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

2. 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.

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

4. 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

5. Community Access Care Coordination
2-year old non-legacy provider
150 enrolled members and growing by 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

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

7. 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

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

9. 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.

10. 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

11. 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

12. 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?

13. 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

14. 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!”

15. 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

16. 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

17. Questions?

18. Thank you!