J E N N I F E R S T O N E , L C S WL O W E R M A N H A T T A N R E G I O N A L D I R E C T O R

INTRODUCTION TO WELLNESS SELF-MANAGEMENT

AGENDA

•What is Wellness Self Management?

•Wellness Self Management Workbook

•How to facilitate a WSM Group•Tips

WHAT IS WSM?

• Evidence based curriculum designed by SAMSHA-providers and consumers to address serious mental illness

• Based on Illness Management and Recovery (IMR), a nationally recognized evidence-based practice for adults with serious mental health problems

CORE COMPONENTS

Recovery, mental health wellness, relapse prevention, and emphasis on the connection between physical and mental health

• Focus on providing information and skills to make decisions and support recovery

• 57-lesson personal workbook

VALUES

• Increase your knowledge and skills to manage serious mental health problems

• Improve your mental and physical health• Develop confidence to pursue important life goals• Increase hope about the future • Make informed decisions about mental and

physical health services• Recognize your strengths and build upon what you

do well

GOALS OF WSM

• Learning about recovery and what it can mean for you • Making the best use of your mental and physical health

services • Learning that mental and physical wellness will help you

achieve your goals and support your personal recovery • Staying well by decreasing symptoms of a mental health

problem • Learning how to manage day to day stress and prevent

relapse • Staying well by connecting with others • Staying well by living a health lifestyle • Recognizing and building on your cultural values and

experience to support your personal recovery

RECOMMENDATIONS

• Every participant gets a workbook and its an active process

• Table• Flipchart- rules/ideas

FAMILY INVOLVEMENT

• Encouragement• Completion of action steps• Assistance with reading the lessons• Discuss interesting topics

- If needed, providers can meet with family members to discuss WSM and how the family can be involved

- Family members are also welcome to come with the participant as appropriate

WELLNESS SELF MANAGEMENT WORKBOOK

Divided into 5 sections:• Introduction • Recovery • Mental Health Wellness and Relapse Prevention • Living a Healthy Lifestyle and Mental Health

Recovery • Wrap up

INTRODUCTION

• Designed to help those patients who may be unsure about the group and deciding if the group will be their needs

RECOVERY

• Focus on how recovery relates to the participant • Emphasis on strengths and cultural background• Stigma

MENTAL HEALTH WELLNESS AND RELAPSE PREVENTION

• Focus on the connection between mind and body-bio-psychosocial factors

• Management of symptoms- stress mgmt• Learning about personal symptoms and signs• Ends with creating a relapse prevention plan

LIVING A HEALTHY LIFESTYLE

• Focus on nutrition and exercise• Unhealthy/unsafe decisions and lifestyle choices

LESSON BREAKDOWN

• Each lesson starts with IMPORTANT INFORMATION-read out loud by group members who choose to do so or by the facilitator

• Personalized worksheet- use information just learned and apply it personally- Encouragement to share information with the group

• Discussion Point- question for the group

ACTION STEPS

• Things that participants can do in between group sessions to further their learning They are not mandatory, but encouraged. The more Action Steps accomplished the more likelihood that recovery goals will be achieved. This is the way to bring the Wellness Self-Management learning into real life

• Each group members given the opportunity to plan their action step- not mandatory

ACTION STEP EXAMPLES:

• Re-reading the written materials• Finding out more about the topic• Talk to a peer or family member about the topic• Ask someone to practice the new skill with you• Talk to someone about your invovlement in WSM

RECOVERY

• Assumption in the WSM program is that recovery is supported when individuals have information, knowledge and skills to guide the decisions they make about their mental and physical health

• Focus on strengths and acknowledge resiliency of people with mental health problems

• Focus on exploration of the personal meaning of recovery to each person and their life

• Increase understanding of the conditions and actions that are likely to help or hinder recovery

• Enhance hopefulness and confidence for one’s future

HOPE

• Long term studies- 50% or more of people diagnosed with major mental illness go on to a significant or complete recovery

• Focus on building positive experiences• One of the most important points of these studies is

that adults who have been provided services that emphasized rehabilitation and focused on providing skills and knowledge showed greater improvement than those who received treatment that focused primarily on stabilization

RECOVERY ORIENTED PRINCIPLES

Person Orientation• Focus on the person first and foremost: a person's talents,

aspirations, interests, strengths and cultural and religious values • A focus on life roles beyond the role of patient

Involvement • Identifying personal goals • Opportunities to read, discuss and personalize workbook topics • Emphasis on participants learning from each other

Choice• Understanding the pros and cons of different choices • Informed decision making and not compliance is the goal

Growth Potential• Emphasis on positive possibilities and resiliency • Recognition that the process of recovery is not linear but often

characterized by setbacks as well as progress

RELATIONSHIPS

• Focus on the development of healthy relationships-sense of isolation

• Building confidence• Emphasis is on providing transparent information

and strategies that promote problem solving andinformed decision making

CULTURAL ISSUES

• Focus on identifying how culture and religion play into making decisions about mental health

Asking Stance:• An asking stance means an openness to inquiring about

and listening to an individual’s history, traditions, values and family experiences

• A non-judgmental communication style that seeks understanding and opportunities to build on cultural and religious resources and strengths

• Appreciating the impact of racism, discrimination and stigma on an individual's comfort with and involvement in treatment including the WSM program

FACILITATING WSM

• Focus on following the framework that has been shown through research to be effective-BEGINNING, MIDDLE AND END

Initially focus on establishing ground rules:• One person talks at a time • Treat each other with respect (no put downs) • What is said here stays here • Staying on topic • Avoid separate conversations

ROPES STRUCTURE

• Dr. William Anthony and associates at the Center for Psychiatric Rehabilitation at Boston University.

What is ROPES? There are five major components of the ROPES format:

• Review • Overview • Presentation • Exercise • Summary

The Beginning of each group consists of the Review and Overview. The Middle of each group consists of the Presentation and Exercise. The End of each group consists of the Summary.

A WSM Group Leader's Quick Guide is available as a download. It includes a summary of the ROPES framework and examples of statements and questions you may choose to utilize as a group facilitator. You may print this 2 page guide and use it for future reference. Many group leaders bring the guide into the group and share it with group members

END OF EACH GROUP

The ending of each group is designed to accomplish the following: • Assessment of participants’ understanding • Reinforcement of participants’ learning • Feedback from participants about the value of the

lesson There are three steps involved: • STEP 1: Summary of the main points of the lesson (by

participants) • STEP 2: Reinforcement of participants’ efforts • STEP 3: Feedback from participants

IMPLEMENTATION

• Group or individual• Encouragement to “shamelessly steal” ideas from

each other in the group• Focus on sharing WSM values and what is learned

with others• Ideally a closed group- no more than 10 people

and co-led with a peer/participant• Length: 45-60 minutes• 12-24 months

RECRUITMENT FOR GROUP

• Due to length the recruitment process can be challenging

• Way to move from individual as a step-down process• Meet the group leader ahead of time otherwise tended

to be a higher no show rate• Have the individual therapist who is referring do a lesson

from WSM to show them how great it is• Depends on the population- SMI• Importance of staff understanding as they will be

recommending the group• Consumers from assessment

CLOSED OR OPEN?

• Framework• Close after 3-4 weeks from experience• Facilitator?

WSM GROUP TYPES

• Found in busier practices that having different types appeals to participants- CHOICE

• Single Gender or Mixed• Co-occurring • 5-6 in busy practices

TIPS

• Can be utilized in both individual or group• Food • Graduation celebration• As part of growth, take on co-facilitating the group• Especially helpful in managing SMI population and

at risk populations

WSM TRAINING AND GUIDES

Link to Training:http://practiceinnovations.org/CPIInitiatives/WellnessSelfManagement(WSM)/tabid/189/Default.aspx

Center for Practice Innovations

Workbook: http://www.nami.org/Content/Microsites316/NAMI_PA,_Cumberland_and_Perry_Cos_/Home310/Education27/WSM_English_Workbook.pdf