PSR Assessment & Treatment Planning From a Strength’s-Based Perspective April 2005

Shifting Paradigms

Public Mental Health Services Shifting Paradigms Universe SMI/SPMI SED Medical Model Consumer Guided

Custodial Alternatives to Hospitalization Psychotherapy Psychosocial Rehabilitation Public Mental Health Services Shifting Paradigms

Problems Strengths & Resiliency Public Mental Health Services Shifting Paradigms Disability Recovery

Artificial Supports Natural Supports Public Providers Private Providers Public Mental Health Services Shifting Paradigms Clinical Experience Evidence Based

Clinic/Office Based Community Based/Systems of Care Unlimited Access Managed Care Mental Health Services Shifting Paradigms Fragmented Services Integrated Services

DEFINITION-”RECOVERY” "A deeply personal, unique process of changing one' s attitudes, values, feeling, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.” "A deeply personal, unique process of changing one' s attitudes, values, feeling, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.” Wisconsin Governor’s Blue Ribbon Commission Wisconsin Governor’s Blue Ribbon Commission “Treatment and Recovery Committee “Treatment and Recovery Committee

What do recovering individuals want? Work and/or education Work and/or education Families & relationships Families & relationships Dignity and respect Dignity and respect Decreased contact with the legal system Decreased contact with the legal system Independent Housing Independent Housing Improved Health Improved Health

What do recovering individuals want? Symptom relief Symptom relief Less hospitalization Less hospitalization Less coercion & negative outcomes Less coercion & negative outcomes Safety Safety Meaningful involvement in their communities Meaningful involvement in their communities

RECOVERY PRINCIPLES Hope: Believing you will recover Hope: Believing you will recover Trust Trust Believing in the person Believing in the person Self-Determination Self-Determination Individuals make their own meaning Individuals make their own meaning Having a voice of one’s own Having a voice of one’s own All feelings are valid All feelings are valid

RECOVERY PRINCIPLES Relating with dignity and respect Relating with dignity and respect Important to follow dreams Important to follow dreams Connecting at the human level Connecting at the human level Source: Daniel b. Fisher, Executive Director Source: Daniel b. Fisher, Executive Director National Empowerment Center National Empowerment Center

Recovery Building Blocks HOPE STRENGTHS OPTIMISM

System of Care A system of care is a wide range of mental health and related services and supports organized to work together to provide care. It is designed to help children or adolescents with serious emotional disturbances get the services they need in or near their home and community. (SAMHSA)

Systems of Care Local Teams/Councils Local Teams/Councils Physical Physical Emotional Emotional Educational Educational Social Social Family Needs Family Needs Team Makeup Team Makeup Family Advocates Educators Mental Health Staff Child Welfare VR SA Counselor Juvenile Justice

System of Care

Psychosocial Rehabilitation

DEFINITION- “PSR” Psychosocial Rehabilitation Psychosocial Rehabilitation Rehabilitative services provided both to children with serious emotional disturbance and to adults with severe and persistent mental illness to address functional deficits due to psychiatric illness and to restore independent living, socialization, and effective life management skills. (Source- IDAPA ) (Source- IDAPA )

Idaho’s PSR Model PSYCHO-PHARMACOLOGICAL CLINICAL PSYCHO-EDUCATIONALSKILLS BUILDING COLLABORATION COMMUNITY-BASED “In-Vivo” CRISIS SUPPORT

PSR- Overarching Goals Recovery & Family-Centered Practice (children) Recovery & Family-Centered Practice (children) Reestablishment of normal roles in the community Reestablishment of normal roles in the community Development of a personal support network, and increased quality of life. Development of a personal support network, and increased quality of life. Integration or reintegration into age-appropriate roles & life activities (children) Integration or reintegration into age-appropriate roles & life activities (children) Freedom of choice & self-determination Freedom of choice & self-determination Respect, dignity and individual worth Respect, dignity and individual worth

PSR-Core Principles Services are individualized- not “cookie cutter” Services are individualized- not “cookie cutter” Objectives are concrete & measurable Objectives are concrete & measurable Treatment focuses on reduction or elimination of functional limitations due to a mental illness (less on diagnosis) Treatment focuses on reduction or elimination of functional limitations due to a mental illness (less on diagnosis) Services are to be coordinated, accessible, and available (24 hours) Services are to be coordinated, accessible, and available (24 hours) Facilitate development of personal support networks Facilitate development of personal support networks

PSR-Core Principles Build on strengths and focus on practical outcomes Build on strengths and focus on practical outcomes Provide services that are culturally sensitive and relevant Provide services that are culturally sensitive and relevant Engage individuals in their own recovery process Engage individuals in their own recovery process Use treatment methodologies that are evidenced based & work; Stop those that don’t Use treatment methodologies that are evidenced based & work; Stop those that don’t Promote continuous quality improvement Promote continuous quality improvement (Source: United States PSR Association-USPRA & Idaho MHA) (Source: United States PSR Association-USPRA & Idaho MHA)

MHA Primary Responsibilities Assure that services are: Assure that services are: Safe Safe Delivered efficiently and effectively Delivered efficiently and effectively Delivered to the Medicaid Recipient Delivered to the Medicaid Recipient Not duplicated Not duplicated Not delivered fraudulently Not delivered fraudulently Achieving desired outcomes Achieving desired outcomes

Roles-Mental Health Authority Sole Source Agency - DHW & Agent for Medicaid Sole Source Agency - DHW & Agent for Medicaid Care Manager Care Manager Prior Authorizer of PSR Services Prior Authorizer of PSR Services Rule and Policy Interpreter in partnership with Medicaid Rule and Policy Interpreter in partnership with Medicaid Communications Disseminator Communications Disseminator Negotiation, problem solving, & dispute resolution Negotiation, problem solving, & dispute resolution Complaint Investigator Complaint Investigator Educator & Trainer Educator & Trainer Data Entry and Performance/Outcomes Measurer Data Entry and Performance/Outcomes Measurer

Prior Authorization Medical Necessity vs. Service Authorization and Stewardship Medical Necessity vs. Service Authorization and Stewardship Assessments & Updated Assessments Assessments & Updated Assessments Ongoing Crisis Support Ongoing Crisis Support Ongoing PSR Services in Treatment Plan Ongoing PSR Services in Treatment Plan Amendments and Plan Updates Amendments and Plan Updates

Roles of MHA Field Representatives Local Representative for MHA & DHW Local Representative for MHA & DHW Policy and rule interpreter Policy and rule interpreter Coordinator of provider relations Coordinator of provider relations Disseminator of MHA Communications Disseminator of MHA Communications Contested Case & Fair Hearings DHW Representative Contested Case & Fair Hearings DHW Representative

Roles of MHA Field Representatives Provider Enrollment Provider Enrollment Educator & Trainer Educator & Trainer Technical Assistance Technical Assistance Site Visitor & Auditor Site Visitor & Auditor Complaint Investigator Complaint Investigator Negotiator, mediator, & advocate Negotiator, mediator, & advocate Care Manager & CQI Monitor Care Manager & CQI Monitor

BEST PRACTICES IN PSYCHOSOCIAL REHABILITATION

Idaho Medicaid bow/Documents/medical/4b02e3d5-9c3a-406f- a31a-ca2fe pdf PSR Service Codes

References Boston Center for Psychiatric Rehabilitation Boston Center for Psychiatric Rehabilitation Evidenced based tool-kits- SAMHSA Evidenced based tool-kits- SAMHSA IDAPA PSR Rules IDAPA PSR Rules IDAPA MH Clinic Rules – IDAPA MH Clinic Rules – IDAPA Medicaid Fraud Rules – IDAPA Medicaid Fraud Rules – Medicaid Provider Agreement Information gen_info.pdf Medicaid Provider Agreement Information gen_info.pdf gen_info.pdf gen_info.pdf Medicaid PSR Provider Handbook 2e3d5-9c3a-406f-a31a-ca2fe pdf Medicaid PSR Provider Handbook 2e3d5-9c3a-406f-a31a-ca2fe pdf 2e3d5-9c3a-406f-a31a-ca2fe pdf 2e3d5-9c3a-406f-a31a-ca2fe pdf Mental Health Services Research Program (MHSRP)– University of Chicago: Mental Health Services Research Program (MHSRP)– University of Chicago: Psychiatric Rehabilitation Consultants Psychiatric Rehabilitation Consultants Recovery Bibliography Recovery Bibliography Recovery Resources Recovery Resources USPRA USPRA

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