S.P.I.R.I.T. (Service Provider Individualized Recovery Intensive Training)

Along with a few others connected to the state Department of Mental Health, in the fall of 1986, planning began in earnest on the first ever formal training of mental health consumers/survivors as service providers.  This program became known as the Denver Consumer Case Manager Aide (CCMA) Program.  In December 1986, the 49 applicants had been narrowed down to 25.  By the time the program actually started, five additional people had dropped out, leaving a class of twenty.  Of these, eighteen graduated in late June, 1987.

The original program continued throughout the 1980's and 1990's in Colorado.  Hundreds of people were trained based upon that original curriculum.  The curriculum was coordinated by the RATC (Regional Assessment and Training Center) based on the grounds of Fort Logan State Hospital in Denver.  One aspect of the curriculum that continues to make this program unique is that it was scientifically derived.

The jobs were envisioned in such a way that the tasks of the people performing the jobs would be extremely similar to the tasks performed by 'case managers.'  Therefore, a study was done and an 'efficiency expert' shadowed case managers and made note of all the tasks that were performed on the job.  This formal 'Job Task Analysis' identified the skill set that was desired.  The desired set of skills dictated the topics that should be taught and thus, the curriculum was defined.

Most modern self-help or peer support curriculums have been developed by having a group of folks sit down and discuss what might or might not be good additions to the list of topics to teach.  The 'Job Task Analysis' is part of what sets the SPIRIT training apart as a more scientific, evidence-based training.

Several factors combined to create an atmosphere in which the Consumer Case Manager Aide Program could develop.  There was a class action lawsuit in Denver District Court, brought by mental health consumers charging that there was a lack of sufficient services.  The city of Denver had just been granted one of nine nationwide demonstration service grants by the Robert Wood Johnson Foundation.  The legislature appropriated several million new dollars in response to the State Division of Mental Health's Plan to improve services to individuals with chronic mental illness.  There was a renewed commitment on the part of the four separate mental health centers in Denver to consolidate into a single service delivery system.  Case Management as a formal, integral part of the service system was developed as Citywide Case Management Services.  Citywide could cross the boundaries of the existing fragmented system before the consolidation was complete.  This allowed them to follow the client and meet them in the community without regard to normal catchment area boundaries.

It was immediately recognized that there were more clients to be served than originally assumed.  An examination of the tasks related to case management revealed many duties that were more paraprofessional in nature and that this might be a way of expanding the capacity of the "professional" case managers scope of services and the numbers of clients that could be served.  It struck someone that "highly functioning" consumers themselves might be able to form this paraprofessional resource pool of employees.  The rationale then followed that consumers already had a knowledge of the community resources, that they had been through the maze of the system, that they might be able to connect with treatment resistant clients who were distrustful of the existing provider system and psychosocial rehabilitation technology claimed that consumers could perform the necessary tasks if given the opportunity to do so.

Although this idea was very radical at the time, there was historical precedent within the Alcohol and Drug field.  It is almost a prerequisite that to help people in the A&D field that you be a recovering alcoholic or addict.  This is part of the fundamental basis for many 12-step programs such as Alcoholics Anonymous.  So, on some levels it made sense to create a program that is based on peer support and self-help principles that had been proven effective in the A&D field for nearly 50 years.

For more on the early history, check out this article by Paul Sherman and Russ Porter in Hospital and Community Psychiatry