Wellness Self-Management for the COVID-19 Crisis

(WSM-COVID19)

Anthony Salerno, Ph.D.Community Technical Assistance Center of New York

McSilver Institute for Poverty Policy and ResearchSilver School of Social Work

New York University

Paul Margolies, Ph.D.Center for Practice Innovations,

New York State Psychiatric Institute, and Department of Psychiatry,

Columbia University Vagelos College of Physicians and Surgeons

May 7, 2020

Learning Objectives

Learners will:

1. Learn about the basics of Wellness Self-Management, which forms the foundation for WSM-COVID19

2. Become familiar with the six new WSM-COVID19 lessons and how to use them

3. Understand that WSM-COVID19 can be provided remotely and in person

4. Know how to organize WSM/WSM-19 lessons, both individually and in groups

Polling Question

Are you familiar with the Wellness Self-Management (WSM) practice and workbook?• Yes • No

Polling Question

Have you ever used the WSM workbook (please check all that apply)?• Yes, individually• Yes, in groups • No

WSM Workbook

Wellness Self-Management: Background

• Developed over decade ago• Curriculum based program organized into a workbook • 50+ lessons designed to support a person to better manage

mental health and substance use difficulties• Can be used in group or individual meetings• Recipient of the SAMHSA Science to Service award 2010• Each lesson follows a format aligned with the principles of

self directed adult learning

Wellness Self-Management: Background•Widespread Implementation (applicable across

clinical conditions, cultural populations and service settings)•Guided by principles of shared decision making,

empowerment, self direction, hope and recovery•Core competencies -- Embedded within the

workbook•Connecting and Motivational skills•Educational•Cognitive-Behavioral

WSM-COVID19 Lessons

Lesson 1: Understanding the Coronavirus and COVID – 19 • Focus on the virus, symptoms and how to protect yourself

Lesson 2: What Is Stress? Why is It Important to Understand Our Stress during the Covid-19 Crisis?

• Focus on stress, learn why it is important to identify our worries, and why this is especially important now

Lesson 3: Identifying Your Personal Signs of Stress during the COVID-19 Crisis

• Focus on signs that we are under too much stress, and how to recognize our own stress reactions

WSM-COVID19 Lessons

Lesson 4:Coping with COVID-19: What works? What doesn’t? • Focus on ways of coping that may be helpful to you, and considering

your own coping plan

Lesson 5: Being Connected with Other People is More Important Now than Ever

• Focus on social support, why it is important – especially now, and steps you can take to make sure that you have the social support that you want

Lesson 6: Staying Physically Healthy During the COVID-19 Crisis• Focus on having a healthy lifestyle generally, things to do to stay healthy

during this crisis, and the connection between a healthy lifestyle and mental health recovery

(Show the 6 Lessons Here)

Introducing WSM-COVID19 to the Individual

• In order for individuals to decide whether they would like to take advantage of these WSM-COVID19 lessons, they will need to know what is available. Please keep in mind that participation is entirely voluntary.

• It will be important to structure a preliminary discussion that will help the individual make an informed choice. This may include providing information about WSM-COVID19, what is expected of the individual, and the structure of the lessons.

Introducing WSM-COVID19 to the Individual

• Please keep in mind that these lessons are designed to be used remotely as well as in person, individually and in groups.

• When using remotely (i.e., telehealth), some individuals may prefer a “discussion” rather than a formal lesson. That’s fine. You should be guided by the individual’s preferences.

• Individuals should be provided with their own copies of these lessons.

Introducing WSM-COVID19 to the IndividualHere are some possible questions and discussion points. You may think of others. • Would you be interested in learning more about the COVID-19 crisis and how to cope

with it? • If you are, we have 6 lessons or discussions that we can use over the next few weeks. • You can choose one, some, or all of them. It's up to you. • They are called (list each lesson)• Each lesson or discussion will provide you with some important information, give you the

opportunity to think about the importance of this information in your life, and identify action steps that you can take to make a difference.

• Do you have any questions?• What do you think?• If you’d like to do this, would you prefer to start with the lesson called “Understanding

the Coronavirus and COVID – 19” or with a different lesson?

Polling Question

Are you familiar with the ROPES approach to organizing lessons –individual or group?• Yes • No

The R.O.P.E.S. FrameworkThe ROPES framework is based on the principles of adult education and the work of Dr. William Anthony and associates at the Center for Psychiatric Rehabilitation at Boston University

The ROPES acronym stands for….

R = Review

O = Overview

P = Presentation

E = Exercise

S = Summary

WSM-COVID19 lessons are designed with this framework in mind.

Organization of Each Lesson• Beginning: Review of previous lesson and introduction of this lesson• Important Information: background information to describe the

Covid-19 related topic and why it may be important• Discussion points: designed to increase interaction and conversation among

users to promote understanding, clarify meaning and address concerns and questions.

• Let’s Get Personal: an opportunity to personalize the topic to one’s unique experience, strength and areas to consider learning about or improving.• Action Step: making a decision to continue learning and/or apply what

you have learned to address your concerns related to the Covid-19 crisis • Ending and Affirmation: end on positive note, motivating and

inspiring message

WSM-COVID Individual Sessions• Can be provided:

• Remotely• Telephone• Online platform such as Zoom

• Face-to-face• Can be structured as formal lessons or informal discussions

• Based on the individual’s preference• Either approach is fine

• Can cover all six lessons, or fewer• Based on the individual’s preference

WSM-COVID19 Groups

• Can be provided:• Remotely• Online platform such as Zoom

• Face-to-face• Best to offer all six lessons as a package

Benefits of groups*Information Exchange: important tasks of psychoeducational support groups. The facilitator disseminates information about [sexual assault] and helps survivors recognize their own strengths. Mutual Support – An effective facilitator introduces the concept of mutual aid and demonstrates to the group how to use empathic responses and supportive comments.Group Cohesion – An effective facilitator emphasizes the members’ similarities and strengths.Coping and Self-Efficacy – facilitator can point out to group members their use of successful mastery over difficult situations and help group members enhance one another’s coping skills.Reduction of Social Isolation – develop a support system around them that includes people who can understand the issues and problems that they are going though.*Self-Help and Support Groups, Linda Kurtz (1997, p.100-101) Paraphrased .

Polling Question

Do you currently run one or more groups in which these WSM-Covid19 topics would be helpful?

A. I run a group and will probably use one or more of these lessonsB. I run a group but we don’t focus on COVID19 topicsC. I don’t run groups- I’ll probably use these topics in individual

meetingsD. I’m really not sure if I will use structured lessons in my work

Group is not for everyone: who does best?

People who say….• I like to share my feelings with others • When I first meet someone, I like to share things about myself, including

personal information • I think that working in a group will really help me• If I participate in a group, I expect to feel quite a bit better when we are

finished • I think that sharing my feelings with others will help me feel better. • I am an open person• I generally trust the group leader and the participants

Ground rules promote safety and help people to stay on task• Ground rules are established very early on in the process, typically during the first

group meeting. • It is essential to engage group participants in establishing their ground rules – this will

result in members owning them. • Posting ground rules also helps • Can also have participants initial/sign the poster ground rules

• Examples:• One person talks at a time • Treat each other with respect (no put downs)• What is said here stays here• Stay on topic• Avoid separate conversations

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Ground Rules are Not Enough! What more is needed?It’s helpful to have an organizing framework that:• Promotes safety and trust• Personalizes the experience for each participant• Transparent and clear to all (makes sense)• Keeps people on track and on topic but also flexible• Focus on issues that empower people• Emphasizes shared decision making and choice• Helps participants to remember and revisit the main ideas of the group• Gives participants an opportunity to continue and/or apply their learning• Gives group leaders a common sense and easy to apply group format

Drs. Salerno and Margolies’ Famous Group Format for Conducting a Theme Centered and Curriculum Based

Group (Also works for individual tutorials)

The Multi-Phasic, Temporally Sequential, Tri-Partite Group Pedagogical Process

(M.P.T.S.T.P.G.P.P)

The Key Elements of a Group or an Individual tutorial on WSM- Covid-19 Lessons

•Beginning

•Middle

•End

The ROPES Approach to Facilitating an Adult Learning ProcessReview OverviewPresentation ExerciseSummaryAdapted for groups from the following references:

Cohen, M., Danley, K., & Nemec, P. B. (1985). Psychiatric rehabilitation practitioner package: Direct skills teaching. Boston, MA: Boston University, Center for Psychiatric Rehabilitation.Carkhuff, R. R., & Berenson, B. G. (1976). Teaching as treatment: An introduction to counseling and psychotherapy. Amherst, MA: Human Resource Development Press.

Beginning (Review)Designed to promote:• Continuity and follow up from the previous lesson, and• The process of engaging, orienting and motivating learners about the topic of the current

lesson• Promote involvement and acknowledge strengths

There are five steps involvedSTEP 1: Review of important points from previous lesson STEP 2: Review of Action StepSTEP 3: Review of participants’ current knowledge of and experience with the current topicSTEP 4: Review of participants’ understanding of the importance of the current topicSTEP 5: Overview of the current learning process (establish the agenda)

Beginning (The Overview)

•What is it? An introductory outline or “roadmap” of the material to be covered.

•Why is it important? It focuses participants on the main points of the learning experience and promotes a sense of safety and predictability by explaining expectations and responsibilities.

Examples of Group Facilitator Language in the Beginning of a Group

Review and Overview• ASK: What was one of the important points you took away from the last meeting?

• CHECK: Did you choose to complete an ACTION STEP? What was your

experience?

• STATE: Today we are starting/continuing a topic called __that starts on page___ of

your workbook/handout

• STATE: The plan for today includes reading and discussing important information on

the topic of_______ , completing a let’s get personal checklist and exploring follow

up Action Steps

• ASK: Let’s begin by discussing what you already know about this topic. What

experience you have had with this topic. What does the topic mean to you?

• ASK: Why is this topic important? IN what way might this topic be helpful to you?

The Middle of a Group: Presentation andExercise

• Important Information (TELL)• Introduces the topic: What it is? Why it’s important?

• Let’s Get Personal (SHOW and DO) • Opportunity for participants to visualize possibilities (show) and

have guidance on how one may connect to the topic in their own personalized manner (do)• Helps to identify strengths and areas to consider improving

• Discussion Points• Promotes sharing and expression of ideas, questions and reactions

Examples of Group Facilitator LanguagePresentation TELL-SHOW-DO• ASK: Who would like to begin reading the important information in this lesson.

• ASK: Now that we’ve read and discussed the important information, do you have any questions? Is anything confusing or hard to understand?

• STATE: One of the goals of the lesson/class is to make sure you get a chance to relate the topic to your life. Please take sometime to complete the Let’s Get Personal checklist and record or keep in mind your responses.

• STATE: It may be helpful for us to go through the first several items together to make sure the Let’s Get Personal Checklist is clear. Afterwards you will have an opportunity to discuss what you have learned.

EXERCISE (Action Step for continued learning)• What is it? An invitation and guide to assist participants in considering taking an action

step based on their learning. The Action Step included in each lesson offers participants an opportunity to:• Continue gathering information and gaining more understanding of the topic with

others or by exploring additional sources of information

• Apply what was learned in the lesson to more effectively manage the Covid-19 crisis• Takes steps towards a goal that the stay at home situation might offer a person an

opportunity to pursue. • A twist on homework assignments - the action step

• Not required• Not given by the “teacher”• The person chooses to take an action step

• High value placed on identifying areas of interest.

Example of Group Facilitator Language

EXERCISE• STATE: One of the important goals of this meeting is to give you the opportunity to

continue your learning and apply what you have learned in a way that works for you.

ACTION STEP• ASK: The lesson provides a guide that you may choose to use to decide on an action

step in the coming week

• STATE: The Action Step is not homework or an assignment, it is an opportunity for you to build on your learning if that works for you. You might find it helpful to consider action steps to get the most out of theses lessons.

EXERCISE: ACTION STEP PLANNING GUIDE

• Each lesson ends with offering the person an opportunity to continue their learning and/or apply what they have learned.• This may involve

• Re-reading the information on one’s own or with others• Monitoring your experience over a period of time• Trying out new behaviors to better address one’s needs

• Coping strategies• Relaxation techniques

The SUMMARY: How to End a Group• The ending of a meeting corresponds to the Summary component of a

R.O.P.E.S. teaching process.• What is it? A very quick review of the material covered in the session and

participants’ reactions to the material.• Gather feedback: Was the lesson……

• Helpful• Personally meaningful and relevant• Clear

• Why is it important? It reinforces learning, assesses participants’ understanding and gathers important feedback.• It ends with an Affirmation – “You might find it helpful to affirm (state out

loud) your ability and motivation to apply what you have learned to improve your health and wellbeing.”

Summary: Example of Facilitator Language

• ASK: What was one main point you took from today’s lesson? What idea was helpful to you?

• ASK: How do you feel about today’s meeting? Was the topic interesting and helpful or not? Did we go too fast, too slow or just right? How well did we work together today?

• STATE: I’d like to share my thoughts about today’s meeting.

NOTE: place emphasis on positive feedback and reinforcement for all efforts and behaviors that contributed to the session.

WHERE TO GET THE WSM-COVID19 LESSONS

https://practiceinnovations.org/Portals/0/QuickLinks/WSM-COVID19%20FINAL%20April%202020.pdf?ver=2020-05-04-081535-450

https://www.ctacny.org

SUMMARY• These lessons are tools to be used flexibly by both the practitioner

and client• Practitioner should feel free to modify the materials and approach

based on his/her knowledge of the clients expressed needs and preferences• Start with the person and not with the practice.• Shared decision making guides the entire process• Action steps, even very small ones, really matters (person goes at

their own pace and in their own way)

Q&A• Submit your questions to “ALL PANELISTS” in the chat box!

• The slides, recording, and lessons will be posted on ctacny.org within 2-3 business days.

Upcoming CTAC Events

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Family Treatment During the COVID-19 Pandemic Pt 2: The Practice ReportTuesday, May 12th at 12 PM

Education During COVID-19: What You Need to Know to Protect Students’ Rights Friday, May 15th at 11 AM

Best Practices for Supporting Kincare Families in Community Settings Tuesday, May 19th at 12 PM