Creating Communities Of Wellness: Strategic Planning For Personal And Professional Well-being

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Copyright Category: Publications and Books
Type of Work: Literary
Copyright Holder: Margaret J. Park
Year Published / Made Public in: 2012
Date Added to Copyright Register: 04-Nov-2012 21:00
Last updated: 30-Jul-2013 14:01

Literary Copyright Work Details:

Creating Communities of Wellness (November 4, 2012

The contextual framework for this training is the 25 year life-expectancy disparity for those who receive services in our Community Mental Health Centers (NASMHPD Medical Directors Council Papers and Publications, Morbidity and Mortality in People with Serious Mental Illnesses, 2006, Measurement of Health Status for People with Serious Mental Illnesses, 2008, http://nasmhpd.org/publicationsmeddir.cfm )

Between 30% and 40% of the illnesses that result in premature death are from suicides and accidents That leaves between 60% and 70% of early deaths caused by preventable and treatable illnesses (NASMHPD, Parks, et al., 2006). The epidemics in the United States of diabetes, heart disease, and obesity are much more prevalent in people with diagnoses of serious mental illness (SMI defined as psychotic disorders, major mood disorders and borderline personality disorder). 

Other factors that also contribute to these mortality and morbidity statistics are the broad-based effects of poverty on nutrition and access to gyms and parks, the social isolation that is common in the current behavioral health system and stigma and discrimination that occurs in the health field.  

Life styles changes for people with SMI are challenging but are not impossible. It will take the combination of acceptance and personal determination that is a hallmark of recovery as well as a service system that can adjust in effective ways to plan, implement, study, and transform service delivery within a new culture that is centered in recovery and wellness instead of the stabilization of symptoms, medication maintenance, and decreasing hospitalizations.
The wellness approach to recovery is based in positive changes that support the whole person’s mental, physical, spiritual, and social health.  This renewed focus on strengths, positive change, and the hope of recovery contributes to an overall sense of well-being.  The wellness perspective within a positive psychology approach to serious mental illness may do more to promote the recovery paradigm than any other single concept.  

The recovery principles provide the philosophy.  The wellness dimensions provide the key to operationalizing that philosophy.

Project Goals & Objectives
We are a culture in which the obesity epidemic is growing for all sectors of society. Type-2 diabetes is at levels never before seen and occurring at age levels never before imagined. Provider staffs that are comfortable talking about diet, exercise, spirituality and intimate relationships, and smoking cessation are much more likely to be able to coach others comfortably. 

This training for those in recovery who receive community mental health service through Single Point of Accountability case management and staff at all levels of care will focus on implementing change for individuals and the systems that service them through proven methods that have helped millions to recover lives lost to addiction and other chronic conditions considered too intractable to merit hope. 

The goal of the training is to create an environment in which staff and service recipients can be comfortable talking about what they want to change and then working together with concrete tools to increase one area of physical health or other area of well-being at a time. 


The training has three parts:
1. The first is the explication of the morbidity and mortality statistics in simple but straight forward science.  Care is taken to make language and concepts available at a middle school level.  Plenty of opportunity for processing this information is provided by the presenter. 
2. Secondly, a 6-step strategic plan comes in a simple handout to be used in pairs.  Participants choose one goal in one dimension of wellness to try out. The strategic plan for change can be used over and over again for any desire change. Special emphasis is placed in helping people to choose attainable and reasonable goals within reasonable time frames. The psychology behind breaking bad habits that we have learned from this addictions field is reframed to be applicable to any desired change in behavior. 
3. Finally, a 21-piece toolkit is available for consumers of services.  The table of contents of the toolkit is attached.

To accomplish this goal the project will meet the following learning objectives. All participants will:
• Objective 1:  Review the values and ethics behind the recovery and wellness based paradigms rooted in the core recovery principle of people living a full and meaningful life in the community of their choice
• Objective 2: Understand the synergistic effects and statistics of some psychotropic medication as side-effect are combined with poor  life-style
• Objective 2: Compare and contrast the stabilization and maintenance based paradigm of disease management with a recovery based paradigm based in personal, staff, community and systems strengths 
• Objective 3: Be able to define and illustrate positive psychology as it applies to wellness coaching. That is, reducing high risk behaviors by replacing with healthful behaviors using an addictions model.
• Objective 4:  Understand Motivational Interviewing and be able to use it and to help others use a complementary, person-centered “motivational inventory.”
• Objective 5: See physical health care providers as being members of the person’s team as it relates to service planning as well as treatment/recovery plans

Project Scope
 The scope of this project includes and excludes the following items:
 In Scope:
• The participants in this project are the Service Coordination Units involved in the Single Point of Accountability Initiative.
• The SCU director can include any staff or service recipients s/he would like to in the training and the post-training evaluation of the lecture, the worksheets, and toolkit. It is recommended that service coordinators, peer supporters, outpatient therapists, psychiatrist, residential, supported employment, and other staff include wellness goals in recovery and treatment plans. 
• Participants will be staff at all levels and those who receive mental health services at SPA SCUs at the discretion of the SCU Director or his or her designee. The inclusion of staff from across a broad range of services is encouraged in order to promote the creation of a “Community of Wellness” across the entire agency.
Out of Scope:
• Staff at mental health or substance abuse provider agencies not participating in the SPA project for this pilot.
• Service recipients and the staff who provide intellectual disability services.
• Family members of service recipients at this time in the sense of in-person training at the site.  Each participant will have the opportunity to name the person of their choice as primary support for their chosen strategic plan for change.  A Commitment Statement page is handed out as the conclusion of the training. The signature of a support person to serve as a witness is included. The training includes the suggestion that this can be a staff person, or at the service recipients desire, a family member or other significant other.
Deliverables of Project:
• Deliverable 1: Pre-training surveys for all who sign up for training to be sent according to the SCU director’s discretion.

• Deliverable 2:  Two-hour training: One hour of lecture with group discussion on the science of early mortality and premature morbidity. Ample time for processing is included in this hour.  The lecture is followed by 30 minutes of breaking into pairs or trios to work with the strategic plans for personal change handouts. The final 30 minutes is for questions and to review the wellness Toolkit materials

• Deliverable 3:  PowerPoint with slides handout

• Deliverable 4: Handouts for strategically planning for one behavioral change in one of the 8 dimensions of wellness (applicable to any behavioral change in the future)

• Deliverable 5: Handout for making a commitment to wellness with witness for peer, professional or family support

• Deliverable 6: Post-training evaluation on the training

• Deliverable 7: Post-training evaluation in 8 to 12 weeks to determine effectiveness.

• Deliverable 8: Wellness Toolkit from the Allegheny County Coalition for Recovery (ACCR), Quality Improvement Committee – table of contents attached

• Deliverable 9: List of References and tools for further wellness education

Creating Communities of Wellness: Strategic Planning for Personal and Professional Well-Being

The Creating Communities of Wellness workshop and the ACCR toolkit were developed separately. Both the toolkit and the workshop were developed to address the 25 year life expectancy disparity.

The Quality Improvement Committee of ACCR worked hard to make sure the toolkit was designed to be client-centered in order to give people on disability some tools to improve their physical health.

Knowledge, Attitudes, Beliefs and behaviors
Creating Communities of Wellness was written to increase the knowledge base of workshop attendees in the data surrounding the epidemic of chronic illness and premature aging while broadening the viewpoint within community mental health centers from symptom management to include the complement of a positive approach based in addictions psychology. Whereas the ACCR toolkit gives hands-on tools to clients; the purpose of Creating Communities of Wellness is to help both professionals and clients be equipped psychologically to make and sustain changes.

Creating Communities of Wellness begins with a review of the science and statistics on physical health based in the 25 life expectancy disparity. There will be many pictures for those who are not oriented to the written word. Ninety percent of the lecture component is not on the slides. The slides are illustrations and resources themselves.

The workshop is split into 3 parts.
1. The information based lecture with plenty of opportunities for questions and discussion
2. A break out time to pick a single goal and filter it the “strategic plan” that is based in addiction and positive psychology. It is actually a recovery plan but will not look familiar as a treatment plan.  The time we break into twos however is billable as planning if client and staff work together on the plan.
3. The third element is the passing out of the tool kits.  It would be lovely if we had a chance to look at some of the items.

Let’s compare & contrast a standard treatment plan and the CCW plan.

Most treatment plans follow something similar to this:
1. goal that is behaviorally based and
2. objectives that are service oriented that lead to behavior change (attend group on budgeting, discuss with therapist difficulties when visiting mother, talk to doctor about raising/lowering dose of medication),
3. the person responsible for taking action (medical necessity)
4. time frame for goal completion or the next review

The CCW Plan explained – psychological preparation.

1 Choose a goal—this is a goal based in any one of the 8 dimensions of wellness. (Ex: lose weight is the number one goal.  People need help in making a reasonable goal.  Two pounds a week is reasonable for someone who is going to eliminate all simple carbs and work out 6 days a week. Other common goals people choose are quitting smoking, reducing stress, eating “better”.    These are all fine but are too broad and not clear enough to facilitate positive successive approximations.  Think 28 days and think ODAT.  Think adding something positive instead of focusing on the negative. This is a wellness goal not a disease management goal. Disease management is an outcome of healthy life-style choices.  Losing weight focuses on the obesity.  Adding one cup of a green vegetable will likely result in weight lost (benefit) but be very easy to track and result in a sense of accomplishment and increased over all well-being.  

2 Define a desired benefit—often people need to start here and go back to setting a goal.  That’s fine. Be flexible. A desired benefit of losing 20 pounds is having more energy.  A benefit of eating one salad 5 times a week is a regulated appetite.  8 hours of sleep increases clarity of thought. There are many benefits to healthy choices. Let them tell you what they want out of the change.  Use motivational interviewing skills here. Resist the urge to tell them how much better they will fell after they lose 20 pounds. 

3 Identify personal & community strengths—This is two-part question. 
a. Personal strength is character traits and talents. What has worked in the past for goal achievement or behavior change? Yin/yang. Stubborn can be reframed as determined.  
b. Community strengths are the whole community-try not to use only your services.  Is there a YMCA, a park that is safe to walk around, a vegetable stand that takes Access cards, do they have a religious community or a social group that can help?

4. Identify potential barriers—where is the sabotage going to come from?  Prepare! 

5 Decide on method for tracking progress—calendar, notebook, scatter charts, line graph, the tools in the ACCR toolkit. Use peers and other staff for positive reinforcement.  We know positive reinforcement works.

6 Decide on rewards and reinforcements—learning theory and behavioral psychology has given us abundant studies on how behavior gets shaped.  People respond to positive reinforcement. Human behavior will change according to conditioning. We also know from many studies that punishment does not work well.

A final note:
Motivational interviewing works for wellness behaviors too.  MI studies have taught us that if we try to scare people into change the natural reaction is to emphasize the opposite. Debating doesn’t work. Pointing out the obvious doesn’t work.  Use a decisional balance rule or likert scale to help people work with their intention to change (Miller, Stephen Rollnick, Flaum, Prochaska, DiClemente). If unwanted behavior is not changing it is because it is somehow gaining a positive reinforcement. Work with your whole unit to find rewards: contests, wellness champion of the month, etc. Let clients and staff reinforce each other.

? Precontemplation-Before any decision is made to break one habit or take up a new desired behavior.
?  Contemplation- ambivalent, a little ‘yes’ a little ‘no’ at the same time
?  Preparation-this is what is missing from most New Year’s resolutions.  Beginning planning before implementing.  That’s called strategic planning
?  Action-O.D.A.T., small steps, K.I.S.S., start again.
?  Maintenance & relapse prevention-avoid & reward.




Literary Keywords/Search Tags:
Wellness, Mental Health, Physical Health, Spiritual Health, Community, Planning

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Submission Details: Literary Work submitted by Margaret J. Park from United States on 04-Nov-2012 21:00 (Last edited on 30-Jul-2013 14:01).
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Margaret J. Park Contact Details: Email: mjparkmdiv@aol.com Phone: 412-953-9885

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