CCISC Changing the World through Partnership ZIAPARTNERS Christie A. Cline, MD, MBA Kenneth Minkoff, MD Debbie Tate, LCSW, SAP ZiaPartners©2009

CONTINUOUS QUALITY IMPROVEMENT CQI is the recovery process for organizations and systems CQI is the recovery process for organizations and systems CQI involves building “recovery partnerships” at every level of the system, horizontally and vertically, to create vision-driven change CQI involves building “recovery partnerships” at every level of the system, horizontally and vertically, to create vision-driven change CQI defines the structures and strategies for implementation of transformation and CCISC CQI defines the structures and strategies for implementation of transformation and CCISC

CCISC Our collective goal is to work in partnership to organize everything we do at every level, with every dollar we have, to be about the hopes, dreams, and needs of the people and families who need help, and the values that we all share. Our collective goal is to work in partnership to organize everything we do at every level, with every dollar we have, to be about the hopes, dreams, and needs of the people and families who need help, and the values that we all share. It’s not just about co-occurring disorders any more. It’s not just about co-occurring disorders any more.

“Transformation” Recovery-oriented services must be co- occurring capable Recovery-oriented services must be co- occurring capable Co-occurring capable services must be recovery-oriented Co-occurring capable services must be recovery-oriented Children’s systems of care must address co-occurring children and families Children’s systems of care must address co-occurring children and families Co-occurring capable = Complexity capable Co-occurring capable = Complexity capable

CCISC Comprehensive, Continuous, Integrated System of Care Every program becomes a welcoming, recovery or resiliency-oriented, co- occurring capable program Every program becomes a welcoming, recovery or resiliency-oriented, co- occurring capable program Every person providing care becomes a welcoming, recovery or resiliency- oriented, co-occurring competent clinician Every person providing care becomes a welcoming, recovery or resiliency- oriented, co-occurring competent clinician

CO-OCCURRING CAPABILITY Each program organizes itself, within its mission and resources, to deliver integrated, matched, best practice interventions for multiple issues to the individuals and families with complex needs who are coming to the door. Each program organizes itself, within its mission and resources, to deliver integrated, matched, best practice interventions for multiple issues to the individuals and families with complex needs who are coming to the door. CCISC Program Self-Assessment Tool: COMPASS-EZ CCISC Program Self-Assessment Tool: COMPASS-EZ

CO-OCCURRING COMPETENCY Each person providing clinical care is helped to develop core competency, within their job, within their level of training, and within their level of licensure or certification (whether they have one license, two licenses, or no license at all) to know how to be helpful to the people and families with complex needs that are likely to already be in their caseloads. Each person providing clinical care is helped to develop core competency, within their job, within their level of training, and within their level of licensure or certification (whether they have one license, two licenses, or no license at all) to know how to be helpful to the people and families with complex needs that are likely to already be in their caseloads. CCISC Clinician Self-Assessment Tool: CODECAT-EZ CCISC Clinician Self-Assessment Tool: CODECAT-EZ 12 Steps of Co-occurring Competency for clinicians 12 Steps of Co-occurring Competency for clinicians

Radical Transformation Recovery oriented co-occurring capable programs and clinicians are only part of the story Recovery oriented co-occurring capable programs and clinicians are only part of the story The entire culture of the system needs to change at every level “to be the change we are trying to create”. Gandhi The entire culture of the system needs to change at every level “to be the change we are trying to create”. Gandhi

How we do this clinically Evidence based and consensus based principles of successful treatment for individuals and families with one or more co-occurring conditions of any kind. Evidence based and consensus based principles of successful treatment for individuals and families with one or more co-occurring conditions of any kind. The principles are placed in the context of an integrated recovery/resiliency philosophy that creates a common language of empowerment, hope, and strength for the whole system. The principles are placed in the context of an integrated recovery/resiliency philosophy that creates a common language of empowerment, hope, and strength for the whole system. Each principle is associated with one or more intervention strategies that can be applied in any program by any clinician with any population. Each principle is associated with one or more intervention strategies that can be applied in any program by any clinician with any population.

Process of Recovery Welcoming and Access Hope for a Happy Life Integrated Relationships Empowered Partnership Continuity and Flexibility Strength-based learning Skills and Supports Small Steps of Success Rounds of Applause Serenity Prayer

How we get there as a system Recovery process for systems: Quality Improvement Partnership at every level of the system to make progress toward a common vision Recovery process for systems: Quality Improvement Partnership at every level of the system to make progress toward a common vision Each agency organizes a Continuous Quality Improvement process so that every program within the agency makes step by step progress toward being welcoming, recovery-oriented and co-occurring capable. Each agency organizes a Continuous Quality Improvement process so that every program within the agency makes step by step progress toward being welcoming, recovery-oriented and co-occurring capable. Each program identifies one or more “Change Agents” to represent the voice of front line clinicians and consumers Each program identifies one or more “Change Agents” to represent the voice of front line clinicians and consumers The Change Agents organize as an empowered group to work in partnership with leadership to achieve the vision The Change Agents organize as an empowered group to work in partnership with leadership to achieve the vision CCISC System Self-Assessment Tool: CO-FIT 100 CCISC System Self-Assessment Tool: CO-FIT 100

ORGANIZATIONAL PRINCIPLE If we want to produce “empowered partnerships” in our relationships with our customers, We need to build a culture of empowered partnership throughout our systems, agencies, and programs.

TRANSFORMATION The process of recovery for systems and agencies UNIVERSAL WELCOMING PARTICIPATION UNIVERSAL WELCOMING PARTICIPATION HOPEFUL VISION HOPEFUL VISION PRINCIPLE DRIVEN PRINCIPLE DRIVEN EMPOWERED PARTNERSHIP EMPOWERED PARTNERSHIP CONTINUOUS QUALITY IMPROVEMENT CONTINUOUS QUALITY IMPROVEMENT STRENGTH-BASED STRENGTH-BASED HONEST SELF-ASSESSMENT HONEST SELF-ASSESSMENT STEP-BY-STEP MEASURABLE PROGRESS STEP-BY-STEP MEASURABLE PROGRESS Serenity Prayer of System Change Serenity Prayer of System Change

In the box: what’s our product? GatekeepingProgram Requirements Eligibility determinationReimbursement Rules Priority PopulationsPlans of Care Intake FormsCompliance Assessment of ProblemsBehavior Plans One Primary ProblemConsequences Waiting ListsProgram Completion AppointmentsEBP CaseloadsDischarge and termination Case ManagementTertiary “outcomes”

In the box: what is our process? How are we with each other? Federal/State; State/County; Funder/Provider; Provider agency/clinician All service delivery/all service recipients Mandatory paperworkUtilization Review Budget rulesQuality Assurance Caseload mandatesContract mandates ProductivityClinician training rules Billable unitsSpecial pilot programs Program requirementsTop-down instructions Reimbursement auditsAssessment of deficits Corrective Action PlansSingle disorder services

LEADERSHIP No matter how few resources we have, No matter how many challenges we face, No matter how familiar the old rules, We do not have to stay in the same old box………

Leadership: out of the box VISION OF HOPE VALUES FIRST AND ALWAYS EMPOWER EVERYONE WORK IN PARTNERSHIP ORGANIZE THE PROCESS CONTINUOUS QUALITY IMPROVEMENT “JUST ENOUGH” STRUCTURE

VISION OF HOPE Leadership is not knowing all the answers. Leadership is knowing that if we put our values first, and work together, we will find solutions we could not imagine while we were still in the box that created our problem.

CQI: Pathway to the vision CQI is NOT QA/compliance monitoring CQI is NOT QA/compliance monitoring CQI is a way to shift culture and solve problems in the context of values. CQI is a way to shift culture and solve problems in the context of values. CQI puts customers first. CQI puts customers first. CQI requires empowered partnership and shared decision making at every level CQI requires empowered partnership and shared decision making at every level CQI is a formal process to get better results within limited resources CQI is a formal process to get better results within limited resources

CQI Transformation Partnerships Who are the partners? Change agents at all levels Change agents at all levels Individuals and families seeking service Individuals and families seeking service State leadership State leadership Provider agency leadership Provider agency leadership Program supervisors Program supervisors Front line clinicians and support staff Front line clinicians and support staff Individuals and families seeking service Individuals and families seeking service

CQI = Shared decision-making At the client/family level, clinicians work in partnership to identify the best “practices” to help clients achieve THEIR goals. At the client/family level, clinicians work in partnership to identify the best “practices” to help clients achieve THEIR goals. At the agency/program level, front line staff - as change agents - work in partnership with managers to identify the best “practices” to help the agency and staff to achieve a shared vision of hopeful and effective service to customers. At the agency/program level, front line staff - as change agents - work in partnership with managers to identify the best “practices” to help the agency and staff to achieve a shared vision of hopeful and effective service to customers.

CQI = Shared Decision-Making At the system level, the state and its providers work in partnership to identify how the state can utilize the best funding, contracting, and regulatory “practices” to support the creative goals of providers to make progress toward a shared vision, and most effectively serve the population in need within existing resources. At the system level, the state and its providers work in partnership to identify how the state can utilize the best funding, contracting, and regulatory “practices” to support the creative goals of providers to make progress toward a shared vision, and most effectively serve the population in need within existing resources.

Leadership: what is our job? “A welcoming, hopeful, value-driven, continuous quality improvement process, working in empowered partnership, to develop recovery/resiliency-oriented, integrated systems and services, with just enough reward and structure to sustain progress” “A welcoming, hopeful, value-driven, continuous quality improvement process, working in empowered partnership, to develop recovery/resiliency-oriented, integrated systems and services, with just enough reward and structure to sustain progress”

Clinicians: what is our job? “A welcoming, hopeful, consumer /family- driven, continuous quality improvement integrated recovery process, working in empowered partnership, with just enough reward and structure to sustain progress” “A welcoming, hopeful, consumer /family- driven, continuous quality improvement integrated recovery process, working in empowered partnership, with just enough reward and structure to sustain progress”

“We are all together” “And in the end, the love we take, is equal to the love we make” John Lennon