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JOE MARRONE INSTITUTE FOR COMMUNITY INCLUSION MAIN OFFICE: BOSTON, MA NW OFFICE: 4517 NE 39 TH AVENUE PORTLAND, OR 97211-8124 TEL : 503-331-0687 HOME TEL : 503-331- 0486 FAX : 509-691-9282 EMAIL:
JM61947@AOL.COM
GENERAL WEB : WWW.COMMUNITYINCLUSION.ORG
or NCWD - ADULT: WWW.ONESTOPS.INFO
VISION OF RECOVERY
JOE MARRONE
RECOVERY MAY BE A JOURNEY; BUT IF YOU NEVER GET ANYWHERE, IT CAN EASILY BECOME A TREADMILL.
IF EVERYONE IS ALREADY DOING IT, HOW COME IT NEVER GETS DONE ???
“ ALL CHANGE IS DIFFICULT – NO MATTER HOW LONG YOU PUT IT OFF. “ ------ JOE MARRONE
“ Ships are safe in harbor, but that is not what ships are built for. “ ------ Anonymous
I WORRY ABOUT:
DISCRIMINATION NOT STIGMA
BEHAVIOR NOT ATTITUDE
CITIZENSHIP/CIVIL RIGHTS NOT CONSUMERISM
POWER/CONTROL NOT CONSUMERISM
COMPETENCY NOT COURTESY
LOVE/RELATIONSHIPS/SEX NOT INTERVENTION/ SERVICES
JOBS/ CAREERS NOT PROGRAMMING VOCATIONAL
VALUES IN WORKING WITH PEOPLE W. MI IN THE COMMUNITY
CULTURE OF CLIENT BENEFIT – WORKING, RELATIONSHIPS LIVING,
PEOPLE HAVE RIGHT TO CONTROL THEIR LIVES, THEIR TX, & KINDS OF HELP THEY RECEIVE. STAFF SHOULD INFLUENCE.
ALL PEOPLE NEED HOPE & SUPPORT
PEOPLE W. MI DO GET BETTER --- > 60%
SYMPTOMS NOT PREDICTIVE IN OTHER AREAS
PEOPLE CAN WORK, SO THEY SHOULD WORK
PEOPLE W. MI BEST SERVED IN COMMUNITY
COMMUNITY/ PEER/ FAMILY SUPPORTS + PROS
IF PEOPLE
CAN
WORK PEOPLE
SHOULD
WORK
UNEMPLOYMENT IS BAD FOR YOU !!!
Dooley, D., Fielding, J., & Levi, L. (1996). Health and unemployment. Annual Review of Public Health Kasl, S. V., Rodriguez, E., & Lasch, K. E. (1998). The impact of unemployment on health and well-being. In B. Dohrenwend, (Ed.). Adversity, Stress and Psychopathology Lennon, M. C. (1999). Work and unemployment as stressors. In A. Horwitz, & T. Scheid, (Eds.). A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems
Dooley, D., Catalano, R., & Hough, R. (1992). Unemployment and alcohol disorders in 1910 and 1990: Drift versus social causation. Journal of Occupational & Organizational Psych ---- increases alcohol use Linn, M. W., Sandifer, R., & Stein, S. S. (1985). Effects of unemployment on mental and physical health. American Journal of Public Health ---- increases in anxiety Dooley, D., Catalano, R., & Wilson, G. (1994). Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study. American Journal of Community Psychology ----- increases in depression
“ YOU NEED A LITTLE LOVE IN YOUR LIFE & FOOD IN YOUR STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN FOOL’S LECTURE ABOUT HOW TO BEHAVE.”
BILLIE HOLIDAY
MARK TWAIN " FEW THINGS ARE HARDER TO PUT UP WITH THAN THE ANNOYANCE OF A GOOD EXAMPLE"
WHAT DO YOU DO TO ENCOURAGE WORK AND DISCOURAGE IDENTITY AS A SELF -- IDENTIFIED FAILURE ???
HOPE
AND
HASSLING
HELPER’S RESPONSIBILITY
TO ENGAGE & MOTIVATE HOPE
VS.
OPTIMISM?
-- PAT ON BACK VS.
COMMUNICATING THAT: YOU CARE YOU UNDERSTAND YOU WILL BE THERE YOU HAVE IDEAS & HELP TO OFFER
OSCAR WILDE
“ TO LOVE ONESELF IS THE BEGINNING OF A LIFE LONG ROMANCE. “
Stages of (Readiness for) Change
PRECONTEMPLATION CONTEMPLATION PREPARATION
ACTION MAINTENANCE
TERMINATION
PROCHASKA, J.0., NORCROSS, J.C., DICLEMENTE, C.C. (1994). CHANGING FOR GOOD. NEW YORK, N.Y.: AVON BOOKS
NO MOTIVATION
• • • • • •
FEAR OF FAILURE NO SELF - CONFIDENCE POOR EXPERIENCES LOSS OF BENEFITS LACK OF INFORMATION LAZINESS
John Galbraith
“Given a choice between changing and proving that it is not necessary, most people get busy with the proof.”
MOTIVATIONAL INTERVIEWING
Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self-efficacy
Miller, W. & Rollnick, S. (1991).
Motivational interviewing: Preparing people to change addictive behavior.
MOTIVATION
VALUES
EXPECTANCY
EXPERIENCE
RESOURCES
INFORMATION ENERGY FROM YOU
WILLIAM JAMES
“ MANY PEOPLE THINK THEY ARE THINKING WHEN THEY ARE MERELY REARRANGING THEIR PREJUDICES “
JERRY GARCIA
“ SOMEONE HAS TO DO SOMETHING AND IT’S PRETTY PATHETIC IT’S GOT TO BE ONE OF US “
THOMAS EDISON
“ RESULTS! WHY, I’VE GOTTEN A LOT OF RESULTS. I KNOW SEVERAL THOUSAND THINGS THAT WON’T WORK. “
PRINCIPLES OF IPS MODEL R. DRAKE & G. BOND
COMP. EMPLOYMENT = GOAL
RAPID JOB SEARCH
MH & REHAB INTEGRATED
TIME UNLIMITED SUPPORT
ATTENTION TO PREFERENCES
CONTINUOUS ASSESSMENT
Research Based Principles of Successful Rehabilitation/ Recovey
People with SMI can be successfully engaged in competitive employment VR services should involve employment in integrated settings at customary wages or above People with SMI should be placed in paid jobs as quickly as possible and according to their preferred pace
Research Based Principles of Successful Rehabilitation/ Recovey
Ongoing employment support services should be available as needed & desired by the person served.
Persons with SMI should be helped to find jobs matching career preferences
VR services should explicitly & proactively address financial planning & provide education/support around disability benefits & entitlements.
VR services should involve family & friends in supporting efforts to work
Research Based Principles of Successful Rehabilitation/ Recovey
Vocational & MH services should be integrated & coordinated.
Vocational providers should work collaboratively w. persons w. SMI to address issues of stigma/ discrimination, & help negotiate reasonable accommodations w. employers.
VR services should be made available to all MH consumers
CLEARVIEW MH EMPLOYMENT Annual Totals (7/01/01 to 6/30/02): Referrals------------------------------ Referrals received directly from PHP Mental Health Services-------------- Attended Orientation----------------------- Vocational Profiles Completed---------- Placed in Competitive Community Employment---------------------------------- Those Placed that are involved with PHP Mental Health Services---------- 416 220 327 240 129 99
“ I’M TIRED OF PLAYING BY THE RULES. LET’S SCRATCH THEIR EYES OUT TILL THEY GIVE US FRESH TUNA.”
GREEK PROVERB “ BEFORE PRACTICING VIRTUE, FIRST SECURE AN INDEPENDENT INCOME. “
OLD YIDDISH PROVERB If 1 person calls you a jackass, ignore him; If a second person calls you a jackass, think about it; If a third person calls you a jackass- get a saddle.
CONSUMER DRIVEN IS NOT:
JUST SAYING YES
STAFF ONLY PLACATING
AVOIDING OPINION
CONSUMER RUN
CONSUMER DRIVEN IS NOT:
AVOIDING RESPONSIBILITY TO INFLUENCE
"I TOLD YOU SO"
JUST LISTENING WITHOUT HELPING
Thom Hartman “ADD, An Alternate View”
“I am not
inattentive, you are just boring.“
RITA MAE BROWN
“ FOR YOU TO BE SUCCESSFUL, SACRIFICES HAVE TO BE MADE. IT’S BETTER THAT THEY ARE MADE BY OTHERS, BUT FAILING THAT, YOU’LL HAVE TO MAKE THEM YOURSELF. “
RITA MAE BROWN
“ IF THE WORLD WERE A LOGICAL PLACE, MEN WOULD RIDE SIDESADDLE “
" There is nothing you can say in answer to a compliment. I have been complimented myself a great many times, and they always embarrass me -- I always feel they have not said enough. " Mark Twain
KEY ISSUES -- TICKET TO WORK: 1] FEW TICKETS DEPOSITED 2] NATIONALLY GREAT MAJORITY OF TICKETS DEPOSITED W. VR 3] PAYMENT STRUCTURE BACKLOADED POSSIBLE CHANGE 4] HOW MUCH MOTIVATION IS THIS FOR RECIPIENTS OR PROVIDERS?
5] IS AVOIDING CDR A BIG DEAL?
6] SHOULD IT EXTEND TO YOUTH OR THOSE WHO HAVE NOT HAD THEIR FIRST CDR?
7] SOME PROVIDER STRUCTURES CONTROVERSIAL – WI ARRANGEMENT 8] FEW NEW PROVIDERS IN POOL
KEY ISSUES -- WIA: 1] DISABILITY LOW ON WIA RADAR SCREEN 2] PERFORMANCE STANDARDS EXCUSE BY WIA?
3] EMPLOYER FOCUS -- EXCUSE BY WIA?
4] REHAB ACT -- EXCUSE BY VR?
5] VR USED AS DISABILITY SERVICE BY WIA – SECTION 188 MANDATES?
6] MANY DISABILITY ENTITIES (E.G., DD/ MH) AVOID IT 7] SHOULD THERE BE A SEPARATE TRANSITION STREAM?
KEY ISSUES -- WIA: 8] SHOULD IN SCHOOL YOUTH MONEY BE GIVEN TO LEAS, NOT WIA?
9] ROLE & STRUCTURE OF WIBS 10] HOW MUCH SELF IN SELF SERVICE?
11] MIDDLE CLASS SYSTEM FOR ALL? OR JUST FOR MIDDLE CLASS?
12] ACCESS FOR “HIDDEN” DISABILITIES 13] DISCLOSURE - DISABILITY INQUIRIES 14] CORE, INTENSIVE, TRAINING SERVICE SEQUENCE 15] ROLE OF TRAINING/ USE OF ITAS OVERALL – HOW BENEFIT PEOPLE WITH DISABILITIES?