Running head: PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT

Psychosocial Rehabilitation Theory Essay Assignment Dermot Connolly Stenberg College PSYN 202-3 D. Klingspohn August 2013

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT Psychosocial Rehabilitation Theory Essay Assignment It can be argued that psychosocial rehabilitation has its roots in the failures of the mental health sector to provide adequate support for its service users. The inability of many to effectively cope with their psychosocial deficiencies has triggered the development of assessment tools to determine the needs of the client and to match those needs with the correct service provider. (Correctional Services Canada 2012). In fact the psychosocial rehabilitation approach to recovery is based on the feedback and voiced concerns of its consumers who demand participation in treatment programs. (Correctional Services Canada 2012). Such participation helps to reignite many of the core values deemed essential to recovery such as empowerment, hope and self determination. (Correctional Services Canada 2012). The recognition of the assessment needs of the client has resulted in the development of a psychosocial rehabilitation process centered on the assessment of the clients needs and the implementation and evaluation of those needs with respect to the client, their family and their community. (Sundeen 2009). The purpose of this paper is to focus on those needs through the assessment, implementation and evaluation phases of psychosocial rehabilitation process. Each phase is discussed separately where psychosocial theory is combined with a case study from the writers current clinical experience within a correctional facility in the lower mainland. Case Study Introduction For the purpose of this discussion, a real life case study will be presented as an introduction to the use of psychosocial rehabilitation skills. This case study will be explored in greater detail throughout this discussion under the topics of assessment, implementation and evaluation. The case presented here discuses Mr. R.L. who at the age or 21 invited a young

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT

Native man up to his apartment along with an accomplice. Both Mr. R.L. and his accomplice had being drinking heavily and were under the influence of illicit drugs (Correctional Services Canada 2012). During the course of the evening a fight broke out between Mr. R.L. and the young man where Mr. R.L. became very angry and both he and his accomplice beat and tortured the young man for an hour before eventually slicing his throat. (Correctional Services Canada 2012). At the age of three, Mr. R.Ls. parents divorced due to his mothers claims that Mr. R.Ls father was very abusive towards her. As a child, Mr. R.L. had a history of violent behaviors such as the torturing of farm animals and his practice of banging his head against the wall until it began to bleed. (Correctional Services Canada 2012). As a young adult, he was in and out of foster homes, had attempted to commit suicide of several occasions and was involved in several break and entries. (Correctional Services Canada 2012). Assessment The importance of the client assessment in psychosocial rehabilitation cannot be overstated as it provides the psychiatric nurse with much of the information needed to help the client achieve maximum functioning. (Sundeen 2009). Completed correctly, the psychosocial assessment enables the psychiatric nurse to identify the clients strengths and opportunities through the analysis of their environment and family relationships. (Sundeen 2009). While such an analysis can take many forms, common topics of assessment include living skills, employment, education, cognition and a full assessment of the clients family and local community. (Sundeen 2009). One of the main benefits of the initial assessment is the universality of its application. Regardless of the clients circumstances, its purpose is consistent. Taking a correction facility as

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an example and we can see with some small modifications, the same assessment topics described above can also be utilized in the psychosocial assessment of a prison inmate. Some assessment modifications may include the definition of the clients community, which will vary depending on whether the client is serving a life sentence or whether they are living freely within the community. While the assessment process may be universal, the rehabilitation goals it highlights are not. Using the example of the client serving a life sentence without parole and their initial assessment will likely highlight some universal concerns such as employment history and living skills. In addition, other needs specific to the prison inmate will also be identified such as expressed emotion towards the client from their family/caregivers and the effects of institutionalization. Looking at the corrections facility in greater detail and we can see the use of the initial client assessment and the role that assessment plays in determining the clients rehabilitation goals. Using my case study as an example, the initial psychological assessment carried out on Mr. R.L. showed that many factors contributed to his crime, including his unstable family background resulting in his introduction to several foster homes, his history of violence towards animals, and his early involvement in break and entries. (Correctional Services Canada 2012). Mr. R.Ls offence is a result of his personality and drug abuse. His childhood pattern of banging his head against a wall had resulted in the development of an acquired brain injury. (Correctional Services Canada 2012). His assessment also concluded that his extensive abuse, neglect and abandonment that he experienced as a child shaped his anti social and borderline personality. (Correctional Services Canada 2012). His assessment concluded that Mr. R.L posed a high risk to violent reoffend if he were to be released back into the community. The assessment concluded

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT

that due to Mr. R.Ls history of being alone, the relationship between him and his victims would likely be that of a stranger. (Correctional Services Canada 2012). In terms of mental health, Mr. R.L was prescribed unknown medication from childhood until the age of sixteen to control his behavior. Mr. R.L claims to have seen several mental health professionals from the age of seventeen, all of whom informed him there was nothing wrong with him. (Correctional Services Canada 2012). In terms of suicidal ideations, Mr. R.L tried to hang himself at the age of fifteen. He also attempted to slash himself twice and overdose once between 1990 and 1992. (Correctional Services Canada 2012). Implementation Implementation is an important phase in the rehabilitation of any client as it is geared towards fostering client independence and recovery. (Sundeen 2009). While rehabilitation programs can take many forms, they are primary directed towards developing the clients strengths through the management of their illness and development of their living skills. (Sundeen 2009). During the implementation phase, the potential barriers to recovery are also worth considering. Looking at examples from a correctional facility, such barriers can include a lack of client insight into their illness or their unwillingness to participate in treatment programs. Such barriers can halt the clients progress towards independence which in turn can negatively impact the psychiatric nurses ability to alter their self- concept. (Sundeen 2009). Other barriers to implementation extend beyond the control of the client or the psychiatric nurse. Such barriers center on the allocation of resources to ensure the assessed needs of the client are adequately met. In the United States for example, there has being a shift since the 1970s towards tougher prison sentences and a reduction in funding for prison services and

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT programs. As a result, many prison rehabilitation programs have taken a back seat as part of the US governments tough on crime strategy. (Benson 2003). A similar strategy has being developed by the Canadian government with the elimination of the award winning lifetime program in 2012 due to budget cuts. (Brosnahan 2012). In the absence of such resources, the client suffers through a lack of services, key for their successful rehabilitation into society. While we have discussed the implementation of rehabilitation programs in theory, it is also important to review such implementation using real life case studies. In the writers current psychosocial clinical rotation, the role of client rehabilitation falls under the auspices of the rehabilitation unit of the Regional Treatment Centre in Abbotsford. Under such a program, the clients goals are determined under a rehabilitation plan which is assessed weekly during client treatment team meetings. In addition, other more extensive psychosocial programs are offered

where axis 1 clients are assessed for their eligibility for rehabilitation into the community. Under such a program, the client is assigned goals aimed at educating them on their illness while working to improve their living and education skills in a nine month internal program. (Personal conversation: Vandenhyde, J. 2013). Returning to the case study presented in this report and a clear link between Mr. R.Ls initial assessment and his rehabilitation plan can clearly be seen. Mr. R.Ls goals primarily focus on his ability to manage his anger through the use of anger logs and the participation in internal programs such as anger management and alternatives to violence. (Correctional Services Canada 2012). In addition Mr. R.L is required to manage his substance abuse addictions by remaining sober and medication compliant throughout his incarceration. Several infractions of this goal were made by Mr. R.L during the early stages of his life sentence but he has remained compliant with this goal over the past number of years. (Correctional Services Canada 2012). Other

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important goals assigned to Mr. R.L are his participation in education and employment programs within the Regional Treatment Centre. Since his incarceration, Mr. R.L has successfully completed Adult Basic Education (ABE) level 3 and his successfully maintained employment within the facility as a cleaner and a mail runner. (Correctional Services Canada 2012). Evaluation The final important stage in the psychosocial treatment of the client is the evaluation phase. The evaluation phase is designed to determine the impact of the rehabilitation goals on the client and their families. (Sundeen 2009). For the purpose of the case study presented in this report, the clients family will be represented by his fellow inmates as he is estranged from his biological family. The evaluation process looks to gage the client progress against their assigned goals and projected outcomes. (Sundeen 2009). In the case of Mr. R.L, he is a resident of the Regional Treatment Centres rehab unit where the goals outlined in his rehabilitation plan are assessed weekly through his participation in weekly treatment team meetings. The treatment team is a cross functional group of mental health professionals who discusses the clients progress towards their agreed goals. The aim of the treatment team is to assess the clients ability to function independently either in a community setting of in a minimum security facility depending on their prison sentence. In terms of Mr. R.L, he has taken great strides towards independence through the completion of several internal programs such as anger management, cognitive skills, peer caregiver program and kitchen living skills. (Correctional Services Canada 2012). During the early stages of Mr. R.Ls sentence, he proved very difficult to manage and received several citations ranging from possession of a banned substance to assaults against other inmates.

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT (Correctional Services Canada 2012). In recent years, Mr. R.Ls behavior has improved substantially where he is a regular participant in his treatment team meetings with no behavioral issues reported. Despite his progress however, Mr. R.L is still poses a high risk to reoffend. (Correctional Services Canada 2012). For this reason, Mr. R.Ls current rehabilitation plan centers around his possible eventual transfer to a minim security facility while also placing recommendations for Mr. R.L should he ever be released into the community. (Correctional Services Canada 2012). It has being argued that the development and implementation of psychosocial rehabilitation programs has its roots in the historic failures of the mental health services to provide adequate services to it service users. Yet through voiced concerns and feedback, the psychosocial rehabilitation process has evolved into a framework that incorporates the assessed needs of the client with the incorporation of both their community and family environments. Throughout the years, the implementation of that rehabilitation model is evident in daily interactions of the mental health professional with the service user. The purpose of this paper was to examine the theoretical basis of the psychosocial rehabilitation model and compare that model using case studies from the field. The universality of the rehabilitation model has being well documented and while it can be refined depending on the needs of the client, we have shown that its application is very much evident in the corrections sector. In the case study presented in this paper, the assessed need of a client serving a life sentence is transferred into a rehabilitation plan designed to allow the client to achieve many of the education and life skills needed to function either in the community or at a minimum security corrections facility.

PSYCHOSOCIAL REHABILITATION THEORY ESSAY ASSIGNMENT References Benson, E. (2003). Rehabilitate or punish. American Psychological Association. 34,7. Retrieved from: http://www.apa.org/monitor/julaug03/rehab.aspx. Brosnahan, M. (2012). Prison rehab program axed due to budget cuts. CBC News Canada Retrieved from http://www.cbc.ca/news/canada/story/2012/04/16/corrections-servicelineline-cut.html Correctional Services Canada (2012). Criminal profile report. Retrieved from: Internal internet communications Regional Treatment Centre Canada. Correctional Services Canada (2012). Rehabilitation unit intervention plan. Retrieved from: Internal internet communications Regional Treatment Centre Canada. Correctional Services Canada (2012). Women offender programs and issues. Retrieved from: http://www.csc-scc.gc.ca/text/prgrm/fsw/warner/warner_e-06-eng.shtml

Sundeen, S.J. (2009). Psychiatric rehabilitation in: Stuart, G.W & Sundeen, S.J. (Eds.) Principles and Practices of Psychiatric Nursing 9th Edition St. Louis, Missouri: Mosby. P199-216 Vandenhyde, J. (2013). Personal conversation pertaining to Regional Treatment Centres Psychosocial Program.