From Evaluation to Action: Tools for Effective Person and Family Engagement Ruth Colón-Wagner, LMSW Director of Training and Development National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health Netsmart Technologies New York Association of Psychiatric Rehabilitation Services, Inc.
The Why?
Learning Objectives 1. Define the critical components of successful engagement strategies 2. Learn ways to develop an engagement implementation plan for your practice 3. Gain a competitive edge in a value-based environment where effective person and family engagement is essential for continued success
Tell Us About You! Poll question: What setting are you joining us from today?
A statewide coalition of people who use and/or provide community mental health recovery services and supports dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their Recovery, Rehabilitation and Rights
Fixing a Broken System Fragmented, Siloed and Uncoordinated Reactive vs. Preventive and Diversionary Wrong Incentives: Volume over Value Illness over Wellness?
Goal Where do we encounter people on this spectrum? Illness Acute Care Where are we moving people too? Wellness
T H E G O A L S Participation in Treatment is the Goal Adapted from McSilver CTAC
Recovery 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 effects of mental illness. (Anthony, Cohen, Farkas, Gagne, Psychiatric Rehabilitation, 2002)
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 not linear. Recovery is a highly individualized process. Recovery occurs in the presence of someone who believes in and stands by the person. Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself. Anthony, W.A. (1993) Recovery From mental Illness: The Guiding Vision of the Mental Health System in the 1990 s. Psychosocial Rehabilitation Journal, 16 (4), 11-23.
Recovery is Not Linear Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience.
Symptoms? Recovery is not the absence of symptoms. It is the full life: Pleasure, love, life, happiness, purpose.
Risk of Not Practicing Recovery Risk of loneliness Demoralization Empty time Untapped potential This is not the result of the illness, it is the result of a health system that does not practice recovery.
Risk of Loneliness Believe in people when they have lost belief in themselves Bring them to opportunities that interest them or might bring them pleasure Offer the resources they need to be able to take advantage of these opportunities Encourage responsible risk-taking to enhance the person s life, to offer a sense of meaning and purpose
My Practice What can I do to help engage the people I work with?
Engagement Engagement is a process through which participants become active and involved in their treatment. Adapted from McSilver CTAC
Family Engagement ENGAGING THE PERSON S SUPPORT SYSTEM PATIENT & FAMILY ADVISORY COUNCILS
Engagement Team Work Participants have contact with various staff throughout all phases of engagement. Administrative Support Staff Interns and Volunteers Clinical Staff of All Disciplines Program Management and Initiative Leader
Team Work Safety Engagement Every contact affects us in one of two ways: Contributes to a safe, trusting and healing environment OR Detracts from a safe and trusting environment Everyone in our organization is important Everyone has a role in assisting people heal and find wellness Everyone is responsible for creating a safe, trusting, and healing environment National Council
Phases of Engagement 1. First Contact 2. Initial Interview/Meeting 3. Ongoing Services/ Retention 4. Terminating Services Adapted from McSilver CTAC based on Dr. Mary McKay s research
Targeted Strategies First Contact Overall Goals: 1. Be welcoming 2. Express empathy and understanding 3. Let them know what to expect remember the person is scared Adapted from McSilver CTAC
Targeted Strategies The First Meeting Overall Goals: 1. Clarify the helping process 2. Encourage shared decision-making 3. Instill hope, reinforce strength, and foster resilience 4. Focus on immediate concerns and needs 5. Create an opportunity for participants to ask questions Adapted from McSilver CTAC
Targeted Strategies Ongoing Engagement Overall Goals: Validate and identify strengths Express empathy and understanding Encourage shared decision-making Build hope and foster resilience Continue to problem-solve around concrete and perceptual barriers Adapted from McSilver CTAC Consider the A.R.C.H. principles
Targeted Strategies Termination Engagement Overall Goals: Identify the progress the person has made Identify areas for future work Identify new support systems Create an opportunity for a healthy good-bye Adapted from McSilver CTAC
Barriers to Engagement What Are They?
Barriers to Engagement Concrete Obstacles Child care concerns Pet care Location of facilities visiting people don t want to be far from home Complex systems Which is more important? Perceptual Obstacles Stigma; being viewed as weak Feel as if I will be blamed for problems Perception of quality of services Fear that others would lose confidence in me Fear of being prescribed medication that would have negative side effects (Adapted from RAND 2011; Hoge 2004)
How Can We Implement Engagement Practices?
Build Relationships When you ask When you share When you connect You form a culture of healing
Offer Hope, Empowerment & Optimism Fostering Recovery Building Hope Supporting Resiliency Trauma-Informed Use Person-First Language Avoid Pathologizing Language; Use Words that are Judgment-Free
Family and friendships Expand Their World & Their Natural Supports Spiritual and faith-based communities Sports and recreational activities Community organizations/activities Cultural activities and associations Social and political activism Peer support
Engagement Implementation: Establish Agency Culture Provide a safe place for people to share who they are Educate people on the impact of trauma Help people to practice their resiliency skills Refrain from judgments/labels Create and sustain natural support systems Create an environment that is reflective of warmth, respect, and care
Engagement Implementation: Staff Competencies for Engagement Recovery-oriented Person-centered Always think engagement Change: it s a process not a destination Person s experience of care Respected Valued Shared decision-making Hope Power sharing Build trusting relationships Caring Listening Being knowledgeable Being non-judgmental Understanding Trusting
Engagement Implementation: Planning Tools & Guides 1. Engagement Practitioner Checklist 2. Engagement Implementation Improvement Planning Guide 3. Engagement Strategy Guidelines for all Phases of Engagement 4. Quick Reference Guide to Conducting Individual Sessions 5. Session Feedback 6. Working Together Brochure 7. Motivational Interviewing
Dr. Patricia Deegan on Recovery It is our job to ask people with psychiatric disabilities what it is they want and need in order to grow and then to provide them with good soil in which a new life can secure its roots. And then, it is our job to wait patiently, to sit with, to watch with wonder, and to witness with reverence the unfolding of another person's life. Pat Deegan, PhD, Advocate, Innovator, Peer Leader www.patdeegan.com
Poll Question Are you interested in a free, on-site training for your practice, focused on effective person and family engagement during discharge/transition planning?
Thank you! Q&A Ruth Colón-Wagner, LMSW RuthCW@nyaprs.org
Resources McSilver s Community Technical Assistance Center for archived webinars on Engagement practices and other clinical topics - www.ctacny.com Engagement Guidelines were created by McSilver CTAC along with their collaborators NYAPRS Collective on-site trainings on mental health practice and related subjects www.nyaprs.org Please contact ruthcw@nyaprs.org Anthony, Cohen, Farkas, Gagne, Psychiatric Rehabilitation, 2002 Elements of Engagement: N. Chovil (2009) - hild%20%26%20youth%20mental%20health.pdf The ARCH Principles: Micucci, Joseph A. - https://www.chc.edu/faculty/joseph-micucci Barriers to Care, RAND 2011; Hoge 2004: http://www.pdhealth.mil/topics/accessingmental-health-care/barriers-care#_ednref21 Larry Davidson, Yale: http://www.adherenceandselfdetermination.org/people/54 www.patdeegan.com Toolkit: NYAPRS.org; http://mcsilver.nyu.edu/programs/training-technical-assistance; www.motivationalinterviewing.org
Thank you! www.caretransitionsnetwork.org CareTransitions@TheNationalCouncil.org The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.