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Jaspreet Brar, MD | Tracy Carney, CPRP, CPS Suzanne Daub, LCSW
Recovery Oriented Health Care: A Framework for Integrating the Physical Health Dimension of Wellness and Recovery Jaspreet Brar, MD | Tracy Carney, CPRP, CPS Suzanne Daub, LCSW Suzanne © 2016 Community Care Behavioral Health Organization
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Learning Objectives Recognize the key elements of a framework for integrating the physical health dimension of wellness and recovery Identify core strategies used to engage individuals in active self-care Describe approaches that lead to effective collaborations among providers and members Suzanne © 2016 Community Care Behavioral Health Organization
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About Community Care Part of UPMC; incorporated 1996
Cover approximately 950,000 HealthChoices members across 39 of Pennsylvania’s 67 counties Implement a wide variety of innovative programs integrating behavioral and physical health Major focus is publicly-funded behavioral health care Suzanne © 2016 Community Care Behavioral Health Organization
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Counties Served by Community Care
Pike Erie Warren Susquehanna McKean Potter Tioga Bradford Crawford Wayne Forest Wyoming Cameron Sullivan Lackawanna Venango Elk Lycoming Pike Mercer Clinton Jefferson Luzerne Clarion Columbia Monroe Lawrence Clearfield Centre Montour Union Butler Carbon Armstrong Northumberland Snyder Northampton Beaver Mifflin Schuylkill Lehigh Indiana Juniata Allegheny Blair Berks Perry Dauphin Bucks Cambria Lebanon Huntingdon Westmoreland Montgomery Suzanne Washington Cumberland Lancaster Bedford Fayette Chester Somerset Franklin York Philadelphia Greene Fulton Adams Delaware Community Care Office
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Community Care’s Path to Integrating Recovery and Wellness
Suzanne © 2016 Community Care Behavioral Health Organization
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Recovery Oriented Care
Recovery Oriented Care: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. SAMHSA Tracy © 2016 Community Care Behavioral Health Organization
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Recovery Oriented Care
Core recovery strategies to promote active self-care Actions, Tools for Individuals to Use Choices and Self-Direction Focus on Function and Environments of Choice Whole Person vs. Illness focus Strengths-based Assessment and Intervention Peer Support and Relationships Partnership and Collaboration Community Involvement, Integration, Inclusion Tracy © 2016 Community Care Behavioral Health Organization
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Community Care Recovery Initiatives
Hearing Voices training Recovery learning collaboratives and toolkits Steps of Hope – recovery Decision support centers and CommonGround Member advisory boards Employing people with lived experience Member resources on public website, including newsletter Recovery and wellness tools in ePortal Recovery Library access for members Tracy © 2016 Community Care Behavioral Health Organization
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Wellness Wellness is not the absence of disease, illness and stress, but the presence of: Purpose in life Active involvement in satisfying work and play Joyful relationships A healthy body and living environment Presence of happiness Peggy Swarbrick Suzanne © 2016 Community Care Behavioral Health Organization
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Physical Wellness Community Care Wellness Initiatives
Behavioral Health Home Plus Stratified Disease registry Wellness nurse Peers and Case Managers as wellness coach and health navigator Comprehensive care management, care coordination Comprehensive transitional care Individual and family support Referral to community and social support Use of information technology to link services Suzanne Core wellness strategies used to engage individuals in active self-care Develop a Wellness Narrative highlighting strengths, struggles, accountability, turning points, accomplishments Assess The Eight Dimensions of Wellness Explore strengths, needs and desires to change in the physical dimension Health Education on common risk factors: weight, nutrition, smoking, physical inactivity, stress Wellness Planning Tool -- SMART Goal Self-management toolkit Track progress on member portal Create an agency-wide culture of wellness © 2016 Community Care Behavioral Health Organization
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1+1= fragmented/siloed service delivery
Limited collaboration between initiatives Treatment approaches became siloed Suzanne Rolled out initiatives separately –-- What’s the next shiny object? Multiple recovery-wellness-service plans and goals © 2016 Community Care Behavioral Health Organization
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What’s your experience with this?
Tracy © 2016 Community Care Behavioral Health Organization
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A unifying framework of wellness
Jaspreet helps us avoid replicating the historical bifurcation of services (i.e., services for the “mind” and services for “the body”). © 2016 Community Care Behavioral Health Organization
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Components of Recovery & Dimensions of Wellness (SAMHSA)
Jaspreet
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Wellness is an Extension of Recovery
Both: Utilize a Whole Person perspective Can be conceptualized as a Philosophy, a Process and Potential Outcome(s) Can be facilitated by providers and peers (perspective of lived experience) Emphasize connection with community Use community-based and natural resources Jaspreet © 2016 Community Care Behavioral Health Organization
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Wellness is an Extension of Recovery
Both require: Change, discipline, and personal responsibility Growth, empowerment, and self-determination Acquiring knowledge and developing skills Interaction with others Improving one’s lifestyle Jaspreet © 2016 Community Care Behavioral Health Organization
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Recovery & Wellness: Differences
Tied to a condition (an illness or significant event) May be focused on factors impacted by the condition A process “Graduation” is possible Applies to everyone Choice to assume responsibility for one life including it’s quality Occurs throughout one’s life Jaspreet © 2016 Community Care Behavioral Health Organization
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Recovery Oriented Health Care
Moving from Diagnosis-Centered to Patient-Centered Care Developing a relationship is its foundation Includes outreach and engagement Services work towards quality of life goals Treat the whole person by addressing all dimensions of wellness Use techniques that promote personal growth and self responsibility Promote self-management Focus on wellness Jaspreet © 2016 Community Care Behavioral Health Organization
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Recovery and wellness oriented behavioral health workbook
Developed by Pat Deegan, PhD and Associates, & Community Care Behavioral Health Suzanne Describe provider experience – Suzanne and Tracy © 2016 Community Care Behavioral Health Organization
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Recovery and Wellness Oriented BH
10 Principles Hope Person-Centered Care Health Care is Co-Created Whole Person Focus Care is Goal-Directed Trauma Sensitive Peer Support Access to Information Choice Self-Advocacy Tracy The ten principles of recovery and wellness oriented behavioral health represent a way of thinking about care and a way of providing care. For instance, if we were to walk into an integrated, recovery and wellness oriented behavioral health agency, the culture would be infused with hope. The goal of services would not be stabilization and maintenance. The goal of services would not be to lower A1c levels or GAF scores. The latter are means to wellness, but do not define it. Instead, the goal of care would be to help each individual develop the skills, confidence, competence, and supports to manage their disorders and pursue the things that give life meaning and purpose. Individuals would define this goal. Towards this end, each individual would have a unified wellness plan that included behavioral and wellness goals. A common medical record would be used by all, including the person receiving services. Person-first language would be evident in all clinical notes and in meetings. In a recovery and wellness oriented behavioral health care organization, emphasis would be placed on helping people help themselves. Coaching and skill building would be the focus of most of the work. Not all work would be clinic or office based. Some staff would be mobile and meet with individuals and their natural supporters in the community. Failure to follow through with a treatment plan or to show up for appointments would not be grounds for care discontinuation. Instead, intensified outreach and engagement strategies would be used to help activate people in the journey towards recovery and wellness. In recovery and wellness oriented behavioral health, the focus of care would be on the whole person. Peer staff would be present at all levels of care. Staff would come together on a regular basis to coordinate care both within the various programs in the agency and with other community providers such as primary care practices and substance abuse treatment centers. The individual receiving services and the family (if applicable) would view themselves as part of the care team. The team would focus not just on areas of need, but also on building individual strengths to improve quality of life. Pat Deegan, PhD and Associates, & Community Care Behavioral Health (2016). © 2016 Community Care Behavioral Health Organization
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Exercise: Recovery & Wellness Oriented Behavioral Health Practice Indicators
Tracy © 2016 Community Care Behavioral Health Organization
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All staff shares the following:
Hope-filled engagement and activation skills. Strengths-based practice skills. Respectful communication skills. Goal-setting skills. Shared decision making skills. Decision support skills. Lifestyle modification knowledge. Motivational interviewing skills. Communication and team participation skills. Tracy With a multidisciplinary workforce, it makes no sense to expect all staff to have equal proficiency in all practices. That said, siloed care is not integrated care and replicates the long history of treating physical health and mental health with distinct services. Simply co-locating wellness nurses and coaches in the same building does not qualify as integrated care. The solution is to acknowledge that staff have unique skills and roles, while also making sure they develop a common set of skills, values, knowledge, and attitudes. In turn, these commonalities allow all staff to work as a team. Thus, all staff share the following: Hope-filled engagement and activation skills. Strengths-based practice skills. Respectful communication skills. Goal-setting skills. Shared decision making skills. Decision support skills. Lifestyle modification knowledge. Motivational interviewing skills. Communication and team participation skills. Finally, in recovery and wellness oriented behavioral health organizations, there is continuous quality improvement. Leadership and champions from all programs within the agency meet regularly to review process and outcome aims, ensure programmatic coordination and integration of care, and troubleshoot areas of concern. Semi-annual patient experience of care surveys are completed and used to inform quality improvement. © 2016 Community Care Behavioral Health Organization
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Exercise: Recovery and Wellness Oriented Skills of Staff
Tracy © 2016 Community Care Behavioral Health Organization
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Common Missteps #1 Siloed Practices
Example: In one agency, recovery resources such as WRAP, Personal Medicine, and Recovery Library are only used by peer staff and by staff at the psychiatric rehabilitation program. These resources are not used by the blended case management team, the mobile med team, or by the wellness nurse and health navigators. Suzanne The first common misstep in the effort to integrate is keeping mental health recovery resources/practices siloed and separated from wellness resources/practices. In organizations that do silo practice into “wellness services” and mental health services”, the right hand doesn't know what the left hand is doing. (“that belongs in psychosocial. That gets addressed in med clinic. That belongs with the wellness nurse. A second common misstep is choosing to put time, energy, and resources into one initiative, while dropping, failing to integrate, and/or taking resources from another. This can create an agency culture of repeatedly adopting the “next shiny object,” while failing to sustain other effective practices. In turn, this can leave staff feeling demoralized and skeptical about investing effort in adopting new best practices. It can also be disorienting for service users who may have come to depend on certain services only to have them become unavailable over time. © 2016 Community Care Behavioral Health Organization
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Common Missteps #2 Discontinuation of Best Practices
Example: An organization made the transition to being a behavioral health home. The contract psychiatrists who worked for the agency declined to attend training about wellness coaching and the role of the wellness nurse. They complained that training time was not in their contract and they were being paid to do medication management only. For fear of alienating and possibly losing the contract psychiatrists, leadership allowed the med clinic to function as usual. Suzanne © 2016 Community Care Behavioral Health Organization
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Questions © 2016 Community Care Behavioral Health Organization
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Community Care Behavioral Health Organization 339 Sixth Avenue, Suite 1300 Pittsburgh, PA © 2016 Community Care Behavioral Health Organization
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