Empowering Vulnerable Populations

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Empowering vulnerable populations:An example of empowering people with mentalillness through treatment planning

Donald M. Linhorst, PhD, MSWProfessor and Director

School of Social Work

Saint Louis UniversityOctober 2, 2012


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PRESENTATION DERIVED FROM:

My 15 years of experience as asocial worker

My research on empowerment Linhorst, D. M. (2006).Empowering People with SevereMental Illness. New York: Oxford

University Press


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PRESENTATION OVERVIEW

Empowerment and treatmentplanning defined

Components of empowerment Conditions for empowerment

through treatment planning

Guidelines for mental health staffand consumers


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EMPOWERMENT DEFINED

Empowerment is themeaningful participation of

people with mental illness indecision making and activitiesthat give them increasedpower, control, or influenceover important areas of theirlives. (Linhorst, 2006, p. 9)


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TREATMENT PLANNING DEFINED

Treatment planning is the process bywhich the needs, strengths, andproblems of people with mentalillness are assessed, treatment goalsare established, and treatment andrehabilitation activities are identified

to facilitate goal achievement.(Linhorst, 2006, p. 88)


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COMPONENTS OF TREATMENTPLANNING

Strengths, problems and/or obstacles

Long-term and short-term goals

Treatment and rehabilitationinterventions to help meet goals

Reassess, reformulate goals andinterventions, and reassess

Format and components of treatmentplans will vary, often guided bypopulation and accreditation standards


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EMPOWERMENT

COMPONENTS OFEMPOWERMENT


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Empowerment involves holdingpower, control, and influence

Holding final decision making power

is most empowering. However, empowerment exists on a

continuum, and it can occur in someinstances through a sharing of power.


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Empowerment is situational

Empowerment is specific to particular

activities at a specific point in time. Individuals can be empowered in one

activity but not another

Empowerment can increase ordecease as circumstances change.


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Empowerment can refer to aprocess

Any process that prepares people to

participate more effectively in anactivity that increases their power,control, or influence can beconsidered empowering.


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Empowerment can refer to anoutcome

Empowerment outcomes

Are the consequences or results ofempowerment processes

Can be short-term or long-term

Can be subjective or objective


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One cannot empower another

People must empower themselves.

However, others play a critical role inproviding individuals with supportiverelationships, resources, decisionmaking opportunities, and other

things many people need to empowerthemselves.


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EMPOWERMENT

CONDITIONS FOREMPOWERING MENTAL

HEALTH CONSUMERS


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Managed Mental Health Symptoms

The consumers symptoms are managed

to the degree necessary tomeaningfully participate in a specificactivity.


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Managed Mental Health Symptomsand Treatment Planning

Symptoms can limit

insight into the mental illness

ability to focus

ability to process information

ability to consider options

ability to make informed choices

ability to understand consequences


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Managed Mental Health Symptomsand Treatment Planning

Addressing the condition

Treat symptoms and provide consumerswith tools to manage symptoms

Involve consumers in as many treatmentdecisions as possible as it is rare thatsymptoms prevent people from makingany decisions

As symptoms subside, increase the roleconsumers play in treatment planning


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Participation Skills

The consumer possesses the skills

required to meaningfully participatein a particular activity.


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Participation Skills and TreatmentPlanning

Identify and express needs and goals

Weigh options for goals and activities

Cognitively link services andinterventions with goal achievement

Resolve conflicts with staff if theyarise during treatment planning


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Participation Skills and TreatmentPlanning


Provide skills training as needed

Promote use of advocates at treatmentplanning sessions if consumers lack theskills to meaningfully participate


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Psychological Readiness

The consumer has the psychological

readiness, that is, confidence,motivation, willingness tomeaningfully participate in aparticular activity.


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Psychological Readiness andTreatment Planning

Lack of psychological readiness canbe associated with

Past failed attempts to improvethemselves

Fear of change

Lack of knowledge of themselves and the

possibilities that exist for them Clinical depression


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Psychological Readiness andTreatment Planning


Must first assess the reasons associatedwith the lack of readiness; may need to:

Treat symptoms of depression

Development of supportive relationshipsbetween case managers and consumers

Create opportunities for small successes

Use motivational interviewing


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Mutual Trust and Respect

The consumer and the persons with

whom he or she is interacting havethe necessary level of mutual trustand respect to meaningfullyparticipate together in a particular

activity.


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Mutual Trust and Respect andTreatment Planning

Lack of trust and respect can be reflected inclinician paternalism

Consumers may not want to participate in

treatment planning unless they believeclinicians respect their right to participateand have their best interests in mind

Development can be more difficult with

consumers from cultural, racial, or ethnicbackgrounds different from staff


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Mutual Trust and Respect andTreatment Planning


Partnerships based on egalitarian relationshipsthat respect and appreciate the different

strengths each bring to the decision makingprocess

Establish positive relationships, which can carryover to treatment planning

Clinician self-disclosure

Reinforce and celebrate accomplishments

Clarify expectations of both parties in thetreatment planning process


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Reciprocal Concrete Incentives

Concrete incentives exist for both the

consumer and persons with whom heor she is interacting to meaningfullyparticipate together in a particularactivity.


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Reciprocal Concrete Incentives andTreatment Planning

Concrete incentives for consumers tomeaningfully participate

Can lead to subjective feelings of empowerment

Are most likely to have goals and interventionsin the plan that reflect their preferences

Need clinicians expertise to assist them toidentify the most helpful interventions

If coerced into treatment, plan can provide aroadmap to ending coercion


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Reciprocal Concrete Incentives andTreatment Planning

Concrete incentives for clinicians tomeaningfully engage consumers Consumer involvement in treatment

planning increases the likelihood thattheir clients will have favorable outcomes

Consumers possess information abouttheir disability, strengths, and goals that

clinicians need to develop anindividualized treatment plan that ismost appropriate for their clients


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Availability of Choices

The consumer has choices he or shevalues and sufficient informationabout those choices to makeinformed decisions about a particularactivity.


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Availability of Choices andTreatment Planning

Consumers should have a range ofchoices

Across service types (e.g., medication,housing, and employment)

Within service types (e.g., choices oftypes and location of housing)


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Factors limiting service choices

Under funding of public mental health services

Emphasis on medication at the cost of other

treatment and rehabilitation options Poor coverage of mental health services by

private insurance companies

Not having health insurance or being underinsured

Managed care restrictions on treatment

Legal or informal sources of coercion


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Political advocacy at the local, state, andnational levels to increase mental health

services

Updating staff on service options

Staff and consumers taking the initiativeto create new services to fill gaps


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Participation Structures andProcesses

The consumer has structures andprocesses through which tomeaningfully participate in aparticular activity.


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Participation Structures andProcesses and Treatment Planning

Basic treatment planning structures

Treatment teams

Case managers

Family involvement

Should be involved when they have a

genuine, constructive interest, And when the consumer agrees to it


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Key processes

Consumers present when writingtreatment plans

Individualizing treatment goals

Breaking down broad goals into smaller,more concrete goals

Adapting decision making to consumersabilities


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Key processes (continued) Having an agreed upon process for

resolving consumer and staff differences

Involving consumer advocates whenneeded to ensure consumerspreferences are identified

Modifying the process when consumers

are experiencing severe symptoms, aredeemed incompetent, or are coerced intotreatment


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Access to Resources

The consumer has access to theresources needed to meaningfullyparticipate in a particular activity.


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Access to Resources and TreatmentPlanning

Client resources

Advocates to participate in the planningprocess when needed

Mediation process for resolvingdifferences between consumers and staff

Logistical resources (e.g., transportation,child care)

Adequate time to participate at a timethat is convenient to the consumer


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Access to Resources and TreatmentPlanning

Staff resources

Staff training

to realize the potential of consumers to direct

their own treatment to understand why some consumers may

choose not to participate and how to address it

to develop the skills to meaningfully engageconsumers in the treatment planning process

Staff time to meaningfully engage consumers inthe treatment planning process


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Supportive Culture

The culture in which the consumer isinteracting in a particular activity issupportive of shared participation.


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Supportive Culture and TreatmentPlanning

A culture is supportive when

Stigma, discrimination, and paternalismare minimized within the mental health

organization Consumers are viewed as capable of

making meaningful decisions and caringfor themselves


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Addressing the condition Mental health organizations adopt

recovery models and psychiatric

rehabilitation approaches Leaders create mission and vision

statements that reflect the recovery andstrengths perspectives

Administrators model these perspectivesfor staff in their interactions withconsumers


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Addressing the condition (continued)

Staff receive extensive training, technicalassistance, and opportunities to discusstreatment planning

Administrators develop systems to evaluateconsumer participation and staff competenciesrelated to treatment planning

Administrators establish caseload sizes at

reasonable levels so that staff have the time tomeaningfully engage their clients in treatmentplanning


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GUIDELINES FOR MENTAL HEALTHSTAFF

Recognize the important contributionsmental health consumers make totreatment planning

Teach skills needed by consumers tomeaningfully participate

Develop trusting and respectfulrelationships to promote meaningfulparticipation

Adapt the treatment planning process forconsumers from diverse backgrounds


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GUIDELINES FOR MENTAL HEALTHSTAFF (continued)

Have mechanisms to resolve conflicts thatinvariably arise during treatment planning

Include consumer advocates in treatment

planning when needed Ensure adequate time for treatmentplanning

Develop an organizational culture thatsupports meaningful participation

Include family members in treatmentplanning when consumers agree to it


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GUIDELINES FOR MENTAL HEALTHCONSUMERS

First and foremost, exercise your right tomeaningfully participate in treatmentplanning

Request, and in some instances demand,meaningful choices

Ask for advocates if you believe they canhelp you make better decisions

Carefully consider the suggestions offeredby staff for goals and treatment activities


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GUIDELINES FOR MENTAL HEALTHCONSUMERS (continued)

If experiencing active symptoms thatinterfere with your ability to participate, askto meet at another time

Ask for more time to complete thetreatment plan if you feel rushed

Seek information that assists you in makingchoices about goals and treatment activities


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CONCLUSIONS

Consciously look for opportunities toempower vulnerable consumers

Be aware of the conditions for

empowerment, and seek ways toensure they are met

The benefits of empowerment areextensive, for consumers, socialservice organizations, and the publicat large.


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CONTACT INFORMATION

Donald M. Linhorst, PhD, MSW

[email protected] 314.977.2745

School of Social Work, Saint LouisUniversity, 3550 Lindell Blvd., St.

Louis, Missouri, 63103
mailto:[email protected]:[email protected]

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Empowering Vulnerable Populations