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Active Consumer Engagement. History. Part of our ARR (Application for renewal and Recommitment) under Section 3 – Assuring Active Engagement National Council for Community Behavioral Healthcare process benchmarking report Consumer Engagement and Retention Best Practices
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History • Part of our ARR (Application for renewal and Recommitment) under Section 3 – Assuring Active Engagement • National Council for Community Behavioral Healthcare process benchmarking report • Consumer Engagement and Retention • Best Practices • Engagement work group created • Engagement Values • Engagement Policy • Training • Implementation
Engagement/Values • Active Engagement: Staff will build meaningful relationships with consumers, families, and guardians. Consumer will be satisfied with services they are receiving; they will feel that they can talk to staff openly and honestly. Phone calls will be returned in a timely fashion and staff will be there to help consumers in their recovery process • Engagement Values: Staff will provide a warm and welcoming environment to consumers, families, and guardians being open-minded, dedicated, and building reliable and trusting relationships. • See your departments’ engagement values
CSM’s/Therapists will routinely call the consumer prior to their initial face-to-face appointment to introduce themselves and establish a rapport and confirm the appointment
First Time Contact • First phone call is made to introduce yourself to the consumer/family as soon the case is assigned to a CSM/therapist • Confirm time of appointment • Confirm where the consumer is comfortable meeting • Explain the process of the first face-to-face • Inform consumer that you are opening their case and to call you if they need to speak with you prior to the meeting • Ask consumer to write down any questions they may have prior to the meeting • Discuss any possible barriers that may prevent them from making appointments (ex. Transportation, work/school schedule, fear) • If the consumer fails to call or show for two consecutive scheduled appointments, the CSM/therapist will follow up with 2 consecutive phone calls, one attempt at face-to-face contact, courtesy letter, and finally an action notice. • The initial phone call will take place within five days from the time the case is assigned to a CSM/therapist.
Consumer is a no call no show for an appointment or cancels • After 2nd no call no show or cancelled appointment, CSM/therapist will call. If no answer or returned phone call received back, CSM/therapist will then attempt to make a face-to-face contact with the consumer • Unable to make face-to-face contact, then send courtesy letter • No contact made within 7 days from date of courtesy letter, Action Notice is then sent • Discuss any possible barriers that may be preventing them from making their appointments • Determine why they are cancelling the appointments
Staff will maintain an active and ongoing discharge process with consumer during the course of their treatment • At the time of intake when first contact is made with CSM/therapist it will be explained to the consumer that the treatment process is geared toward a successful discharge. • Regular review of progress made as it is written in the person center plan • Outcomes met • Reduction of the CAFAS score • Skills for integration into the home and community • Staff will help consumers to achieve their goals and outcomes • Discuss with consumers what they are hoping to improve upon and also discuss what they are hoping to change, implement, or extinguish, ie: stop smoking • Staff will actively discuss discharge planning with consumer from beginning of treatment through end of treatment • The staff will consistently help the consumers in moving forward with their outcomes
Unplanned Discharge • Staff will follow a script when discussing unplanned discharges with consumers • Steps will be taken for staff to follow when a consumer states that they want to prematurely close their case. These steps will help assist with how to continue to keep that consumer engaged with their treatment.
Telephone…Creating a Culture of Anti-Stigma • Do – when answering the telephone, let people know if you’re available to talk • Do – work on maintaining connection and empathy • Under stress? Your tone sets the mark for how much information you’ll receive from the consumer and/or community member • Ask your colleagues for assistance if need be!
Recognizing Consumer Signs of Disengagement • No shows or cancellations • Delayed appointments and re-schedules • Not returning phone calls • Want short sessions (do not want to be there) • Yes/no answers • Avoidance • Guardedness
Recognizing Staff Missteps • Failing to sense important feelings experienced by consumers • Sending messages that consumers interpret as ‘put-downs’ • Failing to acknowledge growth • Manifesting lapses of memory about important events in consumer’s lives • Being late or canceling appointments • Disagreeing, arguing, or giving excessive advice • Appearing to take sides against a consumer • Giving assignments that consumers feel incapable of carrying out
Motivational Interviewing All clinical staff will be trained in motivational interviewing techniques and how to utilize them to effectively engage with consumers
Motivational Interviewing • An approach designed to help staff/consumers build commitment & reach a decision to change • It appears to be consumer-centered, yet staff maintain a strong sense of purpose & direction, largely through choosing the right moments to interject • Non- Authoritarian • Responsibility for change is ultimately left with the consumer, but the case manager plays a critical role
Goals of Motivational Interviewing • To resolve ambivalence • AMBIVALENCE: unsure of the action that one wants to take; Ambivalence must be resolved to move forward with change and reduce the probability of relapse • To develop discrepancy • To increase intrinsic motivation • To increase the consumer’s self perception, regarding the ability to change • To encourage the consumer to present the argument for change
Contributors to Ambivalence • Fear of Change • The payoff should be worth the work to change • The inability to reach a decision • Staff pressure often produces resistance
Principles of Motivational Interviewing • Express empathy • Reflective Listening • Avoid argumentation • Roll with resistance • Develop discrepancy • Support self-efficiency
Five Types of Reflective Statements for Motivational Interviewing • Repeating • Rephrasing • Paraphrasing • Reflection of Feeling • Summarizing
Person Centered approach • Staff will use the person centered or family centered approach • Looking at consumer’s strengths • Staff need to actively seek and listen to the consumer’s feedback • Staff need to be aware of one’s own self-awareness • Consumers understand the services that are available to them • Consumers understand medicalnecessity • Staff will be mindful that the Person Center Plan is the consumer’s treatment plan and not their own
Medical Necessity Criteria • The definition of Medical Necessity is: Determination that a specific service is medically (clinically) appropriate, necessary to meet needs, consistent with the person’s diagnosis, symptomatology and functional impairments, is the most cost-effective option in the least restrictive environment, and is consistent with clinical standards of care. Medical necessity of a service shall be documented in the individual plan of services.
Medical Necessity Criteria • MCMHA services: • Access screens for entry criteria • Assess determines diagnosis • Treat (eliminate, decrease, maintain, stabilize) diagnosis • Result in consumer meeting outcomes • Determination process: • Based on information provided by consumer or people who know them • Based on clinical assessment • Based on person centered planning information • Made by trained clinician • Timely • The service authorized will achieve its purpose • Must be written in the Plan of Service
Medical Necessity Criteria • Authorized services must: • Be delivered timely • Be culturally sensitive • Meet person’s needs • Occur in the least restrictive setting • Occur in the most integrated setting • More restrictive/integrated settings can only be used if lesser restrictive/integrated setting were unsuccessful or not safe • Service is consistent with identified best practices • DECISIONS • Can deny a service request: • Proven to be ineffective • Experimental treatment • If there is another service more appropriate, effective, less restrictive, more cost effective • Another entity in the community that provides a similar service • Authorizations based on review of effectiveness of similar prior services, assessments, agency guidelines • Cannot deny service request solely on basis of cost. • Decision made on individual basis.
Concurrent Documentation • Through our Regional Timeliness policy, all staff are expected to document progress notes within 24 hours of contact with the consumer • Staff need to make sure they are noting the consumer’s progress towards their outcomes, providing examples in the progress notes • Consumer Satisfaction should be noted quarterly in the progress note • Staff need to show active engagement with the consumers through documented progress notes that it is being met through their Person Centered Plan
CSM/therapist must make every attempt to schedule around consumer’s time, not the CSM/therapist’s • Must be within CSM/therapist’s work schedule • The time and location of the meeting must be most convenient and conducive for the consumers/family so that effective engagement can occur
Case Transfer • Phone contact with consumer, guardian, and/or family member is made by the current CSM/therapist • Consumer is offered the option to have their current CSM/therapist sit in on transition meeting with new CSM/therapist • The current case manager will in-service (give a brief history of the consumer’s progress) to the newly assigned case manager
Customer Service Training is Required for All Staff • Customer Service Training Incorporates: • Engagement • Gentleness • Anti-stigma • Effectiveness of Engagement • Consumer Empowerment
Hospital Recidivism – Review Hospital Admissions in 30 days After Intake • Peer review and admission data will be used to provide steps that will need to be taken to engage consumer/family in active treatment • When the consumer is in the hospital, the CSM/therapist will contact the consumer/family on the first working business day • CSM/therapist will work out a discharge plan with the consumer • Appointment will be made with the consumer to see CSM/therapist within 24 hours of the next business day after discharge from the hospital • Frequency of needed contacts will be assessed at that time so active treatment can be actualized • Hospital discharge planner and MCMHA case managers will work together to coordinate consumers discharge planning needs
Relationship Development • Staff will develop relationships between the treatment team, consumers, and families that will begin with the first time of contact and be nurtured through discharge • Building trust with team and consumers/family • Open to feedback from consumer/family • Active listening • Continuous Supports Team Model • If optional Crisis/Safety Plan is in place, ensure that it is current
Staff to establish an ACTIVE ongoing discharge plan process that will help, educate, link and coordinate consumers with outside community resources • Through partnering with consumers, CSM/therapist will develop a plan to include continued engagement to transition consumers into the community. • Achievements will be reviewed and discussed at each meeting. • Follow up phone call needs to take place within 30 days from discharge and be documented. • Consumers are aware of our open door policy.
