Transitioning to Recovery Based Treatment - MI-PTE
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Transcript Transitioning to Recovery Based Treatment - MI-PTE
Transitioning to Recovery Based
Treatment
Mark M. Lowis, LMSW
Member: International Motivational Interviewing Network of Trainers
Ray Rais, LMSW
Quality Improvement Coordinator – Macomb County Community Mental Health
Tolstoy:
“I know that most men, including those at ease with
problems of the greatest complexity, can seldom
accept even the simplest and most obvious truth if it
be such as would oblige them to admit the falsity of
conclusions which they have delighted in explaining
to colleagues, which they have proudly taught to
others and which they have woven, thread by thread,
into the fabrics of their lives.”
Give me
5 Minutes
to learn Names
Transition?
From What?
Institutional Memory
Goal is to Maintain Stability
in within the System
What the Agency Offers
Prescribing/telling
Compliance Based
Monitoring compliance
Mandating Behavior
Deficit Based
To What?
Targeted Treatment
Goal is to Exit the System
through Amelioration
Individualized Issues
Assistive Interventions
Collaborative
Guiding Incremental change
Manageable
Recovery based
Exercise
Work in groups at table
Select a scribe for your table
Select a speaker to represent you table
Together brainstorm a list of deficit based terms
Start by saying; “I see you as….” and finish
with the deficit based term/label. (IE: I see
you as lazy.)
Facilitator gathers list from speaker
Exercise
Work in groups at table
Select a scribe for your table
Select a speaker to represent you table
Together brainstorm a list of strength based terms
Start by saying; “I see you as….” and finish with
the deficit based term/label. (IE: I see you as
protecting yourself.)
Facilitator gathers list from speaker
“Strength Based” means “Making
Sense” out of Resistance!
Some Kinds of Plans
Behavioral –
Uses Behavioral Modification
Awards Points
Privileges
Incentives
Consequences
Some Kinds of Plans
Institutional –
Uses levels of functioning to determine privileges
within the institution
Deficit based –
Professional determines a person’s needs based on
inability
takes over decisions
struggles to control or manage
contest between system and free will of client.
Some Kinds of Plans
Agency –
Converts a person’s desire (what they want from
treatment) to what the agency offers
says what the client can and can’t have
Staged –
Work is collaborative and assistive
Step-by-step process toward recovery
Steps are manageable for the person being served
The pace of recovery is determined by readiness
Throughout the process the focus is on transition
Institutional Memory
• Historical Approach to Treatment in which the need
•
•
•
•
•
is to protect the public
Identify Persons with Mental Illness based upon
dangerous, aberrant or abhorrent behavior
Remove from Mainstream
Place in institution
Stabilize Symptoms
Maintained forever
– State Facility
– Forensic Center
– Jail
Institutional
•Take Possession
•Remove
•Place
•Depersonalize
•Stabilize
•Maintain
•Ineffective
•Costly
Deinstitutionalize
Home Setting
Smaller Institutions
Less Confining
More personal
Placement
Stabilize
Maintain
Costly
•Community Based
•Group Homes
•Same Approach
•Smaller Institutions
•Resistance from Community
Seeking full citizenship
Person Centered Planning
•Institutional
• Assess
• Diagnose
• Prescribe
•Person Centered
• Facilitate
• Collaborate
• Assist
Goals and Objectives are still Maintenance and
Institutional
Strength Based
Its not looking for their
strengths.
Its knowing that they are there
•Honors autonomy
•Emphasizes choice and control
•What assistance are they seeking
•What do they already understand
•How do they see us working with them
Strength Based
The individual has the right to dignity
and respect from the practitioner(s) and
every person whom they encounter at
the agency
(Mutuality)
Push Back
Examples
A job is not a service
We aren’t an employment agency
We don’t do housing
We don’t do that
The CMH has cut our funding so we can’t
They don’t know what they want
Some of them just want us to tell them
The just want medication
They’re just trying to get…
Maintenance Approach (Institutional Memory)
• Prescribed Goals and Objectives
• Encounters are cumulative and general
• Time frames are subjective
• Consumer must accept expert advise
• Consumer must match expectations of system
• Confront Resistance
– Guardianship
– Consequences
– More Restrictive
– Seclusion and Restraint
– Behavior Management Committee
Recovery Approach
Good agreement on Goals, Objectives and
Interventions
Consumer has total choice and control
Professional is assistive and collaborative partner
Encounters are specific
Resistance is understood from consumer perspective
Professional has interventions for any level of
readiness
Goal is to achieve amelioration and discharge
Consumer is welcome back if necessary
Time frames are realistic
Maintenance Plan
• Problem #2 – The consumer lacks coping skills
• Goal #2 – The consumer will Develop Coping Skills
• Objective #1 – The consumer will attend all therapy sessions
•
•
•
•
•
AEB therapist documentation
Intervention #1 – Therapy 1x/week
Objective #2 – The Consumer will make 3 positive selfstatements per week AEB therapist documentation
Intervention #2 – Therapy 1x/week
Objective #3 – The consumer will identify 3 coping skills AEB
therapist documentation
Intervention #3 – Therapy 1x/week
Now What?
What would the Problem Statement Become?
What would an Objective Look Like?
What would an Intervention look like?
Recovery Plan
• Targeted issue – Symptoms interfere with keeping job
• Goal – Stop symptoms from interfering with ability to keep
job
• Objective 1 – Meet with psychiatrist to discuss and
describe symptoms and the way in which they interfere with
ability to keep a job
• Objective 2 – Be able describe medication including
dosage, how taken, possible side effects, how it will help
with Goal
• Objective 3 – Develop agreement with psychiatrist on
medication
Recovery Interventions (Us)
Intervention – Psychiatric Evaluation to
determine medication to support goal for sustaining
employment
Intervention – Demonstrate way in which
medication will assist with goal
Intervention – Periodic medication review to
determine how used, effects/side effects, reaffirm
usefulness toward goal and adjust if necessary.
Intervention - Assist with any concerns or barriers
Intervention
What we do
that is
assistive and collaborative
in helping the person with objectives
for achieving the goal
Dean Fixen
The
Therapist
Is
The
Intervention!
Sufficiency Standards and
Authorization
Amount – number of units needed to provide the
service
Scope - How the service will meet the need
addressed (Think of Medical Necessity)
Duration – How long the service will be provided
based on attaining the objective
Service – Psychiatric Evaluation, Medication Review,
Group/Individual/Family Therapy, Case
Management, etc.
Deficit Based Transition Goals
• Maintain reduction in symptoms for
12/months
• Maintain medication compliance for
12/months
• Comply with treatment
• Stay at Par for 12/months!!
• Intervention – Monitor for compliance
Transition Goals
Recovery
Find a home that provides more independence.
Person’s description of the goal: “I want my own place”
Assist Primary Health Care Provider in transfer of
medication
Person’s description of the goal: “I don’t need help to
take my medication”
Intervention – Assist in connecting, scheduling,
attending and adjusting to a resource
(Warm Transfer)
Recovery Based Supports and Services
EXAMPLES:
Psycho-Education
Health Education
Individual, Family, Group Treatment
Pharmacological
Case Management
Primary Health Care Physician-Community Clinic
Community Resources
Referral to Human Service Agencies
Community Living Supports
Discharge by Warm Transfer
Collaborative
Welcome back
Recovery Based Discharge Queues
• “Person's” treatment goals are attained “to their satisfaction”
• On-going care is achievable through Primary Health Care
•
•
•
•
Physician-Community Clinic
On-going issues are able to be provided through other human
service agencies (MRS, Work First, DHS, etc) or support network
Consumer is not attending “for a reason”
Consumer attends only to protect SSI/D
Consumer cannot be contacted
– Leaves area
– Refuses services
– Receiving services elsewhere
Planning Process
1st Identify the “Person’s” Targeted Issues
Symptoms of Mental Illness (specific) Impact on…
Co-occurring Substance Use (specific) Interferes with…
Co-occurring Health Issues (specific) affect…
Safe and Affordable Housing impacted by one or more life
conditions (specific).
Employment-Income-Resources impacted by one or more life
conditions (specific).
Social (specific) and Community Participation (specific) affected
by…
Self Care (specific) interrupted by…
Issues compounded by 2 or more conditions
Planning Process
2nd Identify Goals for Amelioration of each of the
Person's Targeted Issues
3rd Identify the Person's Stage of Readiness for working
on each Goal
4th Design Objectives based on the Person's Readiness
5th Design interventions in collaboration with the client to
achieve Objectives
6th Establish accurate, sensible time frames for
achieving Objectives
7th Be willing to adjust Plan when necessary
8th Discharge Goal is always part of plan
Process for Strength Based – Recovery Oriented
Stage Matched
Treatment Planning
Presenting Problem
ID Item to be
addressed
Assessment Domain
Effect on Presenting
Problem
New Item to be
addressed
No
Identified Strength
Goal
Level of Readiness
Objectives
Interventions
Goal
Level of Readiness
Objectives
Interventions
An identified need that will not be addressed by the service agency must be
documented in the interpretive summary and indicate where it will be
addressed. IE: under care of primary health care physician and currently stable.
Process continues through each assessment domain. Each domain is assessed to determine if/how it impacts the presenting problem for any new item that will
need to be addressed. If any assessment domain identifies a need that must be addressed, the assessor must determine if it will be address by the agency in the
plan or by an outside resource/agency. If the need will be addressed b y the agency it must be included in the Individual Plan of Service (IPOS). If the need will
be addressed by an outside resource it must be documented in the comprehensive summary at the end of the assessment. Each item in the IPOS must include
the level of readiness of the individual to work on that item, and must have stage matched interventions. Goals and objectives are the person receiving
services. Interventions are the serving agency.
Staging – Block II
Refer to “Stage to Intervention” Power Point