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July 7, 2011 Volume 2, Issue 25
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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 professions (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. For more information about this Situational Analysis, please contact Patricia Black, PhD(c), RN, of the American Psychiatric Nurses Association at pblack@apna.org.
American Psychiatric Nurses Association
The State of Psychiatric–Mental Health Nursing
in the Recovery to Practice Journey: A Situational Analysis
SAMHSA has called for the transformation of mental health care in America from an illness-centered paradigm to recovery-oriented systems of care. As part of this initiative, the American Psychiatric Nurses Association (APNA) launched a 5-year project to develop and implement a training curriculum that promotes greater awareness, acceptance, and adoption of mental health recovery principles and practices among psychiatric–mental health care nurses.

This Situational Analysis summarizes the first year’s efforts of the APNA RTP project and recommends a plan for developing the curriculum.

Participants and methods. The RTP project uses Appreciative Inquiry as its framework. This strengths-based model of thinking, seeing, and acting for powerful, purposeful organizational change assumes that what you want more of already exists in the organization. According to this model, the project seeks to engage representatives from all levels of the system through each of five phases: define, discover, dream, design, and deliver. In year 1, the project concentrated on the first two phases, by defining the need for transformational change and through discovery. The result is a Situational Analysis of our nursing specialty’s strengths, needs, and challenges to achieving the desired change.

RTP team members assessed data collected through chapter discussions with a national sample of psychiatric–mental health care–practicing nurses, nursing educators and administrators, and consumers, as well as by interviewing key informants. In facilitated group discussions, the project team aimed to discover the current knowledge and use of recovery principles and practices by psychiatric–mental health care nurses and the skills they need for recovery-oriented practice. Team members also dialogued with the APNA Consumer Advisory Panel about their experiences with psychiatric nurses’ use of a recovery model. Interviews with leaders of mental health systems at the national, State, and local levels—conducted in person and by phone and email—explored recovery-focused policies and resources.

A literature review examined recovery from the nursing perspective in an attempt to identify whether nursing has strengths that relate to SAMHSA’s 10 Fundamental Components of Recovery. These recovery principles are self-direction, individualized and person-centered, empowerment, holistic, nonlinear, strengths based, peer support, respect, responsibility, and hope.

Findings. The nursing literature contains little data on recovery. However, all 10 components of recovery are embedded in nursing theory, research, and practice, particularly in psychiatric–mental health nursing. Nursing also has a strong foundation in cultural competence. In crucial areas that influence recovery, some nurses are actively seeking education, including full partnership with consumers and trauma-informed care (understanding the impact of trauma on people who receive mental health care). The nursing profession can build on these strengths to facilitate change.

Highlights from the facilitated discussions follow.

  • Education and professional training in recovery-focused nursing practice has been limited, and nurses need more knowledge, support, and tools in this area.
  • Specifically, nurses need to learn and use recovery (e.g., person-centered) language and skills, such as shared decision-making, and to better understand trauma-informed care.
  • Psychiatric–mental health nurses must infuse recovery components into daily nursing practice and continue to increase their partnership with consumers.
  • Barriers to these efforts include a limited number of nurses who are content experts about recovery, insufficient funding, pressures from insurance providers to lower costs, inconsistent reimbursement for recovery services, and difficulty changing from adherence to a diagnostic and maintenance approach to practice.
  • Administrative buy-in is critical to successful implementation of recovery in practice.
  • Nurses often do not realize that recovery is possible.
  • Nurses and consumers should be more visible champions for recovery.
  • Hospital-based nurses are positioned to implement recovery practices.
Thus, the project team identified the following needs: integrated nursing education and training in recovery, peer recovery champions, recovery experts, and consistency in organizational systems and in the mental health care system.

Recommendations and objectives. Within the next 2 years, the RTP nursing curriculum and training manual will be developed, with the continued collaboration of nurses, consumers, and other partners. It will use Web-based technology to be cost effective and highly accessible. Proposed content includes SAMHSA’s recovery principles, trauma-informed care, collaborative relationships, cultural competency, and person-centered communication. The target audience will be psychiatric–mental health registered nurses, advanced practice nurses, student nurses, and administrators.

Field testing will involve a pilot group of practicing nurses from selected inpatient settings, beginning in year 3. Full implementation and marketing will occur in the final 2 years.

Desired objectives on completion of pilot training are that psychiatric–mental health nurses
  • Begin to apply SAMHSA’s 10 mental health recovery components to nursing practice
  • Actively use recovery language
  • Share decision-making with consumers of mental health care
  • Begin to direct consumers to community resources that facilitate recovery
Moreover, the 2012 revision of APNA’s Scope & Standards of Psychiatric–Mental Health Nursing Practice is expected to reflect that mental health recovery is fundamental to our practice.

APNA’s vision is that behavioral health care will significantly improve by the end of year 5 as a result of psychiatric–mental health nurses integrating recovery-oriented care into their practice.

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 pm EDT

This Webinar will describe a few approaches to promoting recovery that involve psychological and social interventions. First, David Kingdon, M.D., will update participants on the state of the art in cognitive–behavioral psychotherapeutic approaches to serious mental illnesses (schizophrenia and bipolar disorder). Next, Larry Davidson, Ph.D., will describe the key common elements of psychiatric rehabilitation approaches that involve in vivo support (supported employment, education, housing, etc.). Finally, Jayme Lynch, CPS, will describe the role of consumer-run programs and businesses as offering alternatives to traditional programs and settings (e.g., clubhouses).

David Kingdon, M.D., is Professor of Mental Health Care Delivery at the University of Southampton, United Kingdom, and Honorary Consultant Adult Psychiatrist for the Hampshire Partnership NHS Trust. Over the past two decades, David has worked with Douglas Turkington from Newcastle and other colleagues to develop techniques for treating patients with persistent delusions and hallucinations, using cognitive–behavioral therapy. His research interests are in cognitive therapy of severe mental illness and mental health service development; he has published extensively on these topics.

Larry Davidson, Ph.D., is the DSG Project Director for the SAMHSA Recovery to Practice initiative. A Professor of Psychiatry and Director of the Program for Recovery and Community Health at the School of Medicine and Institution for Social and Policy Studies of Yale University, his work has concentrated on processes of recovery from and in serious mental illnesses and addictions, evaluation of innovative recovery-oriented practices, including peer-delivered services, and designing and evaluating policies to promote the transformation of systems to the provision of recovery-oriented care. In addition to being a recipient of psychiatric care himself, Dr. Davidson has produced more than 200 publications, including the 2009 book written with several of his colleagues, A Practical Guide to Recovery-Oriented Practice: Tools for Transforming Mental Health Care (published by Oxford University Press), and the more recent The Roots of the Recovery Movement in Psychiatry: Lessons Learned (Wiley–Blackwell. His work has influenced the shape of the recovery agenda and the translation of its implications for transforming mental health practice, both national and internationally.

Jayme Lynch, CPS, is the Director of the Peer Support and Respite Center, a Georgia Mental Health Consumer Network initiative offering 24-hour, 7-days-a-week, consumer-directed peer wellness and crisis respite services, in Decatur, Ga. The center uses peer support services in a safe, noncoercive, nonclinical, and homelike environment in a community setting, and is offered as an alternative to other crisis services. The goal of this project is to encourage consumers to use their crises as learning opportunities, developing their internal and external resources to better understand, manage, and avoid future crises and avoid future hospitalizations.

To Register, go to

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 Resource Center at recoverytopractice@dsgonline.com, or 1.877.584.8535.

STAR CENTER Teleconference Series
July is National Minority Mental Health Awareness Month, a month-long opportunity for recovery-oriented organizations, groups, peer supporters, and national and local media to spotlight mental health issues affecting African American, Asian American and Pacific Islander, Latino, Native American, and Gay Lesbian Bisexual Transsexual Questioning communities.

In honor of National Minority Mental Health Awareness Month,
the STAR Center will be hosting the following teleconferences:

July 19, 2011: Integration of Recovery and Peer Support Models in Latino Communities
STAR Center consultants Katy Castro and Juan Velez–Court will discuss their efforts to integrate recovery and peer support services into community life in Puerto Rico. They look forward to an open exchange of ideas on community outreach, advocacy, and social inclusion of underserved communities.

July 21, 2011: Gay Black Consumer: Is Recovery Less Likely?
STAR Center staff will discuss personal experiences and motivation behind the STAR Center’s latest Recovery & Wellness sheet, Gay Black Consumer: Is Recovery Less Likely? to 1) inspire explorative discussion among participants on issues facing this community and the obstacles they present to recovery, 2) share possible ways to address those issues, and (3) establish the best next steps for improvement.

July 27, 2011: Cultural Competency in Mental Health Peer–Run Programs and Self-Help Groups
STAR Center staff will team with the University of Illinois at Chicago, National Research and Training Center, to discuss its tool to assess and enhance cultural competency in peer support services.

Times and registration information will be distributed at least 1 week before each teleconference.

The STAR Center is funded by a SAMHSA/Center for Mental Health Services (CMHS). Please visit SAMHSA/CMHS for helpful information and resources on mental health and recovery, at www.mentalhealth.samhsa.gov/CSP.

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 health care 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 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 877.584.8535, or email

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
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 HHS.