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Transformation can happen anywhere

July 1, 2006
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If a state hospital can do it, so can your organization

One of the most interesting things about service transformation is that it can happen anywhere. It can creep into some of the most rigid, highly regulated settings and shift the foundation of what we believe to be unchangeable.

Take the concept of recovery, for instance. Themental health system has not been designed to facilitate recovery because recovery from serious mental illness was/nt discussed until recently. Today, conversations about recovery can be overheard in the hallways of nearly any behavioral health organization. Program directors are scrambling to understand and incorporate recovery concepts; researchers are testing recovery practices; accreditation bodies are including recovery principles and practices in their protocols; and program evaluators are measuring recovery outcomes. Now that's transformation!

Conventional wisdom implies that recovery is here to stay. The tipping point has been reached. Recovery is an idea whose time has come, and it requires a fundamental shift in the way we talk, therapeutic relationships' power base and, in general, the way we conduct our daily business.

So how much do existing projects and programs need to change to incorporate recovery-based principles and practices? Noted recovery researcher William A. Anthony, PhD, offers some perspective: “People do not feel in charge of their recovery if they are not choosing what they want to try to do. This sounds like common sense, but common sense has not always been that common in the mental health field.”

Some places are struggling against incredible odds to use recovery practices. Take Arizona State Hospital. Superintendent John Cooper is committed to developing recovery opportunities and environments, but he faces daunting challenges. For starters, the hospital is highly regulated by agencies such as the Centers for Medicare and Medicaid Services, state licensing bodies, and accreditation bodies—many of these organizations have yet to develop a recovery focus.

Also keep in mind that most, if not all, state hospitals have many referrals from the judicial system, adding another set of forensic and civil restrictions and requirements (including involuntary treatments). In many cases the courts, guardians, or security review boards make key decisions. Perhaps in many circumstances, administrators don't have any more decision-making power than the people they are trying to serve.

To help make recovery a reality, Cooper decided to partner with META Services, Inc., a local nonprofit behavioral health company nationally known for its recovery work. Cooper asked META to train a few of his forensic “guests” in using the Wellness Recovery Action Plan (WRAP). WRAP, developed by Mary Ellen Copeland, MS, MA, is a process that:

  1. guides people through identifying who they are when well, what their triggers and early warning signs are, and what works best for them in crisis situations; and

  2. prompts and offers suggestions for people to make plans for each of their issues to diminish the difficulties they are having managing symptoms and troubling situations.

Thus, WRAP has a profound effect on a person's ability to recover.

When the WRAP training was completed, the hospital and META were impressed by the trainees' enthusiasm and their motivation to teach others in the hospital how to use it. The partnership decided to have the trainees formally teach WRAP to other hospital guests. As Cooper's staff started to look for a way to make this happen, META suggested hiring the trainees as long as they completed META's 70-hour Peer Employment Training.

Unfortunately, the forensic patients were not allowed to leave the hospital grounds to participate in the training. While this seemed incredulous to META staff, it seemed like business as usual to the hospital personnel. This could have been a point at which the partnership unraveled, since each party had its own way of looking at the circumstances, but they dug in and began to look for a way around the obstacles.

After several weeks of looking at alternatives, a potential solution came to mind: Was there a place on the hospital's grounds where META could deliver the Peer Employment class? Cooper's staff didn't think so, but eventually they found a space for a classroom.

While this was a real breakthrough, the joy was dampened by the next problem. Tuition for META's Peer Employment Training classes was routinely covered through a partnership META had with the state Rehabilitation Services Administration (RSA). RSA was a great partner, and it was through its financial and moral support that peer training became a reality in Arizona. RSA was solidly behind the plan to extend the peer training to the state hospital guests, but RSA was not able to fund some students' tuition for a variety of reasons. Without RSA's financial support, the plan seemed dead in the water.

Then META considered another solution: What if students from the community could take the class on hospital grounds? This would allow enough reimbursable students to cover most of the class's cost.

When the community students heard about our dilemma, they jumped to the rescue. They were willing to venture behind the hospital's two locked gates, even though as one of them put it, “This freaks me out!” Some had been in state hospitals before, without the opportunity to leave at the end of the day. They were concerned that painful memories might be triggered. But they were willing to take the chance to allow students from the state hospital to participate.