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Recovery Colleges: Support for Individuals with Se ...
Presentation And Q&A
Presentation And Q&A
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Hello and welcome. I'm Dr. Rob Cotez, Associate Professor at Emory University School of Medicine, Director of the Clinical and Research Program for Psychosis at Grady Health System, and also SMI physician expert. I'm so pleased that you are joining us for today's SMI Advisor webinar, Recovery Colleges, Support for Individuals with Serious Mental Health Disorders Realizing Their Full Potential in the Community. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. And now I'd like to introduce you to the faculty for today's webinar, Patrick Hendry and Casey Marion Cooper. First, Patrick Hendry. Patrick is Vice President of Peer Advocacy Supports and Services for Mental Health America. He provides national advocacy and develops new services and training for peers within the behavioral health system. Patrick has worked as an advocate and initiator of peer-run services for 27 years in a variety of leadership roles, including former director of NCSTAC, as a consultant for the National Council for Behavioral Health, the University of South Florida, SAMHSA, NASHPD, among many other agencies. Next, Marion Cooper. Marion Cooper is the Executive Director of the Canadian Mental Health Association, CMHA, for Manitoba and Winnipeg. She serves as the executive lead for strategic partnerships within the CMHA, nationals supporting partnerships with indigenous organizations and communities. She's a clinical social worker and mental health and addictions leader who has worked in the community sector in various positions since 1992. She was instrumental in establishing the Mental Health Promotion Delivery Unit at the Winnipeg Regional Health Authority. Marion is passionate about recovery, system transformation, and innovation to advance mental health and well-being for the entire population. Patrick and Marion, thank you so much for leading today's seminar. Next slide, please. Thank you, Rob. I'd just like to start off by saying that neither Marion nor I have any conflicts of interest related to the contents of today's webinar. Next slide, please. Our learning objectives today are to define recovery colleges and their roles in mental health services, compare the recovery college model to traditional clinical services, and summarize the structure of recovery colleges. Next slide, please. I have to say, I had heard of recovery colleges, but I really learned about them from Marion. There's a lot more work being done in this field in Canada, although there are some roots in the United States. A recovery college is really a unique opportunity. It allows individuals with lived experience, family members, mental health professionals, and educators to work together on an equal basis to develop and deliver courses that support people living with mental health disorders and mental health challenges in their lives. Recovery was first really defined in the 1990s in mental health. I mean, we've talked about it for many, many years in substance use, but in the 1990s, Bill Anthony at the Center for Psychiatric Rehabilitation Services at the University of Boston started talking about recovery, and he defined it this way, and I really love this definition. Recovery is a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and or roles. It is a way of living a satisfying, hopeful, and contributing life, even with the limitations caused by the illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness. Recovery from mental illness involves much more than recovery from the illness itself. Next slide, please. So, recovery colleges are really centers for adult education, and they're not really, they don't involve clinical practice at all. They have really the core qualities of any adult education college, enrollment, registration, full-time staff, term, curricula, sessional teachers, and a yearly cycle of classes, and they really can range through a wide course of things that people can tailor to their own specific lives. The core frequently focus on providing students with the skills that they need to manage their illness themselves, to provide self-care, to maintain physical health. It involves information technology so that people can further their education on their own. It also helps people to change and develop healthy lifestyles and to, when desired, even return to employment or begin to plan to return to employment. Next slide, please. They're really characterized by the involvement of peers, and this is what's different about a recovery college. They frequently employ teachers, but the teachers usually work with another expert, and that would be the peer, the individual with the lived experience. So, peers can be involved in all aspects of a recovery college. They can be involved in the governance and management, and they participate in the development of the curriculum, the structure of the college, the staffing, the overall philosophy, the location, access, anything that will contribute to the use of the college being much broader. Next slide, please. So, when I said there was some roots in the United States, the first recovery colleges emerged in the U.S. at the Center for Psychiatric Rehabilitation in the 1990s, when Bill Anthony was the director. In 2009, the first one opened up in London, and there are now more than 70 in the United Kingdom and growing very rapidly. They offer all kinds of educational courses and workshops that focus primarily on mental health, but also on everything else that is involved in recovery, and as we know, recovery is different for every single person who experiences or moves along that path. Overcoming stigma and discrimination associated with having a mental health diagnosis is really central to their programming. It's to normalize things. It's to provide people with an opportunity to learn where they can feel confident about their abilities, they can feel proud of their accomplishments, and they can move on to gain as much control in their life as they desire. The recovery college model has spread around the world. There's an international group that gets together to further how recovery colleges can improve. There's the Recovery College Collective in England that has helped develop many of the things that have been moved around the world with this idea as it begins to constantly evolve because it really is a living process. Every college is a bit different, and everyone is influenced by the people who attend and the people who help to bring it to life. Next slide, please. So sometimes they're known by other names. In the United Kingdom, they're called recovery colleges, and the ones that I've been familiar with in Canada that Marion's going to talk about, many of those are referred to as recovery colleges. They're also known as empowerment colleges, learning centers, well-being learning centers, discovery colleges for youth. Some people think that the word college is intimidating, but again, part of the process is to normalize things, to not say that everything that we do for ourselves as peers has to be separate from what the rest of the world is doing. So the use of a word like college, I think, gives us the the opportunity to feel that we are just a part of the educational world. Other people feel that, you know, that it legitimizes the perception of being a real educational environment. Some people who are referred to as students, most of the time people who attend recovery colleges are referred to as students, and again, there's some people who feel that that isn't as appropriate as it could be, but every one of us has a different opinion on language, and we know this in the peer community. We constantly are evolving our language and trying to find our way into something that is most comfortable, that says exactly what we want to communicate, but also makes us part of the world around us. Next slide, please. So there's a lot of research starting in the recovery college model. It's been going on for a number of years, but it's really ramping up in the last few years. There was a recent study that used a controlled before and after model with a large sample of recovery college students, and they found that one of the real outcomes of people attending recovery colleges was they had lower rates of service utilization after attending a college. Now, in some types of programs, a lot of peer-run programs, we say that an outcome of increased service utilization is a positive, and that can be true because you're bringing people in who've not had perhaps access to services before, or they felt excluded for some reason, or they even felt fearful about formal services. In this case, though, people, as they begin to learn about themselves and start that process of self-management, then they begin to utilize services more, but they utilize the services that work for them because they begin to participate as full partners in their own service delivery. This is exemplified in shared decision-making, where when a person perhaps is going for a med management meeting, and when they go into the room with the doctor, and we always know that med management meetings are very quick. There's very little time for extra conversation, but when a person enters into a med management meeting with their physician, there's two experts in the room. There's the psychiatrist or doctor who's an expert on treatment, on medication, and then there's the individual who's an expert on their own lives and on the things that have worked for them or not worked for them in the past. A 2018 study evaluated recovery college fidelity measures, and the aim of this was to identify the key components and to develop and evaluate a checklist that would support development of fidelity measures so that you could reproduce the recovery college model where you would be able to anticipate the outcomes, that you would be able to measure what you were providing to make sure that you were achieving your goals, and that you would constantly be able to participate in quality improvement through constant measuring throughout the process of the services. Next slide, please. So, some of the research behind the recovery college model has to do with adult learning techniques, and we know that adults learn in different ways, but there are some things that are fairly constant, and the study that we referred to before identified that there were seven non-modifiable components to a recovery college based upon the fidelity measures they were trying to develop and five modifiable components. Co-production and adult learning approaches were identified as absolutely essential to the development of a recovery college. Co-production, co-delivery, and co-learning are part of the focus of bringing people together, bringing the individual as an expert together with an educational expert and professionals and other people with lived experience to deliver and to receive the best experience possible. In the 1980s, Malcolm Knowles suggested that adult learners have distinct characteristics, and part of that is that we know that adult learners are often goal-oriented. They're practical in their approach. They're relevant. The information they wish to learn is relevant to their lives. They tend to go about learning in a self-directed model or self-directed way. They utilize their experience to enhance the learning experience, and they're task-oriented, so they become problem-centered. They seek out knowledge in order to gain the type of information they need to solve the problems that perhaps present them in employment but also in their lives. Next slide, please. So again, just to go back over a little bit, so there are 12 components, and as we said, there's seven that were identified as non-modifiable and then five that can be modified to some degree and still adhere to the fidelity measures for a successful recovery college model, co-production being one, co-production being that individuals with lived experience co-produce this model with other people who are educational experts and bring other types of expertise to the table. Adult learning techniques are essential. Valuing equality, the equality between the individual receiving the information and the individual giving it. You know, this is one of the essential elements of peer support, and peer support is heavily involved in this model. We know that as peer support staff, when we go to work with somebody, we try to approach that person as an equal. We've got similar lived experience, but we also know that for everyone we help, we are helped in return, and that frequently in my work, I felt that I've learned more from the people that I've tried to support than perhaps they've learned from me. Commitment to recovery is another absolutely essential element. Social connectedness, we are discovering more and more as time goes by, and in this past year at even an enhanced rate, that social connectedness is a primary goal for health care. We know that people experiencing social isolation and loneliness or social exclusion have worse outcomes throughout health care and throughout their lives in almost every aspect of their life, so social connectedness is a primary goal for a recovery college model. We also know that it needs to be tailored to the student, so there's enough selection in the curriculum so that people can find the elements that are meaningful in their own life, and then we also know that there needs to be a community focus. Every community is different. Every experience of learning is different. The site that is chosen, the access, the attitudes of the community around it, all of these things are really important to developing a successful recovery college model, and we also know that the model is very progressive and it's evolving constantly, as I said before. Location is important because you need to have access and people need to be able to get there without too much trouble. It needs to be available to everyone. I mean, we don't try to limit it and say you're only allowed in this door if you have a diagnosis or if you have a relative who has a diagnosis. Recovery colleges are useful to everyone. One of the real goals in peer support is to move beyond peer support, to move to where we're all supporters of each other in the community. What we refer to as peer support has existed throughout time. People have supported each other through times of difficulty, through times of ill health, and it will continue on, and so peer support is formalized in mental health and behavioral health, but the real goal is for it to be available to anyone, any place, at any time. We also know that a desirable aspect is that it be strength-based as opposed to being problem-oriented, and then we also believe in the distinctiveness of the course content. Courses should be unique, should be something that is not available to people through other avenues, and with that, I'm going to turn it over to Marion Cooper. Marion is the one who introduced me to this idea, and I have found it fascinating for these years, and I hope that we will begin to reproduce it in this country, and Marion, take it away. Thank you very much, Patrick. I appreciate that introduction, and I'm very pleased to be here calling in from Canada, and we're very pleased to work with Mental Health America as the Canadian Mental Health Association, supporting the advancement of peer-led and recovery-oriented approaches, so it's been a good partnership. So, one of the things that I'd like to spend some time talking about right now around the paradigm shift that, really, recovery colleges has achieved, the focus has been to shift from a therapeutic focus in terms of the relationship with the individual and the group to more of an education-focused approach. So, recovery colleges are very much focused on creating an environment where there is social learning and an opportunity for individuals to come together in an educational context and to learn together. So, the literature talks a lot about how recovery colleges are educational rather than therapeutic in their approach. So, as opposed to viewing the professional as only the person with the expertise to choose a therapeutic intervention for a patient, a recovery college approach views the student as the person with expertise of their own who can choose the courses that interest them or they believe will support their recovery path. The staff role in a recovery college is focused on providing information about the college, assisting students to see their strengths, and then to support their exploration and goal-setting process. So, it's very much a shift away from this is the recommendation or this is the intervention that will help you in this way, but creating a real discovery process of learning and selecting approaches that will support you through the learning platforms. So, that's a huge shift, and sometimes students might struggle with that shift. Certainly, we've seen that here in our recovery colleges in Canada, where individuals who've often seen themselves as primarily patients going to a mental health service provider or a setting for support are there and are asking for direction from the expert mental health provider. And often there is a period of time where there's a readjustment that needs to happen for the individual as they become oriented with a new way of getting mental health supports through an educational approach. Rather than focusing on problems and deficits, the emphasis within recovery college is really on finding and building a person's strengths and abilities. You know, in mental health and addiction care, we often talk about a strength-based approach. Recovery colleges really provide an environment for true operationalization of that strength-based approach through a focus on, rather than focusing on a clinical professional intervention, the person and peers and coaches encourage and support the individual to explore their personal goals, their hopes and dreams, their aspirations, and then also helping them to find solutions, which ultimately promotes their sense of agency and empowerment. So that's the kind of transformation that often will happen for a student when they experience a recovery college and begin to participate in courses and be a part of a learning community. It becomes a very powerful experience of empowerment. Now, this is, of course, doesn't suggest that we are suggesting that clinical interventions and formal mental health services are not required, but they're incredibly complementary. And in fact, they coexist and they can really begin to support people and move us towards a more recovery-oriented mental health care system by embedding more recovery colleges within a community context, helps that system to truly be able to offer a full menu of a variety of services and supports that support people towards recovery and well-being. We also know, and some of the research has highlighted this, and Patrick has talked about it, we know that therapeutic interventions support symptom improvement and address clinical needs. But in fact, we see some of the same amazing things happening in our recovery colleges. We have been seeing through our work here in Canada, people are seeing a reduction in their symptoms, specifically anxiety, depression, and other psychiatric symptoms. There's been a reduction in the days that they needed and have required in terms of hospitalization, reduction in admissions, and actually an increase in community connections that are non-professional. So building up their support base in a non-professional way, which I think strengthens their social capital and are connected to long-term recovery outcomes. Next slide, please. So who are recovery colleges for? And we've talked a little bit about this, and it's important to kind of explore this a little more deeply, because this is one of the elements that has made recovery colleges very non-stigmatizing and very accessible for just a broad range of individuals who, along a continuum, may have struggled with mental health or substance abuse issues, but have now found a way to work together with people who have struggled with mental health or substance abuse issues, or struggled with stress and worry, or life transitions that have been disruptive. It's a whole continuum of distress and illness that often brings people to seeking out supports. And so what we've seen are recovery colleges are really appealing to very diverse audiences and individuals. When we first started our recovery college here in Winnipeg, in the province of Manitoba, which is in the center of Canada, we thought we would probably see folks that are involved in our other services, like our Housing First programs, or our sort of community treatment programs, or our psychiatric rehabilitation services, our CBT programs. We have a whole range of mental health supports and services. We thought we would see folks from those programs signing up for courses. We certainly did, but we saw people coming from the public and from the broader community also connecting with our organization, who wouldn't necessarily have connected previously, but are registering for courses and connecting to the recovery college opportunity. So it's really a very meaningful experience that when a classroom is full of folks who are very diverse, and some of whom have had long-term psychiatric struggles, others who've had an episodic experience, and others who are there because they're trying to be preventative, or they've had some sort of life stressor or disruption or challenge that has encouraged them to seek supports. So that has a very leveling effect and creates a very open and inclusive environment. The other audience that we've seen really take up this important model are people who work in the mental health sector. So professionals who work in mental health. We've had many, many mental health providers taking courses. And often they'll start with wanting to take the course so that they can understand what the recovery college is all about, so they can encourage their clients and their patients. But what we've found is this whole educational opportunity has been deeply meaningful for mental health professionals as well, and has provided them with something that has been very useful both at a professional and personal level. There are many benefits identified by students and people primarily living with mental illness, lived experience, staff, professionals, and the benefit of the learning model creating such an open space for exploring concepts and ideas and educational topics that make such a difference. And also the opportunity to develop skills. Students benefit from one another's lived experience and that diversity within the student group really brings so much social learning into the context. People learn from other people's perspectives. And there's a real sense of shared hopefulness and compassion and empathy that really begins to sort of transform the learning experience. A recent review by researchers that looked at understanding the impact recovery college is having really looked at subgroups of people who use mental health services and what their experience was within the recovery college environment. Individuals who may be early on in their recovery benefit from the opportunity to get support and guidance as they're making choices around their treatment planning. We've seen a subgroup of folks who find it challenging to engage in other mental health services and show up for appointments, but find the warm, welcoming environment of a recovery college creates an opportunity for them to pursue some type of mental health support without it being connected to formal services. So with the low barrier approach that we have, that's been very appealing. Individuals who have a high level of self stigma certainly benefit from the program and really get so much from exposure to peer trainers. So again, that opportunity to see people who have lived and living experience in a role where they're supporting and educating others and facilitating learning. And then the fourth subgroup are those whose social connections are limited to formal services and would benefit from meeting others outside of that context. And so as day treatment programs and those kinds of environments have been less available, people have struggled to find meaningful ways to connect with others. And those who've experienced a lot of social isolation as a result of their mental illness have found recovery colleges to be an incredibly welcoming and safe space. Next slide. So features of a welcoming recovery college. So this is where I work. This is the Canadian Mental Health Association here in Winnipeg. And so I've just given you a few pictures to give you a bit of an example of what our recovery college looks like. So what you'll see here, that first picture is our wellbeing cafe. So we intentionally really shifted away from having a waiting room atmosphere to being very much a campus vibe and energy. And so obviously this picture is taken probably not that long ago during the pandemic as our in-person offerings have been reduced to ensure public health adherence. But usually this environment is full of people, students coming in, waiting for their course. We do a lot of live courses. We have educational rooms. They'll often be charging their phone, having a snack, connecting with others. And it's a very warm, welcoming, inviting environment. It's accessible and it's very welcoming. It doesn't have a clinical feel to it. And we have peer hosts that are a part of this wellbeing cafe that are there just to connect with people. And for somebody who's new, the focus is we're so glad you came. We're really excited to see you and creating lots of space for people to learn about what we have to offer as a recovery college. We always invite people to know about the other services we offer. We have walk-in services. We have many other kinds of services. So there is an opportunity to connect with other services and have support around service navigation. But the recovery college is very much about focusing on an educational offering. We also offer our courses in the evening and during the day. So again, creating great opportunity for lots of accessibility and participation. We have many people taking courses in the evening because they're working during the day. So that's been highly valued. We have a library, bulletin boards, resources, free books. We have also a free internet access, computer use area, which is very well used and appreciated. And as I said, it's non-clinical. We use plain language. And when we talk about our courses, we have a course prospectus that features all of the various courses that we offer. And more and more, we're trying to offer these programs in different languages that reflect our community need. You'll see that our front door is here and this is a very accessible location on a bus route and very vibrant. And then the last picture is one of our educational rooms that we use. And we've been very fortunate. We have very high quality audio visual equipment and that came to us actually just prior to the pandemic and very much allowed us to pivot to a virtual course offering, which I'll talk a little bit more about later on. Next slide, please. So a little bit about recovery college courses. So Patrick already talked about how important it is to have unique offerings. So here in Canada, we talk a lot about not reinventing the wheel, not replicating courses that might be available at a community college, for example, or through a leisure guide or a fitness or health facility. Our goal is not to reinvent the wheel. If there's other courses out there in the community that people can access, we encourage and we support and facilitate connecting to those courses. But what we do within our recovery college is develop courses and workshops that are based on what students wanna learn. And our courses can range from one hour, we call those taster courses, to one time information sessions, to multi-session workshops and 10 week courses that run once a week. So there's a really broad range of different types of courses and lengths. The number of courses a student enrolls in will vary depending on their interests and their time. This does allow for people who are starting off in their recovery journey and building up their stamina. There's no need to go full time, but you can take as many or as few courses as you choose. The goal though is through our student advisors to support people through a progressive process of setting goals and coming up with a learning plan to help them continue to develop through the recovery college program. The kind of courses and workshops that we offer truly depend on the needs and the wants of the students. And it's important to consider what is already being offered, as I said, in the community, as we don't wanna duplicate. And to also look at developing a broad range of courses that really connect to student needs. Recovery college courses often begin with a basic set of courses and then over time grow and engage more students. These courses can be very specific and address very particular topics or they can be broad. And so I'll give you some examples shortly, but the course development process is a very powerful one. And it's really where some of the empowerment and exciting work happens for students as they get involved in the development and even the facilitation of courses through this process. Next slide. So here's some sample courses. This is just from the recovery college here in Winnipeg. Our recovery college is called the Wellbeing Learning Center. And I just, before I kind of start talking specifically about some of these courses, I just wanna let you know that our beginning started with the work that we were doing around our psychiatric rehabilitation program. And so we were closely affiliated with the University of Boston and the Center for Psychiatric Rehabilitation. And we have been offering learning courses, workshops for several decades. And that work started in the 90s and was really inspired and facilitated by our involvement with the Center for Psychiatric Rehabilitation. That work then kind of continued to grow as we connected with colleagues in the UK who then developed this very focused recovery college approach. And we further developed our learning platforms and our learning offerings here to now be very much a recovery college that is both supported and influenced by our strong foundation of psychiatric rehabilitation, which is so much about learning and resource acquisition and skill development to now this very beautiful recovery college approach that brings in co-production and peer-led initiatives. So we're so excited about the evolution of this work. Here are some sample courses. One of the most foundational courses that you'll see in most recovery colleges is Recovery College 101. So it's that orientation to recovery and recovery college work. And then I've provided you with some different topics here that have been more recent offerings. Establishing boundaries, lots of courses on relationships and social connections. We have lots of courses on mindset, promoting positivity and optimism. We have courses available on vulnerability and developing self-compassion. We have courses that are about social connections and the importance of building healthy, meaningful relationships. There've been very specific courses developed in response to the pandemic, challenging loneliness and isolation. And of course, those issues were there before the pandemic, but certainly were elevated over the last year. Other skills and topics and courses are around emotional regulation, making peace with anger. And then another very popular topic is fatigue and dealing with exhaustion. And again, we try and work with students to develop the content. We get experts in the various topic areas and it's very much a co-design process. And then we pilot test the course, we get feedback and then we make changes. You'll notice that there's a course there on the wellbeing of service providers. And this course is a part of our course offerings through our college, but it's also a topic that we get lots of requests for from our mental health service provider community. Next slide, please. So the role of peers in recovery college, this is really critical. You can't do recovery college without peers being at the center, leading, supporting and being involved. Recovery colleges are a valuable opportunity for people to develop skills such as peer support, mentorship, facilitation skills, instruction. There are worthwhile advantages to having peer development structures in place. And we have those through peer training and facilitation skills and mentoring opportunities and professional development opportunities for peers to enter the workforce. Peer roles support the operation of our recovery college in some very deep and meaningful ways. They're peer supporters, they're peer support workers, peer facilitators, peer trainers, peer instructors, peer learning advisors, peer buddies. So there's a range of ways to formally establish roles. And we've done a variety of these in different configurations. And often when someone comes to a recovery college, it is the peer who is often the first person the student will speak with. This is very meaningful and very inspiring and an important way to create a culture, to offer warm, welcoming information and support when people first come. There's four roles within a recovery college for peers, certainly being a role model where they have the opportunity to share their experience. And that, of course, creates a great opportunity for inspiring hope and creating opportunity for understanding the recovery journey. Peers also provide guidance and information on the program, describe courses, help with developing learning plans. We also have peer advisors who provide support and leadership to guide us in the development of our recovery college, to help in course and curriculum development and also in evaluation. That's a very critical component. And then lastly is the co-facilitation role. Peers co-facilitate and are peer instructors and fulfill a very important role around facilitating learning. Next slide, please. Peer support and the role of peer is fundamental. The other fundamental thing to recovery college that is very much connected to peers is co-production. We use the words co-production, co-design, co-creation, all interchangeably, but it is really taking design thinking and bringing a diverse group of people together who have knowledge, skills and information on a particular topic to co-create the recovery college model. Right from how you set up the Recovery College to specific courses. And our co-production work happens every day and has now become the way we do business in our Recovery Colleges, but within our community-based mental health organizations as well. It hasn't been limited to the Recovery College approach and model. Co-production has really transformed how we engage people with lived and living experience from diverse experiences to be a part of creating what it is we're all about and what we're doing. So that's been a very transformational part of this work. People with lived experience of mental health issues, family members, supporters, they all bring really untapped knowledge and expertise, which often has been overlooked by service providers, by agencies like ours, by the mental health and substance use service systems. And this has created a really elevated opportunity to really work with and really curate and support the development of this work together. In Recovery College models, the value of this knowledge and experience is not only acknowledged, but it's actually fostered and utilized in the development of the college. It creates a shift in power and voice, and it moves us from having an advisory committee to everything about the work that's happening is informed and led by co-production approaches. Next slide. We've seen so many benefits to the co-production work. It is really, as I said, represented a significant shift in the way programs and services are developed and implemented. It goes beyond practices of consultation, and it's more than just asking people about their opinion or having input in limited ways. Co-production is potentially a transformational practice and outcome. It has been described as appreciative, collaborative, respectful, and active. And those are the qualities of our co-production sessions that we're always striving towards. And we evaluate our co-production sessions. We've seen that through this kind of engagement process, and the research has supported this when they've looked at the impact co-production has, that there are many outcomes, including it leads to more efficient use of resources, supports prevention efforts while encouraging self-management, positivity. It supports behavior change. People get activated. And it increased support, social support networks. And it has the potential to enhance mental health and wellbeing. And we have seen over and over again, many people who will come to us and say, I've been involved in so many different programs and services, but there's something very different about their experience in a recovery college. It brought them to a place where they were able to make such a significant shift in their life. And the volume and the level of empowerment that they've experienced to move on into other life roles has been outstanding. And we've got individual after individual sharing these transformational stories based on their experience in a recovery college. Next slide. There are challenges, of course, as with anything. And this is what we work towards trying to really manage. Those who've supported and participated in co-production processes are honest about challenges. It isn't easy to do things in completely new ways and be willing to relinquish power and authority and for some to take on power and responsibilities. So when those roles have to change, there can be some adjustments that can be challenging. We've certainly seen that, especially early on in our work. We saw some of those challenges. Those who have experienced with co-production process speak to the challenges around finding a balance that works. When in balance, the process of co-production has the risk of becoming tokenism. And many of us have seen that over the years. So that's one of the things that needs to be very much managed and considered that you guard against tokenism. The scales that have been shown to tip in the other direction where the input for professionals is not equally sought out or valued has also been one of the realities where mental health providers or professionals feel like their voice isn't heard. So how do you find a balance? And that has definitely been described in the literature and the evaluations. But the goal is recognition of each person's expertise as a valuable resource for co-production process. That really is critical. And it's important for that balance to be had. So both the professional and the person with lived experience. And more and more, we're seeing such diversity and such a perspective that brings often even some of those experiences together because more professionals are sharing openly about their lived experience. And more people with lived experience professional journeys. So we're seeing lots of different roles kind of come into supporting this work. Next slide. There are six principles of co-production and I'm just going to highlight these very quickly, making sure we have time for Q&A. Strength-based approach is very much at the heart of all of this. People are viewed as equal partners. Building on people's existing capacities, recognizing strengths and their capabilities and the enhanced opportunity to grow these capabilities. Co-production sessions can be incredibly transformational in terms of people learning new skills, finding their voice. The other key principle is around reciprocity and mutuality. So citizens and professionals working together to form and to forge new grounds and new relationships based on mutual respect, sharing responsibility, sharing expectations. And then peer support, the full involvement of peers along professional roles and that nothing happens without those two critical perspectives. We've seen a key principle emerge around the reconceptualizing of these roles and recognizing the value of all roles and that there is no hierarchy. And that facilitating rather than delivering, where agencies provide the context for inspiration and growth rather than the deliverers of service. So it's about creating an environment, a context, a culture as a part of that principle of co-production. Next slide. Sorry, there we are. That was an abrupt end. This is the biography, but as you can see, this program brings in the things that we in the mental health and substance use recovery system have been, I think, promoting for decades, the importance of a recovery oriented system, but creates a very interesting and new way to bring people together to co-produce a recovery college that really creates a new way to strive towards educational pursuits around mental health and wellbeing. And the evidence is certainly starting to build and certainly we're seeing an incredible amount of lived experience that demonstrates the power of this model. And happy to respond to any questions. All right, Erin and Patrick, thank you so much. I'd like to just give you a really big thank you for such a great and inspiring presentation. I learned a lot about recovery colleges. Before we shift to the Q&A, I wanna just take a moment to let you know that SMI Advisor is now available from your mobile device. Use the SMI Advisor app to access resources, education and upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI Advisors. Download the app now at smiadvisor.org slash app. All right, and now on to the Q&A. So if members of the audience have questions, please put them into the chat. A couple of things, I guess one of the things that comes to mind is, could you say a little bit more, Mary, and specifically about the adaptations during the pandemic and the transition to a virtual recovery college, any particular challenges with that, and also perhaps what might remain in a digital format sort of moving forward in a post-COVID world one of these days? Absolutely, what we've seen over the last year is that we were able, and many recovery colleges across the globe really, because I've had conversations with colleagues in the UK, in Australia and other places that are delivering recovery college offerings, that the pivot to the online platform actually has been very meaningful. Initially, students were very, very sad to lose that in-classroom, personal, sort of in-person connection, but we quickly started offering courses online, and as people got more comfortable with the online platforms, and we've simply used things like Zoom and Teams meetings and other applications like that that allowed for people to continue on and take courses. What we saw was a huge amount of growth in the number of students that were registering for courses. So just by example, last year, so 2019 and 20, we had 400 students throughout that year, individual students taking courses at our recovery college here in Winnipeg. This year passed, so 2020 to 2021, the end of March, we had 1,700 students, individual students taking courses. So we've seen this amazing growth of people engaging with recovery college, taking online courses, and being very engaged in an ongoing pursuit of learning and growing and developing their mental health and wellbeing through the use of a recovery college platform. So it's been incredibly powerful, and this is the same story I hear from colleagues in recovery colleges all over Canada and throughout the world, that in fact, what will likely happen as we, and when we resume a more usual sort of way of delivering services, we will need to continue to offer the virtual offerings. We've seen people who wouldn't have normally even connected to our service reach out to the virtual platform. So we know that it needs to remain a hybrid, and we've done that. So during periods of time when we were able to bring people back into our center, we did some hybrid where we had 10 people in the classroom when we were allowed to have up to 10 people according to public health guidelines, and then 40 people online. And so our facilitators, our peer facilitators, our educational facilitators have learned lots of versatility around using educational techniques that bring both virtual sort of approaches and in-person approaches together to create meaningful learning. Thank you so much. I was also wondering a little bit about how recovery colleges, how more of them could kind of be out there. I mean, how are recovery colleges funded, or would you have any advice to people who are interested in sort of developing a new recovery college? We do a lot of support, advising organizations and supporting organizations to start up their recovery college. So we're certainly available and happy to have my information be shared with your colleagues there to explore what the next steps might be. In terms of funding, a lot of recovery colleges got their start by reframing existing programs to begin to move towards a recovery college model. So we did have some clubhouses, for example, that hadn't really achieved the kind of outcomes that you'd see in a high-fidelity clubhouse and decided to transition into a recovery college. We've seen organizations who had like a workshop, educational sort of program that has used that base of courses and workshops that they may have delivered to become a formalized recovery college. We've seen funding. So we're seeing more and more provinces here in Canada who are responsible for the healthcare budgets and providing the funding to communities to develop programs and services through health authorities. We're seeing some funding now coming to support recovery colleges. We have some very exciting opportunities that I think are starting to unfold. And we have also seen some programs that decided there needed to be a shift in focus to become more recovery-oriented and have done some reallocation. So there's been a variety of different things. We've seen foundations and philanthropy be all quite interested in this work as well. Terrific. Thank you so much, Mary and Patrick. And there are more questions, but we should probably finish up now for the sake of time. And so if anyone has follow-up questions about this or any topic related to evidence-based care for people with SMI, our clinical experts are now available for online consultations. Any mental health clinicians can submit a question and receive a response from one of our SMI advisors. Consultations are free and confidential. Next slide, please. SMI Advisor is just one of the many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We encourage you to explore the resources available on the Mental Health, Addiction, and Prevention TTCs, as well as the National Center of Excellence for Eating Disorders and the Suicide Prevention Resource Center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. Thank you so much for joining us. And until next time, take care. Thank you for participating in today's free course from SMI Advisor. We know that you may have additional questions on this topic, and SMI Advisor is here to help. Education is only one of the free resources that SMI Advisor offers. Let's briefly review all SMI Advisor has to offer on this topic and many others. We'll start at the SMI Advisor website and show you how you can use our free and evidence-based resources. SMI Advisor's mission is to advance the use of a person-centered approach to care that ensures people who have serious mental illness find the treatment and support they need. We offer several services specifically for clinicians. This includes access to education, consultations, and more. These services help you make evidence-based treatment decisions. Click on consult request and submit questions to our national experts on bipolar disorder, major depression, and schizophrenia. Receive guidance within one business day. It only takes two minutes to submit a question and it is completely confidential and free to use. This service is available to all mental health clinicians, peer specialists, and mental health administrators. Ask us about psychopharmacology, recovery supports, patient and family engagement, comorbidities, and more. You can visit our online knowledge base to find hundreds of evidence-based answers and resources on serious mental illness. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Harvard, Emory, NAMI, University of Texas at Austin, and more. 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They can choose from a list of important questions that individuals who have SMI typically ask. SMI Advisor worked with experts from the National Alliance on Mental Illness to develop these important questions and many of the resources in this section. Watch videos on important topics around SMI, such as what to know about a new diagnosis. They can also find dozens of fact sheets, infographics, and links to other important resources. To access even more evidence-based resources for individuals and families, visit our online knowledge base. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Mental Health America, National Alliance on Mental Illness, and more. Browse by key topics and select View All to uncover a list of resources on each topic. SMI Advisor offers a smartphone app that lets you access all of the same features on our website in an easy-to-use, mobile-friendly format. 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Video Summary
The video is a presentation given by Dr. Rob Cotez, Associate Professor at Emory University School of Medicine, about "Recovery Colleges: Support for Individuals with Serious Mental Health Disorders Realizing Their Full Potential in the Community". The presentation provides an overview of recovery colleges, which are centers for adult education that focus on supporting individuals with mental health disorders. The presenter explains that recovery colleges aim to empower individuals by providing them with the skills and knowledge needed to manage their illness themselves, promote self-care, and develop healthy lifestyles. The colleges offer a range of courses and workshops tailored to individual needs, with a focus on strengths and abilities rather than deficits. The involvement of peers, individuals with lived experience, is a key aspect of recovery colleges. Peers are involved in all aspects of the colleges, including governance, curriculum development, and instruction. The presentation also discusses the benefits of recovery colleges, such as reduced service utilization, improved symptom management, and increased social connections. It highlights the principles of co-production and strength-based approaches that underpin recovery colleges. The presenter also discusses the adaptation to virtual platforms during the pandemic and the potential for hybrid models in the future. Funding for recovery colleges can come from a variety of sources, including reallocation of existing resources, governmental support, and philanthropy. The presentation concludes by highlighting the ongoing growth and impact of recovery colleges and the transformative experiences they provide for individuals with mental health disorders.
Keywords
Recovery Colleges
Support for Individuals
Serious Mental Health Disorders
Community
Adult Education
Self-care
Healthy Lifestyles
Peers with Lived Experience
Co-production
Virtual Platforms
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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