summary of nj dmhs wellness and recovery transformation stakeholder input process presentation to...
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Summary of NJ DMHS Wellness and Recovery Transformation
Stakeholder Input Process
Presentation to StakeholdersMercer County Community College
March 2, 2007
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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
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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
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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.
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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.”
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Consumer Definitions of RecoveryTraditionally 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. “
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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
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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
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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
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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
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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
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Improving Community Supports, Linkages, and Services
Barriers to remaining in the community Lack of employment, Lack of transportation, Inadequate housing, Few educational opportunities
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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
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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
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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
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Therapeutic Environment-Improved Treatment Activities
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
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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,
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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.
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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.
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Additional themes from Community-Based Consumer Family Forums
1. Treatment Planning and Support2. Staffing3. Resource Allocation4. Data Driven Decision Making5. Methods of Disseminating
Information
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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
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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
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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
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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
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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
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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.”
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Evidence Based and Promising Practices: Recommendation Themes
1. Core Competencies for all EBPs2. Training for Specific EBPs3. New Promising Approaches 4. Monitoring of Implementation5. Funding and Regulatory Issues
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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
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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).
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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
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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
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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
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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
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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.
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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
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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.”
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Recommendation Themes
1. Pervasive Treatment Philosophy and Service Provision
2. Evaluation of the Current System3. Documentation4. Consumer/Family Provider5. Advance Directives6. Joint Protocols and Cross Training7. Community and Staff Education8. Access Issues: Point of Entry, Housing,
Other
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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
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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
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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)
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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
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Joint Protocols and Cross Training
Shared responsibilities for multiple service users
Joint and cross training for providers of services for the shared populations
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Public and Community Education Anti-stigma, public information and
education campaign Particularly for the medical
community, legislators, and developers of college curricula
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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
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Access: Housing Develop and maintain information
clearinghouse for housing Wide spectrum of housing for all
levels of the system Emergency assistance and housing
subsidies
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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.
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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
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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
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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
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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
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Recruitment of Like-Minded Individuals
Involve consumers in hiring, supervision, firing
Liaison with colleges for recruitment and influencing of curricula
Support consumer employment in field Centralized website for job listings Market loan forgiveness program Use exit interviews in QA initiative
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Increasing Staff Competency: Standardized Curricula
Developed & delivered by academic entity, SME, or national experts
Core content identified by Workgroups Centralized and coordinated training vs.
On-site and customized Follow-up with TA, consultation, and
monitoring Core courses approved for state licenses
and national certifications Establish incentives for attending training
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Cross Training Infuse Wellness & Recovery in all
state funded training Cross train staff in DD, Aging In, Jail,
DAS, Elderly Cross train and co-train hospital and
community staff
Increasing Staff Competency: Standardized Curricula
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Methods for Increasing Staff Competency: EBPs
Academic entity develop and deliver standardized, replicable training
Develop Centers of Excellence and Centers of Exemplary Practice as training and consultation sites
Develop agency leadership coalition to promote EBPs
Ongoing evaluation
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Methods for Increasing Staff Competency: Supervision
Individual and group supervision Skills based, non-punitive Individual learning plans Performance appraisals, evaluations,
PAR/PES based on W&R principles and competency development
W&R survey tool for measuring staff application of W&R principles
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Consumers as Providers Receive training for administration
of ROSI Deliver training to general
community workers, e.g., police, EMTs, screeners
Deliver training on Advance Directives
Navigator
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Policy & Procedure Changes New policies & procedures will
require training for implementation Data collection and reporting Electronic records, e.g., VIEW Service access based on need
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Community: Standardized Curriculum – 12 Domains
Person–oriented attitudes, values, knowledge and behavior
Engaging families and significant paid and unpaid supporters in all aspects of service planning, care and evaluation
Knowledge of clinical and biological aspects of mental and physical illness and developmental disabilities
Knowledge of addictions and mental illness as co-occurring disorders
Assessment, recovery planning and documentation Intervention and support strategies
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Community Competencies 12 Domains (Continued)
Community resource development and acquisition
Legal issues and civil rights Systems collaboration Ethics and Professional Behavior Cultural competence Methods of evaluation
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Hospitals: Standardized Curricula Contract with academic entity to develop
standardized curricula for Core Competencies and EBPs
Conduct train-the-trainer sessions for training coordinators
Training coordinators will offer ongoing access to training for existing and new employees
Ongoing support and TA available to training coordinators through academic entity
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Hospitals: Curricula Content Echoed community recommendations Additional recommendations for hospital
settings Basic therapeutic skills Accountability Communication Supervisory training Staff safety and security during W&R
introduction Hands on training to “ease the transformation
process”
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Hospitals:Additional Recommendations
Hospital Workforce Subcommittee continue to meet for competency development and implementation monitoring
Allocate FY2008 resources to assure equivalent training resources throughout the hospital system
Consistent staff development plan Monitor and re-evaluate after one year
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V. Data-Driven Decision Making: Contracts,
Regulations, and Outcomes
“Critical to all the recommendations outlined above will be the appropriate administrative structures and processes to support the wellness and recovery transformation effort and sustain this new orientation.”
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Recommendation Themes
1. Establishing measurable outcomes 2. Developing a data collection system 3. Removing systemic obstacles 4. Evaluating service outcomes and basing
funding on performance 5. Providing service performance
information to consumers6. Ensuring consumer input
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Establish Measurable Outcomes
Operationalize NJ’s transformed system
Identify system goals Create associated outcome
measures Identify and/or create fidelity
measures relevant to each modality or service.
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Develop Data Collection System Develop capacity, infrastructure,
and funding Establish baseline data Provide initial and ongoing training
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Remove Systemic Obstacles Promote Cross System Collaboration
System-wide needs assessment Data sharing Include “physical” health data Hospitalization data Employment data
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Evaluate Service Outcomes Performance Based Funding
W & R outcome measures in all contracts Tie service outcomes first to monitoring
and later to reimbursement and contracting decisions
Establish consequences and incentives Redirect resources from
lesser-valued/lower priority to higher priority services
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Ensure Consumer Input In transformation and resource allocation
gather input provide support for participation include reticent groups
Support consumer being well-informed informational newsletter educational forums interactive website
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Provide performance information to consumers and family members
Performance report card Specify outcome data Publish on the Division’s website
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Other Regulatory Issues Work with Medicaid
Share data on “physiological measures’, other illness/diagnoses, and hospitalization
With DMAHS review and if needed revise regulations to support wellness and recovery approaches within federal guidelines
Working with DHS Licensing & Inspections Engage Office of Licensing staff Review and revise regulations