall Empowerment scale While the Overall Empowerment scale can be used as an indicator of progress can be used as an indicator of progress in treatment, in treatment, the individual subscales and the individual subscales and individual items are more useful in the individual items are more useful in the treatment planning processtreatment planning process

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ReportsReports

Several reports are available that give Several reports are available that give information about the Empowerment Subscales information about the Empowerment Subscales and itemsand items Strengths—AssetsStrengths—Assets Red Flags—TargetsRed Flags—Targets Change Over Time—Graphically monitor progress Change Over Time—Graphically monitor progress

at scale levelat scale level ARROW—Suggested ActivitiesARROW—Suggested Activities Adult Basic Report—One-page report monitors Adult Basic Report—One-page report monitors

progress at subscale level and some itemsprogress at subscale level and some items

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ReportsReports Reports are not essential --you can review Reports are not essential --you can review

the individual items of the Empowerment the individual items of the Empowerment scale with the consumerscale with the consumer

Whatever reports you use,Whatever reports you use, give the give the consumer a copy!consumer a copy!

Find out which reports are available from Find out which reports are available from your system, and if you don’t find ones you your system, and if you don’t find ones you like, ask your vendor to add them like, ask your vendor to add them

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Strengths ReportStrengths Report

Lists the Lists the positivepositive and and very positivevery positive responses responses Allows consumers and staff to identify Allows consumers and staff to identify

strengths that the consumer can use to strengths that the consumer can use to achieve their treatment goalsachieve their treatment goals

Invites consumer participation if consumers Invites consumer participation if consumers are allowed to select the strengths they want are allowed to select the strengths they want to useto use

Available in the ODMH Data Entry and Report Available in the ODMH Data Entry and Report TemplateTemplate

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Red Flags ReportRed Flags Report

Lists items with a Lists items with a negativenegative or or very negativevery negative responsesresponses

Invites consumer participation if consumers Invites consumer participation if consumers are allowed to select the targets of treatmentare allowed to select the targets of treatment

Available in the ODMH Data Entry and Report Available in the ODMH Data Entry and Report TemplateTemplate

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Change over Time ReportChange over Time Report Graphic display of how Outcomes scales Graphic display of how Outcomes scales

change over timechange over time Empowerment subscales are includedEmpowerment subscales are included Invites consumers to consider their Invites consumers to consider their

progress in treatmentprogress in treatment Available in the ODMH Data Entry and Available in the ODMH Data Entry and

Report TemplateReport Template

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ARROW ReportARROW Report

Achieving Recovery & Resiliency the Outcomes Achieving Recovery & Resiliency the Outcomes Way (ARROW)Way (ARROW)

Based on Maslow's hierarchy of needs and Based on Maslow's hierarchy of needs and consumer's responses to the Adult Consumer consumer's responses to the Adult Consumer instrumentinstrument

ARROW suggests potential activities for a ARROW suggests potential activities for a consumer's treatment and/or recovery planconsumer's treatment and/or recovery plan

The activities suggested in the report can The activities suggested in the report can augment treatment by calling on non-agency augment treatment by calling on non-agency resourcesresources

More at: More at: www.MHRecovery.comwww.MHRecovery.com Available in the Reports GeneratorAvailable in the Reports Generator

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Adult Basic ReportAdult Basic Report

One-page report to monitor progress on One-page report to monitor progress on subscales and selected itemssubscales and selected items

Includes Provider Community Functioning Includes Provider Community Functioning scale and summary of victimization itemsscale and summary of victimization items

Empowerment subscales are includedEmpowerment subscales are included Useful for looking at how much consumer’s Useful for looking at how much consumer’s

scores have changed, Reliable Change scores have changed, Reliable Change amount notedamount noted

InvitesInvites consumers to consider their progress in consumers to consider their progress in treatmenttreatment

Available in the ODMH Reports GeneratorAvailable in the ODMH Reports Generator

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Getting The ReportsGetting The Reports

Reports come out of two Access Reports come out of two Access databases: databases: Reports Generator Reports Generator Data Entry and Reports TemplateData Entry and Reports Template

These tools are at: These tools are at: http://www.mh.state.oh.us/oper/outcomeshttp://www.mh.state.oh.us/oper/outcomes/data.flow.template.html/data.flow.template.html

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Using The Empowerment Using The Empowerment Scale In TreatmentScale In Treatment

The Empowerment Scale is intended to be The Empowerment Scale is intended to be used the same way as all Outcomes Scales: used the same way as all Outcomes Scales: Complements Complements Initial Clinical AssessmentInitial Clinical Assessment

Basis for Basis for Treatment PlanningTreatment Planning

Basis to Basis to monitor and track progressmonitor and track progress

Basis to Basis to modify treatmentmodify treatment based on progress based on progress

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Outcomes & Self-ReportOutcomes & Self-Report

Reviewing Outcomes with consumers Reviewing Outcomes with consumers gives a starting point for discussiongives a starting point for discussion

Outcomes are not the final word about Outcomes are not the final word about how consumers feelhow consumers feel

Outcomes need to be used Outcomes need to be used collaboratively with the consumer collaboratively with the consumer

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Initial Clinical Initial Clinical AssessmentAssessment

Each subscale reflects a necessary component Each subscale reflects a necessary component of successful treatment; therefore, check of successful treatment; therefore, check where consumers are on eachwhere consumers are on each

Use these reports:Use these reports: StrengthsStrengths Red FlagsRed Flags Adult Basic ReportAdult Basic Report

- AND -- AND -Review the ItemsReview the Items

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Outcomes Use in Treatment Outcomes Use in Treatment PlanningPlanning

The Longitudinal Consumer Outcomes (LCO) Study The Longitudinal Consumer Outcomes (LCO) Study found that good Outcomes were best predicted by:found that good Outcomes were best predicted by: Consumers’ perceptions that their needs are met!Consumers’ perceptions that their needs are met! Consumers’ perceptions of service empowerment (e.g., Consumers’ perceptions of service empowerment (e.g.,

involvement in treatment planning) was most highly involvement in treatment planning) was most highly correlated with degree to which they felt their needs were correlated with degree to which they felt their needs were metmet

Using Outcomes in a collaborative fashion in Using Outcomes in a collaborative fashion in Treatment Planning helps empower Consumers --Treatment Planning helps empower Consumers --they see that they see that theirtheir needs are being attended to needs are being attended to

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Treatment PlanningTreatment Planning

Use Empowerment Items and Scales as Use Empowerment Items and Scales as targets of treatmenttargets of treatment

Use Empowerment Items and Scales as Use Empowerment Items and Scales as strengths in addressing other targets of strengths in addressing other targets of TreatmentTreatment

Use these reports:Use these reports: StrengthsStrengths Red FlagsRed Flags ARROWARROW

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Monitor and Track Monitor and Track ProgressProgress

Review the reports with the consumerReview the reports with the consumer Use the:Use the:

Change Over Time ReportChange Over Time Report Adult Basic ReportAdult Basic Report

And:And: The ARROW report, if you used in original The ARROW report, if you used in original

treatment planningtreatment planning

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Modify TreatmentModify Treatment Based Based on Progresson Progress

Check Empowerment and other Outcomes Check Empowerment and other Outcomes gains scores against planned goals of gains scores against planned goals of treatmenttreatment

If non-responsive, or if deteriorated, seek If non-responsive, or if deteriorated, seek consumer input into what course corrections consumer input into what course corrections are needed in treatmentare needed in treatment

If goals are met, acknowledge success, plan If goals are met, acknowledge success, plan next stepsnext steps

Between formal reviews, take every opportunity Between formal reviews, take every opportunity to recognize and validate consumer steps to recognize and validate consumer steps toward goalstoward goals

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Documenting Work on Documenting Work on Empowerment and RecoveryEmpowerment and Recovery The Empowerment Scale and reports are The Empowerment Scale and reports are

appropriate material to be used as sources of appropriate material to be used as sources of information in documenting need for work on information in documenting need for work on Empowerment and Recovery aspects of treatmentEmpowerment and Recovery aspects of treatment

However, it is outside the scope of this training to However, it is outside the scope of this training to explain what constitutes acceptable medical explain what constitutes acceptable medical necessity documentationnecessity documentation

Therefore, a training on medical necessity is Therefore, a training on medical necessity is included in the Empowerment training package if it included in the Empowerment training package if it is necessary to have guidance on medical is necessary to have guidance on medical necessitynecessity

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Summary The Empowerment scale has 5 parts:

Self-Esteem/Efficacy Power/Powerlessness Optimism/Control over the future Community Activism and Autonomy Righteous Anger

Various Empowerment reports are available The Empowerment Scale items and

subscales can be used during all phases of treatment

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SupervisionSupervision

Especially for new clinicians, write Especially for new clinicians, write comments on Outcomes reports where comments on Outcomes reports where clinicians need to pay attentionclinicians need to pay attention

Assign the use of the ARROW report Assign the use of the ARROW report especially with clinicians new to especially with clinicians new to Recovery Recovery

Use Outcomes to identify where Use Outcomes to identify where clinicians may need further training clinicians may need further training

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SupervisionSupervision

Check progress on Outcomes, and Check progress on Outcomes, and Review consumers who are doing poorly or Review consumers who are doing poorly or

well in supervision: well in supervision: What worked? What worked? What didn’t?What didn’t?

Review change over time reports with clinicians Review change over time reports with clinicians to identify when consumers are progressing or to identify when consumers are progressing or deterioratingdeteriorating

Review Outcomes to identify what kinds of Review Outcomes to identify what kinds of consumers the clinician effectively servesconsumers the clinician effectively serves

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ContributorsContributorsJoyce CampianJoyce CampianJanet GalliganJanet GalliganGeoff GroveGeoff GroveLisa GrubbsLisa GrubbsDana HarlowDana HarlowJames HealyJames HealyKraig KnudsenKraig KnudsenRenee KopacheRenee KopacheMichelle Litton-BettsMichelle Litton-BettsWilma Lutz Wilma Lutz Sandi MillerSandi MillerNancy NickersonNancy NickersonRick SheplerRick SheplerDora SterlingDora SterlingJonas ThomJonas ThomKathy TrubiskyKathy TrubiskyMarsha ZabeckiMarsha Zabecki

"You have been criticizing yourself for years, and it hasn't worked. Try approving of yourself and see what happens."- Louise L. Hay

“Strength does not come from physical capacity. It comes from an indomitable will."- Mahatma Gandhi

outline of entire presentation

Documents

recovery process

ongoing recovery

sense of hope

recoverywithout hope

empowerment scale

mental health treatment

mental illness

treatment provider