- Support Circles
1. MyPlan and WRAP - Twin approaches to Recovery and Wellness
For a very long time in the field of intellectual and developmental disabilities (IDD), there has been a denial of the mental health needs of individuals who have IDD. The focus has been on "changing the person's behavior" rather than treating the mental illness that a person may have. This created a situation where professionals prescribed treatment/behavior plans, medication, structure, and occasionally activities for the individual that was meant to "cure" the behavior.
It is important to note that the focus was on "treatment". The individual was not so much a partner in this experience as much as they were the object of the efforts of professionals. They were typically seen as fragile, often unpredictable, individuals who needed therapy directed by those same professionals to be able to comply with the expectations of those professionals in the environments controlled by those, and other, professionals.
In recent years, this approach has been challenged by the emergence of a new concepts and approaches associated with the outcomes of Recovery and Wellness within the mental health field. One of the most hailed approaches to support these goals is called WRAP (Wellness Recovery Action Planning).
As Stated in the article "Culture of Recovery":
It's a program that was developed in Vermont in 1997 by Mary Ellen Copeland and a group of friends who were all experienced with the mental health system. WRAP is now recognized as an exemplary practice and has been widely implemented throughout 50 states, England and New Zealand.
The WRAP program involves an educational and planning process that is grounded in mental health recovery concepts such as hope, education, empowerment, self- advocacy, and interpersonal support in connection. Within a group setting, individuals explore self-help tools (e.g. peer counseling, focusing exercises, relaxation and stress reduction techniques) and resources for keeping themselves well and for helping themselves feel better in difficult times.
Copeland states: "For a person who's been on the system a long time, WRAP is often a person's first introduction to the idea that their own ideas and views have value, and that they can make their own decisions and move on with the recovery. It can be the initial step in the recovery process."
WRAP not only involves the individual in their search for wellness, it promotes and endorses the idea that people must own their own recovery and direct it as well. There is a presumption of both competency and strength in this approach. Every individual is seen as capable and having the potential to recover from their illness and to seek the treatment and the services that are needed and desired - in a manner, shape, and form that is unique and best suited to the individual as requested by them.
WRAP is much more than a one-time event. It is an ongoing series of life experiences, planning, mini-experiments, trials of various approaches, and documentation that allows individuals to customize their own plan for recovery and wellness - and actively re-engage in their own life with the belief that they will be well again and can remain well over time through these efforts, personal responsibility, and the support of others - including professionals.
Needless to say this approach is very challenging to many professionals, especially those identified as being in the clinical community. At times there is a lack of understanding or appreciation regarding the role of the individual in his or her plan. Professionals sometimes mistakenly think that individuals utilizing a WRAP are incapable of making the necessary decisions to help control and direct their own recovery, and thus, should have no active role other than to report progress. They also mistakenly believe that somehow WRAP automatically excludes the use of medication, counseling, or other therapeutic supports. This is especially true within the IDD system, where professionals frequently question the competence of the individual to be able to make informed decisions about what matters most in their lives.
This is complicated by often complex relationships and the absence of non-clinical supports. The key is to getting the information needed directly from the individual that can help others to support their personal journey. One of the first steps is to find out what their ultimate dreams are for their life in the future. It is also important to accurately capture where things are today so that we understand how the individual, and those who care about them, see their current situation. This is important so that the team can find some things that are positive and possible that can be worked on - in ways that support the WRAP intentions - that can start as of the day that the overall plan is completed.
Finally, it is important that these desires are translated into specific and immediate action steps that individuals on the team commit themselves to, with the individual who desires recovery and wellness as the pilot of this process and the team of supporters they select (professionals and non-professionals alike) as navigators.
This is called the MyPlan process.
MyPlan is a tool to help people plan and achieve their life goals. The MyPlan process involves people who are invested in the success of a single person working as a team to graphically record a colorful and creative process for the participant. This process serves as a guide to help the participant identify his or her most important life goals(1) and what can be done - starting today - to begin the process to reaching those goals.
The MyPlan process developed by Mayer and Dufresne, is efficient and effective-so that the actual team meeting as a group is between 2 and 3 hours. Much work is done with the individual in advance of the team meeting, often including the completion of the Assessment of Essential Motivation, Tension, and Resistance.
Utilizing the MyPlan process, the individual and their chosen allies come together to envision and plan a different future. The realities and issues of the day are discussed and evaluated to ensure the plan is grounded in reality so that it is possible to establish a firm commitment to building a better future so that we do not need to keep repeating the cycles of the past.
A key feature of the MyPlan process is the use of co-facilitators if possible. One facilitator is seated near the person, to create an atmosphere of trust and a safe environment. The other facilitator draws simple pictures that capture the essence of what the person is telling us. This multiple approaches respects and enhances various learning styles and becomes the property of the person at the end of the session.
By establishing specific tasks within an brief overall action plan it is possible to build positive momentum and facilitate the move forward to a desirable future.
The intention is that MyPlan will identify critical elements that will help support the recovery and wellness of the individual and "jump-start" the implementation of overt efforts to reach those outcomes that were identified as positive and possible and getting the person that much closer to their ideal life. It also begins to help identify the types of things that can be considered for inclusion in their WRAP plan that might have been otherwise overlooked.
It is important to note that MyPlan not intended to replace the WRAP, just as WRAP is not intended to replace good support planning. These two techniques truly are twin approaches that can be highly successful when used in conjunction with each other for people who have complicated support needs to address their behavioral/mental/emotional health and related problematic behaviors so that they can be successful in the community.
For each of us, there must be at least one compelling reason to get out of bed in the morning - and to take care of ourselves once we are out of bed. Our need to find meaning in our actions, relationships, work and communities is critical to our emotional and physical health is critical to developing the compelling reason or reasons.
For too long individuals who have IDD, especially those also experiencing mental illness, have been guests at their own table. For these people, all too often the services they receive have been viewed by the person as something they must endure and, often passively, comply with in order to get through the day.
Unfortunately, this often results in a distinct lack of ownership and personal commitment to their planning, behavior change, and wellness process. In many cases it also diminishes the sense of personal responsibility and accountability for decisions that are made by the individual - because they perceive themselves as simply pawns in the game of services and treatment - so if bad things happen it is because others didn't do their job. These two approaches reverse that thinking.
WRAP is an active engagement of the person to take control of their treatment and wellness. By self-directing their plans, they own the process and the result - with dramatically increased personal responsibility and accountability. This also provides hope, meaning, and direction and encourages social reciprocation and community contribution, which are the hallmarks of good citizenship. MyPlan then provides a specific road map on how to get there.
The two approaches -MyPlan and WRAP offer the opportunity for all citizens experiencing IDD and mental illness to take charge of their life and build a better future one day at a time with the support of their allies - both professional and non-professionals.
Derrick Dufresne & Mike Mayer
(1) Definition of New Mexico Department of Developmental Disabilities
(2) Person-Centered Planning: Maps and Paths to the Future
2. Support Circles - Neighbours Inc.
Neighbours depends on finding out what people hope for their future and what they will need to help them to move in that direction.
There is no one way of planning with people. Sometimes we facilitate planning processes such as MAPS and PATH. Often we gather information through meeting with the people we support, their family and support circle. We LISTEN!
Neighbours facilitates the development of a plan that reflects the person's vision and dreams, and details what they will need to work towards them. The plan becomes a guide. It can remind people of what they said they wanted to do and help them to stay on course.
The plan also is the guide for the individual budget.
Neighbours believes that relationships and friendships are key to a full rich life. We all have people that we need, people who help us get through life. All of us can identify people we need for love, for friendship, for inspiration, for support, for work, for money. We all rely on other people, and if we are truly fortunate, they rely on us. We are really inter-dependent.
If we think about it, some of those people are very close to us, family, lovers, best friends, and some are not as close, acquaintances, co-workers, members of clubs we belong to, etc.. There are even people that we pay to support us.
The point of it all is --- none of us do life alone!
Most of us have an informal "support circle". Many of the people in our support circles may never even meet each other. They come from different parts of our lives --- family, work, school ...
But people with disabilities have historically faced challenges than many of us have not. By design, people have been left out or excluded from opportunities to be part of community life.
Their rights of citizenship have not always been upheld.
Circles are groups of people who intentionally come together around a person they know, like and care about. Their common thread is a commitment to the person and his or her right to live a full life.
Support Circles are groups of people who know, like, and care about someone, and come together as a group to make sure that the person they care about is supported to be a part of community life. Support Circles intentionally come together to overcome the barriers that they face.
Advisors help to make it possible for support circles to come together. They facilitate meetings so that circle members can have conversations about:
- What is important to the person?
- What is happening in their life now?
- What is the vision?
- What gets in the way?
- What do we need?
- How can we get it?
- Who can help us?
- ...and much more.
The Circle generates a lot of the content for the Person Centered Plans that are created. A meaningful and effective circle is a key component of self-directed supports.