| What Field Sites Have To Say About Their Initial Work With The Intentional Care Approach
The Village Integrated Services Agency — Long Beach, CA
Summer 2001
At the Village, we have always depended on our management team to provide leadership and guidance to our direct service staff in how to deliver high quality psychosocial, recovery-based services. We take pride in the fact that we have been able to create an agency culture that promotes the recovery of our members and empowers both our staff and our members. However, as we have grown as an agency it has become increasingly difficult for our management staff to provide the same level of individualized, "hands on" training that they have given in the past. Over the past few years we have struggled with what we refer to as "culture slippage." By this I mean the tendency for new staff, as they are hired into the program, to find it difficult to provide recovery-based services because they have not been part of the creation of the agency culture of service delivery and do not understand the values and philosophy underlying it.
I believe that the Intentional Care Approach will be a large part of the solution to this problem. While they are not a 100% overlap with the way we provide services at the Village, the guidelines are the closest written statement that I have seen of standards to which, as an agency, we would like to hold ourselves accountable. They provide practical day-to-day examples of the situations that our staff face as they go about their work and provide a consistent rationale for responding with a recovery-based approach. I see the practice guidelines as a way to introduce new staff to what we would like our agency culture to be, as well as providing a refresher for some of our older staff. The guidelines will give us all a common basis for discussion as we try to improve the services we provide.
Riverbend Community Mental Health Center — Concord, NH
Summer 2001
The Intentional Care Performance Standards are intended to impact the culture of the organization by providing staff with performance expectations that will improve the quality of relationships and work with consumers. Riverbend has espoused a recovery philosophy for several years. This foundation keeps us interested in taking the next steps forward in practice. As with many other mental health organizations, we have a staff turnover rate that is higher than what we wish. That means the Intentional Care Performance Standards can help us achieve our mission both by retaining staff who see this project as an opportunity and by training new staff who come from other work settings or educational institutions where recovery practice has not been explicitly encouraged.
Clubhouse of Suffolk — Ronkonkoma, NY
Summer 2001
Although we are just getting started with the implementation of the project, we have already made use of the Standards in the "Professional Boundaries" section and the standard of "Role Strain" in the "Role of the Direct Service Worker." These Standards were referred to while counseling a new staff member on an instance of inappropriate behavior. It was brought to our attention that this new staff member had engaged in a boundary violation with a new clubhouse member, who had come forward with concerns regarding this staff member's conduct in their relationship. The supervisor was able to utilize the Performance Standards as a backup to our existing personnel policies on appropriate staff conduct. The written Standards served as both an expectation and a reference for future conduct, and provided a template for outlining the corrective action taken.
Clinical Services/PACT — Winnebago Wisconsin
Summer 2001
Front-line staff were regularly finding themselves struggling with and questioning whether they were really following the new "vision" of recovery and empowerment in their everyday clinical practice. Disagreements arose frequently as to what these concepts meant and what their actual implications were for how staff should interact with their clients (e.g. How do you involve clients in treatment planning when they don't even believe they need treatment? How do you empower clients to be in charge of their own lives when we are in the position of having to involuntarily commit them, force them to take medications, give control of their money to payees, etc.?). The Vision Group thus decided to bring in a national consultant to help us with these issues.
Dr. Pat Deegan eventually visited us in May of 1998. She gave an evening talk to our consumers, spent an entire day with our supervisory and administrative staff consulting to us about recovery and empowerment in practice, and met with our front-line staff to answer their practical questions about these issues. The outcome of this visit was the proposal for an ongoing series of meetings aimed at developing "performance standards" to be used to guide staff in operationalizing the concepts of recovery and empowerment. She identified a series of domains for which standards could be developed, summarized for us how the overall process would work, and gave us a sample of a performance standard she had developed in her consultation to another agency.
Since then the long-term teams have been working on their own "performance standards" within areas previously identified. They have thus developed performance standards in the area of client's choosing to take or not take medications, choosing their own case manager, and choosing to use alcohol even when that is viewed negatively by treatment staff. They have also developed a performance standard relative to respecting consumer's decisions to be discharged from services and relative to consumers giving gifts to staff.
Regarding the Intentional Care Approach that has been made available to us as a part of this project, our general plan is to slowly introduce them to the staff of the above mentioned teams while teaching them to use them as "tools" in their daily work, i.e. by regularly referring back to those standards to see how they might help us resolve troublesome issues, by using them in individual supervision sessions to help staff think through difficult situations they are facing with the clients they serve, etc. In this process we fully expect to refine these standards to more closely fit our unique programs and to incorporate into those standards new things that we learn. We are hoping that the performance standards that we'd already started developing internally can be integrated into these new standards and that at some point we will be able to have a standing document that will become the "official" standard that all staff from our teams will be expected to strive towards.
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