Foundations of Recovery and Wellness. Presented by Technical Assistance Training Partners

Transcription

1 Foundations of Recovery and Wellness Presented by Technical Assistance Training Partners

2 Adult BH HCBS Roadmap Partners

3 3 A vision of care that is directed by people in recovery, emphasizes the reality and hope of long-term recovery, and recognizes the many pathways to healing for people with addiction and mental health challenges. Achara-Abrahams, I., Evans, A. C., & King, J. K. (2011).

4 4 Learning Objectives HCBS Foundation Review Gain a better understanding of recovery including definitions, values, and domains Become aware of what research tells us about recovery Know why it is important to provide recovery-oriented services Explore how language and behavior can make a difference in engaging people and providing services Learn about recovery-oriented systems of care

5 HCBS FOUNDATION 5

6 Behavioral Health Transition to Managed Care Health and Recovery Plans (HARP) and HIV Special Needs Plans (SNP): Adults enrolled in Medicaid and 21 years or older with select Serious Mental Illness (SMI) and Substance Use Disorder (SUD) diagnoses having serious behavioral health issues will be eligible to enroll in a new type of health plan, HARP. These specialty lines of business operated by the MCO will be available statewide. Individuals meeting the HARP eligibility criteria who are already enrolled in an HIV Special Needs Plan may remain enrolled in the current plan and receive the enhanced benefits of a HARP. HARPs and SNPs will arrange for access to a benefit package of Home and Community Based Services (HCBS) for members who are determined eligible. HARPs and SNPs will contract with Health Homes, or other State designated entities, to develop a person-centered care plan and provide care management for all services within the care plan, including the HCBS. January 1, 2016 Adult BH HCBS became available for eligible individuals in HARPs and HIV SNPs in New York City October 1, 2016 Adult BH HCBS became available for eligible individuals in HARPs and HIV SNPs in Rest of State (ROS) 6

7 7 Adult BH HCBS Menu of Services Rehabilitation Habilitation Psychosocial Rehabilitation (PSR) Community Psychiatric Support & Treatment (CPST) Crisis Respite Short-Term Crisis Respite Intensive Crisis Respite **Education Support Services **Individual Employment Support Services Pre-Vocational Transitional Employment Intensive Supported Employment Ongoing Supported Employment **Empowerment Services Peer Support Family Support & Training *Non Medical Transport (can only be provided by Medicaid Transportation Vendors) ** Indicates Tier I Services

8 8 Values & Core Principles Person-Centered Care Recovery-Oriented Services Integrated Services (Physical & Behavioral Health) Data-Driven Evidence-Based Trauma-Informed Peer Supported Culturally Competent Flexible & Mobile Inclusive of Social Network Coordination & Collaboration

9 9 HCBS Modalities & Settings Only Psychosocial Rehabilitation and Family Support & Training may be provided in a group format. All other services must be provided 1:1. In keeping with the Values and Core Principles of HCBS, services should be provided in home and community based settings whenever possible.

10 Adult BH HCBS Eligibility State Identified HARP enrolled Medicaid beneficiaries age 21 and older 10 Individuals enrolled in HIV SNPs determined by the State to be HARP-eligible Meets eligibility criteria on the HCBS Eligibility Assessment Tier 1 -- Services include employment, education and peer supports services Tier 2 -- Includes the full array of Adult BH HCBS H Codes indicate HCBS eligibility - available on EPACES

11 Main EPACES HARP/HCBS Codes H9 - HARP eligible but pending enrollment. This person has been determined to be eligible for a HARP. H1 - HARP enrolled At this time HH should begin the NYSCMHA process. Adult BH HCBS eligibility HARP enrolled H2 This code identifies the person as enrolled in a HARP. It also indicates that the person has been assessed and determined to be eligible for Tier 1 HCBS services (peer supports, employment supports, education supports). H3 This code identifies the person as enrolled in a HARP. It also indicates that the person has been assessed and determined to be eligible for Tier 2 HCBS services (All HCBS services) Additional EPACES HARP/HCBS codes can be found in emedny website under MEVS/DVS Provider Manual 11

12 HCBS Workflow 12 Health Home (HH) Care Managers Conducts Brief Eligibility Assessment Health Home Care Managers Submits Minimum Requirement to Managed Care MCO issues Level of Service Determination HH Care Managers Refers Member to HCBS Provider HCBS Provider Notifies MCO of receipt of referral and date of first scheduled appointment Adult BH HCBS Provider notifies MCO and HH Care Manager of Frequency, Scope, and Duration

13 NYS Process for Conflict Free HCBS Referrals 13 HARP enrollees shall be provided with a choice of HCBS designated providers from the MCO s network of a particular service. With respect to conflict-free care management requirements for Health Homes: To promote and ensure integrated care for the best interest of the client, it is possible that an individual may receive care management and direct care services from the same entity, however, in these instances the care management and direct service components will be under different administrative/supervisory structures.

14 WHAT IS RECOVERY? 14

15 Recovery 15 Recovery is a deeply personal, unique process of changing one s attitudes, values, feelings, goals, skills and or roles. It s a way of living a satisfying, hopeful and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one s life as one grows beyond the catastrophic effects of illness. (Anthony, Cohen, Farkas, Gagne, 2002)

16 SAMHA S Working Definition of Recovery Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. 16

17 17 Four Domains that Support Recovery SAMHSA Health Home Purpose Community Overcome/m anage ones disease Physically and emotionally healthy Safe and stable Supports recovery Creative endeavors: job, school, family, caretaking, independence Income and resources to participate in society Social networks and Relationships Support, love, friendship, hope

18 18 Recovery Values Hope Respect Partnership Peer Support Self-Advocacy Meaningful Life Self-Awareness Community Focus Self-Determination Power of Language Trauma Informed Services Informed Choice/Education Wellness Self Management / WRAP Integrated Treatment Co-occurring Disorders

19 Basic Principles Through the Recovery Lens Recovery is possible Recovery can occur without professional intervention. Recovery involves more than symptom reduction and can occur even though symptoms reoccur. Recovery is a highly individualized process. Recovery occurs in the presence of someone who believe in and stands by the person. Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself. 19

20 20 What does Research Tell Us About Recovery?

21 World Studies Demonstrate Recovery is Possible 21 STUDY Sample Size Average Length in Years Lambert et al. (2009) Germany % Ciompi & Muller (1976) Lausanne % Angst & Preisig (1995) Switzerland % Auslander & Jeste (2004) USA % Ogawa et al. (1987) Japan % Ciompi (1980) Switzerland % Kreditor (1977) Lithuania % Marinow (1986) Bulgaria % Kaleda (2009) Russia % Lauronen et al. (2005) Finland % Nyman and Jonsson (1983) Sweden % Vazquez-Barquero et al. (1999) Spain % Subjects Recovered and/or Improved Significantly

22 What Research Tells Us About Recovery THE RESULTS Vermont Longitudinal Study, C. Harding et al 5 to 10 years: 2/3..could be maintained in the community if sufficient transitional facilities and adequate aftercare were provided 20 to 25 years; 50% in independent housing, 34% working or volunteers; 77% had a comparably adequate income 68% were assessed as relatively symptom-free 34% completely recovered in psychiatric status and social roles 34% significantly improved in psychiatric status and social roles 22

23 Recovery from Substance Use Disorders Despite negative stereotypes of hopeless addicts, rigorous follow-up studies of treated adult populations, who tend to have the most chronic and severe disorders, show more than 50 percent achieving sustained remission, defined as remission that lasted for at least 1 year. 23 Philadelphia Department of Behavioral Health and Intellectual Disability Services. 30. Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H.,... Hasin, D. S. (2015). White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports,

24 24 WHAT ARE THE BASICS OF EFFECTIVE TREATMENT? Research shows that combining treatment medications, where available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient's drug abuse patterns and drug-related medical, psychiatric, and social problems. Medication-Assisted Treatment Works!

25 25 Discussion Question Why is it important to provide recovery-oriented services?

26 26 Learn about Recovery-Oriented Systems of Care (ROSC)

27 Recovery Oriented Systems of Care (ROSC) A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those dealing with mental health issues and/or alcohol and substance use disorders. 27

28 ROSC Defined 28 Services are designed to be accessible, welcoming, and easy to navigate. A fundamental value of a ROSC is the involvement of people in recovery, their families, and the community.

29 Recovery Oriented System Of Care (ROSC) A ROSC supports the premise that there are many pathways to recovery. Recovery-oriented activities include providing a menu of traditional and alternative services. Recovery support services include employment /education assistance, financial literacy education, child care, care management, housing support, recovery centers and peer support. 29

30 Recovery Management as a Component of ROSC Recovery management reflects the shift from an acute care model to the provision of longterm supports and wellness. The public health community has long practiced recovery management in primary care when treating diseases such as diabetes, asthma, and hypertension. 30

31 Recovery Management 31 Recovery management engages and assists the person in managing efforts to achieve long-term recovery. Individuals and their families are empowered to seek supports specific to meet the needs of the person. There is no formula or set of rote practices that serve everyone. Different persons require different resources. The role of recovery management is to coordinate access to resources and foster engagement.

32 What Outcomes do People Want From our Behavioral Health System? A better place to live A chance to go to school A satisfying job Supportive Relationships Help in time of crisis 32

33 How do People Want their Services Delivered? 33 Freedom from Stigma Timely Access to needed services and supports Supports that are embedded in the communities for which they serve Physically accessible Offered at non-traditional hours when people are most often able to participate Culturally competent and reflective of the communities served Trauma-informed

34 Change of Focus 34 From System Focus on labels Emphasize deficits and needs. Invest in standardized testing and assessments. Depend on Professionals to make decisions. Generate written reports. See people in the context of the human service system. Distance people by emphasizing difference. To Person Focus on people first. Search for gifts and capacities. Spend time getting to know people. Support people through their own decisions. Give accurate descriptions of people, not illnesses. See people in the context of their local communities. Bring people together by discovering common experiences.

35 Recovery Oriented Systems of Care What It Should Do: Focus in on the participant s life goals and needs Encourage the participant to see many possibilities maximize choice Help the participant to increase competencies Be flexible in admission and program participation criteria Not reject anyone s participation Offer hope-the possibility for change and growth 35

36 Recovery Oriented Systems of Care 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 pre-packaged and pre-defined Set rigid requirements for intervention and force participants to choose either all or nothing Diminish hope, constrain thinking and expectations 36

37 The Healing Power Of Language Use Person-First Language 37 Avoid Pathologizing Language Use Words That Can Help

38 Reframing Labels and Perceptions Chronic Non-Compliant Resistant Manipulative Resilient Independent Cautious Skillful 38 Demanding Frustrating Not ready Assertive Challenging Pre-contemplative

39 39 Reframing Substance Use Disorder Language Addict/ Alcoholic/Consumer Person in Recovery Substance Abuse Substance Use Disorder Clean Abstinent Dirty Actively using Relapse Prevention Recovery Enhancement Self-Help Mutual Aid

40 40 When working with people with a trauma history, does our language matter? Is there supportive language? Is there destructive language? Examples? Examples?

41 Empowering Interactions Promote Self-determination 41 Power Robbing Language You should You need You must You can t No one can do that Problem But It only works when The best way is Your only option is My advice to you is You can t do that Empowering Language Can, could What have you considered? What are your options What can you do? Up till now Challenge, situation, concern And What other ways might work for you? Some choices are Options to possibly consider are What has worked for you in the past? Some things that worked for me are

42 Challenges for Peers/People in Recovery Find/sustain hope Develop/articulate dreams and goals Develop self advocacy and recovery self management skills (e.g. WRAP) Know/exercise your rights (Advance Directives) Build/sustain contact with personal supports and community resources Prepare for more risks, responsibilities Strengthen stamina and endurance Have/find faith Explore alternative forms of healing 42

43 43 Challenges for Providers Train and sustain staff belief in recovery Train and sustain staff competencies in person centered service provision Active engagement and outreach, customer satisfaction in competitive environment Firm up documentation skills Firm up good outcome systems Get comfortable with electronic records Get entrepreneurial: embrace new partners and payers

44 Adopt A Vision 44 A vision is not reflective of what we are currently achieving, but of what we hope for and dream of achieving.a vision begets not false promises but a passion for what we are doing (Anthony, Cohen, & Farkas, 2002)

45 45 What is your vision for your role in recovery?

46 46 Resources Achara-Abrahams, I., Evans, A. C., & King, J. K. (2011). Recovery-focused behavioral health system transformation: A framework for change and lessons learned from Philadelphia. In J. F. Kelly & W. L. White (Eds.), Addiction recovery management: Theory, research and practice. (pp ). Totowa, NJ: Humana Press. 36. Kirk, T. A. (2010). Anthony, Cohen, Farkas, Gagne, (2002) Psychiatric Rehabilitation. Deegan, Pat Institute for the Study of Human Resilence Harding, C. M. (2003). Changes in schizophrenia across time: Paradox, patterns, and predictors. National Empowerment Center Masaru Emoto, Masaru Emoto, peace project Ragins, Mark Recovery Innovations

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