LEAP BOOKS:
LEAP Institute Programs
LEAP Training for couples (descriptions of one day and weekend seminars: under construction)
Level I Training for working with persons with mental illness:
Objectives
The LEAP training program (Listen-Empathize-Agree-Partner approach) teaches participants a set of evidence-based practices to help persons with mental illness that are either noncompliant, or only partially compliant, become fully engaged in treatment (medication, psychotherapy, psychosocial, occupational rehabilitation, etc.) and to cooperate with persons who are trying to help them.
The program consists of a set of four workshops completed over the course of one day.
The workshops are unique in that the same evidence-based practices are taught to:
MENTAL HEALTH PROVIDERS
(psychiatrists, social workers, nurses, psychologists, caseworkers, crisis workers, consumer peer counselors,
occupational therapists, etc.),
FAMILY CAREGIVERS AND FRIENDS
(of persons with mental illness), and
LAW ENFORCEMENT, JUDGES, AND ATTORNEYS
(i.e., others who regularly work with persons with serious mental illnesses).*
* A tailored LEAP program is also taught to law enforcement officers involved in Crisis Intervention Teams (CIT) and
hostage negotiation. It provides tactical communication strategies proven to quickly de escalate and obtain voluntary
compliance.
Scope of the Problem
Poor and partial-adherence to treatment presents staggering obstacles to recovery. It is associated with a poorer course of illness, increased involuntary hospitalizations, suicide, poorer subsequent response to treatment, estrangement and discord with caregivers and providers, criminal behavior, and failure to reach optimal levels of recovery. In light of the tremendous advances made in the treatment of schizophrenia and bipolar disorder, the tragedy of both untreated, and inadequately treated, mental illness is compounded. The urgency to implement strategies that optimize adherence and recovery has never been greater.
Non-adherence rates in schizophrenia and bipolar disorder continue to hover around 50% while partial adherence rates are even higher (75%). Considering that millions of people either flat out refuse to participate in treatment, or if they do, practice only partial-adherence, the "real-world" effectiveness of both the older, and more promising newer treatments, is abysmal.
Deficits in insight (a.k.a. "anosognosia" see DSM IV-TR, American Psychiatric Association Press, 2000, page 304) are very common. Not surprisingly, anosognosia predicts poor and partial-adherence. After all, who would want to take medication for an illness they did not believe they had? Research shows that poor insight is among the top predictors of poor adherence, far more predictive than the person's experience of side effects. Although recent innovations in drugs used to treat these disorders have addressed many of the limitations of traditional antipsychotic medications (e.g., severity of side effects, aspects of cognitive dysfunction), they still do not deal with the problem of poor adherence to treatment.
Improving insight and adherence
Unfortunately, medications do not appear to impact significantly on level of insight, on the other hand, various forms of cognitive therapy and motivational interviewing have been found to improve adherence dramatically. More recently, studies testing the efficacy of such interventions using psychiatric nurses and family members in patents with schizophrenia suggest that extensive professional background is not needed to be effective. Indeed, training caregivers in the LEAP approach is especially effective as there are many more opportunities for interaction than is afforded providers. Furthermore, maladaptive communication patterns in the family are usually improved reducing expressed emotion, discord, and estrangement.
Summary
Because of poor insight into the illness and poor adherence to treatment many persons with schizophrenia and bipolar disorder exist at the margins of society and are unable, or oftentimes unwilling, to utilize available drug therapies and services. A set of communication and problem solving skills that can be used by mental health providers, care-givers and other stakeholders can be readily learned by participating in the LEAP training program. Below, we describe LEAP training in more detail.
LEAP Training
The LEAP Level I program consists of a set of two workshops completed over the course of one day and a follow-up series of assessments and supervision that are completed and returned to the trainers via US mail or internet (if certification is desired). The workshops are unique in that the same evidence-based curriculum is taught to providers, caregivers, law enforcement, judges and attorneys.
The success of the LEAP approach rests on three pillars:
1. Consumer Focus: Developing a new relationship with the mentally ill person that focuses exclusively on problems that the "patient" perceives.
2. Treatment Team: Breaking down the barriers that keep the provider, family, other stakeholders (law enforcement, judges, attorneys), and consumer from functioning as an effective team.
3. Common goals: Finding common ground between team members and the consumer, that can be shaped into goals that will be worked on together.
A brief description of the workshops for mental health providers and family caregivers and a typical training day schedule is given below. Copies of the worksheets provided for workshops A and C follow this. The worksheets provide content, structure for the session, and specific exercises to be completed.
Workshop I: Research on Poor Insight and Engagement in Treatment.
Dr. Xavier Amador (see: www.XavierAmador.com for biography) gives a presentation of the empirical research on the prevalence, etiology and treatment of both poor insight and poor adherence. Although largely didactic, the workshop is interactive in that participants are repeatedly queried to assess and highlight misconceptions they hold about the causes and treatment of poor insight and poor adherence. The evidence base supporting the LEAP technique is reviewed.
Learning Objectives: 1. Participants will learn that the top two predictors of good adherence to treatment are: good insight into how treatment can help one to achieve his/her goals; and a relationship with one person (either provider, friend or relative) in which the mentally ill person feels respected, trusts the other person, and this person is of the opinion that treatment would be beneficial. 2. Severe problems with insight into illness are most often a consequence of the disorder (schizophrenia or bipolar disorder) stemming from brain dysfunction (i.e., anosognosia) rather than defensiveness and/or personality factors. 3. Contrary to popular belief, treatment with antipsychotic medications and/or mood stabilizers rarely results in significant improvements in insight. 4. Motivational interviewing and cognitive therapy (e.g., LEAP) have demonstrated efficacy in improving specific aspects of poor insight associated with poor adherence. These psychological interventions have been shown to be effective whether delivered by providers (at all levels), family members, or consumer peer counselors/educators.
Workshop II: Learning to L.E.A.P.
The goal of this workshop is to give attendees the skills needed to build a collaborative relationship with the mentally ill person they are trying to engage and persuade. A four-step process involving a set of communication and interviewing skills is taught: Listen, Empathize, Agree, and Partner (L.E.A.P.).
Learning objectives: Participants will learn many additional tools-- that involve listening without opining, empathizing without reality-testing, identifying areas of agreement, and quickly forming a partnership to achieve common goals that can be linked to treatment. Participants will learn that the ultimate goal is to arrive at an agreed-upon plan of action that is grounded in the patient's assessment of his/her problems and focused on helping him/her to achieve their goals.
TM
PRAISE FOR LEAP