ADRC OPTIONS COUNSELING SERVICE &

TRAINING UPDATEADRC Advisory Committee

September 11, 2013

Long before ADRCs there was ‘options counseling’

History of Options Counseling(pre-ADRC)

Local community service providers gave more than just information, referral and assistance

• no particular definition or form• no consistency• occurred in silos

History of Options Counseling(circa 2003-2009)

AoA provides a vision for Options Counseling:

•More structured•More formalized•Less focus on condition, age, income or other silos•More focused on where consumer is now in their life and individual need•More robust choices (outside silos)

– service still largely undefined

Options Counseling & Assistance• designed to be a person-centered decision support

process• helps consumers regardless of their age, income or

disability and their families• used in a variety of settings and situations• may occur during an initial needs assessment, upon

discharge from a hospital, or in support of a transition back into the community after a long-term nursing facility stay.

• can also assist individuals regardless of their age, income or disability who do not have an immediate need for help but wish to plan ahead for their long-term independence.

Implementing the Affordable Care Act:Making it Easier for Individuals to Navigate Their Health and Long-Term Care through Person-Centered Systems of

Information, Counseling and Access - Program Announcement and Grant Application Instructions: U.S. Department of Health & Human Services FY 2010

2010: US HSS Secretary Kathleen Sebelius

“We know how difficult it can be for individuals and caregivers to deal with a sudden illness or chronic disease while at the same time trying to navigate through a complex health care system to figure out where to go to get appropriate help.”

Dr. Donald Berwick, CMS Administrator

• “When it comes to long-term health care, each patient has a unique mix of medical and social needs that must be considered. “

• “Helping patients and their families understand these options will help them make informed decisions about long-term care that are in the patient’s best interests.”

ADRC Options Counseling: Refined AoA/CMS Focus

• serve as visible and trusted sources of information on the full range of long-term care options that are available in the community, including both institutional and home and community-based care;

• provide personalized and consumer friendly assistance to empower people to make informed decisions about their care options;

• provide coordinated and streamlined access to all publicly supported long-term care options so that consumers can obtain the care they need through a no wrong door process;

• help people to plan ahead for their future long-term care needs

Options Counseling 2011 - 2012

• Options Counseling Workgroup: Worked to develop CA ADRC Options Counseling Standards

• ADRC Action Plan – the centerpiece of Options Counseling

• Facilitated one-day training• Tested standards in 7 areas of the state for 6

months• Evaluated by university

Options Counseling 2012• Mid Pilot - Second training – extended to 2

days– Invited Money Follows the Person (MFP) Lead

Orgs to join the training– DHCS MFP state staff attend training

• Extension for our Options Counseling work• ACL released new Draft Standards• Revised state Draft Standards

ADRC Options Counseling

… is an interactive process where individuals receive guidance in their deliberations to make informed choices about long-term supports. The process is directed by the individual and may include others that the person chooses or those that are legally authorized to represent the individual.

Information & Assistance

California DraftOptions Counseling

Standards

ADRC Options Counseling

ADRC Options Counseling

Draft Standards OverviewStandard 1 - Definition of Options Counseling; Target Populations: Who Should Receive Options Counseling; Marketing/Outreach Standard 2 - Initiation/Referral Protocols for Options Counseling; Delivery Setting/Model Standard 3 - Components of Options Counseling: Personal Interview; Exploring Options/Planning: Decision Support; Action Plan/Long Term Support Plan Development; Access to Community Supports; Follow-up Standard 4 – Staffing Structure; Education, Work and Experience; Staff Training

Viewing the whole individual

Options Counseling goes beyond the health-only discussion to include areas such as emotional well being, civic involvement, healthy living, financial planning and other issues that must be addressed when talking about long term care services and supports.

ADRC Options Counseling• uses tools that empower individuals to make choices and

to embrace the personal responsibility that comes with those choices.

• involves motivational interviewing techniques: “. . . a collaborative, person-centered form of guiding to elicit and strengthen motivation for change.”

The key component of effective ADRC Options Counseling is person-centered, one-on-one ‘interviewing’ so the

Options Counselor can really understand the person’s individualized values, strengths, preferences, and

concerns.

ADRC Options Counseling

• the first step in moving from the perception that LTSS is custodial in nature to a more robust model where it can and should be both empowering and rehabilitative.

• changes the conversation surrounding LTSS and begins to put responsibility in the hands of the individual.

Functions of Decision-Support Tools• Framing the decision• Providing information in an unbiased

way• Storing, Sorting and Processing

Information• Clarifying Preferences• Guiding Choices

Consumers in Health Care: Creating Decision-Support Tools That Work. Prepared for: California HealthCare Foundation. By Shaller Consulting, June 2006. Available at: http://www.chcf.org/publications/2006/06/consumers-in-health-care-creating-

decisionsupport-tools-that-work

The Spirit of Motivational Interviewing (MI)• Starts with an attitude, frame of reference or

philosophy of extreme respect • Respect client’s wisdom, knowledge and ability to

make decisions• See things from client perspective• Bring an attitude of partnership and collaboration• MI role not to motivate or ‘fix’ the problem - Evoke• ‘Spirit’ of MI: Partnership – Acceptance –

Compassion – Evocation

18

OPTIONS COUNSELING TRAINING

Training Revision• Feedback from previous training participants (12/2011,

2/2012)• Options Counseling pilot/evaluation (Jan – June, 2012)• Options Counseling Workgroup • Changing significance of the Options Counseling service as

a gateway to long-term services and supports (LTSS)• Continued implementation of state initiatives surrounding

LTSS including the Coordinated Care Initiative (Duals Demonstration and Medicaid managed LTSS)

• Updated guidance from Administration on Community Living

• Revised CA Draft Options Counseling Standards (12/2012)

Define the new standards, discuss benefits and challenges of a consumer focused model;

Distinguish Options Counseling from I&R/A;

Describe person-centered interviewing techniques; decision support; self-determination; informed decision making;

Identify and understand trigger situations that lead to start and end of Options Counseling;

Training Objectives

Explain various approaches to empowering individuals to make decisions and take responsibility;

Develop a written Action Plan that captures a consumer's long and short-term goals for getting the LTSS information and services they need.

Training Objectives

http://www.youtube.com/watch?v=mDs7VBzXxbE&feature=youtu.be

http://www.youtube.com/watch?v=mDs7VBzXxbE&feature=youtu.be

http://www.youtube.com/watch?v=mDs7VBzXxbE&feature=youtu.be

http://www.youtube.com/watch?v=mDs7VBzXxbE&feature=youtu.be

What folks are saying

– “ADRC Options Counseling will surely improve our quality of service”

– “I really love the opportunity to have more in depth conversations with clients/consumers.”

– “This is a huge concept to be practiced in our everyday interactions.”

– “I really feel like I will be able to use the skills in other aspects of my job – not just during the Options Counseling service.”

More…

– “We will need to practice this regularly in our agencies since it represents such a change in the way we do things.”

– “The training made me more consumer-centered and compassionate.”

– “I have attended many trainings that I thought were good, but this is the first training where I felt I experienced personal growth.”

ACL views Options Counseling as both a philosophy underpinning how ADRCs interact with individuals, as well as a process that ADRC staff will follow to

support individuals and families to consider their options and access the right

services and supports at the right time.

Looking forward

• Monthly Conference Calls available to all those who attended the training

• Online Learning Community available on the Choices website with password access

• One-on-one TA available to agencies or individuals

The ADRC Options Counseling Training Team

• Ed Ahern• Therese Llanes• Karol Swartzlander• Paula Acosta• Seneca Sharpe• Eric Glunt• Dr. Bill Matulich