2016 Recovery Workforce Summit: VA Innovation Fair

2016 Recovery Workforce Summit: VA Innovation Fair
 

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VA Innovation Fair, presented by VA PSR and Recovery Oriented Services Fellowship Program, will feature a number of display posters on innovative ideas and programs for people working within and/or receiving services from the VA system

Human trafficking: The role of the recovery oriented model in treatment of survivors.

Kathleen W. Gorman, OTD, OTR/L, Kendra Glasper, LMSW, and Stephen Peairson, LMSW

Human trafficking is the fastest growing criminal industry in the world. Research indicates that more than 30 million people are affected by human trafficking worldwide. Individuals at risk for trafficking include those with developmental and physical disabilities, at risk youth, and individuals with low self-esteem. Survivors experience physical, sexual, mental and/or emotional trauma that affect their ability to develop and function in society.  Recovery oriented practices utilize a holistic approach to address the needs of survivors. This poster will provide an overview of human trafficking, education about the needs of survivors, and opportunity for utilization of the recovery model.

Another Lens: A PhotoVoice Intervention for Recovering Veterans

Laura Coleman, RN; Jay Gorman, Ph.D.; Alison W. Hu, Ph.D.; Gervase Spurlin, LCSW

PhotoVoice is piloted at a large Veterans Affairs medical center. The goal of the PhotoVoice project is two-fold: promote self‐determination and empowerment in veterans living with serious mental illnesses (SMI) and bring about positive social change through photographic narratives (e.g., improve quality of services provided to veterans living with SMI). The poster will present the rationale and purpose of PhotoVoice, benefits of this person-centered, culturally-sensitive intervention, recruitment and implementation process, ways to promote interdisciplinary collaboration, and use of outcome measures to capture progress. Products from the project will be displayed in the poster.

Improving Clinical Care of Veterans Using a Recovery Oriented Framework

Crystal Randles, MSW, LCSWA; Ray Mangelsdorf, MSW, LCSWA; Eric Elbogen, PhD

Although a recovery orientation can be used to enhance clinical interventions for individuals with mental illness, there have been few investigations on a systems-level concerning whether training clinicians in recovery actually translates to changes in clinicians’ understanding and application of this framework.  For these reasons, we evaluated the effects of training on clinicians’ long-term knowledge about recovery.   We developed a brief presentation on recovery, a Peer Support Specialist’s story of recovery, and an application component for participants to conceptualize how they can incorporate recovery within their own practice.  Analysis will involve examining pre vs. post training scores on the Recovery Knowledge Inventory (RKI).  Implications of the results will be discussed.

Compassion Focused Therapy for Dual Recovery

David Scheid, MSW

Veterans in dual recovery from serious mental illness and substance use often experience shame, self-critical thoughts, and depression. In this project, I investigate the efficacy of an evidence-based practice called Compassion Focused Therapy to alleviate these experiences. Compassion Focused Therapy aims to increase self-compassion through mindfulness training, guided imagery, cognitive behavioral therapy, and expressive writing. Utilizing these interventions, I designed and implemented a 14-week group with eight Veterans in dual recovery. Although data collection is ongoing, preliminary results suggest that this is a promising approach; Veterans complete homework and actively participate in group discussions.

Community Integration and Transition for Veterans in Mental Health Recovery

Sonya Gomez, MS, CRC

Community integration is an essential part of recovery for individuals with serious mental illness (SMI). The Stepping Forward program was developed to promote community integration in Veterans by connecting them with community resources and volunteer opportunities as they prepare to transition out of a VA outpatient Psychosocial Rehabilitation and Recovery Center. This poster describes the challenges of transitioning Veterans with mental illness from intensive outpatient care to support their community of choice, based in part on a survey of VA providers.  It describes the development of the Stepping Forward program, as informed by survey and qualitative data. 

Promoting Shared Decision-Making between Veterans and Mental Health Care Providers

Linda Nwoga, PhD

Through shared decision-making (SDM), mental health consumers and providers collaborate to determine a course of treatment. This approach supports recovery oriented care by focusing on person-centeredness, empowerment, self-direction, and respect. Its effectiveness was examined to confirm that consumers made informed decisions; and that providers were responsive to this collaboration.  A psychoeducation group for Veterans was implemented. Participants were given baseline measures that gathered demographics, assessed treatment satisfaction, perceived difficulties with a broad range of symptoms and problems, and empowerment. After receiving psychoeducation about shared decision-making, they then received a decision aid to help them become involved in decision-making with care providers. At the end of the group, measures given at baseline were re-administered to determine if the decision aids were effective and aided recovery.

Romantic Relationships:  A Recovery-Oriented Skills-based Approach for Achieving Relationship Goals

Lori Nabors, PsyD

Romantic relationships constitute an important area of functioning and living, but are often neglected in recovery-oriented treatments for individuals with serious mental illness (SMI).  We developed a 6 month integrative group that teaches individuals verbal and nonverbal skills related to starting and maintaining romantic relationships. Interventions include: social skills training, cognitive behavioral therapy, psychoeducation, community reintegration, and open group discussions. Skills and topics covered include: where to meet potential dates, what makes a successful relationship, dating with a mental health issue, types of affection, when and how to incorporate sex into your relationship, and ending a relationship.  Group effectiveness will be measured with pre- and post- assessments of self-esteem, stigma, intimacy attitudes and sexuality.

Promoting Skills Generalization in an Inpatient Setting to Facilitate Recovery

Melissa Mendoza, PsyD

I will present findings from an 8 month project to promote skills generalization, using a Dialectical Behavior Therapy (DBT) model across provider disciplines in a VA inpatient setting. An interdisciplinary Skills Task Force was created to optimize opportunities for Veteran consumers to learn new behaviors in relevant contexts as members of the inpatient milieu. Efforts included psychoeducation and skills training in group and individual sessions with Veterans, implemented collaboratively across disciplines. Pre/post program evaluation methodology was used to evaluate behavioral markers of skills use over time. This project explores how DBT Distress Tolerance skills can be adapted to promote recovery in Veteran populations and inform the culture of the milieu. Implications for informing systems change and promoting continuity of care will be presented.

Evidence-Based Anger Management: Incorporating Psychoeducation and Psychosocial Interventions

Michael Bernard Klein, PhD

Frequent, intense, and enduring anger is associated with various negative psychological, interpersonal, and health consequences – which may be a barrier to recovery and quality of life. This poster summarizes a project aimed to implement an individually-tailored, evidence-based anger management program consistent with psychiatric rehabilitation and recovery principles at VACHS, West Haven. This project utilized a multi-faceted approach: psychoeducation for staff in a range of VACHS programs, consultation for clinical teams, training for providers, and individual/group anger interventions for Veterans. The challenges faced during this project and ideas for future directions are discussed.

Being SMART about the Many Pathways to Recovery; Implementing 12 Step alternatives into aftercare plans for inpatient and outpatient addiction treatment programing at the VA

Miriam Shabazz, LLMSW

Most substance use treatment programs include a requirement of attending AA or NA (12 Step models) as a way of linking clients from both inpatient and outpatient treatment programs to community peer support resources for recovery. However, many can be off put by the 12 step programing’s basis in spiritual concepts, and relying on surrendering to a higher power. In recent years, the popularity of the many pathways to recovery approach has risen due to its secular approach. Disseminating information about supplemental or alternative options to 12 Step models increases the opportunities for recovery, peer support, and community reintegration. This poster explores implementing SMART Recovery and other recovery models into treatment programing as a viable alternative or supplemental option for peer based addiction focused peer support groups, and successful community reintegration.

Evidence-Based Psychotherapies (EBPs) for Post-Traumatic Stress Disorder (PTSD) and Community Re-integration

Miriam Shabazz LLMSW; Meaghan Stacy, PhD; Jason DeViva, PhD

This poster explores whether EBPs for PTSD, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), result in improved community re-integration for Veterans diagnosed with PTSD. As many Veterans return to civilian life and manage their PTSD symptoms, they will need to re-enter the workforce, resume family life, and reconnect with friends; however, it has been shown that this is a difficult process. This study investigates if effective PTSD treatments result in improved community reintegration. Additionally, it will allow for the comparison of CPT and PE with regard to community reintegration.

The use of equine-assisted therapy with Veterans in Mental Health Recovery

Anne Marie Craman, RN, and E. Alice Van Ormer, PhD

Equine-Assisted Therapy has served persons who experience psychiatric, intellectual and/or physical disabilities. Despite limited random controlled studies, particularly with adults with serious mental illness (SMI), anecdotal evidence indicates there is value in relationships between horses and humans.  This pilot program partnered with Strongwater Farm to offer Veterans with SMI the opportunity to develop social, psychomotor and cognitive skills by participating in mounted and unmounted activities. Veterans named their group the “Tuesday Freedom Riders”, met weekly in the community to identify goals, and created their own progress notes. This poster will describe this unique program in detail and present participants’ outcomes.

Animals as Icebreakers: Animal-Assisted Therapy for Veterans in Mental Health Recovery

Megan Pollock, Ph.D., Sonya Gomez, M.S., & Rebecca Williams, PhD

Animal-human interactions have been scientifically supported for enhanced well-being. Animal-based interventions for persons recovering from Schizophrenia have shown particular promise as a mediator to social interactions.  This project explores current literature on animal-based interventions for psychiatric illness and well-being, describes a recently initiated Animal Therapy in the Community pilot group at the San Diego VA, examines the psychosocial impact of Animal Therapy for persons diagnosed with Schizophrenia, and offers recommendations on future directions. A novel group was initiated wherein veterans attend animal organizations allowing animal interaction. The researchers employ a qualitative method of gathering data on quality of life, self-efficacy, and recovery goals.

Promoting person-centered care in institutional settings: Inter-professional training in the recovery model on a VA inpatient unit

Sarah Robertson, PsyD

The focus of this project is on bringing recovery principles to an inpatient setting through effective training methods for interdisciplinary staff. Given that inpatient care is often an initial or intermediary step in an individual’s recovery process, it is important to begin addressing a person’s care holistically from the start in order to facilitate movement toward recovery goals in the community. Pre and post training assessments were administered to demonstrate changes in recovery orientation as a result of the staff training.  The authors will review the design and implementation of the training, and address challenges to implementing person-centered and recovery-oriented programming and philosophy in these settings. The use of peer specialists will also be discussed as an integral aspect of this training.

Integrating Technology to Bolster Work Readiness: Changing “I Can’t” to “I Can”

Jay A. Gorman PhD

Preparing persons diagnosed with Serious Mental Illness (SMI) for vocational rehabilitation can require the coordination of multiple resources and interventions. This case study depicts a supplementary intervention utilizing YouTube to help intervene in the cycle of defeatist beliefs fueling negative symptoms, decrease employment-related anxiety, increase openness to a variety of work responsibilities, and increase job seeking behaviors. Integrating other forms of technology into work readiness preparation will also be discussed. Qualitative information and Subjective Units of Distress Scale (SUDS) ratings are used to capture this person’s vocational rehabilitation journey.

Addressing Barriers to Mental Health Care in a diverse geriatric Population by Examining Cultural views

Deina Nemiary, MD

Significant attention has been aimed at reducing the gap between the mental health needs and utilization of services. Unmet needs for treatment are found in underserved groups, such as the elderly, but especially older persons who are also immigrants, LGB and older persons of ethnic and racial minority backgrounds.    The goal of this poster is for participants to gain knowledge of the barriers to treatment seeking among older minority populations with mental illness and identifying the relevant issues that can impact mental health treatment engagement and retention for this particular population. To improve access to mental health care, mental health providers must be cognizant of these barriers to be able to better engage their patients in services and programs available for them and to be able to better promote participation in mental health treatments.

Barriers to Adherence to Diabetes Treatment Guidelines for Homeless Veterans: A case series study

Deina Nemiary, MD

Homeless Veterans with mental health conditions have a higher prevalence of diabetes but are less likely to receive laboratory tests for diabetes monitoring and screening complications. These patients are at a higher risk of hospitalizations for diabetes complications and experience not only a higher diabetes mortality but also a higher all –cause mortality.  Detailed attention to patient education and self-management is needed.     The authors will assess the rate of adherence of a group of diabetic homeless Veterans to the National Health Care for Homeless Council (NHCHC) and the American Diabetes Association (ADA) guidelines.  3-6 Veterans with diabetes and homelessness were interviewed in three different settings (shelter, transitional housing and recently housed) and followed for  1 -2months.  Adherance was measured by way of questionnaires, assessing clinical response (Hgb A1c), and ascertaining rates of refilling prescriptions.  The authors will identify barriers associated to adherence, and describe which parts of the guidelines were most challenging and which parts would improve patient outcomes.