Interactive Staff Training: Rehabilitation Teams that Work

281 Pages·1997·7.01 MB·English

by  Patrick W. Corrigan, Stanley G. McCracken (auth.)

Interactive Staff Training
Rehabilitation Teams that Work
Plenum Series in Rehabilitation and Health
SERIES EDITORS
Michael Feuerstein
Uniformed Services University of the Health Sciences (USUHS)
Bethesda, Maryland
and
Anthony J. Goreczny
University of Indianapolis
Indianapolis, Indiana
HANDBOOK OF HEALTH AND REHABILITATION PSYCHOLOGY
Edited by Anthony]. Goreczny
INTERACTIVE STAFF TRAINING: Rehabilitation Teams that Work
Patrick W. Corrigan and Stanley G. McCracken
A Continuation Order Plan is available for this series. A continuation order will bring
delivery of each new volume immediately upon publication. Volumes are billed only
upon actual shipment. For further information please contact the publisher.
Interactive Staff Training
Rehabilitation Teams that Work
Patrick W. Corrigan and
Stanley G. McCracken
University of Chicago Center for Psychiatric Rehabilitation
Tinley Park, Illinois
Springer Science+Business Media, LLC
Library of Congress Cataloging-in-Publication Data
On file
ISBN 978-1-4899-0049-4 ISBN 978-1-4899-0047-0 (eBook)
DOI 10.1007/978-1-4899-0047-0
© Springer Science+Business Media New York 1997
Originally published by Plenum Press, New York in 1997
Softcover reprint of the hardcover 1st edition 1997
http://www.plenum.com
All rights reserved
10987654321
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise,
without written permission from the Publisher
To our parents
Lloyd and Eileen
-P.W.C.
Glenn and Evelyn
-S.G.M.
Preface
Individuals who have chosen mental health service as their life's vocation are one of the
most important resources for the rehabilitation of adults with severe mental illness.
Therefore, staff training and development strategies are essential for the evolution of
this resource into an effective workforce. Among other benefits, staff training should
help rehabilitation teams develop and implement innovative programs that address the
independent living needs of their clientele. Unfortunately, this goal has not been
realized in most real-world treatment settings. Despite the promise of the state of the
art, many of the research-tested strategies that make up psychiatric rehabilitation have
not moved out of the clinical lab in which they were developed to join the day-to-day
set of rehabilitation strategies that most professionals use.
Several factors might account for this shortfall. The agenda of institutional admin
istrators might not be supportive of innovative rehabilitation programs and the changes
they entail. Bureaucratic demands for documentation might distract line-level staff
members from initiating new programs. Restrictive rules of unions and labor contracts
might unintentionally prevent staff members from working together as a team to adopt
alternative strategies. Barriers like these must be addressed to free the rehabilitation
team to develop innovative programs.
Even if administrative barriers are diminished, some characteristics of staff mem
bers themselves will undermine the development and implementation of effective reha
bilitation programs. Some staff members lack basic knowledge about the principles and
skills that comprise various rehabilitation strategies. Lecture and classroom-based train
ing strategies will teach these staff members the fundamentals. Classes on the principles
of rehabilitation, functional assessment, skills training, assertive case management, and
vocational rehabilitation are common fare for the line-level clinician. Research on the
effects of classroom-based staff training yields good news and bad news. The good news
is that classroom-based training helps participating staff members increase their basic
knowledge about psychiatric rehabilitation. The bad news, however, is that increased
knowledge about rehabilitation does not necessarily facilitate meaningful change in
clinical behavior or the quality of care. Educating a single member of the team does not
change the rehabilitation program that is operated by all of his or her colleagues.
vii
viii Preface
Some staff members suffer burnout as a result of feeling burdened by caring for
adults with severe mental illness. Feelings such as emotional exhaustion and depersonal
ization tend to be greater in teams that lack any sense of collegial support. Effective
programs are the product of a close-knit team that receives a significant sense of
personal accomplishment from their work. Therefore, staff development efforts need to
be focused on building a team that works well together. This type of team can plan,
implement, and maintain effective interventions for their clientele. Such a team also
provides individual staff members with a sense of mastery and growth.
Classroom-based training in itself does not help team members work better to
gether. However, interventions developed by organizational psychologists-including
team building-might relieve some of the stressors that undermine the spirit of part
nership. Team-building interventions alone, although in the right direction, do not
appropriately focus staff energies on the essential goal: to develop teams that provide
quality psychosocial rehabilitation and that diminish staff exposure to stressors that lead
to burnout.
Addressing staff burden and lack of collegial support requires a change in the
paradigm that governs training and development. First, the focus of training needs to
move away from the individual learning in the classroom to the team functioning on
their home turf. Home turf might be an inpatient unit or sheltered workshop, a day
treatment program, a community residential program, a psychosocial clubhouse, a
specialty program for persons with mental illness and substance abuse, a job develop
ment program, or an assertive case management team. Second, the object of training
needs to change from teaching staff how to perform state-of-the-art interventions to
helping rehabilitation teams mold state-of-the-art into user-friendly and relevant inter
vention packages. Interactive staff training (1ST) was developed to meet this challenge.
1ST is a combination of classroom-based and team development strategies that helps the team
develop and carry out new methods of rehabilitation in a user-friendly format. 1ST comprises
both classroom-based and organizational development strategies. It is made up of
discrete behavioral steps in which the rehabilitation team participates to develop their
program. The organizational development component is not a particularly new or
revolutionary approach to work groups; organizational psychologists and management
experts have been considering such questions and appropriate answers for several de
cades. 1ST is unusual, however, because it builds the organizational development effort
around the central goal of developing psychiatric rehabilitation programs that improve
the quality of service and reduce staff burden. Organizational development strategies
have been criticized in the past when they only emphasize human communication and
role relationships to the exclusion of strategies that promote real change in the tech
niques that enhance the rehabilitation program and that improve quality of work life.
In many ways, 1ST is a behavioral approach to staff training and organizational
change. This varies from some organizational models that are strong in theory but do
not lead to specific interventions. 1ST includes definite recommendations about what
training consultants must do to bring about change in the treatment team. In turn,
positive change in the treatment team is judged by observable changes in work-related
Preface ix
behavior. Ultimately, the worth of this effort is measured by the change in consumer
behavior. Thus, 1ST is a trickle-down intervention; positive changes in the rehabilita
tion team ultimately led to positive gains in consumer functioning.
Past work with 1ST has been limited to working with rehabilitation teams to
develop and carry out behavioral rehabilitation programs. This focus has been by design
and serves two purposes. First, it helps to spread the use of techniques that clinical
research has repeatedly shown to be effective in helping persons with severe mental
illness. Second, the concrete and observable skills that are used in behavioral rehabilita
tion are easier to teach staff than some of the less specific principles that guide other
rehabilitation strategies. Behavioral rehabilitation includes familiar interventions such
as social skills training, family education, incentive therapies, proactive aggression
management, and cognitive rehabilitation. Behavioral rehabilitation also includes spe
cific skills that are part of assertive community treatment, programs for mentally ill
substance abusers, and vocational rehabilitation.
1ST is described in four sections of this book. In Part I, we provide the rationale for
the approach to staff development. The chapters that make up this section represent a
summary of the literature concerning staff training and psychiatric rehabilitation as well
as an overview of research conducted by our group on 1ST. The reader interested in the
conceptual and empirical basis of 1ST will find this section interesting. Chapter 1
begins with a short review of the need for staff development and the ways that class
room-based training has attempted to meet this need, and ends with consideration of
the shortfalls of classroom-based training and the need for other ways to change staff
training. The benefits of supplementing classroom training with techniques that ad
dress organizational change are then discussed in Chapter 2. Chapter 3 concludes the
section with the contention that a change of focus in training and development is
needed to meet staff demands. 1ST is presented as a method that meets this shift.
The specific steps that make up 1ST are summarized in Part II. The specific
activities that are used in 1ST are reviewed and training examples from our efforts over
the past 5 years are provided. Readers interested in the "how to" of 1ST may wish to
focus on the chapters that comprise Part II. Chapter 4 addresses engagement strategies
that help the 1ST consultant join the rehabilitation team in their development of
effective and practical intervention programs. Chapter 5 summarizes participative deci
sion making, the process through which staff develop the components of a treatment
program. Staff members are presented the framework for an intervention (e.g., skills
training, incentive programs, problem-focused case management) and are instructed to
decide the specifics that will expand their outline into a viable program. In Chapter 6,
strategies for piloting the program are reviewed. Piloting a program is presented as a
dynamic task in which the rehabilitation team uses feedback from the pilot to revise the
program into a more effective strategy. Chapter 6 also includes strategies that promote
user-friendly continuous quality improvement, which helps to keep a newly developed
program alive by continuing to appraise its effectiveness.
Studying the effects of staff training has been a difficult process; limitations of
research in this area are discussed in Part III. The chapters that comprise this section
x Preface
read more like a methodological paper than preceding chapters. Chapter 7 proposes
some feasible strategies to examine staff training effects. Chapter 8 then summarizes
several studies conducted by our group, including research that led to the development
of 1ST as well as outcome studies that examined the effect of 1ST on staff attitudes and
behavior as well as consumer behavior.
Conducting 1ST is a more difficult process when attempting to develop rehabilita
tion programs with people from different teams. This issue is discussed in Part IV. In
particular, Chapter 9 reviews 1ST with consumers and family members participating as
equal partners with staff in program development efforts. Chapter 9 also reviews
strategies that foster program development across a network of agencies.
This book was written for members of the rehabilitation team, an admittedly
diverse group that-depending on the setting-can vary from clinicians with doctoral
degrees to paraprofessionals with little formal education. Members of the team include
the counselors, social workers, assistants, psychologists, nurses, psychiatrists, and ac
tivity therapists. Although the focus is on the development of rehabilitation programs
for adults with severe mental illness, training strategies in this book are easily transfer
able to other problems and populations where the intervention is conducted by a team,
e.g., troubled teens in a residential program, drug abusers in a halfway house, behav
iorally disturbed children in a residential program, or developmentally disabled adults.
The concepts and skills in this book also apply to rehabilitation teams that work in
general, physical, and geriatric medicine.
Line-level staff who work on these teams will find this book of interest; they may
adopt specific strategies to improve their rehabilitation team. The administrators and
program supervisors who lead these teams will also find the book useful. The potential
for enhancing the quality of their treatment programs in a cost-effective manner is
highlighted. Finally, professionals responsible for training staff will benefit from learn
ing this new approach. They will be armed with additional techniques that will enable
them to transfer innovative knowledge to real-world, frontline staff members.
This book is also relevant for teachers and students of organizational change and
mental health settings. In particular, social work and psychology students may find the
book useful for understanding some of the central questions in bringing research
findings into applied settings. The text includes ample discussion of the theories and
research that underlie much of 1ST. Moreover, clinical examples are provided to illus
trate some of the hurdles that training facilitators must overcome in order to foster
effective program development.
Several resources are needed to help adults with severe mental illness live indepen
dently and to improve their quality of life. The resources include community programs
that foster independence, financial assistance to support community living, available
medication to treat the biological components of the disorder, and emotional support
from friends and family. Effective rehabilitation teams are important for providing most
of these resources.