Project GREAT

(Georgia Recovery-Based Educational Approach to Treatment)

Transforming Mental Health Education and Services with the Recovery Model and Patient- and Family-Centered Care

       

Peter F. Buckley, MD

Chairman, Department of Psychiatry

 

Gareth Fenley, CPS

Certified Peer Specialist

 

P. Alex Mabe, PhD

Director, Psychology

Residency Training

  

Erick Messias, MD, PhD

Associate Professor

   Denise Noseworthy, CPS Certified Peer Specialist

On behalf of the faculty, residents, staff, and consumer advisors of the Medical College of Georgia’s Department of Psychiatry and Health Behavior, welcome!

Led by Chairman Peter F. Buckley, MD, and the rest of the Project GREAT team (above), we are immersing our psychology and psychiatry faculty and residents in a new vision. We are involving people who receive mental health services and their family members in advisory, teaching, and care-giving roles. The changes we’re making here at MCG lead to fundamental changes beyond our campus in hospital and clinic practice settings, as well as in community life for consumers.

Project GREAT is funded in part by the U.S. Health Resources and Services Administration (HRSA) Bureau of Health Professions.

Project GREAT is a partner in the Campaign for Mental Health Recovery which is funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)

 


Project GREAT Publications

Stay up to date with Project GREAT by downloading our one-page monthly bulletin, "Taking Flight"

Issue 1
Issue 2
Issue 3
Issue 4
Issue 5
Issue 6


Issue 7
Issue 8
Issue 9
Issue 10
Issue 11


The Recovery Approach

Project GREAT is assisting in system transformation to a Recovery model of care through teaching and dissemination. The Recovery approach, which was endorsed in 2003 by President Bush's New Freedom Commission on Mental Health, advocates inclusion of consumers and family members at every level of a person-centered system.

Recovery-oriented care requires a fundamentally different role for a person with a mental illness or disability. It transcends the exclusive focus on symptom reduction that marks the traditional medical model. Recovery sees that the course of life with mental illness can be an empowered one filled with hope, while at the same time being a non-linear process or journey that includes setbacks and challenges. People living with mental illness have strengths, goals, and dreams to be honored with holistic care that provides for well-being of the total person. Practitioners also consider the family integral to care (as defined by the consumer's choice based on biological, legal, or emotional ties) and draw upon surrounding resources in the environment.

Our services at MCG are tailored to the person-centered treatment plans created in the collaborative approach fostered by Project GREAT. Patients and those they choose to define as family members (who will be intimately involved in their care) work as partners with clinicians to select holistic goals for treatment, rather than practitioners defining the goals for each patient centering solely on the reduction of psychiatric symptoms.

Medical College of Georgia Certified Peer Specialists

Department Chairman Peter F. Buckley, MD, initiated Project GREAT. To comprise the core project team, Dr. Buckley works with P. Alex Mabe, PhD, Erick L. Messias, MD, MPH, PhD, and two full-time Georgia Certified Peer Specialists: Gareth Fenley, CPS, and Denise Noseworthy, CPS.  Certified Peer Specialists do not treat symptoms. Their role is to support the multidisciplinary treatment team through role modeling and teaching about Recovery in severe mental illness.

Recovery, in the context of this work, means the process of gaining control over one's life after a psychiatric diagnosis and diminishing the losses usually associated with such a diagnosis. A CPS focuses on dispelling the disabling power of stigma and a negative self-image that often becomes part of receiving repeated stigmatized messages from others. The cornerstone of his or her work is to instill hope, which can be conceived as the belief that one has both the ability and the opportunity to engage in the recovery process. A CPS has a hopeful outlook toward his or her own life, while also possessing an intimate understanding of what it is like to lack hope during difficult periods in a Recovery journey. CPS's also understand the special impact of a hope that is derived from first-person experience and sharing this experience with peers.

Georgia's CPS program was the first ever to be rewarded with Medicaid reimbursement. Payment for peer support services began in the state in July 1999. Kathryn Power, Director of the U.S. Center for Mental Health Services (CMHS), declared the Georgia model to be a national best practice. The “Georgia Model” has been endorsed by the National Association of State Mental Health Program Directors (NASMHPD). It has been adopted by the Depression and Bipolar Support Alliance (DBSA), America’s largest illness-specific patient support organization. As noted by Thomas Bornemann, EdD, Director of the Mental Health Program at the Carter Center, Georgia has even become renowned worldwide for its accomplishments in this area. Peer specialists from Canada and more than a dozen U.S. states have graduated from the Georgia trainings. At home, the number of Georgians who have completed the competitive training program and passed the challenging oral and written certification exams now exceeds 400.

Faculty and resident psychiatrists and psychologists at MCG now have the opportunity to interact with Certified Peer Specialists in their daily routines. Ms. Fenley and Ms. Noseworthy collaborate in department activities including rounds, treatment teams, inpatient and outpatient groups, individual consultations, committee work, and the development of documentation templates, policies, and curricula. They are also entrusted with interviewing residency candidates and evaluating residents.

Curriculum Development

Project GREAT has developed a workshop curriculum that incorporates innovative role plays, live and video presentations, and interactive discussions - all created and presented by practitioners and consumers working together. In the workshops, psychiatrists and psychologists share the teaching ensemble with consumers who have experienced disabling symptoms of the mental illnesses considered most severe, all addressing the audience as role models.

Participants in Project GREAT workshops learn the specific components of the Recovery model, based on a comprehensive literature review and the consensus-building work of the Substance Abuse and Mental Health Services Administration (SAMHSA). Learners receive the latest tools to put Recovery concepts immediately into practice, including pre-assessment, intake interview, and follow-up appointment documents that guide the clinician to focus on strengths, self-directed treatment planning, a systemic orientation, and other aspects of the model.

Medical College of Georgia’s Commitment Mental health is the latest in a series of medical practice fields to benefit from MCG's commitment to Patient-and Family-Centered Care. The achievements of the organization in clinical work were recently featured in a documentary episode of the PBS series "Remaking American Medicine." For MCG, this approach is a natural fulfillment of the health system mission: To Care, To Serve, To Educate, To Discover. Project GREAT defines advocacy as a key element of the Recovery model. The Certified Peer Specialists at MCG advocate for consumers of mental health services in the clinic, the hospital, and the community at large. Ms. Fenley serves in a staff support role for MCG's Behavioral Health Advisory Council. In the Council, MCG patients and families participate alongside providers in reviewing and improving mental health policies and procedures.

Initially, the educational interventions of Project GREAT were limited to the MCG campus, with a control group studied at a partner university. Outcomes were measured scientifically using questionnaire scales. The curriculum is now being disseminated to mental health agencies, hospitals, and medical schools throughout Georgia and North America. Project GREAT has been made possible with special assistance from the Carter Center in Atlanta. Noted researchers and Recovery leaders around the country have contributed to the project, particularly Larry Davidson, PhD (Yale University), Sandra G. Resnick, PhD (Yale University), Larry Fricks (Appalachian Consulting Group), and Steve Harrington (National Association of Peer Specialists).

Bibliography

National and International Presentations

  • Mabe, P.A. & Fenley, G. (2007) Project GREAT: Bringing consumerism to mental health education and services. Presented to the 3rd International Conference on Patient- and Family-Centered Care.  Seattle, Washington.
  • Mabe, P.A. & Fenley, G. (2008) Project GREAT: Immersing academic medical school practitioners in the recovery model of care. Presented to the 33rd Annual U.S. Psychiatric Rehabilitation Association Conference.  Chicago, Illinois.
  • Fenley, G. (2008) Project GREAT: Bringing recovery education to psychiatrists in medical schools. Presented to the 2nd Annual Conference of the National Association of Peer Specialists. Philadelphia, Pennsylvania.
  • Fenley, G., Peebles, S., Mabe, A., Bruce, T.O., Narasimhan, M., Frinks, L., Williams, E., & Buckley, P. (2009) Recovery and schizophrenia: Evaluation of a recovery-based educational program. Presented at the 12th International Congress on Schizophrenia Research. San Diego, California.
  • Fenley, G. (2009) Consumer perspectives: Checking realities. Presented at Science to Services: Progress in Schizophrenia Research from Around the Globe. San Diego, California
  • Messias, E., Shevitz, S., Fenley, G., Buckley, P., Mabe, A., & Peebles, S. (2009) Promoting recovery attitude in academic settings: Results from the Medical College of Georgia Project GREAT. Presented at 38th annual conference of the American Association of Directors of Psychiatric Residency Training. Tucson, Arizona
  • Mabe, P.A. & Fenley G. (2009) Practical tools for recovery-based training and practice. Presented at the 34th Annual U.S.Psychiatric Rehabilitation Association Conference. Norfolk, Virginia
  • Mabe, P.A. & Fenley, G. (2009) Project GREAT: Putting the recovery model of mental health care into practice. Presented at the 4th International Conference on Patient- and Family-Centered Care. Philadelphia, Pennsylvania.
  • Albright, M.J., & Fenley, G. (2009) How to involve peer specialists in the education of medical professionals. Presented at the 3rd Annual Conference of the National Association of Peer Specialists. Phoenix, Arizona.

Academic Publications

  • Buckley, P.F., Fenley, G., Mabe, P.A., & Peeples, S. (2007) Recovery and schizophrenia.  Clinical Schizophrenia and Related Psychoses, 1, 96-100.

  • Peebles, S.A., Mabe, P.A., Davidson, L., Fricks, L., Buckley, P., & Fenley, G. (2007). Recovery and systems transformation for schizophrenia. Psychiatric Clinics of North America, Schizophrenia Issue, 30, 567-583.

  • Fenley, G. (2008) Checking realities: Consumer perspectives; Embarking into recovery. Clinical Schizophrenia and Related Psychoses, 2, 178-181.

  • Fenley, G. (2008) Checking realities: Consumer perspectives; Compliance and recovery.  Clinical Schizophrenia and Related Psychoses, 2, 262-263.

  • Fenley, G. (2009) Checking realities: Consumer perspectives; The impact of diagnosis.  Clinical Schizophrenia and Related Psychoses, 2, 337-338.

  • Fenley, G. (2009) Checking realities: Consumer perspectives; Insight.  Clinical Schizophrenia and Related Psychoses, 3, 64-66.

  • Peebles, S.A., Mabe, P.A., Fenley, G., Buckley, P.F., Bruce, T.O., Narasimhan, M., Frinks, L., & Williams, E. Immersing practitioners in the Recovery model: An educational program evaluation. In press.


Project GREAT Practice Tools


Revised November 2, 2009 .   Please send comments, suggestions or questions about this page to Brenda Maddox, bmaddox@mcg.edu .