Sunday, July 21, 2019
MODULE 6: PERSON AS AGENT
Using Jane Addams' model of person as agent, and examples from the film, reply with at least one thing/idea/actoivity that could facilitate positive change for people labelled with MI living in the community. As you read your classmates' ideas, reply by answering two questions: why do you think this approach might work? What are some potential barriers to this approach?
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(Posted by Kaitlynn Littlefield)
ReplyDeleteThe Jane Addams’ model of person is one of my favorite approaches to patient/person care. In my career, the vast majority of agencies and companies that I have worked for looked at clients in a positive, individual light. In almost every position I have been assigned, my goal has been to meet my clients where they are at and to help them find their own voice. Many of the clients that I have worked with, particularly when doing my crisis intervention and outreach work, were still struggling with being seen as an active member of their community. Although we as a whole like to believe that our state is very inclusive, there are so many communities in which people feel ostracized for simply being who they are. After reading our text and watching the film, I was reminded of a program that NAMI Maine runs. The Crisis Intervention Team (CIT) program is a community outreach and partnership program that connects law enforcement, mental health counselors, and individuals in the community who have been diagnosed with a mental illness. The program helps law enforcement understand what to look for when they come across an individual in a mental health crisis. It allows them to gain experience and tools to appropriately assist a person who does not need to be arrested or jailed because they are struggling with their mental health. This program is, in my opinion, a wonderful bridge to services and treatment for individuals who have been diagnosed with a mental illness.
Though I do believe that the CIT program helps thousands of individuals already, after watching the film this week, I considered how it could be improved upon. Currently, the CIT trained police officers and detectives are only interacting with people labelled with Mental Illness when they are in a mental health crisis. Though they are treated respectfully during that time, these individuals, in my experience, often do not feel comfortable in the presence of police. Regardless of an officer’s training and background, their uniform can be upsetting and unsettling for individuals who may not understand what is happening around them. I noticed in the film that when community events happened, police presence was at a minimum. This can be viewed as a wonderful thing, but I would have liked to have seen police clapping and cheering for Mayor Rudy Giuliani, just as the crowd did, when he stated that “The driving force of the Fountain House is compassion, understanding, and a desire to give people the ability to take care of themselves.” Instead of interacting only when a crisis is happening, I believe it would be incredibly beneficial for police officers to take part of the activities that occur in the community on a different level, if nothing more than to show that “compassion, understanding, and support to give people the ability to take care of themselves.” My thought is, if police officers in uniform begin to be present in their communities in a non-threatening but active way, it may help the citizens of that community feel that their everyday presence is helpful. If this happens enough, and their presence is normalized, then when a mental health crisis occurs, the individual may deescalate far quicker and require a much lower level of care. The police officers may begin to be seen as helpful resources, rather than scary authorities.
Kaitlynn, I enjoyed hearing about your experience and how you meet clients where they are at instead of not relating to them and their needs. I think the Jane Addams model would be beneficial because it builds a secure connection with clients. It allows for you to trust them and them to feel like they have a strong relationship. Relationships are essential when it comes to people who have a mental illness. I believe some potential barriers to the approach are mistrust in a client and structure. When a client does something they are not supposed to it is hard to trust them again and continue the model into their treatment. The lack of structure is a significant aspect of the model. The lack structured compared to other ways of treatment is very significant. I wonder how it will impact the clients in the real world.
DeleteKaiti,
DeleteWhen I was watching the film and the references were being made towards the crisis services, you came to my mind! I completely agree with you -- there is such a high need for our front line (often law enforcement) officers to be well versed and trained in mental health services.
I have noticed a shift in many services being more inclusive in their views. For example, the Mental Health First Aid teaches the same basic first aid components while address how to approach or assist someone who may live with disabilities or is in a crisis state.
I recently went to a training (which was fantastic, I might add :)), with presenter was an individual who lives with Autism Spectrum Disorder(ASD) that has established his own nonprofit agency to help support children living with ASD a sort of big brother/big sister program as they begin to transition from middle to high school, and beyond. One thing has stuck with me since the training - the presenter talked about how he was going into driver's education centers and educating the instructors on how to teach an individual living with ASD driver's education. More specifically, how to prepare, interact, etc. with other drivers; or if they were to be stopped by the police. It was incredibly insightful! I think Jane Addams would be a firm supporter of his mission and his advocacy skills!
-Ashley Williams
Person as an agent just makes sense, it is one of my favorite topics to discuss and something I have had the great opportunity to be a part of in my career. I think in the world of rehab and recovery it is vastly important that we do not treat people all the time but that we give them the tools to be successful and demonstrate their validity and importance. Luckily for me, the video 47th Street made a lot of sense to me and was like reliving 5 years of my life. I worked for Capitol Clubhouse in Augusta, one of those 300 clubhouses throughout the world modeled after Fountain house. I had the unique opportunity to spend 4 weeks at Genesis House in Worcester to really dive into the model and learn the values strengths and systems that have made it such a powerful approach to recovery. The model in its simplest form is to build people up so they can live independently and work. This mirrors Jane Addams theory of social and educational importance and really "meeting people where they are".
ReplyDeleteHaving a casual conversation over coffee, sitting down and taking a break, expressing oneself and questioning peoples emotions is important. We saw all of these interactions happen seamlessly between staff and members of fountain house, we saw some people doing well and others struggling. It was amazing the changes they were able to document, visually for Frances and how far she had come, as well as how well she handled her difficult news. In Addition to that, we saw how not only work was important in the clubhouse but that people who worked on advocacy were supported and cheered while the praise was not taken by the facility or president, etc.
The biggest barrier to this approach for me is that it does not follow the general rules of boundaries and structure of medical treatment and recovery. it's a hard line between professional and peer and it takes a lot to be able to juggle those aspects as a staff member. The philosophy and approach work, I see it work still, I go into business and see people I had supported, I meet employers who tell me continued success stories and I now get to be involved as a partner agency through my work with VR.
Sean,
DeleteWhat I love about your work experience is that you were able to spend such a long time at the Genesis House, working and learning, to help your future clients help themselves in a non-restrictive environment. Being able to meet with a client on whatever level they are at, for better or worse, is such a wonderful tool and service to them. You are right, though, when you discuss barriers in this model. I thought that the differences between the two videos this week were pretty remarkable. In our video last week that focused on that traditional hospital model, the doctor was heard saying, after a patient hugged her, that she believed she would lose her job after the documentary aired. She seemed incredibly uncomfortable and nervous. In the Fountain House video, however, staff referred to the clients/members as "family now" and encouraged them to be authentic. What a big difference in patient/client care! Though the biggest barrier certainly is that hard line between professional and peer interactions, I believe that with the right approach, it can be handled very well. What an asset this model is to our community!
(Kaitlynn Littlefield)
Sean, I was glad to hear your personal postivie exsperince with the model. I hope to one day have a positive exsperince as well I enjoy how the model gives the clients tools to thrive in the community. The foutian house seemed like a very positve atmosphere for people who have mental health issues to exsperince connection and healing.
DeleteI think the Jane Addams aproch works because it give clients freedom and they are able to be part of their treatment. My next placment is at the Morrison Place in POrtland indvidualks come here to recover from drugs and alchol. I think they have some of the same structure and philosphy as the foutain house. I look forward to completing my internship at such a great placement.
One major area of concern with the mode is structure. The patients are part of their traetment which is great and they gain tools. But how are they accountable if they mess up will the patients rember the tools in the outside worls. All these questions seem to overcome my brain when thinking about the model.
Yes yes yes! Obviously I know after working with you at Capitol and now through VR, you are a strong supporter of employment! I agree, Clubhouse model doesn't follow the medical model and as we know, the boundaries are much more every shade of gray instead of black and white. But I do think in our roles when we were at Clubhouse, we as staff, were able to help support members within the medical model by encouraging them to access healthcare when needed including mental health treatment. We got to know people very well and could begin to tell when they were not feeling well and not acting like themselves and because of the relationships we had with the members, we were able to have those conversations of when was the last time you went to the doctors, did you tell them about those symptoms, etc and then help the member to make an appointment or sometimes even drive them to the appointment to ensure they went. So yes, Clubhouse doesn't fit within the medical model but I do think we are able to support the medical model and help members advocate for themselves within that treatment model.
DeleteAbove reply from Lindsay Hill
DeleteI believe that Jane Addams model of the person as an agent is an excellent philosophy for all mental health professionals to follow through their career. Jane Addams is one of my favorite advocates in the field of Social Worker that I hope to portray in my career. Many of the places I have interned have followed the Jane Addams philosophy and let people realize they have a voice. One activity I believe that will help an individual who has mental illness with the labeling in the community could be community service. In the film 47th street, the individuals were able to pass out items to the hikers, and they felt as they were essential members of the community. During the film, individuals were also given a chance to work in the city. When others see individuals who have mental illness working in the community, they will understand they are important and essential to our world. As a mental health professional, I think the most important way to help clients is to prepare them to get back into the community.
ReplyDeleteVictoria,
DeleteAs a rehabilitation counselor working with transition-aged (14-24) individuals living with disabilities, work is so critical. Assisting my clients with gaining employment or employment training so very gratifying. There is often a huge shift in self-confidence, pride, and socialization. Also, I have often noticed a sense of feeling like they (my clients) belong more. There are able to feel the same productivity as same-aged peers who live or live without disability(s).
-Ashley Williams
Ashley thank you for sharing your personal exsperince with me and rest of the class!
DeleteJane Addams is not only an empowering inspiration to individuals who live with disabilities, but also to women. Jane Addams, a mental health philosopher, is one of the most critical women of the women's movement and history.
ReplyDeleteThrough the film, I was most drawn to the vocational component as it is something I am very familiar with since I am a Vocational Rehabilitation Counselor. Seeing, even in the early 1900's, individuals living with disabilities being placed in community work and/or community service/volunteering positions is evidence of the long-standing theory of total inclusion. Not only does work provide financial self-sufficiency, it also provides individuals with a sense of purpose, pride, and acceptance of peers.
-Ashley Williams
I agree with you Ashley! This video was a great example of the positive effects work can have with people and how it should be included their their rehabilitation. Having meaningful work to do and the feeling of being wanted and needed can totally change someone's outlook on life and the support they receive from peers is the best support to help provide encouragement and motivation.
Delete-Lindsay Hill
Ashley,
DeleteThis text must have been so interesting to read from the VRC perspective. It's really interesting to see a model of inclusion and employment for folks with MI/disabilities succeeding in the early 1900s when it is still something that many folks with these challenges are struggling to obtain today. It's so important!
Ashley- I like how you explain work as a sense of purpose pride and acceptance of peers. It is so true if ever I bump into anyone from college or interact with people at a family reunion one of the first questions is "what are you doing now?", This question is in relation to work! We spend the bulk of our early lives preparing for work in education and in social environments, it just makes sense that we use work as a treatment method.
Delete-Sean K
We have read about how patients living with mental health disorders were initially put in prison-like facilities because they couldn't feel the cold, basically they were treated like animals. After overhauling the perception people living with mental health disorders should not live in humane conditions, there was another change in which professionals recognized their patients had the ability to be stakeholders of their own wellness. Jane Addams' model of person as agent allows individuals to have power and control of their lives. It allows people to recover in their familiar environment and take charge of their wellness. In the video West 47th an individual said, "It's almost near impossible to stay locked within yourself and you feel more like a person because you are being treated as a person." He stated this while offering hikers food and beverages, which further connected him into his community. He was not his mental illness but person first living with a mental health disorder. In Portland, there are a few resources that pertain to person as agent. Opportunity Alliance provides Crisis Service and provides wellness visits in the Greater Portland Area. MaineStay, another resource through Opportunity Alliance is sober living for individuals with CoOccurring Disorders that helps create a short term structured environment for individuals to matriculate back into society and independent living. Portland Recovery and Community Center is operational with the help from the volunteers who are also in recovery too. A potential barrier is if the power, control, and accountability is ultimately on the individual then their success is dictated by their motivation and ability to care for self.
ReplyDeleteThe quote you used was a quote that stood out to me as well! I think it is an important thing to remember in any job we have working with people is that they are people first and need to be treated like a person. In our other post this week, we all posted about how inhumane conditions were for psychiatric patients in the 1900s and nothing really changed until the 70s-80s so this video was a good example to show how progress can be made with people when they are treated like humans.
DeleteAbove reply from Lindsay Hill
DeleteBecca,
DeleteThe barrier you discuss is absolutely a big one. I have pondered how we can solve this many times, but my "solutions" only come with bigger questions. I am so grateful for the services offered in Portland. I am familiar with most of the organizations you mentions and they all seem to offer wonderful things. I would love to see them expand north, though. In the areas I work (Somerset County), services are extremely sparse and if they are available, the client and few, if any, choices. Funding is a huge barrier in this, I understand, but I still want to bring it to light. Rent is cheap up here, though. Perhaps some of these organizations may one day see the benefit in this and try it out. I know my clients would appreciate it more than anything.
Kaitlynn Littlefield
Its great to hear about resources in the Portland area, a region of the state I am very unfamiliar with. There are great programs out there and i think the biggest struggle with programming is the ability to stay current and to make sure that your programing does not become stagnant and offers fresh new hope and challenges for people with disabilities across the board.
ReplyDeleteMy first job after graduating UMF was working at Capitol Clubhouse in Augusta. I got to see first hand the positive effects of being a member of a Clubhouse for adults with mental illness. Many people were able to live and work independently in the community and utilized the Clubhouse for support to maintain their independence. I think the Clubhouse model is under utilized within our own state and in other states. The video West 47th Street shows how members interact with each other, how staff interact with members and gives a glimpse of the Clubhouse runs its work ordered day. Many people do not know about the Clubhouse model and there is so much to be said about it but the foundation of the model is that staff and members are thought to be equal and members are at a higher ratio than staff within a clubhouse to create a sense of "urgency" among members to participate in the running of the Clubhouse, otherwise the model doesn't work. One of the best aspects of the Clubhouse model is the outreach it provides to members. During my time at Capitol Clubhouse, I always enjoyed this piece of my job. In the video, it shows one of the members going to visit another member who was hospitalized. In the video, the member talks about his own experience being hospitalized for 11 years and the treatment he received. He understands the importance of outreach because he said he doesn't want anyone to think anyone has forgotten them. When he was visiting the member, he told him he would "keep after him" when he got out of the hospital to help him from returning to the hospital. That is another great thing about the Clubhouse model is the peer support members receive from each other. They are able to share their experiences and support others in trying to help them avoid being in similar situations they had been in. Or help them with navigating through new situations. I think it can reassuring and hopeful for new members.
ReplyDeleteAnother quote in the movie was from a member who said he liked Fountain House because he was "treated like a person so he was able to feel more like himself for once." That is another great aspect of the Clubhouse Model is that members are treated like people and there is no emphasis on what their diagnosis is. It is just a known fact that all members have a mental health diagnosis so people are able to move on with their day and start focusing on their individual goals. The biggest barrier to the Clubhouse model is funding. Clubhouse exist world wide but many have closed in the past 10 years due to lack of funding. In Maine, our Clubhouses are considered a Mainecare funded service for adults with mental health and they are overseen by a community mental health agency. Maine is a leading example of how well this system can work but many other states struggle with funding from their State and try to be a self standing Clubhouse but that relies on donations which can also be unreliable every year.
Part of the Clubhouse model is that staff attend a 2-3 week training at a training Clubhouse. In 2012, I lived and worked at Fountain House in New York for my training so it was cool to see this video and be able to relate to it so much more!
-Lindsay Hill
Lindsay,
DeleteSo cool that you got to watch a film about Fountain House after being there! I would love to hear more about your experience there. I really loved the way that we saw in the film how residents were treated like people. It may not seem like a big deal, but something that stood out to me is the tone of voice that people used to speak to each other. In my work I often hear the loud, higher pitched, singsongy tone of voice that borders on baby talk used with people who are in the "client" role, and I did not notice that tone being used in the film. I just that even though it's something small, it speaks volumes about the attitudes that people have about those they are working with.
Lindsay, I consider us lucky to have worked at Capitol for as long as we did. The experience working within the clubhouse community was so engaging and enabled me to learn about the various other providers and services that members could tap into. As a huge fan of employment, I too enjoy how the work ordered day encouraged the club members to interact within a team environment and to get the necessary functions of the business done. Having the opportunity to experience training in another larger clubhouse that does not have Medicaid funding was also interesting, they really have to work with their community and engage them in fundraising and with stomping out stigma- something I think this non-medical model does well.
Delete-Sean K
I think one of the best things about the Clubhouse model is the lack of staff vs client roles which eliminates the different tones of voices like you mentioned Brenna. I think when I worked there, it was encouraged to be real with the members and sometimes the more direct, the better. There was obviously still levels of boundaries and respect for people but the model works for a reason and I think it's because of how it is set up and the expectation of staff to not create an imbalance between themselves and the members.
DeleteAfter watching this week’s movie and reading the text about Jane Adams model of person as agent, it seems clear that community engagement can be a really effective tool in recovery. It’s not just about medications or one-on-one counseling sessions, but about the power of social connections and respecting clients as the experts of their stories. What really struck me about the chapter focusing on Jane Adams’ work in Chicago was about how little she knew about what was needed when she first started. I respect the fact that, as a practitioner, she wasn’t afraid to admit that she wasn’t sure how best to support the people living in that community until she became part of it, in a way, and she learned from the people around her. As in the film, the people who took such pride in helping the hikers didn’t need a clinician to tell them what to do or how to feel good about themselves regarding their mental illness. They simply needed to be treated as human beings, with all the dignity and respect and opportunity for self-fulfillment that that entails. For me, I view it as important to collaborate with my clients in a way that puts them in the driver's seat of the working relationship, and unfortunately as others have said, not all health care providers feel it necessary to listen to their patients or clients, or to believe them.
ReplyDeleteMegan,
DeleteI really like how you mention Addam's admitting that she did not know how to best support the people in her community who may have needed it. I can certainly relate to this. When I started working in the field, it was without any personal experiences or real-work knowledge. It is humbling to need to admit that "weakness" and move forward professionally. I can only imagine what it must have been like to do that WHILE blazing a trail for other new clinicians and community supports. Sometimes, it isn't about the labels, the offices, or the formality of care. Instead, it is that human connection, the realistic collaborations, and the honest conversations that make the difference. I, too, respect what Addams stood for and the route she took to make it happen for those who benefitted from it.
(Kaitlynn Littlefield)
Megan, I like your point that some people don’t listen to some clients. I still remember a story from undergrad. My professor was doing some work in a homeless shelter. There was a client there that kept repeating the some story over and over. My professor was told by the “seasoned” staff, don’t bother talking to him he is “crazy”. My professor did not follow suit with other staff and stopped to really listen. The “crazy” man was mumbling about losing his daughter. Professor Forbes, listened and reflected, that must have been really hard. The man paused, seemed to step into reality and agreed. “Yes, Yes it was”. Although I heard this personal account over 20 years ago, the simple companionate story has stayed with me. I think Jane Addams would have treated the man with the same respect as my professor.
DeleteHey Kaitlynn, thanks for your response to this! "Sometimes it isn't about the labels, the offices, or the formality of care. Instead, it is that human connection, the realistic collaborations and the honest conversations that make the difference." This is such a powerful thought and statement, and I believe it wholeheartedly. I have been told by so many practitioners I look up to and admire that the treatment modality has so much less to do with positive outcomes than the RELATIONSHIP ITSELF does, and I believe it. If you as a client trust your counselor or therapist to work with you, to believe in you, to not judge you, to advocate for you - the opportunity for change and/or wellness becomes so much more possible! Bridging the divide caused by the "expert" and "client/customer/patient" dynamic is all about trust, communication, and authenticity.
DeleteHey Becky! Your Professor sounds awesome - but I can't imagine being that individual living in a residential program where the staff dismissed me as nothing more than "crazy." How painful, and dehumanizing! A similar situation happened to me in the women's homeless shelter I interned at last year. One particular shelter client was vocally angry in the space, and I offered her the chance to tell me what was going on in a separate room. I'd sit there and listen to whatever she had to say, and she said yes. And she yelled for a good twenty minutes about some of her frustrations about living in the shelter, which were completely valid. I admitted that I had no idea what it must feel like to have to endure what she endures every day, that I thought she was really strong. And we talked about some alternative strategies to yelling at other clients when the anger becomes too much. After a while, she left the room smiling. I honestly just think she wanted someone to vent to, and I was happy to do it. It's such a little thing, listening to someone tell their story, but it's powerful - and it's something we need to do every time we interact with our clients!
DeleteWow Megan, It sounds like you really helped the lady who just needed to yell. I really like how you complimented her for her strength. I think of the movie Bellevieu. One young man kept yelling that “nothing works here, I have been here for 7 years”. I remember the receptionist said to another coworker, “why doesn’t he just yell at home?” I think it would have been good for him to learn some other strategies as you worked with the lady. I agree listening is so important! It is huge!!
DeleteI really enjoyed the themes of cooperative living and community interdependence that were highlighted in both the reading about Jane Addams' work as well as the film. Jane Addams' philosophy emphasized the idea that everyone in a community is able to contribute positively, whether through work, relationships, or some other meaningful activity. From the text, "Addams saw her role as primarily increasing the person’s access to the opportunities to undertake those actions and providing material and social and emotional support for them to do so, when needed" (Davidson et al., 2010).
ReplyDeleteThis really seemed to play out in the Clubhouse model at the Fountain House, as evidenced by the film. The residents were shown as being supported by each other as well as staff, but they were also shown as agents making decisions about their lives. A specific example of the film that struck me was when the community meeting was held after the death of a resident. Staff and residents attended the meeting together, shared together, all on the same level. The community gathered to process what had happened, share emotions as well as support, and just experience grief and loss together. I can imagine that not all mental health facilities have a similar reaction when something tragic happens.
I work with folks with intellectual and developmental disabilities, and there is currently a growing trend of 'caregiver roommates,' which involves a person who has struggled living on their own being paired with a roommate who also acts as a "caregiver." The roommates share household responsibilities and make decisions together. This model challenges the notion that complete independence and self sufficiency (being able to "live independently") should be the ideal, and reminds us that we, as humans, are interdependent in many ways and it is natural to rely on others for support. I think the caregiver roommate model could be helpful for folks with mental illness (or any other challenges that might make it tough to live alone) who might not have access to a clubhouse setting or for whom that model is not the best option.
More about caregiver roommates: https://www.mprnews.org/story/2019/05/31/rumi-allows-caregiver-to-also-be-a-roommate
Hey Brenna, thanks for this link! I think this sort of model can make a lot of sense at helping individuals feel less isolated, especially. For people like the ones you describe, who are often set aside or ignored or separated from the rest due to their mental illness or disability, the "caregiver roommate" concept can help forge connections, which are so important for everyone.
DeleteBrenna,
DeleteI really enjoyed learning about this model! I agree, it can make such a huge impact if offered to the right person. We do need one another - no one is, or should be, and island. To be able to make a decision with someone else, talk out a problem, and work through relationship stresses is not limited to a spouse, which is what I think many people assume. As humans, we ALL need to work together, as you said, in a interdependent way. Thank you for bringing this model to our attention. I learned a lot from it.
Kaitlynn Littlefield
I love the idea of a caregiver model. What a great idea! I agree with you, humans need each other. Sometimes there is a stigma to needing help, but it might be the healthiest option for all. (Sharing childcare responsibilities, cooking, cleaning, etc.)
ReplyDelete