TRAINING CONSUMERS AS MENTAL HEALTH PROVIDERS

The model for the training was first developed in Colorado about fifteen years ago. It has been refined and is still successfully employed there to train consumers. The training has also been tried with various degrees of success in many other states and the curriculum in it's present form is based upon a personal examination of those programs which have been most successful and a look at what worked and what didn't work in providing the most effective training to assure successful employment outcomes for both the consumers and the employers in the mental health systems.

It has been found that consumers who go to work for the mental health system need to have some basic background of knowledge to be effective in their jobs. The training curriculum which follows addresses those basic areas and provides folks with a sound place to begin their career in mental health. Additionally, it has been found that for consumer employees to be most successful, they need to have a strongly developed sense of self and have the self-care skills necessary to tolerate the ambiguities inherent in any human services arena. The training outlined below has successfully integrated these skills so that graduates have at least an 80% success rate on the job.

This training was developed and presented in Contra Costa and Solano Counties in California was titled O.F.F.I.C.E. (OFFICE FOR FAMILY INVOLVEMENT & CLIENT EMPOWERMENT). Forgive me, but it wasn't I who developed the acronym.

It was a collaborative project of the client network, the local AMI group and County Mental Health Administration in Contra Costa and Solano Counties. This partnership was so successful that it's suggested that it be replicated by working closely with the local AMI organization as well the existing providers and contractors currently working in your local area.

The title for the clients who received the training and were subsequently hired to work for the counties was MHCSW (Mental Health Community Support Worker) and the training plan follows. Naturally, it will have to be adapted for your local area. In order to hire consumers, it is recommended that either they be hired in paraprofessional positions under the latitude provided by rehab option or else it has been found that often old civil service positions exist which have been dormant since the 60's or 70's which can be reactivated in order to provide the title and payment means for hiring consumers who might lack academic credentials.

The training plan was developed after much consultation with other counties in California and other states who have organized similar client-provider training.

*Recruitment and outreach to client applicants takes about a month
*Selection of training participants takes a couple of weeks

Previous trainings teamed O.F.F.I.C.E. staff with Adult Services staff to select training participants. It has been found that the best predictor for success for clients working in the mental health field is motivation. With that in mind, a tool has been developed to interview prospective applicants and to rate each applicant to obtain those who rate highest in success potential for the training.

*6-week MHCSW Training The training for the first class was 6 weeks. It was decided in subsequent trainings to extend the training to 8 to 12 weeks and to decrease the length of the classroom day. I believe that based upon experience that it's better to have longer training days and shorter (6 week) training.

The 6-week, 20-30 hour per week training integrated classroom learning, discussion at programs regarding job duties, homework assignments, development of personalized resource manual, and peer support. Training stresses were handled in a flexible manner with each individual trainee.

It was originally envisioned that a K-12 consultant would provide technical assistance on basic reading and writing, and an entry reading and writing assessment will be developed and administered to all incoming trainees. During the first week of training, the skill development component was to include a more thorough assessment of reading and writing and skills. However, the time pressures on the instructors precluded this from happening. If it is desired that this sort of thing happen, then I recommend that working with folks from a local community college to develop a minimal level of basic reading and writing skills and obtain work-study students to tutor the students in these areas.

The following outlines the Monday, Wednesday, Friday classroom training schedule:

 9:00 - 10:00		Check-in/peer support
10:00 - 12:00		Lecture/presentation/guest speaker/discussion/exercise
12:00 -  1:00		Lunch
 1:00 -  2:30		Skill development
 2:30 -  3:00		Check-in/peer support

From 9:00-12noon on Tuesday and Thursday, discussions and presentations will be held at various programs regarding job duties and program operations. A topical outline will be developed for the presenters.

Additional on-going training and support was provided on-the-job for paid and volunteer MHCSW's by O.F.F.I.C.E. staff (See section on COD Training period). A crucial part of the training involves the support of Administration because it is often found to be the case that once on the job, students encounter difficulties because their supervisors often have not been trained in how to supervise anyone, let alone, in how to address the unique needs of folks with a psychiatric disability.

Trainers:

The class was co-taught by consumers and professionals to assure that students receive a balanced perspective. Experts were invited to teach specific content areas. At the same time as outreach efforts were being made to identify and encourage consumer applicants to the training, other staff were identifying the experts in specific content areas and scheduling them for the period of time for the training.

*Selection of COD (Career Opportunity Development) trainees and volunteers took another couple of weeks. Selection was made by a team composed of O.F.F.I.C.E. and Adult Services staff. This is the selection of graduates from the training who best "match" the jobs that are available. This process doesn't happen until at least the middle of the training.

Upon graduation and placement with COD (Career Opportunities Development) positions, students began an on-the-job training period and those who choose to accept volunteer positions began their work assignments.

During the first 6 months of paid and volunteer work experience additional training and support was provided. A once weekly mandatory support group was provided. In addition, O.F.F.I.C.E. staff assisted the on-site work supervisors in developing a schedule of "job-shadowing" and on-the-job training.

The basic outline of the core curriculum is as follows:

Week I:

l.	Introduction and Overview:
	Starting a Resource Directory
	Appreciating Diversity
	Self-Awareness
	Diversity of opinions within the mental health system
	Cultural Awareness
	Awareness of poverty issues

2.	Basic Helping Skills
	Peer Counseling
	Listening Skills
	"Strengths" and other case management models			
	Self Disclosure
	Paperwork and Medicaid-eze
	How to teach Activities in Daily Living
	
Week II:

3.	Approaches in Contemporary Psychology
	Philosophical diversity of thought in the psychological community:
	Mental Illness & Mental Health
	DSM overview
	Introduction to jargon
	
4.	Introduction to the Role of a Helping Professional
	Speakers from different job areas
	Self Awareness
	Paperwork

Week III:

5.	Crisis Intervention
	Management of assaultive behavior
	Suicide prevention
	De-escalating crises
	Watching body language and listening to your gut

6.	Psychotropic Medications

7.	Symptom Reduction

8.	Dual Diagnosis

Week IV:

9.	Patients Rights
	Legal and ethical issues
	Expressed vs best interest
	Advocacy

Week V:

10.	Networking and Resource Development
	Overview of local Mental Health system
	Student presentations
	Field trips

11.	Accessing Public Assistance
	Benefits Advocacy
	Housing
	Transportation
	Vocational Programs

Week VI:

12.	Special Issues
	AIDS
	Homelessness
	Nutrition, Smoking, First Aid, Hygiene
	Poverty

13.	Ethics
	Confidentiality
	Role issues
	Liability
	Boundary issues
	Peer relationships
	"Bad guy" role
	Staff resentment
	Resistance and cooperation

14.	Burn-out and Personal Support

15.	Group Facilitation
	Role play
	Evaluation