Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input Process - PowerPoint PPT Presentation


Title: Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input Process


1
Summary of NJ DMHS Wellness and Recovery
TransformationStakeholder Input Process
  • Presentation to Stakeholders
  • Mercer County Community College
  • March 2, 2007

2
Sources of Recommendations
  • 120 stakeholder committee and subcommittee
    participants including community practitioners,
    advocates, state employees, family members,
    consumers, and others
  • More than 200 consumer and families in focus
    groups

3
Five Broad Areas of the Stakeholder Summary
  • Consumer and Family Input
  • Evidence-Based and Promising Practices will
    Promote Recovery
  • System Enhancements
  • Workforce Development Education, Training,
    Supervision, Retention
  • Data-Driven Decision Making and other
    Contractual/Regulatory Processes

4
I. Consumer and Family Input
  • The value of consumer and family input at every
    level of service development, provision, and
    monitoring was highlighted. All stakeholders
    believe that input from consumers and family
    members is integral to a system that emphasizes
    Wellness and Recovery principles.

5
Consumer Definitions of Wellness from Consumer
Input Forums
  • In general, wellness was understood by consumers
    to be related to
  • taking care of oneself and a state of physical
    and emotional health.
  • statements that defined wellness as, a state of
    mind, attitude, staying drug free, keeping busy
    and getting enough nutrition, exercise and rest,
  • an overall condition of being healthy, not
    being emotional nor physically down.

6
Consumer Definitions of Recovery
  • Traditionally oriented definitions of recovery
    related to becoming free of symptoms and illness.
    In these statements, recovery was large defined
    as an outcome of a process.
  • symptoms to disappear, and medicine,
    stabilize, and get back to your life.
  • Consumer-driven recovery was understood as a
    process and/or
  • Identified community supports as vital in this
    process, for example, having supports in the
    community to stay out of hospital,
  • Learning about your illness, taking your time
    to get better, getting enough love, family
    support, and ,recovery you have to work on.
    If you do not work on it, it will go away.

7
Consumers Recommendations for Wellness and
Recovery
  • Improving Community Supports, Linkages, and
    Services
  • Improving Staff/Consumer Interactions
  • Securing Physical and Emotional Safety
  • Creating Therapeutic Environments
  • Supporting Autonomy, Choices, and Personal Goals
  • Overcoming Personal Barriers Self-management

8
Improving Community Supports, Linkages, and
Services
  • Better community services to prevent long-term
    hospital services
  • Upper management more accountable and accessible
  • Get patients out of the hospital faster

9
Improving Community Supports, Linkages, and
Services
  • Improve linkage between inpatient and aftercare
  • make sure each consumer has a doctor
  • schedule several community agency appointments in
    Advance
  • provide information on which community agencies
    to contact
  • assist with Section 8 and Social Security
    paperwork

10
Improving Community Supports, Linkages, and
Services
  • connect consumers with addiction services and
    community twelve-step programs
  • strengthen ICMS and PACT
  • offering additional support groups, resources,
    general support, individual therapy, and
    personalized treatment plans

11
Improving Community Supports, Linkages, and
Services
  • Address stigma and the relationships between
    various public service employees
  • better linkages between inpatient and outpatient
    providers
  • improved training for police and mental health
    screeners
  • more community staff
  • increase in emergency 911 cell phones
  • live contact support person 24 hrs a day
  • education on mental illness for general public
    and MH providers

12
Improving Community Supports, Linkages, and
Services
  • Barriers to remaining in the community
  • Lack of employment,
  • Lack of transportation,
  • Inadequate housing,
  • Few educational opportunities

13
Improving Staff/Consumer Interactions
  • Hospital staff should be
  • more caring and understanding
  • offer hope through better communication
  • make the hospital a calmer place
  • be receptive to needs, respectful, and nurturing

14
Improving Staff/Consumer Interactions
  • Staff should understand that consumers still had
    to take care of personal business in the
    community while hospitalized
  • Create a business day a day outside of the
    hospital to handle bills and other things

15
Physical and Emotional Safety
  • A lack of physical and emotional safety from
    peers and staff was a concern identified by
    several consumers
  • Experiences ranged from bullying to physical
    attacks
  • Many recommendations that consumers be grouped by
    diagnosis/ functioning level

16
Therapeutic Environment-Improved Treatment
Activities
  • Recommendations
  • 11 therapy
  • employment activities
  • music/game rooms
  • outdoor activities,
  • more exercise
  • educational movies
  • topic specific groups
  • more relaxation time (less forced
    socialization)
  • Community transition activities
  • Attending church of their choice

17
Therapeutic Environment-Improved Treatment
Activities
  • Improving physical aspects of the environment
  • improved lighting and painting the walls in the
    bedrooms
  • Less noise
  • Individual interventions
  • ear plugs, dental floss, and hygiene products,

18
Autonomy, Choices, and Personal Goals
  • Consumers have little choice over small things
    such as phone calls, wake up times, food choices,
    or when to meet with the team.
  • The forums recommended increases in choices.

19
Overcome Personal Barriers Self-management
  • Consumers acknowledged that taking responsibility
    for their behavior and illness is important for
    recovery
  • Consumers comments reflected a level of
    hopelessness and isolation in their experiences
  • Consumers identified building and maintaining
    relationships with others as barriers to their
    recovery.

20
Additional themes from Community-Based Consumer
Family Forums
  1. Treatment Planning and Support
  2. Staffing
  3. Resource Allocation
  4. Data Driven Decision Making
  5. Methods of Disseminating Information

21
Treatment Planning and Support
  • Involvement of family members in wellness and
    recovery planning and support of plans
  • Include the input of significant paid and unpaid
    supporters in all aspects of service planning,
    care, and evaluation.
  • Addressing perceived HIPAA and confidentiality
    concerns may be necessary

22
Input into Staffing Decisions
  • Mechanism for consumer input into
  • Hiring
  • Supervision, and
  • Firing decisions
  • Recruitment and retention
  • include consumers and family members as part of
    the interviewing process as well as supervision
    of evaluation plans

23
Resource Allocation
  • Include more consumers and families on county
    mental health boards and other committees
  • increase statewide input into the development and
    evaluation of programs and services
  • Evaluation of the adequacy of consumer/family
    representation on board and policy making groups

24
Data Driven Decision Making
  • Mechanisms be developed to assure consumers they
    can
  • Rate the value the services that they receive and
  • have sufficient decision making input
  • Utilize surveys in which resulting feedback would
    be incorporated into operational decision making
  • consumers administer surveys to increase
    likelihood of genuine responses

25
Methods of Disseminating Information
  • Consumer advocacy educational forums
  • Consumer dedicated website
  • Informational newsletter
  • provide updates on the transformation including
    consumer written articles
  • Input solicited via written comment on specific
    issues
  • focus groups and consumer/family survey
    information

26
II. Evidence-Based and Promising Practices
  • An ideal system is one that is wellness and
    recovery oriented and has access to a full array
    of evidence based practices as well as an array
    of programs that are promising models of
    exemplary practice.

27
Evidence Based and Promising Practices
Recommendation Themes
  • Core Competencies for all EBPs
  • Training for Specific EBPs
  • New Promising Approaches
  • Monitoring of Implementation
  • Funding and Regulatory Issues

28
Core Competencies
  • Training for mental health clinicians in the
    following areas would support several EBPs
  • Motivational Interviewing
  • Stages of Change/Recovery model of readiness
  • Cognitive-behavioral techniques

29
Core Competencies
  • Those competencies outlined above are used in
    most of the following approaches
  • Illness Management and Recovery (IMR),
  • Assertive Community Treatment (ACT/PACT),
  • Integrated Dual Diagnosis Treatment (IDDT),
  • Supported Employment,
  • Family Psychoeducation,
  • Motivational Interviewing,
  • Peer Support and Self-Help,
  • Cognitive Behavioral Therapy (CBT),
  • Supported Education (SEd), Supported Housing (SH)
  • Wellness and Recovery Action Plans (WRAP).

30
Training
  • Training
  • Current training efforts will need to be expanded
  • Training packages used should be user- friendly
  • Sites determined to be centers of exemplary
    practice should pilot the materials
  • State should collaborate with professional
    societies and academic institutions for training
    and certification of the workforce

31
New Promising Practices
  • Development of funding for
  • clubhouse models,
  • self-help centers, and
  • other consumer preferred models
  • Training for implementation of the shared
    decision making model
  • improve communication between providers and
    consumers

32
New Promising Practices (cont.)Integration of
Physical and Mental Health Services
  • Integrated primary health and mental health
    services
  • Education on physical illnesses
  • Regular assessment of health measures (BMI, BP,
    AIMS, etc.)
  • All programming should include exercise, fitness
    and nutrition and physical wellness
  • Alternative complementary medicines

33
Monitoring
  • Advisory Committee to assist DMHS in efforts to
    implement, expand, and monitor practices
  • Utilization of scientifically derived fidelity
    scales, both existing and new scales
  • Fidelity of funded programs to wellness and
    recovery principles be evaluated
  • Data collection systems at the state level need
    to be developed

34
Funding and Regulatory Issues
  • DMHS
  • provide seed money and develop training and
    implementation plans
  • further support and expand EBPs and Promising
    Practices
  • Financial incentives and/or regulatory relief for
    agencies who adopt EBPs.

35
Inter-agency collaboration
  • Collaboration between
  • Dept. of Human Services, and Dept. of Labor
    Workforce Development in order to expand EBPs and
    Promising Practices
  • NJ Division of Medical Assistance to address
    Medicaid funding of EBPs
  • Practitioners and provider agencies to involve
    providers in the development of regulations

36
III. System Enhancements
  • To complement new and expanded services,
    stakeholders felt that improvements to the
    current service systems would contribute to the
    development of a wellness and recovery-oriented
    system.

37
Recommendation Themes
  • Pervasive Treatment Philosophy and Service
    Provision
  • Evaluation of the Current System
  • Documentation
  • Consumer/Family Provider
  • Advance Directives
  • Joint Protocols and Cross Training
  • Community and Staff Education
  • Access Issues Point of Entry, Housing, Other

38
Evaluation of Current System
  • Systems Mapping
  • Compare the existing system with an ideal system
    designed by stakeholders
  • Service Duplication
  • Evaluate services for duplication and create
    regulations that clearly articulate in which
    multiple programs consumers can participate
  • Recovery Oriented System Indicator (ROSI)
  • Baseline of consumer satisfaction and a method
    for ongoing systems evaluation

39
Documentation
  • The Virtual Individualized Electronic
    Wellness/Recovery Action Plan (The VIEW)
  • Electronic record including Advance directives
  • Integrated Recovery Plan (IRP)
  • To replace the multiple treatment plans in
    multiple programs
  • Uniform Wellness and Recovery documentation
    requirements

40
Consumer/Family in New Roles
  • Navigator
  • Member of a community support team to help
    consumers navigate the system
  • Peer Educator
  • Provide self-help training and mentoring
  • Consumers provide training on mental health
    issues for members of the workforce (hospital and
    emergency personnel)

41
Advance Directives
  • Continued training and education on use of
    Advance Directives
  • Make sure Advance Directives are being honored in
    times of need
  • Navigator and Peer Educator positions can help
    with training and education

42
Joint Protocols and Cross Training
  • Shared responsibilities for multiple service
    users
  • Joint and cross training for providers of
    services for the shared populations

43
Public and Community Education
  • Anti-stigma, public information and education
    campaign
  • Particularly for the medical community,
    legislators, and developers of college curricula

44
Access Point of Entry
  • Eligible for services without having been
    hospitalized
  • No Wrong Door
  • Single point of entry for all services needed
    physical, social services, vocational,
    educational, etc.
  • No exclusionary criteria
  • Matching of consumers with needed services

45
Access Housing
  • Develop and maintain information clearinghouse
    for housing
  • Wide spectrum of housing for all levels of the
    system
  • Emergency assistance and housing subsidies

46
IV. Staff Development Recruitment, Retention,
Education, Supervision
  • Implementing EBPs and promising practices, as
    well as service system enhancements will require
    a highly competent workforce making recruitment,
    retention, and continued development of a
    qualified, competent, caring workforce as
    essential.

47
Recommendation Themes
  • Recruitment and Retention
  • Methods for Increasing Staff Competency
  • Standardized curricula
  • Training for Evidence Based Practices (EBPs)
    Promising Practices
  • Supervision
  • Consumers as Providers
  • Policy Changes
  • Hospital-Specific Recommendations

48
Recruitment Retention
  • Salary and benefit parity with state employees
    for Community Staff
  • Annual true Cost of Living Adjustments
  • Salary differentials for additional credentials
  • Career ladders

49
Recruitment Retention Credentialing
  • Certified Psychiatric Rehabilitation Practitioner
    (CPRP) as preferred credential
  • Recovery-oriented
  • Open to all educational levels/experience
  • Upward mobility for those earn CPRPs and
    specified credentials

50
Some educational programming ideas
  • Pre-paid tuition program
  • Expand existing academic programs to all state
    psychiatric hospitals
  • Expand existing academic programs to all regions
    of state
  • Use flex-time to attend classes
  • Time off for work-related educational programs

51
Recruitment of Like-Minded Individuals
  • Involve consumers in hiring, supervision, firing
  • Liaison with colleges for recruitment and
    influencing of curricula
  • Support consumer employment in field
  • Centralized website for job listings
  • Market loan forgiveness program
  • Use exit interviews in QA initiative

52
Increasing Staff Competency Standardized
Curricula
  • Developed delivered by academic entity, SME, or
    national experts
  • Core content identified by Workgroups
  • Centralized and coordinated training vs. On-site
    and customized
  • Follow-up with TA, consultation, and monitoring
  • Core courses approved for state licenses and
    national certifications
  • Establish incentives for attending training

53
Increasing Staff Competency Standardized
Curricula
  • Cross Training
  • Infuse Wellness Recovery in all state funded
    training
  • Cross train staff in DD, Aging In, Jail, DAS,
    Elderly
  • Cross train and co-train hospital and community
    staff

54
Methods for Increasing Staff Competency EBPs
  • Academic entity develop and deliver standardized,
    replicable training
  • Develop Centers of Excellence and Centers of
    Exemplary Practice as training and consultation
    sites
  • Develop agency leadership coalition to promote
    EBPs
  • Ongoing evaluation

55
Methods for Increasing Staff Competency
Supervision
  • Individual and group supervision
  • Skills based, non-punitive
  • Individual learning plans
  • Performance appraisals, evaluations, PAR/PES
    based on WR principles and competency
    development
  • WR survey tool for measuring staff application
    of WR principles

56
Consumers as Providers
  • Receive training for administration of ROSI
  • Deliver training to general community workers,
    e.g., police, EMTs, screeners
  • Deliver training on Advance Directives
  • Navigator

57
Policy Procedure Changes
  • New policies procedures will require training
    for implementation
  • Data collection and reporting
  • Electronic records, e.g., VIEW
  • Service access based on need

58
Community Standardized Curriculum 12 Domains
  • Personoriented attitudes, values, knowledge and
    behavior
  • Engaging families and significant paid and unpaid
    supporters in all aspects of service planning,
    care and evaluation
  • Knowledge of clinical and biological aspects of
    mental and physical illness and developmental
    disabilities
  • Knowledge of addictions and mental illness as
    co-occurring disorders
  • Assessment, recovery planning and documentation
  • Intervention and support strategies

59
Community Competencies 12 Domains (Continued)
  • Community resource development and acquisition
  • Legal issues and civil rights
  • Systems collaboration
  • Ethics and Professional Behavior
  • Cultural competence
  • Methods of evaluation

60
Hospitals Standardized Curricula
  • Contract with academic entity to develop
    standardized curricula for Core Competencies and
    EBPs
  • Conduct train-the-trainer sessions for training
    coordinators
  • Training coordinators will offer ongoing access
    to training for existing and new employees
  • Ongoing support and TA available to training
    coordinators through academic entity

61
Hospitals Curricula Content
  • Echoed community recommendations
  • Additional recommendations for hospital settings
  • Basic therapeutic skills
  • Accountability
  • Communication
  • Supervisory training
  • Staff safety and security during WR introduction
  • Hands on training to ease the transformation
    process

62
HospitalsAdditional Recommendations
  • Hospital Workforce Subcommittee continue to meet
    for competency development and implementation
    monitoring
  • Allocate FY2008 resources to assure equivalent
    training resources throughout the hospital system
  • Consistent staff development plan
  • Monitor and re-evaluate after one year

63
V. Data-Driven Decision Making Contracts,
Regulations, and Outcomes
  • Critical to all the recommendations outlined
    above will be the appropriate administrative
    structures and processes to support the wellness
    and recovery transformation effort and sustain
    this new orientation.

64
Recommendation Themes
  1. Establishing measurable outcomes
  2. Developing a data collection system
  3. Removing systemic obstacles
  4. Evaluating service outcomes and basing funding on
    performance
  5. Providing service performance information to
    consumers
  6. Ensuring consumer input

65
Establish Measurable Outcomes
  • Operationalize NJs transformed system
  • Identify system goals
  • Create associated outcome measures
  • Identify and/or create fidelity measures relevant
    to each modality or service.

66
Develop Data Collection System
  • Develop capacity, infrastructure, and funding
  • Establish baseline data
  • Provide initial and ongoing training

67
Remove Systemic Obstacles Promote Cross System
Collaboration
  • System-wide needs assessment
  • Data sharing
  • Include physical health data
  • Hospitalization data
  • Employment data

68
Evaluate Service Outcomes Performance Based
Funding
  • W R outcome measures in all contracts
  • Tie service outcomes first to monitoring and
    later to reimbursement and contracting decisions
  • Establish consequences and incentives
  • Redirect resources from lesser-valued/lower
    priority to higher priority services

69
Ensure Consumer Input
  • In transformation and resource allocation
  • gather input
  • provide support for participation
  • include reticent groups
  • Support consumer being well-informed
  • informational newsletter
  • educational forums
  • interactive website

70
Provide performance information to consumers and
family members
  • Performance report card
  • Specify outcome data
  • Publish on the Divisions website

71
Other Regulatory Issues
  • Work with Medicaid
  • Share data on physiological measures, other
    illness/diagnoses, and hospitalization
  • With DMAHS review and if needed revise
    regulations to support wellness and recovery
    approaches within federal guidelines
  • Working with DHS Licensing Inspections
  • Engage Office of Licensing staff
  • Review and revise regulations
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Title: Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input Process


1
Summary of NJ DMHS Wellness and Recovery
TransformationStakeholder Input Process
  • Presentation to Stakeholders
  • Mercer County Community College
  • March 2, 2007

2
Sources of Recommendations
  • 120 stakeholder committee and subcommittee
    participants including community practitioners,
    advocates, state employees, family members,
    consumers, and others
  • More than 200 consumer and families in focus
    groups

3
Five Broad Areas of the Stakeholder Summary
  • Consumer and Family Input
  • Evidence-Based and Promising Practices will
    Promote Recovery
  • System Enhancements
  • Workforce Development Education, Training,
    Supervision, Retention
  • Data-Driven Decision Making and other
    Contractual/Regulatory Processes

4
I. Consumer and Family Input
  • The value of consumer and family input at every
    level of service development, provision, and
    monitoring was highlighted. All stakeholders
    believe that input from consumers and family
    members is integral to a system that emphasizes
    Wellness and Recovery principles.

5
Consumer Definitions of Wellness from Consumer
Input Forums
  • In general, wellness was understood by consumers
    to be related to
  • taking care of oneself and a state of physical
    and emotional health.
  • statements that defined wellness as, a state of
    mind, attitude, staying drug free, keeping busy
    and getting enough nutrition, exercise and rest,
  • an overall condition of being healthy, not
    being emotional nor physically down.

6
Consumer Definitions of Recovery
  • Traditionally oriented definitions of recovery
    related to becoming free of symptoms and illness.
    In these statements, recovery was large defined
    as an outcome of a process.
  • symptoms to disappear, and medicine,
    stabilize, and get back to your life.
  • Consumer-driven recovery was understood as a
    process and/or
  • Identified community supports as vital in this
    process, for example, having supports in the
    community to stay out of hospital,
  • Learning about your illness, taking your time
    to get better, getting enough love, family
    support, and ,recovery you have to work on.
    If you do not work on it, it will go away.

7
Consumers Recommendations for Wellness and
Recovery
  • Improving Community Supports, Linkages, and
    Services
  • Improving Staff/Consumer Interactions
  • Securing Physical and Emotional Safety
  • Creating Therapeutic Environments
  • Supporting Autonomy, Choices, and Personal Goals
  • Overcoming Personal Barriers Self-management

8
Improving Community Supports, Linkages, and
Services
  • Better community services to prevent long-term
    hospital services
  • Upper management more accountable and accessible
  • Get patients out of the hospital faster

9
Improving Community Supports, Linkages, and
Services
  • Improve linkage between inpatient and aftercare
  • make sure each consumer has a doctor
  • schedule several community agency appointments in
    Advance
  • provide information on which community agencies
    to contact
  • assist with Section 8 and Social Security
    paperwork

10
Improving Community Supports, Linkages, and
Services
  • connect consumers with addiction services and
    community twelve-step programs
  • strengthen ICMS and PACT
  • offering additional support groups, resources,
    general support, individual therapy, and
    personalized treatment plans

11
Improving Community Supports, Linkages, and
Services
  • Address stigma and the relationships between
    various public service employees
  • better linkages between inpatient and outpatient
    providers
  • improved training for police and mental health
    screeners
  • more community staff
  • increase in emergency 911 cell phones
  • live contact support person 24 hrs a day
  • education on mental illness for general public
    and MH providers

12
Improving Community Supports, Linkages, and
Services
  • Barriers to remaining in the community
  • Lack of employment,
  • Lack of transportation,
  • Inadequate housing,
  • Few educational opportunities

13
Improving Staff/Consumer Interactions
  • Hospital staff should be
  • more caring and understanding
  • offer hope through better communication
  • make the hospital a calmer place
  • be receptive to needs, respectful, and nurturing

14
Improving Staff/Consumer Interactions
  • Staff should understand that consumers still had
    to take care of personal business in the
    community while hospitalized
  • Create a business day a day outside of the
    hospital to handle bills and other things

15
Physical and Emotional Safety
  • A lack of physical and emotional safety from
    peers and staff was a concern identified by
    several consumers
  • Experiences ranged from bullying to physical
    attacks
  • Many recommendations that consumers be grouped by
    diagnosis/ functioning level

16
Therapeutic Environment-Improved Treatment
Activities
  • Recommendations
  • 11 therapy
  • employment activities
  • music/game rooms
  • outdoor activities,
  • more exercise
  • educational movies
  • topic specific groups
  • more relaxation time (less forced
    socialization)
  • Community transition activities
  • Attending church of their choice

17
Therapeutic Environment-Improved Treatment
Activities
  • Improving physical aspects of the environment
  • improved lighting and painting the walls in the
    bedrooms
  • Less noise
  • Individual interventions
  • ear plugs, dental floss, and hygiene products,

18
Autonomy, Choices, and Personal Goals
  • Consumers have little choice over small things
    such as phone calls, wake up times, food choices,
    or when to meet with the team.
  • The forums recommended increases in choices.

19
Overcome Personal Barriers Self-management
  • Consumers acknowledged that taking responsibility
    for their behavior and illness is important for
    recovery
  • Consumers comments reflected a level of
    hopelessness and isolation in their experiences
  • Consumers identified building and maintaining
    relationships with others as barriers to their
    recovery.

20
Additional themes from Community-Based Consumer
Family Forums
  1. Treatment Planning and Support
  2. Staffing
  3. Resource Allocation
  4. Data Driven Decision Making
  5. Methods of Disseminating Information

21
Treatment Planning and Support
  • Involvement of family members in wellness and
    recovery planning and support of plans
  • Include the input of significant paid and unpaid
    supporters in all aspects of service planning,
    care, and evaluation.
  • Addressing perceived HIPAA and confidentiality
    concerns may be necessary

22
Input into Staffing Decisions
  • Mechanism for consumer input into
  • Hiring
  • Supervision, and
  • Firing decisions
  • Recruitment and retention
  • include consumers and family members as part of
    the interviewing process as well as supervision
    of evaluation plans

23
Resource Allocation
  • Include more consumers and families on county
    mental health boards and other committees
  • increase statewide input into the development and
    evaluation of programs and services
  • Evaluation of the adequacy of consumer/family
    representation on board and policy making groups

24
Data Driven Decision Making
  • Mechanisms be developed to assure consumers they
    can
  • Rate the value the services that they receive and
  • have sufficient decision making input
  • Utilize surveys in which resulting feedback would
    be incorporated into operational decision making
  • consumers administer surveys to increase
    likelihood of genuine responses

25
Methods of Disseminating Information
  • Consumer advocacy educational forums
  • Consumer dedicated website
  • Informational newsletter
  • provide updates on the transformation including
    consumer written articles
  • Input solicited via written comment on specific
    issues
  • focus groups and consumer/family survey
    information

26
II. Evidence-Based and Promising Practices
  • An ideal system is one that is wellness and
    recovery oriented and has access to a full array
    of evidence based practices as well as an array
    of programs that are promising models of
    exemplary practice.

27
Evidence Based and Promising Practices
Recommendation Themes
  • Core Competencies for all EBPs
  • Training for Specific EBPs
  • New Promising Approaches
  • Monitoring of Implementation
  • Funding and Regulatory Issues

28
Core Competencies
  • Training for mental health clinicians in the
    following areas would support several EBPs
  • Motivational Interviewing
  • Stages of Change/Recovery model of readiness
  • Cognitive-behavioral techniques

29
Core Competencies
  • Those competencies outlined above are used in
    most of the following approaches
  • Illness Management and Recovery (IMR),
  • Assertive Community Treatment (ACT/PACT),
  • Integrated Dual Diagnosis Treatment (IDDT),
  • Supported Employment,
  • Family Psychoeducation,
  • Motivational Interviewing,
  • Peer Support and Self-Help,
  • Cognitive Behavioral Therapy (CBT),
  • Supported Education (SEd), Supported Housing (SH)
  • Wellness and Recovery Action Plans (WRAP).

30
Training
  • Training
  • Current training efforts will need to be expanded
  • Training packages used should be user- friendly
  • Sites determined to be centers of exemplary
    practice should pilot the materials
  • State should collaborate with professional
    societies and academic institutions for training
    and certification of the workforce

31
New Promising Practices
  • Development of funding for
  • clubhouse models,
  • self-help centers, and
  • other consumer preferred models
  • Training for implementation of the shared
    decision making model
  • improve communication between providers and
    consumers

32
New Promising Practices (cont.)Integration of
Physical and Mental Health Services
  • Integrated primary health and mental health
    services
  • Education on physical illnesses
  • Regular assessment of health measures (BMI, BP,
    AIMS, etc.)
  • All programming should include exercise, fitness
    and nutrition and physical wellness
  • Alternative complementary medicines

33
Monitoring
  • Advisory Committee to assist DMHS in efforts to
    implement, expand, and monitor practices
  • Utilization of scientifically derived fidelity
    scales, both existing and new scales
  • Fidelity of funded programs to wellness and
    recovery principles be evaluated
  • Data collection systems at the state level need
    to be developed

34
Funding and Regulatory Issues
  • DMHS
  • provide seed money and develop training and
    implementation plans
  • further support and expand EBPs and Promising
    Practices
  • Financial incentives and/or regulatory relief for
    agencies who adopt EBPs.

35
Inter-agency collaboration
  • Collaboration between
  • Dept. of Human Services, and Dept. of Labor
    Workforce Development in order to expand EBPs and
    Promising Practices
  • NJ Division of Medical Assistance to address
    Medicaid funding of EBPs
  • Practitioners and provider agencies to involve
    providers in the development of regulations

36
III. System Enhancements
  • To complement new and expanded services,
    stakeholders felt that improvements to the
    current service systems would contribute to the
    development of a wellness and recovery-oriented
    system.

37
Recommendation Themes
  • Pervasive Treatment Philosophy and Service
    Provision
  • Evaluation of the Current System
  • Documentation
  • Consumer/Family Provider
  • Advance Directives
  • Joint Protocols and Cross Training
  • Community and Staff Education
  • Access Issues Point of Entry, Housing, Other

38
Evaluation of Current System
  • Systems Mapping
  • Compare the existing system with an ideal system
    designed by stakeholders
  • Service Duplication
  • Evaluate services for duplication and create
    regulations that clearly articulate in which
    multiple programs consumers can participate
  • Recovery Oriented System Indicator (ROSI)
  • Baseline of consumer satisfaction and a method
    for ongoing systems evaluation

39
Documentation
  • The Virtual Individualized Electronic
    Wellness/Recovery Action Plan (The VIEW)
  • Electronic record including Advance directives
  • Integrated Recovery Plan (IRP)
  • To replace the multiple treatment plans in
    multiple programs
  • Uniform Wellness and Recovery documentation
    requirements

40
Consumer/Family in New Roles
  • Navigator
  • Member of a community support team to help
    consumers navigate the system
  • Peer Educator
  • Provide self-help training and mentoring
  • Consumers provide training on mental health
    issues for members of the workforce (hospital and
    emergency personnel)

41
Advance Directives
  • Continued training and education on use of
    Advance Directives
  • Make sure Advance Directives are being honored in
    times of need
  • Navigator and Peer Educator positions can help
    with training and education

42
Joint Protocols and Cross Training
  • Shared responsibilities for multiple service
    users
  • Joint and cross training for providers of
    services for the shared populations

43
Public and Community Education
  • Anti-stigma, public information and education
    campaign
  • Particularly for the medical community,
    legislators, and developers of college curricula

44
Access Point of Entry
  • Eligible for services without having been
    hospitalized
  • No Wrong Door
  • Single point of entry for all services needed
    physical, social services, vocational,
    educational, etc.
  • No exclusionary criteria
  • Matching of consumers with needed services

45
Access Housing
  • Develop and maintain information clearinghouse
    for housing
  • Wide spectrum of housing for all levels of the
    system
  • Emergency assistance and housing subsidies

46
IV. Staff Development Recruitment, Retention,
Education, Supervision
  • Implementing EBPs and promising practices, as
    well as service system enhancements will require
    a highly competent workforce making recruitment,
    retention, and continued development of a
    qualified, competent, caring workforce as
    essential.

47
Recommendation Themes
  • Recruitment and Retention
  • Methods for Increasing Staff Competency
  • Standardized curricula
  • Training for Evidence Based Practices (EBPs)
    Promising Practices
  • Supervision
  • Consumers as Providers
  • Policy Changes
  • Hospital-Specific Recommendations

48
Recruitment Retention
  • Salary and benefit parity with state employees
    for Community Staff
  • Annual true Cost of Living Adjustments
  • Salary differentials for additional credentials
  • Career ladders

49
Recruitment Retention Credentialing
  • Certified Psychiatric Rehabilitation Practitioner
    (CPRP) as preferred credential
  • Recovery-oriented
  • Open to all educational levels/experience
  • Upward mobility for those earn CPRPs and
    specified credentials

50
Some educational programming ideas
  • Pre-paid tuition program
  • Expand existing academic programs to all state
    psychiatric hospitals
  • Expand existing academic programs to all regions
    of state
  • Use flex-time to attend classes
  • Time off for work-related educational programs

51
Recruitment of Like-Minded Individuals
  • Involve consumers in hiring, supervision, firing
  • Liaison with colleges for recruitment and
    influencing of curricula
  • Support consumer employment in field
  • Centralized website for job listings
  • Market loan forgiveness program
  • Use exit interviews in QA initiative

52
Increasing Staff Competency Standardized
Curricula
  • Developed delivered by academic entity, SME, or
    national experts
  • Core content identified by Workgroups
  • Centralized and coordinated training vs. On-site
    and customized
  • Follow-up with TA, consultation, and monitoring
  • Core courses approved for state licenses and
    national certifications
  • Establish incentives for attending training

53
Increasing Staff Competency Standardized
Curricula
  • Cross Training
  • Infuse Wellness Recovery in all state funded
    training
  • Cross train staff in DD, Aging In, Jail, DAS,
    Elderly
  • Cross train and co-train hospital and community
    staff

54
Methods for Increasing Staff Competency EBPs
  • Academic entity develop and deliver standardized,
    replicable training
  • Develop Centers of Excellence and Centers of
    Exemplary Practice as training and consultation
    sites
  • Develop agency leadership coalition to promote
    EBPs
  • Ongoing evaluation

55
Methods for Increasing Staff Competency
Supervision
  • Individual and group supervision
  • Skills based, non-punitive
  • Individual learning plans
  • Performance appraisals, evaluations, PAR/PES
    based on WR principles and competency
    development
  • WR survey tool for measuring staff application
    of WR principles

56
Consumers as Providers
  • Receive training for administration of ROSI
  • Deliver training to general community workers,
    e.g., police, EMTs, screeners
  • Deliver training on Advance Directives
  • Navigator

57
Policy Procedure Changes
  • New policies procedures will require training
    for implementation
  • Data collection and reporting
  • Electronic records, e.g., VIEW
  • Service access based on need

58
Community Standardized Curriculum 12 Domains
  • Personoriented attitudes, values, knowledge and
    behavior
  • Engaging families and significant paid and unpaid
    supporters in all aspects of service planning,
    care and evaluation
  • Knowledge of clinical and biological aspects of
    mental and physical illness and developmental
    disabilities
  • Knowledge of addictions and mental illness as
    co-occurring disorders
  • Assessment, recovery planning and documentation
  • Intervention and support strategies

59
Community Competencies 12 Domains (Continued)
  • Community resource development and acquisition
  • Legal issues and civil rights
  • Systems collaboration
  • Ethics and Professional Behavior
  • Cultural competence
  • Methods of evaluation

60
Hospitals Standardized Curricula
  • Contract with academic entity to develop
    standardized curricula for Core Competencies and
    EBPs
  • Conduct train-the-trainer sessions for training
    coordinators
  • Training coordinators will offer ongoing access
    to training for existing and new employees
  • Ongoing support and TA available to training
    coordinators through academic entity

61
Hospitals Curricula Content
  • Echoed community recommendations
  • Additional recommendations for hospital settings
  • Basic therapeutic skills
  • Accountability
  • Communication
  • Supervisory training
  • Staff safety and security during WR introduction
  • Hands on training to ease the transformation
    process

62
HospitalsAdditional Recommendations
  • Hospital Workforce Subcommittee continue to meet
    for competency development and implementation
    monitoring
  • Allocate FY2008 resources to assure equivalent
    training resources throughout the hospital system
  • Consistent staff development plan
  • Monitor and re-evaluate after one year

63
V. Data-Driven Decision Making Contracts,
Regulations, and Outcomes
  • Critical to all the recommendations outlined
    above will be the appropriate administrative
    structures and processes to support the wellness
    and recovery transformation effort and sustain
    this new orientation.

64
Recommendation Themes
  1. Establishing measurable outcomes
  2. Developing a data collection system
  3. Removing systemic obstacles
  4. Evaluating service outcomes and basing funding on
    performance
  5. Providing service performance information to
    consumers
  6. Ensuring consumer input

65
Establish Measurable Outcomes
  • Operationalize NJs transformed system
  • Identify system goals
  • Create associated outcome measures
  • Identify and/or create fidelity measures relevant
    to each modality or service.

66
Develop Data Collection System
  • Develop capacity, infrastructure, and funding
  • Establish baseline data
  • Provide initial and ongoing training

67
Remove Systemic Obstacles Promote Cross System
Collaboration
  • System-wide needs assessment
  • Data sharing
  • Include physical health data
  • Hospitalization data
  • Employment data

68
Evaluate Service Outcomes Performance Based
Funding
  • W R outcome measures in all contracts
  • Tie service outcomes first to monitoring and
    later to reimbursement and contracting decisions
  • Establish consequences and incentives
  • Redirect resources from lesser-valued/lower
    priority to higher priority services

69
Ensure Consumer Input
  • In transformation and resource allocation
  • gather input
  • provide support for participation
  • include reticent groups
  • Support consumer being well-informed
  • informational newsletter
  • educational forums
  • interactive website

70
Provide performance information to consumers and
family members
  • Performance report card
  • Specify outcome data
  • Publish on the Divisions website

71
Other Regulatory Issues
  • Work with Medicaid
  • Share data on physiological measures, other
    illness/diagnoses, and hospitalization
  • With DMAHS review and if needed revise
    regulations to support wellness and recovery
    approaches within federal guidelines
  • Working with DHS Licensing Inspections
  • Engage Office of Licensing staff
  • Review and revise regulations
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