PCP in CCS - August 2017

9/28/2017

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Wisconsin Department of Health Services

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Recovery-Oriented Practice:

Incorporating Person-Centered Planning

into Comprehensive Community Services

Theresa Kuehl

Materials adapted from:Diane Grieder, Neal Adams, and Janis Tondora


Today’s Training

Principles and practice of person-centered planning (PCP)

Linking the “golden thread”

Recovery-oriented documentation discussion and practice

Resources

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The Patient Experience

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Activity


Person-

Driven

Many

Pathways

Holistic

Peer

Support

RelationalCulture

Addresses

Trauma

Strengths/

Responsibility

Respect

Hope

Ten Guiding Principles of Recovery

Substance Abuse and Mental Health Services Administration (SAMHSA)

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Through the provider lens?

Through persons in recovery lens

(what does it look like and feel like)?

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What Does “Recovery-Oriented”

Mean to You?


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Conventional

Staff is the expert and can fix the individual

- Cookie-cutter services

- Deficit-based

- Deny or minimize choice

- Symptom reduction and management

- Professional services

Conventional

Staff is the expert and can fix the individual

- Cookie-cutter services

- Deficit-based

- Deny or minimize choice

- Symptom reduction and management

- Professional services

Person-Centered

The individual is the expert on his/her own life; her/his ideas are central

- Individualized services

- Strengths-based

- Emphasis on person’s choice

- Recovery-oriented

- Natural supports

Person-Centered

The individual is the expert on his/her own life; her/his ideas are central


- Strengths-based

- Emphasis on person’s choice

- Recovery-oriented

- Natural supports

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Available

Resources

Treatment

GoalsAvailable

Supports Person

Focus is on “Cookie Cutter Services”

1 2 3 4

Source: Adapted from the Foundations of Person-Centeredness, Level 1 Workbook

Traditional Approach

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ResourcesDreamsNatural

SupportsPerson

Focus is on “Individualized Recovery”

1 2 3 4

Person-Centered Approach

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Principles Comparison

Comprehensive

Community Services

(CCS)

- Individualized

- Person-centered

- Strength-based

- Collaborative; team approach

to recovery

- Recovery-oriented

- Natural and peer supports

PCP


- Strength-based

- Individuals/families expert on lives;

their ideas are central

- Emphasis on individual and family

choice

- Recovery-oriented

- Natural and peer supports

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Assessment

Services

Understanding

Goals

Objectives

Prioritization

Strengths/Barriers

PCP FrameworkOutcomes

PhilosophyPhilosophy

Adams and Grieder (2014) 10

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Stages of Change and Treatment

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Prochaska and

DiClemente

Stage of

TreatmentTreatment Focus

Pre-contemplation Engagement

o Outreach o Practical helpo Crisis interventiono Relationship building

Contemplation Motivationo Pros/conso Resolve ambivalenceo Build motivation

Preparation Planningo Small stepso Identify supportso Address barriers

Action Active Treatment

o Counselingo Skills trainingo Self-help groupso Bolster self-efficacy

Maintenance Relapse Preventiono Wellness plano Skills trainingo Expand recovery

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Stages of Change and Treatment

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Stages in the Recovery Process

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Stages in the Recovery Process

Impact of the

Illness

Life is Limited Change is

Possible

Commitment

to Change

Actions for

Change

Stage of

Recovery

Overwhelmed Not ready to

commit to

change

Believes

there is more

to life

Willing to

explore

possibilities

Taking

responsibility

for a new

direction

Role of

Services

Reduce

emotional

distress by

reducing

symptoms

Foster hope

and sense of

possibility

Help people

see not so

limited by

the mental

illness

Help people

identify their

strengths and

figure out

skills,

resources and

supports

Help people

trust their own

decision-

making

abilities and to

take more and

more

responsibility

for their lives.

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Assessment





Strengths-Based Assessment

Collaborative process

A shared conversation, not an interrogation

Plans are shared with consumers

Recognizes strengths

- What are your goals?

- What would be helpful?

- What are your interests? Hopes and dreams?

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Importance of Language:

Strength-Based Language

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Activity


Research Shows:

Relationships Matter

“The therapeutic relationship accounts for why clients improve (or

fail to improve) at least as much as the particular treatment method.”

- American Psychological Association Task Force on Evidence-Based Therapy

Relationships, 2011

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Common Mistakes: Assessments

Limited mention of the person’s strengths (e.g., past success,

interests, preferences)

Limited mention of the barriers that are getting in the way

Not sufficiently comprehensive

Does not use all available information resources

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Assessment

Understanding




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Integrates and summarizes the individual’s story in a concise,

coherent manner

Provides the practitioner’s view of why the person has been unable

to overcome existing barriers (hypothesis)

Includes the individual’s view of his/her need for services

Identifies key areas that may be addressed on the recovery plan

related to medical necessity

Provides treatment recommendations

Is the BRIDGE between the data and the plan!


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Assessment

Understanding



Adams and Grieder (2014)

Prioritization

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It’s Not About the Nail

Prioritization


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Partnership: Building on their goals

Important TO the

individual/

family

Important FOR

the individual/

family

Prioritization

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Person served MUST be the driving force.

- Build upon the person’s own expertise

- Services are consistent with concerns/perspective of person served

- Personal / family values need to be considered

- Cultural nuances are significant

What is important TO the person?


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Basic health and safety (Maslow hierarchy)- Reduction of symptoms/medical need

- Practical needs

- Harm reduction

- Risk vs. safety

Legal obligations and mandates

Community safety

What is important FOR the person?

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Recovery ZoneNeglect Control

Let person do what

he/she wants

Get person to do

what I want


Recovery Plan

Person-centered planning format:

- Larger Goal(s): Individual’s stated goal(s)

- Strengths/barriers

- Objectives (short-term Goals): Small steps the individual will take to

accomplish goal(s)

- Interventions/services to assist the person with accomplishing the

objectives and goal(s)

- Transition/discharge criteria

The individual is able to say: “I, not staff, decided my treatment goals.”

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Assessment

Understanding




Prioritization

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Goals


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Goal

Maintain psychiatric stability

Objectives

1. Take meds as prescribed

2. Attend psychiatric appointments

Poor Examples

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Goals

Long term, global, and broadly stated (not quickly

accomplished)

Life changes as a result of services

Written in positive terms/toward recovery

Expressed in person’s words

Quotes add clarity

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Goals: Tips!

Quality, not quantity

Directed toward recovery

Consistent with assessment and clinical summary

Responsive to need

“You cannot organize recovery in a vacuum” – Patricia Deegan

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Assessment

Understanding




Prioritization

Goals

Strengths/Barriers

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Barriers/Assessed Needs

What’s getting in the way?

- Need for skill development

- Intrusive symptoms

- Lack of resources

- Need for assistance/supports

- Challenges in activities of daily living

- Threats to basic health and safety

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Strengths

Strengths Inventory:

- Abilities, talents, competencies and accomplishments

- Values and traditions

- Resources and assets, both monetary/economic, social and

interpersonal

- Unique individual attributes

- Physical

- Psychological

- Performance

- Capabilities

- Sense of humor


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Assessment

Understanding




Prioritization

Goals

Strengths/Barriers

Objectives

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Objectives

Steps the individual takes to reach larger goal(s)

Designed to overcome barriers related to mental health and/or

substance use issues

Understandable to the individual

Achievable, measurable

Written in behaviorally specific language

Directly related to the clinical summary

Time-limited (three months/six months)

Builds on strengths and resources

Builds medical necessity to serve the individual

Services are not an objective.

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Examples of Objectives

JR will be able to manage his symptoms so that they do not interfere

with his ability to look for work as evidenced by his completion of at

least two job applications for two consecutive weeks within three

months.

Diana will have improved academic performance within two months

as measured by having at least one week with 100% completion of

homework with a grade of C or better as reported by her classroom

teacher and parent.

Keisha will be able to better manage her anxiety and avoidance of

social interactions as evidenced by her participation in at least part of

one service at her church within 90 days.

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Objectives: Common Mistakes

Does not support the goal

Not measurable or behavioral

More of an intervention than objective

Not time-framed

Too many simultaneous objectives

Uses AND

Hard to measure

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Assessment

Understanding




Prioritization

Goals

Strengths/Barriers

Objectives

Services

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Interventions/Services

Interventions are specific activities and services provided by the

members of the team.

- Professional and/or peer provider

- Individual and family themselves

- Other supports within the community

Right interventionRight intervention Right intensityRight intensityRight

duration/frequencyRight

duration/frequency


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Five Critical Elements

Staff member’s name and qualificationsStaff member’s name and qualifications

Job titleJob title

Modality/serviceModality/service

Frequency/intensity/durationFrequency/intensity/duration

Purpose/intent/impactPurpose/intent/impact

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Examples of Services/Interventions

CM A.J. will assist Larry in looking for employment by meeting with

him for 2 hours 1x/week to discuss potential employers and discuss

preferred work environments.

Therapist Lee Grove, LCSW, will provide interpersonal therapy to

Larry 1 hour/week to address mood, coping strategies, trauma, and

wellness planning.

Dr. Francis, psychiatrist, will meet with Larry to discuss medication

management for 30 minutes 1x/month for 3 months to assist with

mood management.

Larry will attend a minimum of three AA meetings a week for the

next 12 weeks to get support for abstaining from alcohol.

Larry’s friend R. will meet with Larry 2x/month for 1 hour to help

Larry with creating a resume.


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Services/Interventions: Common

Mistakes• Combined activities a provider is doing

o Ex: CBRF staff will provide cooking, med management,

education, support, interpersonal relationship building, and self-

care monitoring.

• There is no connection to the assessment and clinical summary (Is the

service needed by the person? Does the person already have the

skill?)

• Frequency, intensity, and duration are not included

• Purpose not included

• Does not reflect multidisciplinary activity

• Does not include natural supports when they are available

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Monitoring Outcomes

Invite person into the “driver’s seat”

Involve person in monitoring progress and fit of services

Amplify their voice in any decisions about their care

Can use standardized measures and surveys

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A Person-Centered PlanGOAL

as defined by person

Strengths to draw upon Barriers/assessed needs that

interfere

Objectives- Behavioral

- Achievable

- Measureable

Interventions/Methods/Action Steps- Professional/billable services

- Clinical and rehabilitation

- Action steps by person in recovery

- Roles/actions by natural supporters

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“What you (as an agency or a provider) do cannot force anyone

to recover, but your actions (and even what you believe) can

help to create an environment in which recovery may flourish.”

~ Recovery and Mental Health Consumer Movement in Wisconsin

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Take-Home Message


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Resources

Spokane County, Washington

Person-Centered Recovery Planning

http://www.spokanecounty.org/mentalhealth/content.aspx?c=2996

PCP for mental health and/or substance use diagnosis

Cornell University

Person-Centered Planning Education

http://www.personcenteredplanning.org/

Focus is on PCP for people with various disability labels.

NIATx http://www.niatx.net/Home/Home.aspx

The NIATx model helps behavioral healthcare providers make small

changes that have a big impact on outcomes.

RENEW: Rehabilitation for Empowerment,

Natural Supports, Education, and Work

http://www.iod.unh.edu/Projects/renew/renew_main.aspx

For youth with emotional and behavioral issues

Yale Program for Recovery and Community

Health

http://medicine.yale.edu/psychiatry/prch/tools/pcp.aspx

Person-Centered Planning information

Getting in the Driver’s Seat of Your

Treatment: Preparing for Your Plan

http://www.ct.gov/dmhas/lib/dmhas/publica tions/PCRPtoolkit.pdf

The Learning Community for Person-

Centered Practices

http://www.learningcommunity.us/home.html

Essential Lifestyle Planning for people with developmental

disabilities

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Contact Information

Theresa Kuehl

Person-Centered Planning Coordinator

608-261-6743

[email protected]

Documents

PCP in CCS - August 2017