Implementing Recovery-Oriented Practices

Implementing Recovery-Oriented Practices

Step 2 in the Recovery-Oriented Care Continuum: Person-Centered Care Planning

April 11, 2011Janis Tondora, Psy.D.Assistant Professor, Department of PsychiatryProgram for Recovery and Community Health,Yale University School of Medicine, New Haven, Conn.

Sadé Ali, M.A., CAC, CCSDeputy Commissioner, Department of Behavioral Health& Intellectual disABILITY Services, Philadelphia, Pa.

Kimberly GuyC–RECS Coach/Educator, Focus on Recovery–United, Inc. (FOR–U)Program for Recovery and Community Health,Yale University School of Medicine, New Haven, Conn.

Larry Davidson, Ph.D.Development Services Group (DSG), Inc.

Image: SAMHSA Logo

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Step 2 in the Recovery-Oriented Care Continuum

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Webinar Agenda

• 3:00–3:05 p.m.

• 3:05–3:10 p.m.

• 3:10–3:25 p.m.

• 3:25–3:40 p.m.

• 3:40–3:55

• 3:55–4:30 p.m.

Welcome

Introductions and Overview of Today’s Workshop

Person-Centered Planning From Theory to Practice

Person-Centered Care Planning: What’s Culture Got to Do With It?

Finding Your Voice in Person-Centered Care Planning

Discussion

Wilma TownsendSAMHSA/CMHS

Larry DavidsonDSG, Inc.

Janis TondoraYale Program for Recovery and Community Health

Sadé AliDept. of Behavioral Health & Intellectual disABILITY Services

Kimberly GuyYale Program for Recovery and Community Health

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Process for Our Questions, Answers, and Discussion

• Our speakers will present, followed by moderated questions and answers. We invite you to ask questions or make comments! To ask a question… either click on the Q/A tab and type your question in the window that opens... OR press *1 for the operator, who will take your question in the order in which it is received.

• This Webinar will be recorded and archived for future use. Please visit http://www.dsgonline.com/rtp/resources.html for more information.

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Person-Centered PlanningFrom Theory to Practice

Presented by

Janis Tondora, Psy.DAssistant Professor, Department of PsychiatryProgram for Recovery and Community Health,

Yale University School of Medicine

Image: Janis Tondora, Psy.D

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What We Expectfor Them

• Life worth living• A spiritual connection to

God/others/self• Being a good mom/dad/daughter• Friends• Fun/laughter• Nature/music/hobbies• Pets• Love/intimacy/sex• Having hope for the future• Joy• Giving back/being needed• Learning• A home of our own

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What We Expectfor Us

• Compliance with treatment• Decreased symptoms/clinical stability• Better judgment• Increased insight• Reduced aggression• Acceptance of illness/disability• Adherence to team’s

recommendations• Decreased hospitalization• Residential stability• Abstinence from substances• Increased functioning• Active engagement/showing up• Improved cognitive functioning• Realistic expectations


Toward a Recovery-Oriented System

• People with mental health and addictions issues generally want the exact same things in life as all people.

• People want to thrive, not just survive…• Recovery-oriented care challenges us to move past the

maintenance of clinical stability to the true pursuit of recovery!

Image: Man on ladder, peeling back nighttime to expose daytime

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Increasing Alignment

Image: Publication cover: “Improving the Quality of Health Care for Mental and Substance-Use Conditions”

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IOM TJC

AACP Bazelon

Image: Publication cover: “Keystones for Collaboration and Leadership: Issues and Recommendations for the Transformation of Community Psychiatry”

Image: Publication cover: “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care”

Image: Publication cover: “In the Driver’s Seat: A Guide to Self-Directed Mental Health Care”

Plans Should Focus on What PeopleMost Value in Life…

• Quality of life• Education• Work• Housing• Health/well-being

• Manage their own lives• Social opportunity• Activity/accomplishment• Transportation• Spiritual fulfillment• Satisfying relationships

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… to be part of the life of the community.


…And Not Just on the Territoryof Traditional Treatment Plans

• Goal: Maintain psychiatric stability

• Objectives1. Attend appointments with primary care provider 2. Donna will attend psychiatric appointments

Image: “Do not” symbol

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What is Person-Centered Planning (PCP):Taking a Closer Look

• Person-centered planning: Is a collaborative process resulting

in a recovery-oriented treatment plan Is directed by consumers and

produced in partnership with care providers and natural supporters

Supports consumer preferences and a recovery orientation

—Adams/GriederImage: Publication cover:

“Treatment Planning for Person-Centered Care”

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The Person-Centered Care QuestionnaireTondora & Miller, 2009

• http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQprovider.pdf

• http://www.ct.gov/dmhas/lib/dmhas/publications/PCCQperson.pdf

Image: Questionnaire12

http://www.ct.gov/dmhas/lib/dmhas/%0Bpublications/PCCQprovider.pdf

http://www.ct.gov/dmhas/lib/dmhas/%0Bpublications/PCCQprovider.pdf

http://www.ct.gov/dmhas/lib/dmhas/%0Bpublications/PCCQperson.pdf

http://www.ct.gov/dmhas/lib/dmhas/%0Bpublications/PCCQperson.pdf


Key Practices: Process

• Adhere to person-centered principles in the process Person is a partner in all planning activities/meetings;

advance notice Person has reasonable control over logistics (e.g.,

time, invitees, etc.) Person offered a written copy Education/preparation regarding the process and

what to expect Language as a key practice

Image: Key

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• http://www.yale.edu/PRCH/documents/toolkit.draft.4.16.10.pdf

Image: Publication cover: “Getting in the Driver’s Seat of Your Treatment: Preparing for Your Plan 14

http://www.yale.edu/PRCH/%0Bdocuments/toolkit.draft.4.16.10.pdf

http://www.yale.edu/PRCH/%0Bdocuments/toolkit.draft.4.16.10.pdf


Glass Half Empty vs. Glass Half Full

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Deficit-Based Language Strengths-Based, Recovery-Oriented Alternative

A schizophrenic… a borderline… A person diagnosed with…

Clinical case manager Recovery coach… guide…

Front-line staff… in the trenches… Direct-support staff

Substance abuse/abuser Person living with… SA interferes with…

Suffering from Living with… recovering from…

Treatment team Recovery team

High-functioning vs. low-functioning A person’s symptoms/addiction interferes with the following

Unrealistic Idealistic… high expectations…

Resistant… non-compliant… Disagrees with… chooses alternative…

Weaknesses Barriers to change… support needs….

Maintaining clinical stability… abstinence…

Promoting life worth living

Puts self/recovery at risk Takes risks to try new things/grow

Treatment works Person uses treatment as a tool in recovery


Key Practices: Process

• Recognize the range of contributors to the planning process (e.g., peers, natural supporters).

• Value community inclusion. “While,” not “after” Trap of the one-stop shop

• Demonstrate a commitment to both outcomes and process; high expectations.

• Understand and support human rights such as self-determination (e.g., role of advance directives, Positive Behavior Support Plans).

Image: Key16


What Next?

• So you try your best to implement all of these key practices in PCP… but how do we move from the practice of PCP to the documentation of PCP?

Image: Person wondering

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But Can We Document the Service Plan This Way and Still Get Paid?

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and Water Girl at dinner

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Medical N

ecessit

yPerson-Centered Care

“Let’s face it: Our relationship is doomed!”


A More Hopeful Proposition

• We can balance person-centered approaches with medical necessity/regulations in creative ways to move forward in partnership with persons in recovery.

• We can create a plan that honors the person and satisfies the chart!

• In other words: PCP is not soft!

Image: Scale

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Putting the Pieces Togetherin a Person-Centered Plan

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GOAL as defined by person

Strengths to Draw Upon Barriers /Assessed Needs That Interfere

Short-Term Objective•Behavioral•Achievable•Measurable

Interventions/Methods/Action Steps•Professional/“billable” services•Clinical & rehabilitation•Action steps by person in recovery•Roles/actions by natural supporters


Image: Sample Recovery Plan 21


22Image: Sample Recovery Plan


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Image: Sample Recovery Plan


Get It… Do It… Live It…

• “Getting it” vs. “doing it” and “living it”• Many mental health systems’ change

efforts get derailed by perpetual efforts to help people “get it.”

• “We don’t think ourselves into a new way of acting, we act ourselves into a new way of thinking.” Execution: The Discipline of getting

Things Done, by Larry Bossidy and Ram Charan

Image: Girl on diving board

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Person-Centered Care Planning:What’s Culture Got to Do With It?

Presented by

Sadé Ali, M.A., CAC, CCSDeputy Commissioner,

Department of Behavioral Health& Intellectual disABILITY Services

Image: Sadé Ali, M.A., CAC, CCS

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A Good, Strengths-Based Assessment

• Includes attention to concepts called “Person-first.”• Person-first is a more inclusive way of saying “culturally

appropriate,” and includes Strengths and capacities Nationality and/or ethnicity Sexual orientation Faith and spirituality Gender, gender identity, and/or gender expression Age Social role Intellectual and cognitive abilities Ways in which individuals heal themselves in a cultural context

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One Size Should Never Fit All

Image: Square peg being fitted into a round hole

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Healing in a Cultural Context

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Person-First Issues May ImpactRecovery/Resilience

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These Include, But Are Not Limited To…

• Hours during which services are delivered• The honoring of the individual’s or family’s ways of healing

and an inclusion of them as recovery/resilience supporters• The honoring of non-traditional families and the inclusion of

them as recovery/resilience supporters

Image: Clock

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Outcomes Will Improve When…

• The care being given is relevant to the person, the family, and other supporters of the individual and the community to which, and in which, it is being given.

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• A person-centered plan cannot be created without knowledge of who the individual is beyond the mental health or substance use challenge.

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Helpful Questions

• What do you call your challenge, and what do you think can help to heal it?

• Who is your family? Who do you trust?• What personal pronoun do you use? What would you like to

be called? (This is especially important to transgender and gender-variant people.)

• Have you ever been a member of a faith or spiritual community? Are you a member now? If so, would you like your faith/spiritual leader to become part of your recovery/resilience support team?

Images: Families33


Helpful Questions, cont.

• With whom do you have intimate relations and relationships?

• Have you ever been a victim of police brutality, homophobia, transphobia, or other forms of oppression?

• Has your family always lived in the area?• How do you identify culturally or ethnically? What do you

know about your culture? What were some of the messages you got about the cultures of others?

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Some Final Thoughts

• People should be assumed to have within them everything they need to get into and maintain recovery, but it is up to us, the “guides on the side,” to nurture and support that notion.

• It doesn’t take anything away from us to sit in the “learner’s chair,” especially when working with people whose cultures are different from our own.

• “Dignity” and “respect” are two words that are often overused and undervalued.

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Image: “Love” sculpture

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Finding Your Voice in Person-Centered Care Planning

Presented by

Kimberly GuyC–RECS Coach/Educator,

Focus on Recovery–United, Inc. (FOR–U),Program for Recovery and Community Health,

Yale University School of Medicine

Image: Kimberly Guy

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Image: Kimberly Guy in black jacket

Image: Kimberly Guy

Image: Kimberly Guy holding certificate


Speaker Contacts

• Janis Tondora [email protected]

• Sadé Ali [email protected]

• Kimberly Guy [email protected]

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mailto:[email protected]




For More Information:Web-Based References and Resources

• Sadé Ali: Developing Culturally Competent Recovery Plans – Person-Centered Planning Using the Recovery Model http://www.browndlp.org/dlpannouncement.php?course=199

• Tondora, J.; Pocklington, S.; Gorges, A.; Osher, D.; & Davidson, L. (2005). Implementation of person-centered care and planning: From policy to practice to evaluation. http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm

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http://www.browndlp.org/dlpannouncement.php?course=199

http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm


Web-Based References and Resources, cont.

• Jonikas, J.; Cook, J.; Fudge, N.; Hilebechuk, M.; & Fricks, L. (2005). Charting a meaningful life: Planning ownership in person/family-centered planning. http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm

• New York Care Coordination Program.Extensive materials and tools re: the implementation of PCP, including web-based interactive exercises to practice writing person-centered plans. Extensive materials and tools re. the implementation of PCP,

including Web-based interactive exercises to practice writing person-centered plans

http://www.recoveryskillbuilder.com

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http://www.psych.uic.edu/uicnrtc/cmhs/pfcppapers.htm

http://www.recoveryskillbuilder.com/


Q and A, Discussion, and Summary

• To ask a question… either click on the Q/A Tab and type your question in the window that opens... OR press *1 for the operator, who will take your question in the order in which it is received.

Larry Davidson, Ph.D.Project Director, Recovery to PracticeDSG, [email protected]

Thanks for joining our Webinar today!

Image: Larry Davidson, Ph.D.

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For more information…

• For a copy of today’s presentation: http://www.dsgonline.com/rtp/resources.html

• Recovery to Practice Resource Center:[email protected]

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http://www.dsgonline.com/rtp/resources.html

http://www.dsgonline.com/rtp/resources.html


Documents

Implementing Recovery-Oriented Practices