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Promoting A Recovery Oriented System of Care

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Title: Promoting A Recovery Oriented System of Care


1
Promoting A Recovery Oriented System of Care
  • Arthur C. Evans, Ph.D.
  • Director
  • City of Philadelphia
  • Division of Social Services
  • Office of Behavioral Health/Mental Retardation
    Services

2
The Guiding Principles of the Philadelphia System
of Care
RECOVERY and Resiliency
3
The time is always right to do what is right.
  • Martin Luther King, Jr.

4
Overview
  • Historical context and Background
  • Various Viewpoints on Recovery
  • Principles, Core Values of Definition
  • Program and Practice Models
  • Implications for the System
  • System Change Strategies and Next Steps

5
Philadelphia Office of Behavioral Health/Mental
Retardation Services
Arthur Evans, Ph.D. Director
Michael J Covone Deputy Director
Margaret Minehart, M.D. Medical Director
Office of Mental Health
Coordinating Office of Drug and Alcohol Abuse
Programs
Community Behavioral Health
Mental Retardation Services
6
Division of Social Services
Division of Social Services Julia Danzy
Department of Health
Prisons Department
Department of Human Services
Behavioral Health and Mental Retardation
Recreation Department
Office of Adult Services
Mayors Office of Comm. Service
7
CAVEATS
  • Recovery is not throwing the baby out with the
    bath water. Reorientation
  • Recovery is not panacea it will not solve
    larger societal problems (i.e. inadequate
    housing, poverty, stigma, budget problems, etc.)
  • Reorientation is a process. It is not something
    that will happen overnight.
  • Public Sector Challenges are Real
  • It takes a consensus process to move the system
    in the direction of recovery.

8
HISTORICAL CONTEXTandBACKGROUND
9
Factors Influencing the New Recovery Movement
  • Recovery-Oriented Providers
  • Addiction self-help movement
  • Mental Health consumer/survivor movement
  • Family movement - NAMI
  • Advances in treatment approaches
  • Recovery oriented research
  • Mental health and addiction advocates

10
What has Been our Orientation?
  • Focus primarily on symptom reduction or sobriety
  • Client viewed passively as recipient of
    services
  • Focus on fitting into a program
  • Focus on client pathology and deficits
  • Minimal individual and family voice or input in
    system
  • Responsibility for change and control largely
    owned by programs
  • Persons growth and sense of self is
    constrained by illness

11
Relevant Mental Health Research
  • Vermont Psychiatric Hospital Study
  • Studied outcomes for 269 severely disabled
    patients discharged in mid-1950s
  • 34 had achieved full recovery
  • additional 34 had improved significantly in
    social functioning and psychiatric status
  • findings replicated in WHO study where 45-65 of
    person w/ schizophrenia recovered and only 20-25
    showed classical deteriorating course

12
Preliminary Outcomes from a Peer Outreach Program
Table 4. Inpatient and Outpatient Service
Utilization for Engage vs. Standard Care Only
 
13
Relevant Substance Abuse Research
  • National Treatment Improvement Evaluation Study
  • 5 year study of treatment effectiveness of almost
    4500 addiction clients nationwide
  • reduced substance use by 50
  • reduced criminal activity up to 80
  • increased employment and reduced homelessness
  • improved physical and mental health
  • New research concludes that the longer a person
    is in treatment for addiction, the better the
    odds that the patient will cut down on drug use
  • (The study, entitled "Does Retention Matter?
    Treatment Duration and Improvement in Drug Use,"
    is being published in the May 2003 issue of the
    journal Addiction. )
  • Researcher Bill White has documented spontaneous
    recovery of individuals who do not come into the
    formal Tx System

14
What HindersMental Health Recovery Research by
Steve Onken and Colleagues
  • The lack of helping factors and the resulting
    conditions e.g., poverty, apathy, isolation and
    hopelessness
  • Stigma (internalized and external)
  • Discrimination     
  • Situations and structures which deny persons
    choices and control over their life      
  • Tenaciousness of the disorder itself      
  • Abuse and trauma.

15

What Helps Mental Health Recovery Research by
Steve Onken and Colleagues
  • Basic resources such as a livable income,
    affordable and safe housing and reliable
    transportation
  • Positive attitudes, self-care and self advocacy
    where persons believe that recovery is possible
    for everyone
  • A sense of meaning and purpose, for many hope or
    spiritual faith
  • Choice in whether and what treatment to use and
    life options in general
  • Relationships such as family and friends that
    sustain regular activities including fun
  • Meaningful activities involving employment,
    education and/or volunteer and advocacy work
  • Peer support in the form of groups, programs and
    role models
  • Access to formal mental health services oriented
    toward the whole person where respectful staff
    partner with each person    in achieving agreed
    upon goals

16
Implications of Research
  • People can and do get better with the right
    supports, some of which are outside of formal
    treatment
  • We need to understand and incorporate those other
    factors that are important in peoples recovery

17
VIEWPOINTS ON RECOVERY
18
Current Recovery Perspectives
  • Recovery as Rehabilitation (Deegan) recovery
    is the task of individual, rehab one aspect of
    recovery, extend rehab beyond treatment to all
    areas of life
  • Recovery as Political Process the gaining of
    civil rights, self-determination, dignity and
    respect
  • Recovery as Something Gained functions,
    external things, internal states, (Ragins), more
    than absence of symptoms
  • Recovery Management (White) permanent addictions
    recovery is possible, focus on solutions, open up
    natural pathways to recovery
  • Recovery as Philosophy state of mind, belief
    system,

19
PRINCIPLES and CORE VALUES
20
Recovery Core Values
  • Participation
  • Entry at any time
  • No wrong door
  • Choice is respected
  • Right to participate
  • Person defines goals
  • Programming
  • Individually tailored care
  • Culturally competent care
  • Staff know resources
  • Funding and Operations
  • Income is tied to Outcomes
  • Person selects provider
  • Protection from undue influence
  • Providers compete for business

Participation
Funding-Operations
Programming
21
Recovery Core Values
Direction
  • Equal opportunity for wellness
  • Recovery encompasses all phases of care
  • Entire system supports recovery
  • Input at every level
  • Recovery-based outcome measures
  • New nomenclature
  • System wide training culturally diverse, relevant
    and competent services
  • Consumers review funding
  • Commitment to Peer Support and to
    Consumer-Operated services
  • Participation on Boards, Committees, and other
    decision-making bodies
  • Financial support for consumer involvement

22
Objectives of a Recovery System of Care
  • To the extent possible, individuals should have
    responsibility and control over their personal
    recovery process
  • Increase individual/family participation in all
    aspects of service delivery
  • Expand recovery efforts to all aspects of
    individuals lives- social, vocational, spiritual
    through direct services or linkage to natural
    helping networks
  • Promote highest degree of independent functioning
    and quality of life for all individuals receiving
    care in our system

23
Recovery Defined
  • We endorse a broad vision of recovery that
    involves a process of restoring or developing a
    positive meaningful sense of identity apart
    from ones condition a meaningful sense of
    belonging then rebuilding a life despite or
    within the limitations imposed by that condition.

24
TRANSFORMING PRACTICE
25
Practice Guidelines Prevention/Health Promotion
  • Persons in recovery will
  • be able to access information re health promotion
    and treatment options
  • promote their own health and build Recovery
    Capital (resources for recovery)
  • Agencies will
  • provide community and consumer education
  • Utilize a range of community-based interventions
    to reduce risk factors and enhance resilience
  • encourage access to resources or info, conduct
    anti-stigma campaigns

26
Practice Guidelines Consumer Involvement
  • Persons in recovery/Family
  • participate on Boards
  • participate in agency evaluations
  • participate in planning structures
  • know grievance procedures
  • Agencies
  • offer peer-run services
  • hire peer staff
  • routinely evaluate consumer satisfaction and
    solicit ideas on now to improve care

27
Practice Guidelines Access and Engagement
  • Persons in recovery
  • can access services through any door
  • are offered services where they live
  • Agencies use
  • a range of pre-engagement strategies
  • peer engagement specialists
  • specialized outreach strategies for difficult to
    engage populations
  • specialized procedures to rapidly admit people
    who relapse
  • admission criteria that dont exclude people
    based on prior treatment failure, etc.

28
Practice Guidelines Continuity of Care
  • Persons in recovery arent discharged just for
    being more symptomatic
  • Agencies link people in recovery to
  • appropriate aftercare services upon discharge
  • self-help resources or natural supports
  • Agencies have mechanisms for
  • follow-up post-discharge
  • people returning for services

29
Practice Guidelines Individualized Recovery
Planning
  • Persons in recovery
  • actively participate in the development of their
    recovery plans
  • sign all plans
  • attend all planning meetings
  • designate meeting participants
  • receive their plans
  • Providers
  • develop holistic plans that include wishes,
    interests, goals, etc.
  • regularly review plans with multi-disciplinary
    team (e.g., treatment, housing, work, natural
    supports)

30
Practice Guidelines Recovery Support Staff
  • Providers
  • offer people hope that recovery is possible for
    me.
  • work collaboratively to develop
    relapse-prevention plans and advance directives
  • assist persons in recovery with self-management
    strategies
  • help engage and maximize use of natural supports
    such as friends, family, and neighbors
  • promote autonomy and Recovery Capital
  • aid in skill development as well as symptom
    management and treatment

31
Practice Guidelines Community Inclusion
  • People in recovery can be assisted to connect to
    community resources
  • Agencies
  • identify and regularly update traditional and
    non-traditional resource directories
  • integrate program activities into community life
  • utilize community social, recreational,
    educational, vocational, faith resources

32
Practice Guidelines Housing and Work
  • Agencies
  • link people in recovery to safe affordable
    housing
  • offer a range of work and educational
    opportunities to all persons in recovery
  • eliminate work eligibility requirements
  • strengthen linkages to vocational and educational
    providers

33
Practice Guidelines Evidence-Based Practices
  • People in recovery
  • Provide information to help shape local
    adaptation of EBPs
  • Participate in program evaluations
  • Help interpret data
  • Provide ideas about promising practices that need
    more research
  • Agencies implement and sustain recovery-oriented
    EBPs

34
Practice Guidelines Cultural Competency
  • Agencies
  • evaluate data to ensure that members of diverse
    cultural groups are receiving effective treatment
  • provide services and materials that are
    linguistically and culturally appropriate
  • establish and utilize relationships with local
    community institutions
  • identify and eliminate health disparities
  • conduct culturally competent assessments
  • maintain staff composition that reflects
    diversity of population served

35
Practice Guidelines Quality and Performance
  • Agencies
  • regularly administer opinion and satisfaction
    surveys
  • collect recovery-oriented performance measures
  • have a Continuous Quality Improvement (CQI)
    process that seeks to eliminate barriers to
    recovery
  • Persons in recovery
  • participate on CQI committees
  • inform service needs assessment
  • identify effective practices

36
IMPLICATIONS and STRATEGIES FOR CHANGE
37
System (Policy)
Program (Provider)
Practitioner (Clinical)
Convey Hope and Respect
Culturally competent
Fidelity to model
Person-Centered
38
Phase 1 Determine Direction
  • Develop Concepts Design Model
  • Principles and core values
  • Recovery definition
  • Literature reviews, outside consultation
  • Develop Consensus
  • Consumers/people in recovery
  • Family members
  • Service providers
  • Advocates
  • Spread the Word - Create Awareness

1
2
3
39
Create Awareness
Increasing numbers of people
Consumers, Families, Advocates
Boards of Directors
OBH Staff
Line Staff
Executive Directors
Legislators, Civic Leaders, Clergy
Medical Staff
General Public
Program Directors
And Increasing depth of content
40
Phase 2 Initiate Change
  • Focus on Quality
  • Provider self-assessment Agency Recovery
    plans
  • Plan approval and implementation
  • Performance guidelines
  • Performance measures and monitoring
  • Workforce development
  • Intensive skill-based training
  • Consultation for providers
  • Service system re-design
  • New funding and realignment of existing resources

1
2
3
4
5
41
Phase 3Increase Depth and Complexity
  • Provide Advanced Training
  • Continue Evolving Recovery-Oriented Performance
    Measures
  • Re-align fiscal resources
  • use contract language as change tool
  • use incentives

1
2
3
4
42
Upcoming Activities
  • Community orientation sessions
  • Reinvestment RFPs
  • Release of Trilogy
  • Provider technical assistance
  • Building internal capacity
  • System Transformation Groups

43
Benefits for the Community
  • Improved Recovery Outcomes
  • Improved treatment retention
  • Increased consumer/person in recovery
    satisfaction
  • Broadened community supports
  • Staff development through state-of-the-art
    training

44
How Will This Affect Me?
  • A recovery orientation will impact
  • How we do our jobs
  • Consumer/client outcomes
  • Program models
  • Career development opportunities
  • Our communities

45
Future Challenges
  • Shifting the Culture of the System
  • Reconciling client rights and best practices
  • Ethical rules
  • Risk Management
  • Resource Allocation
  • Changes in Administrative Infrastructure,
    Particularly the Policy of other State Agencies

46
Improved quality of life
Measuring Success
Improved treatment retention
Meaningful social roles
Increased consumer satisfaction
Increased consumer participation
Greater Vocational participation
Independent functioning
Identification of best practices
Increased use of peer support and self help
Reduction in stigma
47
Let no one ever come to you,without leaving
happier better.
  • Mother Teresa

48
Questions?
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