Assessing and Developing Readiness for Rehabilitation
Psychiatric rehabilitation is designed to help people with a psychiatric disability to choose, get, and keep a particular role in the setting that they prefer (Anthony, Cohen, & Farkas, 1990). While emphasizing the values and importance of the practitioner and the consumer working together to clarify an individual’s choices and goals, the process of psychiatric rehabilitation encourages each person to explore and determine his or her choices to undertake change. Over the past 15 years, the staff at the Center for Psychiatric Rehabilitation have worked to create a training technology and practitioner tools to guide and assist consumers and practitioners in the process of change. Both the training technology and the practitioner tools focus on rehabilitation readiness and are designed to address the process of change by examining factors that impact an individual’s understanding of his or her reaction to the internal and external barriers to recovery from mental illness. Barriers, such as the lack of employment or housing opportunities, education or social isolation, impact a person’s readiness to determine his or her direction for the future.
The purpose of this newsletter is to discuss the concepts of assessing and developing readiness and to explain the distinctions between the readiness training technology and the practitioner tools for assessing and developing readiness. Direct service practitioners and their supervisors can benefit from both products. The training technology is designed to be used by supervisors and trainers to teach practitioners, whereas, the practitioner tools are intended for practitioners’ direct use-although supervisors also may use them to monitor their practitioners’ use of the skills.
Assessing Readiness Concepts
The technology for assessing readiness was designed to involve each individual in clarifying his or her motivational readiness to participate in the process of rehabilitation. It prescribes a process whereby both the consumer and the practitioner take a careful look at how hopeful, confident, and motivated a person is to begin choosing or achieving a valued role in a community environment. This structured process helps each individual to participate in the decision about how and when to proceed with each step. In essence, it facilitates a person’s self-assessment of his or her readiness to change by identifying personal barriers to change and clarifying the best course of action to move forward. Assessing readiness is not a “screening out” process. It is an opportunity to review whether an individual is willing and able to participate in the rehabilitation process, and to identify areas that may need further development to promote full and active participation (Cohen & Mynks, 1993).
Assessing readiness addresses five areas, or indicators, that are explored with each person. These areas include need (level of satisfaction and/or success in a current living, learning, working, or socializing environmental role), commitment (beliefs about personal abilities, importance and benefits of change, and support for change), environmental awareness (knowledge about potential future environments), self-awareness (knowledge about personal preferences, values, and interests), and personal closeness (consumer perspective about the quality and type of interactions with practitioners). As each indicator is reviewed, the consumer and practitioner gather, interpret, and process information that is critical in planning personal change (Farkas, Cohen, McNamara, Nemec, & Cohen, 2000). Based on the results of a readiness assessment, a conclusion is discussed considering how each person will proceed with setting a rehabilitation goal or perhaps participate in readiness development activities. Experience has shown that few people are totally unready to participate in choosing and/or preparing to function in a valued role. However, if it is determined that someone is not ready in some areas, there are many strategies that can be used to further develop readiness in order to help the person participate more fully in the psychiatric rehabilitation process.
Developing Readiness Concepts
The developing readiness component is designed to help an individual increase his or her awareness about recovery, rehabilitation, environments, self, and/or mental health services and supports through participation in a variety of learning experiences that are tailored to the person’s preferences and needs. The intent is to select activities most likely to positively impact those factors that were identified during the process of assessing readiness as impeding the person’s confidence, hope, and motivation. The consumer is encouraged to be an active participant in planning and processing the activities and in exploring the personal implications of day-to-day life experiences related to her or his readiness. The consumer is also assisted in securing specified commitments from family members, friends, neighbors, and other “natural supports” that could be supportive of the recovery and rehabilitation processes.
Rationale for Readiness Products
Two types of products were developed to facilitate practitioners’ use of assessing and developing readiness. First, a training technology was developed to train practitioners how to perform the activities of assessing and developing readiness. Rehabilitation Readiness Training Technology, one in a series of five training technology packages designed to teach practitioners how to perform the skills of psychiatric rehabilitation, was developed and field-tested by a team of research, training, and service professionals at the Center for Psychiatric Rehabilitation. The package includes detailed lessons plans for a trainer to teach assessing readiness, developing readiness, and connecting with clients, as well as collateral reference handbooks for each activity, for individual trainees. The package also includes an introduction to rehabilitation readiness in textbook format.
Second, a new series, Psychiatric Rehabilitation Practitioner Tools for Assessing & Developing Readiness, was developed by BCPR Consulting, Inc., as a guide for practitioners to facilitate the activities of the readiness assessment and development. While providing consultation at many mental health facilities, the BCPR associates discovered that practitioners in the field needed more than just training in the skills of psychiatric rehabilitation, they needed practical resource materials to aid them in their jobs. The practitioner tools were designed to include ready-made activities and resources needed to conduct the readiness assessment and development processes. The practitioner tools were intended to save practitioners time by having the necessary materials already prepared. Practitioners may only need to modify the tools to address a specific individual’s particular needs. Sixteen sites were involved in the piloting of the Psychiatric Rehabilitation Practitioner Tools for Assessing & Developing Readiness. These sites represented a range of types of mental health facilities as well as a range of knowledge of and experience with the psychiatric rehabilitation process.
Intensive Psychiatric Rehabilitation (IPR) Services at ResCare, Inc., Fairfield, Iowa
In the state of Iowa, rehabilitative services for Medicaid-eligible persons with psych-iatric disabilities now include a role recovery service called Intensive Psychiatric Rehabilitation (IPR). The IPR service was modeled from service interventions developed at Boston University’s Center for Psychiatric Rehabilitation and gives participants access to a comprehensive process by which to choose, get, and keep valued living, learning, working, and socialization (LLWS) roles in their communities.
Steve LaMaster, Psychiatric Rehabilitation Administrator at ResCare, Inc., explains that many participants begin the IPR process in an extremely disheartened state, in that some individuals express a desire to be in a different place in life, but little belief in the possibility of change. Steve emphasizes:
The Practitioner Tools for Assessing & Developing Readiness are currently used to help practitioners support participants when we aren’t sure if we should encourage or “push” a person into making changes, choices, or decisions that we think may be helpful and/or in their best interests, etc. The tools give us a frame of reference for understanding the importance of this level of intervention and help us get started in the process of helping people wrestle with ambivalence around change-to explore it, to challenge it, and in a good number of cases to begin taking substantive action towards moving beyond it.
Andrew Zuehlke, an IPR practitioner highlights the benefits of using the Practitioner Tools for Assessing & Developing Readiness with the following thoughts:
At the time Susan began IPR services, she had quite a difficult time talking about herself, her feelings, and what she wanted out of life. She was isolated socially and disconnected from the community. She had virtually no friends and spent a good deal of time alone, at times even crying over the void. She easily became flustered when asked questions, and there was concern as to whether she would be able to continue in the program, much less benefit. As time has progressed, I have seen real changes with Susan as we have been using the readiness tools. Her confidence has improved, and she is more aware of choices in her environment. Despite her anxiety, Susan has prepared for and interviewed various people in the community about social groups. She never thought that she could be courageous or gifted enough to do something like this, but to her surprise, she has been very successful. She suddenly began having a new experience: the experience of confidence, pride, and accomplishment. She also began to learn new things about the social opportunities available in the community, a community that was still relatively new to her.
Frontenac Community Mental Health Services, Ontario, Canada
Christine Gayler, the Director of Psychiatric Rehabilitation Consultants and Program Manager at PSR Distance Learning Program at Mohawk College in Ontario, Canada, taught the skills of assessing and developing readiness using the Rehabilitation Readiness Training Technology. She describes an experience of Robert Yeo, an Assertive Community Treatment worker with Frontenac Community Mental Health Services.
He chose to explore the barriers to employment and assess readiness to pursue a work role as experienced by consumers within his service agency. Robert found that each readiness assessment yielded unique information and clarified the “next step.” For example, with one individual, although his awareness relevant to seeking employment was high, his need and commitment to employment were low. Through the assessment process, this individual clarified his satisfaction with his current life situation and realized that he was _not ready to pursue work in the _near future.
A second person scored high on all of the readiness indicators-need, commitment, closeness, and awareness. By completing her readiness assessment, she felt empowered to pursue her desire to work. The process not only affirmed her readiness to make a change, but also helped her identify a number of the qualities that she desired in a work role and setting.
A third person discovered the importance of developing readiness through learning more about the world of work and work options. Robert highlights that “assessing readiness is a viable process that supports both the practitioner and the individual to gain insight related to readiness to change. It is essential to know where the person is in this process so as to develop an appropriate vocational plan….whether it be developing readiness or beginning a job search.”
Technology for Training Practitioners
Rehabilitation Readiness Training Technology is a trainer or supervisor package for teaching practitioners how to involve consumers in actively assessing their readiness for rehabilitation and to create activities to develop their readiness.
This training technology includes:
- Assessing Readiness for Rehabilitation
- Developing Readiness for Rehabilitation
- Connecting for Rehabilitation Readiness
The package includes training modules with easy-to-follow lesson plans; masters for transparencies that can be used to illustrate important points; and participant reference handbooks with lecture summaries, case studies, examples, and practice exercises.
Tools for Practitioners’ Direct Use
Psychiatric Rehabilitation Practitioner Tools for Assessing & Developing Readiness are resources for the direct provision of services to consumers.
Assessing Readiness Practitioner Tools:
Contents: Introduction; Orientation to Assessing Readiness; Activities for Assessing Readiness; Protocols for Assessing Readiness; Sample Questions for Conducting a Readiness Assessment; Example of Assessing Readiness; Work-sheets for Assessing Readiness; and Check-list of Assessing Readiness Procedures
Developing Readiness Practitioner Tools:
Contents: Introduction; Orientation to Developing Readiness; Protocols for Developing Readiness; Activity Descriptions and Resource Guides for Developing Awareness about Recovery, Self, Environments, Rehabilitation, and Mental Health Services and Supports