May 29, 2014

1. It Takes a Community: Learning Together about Tools and Strategies to Support People through Emotional Distress May 29, 2014 http://www.promoteacceptance.samhsa.gov

2. Archive This training teleconference will be recorded. The PowerPoint presentation, PDF version, video archive including closed-captioning, and written transcript will be posted to the Substance Abuse and Mental Health Services Administration (SAMHSA) ADS Center Web site athttp://www.promoteacceptance.samhsa.gov/teleconferences/archive/default.aspx. http://www.promoteacceptance.samhsa.gov/

3. Disclaimer The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, SAMHSA, or the U.S. Department of Health and Human Services. http://www.promoteacceptance.samhsa.gov/

4. Questions At the end of the speaker presentations, you will be able to ask questions. You may submit your question by pressing “*1” on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the conference operator announce your first name, you may proceed with your question. http://www.promoteacceptance.samhsa.gov/

5. Emotional CPR (eCPR) as a Tool for Individual and Community Recovery Leah Harris, M.A. Director National Coalition for Mental Health Recovery eCPR Facilitator eCPR Advisory Committee http://www.emotional-cpr.org http://www.promoteacceptance.samhsa.gov/

6. What is Emotional CPR (eCPR)? A public health education and health promotion program that prepares members of the public to assist a person who is experiencing emotional distress or emotional crisis The three phases of the practice of eCPR: C = Connecting with Compassion and Concern to Communicate P = emPowering to experience Passion, Purpose, and Planning R = Revitalizing through Reestablishing Relationships, Routines, and Rhythms in the community http://www.promoteacceptance.samhsa.gov/

7. Foundations of eCPR Developed by people with lived experience of mental health issues, emotional crises, substance use, homelessness, and the justice system who have found personal recovery Based on 10 components of recovery identified by SAMHSA Based in part on crisis counseling following disasters http://www.promoteacceptance.samhsa.gov/

8. Foundations of eCPR (cont.) Trauma-informed care Trauma’s impact—core experience of disconnection and disempowerment Suicide prevention based on restoring hope Cultural attunement Meeting people where they are http://www.promoteacceptance.samhsa.gov/

9. eCPR Approach vs. Conventional Approach http://www.promoteacceptance.samhsa.gov/

10. eCPR Approach vs. Conventional Approach (cont.) http://www.promoteacceptance.samhsa.gov/

11. Implications of eCPR Approach Fosters hope Promotes self-determination and dignity Puts people at the center of their treatment and decisions about their lives Creates a nonjudgmental and safe space for people to express their distress http://www.promoteacceptance.samhsa.gov/

12. Applications of eCPR eCPR may be used to help people in these situations: Experiencing emotional distress Feeling suicidal Going through emotional crisis Experiencing psychosis eCPR may be used by these people and groups to provide assistance: Law enforcement and all first responders Human service providers of all kinds Teachers and faith community leaders Families, to support their loved ones Friends, coworkers, and community members http://www.promoteacceptance.samhsa.gov/

13. eCPR Basics in Practice Be humble, curious and respectful. Avoid assumptions about what a person’s behavior means. Do not label or make negative judgments. Ask open-ended questions, e.g., “What was that like for you?” Believe in people’s resilience. While they may feel confused or frightened in the short term, affirm that you believe in their ability to heal. This makes such a big difference and gives people hope. http://www.promoteacceptance.samhsa.gov/

14. eCPR Basics in Practice (cont.) Validate the person’s experience. “That sounds really terrifying.” “I’d be upset, too.” Listen with the heart instead of the head. Stay focused on the person in distress, rather than half-listening and half-thinking about what you will say. Meet people where they are. If someone is very quiet or sitting on the ground, you may want to assume the same body language and tone. http://www.promoteacceptance.samhsa.gov/

15. How I Use eCPR in My Life Whenever and wherever I can! With my 8-year-old son and his friends With people I meet on the street who are currently homeless and in distress With colleagues at work to help resolve conflicts Family members and friends open up to me and say, “I can’t tell this to anyone else. I know you won’t judge me.” http://www.promoteacceptance.samhsa.gov/

16. How to Schedule an eCPR Training in Your Area For more information, or to schedule an eCPR training in your community, congregation, business, civic organization, school, or other group, visit http://www.emotional-cpr.org/training.htm. http://www.promoteacceptance.samhsa.gov/

17. Resources • Comparison of eCPR and Conventional Approach,http://www.emotional-cpr.org/downloads/Comparing-the-eCPR-Approach-and-the-Conventional-Approach.pdf [PDF 41 Kb] • Deck, E., Riddell, E., & Spiro, L. (n.d.). Building positive relationships between mental health consumer/survivors and public safety [PowerPoint presentation]. Retrieved from http://www.emotional-cpr.org/downloads/Building-Bridges-with-eCPR.ppt [PPT 2.85 Mb] • Emotional CPR, http://www.emotional-cpr.org • Spiro, L., Harris, L., & Fisher, D. (2013, February 12). Emotional CPR as a way of life. Mad in America. Retrieved from https://www.madinamerica.com/2013/02/emotional-cpr-as-a-way-of-life http://www.promoteacceptance.samhsa.gov/

18. Resources • Blanch, A., Filson, B., Penney, D., & Cave, C. (2012, April). Engaging women in trauma-informed peer support: A guidebook. Retrieved from http://www.nasmhpd.org/publications/engagingWomen.aspx • Mead, S., & Hilton, D. (2003). Crisis and connection. Psychiatric Rehabilitation Journal, 27, 87–94. Available in full text athttp://mentalhealth.vermont.gov/sites/dmh/files/report/legislative/VCAPP/DMH-Futures_Peer_Support_VCA_Crisis_Article.pdf [PDF 72 Kb] • Mead, S., & MacNeil, C. (n.d.). What makes trauma-informed peer support unique? Retrieved from http://ok.gov/odmhsas/documents/Trauma-Informed%20Peer%20Support.pdf [PDF 297 Kb] • National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC), http://www.samhsa.gov/nctic http://www.promoteacceptance.samhsa.gov/

19. Contact Me! Email: leahharris2@gmail.com Emotional CPR Web site: http://www.emotional-cpr.org Personal Web site: http://www.leahidaharris.com http://www.promoteacceptance.samhsa.gov/

20. Recovering Together: Helping Families Move from Hopelessness to Healing Lisbeth Riis Cooper Founder & Vice Chair CooperRiis Healing Community Founding Partner Families Healing Together http://www.promoteacceptance.samhsa.gov/

21. Hopelessness to Action • When my own family member was diagnosed with a mental health challenge, I didn’t know what to do. • I experienced feelings of hopelessness, helplessness, anger, and shame. • I spent 10 years navigating the mental health system, facing challenges that seemed insurmountable. • There had to be a better way—something had to change. http://www.promoteacceptance.samhsa.gov/

22. There Had to Be a Better Way . . . • These experiences led to establishing CooperRiis Healing Community in North Carolina, a place where individuals with mental health challenges could recover and restore their lives. • CooperRiis Healing Community was also established to serve as a place where family members would also have the benefit of recovery education and support so they in turn could support their family member in his or her recovery. • http://www.CooperRiis.org http://www.promoteacceptance.samhsa.gov/

23. The Power of Healing Community • A physical (or virtual) community of people learning and supporting each other based on a person-centered approach A Place Where . . . • Someone believes in you even when you don’t believe in yourself • Hope flourishes • Our actions make a difference • Change happens one person at a time • Change happens one family at a time http://www.promoteacceptance.samhsa.gov/

24. Families Also Need a Healing Community http://www.promoteacceptance.samhsa.gov/

25. Supportive Families CAN Make a Difference Families can be the main support, or the main impetus, in someone’s recovery and yet 80 percent of families I have met over the past 11 years do not know that recovery is possible nor do they get support for themselves. This awareness led to developing “FAMILIES HEALING TOGETHER,” a family recovery education program and virtual community, to make recovery education and support more widely available (offered online). http://www.promoteacceptance.samhsa.gov/

26. Families Healing Together Is . . . • A safe, nonjudgmental virtual community where feelings and experiences can be shared • A place where all expressions—hopelessness, despair, even shame—can be validated • A community with others who have had similar experiences, which helps families get out of the victim mode and out of the blame game • The opportunity to listen and learn from others and practice new skills http://www.promoteacceptance.samhsa.gov/

27. You Are No Longer Alone • Families Healing Together . . . • Empowers family members to be advocates and supporters for their loved one • Builds trust with the person in distress • Helps people live lives where hope is again present • Being in, or part of, a community is one the most important aspects of healing. • You cannot recover for someone else, but you can recover for yourself. http://www.promoteacceptance.samhsa.gov/

28. Did You Know That . . . “Extensive research shows that implementing family psychoeducation in mental health settings dramatically improves the lives of consumers and family members . . . [with] up to 75% reduction in relapse and re-hospitalization after two years.” (University of Kansas, School of Social Welfare, Center for Mental Health Research and Innovation) http://www.promoteacceptance.samhsa.gov/

29. What We Must First Learn . . . • Listen without judgment. • Validate emotions in the moment. • Set healthy boundaries. • Build or rebuild a healthy, respectful, mutual relationship with our family member. • Set expectations and realistic goals together. • Allow your family member to grow and learn from personal experiences. • Become an ally rather than an adversary. http://www.promoteacceptance.samhsa.gov/

30. The Recovery Path The recovery path is not always linear . . . You may encounter twists and turns along the way. http://www.promoteacceptance.samhsa.gov/

31. Recovery is a Journey From . . . Seeing oneself as a diagnosis to a positive personal identity Hopelessness to hope Alienation to meaning and purpose Withdrawal and isolation to participation in meaningful activities http://www.promoteacceptance.samhsa.gov/

32. Families Healing Together Eight-Week Recovery Course, Offered Online Course Outline: 1. Sharing our Experiences2. Exploring Recovery Fundamentals 3. Understanding Mental Health 4. Harnessing the Power of Hope 5. Using a Strengths-Based Approach 6. Building Relationships amidst Psychosis 7. Creating Healthy Boundaries 8. Celebrating Recovery Stories Course participants may also partake in an online forum. To learn more about our online recovery course and register for the next one, which starts June 13, 2014, go to http://family.practicerecovery.com. http://www.promoteacceptance.samhsa.gov/

33. Resources • American Residential Treatment Association, http://www.artaUSA.org • CooperRiis Healing Community, http://www.cooperriis.org • Emotional CPR, http://www.emotional-cpr.org • Families Healing Together, http://family.practicerecovery.com • Foundation for Excellence in Mental Health Care, http://www.FEMHC.org • Hearing Voices Network USA, http://www.hearingvoicesusa.org • Independent Educational Consultants Association, http://www.iecaonline.com • Recovery Innovations, http://www.recoveryinnovations.org • Substance Abuse and Mental Health Services Administration, http://www.SAMHSA.gov • University of Kansas, School of Social Welfare, Center for Mental Health Research and Innovation. (n.d.). Overview of FPR: Family psychoeducation; A Kansas partnership of families [Web page]. Retrieved from http://mentalhealth.socwel.ku.edu/overview-fpe http://www.promoteacceptance.samhsa.gov/

34. Contact Me! Email: Lisbeth@CooperRiis.org CooperRiis Web site: http://www.CooperRiis.org Families Healing Together Web site: http://family.practicerecovery.com http://www.promoteacceptance.samhsa.gov/

35. University of North Carolina School of the Arts (UNCSA): One University’s Response to Distressed Students Tom Murray, Ph.D., LMFT, LPC-S Director of Counseling and Testing Services University of North Carolina School of the Arts Private Practice http://www.tommurrayphd.com/ http://www.promoteacceptance.samhsa.gov/

36. General Mental Health Trends in Higher Education A student experiencing distress must initiate seeking help at a time when he or she may be least able to reach out. There is an assumption that people who are distressed are dangerous, and so the focus becomes avoiding risk rather than supporting the student. Cross-departmental Threat Assessment Teams have been convened to evaluate these situations, without the student of concern present in the meeting. This compromises student confidentiality; perpetuates stigma; and fosters misinformation, misunderstanding, and isolation at a time when greater understanding of the situation is most needed. http://www.promoteacceptance.samhsa.gov/

37. Adverse Impacts of These General Trends Hospitalization may be seen as the first, rather than the last, resort. Students who are hospitalized often experience stigma and a lack of support when they return to campus, which results in a heightened risk of suicide in the 24 to 48 hours after they are discharged from the hospital. http://www.promoteacceptance.samhsa.gov/

38. Current Attitudes That Contribute to the Problem A fear-based mentality about students on campus who experience mental health issues or emotional distress A disease-centered model, which is often the framework for viewing students experiencing distress Risk aversion, which leads officials to assume a paternalistic approach to avoiding risk http://www.promoteacceptance.samhsa.gov/

39. University of North Carolina School of the Arts (UNCSA)—Creating a Supportive Campus Community Meet students in a way that honors their voices. Invite students to be part of any conversation about their mental health. Focus on supporting students in the campus community, including peer-to-peer matching. View counseling services as a partnership to support the student in moving in the direction in which he or she wants to go. See hospitalization as a last resort. http://www.promoteacceptance.samhsa.gov/

40. UNCSA Campus Mental Health Initiatives Training of students (including consumers), faculty, and staff in Emotional CPR (eCPR) Acknowledgment of faculty and staff through annual Mental Health Hero Award Students’ response Partners in Change Outcome Management System http://www.promoteacceptance.samhsa.gov/

41. Emotional CPR Training In 2013, UNCSA began eCPR training of faculty, staff, and students (including consumers). In May 2013, 20 faculty and staff were trained. In January 2014, 6 students, all of whom have experienced mental health challenges, were trained. eCPR teaches people to learn how manage their own anxiety in the face of others’ distress so that they can listen and provide support to the person who is distressed. eCPR equips those closest to students with skills they can use to recognize a student in distress and assist students sooner, before significant distress occurs. eCPR helps people manage crises effectively and support students through crisis resolution. Future eCPR trainings are planned. http://www.promoteacceptance.samhsa.gov/

42. Emotional CPR Training Outcomes Staff trained continue to use eCPR effectively, as reported by their directors. A faculty member trained was recognized through the Mental Health Hero Award. The UNCSA Provost is eager to undergo eCPR training. Students who have been trained are now creating a student organization, with Dr. Murray serving as their advisor. Students trained have hosted events during the last several weeks, a time of high stress due to exams and performances. These events have attracted 100 students and provided a place to relax, unwind, and get support in a safe environment. Of students who complete suicide, 90 percent have never been seen at campus counseling centers, so approaches such as eCPR are critical. When support is available through these informal support networks, it is not only a better practice but also saves campus funds. http://www.promoteacceptance.samhsa.gov/

43. Partners in Change Outcome Management System In 2006, UNCSA’s Counseling Center became the first university counseling center to implement this client-directed, outcome-informed approach. Provider measures own effectiveness based on clients’ feedback. The system defines effectiveness as change in the client’s distress level, i.e., the client is moving in the direction in which he or she wants to go. The provider and student collaborate on the student’s time schedule, i.e., data from client guides the treatment process vs. establishing an arbitrary number of sessions. The system involves no one-size-fits-all treatment modality. http://www.promoteacceptance.samhsa.gov/

44. Partners in Change Outcome Management System—Outcomes The Counseling Center serves 27 percent of students, compared to 10 percent, the national average. Staffing has grown since 2006 and now includes three full-time therapists, one intern, one clinical case manager, and two part-time psychiatrists. In 2009, the Counseling Center was accredited for the first time by the International Association of Counseling Services. The Dean of Students, the Provost, and other UNCSA leadership stand fully behind the new approaches being implemented. http://www.promoteacceptance.samhsa.gov/

45. Resources • Boucher, L. A., & Campbell, D. (2014). An examination of the impact of biological antistigma message for depression on college students. Journal of College Student Psychotherapy, 28(1), 74–81. • Brauser, D. (2013, April 12). Early postdischarge period linked to very high suicide risk. Medscape. Available at http://www.medscape.com/viewarticle/782436 • Crawford, M. J. (2004). Suicide following discharge from in-patient psychiatric care. Advanced in Psychiatric Treatment, 10, 434–438. doi: 10.1192/apt.10.6.434 Available at http://apt.rcpsych.org/content/10/6/434.full • Davis, D. C., & Humphrey, K. M. (2000). College counseling: Issues and strategies for a new millennium. Arlington, VA: American Counseling Association. • Deisinger, G., Randazzo, M., O’Neill, D., & Savage, J. (2008). The handbook for campus threat assessment & management teams. Applied Risk Management, LLC. • Glasser, W. (2005). Defining mental health problems as a public health issue. Available at http://wglasserbooks.com/assets/DefiningMentalHealth.pdf [PDF 446 Kb] http://www.promoteacceptance.samhsa.gov/

46. Web Site Resources • Emotional CPR, http://www.emotional-cpr.org • Partners in Change Outcome Management System, http://www.heartandsoulofchange.com http://www.promoteacceptance.samhsa.gov/

47. Contact Me! Email: murrayt@uncsa.edu UNCSA Counseling and Testing Services Web site: http://faculty.uncsa.edu/ncsacounseling Personal Web site: http://www.tommurrayphd.com/ http://www.promoteacceptance.samhsa.gov/

48. What is Your Vision? http://www.promoteacceptance.samhsa.gov/ 48

49. Leah’s Vision Emotional CPR would become as widespread as regular CPR. The health of the “emotional heart” is as important as physical heart health. Both are needed to stay alive. When people and families are in distress and crisis, they and their supporters would be able to easily access voluntary community resources. Police, all first responders, and providers would be equipped to respond in ways that don’t further traumatize people, and facilitate individual and community recovery. http://www.promoteacceptance.samhsa.gov/

50. Lisbeth’s Vision To use the healing power of community, support, and education to enrich the lives of families touched by mental health challenges and emotional distress http://www.promoteacceptance.samhsa.gov/