Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input Process

1. Summary of NJ DMHS Wellness and Recovery TransformationStakeholder 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

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

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

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

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

12. Improving Community Supports, Linkages, and Services • Barriers to remaining in the community • Lack of employment, • Lack of transportation, • Inadequate housing, • Few educational opportunities

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

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

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

16. 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 Therapeutic Environment-Improved Treatment Activities

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,

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.

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.

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 • 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. 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