INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

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INTEGRATED RECOVERY Lessons Learned: Implementing IDDT. Organizational / System Aspect 2 County Examples Debbie Innes-Gomberg, Ph.D. -Los Angeles Adrian Carroll, MFT - Stanislaus January 19, 2007. Organization-Wide and IDDT Team Specific. - PowerPoint PPT Presentation

Text of INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

  • INTEGRATED RECOVERY

    Lessons Learned: Implementing IDDT

    Organizational / System Aspect2 County ExamplesDebbie Innes-Gomberg, Ph.D. -Los AngelesAdrian Carroll, MFT - StanislausJanuary 19, 2007

  • Organization-Wide and IDDT Team SpecificIDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughout

  • Organization-Wide and IDDT Team SpecificIDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughoutAs well as build specific enhanced IDDT teams

  • Organization-Wide Elements:Commitment Philosophy TrainingAccess policyTime unlimitedOutcome monitoringSelf-help Housing and employmentResidential servicesLevels of careSteering committee

  • System Elements that Support IDDT Specific Programs:Client to staff ratioSupervising to the modelTeam approachEnhanced trainingsQuality managementFidelity monitoringSpecific OutcomesQuality Improvement (forms, processes)Access to housing (wet, damp, dry)

  • Use of IDDT in Larger System Change Efforts in L.A.

    Los Angeles Countys Adult Systems of Care TransformationCreating a continuum of recovery-oriented servicesUsing stages of change to guide service delivery and treatment planningCreating strategies for client flow through the continuum of services

  • COUNTY OF LOS ANGELES DEPARTMENT OF MENATL HEALTH ADULT SYSTEMS OF CARE TRANSFORMATION-RECOVERY-BASED LEVELS OF OUTPATIENT CARE

    COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH

    ADULT SYSTEMS OF CARE TRANSFORMATION RECOVERY-BASED LEVELS OF OUTPATIENT CARE

    Welcoming/Triage

    Strategic Services and Supports

    Wellness Centers

    Full Service Partnerships

    Key Focus: short term, intensive welcoming and assessment resulting in quality referrals and enhanced use of community resources

    Key Focus: Strategic mental health and supportive services resulting in client movement to wellness services and enhanced recovery.

    Key Focus: Self-directed services with peer and professional support geared toward physical/emotional recovery and increased community assimilation

    Key Focus: Intensive, whatever it takes service approach for clients who are homeless, incarcerated, in institutions or for whom care is provided solely through the family

    IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, multi-disciplinary treatment team

    IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, family education and support, secondary interventions for non-responders, multi-disciplinary treatment team

    IDDT Elements: stage-wise interventions, self-help, family education and support, focus on health and well-being

    IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, family education and support, secondary interventions for non-responders, access to comprehensive services, multi-disciplinary treatment team

    MORS levels: 2-7

    MORS levels: 3-6

    MORS levels: 6-8

    MORS levels: At enrollment: 1-2

    At graduation: 7

    Engagement of clients for < 60 days to determine level of need, using extended assessment and recovery scale( referral and linkage to specific service

    Evidence based/best practices designed to enhance recovery, engagement, self-coordination and coping skills short term, intensive and longer term.

    Including CBT, DBT, illness management, referral to housing and employment specialists within Center

    Peer-directed support groups and individualized problem solving, including Wellness Recovery Action Planning

    Multidisciplinary team, including housing and employment specialists and a peer advocate.

    Client to staff ratio

  • Use of IDDT Model Elements to Enhance Service Delivery in L.A.

    Focus on person-centered treatment planningTeam-based servicesStage-based assessment and interventions based on readiness for change

  • COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH

    ADULT SYSTEMS OF CARE

    Big 7 Organizational Transformation

    I. Domains of Change:

    Staff Transformation (enhancing staff belief in recovery, instilling hope in staff).

    Staff-consumer interactions (developing welcoming environments, developing successful strategies to work with challenging individuals).

    Organizational structures and processes (collecting and using quality of life and recovery-based outcome measures, developing structures to promote consumer flow through the system, building strong team structures).

    Available services and capacity (developing quality of life support services, strengthening collaboration with other social service agencies, developing community belonging and connections).

    II. Values of recovery-oriented change:

    Hope

    Healing

    Authority

    Community Engagement

    III. Use of Integrated Dual Diagnosis Treatment principles to create a recovery-oriented service continuum:

    Integrated assessment and treatment planning.

    Use of stage-specific interventions that match client readiness for change, including motivational interviewing.

    Incorporating self-help services into all levels of care.

    Team decision-making.

    Use of SAMHSA-supported practices such as Illness Management, Family Education and Support, psychoeducation, Supported Housing and Employment

    Focus on health and wellness.

  • SAMHSA 4 QuadrantsTarget population for IDDT are those COD individuals with Serious Mental Illness

  • Stanislaus experienceRecovery focusIntegrated system vs. Integrated treatmentWellness Recovery Center Exit strategies as a recovery conceptIdentify internal experts and early adoptersRecovery Milestones

  • Stanislaus experienceStages of change model:-SATS (AOD)-MH stages based on Milestones (MH)-Stage-based treatment-Staff change model

  • STAGE

    1

    2

    3

    4

    5

    STAGES OF CHANGE

    Pre-Contemplation

    Contemplation

    Preparation

    Action

    Maintenance

    STAGES OF IMPLEMENTATION

    Unaware or uninterested

    Consensus building

    Motivating

    Implementing

    Sustaining

    Steps: 1

    Ask important questions

    Conduct a needs assessment

    Define your rationale

    Conduct a baseline fidelity review

    Maintain oversight

    2

    Begin the change process

    Develop awareness of available options

    Identify stake-holders

    Develop a baseline fidelity action plan

    Monitor fidelity

    3

    Identify current practices and rationales

    Build consensus

    Develop stage-wise interventions

    Monitor outcomes

    4

    Examine your mission, values, goals, and vision

    Find your champions

    Acquire and integrate training

    Network with others

    5

    Check it out

    Identify financial resources

    Engage in clinical consultation

    Provide ongoing training

    6

    Engage technical assistance

    Assemble a steering committee

    Provide stage-wise interventions

    Engage in ongoing consultation

    7

    Assess the pros and cons

    Conduct a readiness assessment

    Develop and monitor outcomes

    Expand services

    8

    Develop informed consent and consensus

    Decide to implement or not

    Continue to educate and train stakeholders

    Transform the organizational culture

    9

    Explore concerns

    Recruit a team leader

    Address barriers

    10

    Plan to start small

    Address unintended consequences

    11

    Assemble the multi-disciplinary service team

    12

    Begin an implementation plan

  • Stanislaus experienceSystem Transformation-MHSA FSP, 2034, ACT-Wellness Recovery level of care-LOCUS LOC system, caseload ratio-Normalizing use of Primary Care PhysicianLevels of Care

  • Stanislaus County Behavioral Health and Recovery Services Draft 7/2005

    Mental Health

    Adult

    Community Supports & Integrated Services

    (ACSIS)

    LEVELS

    OF

    CARE

    Stage of Recovery.

    Clinical Risk.

    Level of Functioning.

    KEY COMPONENTS (that support Recovery)

    Case Management / Care Coordination

    Housing, Employment, Education, and Wraparound Supports

    Meds, MD, RN, Physical Health Services

    Counseling and Therapy

    Psycho-Education

    Peer Supports

    Family

    ACT or ACT-lite

    Locus: 4

    Pre-contemplation to early active treatment.

    High risk.

    High degree of impairment.

    < 10-15:1

    24/7

    >50% in field

    Outreach and engagement.

    Multidisciplinary teams.

    Stage-based. Follow while in hospital.

    Extensive use of wrap-around supports, housing and employment services. Housing 1st

    Work 1st.

    Readily available.

  • Stanislaus experienceClient flow through System-Early expectations-Ease of re-admission-SSI concerns-PCP relationships-Peer support throughout-Recovery conversation-Transparency of treatment process-Measurement and accountability

  • Team Structure

  • SUPPORT WHEELBe Selective In Choosing Support Phone NumbersPhone NumbersUse In A Circular Manner So Not To Burn Out Any One SourceMy Recovery

  • Cornerstones of Empowerment

    Developed by Consumers and Family Members

    7/08/06

    I have the right to know my diagnosis, criteria, and what medications are used to treat said diagnosis AND I have the responsibili