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Wellness Classes at the Gainesville Opportunity Center for Persons Living with Mental Illness

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Title:
Wellness Classes at the Gainesville Opportunity Center for Persons Living with Mental Illness
Creator:
Chambless, Melissa
Publication Date:
Language:
English

Subjects

Subjects / Keywords:
Anxiety ( jstor )
Breathing exercises ( jstor )
Friendship ( jstor )
Health promotion ( jstor )
Medicaid ( jstor )
Meditation ( jstor )
Mental disorders ( jstor )
Mental health ( jstor )
Mental health services ( jstor )
Mentally disabled persons ( jstor )
Clubhouses
Health promotion
Mental illness
Mentally ill
Genre:
Undergraduate Honors Thesis

Notes

Abstract:
This project is a thorough discussion on implementing a wellness program in a Clubhouse established by the International Center for Clubhouse Development model. The various topics covered in the wellness classes are retrospectively reviewed for their successes and methods of implementation. The problems approached in the classes are discussed as well as solutions to the various issues. Several studies on wellness classes in past Clubhouses are reviewed for their successes and limitations. The increasing cuts of mental health funds in the United States and Florida are discussed in detail as well as the impact this has on persons living with mental illness. ( en )
General Note:
Awarded Bachelor of Science in Nursing; Graduated May 7, 2013 summa cum laude. Major: Nursing
General Note:
Advisor(s): Martha J. Snider
General Note:
College/School: College of Nursing

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Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright Melissa Chambless. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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Running head: WELLNESS CLASSES 1 Wellness Classes at the Gainesville Opportunity Center for Persons Living with Mental Illness University of Florida Melissa Chambless

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WELLNESS CLASSES 2 Abstract This project is a thorough discussion on implementing a wellness program in a Clubhouse established by the International Center for Clubhouse Development model. The various topics covered in the wellness classes are retrospectively reviewed for their successes and methods of implem entation. The problems approached in the classes are discussed as well as solutions to the various issues. Several studies on wellness classes in past Clubhouses are reviewed for their successes and limitations. The increasing cuts of mental health funds i n the United States and Florida are discussed in detail as well as the impact this has on persons living with mental illness.

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WELLNESS CLASSES 3 When asked what it was like to be diagnosed with a mental illness, a young man that I enjoyed, anytime I tried I would just get Mental illness is a profound diagnosis that After discharge from a hospital, it is common for one to feel lost without knowing how to return to some sembla nce of a normal life. A wonderful way to bridge this gap after a diagnosis of a mental illness is through outreach programs which can become vital to the recovery process There are a various array of outreach programs that can be found throughout the Un ited States. The International Center for Clubhouse Development (ICC D) is a non profit, non governmental organization that was established in 1994. The ICCD is responsible for the creation of a specia l kind of mental health sanction E very Clubhouse is to meet the standards set by the ICCD in an effort to avoid one Clubhouse being considered weaker than others. Today there are 341 C lubhouses located in 35 different countries (International Center for Clubhouse Development, 2013 ) The application of this project included a focus on the young man mentioned in the opening of this paper at a local Clubhouse named Something special about Clubhouses is that everyone who attends is referred to as a mem ber rather than a patient. This puts the focus on the members strengths instead of their illness and aids them in realizing that their mental illness does not define who they are Clubhouses are unique outre ach programs in that they have C lubhouse members and staff work ing together to serve every aspect of the Clubhouse. For example, some members may take the role as a receptionist, while other members may cook meals for the workers and members. This helps them feel apart of the community again as th ey wor k productively in society and rea lize that they can hold valuable roles with or without a mental illness Clubhouses also

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WELLNESS CLASSES 4 provide the opportunity for individuals to reach their goals. Whether it is going back to school, obtaining a job, or securing housing each Clubhouse works hard to help the members get what they need in this stage of their lives ( International, 2013 ). There are a number of reasons attributable to the success of ICCD Clubhouses. Recent studies have focused on the effects and importance of peer support in Clubhou ses. A study by Coniglio, Hancock, & Elliss, took place at the Pioneer Clubhouse in Sydney, Australia The study coordinators asked ten members to provide feedback regarding peer support in the Clubhouse through interviews that were transcribed verbatim. These interviews were analyzed with a cyclical approach involving four stages. The results of the study displayed four distinct levels of peer support within the Clubhouse. These l ayers were 1) s oci al inclusion and belonging; 2) s hared achievement through doing; 3) interdependency; and 4) i ntimacy ( 2012) The first level is the most basic in that simply belonging to a community of people and providing company to others can help decrease the social isolation that many members face The second level is obtained when members work side by side and become active members in the Clubhouse. One member reported that he finds it easier to make friends when working together. This work also provides an opportunity for one to face the challeng es of working with another person as well as confront his or her own limitations. Members can also learn about the skills of their peers and acquire t get to know each other on a deeper le vel. The interpersonal relationships they form allow them to discuss personal experiences, struggles, and trade advice. This relationship is important because members learn that they are not the only ones who are living with a mental illness while discussi ng personal experiences and struggles The environment of a Clubhouse is non judgmental. No person has to explain why he is feeling a certain way; he can just discuss it if he

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WELLNESS CLASSES 5 wishes to. This degree of acceptance is vital for members as it may not be appar ent in other aspects of their lives. While working at GOC one afternoon, the level of int erdependency became apparent in a wa y not considered previously Towards the end of a wellness class, one member was sharing with a new member why GOC is so special to him and the other members. He explained that it is a place he can come and talk with others about serious experiences that no therapist or family member could t ruly understand He explained that he could come here and talk with others about feelings of wa nting to commit suicide and have the supp ort he needed to get through it. This is a type of support that he has not been able to find anywhere else. The of another member. This is when the relationship extends past sharing personal experiences to having a deep caring for the other person. They are concerned about the well being of their friend and take on the responsibility of being needed and valued by another ( Con iglio, et al., 2012 ). Every year, state mental health funds are cut more and more. As these mental health funds are diminishing, vital mental health services have become unavailable to those living with serious mental illnesses. Inpatient and community re sources have been dramatica lly downsized and in some cases even eliminated. In a number of states, entire psychiatric hospitals have been closed. States are now using Medicaid mental health services in an effort to gain federal matching funds. This is grea t for those who are eligible for Medicaid, but those who are not eligible for Medicaid are left out in the dust. Millions of dollars are being added to services for Medicaid recipients while the equivalent is being cut from non Medicaid recipients. What is to become of these drastic cuts? For starters there is a drastic increase in visits to the emergency room related to psychiatric crises. In

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WELLNESS CLASSES 6 Arizona, there was a 40 percent increase in emergency room vi sits of this nature. In Florida, law enforcement and corrections officers are commonly the first responders to people in a psychiatric crisis when a serious crime has not been committed. Inmates in Florida prisons with serious mental illness es are able to get mental health services in prison in order to help them reach a stable position. The rising problem is that the funds providing these services are being drastically cut. At this rate, there may be a day when there are no longer mental healt h services available for the inmates ( Honberg Kimball Diehl Usher & Fitzpatrick 2011). This project took place at the Gainesville Opportunity Center an ICCD Clubhouse in Gainesville, FL T wo wonderful role models assisted in the development of this project that created wellness classes based upon a holistic concept. With the knowledge that GOC does not have the funds to carry out a wellness program while other Clubhouses across the globe are able to hire people for these programs, volunteers conduct ed this project Florida ranks as the 50th state for funds allocated for mental health behind all other states and the District of Columbia Florida spends a mere $39 per person for mental health services. This is compared to the national average of $120. 56 ( Swisher, 2012 ). Over the past three years, Florida has cut a total of $34 million from mental health services. Although only five percent of the general population in Florida has been diagnosed with a mental illness, this does not reflect the large per centage of people living with a mental illness in jails and prisons. Without money to fund services for mental illness, theses people have a smaller chance to escape the criminal justice system ( The New Service of Florida, 2013 ). They are all less likely t o live productive lives and work competitively in the community, which they each are capable of doing. With less hospital beds at psychiatric units and decreased funding for medications, people with a mental illness are struggling to keep their heads above water. The worst part of it all is that these people are lost as

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WELLNESS CLASSES 7 contributing members of society We miss out on all of the Albert Einsteins, Pablo Picassos, and Bill Gates in this state because our representatives do not deem them as important enough to help. As a result, the Gainesville Opportunity Center is only able to afford one employee. With the tight budget constraints, many of the resources that could be availab le to them are missing This is why the project took place at this special Clubhouse. This tiny Clubhouse deserves to have the resources it needs to help the greater Gainesville community. These energetic members deserve to feel that they are worth more than just a mere $39. Before the im plementation of this project, in depth research was p erformed regarding a few different wellness programs that have been implemented in various Clubhouses around the world. A pilot study was done in a Clubhouse in North Carolina to determine the efficacy of implementing wellness program s in the ICCD Clubhous es. The wellness program consisted of different focus groups that members could attend and covered various stages of planning and implementing health changes. Attendance to the focus groups remained high throughout the program which resulted in more grants being sought to help pay for the program. The program provided a booklet with various resources in the area that the members could use, such as free nutrition education. A follow up survey was given a year later with suggestions from the Clubhouse members about what the Clubhouse could do to enhance their health. Suggestions included walking after lunch, practicing yoga, and healthy lunch options. This process was successful in that it involved both staff and members in emphasizing wellness in the Clubhous e The program directors suggested that in the future they would like to include the members in the research and creation of the booklet ( Casstevens, 2011 ) Another study rated the need for health promotion programs in Clubhouses around the world. This st udy used a survey technique and sent the survey to Clubhouses in nineteen

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WELLNESS CLASSES 8 countries, including the United States. The survey responses indicated a desire for health promotion programs in the Clubhouses and the number of Clubhouses that already had programs of the sort. Health promotion activities included smoking cessation, physical exercise, stress management, and weight loss programs. The Clubhouses that repor ted a desire to have health promotion programs but did not actually have them discussed their b arriers to implementing a program. The primary reason was due to lack of financial resources ( McKay & Pelletier, 2007 ). With the financial budget for mental health being cut every year, the feasibility of implementing a program for health promotion is smal l. When there are local universities in the area of the Clubhouse it is a great opportunity to utilize the university resources for the Clubhouse. With all of the students involved in outreach in the university communities, Clubhouses are a great place to dedicate time. Before beginning a wellness p rogram at the Clubhouse, frequent visits were paid for about one month in order to grow to know the members. In this way, the members woul d be able to become familiar with the program coordinator and express their goals for the wellness program. Several members gave input to the program coordinator on subjects they would like to be covered. Another result of these frequent visits was the cre ation of trusting relationships between the program coordinator and the members. T he wellness classes began with the topic of nutrition since members were most interested in this subject Each class had about three members that roughly remained the same th roughout the entire duration of the wellness program Occasionally, a few other members would join and some have actually remained to be apart of the wellness classes each week. The classes are held in a discussion format in an effort to have the group i nteracting with each other. The members share their knowledge related to the topic of

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WELLNESS CLASSES 9 discussion and respond to each other regarding the information shared. With this style, the members have taught each other so much more than could ever have been research ed. Most of the members expressed desires to learn about nutrition as they had gained a significant amount of weight since the diagnosis of their mental illnesses, partially as a side effect to the medications they had b een put on. Therefore, the wellness classes began in late August with the topic of nutrition. The basic concepts of nutrition were covered over a few weeks and introduced that your body has the internal cues to eat when you are hungry and stop when you are full. Through the practice of intuitive eating and examining the eating habits of the various members, the group discovered that the weight gain actually was not fully attributable to the medications. Many of t he members discussed eating in response to boredom or stress, something that many people do on a daily basis. With this knowledge, the hunger scale was discussed The hunger scale helps people interpret how hungry or full they are on a scale of one to ten. Ten is sickly full and one is famished. It was suggested that the members check in with their bodies using the hunger scale before walking to the pantry. If they felt that they were between a ten and a five, they probably were not hungry and were just bor ed. In this case, they should look for something to do instead, like play a game go on a walk, or nap (Tribole, & Resch, 2003) This was a significant finding because it put the control of their weight issues back in their hands. The next concept covered was stress and anxiety management, which has been a large focus of the wellness classes thus far. A few of the members experience anxiety in public situations or occasionally when alone at home. In order to meet the needs of the members, they were asked to describe their experiences with anxiety and in what situations it tended to surface When these moments were identified the members were able to find patterns in which anxiety

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WELLNESS CLASSES 10 was instigated. This helped members analyze what they could do in the situation to lessen their anxiety. The class es also discussed became too much to bare, forcing the members to leave the environment. When anxiety is targeted early on, the members could begin using a coping strategy to immediately decrease the ir anxiousness (Inner Health Studio, 2012) From here, different coping strategies the memb ers utilize in these moments were discussed and analyzed regarding their effectiveness One thing the classes repeatedly emphasized in the stress and anxiety management topic was that there could only ever be one thought in your head at one time. This hel ped the members realize if they refocused their attention, they could actually overcome the anxiety in most cases. It was also found that using breathing exercises was a great strategy to refocus attention When focus shifts towards slowing down and contro lling breathing, the heart rate will slow in response to activation of the parasympathetic nervous system. One member was keen on meditation and actually taught some of the other members how he practices meditation to lessen his anxiety. Although not every one was intrigued to learn meditation, there were a few members that were interested in discovering this new practice (Acosta, 2012 ) The group also practiced self talk to lessen anxiety. For times when anxiety is heightened, the members practiced techniques to shut the anxiety down. For instance, in times of anxiety, one The members have used this technique less than breathing exercises (Inner Health Studios, 2012) A couple of the members were interested in meeti ng new people, particularly women. The class did not blatantly discuss meeting women but instead took a different approach. The group talked about meeting new people and forming friendships. After all, some of the best friendships are formed from relations hips. The members discussed what each member wanted and did not want from a friendship. For example, one member expressed that she did not want to

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WELLNESS CLASSES 11 have a friendship in which the friend focused on the negative aspects of life The group also discussed what boundaries each member would like to set in friendships (Serenity Online Therapy, 2013) One member talked about his need for alone time and that he would like to have a friend that supported this need. When the topic of making new friends was brought up, it was interesting to see that a lot of the members felt the need to make new friends. Almost all of them were discussing meeting new people in the meetings prior, which made it exciting to watch them grow together. One of the best lesson s thus far was af ter New Years when the class discussed what healthy meant to each member. The responses all involved different forms of self care. Some members expressed the need for alone time and meditation, while other members expressed the desire to meet new people or go back to sch ool. With these responses the group was able to decipher that health is individual and what is healthy for one person may not be healthy for another. Health is a constantly shifting domain and the demands of own health may change from time to time. I t was mentioned to be flexible with health needs and to stri ve to meet them as best as possible. I t would be nice to say that the classes taught the members th e uniqueness of health, but it is certain that they had known this somewhere inside them all along. One afternoon at GOC, a member actually took an initiative to lead a class. He asked if he could teach about drawing as an outlet to express emotions. In this lesson, he taught various techniques for drawing and asked the group to draw things that trigger feelings of frustration, happiness and to draw a ghost. This was a great lesson because the members were able to get in touch with their emotions and explain various things that could make them frustrated and how they could deal w ith them. They were also able to be silly and draw a ghost, which resulted in laughter. In the future, it would be ideal to incorporate more lessons that focus on the right side

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WELLNESS CLASSES 12 of the brain to help the members further connect with their emotions. The use of an art medium can benefit someone who is feeling distanced from their emotions and can help people come to terms with events without having to express the words. The National Institute for Health and Clinical Excellence has actually found art therapy t o be one of the best forms of treatment for the effects of negative schizophrenia (Mind, 2013). class focused on drawing was a great introduction to future classes incorporating creativity. Next year, the prog ram coordinator will no longer be living in Gainesville so there is a need to train someone to take over the wellness classes This project is able to be passed on to someone with a vested interest in working in a Clubhouse and is rather simple to continue Before the next person begins these classes, there are a few tips that have been learned through experience with the classes. For one thing, the group does best with a discussion format. There are also various techniques to begin ning the discussions. For example, occasionally questions will be written on the white board and the members will answer individually and than share it with the group. This style has proven to have the group interacting the most and keeps them on topic. It would also be necessary to share the information that has previously been taught so that it will not be repeated. This will also help the new class leader understand the categories of topics to choose from There were a few problems that occurred when carrying out this project. The first problem that came up occurred at the first meeting, or to be more literal, lack thereof. On the day of the first meeting, no one showed up. This was less of a reflection on the interest in wellness classes by the members; and, more of a reflectio n of the members not taking note of the new addition to the schedule. This problem was easy to fix as the members just had be reminded of the time and date the classes would take place The executive director also consistently reminded

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WELLNESS CLASSES 13 the members when to expect the classes to occur With this approach, there has not been much of an issue with absent members in the classes D uring the classes a member would occasionally get off focus It was not a problem when the class strayed from the core topic as long a s it benefitted most of the members. When the t opic was not of benefit to others it would be necessary to refocus the member and acknowledge that their topic of interest would be covered next week s needs to cover a certain wellne ss concept were met as well as the needs of the other class attendees to stay on topic. Occasionally a member would use the class as a place to vent their emotions regarding a current struggle in their life. While it is important to have a safe place to v ent, a wellness class is not always an appropriate time. At times like this the member would be redirected to the topic of the class and the class coordinator would mention the availability to talk after class. When beginning the lessons involving mental health topics it was essential to be careful to remain in accordance with the ICCD standards for Clubhouses. The ICCD standards state that there is to be no psychological or psychiatric care in Clubhouses as it is supposed to remain a place where the membe rs can take the focus away from the medical aspect of their mental illnesses. These topics were cautiously chosen as they could not cross the fine line between mental health in relation to mental well being and mental health in relation to mental illness. In order to avoid this, the t opics researched had to be ones that anyone in society could benefit from regardless of whether or not that person has a mental illness. The biggest issue that arose was when one member had an outburst in the middle of a welln ess class. One member became upset with another and began yelling loudly about h is dislike of the other member. This situation was unexpected and negatively affected the atmosphere of the wellness class. The class is to remain a safe place for members to g o and at

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WELLNESS CLASSES 14 this moment boundaries had to be set to retain this safety. A simple statement, such as, sorry, but I cannot be involved in this. We are in t can actually be enough to pause the situation. The member was still visibly upset after this statement and quickly excused himself. After the class, in search of ad vice on how to deal with yelling in the middle of a class, a dear friend was called In all of h er wisdom, she said that it is acceptable to take a mini break in situations like this. In a mini break, the group would be dismissed for a few minutes to recollect themselves and allow the heightened energy to simmer down Afterwards, the group members c ould return if they so wished and the class would continue. This project has imparted a wealth of knowledge on a more personal level In many ways, the members have taught all of the attendees just as much as the class director has taught them For one thing, they have expressed techniques to better improve self care habits It is an honor to Through this, the benefits of slowing down and taking time to enjoy each day hav e been acquired The members have also clarified the importance of meeting the demands of own health. Without meeting the demands of mental and physical health, than there would be little chance to offer help to others. One of the members dem onstrated breathing exercise s that are a useful practice for a diverse array of situations This exercise can serve to calm mind when it is racing before sleep or when there are anxious feelings regarding a situation that cannot be controlled. More importantly, this breathing exercise was actually used with a patient having a panic attack in the hospital The patient was able to successfully refocus her mind away from the anxiety and towards slow controlled breathing. After utilizing this breathing exercise in the hospital, this was

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WELLNESS CLASSES 15 shared with the member the following week. He was so proud to have helped someone that he could not shed the smile from his face. This project has demons trated the various struggles that those living with a mental illnes s face on a daily basis It is not uncommon for people to think of mental i llness as something similar to climbing a mountain. Some may imagine that the symptoms begin to escalate like the climber ascending the rocky surface of a mountain. The climber woul d rise until he reaches the peak at the point where the symptoms have impeded the ability to carry out daily activities At this moment, the climber would realize that he needs help to get down this mountain as he is stuck at the top with nowhere left to go This can be compared to a person reaching out for medical help The climber would than receive help to deal with this dilemma and begin to slowly descend the mountain until the point where he reach es the ground safely. Afterwards, he would stay grounde d and be able to deal with life as he did before he climbed the mo untain similar to the person returning to the same life as before the diagnosis of a mental illness For a lot of people, this is not the story of living with a mental illness. Many of the members expressed their constant frustrations of dealing with symptoms such as anxiety or paranoia. These frustrations are everyday struggles for these members and impede on their ability to participate in various activities they enjoy. Mental illness inv olves constantly working with symptoms that may not be easy to control. It involves trying different coping mechanisms to manage these symptoms until the right one is hopefully found. Lastly, working with the members has imparted knowledge regarding the st igma associated with mental illness. Since beginning the wellness program at the Gainesville Opportunity Center, it has become easier to pick up on the various hurtful statements regarding mental illness. So many people in society are afraid of mental illness as a result of the

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WELLNESS CLASSES 16 way it is presented by the media Society now associates mental illness with violence, when in actualit y a vast minority of people living with mental illness wind up being violent. When it is uncovered that someone has a mental illness it is possible that they will be denied housing, health insurance, jobs, and loans. Some of this is due to expenses of covering someone with a mental illness; but much of this is associated with the perception of the mentally ill being vio lent ( Canadian Mental Health Association, Ontario, 2013 ). What is most heartbreaking about this perception of mental illness is that many of the members are actually in the community when these prejudiced stateme nts are made because no one can tell that th ey are living with a mental illness. this person has struggled in ways oth ers could never imagine. There is a reaso n they are not ident ified as different from other s in society : most of the people living with a mental illness are the kindest people anyone could meet They work hard to be good friends and family members, to be productive in their lives, and to lend a gentle hand to those in need. The stigma associated with mental illness is beyond outdated. One could only hope that in this day and age people could open their minds to the possibility that not everything written in the news is the whole truth. Going to the Gainesville Opportunity Center each week was a great experience S ome of the most amazing people have imparted their kindness, wisdom, and generosity in these classes Mental illness is just as debilitating as a physical illness and must be taken more seriously in the state of Florida and in the United States. When one has the right tools to face his mental illness, he can offer so much to the community. Through places like GOC, persons living with mental illnesses are able to rediscover themselves and restructure their lives. One can only hope that, as

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WELLNESS CLASSES 17 a nation, we can stand up for the rights of those living with mental illness es to have adequate access to medical care and services directed towards mental wellness.

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WELLNESS CLASSES 18 References Acosta Scott, J. (2010, April 29). Meditation for anxiety relief. Retrieved f rom: http://www.everydayhealth.com/emotional health/anxiety/meditation for anxiety relief.aspx Canadian Mental Health Association, Ontario. (2013). Stigma and mental illness. Retrieved from: http://www.ontario.cmha.ca/fact_sheets.asp?cID=2795 Casstevens, W. J. (2011). A pilot study of health and wellness program development in an international center for clubhouse development (ICCD) clubhouse: procedures, implementation, and i mplications. P sychiatric Rehabilitation Journal, 35 (1), 37 43. doi:http://dx.doi. org.lp.hscl.ufl.edu/10.2975/35.1.2011.37.43 Coniglio, F., Hancock N., & Ellis, L. (2012). Peer support within clubhouse: A grounded theory s tudy. Community Mental Health Journal 48 (2), 153 160. doi:http://dx.doi.org.lp.hscl.ufl.edu/10.1007/s10597 010 935 8 5 Honberg, R ., Kimball, A., Diehl, S., Usher, L., & Fitzpatrick M (2011 November ). State mental health cuts: a continuing crisis. Retrieved from: http://ww w.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=147763 Inner Health Studio. (2012). Anxiety relief scripts. Retrieved from: http://www.innerhealthstudio.com/anxiety relief scripts.html International Center for Clubhouse Development d/b/a C lubhouse International. (2013). History. Retrieved from: http://www.iccd.org/history.html McKay, C., & Pelletier, J. (2007). Health promotion in clubhouse programs: needs, barriers, and current and planned a ctivities. Psychiatric Rehabilitation Journal, 31 (2), 155 159.

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WELLNESS CLASSES 19 Mind. (2013). Making sense of art therapies. Retrieved from: http://www.mind.org.uk/mental_health_a z/7995_making_sense_of_arts_therapies Serenity Online Therapy. (2013). Setting healthy bounda ries: allowing the true self to emerge. Retrieved from: http://serenityonlinetherapy.com/healthyboundaries.htm Swisher. (2012, December 23). Florida 48 th among states in funding for mental health services. The Daytona Beach News Journal. Retrieved from: http://www.news journalonline.com/article/20121223/NEWS/312229993?p=3&tc=pg The News Service of Florida. (2013, January 25). Florida lags in mental health funds. The Flor ida Times Union Jacksonville Retrieved from: http://jacksonville.com/news/florida/2013 01 25/story/florida lags mental health funds Tribole, E., & R esch, E. (2003). Intuitive eating a revolutionary program that works (2 nd ed.) New York, NY: Trade Paperback.