PIER Program

Hope through early intervention

Welcome to the PIER Program! Your orientation package includes the following handouts: • Our team contact information • Multifamily Groups (MFG) information • Supported Employment and Education information • CBTp (Cognitive Behavioral Therapy with Psychosis) and Motivational Interviewing (MI) information • Care Manager and Occupational Therapy information • Peer Support through YouthMove Maine information • NITT (Now Is The Time) grant evaluation by Hornby Zeller Associates, Inc. • Insurance information: How are services paid for • Upcoming appointment calendar • Personalized crisis plan • Releases to sign

We look forward to working with you and your family!

The PIER Team

Rebecca Jaynes, LCPC PIER Program Social Worker (207) 661-7344 [email protected]

Sarah Lynch, LCSW PIER Program Manager (207) 662-3162 [email protected]

Dr. Douglas Robbins, MD PIER Program Psychiatrist (207) 662-2160 [email protected]

Donna Downing, MS, OTR/L MAY Study Coordinator/ Occupational Therapist (207) 662-3681 [email protected]

David Tompkins M.S. Ed. PIER Program Vocation/ Education Specialist (207) 662-6137 [email protected]

Rebecca Wertheimer, LCSW PIER Program Social Worker (207) 661-7343 [email protected]

Tamara Manzer

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Youth Support Partnership Manager (207) 740-5473 [email protected]

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Hope through early intervention

What is PIER multifamily group (MFG)? What is multifamily group (MFG)?

How does MFG help?

Multifamily Group is an opportunity for your family (client with parents, siblings, partners, and/ or other social supports) to meet with clinical staff and 5-6 other PIER families to learn more about the troubling symptoms that brought you into the PIER Program. Studies show that MFG can help your family member get better as everyone learns more about the illness process, ways to reduce stress, and how to get on with your lives (friends, work, school, activities).

Studies show that MFG is more effective than working on issues in individual therapy. Adolescence and young adulthood, by its very nature, is a stressful time. In FPE, you and your family will learn to deal with common problems that often create conflicts, such as:

How often do we meet? Families meet every two weeks in the same location, on the same day of the week, and at the same time for 90 minutes. The time of the meeting is determined by the schedules of all participants - in general, the meetings are held in the early evenings, after school and work. You will learn more specifics about the group from your PIER clinician if you are enrolled in the treatment condition of the program.

What do we do in MFG? Although MFG has a structured format led by 2 clinicians, families are encouraged to participate fully in the process. People learn to deal with problems in a practical, step-by-step manner. Past participants have shared that MFG helps everyone learn about confusing symptoms and behaviors that are a result of brain changes. Families learn that other people have similar needs and experiences, and that together, they can find ways to deal with stress and conflicts, which tend to be the cause of symptom flare-ups. Communication within families tends to improve as well, e.g., less criticism, more understanding, better ways of dealing with conflict.

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Hope through early intervention

• Isolation • Confusion and poor concentration • Missing school for extended periods or not being able to get up in the mornings to get there on time • Poor academic performance • Difficulty finding and/or keeping a job • Taking medication • Spending time with peers who take drugs or “don’t care” • Feeling like a social misfit

Why should my family attend MFG if my loved one is feeling better? We expect that your loved one WILL improve and return to a former level of functioning, which is to be celebrated. However, we know that a teen or young adult’s life is often hectic. We also know that if someone has a biological vulnerability to stress, everyday upsets can lead to symptom flare-ups. Therefore, it’s important to have a place to go to where those stressors can be dealt with in a matterof-fact, non-blaming manner, where everyone learns.

What is supported employment? What is supported employment (SE)?

What is an employment specialist?

Supported Employment is an approach to vocational rehabilitation that assists clients (and members of their families) in finding and keeping a job that pays a competitive wage, capitalizes on personal strengths, and provides the support necessary to be successful in the workplace. Examples of specific services include, but are not limited to: finding a job, keeping a job, connection to resources, an updated résumé, on-site job coaching, and improving interview skills.

The Employment Specialist is a trained clinician providing Supported Employment and participates fully in the PIER clinical treatment team meetings, collaborating with other mental health clinicians to provide integrated, wrap-around services. A central goal for the Employment Specialist is to assist clients in meeting their vocational goals and connecting them to community goods and services through employment. The Employment Specialist also serves as a resource to both clients and employers on the American with Disabilities Act (ADA), and Maine State Child Labor Law.

How does supported employment help? Empirical research has shown that employment is very often an important ingredient in a young person’s journey through recovery. Supported Employment can lead to: • building self esteem • moving to independence and self-reliance • learning to manage finances • development of coping skills • improved social skills • acquiring a work history • a broadening of interests • identifying a career

If I work, will I lose my SSI/SSDI benefits? The Employment Specialist can arrange an appointment with a Community Work Integration Counselor (CWIC) who will explain how to work and hold onto your benefits.

Do I have to be at a certain level of recovery in order to work? No, every client is considered ready to work.

How often do we meet?

Who is eligible for supported employment? No one is excluded from participating in Supported Employment and all clients are considered ready to work, regardless of their symptoms, work history, or other problems, such as substance abuse or involvement with the legal system.

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Frequently asked questions

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Hope through early intervention

Usually once a week for an hour, however the Employment Specialist and client work together to create a work plan that best suits the client’s schedule and needs.

What is supported education? Question: In the past couple of months, have you (or your family) been concerned about any of the following? • Your grades • Getting homework in on time • Getting to classes • Dropping grades If you answered “yes” to any of the above questions, we can help. There is someone on the PIER team who can help with concerns you have about school. Our Employment Specialist is cross-trained to help you with school and work issues.

What is supported education?

Who is eligible for supported education?

Supported Education provides assistance to students so they can successfully return to school or begin either a community-based school system or a post-secondary educational program. The Employment Specialist meets with the client and family, PIER staff, and appropriate school staff to:

All program clients and their families are eligible for Supported Education.

• Develop educational goals • Examine available educational programs • Develop a step-by-step plan • Offer registration assistance • Offer financial aide assistance • Counsel • Explain how to identify and request helpful accommodations • Assist with organizational skills development • Provide guidance on disclosure of mental illness • Provide IEP preparation and support

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How can supported education help? Success in school can help in your overall recovery, contribute to your self-confidence, and provide important connections to teachers and friends. Our goal is to help clients gain knowledge about how education can help them reach their career goals, acquire a well-paying job, and become independent.

What is cognitve behavior therapy for psychosis (CBTp)? Cognitive Behavior Therapy for Psychosis (CBTp) is a collaborative, goal oriented, individual therapy that helps individuals manage their symptoms. It is an evidence-based intervention, shown to be effective in reducing distress and functional deficits associated with psychotic symptoms. CBTp has been developed to target symptoms across the spectrum of psychosis, from individuals identified as being ‘at-risk’ of developing psychosis to individuals with a longstanding diagnosis. The aim of CBTp is to help the individual gain a better understanding of the triggers and maintaining factors associated with their symptoms by developing an individualized formulation. This formulation aids treatment planning and the development of goals related to increasing selfmanagement through acquiring new and helpful cognitive and behavioral skills.

Some of the key principles of CBTp are: • Engagement • Normalizing • Goal centered • Time limited

Some of the techniques used in CBTp are: • Making sense of psychosis • Exploring personal meaning of symptoms • Developing skills to recognize and reframe cognitive distortions • Reducing distress over perceptual experiences

What is motivational interviewing (MI)? Motivational interviewing is a form of collaborative conversation for strengthening a person’s own motivation and commitment to change. It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the stages of change

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process. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

What is care management? This approach to care management builds upon client and family strengths. It helps the client and family build a long term plan to identify and access community resources needed to achieve their goals.

• Community supports

The care manager can help client and families access:

• Help with housing, food stamps, etc.

• Health insurance and Mainecare • Assistance with medication (i.e. organizational tools, reminder calls, pharmacy calls)

What is occupational therapy? Occupational therapy (OT) is a client-centered health profession focused on promoting quality of life through occupation. The term “occupation” refers to everyday activities that are personally meaningful to an individual. It includes activities that people want to do or need to do to lead satisfying lives. Examples of occupations include doing selfcare activities, engaging in a hobby, socializing with friends, attending school and going to work.

How will occupational therapy help? The occupational therapist works with the treatment team to identify a person’s abilities and sensitivities, and then offers him/her specific assessments to better define and understand his/her abilities and needs. Based on the occupational therapy evaluation, the therapist makes recommendations to support the person’s goals, and also works with the employment specialist to identify needed supports for school and/or work. For example, the occupational therapist can recommend strategies to enhance school performance based on a person’s learning style and sensory preferences. Similarly, the occupational therapist can support success in a work setting by recommending ways to structure tasks, the environment, and the amount and type of supervision needed.

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What is the occupational therapy evaluation like? The occupational therapy evaluation can take anywhere from half an hour to over an hour, depending on the person’s goals and tolerance for the tasks. The evaluation is usually scheduled over a couple of sessions, but this can be adjusted to best suit the individual’s needs. Following a brief interview, a menu of assessment options are drawn upon that address the following areas as needed: attention, memory, learning style, and the impact of the sensory environment on the person’s functioning.

Where will the occupational therapy evaluation take place? The OT evaluation will typically take place at the PIER Program. If indicated, the occupational therapist will visit the client’s home, work, or school environment.

What is NITT Grant evaluation by Hornby Zeller Associates, Inc? The PIER Program is funded by a grant through SAMHSA (Substance Abuse and Mental Health Services Administration) called Now Is The Time (NITT). The NITT grant is being evaluated by a company named Hornby Zeller Associates, Inc. Hornby Zeller Associates is a social research and evaluation consultation firm with 20 years of experience working in Maine. As part of Hornby Zeller Associate’s work with the PIER program, they will be taking de-identified information from PIER Program participants in order to independently evaluate the services we are offering. This is an evaluation of the PIER Program, not the participants in the program.

What will be expected of me? The PIER program is asking for your help in evaluating how we are providing services to you and your family. When you first enroll in the program, you will be asked to complete a release form. About a month later, you will be contacted by an evaluator from Hornby Zeller Associates to complete a one hour interview. After that, you will be asked to complete another interview every 6 months that you are involved with the PIER program. You will be compensated for your time doing these interviews.

Insurance information: how are services paid for? The PIER program will bill for services that are covered by private insurance or MaineCare. We will also provide services that are not covered by insurance. MaineCare, and most private insurance companies, cover initial assessments, individual therapy, family therapy, medication management, and Multifamily group therapy. The educational/vocational services, care management services and peer mentoring services are included at no additional charge.

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In order to be equitable among private insurance plans, we will charge a standard $15 copay rate for billable services. We will work with you to figure out insurance and payment information. Your ability to pay for services will not impact the services we provide. If you think you may qualify for MaineCare but do not currently have it, we will help you through the process.

Initial appointment times My next individual counselling appointment is: Date

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My next medication management appointment is: Date

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My next employment/vocational meeting is: Date

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I will be participating in the family workshop on: Date

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I will be participating in the ongoing MultiFamily Groups (MFG) on: Date

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Facilitators