Moving to Recovery and PersonCentered Practice Clinical Supervisor Training

1
Moving to Recovery and Person-Centered
PracticeClinical Supervisor Training

• WNYCCP Spring 2006
• Neal Adams MD MPH
• Diane Grieder M.Ed

2

• If you dont know where you are going, you will
  probably end up somewhere else.
• Lawrence J. Peter

3
Agenda for AM
4
Agenda for PM
5
Assumptions

• This audience
• knows something about recovery principles and
  person-centered care
• is interested in moving from theory/values to
  practical implementation strategies
• wants to improve their clinical and supervisory
  skills

6
(No Transcript)
7
Objectives

• Understand the concepts of medical necessity and
  Medicaid coverage
• Demonstrate knowledge of the technical elements
  of the person-centered plan
• Demonstrate ability to write a person-centered
  plan using stages of change and medical necessity
• Understand the role of the supervisor in
  promoting good planning

8
Planning Exercise

• What is your position at your organization?
• What are your likes and dislikes about planning?
• How does being recovery-oriented change your
  practices?
• What are you doing differently today about PCP at
  your organization (since being trained) ?
• Identify one barrier of change towards being a
  more person-centered recovery-oriented system
  that you have identified at your organization

9
Medicaid/Medical Necessity
10
Recovery

• The 2005 National Consensus Statement on Mental
  Health Recovery from SAMHSA defines mental health
  recovery as
• a journey of healing and transformation enabling
  a person with a mental health problem to live a
  meaningful life in a community of his or her
  choice while striving to achieve his or her
  full potential

11
Being Person-centered in Practice

• The consumer as a whole person
• Sharing power and responsibility
• Having a therapeutic alliance
• The clinician as person
• Language choices

12
Serving Two Masters
Understanding

• Person-centered
• Recovery
• Community integration
• Core gifts
• Partnering
• Supports self-direction

• Regulation
• Medical necessity
• Diagnosis
• Documentation
• Compliance
• Billing codes

Outcomes and Goals
13
Medical Necessity

• History
• Current application
• Standard of service and quality
• Five elements
• indicated
• appropriate
• consider issues of culture
• efficacious
• effective
• efficient

14
Where is Medical Necessity Documented?

• Treatment Plan
• formulation
• measurable objectives
• focus on skills development
• amelioration symptoms
• interventions
• specific services
• clear purpose or intent related to objective
• Service notes
• goal oriented record
• DAP / SOAP / PIE

15
What is Medicaid?

• Multi-faceted and complex federal-state public
  funded medical model insurance program
• payor of last resort
• provides benefits for
• low-income families and children
• individuals with disabilities
• including adults with severe
  mental illnesses in community
  settings
• largest and growing source of
  funding for public MH services

16
Program Characteristics

• Each state has
• its own CMS approved plan
• single designated state authority
• eligibility criteria
• Mandated and optional covered services
• public mental health services are provided under
  various options and waivers
• States responsible for medical necessity criteria
• criteria are embedded in states limitations on
  the amount, duration, and scope of services

17
Clinic vs. Rehab Option

• Clinic medical model core Medicaid benefit
• clinic based
• stabilization
• licensed practitioners
• outpatient programs
• Rehab recovery model state option
• active treatment and participation
• community based
• peer supports and professionals
• providing more than one covered service

18
CMS Guidance for Clinic Option

• Services must be specified / furnished in an
  individual plan of care
• written plan to improve the patient's condition
  so that continued services are no longer
  necessary
• contains a written description of
• treatment objectives for that patient
• treatment regimen
• projected service delivery schedule
• the personnel who will furnish services
• when reevaluations will be conducted to update
  the POC

19
CMS Guidance for Clinic Option

• Services must be specified / furnished in an
  individual plan of care
• POC must be reviewed no less frequently than
  every 90 days
• services that depart from the treatment plan
  (e.g., emergency services) must be thoroughly
  documented when billed

20
Rehabilitation Option Services

• Individual and group clinic outpatient services
• Crisis services
• Family psychosocial education
• Peer support
• Life skills training and support across a variety
  of community living dimensions
• Assertive Community Treatment
• Medication education and management
• Community residential services and supports
• Illness and disability management
• Supported employment

21
Focus on Skills

• 1992 HCFA (now CMS) memorandum to Regional
  Administers
• last broad federal policy guidance published
• distinguished between
• providing assistance (such as meal preparation)
  for the individual (personal assistance)
• teaching meal preparation skills to the person
  (rehabilitation)

22
Rehab Examples

• Basic Skills Training
• restoration of basic skills necessary to
  independently function in the community
• food planning and preparation, maintenance of
  living environment, community awareness, etc.
• Social Skills
• redevelopment of skills necessary to enable and
  maintain independent community living
• communication and socialization skills
• Counseling and Therapy Services
• directed toward the elimination of psychosocial
  barriers that impede the development or
  modification of skills necessary for independent
  functioning in the community

23
Transformation Principles

• services and treatments must be consumer and
  family centered, geared to give consumers real
  and meaningful choices about treatment options
  and providers not oriented to the requirements
  of bureaucracies
• care must focus on increasing consumers ability
  to successfully cope with lifes challenges, on
  facilitating recovery, and on building
  resilience, not just on managing symptoms
• Presidents New Freedom Commission on Mental
  Health

24
Systems transformation begins with a
transformation of the life/services planning
process.
25
Community Support

• CSS framework encompasses a core set of
  principles to guide services for individuals with
  serious mental illnesses
• Services should be
• person-centered
• empowering of individuals
• ethnically and culturally appropriate
• flexible
• focused on a persons strengths
• normalized and incorporate natural supports
• tailored to meet special needs/coordinated
• USING MEDICAID TO SUPPORT WORKING AGE ADULTS
• WITH SERIOUS MENTALILLNESSES IN THE COMMUNITY A
  HANDBOOK
• SAMHSA 2005

26
Caveats

• In deciding whether a service could be offered
  under this coverage, states were advised that
  while it is not always possible to determine
  whether a specific service is rehabilitative by
  scrutinizing the service itself, it is more
  meaningful to consider the goal of the
  treatment.

27
NY Psych Rehab Plan

• Section 587.17 Service Planning for IPRT
• the psychiatric rehabilitation service plan shall
  be a mutually agreed upon course of action which
  identifies the following
•    1)  statement of rehabilitation
  aspirations   
• 2)  statement of service goals and
• objectives
• 3)  identification of planned
  interventions
• 4)  proposed time periods 

28
NY State Section 587.16

• Treatment Planning for Clinic Treatment Programs,
  CDT, and Day Treatment Programs Serving Children
• planning shall be based on an assessment of the
  recipient's psychiatric, physical, social, which
  identify
• recipient's designated psychiatric diagnosis
• recipient's problems and strengths
• recipient's treatment goals consistent with the
  purpose and intent of the program
• the specific objectives and services necessary to
  accomplish goals

29
Reviewing the Plan

• A periodic review of the treatment plan shall
  include the following
• input
• of all staff involved in recipients treatment
• the recipient, his or her family and/or other
  collaterals, as appropriate
• assessment of the progress towards the mutually
  agreed upon goals in the plan
• adjustment of goals, time periods for
  achievement, intervention strategies or
  initiation of discharge planning, as appropriate
• the signature of the physician involved in the
  treatment

30
DRA and Future of Medicaid
31
(No Transcript)
32
Supporting the Participant in Service Plan
Development

• Specify
• the supports and information that are made
  available to the participant (and/or family or
  legal representative, as appropriate) to direct
  and be actively engaged in the service plan
  development process
• the participants authority to determine who is
  included in the process.

33
Service Plan Development Process

• Describe the process that is used to develop the
  participant-centered service plan
• who develops the plan, who participates in the
  process, and the timing of the plan
• the types of assessments that are conducted to
  support the service plan development process
• information about participant needs preferences
  and goals, and health status
• how the participant is informed of the services
  that are available

34
Service Plan Development Process

• Describe the process that is used to develop the
  participant-centered service plan
• how the plan development process ensures that the
  service plan addresses participant goals, needs
  (including health care needs), and preferences
• how waiver and other services are coordinated
• how the plan development process provides for the
  assignment of responsibilities to implement and
  monitor the plan

35
Service Plan Development Process

• Describe the process that is used to develop the
  participant-centered service plan
• how and when the plan is updated
• including when the participants needs change
• State laws, regulations, and policies cited that
  affect the service plan development process are
  available to CMS upon request through the
  Medicaid agency

36
The road to recovery...

• Person-centered planning
• is a collaborative process
  resulting in a recovery
  oriented treatment plan
• is directed by consumers and produced in
  partnership with care providers for treatment
  and recovery
• supports consumer preferences and a recovery
  orientation
• Adams/Grieder

37
Perspectives

• There are no guarantees in life
• Quality of the documentation is the real problem
• Its not about the forms!
• Retreat to the medical model ?
• we dont agree!!!
• Best solution
• promote recovery principles
• carefully and consistently record clinical
  thinking in a way that serves both masters
• be proactive!

38
Nuts and Bolts

39
A Plan is a Road Map

• Provides hope by breaking a seemingly
  overwhelming journey into manageable steps for
  both the provider and the person served.

B
C
D
A
E
life is a journeynot a destination
40
Building a Plan
Outcomes
Services
Objectives
Strengths/Barriers
Goals
Prioritization
Understanding
Assessment
Request for services
41
Goals

• Long term, global, and broadly stated
• the broader the scope the less frequently
  it needs to change
• perception of time may be culture bound
• may influence expectations and participation
• Life changes as a result of services
• focus of alliance / collaboration
• readily identified by each person
• Linked to discharge / transition criteria and
  needs
• describes end point of helping relationship

42
Goals continued

• Person-centered
• Ideally expressed in person serveds / familys
  words
• Easily understandable in preferred language
• Appropriate to the persons culture
• reflect values, life-styles, etc.
• Consistent with desire for
  self-determination and
  self-sufficiency
• may be influenced by
  culture and tradition

43
Goals continued

• Three types
• life goals
• treatment goals
• quality of life / enhancement goals
• Essential features
• attainable
• one observable outcome per goal
• realistic
• written in positive terms
• built upon abilities / strengths, preferences and
  needs
• embody hope
• alternative to current circumstances

44
Barriers

• What is keeping the person
  from their goals?
• need for skills development
• intrusive or burdensome symptoms
• lack of resources
• need for assistance / supports
• problems in behavior
• challenges in activities of daily living
• threats to basic health and safety
• Challenges / needs as a result of a mental /
  alcohol and/or drug disorder

45
Strengths

• Environmental factors that will increase the
  likelihood of success community supports,
  family/relationship support/involvement, work
• Identifying the persons best qualities/motivation
  
• Strategies already utilized to help
• Competencies/accomplishments
• Interests and activities, i.e. sports, art
• identified by the consumer and/or the provider

46
Examples of Strengths

• Motivated to change
• Has a support system friends, family
• Employed/does volunteer work
• Has skills/competencies vocational, relational,
  transportation savvy, activities of daily living
• Intelligent, artistic, musical, good at sports
• Has knowledge of his/her disease
• Sees value in taking medications
• Has a spiritual program/connected to church
• Good physical health
• Adaptive coping skills
• Capable of independent living

47
Objectives

• Work to remove barriers and
• build on strengths
• Culture of persons served shapes setting
  objectives
• address culture bound barriers
• Expected near-term changes to meet long-term
  goals
• divide larger goals into manageable tasks
• provide time frames for assessing progress
• maximum of two or three per goal recommended

48
Objectives

• Build on strengths and resources
• Essential features
• behavioral
• achievable
• measurable
• time framed
• understandable for the person served
• Services are not an objective

49
Objectives

• Appropriate to the setting / level of care
• Responsive to the persons individual
• disability, challenges and recovery
• Appropriate for the persons age, development and
  culture
• The individual / family will
• changes in behavior / function / status
• described in action
  words

50
Interventions

• Actions by staff, family, peers, natural supports
• Specific to an objective
• Respect consumer choice and preference
• Specific to the stage of change/recovery
• Availability and accessibility
  of services may be impacted by
  cultural factors
• Describes medical necessity

51
Five Critical Elements

• Interventions must specify
• provider and clinical discipline
• staff members name
• modality
• frequency /intensity / duration
• purpose / intent / impact
• Clarifies who does what
• Include a task for the family, or other component
  of natural support system to accomplish

52
Carmenan 18 year old Latina

• High school senior
• preparing for graduation
• First generation
• parents monolingual Spanish speaking
• client bilingual
• observant Catholic family
• Lives in predominantly Anglo-American community

53
Vignette continued

• Excellent student
• Active in school and social activities
• Recently unable to attend school because of
  distress
• Graduation from high school and college
  attendance is core value for Carmen and family
• Recent physical problems
• Nausea, vomiting, dizziness, headaches
• Parents believe she is suffering from susto
• Treatment from curandero

54
Vignette continued

• Recent crisis
• Acute physical distress
• Admitted to hearing a baby cry while at school
• Reported feeling sad and blue
• Referred to mental health
• Embarrassed and resistant
• First family member to seek MH services

55
Vignette continued

• Assessment with Latina provider in Spanish
• Revealed she had a miscarriage a year ago
• Feeling increasingly guilty and troubled
• Wants to die and join her baby
• Relationship with parents has become distant and
  conflictual
• father refusing to speak with her

56
Formulation

• Identity
• first generation Latina
• bilingual
• Explanation of Illness
• what appeared to be a physical problem is a
  mental health problem
• somatization is idiom of distress
• shame, guilt and embarrassment are key themes
• Provider relationship
• Spanish preferred
• more open with Latina clinician

57
Formulation continued

• Psychosocial environment
• lives with family, first generation
• some degree of acculturation and distance from
  parents
• difficult and painful
• Diagnosis
• consider possibility of culture bound syndrome
• Susto
• possible depression with psychotic features
• understanding her beliefs may be key to treatment

58
Formulation

• Hypothesis
• Intergenerational issues of acculturation are a
  major factor
• age appropriate issues of individuation and
  separation
• some ambivalence about help-seeking
• school completion and education opportunity and
  advancement are shared values /strengths to build
  upon
• need to help her reconcile feelings of guilt and
  remorse
• religious and spiritual factors may be
  significant

59
Stages of Change and Recovery

• Prochaska and DiClemente
• Ohio Department of MH
• The VillageLA County MHA
• Stanislaus County
• Boston University Center for Psychiatric
  Rehabilitation Center
• AACP / LOCUS

60
Prochaska and DiClemente

• Precontemplation
• not yet considering change
• Contemplation
• considering change but remains ambivalent
• Preparation
• committed to change and planning to make change
  in the near future
• Action
• actively taking steps but has not stabilized
• Maintenance
• achieved change stabilized and maintaining

61
Stages of Recovery and Treatment
62
as suggested by Ed Knight
The person is
63
Another view of recovery stages
derived from BU Center for Psych Rehab
64
Meeting client where theyre at



ADDICTION RECOVERY
Relapse Prevention
Pre Contemplation
Sustained Recovery
Early Intervention
Action
Contemplation
Prevention
Each person is able to utilize interventions
responsive to their stage of change
Pre- Contemplation
Self Care
Engaged in Active Treatment and Rehab
Early Identification and Intervention
Prevention
Contemplation
MENTAL HEALTH RECOVERY
65
Pre-contemplation

• The individual is often
• unwilling to consider change
• unaware of having a disease, disorder, disability
  or deficit
• unaware of the causes and consequences of the
  disease, disorder, disability or deficit
• unaware of the need for treatment and
  rehabilitation
• reluctant/opposed to engaging in treatment and
  rehabilitation

66
Pre-contemplation stage approaches

• Consciousness-raising interventions
• sharing observations, confronting the individual
  with specific consequences of their behavior
• Building a therapeutic alliance
• understanding and emotional relationship
• Non-possessive warmth
• provider relates to the person as a worthwhile
  human being
• shows unconditional acceptance of the person (as
  opposed to the behavior, e.g., addiction, offense)

67
Pre-contemplation stage approaches

• Empathic understanding
• provider tries to understand what the individual
  is experiencing from the individuals frame of
  reference
• Catharsis
• provider engages in active listening skills,
  empathic observations
• Intervention
• confronting the individual in a gentle
  non-judgmental, caring and loving manner

68
Carmen Pre-contemplation

• Now assume that
• Carmen believes that her condition is utterly
  hopeless, that her sins are unforgivable, that
  she has irrevocably shamed her family, and that
  she is doomed to a life of suffering.

69
Carmen's Plan Pre-contemplation

• Goal
• I dont have any goals for my future
• Objective
• Within 6 weeks Carmen will share her daily mood
  journal with her therapist.

70
Carmen's Plan Pre-contemplation

• Intervention
• Olinda Garcia, LCSW, will provide Carmen with
  supportive psychotherapy 1 hour/ week for 6 weeks
  in order to build a safe and trusting
  relationship that can help her to overcome her
  fears and avoidance of treatment

71
Contemplation/preparation

• The individual is often
• somewhat aware of their issues / problems/ needs
• partially able to acknowledge the need for change
• prepared to set goals and priorities for future
  change
• receptive to treatment plans that include
  specific focus of interventions, objectives, and
  intervention plans

72
Contemplation stage approaches

• Continue with precontemplative stage
  consciousness-raising interventions
• Motivational interventions
• pay-off matrix
• Slowly introduce new interventions
• bibliotherapy
• psycho-education
• peer supports/modeling
• Early efforts at goal setting

73
Contemplation stage approaches

• Presuppositional Questions
• used to encourage individuals to examine and
  evaluate their needs
• think about change in a non-threatening context
• Example
• consider an individual who is still not sure
  he/she has a problem
• Lets agree that what you are saying is true
  ...whats keeping you from doing what you really
  want?

74
Contemplation stage approaches

• Circular Questions
• used in a non-threatening manner to ask a
  question about the individuals issues, situation
  or predicament from the perspective of an
  outsider
• Example
• consider an individual who thinks others are
  overstating his/her difficulties
• How can you show your friends and family that
  you are ready to move forward in your life?

75
Contemplation stage approaches

• Miracle questions
• used as a method to assist an individual in
  imaging change and with goal setting
• Example
• Suppose you go to bed tonight, and while you are
  asleep a miracle happens and all your issues,
  situations, or predicaments disappear.
  Everything is resolved to your liking. When you
  wake up in the morning, how will you know that
  the miracle happened? What would be the first
  thing you would notice that is different?

76
Preparation stage approaches

• Continue with contemplative stage awareness
  enhancing interventions
• Slowly introduce new interventions
• Encourage the individuals sense of
  self-liberation and foster a sense of personal
  recovery by taking control of his or her life

77
Preparation stage approaches

• Identifying triggers
• the provider enhances the individuals awareness
  of the conditions that give rise to his/her
  issues, situations or predicaments
• focus is on the presence or absence of
  antecedents, setting events, and establishing
  operations

78
Preparation stage approaches

• Scaling Question
• used as a tool by the individual to buy into
  the treatment planning process
• obtain a quantitative baseline
• assist the individual to take the next step in
  the process of recovery
• encourage the individual to achieve recovery by
  successive approximations
• Example
• On a scale of 1 to 10, with 1 being totally not
  ready and 10 being totally ready, how would you
  rate your current readiness to make changes in
  your life?

79
Carmens PlanContemplation / Preparation

• Now assume that
• Carmen now understands that it is fairly normal
  for teens in this culture to experiment with
  relationships and sex, that people make mistakes
  in their lives, and that it is possible for
  things to change and improve. She feels less
  negative and hopeless about the possibility of
  going to college but cant imagine what else she
  might do or how she can back on track.

80
Carmens PlanContemplation / Preparation Stage

• Goal
• I need to know what my future will be
• Objective
• Within one month Carmen will have a plan for her
  high school and college education

81
Carmens PlanContemplation / Preparation Stage

• Intervention
• Susan Williams, Case Manager, will meet with
  Carmen 2x per week for 1 month in order to help
  her access home-schooling supports so that she
  can graduate without returning to class
• Beth Angeles, peer specialist, will meet with
  Carmen one time per week for one month to provide
  support and encouragement

82
Action

• Characteristics
• making successful efforts to change
• developing and implementing strategies to
  overcome barriers
• requires considerable self-effort
• noticeable behavioral change takes place
• target behaviors are under self-control, ranging
  from a day to six months

83
Action Stage Approaches

• Cognitive-behavioral approaches
• Explore and correct faulty cognitions
• catastrophizing
• overgeneralizing
• magnification
• excessive responsibility
• dichotomous thinking
• selective abstraction
• Learning-based approaches
• Action-oriented approaches
• Skills and support rehabilitation

84
Carmens Plan Action Stage

• Goal
• I want to graduate from high school
• Objective
• Carmen will return to class attendance for 10
  consecutive full days within a month as reported
  by Carmen / or support worker

85
Carmens Plan Action Stage

• Possible interventions
• Psychiatrist to provide weekly to monthly
  pharmacotherapy management for 3 months to
  relieve acute sx of anxiety and depression
• Social worker to provide one hour of
  cognitive-behavioral psychotherapy X2/ week for
  4 weeks to help Carmen resolve feelings of guilt
  and loss
• Support worker to meet with Carmen up to 3 hours
  / week for 4 weeks as required to coordinate /
  facilitate return to school with school
  counselors and mental health team
• Carmen to attend weekly teen support group at
  community center 3 months to address with peers
  issues of identity and acculturation

86
Maintenance/Relapse Prevention

• Characteristics
• Meet discharge criteria
• Be discharged
• Maintain wellness and enhance functional status
  with minimum professional involvement
• Live in environments of choice
• Be empowered and hopeful
• Engage in self-determination through appropriate
  choice-making

87
Maintenance Stage Approaches

• Adapt and adjust to situations to facilitate
  maintenance
• Develop personal wellness recovery plans
• Utilize coping skills in the rhythm of life,
  without spiraling down (i.e., if substance use is
  a problem, cope with distressing or faulty
  cognitions without using drugs)
• Learn about mindfulness, especially unconditional
  acceptance, loving kindness, compassion for self
  and others, and letting go

88
Carmens Plan Maintenance Stage

• Goal builds on goal from active stage
• I want to succeed in college
• Objective
• Carmen will develop the cognitive and behavioral
  skills to remain free of depressive symptoms as
  measured by completing a first semester at
  college

89
Carmens Plan Maintenance Stage

• Interventions
• Continue with monthly pharmacotherapy with Dr.
  Hall to prevent recurrence of symptoms for 6
  months
• Stacey Hahnemann, M.Ed, will provide CBT every
  other week for 6 months to learn affect
  management and conflict resolution skills
• Continue to attend teen support group for 6
  months at least one time per month for ongoing
  support with acculturation issues

90
The tale of two consumers

• Traditional Model
• What are Robertas strengths?
• What are Robertas goals in life?
• What are Robertas treatment goals?
• Recovery Model
• What are Ruths strengths?
• What are Ruths goals in life?
• What are Ruths treatment goals?

91
Roles and Abilities of The Supervisor

• Coach
• Mentor
• Facilitator
• Solution-focused
• Competent (KSAs)
• Capable
• Expert
• Accessible
• Change agent

92
Traveling the Transformation Highway
Transformation Highway
93
Transformation

• A break with the past
• Quantum change
• More than just reorganizing
• new mission and vision for the organization
• Transformation virtually always refers to a
  positive change
• a movement to a new venture
• A radical redesign and new strategic intent for
  the organization

94
Transformation

• T

(V B A) x (CQI)2
Resistance to change
V vision B beliefs A action
CQI continuous quality improvement
95
(No Transcript)
96
(No Transcript)
97
(No Transcript)
98
(No Transcript)
99
(No Transcript)
100
Youre the picture of healthand by the way, Im
totally in love with you
101
Setting the Compass
Experience of Individuals, Families and
Communities
Microsystems of Care Where care occurs
Health Care Organizations
External Environment of Care Policy/Financing/Regu
lation
102
Change Model
Competency knowledge, skills and abilities
Transformation
Project Management work / business flow
Change Management behavior and attitude
103
PCP Competencies

• Providers should be able to
• understand the concepts of
  recovery, resilience, wellness, person-centered
  and culturally competent approaches
• understand and value the centrality of the
  individual planning process as a roadmap to
  recovery and wellness
• understand how emerging new frameworks differ
  from past and current practice
• identify the elements of a plan and the criteria
  for each element

104
PCP Competencies

• Providers should be able to
• understand the concept
  of medical necessity and key
  elements of documentation
• conduct a strengths based person-centered and
  culturally competent assessment
• create a formulation or integrated summary based
  upon the assessment
• evaluate the individuals/families stage of
  change to inform and guide the planning process
• help individuals/families articulate
  person-centered goals and discharge/transition
  needs

105
PCP Competencies

• Providers should be able to
• help individuals/families articulate
  person-centered goals and discharge/transition
  needs
• identify barriers and establish priorities to
  attaining the goal's
• elaborate objectives to resolve barriers in
  partnership with the person and family served
• build on strengths, choices, preferences and
  stage of change to recommend interventions,
  services, supports and other strategies to
  promote positive change

106
PCP Competencies

• Providers should be able to
• Specify a broad range of
  culturally-competent stage
  appropriate supports / services
• Accept the individuals / families dignity,
  ability to take risk and right to fail
• Facilitate/monitor/coordinate plan implementation
  
• Provide timely update of assessment and plan
• Properly document plan elements and services
• Participate in an ongoing quality management
  process
• Provide outcome data to demonstrate effectiveness

107
Competencies New Zealand MH

• A competent mental health worker
• understands recovery principles
  and experiences in the Aotearoa /
  NZ and international contexts
• recognizes and supports the personal
  resourcefulness of people with mental illness
• understands and accommodates the diverse views on
  mental illness, treatments, services and recovery
  
• has the self-awareness and skills to communicate
  respectfully and develop good relationships with
  service users

108
Competencies New Zealand MH

• A competent mental health worker
• understands and actively protects service
  users rights
• understands discrimination and
  social exclusion, its impact on
  service users and how to reduce it
• acknowledges the different cultures of
  Aotearoa/NZ and knows how to provide a service in
  partnership with them
• has comprehensive knowledge of community services
  and resources and actively supports service users
  to use them

109
Competencies New Zealand MH

• A competent mental health worker
• has knowledge of the service user movement and is
  able to support their participation
  in services
• has knowledge of family/ individual perspectives
  and is able to support their participation in
  services

110
12 Aspects of Staff Transformation

• Looking forward and rebuilding the passion
• Building inspiration and belief in recovery
• Changing from treating illness to helping people
  with illnesses have better lives
• Moving from caretaking to empowering, sharing
  power and control
• Gaining comfort with mentally ill co-staff and
  multiple roles
• Valuing the subjective experience
• Mark Ragins, MD

111
Staff Transformation cont

• Creating therapeutic relationships
• Lowering emotional walls and becoming a guiding
  partner
• Understanding the process of recovery
• Becoming involved in the community
• Reaching out to the rejected
• Living recovery values

112
The next step is

• Lunch!

113
Writing Plans

• In your teams write a person-centered plan
  using the principles learned and the assessments
  / formulations provided
• Choose a group recorder
• Select a person to role play the consumer in the
  assessment
• Write your teams plan on the transparency
• 1 goal, 1 objective, 2 to 3 interventions
• Choose a group spokesperson for the report out

114
In Conclusion