This study explored consumers' perspectives on self-determination, vocational rehabilitation engagement, and recovery. Through qualitative interviews, participants described how self-determination influenced their motivation and ability to engage with vocational rehabilitation services and progress in their recovery. Key findings included that developing trust and an individualized approach in the counselor relationship supported engagement. Having intrinsic motivation, social support, and a view of recovery as an ongoing process also helped drive vocational rehabilitation and recovery. The study provides insights to help improve services and support consumers' self-determination.
Zone Chairperson Role and Responsibilities New updated.pptx
RIWC_PARA_A046 Autonomy with Life Limiting Conditions
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. 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. 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)
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.”
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
Notas do Editor
The primary aim of this stage of the research project was to conduct a participatory action research study with peer specialists with the lived experience of mental illness to gain insights about the underlying meaning of self-determination and its relationship with VR engagement.
Vocational rehabilitation (VR) services can help people with SMI to overcome employment obstacles, refocusing them toward the world of work, and subsequently, onto the path to recovery.
Although evidence-based VR practices often lead to successful recovery-oriented outcomes, many individuals with SMI do not seek help or terminate services prematurely (Corrigan, 2004).
Hence, there has been a call for change in mental health service delivery approaches (Corrigan et al., 2012).
SMI is a persistent mental health condition that significantly impacts functioning in multiple life domains, especially the work domain (Dunn, Wewiorski, & Rogers, 2010).
The staggering low rates of employment range from 20% to 25% for people with schizophrenia and related disorders.
Difficulties with finding/maintaining employment can be detrimental to the health-related quality of life and overall well-being of individuals with SMI.
To improve recovery outcomes, the field of mental health is implementing a paradigm shift by encouraging consumers to be self-determined and active participants in all aspects of the treatment and rehabilitation process, including medication, interventions, and employment (Corrigan et al., 2012). Using principles of self-determination to guide mental health services can foster self-determined motivation, thus reducing mental health symptoms and enhancing treatment engagement (Saperstein, Fiszdon, & Bell, 2011; Strauser, 2014).
Paradoxically, there have been limited studies on the theoretical basis for self-determination as a guiding framework for mental health recovery.
However, the self-determination theory of human motivation (SDT; Deci & Ryan, 1985) has been used to enhance motivation and treatment engagement in other contexts (Ng et al., 2012).
Ryan and Deci (2000) posit that people are more likely to participate in an activity when they have a sense of autonomy, competence, and relatedness. Furthermore, autonomy-supportive social environments play an important role in facilitating self-determined motivation, as well as optimal functioning in educational and work settings.
The theory of self-determination (SDT; Deci & Ryan, 1985) describes how human beings achieve goals, reach self-actualization, and experience a higher quality of life while in treatment, healthcare, or other contexts that support the realization of fundamental human needs, including competency, autonomy, and relatedness or feelings of connectedness to others (Reeve, Nix, & Hamm, 2003; Ryan & Deci, 2000). Self-determined individuals are more capable of dealing with setbacks or difficulties related to their goals, whereas individuals less self-determined are prone to giving up, especially if contingent rewards are removed. For people with SMI, experiencing substantial personal (e.g., premorbid occupational functioning, cognitive functioning, severity of illness) and contextual barriers (e.g., work disincentives, perceived workplace stigma) to gainful employment, can be difficult to overcome without a self-determined recovery goal to sustain engagement in vocational rehabilitation services (Fitzgerald et al., in press).
Gathering the Research Team
Typically 2-3 coders, 1-2 auditors
Develop a semi-structured interview protocol and conduct interviews with 12 participants
The goal of the interview is to capture the phenomenon with as little researcher bias as possible
Develop domains and core ideas
Domains: List of topics that broadly describe participants’ experiences
Core Ideas: Summarizes the domains
Cross-Analysis
Developing categories and common themes across participants
Tallying the data
Frequency of participant endorsement in each domain and/or category
“To begin with we weren’t really on the same page, and I attribute that to the fact that I was closed off and you know I didn’t want to be there. But once we had a good relationship and I started opening up to her about who I was and what I was interested in and what I wanted to go to college for and all that, we were on the same page and she understood my passions in life more. And she didn’t really want me to have some just flipping burgers job, she really encouraged me to aim higher than that and go for something better.”
“I was a pre-k teacher and I had a set back where I got locked in a psychiatric ward for a week mainly for medication management…I had to take a short leave of absence from work, and when I went back to work, the parents of the children in my classroom found out why I was gone…and suddenly after a year and a half I was no longer capable or fit to take care of their children, I was no longer trust worthy…so that affected my decision to leave and kind of put the thought in my mind that I was incapable of working anymore…I applied for disability and I was denied and decided at that point to go back to school, and get another degree this time in psychology, and work more towards mental health and try to fight that stigma. So it really affected me with not wanting to work, but at the same time, it affected me in wanting to go back into a different field.”
Psychometric studies..
Which would eventually lead to policy changes if there is supportive evidence..