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June 23, 2011 Volume 2 Issue 23
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Webinar recordings and PowerPoint presentations,
please visit http://www.dsgonline.com/rtp/resources.html.

RTP Professional Discipline
Situational Analysis Executive Summary
This week, we continue with another Situational Analysis summary. As previously mentioned, we will continue to share summaries from the recently completed Situational Analyses conducted by each of the professional disciplines as part of the Recovery to Practice (RTP) initiative. The RTP Situational Analysis is a holistic description that captures unique characteristics of the current status of recovery-oriented practice within each discipline and then sets forth the approach that each will use to advance recovery principles and practices within its profession.

The teams synthesized findings from their yearlong, comprehensive assessment of both qualitative and quantitative data, collected in terms of (1) definitions and understandings of recovery used in their profession (as compared to the Substance Abuse and Mental Health Services Administration’s [SAMHSA’s] Consensus Statement recovery definition); (2) evidence of recovery-oriented practices being used; (3) evidence of the concept of recovery embedded in organizational infrastructure (i.e., in formal policies and procedures); and (4) evidence of recovery-oriented content in institutional training curricula.

The Situational Analysis forms the basis for determining strengths and identifying gaps as each professional organization designs and delivers its curriculum. Factors that make up the Situational Analysis are fluid and will evolve over time, as learning and practice grow. The Situational Analysis presented here, and in later Weekly Highlights, represents the current status of each discipline and its plans for the future. Readers who would like to provide feedback on these plans to any of the professional organizations involved are invited to do so, using the email address below.
American Psychological Association
Psychologists have historically played key roles in the recovery movement, as well as in the community mental health and psychiatric rehabilitation movements that set the stage for it. Studies by psychologists such as Paul and Lentz (1977), Wing and Brown (1970), and Vaughn and Jeff (1976) also helped pave the way for the recovery movement by changing the prevailing idea that there was little hope for improvement in individuals with serious mental illness.

Among the mental health consumer/survivor leaders who ignited and have guided the movement, several have been psychologists (e.g., Bassman, Deegan, Frese). In addition, psychologists have been at the forefront of the research, practice, and policy dimensions of this movement. Their contributions include
  • Longitudinal outcome studies that provided the empirical support for—or confirmation of—first-person recovery narratives (e.g., Harding, Harrow)
  • Groundbreaking research on promoting functioning (e.g., Bell, Bellack, McGurk, Mueser, Silverstein, Spaulding)
  • Contributions to the definition of recovery (e.g., Anthony, Deegan)
  • Support of families (e.g., Johnson, Lefley, Marsh)
  • Addressing of stigma, discrimination, and resilience (e.g., Corrigan, Russinova, Wahl)
  • Addressing of shared decision-making, resilience, and the recovery journey (e.g., Deegan, Harding, Spaniol)
  • Development of principles for recovery-oriented practice and competencies (e.g., Anthony, Cook, Davidson, Farkas, Frese, Russinova, Shepherd, Slade)
  • Articulation of a vision of recovery-oriented practice that can be used to guide system transformation (e.g., Anthony, Davidson, Farkas)
Anthony’s seminal 1993 article, “Recovery from mental illness: The guiding vision of the mental health service system in the 1990s,” was not only prescient, for example, but helped to establish the conceptual basis for recovery to become the overarching aim of mental health care as recommended by the U.S. Surgeon General in 1999 (later to be reaffirmed and elaborated in the President’s 2003 New Freedom Commission on Mental Health).

While psychologists may have been at the center of the recovery movement, the same cannot be said for recovery being at the heart of the discipline of psychology. Many factors, both historical and sociopolitical, may have contributed to the current state of affairs, but at this time there is a relatively small—if growing—number of psychologists who have embraced and attempted to further the recovery paradigm. Some of these factors include the ascendancy of a neurobiological model of mental illness in the 1980s—establishing psychopharmacological treatment as the apparent approach of choice for these disorders—and the emergence of data at the same time suggesting that psychodynamically oriented psychotherapies lacked efficacy for the population of people suffering from these disorders. By the late 1980s, these developments had already appeared to diminish interest by psychologists in this population, when a group of psychologists dedicated to the care of people with serious and persistent mental illness began to make concerted efforts to revive and expand the broader field’s interest in this work (Johnson, 1990; Wohlford, Myers, & Callan, 1993). The relative lack of penetration of the concept of recovery and its implications for transforming mental health practice into the field of psychology can perhaps be read as yet more evidence of the fact that interest in this population has continued to decrease among psychologists.

The involvement of the American Psychological Association (APA) in SAMHSA’s RTP Initiative represents a new opportunity to engage in system transformation. In this effort, the discipline of psychology has many strengths on which to build. These include the outstanding work of clinical, community, counseling, school, psychosocial rehabilitation, humanistic, and neuro–cognitive psychologists who have devoted their professional careers to developing and disseminating innovative approaches to care for and promote resilience and recovery.

Strengths also include an increasing number of psychologists who are in recovery and the previous and current membership of APA’s Task Force on Serious Mental Illness and Severe Emotional Disturbance (SMI/SED), the body of concerned psychologists that has persistently advocated for the discipline to focus more of its energies and resources on this important cause. Kay Jamison, Elyn Saks, and Wendy Walker Davis are all in recovery from serious mental illness. They also all are, or were, APA members and served on the APA's Task Force on the SMI/SED. Keris Myrick, the first vice president of the National Alliance on Mental Illness national board of directors, is a person who has been diagnosed with schizophrenia and who has credentials in psychology. The RTP Initiative offers this task force and other like-minded psychologists the opportunity to amplify their voice and to bring the field of psychology into the center of national system transformation efforts.

Vision. Through the resulting curriculum, the APA will put forth a framework that trains psychologists in providing recovery-oriented behavioral health care. Recovery-oriented care assists individuals to achieve those optimal functional capabilities chosen by each person to enable him or her in achieving his or her full potential. In addition to being consistent with the values, principles, and knowledge of psychology, the provision of recovery-oriented care incorporates such key APA priorities as healthcare reform and the reduction of health disparities. It also is consistent with the fundamental values of psychology and national trends and expectations, thereby positioning APA and its 154,000 constituent psychologists to be responsive to the rapidly changing healthcare environment and shifting expectations for providers.

Opportune time. The RTP Initiative comes at an opportune time for the discipline of psychology. Based in part on the work of generations of psychologists, as well as on the lives and advocacy efforts of people in recovery and their loved ones, the recovery vision has come of age and has been firmly established as the guiding vision for behavioral health care for the foreseeable future. As the APA continues to engage in the important work of healthcare reform and the elimination of health disparities, this vision of recovery will increasingly influence the practice of all psychologists participating in the provision, and study, of health care.

Our field already has many strengths in place, which we can build on as this vision takes root and permeates the broader healthcare arena. The RTP Initiative will need to make effective use of these strengths to expand the circles of psychologists who are embracing and further elaborating on the concepts of both resilience and recovery, overcoming ignorance with education, dispelling stigma and eliminating discrimination toward people with serious mental illnesses, inviting and retaining within the field psychologists with their own firsthand experiences of mental illness and recovery, and bringing the considerable talents, tools, and concepts within the profession together into a coherent and compelling vision of how psychology can enhance and improve the lives of children and youth with serious emotional disturbances and adults with serious mental illnesses.

Key foci for advocacy on behalf of this vision will be to:
  • Ensure that Medicaid/Medicare and private insurance cover a range of recovery-oriented psychosocial interventions and community-based supports
  • Make effective use of emerging technologies, not only for rural and tribal communities but also for providing ongoing support for people working on establishing and sustaining recovery (e.g., telephonic follow-up support)
  • Ensure that all Americans, but especially those with serious mental illnesses, have access to safe and affordable housing and meaningful employment
  • Decriminalize mental illness and develop alternatives to incarceration that ensure that people receive effective care rather than ineffective punishment for illness-related behaviors
  • Develop and apply behavioral assessment and analysis to the task of enabling people to live self-determined and meaningful lives in the community
  • Promote a holistic vision of wellness and well-being, including resilience in the face of adversity, that can be held up as the ultimate goal of health care for all Americans, regardless of trauma history, mental illness, culture, race, ethnicity, sexual orientation, religious affiliation, immigration status, or social class.
For more information about this Situational Analysis, please contact Andrew Austin–Dailey of the American Psychological Association at aaustin-dailey@apa.org.

Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23.

Johnson, D. (ed.). (1990). Service needs of the seriously mentally ill: Training implications for psychology. Washington, D.C.: American Psychological Association.

Paul, G.L, & Lentz, R.J. (1977). Psychosocial treatment of chronic mental patients: Milieu versus social-learning programs. Cambridge, Mass.: Harvard University Press.

Vaughn, C.E., & Leff, J. (1976) The influence of family life and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125–37.

Wing, J.K., & Brown, G.W. (1970). Institutionalism and schizophrenia: A comparative study of three mental hospitals, 1960–68. Cambridge, England: Cambridge University Press.

Wohlford, P.; Myers, H.F.; & Callan, J.E. (eds.) (1993). Serving the seriously mentally ill: Public–academic linkages in services, research, and training. Washington, D.C.: American Psychological Association.

Webinar Announcement
The RTP Resource Center is pleased to announce
the third Webinar in a four-step series:
Step 3 in the Recovery-Oriented Care Continuum:
Promoting Recovery Through Psychological and Social Means
Thursday, July 28, 2011

2:00–3:30 p.m. E.T.

This Webinar will describe a few approaches to promoting recovery that involve psychological and social interventions. A first speaker will update participants on the state of the art in cognitive–behavioral psychotherapeutic approaches to serious mental illnesses (schizophrenia and bipolar disorder). A second speaker will describe the key common elements of psychiatric rehabilitation approaches that involve in vivo support (supported employment, education, housing, etc.). A third speaker will describe the role of consumer-run programs and businesses as offering alternatives to traditional programs and settings (e.g., clubhouses).

To Register

Please share this announcement with friends and colleagues who may be interested in learning more about recovery-oriented practice in behavioral health services. For more information on SAMHSA’s RTP project, please contact the RTP Technical Assistance Center at
recoverytopractice@dsgonline.com, or 1.877.584.8535.

FOA: Sustainable Comprehensive Tobacco Cessation and Prevention
Clinical Program for Low Socioeconomic Status Women of Childbearing Age
The mission of the Office on Women’s Health (OWH) of the Department of Health and Human Services (HHS) is to provide leadership to promote health equity for women and girls through sex/gender–specific approaches. The Tobacco and Young, Low Socioeconomic Status (LSES) Women: Federal Collaboration to Make a Difference interagency working group (the Collaboration) was launched by HHS/OWH, the National Cancer Institute (NCI), and other HHS agencies in 2008. Because LSES women and girls of childbearing age have special burdens related to tobacco use, OWH and the Collaboration implemented a three-phase initiative, outlined below, to reduce tobacco use in this population. (See Appendix I for more information).
  • Phase 1: Tobacco Clinical Collaborative Programs (TCCP) involves implementing the “Treating Tobacco Use and Dependence, Clinical Practice Guideline, 2008 Update” (“Public Health Service Guideline”), or similar tobacco-cessation programs, in selected Health Resources and Services Agency (HRSA)– and Indian Health Service (IHS)–funded clinics.

  • Phase 2: Expansion planning involves using lessons learned from the TCCP to develop a toolkit of resources and to plan expansion from the TCCP to other populations of LSES women of childbearing age served through Federal healthcare dollars.

  • Phase 3: Comprehensive and sustainable funded projects involves providing cooperative agreements to projects that (1) implement the Public Health Service Guideline to provide comprehensive culturally and linguistically appropriate tobacco prevention and cessation services for the targeted population, (2) show organizational and structural changes that will ensure long-term sustainability and ability to implement and to replicate the Public Health Service Guideline implementation, and (3) evaluate the impact of the Public Health Service Guideline implementation and structural changes on tobacco cessation in LSES women of childbearing age.
Through this cooperative agreement (Phase 3 of the Collaboration initiative), OWH intends to foster its mission and support the Collaboration by providing OWH fiscal year 2011–appropriated funds to entities to:
  1. Partner with federally funded healthcare organizations and/or Medicaid-reimbursed providers (“Federal Clinical Partners”) that serve LSES women of childbearing age

  2. Provide training, materials, and technical assistance to implement a comprehensive and sustainable tobacco cessation and prevention program in the Federal Clinical Partners’ organizations for LSES women of childbearing age, based on the Public Health Service Guideline

  3. Assist the Federal Clinical Partners to implement a process model to create an organizational culture of tobacco awareness and action that results in increased quit attempts, abstinence, or cessation for LSES women of childbearing age

  4. Contribute new information and resources that will assist other federally funded clinics to replicate this program.
Funding Opportunity Description
The purpose of this project is to implement and to evaluate the success of tobacco cessation and prevention programs in selected Federal Clinical Partners to address tobacco use among LSES women of childbearing age. The Federal Clinical Partners are HRSA or IHS federally funded healthcare clinics, or Medicaid-reimbursed providers. Successful applicants will design tobacco cessation and prevention programs to be implemented in the Federal Clinical Partners’ organizations that:
  1. Are based on the Public Health Service Guideline
  2. Employ implementation process steps that will ensure project sustainability after the grant period ends for the Federal Clinical Partners
  3. Ensure that a certified tobacco specialist uses the 5As (Ask, Advise, Assess, Assist, Arrange; see the Public Health Service Guideline for detailed information) with every patient
  4. Ensure LSES women of childbearing age identified as tobacco users are offered brief intervention, counseling, follow-up, and other cessation services listed in the Public Health Service Guideline
  5. Demonstrate increased quit attempts, abstinence, or cessation for LSES women of childbearing age using the services of the Federal Clinical Partners
Due Date for Response
Friday, July 15, 2011

For More Information

SAMHSA Consumer-Operated Services
Evidence-Based Practices KIT Now Available
The SAMHSA Consumer-Operated Services Evidence-Based Practice Knowledge Informing Transformation (KIT) is now available through the SAMHSA Web site at: http://store.samhsa.gov/product/Consumer-Operated-Services-Evidence-Based-Practices-EBP-Kit/SMA11-4633CD-DVD

People with mental health problems as audience, family and advocates, program planners, administrators, and project managers

Population Group
People with mental health problems as population group

Provides tools for developing mental health services that are owned and operated by people who have personal experience living with a psychiatric disorder. Offers guidance grounded in evidence-based practices. CD–ROM/DVD includes 10 booklets.

Invitation to Submit Personal Stories
Personal stories are a powerful way to share information, influence others, and advance recovery-oriented practice. The RTP team would like to hear from military family members about your recovery-oriented experiences.

We're also interested in receiving your personal stories about how healthcare reform has affected your recovery journey.

We will add your stories to our library of resources that will soon become available to our ListServ subscribers.
To submit personal stories or other recovery resources, please contact
Stephanie Bernstein, MSW, at 1.877.584.8535,
or email recoverytopractice@dsgonline.com.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-oriented work and how it has changed the way they currently practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit personal stories or other recovery resources, please contact Stephanie Bernstein, MSW, at 1.877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
1.877.584.8535 or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.