Transforming Agency Culture. Presented by Technical Assistance Training Partners

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1 Transforming Agency Culture Presented by Technical Assistance Training Partners

2 Adult BH HCBS Roadmap Partners

3 Learning Objectives Understand the changing landscape from traditional to recovery-oriented system of care Describe what a recovery-oriented system of care looks like Articulate reasons for shifting to a culture of recovery Develop a clear plan for organizational change Understand the link between participant-success and organizational-success

4 SUD Treatment: Where We Were Treatment of Alcohol Use Disorder and Drug Use Disorders silo-ed Historical conflict about who is qualified to treat An acute care model A single treatment approach for all

5 SUD Treatment: On the Recovery Path Where We Are: Recovery-Oriented System of Care Model Person- Centered (menu of services) Community Based Integrated & Collaborative Medication Assisted Treatment (MAT) Multiple Levels of Care Trauma-Informed Evidence-Based Mobile Recovery Peers Chronic Care Approach

6 MH Services Where We ve Been Maintenance and Symptom Management Rehabilitation and Recovery Wellness and Community Integration 1970 s 1980 s 1990 s 2000 s 2010 s Deinstitutionalization Rights Protection and Empowerment

7 MH Services Where We Are 2017 PRIMARY TRENDS Recovery Oriented Systems of Care Person Centered Planning Integrated Care Rehabilitation and Peer Delivered Services Self Determination Health and Wellness Community Integration Managed Care PRIMARY SERVICES Health Homes DSRIP Networks Downsized Hospitals Reformed Crisis Systems Supported and Independent Housing Integrated Clinics Peer Services Care Coordination HCBS Services

8 RECOVERY: SAMHSA s Working Definition A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

9 Basic Principles of Looking with a Recovery Lens Recovery is possible. Recovery is based on respect. Recovery is a highly individualized process. Recovery can include the use of medication assisted treatment. Recovery can occur without professional intervention. Recovery involves more than symptom reduction and can occur even though symptoms reoccur. Recovery occurs in the presence of someone who believes in and stands by you. Recovery services are culturally based and trauma informed. Recovery from the consequences of the illness can be more difficult than recovering from the illness itself.

10 TRADITIONAL System/Provider Focus Focuses on symptoms Change of Focus Clients seen in context of the system RECOVERY Person-Centered Focus Looks at a person s uniqueness Individuals seen in context of their communities and lives Emphasizes deficits and needs 1 expert in the room the provider Emphasizes strengths/gifts and capacities 2 experts in the room client and provider

11 What Does Recovery Oriented Care Look Like? Peer leadership at all levels Use of a variety of peer services and supports Empowered, passionate, hopeful and supportive staff Diverse menu of services and supports that promote choice, quality of life and individualized approaches Promotion and facilitation of community integration Increased access: more flexibility in admission, planning and discharge Belief in people s ability to recover and be resilient in the face of challenges

12 A Recovery-Oriented Approach What it Should Do: Focus in on the individual s life goals and needs Encourage the individual to see many possibilitiesmaximize choice Help the individual to increase competencies Be flexible in admission and program participation criteria Not reject anyone s participation Offer hope-the possibility for change and growth

13 A Recovery Oriented Approach What It Shouldn t Do: Disregard personal values, desires and wishes Set goals unmindful of individual strengths and limitations Offer a homogenized program that s prepackaged and pre-defined Set rigid requirements for intervention and force participants to choose either all or nothing Diminish hope, constrain thinking and expectations

14 Poll Question

15 Chat Box Question Why change to a recovery-oriented system of care? Why should your agency take this on?

16 Why Embrace Recovery? Participants rediscover and follow their dreams Sharing power reduces staff burden As a result, staff retention improves People improve! & work harder for a goal they author ACA demands coordinated, active, engaging, accountable, integrated, outcome oriented and person-centered services Managed care demands successful outcomes and will not support inefficient, costly services that don t encourage wellness

17 How can you transform your organization?

18 Planned Change Whenever an organization can identify differences between where it is and where it would like to be on any dimension, it can engage in a process of planned change. (Kast and Rosenzweig, Organizational Management, 1974)

19 3 Approaches to Recovery-Focused Systems Change Additive: Adding peer and recovery-based support to the existing system Selective: Practice and administrative alignment in selected parts of the system (i.e. pilot projects) Transformative: Cultural values-based change drives practice, community, policy and fiscal changes in all parts and levels of the system. Everything is viewed through the lens of and aligned with recovery-oriented care. Ijeoma Archer Consulting 2013

20 Creating a Recovery Vision Believe that recovery is possible, even from the most difficult circumstances or challenging conditions Help people to uncover abandoned hopes and dreams Help people to discover their personhood through culture, strengths, values, skills Engage communities as life-sustaining forces Re-author the way people see themselves Assure that everyone can reclaim a meaningful life role

21 Leadership Ensures the vision is shared Consistently and clearly communicates the vision Uses the vision to inspire Identifies the relevance of the vision Embodies the vision in every action Persuades others of the potency of the vision Uses the vision to shape the future William Anthony, 2008

22 Chat Box Question What are some challenges you have faced in creating a culture of recovery?

23 Administrative Challenges in Shifting to Recovery-Oriented Services More diverse staffing needs and possible retraining Changes in liability New rules and consequences Shift in thinking to appreciate small steps for staff and participants Changes in policies and procedures (human resources, marketing, IT) Education for the Board of Directors

24 Practice Challenges in Shifting to Recovery-Oriented Services Person-centered work takes time Feeling alone with the recovery approach Shift in thinking for both staff and participants Developing and sharing hopes and dreams Power-sharing Liability Time Management Issues Planning and scheduling meaningful activities Including participants in all aspects of service planning

25 Create and Maintain Change DO Create your Transformation Team Encourage strong teamwork and positive relationships between direct staff, participants, management and the community Provide staff training Develop procedures and tools to implement organizational and program level changes Examine and modify agency policy and procedures that are not in keeping with a recovery-oriented vision Fund and support only services consistent with the mission and vision Monitor these changes

26 Create and Maintain Change STUDY Have we met our objectives and targets? Stress outcomes over process Collect and use quality of life and recovery-oriented data Identify obstacles to change Implement corrective action

27 Create and Maintain Change ACT Determine what, if anything, needs to be changed Identify accomplishments Make modifications based on study Begin the cycle again if necessary, until the organization and programs feel successful in creating recovery-oriented services

28 The Goals For the Participant & the Provider!

29 References Anthony, W.A., Cohen, M., Farkas, M., Gagne, C. (2002) Psychiatric Rehabilitation, 2 nd edition. Center for Psychiatric Rehaabilitation, Sargent College, Boston University. Anthony, W.A. (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal. Retrieved from: Chamberlin, J., Rogers, J. (1990) Planning a community based mental health system: Perspective of Service Recipients. American Psychologist, 1990, 45 (11) pp Farkas, M., Gagne, C., Anthony, W., Chamberlin, J. (2005). Implementing recovery oriented evidence based programs: Identifying the critical dimensions. Community Mental Health Journal, 41 (2), Gagne, C., White, W.L., & Anthony, W.A. (2007). Recovery: A Common Vision for the Fields of Mental Health and Addictions. Psychiatric Rehabilitation Journal, 31 (1). Kast, F.E., Rosenzweig, J.E. (1970) Organization and Management, A System s Approach. Graduate School of Business Administration, University of Washington. SAMSHA. (2009). Guiding Principles and Elements of Recovery-Oriented Systems of Care: What do we know from the research? Retrieved from:

30 Additional Questions? Contact us at: For slides and additional resources:

31

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