Transcript Foundations for Building a Recovery Oriented Program

Foundations for Building a
Recovery Oriented Program
Chacku Mathai, CPRP
Associate Executive Director
New York Association of Psychiatric
Rehabilitation Services
April 28, 2011
Backdrop: High Cost of Medicaid Care for
New Yorkers w/ Multiple ‘Chronic’ Conditions
• New York’s Medicaid program serves over 4 million
beneficiaries at a cost of over $47 billion annually (30% of
all healthcare spending in NYS).
• 20% of Medicaid beneficiaries (1,029,621 ) account for
75% of the program’s expenditures: $31.1 million
• Average cost per year: $30,195
• These beneficiaries have “multiple co-morbidities, are
medically complicated and require services across multiple
provider agencies. Due to their multiple and intensive
needs, their care can often be fragmented, uncoordinated
and at times duplicative. “
• 40% of these beneficiaries are diagnosed with mental
illness and chemical dependency.
Backdrop: NYS Ranks 50th in
Avoidable Hospital Readmissions
• NYS Department of Health estimated that
$800 million was spent last year on ‘avoidable
Medicaid hospital readmissions.’
• 70% of these involved beneficiaries with
mental health, substance use and major
medical conditions.
• 65% of admissions for this group were for
medical reasons.
Vision for Recovery Outcomes
• Believe that recovery is possible, even from
the most tragic circumstances or disabling
conditions
• Uncover abandoned hopes and dreams
• Discover our personhood through culture,
strengths, values, skills
• Engage communities as life sustaining forces
• Re-author the way we see ourselves
• Reclaim a meaningful life and roles
Themes to Consider
• Quality of life orientation as well as symptoms
• Capacity to individualize interventions
• Discharge planning with a focus on peer and
natural supports
• Moving from diagnostically focused tracks to
fully integrated services
• Supervision models to build hope and focus
on recovery
• Increased visibility of people in recovery and
alumni as mentors and bridgers to community
Unemployment and poverty:
A two-way street
Poverty/
Unemployment
Low socioeconomic
status
Lower education
Low occupational status/less
stable employment
Fewer “wraparound” supports:
unstable housing, lack of
childcare, unreliable
transportation
Unemployment
Poverty
Dependency on public programs
Fewer assets for social mobility
(e.g., property, further education)
Less developed job
skills/competencies
Poorer financial management
skills
Social and material capital limited
MH programs
EMPLOYMENT
Human Capital:
interviewing skills, job competencies,
education, training,
certifications, etc.
Material Capital:
work incentives, reliable transportation,
stable housing, work attire, savings, assets,
etc.
Social Capital:
Social connections
community organizations,
support networks,
relationships/ connections “outside” mental
health system, family supports, etc.
Adapted from Potts’ definitions of: human, cultural and social capital (Potts, 2005)
Recovery Facilitation Capability
Dimension
Content of Items
I
Program Design
Program mission, outreach, services, community
involvement, flexibility, crisis
II
Physical Environment
First contact/reception, publicly available resources,
accessibility, non-segregated environment
III
Staffing
Recruitment, hiring, visibility of peer experience
IV
Training
Person-centered planning, connecting and coaching
competencies, supervision, recognition systems
V
Service Provision
Relationship and hope-building engagement
activities, assessment, recovery planning, focus on
quality of life and life beyond services
VI
Quality Improvement
QI process reflects recovery indicators, QI team
includes people receiving services
VII
Program Evaluation
Consumer needs, recovery outcomes, collection
method, program design informed by data
Observable Correlates of Recovery
1. Level of Risk
2. Level of Engagement
3. Level of Skills and Supports
RECOVERY-BASED ACCOUNTABILITY
Quality of Life Outcome Domains
•Housing/Home
•Work/Career
•Relational: Family/Friends/Romantic
•Educational
•Legal
•Financial (Payee Status, e.g.)
•Conservatorship
• Incarceration
•Hospitalization
•Recreation/Leisure
•Community/Citizenship
•Health/Physical Wellbeing
•Spiritual/Religion
Benefits of a New Workforce Culture
• Reflects most basic values of recoveryoriented systems of care
– Belief in recovery
– Community inclusion
– Economic self-sufficiency
– Workforce diversity
• Regular opportunities to see “recovery in
action” for consumers and providers
General Workforce Roles for
People in Recovery
• Peer-run organizations, e.g. recovery centers
• Peer counseling positions, e.g. bridgers
• Regular employee positions such as therapist,
practitioner, counselor, advocate, service
coordinator, adminstrator…
• Volunteer peer roles
• Community citizen volunteers
Developing Jobs for People in Recovery
• Review workforce needs throughout the
agency (evaluate service needs and gaps)
• Include experience as a consumer of services
in qualifications or preferences
• Create educational equivalencies to standard
college requirements, e.g. work experience,
related credentials, certificates
• Remove discriminatory or stigmatizing
language from all written materials
Creating diverse teams
• Integrate peer positions in multi-disciplinary
teams
• Create flexible schedules
• Career ladders with opportunities for
advancement
• Opportunities for recognized continuing
education
• Performance reviews
Preparing the Work Environment
•
•
•
•
•
Dual relationships, role definition, boundaries
Culture and standards for self-disclosure
Understanding reasonable accommodations
Will professional roles be diminished?
Will consumers require unreasonable amount of
support or lack necessary skills?
• Role of consumer and non-consumer staff in staff
meetings and social events
• Engaging people in recovery as colleagues
Preparing People in Recovery
•
•
•
•
Impact of employment on benefits
Fears about ability to do the job
Fear of not being liked or accepted
Potential loss of friendships with other
consumers
• Role of supervisor
• Engaging other staff as colleagues
Education and Training
• Experience as a consumer does not equal
capacity to serve in the workforce
• Review existing employee training programs
for discriminatory or stigmatizing language
• Revise training programs to include recoveryoriented, person-centered, culturally
competent content
• Recognize credentials, e.g. CASAC, Recovery
Coaching, CPRP, etc.
NYAPRS Partnership with CEIC
• Building Recovery Facilitation Capability
– Integrating peer support
– Natural community supports
• Recovery Implementation Forums across NYS
• Onsite Recovery Implementation Technical
Assistance
• Case studies of local implementation
• Dual Diagnosis Capability Assessments
References
•
•
•
•
•
•
•
•
•
•
Adams, Neal, & Grieder, Diane M. (2005). Treatment Planning for Person-Centered Care. Amsterdam, The
Netherlands: Academic Press.
Anthony, William A., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric Rehabilitation (2nd ed.). Center for
Psychiatric Rehabilitation, Boston University.
Davidson, Larry, Courtenay Harding, & LeRoy Spaniol (Eds.). (2005). Recovery from Severe Mental Illnesses:
Research Evidence and Implications for Practice. Boston, Mass.: Center for Psychiatric Rehabilitation, Boston
University.
Davidson, Larry, Michael Rowe, Janis Tondora, Maria J. O’Connell, Martha Staeheli Lawless. (2009). A Practical
Guide to Recovery Oriented Practice: Tools for Transforming Mental Health Care. Oxford, England: Oxford
University Press.
Farkas, Marianne, Cheryl Gagne, William Anthony, & Judi Chamberlin. (2005). Implementing recovery oriented
evidence vased programs: Identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–58.
Harding, C.M.; G.W. Brooks; T. Ashikaga; J.S. Strauss; and A Breier. (1987). The Vermont longitudinal study of
persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American
Journal of Psychiatry, 144, 718–26.
Mathai, Chacku. (2009). Building Integrated and Recovery Oriented Programs.
Ragins, Mark. (2007). Concrete Approaches to Recovery Based Transformation.
Ralph, Ruth, Kidder, Kathryn, Phillips, Dawna. (2000). Can We Measure Recovery? A Compendium of Recovery
and Recovery-Related Instruments. Cambridge, Mass.: The Evaluation Center at HSRI.
Spaniol, Leroy, Nancy J. Wewiorski, Cheryl Gagne, & William A. Anthony. (2002). The Process of recovery from
schizophrenia. International Review of Psychiatry, 14, 327–36.
Contact Information
Please go to our website
www.nyaprs.org
for a description of all
our available trainings.
To schedule a training,
please contact the
NYAPRS Main Office at
(518)436-0008