Sharing on Overseas Corporate Scholarship Program for Clinical Leaders 2015/16

Psychiatric Rehabilitation Nursing

Yale Program for Recovery and Community Health (PRCH), Yale University, the USA

(2 May 2016 – 27 May 2016)

TSANG Ho-wing APNP (PYNEH) / PANG Pui-ling, Nancy APNP (KH) WONG Choi-wan APNP (UCH) / CHENG Lai-ki APNP (KCH) /

FONG Siu-yin, Vincent APNP (KCH)

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Learning Objectives To acquire knowledge and experiences on following aspects:

1. Understand the recovery-oriented practice in in-patient and

community psychiatric rehabilitation services;

2. Understand the recovery-orientated psychiatric rehabilitation models, practice and therapies across different healthcare institutions;

3. Understand the knowledge and skills for psychiatric nurses to support the recovery of people with severe mental illness.

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Highlight of Prioritized Observations Today

1. Peer Support Service (PSS) (Phased launching in Hong Kong in

recent years) 2. Trauma Informed Care (TIC) 3. Citizens Project 4. International Recovery & Citizenship Council Symposium 2016 5. Person Centered Recovery Plan (PCRP) (Practicing in HK for

years)

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Peer Support Service (PSS)

• PSS are paid staff who are also people in recovery from mental illness and/or substance abuse, and "have shown success in their recovery journey" (Rebecca Miller, 2016).

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Other Names of Peer Support • Role model/ mentor • Resource broker • Motivator/ cheerleader • Ally/ confidant • True-teller • Advocate • Community organizer (White, 2006)

• Recovery coach • Recovery specialist • Recovery experts (Program for Recovery & Community Health {PRCH}, 2016)

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Recovery University

Recovery University • Design and provide detailed curriculum, core

competencies and certification examination

• 80-hour training, internship, examination, continuing education for re-certification

• Run by the Advocacy Unlimited, a peer run / client advocacy agency obtaining state support

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Training to Become Peer Support Worker

Basic Training

• Peer support specialist training by Recovery University; and

• Mandatory training of the hiring organization such as collaborative safety strategies, environment of care, infection control, workplace violence, CPR.

Job Specific Trainings

• Intentional peer support training (Shery Mead’s model)

• Recovery coach and recovery support specialist

• Person-centered planning • Employment services • Self-esteem and healthy

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Roles of Peer in Peer Support Service of PRCH

• Peer Supporter (PRCH) • Researcher/ Research Assistant (PRCH) • Forensic Peer Specialists (PRCH) • Peer Mentor (PRCP) • Receptionist (CMDC) • Health Navigator (Hispanic Clinic) • Direct support to out-patient team • Serve in governing committees

(CMHC)

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Recovery Speaks

• For Primary Care Providers to reduce stigma, 2011 • "Recovery Speak" performers (speakers) are RSS,

present with real life experiences of mental illness, addiction and incarceration, sharing own lived recovery stories

• 5 hours' workshop - 2 hours storytelling sharing by 5 speakers - 3 hours group discussions

• For high school & colleges' students in 2012, inspire and motivate them to do better in lives

• Pre and Post Feedback survey

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Supervision to Peer Support Service

• Supervisors work on coaching & mentoring peer support worker (PSW)

• Peers have a weekly group supervision to discuss concerns, rewards, and challenges

• Individual supervision on regular and as needed basis

• Peers on clinical teams are supervised directly by the team leader

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Reflection of Peer Support Local Situation

Integration of Primary Care in different community settings 1. HA has officially launched PSW services in 3 Clusters (KCC, KWC,

NTW) in 2015-16 and other 4 remained clusters in 2016-17. 2. PSW training curriculum framework is standardized among HA

hospitals in 2015. 3. Peer Support Workers (PSW) positioned as supporting staff &

holding a post of PCA IIIA {Patient Care Assistant(III)A} and /or PCA II.

4. Base on our available information, there is no foreseeable career pathway for local PSW as what we seen in USA. 11

Reflection of Peer Support Challenges in Local Situation 1. Lack of long term government policy on peer support service

development in HK; 2. No regional recognized governing board in HK; 3. Lack of standardized accredited PSW trainings in Hong Kong,

different organizations (NGOs, HA) develop their own PSW services and training programs;

4. Uncertain HA / management Policy; 5. No independent Career Job Rank in the HA organizational

structure (i.e. PSW recruitment under PCA Post) 6. Unclear career pathway

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Trauma Informed Care (TIC)

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Trauma-informed care (TIC) • A trauma-informed care is an approach to deliver behavioral health

services includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations.

• It involves viewing trauma through an ecological & cultural lens and • recognizing that context plays a significant role in how individuals perceive

and process traumatic events, whether acute or chronic. • TIC involves vigilance in anticipating and avoiding institutional processes

and individual practices that are likely to re-traumatize individuals who already have histories of trauma, &

• it upholds the importance of consumer participation in the development, delivery, and evaluation of services. (SAMHSA, 2014) 14

Key Assumptions in Trauma Informed Care Applying to program, organization, or system that is trauma-informed

(Substance Abuse and Mental Health Services Administration, 2014) 15

Core Features of Trauma-Informed Care Safety

Ensuring physical and emotional

safety

Trustworthiness

Making tasks clear and maintaining

appropriate boundaries

Choice

Prioritizing choice and control

Collaboration

Maximizing collaboration and sharing of power

Empowerment

Prioritizing empowerment and

skill–building

Source: Adapted from Roger Fallot, PhD and Maxine Harris, PhD, Community Connections, Inc.

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• An concept of systematic quality customer service • TIC not confine to service users but also service providers • Demand us have a systematic view to realize trauma & its impacts, • Enhance our vigilance to recognize trauma cues, signs &

symptoms in our clients and staff • Strengthen our readiness to respond with full integrated

knowledge • Make concerted efforts to resist re-traumatization

REFLECTION: Trauma Informed Care (TIC)

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Citizens Project

• Understand and exercise their Rights • Identify ways to fulfill goals &

Responsibilities • Enhance Roles as community members • Enrich knowledge to access community

Resources • Strengthen ability to develop

Relationship networks

“Anything is possible when citizens come together!”

is designed to assist people with mental problems, trauma, co-occurring with substance abuse and having involved in criminal offences to

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What’s Up Group? (Peers Co-learning Group)

• Is a therapeutic group •Facilitated by target who claimed as “student” •“Students” share successes & offer feedbacks around challenges of daily lives

•US$10 for each attendance, food incentives •Certificate of completion & •Graduation Ceremony at City Hall

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Reflection of Citizenship Project

• Get respect, peer support & hope; • Realize their rights & strength; • Gain relationship & resources; & • Learn their roles & responsibilities.

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International Recovery & Citizenship Council Symposium 2016

• Recognition addresses the needs of people with mental health problems. Recognition makes every individual being valued; not being measured and not being viewed as perfect.

• Recognition is the way to empower person in recovery (PIR) to be reconnected with social solidarity & acquire social recognition through “partnership”.

• Recognition emphasizes the connection between people.

• Recognition of “people has a goal to do something” & helping them to understand how to make their ways to reach their goals in sustaining recovery movement in mental health service

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Reflection of the IRCC Symposium 2016

• Scottish Mental Health Arts & Film Festival is one of world’s largest Social Justice festivals

• Attendance over 25,000- over 300 events throughout the country

• Use Arts to inspire social change • e.g. dance, theatre, music

performance, magic, poetry & literature, motion picture, stories telling etc.

• Promote recovery • Challenge stigma • Promote understanding & recognition

• The rise of Mad Studies in Canada to promote mental health & mental illness education for younger generations.

• Mad Studies courses launched in the early 2000s in university

• Recovery movement in the United Kingdom emphasized

• social inclusion, • recognition of role & trauma, • value of experience and partnership, • shift power to service users

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Person Centered Recovery Plan (PCRP)

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GOAL

as defined by person in recovery

Strengths to draw Upon

Short-Term Objectives

Behavioural , Achievable, Measurable

Barriers / Assessed Needs

Interventions/ Methods/ Action Steps

Professional service

Clinical & Rehabilitation

Action PIR/ Roles and Actions by natural supporters

Reflection of PCRP

• Transform from “Care for” to “Care with” culture; • Staff training, coaching and supervision; • Commitment in coproduction process; • Standard strength-based and PCRP documentation • Consistent recovery coaching approach

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1. The progress of recovery work in Hong Kong is not bad, we should try our best even it is a tiny step, we still moving forward.

2. Teamwork, open-minded culture, support from policy can help development of recovery in Hong Kong.

3. To facilitate shifting from tradition medical model to recovery model among staff, it is important to offer skill training with engagement of persons in recovery (PIRs)

4. Research study on providing the important role of nursing in recovery oriented practice is the way to avoid mental health nursing being marginalized.

REFLECTION: Psychiatric Nursing in Rehabilitation

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