Program Manual

for a Consumer-Run Drop-In Center

based on the Mental Health Client Action Network in Santa Cruz, CA

by Bonnie Schell, M.A., CPRP

for

COSP-MultiSite Study, FliCA site, SAMHSA

November 28, 2003

Consumer-Run Drop-In Center

TABLE OF CONTENTS

Introduction	Why This Manual Is Needed	4
Section 1:	Research on Drop-In Centers	5
Section 2:	Setting up a Drop-In Center	9
	The Principle of Self Help or Mutual Assistance	9
	A Typical Day	10
	Who Will You Serve?	12
	Standards of Conduct for Guests	14
	Reasons for Eviction	14
	Asking Individuals To Leave	15
	Special Populations	17
Section 3:	What skills Are Needed for a Drop-In Center?	19
	Job Descriptions	20
	Executive Director	22
	Co-Managers or Coordinators	24
	Host/Hostess/Reception	26
	Guidelines for Receptionist	26
	Maintenance/Janitorial	28
	Facilities Manager	29
	Kitchen Monitor/Organizer	31
	Host/Officer of the Day	32
	Van Driver	34
	Office Manager	35
	Art Program Coordinator	36
	Client Rights Information Specialist	37
	Program Publication Assistant	38
	Hospital Volunteer	40
	Information Coordinator	41
	Inside Bookkeeper	42
	Mutual Support Specialist	43
	Ideas for Volunteer Jobs	44
	Standards of Conduct for Staff-Drug Free Workplace	45
	Disciplinary Procedures	48
	Complaint Procedures	48
	Voluntary and Involuntary Terminations	49
	Staff Meetings	52
Section 4:	Personnel Forms	53
	Volunteer Interest Form	55
	Agreement for Stipend to Volunteer	57
	Employment Application	58
	Emergency Contact Form	62
	Grievance Form	63
	Performance Review Forms	65
	Contract Labor	69
	Award Certificates	69
Section 5:	Facility Design & Management	70
	Program Components and Their Space Requirements	71
	Drop-In Room	71
	Administration and Accounting	72
	Insurance	73
	Coffee & Snacks	73
	Computer Lab & Pornography Viewing Policy	74
	Peer Counseling/Mutual Support	77
	Advocacy	80
	Print Communications	81
	Telephones and Message Procedures	81
	Health and Safety and Medications	84
	Fire / Earthquake/ Bomb Drills	85
	Violence in the Workplace	85
	Neighbor & Provider Complaints	86
Section 6:	Making a Difference	87
	Promoting Change in Care-giving Systems	87
	Methods of Collecting Information	87
	Focus Groups on Traditional Service Provision	88
	Committee & Board Membership	92
	Evaluation	93
	Counting for COSTS	94
	Self-Assessment	95

Introduction – Why this manual is needed

The Mental Health Client Action Network is a consumer-run community organization / advocacy network for adults with a serious mental illness. MHCAN is located in a part urban and part rural county with a population of 134,753. Santa Cruz is second only to Marin County in being the place with the highest cost of housing in the United States. The traditional System of Care serves only about 1,600 outpatients out of close to 4,000 eligible for MediCaid mental health services. Since its inception MHCAN has served not only those formally diagnosed by professional providers, but also those considered by the mental health community to have emotional and cognitive problems. Part of the Mental Health Consumer Self-Help movement, MHCAN gives clients an opportunity to help themselves while assisting others in navigating through the treatment system and community environment.

Our program has developed over This manual for operating a drop-in center is based on 10 years of trial and error without an operations manual to follow. In 1991 when a cluster of consumers in Santa Cruz County, California, wanted to start a drop-in center there were no consumer-run listservs where questions could be asked. Technical Assistance Centers did not yet exist, but consumers around the country did participate in the monthly teleconferences out of Boston University Rehabilitation Center with Judi Chamberlain who had started the Ruby Rogers Drop-In Center in Cambridge, Massachusetts. Alternatives Conferences once a year were the chief opportunity we had to meet other consumers with similar projects already in operation. The Mental Health Client Action Network in Santa Cruz parallels in name the California Network of Mental Health Clients (CNMHC) which began in 1987 with regional meetings and self-help and legislative teleconferences. We added the word “Action” to make our name include the word “CAN”; we wanted to be active, to be doing for others, not only sitting in a circle complaining. In the 1980’s and 90’s, many ideas were borrowed from the 12 to 20 newsletters that came from advocacy centers all around the country. Drop-In Centers and other consumer-run organizations now post job notices and share information through electronic mail. Many active participants on national listservs are people who reject traditional mental health services. For mental health clients who want to be an adjunct to professional services a practical manual is necessary that details the nuts and bolts that hold the structure of a Drop-In together.

As a Drop-In Center, our goal is not to alleviate symptoms of diagnoses in psychiatry books. Our goal is a better society. We believe in the 1948 World Federation for Mental Health’s definition of mental health as the “ability to live peacefully with others, and the capacity to empathize, to relate and to collaborate.” To the extent that cognitive and mood symptoms get in the way of living peacefully, being able to empathize, relate and collaborate, we support the best treatments that medical science offers to enable individuals to experience community and social support.

Section 1: RESEARCH ON DROP-IN CENTERS

Research supports consumer-run services as valuable and effective. Drop-ins have the lowest threshold for participation of all consumer-run programs. There is no triage to belong. Treatment is conversation or respect for someone who seeks silence. Participants are not required to show up at a particular time or to read classroom material. One is not considered a failure if he gets a cup of coffee and sits in a chair or goes to sleep on the couch. It’s okay to draw or sing all day. It’s okay to play games on the computer. It’s okay to do absolutely nothing but think and decide what you want to do later. On the other hand, drop-ins offer the greatest opportunity for volunteer and paid work and skill development from payroll to driving to reception to arranging furniture.

The purpose of Drop-Ins is five fold:

1. To provide a safe place where those economically disadvantaged by their mental health status can be off the street.
2. To provide a place where people with common treatment experiences can talk freely and be understood.
3. To provide grassroots gathering to address improvements that can be made in the system, to address wrongs, to have a common voice that will be given attention because it comes from the rubric of an organization.
4. To provide a place where usually a phone, bathroom, and information, sometimes food, is available.
5. To provide a place where people can be natural without being watched for symptoms, where usually records are not kept about behavior, only attendance.

Historically peer-run Drop-In Centers were set up as alternatives to traditionally provided services, not as adjuncts to treatment. The classic statement of this function of the Drop-In is found in Judi Chamberlin’s On Our Own. Today Consumer-operated Service Programs are part of the continuum of community mental health care. The consumer-mental health movement is now 20 years old and the drop-in has survived from the early days of the movement when current or ex-patients might met in someone’s apartment or at a community center or in the basement of an urban church.

Self Help Agencies called SHA’s by some researchers [Segal, Hodges, Hardiman, American Journal of Orthopsychiatry (Vol. 72, 2, 2002)] are being studied today because they have always espoused the belief that consumers can re-cover from the marginalization and stigma of mental health diagnosis; SHA’s historically have viewed the act of labeling and subsequent shunning by society as the main cause of long-term disability.

Ed Knight has called Drop-In Centers a form of “self-directed rehabilitation” (Special Edition). Self-directed rehabilitation. Albany, NY: Mental Health Empowerment Project. <http://www.rfmh.org/csipmh/> . If one accepts the argument that people who call a suicide hot line want to be prevented from killing themselves, then a similar argument can be made for a mental health patient or ex-patient who seeks out a drop-in center: they want to be around people even if communication is a problem or difficult for them. For this reason it is debatable whether or not drop-in activities should be “prescribed” for consumers of mental health services in an effort to socialize them or adult-sit them.

Forquer & Knight, Ed (2001) looked at Colorado’s Mental Health Assessment Agencies which created between 1997 and 1999 seventy self-help groups and four consumer-run drop-in centers. They found a decrease in suicide rate, substance abuse, and hospitalization and an increase in social contacts and ability to carry out activities of daily living. Another state that decided to finance drop-in centers was Michigan.

Mowbray C. T. and Tan, C. (1992) "Evaluation of an Innovative Consumer-Run Service

Model: The Drop-In Center," Innovations & Research 1 (2):19-24. This study evaluated six drop-in centers in Michigan started with the assistance of the Michigan Dept. of Mental Health. Experience at a drop-in center was associated with high satisfaction, increased quality of life, enhanced social support and problem solving (1993). The definition of a drop-in center used by the parent group, Justice in Mental Health Organization was “a place which provides a critical social support function for high-risk hospital users with both organized and informal recreational and social activities where individuals and center staff assist each other in solving their social, recreational, housing, transportation, and vocational problems.”

In a study of 10 agencies in the Bay Area, Steven P. Segal, E. R. Hardiman and J. Q. Hodges, (2002) found that clients of community mental health agencies had more acute symptoms, lower levels of social functioning, and more life stressors in the previous 30 days than clients of self-help agencies. The self-help agency group, connected to drop-in centers, showed greater self-esteem, locus of control, and hope about the future. Clients of self-help agencies had also received more services from facilities other than self-help or community mental health. Self-help agencies deliver services aimed at fostering socialization, mutual support, empowerment, and autonomy. (Psychiatric Services 53(9), 1145-1152. 2002)

Previous studies have identified the characteristics of people who choose to participate in these programs, the processes that lead to change, and service recipient program satisfaction (Chamberlin et al., 1996; Kaufman, Schuldberg, & Schooler, 1994; Luke, Rappaport & Seidman, 1991; Mowbray, Chamberlin, Jennings, & Reed, 1988; Mowbray & Tan, 1993; Segal, et al., 1995; Van Tosh & Del Vecchio, 2000. Mowbray, Chamberlain, Jennings, & Reed’s study (1988) studied 1800 consumers who used the Daybreak Drop-In Centers that provided recreation, cooking, housing and employment assistance They found high client satisfaction and a cost per person of $470 a month for average of 150 persons a month.

Some research that looked particularly at Drop-In Centers as examples of Consumer-Operated Services are listed below:

Carpinello, S., E. Knight, and L. Jatulis. (1992). A study of the meaning of self-help, self-help group processes, and outcomes. Proceedings: Third Annual Conference on State Mental Health Agency Services Research and Program Evaluation, Alexandria, VA: NASMHPD Research Institute

Chamberlin, J. (1978). On our own: Patient-controlled alternative to the mental health system. New York: Hawthorne Books. This book is now in reprint.

Clay, Sally, and Dianne Côté (1992) Drop-in Center Training (Video of all-day training to PEER Center given in Fort Lauderdale, FL.

Clay, Sally, Crisis intervention and alternative treatment. (Video: Interviewer: Pat Deegan., Learn from Us, Series #1, National Empowerment Center; 1994)

Hodges, John, and Markward, Martha, “Effects of self-help service use upon mental health consumer satisfaction with professional mental health services,” Psychiatric Services (summer, 2004)

Kaufmann, C.L., Ward-Colasante, C. & Farmer, J. (1993) Development and evaluation of drop-in centers operated by mental health consumers. Hospital and Community Psychiatry, 44 (7) 675-678.

Knight, E., ( ) Self-Selection Distinguishing Factors: Participants and Non Participants of Mental Health Self-Help Groups, NYS OMH - http://www.rfmh.org/csipmh/

Long. L. and Van Tosh, L. Program Descriptions of Consumer-Run Programs for Homeless People with a Mental Illness (Vol 11). Rockville, MD: NIMH, 1988 (Report 15 pages. site visits to 8 programs including two drop-in centers.

Meek, C. Consumer-Run Drop-In Centers, Philadelphia, PA: National Mental Health consumer Self-Help 1988 Booklet 14 pages. The 2000 Edition is 18 pages, $3.00 Order from National MH Consumers’ Self-Help Clearinghouse, 1211 Chestnut Street, Suite 1207, Philadelphia, PA 19107. On line it’s www.mhselfhelp.org

Zinman, Sally, Harp, H. and Budd, S. (1987). Reaching Across: Mental Health Clients Helping Each Other. Riverside, CA: California Network of Mental Health Clients.

Zinman, Sally and Harp, Howie T., editors Reaching Across II: Maintaining our roots/The challenge of growth (1994). Sacramento, CA: California Network of Mental Health Clients. Order from CNMHC, 1722 J St., Suite 324, Sacramento, CA 95814.

Annotated bibliographies on consumer-run services have been compiled by The National Resource Center on Homelessness and Mental Illness in July 1993, by Denise Sommers, Jean Campbell & Teresa Rittenhouse for the Program in Consumer Studies and Training in 1999, and more recently (1993) by Ruth Ralph.

The perfect research design to capture the outcomes of drop-in centers may not have been devised. Randomizing subjects to attendance at a Drop-In nullifies an essential ingredient of Drop-Ins, which is self-selection and self-determination. Doing intensive outreach and public relations, followed by tracking those who come for the first time might yield more promising results. The issue is whether the researcher would not really be getting a picture of the type of person who chooses the drop-in experience. Doctors, however, prescribe a particular drug for patients who fit a particular set of algorithm of characteristics or properties. If doctors were better at matching treatment to symptoms and personality, they would have better compliance. Mental Health workers, including consumers, are beginning to question having Drug Courts prescribe the AA Self-Help experience as being beneficial long term. If research would tell us who is apt to take the risk of going to a Drop-In and who is most apt to benefit, then foundations and government agencies that fund Drop-Ins could better target their outreach and publicity. Further research also needs to be conducted on the positive outcomes for mental health clients who work at Drop-Ins creating a special place for their peers.

Consumer-Run Drop-Ins escape the problems that consumers frequently feel when employed and supervised by non-consumers. Our job titles describe what the person does. We do not use the word “client” or “consumer” in job titles. Laurie Curtis, Director of Training and Program Development at the Center for Community Change, Burlington, VT, in an institute at IAPSRA, addressed the relationship boundaries that cause critical problems in organizations that are not consumer-run. Boundary issues arise when a client visits in a person’s home, when giving others a choice in what they do, in relationships with staff, in social integration and fraternization, in being considered a colleague. To the extent that a diagnosis creates expectations of functioning, to what extent does calling a consumer worker Peer Associate (COPES in Santa Fe, NY) of Peer Specialist as opposed to Mental Health Specialist or Lead Driver predict how well someone functions at their work? This is another area that merits research and study.

Section 2: Setting Up a Drop-In Center

First you need a place. That place could initially be someone’s apartment, a meeting room in the public library or community center, or an available space in a public or private mental health clinic.

You need a consistent, reliable schedule. It is more important to be open every Tuesday afternoon from 2 to 5 than to offer a bunch of varied hours when a room may be locked with a note posted on the door that says the meeting has been cancelled.

You need leadership, whether one person, a small committee, or a large advisory council. They must have passionate commitment to the value of mental health clients being able to meet and talk and listen.

Leadership and passion are more essential than a budget. Sometimes government entities decide that a drop-in center is a good thing, budget for it, and then send some case managers out to organize it. This is a prescription for disaster. The expressed need and commitment must first come from the people to be served. It is preferable if they then seek out traditional providers to work with them or give budget and organizational advice.

The Principle of Self Help/ Mutual Assistance

Unlike any service that makes up mental health services, a drop-in center is distinguished by the fact that it is not prescribed for anyone by anyone. Clients self-select to attend, and this step is an act of self-determination that accounts for the value of the enterprise.

Consumer principles of self-help are captured in our Mission Statement, first written in 1992:

The Mental Health Client Action Network of Santa Cruz County

is a client-run organization

designed to reclaim our dignity through self-help.

We do this by:

· Providing mutual support and networking;

· Having a voice in all matters which affect us;

· Creating programs controlled by clients;

· Advocating for the right to choose our own life path;

· Educating the public from our perspective, and

· Confronting discrimination.