Erme C. Maula, RN, MSN, CRRN, CPS Program Manager

MHASP Consumer Recovery Investment Fund: Self Directed CareDelaware County, PAPresentation to PA MHA ConferenceApril 27, 2011 Erme C. Maula, RN, MSN, CRRN, CPS Program Manager Mental Health Association of Southeastern Pennsylvania

CRIF SDC Definitions • CRIF: Consumer Recovery Investment Fund • SDC: Self Directed Care • CPS: Certified Peer Specialist • Recovery Coach: Certified Peer Specialist and WRAP trained facilitator that accompanies participants along their recovery journey • Freedom Funds: Funds in the SDC budget used to purchase non-traditional goods and services

Collaborators • Magellan Health Services – Magellan Behavioral Health of Pennsylvania is an affiliate of Magellan Health Services • Office of Behavioral Health, Delaware County, Pennsylvania • Temple University Collaborative on Community Integration of People with Psychiatric Disabilities • Mental Health Association of Southeastern Pennsylvania • National Institute on Disability and Rehabilitation Research

Meet the Operations and Recovery Coach Team Evon Bergey, General Manager, Magellan Health Services Joseph Rogers, Director of Advocacy, MHASP Bill Chambers MH Program Director Delaware County Office of Behavioral Health Erme Maula, Program Manager, MHASP Bob Waters, National V.P., Account Management Magellan Health Services Mark Salzer Professor and Chair Department of Rehabilitation Sciences Temple University Tim Connors, Recovery Coach, MHASP Bill Dinwiddie, CEO MHASP Brett Diamond, MHASP Andrea Bilger Research Assistant Temple University Jennifer Tripp VP, Public Sector Program Innovation Magellan Public Sector Solutions Rita Burns CFO, MHASP Richard Baron Director, Knowledge Translation Activities Temple University Collaborative on Community Integration of People with Psychiatric Disabilities Jeff Quick, Recovery Coach, MHASP Julie Brown, Delaware County Senior Account Executive, Magellan Health Services Not Pictured: Jonna DiStefano, Lisa Gardner, Dawn Berardinelli, Lynne Baumeister, Donna Holiday

CRIF SDC Program Philosophy is based on the following elements: • Recovery • Peer Support • Self Directed Care

Recovery • The program philosophy is based on the fundamental belief that people can and do recover from mental illness. • Recovery is a deeply personal process that involves the restoration of hope, self-esteem, creativity, and self-determination. • Recovery is a life-long journey that restores and maintains individual dignity and control over one’s own destiny.

Recovery Values HOPE INDIVIDUALITY SELF-AWARENESS SELF-DETERMINATION MEANINGFUL LIFE RESPECT PEER SUPPORT COMMUNITY FOCUS ADVOCACY

Peer Support • All CRIF SDC Program Recovery Coaches are Certified Peer Specialists. • Peers helping other peers has been identified as a critical part of the recovery process. • The President’s New Freedom Commission on Mental Health (2003) explicitly recognized the critical role of peer support. • People who are employed as Recovery Coaches have the unique capacity to inspire hope, trust, personal responsibility, empowerment, self-determination and social connectedness in their fellow peers. • Recovery Coaches are able to use their own Recovery Journey as an example of the possibility of recovery.

Self Directed Care • This approach supports individuals in developing their own wellness goals and in controlling the funds that are used to implement their self-directed behavioral health recovery plan. • Each person is responsible for making his or her own choices on the recovery journey and must be responsible for the outcomes of those choices. • Giving people decision-making power over their own behavioral health-care budget is a concrete step toward self-determination and responsibility. • The process of creating a recovery plan, identifying appropriate services, and deciding how to spend service dollars encourages independence and self-determination.

How exciting would it be if… • We can show that working with a Recovery Coach/CPS/WRAP Facilitator moves people forward in their recovery • By allowing people to determine what best works for them, the final cost to the Behavioral Health Care system is reduced or equivalent to the cost of “Services as Usual” • By allowing people to direct their own care, they experience significant movement forward in their recovery journey • We can model the possibility of four very different entities successfully working together • We are able to create more CPS job positions • We are able to generate outcomes that help to establish a waiver that allows for the establishment of similar programs in other parts of the state

Goals of CRIF SDC • Individuals in the SDC condition will experience greater levels of empowerment, recovery, and quality-of-life compared to those in the control condition. • Individuals in the SDC condition will experience greater levels of community participation over time compared to those in the control condition. • Individuals in the SDC condition will live more independent lives, depending less on high cost, acute/crisis services (e.g., inpatient hospitalization, crisis service use) compared to those in the control condition.

Criteria for Enrollment • Delaware County Resident • Member of Health Choices, Magellan Behavioral Health • Diagnosed within either the schizophrenia or bipolar family of disorders • 60 – 90th percentile utilizer of services • No hospitalizations within the past 6 months • Randomized into Temple study • 150 total in study: 75 in control, 75 in SDC

Process for Enrollment • Study group randomized by Magellan Health Services—letters sent to 50 at a time • Temple University contacts potential participants for enrollment • Participants enrolled in study are randomized into either the Control, or “Services as Usual” group, or the SDC group • SDC Group is enrolled by MHASP Recovery Coach Team • Initial orientation period is followed by monthly visits over the subsequent 24-month period

Process of Engagement • Establishing relationship • Exploring Dreams • Setting Goals from Dreams Exercise • Reviewing past 24-month utilization of traditional services with peer • Setting budget from goal activities • Requesting authorization for purchases • Authorization for purchases approved or declined by Magellan Health Services representatives • Approved purchase amounts placed on Allow Card • Monthly check-ins with Recovery Coach, or as determined by Participant

MH Budget • Mental Health Budget includes • All In-Plan (traditional outpatient Medicaid Reimbursable services, including Peer Support by Recovery Coach) • Non-traditional services (Freedom Funds) • Equal to previous 24-month period mental health costs

Recovery Goals • All activities and purchases must fit within the Participant’s Recovery Plan • Recovery Plans can change over time • Recovery Coaches help to educate Participants about the concepts and processes of recovery • The Recovery Coach team keeps track of proposed monthly budget, as well as actual utilization, over the next 24 months.

What we have learned • Similar to the Dallas, TX program, we found that some of the first “asks” pertained to physical medical health care needs • As opposed to focusing on assessments, we focus on dreams. Self Directed Care allows the peer to set the area of focus • This program really puts recovery into action • Participants may not have experienced recovery in such a comprehensive way before • Some people focus on short-term needs and have not had the opportunity to have a longer-term focus on their dreams and hopes for their future

Sample “asks” • Back Rent • Electric Bill • Exercise Clothing and equipment • Gym Memberships • Computer Software to write poetry • Glasses after charges are made to Physical Health Insurance • Relocation Costs • Car Repair • Books for School • Social Activities • Lawnmower to start a lawncare business • Digital Camera and Printer • Transportation • Membership to the Philadelphia Museum of Art

Life Domains • Mental Wellness • Physical Health • Education (or learning something new) • Work or Meaningful Activities • Social Activities • Housing

Freedom Fund Categories

SDC Card, formerly Allowcard • Similar to a check/credit card • Decreases the stigma related to mental health • Allows participants to have responsibility of funds • Allows restrictions to be placed on card from Program Staff (certain items are not allowed to be purchased: alcohol, illegal drugs, guns, cash, pornography, etc.) • Allows monitoring of activity

Next Steps • 120 people enrolled in study • 63 in SDC • 57 in Services as Usual Group • Moving forward with Recovery Process and Peer Support with “enrollees” • Meeting with non-MH Providers to talk about Recovery and ask for possibilities of services to purchase • Operations Team meetings • On-going program evaluation

Policy Implications Cross Disability work as a result of the Power to the People Summit 2009 Presentations at Alternatives 2010, NYAPRS 2010, NYAPRS Executive Summit 2011, Netherlands 2011, and other Enhancing People in Recovery being able to control the amount of money being spent on their care in a way that moves them forward in their recovery and teaching self direction and hopefully decreasing costs to the system

Quotes from Participants How has your life been changed by being a participant in the program so far? • I am far too busy to see a therapist; I am very busy with school. However, I do have coping skills which help me. CRIF's coaches are there for me whenever I need them; they have given me new coping skills that I can use and what’s best about this is CRIF's coaches are available to coach me whenever I need them. - Alicia, CRIF SDC participant

How has the CRIF SDC Project helped you in your journey of recovery? • CRIF has helped me tremendously. I began treatment a few years ago, when [Health Choices Physical Health Insurance] stopped providing eye care benefits. I knew that I needed glasses but I could not afford them as I am a student and I have plenty of other priorities that I must take care of first. The CRIF program, my coaches, have given me the opportunity to get the eye glasses that I needed. In addition to this, my coaches have worked as advocates, friends and have given me additional coping skills. My coaches are currently helping me take care of other issues that I otherwise would not have been able to take care of. I love CRIF and my coaches.

"It [the CRIF SDC Project] gives me perspective on where I'm going. I may not have a plan yet, but I do have hope" - Roderick, CRIF SDC participant

Contact Information for CRIF Self Directed Care Team: Erme C. Maula, RN, MSN, CRRN, CPS Program Manager, CRIF Mental Health Association of Southeastern Pennsylvania 1211 Chestnut St., 11th Floor Philadelphia, PA 19107 emaula@mhasp.org Office: 267 507 3873 Secure Fax: (215) 525-9698

Erme C. Maula, RN, MSN, CRRN, CPS Program Manager