Inter-professional Psychosocial Rehabilitation (PSR)

Inter-professional Psychosocial Rehabilitation (PSR)
Dr. Andrew Peckham | andrew.peckham@va.gov

Within the Psychosocial Rehabilitation (PSR) track, the resident will become part of an interdisciplinary team of postgraduate fellows which may also include social work, nursing, psychiatry, vocational rehabilitation and/or occupational therapy. Each resident will select two programs to work in throughout the year. The primary placement will be a program that focuses on serving Veterans with serious mental illness (SMI). For the second placement, residents can choose from a variety of clinical, research, and/or administrative placements across inpatient, outpatient, or community-based programs. No specific emphasis is required for the second placement choice, and the options are designed to be flexible and offer the resident opportunities to pursue individual professional interests.

The program placements provide the resident with an environment to learn and to apply the principles of psychosocial rehabilitation while working with an interdisciplinary team of experienced professionals. All residents will provide outpatient individual therapy services to veterans with SMI through the Program for Outpatient Wellness, Engagement, and Recovery (POWER). In addition, the resident will be actively involved in recovery-oriented assessments, program development, consultation, and educational dissemination regarding psychosocial rehabilitation within the medical center and nationally via conference presentations. Opportunities for participation in research are also available in collaboration with the VISN 1 Mental Illness Research, Education and Clinical Center (MIRECC).

The overall goals of the PSR fellowship are to provide training and clinical experiences for residents so that they become grounded in the principles and values of PSR and incorporate them into their work with Veterans. Residents receive a range of didactics and training to hone clinical skills and SMI knowledge. In addition, residents can pursue professional interests by taking advantage of a range of training opportunities offered by the. Residents acquire knowledge of current PSR research and practices in order to become a skilled PSR practitioner capable of promoting change in the VA system (to act as “agents of change”).

There are four main components to the PSR Fellowship at VA Bedford:
1. First Program Placement: Each resident can choose a primary placement in one of the programs that serves Veterans with SMI. The possible placements include: 1) Community Residential Care (CRC); 2) the Mental Health Intensive Case Management (MHICM) Program which uses the Assertive Community Treatment model; 3) inpatient psychiatric services. (Estimated 10/15 hrs per week).

2. Second Program Placement: Each resident has the opportunity to choose one or more secondary placements, with approval from one’s preceptor and the PSR Fellowship Committee. Residents’ work in this placement must be recovery-oriented and focused on Veterans with more significant mental health disabilities. There are many possibilities for secondary program placements to choose from based upon the residents’ professional interests, including but not limited to: Compensated Work Therapy (CWT); Domiciliary; Programs and Services for Homeless Veterans (HCHV); Veterans Administration Supported Housing (VASH); Behavioral Addictions Clinic; and clinical research via faculty affiliated with the VISN 1 MIRECC. (Estimated 10 hrs/week).

3. Program for Outpatient Wellness, Engagement, and Recovery (POWER): All residents will carry a caseload of veterans receiving services through this outpatient program for Veterans living with SMI. This can also include development and implementation of outpatient groups for SMI (e.g., Living with Bipolar Disorder, Social Skills Training, etc.). (Estimated 5 hrs/week).

4. Group Project—Program Development/Evaluation & Education Dissemination: All the PSR fellows will work together throughout the course of the fellowship year on a program development or program evaluation project. The residents will be given projects to choose from or may develop their own project idea with approval from the PSR Fellowship Committee. A final, written report of the project, including lessons learned, will be submitted to the PSR Fellowship Committee. Past education dissemination efforts have included presentations about the group projects at national conferences and presentations of project evaluation results to the hospital’s program managers and staff of recovery-oriented programs. (Estimated 2-3 hrs/week).

Residents are afforded considerable flexibility to design and implement clinical and/or programmatic changes toward the goal of greater enactment of psychosocial rehabilitation principles and practice. Residents are seen as “change agents” within the medical center’s psychosocial rehabilitation-oriented programs. As such, they often engage in consultation, program evaluation, and program development in their individual placements. In addition, the residents are actively involved in program development, consultation, and educational dissemination regarding psychosocial rehabilitation within the larger medical center and nationally via conference presentations.

Learning Objectives
1. Knowledge of current and relevant research of PSR practices

2. Knowledge of the signs and symptoms of serious and persistent mental illnesses

3. Understanding of the interaction of biological, social, and environmental factors in mental illnesses

4. Knowledge of the definition of PSR and concept of recovery

5. Ability to conceptualize issues of choice and risk as related to the PSR model

6. Accurately conceptualize overall client functioning from a PSR-oriented recovery model

7. Ability to assess Veterans’ readiness for change

8. Ability to assess Veterans’ working alliance with practitioners

9. Skill in assisting Veterans to develop rehabilitation readiness

10. Ability to integrate Veterans’ goals, strengths and obstacles into a treatment agreement and an overall rehabilitation goal that is documented

11. Skill in assisting Veterans’ understanding of their strengths and weaknesses in the context of their recovery goals

12. Ability to collaborate with Veterans in the development and pursuit of specific goals

13. Effective implementation of recovery/PSR interventions to facilitate Veterans’ new skills into everyday functioning

14. Ability to work with Veterans to determine ongoing assessment of progress and appropriate modification as necessary

15. Skill in facilitating Veterans’ integration into the community

16. Skill in assisting Veterans to explore service options and match Veterans with system resources, including entitlement and benefit programs, and legal and advocacy resources as needed

17. Ability to identify opportunities for transition of services

18. Skill in providing group therapeutic services from a PSR framework

19. Ability to teach necessary skills to overcome cultural barriers and stigma

20. Understanding of institutional dependency and helping Veterans overcome barriers to living in less restrictive environments

21. Ability to provide useful information on result of work with Veterans to other treatment team members

22. Ability to work effectively with interdisciplinary providers who hold differing therapeutic orientations

23. Ability to speak clearly about the premises and practices of PSR to Veterans and staff

24. Skill in advocating for PSR principles and negotiating Veterans' needs with stakeholders for the benefit of the Veterans

25. Ability to design and implement programmatic changes