Presentation is loading. Please wait.

Presentation is loading. Please wait.

Presentation to Stakeholders Mercer County Community College

Similar presentations

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 Process Presentation to Stakeholders Mercer County Community College March 2, 2007

2 Sources of Recommendations
120 stakeholder committee and subcommittee participants including community practitioners, advocates, state employees, family members, consumers, and others More than 200 consumer and families in focus groups

3 Five Broad Areas of the Stakeholder Summary
Consumer and Family Input Evidence-Based and Promising Practices will Promote Recovery System Enhancements Workforce Development: Education, Training, Supervision, Retention Data-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/or Identified 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 Services Improving Staff/Consumer Interactions Securing Physical and Emotional Safety Creating Therapeutic Environments Supporting Autonomy, Choices, and Personal Goals Overcoming Personal Barriers – Self-management Consumer 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 services Upper management more accountable and accessible Get patients out of the hospital faster Having 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 doctor schedule several community agency appointments in Advance provide information on which community agencies to contact assist with Section 8 and Social Security paperwork Consumers 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 programs strengthen ICMS and PACT offering additional support groups, resources, general support, individual therapy, and personalized treatment plans Some 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 employees better linkages between inpatient and outpatient providers improved training for police and mental health screeners more community staff increase in emergency 911 cell phones live contact support person 24 hrs a day education on mental illness for general public and MH providers Consumers 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 community Lack of employment, Lack of transportation, Inadequate housing, Few educational opportunities Lack 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 be more caring and understanding offer hope through better communication make the hospital a calmer place be receptive to needs, respectful, and nurturing The 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 hospitalized Create a business day – a day outside of the hospital to handle bills and other things Another 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 consumers Experiences ranged from bullying to physical attacks Many recommendations that consumers be grouped by diagnosis/ functioning level A 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 therapy employment activities music/game rooms outdoor activities, more exercise educational movies topic specific groups more relaxation time (less “forced” socialization) Community transition activities Attending church of their choice Consumers 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 environment improved lighting and painting the walls in the bedrooms Less noise Individual interventions ear 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 recovery Consumers comments reflected a level of hopelessness and isolation in their experiences Consumers 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 Support Staffing Resource Allocation Data Driven Decision Making Methods of Disseminating Information

21 Treatment Planning and Support
Involvement of family members in wellness and recovery planning and support of plans Include 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 into Hiring Supervision, and Firing decisions Recruitment and retention include consumers and family members as part of the interviewing process as well as supervision of evaluation plans

23 Resource Allocation Include more consumers and families on county mental health boards and other committees increase statewide input into the development and evaluation of programs and services Evaluation 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 and have sufficient decision making input Utilize surveys in which resulting feedback would be incorporated into operational decision making consumers administer surveys to increase likelihood of genuine responses

25 Methods of Disseminating Information
Consumer advocacy educational forums Consumer dedicated website Informational newsletter provide updates on the transformation including consumer written articles Input solicited via written comment on specific issues focus 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 EBPs Training for Specific EBPs New Promising Approaches Monitoring of Implementation Funding and Regulatory Issues

28 Core Competencies Training for mental health clinicians in the following areas would support several EBPs: Motivational Interviewing Stages of Change/Recovery model of readiness Cognitive-behavioral techniques

29 Core Competencies Illness Management and Recovery (IMR),
Those competencies outlined above are used in most of the following approaches Illness 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- friendly Sites determined to be “centers of exemplary practice” should pilot the materials State 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, and other consumer preferred models Training for implementation of the shared decision making model improve communication between providers and consumers

32 Integrated primary health and mental health services
New Promising Practices (cont.) Integration of Physical and Mental Health Services Integrated primary health and mental health services Education on physical illnesses Regular assessment of health measures (BMI, BP, AIMS, etc.) All programming should include exercise, fitness and nutrition and physical wellness Alternative & complementary medicines

33 Monitoring Advisory Committee to assist DMHS in efforts to implement, expand, and monitor practices Utilization of scientifically derived fidelity scales, both existing and new scales Fidelity of funded programs to wellness and recovery principles be evaluated Data collection systems at the state level need to be developed

34 Funding and Regulatory Issues
DMHS provide seed money and develop training and implementation plans further support and expand EBPs and Promising Practices Financial 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 Practices NJ Division of Medical Assistance to address Medicaid funding of EBPs Practitioners 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 Provision Evaluation of the Current System Documentation Consumer/Family Provider Advance Directives Joint Protocols and Cross Training Community and Staff Education Access Issues: Point of Entry, Housing, Other

38 Evaluation of Current System
Systems Mapping Compare the existing system with an ideal system designed by stakeholders Service Duplication Evaluate services for duplication and create regulations that clearly articulate in which multiple programs consumers can participate Recovery Oriented System Indicator (ROSI) Baseline of consumer satisfaction and a method for ongoing systems’ evaluation

39 Documentation The Virtual Individualized Electronic Wellness/Recovery Action Plan (The VIEW) Electronic record including Advance directives Integrated Recovery Plan (IRP) To replace the multiple treatment plans in multiple programs Uniform Wellness and Recovery documentation requirements

40 Consumer/Family in New Roles
Navigator Member of a community support team to help consumers navigate the system Peer Educator Provide self-help training and mentoring Consumers provide training on mental health issues for members of the workforce (hospital and emergency personnel)

41 Advance Directives Continued training and education on use of Advance Directives Make sure Advance Directives are being honored in times of need Navigator and Peer Educator positions can help with training and education

42 Joint Protocols and Cross Training
Shared responsibilities for multiple service users Joint and cross training for providers of services for the shared populations

43 Public and Community Education
Anti-stigma, public information and education campaign Particularly for the medical community, legislators, and developers of college curricula

44 Access: Point of Entry Eligible for services without having been hospitalized No Wrong Door Single point of entry for all services needed: physical, social services, vocational, educational, etc. No exclusionary criteria Matching of consumers with needed services

45 Access: Housing Develop and maintain information clearinghouse for housing Wide spectrum of housing for all levels of the system Emergency 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 Retention Methods for Increasing Staff Competency Standardized curricula Training for Evidence Based Practices (EBPs) & Promising Practices Supervision Consumers as Providers Policy Changes Hospital-Specific Recommendations

48 Recruitment & Retention
Salary and benefit parity with state employees for Community Staff Annual true Cost of Living Adjustments Salary differentials for additional credentials Career ladders

49 Recruitment & Retention: Credentialing
Certified Psychiatric Rehabilitation Practitioner (CPRP) as preferred credential Recovery-oriented Open to all educational levels/experience Upward mobility for those earn CPRP’s and specified credentials

50 Some educational programming ideas
Pre-paid tuition program Expand existing academic programs to all state psychiatric hospitals Expand existing academic programs to all regions of state Use flex-time to attend classes Time off for work-related educational programs

51 Recruitment of Like-Minded Individuals
Involve consumers in hiring, supervision, firing Liaison with colleges for recruitment and influencing of curricula Support consumer employment in field Centralized website for job listings Market loan forgiveness program Use exit interviews in QA initiative

52 Increasing Staff Competency: Standardized Curricula
Developed & delivered by academic entity, SME, or national experts Core content identified by Workgroups Centralized and coordinated training vs. On-site and customized Follow-up with TA, consultation, and monitoring Core courses approved for state licenses and national certifications Establish incentives for attending training

53 Increasing Staff Competency: Standardized Curricula
Cross Training Infuse Wellness & Recovery in all state funded training Cross train staff in DD, Aging In, Jail, DAS, Elderly Cross train and co-train hospital and community staff

54 Methods for Increasing Staff Competency: EBPs
Academic entity develop and deliver standardized, replicable training Develop Centers of Excellence and Centers of Exemplary Practice as training and consultation sites Develop agency leadership coalition to promote EBPs Ongoing evaluation

55 Methods for Increasing Staff Competency: Supervision
Individual and group supervision Skills based, non-punitive Individual learning plans Performance appraisals, evaluations, PAR/PES based on W&R principles and competency development W&R survey tool for measuring staff application of W&R principles

56 Consumers as Providers
Receive training for administration of ROSI Deliver training to general community workers, e.g., police, EMTs, screeners Deliver training on Advance Directives Navigator

57 Policy & Procedure Changes
New policies & procedures will require training for implementation Data collection and reporting Electronic records, e.g., VIEW Service access based on need

58 Community: Standardized Curriculum – 12 Domains
Person–oriented attitudes, values, knowledge and behavior Engaging families and significant paid and unpaid supporters in all aspects of service planning, care and evaluation Knowledge of clinical and biological aspects of mental and physical illness and developmental disabilities Knowledge of addictions and mental illness as co-occurring disorders Assessment, recovery planning and documentation Intervention and support strategies

59 Community Competencies 12 Domains (Continued)
Community resource development and acquisition Legal issues and civil rights Systems collaboration Ethics and Professional Behavior Cultural competence Methods of evaluation

60 Hospitals: Standardized Curricula
Contract with academic entity to develop standardized curricula for Core Competencies and EBPs Conduct train-the-trainer sessions for training coordinators Training coordinators will offer ongoing access to training for existing and new employees Ongoing support and TA available to training coordinators through academic entity

61 Hospitals: Curricula Content
Echoed community recommendations Additional recommendations for hospital settings Basic therapeutic skills Accountability Communication Supervisory training Staff safety and security during W&R introduction Hands on training to “ease the transformation process”

62 Hospitals:Additional Recommendations
Hospital Workforce Subcommittee continue to meet for competency development and implementation monitoring Allocate FY2008 resources to assure equivalent training resources throughout the hospital system Consistent staff development plan Monitor 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 outcomes Developing a data collection system Removing systemic obstacles Evaluating service outcomes and basing funding on performance Providing service performance information to consumers Ensuring consumer input The 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 system Identify system goals Create associated outcome measures Identify 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 funding Establish baseline data Provide initial and ongoing training It 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 assessment Data sharing Include “physical” health data Hospitalization data Employment data Recommendations 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 contracts Tie service outcomes first to monitoring and later to reimbursement and contracting decisions Establish consequences and incentives Redirect resources from lesser-valued/lower priority to higher priority services It 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 input provide support for participation include reticent groups Support consumer being well-informed informational newsletter educational forums interactive website Several 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 card Specify outcome data Publish on the Division’s website It 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 Medicaid Share data on “physiological measures’, other illness/diagnoses, and hospitalization With DMAHS review and if needed revise regulations to support wellness and recovery approaches within federal guidelines Working with DHS Licensing & Inspections Engage Office of Licensing staff Review and revise regulations

Download ppt "Presentation to Stakeholders Mercer County Community College"

Similar presentations

Ads by Google