Project GREAT Educates Clinicians, Empowers Patients

What is "great" about the Georgia Recovery-Based Educational Approach to Teaching, in addition to its acronym, is the sense of hope it fosters among psychiatric patients by making them full partners in their own care rather than passive recipients of symptomatic treatment, P. Alex Mabe, Ph.D., says.

In fact, shared decision-making and empowerment are the lynchpins of the psychoeducational model, which recently earned the 2012 Award for Creativity in Psychiatric Education from the American College of Psychiatrists.

Courtesy Gareth Fenley, Project GREAT

Project GREAT, conceived by Dr. Peter F. Buckley, former chair of the department of psychiatry and health behavior and current dean of the medical college at Georgia Health Sciences University in Atlanta, is a recovery-oriented treatment program designed to not only change the nature of patient involvement in their own care, but also to change the way in which providers think about treatment, said Dr. Mabe, faculty leader of the program.

Recovery-oriented treatment programs – those that focus on promoting the ability of individuals to cope with their mental illness and to recover meaningful roles and quality of life in the community – began to emerge in the late 1980s. But Project GREAT is among the first to attempt to change clinical services and educational curriculum, Dr. Mabe said. Specifically, the project comprises both an educational/curriculum development and a treatment component, he said.

With respect to provider education, the team has developed a workshop curriculum made up of role plays, live and video presentations, and interactive discussions created and presented by providers and patients working together, Dr. Mabe explained. "Psychiatrists and psychologists teach along side certified peer specialists (CPS) – individuals who have experienced the disabling symptoms of severe mental illness and have gained control over their lives."

Through the multimedia presentations, workshop participants gain an understanding of the recovery model and obtain the tools to put the concepts into practice immediately, including the pre-assessment process, intake interview, and follow-up appointment documentation that stresses self-directed treatment planning and a focus on strengths and hope rather than on psychopathology and symptoms, he said.

"Conventional psychiatry has tended to focus exclusively on diagnosis and symptom treatment, without a consideration of well-being and overall quality of life," Dr. Mabe said. "Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

Toward this end, the treatment component of the program is built on shared decision making. In this regard, the CPS members of the treatment team are mission-critical. Their role is tri-fold: provide direct support to patients; educate and provide feedback to residents and other providers with respect to listening to, collaborating with, empowering, and fostering a partnership with patients; and represent the project in the community through participation on advisory boards.

By sharing their own stories, the treatment team members help to dispel patients’ negative self images, an all-too-frequent byproduct of societal stigmatization of mental illness, he said.

"Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

"Because these specialists have themselves successfully engaged in the recovery process, they are able to instill hope in the consumers in a more powerful way than someone who has not been on that journey would be able to, including providers."

Time and resource restraints are often cited as obstacles to new program acceptance, but "there is no difference in the treatment course or duration between Project GREAT and conventional care," Dr. Mabe said. The differences lie in the underlying philosophy and the nature of its implementation.

"Financially, the main economic question will center around the peer specialists and whether they can be sustained in terms of their own income," he said. "Many states have funding through Medicaid, but the rates are fairly low at this point. Although we haven’t yet done a financial assessment of the program, which we began in earnest in 2007, it’s easy to see how recovery-based care in the long-run will reduce recidivism and actually make systems more efficient."

Curiously, although initial skepticism among providers that a recovery-based treatment approach is feasible in mental health practice is among the implementation challenges, one of the more stubborn obstacles is the pervasive stigmatizing attitudes that providers have toward their patients, Dr. Mabe said. "Unfortunately, the research is quite clear that providers still have trouble being hopeful about outcomes, particularly with people who have serious or chronic mental illness."

This is exacerbated by the paternalistic perspective that continues to be taught by the traditional model "So shifting this attitude and getting providers to see their patients as capable and helping them instill hope is not at all intuitive or easy," he said.

"What we’re finding, though, is that the more contact providers have with the consumer, and particularly the CPS, the more they are able to see and appreciate a more promising outlook: that recovery is possible and that people can reclaim their lives, so this constant exposure is very valuable."

Although the model, which is being implemented at the Medical College of Georgia and its affiliated hospital as well as at a traditional mental health public hospital in Atlanta, is still new enough to preclude comprehensive outcome studies in the scientific domain, "our program evaluation materials suggest we’re on the right track," Dr. Mabe said. "The scores for the questions on our patient satisfaction measures that are most relevant to Project GREAT, including, ‘Does my doctor understand me? Does my doctor give a good explanation of the treatment options? Am I allowed to be an active participant in the decision-making process?’ have risen from the mid-80% range prior to 2007 to the 95% and higher range since 2007."

Further, in an assessment of the Project GREAT curriculum’s effectiveness for instilling knowledge about recovery and promoting recovery-based attitudes among psychiatrists and psychologists, investigators showed that the recovery principles were effectively taught and that when patients and CPS shared their recovery stories, provider attitudes "shifted toward recovery," Dr. Mabe said (Community Ment. Health J. 2009;45:239-45).

Project GREAT continues to be a work in progress. "Right now, we are piloting a new seminar on shared decision making in psychiatry and looking at the impact on attitudes in practice," Dr. Mabe said. Looking 5-10 years out, "our hope is that by then, there will be a solid skill base in faculty and students where they are really integrating the holistic perspective into their practice by considering life purpose and meaning rather than just symptoms," he said.

"Also, we hope collaboration and shared decision-making are established, valued clinical skills."

Dr. Mabe disclosed having no financial conflicts of interest.

What is "great" about the Georgia Recovery-Based Educational Approach to Teaching, in addition to its acronym, is the sense of hope it fosters among psychiatric patients by making them full partners in their own care rather than passive recipients of symptomatic treatment, P. Alex Mabe, Ph.D., says.

In fact, shared decision-making and empowerment are the lynchpins of the psychoeducational model, which recently earned the 2012 Award for Creativity in Psychiatric Education from the American College of Psychiatrists.

Courtesy Gareth Fenley, Project GREAT

Project GREAT, conceived by Dr. Peter F. Buckley, former chair of the department of psychiatry and health behavior and current dean of the medical college at Georgia Health Sciences University in Atlanta, is a recovery-oriented treatment program designed to not only change the nature of patient involvement in their own care, but also to change the way in which providers think about treatment, said Dr. Mabe, faculty leader of the program.

Recovery-oriented treatment programs – those that focus on promoting the ability of individuals to cope with their mental illness and to recover meaningful roles and quality of life in the community – began to emerge in the late 1980s. But Project GREAT is among the first to attempt to change clinical services and educational curriculum, Dr. Mabe said. Specifically, the project comprises both an educational/curriculum development and a treatment component, he said.

With respect to provider education, the team has developed a workshop curriculum made up of role plays, live and video presentations, and interactive discussions created and presented by providers and patients working together, Dr. Mabe explained. "Psychiatrists and psychologists teach along side certified peer specialists (CPS) – individuals who have experienced the disabling symptoms of severe mental illness and have gained control over their lives."

Through the multimedia presentations, workshop participants gain an understanding of the recovery model and obtain the tools to put the concepts into practice immediately, including the pre-assessment process, intake interview, and follow-up appointment documentation that stresses self-directed treatment planning and a focus on strengths and hope rather than on psychopathology and symptoms, he said.

"Conventional psychiatry has tended to focus exclusively on diagnosis and symptom treatment, without a consideration of well-being and overall quality of life," Dr. Mabe said. "Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

Toward this end, the treatment component of the program is built on shared decision making. In this regard, the CPS members of the treatment team are mission-critical. Their role is tri-fold: provide direct support to patients; educate and provide feedback to residents and other providers with respect to listening to, collaborating with, empowering, and fostering a partnership with patients; and represent the project in the community through participation on advisory boards.

By sharing their own stories, the treatment team members help to dispel patients’ negative self images, an all-too-frequent byproduct of societal stigmatization of mental illness, he said.

"Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

"Because these specialists have themselves successfully engaged in the recovery process, they are able to instill hope in the consumers in a more powerful way than someone who has not been on that journey would be able to, including providers."

Time and resource restraints are often cited as obstacles to new program acceptance, but "there is no difference in the treatment course or duration between Project GREAT and conventional care," Dr. Mabe said. The differences lie in the underlying philosophy and the nature of its implementation.

"Financially, the main economic question will center around the peer specialists and whether they can be sustained in terms of their own income," he said. "Many states have funding through Medicaid, but the rates are fairly low at this point. Although we haven’t yet done a financial assessment of the program, which we began in earnest in 2007, it’s easy to see how recovery-based care in the long-run will reduce recidivism and actually make systems more efficient."

Curiously, although initial skepticism among providers that a recovery-based treatment approach is feasible in mental health practice is among the implementation challenges, one of the more stubborn obstacles is the pervasive stigmatizing attitudes that providers have toward their patients, Dr. Mabe said. "Unfortunately, the research is quite clear that providers still have trouble being hopeful about outcomes, particularly with people who have serious or chronic mental illness."

This is exacerbated by the paternalistic perspective that continues to be taught by the traditional model "So shifting this attitude and getting providers to see their patients as capable and helping them instill hope is not at all intuitive or easy," he said.

"What we’re finding, though, is that the more contact providers have with the consumer, and particularly the CPS, the more they are able to see and appreciate a more promising outlook: that recovery is possible and that people can reclaim their lives, so this constant exposure is very valuable."

Although the model, which is being implemented at the Medical College of Georgia and its affiliated hospital as well as at a traditional mental health public hospital in Atlanta, is still new enough to preclude comprehensive outcome studies in the scientific domain, "our program evaluation materials suggest we’re on the right track," Dr. Mabe said. "The scores for the questions on our patient satisfaction measures that are most relevant to Project GREAT, including, ‘Does my doctor understand me? Does my doctor give a good explanation of the treatment options? Am I allowed to be an active participant in the decision-making process?’ have risen from the mid-80% range prior to 2007 to the 95% and higher range since 2007."

Further, in an assessment of the Project GREAT curriculum’s effectiveness for instilling knowledge about recovery and promoting recovery-based attitudes among psychiatrists and psychologists, investigators showed that the recovery principles were effectively taught and that when patients and CPS shared their recovery stories, provider attitudes "shifted toward recovery," Dr. Mabe said (Community Ment. Health J. 2009;45:239-45).

Project GREAT continues to be a work in progress. "Right now, we are piloting a new seminar on shared decision making in psychiatry and looking at the impact on attitudes in practice," Dr. Mabe said. Looking 5-10 years out, "our hope is that by then, there will be a solid skill base in faculty and students where they are really integrating the holistic perspective into their practice by considering life purpose and meaning rather than just symptoms," he said.

"Also, we hope collaboration and shared decision-making are established, valued clinical skills."

Dr. Mabe disclosed having no financial conflicts of interest.

What is "great" about the Georgia Recovery-Based Educational Approach to Teaching, in addition to its acronym, is the sense of hope it fosters among psychiatric patients by making them full partners in their own care rather than passive recipients of symptomatic treatment, P. Alex Mabe, Ph.D., says.

In fact, shared decision-making and empowerment are the lynchpins of the psychoeducational model, which recently earned the 2012 Award for Creativity in Psychiatric Education from the American College of Psychiatrists.

Courtesy Gareth Fenley, Project GREAT

Project GREAT, conceived by Dr. Peter F. Buckley, former chair of the department of psychiatry and health behavior and current dean of the medical college at Georgia Health Sciences University in Atlanta, is a recovery-oriented treatment program designed to not only change the nature of patient involvement in their own care, but also to change the way in which providers think about treatment, said Dr. Mabe, faculty leader of the program.

Recovery-oriented treatment programs – those that focus on promoting the ability of individuals to cope with their mental illness and to recover meaningful roles and quality of life in the community – began to emerge in the late 1980s. But Project GREAT is among the first to attempt to change clinical services and educational curriculum, Dr. Mabe said. Specifically, the project comprises both an educational/curriculum development and a treatment component, he said.

With respect to provider education, the team has developed a workshop curriculum made up of role plays, live and video presentations, and interactive discussions created and presented by providers and patients working together, Dr. Mabe explained. "Psychiatrists and psychologists teach along side certified peer specialists (CPS) – individuals who have experienced the disabling symptoms of severe mental illness and have gained control over their lives."

Through the multimedia presentations, workshop participants gain an understanding of the recovery model and obtain the tools to put the concepts into practice immediately, including the pre-assessment process, intake interview, and follow-up appointment documentation that stresses self-directed treatment planning and a focus on strengths and hope rather than on psychopathology and symptoms, he said.

"Conventional psychiatry has tended to focus exclusively on diagnosis and symptom treatment, without a consideration of well-being and overall quality of life," Dr. Mabe said. "Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

Toward this end, the treatment component of the program is built on shared decision making. In this regard, the CPS members of the treatment team are mission-critical. Their role is tri-fold: provide direct support to patients; educate and provide feedback to residents and other providers with respect to listening to, collaborating with, empowering, and fostering a partnership with patients; and represent the project in the community through participation on advisory boards.

By sharing their own stories, the treatment team members help to dispel patients’ negative self images, an all-too-frequent byproduct of societal stigmatization of mental illness, he said.

"Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."

"Because these specialists have themselves successfully engaged in the recovery process, they are able to instill hope in the consumers in a more powerful way than someone who has not been on that journey would be able to, including providers."

Time and resource restraints are often cited as obstacles to new program acceptance, but "there is no difference in the treatment course or duration between Project GREAT and conventional care," Dr. Mabe said. The differences lie in the underlying philosophy and the nature of its implementation.

"Financially, the main economic question will center around the peer specialists and whether they can be sustained in terms of their own income," he said. "Many states have funding through Medicaid, but the rates are fairly low at this point. Although we haven’t yet done a financial assessment of the program, which we began in earnest in 2007, it’s easy to see how recovery-based care in the long-run will reduce recidivism and actually make systems more efficient."

Curiously, although initial skepticism among providers that a recovery-based treatment approach is feasible in mental health practice is among the implementation challenges, one of the more stubborn obstacles is the pervasive stigmatizing attitudes that providers have toward their patients, Dr. Mabe said. "Unfortunately, the research is quite clear that providers still have trouble being hopeful about outcomes, particularly with people who have serious or chronic mental illness."

This is exacerbated by the paternalistic perspective that continues to be taught by the traditional model "So shifting this attitude and getting providers to see their patients as capable and helping them instill hope is not at all intuitive or easy," he said.

"What we’re finding, though, is that the more contact providers have with the consumer, and particularly the CPS, the more they are able to see and appreciate a more promising outlook: that recovery is possible and that people can reclaim their lives, so this constant exposure is very valuable."

Although the model, which is being implemented at the Medical College of Georgia and its affiliated hospital as well as at a traditional mental health public hospital in Atlanta, is still new enough to preclude comprehensive outcome studies in the scientific domain, "our program evaluation materials suggest we’re on the right track," Dr. Mabe said. "The scores for the questions on our patient satisfaction measures that are most relevant to Project GREAT, including, ‘Does my doctor understand me? Does my doctor give a good explanation of the treatment options? Am I allowed to be an active participant in the decision-making process?’ have risen from the mid-80% range prior to 2007 to the 95% and higher range since 2007."

Further, in an assessment of the Project GREAT curriculum’s effectiveness for instilling knowledge about recovery and promoting recovery-based attitudes among psychiatrists and psychologists, investigators showed that the recovery principles were effectively taught and that when patients and CPS shared their recovery stories, provider attitudes "shifted toward recovery," Dr. Mabe said (Community Ment. Health J. 2009;45:239-45).

Project GREAT continues to be a work in progress. "Right now, we are piloting a new seminar on shared decision making in psychiatry and looking at the impact on attitudes in practice," Dr. Mabe said. Looking 5-10 years out, "our hope is that by then, there will be a solid skill base in faculty and students where they are really integrating the holistic perspective into their practice by considering life purpose and meaning rather than just symptoms," he said.

"Also, we hope collaboration and shared decision-making are established, valued clinical skills."

Dr. Mabe disclosed having no financial conflicts of interest.