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CPRP Practice Exam
What does WRAP stand for? - Wellness Recovery Action Plan What elements are central to recovery as identified by SAMHSA? - Holistic, Hope, Self-direction, Individualized and person centered, empowerment, nonlinear, strengths-based, respect, peer support Rights of Passage (ROP) - A community based model for african american youth Interpersonal and Intrapersonal factors to consider for cultural competency are - (1) sociocultural and demographic descriptors, (2) historic and current sociopolitical context, (3) cultural values beliefs and behaviors, (4) family & kinship network, (5) acculturation and adaptation styles, (6) developmental life stage, (7) multicultural identity development, (8) individual presentation style, (9) intrapersonal variables Who developed the WRAP? - Developed by Mary Ellen Copeland in the 1960s. What are the components of a WRAP? - (1) triggers, (2) crisis plan, (3) daily maintenance plan, (4) early warning signs How many principles of psychiatric rehabilitation are there? - 12 How are the principles of psychiatric rehabilitation grouped? - 1-3: Role of the Practitioner 4-10: Best practices in the field 11-12: Service delivery What are principles 1-3 of Psychiatric Rehabilitation? - Principles 1-3 relate to the role of the practitioner. (1) PRP Practitioners convey hope and respect. Believe that all individuals have the capacity for learning and growth. (2) PRP practitioners recognize that culture is central to recovery and strive to provide culturally appropriate and relevant services to consumers. (3) PRP practitioners engage in the process of informed, shared decision-making and facilitate partnerships with other people/resources the individual receiving services has identified. What are principles 4-10 of Psychiatric Rehabilitation? - Principles 4-10 relate to best practices in the field
(4) PRP services build on strengths and capabilities of the individual. (5) PRP services are person-centered and designed to address the unique need of the individuals, consistent with their values, hopes, and aspirations. (6) PRP services support full integration of people in recovery into their respective communities; to exercise their citizenship and explore responsibilities/ opportunities that come with being a community member in society. (7) PRP services promote empowerment and self-determination. Everyone has the right to make their own decisions about their treatment and life. (8) PRP services facilitate the development of support networks through natural community supports, peer support initiatives, and self/mutual help groups. (9) PRP services help people promote the quality of ALL aspects of their lives. Including: social, occupational, residential, intellectual, spiritual, and financial. (10) PRP services promote health and wellness and encourages people to use individualized wellness plans. What are principles 11-12 of Psychiatric Rehabilitation? - Principles 11-12 relate to service delivery. (11) PRP services emphasize evidence-based practices, promising/ emerging best practices that produce outcomes in line with personal recover. Programs should have structured program evaluation, quality improvement/assurance that actively involves consumers (12) PRP services must be readily accessible to all whenever they need them. Services should be well coordinated with other psychiatric, medical, and holistic practices/ treatment. What are the components of a WRAP? - Four main elements include: Triggers, crisis plan, daily maintenance plan, early warning signs. True or False: In psychiatric rehabilitation (PRP) there is no one definition of recovery that has been agreed upon. It can refer to both a process or an outcome of interventions, or both. - True; Overall when discussing recovery we're talking about a person's right & ability to live a safe, dignified and meaningful life in the community of their choice despite a continuing/ persistent disability/ illness. What is SAMHSA? - Substance Abuse and Mental Health Services Administration. What does SAMHSA do? - Provide technical assistance to consumer run programs. They also fund various demonstration projects to promote the development of self-help groups and other innovative peer support programs. What is SAMHSA definition of recovery? -
(3) must have abnormal response to an event or a culturally/ socially acceptable reaction to circumstances/ events (4) a faulty way of perceiving or reacting to the world or a biological cause Positive symptoms - Refers to the presence of signs and symptoms. Such as delusions or hallucinations Negative symptoms - Refers to the absence of typical/ normal behavior. Such as social withdrawal, poverty of thought content, blunted or flat affect How are symptoms classified? - Affective, behavioral, and cognitive Affective symptoms - Relate to how we feel Behavioral symptoms - Refer to our actions and how we behave Cognitive symptoms - Refers to thoughts, how we think, and process information Define the "disability perspective" on psychiatric disability. - Psychiatric disabilities occur when a mental health condition interferes with a person's function in living, learning, working, and/or social environments and roles. Uses terms like psychiatric disability vs. mental illness. Implies hope of reacquiring abilities, valued roles, and independence. What is the ADA? - Americans with Disabilities Act of 1990 What is the SSA? - Social Security Administration How does the ADA define disabilities? - The ADA is based on prohibiting discrimination against people with disabilities. Defines disability as a physical or mental impairment that substantially limits one or more major life activities of the individual. How does the SSA define disability? - The inability to engage in any substantial gainful activity/ employment by reason of any medically determinable physical/ mental impairment which can be expected to result in death or which has lasted/ can be expected to last for a continuous period of no less than 12 months. How does the PRA define disability? - The concept is seen as more relevant to rehabilitation than is the concept of illness, and implies the hope of reacquiring abilities and roles.
Define the "bio-psycho-social perspective" on psychiatric disability. - Health condition is seen as interacting with environmental and personal factors to affect an individual's functioning at the level of body functions and structures, in performance of daily activities, and in participation in values, roles, and life domains. Bio-Psycho-Social Perspective functions related to symptoms of the body - Affective functions, Behavioral functions, Cognitive functions (ABC) Affective functions - Refers to experience, expression, regulation of affect Behavioral functions - Refers to energy and drive, sleep and appetites, and psychomotor functions Cognitive functions - Refers to experience of self and time, attention and concentration, memory and executive functions What kinds of activities can be affected by mental health conditions? - Learning and applying knowledge, general tasks and demands, communication, interpersonal interactions and relationships, self-care/mobility and domestic life Per the bio-psycho-social perspective of psychiatric rehabilitation, how do mental health conditions affect various life domains? - It can impact participation in (1) major life areas such as education, employment, and economic self-sufficiency. And (2) community, social and civic life including recreation, leisure, religion and spirituality, and citizenship. Define the "social perspective" on psychiatric disability. - Sees disability as a product of the social and interpersonal factors. There's no such thing as mental illness, and psychiatric symptoms can be a healthy response to a dysfunctional world. What, looks like illness, represents a method of surviving difficult times or coping with trauma. Since the environment helps define "disability", disability is a socially constructed concept. What is person-first & person-centered language? - A way of referring to an individual in treatment. Refers to the person alone and the diagnosis as secondary. The diagnosis does not define the individual as a whole. An example of person first & person-centered language - Someone with a history of depression vs. suffering from depression. Why is the term consumer used in place of client? - The term client does align with person-centered language. The term implies ownership over the individual, while consumer does not. What are the peer support competencies? - (1) understanding and fulfilling the peer-worker role, (2) empowerment, (3) recovery, (4) building relationships, (5) service delivery, (6) documentation
Trauma-informed - Peer recovery support utilizes a strength-based framework that emphasizes physical, psychological, and emotional safety and creates opportunities for survivors to rebuild a sense of control and empowerment. How does recovery work as a process of intervention? - As a process of intervention, recovery is a long-term, multidimensional with dimensions that should be viewed along a continuum. It can involve adjustment to disability, symptom remission, and/or improvement in instrumental role functioning and community integration. How does recovery work as an outcome of intervention? - Recovery outcomes can include improvements in role functioning at work, social and living situation. What are the critical ingredients of family psycho-education? - (1) Mental illness education, (2) problem-solving, (3) stress reduction, (4) long-term duration, (5) family and consumer involvement What are the categories of peer delivered services? - (1) Peer-run and operated services, (2) peer partnership, (3) peer employees Reflecting - A skill used in motivational interviewing. Refers to the rephrasing of the expressed feelings to show that a rehabilitation practitioner understands what is being said. Incrognruence - When body language is a more accurate reflection of a person's true feelings if body language is in conflict with what is being said. A consumer may see the practitioner as untrustworthy. Avolition - Refers to the deficits in the initiation of goal-oriented behavior. Catatonia - Psychomotor disturbance characterized by lack of movement, activity, or expression. For example - flat affect. Often seen as a symptom of schizophrenia. Anhedonia - An inability to feel or experience pleasure. Alogia - Poverty of speech from impairment in thinking that affects language abilities. Recovery international organization - An important resource for people who are recovering from a variety of mental illness. What are the four principles of motivational interviewing? -
(1) express empathy, (2) develop discrepancy, (3) roll with resistance, (4) support self-efficacy What is motivational interviewing? - An empathetic communication method that nurtures the individual's intrinsic motivation to change by assessing the person to see discrepancies between their behavior and personal goals. What is the trans-theoretical model of change? - A model used to determine a patient's willingness to change. What are the stages of the trans-theoretical model of change? - Pre-contemplation, contemplation, preparation, action, maintenance, termination Pre-Comtemplation Stage - Refers to when an individual doesn't believe there is a problem and therefore not even considering behavior change. Contemplation stage - Someone is experience ambivalence about their problem and are beginning to think about/ consider behavior change. Preparation stage - Someone recognizes that a change needs to be made and is exploring and/or creating a plan of action. Action - Someone is taking definite steps to change problem behavior and acquiring new, healthy behaviors. Maintenance stage - Someone has sustained change for a while (at least 6 months) and are working towards preventing relapse Termination stage - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs Relapse stage - Represents the time in a person's treatment where they have slipped back into old habits and returned to use. Define empirically supported treatment (EST). - A kind of intervention that has been proven effective. Such as CBT to treat depression. What are the different schizophrenia categories? - Paranoid, catatonic, undifferentiated
Treatment focuses on assessments, screening, and treatment for both mental illness and substance use, helps consumers not get lost navigating between mental health and substance use programs. Delusions - Bizarre beliefs or ideas that a person has that are not based in realist, and they can't be talked out of Hallucinations - Incorrect sensory information that the individual experiences as real. What was the Vermont Study? - A longitudinal study run by CM Harding of deinstitutionalized people in the 1960s. This was the first study that proved and demonstrated that people with schizophrenia could have positive long-term outcomes. Define peer-support - Emotional support provided by a peer support specialist to others with similar mental, substance use or co-occurring mental health and substance use disorder to achieve a desired social/ personal change. A process of sharing mutuality, giving and receiving hope, and strengths and lived experiences. What are peer support programs? - Programs, discussions, events, groups, etc. within the mental health system that are led by people in recovery and based on the principle of peer support. What are the 5 theories that account for the effectiveness of peer support? - (1) Social learning theory (Bandura), (2) Social comparison theory (Festinger), (3) Helper theory principle, (4) Social support theory, (5) experiential knowledge theory. Social learning theory (Bandura) - Emphasizes modeling, also known as imitation or observational learning, as a powerful source of development/ learning Social comparison theory (Festinger) - The idea that we learn about our own abilities and attitudes by comparing ourselves to other people. Suggests that learning from personal experience adds a level of understanding beyond what can be gained from observation and research. Helper theory principle (Riessman) - When an individual (the "helper") provides assistance to another person, the helper may benefit. Benefitting from helping others Social support theory (Drennon-Gala, Cullen) - Focuses on the various types of supports that people rely on including: emotional, instrumental/ informational, companionship, and validation. These forms of support can reduce the likelihood of delinquency, crime, and negative life outcomes. Experiential knowledge theory (Dewey) -
This is the basis for the experiential learning theory. Experiential learning focuses on the idea that the best ways to learn things is by actually having experiences. Those experiences then stick out in your mind and help you retain information and remember facts. What are the outcomes of peer services? - (1) reduced hospitalization (2) lower rates of hospital utilization (3) reduced contact with the rest of the mental health system (4) better employment outcomes (5) lower cots to the mental health system (6) increased well-being and empowerment of service participants What is TRIGRS? - Treatment Request and Integrated Georgia Reporting Survey Define TRIGRS - A research design used to analyze consumer progress from peer support services. Particularly (1) current symptoms and behaviors, (2) skill deficits, (3) available resources and needs. What is the difference between a recovery story vs. an illness story? - A recovery story tells of success of walking in one's recovery, while an illness story states that on is still in their illness. What are the 5 stages of recovery? - (1) impact of illness, (2) life is limited, (3) change is possible, (4) commitment to change, (5) actions for change. True or false: Recovery is an operationalized construct that can only be measured by medical doctors. - FALSE What doe PSWHR stand for? - Peer Support Whole Health and Resiliency. It is a new role for certified peer specialists and is designed to offset premature death of people who are served in public health systems. Promotes wellness and resiliency that lines up with health care reform. Respite services - Provide peers a place to stay for up to 7 nights when they are in serious emotional distress. The lack of clinical atmosphere encourages individuals to move towards recovery while not interfering with their existing routines. What is the Pathways Housing First Model (PFH)? -
Inoculation against discrimination - Intervention aimed at resisting the internalization of accumulated, daily microaggressions to strengthen one's resistance against potential discriminatory experiences. Psychiatric disability - Implies something a person has (not "is"), while emphasizing ability. Mental illness - Implies a medical perspective that emphasizes the diagnosis and symptoms Mental health - Implies a wellness perspective and successful cognitive and interpersonal behaviors. Discrimination - Making a distinction in favor of or against a person, based on the group or category to which that person belongs Stigma - Refers to a mark or evidence of shame that is intrinsic to a person and which is often used as a justification for discrimination Filing a grievance -
- the applicant must specify exactly which principle in the code was being violated and how.
- the CPRP will be notified immediately and is required to respond in writing within 30 days and send to Ethics Review Panel. SMART goals - Specific Measurable Attainable Realistic Time-based Competitive work - Refers to jobs that are a) available to everyone, b) offers wages and benefits that are comparable to industry standards, c) provide opportunities to work alongside non-disabled co-workers How does competitive work relate to psychiatric rehabilitation? - People with psychiatric disability, like everyone else, should work, would work, and could work. What are the barriers to returning to work? -
Distractions of the illness itself, discouragement from staff and families, perspective of financial disincentives, limited educational and training qualifications, current dismal job market What are the first generation employment programs and approaches? - Sheltered work programs, step wise practices Sheltered work programs - Centered around the idea that the best way to get into competitive employment is to start off in a sheltered work setting where consumers are provided a supportive environment to relearn the fundamentals of employment. Why are sheltered work programs ineffective? - (1) competitive employment goals eventually became a goal to just be in the sheltered work program itself. Sheltered workers became reluctant to move on and were fearful of the demands of genuinely competitive work. (2) sheltered work environments provide a poor place to prepare people for the actual demands of a competitive job environment, where there in an increased pressure for consistent production and low tolerance for differences. Step-wise practices - Linear step-wise approach to vocational rehabilitation. Counselors would begin discussing work only when the consumer was clinically stable and ready for the challenges of a job. The worker would need to prove their competency in a variety of tasks. Why are step-wise practices ineffective? -
- waits for clinical stability instead of the abatement of the most acute symptoms
- clinical stability was not really a prerequisite for work demands vs. a product of the opportunity to work
- consumers could only hold off their symptoms when they were called upon to focus on work tasks What are the second generation employment programs and approaches? - Community based employment programs, Agency operated business, Placement practices Community based employment programs - Provide consumers an opportunity to work in the community, but with a range of assistance and support through transitional employment. Transitional employment (TE) - A type of community based employment program. Consumers have an available array of community based job placements arranged for them that are reserved for each agency. Each worker spends 6 months in TE before moving onto another TE or fully competitive employment or supported employment. Agency operated business -
-Clubhouse staff member do not dived their time between the clubhouse and other responsibilities Clubhouse model: space - All clubhouse space is member and staff accessible. there are no staff only or member only space Clubhouse model: work ordered day -
- The work ordered day engage members and staff together -The clubhouse focuses on members strengths talents and abilities; therefore the work ordered day is inconsistent with medication, day treatment or therapy programs -All work in the clubhouse is designed to help members regain self-worth, purpose and confidence; it is not intended to be job specific training Clubhouse model: employment - Enables members to return to the normal work world through transitional employment and independent employment Neffinger and day program evaluations - 1981 proposed a taxonomy of partial hospitalizations programs that identified three primary purposed or functions of partial hospitalization;
- an alternative to inpatient treatment, "day hospital", stabilize acute episode
- a supplement to traditional outpatient treatment and vocational rehabilitation "day treatment", accelerate rapid improvement
- Functional maintenance in the community "day care", prevent further deterioration Criticisms of psychiatric day programs - No two programs are the same, it is hard to measure program and effectiveness In the typical day program, what are the staff levels - The staff in a day program typically include: Staff Director: Sets both the philosophical and administrative tone for the program. Tasks may include setting the program design, supervising the daily operations of the program, recruiting and supervising staff Counselors/case managers: may be referred to as line staff, spend most of their time working directly with consumers.
Mental health aides or paraprofessionals: often work with pre-vocational units helping out with activities, drive vans to transport program members and conduct outreach to name just some of their roles Auxiliary or support staff: Auxiliary staff include -medical staff such as psychiatrists and nurses, specialized therapists Support staff are secretaries: file clerks, accountants Wellness for life community based group intervention - Wellness for life is a multidisciplinary intervention for persons living with serious mental illness and metabolic syndrome. The planned intervention takes place over a period of three or four months, followed by transition to other services to maintain gains. What are the steps in the Wellness coaching process - Orienting, assessment, goal setting, planning/accountability, mentoring and support Orienting - Describe what wellness coaching is and what it is not and roles of everyone involved Assessment - Review wellness status to clarify an area of focus. Goal setting - Use SMART method to set a goal Planning and accountability - Create a plan to succeed, including steps to take in the next weeks or months. Mentoring and support - Provide support and guidance. Help person maintain momentum. In shape community based group interventions - A full community integrated approach, potentially replicated anywhere. Staff are trained to address the symptoms and functional impairment affecting an individuals' ability to manage health, wellness, fitness and nutrition. Day wasting programs - Programs that allow habituation and do not give the client the needed skills to be independent Define: Continuity of care - Receiving all the services needed for the length of time they are required and across all settings What does continuity of care look like? - -A shift from individual agencies to interdisciplinary teams
Rehabilitation case management - Follows a traditional rehabilitation approach. Emphasis is on helping clients achieve success in the environments of their choice. Clients choose a goal, complete a functional assessment, from which the rehab is developed. Strengths case management - Based on two assumptions-
- to be a successful person, regardless of whether you have a serious mental illness or not, you must be able to use, develop and access your own potential and have the resources to do this
- a persons' behavior is dependent on the resources he or she has available. A focus on an individual's strengths as opposed to his or her pathology defects and symptoms is the defining element of this model Assertive Case Management - Also referred to as Assertive Community Treatment (ACT). In addition to providing the five basic case management functions, model directly provides most or all of the necessary services needed by persons living with serious mental illness. There is little or no emphasis on referring clients to other services. Treatment team members provide basic case management and a variety of rehabilitative and treatment services Intensive Case Management - General approach with a relatively low caseload and relatively few clients per staff person Reasonable accommodations - Accommodation is considered reasonable if it is not an undue burden. The employer is required to prove that an accommodation would be significantly difficult or expensive. What are the types of substance abuse models - Sequential services, parallel services, integrated services Sequential services - Person with co-occurring disorder first receives the treatment for one of the disorders and later for the other. When the first disorder is successfully under control, the individual is referred to treatment for the other disorder that is not being treated Parallel services - Different practitioners, working in different programs or agencies, treat each of the two disorders separately but simultaneously. Integrated services -
Developed to overcome the shortcomings of the sequential and parallel approaches - both of which are least effective. The integrated services the person with both a substance abuse disorder and a psychiatric illness receive treatment for both the disorder in the same place, same time and by the same practitioners. These practitioners are knowledgeable about both the disease and addiction. What are the group Treatments for Co-occurring Disorders - 12-Step Models, broad-based educational groups, social skills training group, stagewise treatment groups 12-Step Models - Professionally assisted pre-AA groups focused on facing denial, overcoming rationalization, surrendering to a higher power, ect. Broad-based educational groups - covers the need for education and support Social skills training group - living substance free Stage wise treatment groups - provides mutual support promotes the action and maintenance stages, not usually those in the engagement stage Principles of Treatment for People With Co-occurring Disorders - -Integrated Treatment - concurrent treatment for both disorders, same team or same clinician -Stage wise Treatments - A.) Engagement Interventions (Pre-contemplative and contemplative) B.) Motivational Counseling (Preparation Stage) C.) Active Treatment Intervention (Active Phase) • D.) Relapse prevention Interventions (Maintenance) What is the role of the employment specialist? - Provide supports away from the job site, employment specialist do not disclose the disability status of the worker unless directed by the person him or herself to do so, assist the supported employee with interpersonal relationships on the job, health, wellness goals, career planning, disclosure decision-making, money management, transportation, planning for the effect of earned income on social security and other information Reducing fear of benefit of loss - Ticket to work and working center improvement - method of reducing anxiety and not having your benefits. This allowed individuals to work without fear of loosing their benefits. The Carl Perkins vocational education act of 1984 -
