Tamara Layne MS, OTR/L Integrated Services Coordinator COMMUNITY ACCESS TO RECOVERY SERVICES (CARS) BRANCH 1

THE INITIAL CONSUMER CONTACT: Build a brief introduction to the Recovery Team and development of the IRP into your CCS outreach process. When you receive a CCS referral: Call the consumer to schedule a meeting in a location that they are comfortable with 2

THE INITIAL CONSUMER CONTACT When you meet the consumer for the first time: 1) Explain What CCS Is: Recovery-focused level of care Consumer driven, strength based Opportunity to select from a menu of services that the consumer feels with best fit their needs in order to attain personal goals Provide the CCS brochure and encourage the consumer to review it 3

THE INITAL CONSUMER CONTACT: 2) Review the CCS Process: Signing of the Application/Admission Agreement Completing the Screen/Assessing process Creating the Recovery Team to support the development of the Individualized Recovery Plan (IRP) 4

THE INITIAL CONSUMER CONTACT: IMPORTANT: Make sure you inform the consumer, from the date the Application/Admission Agreement is signed, there is a 30-day window to complete the Screen, Assessment, and IRP (DHS (a)(6) and P&P CSB-613) 5

WHAT IS THE “RECOVERY TEAM?” WHAT IS THE “RECOVERY TEAM?” According to DHS 36… (24) The “Recovery Team” is a group of individuals who are identified to participate in a assessment of the needs of the consumer, services planning and delivery, and evaluation of desired outcomes. 6

RECOVERY TEAM PRINCIPLES: The Recovery Team approach utilizes a combined team of formal and informal supports to assist the consumer in: Identifying needs across life domains Prioritizing needs Developing action steps and strategies to support the consumer in attaining goals and addressing needs Assigning team members (including the consumer) to commit to performing various tasks listed on the IRP 7

DEVELOPING THE RECOVERY TEAM: During the Screening and Assessment process focus on: Building trust and rapport Listening for potential barriers/needs as the client tells their story Identifying functional strengths Establishing a vision Exploring existing supports (potential members for the Recovery Team) 8

WHAT DOES THE RECOVERY TEAM LOOK LIKE? IDEALLY, the Recovery Team should be as follows: 50% formal/ professionals +50% informal/natural supports = Recovery Team (P&P CSB-614) 9

ACCORDING TO DHS 36… (7) and P&P CSB-614 The consumer shall be asked to participate in identifying members of the recovery team. Each Recovery Team MUST include the following: 1) Consumer 2) Care Coordinator (Service Facilitator) 3) MH Professional 4) SA Professional (if there is an active, recent or suspected dx) 10

IMPORTANT: The Recovery Team may start small, but grow and/or change over time. 11

ACCORDING TO DHS 36… (18) “Natural Supports” means a friend, or other person available in the community who may assist consumers seeking stability and independence. 12

FORMAL VERSUS INFORMAL SUPPORTS Examples of Formal and Informal/natural supports: Formal supports Formal supports consist of representatives from various systems with whom the client and family are involved, (e.g., treatment /service provider, MH professional, SA professional, child welfare, probation agent, etc.). Informal/natural supports Informal/natural supports may include relatives, friends, clergy or other members of the faith community, school personnel, and/or other community members. 13

WHAT A RECOVERY TEAM MEETING ISN’T….. 1. It is not a staffing with the client present 2. It is not crisis planning (although reconvening the team is always good practice during/after crisis) 3. It is not “wrapping” services around the client (although there is service identification and provision involved) 4. It is not group or family therapy (although additional treatment needs may be identified) 14

RECOVERY TEAM MEETING FACILITATION 15

TEAM MEETING FACILITATION: CREATING AN AGENDA Recovery Team Meeting Agenda Recovery Team Meeting Agenda : 1) Introductions 2) Set Ground Rules 3) Strengths Discovery 4) Vision Statement 5) Needs Assessment 6) Prioritize Needs 7) Action Plan 8) Commitment 16

TEAM MEETING FACILTATION: CREATING AN AGENDA IMPORTANT: Have team members review your agenda prior to the meeting and provide feedback as to items that need to be revised and/or added 17

TEAM MEETING FACILITATION: THE PROCESS 1) A t the Beginning of the Meeting (in accordance with P&P CSB- 614 and DHS36.17 (2)(b) Explain the service planning process Have all team members sign the attendance roster- this can be the signature page of the IRP (inc. the consumer) and review confidentiality procedures 18

TEAM MEETING FACILITATION: THE PROCESS 2) Introductions 2) Introductions: Name + role Purpose 19

TEAM MEETING FACILITATION: THE PROCESS 3) Set Ground Rules 3) Set Ground Rules: Be prepared to set basic Ground Rules (e.g. one person speaks at a time, the meeting will end on time) Elicit additional Ground Rules from team members 20

TEAM MEETING FACILITATION: THE PROCESS 4) Strengths Discovery 4) Strengths Discovery: Info collected during initial meetings, assessment, etc. Be prepared to identify consumer's strengths Team members will identify their strengths (what does the team member bring to the Recovery Team to help support the consumer) Repeat the strength review process during each team meeting and build on strengths as process progresses 21

TEAM MEETING FACILITATION: THE PROCESS 5) Vision Statement: Review Vision Statement (the vision statement should be established with the consumer prior to the team meeting) 22

TEAM MEETING FACILITATION: THE PROCESS 6) Needs Assessment: Review and identify consumer's needs (client discusses their needs and goals to start) The Team adds to client’s needs and discusses what has to occur to get these needs met Dialogue among team members is essential 23

TEAM MEETING FACILITATION: THE PROCESS 7) Prioritize Needs 7) Prioritize Needs: Prioritizing needs is a team process and dialogue based List identified needs and narrow to the top four (can be less) in order of priority 24

TEAM MEETING FACILITATION: THE PROCESS 8) Action Plan 8) Action Plan: Involve the Team in the Action Plan development Who’s going to do what, when, and where to help that consumer get their needs/goals met This phase of the meeting is a brainstorming opportunity to identify what are the most effective strategies to put in place to promote success 25

TEAM MEETING FACILITATION: THE PROCESS 9) Commitment 9) Commitment: Opportunity to review ‘who is doing what’ Care Coordinator and the consumer ‘should not be doing everything’ Everyone on the team should have a role on the IRP 26

TEAM MEETING FACILITATION: THE PROCESS 10) At the End of the Meeting: Make sure all the Recovery Team members signed the signature page of the IRP (including contact information) and list all members not in attendance at the meeting (in accordance with P&P CSB-614) 27

TEAM MEETING FACILITATION: THE PROCESS 10) At the End of the Meeting (continued): Schedule a date and time for the next Recovery Team meeting (According to DHS (3) the IRP needs to be reviewed and updated as the needs of the consumer change or at least every six months (Milwaukee County CCS P&P CSB-614) indicates Recovery Team meeting shall be facilitated “every 30 days or as needed” 28

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KEY POINTS KEY POINTS: THE RECOVERY TEAM Each team meeting should be unique to the needs of the consumer Be prepared and take the time to set up an agenda/plan before each team meeting Care Coordinator must stop any consumer ‘bashing’ – the purpose of the Team meeting is to EMPOWER the consumer 30

KEY POINTS KEY POINTS: THE RECOVERY TEAM It is the care coordinator’s responsibility to make sure that the meeting stays organized and on track All providers on the Recovery Team (if a CCS provider) should enter a case note documenting their attendance and participation in the team meeting inc. any updates that were provided re: services, consumer progress, and recommendations 31

THANK YOU 32