Project GREAT
(Georgia
Recovery-Based Educational Approach to Treatment)
Project GREAT - Bringing
Consumerism to Mental Health Education and Services
A pioneering initiative at the Medical
College of Georgia's Department of Psychiatry and Health Behavior is
positioned to transform training of mental health care professionals,
leading to a fundamental change in mental health practice in the hospital,
outpatient clinic, and community settings.
The Recovery Approach
Project GREAT (Georgia Recovery-Based
Educational Approach to Treatment) is
piloting an effort to assist 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.
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A delegation of practitioners from the inpatient psychiatry unit of Mount Sinai Hospital, Toronto, Ontario, Canada, visited MCG on March 7, 2008. The visitors plan to implement what they learned about the Recovery approach and Patient/Family Centered Care at MCG in their own mental health care setting. |
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Project GREAT is designed to
immerse psychology and psychiatry faculty and residents in this new vision.
To implement the plan, Medical College of Georgia is involving people who
receive mental health services and their family members in advisory,
teaching, and care-giving roles.
The project is funded by the Georgia Department of Human Resources, Division of Mental Health, Developmental Disabilities, and Addictive Diseases to evaluate and amplify the impact of Georgia's Certified Peer Specialist (CPS) program. The division sponsors this now internationally recognized program that created the "Georgia model" of training individuals who are recovering with mental illness to provide services to peers including role modeling, support, and education.
Project GREAT Core Team
and Curriculum
Department Chairman
Peter F. Buckley,
MD, initiated Project GREAT. Dr.
Buckley works with
P. Alex Mabe, PhD,
Scott A. Peebles, PhD,
and Gareth Fenley, CPS, as the core of the project team.
This group is developing 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. The first two workshops will
be presented to MCG faculty and residents in Spring 2007. Consumers who have
experienced disabling symptoms of the mental illnesses considered most
severe will address the audience as teachers and role models.
An in-depth didactic presentation by a psychiatrist will instruct participants in the specific components of the Recovery model, based on a comprehensive literature review and the recent consensus-building work of the Substance Abuse and Mental Health Services Administration (SAMHSA). Learners will receive new 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. A third workshop for faculty members will improve supervisory skills from a Recovery perspective.
Certified Peer Specialist
on Medical College Staff
In concert with the workshops, faculty
and resident psychiatrists and psychologists at MCG will have the
opportunity to refer their patients to a Certified Peer Specialist (Gareth
Fenley) for innovative services. Ms. Fenley will meet one-on-one and in
groups with those who wish to experience peer support with no session fee
charged. The services will be 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) will 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.
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. Kathryn Power, Director of the U.S. Center for Mental Health Services (CMHS), declared the Georgia model to be a national best practice. As noted by Thomas Bornemann, EdD, Director of the Mental Health Program at the Carter Center, Georgia has become renowned worldwide for its accomplishments in this area. Peer specialists from Canada and 13 U.S. states have graduated from the Georgia trainings. And, at home, the number of Georgians who have passed the challenging oral and written certification exams now exceeds 300.
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 MCG CPS advocates for consumers of mental health services in the clinic, the hospital, and the community at large. Ms. Fenley has accepted the role of Facilitator of 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 will be limited to the MCG campus, with a control group studied at a partner university. Outcomes will be measured scientifically using questionnaire scales. Upon completion of the pilot program, the curriculum will be evaluated and packaged for dissemination to mental health agencies and medical schools throughout Georgia and beyond.
Project GREAT is made possible by the support of Georgia's Division of Mental Health, Developmental Disabilities, and Addictive Diseases within the Department of Human Resources, with special assistance by the Carter Center in Atlanta. Noted researchers and Recovery leaders around the country have contributed to the project, particularly Larry Davidson, PhD (Yale University), and Larry Fricks (Appalachian Consulting Group).
Forthcoming articles about Project GREAT will be published by Academic Psychiatry, Psychiatric Clinics of North America, and other esteemed professional journals. A slide presentation (see link below) was presented at the Third International Conference on Patient-and Family-Centered Care in Seattle, Washington in July 2007. The Project GREAT team is confident that these initial articles and presentations are the start of a burgeoning literature that demonstrates the effectiveness and utility of a Recovery-based educational intervention.
Update: MCG peer specialist now has access to medical record system.