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Visit with ........................... Scotch Plains, NJ, January 24, 2014 What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. 2 What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Psychosocial 3 What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Schizophrenia Bipolar Schizoaffective Borderline Depression 4 What is PsyR? Coping Relaxation Living Financial Social Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. 5 What is PsyR? Friends Lover Psychiatric Rehabilitation... College Spouse helps those with psychiatric disabilities... Grad School get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Tech School Social life Clubs Church 6 Worker Manager Volunteer What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Choice Community 7 What is PsyR? Programs Doctors Psychiatric Rehabilitation... Hospitals helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... “Interventions” to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. “Disability” supports SSI / SSD 8 What is PsyR? ... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. “Stabilization” Remission “Normal” 9 Adjustment Actualization Autonomy Recovery Principles... 10 What Is PsyR? A goal A role A specialty A discipline Evidence-based 11 Who Provides PsyR? Psychiatrists Peer Providers Psychologists Consumer Direct Care Nurses Social Workers 12 Where is PsyR? Programs Residences Service support PACT (Programs of Assertive Community Treatment) Workplaces Schools Hospitals Families Self-help Centers 13 Why PsyR? Psychiatric disabilities can be... Lengthy Recurrent Difficult Disruptive (of life) Interruptive (of development) Debilitating (of capacity) PsyR thus advances... 14 Long-term recovery Community integration Quality of life HOPE PsyR Principles 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 15 Person-centered Partnership Peer support Natural supports Strengths based Work Goal-related Integration of treatment and rehabilitation Sustained, coordinated services Empirical orientation Challenges to PsyR Institutional pessimism Organizational barriers Training demands Funding shortages Quick-fix thinking “Courtesy” stigma 16 The National Organization Since 1975 Formerly IASPRS Formerly USPRA 8000 members 17 What Is A CPRP? 18 “Certified Psychiatric Rehabilitation Practitioner” Supervised by the Commission Partly “founded” in NJ Transdisciplinary The State Organization 1000 members 30 org members Leading state chapter 19 Annual conference Various trainings Advocacy work Sector Analysis Government, Industry, Market, Customer, Product... 20 Government of New Jersey 21 Government of New Jersey 22 Government 23 Government Increasing regulations Electronic Medical Records “RAC” Audits Capricious and arbitrary administration 24 Industry: 120 Agencies Of which... Bridgeway Catholic Charities Drenk Easter Seals Family Services Greater Trenton Mental Health Assn Essex Twin Oaks ...others... 25 Industry: Specialty Providers Supported Housing: Supported Employment: 22 agencies Consumer-operated: State Hospital patients: ~1500 per year 26 46 agencies 33 centers Market: NJ Medicaid Enrollment 27 Market: Medicaid Enrollments (Centers for Medicare and Medicaid, 2012) 28 Customer: Consumers DMHAS BG appl. says... 285,000 “unduplicated consumers in community settings”, of which... 123,000 with SMI 29 Governor’s budget says.. Community Care Services Screening Services Outpatient Services Partial Care Residential Supported Housing Supported Employment Self-help Centers Integrated Case Mgt PACT 329,664 98,217 136,704 12,127 3,499 5,858 2,371 6,240 10,725 2,443 State Psychiatric Hospitals 1,500 Product: PsyR Evidence-Based Practices Illness Management and Recovery Integrated Dual Disorder Treatment Assertive Community Treatment Family Psychoeducation Supported Employment Supported Education Supported Housing Other “promising” practices PsyR Recovery 30 Recovery: As Outcome time 31 Recovery: As Process time 32 Medical Recovery: 3 Models of Care Psychiatric Rehabilitation Individual Empowerment time 33 Models of Care Medical Psychotherapy Psychiatric Rehabilitation Individual Empowerment time 34 Models of Care Psychotherapy Medical Illness Management & Recovery Psychiatric Rehabilitation Individual Empowerment time 35 Models of Care Psychotherapy Medical Illness Management & Recovery Supported Housing Psychiatric Rehabilitation Individual Empowerment time 36 Models of Care Psychotherapy Medical Illness Management & Recovery Supported Housing Supported Education PsychiatricSupported Rehabilitation Employment Individual Empowerment time 37 Models of Care Psychotherapy Medical Illness Management & Recovery Supported Housing Supported Education PsychiatricSupported Rehabilitation Employment Assertive Community Treatment Family Psychoeducation Individual Empowerment time 38 Finance: Rate Ratio (Zuckerman et al., 2009) 39 US 0.72 WY AK DE PA CA NY 1.43 1.40 1.00 0.73 0.56 0.43 NJ 0.37 Finance: Rate Ratio (Zuckerman et al., 2009) 40 US 0.72 WY AK DE PA CA NY 1.43 1.40 1.00 0.73 0.56 0.43 NJ 0.37 Finance: Rate Ratio (Zuckerman et al., 2009) 41 US 0.72 WY AK DE PA CA NY 1.43 1.40 1.00 0.73 0.56 0.43 NJ 0.37 Industry: Providers = f(Rate Ratio) (Decker, 2013) % doctors accepting 𝑥= 42 𝑴𝒆𝒅𝒊𝒄𝒂𝒊𝒅 𝑟𝑎𝑡𝑒 𝑀𝑒𝑑𝑖𝑐𝑎𝑟𝑒 𝑟𝑎𝑡𝑒 Competition (“Stakeholders”) 43 Competition (“Stakeholders”) 44 Issues and Positions 45 3 Mega Issues affecting PsyR 1. “Reductionism” Paternalism 2. Managed Care “Brain” over “mind 3. Medicaid Expansion ST over LT “Evidence”: only RCTs... Problems: Stigma. Pharmacology. 46 3 Mega Issues affecting PsyR 1. “Reductionism” Paternalism 2. Managed Care “Brain” over “mind 3. Medicaid Expansion ST over LT “Evidence”: only RCTs... Problems: Stigma. Pharmacology. 47 3 Mega Issues affecting PsyR 1. “Reductionism” 2. Managed Care 3. 48 Medicaid Expansion Administrative Services Organization (ASO) Fee-for-service Problems: Cost “containment” Incremental care Stressed operations . 3 Mega Issues affecting PsyR 1. “Reductionism” 2. Managed Care 3. Medicaid: 65% of public mental health Enrollment: 25% Medicaid Expansion 234,000 in NJ No provider increase... Problems: Access, Availability, Quality, Cost, Innovation 49 Advocacy: 6 Development Domains 1. Workforce 2. Agency 3. Sector 4. Practice 5. Client/Consumer/Family 6. Government 50 Advocacy: 6 Development Domains 1. Workforce COLA 2. Agency CPRP (dissemination) 3. Sector Pay parity (with hospitals) Training (R-SHRP) Licensing (hurdles) Peer Providers 4. 5. 6. 51 Practice Client/Consumer/Family Government Advocacy: 6 Development Domains 1. Workforce Transition support ($) 2. Agency “RAC” auditing 3. Sector 4. Practice 5. Client/Consumer/Family 6. Government 52 Advocacy: 6 Development Domains 1. Workforce Medicaid Rate Setting 2. Agency “Medical Necessity” 3. Sector Community Support Services (CSS) 4. Practice 5. Client/Consumer/Family 6. Government 53 Advocacy: 6 Development Domains 1. Workforce 2. Agency 3. Sector 4. Practice 5. Client/Consumer/Family 6. Government 54 Supported Housing “medical necessity”) Supported Employment (“balkanized” process) (a Advocacy: 6 Development Domains 1. Workforce 2. Agency 3. 4. 5. 6. 55 Support Olmstead funding (for housing) Oppose National Registry Improve crisis screening Support CIT for police Benefits parity for “old” Medicaid eligibles Sector Practice Client/Consumer/Family Government Advocacy: 6 Development Domains 1. Workforce Mental health courts 2. Agency More and better outcome measurements 3. Sector 4. Practice 5. Client/Consumer/Family 6. Government 56 Advocacy: NJPRA Strategy Outreach diversification More individualized positioning Higher public profile More impact 57 Advocacy: What NJPRA Needs... More non-legislative representation More press contacts and networks A meeting with Governor’s office More focus on Medicaid office and rate setting process More “assertion” with DMHAS More help with interdepartmental contact, e.g. DCA News articles Radio and TV appearances More contacts with philanthropies, corporations 58