3Objectives for the DayUnderstand the history and process of development for the new servicesUnderstand the role of new services in supporting Recovery/ResiliencyUnderstand the clinical framework of new servicesCommunity SupportPsychosocial RehabilitationAssertive Community TreatmentNon-Medicaid Vocational & Outreach
4History and Development Process System Restructuring Initiative (SRI)Statewide advisory task group (consumer chaired, included consumers, providers, trade associations, advocates, state)SRI WorkgroupsServicesFinancialAccess and EligibilityServices WorkgroupApprox. 130 individuals counting allIndividuals with mental illnesses, providers, trade associations, hospitals, state departments, consultants
5History and Development Process Services Workgroup ObjectivesReview service array and Rule 132 with focus on:Supportive of recovery/resiliencyAccessible to individuals with mental illnessesCompliance with Medicaid State Plan and other guidanceIdentify gapsFindingsCurrent service definitions did not fully promote recovery/resiliencyMedicaid State Plan and Rule should be updated
6History and Development Process Workgroup established service prioritiesCommunity SupportPsychosocial RehabilitationAssertive Community TreatmentSubgroups formed for each of the above:Researched Evidence-Based Practices (EBP)/Best PracticesReviewed other states’ definitionsReviewed recent federal CMS/OIG audits/actions
7History and Development Process Services Workgroup ResultsDeveloped new definitions whichpromote recovery/resiliencysupport Evidence Based Practices/Best PracticesMinimize audit compliance riskNew non-Medicaid servicesRecommended improvements to current definitionsNew definitions and recommendations were used to develop revised Rule 132 and Medicaid State Plan Amendment
8New Taxonomy – Rule 132 Services Assertive Community TreatmentCase Management – MHCase Management – Transition Linkage, AftercareClient Centered ConsultationCommunity Support – IndividualCommunity Support – GroupCommunity Support – TeamCommunity Support – ResidentialComprehensive Mental Health Services*Crisis InterventionMental Health AssessmentMental Health Intensive OutpatientPsychological EvaluationPsychosocial RehabilitationPsychotropic Medication AdministrationPsychotropic Medication MonitoringPsychotropic Medication TrainingTherapy/CounselingTreatment Plan Development, review and modification*Sunset
10Primary Changes to Medicaid Taxonomy Service labels deleted and activities subsumed under new definitionsSkills Training & DevelopmentTherapeutic Behavioral ServicesActivity TherapyDay TreatmentNew/expanded servicesCommunity Support (Indiv., Group, Team, Residential)Psychosocial RehabilitationAssertive Community Treatment
11Status of Approval & Implementation Medicaid State Plan Amendment (SPA)Accepted proposed languageAlignment between SPA and RuleRevised Rule 132
12Recovery and Resilience The Goal of Services in a Transformed Mental Health System
13Recovery Refers to a process The outcome of the process of recovery is that individuals are able to live, work, learn and participate fully in their communitiesThe life picture of recovery is unique for each individualAccording to research, hope is an essential element in recoveryPresident’s New Freedom Commission 2003
14Facilitating Recovery: Ten Fundamental Components HopeSelf-DirectionIndividual and Person-CenteredEmpowermentHolistic
15Facilitating Recovery: Ten Fundamental Components (cont.) Non-LinearStrengths-BasedPeer SupportRespectResponsibility
16Recovery Components: Hope The catalyst to the recovery processProvides the essential and motivating message of a better futurePeople can and do overcome the barriers and obstacles that confront themHope is internalized, but it can be fostered by peers, families, friends, providers and others
17Recovery Components: Self-Direction By definition, the recovery process must be self-directed by the individualThe individual defines his or her own life goals and designs a unique path towards those goals
18Examples of Self-Direction in Mental Health Services Strengthening ACT service planning to be a participatory processCommunity Support: promote active participation in decision-makingPsychosocial Rehabilitation: participating in curriculum/strategy choices and selection
19Recovery Components: Individualized and Person-Centered There are multiple pathways to recoveryServices take into consideration: an individuals’ unique strengths and resiliencies; his/her needs, preferences and experiences; past trauma; cultural background
20Examples of Individualized and Person-Centered Mental Health Services Community Support: point out strengths and suggest ways to use them; consider barriers and suggest ways to overcome themCommunity Support: include the development of such examples as crisis contingency and Wellness Recovery Action Plans (WRAP)
21Recovery Components: Empowerment Individuals with mental illnesses have the authority to choose from a range of optionsIndividuals with mental illnesses have the authority to participate in all decisions that will affect their lives, and are educated and supported in so doing
22Recovery Components: Empowerment (cont.) Individuals with mental illnesses have the ability and opportunity to join with one another to collectively and effectively speak for themselves about their needs, wants, desires and aspirationsThrough empowerment, an individual gains control of his or her own destiny
23Examples of Empowerment in Mental Health Services ACT: person-centered service planning as evidenced by person’s participation in service planning meetings with the teamPSR: inclusion of individuals with mental illnesses in program design, development, planning, implementation, evaluation
24Recovery Components: Holistic Encompasses an individual’s whole life, includingMindBodySpiritCommunity
25Recovery Components: Holistic (cont.) Embraces all aspects of life, includingHousingEmploymentEducationMental Health and Healthcare Treatment ServicesComplementary and Naturalistic ServicesAddictions TreatmentSpirituality, Creativity, Social Networks, Community Participation, and Family Supports as determined by the person
26Examples of Holistic Strategies in Mental Health Services Community Support: Encourage identification and enhancement of the existing natural supports in the individual’s social systemCommunity Support: Assist the individual to maximize the degree to which natural supports can be used
27Recovery Components: Non-Linear Not a step-by-step processBased on continual growth, occasional setbacks, and learning from experienceBegins with an initial stage of awareness in which a person recognizes that positive change is possible
28Examples of Non-Linear Components of Mental Health Services If a person is receiving Community Support and has a temporary increased need:Add PSR for a period of timeIntensify Community SupportWhen increased need has resolved or changed, the person can elect discontinuance of PSR and/or reduction in Community Support
29Recovery Components: Strengths-Based Focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individualsBy building on strengths, individuals with mental illnesses leave stymied life roles behind and engage in new life roles
30Examples of Strengths-Based Focus in Mental Health Services Designing ACT interventions to build on the strengths of the persons servedPSR: identifying, using and promoting strengths
31Recovery Components: Peer Support Mutual support, including the sharing of experiential knowledge and skills and social learningIndividuals with mental illnesses encourage one another and engage each other in recoveryIndividuals with mental illnesses provide each other with a sense of belonging, supportive relationships, valued roles and community
32Examples of Peer Support in Mental Health Services Strengthening ACT teams to have solid peer support opportunities for all persons servedPeer support is encouraged throughout the taxonomy via the RSA credential
33Recovery Components: Respect Includes respecting persons’ rights and eliminating discrimination and stigmaEnsures the inclusion and full participation of persons in all aspects of their livesSelf-acceptance and regaining belief in oneself are particularly vital
34Recovery Components: Responsibility Individuals have a personal responsibility for their own self-care and journeys of recoveryTaking steps toward one’s own personal goals may require great courageIdentifying coping strategies and healing processes to promote one’s own wellness
35Examples of Responsibility in Mental Health Services Community Support: Teaches “how,” does not “do for”Community Support: Assists the individual to do for self rather than doing for the person
36ResilienceRefers to the ability to harness inner strengths and rebound from setbacks or challengesPeople who are less resilient may dwell on problems, feel victimized, become overwhelmed and turn to unhealthy coping mechanismsAllows individuals to go on with life with a sense of mastery, competence and hopeIf you aren't as resilient as you'd like, you can teach yourself to become more resilient.Mayo Clinic WebsitePresident’s New Freedom Commission, 2003
37Building Resilience: Eleven Essential Skills Getting ConnectedUsing Humor and LaughterLearning From Your ExperiencesRemaining Hopeful and OptimisticTaking Care of Yourself
38Building Resilience: Eleven Essential Skills Accepting and Anticipating ChangeWorking Toward GoalsTaking ActionLearning New Things About YourselfThinking Better of YourselfMaintaining Perspective
39Fundamentals of Effective Community Support (CS)
40Pop QuizOf persons in the U.S. who have been diagnosed with Schizophrenia, how many function well with no or minimal professional supports?10%20%35%50%New Freedom Commission Report
41Pop Quiz (cont’d)In what location do individuals with mental illnesses learn and retain skills best?Counselor’s/case worker’s officeClassroomStructured psychoeducational groupsNatural settingsNew Freedom Commission Report
42Pop Quiz (cont’d)Do individuals with mental illnesses or case managers better predict the mental health outcomes for individuals?Case managersIndividuals with mental illnessesNew Freedom Commission Report
43Overview Purpose of Community Support (CS) What Does the Community Support Worker Do?IL CS Definition/Core Service ActivitiesAreas of Core Competence for Community SupportDifferentiating Community Support from Case ManagementThe Four Modalities of Community Support10 Common Denominators of Good Community Support
44Purpose of Community Support Provide mental health rehabilitation interventions and supports necessary to assist individuals with mental illnesses to achieve rehabilitative, resilience and recovery goals primarily in a person’s own environmentGoes beyond just treating symptoms!
45What Does the CS Worker Do? Assists individuals with mental illnesses and families with skills teaching and support with respect to:Symptom self-management and reductionEnvironmental modification for stability and growthResource acquisitionRecovery planningDevelopment of resilience
46What Does Community Support Consist Of? Necessary Mental health rehabilitation interventions and supports:To build capacity with the person to achieve their self identified rehabilitative, resiliency, and recovery goalsDesigned to meet the following types of treatment support needs of the person:Educational VocationalResidential Mental HealthCo-occurring disorders FinancialSocial Others
47Who Gets Community Support? When & Where Do They Get It? Who: Services are directed towardAdults, Children, Adolescents, FamiliesThe primary beneficiary of the services must be the individual with the mental illnessWhen: The changing needs of the individual dictate:Services hours, type, intensity, staff credentialWhere: Interventions are deliveredPrimarily in natural settings (off site)By telephone, videoconference, face to face
48What are the Goals of Community Support? Interventions and activities are targeted toward:Development of person’s capacity to manage his or her symptomsFostering the ability of the person to reduce symptoms as much as possibleAssist the person in promoting stability in his or her lifeDevelopment of person’s ability to foster mastery & independence
49IL CS Core Principles/Activities Promote active participation in decision-making.Build a context in which shared decision-making is the normAssist the person to:Identify his or her strengths & ways to use themIdentify his or her barriers to recovery & ways to overcome them
50IL CS Core Principles/Activities Suggest strategies/interventions for greatest independencePromote recovery-oriented treatment in the least restrictive settingSupport self determinationEducation, training and assistance in the development of the individual’s strengths, resources, preferences, and choicesIncludes the development of such examples as crisis contingency and Wellness Recovery Action Plans (WRAP).
51IL CS Core Principles/Activities Assist the person to develop and maximize support from family and significant othersConsumer focusedSupport and consultation to the individual’s family and their support systemInterventions must be to directed to the primary well-being and benefit of the individual and related directly to the individual’s treatment plan.
52IL CS Core Principles/Activities Psychoeducation and skill building for individuals’ families and their support systemsWith or without the individual being presentFamily or support system psychoeducation or skill building must relate to a need identified in the assessment of the individual and be reflected on the Individual Treatment Plan
53IL CS Core Principles/Activities Interpersonal, family, community and functional skills training and supportAssist the person to develop:Functional skills with respect to adaptation to the home, school, family, and work negatively impacted by the individual’s mental illness.The ability to cope at the following levels:InterpersonalFamilyCommunity
54IL CS Core Principles/Activities Assist the individual with mental illness(es) to develop tools to self-monitor, reduce and manage symptoms in order to improve the quality of lifeHelp to foster the ability to identify & minimize the negative effects of mental illness, serious emotional disturbance, and co-occurring disordersAssist the person in putting together a proactive relapse management planIn conjunction with the individual, identify risk factors and related strategies to manage relapse.
55IL CS Core Principles/Activities Explore trauma management skillsAssist the individual with mental illness(es) to develop skills for coping with trauma and trauma issuesEncourage the use of these skills
56Staff Competencies for CS Embracing Recovery and Resiliency PrinciplesDesigning & Delivering CS InterventionsRecovery-supportive approachesAssisting with skill-buildingAssisting individuals with mental illnesses to develop capacity to acquire resources & supportsTraining families & natural supports in effective support strategiesLearning from individuals with mental illnesses and their families/natural supportsCultural literacy and competency
57Differentiating Community Support v. Case Management Helping individual or family build capacity to assess, access, and self-monitorActive, rehabilitative, recovery-oriented set of interventionsTeaches “how”Limits “doing for”CASE MANAGEMENT(MH, TLA, CCC)Assessment of resource needsProvide Access/LinkageMonitoringClient-focused professional communicationsExpressly precludes direct provision of underlying service
58A Sidebar on Case Management in IL MENTAL HEALTH CASE MANAGEMENTAssessmentPlanning & CoordinationIdentifying/investigating resourcesAdvocacyClients with multiple service needsExplaining optionsLinkage (non-transition)Maximum 240 hours/year (including CCC)For persons who need assistance getting or using services like:- Mental health - Housing- Social - Vocational- Public benefitsCLIENT CENTERED CONSULTATIONClient-focused professional communicationMaximum of 240 hours/year (including MH Case Manage.)Face to face or phone contacts with other professionals involved in treatment (internal and external providers)Contacts with SOF, educational, medical systemNOT supervision or utilization review
59A Sidebar on Case Management in IL TRANSITION LINKAGE, & AFTERCARETransition to different living arrangements consistent with improvement & developmentMaximum of 40 hours/yearIncludes when:The person is discharged from psychiatric hospital or psychiatric nursing home servicesA young person is transitioning to adult servicesAssisting client’s family with transition related issues
60Community Support Options CS-ResExtended high acuityMulti-disciplinaryIntensity of serviceCS-TeamCS-IndividualCS-Group(can flex to high intensity when needed)
61Four Ways of Delivering CS Choice of intensity, frequency and modality is governed by a matrix of factors including individual/family preference, level of consumer need (medical necessity), types of specific interventions prescribed, and safety considerations.Individual(1 staff : 1 person)Group(1 staff : 2 or more persons)Team(Team : 1 person)Residential(Individual and Group)
62Community Support-Individual A Core Service for the Target PopulationExample… Assisting the client/family to build a natural support team, such as working with the child’s parents to enroll the child in community recreation activities or working with an adult to join a church, temple or mosque.Provided face to face, by phone or via video conference in order to maximize accessibility
63Community Support-Group Services to assist a group of individuals to achieve and practice rehabilitative, resilience and recovery goals.Example… A group of consumers practicing appropriate social interaction skills.Skill application and integration/practice in the community.
64Community Support-Team Provided to persons with moderate to severe mental health symptoms meeting admission criteria, who need more intense, coordinated and complex intervention.Services are delivered by a multidisciplinary team.Example… Client loses their medication and experiences a crisis then requires support to problem solve on a weekend.Interventions to address consumer’s needs are divided among team membersThis is the first team intervention also available to children and adolescents.
65Community Support-Team A strong vehicle to develop community-based supports for the transition age (17-25) population.A step-down from more intense services such as ACT, SASS or supervised residential.A step-up from less intensive community support-individual.
66Community Support-Residential Interventions delivered to a person residing in a state-approved living arrangement.“State-approved living arrangement” is a non-Institutes for Mental Diseases (IMD) residential setting that requires State-authority approval and is funded in part with State (non-Medicaid) dollars (used to pay for room, board, and non-Medicaid services). Examples include crisis residential, congregate living, and group home arrangements.
67Community Support-Residential For AdultsSupervised & CILA Residential sitesCrisis ResidentialFor Children and AdolescentsChildren who are wards of DCFS in residential treatment facilitiesYouth placed in residential facilities by DCFS and Department of CorrectionsPersons served through Division of Mental Health’s Individual Care Grant Program.
68Ten Best Practices for CS Primary worker delivers service rather than ‘brokering’ referralsNatural community supports are the primary partnersInterventions occur in the communityBoth individual and team modalities workIndividual has a consistent CS WorkerRapp & Gosha
69Ten Best Practices for CS Workers can be paraprofessionals. Supervisors are experienced and fully credentialedCaseload size (and/or acuity mix) is small enough to allow frequent contact, if necessaryServices are time unlimited, if medically necessaryIndividuals have access to familiar staff on a 24/7 basisWorkers foster individuals’ choicesRapp & Gosha
70Community Support Leads to Progress Community Support interventions are the “in-between” stepsWhere does individualwant to go?Where is individual now?Start at individual’s current capacity.Move toward capacities needed to meet recovery goals
71CS Summary Concepts Builds Capacity Assists the individual to do for self rather than doing for the personActive InterventionDevelops, teaches, and supports rather than simply observing and monitoringCore Service to Support Recovery/Resilience80% + of enrolled target population individuals should participate in some modality of this service
73What Consumers Identified as Important “Being able to choose mental health services from among those the agency has to offer in order to best meet the identified treatment goals and priorities per the individual is imperative in learning/relearning and practicing the skills necessary for the individual to gain, sustain and maintain a healthy quality of life.” (Illinois Consumer Focus Group Report, 2006)
74What Are the Differences? PSR SERVICENew PSR service is defined in the revised Rule 132Focus on agency -based skills developmentIntensive service that is a supplement to CSPSR PROGRAMDefined in the Mental Health Program BookComprised of 5 core servicesClinical home
75What Happens to the Other Four Core PSR Components? Peer SupportEmbedded in all mental health servicesCommunity Resource DevelopmentIncorporated into a Capacity GrantPSR EngagementNew Non-Medicaid serviceVocational Skills DevelopmentIncluded in PSR ServiceIncluded in new Non-Medicaid Services
76The New PSR Model PSR Model has two separate components Community practice, application, & integration (Community Support Service)Agency-based psychoeducation and skills training and development (PSR Service)
77What is the New PSR Service? A recovery oriented skill-building service to assist individuals to develop or regain skills to live, work, learn and participate fully in their communities.
78What Consumers Identified as Important Being able to choose …~ what to practice ~~ where to practice ~
79What does the New PSR Service Consist of? Necessary individual or group skill building activities that focus on:Individual participation in setting goalsSocialization, adaptation, problem solving and coping skills developmentSelf management of symptoms and recoveryPrevocational and work readinessEducation readinessIdentification of interests, strengths, and resources to leisure, recreational, and community social activities
80~Example~Several individuals have a goal to lose weight that is associated with their psychotropic medicationModule from Healthy Lifestyle Solutions: Guide to Weight ManagementPSR skills training - developing a personal healthy menu planCommunity support - shopping at their local grocery store (natural setting) to purchase food items on their individual plans (in-vivo practice)
81~Example~Individual(s) identify a goal to find a different place to live that will support their recoveryPSR skills training - teaches how to locate resources and select locations to visit, identify questions, role play questionsCommunity support – support (go with) individual(s) to tour available apartments, ask questions and request application
82What does the New PSR Service Consist of? Cognitive-behavioral interventionsInterventions to address co-occurring psychiatric disabilities, medical issues, and substance abuse issues
83Core PSR Principles/Activities Create a recovery-oriented environment where hope is evident and success is celebratedProvide interventions that are recovery oriented, person driven, evidence-based, fully integrated, flexible, and available as neededAssist individuals to achieve desired roles and activitiesFocus on skills development relevant to the individual’s life
84Core PSR Principles/Activities Develop Empowerment through Active Involvement in:one’s own rehabilitationsetting personal recovery goalssetting prioritieschoosing strategies to meet personal recovery goals
85How Does the PSR Service Relate to Community Support Services? The new PSR Service is a supplement to Community Support ServiceCommunity Support is the “clinical home”
86Why Does PSR Require Community Support Services? Research indicates that skill transfer is best facilitated in the individual’s natural living environment and / or communityThe emphasis of rehabilitation services needs to be shifted to community integration and recovery
87Who Receives the New PSR Service? Individuals who are receiving community support services and need some additional assistance to meet one or more of their recovery goals. Example:Individual is not making progress toward their self-identified recovery goals and identifies a need for more assistance
88~Example~ Community Support + PSR Client is severely depressed and at risk for hospitalization as evidenced by: lack of energy, increased anxiety, not eating adequately, not caring for physical self, lack of interests, difficulty sleeping and awakening. Community Support – Individual service has not resulted in improvement over 4 months. Referral to PSR as an adjunct to Community Support.Focused PSR interventions including helping person to learn and practice relaxation and anxiety reduction techniques.PSR Groups to identify strengths, interests, goals, barriers to meeting goals, strategies (use of strengths, ways to avoid barriers, skills to develop natural supports)Community Support – Individual/Group used to practice and integrate skills learned in PSR, into community. Once integrated, PSR discontinues and Community Support continues
89Staff Competencies for PSR Embracing Recovery/Resiliency principlesOrientation and integration of persons with mental illnesses as part of the staff teamInclusion of persons with mental illnesses in service design
90Staff Competencies for PSR Assessing skills and supportsIdentifying natural environments/natural supportsIdentifying, using and promoting strengthsUsing Motivational Interviewing
91Staff Competencies for PSR Converting all areas of life into skills trainingDesigning and implementing diverse skills programPlanning program designIncluding Evidence Based PracticeIntroducing skills training modulesAdapting skills trainingIndividualizing skills sessionsEngaging individualsProviding clinical supervision
92Summary The new PSR service is a supplement to Community Support The new PSR service is designed to help individuals become fully-integrated members of their community thru:Helping individuals identify their personal goalsProviding individuals with services choicesProviding Recovery oriented skills trainingIntegrating of skills training with Community Support
94Presentation GoalsBrief review on why the ACT definition is being changed.Describe who receives the new ACT service.Discuss ACT service interventions and activities.Define who delivers the new ACT service.During this segment we’ll cover four major areas, which are…1. Brief review on why the ACT definition is being changed.2. Describe who receives the new ACT service.3. Discuss ACT service interventions and activities.4. Define who delivers the new ACT service TRANSITION TO SLIDE #3
95Principles Driving the Change to the New ACT Definition Belief in recovery driven services.Need to focus limited ACT resources on people with most acute needs.Compliance with Medicaid expectation that ACT services be comprehensive, wrap-around package.Before we get started… it’s worth reviewing a few facts…ILLINOIS has a LONG and ILLUSTRIOUS history of providing ACT services, contributing to the body of research and knowledge on ACT. Illinois teams have used this approach in very innovative ways to help people who are DEAF & HARD OF HEARING, people who are HOMELESS, people with dual disorders (or MISA), and even people leaving JAILS & PRISONS.So why change a thing? Good question! This slide touches on three main principles behind the changes to the ACT service definition we’ll be discussing today…. They areFIRST – The belief in recovery driven services. People can and do get better.SECOND – If you believe that people get better and move on, then it becomes even more important to assure that the limited ACT resources in the state be FOCUSED on the people MOST IN NEED or people in ACUTE NEED.THIRD – We had to change the language to be crystal clear on the Medicaid expectation that ACT services be a COMPREHENSIVE, WRAP-AROUND PACKAGE This makes perfect sense, because ACT should function as a real alternative to the other, more costly wrap-around alternative of inpatient hospitalization.So, with these things in mind, what did we do? TRANSITION TO SLIDE #4
96Strengthening ACT to be Evidence-Based Service Admission criteria assure that persons most in need receive ACT for the appropriate length of time.Service planning is a participatory process.Interventions build on strengths of the person served.Skills training to occur in natural settings as a strategy to restore functioning and promote recovery.The modifications to the service definition can best be characterized as changes to STREGTHEN ACT so that it meets the test of an EVIDENCE-BASED SERVICE… and the next two slides detail eight of the changes made (not al but 8 we want to emphasize here), and these are NOT presented in any particular order of importance, they are: Admission criteria that assures that persons most in need of the service receive it for an appropriate length of time. That the service planning is a PARTICIPATORY process with the person served. That the ACT interventions build on the STRENGTHS of the person served. ACT uses SKILLS TRAINING IN NATURAL SETTINGS to focus on the restoration of functioning and to promote recovery.TRANSITION TO SLIDE #4
97Strengthening of ACT (cont.) The recipients receive comprehensive, wrap–around services & supports.The team has the capacity to respond to emergency psychiatric needs (24/7).The service includes solid peer support.The documentation always supports the medical necessity for ACT level of care.· Changes to meet the threshold for being a COMPREHENSIVE, WRAP-AROUND service package (we’ll give a little more detail on this later). The capacity to DIRECTLY respond to emergency psychiatric needs (24/7). The inclusion of PEER SUPPORT opportunities for persons served. Documentation expectations that would be sufficient to support the medical necessity for the ACT level of care.Again, these were some of the changes made to the Illinois ACT definition to make it clear to Medicaid that Illinois could meet the EVIDENCE BASED SERVICE test…TRANSITION TO SLIDE #6
98About Evidence Based Service To be an evidence based service, you must:Deliver the service to the population for whom the service has been proven to be effective;Deliver the service interventions and activities consistent with those that have been tested and proven effective; and,Provide the service interventions by the staff who have the qualifications, case loads, and integrated team-functioning that have been tested and proven effective.SO, let’s take a look at what we consider, from a clinical standpoint, to be the three KEY FEATURES of any EBP…To be an evidence based service, you must:1. Deliver the service to the POPULATION for whom the service has proven to be effective;2. Deliver the service INTERVENTIONS and ACTIVITIES consistent with those tested as effective; and,3. Provide the interventions in a way that has been proven most effective… by staff who have the QUALIFICATIONS, the proper CASE LOAD, and who function as an INTEGRATED TEAM.So, to paraphrase… the right recipient, getting the right intervention, delivered by a dynamic team approach.OR… WHO GETS THE SERVICE, WHAT SERVICE DO THEY GET, AND WHO CAN DELIVER THE SERVICE.Let’s go on to look at these three features… TRANSITION TO SLIDE #7
99Who To Enroll in ACT ACT to engage persons with: High acuity and/or complex needsEpisodes of repeat or chronic homelessnessEpisodes of incarceration in jail and prisonsMultiple psychiatric hospitalizationsHistory of poor engagement or response to traditional approachesDocumented functional impairments to community livingMost severe and persistent mental illnessesWHO GETS THE SERVICE… WHO do we envision being enrolled in the new ACT service…Some of this is familiar ground for anyone providing the service now… DMH wants ACT teams to engage persons with:High acuity and/or complex needsEpisodes of repeat or chronic homelessnessEpisode of incarceration in jails or prisonsMultiple psychiatric hospitalizationsHistory of poor engagement or response to traditional approachesDocumented functional impairments to community livingMost severe and persistent mental illnessesWhat is meant by severe and persistent forms of mental illness?…. TRANSITION TO SLIDE #8
100ACT is an Evidence Based Practice for… SchizophreniaSchizophreniform DisorderSchizo-Affective DisorderDelusional DisorderShared Psychotic DisorderPsychotic DisorderBrief Psychotic Disorder NOSBi-Polar DisorderHere are the diagnoses for which ACT has proven clinical value as an EBP… I’ll not read these, but just give you a chance to peruse TRANSITION TO SLIDE #9
101Core ACT Interventions & Activities Comprehensive assessment by the team.Individualized treatment/service and recovery planning.Person’s participation in the service plan meeting;Person’s service priorities are addressed in service plan;Service plan has skills training activities that build on strengths; and,Service plan uses natural surroundings and not the agency setting.The next few slides will review in a little detail 4 of the core activities that comprise EVIDENCE BASED ACT interventions….1. Comprehensive assessment by the team (multi-disciplinary make-up should equate to multi-disciplinary assessment approach).2. Person-centered service planning, as evidenced by:Person’s participation in the SP meeting with the team.The needs as prioritized by the person served.Action plan for skills training activities that build on strengths.Services provided in natural settings, not a program site TRANSITION TO SLIDE #10
102Core ACT Interventions & Activities Assignment of primary service coordinator to:Write the service plan with the individual;Ensure immediate changes to the service plan are made as needs change;Act as “point person” for family, and,Etc.Assignment of a primary service coordinator to:Write the SP with the individual;Ensure immediate changes to the SP are made as needs change;Act as “point person” for family, and,ETC., A few other things itemized in the full text of the rule TRANSITION TO SLIDE #11
103Core ACT Interventions & Activities Provide dual diagnosis substance abuse services, including :Stage-based approaches, such as:EngagementAssessmentMotivational enhancementActive treatmentContinuous relapse preventionThe new ACT service is expected to provide dual diagnosis substance abuse services, including :Stage-based approaches, such as:EngagementAssessmentMotivational enhancementActive treatmentContinuous relapse prevention TRANSITION TO SLIDE #12
104Core ACT Interventions & Activities Work and education related services.Peer Support Services:Peer counseling and supportLinking to self-help programs and organizations that promote recovery.Environmental and other Support Services:Medical & DentalHousingBenefits5. There is an expectation that ACT teams provide work and education related services.Peer Support Services:Peer counseling and supportLinking to self-help programs and organizations that promote recovery.Environmental and other Support Services:Medical & DentalHousingBenefits TRANSITION TO SLIDE #13
105Distinguishing ACT Requirement “Services must be available 24 hours/day, 7 days a week with emergency response coverage, including psychiatric coverage. Crisis services shall be provided 24 hours per day, seven days per week by the ACT team assigned to the individual.”Now it is a good point to insert a separate statement about a required feature of this new ACT service that distinguishes it from all others, that is the requirement that …“Services must be available 24 hours/day, 7 days a week with emergency response coverage, including psychiatric coverage. Crisis services shall be provided 24 hours per day, seven days per week by the ACT team assigned to the individual.”TRANSITION TO SLIDE #14
106Who Delivers ACT Service “ACT team requires a minimum 6.0 FTE staff (excluding the psychiatrist and the program assistant).”NOW let’s move on to WHO DELIVERS THE SERVICE….The first major feature is this requirement that the… “ACT team requires a minimum 6.0 FTE staff (excluding the psychiatrist and the program assistant).”TRANSITION TO SLIDE #15
107ACT Team Composition Full-time team leader (licensed clinician) Full-time registered nurseFour rehabilitation services associates (RSAs)Plus:Psychiatrist (minimum 10 hrs/wk/60 registered individuals)A program/administrative assistant.THE ACT TEAM is composed ofFull-time team leader (who is a licensed clinician)Full-time registered nurse (we’ll talk about a grandfather clause for existing ACT teams later)Four (4) rehabilitation service associates (or RSAs)PLUS –Psychiatrist (minimum 10 hrs/wk/50 registered individuals)A program/administrative assistant TRANSITION TO SLIDE #16
108ACT Team Leader“Full-time team leader who is the clinical and administrative supervisor of the team and also functions as an ACT clinician. The team leader shall be a licensed clinician.”Now because of the comprehensive wrap-around nature of this service, the role of the team leader becomes vitally important to the delivery of care and supports, the quality assurance, and the rule compliance functions for the program. Because of the high accountability of this position, were have the following language…THE ACT TEAM LEADER is a… “Full-time team leader who is the clinical and administrative supervisor of the team and also functions as an ACT clinician. The team leader shall be a licensed clinician.”TRANSITION TO SLIDE #17
109ACT Registered Nurse“A full-time registered nurse who provides services to all ACT individuals and who works with the ACT team to monitor each individuals clinical status and response to treatment. The registered nurse functions as a primary practitioner. For a period of two years following the adoption of this service, existing ACT providers may use an LPN with two years experience in mental health services as part of an ACT team…”The ACT Registered Nurse position; the definition states…“A full-time registered nurse who provides services to all ACT individuals and who works with the ACT team to monitor each individuals clinical status and response to treatment. The registered nurse functions as a primary practitioner. For a period of two years following the adoption of this service, existing ACT providers may use an LPN with two years experience in mental health services as part of an ACT team…”Of course the definition goes on to say that… New ACT providers shall be required to utilize an RN on all ACT teams.”TRANSITION TO SLIDE #18
110Other ACT Team Positions… “Four rehabilitation service associates who work under the supervision of a licensed clinician and function as primary practitioners for a caseload of individuals and who provide rehabilitation and support functions”Other ACT Team Positions (that round out the 6.0 FTE team)… “Four rehabilitation service associates who work under the supervision of a licensed clinician and function as primary practitioners for a caseload of individuals and who provide rehabilitation and support functions”Now, of course this is a simple statement on the minimum requirement for RSA positions, but in practice an ACT team will likely have a mix of staff with different credentials, qualifications, and life experiences in these positions. These positions could be filled by a combination of LPHA, QMHP, and RSA level staff. As you will see in a couple of slides, there are some other clinical requirements (or competencies) that will influence hiring strategies for the team.TRANSITION TO SLIDE #19
111The ACT Psychiatrist“A psychiatrist who works on a full- or part-time basis for a minimum of 10 hours per week for every 60 individuals. The psychiatrist must provide clinical and crisis services to all team individuals, work with the team leader to monitor each individual’s clinical and medical status and response to treatment, and direct psychopharmacologic and medical treatment…”In addition to the 6.0 FTE positions we just reviewed, the definition calls for a psychiatrist who is an integrated part of the ACT team… so, not a agency doc or doctors that works in a parallel fashion to the ACT team, but a clearly integrated member of the team. The definition states…“A psychiatrist who works on a full- or part-time basis for a minimum of 10 hours per week for every 50 individuals. The psychiatrist must provide clinical and crisis services to all team individuals, work with the team leader to monitor each individual’s clinical and medical status and response to treatment, and direct psychopharmacologic and medical treatment…”Although not noted here, there is also a provision that with a certification waiver, an Advanced Practice Nurse may substitute for up to half of the psychiatrist time.TRANSITION TO SLIDE #20
112ACT Program Admin Assistant “…is responsible for organizing, coordinating, and monitoring all non-clinical operations of ACT, including managing medical records; operating and coordinating the management information system; maintaining accounting and budget records for individual and program expenditures; and providing receptionist activities, including triaging calls and coordinating communication between the team and individuals.”If you look to successful ACT teams, that meet the National standards for the service and have proven effectiveness with the population, you will pretty consistently find that these programs have administrative support designed into their day-to-day operations. For that reason, the Illinois definition also includes a requirement for a program/administrative assistant, and as we see here the assistant ……is responsible for organizing, coordinating, and monitoring all non-clinical operations of ACT, including managing medical records; operating and coordinating the management information system; maintaining accounting and budget records for individual and program expenditures; and providing receptionist activities, including triaging calls and coordinating communication between the team and individuals.”TRANSITION TO SLIDE #21
113Required Competencies At least one member of the team must be trained and certified to provide substance abuse and/or co-occurring disorders.At least one member of the team should be a person in recovery and, if available, credentialed as a Certified Recovery Support Specialist.At least one member of the team must have training in rehab counseling, especially vocational, work readiness, and educational support.Now, here are the competencies I referred to a few slides previous… and when you read the rule, perhaps like me it might take a few reviews of the language to understand the mechanics of how this works, but within the 6.0 FTE team positions we described earlier, the definition requires that….At least one member of the team must be trained and certified to provide substance abuse and/or co-occurring disorders.At least one member of the team should be a person in recovery and, if available, credentialed as a Certified Recovery Support Specialist.At least one member of the team must have training in rehab counseling, especially vocational, work readiness, and educational support.TRANSITION TO SLIDE #22
114Requirements for the Whole ACT Team Each ACT team is expected to maintain a staff to individual ratio of no more than 1:10.Each team is expected to reflect the language, culture, and ethnicity of the population being served.Now we would like to consider two important “expectations” of the team operations…(FIRST) Each ACT team is expected to maintain a staff to individual ration of no more than 1:10.(AND) Each team is expected to reflect the language, culture, and ethnicity of the population being served.The first is a widely recognized cornerstone feature of the ACT model, that among other things, makes the comprehensive, wrap-around, in-vivo approach work. The second is of course, an ingredient for success in many models of care.TRANSITION TO SLIDE #23
115Competencies for Successful ACT Team Leaders Ability to lead a recovery-focused service planning process that fully includes the person served.Leadership to assure clinical focus and orientationModel for continuous learning.Good leadership skills with ability to keep team members from different disciplines working together.Management to assure that documentation supports medical necessity.We want to speak to what the new definition, although not specifically stated, does strive for in terms of the competencies of staff for EACH INDIVIDUAL ACT staff, for the TEAM LEADER, and for the team AS A WHOLE. The next 3 slides will do this beginning with the Team Leader…Ability to lead a recovery-focused service planning process that fully includes the person served.Leadership to assure clinical focus and orientationModel for continuous learning.Good leadership skills with ability to keep team members from different disciplines working together.Management to assure that documentation supports medical necessity.TRANSITION TO SLIDE #24
116Competencies for Successful ACT Team Members Belief that people can and will recover.Respect for individuals regardless of level of recovery.Ability to work as a team member.Ability to work and do assessments in-vivo.Ability to be creative when engaging people in services and a corresponding avoidance of “coercive” techniques.Respect for an individual’s cultural and trauma background.Competencies for Successful ACT Team MembersBelief that people can and will recover.Respect for individuals regardless of level of recovery.Ability to work as a team member.Ability to work and do assessments in-vivo.Ability to be creative when engaging people in services and a corresponding avoidance of “coercive” techniques.Respect for an individual’s cultural and trauma background.TRANSITION TO SLIDE #25
117Competencies for Successful ACT Teams Ability to support and train in the basic community living skill areas of:Safe affordable housingAccessing entitlements and benefitsActivities of daily livingMedication managementHealth care needsTRANSITION TO SLIDE #26
118ACT Team vs. CS-Team 1:10 staff to persons served ratio Serves narrower range of peopleServes broader range of personsRequires at least 6.0 FTE staffRequires at least 3.0 FTE staffRequires M.D., R.N., on teamMD, RN not required on teamRequires person in recoveryPerson in recovery not requiredRequires SA/MISA specialistSA/MISA specialist not requiredRequires Rhb/Voc/Sp Ed spclRhb/Voc/Sp Ed spcl not rqrdRequires 24/7 crisis interventionMay use auxiliary crisis services.This is our last slide, and because earlier today we spoke about the new definition for community support services, and because we realize that the Community Support Team (or CST) service can and will be applied to people with the serious and persistent mental illnesses, we wanted to take this opportunity to point out some of the SALIET DIFFERENCES between the two, so Let’s look at 8 elements across both services… ACT Team CS-Team1:10 staff to persons served ratio 1:18 staff to persons served ratioServes narrower range of people Serves broader range of personsRequires at least 6.0 FTE staff Requires at least 3.0 FTE staffRequires M.D., R.N., on team MD, RN not required on teamRequires person in recovery Person in recovery not requiredRequires SA/MISA specialist SA/MISA specialist not requiredRequires Rhb/Voc/Sp Ed spcl Rhb/Voc/Sp Ed spcl not rqrdRequires 24/7 crisis intervention May use auxiliary crisis services.TRANSITION TO SLIDE #27
119Thank You!IN CLOSING… Thank you very much for your attention to this presentation on ACT, as we stated, DMH will address questions you may have from this presentation if you’ll just jot them down and submit them to us.Thanks,
121Evidence-Based SE Principles Find & keep competitive employmentVocational interventions are fully integrated w/mental health treatmentAnyone who wants to work is eligibleRapid job searchTime unlimited serviceJobs seen as transitionsConsumer preferences are importantBenefits planningCompetitive employment = work in the community that anyone can apply for & pays at least minimum wage. The wage should not be less than the normal wage (and level of benefits) paid for the same work performed by individual who do not have a mental illness. Must be a job anyone can apply for. Not a set aside job.Eligibility - people are not excluded because they are not “ready” or because of prior work history, substance use, or symptoms.Rapid job search - instead of requiring extensive pre-employment assessment & training, or intermediate work experiences (like prevocational work units, transitional employment, or sheltered workshops).Jobs as transitions: people commonly try several jobs before finding a job they want to keep. Emp specialists help consumers find further jobs when they leave jobs.All choices and decisions about work and support are individualized, based on the person’s preferences, strengths, and experiences.
122Vocational Engagement Activities for a specific person to engage them in making a decision to actively seek competitive employment or formal credit/certificate bearing education.Note: this does not include pre-vocational agency based work programs or agency based education programs that do not result in credentials recognized by an employer.Intent is to have the idea that competitive employment is possible fully imbedded into the culture of the agency.
123Vocational Assessment Developing a vocational profile to guide individual choices in seeking and maintaining competitive employment.Work history, interests, skills, strengths, education, impact of symptoms, job preferences.Note: This does not include pre-vocational work experiences or simulated/situational work experiences at the agency.
124Job Finding SupportsActivities for a specific individual, directed toward helping them find and procure a job, when provided under the following conditions: placement based on consumer job preferences, competitive employment in integrated work settings, ongoing supports as needed and integration of supported employment services with other mental health services.Note: does not include general job development.Italics: general conditions of evidence-based supported employment.
125Job Retention Supports Directed toward helping the individual keep his/her competitive integrated job.Interventions that are specific to work and the job are considered job retention supports.Note: therapeutic support to help individuals manage their mental health symptoms and illness as they work toward achieving their recovery goals is a Rule 132 service. Recovery goals can include employment goals.
126Job Leaving/Termination Supports Directed toward helping the person leave a job in good standing, or view unplanned job loss as transitional and a learning experience that will help them with the next job.Intent: Job loss is not seen as a reason to discontinue participation in supported employment.
127Outreach and Engagement & Stakeholder Education
128Two related services…Outreach and Engagement – Reaching out to people with mental illnesses or emotional disorders and bringing them into the public mental health system.Stakeholder Education – Going into community to speak/train/educate groups about mental illnesses, treatment alternatives, access issues, etc.
129Outreach & Engagement: Activities & Interventions Case finding to identify adults, adolescents, and children suspected to have a mental illness or emotional disturbance who have not consented to services, require engagement or re-engagement to services.Interventions to link to emergency medical or psychiatric care.Repeat contacts over extended periods of time to engage.Developing strategies to reduce or eliminate risk.
130Facts About Outreach & Engagement No prior authorization needed.Funded with State dollars only.A new FFS option; however, NO new contract dollars involved in roll-out.This first iteration of the service is based on the experience of Illinois providers working with these special populations.Division has more freedom to revise the definition and intends to monitor & modify as desired.
131Outreach & Engagement: Service & Clinical Exclusions People already engaged in DMH provider service not eligible for Outreach & Engagement.Discontinuation of O&E should happen when person found to have certain non-MH disorders.Not intended to cover activities of PATH or other federally funded project staff.
132Stakeholder Education: Activities & Interventions Educational meetings with stakeholder groups to provide information about the signs and symptoms of mental illnesses/emotional disturbances.Meetings to collaborate with other community service sites and build opportunities for referral and engagement of people in need.Public speaking engagements that strengthen the relationships among stakeholder groups and the public MH system.
133Stakeholder Education: Goals To support collaboration between DMH providers and community stakeholders that have regular contact with high risk populations.To fight stigma with information about the signs and symptoms of mental illnesses & emotional disturbances and the availability of public MH services.To promote innovative service access strategies.
134Stakeholder Education: Facts No prior authorization needed.Funded with State dollars only (non-Medicaid).A new FFS option; however, NO new contract dollars.This first iteration of service is based on provider history of performing these activities.Division has more freedom to revise the definition and intends to monitor & modify as desired.
135Stakeholder Education: Service Exclusions The following activities are not covered:Ad hoc gatherings or impromptu presentations lacking advance preparation.Repetitious trainings with regard to content or attendees.The service is provided as an activity of a Program to Aid in the Transition from Homeless (PATH) or any other federally funded project operated by the provider.
138Parameters and Medical Necessity Medicaid OverviewParameters and Medical Necessity
139Medicaid OverviewMedicaid is a health entitlement program for people who are low-income and/or disabled that is jointly funded by the federal government and the state governmentThe federal government sets basic parameters and approves State customization of a Medicaid plan (called a ‘State Plan’)The basic Medicaid plan primarily covers in-clinic and in-hospital services.
140Three Primary Medicaid Options Clinic OptionIn clinic and in hospital servicesPhysician directedTargeted Case Management (TCM) OptionSpecific populationAssessment, planning, linkage, follow upNo direct interventionsRehabilitation (Rehab) Option
141IL Mental Health Services by Medicaid Option Targeted Case ManagementTransition Linkage & AftercareMental Health Case ManagementRehabilitation OptionAll other Rule 132 services
142Medicaid Psychiatric Rehabilitation Option Used with behavioral healthcareFocuses on community-based services that actively encourage rehabilitation and progress toward a return to optimal functioningEmphasizes participation and choiceRequires rehabilitation from a psychiatric disability
143Federal Guidance says Rehabilitation Is: Restoration of basic skills necessary to function independently/developmentally appropriate in the communityExamples: food planning and preparation, maintenance of living environment, community awareness, mobility skills, academic participation
144Federal Guidance says Rehabilitation Is: Redevelopment of communication and socialization skillsEspecially those skills that help individuals with mental illnesses move toward recovery/resiliency, maintain age appropriate community living, and achieve optimal independence from disability
145Federal Guidance says Rehabilitation Is: Family education and other family services exclusively related to treatment or rehabilitation of the covered individual.
146Federal Guidance says Rehabilitation Is: Interventions which will assist individuals to build capacity to gaining access to needed medical, social, educational and other services.These services might include housing, social services, vocational training and education.
148BUT Rehabilitation CAN provide: Skills teaching and support critical to successful job functioning,including ability to get along with peers and supervisors, concentrate on tasks at hand, work at a reasonable pace, persist at tasks, present self (cleanliness, attire and communication) appropriately for the work site, maintain work schedule (show up on time), and follow instructions.
149AND Rehabilitation CAN provide: Social skills and basic and daily-living skills required for success in an academic program.Note: Academic goals can be included in Service Plan as long as focus is on rehabilitative skills that allow person to complete that education, reduce disability, and restore the individual to his or her best functional level.
150AND Rehabilitation CAN provide: Skills development and practice of skills necessary to structure and use leisure time, recreational opportunities, and social occasions.Improving natural support systemsDeveloping relationship skillsPlanning skillsReducing isolation and withdrawal
151Federal Guidance says Rehabilitation Is Medically Necessary: What does that mean?Focus on issues caused or impacted by psychiatric disability and directly related to the mental illnessNot just beneficial – necessary to remediate the disability
152Demonstrating Medical Necessity: Five Basic Steps Assessment documents psychiatric condition and impact on functioningService Plan addresses areas identified on assessment and includes steps to returning to baseline (Signed by authorized person)Service Plan prescribes services in amount & duration reasonably expected to foster changeInterventions (& notes) directly relate to Service PlanNotes demonstrate progress
153Eleven Essential Skills Building ResilienceEleven Essential Skills
154Resilience Skills: Getting Connected Building strong, positive relationships with family and friendsGetting involved in civic groups, faith groups or volunteer organizationsFulfilling the need for a sense of belonging and banishing loneliness through relationships/connectedness
155Resilience Skills: Using Humor and Laughter Remaining positive/finding humor in distressing situations does not mean a person is in denialHumor is a helpful coping mechanismFunny books and movies can add humor to life
156Resilience Skills: Learning From Our Experiences Recalling how you have coped with hardships in the past, either in healthy or unhealthy waysBuilding on what helped you through the rough times; not repeating actions that did not helpFiguring out what lessons you learned and how you will apply them when faced with similar situations
157Resilience Skills: Remaining Hopeful and Optimistic Looking toward the future, even if it’s just a glimmer of how things might improveFinding something in each day that signals a change for the betterBelieving things happen for a reason often helps to sustain people
158Resilience Skills: Taking Care of Yourself Tending to your own needs and feelings, both physically and emotionallyParticipating in hobbies you enjoy; exercising regularlyGetting plenty of sleep; eating a well-balanced diet
159Resilience Skills: Accepting and Anticipating Change Being flexible: change and uncertainty are part of lifeTrying not to be so rigid that even minor changes upset you or that you become anxious in the face of uncertaintyExpecting changes to occur makes it easier to adapt to them, tolerate them, and even welcome them
160Resilience Skills: Working Toward Goals Doing something every day that gives you a sense of accomplishmentRecognizing that even small, everyday goals are importantHaving goals which help direct you toward the future
161Resilience Skills: Taking Action Figuring out what needs to be doneMaking a plan to do itTaking action to resolve your problemsWishing problems away, or ignoring them, does no good
162Resilience Skills: Learning New Things About Yourself Looking back on past experiences and thinking about how you’ve changed as a resultRecognizing that you may be stronger than you thoughtExploring new interests, such as taking a cooking class or visiting a museum
163Resilience Skills: Thinking Better of Yourself Congratulating yourself for enduring hard times, loss or stressBeing proud of yourselfTrusting yourself to solve problems and make sound decisionsThinking positive thoughts about yourselfNurturing your self-confidence and self-esteem so that you feel you’re a strong, capable and self-reliant person
164Resilience Skills: Maintaining Perspective Recognizing that perspective is not about comparing yourself to othersComparing yourself to someone who may be worse off may only make you feel worse or feel guiltyPerspective is about looking at your situation in the larger context of your own life, and the worldIt is about keeping a long-term perspective and knowing that your situation can improve if you actively work to make it better
165A Brief Bibliography on Recovery/Resiliency Anthony, William. A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal, Vol. 24, No. 2. (2000).National Consensus Statement on Mental Health Recovery. U.S. Department of Health & Human Services. Substance Abuse & Mental Health Services Administration. Center for Mental Health ServicesNew Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. (2003)
1674 Ways of Delivering CS: Quick Review Person Receiving:CS-Individual: An individual staff member will work with you.CS-Group: One or two staff members work with you and other consumers together.CS-Team: A team of staff members will work with youCS-Residential: You’ll receive service in a residential setting from several staff membersFactors common to all four ways:ALL work toward mutually agreed upon rehabilitative, resilience-oriented, and recovery-focused goals.A minimum of 60% of all CS services must be delivered in natural settings.CS occurs at locations that reasonably accommodate the person’s needs,and at hours that do not interfere with work, educational, and other community activities.
168A Brief C.S. Bibliography Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences. Boston University: Recovery from Serious Mental Illness.Farkas & Anthony (Eds.). Psychiatric rehabilitation programs: Putting theory into practice. Baltimore, MD: Johns Hopkins University PressThe President’s New Freedom Commission: Goals and Recommendations for a Transformed Mental Health System.available at:Rapp. The strengths model. NY: Oxford U. Press, 1998Rapp and Gosha: The Principles of Effective Case Management; Psychiatric Rehabilitation Journal, Spring 2004—Volume 27, Number 4
169EVIDENCE-BASED ACT WEB SITE SAMSHA' National Mental Health Information CenterEvidence-Based Practices: Shaping Mental Health Services Toward Recovery