Transformation to a Recovery Focused Mental Health Center
Transformation to a Recovery Focused Mental Health Center Roy Starks, MAMental Health Center of Denver Linda LaGanga, Ph.D.Mental Health Center of Denver
What is Recovery?> Recovery takes on many meanings> We believe people can, and do, recover from mental illness.> Appropriate and compassionate treatment for a mental health problem> The individual can get back to living a happy and productive life.> Consumers are involved in shaping their own recovery and given the chance to regain control of their lives.
Pick your synonym for Transformation> Changeover> Metamorphosis> Transfiguration> Conversion> Other?
What is Your Center doing totransform to Recovery Focus> How Do You Know it is happening?> How Do You measure it?
Using Outcomes to Drive Recovery-Focused Practice Development ofRecovery-focused Outcomes The Four Measures of Recovery Using Data and Reporting To Drive Recovery Transformation
Mental Health Center of Denver> Formed 1989> Combined four previous centers in order to obtain Robert Wood Johnson funding for housing> Law suit settlement of 1993 ordering intensive services including rehabilitation
The Mental Health Center ofDenver > Mandate to serve the hardest to serve • Persons who are homeless with a diagnosis of Schizophrenia, Bi-Polar, or Major Depression > Serve 4,200 adults at any point in time • Every day we admit 7 but must turn away 17 • Our goal is to increase funding to be able to serve ALL who need our services • Additional consumers served through special grants and funding > Mission: Enriching Lives and Minds By Focusing on Strengths and Recovery
Three Types of Adult Services> Intensive Services (2,100) Three levels of case management> Outpatient Services (2,100)> Psychiatric Rehabilitation (1,000 per year) • Supported Education • Supported Employment
Recovery Conferences and Committee> Annual Recovery Conferences> Decision following conference to work toward system transformation> Created Recovery committee and proceeded with Logic Modeling> Lead to Creation of Recovery Measures
Quick Poll: Which of the following is true ofLogic Modeling?A. It is a structured processB. It uses gap analysis and planningC. The goal is to achieve desired outcomesD. It is a rapid change process
Four Measures of Recovery Recovery Marker Inventory (RMI) Provider ratingRecovery Needs To what degree is RECOVERY Level (RNL) happening? Multiple perspectives Suggests best level of Multiple dimensionsservices for stage of recovery Change over time Promoting Recovery in Consumer Recovery Organizations (PRO) Measure Consumer rates provider (CRM) Consumer rating
Measure #1:Recovery Needs Level> Assigns the right level of service to the consumers> The basic assumption being that people recover and their needs change over time.> Completed by the primary clinician in electronic record every 6 months in combination with their service plan> Scored electronically according to algorithm> Algorithm weighted – based on clinical decision
Stretch Your Dollar$ Denver admitted 400 new adults with serious mental illness into high intensity services the first year of implementation of the RNL with no additional resources.$ Based on a cost of $12,500 per consumer= Total public cost saving annually is $5 Million.
Measure #2: Recovery Marker Inventory Eight dimensions that “tend to correlate” with an individual’s recovery. They do not always correlate with recovery for everyone. 1. Employment 2. Learning/Education 3. Active Growth Orientation 4. Symptom Management 5. Participation in Services (engagement) 6. Housing 7. Substance abuse (level of use) 8. Substance abuse (stages of change) * Physical Health is being added within the yearThe Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this presentation,receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the information you will receive.
The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewingthis presentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of theinformation you will receive.
Measure #3: Consumer consumer’s perception of their > Measures the Recovery Measure recovery on 5 dimensions. > Is completed quarterly by the person receiving services. Hope 1. Active Growth Orientation P er of sonal 2. Hope Sa f et S e n s y e ive/ Gr o wth Act tation n Or i e 3. Symptom Management L e te r Perceived Sense of Safety rk th 4. In ve fe wo w i s l o re et n N t io f nc Sy e al c ci fa Satisfaction with Social mp 5. S o a t is to S m NetworksThe Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing thispresentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of theinformation you will receive.
Consumer Recovery MeasureGraphic representation of this data is shared with the consumerto initiate: • clinical discussion about changes in these areas, • what the consumer attributes the changes to, and • possible relationships between categories. This process promotes insight, and empowers the person to share their story in a new and different way.
Measure #4:Promoting Recovery in MentalHealth Organizations (PRO) Measures staff’s characteristics which promote recovery. • Sections for each type of staff that interact with our members (front-desk staff, clinical, medical, case managers, rehabilitation, etc.)
PRO Survey Administration > 10% stratified random sample > Collected annually for each type of staff a consumer has dealt with in the last 6 months. > Only 10 to 15 questions per type of staff. > Administered to consumers by a Consumer Survey Team. > Gift Card Incentives
PRO ResultsThe following graph displays a team’s scores compared to the overall score at the center. If the team scored higher than the average score for the center, then the team has more recovery-oriented skills than the average staff member. If the team scored lower than the average score for the center, then the team has less recovery-oriented skills than the average staff member. Pro F: Front Desk Staff 3.78 3.23 Pro D: Nursing Staff 2.15 1.31 MHCD Average Pro C: Medical Staff 3.06 Team 222 1.73 Pro B: Case Managers 2.25 0.95 Pro A: Therapist 3.05 3.45 0 1 2 3 4
Using Data and Reporting to Drive Systems TransformationIndividual Outcomes Program Outcomes System Review
Consumer Outcomes –Changes in Recovery> Change Charts automatically flag when a consumer has a substantial change in their recovery profile. • We can compare the consumer’s progress to their own prior recovery outcome scores as well as compare their progress to the typical progress of their peers.> Detection Charts automatically target outliers in recovery. • .
Recovery Focused Utilization Management Review> If the control chart flags a consumer the consumer’s record is automatically a possible candidate for a utilization management review.> This review consists of other clinicians reviewing notes, consumer outcomes, and service hours to determine if there are gaps in services and if other services should be considered. Recommendations are then forwarded to the program manager for review and implementation.
Program Outcomes> Evaluation and Fidelity • Assessing how well our treatment and services are working> Cost-Benefit Analysis • Exploring the most efficient allocation of time and resources with the most successful results> Effective Program Components • Identifying specific indicators that point to high performance
Evaluation and FidelityWe can utilize the recovery outcomes to ensure that goals andservice standards of a program are being met. Below is the averagerecovery among all consumers in our Growth and Recoveryopportunities for Women (GROW) Program By reviewing these outcomes in conjunction with the fidelity level of the program, we are able to determine the overall effectiveness of the program and identify areas where service improvements can be made.
System Review> Measuring performance across an agency> Establishing realistic goals • If changes in recovery are not occurring as expected then further investigation is done on program and consumer level outcomes.> Recovery Metrics Report • Admissions, Discharges, Total consumers served • Consumer Service Level Transfers (RNL) • Increases and decreases in recovery environmental factors (RMI) • Increases and decreased in consumer’s perception of their recovery (CRM)
Benefits of Outcomes Reporting For the Consumer For the Clinician Increased likelihood of More clinically significant sustained mental health information readily available recovery Greater recovery Integration of own perception improvements for time into treatment planning invested Improved allocation of Improved matching of services caseload balance to individual needs Tools to aid in identifying appropriate services for a consumer
Question and Discussion:How do your staff influence consumerrecovery?
Development of Wellness Culture> Which of the following are elements of a Wellness Culture? A. Bringing out the best in everyone B. Support and encouragement C. Celebration and fun D. Believing anything is possible! E. All of the above
MHCD Wellness Culture> We intentionally bring out the best in ourselves and others by:> Seeing everyone’s strengths> Supporting and encouraging one another> Celebrating staff, accomplishments, and diversity> Respecting ourselves and others> Listening to each other> Creating an environment of healthy and positive relationships and community partnerships> Believing everyone wants to be great> Being passionate about our mission and having fun in the process> Believing anything is possible!
How to Define and Develop YourWellness CultureA. Adopt MHCD’s definitionB. Have top management define itC. Use the authoritative definition from Who Moved My Cultured Cheese?D. Take lots of time and many iterations to get it rightE. All of the aboveF. None of the above
Building our definition of Wellness Culture: How did we do it?> After common experience of Pathways leadership training> All Managers Meeting> Structured creative process • Brainstorming • Flip charts • Table discussion groups • Organizing themes • Movement and discussion • Recording and projecting changes • Completed and accepted by the end of the meeting!
MHCD ValuesWe, the staff, consumers, and governing board of MHCD, value:> Consumer recovery and resiliency fueled by hope and encouragement toward consumer goals> Compassion and empathy> Service excellence, efficiency, and effectiveness to meet the needs of consumers and the community> A wellness culture that recognizes, respects, and develops the strengths of consumers, staff, and our partnerships in the community;> Honesty, integrity, and ethical behavior in all our actions, communication, and relationships;> Diversity in our workplace, relationships, and community;> Innovation, creativity, leadership, and flexibility> Green sustainability to protect the environment and reduce waste in all our valued resources.
Creation of our Values Statement:How many people participated in identifyingvalues?A. 1: The chairperson of the boardB. 2: Roy and Linda made it upC. 50-60 managersD. 300-400 employeesE. 300-412
Creation of our Values Statement> How many people participated in identifying values?A. 1: The chairperson of the boardB. 2: Roy and Linda made it upC. 50-60 managersD. 300-400 employeesE. 300-412Facilitated group activity at All-Staff meetingsConsumer/Staff Partnership Council
Breaking Rules, Leading, andPutting Our Strengths to Work> First Break All the Rules by Marcus Buckingham & Curt Coffman> The Gallup 12 = Q12 = “The Measuring Stick”> Simplest and most accurate way to measure the strength of the workplace
First Break All the RulesMarcus Buckingham & Curt Coffman> The 12 questions: 1. Do I know what is expected of me at work 2. Do I have the materials and equipment I need to do my work right? 3. At work, do I have the opportunity to do what I do best every day? 4. In the last seven days, have I received recognition or praise for doing good work? 5. Does my supervisor, or someone at work, seem to care about me as a person? 6. Is there someone at work who encourages my development?
The 12 Questions: Continued 7. At work, do my opinions seem to count? 8. Does the mission/purpose of my company make me feel my job is important? 9. Are my co-workers committed to doing quality work? 10.Do I have a best friend at work? 11. In the last six months, has someone at work talked to me about my progress? 12. This last year, have I had opportunities at work to learn and grow?
Now Discover Your StrengthsMarcus Buckingham & DonaldClifton, Ph.D.> Describes in detail the strengths-finder process> Describes how to manage people with the different strengths> Discusses how to build a strengths-based organization
Go Put Your Strengths to WorkMarcus Buckingham> Set out format for how to maximize the use of your strengths in the workplace> Sets course for how to build on the strengths of others and to maximize their strengths in the workplace
Strength Based Leadership> Strength Finder assessment of the 34 themes> Organizes themes into Domains • Executing • Influencing • Relationship Building • Strategic Thinking> Individuals don’t have to be well-rounded> Rounding out your teams
Catalytic CoachingGarold L. Markle> Provides detailed alternative to traditional performance evaluation which enables people to create a course to maximize strengths and accomplishments • Employee input sheet • Coaches perception • Employee creates plan
Small groups—> What is one thing we can implement at our center toward recovery-focused transformation?> What will be the value of this action?> 15 minutes