Along with a few others connected to
the state Department of Mental Health, in the fall of 1986, planning began in earnest
on the first ever formal training of mental health consumers/survivors as
service providers. This program
became known as the Denver Consumer Case Manager Aide (CCMA) Program. In December 1986, the 49 applicants had
been narrowed down to 25. By the
time the program actually started, five additional people had dropped out,
leaving a class of twenty. Of
these, eighteen graduated in late June, 1987.
The
original program continued throughout the 1980's and 1990's in Colorado. Hundreds of people were trained based
upon that original curriculum. The
curriculum was coordinated by the RATC (Regional Assessment and Training
Center) based on the grounds of Fort Logan State Hospital in Denver. One aspect of the curriculum that
continues to make this program unique is that it was scientifically derived.
The
jobs were envisioned in such a way that the tasks of the people performing the
jobs would be extremely similar to the tasks performed by 'case managers.' Therefore, a study was done and an
'efficiency expert' shadowed case managers and made note of all the tasks that
were performed on the job. This
formal 'Job Task Analysis' identified the skill set that was desired. The desired set of skills dictated the
topics that should be taught and thus, the curriculum was defined.
Most
modern self-help or peer support curriculums have been developed by having a
group of folks sit down and discuss what might or might not be good additions
to the list of topics to teach.
The 'Job Task Analysis' is part of what sets the SPIRIT training apart
as a more scientific, evidence-based training.
Several
factors combined to create an atmosphere in which the Consumer Case Manager
Aide Program could develop. There
was a class action lawsuit in Denver District Court, brought by mental health
consumers charging that there was a lack of sufficient services. The city of Denver had just been
granted one of nine nationwide demonstration service grants by the Robert Wood
Johnson Foundation. The
legislature appropriated several million new dollars in response to the State
Division of Mental Health's Plan to improve services to individuals with
chronic mental illness. There was
a renewed commitment on the part of the four separate mental health centers in
Denver to consolidate into a single service delivery system. Case Management as a formal, integral
part of the service system was developed as Citywide Case Management
Services. Citywide could cross the
boundaries of the existing fragmented system before the consolidation was complete. This allowed them to follow the client
and meet them in the community without regard to normal catchment area
boundaries.
It
was immediately recognized that there were more clients to be served than
originally assumed. An examination
of the tasks related to case management revealed many duties that were more
paraprofessional in nature and that this might be a way of expanding the
capacity of the "professional" case managers scope of services and
the numbers of clients that could be served. It struck someone that "highly functioning"
consumers themselves might be able to form this paraprofessional resource pool
of employees. The rationale then
followed that consumers already had a knowledge of the community resources,
that they had been through the maze of the system, that they might be able to
connect with treatment resistant clients who were distrustful of the existing
provider system and psychosocial rehabilitation technology claimed that
consumers could perform the necessary tasks if given the opportunity to do so.
Although
this idea was very radical at the time, there was historical precedent within
the Alcohol and Drug field. It is
almost a prerequisite that to help people in the A&D field that you be a
recovering alcoholic or addict.
This is part of the fundamental basis for many 12-step programs such as
Alcoholics Anonymous. So, on some
levels it made sense to create a program that is based on peer support and
self-help principles that had been proven effective in the A&D field for
nearly 50 years.
For more on the early history, check out this article by Paul
Sherman and Russ Porter in Hospital and Community Psychiatry