14th International Mental Health Conference

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Supported Education:

community participation through

education for youth and adults with

psychiatric disabilities

Opening Doors

The 14th International Mental Health Conference Outrigger Surfers Paradise, August 7 2013

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Hanze University Groningen, Research & Innovation Centre

for Rehabilitation

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Learning Objectives

 _{The participants will have increased knowledge of a}

Supported Education program with integrated services

 The participants will have increased knowledge of a

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Hanze University Groningen, Research Department of

Rehabilitation

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Overview

1. Why focus on (Supported) Education? 2. What is Supported Education?

3. Supported Education programme: ImpulSE course 4. SEd products & services

5. New activities

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Hanze University Groningen/ Department of Rehabilitation

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Rehabilitation

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Rehabilitation

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Rehabilitation

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Rehabilitation

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Rehabilitation

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Hanze University Groningen, Research Department of Rehabilitation 12

Why focus on

(Supported) Education?

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Rehabilitation

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Mental health issues…

 Most college students are young adults

 Young adulthood represents a high risk

developmental stage for the onset of psychiatric symptoms

 Typical onset for many serious mental illnesses

is ages 17-25, as most adults are beginning higher education & careers

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Rehabilitation

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Economic issues...

 Increasing #’s of young adults attend college;

college degrees are required for success

 Early-onset psychiatric disability contributes to

under- and unemployment through its effects on education

 People with psychiatric disabilities who enter the

labour market, most of the time, end up in low-paid jobs

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Rehabilitation

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Educational issues...

 An estimated 6% of students in Higher Education

report psychiatric symptoms serious enough to need mental health services (2001/2005)

 50% of them need extra support to finish their

education

 Students with psychiatric disabilities either don’t

know about disability services or don’t know they are eligible

 Emotional/psychological disabilities constitute

the largest disability group

 Yet on most colleges, students with psychiatric

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Rehabilitation

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People with chronical

diseases and disabilities

belong to the most

disadvantaged group of

people in our society.

(Rapportage Gehandicapten 2002)

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Rehabilitation

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Hanze University Groningen, Research Department of Rehabilitation

From a person’s

point of view

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Hanze University Groningen, Research Department of Rehabilitation

Personal issues…

Recovery is the process of self-discovery and change as one grows beyond the

catastrophe of mental illness

It is a way of living a satisfying and

meaningful life with or without limitations caused by the illness

The role of student (most of the time) supports the recovery process of the (young) adult with

psychiatric disabilities

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WHAT IS

SUPPORTED EDUCATION?

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Rehabilitation

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THREE ASPECTS OF MH CARE

Problem-oriented Developmentally oriented Environmentally oriented Treatment (Cure) Support (Care) Psychiatric Rehabilitation

(Living, Working, Learning, Socializing)

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Rehabilitation

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Traditional treatment plan

1. Medication (management)

2. Day-night rhythm

3. Personal hygiene

4. Financial problems

5. Cleaning the room

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Rehabilitation

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Rehabilitation / Treatment plan

1. Return to or remain at school

2. Medication (management)

3. Day-night rhythm

4. Personal hygiene

5. Financial problems

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Hanze University Groningen, Research Department of Rehabilitation24

SEd: the link between

psychiatry and community

Psychiatry PSR / SEd Community

Living Working

Patient =>Client/consumer =>Citizen => Learning =>

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Mission of SEd

To help people with psychiatric

disabilities to choose, get and keep regular post-secondary education of their choice with the least amount of professional interventions

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Rehabilitation

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Supported Education principle

Student role +

Educational setting

of preference

Skills + Support

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SUPPORTED EDUCATION

PROGRAMME

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Choose-Get-Keep model

Choose & Get

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_{Preparation course ImpulSE (group)}

Keep

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Rehabilitation

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Preparation Course ImpulSE

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Duration: 12 weeks

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Frequency: 1 day per week for 6 hours

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Location: (Community) College

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Participants: (young)adults who do not yet

know what kind of education they prefer

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Teacher/trainer: 1-2

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Financing of Sed services

 Educational system:

* budget for drop out prevention

* student related budget for students with disabilities

 Mental Health care system:

* personal related budget * assurance company

 Municipality:

* budget for citizens with disabilities * social security

 Disability grant

 Private:

* parents

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Eligibility requirements



16 years of age or over



Be willing to use an educational (group)

environment to develop and utilize an

educational plan



Have experienced a severe disability due

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Subjects

• Setting an overall educational goal:

- Identifying Personal Criteria

- Orientation to college locations and services

• Academic & Social Skills building

• Development of coping strategies

• Resource Assessment & Coordination

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Setting an overall educational goal

Identify personal criteria

+

Describing alternative educational

settings

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Identify personal criteria

Analyzing experiences

+ Future preferences

Clarifying values

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Skills & Support

Educational Goal

Success

+ Satisfaction

Skills+Support Skills+Support

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Functional Assessment

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_{Behavioral requirements to assess}

the critical skills to be successful at

school

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Personally important behaviors to

assess the critical skills to be

satisfied at school

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Resource Assessment

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Behavioral requirements to assess

the critical support/resources to be

successful at school



Personally important behaviors to

assess the critical support/resources

to be satisfied at school

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Critical skills

•

Coping with stress

•

Disclosing the disability

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Requesting support / modifications

•

Responding to feedback

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Disclosing the disability

Dilemma: do I tell or do I not tell others about my psychiatric disability?

Some important aspects:

 _{Do I benefit from disclosing my disability?}  Who do I tell and why?

 What, if people find out?  What do they think of me?

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Disclosure

"Disclosing your psychiatric disability" means that you tell someone about your psychiatric condition in the present and/or in the past.

To prepare yourself whether to tell about your psychiatric disabilitiy, consider the following:

Steps: 1. Whether to Tell 2. What to Tell 3. Who to Tell 4. When to Tell 5. How to Tell

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Mark

Mark is 22 years old and at the point in his study at the university to start a period of apprenticeship. He has an interview with a supervisor of the company where he likes to do his apprenticeship. During the interview the supervisor asks Mark why one year in his curriculum vitae is blank. Mark tells the

supervisor that three years ago he was treated for a year because of a psychosis. The supervisor ends the interview quickly and Mark never heard of the company again.

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Inez

Inez is 23 years old and first year University student Economy. At the age of 19 Inez became very depressed. She attempted

suicide and has been admitted to a Mental Hospital for some time. She has been in Day Treatment at the same Mental Health

organization for the past two years. The last year Inez has been doing very well and she went back to study Economics again (at a different University).

In an introduction meeting with the lecturer and other students, the lecturer asks Inez: “Inez, what have you done before?”.

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Exercise

Step 1: Identify Whether to Tell

a.

Identify benefits

b.

Identify risks

c.

Compare the balance

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Disclosing your psychiatric disability Worksheet 1

Directions: Determine whether you want to tell about your psychiatric disability

Remember to: a. Identify benefits, b. Identify risks, c. Compare the balance

Identify Whether to Tell

a. Identify benefits: b. Identify risks:

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Conclusion

Disclosing is a personal decision –

the student with a psychiatric disability

him-/herself is the only one who can make it,

taking in account his/her own situation and

circumstances

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Rehabilitation

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WHO ARE SERVED BY A

SEd PROGRAM?

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Rehabilitation

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Characteristics of the Participants (N = 45)

 Sex: Female 51% Male 49%  Age (years): Mean 30.6 Range 17-51  Marital Status: Single 80% Married 20%

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Rehabilitation

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Characteristics of the Participants (N = 45)

 Diagnosis Category: • Schizophrenia 31% • Affective disorder 18% • Personality disorder 24% • Other 24% • Unknown 3%

 Years of contact with mental health:

Mean 6.5 years

Range 1-24 years

 Psychotropic medication:

Yes 80%

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Rehabilitation

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Characteristics of the Participants (N = 45)

 Living Situation: Alone 42% With family 31% Sheltered/clinic 24% Other 3%  Education: Primary education 31% Secondary education53% Tertiary education 16%

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Rehabilitation

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Outcomes

PREPARATION CLASS:

45 students started the ImpulSE course

30 of the 45 students completed the course (66%) 26 of the 30 set an Educational Goal

20 of the 26 students continued with regular education together with “regular” students Drop-outs

No significant differences on sociodemographic characteristics

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Rehabilitation

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Rehabilitation

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another LIFE AREA than EDUCATION

‘GET’ ‘GET’

‘KEEP’ ‘KEEP’ ‘KEEP’ ‘KEEP’

REHAB CENTER/ Mental Health settings ON-SITE SUPPORT SERVICE Supp Ed CLASS-ROOM IMPULSE ‘GET’ REHAB CENTER and other Mental Health Settings ON-SITE SUPPORT SERVICE Supp Ed ON-SITE SUPPORT SERVICE ZADKINE COLLEGE ON-SITE SUPPORT or MOBILE SUPPORT Orientation Intake

‘CHOOSE’ ‘GET’ ‘KEEP’

INDIVIDUAL GROUP INDIVIDUAL INDIVIDUAL

MOBILE S ON-SITE S ON-SITE S MOBILE S ON-SITE S _COLLEGEZADKINE ANOTHER _COLLEGE

‘KEEP’ includes also PEER GROUP SUPPORT

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Rehabilitation

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SEd activities in the Netherlands

2002-2012

 _{SEd initiatives and programmes in ± 20-25 cities or regions}

(Study Buddy Project)

 Four national SEd conferences

 Website www.begeleidleren.nl (Begeleid Leren = Supported Education),  ± 20 articles in journals; 2x a special issue in the Journal of Rehabilitation,

± 45 presentations & workshops

 Dissertation about SEd (in Dutch, English summary)

 Interest from and contacts with other (European) countries: Belgium,

England, Norway, Portugal, Sweden, Czech, South Africa

 Studying with Support Project 2004-2005 (see next slides)

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Overview products 1

Brochures:

1. Successful studying with psychiatric disabilities, Experiences of students

2. Successful studying with ADHD

3. Successful studying with a borderline personality disorder

4. Successful studying with a mood disorder 5. Successful studying with an eating disorder 6. Successful studying with schizophrenia

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Overview products 2

Skills brochures:

7. “To tell or not to tell?”. Selfdisclosure about your psychiatric background

8. “When it becomes too much”. Coping with stress

9. “How to be on time?”. Requiring support

10. “Who is going to adapt?”. Requiring modifications

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Rehabilitation

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Overview products 3

Peer support group:

12a. “Studying with mutual support”. Manual for starting and performing a Peer Support

Group

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Overview products 4

Information:

13. “Where to go to get support?”

A guide for students in Groningen with psychiatric problems and disabilities Workshops for Educational Staff:

14. “How do I recognize that students have mental problems?”

15. “What kind of support do students with psychiatric disabilities need?”

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www.begeleidleren.nl

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Rehabilitation

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SEd plans in the Netherlands 2013-2016



Implementation of SEd programmes in

other cities & regions

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SEd handbook (in Dutch)

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More research (multi site RCT)

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European SEd Project ImpulSE

Netherlands, Czech, Norway & Portugal

1. Development of a toolkit

 The main aim of the project is the development of

a toolkit for Supported Education services for students with psychiatric disabilities

 The joint development of the toolkit will be done

in English. The partners will then develop

versions in their respective languages, for use ‘at home’

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European SEd project-2

The toolkit will contain the following items:

 1. List with psychiatric disabilities and related

educational limitations

 2. List with available/required resources

 3. List with critical skills needed for the study

 4. Preparation course manual

 5. Manual for on site and mobile support services

 6. Information brochures for:

* students

* clients/consumers * teachers

* family members

* policy makers / management

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European SEd project-3

2. Establishing a European Network

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Secondly, a European Network of

Supported Education (ENSED) will be

initiated, starting with a first International

Conference on Supported Education

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Each partner finds himself a national and

a international partner

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Background information

 Supported Education Evidence-Based

Practices (EBP) Kit: www.samhsa.gov

 http:/www.supportededucation.com

 Systematic Review of Supported Education Literature

1989 – 2009:

http://www.bu.edu/drrk/research-syntheses/psychiatric-disabilities/supported-education/

 Higher Education SupportToolkit: Assisting Students with

Psychiatric Disabilities: www.bu.edu/cpr

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Rehabilitation

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Not only runners

move forward,

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Not only Ian Thorpe

moves forward,

also (young) people in

Australia with psychiatric

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Thank you very much for your

attention & participation

Lies Korevaar

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Service 2: On Site and

Mobile Support



Duration: As long as needed and wanted

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Supports includes:

• Emotional Support

• Academic & Social Skills building

• Advocacy with faculty for accommodations

• Assistance with financial aid application

• Peer Support Group

• Development of coping strategies