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ENHANCING RECOVERY THROUGH LINKAGE
WITH INDIGENOUS NATURAL SUPPORTS

by
John B. Allen Jr.
11th Annual CMHP Statewide Training
March 8, 2005

Natural Supports

"Since Nisbet and Hagner (1988) first introduced the term 'natural support,' this concept has been discussed and applied with varying interpretations. The term natural supports refers to the resources inherent in community environments that can be used to habilitative and supportive purposes. Recently, several writers in the field have further broadened the context to include other types of community and workplace resources, such as employee assistance programs, transportation providers, community service organizations, recreational and social associations, and government supports that are not limited to persons with disabilities such as subsidized house, income tax assistance”. (pg 175 West, M.D., Kregel, J., Hernandez, A. and Hock, T. (1997) – Everybody’s doing it: A national study of the use of natural supports in supported employment.). This is evidenced by the definition used in Sacramento, California Lanterman Developmental Disabilities Services Act, Section 4512 of the Welfare and Institution Code, Part (e), “Natural Supports means personal associations and relationships typically developed in the community that enhance the quality and security of life for people, including, but not limited to, family relationships; friendships reflecting the diversity of the neighborhood and the community; association with fellow students or employees in regular classrooms and work places; and associations developed through participation in clubs, organizations, and other civic activities.”

Although “to most authors, the setting for natural supports seems to occur largely or exclusively in the workplace” (Fabian, et al., 1993; Fabian & Luecking, 1991; Lee, et al., 1997; Mank, et al., 1997; Rogan, et al., 1993) this document will explore the ability to assist individuals with disabilities to live integrated in communities by taking advantage of the natural supports that most people take for granted. Critical activities, such as social networks, that constitute natural supports will be examined.

The findings of West, et al. (1997) survey point to the potential impact, that better than eight of ten respondents indicated that they had found natural supports to be useful and relevant for all members of their caseload.

Natural Supports in Community Life

As society has evolved, relatively few people are totally self sufficient living independent of others. Most people, with or without disabilities, have become reliant on a variety of natural supports that exist in every community. Many of our natural supports are so integrated into the fabric of modern society that we no longer consider them as supports, but often deem them essential services. These include mailmen, teachers, emergency personnel, doctors, delivery services, service providers, and spiritual connections. There are many other natural supports that we use frequently in addition to those though of as essential including: family, friends, neighbors, co-workers, clubs, social organizations, civic groups, professional organizations, recreation centers, entertainment outings, hobbies/special interest, volunteer opportunities, education opportunities, transportation resources, and child care providers.

Couples with their first baby will often report that family, friends and neighbors typically volunteer to assist the new parents with the myriad of tasks they face. Individuals confronted by a death in the family are often comforted by friends and neighbors providing food and other supports during the funeral and grieving process. Even vacation activities are not immune to taking advantage of natural supports as neighbors are asked to look after property or take care of pets. Yet, as pervasive as natural supports are utilized by most people, we often think of extraordinary measures to incorporate natural supports into the lives of individuals with disabilities usually after first considering professional paid supports.

Circles of Friends: “The Joshua Committee”

One of the first cases to clearly document a difference in utilizing natural supports to move an individual from institutional life to the community is Judith Snow (Perske, R., 1987, Pearpoint, J. 1990). Born in 1949 with muscular dystrophy, Judith was unable to move from the neck down, except for one thumb, as a result of medical attempts to fix her condition. Upon graduating from York University in Toronto in 1976 she lost her attendant care which had been provided since childhood as part of her education. After ending up in a nursing home due to her need of attendants, she was eventually hospitalized after deteriorating with a prognosis of lifetime institutional care. Five friends and colleagues organized Judith’s circle of friends to move her out of the institution and save her life. One of these friends moved Judith into their home and a group of volunteer attendants was formed. The group brainstormed to solve the problems Judith faced in living outside of an institution. As the sixth member of this committee Judith gradually took control of her own support system making choices relevant to her own life, eventually naming the group, “the Joshua Committee.” Today, Judith is considered a leading expert on political/social situation of persons with disabilities, in no small part thanks to her social network and the initial support of the “Joshua Committee.”

Social Functioning and Integration

Psychiatric assessments typically include an exploration of social functioning to determine in part symptoms impairment. As a result of these clinical assessments, public mental health systems have developed a number of programs to provide social and recreational opportunities for individuals receiving psychiatric services. Clubhouses, social recreation activities and drop-in centers were created in systems to address the socialization skills of individuals with psychiatric disabilities.

Although it is clear, social networks greatly expand the opportunities of natural support, traditional mental health providers often don’t explore expanding social networks beyond the mental health system. Individuals receiving mental health services are typically provided opportunities to build social skills only with others receiving services.

In many psychiatric rehabilitation programs, socialization opportunities are often arranged around recreation such as bowling. These opportunities are often experienced, as programs take clients bowling as a group, partially in order to maximize staff availability. The concept as practiced in this example actually limits social connections to other mental health consumers and community integration by isolating individuals to the program. In contrast the same concept could be applied by creating one or more teams on the local bowling league with staff support. Individuals would then have the same opportunity to receive support and build skills with their peers while expanding social horizons outside of the mental health system.

Many opportunities exist to provide rehabilitation and systemic support by integrating individuals into existing community structures. This integration assists individuals with psychiatric disabilities in expanding their social networks and thereby increasing their access to natural supports. Although this concept is relatively simple, its implementation is complicated by variances in communities and the ability of rehabilitation programs and case managers to identify opportunities to link individuals with indigenous community supports.

Local Communities and Natural Support Systems

Every local community and neighborhood has individuals, organizations and institutions where people formally and informally go to seek advice, information and support. These are the resources that influence and enhance community life providing numerous support mechanisms. Many of the informal sources that regularly provide advice and support (such as bartenders, barbers and beauticians) likely would not identify support as a part of their activities. These individuals provide natural supports for the people around them. This collection of formal and informal resources makes up what this document is calling a community’s natural support system.

Within each system of natural supports, many of the resource individuals, organizations and institutions are part of formal linkages which regularly communicate and support their activities. These linkages may come from licensing sources, trade associations, and professional societies or as part of formal organizational structure. The grouping of individuals who provide natural supports, within linked structures, we call natural support networks. These networks may be highly sophisticated or very informal but share at a minimum an infrastructure that permits and fosters identification and information dissemination from a central location. These networks include individuals who are part of organizations or government structures, but who within their local communities provide a listening ear that could individually be viewed as providing natural support.

Identification of these networks is critical for linkage since few natural supports are listed under support in the “yellow pages”. These centralized information sources on the natural supports available at the local level can be an invaluable resource for rehabilitation programs, case managers and the people with psychiatric disabilities they serve.

Building Social Networks

Social networks are one of the primary sources of natural supports. Individuals with disabilities, especially those who have been institutionalized may need assistance in building and maintaining the social networks necessary to aid in support. Even casual social networks contribute to the feeling of support which builds community tenure.

Many social networking opportunities can be easily identified from the person with disabilities own routines, hobbies, and passions. Although a beautician or barber is not usually someone we identify as a natural support, they can become an excellent place to have an individual with a disability start practicing the art of speech and how to build a relationship. Almost all stylists and barbers talk with clients as they cut hair and welcome regular customers. Simply having an individual with a psychiatric disability identify their barber or beautician and then ask for the same person on return visits will being building a relationship. Each future visit becomes an opportunity to practice conversation and build social skills. The simple transaction of having one’s hair cut becomes a practical laboratory for modeling a number of social network building skills.

Similar opportunities exist with quite a number of people that one regularly encounters in daily community living. People such as mail handlers, street vendors, cashiers, bank tellers, bus drivers, and service station attendants can all become regulars in someone’s life. Everyday pleasantries, regularly practiced, lead to connections with other people that are the fabric of our social being. Even in the most urban environments, people acknowledge those that they see regularly who acknowledge them.

Linkage Through Natural Support Networks

Once you have identified areas of interest, daily routines, and passions of life, the next step is to link the individual with disabilities to groups, associations and societies which can broaden social networks and create natural supports. Few individuals have an intimate knowledge on the wide variety of topics and subject matter areas that one is likely to identify. This causes problems in knowing where and how to refer individuals to sources to that offer support on these topics. Fortunately in American society there are associations and societies on almost any special interest area. Almost every community, including the most rural, has at least a limited number of these organizations. Even the most isolated communities can participate in these networks via internet chats, forums and other virtual gatherings.

In order to link individuals with these networks, one must first identify the local opportunities that exist. This is easily accomplished by finding the society or association on the topic of interest and contacting them for local chapters. A quick internet search for the State of New York alone indicates 3,183,000 web pages connected with associations, 200,000 web pages focusing on collecting and collectors, over 1,400,000 web pages on self-help, 300,000 web pages associated with civic groups, and over 300,000 advocacy web sites. Between the real and virtual communities served by the groups represented in this collection of web sites (for New York State alone), it is hard to imagine not being able to link people with a number of support opportunities. Since many mental health professionals think primarily of family, friends and self-help groups as the focus of discussions on natural supports, this document will omit these obvious links and focus on providing practical guidance in other areas.

Online Communities

Virtual communities available on the Internet offer many of the same benefits for expanding social networks and natural supports. Online forums and support groups cover every imaginable subject area. Servers such as yahoo.com, egroups.com. msn.com and smartgroups.com offer online support groups / forums which often include the opportunity for real-time chats in addition to regular email and other exchanges. Many of the groups in addition to their online activities host gatherings in which members meet face to face. News servers available on almost every host site, currently offer over 30,000 areas to dialogue with others on a variety of subject matter. Although many individuals with psychiatric disabilities may find having their own computer and internet access too expensive, almost all public libraries across the country now offer free service.

Religious and Faith Communities

Many faith-based organizations provide a variety of holistic and natural supports to the communities and members they serve. In addition to ministering to the spiritual needs of individuals with psychiatric disabilities, most faith communities offer opportunities to build relationships through mixers, socials and spiritual study. Many offer a variety of natural supports in the form of pastoral counseling, temporary emergency assistance, homeless services and food pantries around the state. In many areas, churches, synagogues, mosques, temples and other faith communities provide transportation or van service to elderly and disabled members. Faith communities often have a number of opportunities for individuals to volunteer. Local faith communities can be identified through listings in most telephone directories as well as the Internet.

Students/Schools

There are a number of natural support networks that exist to support students both young and old. Even individuals who have long since been enrolled in school can build social networks by participating as a member of alumni associations, school boosters, supporters, and volunteer opportunities as aides or coaches. Schools of all types typically have a health center often staffed by a nurse. Like primary and secondary education health centers, colleges and universities typically have student assistance centers and disability assistance centers often as part of their health centers or suites.

Recreation/Sports

For those individuals that have an interest in sports and recreation, there are numerous opportunities to participate as an athlete, Individuals who are interested in sports but who are not athletic, can find plenty of opportunities to be involved with coaching, officiating, organizing, promoting or other volunteering with any sport. Everything from bowling, mountain biking, snowmobiling, soccer, softball, baseball, basketball, volleyball, camping, arm wrestling, hunting to pinball playing has an association which can provide linkages to local groups and activities. A search in any public library on any of the national association directories is the easiest starting point to find the natural support network leading to local connections. At each local connection, individuals with psychiatric disabilities can not only participate in sports and other recreation activities, but can expand their social networks. In addition, local departments of recreation often have special programs and opportunities for individuals with disabilities where a simple telephone call can begin the connection.

Hobbies

For many people, friendships are begun out of a shared connection with a hobby or other special interest. Understanding an individual with psychiatric disabilities' interests can provide an opportunity to link them with other individuals in pursuit of hobby or special interest. Special interests include things such as: stamp collecting, photography, bird watching, painting, coin collecting, bridge players, chess enthusiasts, flower arranging, historical societies, art appreciation, dance, music, theatre, re-enactors societies, amateur astronomers, classical guitar societies, genealogy, radio controlled airplanes, arts and crafts, scale modeling, and collecting of all kinds. Engaging an individual with a psychiatric disability can often be as simple as helping to connect them with others who share their common interest. One may find that an individual, who appears obsessed with a particular topic, will find others who are healthy but similarly obsessed within a special interest group. Organizations and societies abound that cover ever conceivable interest that one might identify. A simple search of the internet on the word association without any particular focus yielded over 24 million possible web sites from which one could search for local links.

Ethnic/Recent Immigrants

Many urban areas have societies and groups to support and bring together those individuals from a particular ethnic group. Individuals who identify themselves as Italian Americans, Irish Americans, Jewish Americans, Polish Americans, Ukrainian Americans and other ethnic groups can often locate a club, society or group with which to identify and belong. Even those from multiple ethnic backgrounds can find groups like the Association of MultiEthnic Americans. Recent immigrants may even find connections from the New York Association for New Americans (www.nyana.org). Each national association is a starting point to identify local organizations. In addition, foreign embassies may be able to direct an individual to local organizations that support people of the same heritage. Searching the internet yields over 200 different groups spread across New York State.

Community Civic / Social Organizations

It would be difficult to think of a locality that didn’t have at least one civic organization. Most communities have a number of civic organizations that offer socialization and social services to their members and the community at large. Organizations like the American Legion, Elks Lodge, Knights of Columbus, Loyal Order of the Moose, Masonic Lodge/Temple, Kiwanis, National Association for the Advancement of Colored People, and the League of Women Voters, are organized as networks with state organizations able to provide referrals to local chapters. Many local neighborhoods, communities and even apartment buildings have community or tenant associations where individuals with psychiatric disabilities can become involved to build social networks.

Corporate Leadership

It is not often one would think of local corporate leaders being able to assist with providing natural supports or the expansion of social networks for individuals with psychiatric disabilities. Yet local Chambers of Commerce often meet publicly with networking opportunities for all in attendance. These meetings not only provide opportunities for local leaders to meet and exchange support, but may be just the opportunity for an individual with a business background who has a psychiatric disability to begin reconnecting themselves. Many Chambers of Commerce or local business associations would welcome volunteers to assist with their efforts. Not only would this provide excellent opportunity to expand social networks, but for an individual who may be seeking employment a wonderful “foot in the door”.

Gay/Lesbian/Bi/Transgender/Trans-sexual Organizations

There are a number of organizations with many local chapters, providing natural services and support to this community. Groups like Parents, Families and Friends of Lesbians and Gays (PFLAG), The Gay, Lesbian and Straight Education Network (GLSEN), and the Human Rights Campaign. An internet search on any of these organizations can begin to identify local organizations. Support for gay youth who have psychiatric disabilities is especially critical as gay youth are frequently cited as having the highest of all suicide rates.

Local Political Parties and Organizations

All political parties rely heavily on volunteers to staff offices, work on campaigns and help with fundraising activities. Individuals with psychiatric disabilities who are interested in law, politics or employment, will not only benefit in terms of job experience, and greater social networks, but can become valuable partners in advocating for disability issues.

Volunteer Opportunities

In programs ranging from hospice, to animal shelters, to literacy campaigns and social justice causes, America relies on volunteers. There are over 690,000 web sites devoted to volunteering in New York State alone. Volunteer opportunities for individuals with psychiatric disabilities provide not only an opportunity to gain valuable employment experience but also expand social networks from the interactions of people they work with.

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