by: Ella Jackson, MA, LMFT
Clinical Specialist, Sonoma County Behavioral Health
Continued from Part 1 posted April 5, 2018
I worked with Anna for 4 years. She was the first client I moved out of a state hospital. She transferred to a local locked treatment program, and as I carefully tracked her progress and setbacks, I learned the value of using the language of the ANSA to talk to my program managers and to Anna herself about decisions regarding her care. As I grew in my work with her, I discovered ways to promote hope for adult clients who had been trapped in locked care for years. The ANSA became a precise tool for accurate reporting to my managers, and a way I could encourage a view of clients that reflected who they were now.
As a clinical supervisor supporting staff who work with adults with severe and persistent mental health conditions, I have seen many new clinicians who come into this work with a belief in recovery and a conviction that every person holds infinite possibilities for a better life. After years, sometimes only months of working in the daunting system of adult care, I often see their hope for our clients begin to dim. Their ANSAs become static forms that they do as a cursory measure to keep services in place, or as a job requirement, or another form to be completed in a giant system where stacks of forms must be done to perpetuity.
My work now, is around helping staff to understand that although we work in a large system which often does not seem to be recovery-driven, that we as individual providers within that system, can promote recovery-focused care for our clients. The key principles of the ANSA have created a road map for me in my direct work and in my supervision, which allows me to advocate for clients and to help staff maintain their belief in a person’s ability to get better.
The adults we serve in the public mental health system face a million visible and invisible obstacles. Progress and success for people who face this myriad of challenges may come slowly, and may ebb and flow.
A person who has been receiving care in the adult system for years, a person with Schizophrenia, with a history of substance abuse CAN get better.
The woman I first met in a state hospital, sitting across from me in walking restraints, now lives in my community, in a house with 11 other women with severe and persistent mental health conditions. I see Anna in line at my bank, managing her money, buying groceries in our local market, and walking in a neighborhood close to mine, talking quietly to herself. She still stumbles, and has set backs, as we all do, but my work with her taught me that it is possible to work in a giant system that is focused on impairments, and to focus my work on promoting strengths. The ANSA has been transformative in my endeavors in the adult system of care, supplying the tools I use daily to help adults move forward in their lives.
Ella has hit on something that I also think is really key in TCOM tools like the ANSA, which is that you can improve your communication with others by referencing the items so easily! There are other tools out there with experimental precision (such as the Beck, or the MMPI), but that precision is mostly for the benefit of scientists and professionals. Most people don’t know what it means when you say, “This client’s Beck is 43,” or “The K index is really out of whack for this client…”. However, a statement like “They have a lot of mental health needs, including Depression, Anxiety and Adjustment to Trauma … and their Danger to Self risk requires immediate action,” makes perfect sense to even lay-persons. It is this ability to clearly communicate needs and action pathways that makes the ANSA, and all TCOM tools, so helpful for fostering a recovery environment.