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Partnering With People to Discover and Develop Readiness

Overview
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Exploring and developing the person’s willingness to set a goal makes it more likely they will be open to considering the kind of future change(s) that might be involved in making the goal a reality later on.
Exploring the participant’s degree of preparation for making such an important decision helps the participant understand how much decision-making knowledge they have, ensuring that the choice they finally make is based on an understanding of themselves and the implications of characteristics about different environments.
Spending the time to fully consider if this is the right time to begin thinking about a commitment to a future life goal is crucial. This will help the participant make an informed decision about their chosen valued role and setting, despite the changes the decision may require.

Foundational Concepts

The concepts and skills of orienting and active listening are fundamental to Psychiatric Rehabilitation and should be used throughout all steps of the Psychiatric Rehabilitation process. Click below to learn more about the steps to the skills of orienting and active listening.

Orienting
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Active Listening
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Orienting 

Steps include:

  1. Name the activity
  2. Show the participant what the process looks like by showing an example and explaining it.
  3. Discuss how it might be helpful to the participant.
    Identify what the participant can expect the practitioner to do; and
  4. Identify what the participant will be asked to do in order to successfully participate.
  5. Ask the participant to repeat back, in their own words, what they heard you explain.

Active Listening

Steps include:

  1. Includes all three skills associated with empathically responding to the participant’s perspective.

  2.   a. Listening for content (i.e. What they said)

      b. Listening for feeling (i.e. “Sounds like you’re feeling….is that correct?”

      c. Listening for feeling and meaning (i.e. “Sounds like you’re frustrated and don’t want to live there anymore, is that correct?”)

  3. The practitioner checks in with the participant to ensure they have accurately understood the participant’s perspective.

  4. Practitioner avoids advice giving, judging, or directing the conversation away from the participant’s perspective.

Three Step Process to Partnering With People to Develop and Discover Readiness

Step 1: Exploring and Rating Domains of Dissatisfaction

a. Discuss current experiences and feelings within Living, Learning, Working, and Socializing Domains,
b. Identify what domains they are dissatisfied in, and
c. Discuss internal and external pressures for change and then rate (low, med, high) level of dissatisfaction in each domain.

An early discussion focused on the participant’s current experience in the areas of living, learning, working, and socialization (Li, Le, W, S). Questions should be focused on the participant’s current level of satisfaction or dissatisfaction with each area (or domain) AND external pressure to make changes in one, none or more of those areas, regardless of the person’s current level of satisfaction/dissatisfaction. Based on this conversation, the participant decides if there is a desire for change in any area (or domain).

Once the domain(s) of dissatisfaction are identified, the individual rates their readiness on a scale using low, medium, and high. The practitioner then partners with the individual to discuss the participant’s desire to continue with the process of pursuing a life goal.

Step 2: Exploring Readiness for Change

Partnering with the individual to discuss their beliefs about change and knowledge about how a person makes decisions about change.

Readiness Exploration involves a process of self-discovery, facilitated by the practitioner, of a person’s personal perspectives and knowledge associated with their readiness to consider setting a goal.

There are two categories of factors that influence a person’s readiness to make a life change and set a life goal: Personal Perspectives and their Knowledge of Self and Environments. Each factor is reviewed and rated (low, med, high).

Personal Perspective Factors (Beliefs on Change)

  • Belief that change is possible (e.g., how much of the time do you believe that you can make a change in your (Li, Le, W, S) situation? Let’s talk about how confident are you that you can make a change in your situation.)
  • Belief that change is desirable and positive (e.g., How better off will you be if you make a change in your (Li, Le, W, or S) situation? Let’s talk about how worried you are that if you made a change you would be worse off than you are now.)
  • Belief that change is manageable by having access to supports and resources (e.g., Let’s discuss your confidence that you will be able to manage a change in your (Li, Le, W, S) situation. How strongly do you believe that you will have the support and resources to make a change in your (Li, Le, W, S) situation?)

Knowledge Factors (about how a person makes decisions about change)

  1. Knowledge/awareness of one’s values and interests (e.g., What’s most important to you when you think of making a change in your (Li, Le, W, S) situation? What would you want most out of making a change in your (Li, Le, W, S) situation?)
  2. Knowledge/awareness of one’s decision-making approach (e.g., How do you go about making important decisions?)
  3. Knowledge/awareness of the type of environments in a life-role domain including settings, roles, responsibilities, and activities (e.g., environmental requirements and expectations-What do you know about what’s expected in a (Li, Le, W, S) situation? What are your responsibilities when you imagine yourself in a (Li, Le, W, S) situation?)
  • Worksheet 3 - Exploring Readiness for Rehabilitation Knowledge about Environments
  • Worksheet 4 - Exploring Readiness for Rehabilitation Knowledge about Myself

Step 3: Developing Readiness (Four Step Process)

Partnering with the individual to identify what areas of readiness they want to develop, strategies that will be used to develop readiness and how to implement the strategies.

Step 1: Identify readiness components that will benefit from development (the factors rated the lowest).
Step 2: List strategies (readiness activities) that can be used to develop readiness.
Step 3: Select one or more strategies and implement them.

Readiness Factor Strategies:
Increase belief that change is possible
  • Cognitive-behavioral approach to identifying and addressing self-defeating thinking. 
  • Engage the participant in discussing the pros and cons of success and failure.
  • Inspire hope: Review and emphasize that the process of Psychiatric Rehabilitation is designed to help the participant understand and build on strengths that the participant may not recognize. 
  • Discuss opportunities for the participant to meet with peers in the program who are making progress towards their life role goals.
  • Explore possible confidence building activities that focus on small steps such as non-pressured and low risk activities associated with the relevant life role area. 
  • Engage the participant in identifying past challenges that the participant successfully accomplished.
Increase belief that change is desirable and positive
  • Gather Information: Invite the participant to consider talking to one or more peers or others in their social network who have made progress on a related goal area and discuss the positive aspects of change.
  • Gather information (through Bibliotherapy): Research benefits associated with a particular life role via internet, books, articles.
    Explore cognitive-behavioral strategies:
  • Explore the presence of self-defeating negative thinking about the outcomes associated with change. Engage the participant in reviewing negative thinking, challenge the underlying belief and explore alternative positive ways of thinking.
  • Ask the participant to review their experiences related to the pertinent life role area and discuss positive and satisfying experiences associated with that life role.
Increase belief that change is manageable by having access to supports and resources
  • Increase the participant’s understanding of support by reviewing and writing down the members of the participant’s social network and all service providers involved in the participant’s care to generate a list of potential supports and resources.
  • Practitioner provides information about the types of system level supports and resources related to a particular domain that may be available to the participant.
  • Identify a peer who has made progress on a particular domain and explore how the participant may discuss the supports and resources that were available to the peer.
Increase knowledge/awareness of one’s values and interests
  • Values clarification activities found online and in the literature.
  • Reviewing lists of values and interests and asking the participant to identify those that are meaningful.
  • Ask the participant to discuss hopes, wishes, and dreams in the past and present.
  • Ask the participant to identify people that they admire and why.
  • Ask the participant to complete sentences that are designed to reveal values such as:
    • If I could be anywhere in the world, I would want to be…
    • The most important thing in the world to me is …
    • If I could change places with anyone, I would pick…
    • The happiest people usually…
Increase knowledge/awareness of one’s decision-making approach
  • Review a recent decision made by the participant and discuss how that decision was made.
  • Watch a YouTube video focusing on the steps involved in making good decisions.
  • Discuss a decision made by the participant that resulted in a negative outcome.
  • Review a website designed to teach decision-making skills.
  • Explain the decision-making approach in Psychiatric Rehabilitation and ask the participant which aspects are acceptable and which might be difficult to accept or would be a source of discomfort.
Increase knowledge/awareness of environmental requirements and expectations
  • Ask the participant to take a guess about what is required in a particular domain and reinforce any perception that is accurate.
  • Share the various roles and responsibilities associated with a particular domain with the participant and discuss each of the roles and responsibilities.
  •  Assist the participant to identify and plan to meet with someone who has knowledge about the requirements and expectations of a particular domain.
  • Look up roles and responsibilities in a particular domain on the internet and discuss.
  • Consider speaking to a person who defines the requirements (e.g., landlord, employer, social environment director, teacher) across domains.

Step 4: Reassess readiness after implementation

Key Points of Partnering With People to Discover and Develop Readiness (Considering)

The process of assessing and developing readiness requires you to partner with the participant in their journey of self-discovery.
Key Point
Key Point1
Use orienting throughout the process of Psychiatric Rehabilitation.
Key Point
Key Point 1
Use the image of the house to orient participants to the process of Psychiatric Rehabilitation, explaining in your own words, what it means and what the outcomes might be.
Key Point
Key Point3
Be sure to check in with participants often. You can use words and phrases like “I want to make sure I’m communicating effectively with you. You are in the driver’s seat here.” This ensures that you are working at the same pace and “not leaving them behind.” It also fosters a sense of ownership over the process for the participant, which may be a shift for many people who participate in services.
Key Point
Key Point4
Use the profile worksheet to work with someone to identify personal perspectives and knowledge about change, asking questions that will lead to a rating of low, medium, or high. This information will help you to identify areas for readiness development. The end result of this exploration will be a summary profile of the rating the participant gives themselves on each factor and an overall decision about what to do next-develop readiness, go ahead and set a goal,or not continue with Psychiatric Rehabilitation but use another service or activity.
Key Point
Key Point5
Developing readiness is helpful for people who rated themselves low to moderate on readiness factors related to personal perspectives and knowledge and want to continue with the Psychiatric Rehabilitation process.
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Key Point6
Psych Rehab practitioners can use various strategies to develop readiness to address areas with low to moderate dissatisfaction.
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Key Point7
A person may choose to skip developing readiness even if they have rated themselves as low to moderate on readiness factors. They should be made aware that if they do, achieving the goal might take more time and more intensive work as the process unfolds.
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Key Point8
The practitioner’s skills of active listening, asking open-ended questions, self-disclosure and other skills often included in Motivational Interviewing techniques are important for each step in the Psychiatric Rehabilitation process and should be practiced.
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Key Point9

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