Foundations for Building a Recovery Oriented Program
Chacku Mathai, CPRPAssociate Executive Director
New York Association of Psychiatric Rehabilitation Services
April 28, 2011
Backdrop: High Cost of Medicaid Care for New Yorkers w/ Multiple ‘Chronic’ Conditions
• New York’s Medicaid program serves over 4 million beneficiaries at a cost of over $47 billion annually (30% of all healthcare spending in NYS).
• 20% of Medicaid beneficiaries (1,029,621 ) account for 75% of the program’s expenditures: $31.1 million
• Average cost per year: $30,195 • These beneficiaries have “multiple co-morbidities, are
medically complicated and require services across multiple provider agencies. Due to their multiple and intensive needs, their care can often be fragmented, uncoordinated and at times duplicative. “
• 40% of these beneficiaries are diagnosed with mental illness and chemical dependency.
Backdrop: NYS Ranks 50th in Avoidable Hospital Readmissions
• NYS Department of Health estimated that $800 million was spent last year on ‘avoidable Medicaid hospital readmissions.’
• 70% of these involved beneficiaries with mental health, substance use and major medical conditions.
• 65% of admissions for this group were for medical reasons.
Vision for Recovery Outcomes • Believe that recovery is possible, even from
the most tragic circumstances or disabling conditions
• Uncover abandoned hopes and dreams• Discover our personhood through culture,
strengths, values, skills• Engage communities as life sustaining forces • Re-author the way we see ourselves • Reclaim a meaningful life and roles
Themes to Consider • Quality of life orientation as well as symptoms• Capacity to individualize interventions• Discharge planning with a focus on peer and
natural supports • Moving from diagnostically focused tracks to
fully integrated services• Supervision models to build hope and focus
on recovery• Increased visibility of people in recovery and
alumni as mentors and bridgers to community
Unemployment and poverty: A two-way street
Social Capital: Social connections
community organizations,support networks,
relationships/ connections “outside” mental health system, family supports, etc.
Human Capital:interviewing skills, job competencies,
education, training, certifications, etc.
Material Capital: work incentives, reliable transportation,
stable housing, work attire, savings, assets, etc.
EMPLOYMENT
Adapted from Potts’ definitions of: human, cultural and social capital (Potts, 2005)
Recovery Facilitation Capability Dimension Content of Items
I Program Design Program mission, outreach, services, community involvement, flexibility, crisis
II Physical Environment First contact/reception, publicly available resources, accessibility, non-segregated environment
III Staffing Recruitment, hiring, visibility of peer experience
IV Training Person-centered planning, connecting and coaching competencies, supervision, recognition systems
V Service Provision Relationship and hope-building engagement activities, assessment, recovery planning, focus on quality of life and life beyond services
VI Quality Improvement QI process reflects recovery indicators, QI team includes people receiving services
VII Program Evaluation Consumer needs, recovery outcomes, collection method, program design informed by data
Observable Correlates of Recovery
1. Level of Risk
2. Level of Engagement
3. Level of Skills and Supports
RECOVERY-BASED ACCOUNTABILITYQuality of Life Outcome Domains
•Housing/Home•Work/Career•Relational: Family/Friends/Romantic•Educational•Legal•Financial (Payee Status, e.g.)•Conservatorship• Incarceration•Hospitalization•Recreation/Leisure•Community/Citizenship•Health/Physical Wellbeing•Spiritual/Religion
Benefits of a New Workforce Culture
• Reflects most basic values of recovery-oriented systems of care– Belief in recovery– Community inclusion– Economic self-sufficiency– Workforce diversity
• Regular opportunities to see “recovery in action” for consumers and providers
General Workforce Roles for People in Recovery
• Peer-run organizations, e.g. recovery centers• Peer counseling positions, e.g. bridgers• Regular employee positions such as therapist,
practitioner, counselor, advocate, service coordinator, adminstrator…
• Volunteer peer roles • Community citizen volunteers
Developing Jobs for People in Recovery
• Review workforce needs throughout the agency (evaluate service needs and gaps)
• Include experience as a consumer of services in qualifications or preferences
• Create educational equivalencies to standard college requirements, e.g. work experience, related credentials, certificates
• Remove discriminatory or stigmatizing language from all written materials
Creating diverse teams
• Integrate peer positions in multi-disciplinary teams
• Create flexible schedules• Career ladders with opportunities for
advancement• Opportunities for recognized continuing
education• Performance reviews
Preparing the Work Environment
• Dual relationships, role definition, boundaries• Culture and standards for self-disclosure• Understanding reasonable accommodations• Will professional roles be diminished?• Will consumers require unreasonable amount of
support or lack necessary skills?• Role of consumer and non-consumer staff in staff
meetings and social events• Engaging people in recovery as colleagues
Preparing People in Recovery
• Impact of employment on benefits• Fears about ability to do the job• Fear of not being liked or accepted • Potential loss of friendships with other
consumers• Role of supervisor • Engaging other staff as colleagues
Education and Training
• Experience as a consumer does not equal capacity to serve in the workforce
• Review existing employee training programs for discriminatory or stigmatizing language
• Revise training programs to include recovery-oriented, person-centered, culturally competent content
• Recognize credentials, e.g. CASAC, Recovery Coaching, CPRP, etc.
NYAPRS Partnership with CEIC
• Building Recovery Facilitation Capability– Integrating peer support– Natural community supports
• Recovery Implementation Forums across NYS• Onsite Recovery Implementation Technical
Assistance • Case studies of local implementation• Dual Diagnosis Capability Assessments
References • Adams, Neal, & Grieder, Diane M. (2005). Treatment Planning for Person-Centered Care. Amsterdam, The
Netherlands: Academic Press.• Anthony, William A., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric Rehabilitation (2nd ed.). Center for
Psychiatric Rehabilitation, Boston University.• Davidson, Larry, Courtenay Harding, & LeRoy Spaniol (Eds.). (2005). Recovery from Severe Mental Illnesses:
Research Evidence and Implications for Practice. Boston, Mass.: Center for Psychiatric Rehabilitation, Boston University.
• Davidson, Larry, Michael Rowe, Janis Tondora, Maria J. O’Connell, Martha Staeheli Lawless. (2009). A Practical Guide to Recovery Oriented Practice: Tools for Transforming Mental Health Care. Oxford, England: Oxford University Press.
• Farkas, Marianne, Cheryl Gagne, William Anthony, & Judi Chamberlin. (2005). Implementing recovery oriented evidence vased programs: Identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–58.
• Harding, C.M.; G.W. Brooks; T. Ashikaga; J.S. Strauss; and A Breier. (1987). The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718–26.
• Mathai, Chacku. (2009). Building Integrated and Recovery Oriented Programs.• Ragins, Mark. (2007). Concrete Approaches to Recovery Based Transformation.• Ralph, Ruth, Kidder, Kathryn, Phillips, Dawna. (2000). Can We Measure Recovery? A Compendium of Recovery
and Recovery-Related Instruments. Cambridge, Mass.: The Evaluation Center at HSRI.• Spaniol, Leroy, Nancy J. Wewiorski, Cheryl Gagne, & William A. Anthony. (2002). The Process of recovery from
schizophrenia. International Review of Psychiatry, 14, 327–36.
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