EBD Blog

The University of Pennsylvania Collaborative on Community Integration has published its latest newsletter. To view this newsletter in fully formated form, click here. You can also find this issue and previous ones in the newsletter archive on the UPenn Collaborative Web site.

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COMMUNITY INTEGRATION NEWS
(Spring/Summer, 2008)

An e-Newsletter from the
UPENN COLLABORATIVE ON COMMUNITY INTEGRATION

THIS ISSUE: FOCUS ON PARENTING, PUBLICATIONS & RESOURCES

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*** CONTENTS ***
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ONLINE PARENTING SURVEY NEEDS PARTICIPANTS!
- Survey seeking to learn how to better support parents with psychiatric disabilities is looking for participants!

NEW COMMUNITY INTEGRATION TOOLS & RESOURCES… free downloads!
- In The Driver’s Seat: A Guide to Self-Directed Mental Health Care
- How Case Managers Can Help Behavioral Health Clients with Parenting and Child Custody Issues
- Keeping Your Children or Getting Them Back!
- Additional Parenting Resources
- Key Resources for Action in Your Community

NEW INITIATIVES & REPORTS
- UPenn Collaborative Launches Community Integration Institute
- New UPenn Collaborative Report Focuses on Career Patterns of People with Serious Mental Illnesses

UPENN COLLABORATIVE PUBLICATION HIGHLIGHTS
- Brief review of several recent studies published by our faculty

IDENTIFYING UNIQUE COMMUNITY INTEGRATION EFFORTS, FEATURING
“STEPS OF LIFE”

UPENN COLLABORATOR IN THE NEWS: Katy Kaplan advocates for fairer legislative policies regarding parents with psychiatric disabilities.

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* ONLINE PARENTING SURVEY NEEDS PARTICIPANTS! *
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The UPenn Collaborative on Community Integration is conducting an online survey to learn more about how to better support parents with psychiatric disabilities. If you have children under the age of 18 and consider yourself a mental health consumers/survivor and/or a person in recovery with respect to your mental health, then we would be very interested in hearing from you. The survey will take about 10 to 15 minutes to complete. It is voluntary and anonymous. We will not ask for any identifying or contact information. Your responses will be useful in planning programs and designing services to better support parents. To complete the survey, please go to: http://www.upennrrtc.org/news/view.php?id=44 .

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* NEW COMMUNITY INTEGRATION TOOLS & RESOURCES *
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IN THE DRIVER’S SEAT: A GUIDE TO SELF-DIRECTED MENTAL HEALTH CARE -

People who rely on public mental health services should be directly involved in designing their own care plan. In what are termed self-directed care programs, individuals may choose from a wider array of services and supports than have traditionally been offered them. Further, they have the flexibility to spend some of the money allocated for their care in new ways, based on an individualized plan and budget. The Bazelon Center and the UPENN Collaborative have
produced a guide to help consumers and other advocates obtain policies that give consumers a primary role in their recovery planning and greater control over how resources are spent to meet their needs. Learn more at: http://www.upennrrtc.org/resources/view.php?tool_id=184
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PARENTING WITH A MENTAL ILLNESS SERIES - The University of Pennsylvania Collaborative on Community Integration is committed to reducing barriers and increasing supports for parents with psychiatric disabilities. Below are parenting resources and trainings that have been developed for parents, advocates and providers.

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* NEW! - HELPING BEHAVIORAL HEALTH CLIENTS with PARENTING & CHILD CUSTODY ISSUES *

This training tool kit is suitable for professional, educational and in-service training, as well as a personal resource and training guide. The tool kit:

- Provides guidance to assist parents who have lost custody or are in danger of losing custody of their children.

- Addresses key issues, including the dilemma of balancing the responsibility to develop an alliance with one’s clients and the responsibility/mandate to report child abuse or neglect.

- Contains important information and resources for helping adult clients in recovery from psychiatric disabilities successfully negotiate the stages of parenting.

Tool kit contains: Curriculum for a Half-Day Training Seminar,  PowerPoint Presentation, Small Group Practice Sheets, Resources and Hand-outs. For more information or to download, please see: http://www.upennrrtc.org/resources/view.php?tool_id=185

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* NEW! - KEEPING YOUR CHILDREN OR GETTING THEM BACK*

This new training tool educates parents in recovery from psychiatric disabilities about child abuse laws and the child protective service system. Includes:
- PowerPoint presentation
- Focus group results about parent preferences for learning about child abuse laws and dealing with child protective services

Follow link at: http://www.upennrrtc.org/resources/view.php?tool_id=128
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ADDITIONAL PARENTING RESOURCES CAN BE FOUND AT: http://www.upennrrtc.org/resources/list.php?catid=14

Please contact Katy Kaplan ( katykap _at_ mail.med.upenn.edu or 215-746-6713) for more information about the technical assistance and consultation available from the UPenn Collaborative.
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* KEY RESOURCES TO HELP YOU TAKE ACTION IN YOUR COMMUNITY *
We currently offer more than twenty Community Integration (CI) Tools that address a variety of topics and tell you how to get involved. Among them is our acclaimed “Parenting with a Mental Illness” series.
For a complete list of CI Tools, please click on: http://www.upennrrtc.org/resources/list.php?catid=6

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NEW INITIATIVES & REPORTS
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UPENN COLLABORATIVE LAUNCHES COMMUNITY INTEGRATION INSTITUTE

The UPenn Collaborative has recently embarked on a pilot for a new training vehicle on community integration. On April 8, 2008, the first session of a ten hour institute was held that includes the basics of community integration along with specific information and strategies on 5 domains including employment, education, self-determination, spirituality, and social roles. The curriculum for each domain is taught by Collaborative faculty who are experts in that area. Faculty members include Richard Baron, Arlene Solomon, Lauren Shawl, Katy Kaplan, and Bob Manrodt who provides trainings and consultation on Spirituality for the Commonwealth. The intent of this institute is to help staff develop and implement a plan to initiate change within their agency or organization.

Requirements for completion include an assessment of each participants program or agency, and the development and demonstration of a plan of action. Faculty provides technical assistance and feedback. The final session, scheduled for June 12, is a “show and tell” of what has been accomplished. These highlights will then be featured on this website. If you would like more information about the institute, contact Katy Kaplan at 215- 746-6713. We plan to offer this institute again in the near future.
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NEW COLLABORATIVE REPORT FOCUSES ON CAREER PATTERNS OF PEOPLE WITH SERIOUS MENTAL ILLNESSES

UPenn Collaborative staff member Richard Baron, M.S., has recently authored a report titled: The Past and Future Career Patterns Of People with Serious Mental Illnesses: A Qualitative Inquiry

Not much is known about the long-term career paths of people with serious mental illnesses, and neither policy makers nor program providers have sufficient information about the kinds of jobs people with mental illnesses have held in the past or the work patterns they have established following their participation in rehabilitation programs. This report begins to fill in the gaps and the study’s results challenge many misconceptions about the willingness and capacity of consumers to work. It provides an eye-opening assessment of consumers’ past experiences, current motivations, and future ambitions with regard to the competitive labor market, emphasizing that the long-term career patterns of people with serious mental illnesses may not be dramatically different from people without mental illnesses with whom they have worked. An important document for program planners, job coaches, and consumer advocates promoting employment as a key element in achieving community integration. Click on this link to access full report: http://www.upennrrtc.org/resources/view.php?tool_id=180

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PUBLICATION HIGHLIGHTS: Selected UPenn Collaborative publications examine a variety of community integration issues
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EDUCATION: ACCOMODATION AND SUPPORTS AMONG POST-SECONDARY STUDENTS

Salzer, Mark S; Wick, Lindsay C; Rogers, Joseph C. (2008). Familiarity With and Use of Accommodations and Supports among Postsecondary Students with Mental Illness. Psychiatric Services, 59 (4).

Many persons with serious mental illnesses are interested in pursuing postsecondary education. Accommodations can be essential, but limited research suggests that few formally seek accommodations. The purpose of this study was to examine whether students with mental illnesses are increasingly aware of, and utilize, accommodations and academic supports and to identify the supports that are most used and perceived to be most helpful. Current and former students received a significant amount of informal supports from instructors without going through disability offices. Encouraging students to utilize disability offices and greater attention to accommodation barriers may further increase support seeking. See http://www.upennrrtc.org/project/products/view.php?id=29 to download the full publication.
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HOUSING: ASSESSING RESIDENTIAL SEGREGATION

Metraux, Stephen; Caplan, Joel M; Klugman, Dutch; Hadley, Trevor R. (2007). Assessing Residential Segregation among Medicaid Recipients with Psychiatric Disability in Philadelphia. Journal of Community Psychology, 35(2).

This study assesses the extent of residential segregation among 15,246 people diagnosed with psychiatric disabilities and receiving Medicaid (MA) in Philadelphia, and an identically sized group of MA recipients serving as matched controls. Results indicate that localized areas in Philadelphia that showed distinct concentrations of persons with psychiatric disability, suggesting there may be a subgroup that is more at-risk for living in areas with elevated concentrations of persons with serious psychiatric disability. Download article at: http://www.upennrrtc.org/var/product/26-Assessing%20Residential%20Segregation.pdf
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EMPLOYMENT: PROMOTING JOB TENURE BY INTEGRATING NATURAL SUPPORTS AND SUPPORTED EDUCATION

Murphy, Ann A; Mullen, Michelle G; Spagnolo Amy B. (2005). Enhancing Individual Placement and Support: Promoting Job Tenure by Integrating Natural Supports and Supported Education. American Journal of Psychiatric Rehabilitation, 8:37-61.

Competitive employment represents a normalized and valued social role for adults in this culture. Individuals with psychiatric disabilities often desire this role and frequently express that employment is a goal in their recovery process. Despite this, they have historically had very low rates of competitive employment and when work is obtained, the employment tenure is alarmingly short. This article proposes the addition of two service enhancements to the most recognized Supported Employment (SE) model, Individual Placement and Support (IPS), -to increase job tenure. This article identifies the major limitation of the IPS model, short job tenure, and outlines the potential for the proposed service enhancements to address this limitation for people with psychiatric disabilities. Download article at: http://www.upennrrtc.org/project/products/view.php?id=28
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TREATMENT & RECOVERY: CATIE AND THE VALUE OF ATYPICAL ANTIPSYCHOTICS

Salzer, Mark S; Evans, Arthur C. (2006). CATIE and the Value of Atypical Antipsychotics in the Context of Creating a Recovery-Oriented Behavioral Health System. Administration and Policy in Mental Health and Mental Health Services Research 33:536–540.

This paper discusses the implications of clinical antipsychotic trials of intervention effectiveness (CATIE) findings within the context of an active recovery-oriented systems transformation effort of the Philadelphia behavioral health system. The authors argue that atypical antipsychotics should maintain an important role in a transformed system, but that symptom reduction and medication compliance should not remain the cornerstones of treatment services. The findings suggest that we need to better understand and positively influence the therapeutic relationship between consumers and providers as they relate to treatment participation and engagement. Psychotropic medications need to be discussed within the context of developing positive, empowering therapeutic relationships and offering psychosocial rehabilitation supports that together can enhance functional outcomes that individuals most desire. Examples of specific efforts to develop a CATIE-informed, recovery-oriented systems transformation are offered. Download article at: http://www.upennrrtc.org/var/product/22-Salzer-Evans%20CATIE%20article.pdf
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SOCIAL ROLES/PARENTING: INVOLVEMENT IN THE CHILD WELFARE SYSTEM

Park, Min Jung; Solomon, Phyllis; Mandell, David S. (2006). Involvement in the Child Welfare System Among Mothers With Serious Mental Illness. Psychiatric Services, 57 (4).
This study sought to determine the association between maternal schizophrenia and major affective disorders (serious mental illness) and child custody arrangements in a sample of Medicaid-eligible mothers. Analyses revealed that mothers with serious mental illness were almost three times as likely to have had involvement in the child welfare system or to have children who had an out-of-home placement. Read the entire article at: http://www.upennrrtc.org/project/products/view.php?id=23
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OLMSTEAD: EVIDENCE OF DECELERATING DEINSTITUTIONALIZATION AFTER 1999 OLMSTEAD DECISION

Salzer, Mark S; Kaplan, Katy; Atay, Joanne (2006). State Psychiatric Hospital Census After the 1999 Olmstead Decision: Evidence of Decelerating Deinstitutionalization. Psychiatric Services, 57 (10).

The Supreme Court ruled in the 1999 Olmstead decision that “unjustified isolation” of individuals with disabilities in institutions is a violation of the Americans with Disabilities Act. This study examined the extent to which state psychiatric hospital census across the United States has changed significantly post- Olmstead. Twenty years of national state hospital census data (1984–2003) were used to assess trends in the rate of declines from pre- to post-Olmstead periods. Steady declines in the hospital census nationally were found over all periods, with especially large decreases in the 1990s. However, rate of decline has slowed significantly during the post-Olmstead period. View entire article at: http://www.upennrrtc.org/project/products/view.php?id=21

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* HEALTH: UNDERSTANDING CONSUMER PREFERENCES FOR COMMUNICATION CHANNELS *

DiFranco, Evelina; Bressi, Sara K; Salzer, Mark S. (2006). Understanding Consumer Preferences for Communication Channels to Create Consumer-Directed Health Promotion Efforts in Psychiatric Rehabilitation Settings. Psychiatric Rehabilitation Journal, 29 (4).

People with serious mental illnesses experience increased rates of physical illnesses. Drop-in centers and psychosocial rehabilitation programs can serve as important settings for health promotion efforts, but such efforts should utilize communication strategies that are used by consumers and are perceived to be reliable. Implications for health promotion efforts are discussed. Click on following link to download article: http://www.upennrrtc.org/project/products/view.php?id=24

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UPENN COLLABORATIVE FEATURED PROGRAM FOR UNIQUE COMMUNITY INTEGRATION EFFORTS: “STEPS OF LIFE”
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The UPenn Collaborative on Community Integration has chosen STEPS OF LIFE as a featured program in our series that highlights progressive initiatives that address the barriers that face people with psychiatric disabilities as they seek to build meaningful lives in the community.

STEPS OF LIFE (SOL) Psychosocial Rehabilitation Recovery Center (PRRC) was named by the veterans/consumers it serves. STEPS OF LIFE is an acronym, which stands for Specialized T raining Empowering People with Social Skills Offering Freedom in Learning from each other, Involved and actively participating in groups, treatment and recovery; Finding hope, and Enriching our lives for the future. SOL serves veterans who have serious mental illnesses. The program, which is curriculum-based, is designed to teach the skills essential for defining and realizing the veterans’ self-chosen goals. Please read a full description of the program at: http://www.upennrrtc.org/news/view.php?id=37

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UPENN COLLABORATOR IN THE NEWS: Legislative Advocacy around Child Custody and Family Reunification Issues for Parents with Psychiatric Disabilities
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A primary focus for UPenn Collaborative Center Coordinator, Katy Kaplan, M.S.Ed., involves addressing barriers and developing supports for parents who have lost custody of their children on the basis of having a diagnosis of psychiatric disability. She is coordinating a team of UPenn collaborators who are working to change or eliminate language in state policies that discriminate against family reunification for such parents. This initiative is aimed at educating legislators in states with the most discriminatory policies about the importance of keeping families together. A model statute is being developed by Collaborative staff and will be offered to legislators as a guide for changing their state’s policies. The public is also being educated via a national press release on this issue. Katy has presented information on supporting parents with mental health disabilities in the following venues:

(June, 2008). What’s Important in Your Life? Why Supporting Parents Matters. 33rd annual Conference of the United States Psychiatric Rehabilitation Association. Chicago, IL.

(April, 2008). What You Need to Know About Supporting Parents with Psychiatric Disabilities. Winds of Change: Annual Regional Conference on Transforming Systems and Services for Parents Recovering from Mental Illness and their Children. Marlboro, MA.

(April, 2008). Protecting the Rights of Parents with Mental Illnesses by Targeting Discriminatory Legislation. Poster presented at Boston University’s State of the Science Conference. Boston, MA.

(March, 2008). Strategies for Supporting Parents with Psychiatric Disabilities in Neglect/TPR Cases. Neglect and Delinquency Practice Institute. University of the District of Columbia Law School, Washington, DC.

(February, 2008 & December, 2007 ). Supporting Parents with Psychiatric Disabilities: Keeping Families Together. Parents with Psychiatric Disabilities Regional Training Meeting. Long Island, NY and Albany, NY, respectively.

(December, 2007). Overview of Community Integration and Parenting with a Psychiatric
Disability. United States Psychiatric Rehabilitation Association’s National Web Conference on Parenting with a Psychiatric Disability.

(May, 2007). Overview of Community Integration and Parenting with a Psychiatric Disability. Moderated Mental Heath America’s Teleconference on Supporting Parents with Mental Illnesses.

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The Community Integration News is a Web-based publication of the
UPENN COLLABORATIVE ON COMMUNITY INTEGRATION

Mark Salzer, Ph.D.
Director

Lauren Rieser Shawl, M.S.
Publication Editor / Designer

Publication is funded by the National Institute on Disability and Rehabilitation Research
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