Supporting Recovery and Inclusion (PDF)

This book presents a basic methodology for care workers to enable them to helppeople who require temporary or long-term professional support. This methodology- the Comprehensive Approach to Rehabilitation - has been around fortwenty-five years now and is used by thousands of professionals, both in theNetherlands and abroad. The first version of the manual was published in 1994(Wilken, Kaiser and Den Hollander, 1994), the second version in 1999 (Wilkenand Den Hollander, 1999) and the third version in 2005 (Wilken and DenHollander, 2005). In 2012 the last version of the manual was published, devotingattention to underlying theories and practical applications (Wilken and DenHollander, 2012).The Comprehensive Approach to Rehabilitation, or CARe for short, comprisestheories, a basic vision, a practical working method and tools. Though its coreessence has remained unchanged over the years - supporting people in achievingtheir desired level of quality of life - the methodology has evolved over timeunder the influence of new scientific understanding and social movements. Furthermore,specific applications have been developed, e.g. for the purposes of reintegrationto work. CARe is used in assisted living facilities, within wards ofmental health care institutions, homeless shelters, in ACT and FACT teams, insupported housing, in geriatric care, youth care, forensic care, and in the treatmentof addiction. It is used in supporting clients with an intellectual disabilityand clients with an autism spectrum disorder.This book sets out the methodology in its current form. The book is first and foremosta practical manual. Writing a practical manual entails us primarily payingattention to the working method of CARe as this can be employed for each andevery client. It pertains to the core essence of the methodology. We will not beexamining the applications that have been developed for various specific settingsand target groups. To this end, we would refer the reader to the handbook andother publications, as well as training programmes such as those offered by CAReEurope and a number of universities and training centres.The book is intended to enable the provision of effective support for people whoare at a given moment unable to cope on their own in society and who have beenreferred for professional help and guidance. Sometimes this will be for a limitedperiod in their lives, and sometimes it will be for the long term. Their need of thisguidance and care may occasionally be complex, mostly due to the concurrence of multiple factors, such as a psychiatric disorder, unemployment and social isolation.An intellectual disability or behavioural problems may also be an issue.In short, their efforts to lead a normal life may be blighted by all sorts of troublesomeand unusual factors.Clients' stories of their recovery show that recovery is possible for everyone. Byrecovery we mean a unique personal process during which the individual regainshis self-confidence, learns to cope better with his vulnerability and startsto play roles in society once more. Many people are resilient beyond their ownexpectations. Although the recovery process is a personal one, it does necessitatethe contribution of others. These others could be people who have experiencedsimilar issues, family or friends, and care workers. Our knowledge regarding thekinds of support that genuinely help people in their recovery process is continuouslyimproving. CARe is intended to harmonize the support provided by careworkers with the wishes and needs of people engaged in a recovery process in amanner that is purposive and effective.As such, this book also considers wishes, talents and possibilities. It considersrecovery and the use of the individual's strengths. It is about creating and makingthe most of opportunities in individuals and within society.Chapter 1 describes the background, fundamental principles and objectives ofthe CARe methodology. It entails a brief overview of current developments andthe theories underpinning the methodology.Chapter 2 presents an outline of the CARe way of working. It sets out how a relationshipcan be built systematically, how information can be exchanged, howgoals can be set, how a plan can be drawn up, implemented and evaluated.Chapter 3 looks at building cooperative relationships. A cooperative relationshipinvolving trust and willingness to make an effort is the cornerstone of CARe.In Chapter 4 we will examine aspects of vulnerability associated with mentaldisorders and how clients can be helped to cope with these as best they can.Chapter 5 describes how one can work with the client's environment. This pertainsto environments in which the client wishes to live, work, learn and spendhis free time. It also concerns the client's social networks and community supportsystems.Chapter 6 starts with a description of features of health care conducive to recovery.We then outline the profile of the CARe worker and how CARe can be implementedeffectively as a methodology supporting recovery.This book was published in 2011 in the Dutch language with reprints in 2011,2012, 2014 and 2015. In this English edition, we have made some adaptations tothe case examples and references, in order to make them more understandable forreaders who are not familiar with the Dutch context. We would like to take thisopportunity to thank all CARe trainers and coaches for their indefatigable dedicationand contributions to the development and dissemination of the methodology.We thank Dr David Blazey for being so kind as to edit the English version ofthe book.Finally a remark about the use of the word 'client' or 'user' in this book. Althoughwe often refer to the client as 'person', we also use client to refer to the role theperson has in the mental health system. This seems curious since the focus ofthis book is to change the view of professionals, encouraging them to take theperspective of personhood and citizenship as a starting point. Although the wordclient is used to avoid confusion about who we are referring to, or to avoid longdescriptions like 'a person with vulnerability', or a 'person with lived experience',please keep our focus in mind.Dirk den Hollander and Jean Pierre Wilken