Transcript Recovery Tools for Peers in Medication Management Programs

Recovery Tools for Peers in
Medication Management
Programs
Presented to:
USPRA
June 13, 2011
© 2010 Community Care Behavioral Health
Presenters
• James Schuster: Supporting Recovery in Clinical Services In
Pennsylvania
• Pat Deegan: CommonGround: Electronic systems and portable
toolkits that promote shared decisions involving recovery in
medication clinics
• Leanna Plonka: Implementing Recovery focused toolkits with
peers in medication clinics
• Andrew Henderson and Nick DeSantis: Using an electronic
decision support system in a Peer Center
© 2010 Community Care
Definition of Recovery
• Recovery is a self-determined and holistic journey
that people undertake and through which they can
grow.
• Recovery is facilitated by relationships and
environments that provide hope, empowerment,
choices and opportunities that promote people
reaching their full potential as individuals and
community members.
• from “A Call for Change: Toward a Recovery-Oriented
Mental Health Service System for Adults”
© 2010 Community Care
The Role of Shared Decision Making
• Focus on
– Person Centered Care
– Respect for Autonomy
– Choice and Collaboration
• Uses technologies
– Decision Aids
– Electronic Decision Support Programs
• Goal is to put person centered and recovery values into
practice
Drake, R, Deegan P, Rapp C: The Promise of Shared Decision Making in Mental
Health. Psychiatric Rehabilitation Journal 2010 34: 7-13
© 2010 Community Care
Relevance of SDM
• Aids in complex decisions, e.g. psychopharmacology
• Support for re-engineering psychiatric services,
especially outpatient psychiatrist clinics
• Reinforces the patient centered focus that is key to
success
• Identified as key by National Institute of Health
Improving the Quality of Health Care for Mental and Substance Use
Disorders, Institute of Medicine, National Academies Press, 2006
© 2010 Community Care
Impact of SDM
• Improves consumer satisfaction
• Lack of informed involvement may decrease patient
adherence
• Not necessarily correlated with the “right” decision,
but with individual’s consumer values
• No satisfactory research on relationship to long term
outcomes
Curtis L, Wells S, et al: Pushing the Envelope. Psychiatric Rehabilitation Journal
2010 34:14-22.
© 2010 Community Care
Pennslyvania HealthChoices
• Medical Assistance (Medicaid) Managed Care
Program
• Department of Public Welfare; Office of Mental
Health and Substance Abuse Services Oversight
• Statewide Behavioral Health Carve-Out
– 1915b Federal waiver
– County government is the recipient of funds
– County government contracting models vary
© 2010 Community Care
About Community Care
• Behavioral Health Managed Care Company
• Founded in 1996
• Federally tax exempt non-profit 501(c)3
• Sole member corporation (UPMC) – provider
owned
• Licensed as a Risk-Assuming PPO
• Major focus: publicly funded behavioral health
care system
© 2010 Community Care
About Community Care
• Medicaid/HealthChoices membership: 700,000
• Commercial/Medicare membership: 430,000
• Statewide HealthChoices presence
– 36 of 67 Pennsylvania counties
• 8 offices across the Commonwealth
• More than 500 employees
• Approximately 110,000 people served
• Statewide network of more than 2,500 providers
© 2010 Community Care
Developing Community Partnerships
•
•
•
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Department of Public Welfare
Counties
Advocacy Groups
Other Stakeholders
– Law Enforcement
– Forensic Systems
– Education
© 2010 Community Care
Community Care Counties
Erie
Warren
McKean
Tioga
Potter
Susquehanna
Bradford
Wayne
Crawford
Wyoming
Forest
Elk
Venango
Cameron
Pike
Lycoming
Mercer
Clinton
Jefferson
Clarion Jefferson
Clarion
Lawrence
Luzerne
Clearfield
Butler
Centre
Centre
Beaver
Mifflin
Mifflin
Indiana
Allegheny
Cambria
Westmoreland
Northumberland
Snyder
Juniata
Juniata
Perry
Blair
Columbia
Montour
Union
Armstrong
Monroe
Carbon
Northampton
Schuylkill
Lehigh
Dauphin
Huntingdon
Huntingdon
Washington
Berks
Bucks
Lebanon
Cumberland
Montgomery
Lancaster
Bedford
Greene
Lackawanna
Lackawanna
Sullivan
Fayette
Somerset
Fulton
Franklin
Adams
Chester
York
Philadelphia
Delaware
Community Care Office
© 2010 Community Care
Community Care Contract
Community Care’s Recovery Goals
• Transforming the attitudes of those who
are directly or indirectly involved with the
behavioral health system
• recovery is possible for all
• empowerment and integration for all
behavioral health consumers is essential
• shared decision-making at all levels is key.
© 2010 Community Care
Strengthening Focus on Recovery
• Multiple annual, regional, and statewide conferences
focused on recovery concepts and tools
• Hearing Voices trainings across the state with
thousands of participants
• Recovery-focused webinars with thousands of
participants
• Web-based information and tools
• Learning Collaborative Development
• Targeted Engagement with Psychiatrists
© 2010 Community Care
Community Care’s Recovery Institute
• Assistance through a multi-year contract with Pat
Deegan, PH.D. & Associates, LLC
– To provide consultation and training on systemwide efforts to implement recovery-oriented
services at all levels of behavioral health service
systems.
– Model is one of engagement and support with
providers, not confrontation.
– Recognizes that safety issues can be addressed in
a recovery model.
© 2010 Community Care
Providing technical assistance and resources
for new program implementation
• Use of Learning Collaborative or similar model
• A regional network of providers with initial
external technical expertise
• Tap the collective strengths of members
• Goal is for the collaborative to be self sustaining
• Measureable progress
• Longer term goal is changing the agencies’
culture
© 2010 Community Care
Clinical Interventions supported by state
policy and county direction
• Adaptation of Clinical Services
– Partial Hospital to Psych Rehab
– Peer Services
– Stress on Motivational and Engagement Strategies
– Close collaboration/integration with other
psychosocial services (Housing, Employment, etc)
© 2010 Community Care
New Clinical Services
• CommonGround Decision Support Center
– Peer support
– Installation in medical clinic or peer center
– Reviews the consumer’s progress towards their
recovery goals
– Reviews the consumer’s progress in treatment
– Prints out a summary report for the member and
clinician
© 2010 Community Care
Development of CommonGround Toolkits
• Focus on Personal Medicine, Power Statements,
shared decision making
• Can be paper and pencil or electronic
• Can be used in or out of clinical settings
© 2010 Community Care
Recovery Learning Collaborative
Erie
Warren
McKean
Tioga
Potter
Susquehanna
Bradford
Wayne
Crawford
Wyoming
Forest
Cameron
Elk
Venango
Lackawanna
Sullivan
Lycoming
Mercer
Clinton
Jefferson
Clarion
Pike
Luzerne
Columbia
Lawrence
Clearfield
Butler
Union
Centre
Carbon
Armstrong
Snyder
Beaver
Mifflin
Indiana
Monroe
Montour
Northumberland
Northampton
Schuylkill
Lehigh
Juniata
Allegheny
Cambria
Blair
Westmoreland
Perry
Dauphin
Huntingdon
Washington
Berks
Lebanon
Cumberland
Montgomery
Lancaster
Bedford
Fayette
Somerset
Greene
Fulton
Franklin
Adams
Bucks
Chester
Delaware
York
Philadelphia
Allegheny County
Chartiers Community
MR/MR, Inc.
Family Services of Western PA
MBH
Milestone
Northwestern Human Services
Residential Care Services, Inc.
Transitional Services, Inc.
Turtle Creek Valley MH/MR, Inc.
Staunton Clinic
WPIC
© 2010 Community Care
Lehigh-Capital Region
Bell Socialization
Familicare Counseling Center
SAM, Inc.
Berks Counseling Center
Threshold
Project Transition
Adams Hanover Counseling
Services, Inc.
York/Adams MH/MR Program
Chester County
Cherry Hill Lane LTSR
Fellowship
Holcomb
Elwyn
Human Services, Inc.
Kelsh Associates, Inc.
Penn Psychiatric Center
Salisbury BH, Inc.
Northeast Region
BH Services
of Wyoming Valley
NHS Human Services
of NE PA
NHS Carbondale
Northeast Counseling
Services
Scranton Counseling
Center
North Central Region
Beacon Light Behavioral
Health Systems
Clearfield-Jefferson
Community MH Center
Community Service Group
Dickinson MH Center
SAM, Inc.
----------------------------------Centre County MH/MR
Strawberry Fields, Inc.
The Meadows
Universal Community BH
Carbon, Monroe, Pike
Resources of Human
Development – Crossroads
Community Services
REDCo
NHS Mt. Pocono
Learning Collaborative
• The “learning collaborative” approach, in
which clinical staff work together to redesign
their systems to become more patient-focused
and efficient.
*Chin, Mathew: Improving Health Care Delivery: “Learning Collaborative” Approach; The Commonwealth
Fund: June 2005.
Learning Collaborative
• According to the Institute of Medicine the Learning
Collaborative focuses on:
– Group management and processes through
collaborative problem-solving, exchange of best
practices and strategies for project implementation
– The sharing of information
– Working to design, develop, test, and evaluate
innovative approaches to healthcare delivery and
payment including, assessment of value
*President’s Report Supplement, 2009 Edition; Institute of Medicine; 15-18
Cost Efficiency
• Our experience:
– Use of the in-office tools (SDM/Common Ground)
is supported by a Peer Specialist prior to the MD
visit.
– The cost has not demonstrated any substantive
increase in the overall cost per member.
– Literature clearly demonstrates that heightened
recovery is associated with improved clinical
outcomes
© 2010 Community Care
CommonGround:
Prepare, Participate & Self-Manage
Psychiatric Disorders and Recovery
http://www.patdeegan.com
Our Proposition:
In today’s healthcare
environment, there is
no time for waiting in
waiting rooms
• Prepare
• Participate
• Self-manage
Before
During the appointment
Shared Decision Making
What we have learned:
• 6,000 users
• 75% shared
decisions entered for
over 15,000
CommonGround
Health Reports
Shared decision making
• 8/2006 – 3/2011
can happen within the
constraints of the 15-min
appointment
Personal Medicine: It’s what you do,
not what you take!
Analysis of 2,500 Personal Medicines
CATEGORIES
• Family/friends
• Music, TV, movies
• Physical activity/exercise
• Religion & faith
• Personal philosophy
• Hobbies & games
• Reading
• Relaxation, meditation,
rest
EXAMPLES
• Cooking for my mom
• Reading my Bible
• Fishing on Sunday
• Providing for my family
• Playing hoop w/ my
friends
• Petting my cat
A Power Statement
helps your doctor
know how YOU
want medicine to
help.
Dwight’s Power Statement
Being a good dad and keeping up with my 1-year
old daughter is the most important thing in
my life. I want you to work with me to find a
medication that will help me pay attention to
my daughter and not my voices. We have to
find a medicine that also has no sexual side
effects.
CommonGround Health Report
How I Am Doing Scale
CommonGround Features
Three minute videos that offer stories of recovery and hope!
Shared Decision
The medication is helping but I still feel anxious.
I will attend the relaxation group and art
group because they help manage my anxiety.
I’m working with the peer specialist to find the
Personal Medicine Cards that will work for me.
Definition of Personal Medicine
• The things that give my life meaning and
purpose and that put a smile on my face
• The things I do that that help make me well
• The things I do that help me avoid jail,
hospital, homelessness, losing my job, losing
custody of my kids, etc.
Example:
NOT Personal Medicine
Drinking Nyquil for sleep
Quiet reading before
bed to improve sleep
Personal Medicine is what
we do NOW
I want to work
My job keeps me well
by keeping me busy
Personal Medicine is not a feeling
or state-of-mind
Relaxing or chilling-out is
my Personal Medicine
Reading before bed
relaxes me and helps
me fall asleep
Personal Medicine
 What we DO to be well
– Not what we take
 Is what we do NOW
– Not a future goal
 Is not a feeling or state of mind
– It’s what we DO to feel better
QUIZ
I use St. John’s Wort
for my Personal
Medicine.
Quiz
When I get out of
hospital I will swim to
relieve my stress
Quiz
Self-harm is Personal
Medicine because it
helps me manage
flashbacks
QUIZ
When I get home
from work, I take my
dog out for a game of
Frisbee and I feel the
stress of the day just
melt away.
Quiz
It is better to use Personal
Medicine than psychiatric
medicine in the recovery
process.
True
Fals
e
Quiz
First comes symptom reduction
through medication, then
comes Personal Medicine.
True
Fals
e
Lift weights
Makes me less angry
Care for my cat
Helps me stay out of the
hospital
√
Don’t know
Smoke
Calms me down
Call my brother
He makes me laugh
Staying sober
Staying sober gives me a
future
√
√
Find the essential active ingredient
in your Personal Medicine
Mon Yough Community Services
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Community Mental Health Center since 1969
Serves the Mon Valley “Rust Belt”
2000 adults in Mental Health Outpatient
Recovery Services include:
– Psychiatric Rehabilitation/ Social Rehabilitation
– Supported Housing, Supported Employment
– Peer Support, CommonGround Toolkits
Learning Collaborative
Personal Medicine Toolkit
• Proposal Submitted May 2009 / Objectives:
– Continue to build principles and practices of mental health recovery
– Within the first year, train Adult Outpatient staff in Hearing Voices
simulation and watch the Personal Medicine and Power Statement
screen casts.
– Within the first year have between 5-10% of active adult clients in the
Outpatient clinic with Personal Medicine and Power Statement
– Within the second year have between 15-20% of active adult clients in
the Outpatient clinic with Personal Medicine and Power Statements,
85% of first year clients update their Personal Medicine and Power
Statements at 6 month Intervals.
• First Team meeting October 2009
• Team – Administrator, Quality Assurance, Clinical, Peer
• First Implementation of Personal Medicine February 2010
– Medication Clinic, CRR, ACT team (lite)
• Second Implementation of Personal Medicine June 2011
– Recovery Services, Outreach team, IOP Program
• First Implementation of Power Statements July 2011
MYCS PM Implementation Milestones
3
Sign the "Leadership Team Pledge"
4
Plan for/carry out agency-wide announcement of initiative
5
Schedule monthly meetings of the Team to track progress
6
Identify the program that will begin the implementation
7
Develop training plan:
OPA, Med Clinic, White Oak CRR, ESCS, Front Desk
Committee member PM
Adult SC, Intake/Crisis, Rehab, SE, Outreach
8
All Staff have completed their own PM Worksheet
9
Identify # of clients who will need to complete PM & partner
with appropriate Staff Member MED CLINIC 150, ESCS
30, WHITE OAK 8
11
Begin Initiative is use of PM worksheet and PM cards
12
Develop plan for replenishing PM Cards
13
Develop plan for updating PM worksheets
14
Develop plan for collecting Performance Indicators (see
page two)
15
Develop plan for using PM agency wide
16
Develop
© 2010 Community
Careplan for integrating PM into new staff orientation
17
Chair
05/01/2009
08/26/2009
Chair
07/01/2009
10/05/2009
Chair
09/01/2009
11/01/2009
QIT
10/12/2009
BOD present, All Staff, Operations, powerpoint on
11/05/2009 sharepoint
QIT
8/31/09
Develop plan for integrating PM into new client orientation
Notes
Sr Mgmt wants Res and SCU plan added
08/31/2009
Added White Oak CRR and ESCS team
Chair
05/01/2009
08/26/2009
QIT
below
below
Varies
11/09/2009
Committee agrees all staff in these departments will
02/01/2010 receive the 1.5 hr training by 12/15/09,
QIT
09/01/2009
11/17/2009
Varies
11/09/2009
closer to beginning initiative. Intake/Crisis schedule 12/31
02/01/2010 and 1/7, 1/5 ontrack
QIT
09/01/2009
01/31/2009
QIT
09/01/2009
12/07/2009
QIT
11/04/2009
02/01/2010
Programs
09/01/2009
02/01/2010
QIT
12/07/2009
02/01/2010
QIT
12/07/2009
02/01/2010
QIT
11/01/2009
02/01/2010
QIT
04/01/2010
Start up in phases with a plan to have PM
04/01/2011 agency wide by 4/1/12
QIT
04/01/2011
QIT
12/09/2009
Prepare PM Cards for distribution
Spread
Sustain
10
Completio
n Date
Review Toolkit Components
Start Date
2
Start
1
Identify the members of and form the leadership team (see
page two)
Timeline
Who's in
Charge
Personal Medicine Implementation
Milestones
04/01/2011
all staff means anyone above or below
1/4/10 have prices for all supplies committee approval,
debs restock card template idea, 1/4 on target
Target July 2011
Learning Collab vs Training
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Advise
Resource rich
Everyone is an expert
Openness about what is
working/not working
• Many team members
• Learn how to
participate in conf calls
•
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Teach
Set curriculum
Trainer is expert
Are you doing it or not
• Individualized/Dept
• Webinar/ Face-to-Face
Lessons Learned
• Realistic objective targets – met 1st year objectives
by the 2nd year
• Value in Guiding tools / Guiding learning
collaborative
• Value of the Learning Collaborative focus on success
and problem solving barriers
• Strength in unique provider plans
• Strong internal Team
• Borrow excellence, fail fast
• Strength of the Organizations Integrated care vision
Lessons Learned
• Proposal anticipated challenges: Staff turnover,
competing training demands, competing program
development demands
• Challenge - staff buy-in
• Challenge - staff turnover
• Challenge – Org Development: Improved Access,
Integrated Care
• Challenge – lack the visibility of the Decision Support
Center in the Med Clinic
Lessons Learned
• Challenge – Med Clinic vs CRR / ECSC
• Challenge – Shifting culture and service recipients
experience of typical med visit
Data
CRR – all 8 residents have completed PM
worksheets, with updated every 6 months
with trt plans and medical records referencing
PM.
ECSC – all 28 service recipients have completed
PM worksheets
Medication clinic – 27 service recipients have
completed PM worksheets
COMMONGROUND in a Peer Center
The County Vision was to have this recovery tool in a Peer
Center, making Community Crossroads the first Peer Center to
fully implement CommonGround
• Challenges
– Privacy parameters of system restrict psychiatrist from viewing
online report
– Training of all county providers and psychiatrists
© 2010 Community Care
COMMONGROUND in a Peer Center
• Advantages
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Open to entire county
Participants have unlimited access
All staff are trained CommonGround
Implies that the use of CommonGround is voluntary
Builds relationships with all stakeholders
© 2010 Community Care
COMMONGROUND in a Peer Center
Concepts that mesh with peer support philosophy
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Engagement
Self-esteem
Personal Medicine
Power Statement
© 2010 Community Care
COMMONGROUND in a Peer Center
CommonGround as a self-assessment
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Aided by resource library
A way to ask tough questions/ non judgmental
Share experience with doctors
Ability to feel comfortable with each other which allow some
difficult discussions
© 2010 Community Care
COMMONGROUND in a Peer Center
Preparing for a Brief Psychiatric Appointment
• Review report and help prioritize questions/concerns
• It can be hard to organize thoughts, answer the doctor's
questions, ask questions, speak up about concerns and make
decisions
• Aids in motivating someone to go to the appointment
• CommonGround Report creates partnerships in treatment
decision-making and in peer support
© 2010 Community Care
COMMONGROUND in a Peer Center
Statistics (As of April 30, 2011)
• 102 Active Users
• 170 Finished Reports (172 Started)
• 2,255 Clicks to links to other resources in CommonGround
April 2011
• 31 Used CommonGround
• 28 Reports started and finished
• 20 Users updated their Pill Medicine, Personal Medicine
and/or Power Statement.
© 2010 Community Care
COMMONGROUND in a Peer Center
Anecdotal outcomes-Lessons Learned
• In Self, Service & Support Look for Similarities not Comparisons
• "From Resentment to Resolution“: The CommonGround Road
to Recovery
• "While my Guitar Gently Weeps”: So I don't have to.
© 2010 Community Care
Questions or Comments?
© 2010 Community Care
List of Presenters
James Schuster, MD. MBA – Chief Medical Officer Community Care
[email protected]
Pat Deegan- [email protected]
Leanna M Plonka, MS, CRC, CRRP- [email protected]
Andrew Henderson- [email protected]
Nick Desantis- [email protected]
© 2010 Community Care