Changing the World: Inspiring Hope, Health & Recovery

Transcription

1 Changing the World: Inspiring Hope, Health & Recovery Transforming systems at every level to be about the needs, hopes and dreams of the people and families with complex needs who come to our door 2011 by ZiaPartners, Inc. All rights reserved. Recovery- Oriented, Principle- Driven Adult and Child Systems of Care ALL services and interven0ons are: Hopeful Person- or family- centered Empowering and strength- based Designed to help people achieve their most important and meaningful goals. Integrated Systems of Care Complexity is an expecta0on, not an excep0on. ALL services and interven0ons are designed to welcome, engage, and provide integrated services to individuals and families with mul0ple co- occurring complex issues (mental health, SUD, health, housing, trauma, etc.). 1

2 Comprehensive, Con0nuous Integrated System of Care CCISC All programs in the system become welcoming, recovery- oriented, trauma- informed, and complexity- capable. All persons delivering care become welcoming, recovery- oriented, trauma- informed, and complexity- capable. 12- Step Program of Recovery for Systems Recovery- Oriented Complexity Capability Each program organizes itself, within its mission and resources, to deliver integrated, matched, hopeful, strength- based best prac0ce interven0ons for mul0ple issues to individuals and families with complex needs who are coming to the door. Recovery- Oriented Complexity Capability CCISC Program Self- Assessment Tool: COMPASS- EZ 12 Steps for Programs Developing Recovery- oriented Complexity Capability 2

3 Recovery- Oriented Complexity Competency Each person providing clinical care is helped to develop core competency, within their job and level of training, licensure or cer0fica0on, to become an inspiring and helpful partner with the people and families with complex needs that are likely to already be in their caseloads. Recovery- Oriented Complexity Competency CCISC Clinician Self- Assessment Tool: CODECAT- EZ 12 Steps for Staff Developing Recovery- oriented Complexity Competency Is this your vision? If so, how do you get there? 3

4 How do we get there clinically? Research- based recovery- oriented principles of successful assessment and interven0on that can be applied to any popula0on in any program by any person delivering care. Integrated Longitudinal Strength- Based Assessment - ILSA Recovery oriented assessment process based on CCISC Principles The Principles inform both prac0ce and paperwork! Principle #1 Complexity is an expecta0on. Welcome people with complexity as priority customers. The assessment process begins with formal welcoming. Welcoming is visually prompted on the assessment format. Remove access barriers that make it hard to be welcomed. The assessment begins as soon as possible. There are no requirements re: substance levels or length of sobriety. See all the complex issues: integrated screening and documenta0on. See next slide. 4

5 Principle #2 Recovery partnerships are empathic, hopeful, integrated, and strength- based. Hopeful goals for a happy life. Begin by asking about the person s happy life goals and what he or she most wants help with to make progress. Document happy life vision and most important request. Integrated empathy is based on listening to the client s story. Obtain a longitudinal story, starmng with recent period of Mme and basic funcmoning during that period. Listen empathically to the story, and idenmfy all the issues integrated in the story. This is integrated screening! Document the story, and list all the issues present. Principle #2 Recovery partnerships are empathic, hopeful, integrated, and strength- based. Build on strengths used during periods of success. IdenMfy a period of Mme of relamve and recent success, and document all the strengths the client used to be successful in the face of all of his or her issues and challenges. Follow the Mme sequence forward to understand present challenges. IdenMfy in parmcular periods of Mme of 30 days or longer with no substance use (for MH diagnosis) Obtain details of why the period of success ended, with the goal of idenmfying how the client can build on strengths to learn new skills to be more successful in the future. Principle #3 All people with complex issues are not the same. Four- Quadrant model: Dis0nguish high and low severity issues and diagnoses Establish or document diagnoses based on longitudinal history more than based on current symptoms Look for periods of Mme where substance use was stable to evaluate base line mental illness DisMnguish substance abuse and dependence DisMnguish painful feelings, transient disorders, persistent disorders, and persistent disabling disorders. 5

6 Principle #4 For people with complexity, all co- occurring condi0ons are primary. Integrated mul0ple primary condi0on- specific best prac0ce interven0ons are needed. For each issue, based on past success and current services being umlized, idenmfy what is likely to be the best intervenmon to recommend. If this is not clear for any issue, idenmfy where you and the client can obtain addimonal informamon or assessment to figure it out. Principle #5 Parallel process of recovery for mul0ple condi0ons Recovery of the person with one or more condi0ons. Recovery involves: Addressing each condi0on over 0me in small steps. Moving through stages of change for each condi0on. Integrated services involve stage- matched interven0ons for each condi0on. IdenMfy stage of change for each issue, both currently and during recent period of success. Use sentence prompts to idenmfy stage of change (Next slides) Principle #5 (con0nued) Stages of Change Issue- specific, not person- specific. Pre- contemplamon: You may think this is an issue, but I don t and even if I do, I don t want to deal with it, so don t bug me. ContemplaMon: I m willing to think with you and consider if I want to change, but have no interest in changing, at least not now. PreparaMon: I m ready to start changing but I haven t started, and I need some help to know how to begin. Early AcMon: I ve begun to make some changes, and need some help to con0nue, but I m not commihed to maintenance or to following all your recommenda0ons. Late AcMon: I m working toward maintenance, but I haven t gohen there, and I need some help to get there. Maintenance: I m stable and trying to stay that way as life con0nues to throw challenges in my path. 6

7 Principle #6 Adequately supported, adequately rewarded, skill- based learning for each condi0on. Small steps of prac0cal learning Self- management skills and asking for help skills Strength- based assessment involves idenmfying next step skills that the person can and will learn to make progress for each issue, based on what they already know, and where they are struggling in the present. Rounds of applause for each small step of progress The assessment also idenmfies measurable stage- matched objecmves ( baby steps ) for each issue and how to provide a round of applause for each step of progress. Principle #7 There is no one correct interven0on or program. Integrated Longitudinal Strength- Based Assessment (ILSA ) is organized to obtain informa0on in order to match interven0ons based on the principles. Principles Made Simple Summary ILSA occurs in a welcoming, empathic, hopeful, con0nuous, integrated recovery partnership Addressing mul0ple primary issues Iden0fying adequately supported, adequately rewarded, strength- based, skill- based, stage- matched, community- based learning for each issue Moving toward the goal of a happy, meaningful life 7

8 What will be your next small step of success as a system, agency or program? And let s give each other a round of applause!!! Thank You 8