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Webinar by Dr. Paul Poplawski addressing Recovery-Oriented Systems of Care and the Partners for Change Outcome Management System. The similarities in values make them a natural fit--ROSC and PCOMS.

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  1. 1. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 1 ROSC & PCOMS: TRANSFORMING DELIVERYDELIVERY SYSTEMS Paul Poplawski, PhD LLC paulpop@comcast.net 302/737-8738 htt // li k di /i / l l kihttp://www.linkedin.com/in/paulpoplawski
  2. 2. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 2 WEBINAR PRESENTER  32 years in the State of Delaware SUD & MH public system; member of the executive staff; directed the statewide professional f Sdevelopment function; directed the Summer Institute in partnership with the U of DE  Psychologist in private practice from 1976 through the early 2000s  10 years as a fulltime independent consultant with a focus on public behavioral health system transformation  More than a passing acquaintance with PCOMS – assisting with the implementation of PCOMS in the Philadelphia DBHIDS  http://www.linkedin.com/in/paulpoplawski  Personal transformation PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 3 AFFINITY GROUP Colleagues who are making both individual and collaborative contributions to what is contained in this presentation.  William White > www.williamwhitepapers.com  Arthur Evans, Ph.D. > dbhids.org/arthur-c-evans-jr-ph-d/  Ijeoma Achara, Psy.D. > http://www.attcnetwork.org/userfiles/file/GreatLakes/Webinars/Ijeo ma%20Achara%20Bio.pdf  Joan King > joankkingconsulting.com Joan King joankkingconsulting.com  Barry Duncan, Psy.D. > heartandsoulofchange.com PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 4
  3. 3. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 3 OBJECTIVES  Provide definitions and the underlying value base of a recovery-oriented system of care (ROSC) and recovery/resilience oriented servicesrecovery/resilience-oriented services  Present the features of a recovery-oriented service approach  System Transformation  Examine the relationship of ROSC and PCOMS  Present the Philadelphia story of recovery system transformation and the adoption of PCOMS for one level of carecare  Provide time for discussion and questions. PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 5 WHY ROSC, WHY NOW  Communities of peers, advocacy groups, families, communities demanding choice, a voice, self-determination  Access to services – unmet need  Insufficiency of “therapy” for those in the public system  Myopic view of the policies and practices necessary for healing and recovery  Lack of continuing care  Low retention  Lacking a commitment to peer support PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 6
  4. 4. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 4 PARADIGM SHIFT System Transformation > Create a system of care that accomplishes the following:Create a system of care that accomplishes the following: Provides the necessary supports that are “actually” individualized, meaningful and sufficient in addressing the clinical, social, emotional, interpersonal, aspirational domains of a person’s life and do so through authentic partnership, the communication of hope, the igniting of individual strengths, with an overall goal of achieving a solid interdependent relationship with people and resources in the community – a quality of life that we all desire!! PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 7 DEFINING ROSC  A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk for substance use and all other behavioral health challenges. (adapted from CSAT)  Achieving this requires transformation at the system (financing, regulations, etc.), provider, staff, participant and community levels to accomplish
  5. 5. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 5 ROSC – A DEEPER DIVE  The phrase recovery-oriented systems of care (ROSC) refers to the complete network of indigenous and professional services and relationships that can support the long-term recovery of individuals and families and the creation of values and policies in the larger cultural and political environment that are supportive of these recovery processes. The system in this phrase is not a federal, state, or local agency, but a macro level organization of the larger cultural and community environment in which long-term recovery is nested. William White, 2008 PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 9 PRIMARY GOALS OF A ROSC  Prevent the development of behavioral health conditions (e.g. Mental Health First Aid)  Intervene earlier in the progression of illnesses (e.g. Assertive outreach practices)  Reduce the harm caused by behavioral health conditions (e.g. rapid engagement)  Help people transition from brief experiments in recovery initiation to recovery maintenance (e.g. recovery planning driven by the person)  Acti el promote a holesome q alit of life comm nit health and Actively promote a wholesome quality of life, community health and wellness for all (public health orientation) PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 10
  6. 6. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 6 ROSC VALUES & PRINCIPLES  Person-centered; person-driven  Many pathways to recovery Many pathways to recovery  Family & other ally involvement; peer support  Individualized; communicate hope  Systems anchored in the community  Continuity of care  Partnership-consultant relationships  Strength-based Strength based  Culturally responsive, culturally-based & influenced  Responsiveness to personal belief systems  Embedded in social networks and relationships ROSC ORIENTATION TO SERVICES  Integration of primary healthcare and behavioral health treatment  Peer culture, peer support, recovery coachingPeer culture, peer support, recovery coaching  Life domain orientation  Employment, education, opportunities  Real community involvement  Recovery/treatment plans live in the community  Involving everyone in the change process
  7. 7. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 7 Primary Focus Traditional Treatment Model  Love, Work, & Play ocus Community Life  Treatment 13 Housing, Faith, & Belonging Primary In the model. clinical care is viewed as one of many resources needed for successful integration into the community Recovery and Resilience Oriented System of Care  Faith Work or school Social Peer support Treatment & rehab y Focus Community Life 14 support Belonging Family Housing support
  8. 8. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 8 3 APPROACHES TO RECOVERY- FOCUSED SYSTEM CHANGE (HANDOUT) 1. Additive Approach: adds non-clinical recovery support services1. Additive Approach: adds non clinical recovery support services 2. Selective Approach: a focus on treatment practices of select programs or in particular LOC and incorporating recovery support services into the system 3. Transformative Approach: entire system change including the context in which it operates – clinical, non-clinical, fiscal, policy, community and social contexts within which the system operates 15 KOTTER’S STRATEGIES FOR SYSTEM TRANSFORMATION  1. Establishing a sense of urgency  2. Forming a powerful guiding coalition  3. Creating a vision  4. Communicating vision  5. Empowering others to act on the vision  6. Planning for and creating short-term wins  7. Consolidating improvements and producing still more change  8. Anchoring new approaches in the culture John Kotter, Leading Change, 1996 PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 16
  9. 9. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 9 4 ROSC Building Blocks Optimize clinical service delivery Add and integrate recovery support services Fiscal and Administrative Policy & Procedures Build Cross-Systems Partnerships and Community Recovery Capital PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 17 Community Recovery Capital OPTIMIZE CLINICAL SERVICE DELIVERY Provide Recovery-Oriented Services  Attraction via Assertive Outreach and Engagement  Holistic Screening, Assessment and Service Planning  Expanded Composition of the Service Team  Collaborative Service Relationships  Focus on Community Integration  Assertive Linkages to Communities of Recovery  Post-treatment Monitoring Support and Early Re-intervention  Clinical Supervision & PCOMS PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 18
  10. 10. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 10 FAILURE TO MEASURE BENEFIT IN A TRADITIONAL SYSTEM OF CARE  System focus on volume  System focus on individual service achievement – poor designs,System focus on individual service achievement poor designs, unworkable, inaccurate and rarely support the clinical process  System focus on accountancy not clinical progress  We are not in the business of “manufacturing” recovered persons  “Outcomes” are typically understood through data that serves as proxies of program or provider performance and almost always from the perspective of the provider – proxies are important but insufficientinsufficient PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 19 ROSC & OUTCOMES  Infancy  Continued use of traditional methods – volume dataContinued use of traditional methods volume data  Presence of ROSC alignment tools  Anecdotal, self-report  Peer stories  Poor quality in service organizations’ use of data  Lack of clinical supervision – changing with ROSC  Prior ROSC History of collecting information documentation Prior ROSC - History of collecting information, documentation, etc. that reinforced traditional approach to services or that laid dormant PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 20
  11. 11. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 11 WHAT DO ROSC & PCOMS SHARE?  Values base: empowered service recipients; voice; self- determination  Focus on multiple life domains > PCOMS reinforces this  Dynamic, in motion, useful, feasible  Recovery work and PCOMS connect to the person’s aspirations and are purposeful – another way of saying this ….  Both identify issues that are occurring in the foreground without losing sight of the person’s aspirations  Both squarely focus on achievement, progress, goals, and the work necessary by both the person and helper  Serve to ignite the clinical supervisory process PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 21 SHARE, CONTINUED  Quality of the relationship is underscored  Failure to progress is almost always a shared responsibilityFailure to progress is almost always a shared responsibility  ROSC is undergirded by an expectation of the person’s choice for what, how and with whom services are to rendered – PCOMS provides the data to analyze the outcomes of those choices  Both are action oriented  Both are strength-based PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 22
  12. 12. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 12 ROSC & PCOMS AS SYMBIOTIC  ROSC provides a healthy environment to seed an implementation of PCOMS  PCOMS provides a persistent reinvigoration to the underlying intentions of a ROSC  The process of discussing ORS/SRS findings between service recipient and staff person enlivens and informs the intensity believed to be necessary in using recovery plans as roadmaps to a preferred future  PCOMS and ROSC form their own accountability partnership PCOMS and ROSC form their own accountability partnership  PCOMS and ROSC require a change in thinking on everyone’s part  Reinforcing of one another PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 23 PHILADELPHIA STORY  One billion dollar behavioral health organization  Arthur Evans, Ph.D. – a vision of a transformed system and the courage to drive it forward  Concept – Practice - Context  Intentional & Organized: Blueprint for Change  Multidimensional – work at the all levels of the system  Pioneers, early adopters, emphasis on experimentation & learning  Community Integrated Recovery Centers (CIRC)  Practice Guidelines Practice Guidelines  PCOMS PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 24
  13. 13. https://heartandsoulofchange.com 3/31/2014 paulpop@comcast.net 13 LESSONS LEARNED FROM IMPLEMENTING A ROSC  Resilient leadership  Conceptual clarity  Non-linear, non-sequential, many balls in the air – ability to tolerate ambiguity  Preparation is important but often you must just pull the trigger  Requires rethinking the role and relationship between the funding agency and the organizations supported  Some people don’t make it  A change in thinking is fundamental to success  The critical role of peers can not be overstatedp  CDOI, PCOMS along with solid recovery-oriented clinical practice is a recipe for success PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 25 ROSC RESOURCES  Transformation of Behavioral Health Services in Philadelphia: Practice Guidelines for Recovery and Resilience Oriented Treatment (http://www.dbhids.org/assets/Forms-- Documents/transformation/PracticeGuidelines.pdf)  Peer Culture, Peer Support, and Peer Leadership > http://www.dbhids.org/assets/Forms-- Documents/  Community Integration > http://www.dbhids.org/assets/Forms--Documents/  Person First Assessment and Person Directed Planning > http://www.dbhids.org/assets/Forms--Documents/personFirst.pdf  The Recovery Revolution for Children and Adolescents http://www.dbhids.org/assets/Forms-- Documents/personFirst.pdf > http://www.dbhids.org/assets/Forms-- Documents/transformation/BillWhite/2009RecoveryRevolutionChildAdolescents.pdf  http://partnersforrecovery samhsa gov/docs/Guiding Principles Whitepaper pdf http://partnersforrecovery.samhsa.gov/docs/Guiding_Principles_Whitepaper.pdf PAUL POPLAW SKI, PHD LLC PAULPOP@COMCAST.NET 26