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RIWC_PARA_A046 Autonomy with Life Limiting Conditions


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A046 Autonomy with Life Limiting Conditions

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RIWC_PARA_A046 Autonomy with Life Limiting Conditions

  1. 1. SELF-DETERMINATION, VOCATIONAL REHABILITATION ENGAGEMENT AND RECOVERY FROM CONSUMERS’ PERSPECTIVE: A QUALITATIVE STUDY Jessica Brooks, Ph.D., CRC Geisel School of Medicine at Dartmouth, Lebanon, NH and University of North Texas, Denton, TX, USA *This project was supported by a mental health recovery-oriented research grant from the Hogg Foundation for Mental Health (#RRG-002).
  2. 2. Self-Determination  Self-determination represents a paradigm shift from the “shoulds” to “informed choices”  Enabling consumers to participate in treatment as they see fit is consistent with the principles of recovery, an increasingly important concept in mental health services research and policy-making.  Recent improvements to the mental health system have included the addition of certified peer specialists (CPSs).  CPSs are described as role models to instill hope, engage consumers in treatment, and help consumers access supports.
  3. 3. Research Questions & Methodology  Research Questions:  How do peer specialists define self-determination and the underlying meaning of self-determination?  How does self-determination influence VR engagement and recovery?  What contextual factors affect the self-determination and VR engagement relationship?  Methodology used was consensual quality research (CQR)
  4. 4. Results
  5. 5. Past Experiences with VR  Positive Aspects of VR services  Encouragement, hope, support  Collaboration in goal-setting and service coordination “It was excellent. I mean it made me want to work harder to begin with you know? She gave me hope and encouragement and she made me see that I was a better person… and just DARS is a great organization.”
  6. 6. Past Experiences with VR  Negative Aspects of VR services  Generic, non-individualized recommendations  Recommending menial jobs  Lack of following up and staying connected “I felt that the options and suggestions were pretty generic. They weren’t necessarily tailored to me and my interests, and my personal goals. It was more cookie cutter, that you know anybody can do this regardless of their skills or their education or their training. You need a paycheck so let’s just go and get you a paycheck. It wasn’t any suggestions that would
  7. 7. Past Experiences with VR  Building the Counseling Relationship  Adequate time must be given to develop the relationship between client and counselor “When she realized that I wanted to go to college, it was like OK this is a little bit different than what we originally talked about. This was like the 6th or 7th visit that I had with her.” “I would say the relationship has to evolve.”
  8. 8. Attitudes Toward Employment  Work Values  Sufficient time for self-care and other activities  Feeling appreciated and welcomed at work  Having the opportunity to pursue one’s passion  No mention of pay, advancement opportunities “I talked to my doctor and we discussed me working part time, and I thought I could probably do that and not work a full schedule, and feel overwhelmed or feel like I can’t do what needs to be done in a day.”
  9. 9. Personal Motives for Employment  Individual Incentives  To be productive, feel accomplished, and have meaning  Income (for self and family)  Improve mental health and self-esteem  More independence and autonomy“…it was a financial thing for me but it was also kind of self-esteem I guess. I wanted to be independent… when everything fell apart in my life, my diagnosis and just not being able to do anything anymore and I needed that, I needed that in my life to feel like part of society and feel like I was worthy… having a job and being out there makes a person feel good about themselves.”
  10. 10. Personal Motives for Employment  Social Incentives  To help others  To participate in community and be member of society “I didn’t want to sit at home and be a homebody and isolate myself from the world. I wanted to get out..” “I have to feel like I’m doing something that makes a difference, that I’m putting someone’s needs above and beyond my own…”
  11. 11. Impact of Disability Benefits  Chronic condition = lifelong need  Benefits counseling does help alleviate anxiety about possibility of returning to work  No ambivalence about how much to work “This is the first year that I’m going to probably go to 29 hours, because I feel very confident that if they review my case they can see everything that is in there… that there are no big changes and my recovery is moving forward. I don’t think that it will affect my benefits. So that is what my plan is for 2016.”
  12. 12. Conceptualization of Self- Determination  Self-driven and motivated to reach potential  Self-awareness (i.e. goals, needs, skills)  Confidence and positive mindset  Self-advocacy (and advocacy for other consumers) “I would define it [self-determination] as having a personal drive for self-betterment…How can you take one more step? How can you find the motivation to take one more step? …if you can take one more step ok now you have taken it maybe you can take one more and eventually see the bigger picture and the baby steps of how to get there.”
  13. 13. Effect of Societal Attitudes (Stigma)  Many suggested stigma had little or no effect on VR engagement  Others suggested that stigma motivated them to pursue certain jobs (i.e. mental health field) “I never really thought about the stigma…it had never occurred to me I guess. So it really didn’t affect me.”
  14. 14. View of Recovery  Not going backward; keep moving forward  Positive thoughts vs. “stinking thinking”  Work is a big part of recovery  Finding a healthy balance in life while meeting basic needs through working “Vocational recovery to me is being able to go back to work and be back in the work force but also to know what your limitations are. You have to know your limits…to be aware of when things are getting to be too much for you and you have to be able to take a step back. If I don’t take care of myself then I’m going to fall backwards in my recovery.”
  15. 15. Social Support  Families were inextricably linked to recovery  Encouragement, support, collaborative consultation  Having a strong work culture in the family was a big influence for people  Having peer support was also helpful
  16. 16. Intrinsic Motivation  Being passionate about their work motivated participants to strive for excellence  Perceived competence based on training and past experiences motivated participants to engage in their role as a CPS “I got certified in May and I started doing all the trainings. You only have to have 20 CEUs per 2 years… and right now I have 85. I want to have the knowledge. I want the knowledge of what I’m doing and how to help others, and what the best way to go about it is.”
  17. 17. Advice To Others  Advice to Consumers  Keep focus, do not give up, do not set limits  Do your own research on potential jobs or schooling  Must advocate for self and take charge of own situation“…just speak up and be your own advocate…nobody is going to do it for you, you have to do it for yourself and if you feel that you’re not getting the services that you need, if you feel that you’re not being bettered by doing what you’re doing, then it’s time to either speak up and change it or seek out something else.”
  18. 18. Advice To Others  Advice to Service Providers  Help consumer form realistic goals w/o dismissing consumer’s ideas  Do not give up on difficult consumers; have patience  Individualized process; do not judge consumer based on diagnosis “…we are people in recovery that have to take the time to learn it [vocational goal] on our own and pushing it on somebody isn’t gonna be the best way. But allowing someone else to make their own choices, giving the freedom to succeed or not succeed…and if they don’t succeed, try, try again.”
  19. 19. Conclusion
  20. 20. Rehabilitation Implications  Quantitative research  Self-Determination Theory and vocational rehabilitation engagement and recovery  Self-Determination Theory and other recovery constructs (e.g., job well-being, job satisfaction)  Intervention research  Designing and conducting pilot interventions influenced by the self-determination theory