From FSP to Wellness: Creating a RecoveryOriented Continuum of Services and Supports

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From FSP to Wellness Creating a
Recovery-Oriented Continuum of Services and
Supports

• Debbie Innes-Gomberg, Ph.D.
• Los Angeles County Department of Mental
  Health
• David Pilon, Ph.D.
• National Mental Health Association
• Mark Ragins, M.D.
• National Mental Health Association

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Initial Focus around Transformation

• Creating FSP Capacity
• The Big 7

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Transformation Strategy- Year 1

• Recovery Retreats
• Recovery Presentations
• Focused Outreach
• Introducing the Domains of Change
• Recovery-Oriented Leadership Training
• Recovery-Oriented Values

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Introducing the Domains of Change

• Domain One Staff Transformation
• Goal One Develop and enhance staff belief in
  recovery
• Goal Two Energize and instill hope in staff
• Domain Two Staff-Consumer Interactions
• Develop welcoming environments
• Develop successful strategies to work with
  challenging individuals

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Introducing the Domains of Change

• Domain Three Organizational Structures and
  Processes
• Goal One Collect and use Quality of Life and
  Recovery-Based Outcomes
• Goal Two Develop structures to promote consumer
  flow through the system
• Domain Four Available Services / Capacity
• Goal One Develop quality of life support
  services
• Goal Two Strengthen collaboration with other
  social service agencies
• Goal Three Develop community belonging and
  connection

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Domain One Employee AwarenessGoal One Develop
and enhance staff belief in recovery

• Stories of Hope and Recovery. Quarterly, one
  consumer/staff pair, chosen by the team, will
  dialogue about the recovery process from the
  perspective of hope, authority, healing, and
  community engagement.
• Weekly leadership meetings and weekly team
  meetings will discuss an aspect of Recovery
  Oriented Leadership.

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Domain Two Employee/Client Interactive
ProcessesGoal One Create a more welcoming
environment

• Improve waiting area with stuff for kids, make it
  homey, decorate for holidays, add illness
  information brochures
• Have a consumer greeter
• Create a large display board that lists current
  wellness activities and other social and
  community events relevant to consumers

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Domain Three Organizational Structures
ProcessesGoal One Develop structures to
promote consumer flow through the system

• Establish a clients stage of recovery at
  intake screening, with six months goals
• Based on stage of recovery, develop levels of
  care protocols on when/how to make referrals to
  different programs within the clinic

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Domain Four Available Services CapacityGoal
One Develop quality of life support services

• Change the entire clinic operating system to a
  modified ACT format, to better serve clients
  needing immediate and intense service delivery
  effort. Target meds only early recovery cases
  and move them towards wellness. Utilize client
  peer counselors as a key resource. Establish a
  time-limited ACT-like client caseload for
  clinical staff.

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Recovery-Oriented Leadership Training

• Can the experience of our
• members in recovery inform us
• in how we lead our organizations?

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The ROL Format

• Provide novel and challenging ideas and
  frameworks for thinking about the relationship
  between recovery, leadership and organizational
  change.
• Present and use self-assessment tools for
  evaluating the current status of an organization
  within each of the four ROL target areas.
• Provide a forum for frank dialogue between
  leaders which surfaces common struggles and
  achievements in their organizations within the
  ROL framework.
• Plan for organizational change using the
  experience and help of other leaders.

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STAGES OF RECOVERY(Mark Ragins, M.D.)

• HOPE
• EMPOWERMENT
• SELF-RESPONSIBILITY
• MEANINGFUL ROLES

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The translation of the four recovery stages
into four corresponding leadership tasks

• Hope Hope
• Empowerment Authority
• Self-Responsibility Healing
• Meaningful Roles Community Engagement

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HOPE

• Having a vision that is worth working towards.
• Communicating a compelling vision/mission that
  resonates among clients, staff and the community.
• Acknowledging the significant barriers to system
  change, including the possible doubts,
  disappointments and cynicism from past, failed
  change efforts.
• Believing that things can improve and the vision
  is achievable.

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AUTHORITY

• Believing that we have the power to decide our
  future and take meaningful action based on our
  beliefs and desires.
• Practicing empowerment strategies that promote
  responsibility and risk-taking among our clients,
  staff and stakeholders in moving forward despite
  uncertainty.

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HEALING

• Acknowledging the parts of us that need healing
  and receive compassion and encouragement as we
  work towards finding wholeness and health.
• Helping staff and clients to discover and use
  their passions, life experiences, struggles and
  core values in receiving or providing services.

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COMMUNITY ENGAGEMENT

• Believing that we can be a part of the community
  in which we live, make a contribution and be
  accepted for who we are.
• Initiating routine, systematic interactions and
  forming relationships with community resources
  that support access to meaningful roles for
  clients and staff

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Transformation Strategy- Year 2

• The Big 7 to the Big 13
• Establishing Levels of Care
• Milestones of Recovery Scale

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Levels of Care
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MILESTONES OF RECOVERY SCALE A System for
Measuring Recovery
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The Mental Health Services Act

• Planning for services shall be consistent with
  the philosophy, principles, and practices of the
  Recovery Vision for mental health consumers
  (Section 7)

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Recovery (New Freedom Commission Final Report)

• Recovery refers to the process in which people
  are able to live, work, learn, and participate
  fully in their communities. For some
  individuals, recovery is the ability to live a
  fulfilling and productive life despite their
  disability. For others, recovery implies the
  reduction or complete remission of symptoms.
  Science has shown that having hope plays an
  integral role in an individuals recovery.

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SAMHSA Consensus Statement

• Recovery must be the common, recognized outcome
  of the services we support.
• Charles Curie, Former Director, 2/6/06

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What is Recovery?

• Many consumers speak about the process of
  recovery in terms of their own internal
  experience this is often phrased in such terms
  as becoming empowered, taking charge of my own
  life, improving my self-esteem, or becoming
  responsible for myself.
• The mitigation of psychiatric symptoms and
  improvement in functioning.
• Finding and taking on meaningful roles in ones
  life.

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Recovery Definition Matrix
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Components and Milestones of Recovery

• Components of Recovery
• Level of Risk
• Level of Engagement
• Level of Skills and Supports

• Milestones of Recovery
• Extreme Risk
• High Risk/Unengaged
• High Risk/Engaged
• Poorly Coping/ Unengaged
• Poorly Coping/Engaged
• Coping/Rehabilitating
• Early Recovery
• Advanced Recovery

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(Early) Recovery

• These individuals are actively managing their
  mental health treatment to the extent that mental
  health staff rarely need to anticipate or respond
  to problems with them. They are rarely using
  hospitals and are not being taken to jails. They
  are abstinent or have minimal impairment from
  drugs or alcohol and they are managing their
  symptom distress. With minimal support from
  staff, they are setting, pursuing and achieving
  many quality of life goals (e.g., work and
  education) and have established roles in the
  greater (non-disabled) community. They are
  actively managing any physical health
  disabilities or disorders they may have (e.g.,
  HIV, diabetes). They are functioning in many
  life areas and are very self-supporting or
  productive in meaningful roles. They usually
  have a well-defined social support network
  including friends and/or family.

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Recovery-Based Service Delivery

• Unengaged
• Engaged, but poorly self-directed
• Self-responsible

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Measuring Recovery The Future?

• Service Provision based on MORS
• Case Rates based on MORS
• Mathematical Modeling of Recovery

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Markers of Transformation

• Welcoming
• Ongoing leadership
• Creating a learning culture
• Quality of life outcomes
• Employing consumers

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Building Recovery Transformation

• Build Exposure and Enthusiasm about Recovery
• Build Believability and Motivation
• Build Action
• Build Technical Expertise
• Build Sustainability and Infrastructure

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Keys to Transformation

• Sustained coordinated leadership
• Creating learning cultures in the programs
• Improving connections between programs and
  administration
• Including and hiring consumers

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Progression of Including Consumers

• Consumer movement presentation
• Consumer councils
• Including consumers in domain groups
• Consumer volunteers
• Hiring consumers
• Consumer leadership

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Hiring Consumers and Families

• Engagement
• Job training
• Transitional Support / Role Training
• Hiring
• Orientation
• On job supervision
• On job support
• Transition to integrated employment (non-consumer
  restricted jobs)

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Stories of Success

• The consumer greeter turned leader
• The administrator with a natural recovery based
  style
• The psychiatrist who stepped up after her
  patients funeral
• The employment specialist who championed consumer
  volunteers and staff
• The young social worker who led the Wellness
  Center development
• The program director who led the way

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If LA County can do it, anyone can!

• Debbie Innes-Gomberg, Ph.D. DIGomberg_at_dmh.lacounty
  .gov
• David Pilon, Ph.D.
• Dpilon_at_mhala.org
• Mark Ragins, M.D.
• Mragins_at_mhala.org