The Managed Care Technical Assistance Center of New York

Transcription

1 Thomas Jewell, PhD Senior Consultant at CCSI s Center for Collaboration in Community Health; Director of Research & Evaluation at URMC s Family Institute for Education, Practice & Research The Managed Care Technical Assistance Center of New York

2 What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC s Goal: Provide training and intensive support on quality improvement strategies including business, organizational and clinical practices, to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.

3 Who is MCTAC?

4 Thomas Jewell, PhD Senior Consultant, CCSI; Director of Research & Evaluation, URMC s Family Institute MCTAC Partners

5 This is the final in the series of Utilization Management webinars There will not be an Applied Learning Discussion on January 19 th MCTAC will be ing a very brief follow up evaluation about the entire series in addition to the poll questions about this webinar. Please complete the evaluations so we know how to improve series in the future.

6 1. Engaging families in the context of managed care 2. Understanding common experiences of families and people with mental illness 3. Engaging people regarding their interest in family involvement 4. Engaging family members

7 Recommendation of the President s New Freedom Commission relate to family issues: Mental health care is consumer and family driven. In NYS, big picture goals include developing a person- and family-oriented system. It s important to consider aligning with that goal and document that it is happening.

8 Families and significant others are important and can be helpful members of the team With proper documentation, involving families can be a strategy to help us provide optimal care that is both needed and cost effective

9 Process by which an MCO decides whether specific health care services, or specific level of care are appropriate for coverage under an enrollee s plan Primary purpose of UM is to ensure that services are necessary, appropriate, and cost-effective Maintain fidelity and integrity of service provisions while meeting UM standards and requirements Required for reimbursement Intended to be consistent with optimal care for clients/consumers For more information about UM, visit and contact managed care companies serving your clients/consumers

10 HCBS or Home and Community Based Services are special services that some people in a HARP may be offered. HCBS services are designed to help people achieve recovery, and stay out of hospitals or other institutions. HCBS services focus on four basic areas: employment, peer support, family support, and coping and everyday living skills. To get HCBS services, people need to participate in an assessment. Everyone in a HARP is required to do this. But just being eligible for HCBS doesn t mean you automatically get these services. A service has to be listed in your Plan of Care - meaning it makes sense for you, and it is something you are interested in receiving. Go to MCTAC.org for more information

11 Client education webinar educate person about their options, including HCBS family support options Tracking treatment plan adherence webinar managed care companies are interested in: How we re planning with people? How is it working? Family engagement can be included in assessment, clinical formulation for treatment planning, and treatment. Supervision in managed care environment webinar supervisors can assist practitioners in understanding how enhancing family engagement practices can help support their work (clinically and fiscally) in the managed care context

12 Many different ways to define family. Family can be blood relatives, non-blood relatives, immediate, extended, blended, significant others, close friends, clergy, etc. Most important is that consumer defines who s in his or her family and support network [from UM perspective, document consumer s choice and how family involvement may inform and support individualized recovery goals] Worth noting: 1 in 4 people in U.S. diagnosed with a major mental illness = lots of family members

13 Family members experience subjective burden E.g., Worry, anxiety, confusion, grief, sadness, frustration Family members experience objective burden E.g., Expenditure of time, resources, day-to-day activities impacted by mental illness, changes in family roles Family members have a wide range of other experiences E.g., Impact on family relationships and friendships, burned bridges, unsure how to be helpful, conflict about what to do, personal growth, fulfillment via caring role Consumers and professionals also have a range of experiences when it comes to family involvement

14 Consumers want their families involved only in specific ways Consumers are angry/frustrated with families and don t want involvement Initially, there simply are no family members Consumers sometimes don t go to appointments, and have nobody supporting them to do so Consumers are worried family involvement will take away their own control Burned bridges People are traumatized (consumer; family) Families say no to involvement if asked Families don t know how to be involved in helpful ways

15 Broadening the network or team of people who can work together to assist person Relapse/readmission prevention is typically most effective when early warning signs of relapse are identified and monitored Increased revenue by increasing show rates in outpatient settings, and when people are transitioning from more restrictive settings into outpatient settings Improved consumer views about and satisfaction with treatment and their relationships with practitioners

16 Although historically excluded from mental health system, recognition in recent years that there are many important roles of family members in recovery Families can provide: Crisis Intervention Help Case Management Counseling Help with Basic Needs Socialization and Rehabilitation Opportunities Advocacy Love, companionship, relationships with history $$$? Families often need some combination of education, support and practical skills to be most effective in supporting recovery White Paper of NAMI New York State, 2006

17 People with mental health concerns who have ongoing contact with their families (or wish to) should be offered a family based intervention which provides a combination of: education about the illness family support crisis intervention problem solving skills training practical guidance Schizophrenia PORT Treatment Recommendations

18 Show concern, empathy Provide information Avoid blaming Promote adherence to medications Flexible, individualized treatment Encourage family to develop outside supports Instill hope Take a long term perspective Strengthen communication and problem solving skills

19 Family intervention has been shown to have many positive effects, such as: Reduced relapse rates in schizophrenia by 20-50% Fewer/less severe symptoms and greater stability Improved adherence with medication Improved family knowledge, functioning and coping Reduced family member distress (e.g., anxiety, depression) Greater hope, empowerment and life satisfaction for family member

20 Average relapse rates across 11 RTC s (N = 895) Mean length of treatment = 19.7 months McFarlane, W. R., Dixon, L., Lukens, E., Lucksted, A. (2003). Family psychoeducation and schizophrenia: a review of the literature. Journal of Marital and Family Therapy, 29(2), TAU SF MF

21 The problem: Overwhelming evidence that family participation in the mental health care of individuals with mental illness contributes to improved consumer and family outcomes. But family involvement typically does not occur. WHY? Consumer (and family) preferences often left out of the process Engaging consumers regarding this issue is not always easy for practitioners People want and need different things at different times Boyer CA, et al.. Am J Psychiatry. 2000;157: ; McFarlane WR, et al. Am J Orthopsychiatry. 2000;70: ; Olfson M,et al. J Nerv Ment Dis. 1999;187: ; Resnick SG, Rosenheck RA, Lehman AF. An exploratory analysis of correlates of recovery. Psychiatric Services. 2004;55: ; McFarlane, WR., et al. (2003). Journal of Marital and Family Therapy, 29(2),

22 Many choices for involving families/supports in different ways: - Giving written information - Attending treatment sessions - Formal family psychoeducation - Attending support groups - Calling team as needed - Family consultation meetings - Family information nights - Linking with NAMI No single form of family intervention is sufficient to treat the diversity of issues, cultures, characteristics, time since diagnosis, and life stages of all families and people. No one size shoe fits all Things go best when options are matched to meet people s wants/needs

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24 Consumer Centered Family Consultation (CCFC) is a brief, education-based engagement and consultation service that is typically completed in one to five sessions It promotes collaboration among adult consumers of mental health services, members of their family or social network, and service providers to support each consumer s recovery There are specific shared decision-making tools embedded in the process of engaging people and their natural supports Involves people s natural supports in meaningful ways, and helps people make choices about family involvement options (i.e., individualized care)

25 It s best to use a person-centered approach to engage Important to give consumers choices, use shared decision making strategies, and avoid trying to coerce Emphasis is on starting a conversation about whether, when and how to involve (or not involve) specific family members or significant others

26 % of Study Participants (N=230) Agree Disagree/Mixed/Refused Written Information Attend Support Group Treatment Sessions Call Team Cohen, Drapalski, Glynn, Medoff, Fang, Dixon. Preferences for Family Involvement in Care Among Consumers With Serious Mental Illness. (Psychiatric Services in Advance, December 15, 2012; doi: /appi.ps )

27 Tools and visual aides can be helpful for practitioners Examples of engagement tools are: Decisional balance exercise Values clarification exercise Decision Guide Pre-planning tool

28 What is this guide about? This guide helps adults with mental health concerns and their practitioners. It s a tool for making decisions about whether and/or how to involve family members or friends in support of recovery goals and treatment.

29 1-2 conversations between consumer and practitioner Emphasis: Consumer is in the driver s seat and has choices Plan: the goals/issues to discuss (and what not to discuss) Plan: outreach method to family/supports Prep: the family often wants to share some perspectives and experiences Discuss: how to handle curveballs

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32 Families are best engaged with a flexible, transparent approach Practitioners should be prepared to hear the family s story Families sometimes have mixed feelings about involvement for good reasons Families should be educated about options for involvement (it s not all or nothing ) Hope is important! People can and do recover. And families can play a meaningful role.

33 Set aside enough time to discuss their possible involvement Introduce yourself with a focus on your role in helping consumer Share some personal aspect(s) of yourself to foster genuine relationship building Explain that this is proactive outreach and not crisis oriented Make sure to tell them that you re not inviting them to family therapy Explain the goals (e.g., inviting them to treatment team meeting; inviting them to consultation meeting; helping them best support loved one)

34 Explain: your work is person driven and their relative has given permission for everyone to talk with one another Ask if they are interested in participating in getting involved with the treatment team in a few possible ways. Let them know it may be timelimited. If interested, set up a time and work out logistics (date, time and location) If not interested, ask if you can call them again in the future and give them your phone number for them to call if they change their mind Thank them for their time and consideration and end with comments that instill hope

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36 Implementation of family work can be difficult for practitioners and programs Many practitioners have mixed feelings about family involvement, for a variety of reasons (e.g., family blaming theories; seeing family at worst because of crisis; anxiety about involving families; lack of training) However, the jury is in and the verdict is clear: there are many benefits if practitioners do it right and respectfully offer people choices and a range of family involving services

37 Families and significant others are important and can be helpful members of the team With proper documentation, involving families can be a strategy to provide optimal care that is both needed and cost effective

38 This was the final utilization series events We ll be ing a link to a very brief evaluation of the entire series. Please help us ensure that future MCTAC offerings are helpful. Questions: Please any questions, comments, or suggestions to mctac.info@nyu.edu with the subject line Family Engagement Webinar Before you go, please take a minute to complete the survey (in the comments section to the right)