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Mark M. Lowis, LMSW Member: International Motivational Interviewing Network of Trainers Ray Rais, LMSW Quality Improvement Coordinator – Macomb County.

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Presentation on theme: "Mark M. Lowis, LMSW Member: International Motivational Interviewing Network of Trainers Ray Rais, LMSW Quality Improvement Coordinator – Macomb County."— Presentation transcript:

1 Mark M. Lowis, LMSW Member: International Motivational Interviewing Network of Trainers Ray Rais, LMSW Quality Improvement Coordinator – Macomb County Community Mental Health Transitioning to Recovery Based Treatment

2 Tolstoy: “I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others and which they have woven, thread by thread, into the fabrics of their lives.”

3 Give me 5 Minutes to learn Names

4 Transition? From What?To What? Institutional Memory Goal is to Maintain Stability in within the System What the Agency Offers Prescribing/telling Compliance Based Monitoring compliance Mandating Behavior Deficit Based Targeted Treatment Goal is to Exit the System through Amelioration Individualized Issues Assistive Interventions Collaborative Guiding Incremental change Manageable Recovery based

5 Exercise Work in groups at table Select a scribe for your table Select a speaker to represent you table Together brainstorm a list of deficit based terms Start by saying; “I see you as….” and finish with the deficit based term/label. (IE: I see you as lazy.) Facilitator gathers list from speaker

6 Exercise Work in groups at table Select a scribe for your table Select a speaker to represent you table Together brainstorm a list of strength based terms Start by saying; “I see you as….” and finish with the deficit based term/label. (IE: I see you as protecting yourself.) Facilitator gathers list from speaker

7 “Strength Based” means “M aking Sense” out of Resistance!

8 Some Kinds of Plans Behavioral – Uses Behavioral Modification Awards Points Privileges Incentives Consequences

9 Some Kinds of Plans Institutional – Uses levels of functioning to determine privileges within the institution Deficit based – Professional determines a person’s needs based on inability takes over decisions struggles to control or manage contest between system and free will of client.

10 Some Kinds of Plans Agency – Converts a person’s desire (what they want from treatment) to what the agency offers says what the client can and can’t have Staged – Work is collaborative and assistive Step-by-step process toward recovery Steps are manageable for the person being served The pace of recovery is determined by readiness Throughout the process the focus is on transition

11 Institutional Memory Historical Approach to Treatment in which the need is to protect the public Identify Persons with Mental Illness based upon dangerous, aberrant or abhorrent behavior Remove from Mainstream Place in institution Stabilize Symptoms Maintained forever – State Facility – Forensic Center – Jail

12 Institutional Take Possession Remove Place Depersonalize Stabilize Maintain Ineffective Costly

13 Deinstitutionalize Home Setting Smaller Institutions Less Confining More personal Placement Stabilize Maintain Costly Community Based Group Homes Same Approach Smaller Institutions Resistance from Community Seeking full citizenship

14 Person Centered Planning Institutional Assess Diagnose Prescribe Person Centered Facilitate Collaborate Assist Goals and Objectives are still Maintenance and Institutional

15 Strength Based Its not looking for their strengths. Its knowing that they are there Honors autonomy Emphasizes choice and control What assistance are they seeking What do they already understand How do they see us working with them

16 Strength Based The individual has the right to dignity and respect from the practitioner(s) and every person whom they encounter at the agency (Mutuality)

17 Push Back Examples A job is not a service We aren’t an employment agency We don’t do housing We don’t do that The CMH has cut our funding so we can’t They don’t know what they want Some of them just want us to tell them The just want medication They’re just trying to get…

18 Maintenance Approach (Institutional Memory) Prescribed Goals and Objectives Encounters are cumulative and general Time frames are subjective Consumer must accept expert advise Consumer must match expectations of system Confront Resistance – Guardianship – Consequences – More Restrictive – Seclusion and Restraint – Behavior Management Committee

19 Recovery Approach Good agreement on Goals, Objectives and Interventions Consumer has total choice and control Professional is assistive and collaborative partner Encounters are specific Resistance is understood from consumer perspective Professional has interventions for any level of readiness Goal is to achieve amelioration and discharge Consumer is welcome back if necessary Time frames are realistic

20 Maintenance Plan Problem #2 – The consumer lacks coping skills Goal #2 – The consumer will Develop Coping Skills Objective #1 – The consumer will attend all therapy sessions AEB therapist documentation Intervention #1 – Therapy 1x/week Objective #2 – The Consumer will make 3 positive self- statements per week AEB therapist documentation Intervention #2 – Therapy 1x/week Objective #3 – The consumer will identify 3 coping skills AEB therapist documentation Intervention #3 – Therapy 1x/week

21 Now What? What would the Problem Statement Become? What would an Objective Look Like? What would an Intervention look like?

22 Recovery Plan Targeted issue – Symptoms interfere with keeping job Goal – Stop symptoms from interfering with ability to keep job Objective 1 – Meet with psychiatrist to discuss and describe symptoms and the way in which they interfere with ability to keep a job Objective 2 – Be able describe medication including dosage, how taken, possible side effects, how it will help with Goal Objective 3 – Develop agreement with psychiatrist on medication

23 Recovery Interventions (Us) Intervention – Psychiatric Evaluation to determine medication to support goal for sustaining employment Intervention – Demonstrate way in which medication will assist with goal Intervention – Periodic medication review to determine how used, effects/side effects, reaffirm usefulness toward goal and adjust if necessary. Intervention - Assist with any concerns or barriers

24 Intervention What we do that is assistive and collaborative in helping the person with objectives for achieving the goal

25 Dean Fixen The Therapist Is The Intervention!

26 Sufficiency Standards and Authorization Amount – number of units needed to provide the service Scope - How the service will meet the need addressed (Think of Medical Necessity) Duration – How long the service will be provided based on attaining the objective Service – Psychiatric Evaluation, Medication Review, Group/Individual/Family Therapy, Case Management, etc.

27 Deficit Based Transition Goals Maintain reduction in symptoms for 12/months Maintain medication compliance for 12/months Comply with treatment Stay at Par for 12/months!! Intervention – Monitor for compliance

28 Transition Goals Recovery Find a home that provides more independence. Person’s description of the goal: “I want my own place” Assist Primary Health Care Provider in transfer of medication Person’s description of the goal: “I don’t need help to take my medication” Intervention – Assist in connecting, scheduling, attending and adjusting to a resource (Warm Transfer)

29 Recovery Based Supports and Services EXAMPLES: Psycho-Education Health Education Individual, Family, Group Treatment Pharmacological Case Management Primary Health Care Physician-Community Clinic Community Resources Referral to Human Service Agencies Community Living Supports Discharge by Warm Transfer Collaborative Welcome back

30 Recovery Based Discharge Queues “Person's” treatment goals are attained “to their satisfaction” On-going care is achievable through Primary Health Care Physician-Community Clinic On-going issues are able to be provided through other human service agencies (MRS, Work First, DHS, etc) or support network Consumer is not attending “for a reason” Consumer attends only to protect SSI/D Consumer cannot be contacted – Leaves area – Refuses services – Receiving services elsewhere

31 Planning Process 1 st Identify the “Person’s” Targeted Issues Symptoms of Mental Illness (specific) Impact on… Co-occurring Substance Use (specific) Interferes with… Co-occurring Health Issues (specific) affect… Safe and Affordable Housing impacted by one or more life conditions (specific). Employment-Income-Resources impacted by one or more life conditions (specific). Social (specific) and Community Participation (specific) affected by… Self Care (specific) interrupted by… Issues compounded by 2 or more conditions

32 Planning Process 2 nd Identify Goals for Amelioration of each of the Person's Targeted Issues 3 rd Identify the Person's Stage of Readiness for working on each Goal 4 th Design Objectives based on the Person's Readiness 5 th Design interventions in collaboration with the client to achieve Objectives 6 th Establish accurate, sensible time frames for achieving Objectives 7 th Be willing to adjust Plan when necessary 8 th Discharge Goal is always part of plan

33

34 Staging – Block II Refer to “Stage to Intervention” Power Point


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