Psychiatric Rehabilitation Journal 2014, Vol. 37, No. 1, 71–72

© 2014 American Psychological Association 1095-158X/14/$12.00 DOI: 10.1037/prj0000056

EDUCATION AND TRAINING

Creating a Learning Culture Karyn Mathewson

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Canadian Mental Health Association—Sudbury, Ontario, Canada Topic: This column describes the efforts of an agency to build a learning culture as part of changing their approach to service delivery, when adopting a focus on psychiatric rehabilitation and recovery. Purpose: This example of one organization’s challenges and successes in workforce development provides an alternative approach to the common single-session staff training that typically fails to change practice. Sources Used: This description draws from published material on communities of practice, technical consultation, and agency experience. Conclusions and Implications for Practice: Training alone is not enough to create change. An organizational commitment to ongoing quality improvement, along with available and accessible technical assistance for staff, creates an environment where change is anticipated, managed, and celebrated. Keywords: staff training, best practices, psychiatric rehabilitation

believed that, if we wanted to truly be a recovery-oriented agency, we needed to find a way to help people move along in their journey toward recovery and wellness. As part of program restructuring, we implemented psychiatric rehabilitation (Anthony, Cohen, Farkas, & Gagne, 2002). Our agency adopted the term psychosocial rehabilitation (PSR) to be in keeping with language, principles, and values of PSR-RPS Canada. The agency wanted to have a focus that would help people get the skills and supports they needed in order to be successful and satisfied in the environment of their choice (living, learning, working, or social). In order to accomplish the needed shift in culture and how we would provide services, we recognized that we needed to train all staff in PSR. We hired a consultant (Michael Seibold from Alternatives in Central Massachusetts) who had extensive experience in implementing and training in psychiatric rehabilitation. Over a period of 18 months, he trained staff on-site in the technology of PSR. He helped us to understand the “3 Es” of staff development: Exposure, Experience, and Expertise (Anthony et al., 2002). We identified the staff who needed to know the basics about the change in service delivery and the rational for making this change now (Exposure). We looked at other programs of the agency, such as our justice and intake service, and saw the importance of the staff in those programs knowing more about PSR and being able to actually use some PSR tools to provide service (Experience). We also identified that which practitioners had a significant need to develop Expertise in the tools of PSR. These staff needed to be able to confidently use the technology to assist people in learning or relearning skills and in establishing supports so they could achieve meaningful and personal goals for lives in their communities. Using the “3 Es” to identify levels of learning needed was beneficial as it ensured the focus of training was clear and targeted to the right staff. We quickly identified that simply providing staff training was not sufficient to embedding this new learning and approach. To fully implement PSR would require building and sustaining a staff development program, not just rolling out a series of training

Staff training and retraining requirements for service agencies seem endless, what with service system changes, developing knowledge of best practices, and high rates of staff turnover. As the saying goes, the only constant is change. Service providers and agency administrators are often burdened by training, due to high workloads and limited budgets, which make it difficult to find coverage or arrange release time for staff to allow them to attend training. These practical difficulties are sometimes compounded by negative staff attitudes toward training, lack of awareness of its value, and a false belief on the part of staff that training is a one-time event and, once trained, staff are “done.” To maximize participation in training and the application of new knowledge, an organization culture is needed that values training, expects and welcomes change, and rewards staff taking the initiative to learn and use new approaches to their work. This article describes the efforts of an agency to build just such a learning culture as part of a change in their approach to service delivery. In 2007, the Canadian Mental Health Association—Sudbury Manitoulin identified the need to provide more meaningful service to the people we serve. We restructured two programs and aligned all of the front line workers to be practitioners. Prior to this change, our case management program did not follow any particular approach to providing service. The service was a reactive one that, in the short term, may have appeared beneficial, but that did not help people move beyond their situation. Individuals were coming into service and expecting to have a paid support worker who would be in their life forever. As an agency, we understood that people felt comforted by having a permanent paid support person, but we

Correspondence concerning this article should be addressed to Karyn Mathewson, MS, RSW, CPRP, Manager of Clinical Services for the Canadian Mental Health Association—Sudbury, Manitoulin, 111 Elm Street, Suite 100, Sudbury, Ontario, Canada, P3C 1T3. E-mail: [email protected] 71

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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sessions. We identified the need for rehabilitation trainers to support their peers in this new learning. A job description was developed and we recruited interested staff for these new positions, which required a 1-year commitment. The primary role of the rehabilitation trainers was to facilitate monthly learning group meetings. Staff who required expertise were divided into two learning groups, which were mandatory for staff to attend. For staff requiring some experience in PSR, but not expertise, each was assigned a rehabilitation trainer as a resource person with whom they could connect with when they had questions; their attendance at learning groups was considered voluntary. Any staff who needed simple exposure, such as our receptionist and other staff of the administration team, received global overview training that explained primary principles of PSR at our quarterly all staff training days. They were also encouraged to request further training they felt they needed through discussions with their supervisor. For mandatory learning group meetings, the focus was to review the tools and technology of PSR. During the meetings, staff would role-play active listening scenarios to strengthen their skills. Staff also reviewed and role-played the completion of PSR readiness assessments (Farkas, Cohen, McNamara, Nemec, & Cohen, 2000) and walked through other processes, such as the worksheets for setting an overall rehabilitation goal (Cohen, Farkas, Cohen, & Unger, 1991). As the learning groups developed, so did an interest in expanding the activities during this time. Staff identified the need to spend time working with their peers to develop selfawareness activities that would help people in strengthening their readiness for change. Staff also identified personal areas of interest that they would like to research and present back to their learning group colleagues. The agency encouraged all practitioners to consider pursuing their CPRP certification (http://www.uspra.org). With this intent, the learning group focus for 1 year was to review the CPRP Exam Blue-Print to understand the different domains. Staff found this to be a meaningful use of time even if they were not pursuing the certification, because the discussions were meaningful to the work they were doing with people using their services. Recently, our agency has identified a need to go back to basics. An influx of new staff, combined with staff returning from leave, resulted in reduced quality of the PSR-focused work that was being done in the programs. All practitioners completed a selfassessment on recovery-oriented practice and wellness, which helped us identify training needs and priorities. We developed a training called PSR 101. The rehabilitation trainers developed specific monthly topics that would target these more basic learning needs. We have renamed our learning groups as “Communities of Practice” (Walker, 2010; Wenger, McDermott, & Snyder, 2002) because this term captures what we are trying to accomplish through dedicated staff training time on PSR and recoveryoriented practice. Wenger and colleagues define a community of practice as a group of people “who share a concern or a passion for something they do and learn how to do it better as they interact regularly” (Wenger et al., 2002, p. 4), which clearly articulates what our agency is encouraging through these groups. According to Wenger, McDermott, and Snyder (2002), three conditions must be met for a group to be termed a community of practice. There is

a domain and the group membership demonstrates a commitment to this domain. There is an identified community where members have joint conversations, share information, and help each other. Just because group members have the same job or job title does not make the group a community of practice, unless the members interact and learn together. Finally, there is a practice—an area where group members are practitioners desiring to improve; a community of practice is not simply an interest group. In addition to facilitating the community of practice sessions, the rehabilitation trainers provide one-to-one guidance for staff who need additional support. They assist with staff returning from a leave of absence and are in need of relearning PSR. The rehabilitation trainers also provide support and learning to student interns in placements with our agency. Our agency holds quarterly meetings with all staff, and the rehabilitation trainers often use this venue to provide training. As an agency, we encourage a culture of learning. We firmly believe that learning leads to excellence, creativity, and faithfulness to PSR values and principles. Ultimately, in the right climate, with the right supports, learning increases skills. Staff are expected to dedicate at minimum 2 hr a month to attend their community of practice meeting. We refer staff to their rehabilitation trainer as needed for support from a peer, and supervisors are available to answer any questions and to assist staff in seeing how they can work with people to ensure that they are providing the right service by using the tools of PSR within a context of recovery-oriented practice. Our new learning culture gives a clear message that training is never done, that nobody knows everything, and that best practices are likely to continue to evolve. This message helps staff feel comfortable asking for help, suggesting service changes, and sharing new knowledge. Yes, change is hard, but a commitment to ongoing quality improvement, along with available and accessible technical assistance, creates an environment where change is anticipated, managed, and celebrated by all.

References Anthony, W. A., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric rehabilitation, 2nd edition. Boston: Boston University, Center for Psychiatric Rehabilitation. Cohen, M., Farkas, M., Cohen, B., & Unger, K. (1991). Psychiatric rehabilitation training technology: Setting an overall rehabilitation goal (trainer package). Boston, MA: Boston University Center for Psychiatric Rehabilitation. Farkas, M., Cohen, M., McNamara, S., Nemec, P. B., & Cohen, B. (2000). Assessing readiness: Psychiatric rehabilitation trainer package. Boston, MA: Center for Psychiatric Rehabilitation at Boston University. Walker, D. (September 27, 2010). Using communities of practice as a mechanism for change. Presented at the PRS Housing Symposium, Vancouver, BC, Canada. Wenger, E. (1998, June/July). Communities of practice: Learning as a social system. The Systems Thinker Newsletter, 9. Retrieved from http:// www.co-i-l.com/coil/knowledge-garden/cop/lss.shtml Wenger, E., McDermott, R., & Snyder, W. M. (2002). Cultivating communities of practice. Boston, MA: Harvard Business School Press. Wenger, E. C., & Snyder, W. M. (2000). Communities of practice: The organizational frontier. Harvard Business Review, 78, 139.

Received January 24, 2014 Accepted January 24, 2014 䡲

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