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					 California Association of Social
      Rehabilitation Agencies


Developing a Curriculum for the
  Psychosocial Rehabilitation
          Practitioner

             2001-2002

          Final Project Report



                Funded by

     The Center for Health Professions
   University of California, San Francisco
Allied and Auxiliary Health Care Workforce
                   Project
  California Association Of Social Rehabilitation Agencies
Developing a Curriculum for the Psychosocial Rehabilitation
                        Practitioner

             Curriculum Project Advisory Committee
                          Betty Dahlquist, Chair

        Rachael Buetler                            Debbie Malcarne
        Michele Curran                              Bob Martinez
           Ed Diksa                                 Herb Putnam
        Joseph Georges                              Debby Senna
         Dave Hosseini                              Stan Taubman
         Olivia Loewy                                Mel Voyles



                 Curriculum Advisory Committee
                           Debra Rades, Chair

       Neal Ådams, MD                                 BJ North
        Steve Bucholtz                             Judith Norton
        Michele Curran                              Dave Pilon
        Frances Freitas                            Maria Sardinas
         Nina Kulgein                              Debby Senna
       Peter McKimmin                              Stan Taubman
         John Nickens




      Staff and Consultants, Ex-Officio Committee Members
             Betty Dahlquist, MSW, CPRP, Project Coordinator
             Debra Rades, MS, RPRP, Curriculum Coordinator
      Vicki Smith, MSW, CPRP, Project Consultant, Curriculum Writer
              Ken Gill, PhD, CPRP, PSR Education Consultant
                      Jim Comins, ED>Net, Consultant
                Jose Romero, LCSW, Curriculum Consultant
                     Pat Risser, Curriculum Consultant
              Karin Brooks, MSW, CPRP, Curriculum Writer
               Sheila Boltz, MSW, CPRP, Curriculum Writer
                 Kim Kmetz, MS, CPRP, Curriculum Writer
CASRA PSR Curriculum Project                                       3
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   California Association Of Social Rehabilitation Agencies
 Developing a Curriculum for the Psychosocial Rehabilitation
                         Practitioner



                                   Partners

                Sacramento County Mental Health Services

                            American River College

         ED>Net Regional Health Occupation Resource Centers

                     Human Resources Consultants, Inc.

                       Consumer Self Help Center, Inc.

                 San Diego County Mental Health Services

                   Shasta County Mental Health Services

       Stanislaus County Behavioral Health and Recovery Services
CASRA PSR Curriculum Project                                           4
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   California Association Of Social Rehabilitation Agencies
 Developing a Curriculum for the Psychosocial Rehabilitation
                         Practitioner
                              Final Project Report
                               Table of Contents



                                                                Page
      I.          Executive Summary                                6

     II.        Background                                       14
             A. Problem Statement                                14
             B. Description of CASRA                             16

    III.        Project Description                              17
             A. Goals and Outcomes                               17
             B. Population                                       18
             C. Advisory Committees:
                1. Project Advisory Committee                    18
                2. Curriculum Advisory Committee                 19
             D. Partners:                                        19
                1. ED>Net/Regional Health Occupation Resource
                   Center
                2. Sacramento Partners
                3. San Diego Partners
                4. Other Mental Health Partners

    IV.         Outcomes                                         21
             A. DACUM                                            21
                1. Development of DACUM
                2. Definition of Psychosocial Rehabilitation
                Practitioner
             B. Curriculum Development:                          22
                1. Curriculum Chair And Writers
                2. Curriculum Trainers and Consultants
                3. Summary Of Courses
             C. Implementation:                                  24
                1. Sacramento/American River College             24
                2. San Diego County Partners                     26
                3. Shasta County Partners                        26
CASRA PSR Curriculum Project                                                 5
Draft final report, 05/26/02 rev


             D. Replication Guidelines                                  27
             E. Potential Sites for Replication                         29

     V.            Recommendations For Future Activities & Needed
                   Resources:                                           30
             A.    Acquire Funding for Implementation at Local          30
                   Levels
             B.    Develop marketing program to attract broader         30
                   community college student body.
             C.    Provide training in transfer of knowledge to         31
                   potential instructors
             D.    Develop evaluation tool to assess effectiveness of   31
                   classes and certificate program
              E    Assure periodic review of DACUM and Course           31
                   Content
             F.    Develop Distance Learning Program                    31
             G.    Develop BA Level Curriculum                          32
             H.    Advocate for State DMH Recognition of the            33
                   IAPSRS Certificate for Psychiatric Rehabilitation
                   Practitioner (CPRP)
              I.   Continue Project Advisory Committee                  34

    VI.            Attachments:
             A.    List of Project Advisory Committee Members
             B.    List of Curriculum Committee Members
             C.    DACUM
             D.    Definition of Psychosocial Rehabilitation
                   Practitioner
             E.    Course Outlines
             F.    IAPSRS CPRP information
             G.    Description of CASRA
             H.    Sample Employer Survey
CASRA PSR Curriculum Project                                                                     6
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                              I.      Executive Summary


The Problem
The public mental health system in California is severely challenged by the need for more
staff, more ethnically and culturally diverse staff, and staff with a different skill set than
traditionally found in the mental health professions. Specifically the system experiences:
       a high rate of vacant positions at all levels,
       difficulty recruiting, hiring and retaining staff that reflect the ethnic and cultural
        diversity of the people that use or need mental health services,
       a shortage of staff that are trained in psychosocial rehabilitation and recovery-
        based practice, and
       a lack of educational systems to train current or potential staff to provide
        culturally competent psychosocial rehabilitation and recovery-oriented services


The workforce problem in California is so critical that three years ago the California
Mental Health Planning Council embarked on a human resources initiative. Based on the
survey responses, the California Mental Health Planning Council estimates the average
vacancy rate for mental health positions, including unlicensed mental health workers and
rehabilitation specialists, to be 22% throughout the State. The vacancy rate for positions
requiring fluency in two or more languages ranges from 26-100%.


Another significant factor relating to the mental health workforce shortage is that mental
health field has advanced from a strictly medical model, with an emphasis on pathology
and medications, to a community-based psychosocial rehabilitation and recovery-oriented
model. The growing literature on the advantages of providing psychosocial rehabilitation
services to people in recovery from mental illness is summarized in the recent Surgeon
General’s Report (Mental Health: A Report of the Surgeon General 1999, p. 287):
CASRA PSR Curriculum Project                                                              7
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       “Randomized clinical trials have shown that psychosocial rehabilitation
       recipients experience fewer and shorter hospitalizations than comparison
       groups in traditional outpatient treatment (Dincin & Witheridge, 1982;
       Bell & Ryan, 1984). In addition, recipients are more likely to be
       employed (Bond & Dincin, 1986.”


Despite the need for different skills, knowledge and orientation on the part of mental
health staff, no formal psychosocial rehabilitation curriculum has been developed in
California. Attempts on the part of County Mental Health Directors to influence the
curriculum at the schools of social work have met with little success. Most training in
psychosocial rehabilitation is on the job and in-service training in community mental
health agencies and at the semi-annual CASRA conferences. Staff qualifications for
psychosocial rehabilitation positions have emphasized experience. With the advent of
managed care and the need for increased accountability in providing services now require
more rigor in assessing qualifications.


One Solution
To address these issues, the California Association of Social Rehabilitation Agencies
(CASRA), in 1998, initiated a project to develop curriculum that could be used in
community colleges to lead to a psychosocial rehabilitation certificate. The initial
investigative effort was funded by CASRA, with support from the behavioral or mental
health departments of four Counties. The University of California at San Francisco with
an Allied and Auxiliary Health Care Workforce Project grant awarded in 2001 supported
the development of the curriculum.
CASRA PSR Curriculum Project                                                               8
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The Project
The specific objectives of the project were to:
    1) Delineate psychosocial rehabilitation competencies upon which to build
        curriculum (April 2001):
    2) Develop curriculum for seven psychosocial rehabilitation courses that can be used
        in community colleges
    3) Produce a final project report that will describe the process for developing the
        curriculum, the constituencies involved in the project and strategies for replication
        in Counties/regions throughout the State (July 2002)


The populations served directly by this project include:
    1. current psychosocial rehabilitation staff, some of whom are or have been
        recipients of public mental health services: Current staff include employees of
        private, contracted and County mental health agencies, employees who may, or
        may not, have an AA, or a BA,
    2. licensed mental health staff:
    3. potential mental health employees, including community college students looking
        for career opportunities and/or people who are currently using public mental
        health services.


Ultimately, the goal is to improve services and access to services to the many diverse
Californians needing public mental health services.


Staff
Staff included the project coordinator, educational and project consultants, curriculum
consultants for cultural competence, recovery and client orientation.


Collaboration
The Project Advisory Committee was composed of representatives of the San Diego and
Sacramento County Mental Health Services, the State Department of Mental Health, the
CASRA PSR Curriculum Project                                                              9
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NASW, the California Network of Mental Health Clients, NAMI of California and the
California Association of Local Mental Health Directors.


The Curriculum Advisory Committee was composed of representatives of several
constituency groups, educators and people who provide training in mental health
(including consumers) and professionals in the field who are familiar with the
psychosocial rehabilitation skills needed by staff.
Partners in the project include 1) ED>Net/s of the California Community College
System, that develop partnerships that encourage collaboration around emerging health
professions among health care employers and education providers from all segments,
complete needs assessments, job analyses, curricula and resource development, training,
certification testing and referrals to health care industry employers.


Other partners include Sacramento County Mental Health, American River College,
Human Resources Consultants, Inc. and Consumer Self-Help Center in Sacramento: San
Diego County Mental Health Services and Community Research Foundation; Shasta
County Mental Health Services and Northern Valley Catholic Social Services and
Stanislaus County Behavioral Health and Recovery Services


Outcomes
The Psychosocial rehabilitation competencies were identified by the DACUM completed
by ED>NET in April 2001 with 11 psychosocial rehabilitation practitioners with diverse
genders, ethnic and cultural backgrounds, including consumer providers. Practitioners
included people whose educational levels varied from completion of high school to
completion of a Ph.D. program.
CASRA PSR Curriculum Project                                                              10
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The major competency areas defined by the DACUM are:
      Engagement
      Strengths and skill building
      Life skills straining
      Assistance in vocational and educational planning
      Clinical interventions and education
      Service Coordination
      Charting and documentation
      Advocacy


CASRA contracted with five practitioners with psychosocial rehabilitation and
teaching/training experience, one to coordinate the writing of the curriculum and four
more to write the curriculum.
The writers were trained by
      Josie Romero, Professor of Social Work Policy and Clinical Practice, at
       California State University at San Jose and contributor to the development of the
       Cultural and Linguistic Competence Regulations for the California State
       Department of Mental Health. Ms. Romero trained curriculum writers on
       integrating cultural competence into the curriculum
      Pat Risser, Consumer Activist/Consultant, has extensive experience as a trainer,
       facilitator, consultant and mental health advocate. Her served as the Executive
       Director of Mental Health Consumer Concerns where he developed and co-
       facilitated training for consumers to work in the mental health system. He trained
       writers on integrating a recovery-orientation and the consumer perspective into
       the training.


A third educational consultant, Ken Gill, Ph.D., CPRP, from the New Jersey School of
Medicine and Dentistry, provided consultation in curriculum development. Dr. Gill has
coordinated the development of Psychosocial Rehabilitation Curriculum in New Jersey at
the community college, BA, Masters and PhD level, as well as on-line courses.
CASRA PSR Curriculum Project                                                                11
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Based on the competencies identified in the DACUM, the advice of the Educational
Consultant and consultation with American River College, it was determined that four
core courses plus a field practicum were appropriate for the community-college-level
curriculum. The curriculum includes five courses:
   1. Introduction to Psychosocial rehabilitation
   2. The Helping Relationship
   3. Rehabilitation and Recovery
   4. Community Integration
   5. Practices in Psychosocial Rehabilitation: Field Seminar and Field Work


Implementation
   1. Sacramento -- Prior to receiving funding, CASRA approached the Psychology
       Department of American River College in Sacramento with the concept of
       developing a psychosocial rehabilitation certificate program. The college is
       known for its interest in developing certificate programs and Debby developed the
       first KADAC certificate program in the California Community Colleges. The
       College and was receptive to the idea of a psychosocial rehabilitation certificate
       program. The County Mental Health Department had been instrumental in
       promoting the hiring consumers as providers and was very interested in the
       project and provided support for the development of the curriculum. With this
       congruence of resources and interest, American River College became the
       demonstration site for the curriculum project.
   2. San Diego -- San Diego County Mental Health Services also funded the project.
       San Diego County Mental Health, CASRA, and the local Regional Health
       Occupation Resource Center met to discuss how the possibility of implementing
       the curriculum in the San Diego community colleges. San Diego Regional Health
       Occupation Resource Center has a staff person skilled in marketing who may be
       very helpful in finding ways to reach the general student body to develop interest
       in the course.
CASRA PSR Curriculum Project                                                                    12
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    3. Shasta -- Shasta County Mental Health Services is a supporter of this project. At
        the time of the writing of this report, a meeting is being planned with the Northern
        Valley Catholic Social Services, the local Regional Health Occupation Resource
        Center, CASRA and Shasta Community College.


Replication Guidelines for Local Communities
    1. Meet with the local Regional Health Occupation Resource Center
    2. Document the need for staff trained in psychosocial rehabilitation
    3. Develop an advisory council for the project
    4. Prepare for the approach to the community college
    5. Dedicate a staff person to coordinate the project during the initial stages, to
        convene and coordinate the Advisory Council, complete the employer survey and
        assure that the college has all the information needed to implement the curriculum


Potential Sites for Implementation
In addition to the initial county partners, i.e., Sacramento, San Diego, Shasta, Stanislaus
Counties, County mental departments, constituents, providers and community colleges in
several counties have expressed an interest in the Psychosocial Rehabilitation
Curriculum, including organizations and individuals from the following counties:
       Los Angeles                             •Kern
       Alameda                                 •Riverside
       Contra Costa                            •Tri Cities
       Santa Barbara                           • Monterey
       Mendocino                               •Lake


Recommendations for Future Activities and Needed Resources
The Psychosocial Rehabilitation Curriculum Project was originally conceived to be a
self-sustaining project once the curriculum was completed and implementation strategies
were developed. It is clear, however, that CASRA will need to secure additional
resources in order to support local initiatives, e.g., facilitating the interface between the
CASRA PSR Curriculum Project                                                             13
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mental health community, the Regional Health Occupation Resource Centers and
ultimately the rest of the educational community.
       1. Seek and acquire funding for implementation at local levels
       2. Develop marketing program to attract broader community college student
           body
       3. Provide transfer of knowledge training for potential instructors
       4. Develop evaluation tools to assess effectiveness of classes and certificate
           program
       5. Assure periodic review and updating of DACUM and course content
       6. Develop Distance Learning Program
       7. Develop B.A. Level Curriculum

       8. Advocate for State Department of Mental Health recognition of the
           International Association of Psychosocial Rehabilitation Services, Inc., test-
           based certification for a Certified Psychiatric Rehabilitation Practitioner
           (CPRP) as a Mental Health Rehabilitation Specialist under the categories for
           Qualified Mental Health Professional
       9. Continue Project Advisory Committee to oversee development of further
           curriculum
CASRA PSR Curriculum Project                                                                 14
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                                   II.     Background
A. Problem Statement
The public mental health system in California is severely challenged by the need for more
staff, more diverse staff and staff with a different skill set than traditionally found in the
mental health professions. Specifically the system:
       experiences a high rate of vacant positions at all levels,
       experiences difficulty recruiting, hiring and retaining staff that reflect the
        diversity of the people using services,
       suffers a shortage of staff that are trained in psychosocial rehabilitation and
        recovery-based practice, and
       has no educational systems to rely on to train staff in psychosocial rehabilitation


1. Staff Shortages -- The workforce problem is so critical that three years ago the
California Mental Health Planning Council (CMHPC) embarked on a human resources
initiative. CASRA has participated in the Human Resources Committee of the Council
that oversees the initiative. As part of their work, the Council surveyed county mental
health systems to identify vacancy rates and the need for a more culturally and ethnically
diverse workforce. The data substantiating the workforce need is mostly anecdotal at this
point, based on provider and county mental health department self-reports of staff
shortages. Based on the survey responses, CMHPC, estimates the average vacancy rate
for mental health positions to be 22% throughout the state, including unlicensed mental
health workers and rehabilitation specialists. The vacancy rate for positions requiring
fluency in two or more languages runs from 26-100%. Survey respondents estimated a
two and a half (2.5) to four (4)-month delay to fill vacancies.


2. Shift in Service Provision – The mental health field has advanced from a strictly
medical model, with an emphasis on pathology and medications, to a community-based
psychosocial rehabilitation model. In today’s community mental health service delivery
system there is an emphasis on recovery-based psychosocial rehabilitation services. The
provision of psychosocial rehabilitation services increases a person’s chances of
integrating or reintegrating into the community. The growing literature on the
CASRA PSR Curriculum Project                                                                 15
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advantages of providing psychosocial rehabilitation services to people in recovery from
mental illness is summarized in the recent Surgeon General’s Report (Mental Health: A
Report of the Surgeon General 1999, p. 287):


       “Randomized clinical trials have shown that psychosocial rehabilitation
       recipients experience fewer and shorter hospitalizations than comparison
       groups in traditional outpatient treatment (Dincin & Witheridge, 1982;
       Bell & Ryan, 1984). In addition, recipients are more likely to be
       employed (Bond & Dincin, 1986.”


In California, legislative initiatives over the last two decades have expanded the role of
psychosocial rehabilitation in the community mental health system. When the locus of
California mental health services moved from state hospitals to the communities, the
money did not follow. In the ongoing effort to fund community services, budget
augmentations for community mental health have been tied to the development of
specific types of services. These have primarily been community-based, client-centered
rehabilitation services, such as the Community Residential Treatment System, sponsored
by CASRA, 1978, the Bronzon legislation for services for people who are mentally ill
and homeless, the AB 3777 demonstration funding for Integrated Service Agencies and,
most recently, AB 34/2034/334 legislation which calls for intensive outreach to people
with psychiatric disabilities who are homeless or at risk of becoming homeless.


The State Mental Health Department has identified psychosocial rehabilitation services
and skills as critical to serve adults recovering from mental illness; and Medi-Cal now
reimburses for “non-clinic” mental health services, i.e., services provided in community
locations such as someone’s home or school or workplace (Short-Doyle Medi-Cal
Rehabilitation Option, State of California, 1993).


3. Lack of educational programs – Despite the need for different skills, knowledge and
orientation on the part of mental health staff, no formal psychosocial rehabilitation
curriculum has been developed in California. Attempts on the part of County Mental
CASRA PSR Curriculum Project                                                                16
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Health Directors to influence the curriculum at the schools of social work have met with
little success. Most training in psychosocial rehabilitation is on the job and in-service
training in community mental health agencies and at the semi-annual CASRA
conferences. Staff qualifications for psychosocial rehabilitation positions have
emphasized experience. With the advent of managed care and the need for increased
accountability in providing services now require more rigor in assessing qualifications.


B. California Association of Social Rehabilitation Agencies
To address these issues, in 1998 the California Association of Social Rehabilitation
Agencies (CASRA) initiated a project to develop curriculum that could be used in
community colleges to lead to a psychosocial rehabilitation certificate. The organization
invested in literature review of workforce issues and search of community college
psychosocial rehabilitation curriculum. The development of the curriculum was
supported by the Allied and Auxiliary Health Care Workforce Project grant that was
awarded in 2001.


CASRA, a 501(c)(3), is a statewide association of psychosocial rehabilitation agencies.
Founded in 1969, CASRA’s mission is to promote the philosophy and values of
psychosocial rehabilitation as the primary treatment approach to serving people
considered to have a mental illness or psychiatric disability. The organization has
successfully promoted recognition of psychosocial rehabilitation through
      legislation (AB3052, the Community Residential Treatment System Act of 1978)
      regulation (Short-Doyle Medi-Cal Rehabilitation Option of 1993 (The Rehab
       Option provides standards for psychosocial rehabilitation programs and staff
       qualifications), and
      staff training (CASRA hosts two psychosocial rehabilitation practitioner training
       conferences annually)
CASRA PSR Curriculum Project                                                             17
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                               III. Project Description
A. Goals and Outcomes
The overall goals for this project were to increase the professionalism of the psychosocial
rehabilitation field, offer educational opportunities and career ladders for staff and
consumers, provide a basis to increase salaries, increase the number of trained personnel
and increase the diversity of mental health staff by tapping into the diversity of the
community college student base.
The specific objectives for the project were to:
   4) Delineate psychosocial rehabilitation competencies upon which to build
       curriculum (April 2001):
   5) Develop curriculum for seven psychosocial rehabilitation courses that can be
       used in community colleges
   6) Produce a final project report that will describe the process for developing the
       curriculum, the constituencies involved in the project and strategies for
       replication in Counties/regions throughout the State (July 2002)


B. Population:
The population to be served directly by this project includes:
      current psychosocial rehabilitation staff, some of whom are or have been
       recipients of public mental health services: Current staff are employees of
       nonprofit psychosocial rehabilitation agencies and county mental health agencies
       who may, or may not, have an AA, or a BA, (Blankertz, L.E., et al, 1997, A
       National Survey of the Psychosocial Rehabilitation Workforce). For these staff,
       the project offers an opportunity to advance their career and provides a step
       toward higher education.
      licensed mental health staff: Staff who have completed masters and doctoral
       programs and/or may be licensed counselors, social workers, nurses, psychiatric
       technicians and psychiatrists can develop and/or enhance their rehabilitation skills
       by taking relevant courses.
      potential mental health employees, including community college students looking
       for career opportunities and/or people who are currently using public mental
CASRA PSR Curriculum Project                                                            18
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       health services. The community colleges, in particular, offer a diverse cultural and
       ethnic population from which to draw, thus addressing a critical workforce issue
       for the public mental health system.
Ultimately, the goal is to improve services to the many diverse Californians needing
public mental health services.


C. Staffing the Project
      Betty Dahlquist, the Executive Director of CASRA, served as the Project
       Coordinator
      Debra Rades was contracted to serve as Curriculum Coordinator
      Four curriculum writers were contracted: Sheila Boltz, Karin Brooks, Kim
       Kmetz, Vicki Smith
      ED.Net conducted the DACUM, the job analysis identifying the competencies
      Project Consultant was Vicki Smith
      Educational Consultant was Ken Gill
      Jose Romero was contracted to train writers in developing culturally competent
       curriculum and to review the curriculum
      Pat Risser was contracted to train writers in incorporating the recovery and
       consumer perspective and review the final curriculum.
CASRA also identified collaborative partners and established advisory committees,
which are described below.


D. Advisory Committees
CASRA developed two committees to assist in the development and oversight of the
project, a Project Advisory Committee and a Curriculum Advisory Committee. Both
committees met four times, two face – face meetings and two telephone conferences.


1. The Project Advisory Committee was composed of representatives of the San Diego
and Sacramento County Mental Health Services, the State Department of Mental Health,
NASW, the California Network of Mental Health Clients, NAMI of California and the
CASRA PSR Curriculum Project                                                              19
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California Association of Local Mental Health Directors. (Committee members are listed
in the Appendices.)


2. The Curriculum Advisory Committee was composed of representatives of several
constituency groups, educators and people who provide training in mental health
(including consumers) and professionals in the field who are familiar with the
psychosocial rehabilitation skills needed by staff. (Committee members are listed in the
Appendices.)


E. Project Partners:
1. ED>Net/Regional Health Occupation Resource Center -- Jim Comins, RN, Statewide
Director Health Care, was interested in having the Regional Health Occupation Resource
Centers assist with the project because it is their mission to develop curriculum for
emerging health professions. The Regional Health Occupation Resource Centers develop
partnerships that encourage collaboration between health care employers and education
providers from all segments. They also complete needs assessments, job analyses,
curricula and resource development, training, certification testing and referrals to health
care industry employers. The Centers focus the services of qualified community colleges
on the critical needs of the Health Care Delivery industry anticipating high job growth in
that industrial sector


ED>Net staff conducted the DACUM for CASRA as described below. Jim continues to
serve as a consultant to the project.


2. Sacramento Partners -- In Sacramento County, several entities became involved in the
project:
       Sacramento County Mental Health
       American River College
       Human Resources Consultants, Inc.
       Consumer Self-Help Center
       ED>Net
CASRA PSR Curriculum Project                                                      20
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3. Other Mental Health Partners –
      San Diego County Mental Health Services and Community Research Foundation
      Shasta County Mental Health Services and Northern Valley Catholic Social
       Services
               Stanislaus County Behavioral Health and Recovery Services
CASRA PSR Curriculum Project                                                            21
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                                        IV. Outcomes:
A. DACUM:
1. Development of the DACUM (Objective 1: Delineate psychosocial rehabilitation
   competencies upon which to build curriculum (April 2001)
      Jim Comins and Linda Zorn of ED>Net conducted a DACUM (Develop a
       Curriculum, a job analysis tool from Ohio State University) with a group of 11
       exemplary psychosocial rehabilitation practitioners for two and a half days in
       April 2001. The group represented the broad diversity of people who practice
       psychosocial rehabilitation, from people with high school diplomas to those with
       PhDs and ethnic and gender diversity, including consumer provides.


       The DACUM process elicits the core competencies needed for a person to do the
       work in a particular field. The major training content areas defined by the
       competencies determined by the DACUM are:
       o Engagement
       o Strengths and skill building
       o Life skills straining
       o Assistance in vocational and educational planning
       o Clinical interventions and education
       o Service Coordination
       o Charting and documentation
       o Advocacy


      Clinical Directors of CASRA Agencies and the Curriculum Advisory Committee
       reviewed and basically concurred with the competencies. The competencies were
       then used to identify courses and content. (The DACUM is found in the
       Appendices.)


2. Definition of Psychosocial Rehabilitation Practitioner.
      In addition to the DACUM, the Advisory Committees recommended developing a
       definition of the work of the psychosocial rehabilitation practitioner. The
CASRA PSR Curriculum Project                                                              22
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       curriculum writers developed a draft that has been reviewed by the Curriculum
       Advisory Committee and the Board of CASRA. This can be used in the work
       with the colleges in promoting the curriculum. (The definition is found in the
       Appendices.)


B. Curriculum Development (Objective 2) Develop curriculum for seven psychosocial
rehabilitation courses that can be used in community colleges throughout the state
(January 2002)
1. Writing the curriculum -- As noted above, CASRA contracted with Debra Rades to
coordinate the curriculum writing and with four additional practitioners that have
teaching/training experience to write the curriculum. Debra has a masters in
rehabilitation counseling psychology and 20 years of experience in psychosocial
rehabilitation. She is Clinical Director for Caminar/CLC and teaches in the Human
Service Department at San Mateo and Canada College.


CASRA contracted with four psychosocial rehabilitation practitioners who had training
and teaching experience as well experience in direct service and administration in the
field. The writers were trained by
      Josie Romero, Professor of Social Work Policy and Clinical Practice, at
       California State University at San Jose and contributor to the development of the
       Cultural and Linguistic Competence Regulations for the California State
       Department of Mental Health. Ms. Romero trained curriculum writers on
       integrating cultural competence into the curriculum
      Pat Risser, Consumer Activist/Consultant, has extensive experience as a trainer,
       facilitator, consultant and mental health advocate. Her served as the Executive
       Director of Mental Health Consumer Concerns where he developed and co-
       facilitated a training for consumers to work in the mental health system. He
       trained writers on integrating a recovery-orientation and the consumer perspective
       into the training.
CASRA PSR Curriculum Project                                                               23
Draft final report, 05/26/02 rev

   CASRA also contracted with a third educational consultant, Ken Gill, PhD, CPRP,
   from the New Jersey School of Medicine and Dentistry, for consultation in
   curriculum development. Dr. Gill has coordinated the development of psychosocial
   rehabilitation Curriculum in New Jersey at the community college, BA, Masters and
   PhD level, as well as on-line courses. Dr. Gill has been available to project staff and
   the curriculum advisory committee for technical assistance throughout the project.


2. Courses
      Based on the competencies identified in the DACUM, the advice of the
       Educational Consultant and consultation with Debby Senna at American River
       College, it was determined that four core courses plus a field practicum were
       appropriate for the community-college-level curriculum. Thus curriculum
       includes five courses as opposed the seven originally projected.
      Using the DACUM, the following course subjects were identified:
       o Introduction to Psychosocial Rehabilitation
       o The Helping Relationship
       o Rehabilitation and Recovery
       o Community Integration
       o Practices in Psychosocial Rehabilitation: Field Seminar and Field Work
      The draft curriculum for each of the courses was sent out for review at the
       beginning of March and was reviewed by the curriculum consultants and
       members of the Curriculum Advisory Committee. The final version is currently
       being formatted.
      The curriculum writing ran three months behind schedule because of the extent of
       coordination needed among the writers to regarding the content. While each class
       is written as a stand alone, it is intended that they can be taught sequentially and it
       was important to avoid needless duplication. Additionally, the time needed to
       format the curriculum once it was written was not incorporated in the original
       timeline. The review process also took longer than scheduled. The courses will
       be copied and ready for distribution by July 2002, (Curriculum Outlines are
       found in the Appendices.)
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C. Implementation (Objective 3) Produce final project report that will describe the
   process for developing the curriculum, the constituencies involved in the project and
   the strategies for replication in Counties/regions throughout the State (July 2002).
   This document constitutes the final report. The Project Advisory committee will
   review the draft of the final report at the June 2002 meeting.


1. Sacramento/American River College --. Human Resource Consultants (HRC), a
CASRA member agency in Sacramento, has been a long-term employer of consumers
that provide mental health services. The agency wanted a curriculum to help their
employees improve their knowledge and skills and improve their opportunities for
advancement.


Prior to receiving funding for thus project, Sheila Boltz, of Human Resources, Inc., in
conjunction with CASRA, approached Debby Senna of the Psychology Department of
American River College with the concept of developing a psychosocial rehabilitation
certificate program. The college is known for its interest in developing certificate
programs and Debby developed the first KADAC certificate program in the California
Community Colleges. Debby formerly served as Executive Director of another CASRA
agency in Sacramento. The College and Debby Senna were receptive to the idea of a
psychosocial rehabilitation certificate program.


Sheila also approached Sacramento County Mental Health Services with the project. The
County has been instrumental in promoting the hiring consumers as providers and was
very interested in the project and provided support for the development of the curriculum.


With this congruence of resources and interest, American River College became the
demonstration site for the curriculum project.


After the initial interest was determined several steps were take to move the project
along:
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Draft final report, 05/26/02 rev

      HRC allocated staff time to organize the local support for the project
      Local staff conducted an informal survey of employers – County Mental Health
       and non-profit providers – to demonstrate the need for the courses. This provided
       a justification for the college to undertake the curriculum.
      Using a curriculum outline for the Introduction to Psychosocial Rehabilitation,
       Ms. Senna got the introductory course approved by the Curriculum Committee at
       the college. The Introductory class was offered in the fall of 2001 and the spring
       of 2002. A total of 36 students completed the course.
      Sacramento County Department of Mental Health, and the individual providers,
       Human Resource Consultants and Consumer Self-Help Center and Transitional
       Living Community Support assisted employees and consumers to attend classes in
       several ways:
       o by granting time-off work to attend class
       o reimbursing fees for classes
       o reimbursing the cost of books
       o directly purchasing books to be used by employee/students.
       o In addition, a $3000 grant from the University of California, Davis,
           administered by the Mental Health Association of Sacramento, provided funds
           for course fees and books for students
During the development stage, several critical components to this process were identified:
      Dedicated staff person
      Interest at the Community College
      Support of the County Mental Health Services
      Employment survey documenting numbers of students to justify offering the
       courses and developing a Certificate Program
      A ready to use curriculum
      Information about how the community colleges operate and how they adopt
       curriculum and initiate new programs – this varies from college to college
Other factors that would have been helpful include:
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      Local advisory council of employers and other resources (e.g., Department of
       Rehabilitation) to assure ongoing support of the project.
      Assist in the identification of a pool of practitioners with psychosocial
       rehabilitation and teaching/training experience from which to select instructors.


2. San Diego Partners – San Diego County Mental Health Services also funded the
project. The County, CASRA, and the local Regional Health Occupation Resource
Center have met to discuss the possibility of implementing the curriculum in the San
Diego community colleges. Next steps include:
      Develop and administer an employer survey for County and private providers
      Develop an advisory council to identify 1) schools to approach, 2) supports and
       resources needed for students, including time off from work and funding for
       tuition, books, childcare and transportation and ways to facilitate articulation of
       the community college classes to the local four-year college. The following
       parties will be invited to participate in the Advisory Council:
       o San Diego County Mental Health Services
       o Private provider organizations, including Community Research Foundation,
           the local CASRA agency
       o Consumers
       o Family members
       o Regional Health Occupation Resource Center
       o Local community colleges
       o Department of Rehabilitation.
       o BA Social Work program at San Diego State University


San Diego REGIONAL HEALTH OCCUPATION RESOURCE CENTER has a staff
person skilled in marketing who may be very helpful in finding ways to reach the general
student body to develop interest in the course.
CASRA PSR Curriculum Project                                                               27
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3. Shasta County Partners – Shasta County Mental Health Services is a supporter of this
project. At the time of the writing of this report, a meeting was being planned with the
Northern Valley Catholic Social Services, CASRA and Shasta Community College


4. Replication Guidelines – CASRA did a significant amount of research in developing
the project including a workforce literature review and phone interviews with similar
programs in Illinois, Maryland and Canada. (At the time of our initial search, we could
identify three community college level Psychosocial Rehabilitation Certificate or AA
programs.) We used the information from the research, our Sacramento experience and
beginning conversations in San Diego to identify key ingredients and promising practices
in initiating a program in a community.
If you are a county, a private mental health provider, or a consortium of providers,
      Meet with the local Regional Health Occupation Resource Center. They are
       major resource when it comes to implementing courses in the “emerging health
       professions”. They can help identify potential colleges and faculty to talk to
       about the program (they can be found on the internet
       (http://ednet.cc.ca.us/services/services_hc.jsp)


      Document the need. The local Regional Health Occupation Resource Center can
       help with this, or you can use the sample survey in the appendices of this report.
       Survey all potential employers of people with this certificate -- county and private
       mental health provider agencies. The employer survey should:
           o Determine the number of jobs and positions that can be filled by people
               completing the AA or Certificate program.
           o Determine what kinds of supports employers are willing to give current
               employees (e.g., tuition and book reimbursement; time off for classes;
               assistance with transportation and/or childcare)
           o Identify any promotional opportunities or pay increases that might occur if
               an employee gets a certificate


      Develop an advisory council. The purpose is to
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          o Provide support for the project, including support for students and field
              practice sites
          o Assist in the development and administration of the employer survey
          o Meet with potential community colleges
          o Work with the community college and the four-year college on
              articulation issues
          o Recommend sequencing of classes and qualifications of instructors and
              field supervisors
          o Participate in instructor interviews


       The members of the advisory council should include:
              o Employers – both county and private mental health providers
              o Department of Rehabilitation and other resources for students
              o Consumers
              o Family members
              o REGIONAL HEALTH OCCUPATION RESOURCE CENTER
              o Community colleges
              o Local four-year college(s)


             Prepare for the approach to the community college
              o Be familiar with their courses, certificates and degree programs
                  offered by the college. The psychosocial rehabilitation curriculum
                  may fit well with their Human Services AA program. Look for a
                  vocationally oriented department as opposed to an academic
                  department – this is not a rule, but it makes a better fit.
              o Understand how the college makes decisions about adding courses and
                  programs – the staff at your Regional Health Occupation Resource
                  Center office will be able to explain this you. Take the time to
                  understand it well to enhance your ability to communicate with the
                  college. This is another reason to partner with your local Regional
CASRA PSR Curriculum Project                                                               29
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                    Health Occupation Resource Center. They can be very helpful in the
                    meetings with the community colleges.
                 o Have a summary of the curriculum in hand
                 o Have your employer survey in hand
                 o Know of practitioners that are qualified and interested in teaching
                    psychosocial rehabilitation courses. This project recommends that
                    instructors be Certified Psychiatric Rehabilitation Practitioners
                    (CPRPs) or equivalent. The CPRP is a test-based credential offered by
                    the International Association of Psychosocial Rehabilitation Services
                    (IAPSRS). The instructor should have at least one years of working in
                    the field and experience as an instructor or a supervisor.
                Designate a dedicated staff person to coordinate the project during the
                 initial stages, to convene and coordinate the Advisory Council, complete
                 the employer survey and assure that the college has all the information
                 needed to implement the curriculum


5. Potential Sites for Implementation of Psychosocial Rehabilitation Curriculum: In
addition to the initial county partners i.e., Sacramento, San Diego, Shasta, Stanislaus
Counties, interest in the psychosocial rehabilitation curriculum has been expressed by
mental health constituents, providers and community colleges in several other counties,
including:
      Los Angeles                             •Kern
      Alameda                                 •Riverside
      Contra Costa                            •Tri Cities
      Santa Barbara                           • Monterey
      Mendocino                               •Lake
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    V. Recommendations for Future Activities and Needed Resources


The Psychosocial Rehabilitation Curriculum project was originally conceived to be a
self-sustaining project once the curriculum was completed and implementation strategies
were developed. It is clear, however, that CASRA will need to secure some resources in
order to support local initiatives, e.g., facilitating the interface between the mental health
community and the Regional Health Occupation Resource Center and ultimately the
educational community. In the event the funding for Regional Health Occupation
Resource Center is eliminated in the 2002/03 California State Budget process, there
would be even more need for CASRA to assist mental health communities make linkages
to the educational community using the information garnered from this project.
Therefore the first recommendation for follow up is to recruit funding for local
implementation.


A. Acquire funding for implementation at local levels.
Potential sources include County Mental Health Systems and community foundation
grants. Expenses would include staff time, telephone, meeting expense costs,
promotional materials and travel.


B. Develop marketing program to attract broader community college student body.
One possibility would be to work with the San Diego Regional Health Occupation
Resource Center when the curriculum is implemented in San Diego. A Regional Health
Occupation Resource Center staff person in San Diego has the skills needed to develop
the materials for such a strategy. If so, local funding could be solicited to pay for
materials and distribution. Marketing strategies and materials could be duplicated in
other communities.


C. Provide training in the transfer of knowledge to potential instructors
Many potential instructors are seasoned practitioners, but not educators. In the
implementation of the Illinois Community College Psychosocial Rehabilitation
curriculum, the College found that faculty that had no field experience were unable to
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Draft final report, 05/26/02 rev

convey the depth of the material for potential practitioners. Consequently they developed
a program to train practitioners to teach. CASRA anticipates developing a training
program in best practices in transfer of knowledge for adult learners. Such a training
program could be offered on a regional basis and/or as an institute in conjunction with the
CASRA conferences. CASRA will solicit funds to cover the cost of such trainings,
including instructor fees and facility costs and travel expenses for the trainees.


D. Develop evaluation tools to assess effectiveness of classes and certificate program.
This could include several levels of activities, some of which can be done at no cost:
   1. Student evaluations of class and applicability to work if they are working in the
       field. This survey could be developed by the CASRA Program Practitioner
       Division and distributed by CASRA to course instructors.
   2. Employer evaluations of impact on employee’s performance (again, if the student
       is working in the field). This project could be taken on by the CASRA Human
       Resource Committee, but may require some funding.
   3. A research design to evaluate effectiveness of education of the provision of
       services on the people receiving services.
   4. A longitudinal study tracking students who take the psychosocial rehabilitation
       courses, including their ethnicity and culture, to determine a) if the certificate
       leads to a career ladder in the mental health field and b) if the certificate program
       contributes to the diversity of the mental health workforce. Such a study, or
       studies, could include information about the following issues:
          whether students receive the Certificate
          how long the student stays in the field
          whether the ethnicity of the students who complete the certificate and stay in
           the field for a specified period of time reflects the community population
           and/or the people served


E. Assure periodic review and updating of DACUM and course content.
The DACUM should be conducted again within five years.
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F. Develop Distance Learning Program
Because of the great need in rural areas for skilled practitioners, CASRA is investigating
the potential cost and benefits of providing some of the classes on line. Judith Norton,
from the California Virtual College, who serves as a Curriculum Advisory Committee
member, has been extremely helpful in facilitating group discussion of the pros and cons
of providing on line classes. Ken Gill, the project educational consultant from UNJMD,
is also very helpful in this area as he has developed an on-line psychosocial rehabilitation
curriculum.


A primary concern expressed by representatives of the field is whether a community of
students can be developed with and on-line class. One suggestion to address this issue is
to combine on-line and face-to-face classes for specific courses. Other classes may lend
themselves more easily to on-line instruction. To pursue this endeavor, the resources of
the California Virtual College and the UMDNJ are available to the project. The initial
estimates of costs to implement on-line instruction are in the range of $100,000.



G. Develop BA Level Curriculum

Using the DACUM as the basis, adapt the initial curriculum for use in a BA-level

program, one with more emphasis on theory and research. Like the community college

curriculum, there are only a few four-year programs throughout the country that the

project can look to as models. The project sees the potential of using the psychosocial

rehabilitation curriculum, at the BA level, as a stand alone major or as a specialty within

another major, such as social work, counseling, sociology, etc.. As the project is

implemented throughout the state, CASRA will identify one or more four-year schools

that may be interested in the four-year curriculum. The development of the four-

curriculum can be done in conjunction with an interested four-year college.
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H. Advocate for State Department of Mental Health recognition of the IAPSRS

Certified Psychiatric Rehabilitation Practitioner (CPRP) as a Mental Health

Rehabilitation Specialist under the categories for Qualified Mental Health

Professional.

The CPRP is a test-based credential for experienced psychosocial rehabilitation

practitioners. In order to take the test applicants have to meet a specified combination of

education and experience. A person completing a psychosocial rehabilitation certificate

program in the community college can use their education units to count toward the

CPRP test eligibility.



In order to promote the professionalization of the psychosocial rehabilitation practitioner

in California and to assist the state defining a qualified practitioner of psychosocial

rehabilitation and a Mental Health Rehabilitation Specialist, it is recommended that the

state amend the regulatory language defining the qualifications of the Mental Health

Rehabilitation Specialist to read as follows (underlines indicate suggested additions):

       Mental Health Rehabilitation Specialist
       Mental Health Rehabilitation Specialist means an individual who
           1. is a Certified Psychiatric Rehabilitation Practitioner , or
           2. has a baccalaureate degree and four years of experience in a mental
       health setting as a specialist in the fields of physical restoration, social
       adjustment, or vocational adjustment. Up to two years of graduate
       professional education many be substituted for the experience requirement
       on a year-for-year basis; up to two years of post associate arts clinical
       experience may be substituted for the required educational experience in
       addition to the requirement of four years experience in a mental health
       setting.
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I. Continue Project Advisory Committee
The Project Advisory Committee was slated to disband in June 2002 at the end of this
project. Given the overwhelming enthusiasm of and dedication of the Project Advisory
Committee members and their recommendations for future project activities, it is
recommended that the Committee be continued and that committee members be invited
to continue to serve. Additional members maybe invited to participate, including
representatives of the California Mental Health Planning Council.

				
DOCUMENT INFO
Description: Ca Certificate of Rehabilitation document sample