job skills.

progressing to a more complex work situation, Fountain house has creatively arranged for
transitional employment place ments (TEPs). Recognizing that job interviews are tremendously
streesful, staff members, rather than members, seek out and conract with businesses for job.

The jobs are assigned of fonubtain house rather than to individual. Staff members assign a
member to a transitional employtment position for as needed. The employer is promised that if
members are unable to manage the jobs or do not show up, fountain house staff will work in their
place.

In the words of a fountain house member:

I think the greates need is to have a place to go where you are expected each day, a place
where yu can be with people like your self and do things that mean something to yourself and
other. . . . places to go and be wich people who need us to contribute, to take part, to hel, and who
notice when we’re not present and do something about it(Peterson, 1978).

Assertive community treatment. Assertive community treatment (ACT) programs are an

avidence-based psychiatric rehabilitation practice based on the program of assertive community
Treatment (PACT) that was developed in the 1970s by Stein and test in Madison, Wasconsin. They
are designed to provide intensive community support to individual who have serious mental
illnesses. The goal is to prevent hospitalization support the individual in achieving the highest
possible level of functioning.

A multidisciplinary team is used, including nurse, social workers, case managers, employed
counselors, and a psyhiatritis. Some program also employ peer counselors, people who have mental
illness. In one survey case managers ranked the presence of a full-time nurse as the most important
ingredient of a successful ACT team (Mc Grew et al, 2003). These staff members are often effective
in reaching individuals who are reluctant to participate in treatment, such as homeless people, and
engaging them in treatment.

ACT is characterized by 24-hour, 7 days per week staff coverage; comprehensive treatment
planning; ongoing responsibility; continuity of staff; and small; shared caseloads. ACT and other
community-based programs are discussed in chapter 34.

Consummer-run services. There continues to be a strong feeling among some consumes that
psycosocial rehabilitation program are not truly responsive to their needs unless they are consumer
run. The empowerment Model of Recovery was developed by the National Empowerment Center, a
research and training organization that is administered by ex-consumers of mental helath services.
These ex-consumers developed a trainingand education program called PACE (Personal Assitance in
Community Existense) that is bassed on an emprowermwnt model.the principle of PLACE are
presented in box 14-7.

In recent years slow but steady growth of new consumer-run program has occurred in many
communities. Some of these aredrop-in centers that provide peer support and a safe place to be,
whereas others offer a full range of rehabilitative services.

Successful consumer-run program include specific elements. They should address needs
identified by the members, and participation in all part of the total program should voluntary. Help is
provided either by member selects. Consumers are responsible for the administractive direction of
the program, and they determine criteria for membership. Finally, the program is mainly
accountable to the members, and strict confidentiality is main tained.

BOX 14-7 Principle of Personal Assistance in Community Axistence (PACE)

 People fully recover from even the most severe forms of mental illness.
 Trust is the comerstone of recovery.
 Control and coerction are emphasized in the absence of trust and interfere with recovery.
 People have tobe able to follow their own dreams, not someone else’s to recover.
 Self-determination is vital to recovery.
 Human dignity and respect are vital to recovery.
 Understanding that mental illness is a label for severe emotional distress that interrupts a
person’s role in society in recovery.
 People who believe in people with mental illnesses help them recover.
 People with mental illnesses and those around them have to believe they will recover or
they will not recover.
 There is always meaning, even in periods of severe emotional distress, and understanding
that meaning helps in recovery.
 People can and do yeam to connect emotionally, especially when they are experiencing
severe emotional distress.
 Feeling emotionally safe in relationships is vital to expressing feelings.
 Everything learned about importance of human connections equally applies to people
lebeled with mental ilnasses.

From Athem L, Fisher D: J Psychosoc Nurs Ment Health Serv I39:22, 2001.

One study of peer support within consumer-operated services concluded that there was a
positive association between peer support and measures of recovery and empowerment (Corrigan,
2006).

 Critical Thinggking, what is your response to the idea to that consumers should run
alternative treatment program? Discuss positive and negative implication.

Residential services. Housing is consistently identified as a critical element of successful

recovery and rehabilitation services (O’Hara, 2007). Appropriate housing must be safe, affordable,
and acceptable to the consumer. Early housing programs tended to focus an existing supervised
living situations, such as foster care. More recently, array of housing option has been developed
under the leadership of consumers and psychiatric rehabilitation professionals.

Most recovering patients live at home with their families. For those who do not, group
homes and supervised apartments are the predominat types of housing available. Most incorporate
some form of rehabilitation program along with housing. Staff supervision rangers from intensive 24-
hours awake staffing to telephone consultation, based on the consumer’s level of need.
 Most Housing program focus on providing a ‘norma ‘ community living experience, but many
fall short of this goal. Supervision needs may lead organization of housing around levels of care,
something requiring consumers to move if their needs become more or less intensive.