Foes or Friends: Reconciling Person-Centered and Outcomes-Based Care Presented by Elizabeth Mackey, LMSW

Community Access MISSION Community Access expands opportunities for people living with mental health concerns to recover from trauma and discrimination through affordable housing, training, advocacy and healing-focused services. We are built upon the simple truth that people are experts in their own lives.

Community Access VALUES Human Rights Peer Expertise Self-Determination Harm Reduction Healing and Recovery

Community Access 1,600 Participants 350+ Employees 25 Program Locations in 3 NYC Boroughs Healing-focused services: Housing for 1,100 Households Howie the Harp Peer Advocacy and Training Center Thrive NYC Peer Training Program East Village Access PROS Program Crisis Respite Center Art Collective Urban Agriculture Blueprint Supported Education Program Health Home Care Coordination

Community Access Care Coordination 2-year old non-legacy provider 150 enrolled members and growing by 15-20 members per month most medical-model program in the agency 90% of members have mental health concerns over 50%any are active substance users share participants with other agency programs

Care Coordination Outcomes Reducing avoidable hospitalizations Connection to primary, specialty, and behavioral health care Improved communication and collaboration across providers

What is person-centered care? Individual is expert in their own life Self-determination and autonomy are supported Language used in interactions and documentation is non-labeling and empowerment-oriented

Why person-centered care? Self-efficacy is crucial to health behavior change It’s a human rights and ethics issue

What is Harm Reduction? A pragmatic approach to reducing the harmful consequences of behavior without demanding that the behavior itself be reduced A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use and other risky behaviors (Harm Reduction Coalition) A pragmatic and humane approach to help people change risky behavior (Alan Marlatt) A targeted approach that focuses on specific risks and harms (IHRA) Harm reduction is meeting people where they are at.

Harm Reduction for Substance Use “Drug, set, setting” Practical interventions and tools: Syringe exchange Narcan Safer smoking kits Reviewing recreational and prescribed drug interactions in a non-judgmental manner

Harm Reduction for Substance Use Other benefits of open dialogue about commonly stigmatized behaviors: You won’t be engaging in a power struggle with your participants which you will never win You will actually know what’s going on with a participant because they can be honest and will maintain engagement You are reducing the psychological impact of stigma and trauma by simply having these conversations

Harm Reduction for Medication Non-adherence Individuals have the right not to take medication regardless of whether it is a good idea or not, and we can partner with them to do so safely Helping to explore alternative treatments Helping advocate to providers Education on withdrawal symptoms/expectations Crisis planning ….but what about AOT?

Harm Reduction Meets Medical Model Rapport building: initiate contact warmly and respectfully, frame goals as supportive and collaborative Give credence to their experience or knowledge base using active listening Ask for permission to offer information or an alternate perspective Speak pragmatically and use mutual goal-oriented and person/consumer-centered language

Harm Reduction Meets Medical Model When it doesn’t go so well… Roll with resistance - know when to back off and validate and when to speak up and advocate …and when to use evidence to make your case e.g., “We all want to see Bob meet his health goals, and bottom line is that there is great evidence that people do not change when we tell them to, and that negative reinforcement that could induce shame often entrenches behavior even further - doesn't sound like any of us really see that as the goal!”

Harm Reduction Meets Medical Model Check your reactions (e.g., frustration) by using empathy and remember the goal is collaboration with/on behalf off the consumer Don’t expect a full a full embracing of harm reduction right off the bat; change occurs through feeling ownership for the adoption of new ideas and that takes time Modeling this style with consumers in collaborative meetings can inspire change You’ll have a greater chance of assisting in reducing potential harms incurred during service provision just by being involved

Dodging the ER Crisis Respite for psychiatric distress Crisis planning Harm reduction drop-in centers HIV/STI/HEP-C testing drop-in groups for support Having pragmatic, trauma-informed conversations around cost/benefit of an ER visit

Questions?

Thank you!