implementing recovery-oriented practices
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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, - PowerPoint PPT PresentationTRANSCRIPT
Implementing Recovery-Oriented Practices
Step 2 in the Recovery-Oriented Care Continuum: Person-Centered Care Planning
April 11, 2011Janis Tondora, Psy.D.Assistant Professor, Department of PsychiatryProgram for Recovery and Community Health,Yale University School of Medicine, New Haven, Conn.
Sadé Ali, M.A., CAC, CCSDeputy Commissioner, Department of Behavioral Health& Intellectual disABILITY Services, Philadelphia, Pa.
Kimberly GuyC–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: SAMHSA Logo
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Step 2 in the Recovery-Oriented Care Continuum
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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 TownsendSAMHSA/CMHS
Larry DavidsonDSG, Inc.
Janis TondoraYale Program for Recovery and Community Health
Sadé AliDept. of Behavioral Health & Intellectual disABILITY Services
Kimberly GuyYale Program for Recovery and Community Health
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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.
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Step 2 in the Recovery-Oriented Care Continuum
Person-Centered PlanningFrom Theory to Practice
Presented by
Janis Tondora, Psy.DAssistant Professor, Department of PsychiatryProgram for Recovery and Community Health,
Yale University School of Medicine
Image: Janis Tondora, Psy.D
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Step 2 in the Recovery-Oriented Care Continuum
What We Expectfor Them
• 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
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What We Expectfor Us
• 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
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
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Step 2 in the Recovery-Oriented Care Continuum
Increasing Alignment
Image: Publication cover: “Improving the Quality of Health Care for Mental and Substance-Use Conditions”
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IOM TJC
AACP Bazelon
Image: Publication cover: “Keystones for Collaboration and Leadership: Issues and Recommendations for the Transformation of Community Psychiatry”
Image: Publication cover: “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care”
Image: Publication cover: “In the Driver’s Seat: A Guide to Self-Directed Mental Health Care”
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
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… to be part of the life of the community.
Step 2 in the Recovery-Oriented Care Continuum
…And Not Just on the Territoryof Traditional Treatment Plans
• Goal: Maintain psychiatric stability
• Objectives1. Attend appointments with primary care provider 2. Donna will attend psychiatric appointments
Image: “Do not” symbol
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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/GriederImage: Publication cover:
“Treatment Planning for Person-Centered Care”
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Step 2 in the Recovery-Oriented Care Continuum
The Person-Centered Care QuestionnaireTondora & Miller, 2009
• http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQprovider.pdf
• http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQperson.pdf
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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
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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
Step 2 in the Recovery-Oriented Care Continuum
Glass Half Empty vs. Glass Half Full
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Deficit-Based Language Strengths-Based, Recovery-Oriented Alternative
A schizophrenic… a borderline… A person diagnosed with…
Clinical case manager Recovery coach… guide…
Front-line staff… in the trenches… Direct-support staff
Substance abuse/abuser Person living with… SA interferes with…
Suffering from Living with… recovering from…
Treatment team Recovery team
High-functioning vs. low-functioning A person’s symptoms/addiction interferes with the following
Unrealistic Idealistic… high expectations…
Resistant… non-compliant… Disagrees with… chooses alternative…
Weaknesses Barriers to change… support needs….
Maintaining clinical stability… abstinence…
Promoting life worth living
Puts self/recovery at risk Takes risks to try new things/grow
Treatment works Person uses treatment as a tool in recovery
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: Key16
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
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Step 2 in the Recovery-Oriented Care Continuum
But Can We Document the Service Plan This Way and Still Get Paid?
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and Water Girl at dinner
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Medical N
ecessit
yPerson-Centered Care
“Let’s face it: Our relationship is doomed!”
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!
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Step 2 in the Recovery-Oriented Care Continuum
Putting the Pieces Togetherin a Person-Centered Plan
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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
Step 2 in the Recovery-Oriented Care Continuum
Image: Sample Recovery Plan 21
Step 2 in the Recovery-Oriented Care Continuum
22Image: Sample Recovery Plan
Step 2 in the Recovery-Oriented Care Continuum
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Image: Sample Recovery Plan
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
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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, CCSDeputy Commissioner,
Department of Behavioral Health& Intellectual disABILITY Services
Image: Sadé Ali, M.A., CAC, CCS
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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
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Step 2 in the Recovery-Oriented Care Continuum
One Size Should Never Fit All
Image: Square peg being fitted into a round hole
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Step 2 in the Recovery-Oriented Care Continuum
Healing in a Cultural Context
Image: American Indian woman
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Step 2 in the Recovery-Oriented Care Continuum
Person-First Issues May ImpactRecovery/Resilience
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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
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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.
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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.
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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?
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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?
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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.
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Step 2 in the Recovery-Oriented Care Continuum
Image: “Love” sculpture
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Step 2 in the Recovery-Oriented Care Continuum
Finding Your Voice in Person-Centered Care Planning
Presented by
Kimberly GuyC–RECS Coach/Educator,
Focus on Recovery–United, Inc. (FOR–U),Program for Recovery and Community Health,
Yale University School of Medicine
Image: Kimberly Guy
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Image: Kimberly Guy in black jacket
Image: Kimberly Guy
Image: Kimberly Guy holding certificate
Step 2 in the Recovery-Oriented Care Continuum
Speaker Contacts
• Janis Tondora [email protected]
• Sadé Ali [email protected]
• Kimberly Guy [email protected]
Image: Computer
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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
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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
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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 PracticeDSG, [email protected]
Thanks for joining our Webinar today!
Image: Larry Davidson, Ph.D.
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For more information…
• For a copy of today’s presentation: http://www.dsgonline.com/rtp/resources.html
• Recovery to Practice Resource Center:[email protected]
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