Presentation on theme: "Presentation to Stakeholders Mercer County Community College"— Presentation transcript:
1 Presentation to Stakeholders Mercer County Community College Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input ProcessPresentation to StakeholdersMercer County Community CollegeMarch 2, 2007
2 Sources of Recommendations 120 stakeholder committee and subcommittee participants including community practitioners, advocates, state employees, family members, consumers, and othersMore than 200 consumer and families in focus groups
3 Five Broad Areas of the Stakeholder Summary Consumer and Family InputEvidence-Based and Promising Practices will Promote RecoverySystem EnhancementsWorkforce Development: Education, Training, Supervision, RetentionData-Driven Decision Making and other Contractual/Regulatory Processes
4 I. Consumer and Family Input The value of consumer and family input at every level of service development, provision, and monitoring was highlighted. All stakeholders believe that input from consumers and family members is integral to a system that emphasizes Wellness and Recovery principles.
5 Consumer Definitions of Wellness from Consumer Input Forums In general, wellness was understood by consumers to be related to:taking care of oneself and a state of physical and emotional health.statements that defined wellness as, “a state of mind, attitude, staying drug free, keeping busy and getting enough nutrition, exercise and rest,”“an overall condition of being healthy, not being emotional nor physically down.”
6 Consumer Definitions of Recovery Traditionally oriented definitions of recovery related to becoming free of symptoms and illness. In these statements, recovery was large defined as an outcome of a process.“symptoms to disappear,” and “medicine, stabilize, and get back to your life.”Consumer-driven recovery was understood as a process and/orIdentified community supports as vital in this process, for example, having supports in the community to stay out of hospital,”“ Learning about your illness, taking your time to get better, getting enough love,” “family support,” “and ,”recovery you have to work on. If you do not work on it, it will go away. “
7 Consumers’ Recommendations for Wellness and Recovery Improving Community Supports, Linkages, and ServicesImproving Staff/Consumer InteractionsSecuring Physical and Emotional SafetyCreating Therapeutic EnvironmentsSupporting Autonomy, Choices, and Personal GoalsOvercoming Personal Barriers – Self-managementConsumer forums identified several areas of recommendations including improving Community Supports, Linkages, and Services; Improving Staff/Consumer Interactions; securing Physical and Emotional Safety; developing a Therapeutic Environment; supporting Autonomy, Choices, and Personal Goals.
8 Improving Community Supports, Linkages, and Services Better community services to prevent long-term hospital servicesUpper management more accountable and accessibleGet patients out of the hospital fasterHaving the necessary supports in the community to stay out of the hospital as well as the support of the community while in the hospital was important to consumers participating in the forums. Recommendations included large system changes, such as “Better community services to prevent long-term hospital services.” and making upper management more accountable and accessible, “upper staff such as complex administrators and other such upper staff should be accessible or reachable to patients to deal with problems and issues that might arise and please listen, hear and try to understand.” Consumers were also very concerned about “feelings of stagnation, feeling ready for discharge, but not being discharged.” “There needs to be a way to get patients out of the hospital faster.”
9 Improving Community Supports, Linkages, and Services Improve linkage between inpatient and aftercare:make sure each consumer has a doctorschedule several community agency appointments in Advanceprovide information on which community agencies to contactassist with Section 8 and Social Security paperworkConsumers identified the need for improved linkages between inpatient and community aftercare. They pointed to poor follow-up and a sense of “being lost in the system and the system’s lack of follow-up with you.”
10 Improving Community Supports, Linkages, and Services connect consumers with addiction services and community twelve-step programsstrengthen ICMS and PACToffering additional support groups, resources, general support, individual therapy, and personalized treatment plansSome consumers were concerned about “too easy access to alcohol,” “friends that like to drink,” and “peer pressure”, so assistance with addiction services and connecting consumers with their community twelve-step programs was recommended. The forums also recommended strengthening ICMS and PACT, as well as offering additional support groups and resources, general support, individual therapy and personalized treatment plans.
11 Improving Community Supports, Linkages, and Services Address stigma and the relationships between various public service employeesbetter linkages between inpatient and outpatient providersimproved training for police and mental health screenersmore community staffincrease in emergency 911 cell phoneslive contact support person 24 hrs a dayeducation on mental illness for general public and MH providersConsumers were concerned about the stigma of their mental illness and the relationships between various public service employees when serving persons with mental illness. The forums recommended better linkages between inpatient and outpatient providers, improved training for police and mental health screeners, more community staff, an increase in emergency 911 cell phones, and having a 24-hour community agency live contact person that one can contact anytime for a ride, support, or just to “vent.” Additional education on mental illness was suggested for both the general public and persons working in the mental health field.
12 Improving Community Supports, Linkages, and Services Barriers to remaining in the communityLack of employment,Lack of transportation,Inadequate housing,Few educational opportunitiesLack of employment, transportation, and housing were identified as barriers to remaining in the community. Some sought group homes while others were looking for a place to live on their own. Additionally, consumers noted a desire to complete their GED or other educational goals. Employment opportunities are needed for persons while they are in the hospital. Financial problems resulting from unemployment and a poverty of work opportunities were listed as barriers as was transportation (e.g., not having a car or driver’s license).
13 Improving Staff/Consumer Interactions Hospital staff should bemore caring and understandingoffer hope through better communicationmake the hospital a calmer placebe receptive to needs, respectful, and nurturingThe interactions between staff and consumers were an overwhelming concern in the forum comments. Consumers perceive that direct care and professional hospital staff do not have empathy, care, or respect for them.
14 Improving Staff/Consumer Interactions Staff should understand that consumers still had to take care of personal business in the community while hospitalizedCreate a business day – a day outside of the hospital to handle bills and other thingsAnother interesting finding was that many consumers expressed that staff had a lack of concern, failed to offer help with, and/or understand that consumers still had to take care of personal business in the community while hospitalized. Consumers cited, “make sure people don’t lose things in the community,” while they are in the hospital. They suggested, “Create a business day – a day out of the hospital to handle bills and other things.” Worries over children, rent, legal issues, bad credit, and families could be handled through effective community connections and support services.
15 Physical and Emotional Safety A lack of physical and emotional safety from peers and staff was a concern identified by several consumersExperiences ranged from bullying to physical attacksMany recommendations that consumers be grouped by diagnosis/ functioning levelA lack of physical and emotional safety from peers and staff was a concern identified by several consumers in statements such as, “hustling, borrowing, gambling, trading, selling and buying.” Several comments were made about having “bullies on the unit.” In the varying contexts of this comment, some individuals were referring to fellow patients, and some were referring to staff. One person reported being given a black eye by a peer. Other people commented on peers not being motivated or being too negative. Another consumer’s concern was whether staff would be able to “Keep me from hurting myself.” Perhaps most strongly stated, “This is a f-----d up place. It’s very unstructured and unorganized.” Several consumers recommended that consumers be grouped by diagnosis/ functioning level.
16 Therapeutic Environment-Improved Treatment Activities Recommendations:1:1 therapyemployment activitiesmusic/game roomsoutdoor activities,more exerciseeducational moviestopic specific groupsmore relaxation time (less “forced” socialization)Community transition activitiesAttending church of their choiceConsumers were clear about their need for therapeutic activities while in the hospital. They noted isolation, noise, boredom, and a lack of appropriate activities as barriers to their recovery. Medications are the main focus of current interventions, while they noted that they need more psychological service/help. Recommendations from the forums included additional 1:1 therapy, employment activities, music/game rooms, outdoor activities, more exercise, and educational movies. While some consumers requested additional groups for specific issues (e.g., women’s groups, trauma groups), others advocated for more relaxation time (less “forced” socialization). Community transition, including activities like shopping, community bingo and bowling, was another area where some consumers thought additional groups would be helpful. Being able to attend the church of their choice as a “level three” to meet spiritual needs was
17 Therapeutic Environment-Improved Treatment Activities Improving physical aspects of the environmentimproved lighting and painting the walls in the bedroomsLess noiseIndividual interventionsear plugs, dental floss, and hygiene products,Improving physical aspects of the environment, such as improved lighting and painting the walls in the bedrooms was recommended. Consumers were interested in improvements that would make the environment feel calmer. Individual interventions that could help consumers accommodate to the environment, such as ear plugs, dental floss, and hygiene products, were also recommended in the forums.
18 Autonomy, Choices, and Personal Goals Consumers have little choice over small things such as phone calls, wake up times, food choices, or when to meet with the team.The forums recommended increases in choices.“Constantly having people in charge of me, isolation and seclusion,” was a concern noted in the forums. Consumers have little choice over small things such as phone calls, wake up times, food choices, or when to meet with the team. The forums recommended increases in choices.
19 Overcome Personal Barriers – Self-management Consumers acknowledged that taking responsibility for their behavior and illness is important for recoveryConsumers comments reflected a level of hopelessness and isolation in their experiencesConsumers identified building and maintaining relationships with others as barriers to their recovery.Some consumers identified their own behavior or symptoms as barriers, both in the hospital and in the community. While these consumers implicitly or explicitly acknowledged that taking responsibility for their actions and illness is important for recovery to occur, these comments also reflect a level of hopelessness and isolation in their experiences. Building and maintaining relationships with others was another area where individuals noted barriers to their recovery. For some this was apparent in a “lack of friends” while for others it was manifested in family issues. “Family not understanding or desiring to be educated about mental illness being a life long process,” was reported by one consumer. Others had problems with information not being shared with family members or with stigma in the community.
20 Additional themes from Community-Based Consumer Family Forums Treatment Planning and SupportStaffingResource AllocationData Driven Decision MakingMethods of Disseminating Information
21 Treatment Planning and Support Involvement of family members in wellness and recovery planning and support of plansInclude the input of significant paid and unpaid supporters in all aspects of service planning, care, and evaluation.Addressing perceived HIPAA and confidentiality concerns may be necessary
22 Input into Staffing Decisions Mechanism for consumer input intoHiringSupervision, andFiring decisionsRecruitment and retentioninclude consumers and family members as part of the interviewing process as well as supervision of evaluation plans
23 Resource AllocationInclude more consumers and families on county mental health boards and other committeesincrease statewide input into the development and evaluation of programs and servicesEvaluation of the adequacy of consumer/family representation on board and policy making groups
24 Data Driven Decision Making Mechanisms be developed to assure consumers they can:Rate the value the services that they receive andhave sufficient decision making inputUtilize surveys in which resulting feedback would be incorporated into operational decision makingconsumers administer surveys to increase likelihood of genuine responses
25 Methods of Disseminating Information Consumer advocacy educational forumsConsumer dedicated websiteInformational newsletterprovide updates on the transformation including consumer written articlesInput solicited via written comment on specific issuesfocus groups and consumer/family survey information
26 II. Evidence-Based and Promising Practices “An ideal system is one that is wellness and recovery oriented and has access to a full array of evidence based practices as well as an array of programs that are promising models of exemplary practice.”
27 Evidence Based and Promising Practices: Recommendation Themes Core Competencies for all EBPsTraining for Specific EBPsNew Promising ApproachesMonitoring of ImplementationFunding and Regulatory Issues
28 Core CompetenciesTraining for mental health clinicians in the following areas would support several EBPs:Motivational InterviewingStages of Change/Recovery model of readinessCognitive-behavioral techniques
29 Core Competencies Illness Management and Recovery (IMR), Those competencies outlined above are used in most of the following approachesIllness Management and Recovery (IMR),Assertive Community Treatment (ACT/PACT),Integrated Dual Diagnosis Treatment (IDDT),Supported Employment,Family Psychoeducation,Motivational Interviewing,Peer Support and Self-Help,Cognitive Behavioral Therapy (CBT),Supported Education (SEd), Supported Housing (SH)Wellness and Recovery Action Plans (WRAP).
30 Training Training Current training efforts will need to be expanded Training packages used should be user- friendlySites determined to be “centers of exemplary practice” should pilot the materialsState should collaborate with professional societies and academic institutions for training and certification of the workforce
31 New Promising Practices Development of funding for:clubhouse models,self-help centers, andother consumer preferred modelsTraining for implementation of the shared decision making modelimprove communication between providers and consumers
32 Integrated primary health and mental health services New Promising Practices (cont.) Integration of Physical and Mental Health ServicesIntegrated primary health and mental health servicesEducation on physical illnessesRegular assessment of health measures (BMI, BP, AIMS, etc.)All programming should include exercise, fitness and nutrition and physical wellnessAlternative & complementary medicines
33 MonitoringAdvisory Committee to assist DMHS in efforts to implement, expand, and monitor practicesUtilization of scientifically derived fidelity scales, both existing and new scalesFidelity of funded programs to wellness and recovery principles be evaluatedData collection systems at the state level need to be developed
34 Funding and Regulatory Issues DMHSprovide seed money and develop training and implementation plansfurther support and expand EBPs and Promising PracticesFinancial incentives and/or regulatory relief for agencies who adopt EBPs.
35 Inter-agency collaboration Collaboration between:Dept. of Human Services, and Dept. of Labor & Workforce Development in order to expand EBPs and Promising PracticesNJ Division of Medical Assistance to address Medicaid funding of EBPsPractitioners and provider agencies to involve providers in the development of regulations
36 III. System Enhancements “To complement new and expanded services, stakeholders felt that improvements to the current service systems would contribute to the development of a wellness and recovery-oriented system.”
37 Recommendation Themes Pervasive Treatment Philosophy and Service ProvisionEvaluation of the Current SystemDocumentationConsumer/Family ProviderAdvance DirectivesJoint Protocols and Cross TrainingCommunity and Staff EducationAccess Issues: Point of Entry, Housing, Other
38 Evaluation of Current System Systems MappingCompare the existing system with an ideal system designed by stakeholdersService DuplicationEvaluate services for duplication and create regulations that clearly articulate in which multiple programs consumers can participateRecovery Oriented System Indicator (ROSI)Baseline of consumer satisfaction and a method for ongoing systems’ evaluation
39 DocumentationThe Virtual Individualized Electronic Wellness/Recovery Action Plan (The VIEW)Electronic record including Advance directivesIntegrated Recovery Plan (IRP)To replace the multiple treatment plans in multiple programsUniform Wellness and Recovery documentation requirements
40 Consumer/Family in New Roles NavigatorMember of a community support team to help consumers navigate the systemPeer EducatorProvide self-help training and mentoringConsumers provide training on mental health issues for members of the workforce (hospital and emergency personnel)
41 Advance DirectivesContinued training and education on use of Advance DirectivesMake sure Advance Directives are being honored in times of needNavigator and Peer Educator positions can help with training and education
42 Joint Protocols and Cross Training Shared responsibilities for multiple service usersJoint and cross training for providers of services for the shared populations
43 Public and Community Education Anti-stigma, public information and education campaignParticularly for the medical community, legislators, and developers of college curricula
44 Access: Point of EntryEligible for services without having been hospitalizedNo Wrong DoorSingle point of entry for all services needed: physical, social services, vocational, educational, etc.No exclusionary criteriaMatching of consumers with needed services
45 Access: HousingDevelop and maintain information clearinghouse for housingWide spectrum of housing for all levels of the systemEmergency assistance and housing subsidies
46 IV. Staff Development: Recruitment, Retention, Education, & Supervision Implementing EBPs and promising practices, as well as service system enhancements will require a highly competent workforce making recruitment, retention, and continued development of a qualified, competent, caring workforce as essential.
47 Recommendation Themes Recruitment and RetentionMethods for Increasing Staff CompetencyStandardized curriculaTraining for Evidence Based Practices (EBPs) & Promising PracticesSupervisionConsumers as ProvidersPolicy ChangesHospital-Specific Recommendations
48 Recruitment & Retention Salary and benefit parity with state employees for Community StaffAnnual true Cost of Living AdjustmentsSalary differentials for additional credentialsCareer ladders
49 Recruitment & Retention: Credentialing Certified Psychiatric Rehabilitation Practitioner (CPRP) as preferred credentialRecovery-orientedOpen to all educational levels/experienceUpward mobility for those earn CPRP’s and specified credentials
50 Some educational programming ideas Pre-paid tuition programExpand existing academic programs to all state psychiatric hospitalsExpand existing academic programs to all regions of stateUse flex-time to attend classesTime off for work-related educational programs
51 Recruitment of Like-Minded Individuals Involve consumers in hiring, supervision, firingLiaison with colleges for recruitment and influencing of curriculaSupport consumer employment in fieldCentralized website for job listingsMarket loan forgiveness programUse exit interviews in QA initiative
52 Increasing Staff Competency: Standardized Curricula Developed & delivered by academic entity, SME, or national expertsCore content identified by WorkgroupsCentralized and coordinated training vs. On-site and customizedFollow-up with TA, consultation, and monitoringCore courses approved for state licenses and national certificationsEstablish incentives for attending training
53 Increasing Staff Competency: Standardized Curricula Cross TrainingInfuse Wellness & Recovery in all state funded trainingCross train staff in DD, Aging In, Jail, DAS, ElderlyCross train and co-train hospital and community staff
54 Methods for Increasing Staff Competency: EBPs Academic entity develop and deliver standardized, replicable trainingDevelop Centers of Excellence and Centers of Exemplary Practice as training and consultation sitesDevelop agency leadership coalition to promote EBPsOngoing evaluation
55 Methods for Increasing Staff Competency: Supervision Individual and group supervisionSkills based, non-punitiveIndividual learning plansPerformance appraisals, evaluations, PAR/PES based on W&R principles and competency developmentW&R survey tool for measuring staff application of W&R principles
56 Consumers as Providers Receive training for administration of ROSIDeliver training to general community workers, e.g., police, EMTs, screenersDeliver training on Advance DirectivesNavigator
57 Policy & Procedure Changes New policies & procedures will require training for implementationData collection and reportingElectronic records, e.g., VIEWService access based on need
58 Community: Standardized Curriculum – 12 Domains Person–oriented attitudes, values, knowledge and behaviorEngaging families and significant paid and unpaid supporters in all aspects of service planning, care and evaluationKnowledge of clinical and biological aspects of mental and physical illness and developmental disabilitiesKnowledge of addictions and mental illness as co-occurring disordersAssessment, recovery planning and documentationIntervention and support strategies
59 Community Competencies 12 Domains (Continued) Community resource development and acquisitionLegal issues and civil rightsSystems collaborationEthics and Professional BehaviorCultural competenceMethods of evaluation
60 Hospitals: Standardized Curricula Contract with academic entity to develop standardized curricula for Core Competencies and EBPsConduct train-the-trainer sessions for training coordinatorsTraining coordinators will offer ongoing access to training for existing and new employeesOngoing support and TA available to training coordinators through academic entity
61 Hospitals: Curricula Content Echoed community recommendationsAdditional recommendations for hospital settingsBasic therapeutic skillsAccountabilityCommunicationSupervisory trainingStaff safety and security during W&R introductionHands on training to “ease the transformation process”
62 Hospitals:Additional Recommendations Hospital Workforce Subcommittee continue to meet for competency development and implementation monitoringAllocate FY2008 resources to assure equivalent training resources throughout the hospital systemConsistent staff development planMonitor and re-evaluate after one year
63 V. Data-Driven Decision Making: Contracts, Regulations, and Outcomes “Critical to all the recommendations outlined above will be the appropriate administrative structures and processes to support the wellness and recovery transformation effort and sustain this new orientation.”Recommendations for changes in contracting, regulations, and outcome measures were addressed by the relevant subcommittees as well as other sub-committees.
64 Recommendation Themes Establishing measurable outcomesDeveloping a data collection systemRemoving systemic obstaclesEvaluating service outcomes and basing funding on performanceProviding service performance information to consumersEnsuring consumer inputThe recommendations across subcommittees consistently reflected the themes of 1)establishing measurable outcomes that are consistent with wellness and recovery, 2) developing an accurate data collection system, 3) removing systemic obstacles to achieving wellness and recovery outcomes, 4) evaluating service outcomes and basing funding on performance, 5) providing service performance information to people with psychiatric disabilities and family members, and 6) ensuring consumer input into the development of a wellness and recovery system and into funding decisions.
65 Establish Measurable Outcomes Operationalize NJ’s transformed systemIdentify system goalsCreate associated outcome measuresIdentify and/or create fidelity measures relevant to each modality or service.It was recommended that DMHS operationalize a model of New Jersey’s transformed system including an articulation of the role of DMHS. It is thought that this process could be informed by consultation from other states that have successfully made such a transformation. It is necessary for DMHS, in consultation with providers, participants and experts, to identify system goals and create associated outcome measures that are client/consumer specific; program specific, and system specific. It is also recommended that DMHS in consultation with these same groups identify and/or create fidelity measures.
66 Develop Data Collection System Develop capacity, infrastructure, and fundingEstablish baseline dataProvide initial and ongoing trainingIt is recommended that DMHS develop the capacity, infrastructure, and funding to support statewide data collection and analysis that is consistent with program modality. This should include the establishment of a baseline of data to support outcomes evaluation and system transformation. Further, DMHS should provide initial and ongoing training for data collection and reporting for all Division funded agencies and hospitals.
67 Remove Systemic Obstacles Promote Cross System Collaboration System-wide needs assessmentData sharingInclude “physical” health dataHospitalization dataEmployment dataRecommendations reflect obstacles in many aspects of the system. A system-wide needs assessment should be conducted to identify service gaps and provide a statewide report card. It was recommended that providers serving the same individual be required to share data. This should include physical health care data as well. Data related to physical health and wellness service needs, availability, and effectiveness should be collected and tracked. There should be a review of requirements from regulatory agencies to reduce duplication of data submission. DMHS should advocate with NJ Medicaid for changes that remove obstacles to wellness and recovery services (e.g., changing from clinic to rehabilitative).
68 Evaluate Service Outcomes Performance Based Funding W & R outcome measures in all contractsTie service outcomes first to monitoring and later to reimbursement and contracting decisionsEstablish consequences and incentivesRedirect resources from lesser-valued/lower priority to higher priority servicesIt was recommended that DMHS embed wellness and recovery outcome measures in all inpatient treatment services and community contracts including partially funded agencies. Service outcomes should be tied to continued funding and the contract award and monitoring processes. Some suggested a continuum of compliance levels (e.g., minimal, recommended, and ideal) with associated financial consequences and incentives. DMHS should planfully redirect resources from lesser-valued/lower priority to higher priority services. Funding should be available for pilot studies.
69 Ensure Consumer Input In transformation and resource allocation gather inputprovide support for participationinclude reticent groupsSupport consumer being well-informedinformational newslettereducational forumsinteractive websiteSeveral recommendations addressed the need to ensure consumer input in the transformation process as well as ongoing resource allocation and funding decisions. DMHS should identify ways of gathering input (e.g., county MH boards, policy groups focus groups, distributing surveys), provide adequate support for participation (e.g., travel reimbursement), and include groups of consumers who tend to be reticent (e.g., those rejecting services, those who have left services, and those who have yet to feel empowered enough to provide input). Further, it was recommended that DMHS support the consumer community to be well informed by creating an informational newsletter, providing educational forums, and creating an interactive website.
70 Provide performance information to consumers and family members Performance report cardSpecify outcome dataPublish on the Division’s websiteIt was recommended that DMHS create a reader-friendly performance report card on programs, agencies, and hospitals. This report card should specify outcome data and should be published on the Division’s website.
71 Other Regulatory Issues Work with MedicaidShare data on “physiological measures’, other illness/diagnoses, and hospitalizationWith DMAHS review and if needed revise regulations to support wellness and recovery approaches within federal guidelinesWorking with DHS Licensing & InspectionsEngage Office of Licensing staffReview and revise regulations