Transcript PowerPoint Template

Day Two
A Framework and Approach to Developing a ROSC
Based on Achara, Evans & King, 2010
Overview
• Discuss the nature and implications of
transformational change processes
• Present a conceptual framework that can be used
to guide recovery focused system transformation
efforts
• Identify strategies and tools that can be used to
support transformation efforts
Three Types of Change
Developmental
Transitional
New
Old
State
Transition
State
Three Types of Change (cont’d.)
Transformational
Wake-Up Calls
Reemergence
Through Visioning and
Learning
Growth
Chaos
Mindset
Forced to Shift
Birth
How Transformational Change
(TC)
is Different
TC is unique in three critical ways:
•
•
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The future is unknown and only through forging
ahead will it be discovered.
The future state is so different than the traditional
state that a shift of mindset is required to invent it.
The process and the human dynamics are much
more complex, partnership is critical!
Conceptual Framework
Guiding the Transformation Process
• Aligning Concepts:
Changing how we think
• Aligning Practice:
Changing how we use
language and practices at
all levels; implementing
values based change
• Aligning Context:
Changing regulatory
environment, policies and
procedures, community
support
Aligning
Practice
Aligning
Concepts
Aligning
Context
LEADERSHIP
Leading Transformational
Change
Transformational change requires:
• Courageous leadership
• A focus on empowering others
• Leaders who can motivate and inspire others
• A shift from micro-management and “accountability” to
empowerment
• Leaders and Managers working in partnership
– Leadership creates vision and strategies
– Management creates plans and budgets (Kotter, 1996)
Strategies to Promote
Conceptual Alignment
1. Set the Context and Establish a Sense of
Urgency
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Community meetings
Conferences
Recovery Asset Baseline Assessment
National Experts
Collaboration and Mobilization of the recovery
community
Strategies to Promote
Conceptual Alignment
2. Form Powerful Guiding Coalitions
–
Examples:
• Philadelphia’s Recovery Advisory
Committee (RAC)
–
Developed Recovery Definition, Recovery
Values and continues to generate ideas and
provide guidance to the overall transformation
•
Office of Addictions Service Advisory
Committee
•
Michigan’s Transformation Steering
Committee (TSC)
Strategies for Developing
Effective Coalitions
Strategies to Promote
Conceptual Alignment
3. Create and Over-Communicate the Vision
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Develop participatory, collaborative processes
Host relevant conferences
Mobilize internal and external recovery
champions
Develop communication tools (e.g. White
Papers, Newsletters, Webinars, First Fridays
Series)
Connect the dots between different initiatives
Strategies to Promote
Conceptual Alignment
4. Utilize a Participatory and Transparent
Approach at ALL Times
•
•
Establish New Workgroups internally
Involve people in Recovery and the Community in
new ways (Examples from Philadelphia)
• RFP Review Processes
• Program Development/Evaluation and Monitoring
• Conference Planning
•
Collaboration vs. Input with Providers
Strategies to Promote
Practice Alignment
1. Establish Priorities
• Use participatory processes
• Identify areas in the system where there is
currently interest or urgency
• Explain how priorities will inform the process
going forward
• Identify implications of the prioritized practices for
all stakeholders in the system
• Identify implications for cross system
collaborations
2. Develop Mechanisms for Skill Building
Strategies to Promote
Practice Alignment
2. Mechanisms for Skill Bldg (cont’d)
Examples from Philadelphia DBHMRS:
• Tools for Transformation Series on Each
System Transformation Priority
• Includes:
• -Brief White Paper on the Concept
• -Checklists for PIR, Providers, and
DBH/MRS Staff
• -On-line Power Point with audio file
• Unit Recovery Plans
• Recovery Foundations Training
• Provider Learning Collaborative
• Staff Leadership Development Program
Strategies to Promote
Practice Alignment
3. Empower and Involve Others
People in Recovery:
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Inclusion of people in recovery in trainings as participants and
trainers
Storytelling Training
• Has put a face on recovery and created massive momentum
Leadership Academy
• Partnership with local community college to get college credits
Taking Recovery to the Streets Initiative
• Peer to Peer description of transformation efforts
Requirement in all new RFP’s for some form of peer leadership
group
Strategies to Promote
Practice Alignment
3. Empower and Involve Others, cont’d.
Staff
• Interest Inventory for staff who were then assigned
to workgroups
• New leadership opportunities
• Increased Communication
Providers
•
•
Participation in workgroups
Developing the vision for different levels of care
Strategies to Promote
Practice Alignment
4. Create Short Term Wins
•
Enhance existing programs to become model
programs
e.g. Philadelphia Day Program Transformation vs.
Residential
e.g. Connecticut lessons learned initiative and
centers for excellence
5. Celebrate
the
Successes
Strategies for
Aligning the Context
1. Address Fiscal Issues for Long-Term Sustainability
Funding mechanisms must shift toward
long term recovery management models
• Systems often don’t pay for outreach, pre-treatment
engagement, assertive early re-intervention, continuing support
• Explore alternative payment structures other than Fee for
Service model or align the fee for service model.
Strategies for
Aligning the Context
2.Take a systematic and participatory approach to
identifying policies that are inconsistent with recovery
Examples of Inconsistent Policies
– Policies that allow administrative discharges for relapse
– Policies that predict future success in treatment based on
prior experience and thereby limit tx episodes in a given
year
– Policies that prevent integrated recovery and treatment
planning
– Policies that limit the amount of support that can be
provided in community settings
– Policies that promote a fail first approach
Strategies for
Aligning the Context
3. Align the organizational infrastructure
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Identify a Point person and supporting team
– Example: Philadelphia developed Strategic Planning
Unit
Ensure that the vision drives operations/structure and
not vice versa
Align staff performance evaluations with transformation
goals
Change Contract Language
RFP’s aligned with Recovery
4. Align and Streamline
Administrative and
Regulatory Processes
Strategies for
Aligning the Context
5. Engage the Community to Sustain Change
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Build indigenous leadership (Insurgency)
Build community support
Address Stigma
Collaborate with vibrant advocacy groups
• Recovery Walks
• Recovery Center
Move beyond the choir
• Tie into the broader political agenda
• Building allies from other systems
• Address Stigma
• Put a face on recovery
Sustainability Tool
Tools: Where are you in the
change framework?
Pre-Contemplation
• Stakeholders not giving any consideration to aligning services. They
tend to defend existing service delivery systems and do not believe
that there is a need to modify them.
Contemplation
• Stakeholders see some of the challenges associated with the way in
which services and systems are currently configured. They may be
considering the possibility of aligning services but they are
ambivalent and unsure of the long-term benefits.
Preparation
• Stakeholders have made a commitment to transforming their service
system and are engaging in the necessary planning. During the
Preparation stage, stakeholders focus on the development of a
shared vision of a recovery oriented system of care, along with the
identification of guiding principles or values that are relevant to their
system and community.
Tools: Where are you in the change
framework?
Action
• Stakeholders are actively involved in aligning all levels of the service system
with a recovery orientation. They are modifying their behavior and relational
dynamics. Additionally, there is a considerable investment of time, energy
and resources devoted to operationalizing all of the principles of recovery
oriented care.
Maintenance
• Stakeholders are engaged in activities to ensure that the practice changes in
the system are sustainable. They ensure that recovery oriented care is
supported by regulatory and fiscal alignment and that lessons learned are
fed back into the system. The focus during this stage is on consolidating
and reinforcing the gains made during "Action."
Change Strategies
Stages of
Change
Major Focus of
Alignment
Technology
Transfer Phase
Pre-Contemplation
Conceptual
Awareness Raising
Contemplation
Conceptual
Knowledge
Dissemination
Preparation
Conceptual and
Practice
Practice and
Contextual
Adoption
Practice and
Contextual
Evaluation
Action
Maintenance
Implementation