Implementing Our 10 Key Challenges

ImROC has a clearly defined methodology including 10 key challenges that systems, services and communities can review to develop and improve their recovery-orientated thinking and practice. Originally created in 2011, we reviewed the 10 organisational challenges in 2016 and found the challenges were as relevant today as they were in 2011. This table sets out how ImROC can support you to address each of these challenges.

What it looks like in practice

Conversations at all levels and between all parties are respectful, strengths based, honest, reflect recovery principles and promote recovery values. These values include: inspiring hope and self belief; facilitating greater control of personal challenges, treatment/support and life in general; and enabling access to opportunities to achieve personal goals.

Conversations include all those who are important to the person, especially the family and friends who support the person. Recovery may be an individual journey but it is not one travelled alone. It is travelled in the context of families, social networks, communities and cultures. All must be included if the person is to rebuild their life.

Ways in which ImROC can help you to achieve this

Coproduced coaching, mentoring and learning opportunities focusing on recovery focused language; coproduction and shared decision making.

Supporting the recruitment, selection, employment and support of peer workers who both embody recovery and model recovery focused conversations.

Facilitating the development and documentation of Recovery focused staff supervision and appraisal systems.

Supporting the creation of accountability systems across the whole organisation that includes the review and rating of relationships (staff-staff and staff-patient).

Supporting coproduction and co-review of documentation, policies and processes.

Offering information, training and support to introduce an Open Dialogue approach that informs non-hierarchical relationship building in clinical services.

Supporting the development of systems for employing people using services in values based processes for selecting and recruiting staff.

Workshops on learning from and working with families and people who are close to the person.

Supporting the development of shared decision making/coproduction at all levels.

Workshops for distributed recovery leaders to review/establish recovery focused organisational values and practices

What it looks like in practice

A comprehensive range of coproduced, co-delivered and co-received recovery focused learning opportunities are available.

Managers have access to tailored training that clarifies their role in supporting recovery focused practice through a more transformational approach, in line with recovery values.

The complexity and challenges of introducing a true recovery focus in services is acknowledged in training.

An introduction to Recovery is a priority in staff induction training and incorporated in mandatory training.

A directory of accredited trainers who either use services or are family members is established as a point of reference. Details of their skills and interests are included in the database and guide their role in coproducing and co-delivering training.

Ways in which ImROC can help you to achieve this

Coproduced and codelivered workshops on what Recovery means for people working at all levels – commissioners, people who use services, family members, executive directors, managers, practitioners – and for all professional groups. These can be delivered to targeted or mixed groups.

Support to co-develop a range of recovery training courses and produce an annual learning and development prospectus to detail all Recovery focused learning opportunities including courses, workshops, masterclasses, coaching, mentoring, action learning sets and team coaching.

Advise on options available for developing and delivering training for trainers in the organisation – including staff and people who use services and family members.

Support coproduction training and advise on mechanisms that might help to ensure coproduction is well understood, routinely practised, fully resourced, supported and sustained.

What it looks like in practice

A Recovery College has been established in the service with courses offered in the central location which offers co-produced courses with various local communities (including those living in rural areas, people from Black and minority ethnic groups, prisoners, older people, children and adolescents, people with intellectual disability, BME groups, for family members, people with long term physical conditions etc).

Ways in which ImROC can help you to achieve this

Comprehensive support to develop a Recovery College that meets ImROC key characteristics and builds on local strengths, resources and opportunities. This includes training, visits to established colleges, support to develop policies, procedures, documentation and outcome indicators.

What it looks like in practice

Recovery outcomes, values and practices are incorporated in commissioning, organisational strategy and purpose, performance targets and outcome measurement.

Strategic Recovery goals are identified, agreed and progress towards them is monitored with Board overview and accountability.

Identified recovery leads in every service and all teams working towards annual coproduced recovery plans.

Understanding of, and commitment to, recovery evident in practice, middle management and at Board level.

Recovery values embedded in every operational policy and in documentation, referral, assessment, review and discharge procedures as well as staff recruitment, appraisal and supervision.

To embed recovery values and practice at the front line and utilise the expertise within teams, every team has a coproduced Team Recovery Implementation Plan (possibly based on a TRIP assessment) and agreed priorities with SMART action plans and identified peer and staff leads for each goal. Progress is reviewed annually.

Ways in which ImROC can help you to achieve this

Working with commissioners to coproduce recovery focused plans and review existing services.

Bespoke consultancy to facilitate development of a coproduced organisational Recovery Strategy.

Training, coaching and mentorship for individuals at every level. Team coaching and supervision to discuss challenges they are facing and generate plans to overcome these.

Introduction to Recovery and Recovery planning at team levels (eg using Team Recovery Implementation Planning (TRIP) processes).

Workshops for executive team and for managers on their role in supporting Recovery.

Support to develop evaluation of Recovery projects and to introduce routine outcome measures.

What it looks like in practice

Shared decision making is well understood and practiced in every conversation. This is clearly documented in care plans, treatment plans, discharge plans and safety plans with both the staff and the person using services recording their views and preferences.

Throughout the service, people are routinely assisted to develop their own Personal Recovery Plans.

Joint crisis plans are negotiated with everyone who has used acute inpatient and crisis services.

All care pathways have been reviewed to ensure that opportunities for shared decision making are maximised.

At team and service level, the opportunity for developing personal health budgets has been considered and where appropriate mechanisms are in place for health funding to be used to meet individual goals in a personalised manner.

Staff are fully informed about the function of personal budgets for social care and know how to apply for these. There are annual targets to increase the take up of personal budgets to maximise achievement of life goals.

Ways in which ImROC can help you to achieve this

Bespoke consultancy package to develop systems to support personal health budgets.

Training in personalisation, personal budgets and self directed care.

Training in shared decision making including joint crisis planning, personal recovery planning and shared safety planning.

What it looks like in practice

All practices reviewed to identify and abolish unnecessary blanket restrictions.

Risk assessment has been transformed into collaborative safety planning with full involvement of the person using services and those important to them.

Courses available in Recovery College to help people using services to understand risk assessment and management processes.

Training on collaborative safety planning available to all staff.

Trust Board explicitly supports Recovery focused risk taking when there is careful consideration of ways to maximise safety.

The organisation routinely explores successful initiatives to take recovery focused risks in full collaboration with people using services so that lessons can be learnt.

There is explicit ambition to reduce the use of restraint and review of the experiences of all involved whenever restraint is used so that lessons can be learnt.

People using services are routinely involved in the assessment of environmental and operational risks and in the development of policies to mitigate these.

People using services and their relatives/friends are, with appropriate training, part of the team investigating untoward incidents and complaints.

Ways in which ImROC can help you to achieve this

Facilitation of stakeholder meetings to discuss and debate hopes and fears about shifting thinking about risk.

Transparent discussion about the drivers for/implications of risk adverse practices at Board and senior management levels. Support to develop approaches that place safety to recover before risk assessment and management.

Comprehensive support to develop a No Force First approach in inpatient services.

Bespoke consultancy to develop plans to reduce restrictive practice tailored to the organisation.

Training in shared safety planning.

Support to develop documentation to support shared safety plans.

Support to develop methods of evaluating reduction of restrictive practice.

What it looks like in practice

A database of people with lived experience and family members is maintained with details of their experience, expertise and interests as well as records of training they have undertaken.

People involved in coproduction (staff, people who use services and family members) receive coproduced training in coproduction.

Documentation includes records of the role played by people with lived experience and family members.

Coproduction is included in accountability mechanisms and performance targets.

Extending co-production to include communities and community organisations?

Ways in which ImROC can help you to achieve this

Training in coproduction for people working in practice, management and executive team.

Support to develop appropriate documentation.

Facilitated workshops to vision what coproduction means at different levels of the service (in work with individuals, at team and service level, in corporate departments and in community engagement and development.)

What it looks like in practice

Lived experience of mental health problems is demonstrably valued in the workforce (e.g. recruitment procedures value lived experience; multidisciplinary teams are expected to include the expertise of lived experience)

Peer workers are seen to bring additional skills and contributions to teams so actively recruited into appropriate posts.

HR processes and occupational health assessments have been reviewed to facilitate the employment of people with lived experience in both peer and professional posts.

Systems are in place to routinely support/make reasonable adjustments to people working in the Trust who have lived experience of mental health problems.

Staff are recruited for their values as much as for their professional skills.

Training is available for people wishing to become peer workers and for professional staff who have lived experience and wish to use it in their practice.

All mental health workers are encouraged/expected to use their life experience and lived experience of mental health problems and other challenges in their work.

Policies and procedures are reviewed to ensure that there are no barriers to people using their lived experience in their work appropriately, safely and effectively.

Ways in which ImROC can help you to achieve this

Bespoke consultancy support to review processes for recruiting and supporting the employment of people with lived experience whether as peer workers or in professional posts.

Support for managers to understand and introduce peer working appropriately and effectively in their services.

Support to develop job descriptions, person specifications and to prepare teams who wish to employ peer workers.

Support to develop training for peer workers and for staff with lived experience.

Training for peer support workers and/or support to develop your own peer worker training available for those wishing to apply for peer worker posts.

Support to develop mechanisms to provide ongoing support and development of peer workers.

Workshops to develop systems to support to staff to use their experience of life and mental health/other challenges in their work.

What it looks like in practice

Team leaders and managers are trained to support staff to stay well at work.

The wellbeing of all staff, and any adjustments they need in order to improve their well-being and performance at work are routinely addressed on recruitment and in supervision and appraisal.

Staff wellbeing plans are available for staff who wish to use them to optimise their resilience and wellbeing.

Whole team ‘well-being plans’ are developed to enable the team to address the challenges they face and maximise the well-being of their members. (or something like this)

Whole team support is available for teams who have experienced an incident, change or are struggling to work cohesively and effectively.

The personal qualities and prior life experience of staff are valued and included in selection criteria.

The organisation offers schemes, and groups to support staff wellbeing – like mindfulness, relaxation, yoga, buddying for people returning to work…

The organisational culture values and explicitly recognises individual initiatives and creativity of staff.

Ways in which ImROC can help you to achieve this

Support for HR teams to develop Recovery focused procedures and policies including recruitment processes, job descriptions, staff wellbeing plans.

Training for managers to enable them to support staff to stay well at work and/or support to develop your own training for this purpose.

What it looks like in practice

The organisation has established effective partnerships with local communities, resources, activities and facilities.

People using the service are actively supported to explore possibilities in the community.

The expertise of people using the service is used to develop information about activities and opportunities in communities.

All documentation emphasises the maintenance/development of meaningful roles and relationships in the communities of the persons’ choice, recognising their age, ability, personal, cultural and geographical preferences.

Initial assessments always involve an exploration of the person’s valued roles and relationships within their community and efforts are routinely made to enable people to maintain these roles and relationships.

Always to be on the receiving end of help from others is a devaluing and dispiriting place to be. Everyone using the service is encouraged to think about how they can contribute to their family/community and offered support to use their skills to do things for other people.

All people using the service are encouraged to think about their goals for employment evidence based support (Individual Placement with Support) is available to all who would like to think about returning to work, and to enable those who have jobs to retain them.

The importance of safe, appropriate housing is recognised with support available to maintain and/or gain housing of the person’s choice with the support required to maintain this. Accommodation should offer more than a roof over the person’s head. It should afford them choice and control over the environment in which they live and where who they live, as well as the ordinary tenancy rights that any citizen should expect.

The importance of social networks is recognised and people are routinely assisted to maintain and develop friendships and networks in communities.

Peer networks are actively involved in providing effective support.

The organisation actively supports a range of anti stigma work to reduce discrimination and exclusion in the communities that it serves.

Ways in which ImROC can help you to achieve this

Bespoke consultancy to review organisations’ relationships with local communities and to use evidence based tools and activities to expand and improve effective working relationships with organisations, groups and mainstream resources.

Support to review and develop appropriate assessment processes and documentation.

Training in asset based community development.

Support to coproduce care pathways in partnership with all relevant parties.

Support to develop evidence based employment support that meets the IPS fidelity criteria.

Support to develop team processes for enabling people to retain and regain valued community roles, relationships and activities (as part of their Team Recovery Implementation Plan).

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