| A | B |
|---|
| Actions during intervention stage of PsyR | Offering Direct Skills Teaching; Offering skills use training; coordinating resources; Modifying resources |
| Direct Skills Teaching | Instructional plan to engage the client in activities to learn a skill and provide modeling and support during the entire process. Done during the intervention stage |
| Skills Use Programing | Assists the client in determining what obstacles are keeping him from successfully using skills, designing a plan to guide a client in using skills as desired in specific situations and providing support during the entire process. |
| Coordinating resources | Providing education about all options, services, programs and systems that are available working with the client to resolve any issues related to accessing resources and assist the client in choosing and maintaining specific resources that are most appropriate. |
| Modifying Resources | Modify resources to best meet the needs of the client by evaluating needed changes suggesting modifications for the client's consideration, working as a liaison to resources and facilitate the change offering training if needed. |
| Partial Hospitalization Movement | Also known as day hospital treatment refers to programs in which an individual spends part of a day in hospital or psychiatric center or clinic for treatment and part of a day usually the night at home. Initially was started to deal with limited space in hospital beds. Later recognized as a step away from institutionalization and towards community integration. Problems relate to tendency to focus on clients with milder symptoms and ignore more severe cases. Focus is placed on medication monitoring and different therapy options such as group to learn social interaction and leisure activities. Government regulations and funding problems are behind the trend to focus treatment on partial hospitalization. |
| Case Management | developed as a strategy to meet the needs of individuals living in the community and followed deinstitutionalization. Although its meaning can vary widely a generally accepted definition is any program or strategy that makes sure an individual gets all needed services in a timely, coordinated and cost effective manner. Focus on ensuring continuity of care, ease of access to services and programs, appropriate care from service agencies and finding the services that are most appropriate to the client's needs including financial needs. Develop a complete plan that involves determining needs, services and setting goals covering logistics for accessing the services making sure the individual receives with continued monitoring and analyzing if services are appropriate on a continuous basis by monitoring progress towards goals. |
| Clubhouse Movement | Started in 1940's as individuals left hospitals and sought out the support and companionship of others with mental illness. The natural gravitating to one another was a result of the stigma associated with them. Primarily were social groups but later evolved into a key factor in psychiatric rehab. Receive support and services from each other . Primary focus is on employment and how employment leads to confidence and independence. Fountain House in New York was the model. |
| Milieu Approach | Milieu is French for environment. The milieu therapy focuses on environment as the most important factor to treatment. Including cultural, social, physical are considered in designing a treatment plan. |
| Five Characteristics of Milieu Day Program | 1. clients should feel contained or managed by their environment. 2. The environment should feel supportive and uplifting. 3. Clients should experience a sense of acceptance and comfort in participating. 4. Structure is key to providing a sense of order without unexpected events and surprises. 5. the client should feel the environment personally confirms their value. Decreases anxiety and facilitates change. |
| Case Management in Rehabilitation Model | Case Manager's focus on helping individuals set and reach goals in specific settings of their choice. Plan is all encompassing. Begins with administration of function assessments in order to create a plan. Case manager supervises the client, supporting skills training and helping the client build a support system in his/her chosen environment. |
| Case Management in Personal Strengths Model | Also called the development-acquisition model, case managers work from two basic ideals: 1. success requires a person to utilize their own potential and access resources and 2. how a person behaves is determined by resources they have. From this perspective, case managers emphasize an individual's strengths rather than their overall makeup and guide them to develop their own problem solving skills and locate needed resources. This model is most in line with PsyR. |
| Double Trouble | Self help groups offering support and tiered programs to individuals with a dual diagnosis |
| Family Foster Care | A residential environment where one or more individuals with mental illness live with a family other than their own |
| Individual written rehabilitation plan(IWRP) | A formalized statement jointly developed between client an practioner that identifies the employment goals and resources needed to reach that goal |
| Psychoeducation | an intervention strategy in which the mental health practioners partners with the client's family to build a rehabilitation partnership and increase support for the client accomplished through communication, education, training and resource identification. |
| Reasonable Accommodations | changes in a work environment that help a worker with a disability function effectively but do not place excessive financial burden on employer or negatively impact the business function and performance. |
| Acute phase | the stage during which a disease is most noticeable and its symptoms are most extreme. |
| Biological treatment | a medical approach to addressing the disease or minimizing symptoms that utilizes medications |
| decompensation | when an individual cannot sustain a balanced state generally avoiding symptoms |
| depressive episode | a period of time of at least 14 days during which an individual experiences feeling of overwhelming sadness or loss for most or all of each day |
| delusions | inaccurate ideas that an individual refuses to give up even though there is no evidence to prove the ideas and possible even evidence to contradict it. |
| Health Belief Model | based on behavioral concept that a person will only change if there is incentive to do so. Person must feel s/he can facilitate the change and access the resources to change. An individual must be enlightened regarding the specific risks of not changing. Must be educated to the benefits of treatments |
| Three Guidelines of involuntary interventions | 1. Protection of people and property; 2. Mandates of treatment. 3. Orders stemming from legal actions. |
| Protection of people and property | covers actions and programs designed to protect the welfare of an individual and care for his property. Includes things such as Social Security Disability, legal trusts and guardianships. |
| Mandates on Treatment | Vary from state to state individuals may be forced to receive treatment such as hospitalization, medications and participation in therapy when released from residential treatment/ |
| Orders stemming from illegal actions | May have treatment or rehabilitation mandated as part of legal actions resulting from criminal charges, probation , parole. May be therapy, vocational training, medication compliance. |
| Manic episode | a period that can last a week or longer in which the individual experiences a raised or high mood |
| Empowerment | a sense of control over one's life built on elements of self-esteem, confidence in one's abilities, positive outlook and an active role in the present and future |
| Hallucinations | an individual senses the presence of sounds, objects or situations that are not there |
| Mixed episode | includes both manic and depressive episodes that alternate |
| residual phrase | the time after an acute phase of disease when symptoms subside or lessen |
| prodromal phrase | the time prior to the disease becomes full blown when an individual starts to experience difficulty functioning and symptoms appear and or increase. |
| Tuckerman's four stages of Group Development | 1. FORMING- group members maintain surface politeness and pretend to get along and agree 2. Storming-group members try to approach issues through sharing and become more honest even if it causes conflict. Individuals are challenging for group roles. 3. Norming - individuals are establishing trust through deciding what is ok in the group and how to behave. 4. Conforming or performing- Group dynamics become therapeutic and members benefit from each other to work on issues. |
| Kurt Lewin's group dynamics | 1. impact of democratic leadership- exhibited more cooperation, unity and friendly attitudes ; 2. interdependence of fate- when group members discovered their common goal or that their success depended upon each others success, groups were more productive. 3. interdependence- if one member cannot successfully complete a task without the help of another, productivity and success were increased. |
| Five steps of problem solving | 1. Problem orientation. 2. Defining the problem. 3. Generate multiple solutions. 4. Choose one solution. 5. Move on solution. |
| Problem Orientation | accepting the reality of an existing problem and determining that it is worth time to solve it. Important to get the right frame of mind finding confidence and power to overcome the problem |
| Defining the Problem | Gather information and considering it carefully to be sure the real problem is defined; if multiple problems- prioritize |
| Generate Solutions | Brainstorming about possible options and considering what past actions might be applicable with this problem |
| Narrow down Problem solutions | Use pros and cons lists and success likely hood to each solution |
| Moving forward on solution | monitor success of solution and back stepping to consider other options if necessary. |
| Eleven Principles of skill development by Cohen | 1. Behavior reinforcement that will apply to persons real life. 2. Make sure support is available . 3. Anyone providing support should know how to use rewards that motivate person. 4. Move away from extrinsic rewards helping the individual determine what inner motivation is. 5. Decrease dependence on reward behavior with gradual lengthen of time between rewards. 6. Give skills instruction in many different situations. 7. Instruct individuals how to monitor their own progress and reward themselves. 8. Create true understanding and deep learning by teaching clients the ideas or rules behind a skill. 9 Explain skills by giving instructions in variations of the same skill; 10. Give outside assignments of increasing difficulty.; 11. Emphasize self-determination by including an individual in making decisions. |
| Warning signs that may precede relapse in ddx. | Discontinuing meds; isolation; over confidence; significant relationship problems; major life stress; sudden onset of psychiatric symptoms; changes in appearance; refusal to deal with daily problems; establishing unrealistic goals. |
| Factors that effect group cohesion | 1. Commonality- if group members have in common, age, gender, medical conditions, they are more likely to cohesiveness. 2. Stability- cohesion increases over time when a group maintains the same members. Introduction of new members can impact cohesion. 3. Happiness- the level of happiness experienced with each other, impacts norms, and accomplishments. 4. Support/Leadership- external support and good leadership increases cohesion and then success. |
| Stress Vulnerability Model | Model offers a theory about the cause of mental illness being that individuals can be predisposed to mental illness through heredity. The illness then can be brought on by external factors such as death of loved one or major transitions like moving or marriage. Physical factors such as disease, traumatic injury or severe illness can also trigger the mental illness. Model suggests that an individual's reaction and response to triggers is influenced by support systems and personal coping skills. Strong personal coping skills and supportive environment can minimize illness when brought on. |
| Broker Model of Case Management | Also known as the generalist model approaches case management with focus of directing clients to other agencies to provide services instead of providing any service themselves. Case managers function as representatives and advocates as needed. Case Managers intervene only to resolve issues with other service providers. Does not have the quality level or personal relationships with clients. It does allow case manager to support more individuals than intensive case management. Case Mangers must know the community resources and gov't sources. Success depends on the quality of services of providers. |
| Principles that guide skill development interventions | targeting skills and interventions of client's choice; positive and supportive environment during training process; Give client support that he needs in the target environment; Use rewards in skill development process with slow decline in reward usage as skills progress; Provide deep understanding of skills as related to rules and beliefs of skill; Provide practice opportunities outside instruction with increasing levels of difficulty; help client understand how to value internal rewards. |
| Steps in client practioner collaboration that promotes client self help initiatives | 1. Staff encouragement of social interaction of clients; 2. increasing client involvement in their own treatment; 3. encourage openness and even rebellion among clients about their situations. Encourage clients to express discontent and then solutions without personalization by staff; 4. Roles change as clients assume greater responsibility and take on meeting with each other without staff.; 5. Clients take the step of formally created self help without staff but supported by staff. |
| Assertive Community Treatment or Training for Community Living | Approach that seeks to supply all the support and services an individual may need. Created as an approach to psychiatric rehabilitation with emphasis on keeping clients from rehospitalization. TCL starts with an individual plan for each client. Services are provided by a team of experts in every area from medical care and counseling to vocational training and are offered to the client at home work school or leisure. Staff focus on providing support in any area that is likely to precipitate a setback; support extends from ensuring basic services to support of placements, medication monitoring, counseling and 24 hour crisis beds. |
| Reasons that medications fail to treat mental illness | Irregular adherence by client to medication; severe physical side effects; tolerance reducing efficacy; insufficient duration; failure to monitor benefits and side effects; failure to prescribe most effective medication; failure to adjust medications to prevent discontinuing; negative side effects of drug interaction with other meds. |
| MICA and impact of self help groups with MICA clients | Mentally Ill substance abuser- because of lack of fit in traditional groups such as AA or NA, new groups such as double trouble groups evolved. Follow AA and NA but promote adherence to medication plans and practice greater acceptance of a variety of psychiatric symptoms. |
| Characteristics of supported employment | Client must be an active participant in job search and job selection; Enough time must be allowed for a client to choose job; extensive selections of jobs and job categories are necessary for clients to find one that they are best suited; Places of employment must offer growth, promotion and career op[opportunities instead of transitional or basic level jobs; All workplace members need adequate training knowledge about mental illness so that the client is not ostracized or alienated and can be productive; Support should be available at the place of employment and outside of work if needed. |
| General characteristics of staff physical location and activities in PsyR day program | training in the psyr field; social services; human behavior; all levels of education; Physical space should be big enough to accommodate numerous acti9vities in a single space; environment should be normal and safe and easy to get to with public transportation; Program activities should include job coaching; training; social skills training; medication education; recreational activities; education opportunities. |
| Characteristics of Clients participating in day program | Diagnosed with major mental illness and not a danger to self or others. Highly functional clients are not appropriate as this is not the least restrictive environment for them. Past hospitalization and in need of training. |
| Relapse Prevention Strategies for DDx | Accessing services of self help organizations; focusing on strengths and weaknesses; (weaknesses- triggers); Connections with others whom are successful; Opportunities to help others builds confidence and strength in stability. |
| Current consensus of effectiveness of PsyR programs | Day programs are preferable to hospitalization decreasing stigma and difficult transitions back to community; programs allow normal lives while at same time decreasing burden on families; Research show that day programs with combo medications significantly reduces hospitalization and is cheaper than hospitalization. Research shows that all programs are not effective and one important factor is tailoring the program to individual needs of clients. |
| Principles of mental health courts available in some states | Courts that recognize the role of mental illness in crimes and seek to reduce repeat offenses by mandating participation in programs. The courts develop plans for clients. Defendants might receive less stringent punishments if completing programs. Individuals are held accountable through judicial monitoring and conditions can change as warranted. |
| Strategies to encourage mediation maintence | Medication regimes should be simple; should limit number of medications; closely monitor side effects; avoid long term nature of treatment; enlist support of family and caregivers; provide referrals to peer support. |
