Transforming Behavioral Health Organizations to a Person-Centered Approach to Care BHA Annual Conference May 3, 2017 Diane Grieder, M.Ed AliPar, Inc.
Some definitions: A Person-Centered System • Promotes Individual Preferences, Strengths and Dignity • Promotes Natural Supports • Promotes an Individualized Approach to care • Promotes Self-Determination • Promotes Partnership with Professionals • Promotes Sharing of Knowledge; Free Flow of Information Adams/Grieder
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 4
Ultimate Goal of Transformation A system that — – Is consumer and family driven — each adult and child will have access to the full spectrum of services needed to support recovery – Focuses on recovery — a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community – Builds resilience — the ability to face life ’ s challenges
Current Thinking • The PCCP can be the bridge between the system as it exists now and where we need to go in the future PCCPs are a key lever of personal and systems transformation at all levels: Individual and family Provider Administrator Policy and oversight 6
What are the Benefits of PCCP? • Provides a road map that guides the treatment process • Forces critical thinking to develop methods and strategies for intervention • Assists with ensuring accountability • Assists in coordination of care with other healthcare professionals (e.g., primary care physicians, social workers, housing and employment counselors, etc.) Healthcare Partnerships are key!
National Perspective IOM JCAHO CARF AACP Bazelon ACA 8
For Effective SU Treatment NIDA says: “Addiction is a complex but treatable disease that affects brain function and • behavior No single treatment is appropriate for everyone • Treatment needs to be readily available • Effective treatment attends to multiple needs of the individual, not just his • or her drug abuse Remaining in treatment for an adequate period of time is critical • Counseling — individual and/or group — and other behavioral therapies are • the most commonly used forms of drug abuse treatment Medications are an important element of treatment for many patients, • especially when combined with counseling and other behavioral therapies An individual’s treatment and services plan must be assessed continually • and modified as necessary to ensure that it meets his or her changing needs
NIDA, cont … • Many drug-addicted individuals also have other mental disorders Medically-assisted detoxification is only the first stage of addiction • treatment and by itself does little to change long-term drug abuse Treatment does not need to be voluntary to be effective • Drug use during treatment must be monitored continuously, as • lapses during treatment do occur Treatment programs should assess patients for the presence of • HIV/AIDS, Hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading
PCCP History in Maryland • Under the SAMHSA Transformation Grant which was awarded to the then MHA, that project included a Recovery Initiative, for which Maryland sought consultation from Janis Tondora at Yale, after having heard Dr. Tondora when she addressed this same Annual Conference in 2007 as the keynote speaker. For the Recovery Initiative, Dr. Tondora advised MHA and the Recovery Subcommittee that implementing person centered care planning was the way to accomplish a truly recovery oriented system. So under that Recovery Initiative, PCCP training was included as a key component of that project.
MD PCCP History cont. • Steve Reeder, in both his prior position as chief of EBPs at MHA/BHA and his current one as director of Adult Services, then furthered the work of bringing PCCP to Maryland. Working collaboratively with the EBP Center at the University of Maryland, it was determined that all EBPC trainers and the staff at MHA/BHA who routinely did training, would be trained by an expert consultant on PCCP, in order to embed those principles in all EBP implementation efforts and BHA trainings. Dr. Tondora recommended Diane Grieder, and using Adult Services Training funds, Ms. Grieder has provided training and ongoing consultation for the past 10 years.
Also in Maryland…. • PCCP has become one of the bedrock philosophies of all EBP implementation efforts throughout Maryland, with training on it provided to all programs implementing an evidence-based practice. • PCCP Trainings have been held at state-wide conferences for 10 years (including TCM in 2012), and for ACT teams, Supported Employment providers, other provider organizations by consultants • Technical assistance has been offered to ACT and SE supervisors via meetings, phone calls and case based consultations • Specialized PCCP and Supervisory training, TA, and follow-up has been given to a cadre of in state Master Trainers (10), including opportunities for them to be evaluated by me conducting trainings and for them to view other trainings • An introduction to PCCP online webinar was developed by the University of Maryland and posted at http:mdbehavioralhealth.com
A Logic Model for Building Person Centered Recovery Plans Outcomes Services Objectives Strengths/Barriers Goals Prioritization Understanding Assessment Request for services 14 Adams & Grieder, 2004
Consider the Whole Person • All of these factors must be viewed in context of the individual ’ s life/societal role, culture, family and community.
Importance of Understanding • The Integrated Summary is the bridge between the data that is collected and the creation of the individual’s Goal and Recovery Plan.
Integrated Summary (Understanding) – Guiding “ Ps ” 1. Pertinent history: e.g., personal; psychiatric; & legal 2. Predisposing factors: e.g., trauma history, head injury, co-occurring medical issues, family hx 3. Precipitating factors: e.g., What led to current admission or forensic involvement? 4. Perpetuating factors: e.g., What factors contribute to repeated adverse outcomes, e.g., cycle of readmissions? 5. Previous treatments and responses: e.g., A synthesis (not a chronological listing) of adverse and positive responses to range of previous treatments
10 P’s to Understanding, cont. 6. Protective factors/preferences: e.g., strengths/ assets that will improve a person ’ s chance of achieving stability and recovery 7. Presenting symptoms: symptoms and functional impairments as a result of the diagnosis 8. Prioritization: what’s important to the individual now? Maybe legal mandates, family 9. Prognosis: likely outcome for this person? 10. Possibilities: what is available to the person in the community; what will help his/her recovery?
A Logic Model for Transforming Organizations to a Person-Centered Approach: the 10 P’s 1. Patience/Perseverance 2. Practice 3. Personal Responsibility 4. Parsimony 5. Persuasion 6. Purpose 7. Performance Improvement 8. Passion 9. Planning 10. Playful
1. Patience/Perseverance • Recovery oriented person-centered approaches reflect a significant cultural change and a new way of doing business that is not going to happen overnight and can’t be achieved simply through staff training. Leaders need to recognize that--and so do clinicians and consumers!
Everybody has accepted by now that change is unavoidable. But that still implies that change is like death and taxes — it should be postponed as long as possible and no change would be vastly preferable. But in a period of upheaval, such as the one we are living in, change is the norm. — Peter Drucker Management Challenges for the 21 st Century
Leading Effective Change Change takes a long time…involves numerous steps and skipping any of the steps only creates the illusion of speed…and never produces a satisfying result. John Kotter Leading Change
Premise I While we may have evidence based practice models for the delivery of services….. …we do not have research based methods for implementing those practices to change current systems.
Premise II Although we may do a good job of teaching the best mental health practice available today… …we do a poor job of teaching ourselves how to decide when what we learned in the past is no longer good enough and needs to be changed .
Premise III Toolkits, manuals and other resources are helpful in defining an evidence based practice and can be a catalyst for change… …but are in and of themselves not sufficient to direct implementation and support scalability.
System-wide Change as Part of EBP Implementation Consumer Organization access structure and and climate engagement Change associated with EBPs External Provider environment knowledge (stigma, and behavior financing )
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