Transcript The New Age of Psycho-Social Rehabilitation

THE NEW AGE OF
PSYCHO-SOCIAL REHABILITATION
Roadmap to
Outcome-Oriented
Treatment
and Recovery
THE NEW AGE OF
PSYCHO-SOCIAL REHABILITATION
Today’s Objectives: How You Can…
– Meet Payer Standards
– Demonstrate People Improve
– Develop a PSR program that
• helps people improve
• enhances recovery
– Maintains/Builds Revenue
Streams
THE NEW AGE OF
PSYCHO-SOCIAL REHABILITATION
What Can You Get PAID For Providing?
– Services
What Do You Have To Do To Get Paid?
– Develop Outcomes
– Delivery Services that Generate Anticipated Outcomes
– Document Reached Outcomes
How Do You Get People Connected?
– Without People:
• No Services
• No Outcomes
• No Payments
Meeting Payer Standards: Outcomes
Assessment and Planning (Rule 132):
– Client’s preferences relating to services and
desired treatment outcomes.
– Documenting goals &
anticipated outcomes.
Clinical Recording Keeping (Rule 132):
– Discharge summary documenting
the outcome of treatment and,
as necessary, linkage to continued
services.
Meeting Payer Standards: Outcomes
Utilization Reviews (Rule 132):
– The expected short-term and
long-term outcome of
each service needed by
the client and
– Progress made in
response to treatment.
THE NEW AGE OF
PSYCHO-SOCIAL REHABILITATION
Do You View “Recovery” as a
Continuum:
or
Trend:
Developing a World Class PSR Program
Starts with a Philosophy of Recovery
– Trend vs. Continuum
– People ARE SMART
– People KNOW What ISN’T WORKING
– People KNOW What They WANT
– People KNOW What HELPS
– People ENGAGE When TREATMENT Has Quality
– People IMPROVE the QUALITY of Their Life
Developing a World Class PSR Program
Presumptions
– Staff Deserves To Be:
• Compensated for Expertise and Passion
– Thus – Generate Income with Services
• Retention of Quality Staff
– Clinically Challenge Staff – expect the best,
– Pay Raises Through Increased Income
– Agency Deserves To Be:
• Compensated for Services Provided
• Remain OPEN to Serve Community Members.
Developing a World Class PSR Program
Assessment and Planning (from Rule 132):
– Client preferences relating to services and desired
treatment outcomes.
Getting Client’s Preferences Means PSR MUST:
– Get to Know the Person
– Understand THEIR GOALS
– Review Assessment Data
– Bring the Person TO THE
PROGRAM: Community
– Develop Motivation & Hope
Developing a World Class PSR Program
Assessment and Planning (from Rule 132):
– Documenting goals & anticipated outcomes
Means PSR MUST:
– Assess the Client’s Needs (baseline)
• DLA – Functional Measure
• MHA – Tx History.
– Connect Treatment to DLA
and MHA = Prescriptive
Item
Score
Item
DLA
Telling Someone How I Feel
0
11
0
Asking Someone for Help
0
11
Telling Others What I Need
0
6, 11, 22
Listening to Other Peoples' Ideas and Suggestions
0
6
Identifying Options to Solve my Problem
0
11
Creating & Executing a Plan that Solves my Problem
0
2
Doing Something Fun That I Enjoy
0
17
0
Starting a New Relationship/Friendship
0
22
0
Going to the Doctor When I'm Sick or Hurt
0
2
0
Joining a NEW Social Group
0
20
0
Prepare & Eat at Least 2 Meals Per Day
0
10
0
Pay My Bills On Time
0
9
0
Control My Spending and Budget my Monies
0
9
Manage My Daily Schedule and Keep Appointments
0
8
0
Clean My Home and Pay Rent/Mortgage on Time
0
4
0
Work Safely with Tools, Kitchen Knives & Razors
0
7
0
Choose from the Options I Have to Solve Problems
0
11
Use Public Transportation or Drive Myself
0
20
Shop for Myself
0
20
Tell My Family and/or Friends What I Need
0
6, 11, 13, 22,
27
Question
Seldom
Occasionally
Often
Frequently
I Take Risks By…
Question
Seldom
Occasionally
Often
Frequently
I am Self-Confident and Can…
0
L10 Have client Identify what they perceive as potential strengths and obstacles to their recovery?
Strengths
Obstacles
(Check all that apply)
(Check all that apply)
_____ History of treatment success
_____ History of treatment disappointment
_____ Understanding of illness
_____ Denies illness/problems or blames others
_____ Has decision making skills
_____ Lacks decision making skills ability
_____ Good communication skills
_____ Limited communication ability
_____ Adequate education
_____ Limited education or learning difficulties
_____ Good physical health
_____ Physical/medical problems
_____ Ability to manage finances
_____ Financial difficulties
_____ Stable living conditions
_____ Unstable living conditions
_____ Ability to form and maintain relationships
_____ Difficulty with interpersonal relationships
_____ Ability to care for self/others
_____ Lack of trust in others
_____ Vocational skills, some work history
_____ Limited vocational skills and work history
_____ Transportation available
_____ Lacks transportation
_____ Family support
_____ Lack of family support
_____ Social support system present
_____ Lacks friends and social outlets
_____ Has confidence in treatment provider
_____ Doubts their capacity to improve/be helped
_____ Religious, spiritual or cultural beliefs
_____ Religious, spiritual or cultural beliefs
_____ Other Strengths, specify:
_____ Other Obstacles, specify:
Developing a World Class PSR Program
Means PSR MUST:
– Deliberately Intervene: Development of
• Group: Evidenced Based, Curriculum Driven
• Individual: “Supersize the Fries” Con-Current with Group
• Milieu: Practice Socialization and Skills Lab.
– Connect Treatment to DLA and MHA = Prescriptive
PSR Treatment Team Therapists and Supervisor met for a 90 day treatment review session to evaluate the client's
progress toward goals identified in the client's individual treatment plan (ITP) driven by assessed needs identified
in a yearly mental health assessment. The review also determined and discussed the consumer's readiness to be
transitioned and connected to less supportive therapeutic services and/or community-based and socially driven
support activities. Prior to this review session, the consumer completed a self-report psychometric based on the
Daily Living Assessment to determine a level of functional impairment that prevents the consumer from engaging
in less supportive therapeutic services and/or community-based and socially driven support activities. Staff
discussed their clinical observation of the consumer while in treatment and the data collected during the
completion of the self-report psychometric, which assisted the staff in determining gains or decreases in
functionality over the past 90 days of treatment. In addition, staff reviewed and discussed the client's compliance
percentages and their levels of engagement with the treatment measured each week using an engagement matrix
and the client's overall reported progress during each session of the treatment.
Recommendation: Continue PSR services.
Justification: During the review session, staff came to the decision that the consumer has reached very few of the
goals identified in PSR services ITP as evidenced by the completion of a self-report psychometric and
observations by the staff and the client's scores in compliance, engagement and progress toward goals. The client’s
progress in the past 90 day session includes: XXXXX.
Anticipated continued therapeutic services: Staff observes and conceptualizes that XXXX. Client is encouraged to
attend XXXX to learn XXXXX. Client is also encouraged to attend XXXX to start learning how to XXXXX.
Consumers will attend Anxious No More to acquire, practice, and use in natural/community settings skills
including:
Coping Skills:
Will learn cognitive restructuring techniques that allow them to be more competent of their anxiety
triggers and accompanying reactions measured through client self-reports and the completion of
activities and worksheets provided in the group and as evidenced by at least 75% engagement in the
group.
Will learn to be in control of their anxiety by identifying at least three healthier and more effective
cognitive reactions associated with anxiety-provoking events measured by the completion of activities
and worksheets provided in the group and as evidenced by at least 75% engagement in the group.
Problem Solving:
Will identify and respond to options about the way in which they interpret and react to anxietyprovoking events measured by the completion of activities and worksheets provided in the group and
as evidenced by at least 75% engagement in the group.
Will learn to set realistic expectations related to anxiety-provoking events so that accompanying
cognitive, emotional, and behavioral reactions are appropriate measured by the completion of activities
and worksheets provided in the group and as evidenced by at least 75% engagement in the group.
What are You Attracting?
Have you wondered why you keep finding yourself in the same situations? Bad relationships, encountering “toxic” people,
feelings of being out of control with the direction your life is taking? Shifting the manner in which you approach the world can be
hugely empowering and give you the feeling of being more in control. We will explore, through activities and discussions, what
YOU can do to feel that no matter what life throws at you, you are more powerful than you think you are!
*Family relationships, social network, coping skills, problem solving.
Coping including the following objectives: To be able to:
Identify three new ways in which the client can engage with and interact in their social, family and career/education
environments measured by the client’s self-report and observation of the client in group as evidenced by 75% or higher
compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward
goal measure.
Identify at least 3 personal strengths that will enable the client to resolve daily living issues and communicate effectively
with others measured by the client’s self-report and observation of the client in group as evidenced by 75% or higher
compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward
goal measure.
Anticipate and predict the potential outcome of a new behavioral approach to engagement with the client’s social, family
and career/education environments measured by the client’s self-report and observation of the client in group as evidenced
by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the
progress toward goal measure.
Problem Solving including the following objectives: To be able to:
Effectively emotional regulate while communicating needs, cognitions and emotional reactions to life stressor when
engaged socially with others as measured by the client’s engagement with role plays and the discussion after the roll play
evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or
higher on the progress toward goal measure.
Developing a World Class PSR Program
Anticipating Outcomes Means PSR MUST:
– Adapt to Changing Needs of Client
• Develop Progressive, Trend-Oriented Program
• Offer Services That Meet Person on Multiple Levels of
Recovery.
– Assist the Client in
Reaching Outcomes
• Motivational
• Hope Inspiring
• Community-Based
Developing a World Class PSR Program
Clinical Recording Keeping:
– Discharge summary documenting the outcome of
treatment and, as necessary, linkage to continued
services.
Quarterly Conferences
– Compliance, Engagement & Progress
– DLA Completion and Reviewed
– Face to Face Collaborative Meetings
Attendance: May 31, 2013
Client 1
ITP DUE:
MHA DUE: Payer: Medicaid
Current DLA XX
Original DLA: XX
100%
Engagement
100%
Progress Toward
Goals
100%
1
Relationships
Worker
Member
Own Issues
Empathy
2
2
2
2
2
0 = None, 1 = Minimum ; 2 = Moderate; 3 = Maximum
3
Item
Score
Item
DLA
Telling Someone How I Feel
0
11
0
Asking Someone for Help
0
11
Telling Others What I Need
0
6, 11, 22
Listening to Other Peoples' Ideas and Suggestions
0
6
Identifying Options to Solve my Problem
0
11
Creating & Executing a Plan that Solves my Problem
0
2
Doing Something Fun That I Enjoy
0
17
0
Starting a New Relationship/Friendship
0
22
0
Going to the Doctor When I'm Sick or Hurt
0
2
0
Joining a NEW Social Group
0
20
0
Prepare & Eat at Least 2 Meals Per Day
0
10
0
Pay My Bills On Time
0
9
0
Control My Spending and Budget my Monies
0
9
Manage My Daily Schedule and Keep Appointments
0
8
0
Clean My Home and Pay Rent/Mortgage on Time
0
4
0
Work Safely with Tools, Kitchen Knives & Razors
0
7
0
Choose from the Options I Have to Solve Problems
0
11
Use Public Transportation or Drive Myself
0
20
Shop for Myself
0
20
Tell My Family and/or Friends What I Need
0
6, 11, 13, 22,
27
Question
Seldom
Occasionally
Often
Frequently
I Take Risks By…
Question
Seldom
Occasionally
Often
Frequently
I am Self-Confident and Can…
0
Developing a World Class PSR Program
Utilization Reviews:
– The expected short-term and long-term outcome
of each service needed by the client and
– Progress made in response to treatment.
Conferences and ITPs
– All Progress Documented in ITP
– Collaborative, Strengths Based Consultations
Activity and Wellness Center
Assessed Need
Anticipated Outcome: Staff
Anticipated Outcome: Client
After a Mental Health and Daily Living Activities (DLA) Assessment XXXX has received a DMV-IV tm diagnosis of XXXX and has been
assessed to have a role functioning deficits which prevent the client from engagement and connectivity with natural and community supports.
Client will acquire, practice and use in natural/community settings skills that will assist the client in mitigating impaired functioning and deficits
identified in the Mental Health and Daily Living Activities (DLA) Assessment so that the client can live independently, manage illness with as
little intervention as possible and achieve functional, social, educational and vocational goals.
“Gathered in the First Session/Registration”
Service Goals for Community Support Group
Objective
Progress
Objective
Status
Level of
Service
(see key below)
(see key below)
(see key below)
0
N
I
XXXX will attend What You See Is What You Get to acquire, practice and use in natural/community settings skills including:
1.
2.
3.
Communication including the following objectives: To be able to:
a. Calmly and effectively relay their thoughts, opinions and emotions to family and friends as well as ask for
support when needed measured through client self-reports and therapeutic activities in session as evidenced by
75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or
higher on the progress toward goal measure.
Social Network including the following objectives: To be able to:
a. Effectively make connections to others and maintain those connections to form healthy and balanced
relationships as measured by observation in group of the client’s relational development as evidenced by an
engagement matrix average score of 50%.
Coping including the following objectives: To be able to:
a. Effectively evaluate the outcome of client’s behavior as well as other individual’s behavior and communicate
one’s cognitive and emotional response to the outcome and other’s responses to the outcome measured through
client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with
treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal
measure.
b. Routinely improve cognitive responses by remaining in control and restoring feelings of self-worth as evidenced
by self-reports.
Progress Review: XXXX has been XX% compliant with treatment and engaged XX% of the time during session and has an
overall progress of XXXXX.
Recommend Service: Increase Community Support Group
Justification/Why: Consumer Admitted to the Group due to MHA and DLA Assessments and perception of licensed staff that the
consumer can and will benefit from the group and reach identified goals and outcomes.
Key:
Progress:
0= None
1 = Minimal Progress
2 = Moderate Progress
3 = Maximum Progress
4 = Obtained
Status:
N = New
C = Continued
E = Ended
R = Revised
A = Achieved
Service Level
I = Increased
C = Continued
D = Decreased
Activity and Wellness Center
Assessed Need
Anticipated Outcome: Staff
Anticipated Outcome: Client
After a Mental Health and Daily Living Activities (DLA) Assessment XXXX has received a DMV-IV tm diagnosis of XXXX and has been
assessed to have a role functioning deficits which prevent the client from engagement and connectivity with natural and community supports.
Client will acquire, practice and use in natural/community settings skills that will assist the client in mitigating impaired functioning and deficits
identified in the Mental Health and Daily Living Activities (DLA) Assessment so that the client can live independently, manage illness with as
little intervention as possible and achieve functional, social, educational and vocational goals.
“Gathered in the First Session/Registration”
Service Goals for Community Support Group
Objective
Progress
Objective
Status
Level of
Service
(see key below)
(see key below)
(see key below)
3
E
D
XXXX will attend What You See Is What You Get to acquire, practice and use in natural/community settings skills including:
1.
2.
3.
Communication including the following objectives: To be able to:
a. Calmly and effectively relay their thoughts, opinions and emotions to family and friends as well as ask for
support when needed measured through client self-reports and therapeutic activities in session as evidenced by
75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or
higher on the progress toward goal measure.
Social Network including the following objectives: To be able to:
a. Effectively make connections to others and maintain those connections to form healthy and balanced
relationships as measured by observation in group of the client’s relational development as evidenced by an
engagement matrix average score of 50%.
Coping including the following objectives: To be able to:
a. Effectively evaluate the outcome of client’s behavior as well as other individual’s behavior and communicate
one’s cognitive and emotional response to the outcome and other’s responses to the outcome measured through
client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with
treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal
measure.
b. Routinely improve cognitive responses by remaining in control and restoring feelings of self-worth as evidenced
by self-reports.
Progress Review: Bob has been 95% compliant with treatment and engaged 76% of the time during session and has an overall
progress of Maximum.
Recommend Service: Decrease Community Support Group
Justification/Why: Bob has reached all of the goals associated with this service as evidenced by him compliance and engagement
with treatment as well as his maximum progress scores.
Key:
Progress:
0= None
1 = Minimal Progress
2 = Moderate Progress
3 = Maximum Progress
4 = Obtained
Status:
N = New
C = Continued
E = Ended
R = Revised
A = Achieved
Service Level
I = Increased
C = Continued
D = Decreased
Ecker’s PSR Program Particulars
Golden Corral of Treatment
– Large and Diverse Team
Includes:
• Staff
• Interns
• Clients
– Multi-Leveled Treatment Program
• Varying Functional Skills
• Varying Skill Development Needs
– Deliberate Program Design and Implementation
Ecker’s PSR Program Particulars
3-Tiered System to Meet Assessed Needs
– Ecker Offers:
•
•
•
•
Do Drop-Inn: Social Laboratory
2 Hour Treatment Groups - Catalog
4 Hour Treatment Cohort - Workbook
Individual Treatment
Monday
Therapy Service & Time
9:00 to 9:30
9:30 to 11:30
11:30 to 1:30
Anxious No More
Room 3N5
Social Skills Time
Room 3N5
Addiction Process Group
Room 1S1
Change Your Life Room
1S1
Community Support Group
Cohort
Does Not Meet
Monday Movie Matinee in Room 3N1
Do Drop-Inn
The Social 30
Room 3N1
Camp Steffani in Room 1N14
Tuesday
Therapy Service & Time
9:00 to 9:30
Community Support Group
11:30 to 1:30
What are You Attracting?
Room 1S1
What You See Is What You Get
Please Don't Stop the Music
Room 3N5
Kicking Addictions
Room 1S1 Annex
KID-ing Around
Room 1S1 Annex
Your Hero’s Journey
Room 3N5
Room 1N14
Cohort
Do Drop-Inn
9:30 to 11:30
Room 1S1
(Admission Required Consult with Bob Zima)
Fun and Games, Writing the Mind Alive, Just Listen,
Great Courses, & Reading Club
Room 3N1
The Social 30
Room 3N1
Wednesday
Therapy Service & Time
9:00 to 9:30
9:30 to 11:30
Be Selfish
Room 1S1
11:30 to 1:30
Anger Replay
Room 1S1
Contact information:
• Rick Vander Forest, Director of Recovery
• [email protected]
• 847-695-0484 x 322
• Bob Zima, MA/LCPC, PSR Supervisor
• [email protected]
• 847-695-0484 x 347