Elements and Performance Criteria
- Elements define the essential outcomes
- Share and collect information to collaboratively inform the plan for recovery
- Work in a recovery oriented framework that respects the person’s experience, culture and unique recovery journey and the agreed recovery alliance relationship
- Use a collaborative approach to discuss and determine information to be collected and sources of information to be accessed
- Explain any organisation or program requirements including the commitment to access and equity, and limits to confidentiality
- Obtain consent from the person according to organisation policy and procedure
- Gather and document information from the person and other agreed sources to explore and clarify the person’s preferences, meanings and needs
- Apply best practice principles, if formal assessment is to be conducted, and work within organisation policy and procedures relating to assessment protocols
- Together identify the range and potential effects of social and other barriers that are impacting on the person
- Facilitate collaborative planning process for recovery
- Work collaboratively to develop a plan for recovery and transition based on the person’s choices, preferences, values, needs and goals and discuss different planning options and tools
- Facilitate planning sessions using effective communication strategies in a manner that respects the person as their own expert, fosters their strengths and supports them as the driver of their recovery journey
- Discuss and confirm the person’s choices for personal wellness, development of self-efficacy, cultural requirements, values, meanings and purpose in life
- Work collaboratively with the person to identify strategies and priorities to achieve goals including self-advocacy strategies and transition beyond the service
- Identify possible barriers or risks with the person and the strategies and/or other people who can assist in responding to or overcoming these challenges
- Develop and document personal wellness plan, risk plans or other plans to meet the person’s priorities, as appropriate
- Work collaboratively with the person to identify and balance duty of care and dignity of risk considerations whilst promoting independence from service
- Identify and document the person’s and worker’s roles and timelines for action
- Collaboratively implement plan for recovery
- Discuss with the person their interest and readiness to initiate their plan for recovery
- Undertake service actions as agreed in the plan in a timely manner
- Facilitate access to information, resources and education about opportunities and service options relevant to the persons aspirations
- Support person’s decision making and self-advocacy
- Support person’s positive risk taking and resilience building
- Maintain regular contact with the person, and be available to offer support and follow up on actions
- Maintain records and progress notes in collaboration with the person
- Develop and maintain effective working relationships with care support network
- Determine with the person who else they choose to involve in their recovery process and the roles they want them to play
- Obtain consent specifying what information can be shared with specific members of their care network and the circumstances in which the information can be released
- Identify the information and support needs of family, carer/s and friends
- Establish rapport and build an effective working relationship with relevant members of the care network
- Provide and communicate information so that it is readily understood by members of the care network
- Work from a strength based approach and communicate in a manner that respects the rights, dignity, choices and confidentiality of the person with the mental health condition while facilitating the care network to support the person
- Facilitate support, training or services to family, carer/s and friends based on identified needs
- Support person during challenges
- Respond proactively to potential obstacles, challenges and barriers that arise, working with the person to identify ways to proceed and to reduce the likelihood of occurrence
- Maintain an empathic, supportive and hope inspiring approach as challenges occur seeing challenge as part of the recovery journey and sources for learning
- Respond promptly, positively and supportively to person in distress or crisis and support access to required services
- Respond promptly to de-escalate potential incidents or risks and promote safety
- Collaboratively review the effectiveness of the plan and support provided
- Review recovery plan and alliance regularly with person to ensure continued relevance and effectiveness
- Gather feedback from the person at key milestones about the effectiveness and progress in implementing their recovery plan
- Identify new directions and areas for change in the recovery plan and amend plans and transition strategies
- Continue implementation and review cycle for the recovery plan until outcomes have been achieved and no further service or support is required
- Gather and respond to feedback from the person on their satisfaction with the service and support provided
- Reflect on work practice and feedback and identify opportunities for enhancing empowerment and improved processes