Recovery Oriented System Transformation: The Philadelphia Experience: Recovery Oriented System Transformation: The Philadelphia Experience Arthur C. Evans, Ph.D. Director Philadelphia Department of Behavioral Health & Mental Retardation Services and University of Pennsylvania School of Medicine Midwest Recovery Management Symposium March 28, 2007 Chicago Illinois


Take Home Messages: Take Home Messages Transforming Systems of Care to a Recovery Management Orientation is Necessary True transformation is complex and must occur at multiple levels and across multiple domains There are important Lessons Learned that can guide the transformational work


Outline: Outline Background and Conceptual Framework for Transformation Vision for Recovery Oriented System of Care Making Transformational Change Strategies and Examples: The Philadelphia Model


Background: Background


System TransformationWHY NOW?: System Transformation WHY NOW? Federal emphasis and expectation President’s New Freedom Commission SAMHSA Surgeon General’s Report IOM: Improving the Quality of Mental and Substance Use Health Care State Level Initiatives - Pennsylvania Blueprint – Building a Recovery-Oriented Service System Expectations of consumers and people in recovery Expanding research base showing improved effectiveness of treatments and natural supports


EVOLUTION OF THE SERVICE SYSTEM: EVOLUTION OF THE SERVICE SYSTEM MENTAL MODELS AND THE


Slide8: OUTCOMES


Slide9: OUTCOMES


Slide10: CREATING RECOVERY ORIENTED SYSTEMS OF CARE


This Conceptual Framework requires systems to work in new ways: This Conceptual Framework requires systems to work in new ways


How Transformational Change is Different: How Transformational Change is Different Transformation is unique in three critical ways: The future is unknown and only through forging ahead will it be discovered. The future state is so different than the traditional state that a shift of mindset is required to invent it. The process and the human dynamics are much more complex, unpredictable and uncontrollable.


Knowing Where Your System is Re: Transformation: Knowing Where Your System is Re: Transformation


Leadership in Transformation: Leadership in Transformation Vision and Direction Transparency and openness Bauer’s Curve Over Communicate The Power of Language and Concepts Parallel Processes and modeling Giving Voice


Internal Work : Internal Work Policy makers must attend to their own organizations re: transformation. An external focus must be balanced with the need for organizational change Building internal leaders (vs managers) Change administrative policy and practices Empowering and developing staff Changing roles Organizational culture


Conceptual Framework for Transforming Systems: Conceptual Framework for Transforming Systems Conceptual Clarity (Thinking) Practice Change (Behavior) Shaping the Environment (Context)


I. Conceptual/Philosophical Clarity: I. Conceptual/Philosophical Clarity Consistency is needed across stakeholder groups regarding what recovery is, and the philosophical approach to treatment. Should have comparable concepts regarding the goals of the system. Activities: Recovery Advisory Group – White Paper Communication Strategy Conferences Resource Documents Community Meetings Speakers Bureau Story Tellers Collaborative


II. Practice Change: II. Practice Change Practices and service components should be aligned with the recovery management framework. Activities: Training and Technical Assistance Demonstration Projects Integrated Behavioral Health Tx Monitoring Case Management Addictions Service System Transformation Plan Philadelphia Compact for Children’s Services Improving Service Outcomes (e.g. Health Disparities, Trauma, and EBP Initiatives) Transformed Day Services


III. Shaping the Environment: III. Shaping the Environment Contextual alignment is necessary in order to sustain any system changes Activities: Fiscal and Administrative Policies Community Support Faith Based Initiative Anti-stigma Campaign Community Education Housing Supports


Peer Support Relationship with Treatment: Peer Support Relationship with Treatment Treatment Peer Supports Example: Detox—Primarily professionally driven. Little peer involvement Example 6-month aftercare checkups. Could be primarily peer based Spontaneous Recovery: Outside the treatment process The degree of peer based service involvement can vary depending on the type of service


Examples from Philadelphia’s Department of Behavioral Health/Mental Retardation Services: Examples from Philadelphia’s Department of Behavioral Health/ Mental Retardation Services


Philadelphia Department of Behavioral Health/Mental Retardation Services: Philadelphia Department of Behavioral Health/Mental Retardation Services Arthur Evans, Ph.D. Director Office of Mental Health Coordinating Office of Drug and Alcohol Abuse Programs Community Behavioral Health Mental Retardation Services Peg Minehart, MD Medical Director Michael Covone Deputy Director BEHAVIORAL HEALTH SYSTEM MR SYSTEM


The Philadelphia Transformation Initiative: The Philadelphia Transformation Initiative $1 Billion System serving over 100,000 people annually City manages all behavioral health funding streams including Medicaid dollars 5-year plan to completely transform the System of Care at all levels Using multi-level approach which includes practice, program and policy level strategies


The Philadelphia Model: The Philadelphia Model Recovery as the overarching framework Individualizing Treatment by addressing: Trauma Co-occurring conditions Appropriate developmental stage, etc. Using data, science and technology to inform Policy and Practice Addressing known Health Disparities Using a community approach Faith Based Initiative Prevention and Outreach Implementing Evidence Based Practices


Three Primary Strategies: Three Primary Strategies


Three Strategies: Three Strategies Build Community Capacity Enhance the Quality of Treatment Change Administrative Structures


Policy Changes: Policy Changes Peer Supports Recovery oriented monitoring Medication Assisted Tx Rate Adjustments Hiring Recovery Staff Transforming Day Treatment Programs Funding non-traditional supports Emphasis on Earlier Intervention and Children


1. Build Community Capacity: 1. Build Community Capacity Purpose is to develop the non-treatment community resources to effectively support long term recovery outside of treatment


Build Community Capacity(examples): Build Community Capacity (examples) Mini-grant/grassroots Faith Based Initiative Face on Recovery Collaboration with other systems Prevention Peer Supports


2. Enhance the Quality of Treatment: 2. Enhance the Quality of Treatment Purpose is to improve the treatment experience so that it is one of several effective pathways to recovery


Enhance the Quality of Treatment(examples): Enhance the Quality of Treatment (examples) Evidence Based Practices Health Disparities/Cultural Competency (SE Asian, Latino, LGBT, etc.) Day Treatment Transformation MMT Treatment Enhancement Aaron Beck’s work integration in behavioral health services across the system, Peer Specialist


3. Change Administrative Structures: 3. Change Administrative Structures Purpose is to change the way business is done so that it better matches the vision of recovery management


Change Administrative Structures(examples): Change Administrative Structures (examples) Rate Adjustments RFP process Advisory Panels - integrate the voice of consumers Policy work Monitoring the change with Quality Assurance Increasing use of technology


Point is must work at multiple levels and across multiple domains simultaneously.: Point is must work at multiple levels and across multiple domains simultaneously.


Examples from Transformation Initiatives: Examples from Transformation Initiatives


Philadelphia Peer Initiative: Philadelphia Peer Initiative Joint work with the Mental Health Peer organization Peer Specialist model, pilot training 100 across system for now Putting a Face on Recovery – training and events Telephonic Aftercare Medicaid reimbursement Credentialing peer run providers All funding decisions for new programs include determining if a program is committed to peer work Evolving roles within the DBH/MRS Implementing Bill White’s 16 Principles of Recovery Management


Technical Assistance : Technical Assistance Providers and stakeholders will need consultation,training and support to initiate and sustain the transformational change. Provided both as a component of the RFP process and by identified needs in existing agencies. Three types of TA have been identified: Basic - with the award of a new program Clinical - offer training and consultation to improve quality of care at individual agencies or small groups of agencies at the programmatic level, shift from monitoring to collaboration Administrative - offer providers resources for transformational change in their daily operational areas – budgeting, billing, program development, data reporting, and introduction of recovery concepts


Technical Assistance (cont’d.): Technical Assistance (cont’d.) In addition to traditional methods of technical assistance, provider to provider supports will be used as well Mentoring Corporate Partnerships Apprenticing Resource Sharing Incubator Relationships Management Contracts


Evidence-Based Practices Initiative: Evidence-Based Practices Initiative Goal: To advise the Department Leadership on ways to promote: Awareness and education Structural and clinical reform that will focus on EBP Interdigitation of these strategies with the other departmental guiding principles


Evidence-Based Practices Initiative: Evidence-Based Practices Initiative Initial Objectives: Review DBH/MRS programs and activities Develop repository of EBP information available to all stakeholders Assess understanding, acceptance, and implementation of EBPs In-depth interviews with providers as f/u to surveys Recommendations to executive management e.g. policies and procedures for incorporating EBPs into RFP process


Philadelphia Example:Day System Transformation: Philadelphia Example: Day System Transformation Care Delivery Conversion of $31 million dollar Partial Hospital day system serving 5,000 adults to a recovery oriented, consumer-directed, community integrated menu of rehabilitation & treatment services Shift from stabilization & symptom management orientation to a recovery focus intended to impact all major life domains (employment, education, housing, socialization, spirituality, etc.) Expectation that all services will include community based, mobile components Extensive use of Certified Peer Specialists


Slide44: Fiscal Considerations Collaboration with State regarding flexible use of Medicaid funding Budget neutral transformation requiring increased dependence on external supports in the community Cost effective alternatives to Partial Hospitalization including services intended to decrease the use of inpatient & crisis treatment Use of flexible funding strategies including case rates Planned implementation of outcome-driven financial incentives (rewards-based contracting) Philadelphia Example: Day System Transformation


Faith Based Initiative: Faith Based Initiative Foster relationships with the faith community that will promote our collective ability to address mental health, substance abuse, and mental retardation issues within the Philadelphia community.


What this means for DBH/MRS?: What this means for DBH/MRS? People’s faith needs to be recognized and respected – Our programs need to allow interaction with the faith community while in treatment. People will seek out leaders in their faith community for help – We will support faith community leaders to help people. People need to have supports that assist their recovery – Our providers need to encourage people of faith to seek support from their community. People should have the option of receiving help thru the lens of their faith – We need to make sure these services are available.


Areas of Activity for the Faith Based Initiative: Areas of Activity for the Faith Based Initiative Community Forums Develop Workgroups Education and Training, Coordination and Linkages, and Service Delivery Expand and Develop Faith-Based Initiative Task Force Participate in Upcoming Conferences


Take Home Messages: Take Home Messages Transforming Systems of Care to a Recovery Management Orientation is Necessary True transformation is complex and must occur at multiple levels and across multiple domains There are important Lessons Learned that can guide the transformational work


Change is Coming: Change is Coming It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. - Charles Darwin


Let’s Make Transformation Happen!!!: Let’s Make Transformation Happen!!!