1. 1 MHASP Consumer Recovery Investment Fund: Self Directed Care Delaware County, PA Presentation to PA MHA Conference April 27, 2011 Erme C. Maula, RN, MSN, CRRN, CPS Program Manager Mental Health Association of Southeastern Pennsylvania 4/27/11

2. 2 CRIF SDC Definitions CRIF: Consumer Recovery Investment Fund CRIF: Consumer Recovery Investment Fund SDC: Self Directed Care SDC: Self Directed Care CPS: Certified Peer Specialist CPS: Certified Peer Specialist Recovery Coach: Certified Peer Specialist and WRAP trained facilitator that accompanies participants along their recovery journey Recovery Coach: Certified Peer Specialist and WRAP trained facilitator that accompanies participants along their recovery journey Freedom Funds: Funds in the SDC budget used to purchase non-traditional goods and services Freedom Funds: Funds in the SDC budget used to purchase non-traditional goods and services

3. 4/27/11 3 Collaborators Magellan Health Services – Magellan Health Services – Magellan Behavioral Health of Pennsylvania is an affiliate of Magellan Health Services Office of Behavioral Health, Delaware County, Pennsylvania Office of Behavioral Health, Delaware County, Pennsylvania Temple University Collaborative on Community Integration of People with Psychiatric Disabilities Temple University Collaborative on Community Integration of People with Psychiatric Disabilities Mental Health Association of Southeastern Pennsylvania Mental Health Association of Southeastern Pennsylvania National Institute on Disability and Rehabilitation Research National Institute on Disability and Rehabilitation Research

4. 4/27/11 4 Meet the Operations and Recovery Coach Team Joseph Rogers, Director of Advocacy, MHASP Bill Dinwiddie, CEO MHASP Rita Burns CFO, MHASP Erme Maula, Program Manager, MHASP Brett Diamond, MHASP Jeff Quick, Recovery Coach, MHASP Bob Waters, National V.P., Account Management Magellan Health Services Evon Bergey, General Manager, Magellan Health Services Julie Brown, Delaware County Senior Account Executive, Magellan Health Services Tim Connors, Recovery Coach, MHASP Jennifer Tripp VP, Public Sector Program Innovation Magellan Public Sector Solutions Bill Chambers MH Program Director Delaware County Office of Behavioral Health Mark Salzer Professor and Chair Department of Rehabilitation Sciences Temple University Richard Baron Director, Knowledge Translation Activities Temple University Collaborative on Community Integration of People with Psychiatric Disabilities Andrea Bilger Research Assistant Temple University Not Pictured: Jonna DiStefano, Lisa Gardner, Dawn Berardinelli, Lynne Baumeister, Donna Holiday

5. 4/27/11 5 CRIF SDC Program Philosophy is based on the following elements: Recovery Recovery Peer Support Peer Support Self Directed Care Self Directed Care

6. 4/27/11 6 Recovery The program philosophy is based on the fundamental belief that people can and do recover from mental illness. The program philosophy is based on the fundamental belief that people can and do recover from mental illness. Recovery is a deeply personal process that involves the restoration of hope, self-esteem, creativity, and self-determination. Recovery is a deeply personal process that involves the restoration of hope, self-esteem, creativity, and self-determination. Recovery is a life-long journey that restores and maintains individual dignity and control over one’s own destiny. Recovery is a life-long journey that restores and maintains individual dignity and control over one’s own destiny.

7. 4/27/11 7 Recovery Values HOPEINDIVIDUALITYSELF-AWARENESSSELF-DETERMINATION MEANINGFUL LIFE RESPECT PEER SUPPORT COMMUNITY FOCUS ADVOCACY

8. 4/27/11 8 Peer Support All CRIF SDC Program Recovery Coaches are Certified Peer Specialists. All CRIF SDC Program Recovery Coaches are Certified Peer Specialists. Peers helping other peers has been identified as a critical part of the recovery process. Peers helping other peers has been identified as a critical part of the recovery process. The President’s New Freedom Commission on Mental Health (2003) explicitly recognized the critical role of peer support. The President’s New Freedom Commission on Mental Health (2003) explicitly recognized the critical role of peer support. People who are employed as Recovery Coaches have the unique capacity to inspire hope, trust, personal responsibility, empowerment, self-determination and social connectedness in their fellow peers. People who are employed as Recovery Coaches have the unique capacity to inspire hope, trust, personal responsibility, empowerment, self-determination and social connectedness in their fellow peers. Recovery Coaches are able to use their own Recovery Journey as an example of the possibility of recovery. Recovery Coaches are able to use their own Recovery Journey as an example of the possibility of recovery.

9. 4/27/11 9 Self Directed Care This approach supports individuals in developing their own wellness goals and in controlling the funds that are used to implement their self-directed behavioral health recovery plan. This approach supports individuals in developing their own wellness goals and in controlling the funds that are used to implement their self-directed behavioral health recovery plan. Each person is responsible for making his or her own choices on the recovery journey and must be responsible for the outcomes of those choices. Each person is responsible for making his or her own choices on the recovery journey and must be responsible for the outcomes of those choices. Giving people decision-making power over their own behavioral health-care budget is a concrete step toward self-determination and responsibility. Giving people decision-making power over their own behavioral health-care budget is a concrete step toward self-determination and responsibility. The process of creating a recovery plan, identifying appropriate services, and deciding how to spend service dollars encourages independence and self-determination. The process of creating a recovery plan, identifying appropriate services, and deciding how to spend service dollars encourages independence and self-determination.

10. 4/27/11 10 How exciting would it be if… We can show that working with a Recovery Coach/CPS/WRAP Facilitator moves people forward in their recovery We can show that working with a Recovery Coach/CPS/WRAP Facilitator moves people forward in their recovery By allowing people to determine what best works for them, the final cost to the Behavioral Health Care system is reduced or equivalent to the cost of “Services as Usual” By allowing people to determine what best works for them, the final cost to the Behavioral Health Care system is reduced or equivalent to the cost of “Services as Usual” By allowing people to direct their own care, they experience significant movement forward in their recovery journey By allowing people to direct their own care, they experience significant movement forward in their recovery journey We can model the possibility of four very different entities successfully working together We can model the possibility of four very different entities successfully working together We are able to create more CPS job positions We are able to create more CPS job positions We are able to generate outcomes that help to establish a waiver that allows for the establishment of similar programs in other parts of the state We are able to generate outcomes that help to establish a waiver that allows for the establishment of similar programs in other parts of the state

11. 4/27/11 11 Goals of CRIF SDC Individuals in the SDC condition will experience greater levels of empowerment, recovery, and quality- of-life compared to those in the control condition. Individuals in the SDC condition will experience greater levels of empowerment, recovery, and quality- of-life compared to those in the control condition. Individuals in the SDC condition will experience greater levels of community participation over time compared to those in the control condition. Individuals in the SDC condition will experience greater levels of community participation over time compared to those in the control condition. Individuals in the SDC condition will live more independent lives, depending less on high cost, acute/crisis services (e.g., inpatient hospitalization, crisis service use) compared to those in the control condition. Individuals in the SDC condition will live more independent lives, depending less on high cost, acute/crisis services (e.g., inpatient hospitalization, crisis service use) compared to those in the control condition.

12. 4/27/11 12 Criteria for Enrollment Delaware County Resident Delaware County Resident Member of Health Choices, Magellan Behavioral Health Member of Health Choices, Magellan Behavioral Health Diagnosed within either the schizophrenia or bipolar family of disorders Diagnosed within either the schizophrenia or bipolar family of disorders 60 – 90 th percentile utilizer of services 60 – 90 th percentile utilizer of services No hospitalizations within the past 6 months No hospitalizations within the past 6 months Randomized into Temple study Randomized into Temple study 150 total in study: 75 in control, 75 in SDC 150 total in study: 75 in control, 75 in SDC

13. 4/27/11 13 Process for Enrollment Study group randomized by Magellan Health Services—letters sent to 50 at a time Study group randomized by Magellan Health Services—letters sent to 50 at a time Temple University contacts potential participants for enrollment Temple University contacts potential participants for enrollment Participants enrolled in study are randomized into either the Control, or “Services as Usual” group, or the SDC group Participants enrolled in study are randomized into either the Control, or “Services as Usual” group, or the SDC group SDC Group is enrolled by MHASP Recovery Coach Team SDC Group is enrolled by MHASP Recovery Coach Team Initial orientation period is followed by monthly visits over the subsequent 24-month period Initial orientation period is followed by monthly visits over the subsequent 24-month period

14. 4/27/11 14 Process of Engagement Establishing relationship Establishing relationship Exploring Dreams Exploring Dreams Setting Goals from Dreams Exercise Setting Goals from Dreams Exercise Reviewing past 24-month utilization of traditional services with peer Reviewing past 24-month utilization of traditional services with peer Setting budget from goal activities Setting budget from goal activities Requesting authorization for purchases Requesting authorization for purchases Authorization for purchases approved or declined by Magellan Health Services representatives Authorization for purchases approved or declined by Magellan Health Services representatives Approved purchase amounts placed on Allow Card Approved purchase amounts placed on Allow Card Monthly check-ins with Recovery Coach, or as determined by Participant Monthly check-ins with Recovery Coach, or as determined by Participant

15. 4/27/11 15 MH Budget Mental Health Budget includes Mental Health Budget includes All In-Plan (traditional outpatient Medicaid Reimbursable services, including Peer Support by Recovery Coach) All In-Plan (traditional outpatient Medicaid Reimbursable services, including Peer Support by Recovery Coach) Non-traditional services (Freedom Funds) Non-traditional services (Freedom Funds) Equal to previous 24-month period mental health costs Equal to previous 24-month period mental health costs

16. 4/27/11 16 Recovery Goals All activities and purchases must fit within the Participant’s Recovery Plan All activities and purchases must fit within the Participant’s Recovery Plan Recovery Plans can change over time Recovery Plans can change over time Recovery Coaches help to educate Participants about the concepts and processes of recovery Recovery Coaches help to educate Participants about the concepts and processes of recovery The Recovery Coach team keeps track of proposed monthly budget, as well as actual utilization, over the next 24 months. The Recovery Coach team keeps track of proposed monthly budget, as well as actual utilization, over the next 24 months.

17. 4/27/11 17 What we have learned Similar to the Dallas, TX program, we found that some of the first “asks” pertained to physical medical health care needs Similar to the Dallas, TX program, we found that some of the first “asks” pertained to physical medical health care needs As opposed to focusing on assessments, we focus on dreams. Self Directed Care allows the peer to set the area of focus As opposed to focusing on assessments, we focus on dreams. Self Directed Care allows the peer to set the area of focus This program really puts recovery into action This program really puts recovery into action Participants may not have experienced recovery in such a comprehensive way before Participants may not have experienced recovery in such a comprehensive way before Some people focus on short-term needs and have not had the opportunity to have a longer-term focus on their dreams and hopes for their future Some people focus on short-term needs and have not had the opportunity to have a longer-term focus on their dreams and hopes for their future

18. 4/27/11 18 Sample “asks” Back Rent Back Rent Electric Bill Electric Bill Exercise Clothing and equipment Exercise Clothing and equipment Gym Memberships Gym Memberships Computer Software to write poetry Computer Software to write poetry Glasses after charges are made to Physical Health Insurance Glasses after charges are made to Physical Health Insurance Relocation Costs Relocation Costs Car Repair Car Repair Books for School Books for School Social Activities Social Activities Lawnmower to start a lawncare business Lawnmower to start a lawncare business Digital Camera and Printer Digital Camera and Printer Transportation Transportation Membership to the Philadelphia Museum of Art Membership to the Philadelphia Museum of Art

19. 4/27/11 19 Life Domains Mental Wellness Mental Wellness Physical Health Physical Health Education (or learning something new) Education (or learning something new) Work or Meaningful Activities Work or Meaningful Activities Social Activities Social Activities Housing Housing

20. Freedom Fund Categories 4/27/11 20

21. 4/27/11 21 SDC Card, formerly Allowcard Similar to a check/credit card Similar to a check/credit card Decreases the stigma related to mental health Decreases the stigma related to mental health Allows participants to have responsibility of funds Allows participants to have responsibility of funds Allows restrictions to be placed on card from Program Staff (certain items are not allowed to be purchased: alcohol, illegal drugs, guns, cash, pornography, etc.) Allows restrictions to be placed on card from Program Staff (certain items are not allowed to be purchased: alcohol, illegal drugs, guns, cash, pornography, etc.) Allows monitoring of activity Allows monitoring of activity

22. 4/27/11 22 Next Steps 120 people enrolled in study 120 people enrolled in study 63 in SDC 63 in SDC 57 in Services as Usual Group 57 in Services as Usual Group Moving forward with Recovery Process and Peer Support with “enrollees” Moving forward with Recovery Process and Peer Support with “enrollees” Meeting with non-MH Providers to talk about Recovery and ask for possibilities of services to purchase Meeting with non-MH Providers to talk about Recovery and ask for possibilities of services to purchase Operations Team meetings Operations Team meetings On-going program evaluation On-going program evaluation

23. Policy Implications Cross Disability work as a result of the Power to the People Summit 2009 Cross Disability work as a result of the Power to the People Summit 2009 Presentations at Alternatives 2010, NYAPRS 2010, NYAPRS Executive Summit 2011, Netherlands 2011, and other Presentations at Alternatives 2010, NYAPRS 2010, NYAPRS Executive Summit 2011, Netherlands 2011, and other Enhancing People in Recovery being able to control the amount of money being spent on their care in a way that moves them forward in their recovery and teaching self direction and hopefully decreasing costs to the system Enhancing People in Recovery being able to control the amount of money being spent on their care in a way that moves them forward in their recovery and teaching self direction and hopefully decreasing costs to the system 4/27/11 23

24. 4/27/11 24 Quotes from Participants How has your life been changed by being a participant in the program so far? I am far too busy to see a therapist; I am very busy with school. However, I do have coping skills which help me. CRIF's coaches are there for me whenever I need them; they have given me new coping skills that I can use and what’s best about this is CRIF's coaches are available to coach me whenever I need them. - Alicia, CRIF SDC participant

25. 4/27/11 25 How has the CRIF SDC Project helped you in your journey of recovery? CRIF has helped me tremendously. I began treatment a few years ago, when [Health Choices Physical Health Insurance] stopped providing eye care benefits. I knew that I needed glasses but I could not afford them as I am a student and I have plenty of other priorities that I must take care of first. The CRIF program, my coaches, have given me the opportunity to get the eye glasses that I needed. In addition to this, my coaches have worked as advocates, friends and have given me additional coping skills. My coaches are currently helping me take care of other issues that I otherwise would not have been able to take care of. I love CRIF and my coaches. CRIF has helped me tremendously. I began treatment a few years ago, when [Health Choices Physical Health Insurance] stopped providing eye care benefits. I knew that I needed glasses but I could not afford them as I am a student and I have plenty of other priorities that I must take care of first. The CRIF program, my coaches, have given me the opportunity to get the eye glasses that I needed. In addition to this, my coaches have worked as advocates, friends and have given me additional coping skills. My coaches are currently helping me take care of other issues that I otherwise would not have been able to take care of. I love CRIF and my coaches.

26. 4/27/11 26 "It [the CRIF SDC Project] gives me perspective on where I'm going. I may not have a plan yet, but I do have hope" - Roderick, CRIF SDC participant

27. 4/27/11 27 Contact Information for CRIF Self Directed Care Team: Erme C. Maula, RN, MSN, CRRN, CPS Program Manager, CRIF Mental Health Association of Southeastern Pennsylvania 1211 Chestnut St., 11th Floor Philadelphia, PA 19107 emaula@mhasp.org Office: 267 507 3873 Secure Fax: (215) 525-9698