Integrating Mental
Health Recovery into
Social Work
SAMHSA Recovery-to-Practice Project
Council on Social Work Education (CSWE)
http://www.cswe.org/recovery
Presentation developed by CSWE
Contact: Jessica Holmes, jholmes@cswe.org
Presented by Susan Rogers,
CSWE Steering Committee Member and Director, National
Mental Health Consumers’ Self-Help Clearinghouse
srogers@mhasp.org
1
Recovery to Practice
Year 1 – Situational Analysis (3/2010 – 9/2011)
Year 2 – Develop training outline
Year 3 – Develop training manual and pilot test
training
Year 4 – Continue pilot testing and finalize training
Year 5 – Implement training
10/2013
to
9/2014
2
Situational Analysis: Methodology
 Qualitative
 Focus groups
 Interviews
 Discussion forums
 Comments from individuals
with lived experience
 Syllabi review
 Review of state documents
and training materials
 Literature review
 Review of professional
organizations
 Site visits
3
Situational Analysis: Methodology
Quantitative
CSWE Annual
Survey of Social
Work Programs
NASW Workforce
Studies
Mental Health,
United States
4
Situational Analysis: Methodology
 Stakeholders engaged:
Individuals with lived
experience of
psychiatric conditions
Practitioners
Students
Educators
Field Education
Directors
Field Instructors
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Social Workers and Mental Health
 More than 100,000 social
work students enrolled
 Master’s level
concentrations:
49 programs offered
“mental health”
39 offered “health and
mental health”
111 offered “direct
practice/clinical”
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Social Workers and Mental Health
Social workers are
estimated to provide
almost half of all mental
health services.
36.8% of licensed social
workers identify mental
health as primary sector
of employment.
7
Positive Findings
 Strong theoretical connections
 Recognition of the term recovery
 Ready “acceptance” of the idea
of recovery
 Integration of some recovery
components
 Longstanding commitment to
cultural competency and social
justice
 Some programs have begun to
infuse trauma-informed practice
 Social workers can provide a
unique role
8
Negative Findings
Dissonance between social work
theory and practice
Weak integration of some recovery
components (e.g., hope, peer
support)
Confusion about definition of
recovery
Wide use of medical model and
deficits thinking
Only small number infusing recovery
as a whole
Need to enact organizational policy
change
Funding uncertainty
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Recovery-oriented Social Workers
o
o
o
o
o
o
o
o
o
Use hope-inducing behaviors and practices
Believe individuals can and do recover
Amplify clients’ voices
Engage in goal-directed treatment
Facilitate individual choice and selfdetermination
Include family and significant others (with
permission)
Expect life beyond the mental health system community and social inclusion
Emphasize natural community supports
Recommend peer support networks and services
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Comparing the Two
Approaches
Strengths Assessment
Problems Assessment
What the person wants, desires,
aspires to, dreams of; person’s talents,
skills and knowledge. A holistic
portrait.
Defines diagnosis as the problem.
Questions are pursued related to
problems; needs, deficits, symptoms.
Is conversational and purposeful.
Is an interrogative interview.
Strengths assessment is specific and
detailed; individualizes person.
Places the person in a diagnostic or
problem category using generic,
homogeneous language.
Client authority and ownership.
Is controlled by the professional.
The professional asks, “What can I
learn from you?”
The professional dictates, “What I
think you need to learn/ work on.”
From The Strengths Model (3rd ed.), Rapp & Goscha, 2012, p. 95)
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“But we already do that!”
Traditional Services
Recovery
Relationship
with worker
• Client is usually “less
than” the worker
• “Us/Them”
• Frequently “power over”
• “Power with”, shared risk, and
responsibility.
• Meeting of “equals” with different
expertise, experiences
• Negotiated boundaries
Goal of
service
• Maximize functioning
• Skill development
• Re-integration into society
• A meaningful life
Treatment
• Increase strengths, reduce
barriers; skills teaching;
Vocational rehab
• Lifestyle changes:
grooming, housing, diet,
exercise, substance abuse
• Medications can play a
vital role
• Consumer driven. Worker as ally,
consultant
• Mutual help & self help
• Seeing possibility, building hopes, dreams.
• Address issues & consequences important
to consumer.
• Taking personal responsibility
• Move from passive to active roles. Risktaking rather than care-taking
• Attention to impact of trauma as well as
substance abuse issues
• Medications can play a vital role
12
From Noordsy, et al
“But we already do that!”
Pre-Recovery MH System
Recovery Enhancing System
Message is: “you’ll never recover” –
illness is a life long condition
Message is: “recovery is likely” you can
and will attain both symptom relief and
social recovery
Staff primarily set treatment plan and
goals with minimal input by consumer.
Plans often generic and focus on
illness/medical necessity of treatment
Personalized recovery plan is mandated
based on person’s individual goals and
dreams.
Crisis services emphasize coercion and
involuntary treatment, often use seclusion
and restraint which can be
(re)traumatizing
Crisis alternatives such as warm lines and
respite are available. Staff has been
trained to avoid seclusion and restraint
and is skilled in alternative approaches
Families are left out; they are not educated Families are educated about recovery as
about recovery. Little or no family support well as about mental illness. Family
or education
support and conflict mediation are readily
available
from Ridgeway (2004)
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Some Challenges
Chronic thinking
Practitioner cynicism
- It is not enough for the
practitioner to engage in a series
of empowering practices if the
practitioner has no hope that the
consumer can achieve recovery
(Simon, 1994)
- Importance of recognizing the
nonlinear aspect of the recovery
process
14
Comments from Alternatives
2010 Caucus
“In terms of my recovery process, I was in contact with
a lot of different professionals – psychologists,
psychiatrists, social workers – and I think the person
was helpful regardless of their professional standing.
The social workers were most helpful because they
did offer that hope, that possibility of recovery,
whether they knew what that framework was or not.”
15
Trauma-Informed Care
• Literature clear on
importance of
recognizing signs of
trauma and traumainformed care
• Peers said this was an
area where social
workers are lacking....
16
“I felt dismissed,
patronized,
demeaned and
ignored in the
system. Everything I
was taught as a
child in my trauma
was reinforced in my
journey through the
system.”
-Alternatives 2010
17
“The biggest thing that was
so frustrating was that, even
though it was in the record
that I had a traumatic brain
injury, they had no understanding whatsoever of the
effects of trauma…. It was
me educating them about
what I needed.”
- Alternatives 2010
18
Peer Participation in Social Work
• Stand-out examples exist
o Via peer support
o Co-teaching of courses or
class guests
o Participation in organizational
policy
“I’ve learned more from my
data collecting of personal
stories than from any of my
mental health courses”
Peer
- APM Discussion
participation
Participant, 2010
is not the
norm.
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Culturally Competent Practice
“…Recovery cannot take place
outside the context of a person’s
culture, sexual orientation, or
spiritual beliefs”
- Faculty interviewee, 2010
• Necessity of culturally
competent practice has been
included in:
o Conferences/training events
o NASW Code of Ethics
o CSWE Educational Policy and
Accreditation Standards
• Needs constant attention
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Plan for Social Work
 Provide a holistic
training
 Build on existing
partnerships
between schools
and field instructors
 Training will target:
Field instructors
Social work
programs/faculty
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Structure for the Curriculum
Target audience: Field
Instructors
• Curriculum components
• 3 webinars (with CEUs)
• Competencies for
Recovery-oriented
Social Work Practice
• Language for field
contracts/assessments
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Structure for the Curriculum
Secondary target: Social work
education programs
• Curriculum components
• Launch at CSWE Annual
Program Meeting
• Posted webinars
• Competencies document
• Model syllabi
• Recovery bibliography
• Student exercises
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Training Manual Development
Steering Committee
Webinar Presenters
CSWE Director of Accreditation
SAMHSA and Development
Services Group
• Comments from participants at
conferences
•
•
•
•
• CSWE’s Annual Program Meeting
• Alternatives Conference
• APA’s Institute
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Structure for the Curriculum
3rd webinar:
Putting it into
practice in
field ed
2nd webinar:
recovery in
social work
1st webinar:
What is
recovery?
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Webinar 1: Introduction to Mental
Health Recovery in Social Work
Presenters
o Lauren Spiro (National
Coalition for Mental Health
Recovery)
o Patrick Sullivan (Indiana
University)
o Video Clips
• Paolo del Vecchio
(SAMHSA)
• MSW with lived
experience
Goal
Educate social workers
about mental health
recovery
Learning Objectives
– Define recovery
– List 2 milestones in the
evolution of the recovery
movement
– List 3 of the 10 components
of recovery
– Identify 2 similarities
between social work and
recovery
– Identify 1 area of social
work practice that would
change if recoveryoriented practice is
implemented
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Webinar 2: Mental Health Recovery
Competencies in Social Work
Presenters
o Patrick Sullivan (Indiana
University)
o Debbie Plotnick (Mental
Health Association of
Southeastern Pennsylvania)
o Video Clips
• Charles Curie (Curie Group,
LLC & former SAMHSA
administrator)
• Richard Goscha (University
of Kansas)
Goal
Teach competencies needed
to integrate mental health
recovery into social work
practice
Learning Objectives
– Identify 2 methods for
involving individuals with
lived experience throughout
the process
– List 5 competencies for social
work practice in a recovery
framework
– Identify 2 recovery-oriented
practices
– Describe 1 opportunity and 1
challenge in implementing
the recovery model
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Webinar 3: Infusing Mental Health
Recovery in Social Work Field Instruction
Presenters
o Lauren Spiro (National
Coalition for Mental Health
Recovery)
o Marylou Sudders
(Massachusetts Society for
the Prevention of Cruelty to
Children)
• Video Clips
o King Davis (University of
Texas at Austin)
o Marvin Southard (LA County
Department of Mental
Health)
o MSW student in recovery
agency (Recovery
Empowerment Network)
Goal
Infuse mental health recovery in
field instruction
Learning Objectives
– List 5 competencies for social
work practice in a recovery
framework
– Describe a model recoveryoriented agency
– Identify at least 3 recovery
practices essential to the
student field experience
– List at least 1 potential example
of student assessment measures
28
Plan for Piloting Curriculum
• Expected pilot participants
(Stakeholder Representatives)
• Utilize the already established
network of people (interviews,
focus groups, etc.) to solicit
pilot participants
• Field instructors, MFP fellows,
students, consumers, faculty
members
• At least 10 individuals
• Initial pilot trainings occured early
September 2012.
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Plan for Piloting Curriculum
Identify
participants
Present webinars
Review/evaluate
(structured &
open-ended
feedback)
Make changes to
the webinars
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