erme c. maula, rn, msn, crrn, cps program manager

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MHASP Consumer Recovery Investment Fund: Self

Directed CareDelaware County, PAPresentation to PA MHA

ConferenceApril 27, 2011

Erme C. Maula, RN, MSN, CRRN, CPS

Program ManagerMental Health Association of Southeastern

Pennsylvania

4/27/11

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CRIF SDC Definitions CRIF: Consumer Recovery

Investment Fund SDC: Self Directed Care CPS: Certified Peer Specialist Recovery Coach: Certified Peer

Specialist and WRAP trained facilitator that accompanies participants along their recovery journey

Freedom Funds: Funds in the SDC budget used to purchase non-traditional goods and services

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Collaborators Magellan Health Services –

Magellan Behavioral Health of Pennsylvania is an affiliate of Magellan Health Services

Office of Behavioral Health, Delaware County, Pennsylvania

Temple University Collaborative on Community Integration of People with Psychiatric Disabilities

Mental Health Association of Southeastern Pennsylvania

National Institute on Disability and Rehabilitation Research

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Meet the Operations and Recovery Coach Team

Joseph Rogers, Director of Advocacy, MHASP

Bill Dinwiddie,CEO MHASP

Rita BurnsCFO, MHASP

Erme Maula, Program

Manager, MHASP

Brett Diamond,

MHASP

Jeff Quick, Recovery

Coach, MHASP

Bob Waters, National V.P., Account

ManagementMagellan Health Services

Evon Bergey, General Manager, Magellan Health

Services

Julie Brown, Delaware County Senior

Account Executive, Magellan Health Services

Tim Connors,

Recovery Coach,

MHASP

Jennifer TrippVP, Public Sector Program

InnovationMagellan Public Sector Solutions

Bill ChambersMH Program DirectorDelaware County Office of Behavioral Health

Mark SalzerProfessor and ChairDepartment of Rehabilitation SciencesTemple University

Richard BaronDirector, Knowledge Translation ActivitiesTemple University Collaborative on Community Integration of People with

Psychiatric Disabilities

Andrea BilgerResearch AssistantTemple University

Not Pictured: Jonna DiStefano, Lisa Gardner, Dawn Berardinelli,

Lynne Baumeister, Donna Holiday

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CRIF SDC Program Philosophy is based on the

following elements:

Recovery Peer Support

Self Directed Care

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Recovery The program philosophy is based on

the fundamental belief that people can and do recover from mental illness.

Recovery is a deeply personal process that involves the restoration of hope, self-esteem, creativity, and self-determination.

Recovery is a life-long journey that restores and maintains individual dignity and control over one’s own destiny.

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Recovery ValuesHOPE

INDIVIDUALITY SELF-AWARENESS

SELF-DETERMINATIONMEANINGFUL LIFE

RESPECTPEER SUPPORT

COMMUNITY FOCUSADVOCACY

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Peer Support All CRIF SDC Program Recovery Coaches are

Certified Peer Specialists. Peers helping other peers has been identified as

a critical part of the recovery process. The President’s New Freedom Commission on

Mental Health (2003) explicitly recognized the critical role of peer support.

People who are employed as Recovery Coaches have the unique capacity to inspire hope, trust, personal responsibility, empowerment, self-determination and social connectedness in their fellow peers.

Recovery Coaches are able to use their own Recovery Journey as an example of the possibility of recovery.

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Self Directed Care This approach supports individuals in developing

their own wellness goals and in controlling the funds that are used to implement their self-directed behavioral health recovery plan.

Each person is responsible for making his or her own choices on the recovery journey and must be responsible for the outcomes of those choices.

Giving people decision-making power over their own behavioral health-care budget is a concrete step toward self-determination and responsibility.

The process of creating a recovery plan, identifying appropriate services, and deciding how to spend service dollars encourages independence and self-determination.

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How exciting would it be if…

We can show that working with a Recovery Coach/CPS/WRAP Facilitator moves people forward in their recovery

By allowing people to determine what best works for them, the final cost to the Behavioral Health Care system is reduced or equivalent to the cost of “Services as Usual”

By allowing people to direct their own care, they experience significant movement forward in their recovery journey

We can model the possibility of four very different entities successfully working together

We are able to create more CPS job positions We are able to generate outcomes that help to

establish a waiver that allows for the establishment of similar programs in other parts of the state

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Goals of CRIF SDC

Individuals in the SDC condition will experience greater levels of empowerment, recovery, and quality-of-life compared to those in the control condition.

Individuals in the SDC condition will experience greater levels of community participation over time compared to those in the control condition.

Individuals in the SDC condition will live more independent lives, depending less on high cost, acute/crisis services (e.g., inpatient hospitalization, crisis service use) compared to those in the control condition.

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Criteria for Enrollment Delaware County Resident Member of Health Choices, Magellan

Behavioral Health Diagnosed within either the schizophrenia

or bipolar family of disorders 60 – 90th percentile utilizer of services No hospitalizations within the past 6

months Randomized into Temple study 150 total in study: 75 in control, 75 in

SDC

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Process for Enrollment Study group randomized by Magellan

Health Services—letters sent to 50 at a time

Temple University contacts potential participants for enrollment

Participants enrolled in study are randomized into either the Control, or “Services as Usual” group, or the SDC group

SDC Group is enrolled by MHASP Recovery Coach Team

Initial orientation period is followed by monthly visits over the subsequent 24-month period

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Process of Engagement Establishing relationship Exploring Dreams Setting Goals from Dreams Exercise Reviewing past 24-month utilization of traditional

services with peer Setting budget from goal activities Requesting authorization for purchases Authorization for purchases approved or declined

by Magellan Health Services representatives Approved purchase amounts placed on Allow

Card Monthly check-ins with Recovery Coach, or as

determined by Participant

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MH Budget Mental Health Budget includes

All In-Plan (traditional outpatient Medicaid Reimbursable services, including Peer Support by Recovery Coach)

Non-traditional services (Freedom Funds)

Equal to previous 24-month period mental health costs

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Recovery Goals All activities and purchases must fit

within the Participant’s Recovery Plan

Recovery Plans can change over time

Recovery Coaches help to educate Participants about the concepts and processes of recovery

The Recovery Coach team keeps track of proposed monthly budget, as well as actual utilization, over the next 24 months.

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What we have learned Similar to the Dallas, TX program, we found that

some of the first “asks” pertained to physical medical health care needs

As opposed to focusing on assessments, we focus on dreams. Self Directed Care allows the peer to set the area of focus

This program really puts recovery into action Participants may not have experienced recovery

in such a comprehensive way before Some people focus on short-term needs and have

not had the opportunity to have a longer-term focus on their dreams and hopes for their future

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Sample “asks” Back Rent Electric Bill Exercise Clothing and equipment Gym Memberships Computer Software to write poetry Glasses after charges are made to Physical Health

Insurance Relocation Costs Car Repair Books for School Social Activities Lawnmower to start a lawncare business Digital Camera and Printer Transportation Membership to the Philadelphia Museum of Art

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Life Domains Mental Wellness Physical Health Education (or learning something

new) Work or Meaningful Activities Social Activities Housing

Freedom Fund Categories

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SDC Card, formerly Allowcard

Similar to a check/credit card Decreases the stigma related to

mental health Allows participants to have

responsibility of funds Allows restrictions to be placed on

card from Program Staff (certain items are not allowed to be purchased: alcohol, illegal drugs, guns, cash, pornography, etc.)

Allows monitoring of activity

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Next Steps 120 people enrolled in study

63 in SDC 57 in Services as Usual Group

Moving forward with Recovery Process and Peer Support with “enrollees”

Meeting with non-MH Providers to talk about Recovery and ask for possibilities of services to purchase

Operations Team meetings On-going program evaluation

Policy Implications Cross Disability work as a result of the

Power to the People Summit 2009 Presentations at Alternatives 2010,

NYAPRS 2010, NYAPRS Executive Summit 2011, Netherlands 2011, and other

Enhancing People in Recovery being able to control the amount of money being spent on their care in a way that moves them forward in their recovery and teaching self direction and hopefully decreasing costs to the system

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Quotes from ParticipantsHow has your life been

changed by being a participant in the program so far?

I am far too busy to see a therapist; I am very busy with school. However, I do have coping skills which help me. CRIF's coaches are there for me whenever I need them; they have given me new coping skills that I can use and what’s best about this is CRIF's coaches are available to coach me whenever I need them.

- Alicia, CRIF SDC participant

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How has the CRIF SDC Project helped you in your journey of

recovery? CRIF has helped me tremendously. I began

treatment a few years ago, when [Health Choices Physical Health Insurance] stopped providing eye care benefits. I knew that I needed glasses but I could not afford them as I am a student and I have plenty of other priorities that I must take care of first. The CRIF program, my coaches, have given me the opportunity to get the eye glasses that I needed. In addition to this, my coaches have worked as advocates, friends and have given me additional coping skills. My coaches are currently helping me take care of other issues that I otherwise would not have been able to take care of. I love CRIF and my coaches.

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"It [the CRIF SDC Project] gives me perspective on where I'm going.  I may not have a plan yet, but I do have hope"

- Roderick, CRIF SDC participant

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Contact Information for CRIF Self Directed Care

Team:

Erme C. Maula, RN, MSN, CRRN, CPSProgram Manager, CRIF

Mental Health Association of Southeastern Pennsylvania

1211 Chestnut St., 11th FloorPhiladelphia, PA 19107

emaula@mhasp.orgOffice: 267 507 3873

Secure Fax: (215) 525-9698