[NYAPRS Enews] CRR: Harding Consider PROS A Key Turning Point

[Harvey Rosenthal]

NYAPRS Note: The following comes from Dr. Courtenay Harding, noted recovery researcher and director of the Center for Rehabilitation and Recovery, a program of the Coaliton for Behavioral Health Agencies which provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects (http://www.coalitionny.org/the_center). 

 

Turning Points

By Courtenay M. Harding, PhD  Center for Rehabilitation and Recovery  March 5, 2010

 

"A long time ago in a galaxy far, far away," (1) a young psychiatrist, named George Brooks, was flummoxed. He had received one of the first Smith Klein French fellowships to study the effects of the new drug called Thorazine.  He put all the so-called hopeless cases on it and lo and behold 178 profoundly ill people became well enough to leave the backwards of Vermont State Hospital. However there was a group of other such people who only had a modest response after 2 ½ years of trying the medication. He didn't know what to do. He went back to those wards and admitted it. He said: "What do you need to get out of here because I do not know?" Thus began an amazing collaboration between staff and patients. Together, they invented most of modern rehabilitation and that was 1955! (2)

The message here is two-fold. First, we have known for a long time about a recovery model. It is 55 years old! We are now trying to transfer it to New York as the philosophical underpinning for PROS (Personalized Recovery Oriented Services) programs. Secondly, these Vermonters pioneered this collaborative, level playing field approach and it worked. It was an enormously creative and bold joint endeavor by both staff and patients. It was a turning point in mental health care. We now have that opportunity again to fully operationalize a recovery model within PROS, but it is very anxiety provoking.

There is no question that this change is unnerving. Recently, the Center's Associate Director, Aaron Vieira, LMSW, led a meeting with agency leaders about managing the human side of the PROS conversion process. Together, they generated a long and varied list of fears that people often experience when confronting organizational change. These included fears of the unknown, of being temporarily incompetent, of being judged and punished for this temporary incompetence, of losing status and professional identity. There are also fears of being marginalized by colleagues who are opposed to change. It is worth noting that consumers share many of the same fears. Everyone agreed that these underlying concerns need to be addressed if staff and consumers are to work together to create a stronger, recovery-based culture in a PROS program. Such a culture would provide the enhanced support that consumers need to achieve their life goals.

Developing a person-centered, recovery-oriented culture must begin in the planning and implementation phases of PROS. Program leaders would do well to avoid using authoritarian and micromanaging methods during the PROS conversion process. That is because these approaches simply do not work. Authoritarianism provokes covert resistance. Micromanagement is very time consuming and disrespectful. It also stifles creativity and produces only incremental change. Fortunately, as Aaron pointed out, there are organizational strategies that do work. These include: comprehensive and transparent communications about the need to convert to PROS, presentation of the benefits of the new program design (e.g. reclaiming more lives), development of a clear vision and plan for PROS conversion, involvement of all levels of staff and consumers in the process, creation of a supportive learning environment, and regular celebrations of agency, staff and consumers achievements. These change strategies are supported by substantial research in organizational development as well as the direct experience of agency leaders running successful PROS programs in early adopter counties.

The work of starting PROS programs in New York City will be hard at first. There will be fears and resistance pushing back against change. Everyone thinks that they are already using a "recovery model" so why change? However, PROS is actually a real cultural shift from the "one up and one down approach" used by many providers as they were trained by applying the "doing things to or for others" who are struggling. Just as George Brooks did, one has to admit that we do not know everything and ask "What do you need?" Then, one begins the process of working together, each pooling the knowledge between the two partners to make a plan and celebrate every little gain. 

The new system is being built on the strengths of everyone at the table just as rehabilitation is built on strengths. The old system and current providers display a depth of knowledge and experience upon which the new one is founded. We are not throwing the baby out with the bath water and starting from scratch. We are putting on a new set of glasses with which to see the world, our jobs, and our customers. The recovery movement is going on around the world. This is another turning point in mental health care. A couple of months ago, I took our OMH Statewide Comprehensive Plan(3) to Beijing for their NIMH to consider in restructuring their own mental health system. Suddenly we are seeing all sorts of new possibilities, discovering new strengths, and perhaps New York will become the next place where people come to see how we did it!  

 

1) Lucas, G. Star Wars, 1977

2) Chittick, R.A., Brooks, G.W., Irons, F.S. and Deane, W.: The Vermont Story: Rehabilitation of Chronic Schizophrenic Patients.  Burlington, VT., Queen City Printers, 1961

3) New York State Office of Mental Health: Statewide Comprehensive Plan (2009-2013), Albany, NY, Oct 1, 2009.

 

http://www.coalitionny.org/the_center/ 

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