Implementing Recovery-Oriented Practices

1. Implementing Recovery-Oriented Practices Step 2 in the Recovery-Oriented Care Continuum: Person-Centered Care Planning April 11, 2011 Janis Tondora, Psy.D. Assistant Professor, Department of Psychiatry Program for Recovery and Community Health, Yale University School of Medicine, New Haven, Conn. Sadé Ali, M.A., CAC, CCS Deputy Commissioner, Department of Behavioral Health & Intellectual disABILITY Services, Philadelphia, Pa. Kimberly Guy C–RECS Coach/Educator, Focus on Recovery–United, Inc. (FOR–U) Program for Recovery and Community Health, Yale University School of Medicine, New Haven, Conn. Larry Davidson, Ph.D. Development Services Group (DSG), Inc. Image: Recovery to Practice logo Image: SAMHSA Logo 1

2. Step 2 in the Recovery-Oriented Care Continuum If You’re Not Hearing Any Audio… • To access the audio for this Webinar, please dial the conference service directly, and enter the participant access code • Audio Conferencing (Toll-Free):1.888.769.8795 • Participant Access Code:5067580 Image: Picture of Phone 2

3. Step 2 in the Recovery-Oriented Care Continuum Webinar Agenda • 3:00–3:05 p.m. • 3:05–3:10 p.m. • 3:10–3:25 p.m. • 3:25–3:40 p.m. • 3:40–3:55 • 3:55–4:30 p.m. Welcome Introductions and Overview of Today’s Workshop Person-Centered Planning From Theory to Practice Person-Centered Care Planning: What’s Culture Got to Do With It? Finding Your Voice in Person-Centered Care Planning Discussion Wilma Townsend SAMHSA/CMHS Larry Davidson DSG, Inc. Janis Tondora Yale Program for Recovery and Community Health Sadé Ali Dept. of Behavioral Health & Intellectual disABILITY Services Kimberly Guy Yale Program for Recovery and Community Health 3

4. Step 2 in the Recovery-Oriented Care Continuum Process for Our Questions, Answers, and Discussion • Our speakers will present, followed by moderated questions and answers. We invite you to ask questions or make comments! To ask a question… either click on the Q/A tab and type your question in the window that opens... OR press *1 for the operator, who will take your question in the order in which it is received. • This Webinar will be recorded and archived for future use. Please visit http://www.dsgonline.com/rtp/resources.html for more information.

5. Step 2 in the Recovery-Oriented Care Continuum Person-Centered PlanningFrom Theory to Practice Presented by Janis Tondora, Psy.D Assistant Professor, Department of Psychiatry Program for Recovery and Community Health, Yale University School of Medicine Image: Janis Tondora, Psy.D 5 5

6. Step 2 in the Recovery-Oriented Care Continuum What We Expectfor Them What We Expectfor Us • Life worth living • A spiritual connection to God/others/self • Being a good mom/dad/daughter • Friends • Fun/laughter • Nature/music/hobbies • Pets • Love/intimacy/sex • Having hope for the future • Joy • Giving back/being needed • Learning • A home of our own • Compliance with treatment • Decreased symptoms/clinical stability • Better judgment • Increased insight • Reduced aggression • Acceptance of illness/disability • Adherence to team’s recommendations • Decreased hospitalization • Residential stability • Abstinence from substances • Increased functioning • Active engagement/showing up • Improved cognitive functioning • Realistic expectations 6

7. Step 2 in the Recovery-Oriented Care Continuum Toward a Recovery-Oriented System • People with mental health and addictions issues generally want the exact same things in life as all people. • People want to thrive, not just survive… • Recovery-oriented care challenges us to move past the maintenance of clinical stability to the true pursuit of recovery! Image: Man on ladder, peeling back nighttime to expose daytime 7

8. Step 2 in the Recovery-Oriented Care Continuum Increasing Alignment Image: Publication cover: “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care” IOM Image: Publication cover: “In the Driver’s Seat: A Guide to Self-Directed Mental Health Care” TJC Image: Publication cover: “Improving the Quality of Health Care for Mental and Substance-Use Conditions” Image: Publication cover: “Keystones for Collaboration and Leadership: Issues and Recommendations for the Transformation of Community Psychiatry” Bazelon AACP 8

9. Plans Should Focus on What PeopleMost Value in Life… • Quality of life • Education • Work • Housing • Health/well-being • Manage their own lives • Social opportunity • Activity/accomplishment • Transportation • Spiritual fulfillment • Satisfying relationships … to be part of the life of the community. 9

10. Step 2 in the Recovery-Oriented Care Continuum …And Not Just on the Territoryof Traditional Treatment Plans • Goal: • Maintain psychiatric stability • Objectives • Attend appointments with primary care provider • Donna will attend psychiatric appointments Image: “Do not” symbol 10

11. Step 2 in the Recovery-Oriented Care Continuum What is Person-Centered Planning (PCP): Taking a Closer Look • Person-centered planning: • Is a collaborative process resulting in a recovery-oriented treatment plan • Is directed by consumers and produced in partnership with care providers and natural supporters • Supports consumer preferences and a recovery orientation —Adams/Grieder Image: Publication cover: “Treatment Planning for Person-Centered Care” 11

12. Step 2 in the Recovery-Oriented Care Continuum The Person-Centered Care Questionnaire Tondora & Miller, 2009 • http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQprovider.pdf • http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQperson.pdf Image: Questionnaire 12

13. Step 2 in the Recovery-Oriented Care Continuum Key Practices: Process • Adhere to person-centered principles in the process • Person is a partner in all planning activities/meetings; advance notice • Person has reasonable control over logistics (e.g., time, invitees, etc.) • Person offered a written copy • Education/preparation regarding the process and what to expect • Language as a key practice Image: Key 13

14. Step 2 in the Recovery-Oriented Care Continuum • http://www.yale.edu/PRCH/documents/toolkit.draft.4.16.10.pdf Image: Publication cover: “Getting in the Driver’s Seat of Your Treatment: Preparing for Your Plan 14

15. Step 2 in the Recovery-Oriented Care Continuum Glass Half Empty vs. Glass Half Full 15

16. Step 2 in the Recovery-Oriented Care Continuum Key Practices: Process • Recognize the range of contributors to the planning process (e.g., peers, natural supporters). • Value community inclusion. • “While,” not “after” • Trap of the one-stop shop • Demonstrate a commitment to both outcomes and process; high expectations. • Understand and support human rights such as self-determination (e.g., role of advance directives, Positive Behavior Support Plans). Image: Key 16

17. Step 2 in the Recovery-Oriented Care Continuum What Next? • So you try your best to implement all of these key practices in PCP… but how do we move from the practice of PCP to the documentation of PCP? Image: Person wondering 17

18. Step 2 in the Recovery-Oriented Care Continuum But Can We Document the Service Plan This Way and Still Get Paid? Person-Centered Care Medical Necessity Image: Cartoon with Oil Man and Water Girl at dinner “Let’s face it: Our relationship is doomed!” 18

19. Step 2 in the Recovery-Oriented Care Continuum A More Hopeful Proposition • We can balance person-centered approaches with medical necessity/regulations in creative ways to move forward in partnership with persons in recovery. • We can create a plan that honors the person and satisfies the chart! • In other words: PCP is not soft! Image: Scale 19

20. Step 2 in the Recovery-Oriented Care Continuum Putting the Pieces Togetherin a Person-Centered Plan GOAL as defined by person Strengths to Draw Upon Barriers /Assessed Needs That Interfere • Short-Term Objective • Behavioral • Achievable • Measurable • Interventions/Methods/Action Steps • Professional/“billable” services • Clinical & rehabilitation • Action steps by person in recovery • Roles/actions by natural supporters 20

21. Step 2 in the Recovery-Oriented Care Continuum Image: Sample Recovery Plan 21

22. Step 2 in the Recovery-Oriented Care Continuum Image: Sample Recovery Plan 22

23. Step 2 in the Recovery-Oriented Care Continuum Image: Sample Recovery Plan 23

24. Step 2 in the Recovery-Oriented Care Continuum Get It… Do It… Live It… • “Getting it” vs. “doing it” and “living it” • Many mental health systems’ change efforts get derailed by perpetual efforts to help people “get it.” • “We don’t think ourselves into a new way of acting, we act ourselves into a new way of thinking.” • Execution: The Discipline of getting Things Done, by Larry Bossidy and Ram Charan Image: Girl on diving board 24

25. Step 2 in the Recovery-Oriented Care Continuum Person-Centered Care Planning:What’s Culture Got to Do With It? Presented by Sadé Ali, M.A., CAC, CCS Deputy Commissioner,Department of Behavioral Health& Intellectual disABILITY Services Image: Sadé Ali, M.A., CAC, CCS 25 25

26. Step 2 in the Recovery-Oriented Care Continuum A Good, Strengths-Based Assessment • Includes attention to concepts called “Person-first.” • Person-first is a more inclusive way of saying “culturally appropriate,” and includes • Strengths and capacities • Nationality and/or ethnicity • Sexual orientation • Faith and spirituality • Gender, gender identity, and/or gender expression • Age • Social role • Intellectual and cognitive abilities • Ways in which individuals heal themselves in a cultural context 26

27. Step 2 in the Recovery-Oriented Care Continuum One Size Should Never Fit All Image: Square peg being fitted into a round hole 27

28. Step 2 in the Recovery-Oriented Care Continuum Healing in a Cultural Context Image: American Indian woman 28

29. Step 2 in the Recovery-Oriented Care Continuum Person-First Issues May Impact Recovery/Resilience Image: Woman standing at edge of pier, looking out on horizon 29

30. Step 2 in the Recovery-Oriented Care Continuum These Include, But Are Not Limited To… • Hours during which services are delivered • The honoring of the individual’s or family’s ways of healing and an inclusion of them as recovery/resilience supporters • The honoring of non-traditional families and the inclusion of them as recovery/resilience supporters Image: Clock 30

31. Step 2 in the Recovery-Oriented Care Continuum Outcomes Will Improve When… • The care being given is relevant to the person, the family, and other supporters of the individual and the community to which, and in which, it is being given. Image: Indian goddesses 31

32. Step 2 in the Recovery-Oriented Care Continuum • A person-centered plan cannot be created without knowledge of who the individual is beyond the mental health or substance use challenge. 32

33. Step 2 in the Recovery-Oriented Care Continuum Helpful Questions • What do you call your challenge, and what do you think can help to heal it? • Who is your family? Who do you trust? • What personal pronoun do you use? What would you like to be called? (This is especially important to transgender and gender-variant people.) • Have you ever been a member of a faith or spiritual community? Are you a member now? If so, would you like your faith/spiritual leader to become part of your recovery/resilience support team? Images: Families 33

34. Step 2 in the Recovery-Oriented Care Continuum Helpful Questions, cont. • With whom do you have intimate relations and relationships? • Have you ever been a victim of police brutality, homophobia, transphobia, or other forms of oppression? • Has your family always lived in the area? • How do you identify culturally or ethnically? What do you know about your culture? What were some of the messages you got about the cultures of others? 34

35. Step 2 in the Recovery-Oriented Care Continuum Some Final Thoughts • People should be assumed to have within them everything they need to get into and maintain recovery, but it is up to us, the “guides on the side,” to nurture and support that notion. • It doesn’t take anything away from us to sit in the “learner’s chair,” especially when working with people whose cultures are different from our own. • “Dignity” and “respect” are two words that are often overused and undervalued. 35

36. Step 2 in the Recovery-Oriented Care Continuum Image: “Love” sculpture 36

37. Step 2 in the Recovery-Oriented Care Continuum Finding Your Voice in Person-Centered Care Planning Presented by Kimberly Guy C–RECS Coach/Educator, Focus on Recovery–United, Inc. (FOR–U),Program for Recovery and Community Health,Yale University School of Medicine Image: Kimberly Guy 37 37

38. Step 2 in the Recovery-Oriented Care Continuum Image: Kimberly Guy in black jacket Image: Kimberly Guy holding certificate Image: Kimberly Guy 38

39. Step 2 in the Recovery-Oriented Care Continuum Speaker Contacts • Janis Tondora • Janis.tondora@yale.edu • Sadé Ali • Omisade.ali@phila.gov • Kimberly Guy • Guy.kimberly@gmail.com Image: Computer 39

40. Step 2 in the Recovery-Oriented Care Continuum For More Information: Web-Based References and Resources • Sadé Ali: Developing Culturally Competent Recovery Plans – Person-Centered Planning Using the Recovery Model • http://www.browndlp.org/dlpannouncement.php?course=199 • Tondora, J.; Pocklington, S.; Gorges, A.; Osher, D.; & Davidson, L. (2005). Implementation of person-centered care and planning: From policy to practice to evaluation. • http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm 40

41. Step 2 in the Recovery-Oriented Care Continuum Web-Based References and Resources, cont. • Jonikas, J.; Cook, J.; Fudge, N.; Hilebechuk, M.; & Fricks, L. (2005). Charting a meaningful life: Planning ownership in person/family-centered planning. • http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm • New York Care Coordination Program.Extensive materials and tools re: the implementation of PCP, including web-based interactive exercises to practice writing person-centered plans. • Extensive materials and tools re. the implementation of PCP, including Web-based interactive exercises to practice writing person-centered plans • http://www.recoveryskillbuilder.com 41

42. Step 2 in the Recovery-Oriented Care Continuum Q and A, Discussion, and Summary • To ask a question… either click on the Q/A Tab and type your question in the window that opens... OR press *1 for the operator, who will take your question in the order in which it is received. Larry Davidson, Ph.D. Project Director, Recovery to Practice DSG, Inc. ldavidson@dsgonline.com Thanks for joining our Webinar today! Image: Larry Davidson, Ph.D.

43. Step 2 in the Recovery-Oriented Care Continuum For more information… • For a copy of today’s presentation: http://www.dsgonline.com/rtp/resources.html • Recovery to Practice Resource Center:RecoverytoPractice@dsgonline.com