Erme C. Maula, RN, MSN, CRRN, CPS Program Manager
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Transcript of Erme C. Maula, RN, MSN, CRRN, CPS Program Manager
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MHASP Consumer Recovery Investment Fund: Self
Directed CareDelaware County, PAPresentation to PA MHA
ConferenceApril 27, 2011
Erme C. Maula, RN, MSN, CRRN, CPS
Program ManagerMental Health Association of Southeastern
Pennsylvania
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CRIF SDC Definitions CRIF: Consumer Recovery
Investment Fund SDC: Self Directed Care CPS: Certified Peer Specialist Recovery Coach: Certified Peer
Specialist and WRAP trained facilitator that accompanies participants along their recovery journey
Freedom Funds: Funds in the SDC budget used to purchase non-traditional goods and services
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Collaborators Magellan Health Services –
Magellan Behavioral Health of Pennsylvania is an affiliate of Magellan Health Services
Office of Behavioral Health, Delaware County, Pennsylvania
Temple University Collaborative on Community Integration of People with Psychiatric Disabilities
Mental Health Association of Southeastern Pennsylvania
National Institute on Disability and Rehabilitation Research
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Meet the Operations and Recovery Coach Team
Joseph Rogers, Director of Advocacy, MHASP
Bill Dinwiddie,CEO MHASP
Rita BurnsCFO, MHASP
Erme Maula, Program
Manager, MHASP
Brett Diamond,
MHASP
Jeff Quick, Recovery
Coach, MHASP
Bob Waters, National V.P., Account
ManagementMagellan Health Services
Evon Bergey, General Manager, Magellan Health
Services
Julie Brown, Delaware County Senior
Account Executive, Magellan Health Services
Tim Connors,
Recovery Coach,
MHASP
Jennifer TrippVP, Public Sector Program
InnovationMagellan Public Sector Solutions
Bill ChambersMH Program DirectorDelaware County Office of Behavioral Health
Mark SalzerProfessor and ChairDepartment of Rehabilitation SciencesTemple University
Richard BaronDirector, Knowledge Translation ActivitiesTemple University Collaborative on Community Integration of People with
Psychiatric Disabilities
Andrea BilgerResearch AssistantTemple University
Not Pictured: Jonna DiStefano, Lisa Gardner, Dawn Berardinelli,
Lynne Baumeister, Donna Holiday
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CRIF SDC Program Philosophy is based on the
following elements:
Recovery Peer Support
Self Directed Care
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Recovery The program philosophy is based on
the fundamental belief that people can and do recover from mental illness.
Recovery is a deeply personal process that involves the restoration of hope, self-esteem, creativity, and self-determination.
Recovery is a life-long journey that restores and maintains individual dignity and control over one’s own destiny.
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Recovery ValuesHOPE
INDIVIDUALITY SELF-AWARENESS
SELF-DETERMINATIONMEANINGFUL LIFE
RESPECTPEER SUPPORT
COMMUNITY FOCUSADVOCACY
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Peer Support All CRIF SDC Program Recovery Coaches are
Certified Peer Specialists. Peers helping other peers has been identified as
a critical part of the recovery process. The President’s New Freedom Commission on
Mental Health (2003) explicitly recognized the critical role of peer support.
People who are employed as Recovery Coaches have the unique capacity to inspire hope, trust, personal responsibility, empowerment, self-determination and social connectedness in their fellow peers.
Recovery Coaches are able to use their own Recovery Journey as an example of the possibility of recovery.
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Self Directed Care This approach supports individuals in developing
their own wellness goals and in controlling the funds that are used to implement their self-directed behavioral health recovery plan.
Each person is responsible for making his or her own choices on the recovery journey and must be responsible for the outcomes of those choices.
Giving people decision-making power over their own behavioral health-care budget is a concrete step toward self-determination and responsibility.
The process of creating a recovery plan, identifying appropriate services, and deciding how to spend service dollars encourages independence and self-determination.
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How exciting would it be if…
We can show that working with a Recovery Coach/CPS/WRAP Facilitator moves people forward in their recovery
By allowing people to determine what best works for them, the final cost to the Behavioral Health Care system is reduced or equivalent to the cost of “Services as Usual”
By allowing people to direct their own care, they experience significant movement forward in their recovery journey
We can model the possibility of four very different entities successfully working together
We are able to create more CPS job positions We are able to generate outcomes that help to
establish a waiver that allows for the establishment of similar programs in other parts of the state
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Goals of CRIF SDC
Individuals in the SDC condition will experience greater levels of empowerment, recovery, and quality-of-life compared to those in the control condition.
Individuals in the SDC condition will experience greater levels of community participation over time compared to those in the control condition.
Individuals in the SDC condition will live more independent lives, depending less on high cost, acute/crisis services (e.g., inpatient hospitalization, crisis service use) compared to those in the control condition.
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Criteria for Enrollment Delaware County Resident Member of Health Choices, Magellan
Behavioral Health Diagnosed within either the schizophrenia
or bipolar family of disorders 60 – 90th percentile utilizer of services No hospitalizations within the past 6
months Randomized into Temple study 150 total in study: 75 in control, 75 in
SDC
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Process for Enrollment Study group randomized by Magellan
Health Services—letters sent to 50 at a time
Temple University contacts potential participants for enrollment
Participants enrolled in study are randomized into either the Control, or “Services as Usual” group, or the SDC group
SDC Group is enrolled by MHASP Recovery Coach Team
Initial orientation period is followed by monthly visits over the subsequent 24-month period
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Process of Engagement Establishing relationship Exploring Dreams Setting Goals from Dreams Exercise Reviewing past 24-month utilization of traditional
services with peer Setting budget from goal activities Requesting authorization for purchases Authorization for purchases approved or declined
by Magellan Health Services representatives Approved purchase amounts placed on Allow
Card Monthly check-ins with Recovery Coach, or as
determined by Participant
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MH Budget Mental Health Budget includes
All In-Plan (traditional outpatient Medicaid Reimbursable services, including Peer Support by Recovery Coach)
Non-traditional services (Freedom Funds)
Equal to previous 24-month period mental health costs
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Recovery Goals All activities and purchases must fit
within the Participant’s Recovery Plan
Recovery Plans can change over time
Recovery Coaches help to educate Participants about the concepts and processes of recovery
The Recovery Coach team keeps track of proposed monthly budget, as well as actual utilization, over the next 24 months.
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What we have learned Similar to the Dallas, TX program, we found that
some of the first “asks” pertained to physical medical health care needs
As opposed to focusing on assessments, we focus on dreams. Self Directed Care allows the peer to set the area of focus
This program really puts recovery into action Participants may not have experienced recovery
in such a comprehensive way before Some people focus on short-term needs and have
not had the opportunity to have a longer-term focus on their dreams and hopes for their future
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Sample “asks” Back Rent Electric Bill Exercise Clothing and equipment Gym Memberships Computer Software to write poetry Glasses after charges are made to Physical Health
Insurance Relocation Costs Car Repair Books for School Social Activities Lawnmower to start a lawncare business Digital Camera and Printer Transportation Membership to the Philadelphia Museum of Art
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Life Domains Mental Wellness Physical Health Education (or learning something
new) Work or Meaningful Activities Social Activities Housing
Freedom Fund Categories
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SDC Card, formerly Allowcard
Similar to a check/credit card Decreases the stigma related to
mental health Allows participants to have
responsibility of funds Allows restrictions to be placed on
card from Program Staff (certain items are not allowed to be purchased: alcohol, illegal drugs, guns, cash, pornography, etc.)
Allows monitoring of activity
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Next Steps 120 people enrolled in study
63 in SDC 57 in Services as Usual Group
Moving forward with Recovery Process and Peer Support with “enrollees”
Meeting with non-MH Providers to talk about Recovery and ask for possibilities of services to purchase
Operations Team meetings On-going program evaluation
Policy Implications Cross Disability work as a result of the
Power to the People Summit 2009 Presentations at Alternatives 2010,
NYAPRS 2010, NYAPRS Executive Summit 2011, Netherlands 2011, and other
Enhancing People in Recovery being able to control the amount of money being spent on their care in a way that moves them forward in their recovery and teaching self direction and hopefully decreasing costs to the system
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Quotes from ParticipantsHow has your life been
changed by being a participant in the program so far?
I am far too busy to see a therapist; I am very busy with school. However, I do have coping skills which help me. CRIF's coaches are there for me whenever I need them; they have given me new coping skills that I can use and what’s best about this is CRIF's coaches are available to coach me whenever I need them.
- Alicia, CRIF SDC participant
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How has the CRIF SDC Project helped you in your journey of
recovery? CRIF has helped me tremendously. I began
treatment a few years ago, when [Health Choices Physical Health Insurance] stopped providing eye care benefits. I knew that I needed glasses but I could not afford them as I am a student and I have plenty of other priorities that I must take care of first. The CRIF program, my coaches, have given me the opportunity to get the eye glasses that I needed. In addition to this, my coaches have worked as advocates, friends and have given me additional coping skills. My coaches are currently helping me take care of other issues that I otherwise would not have been able to take care of. I love CRIF and my coaches.
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"It [the CRIF SDC Project] gives me perspective on where I'm going. I may not have a plan yet, but I do have hope"
- Roderick, CRIF SDC participant
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Contact Information for CRIF Self Directed Care
Team:
Erme C. Maula, RN, MSN, CRRN, CPSProgram Manager, CRIF
Mental Health Association of Southeastern Pennsylvania
1211 Chestnut St., 11th FloorPhiladelphia, PA 19107
[email protected]: 267 507 3873
Secure Fax: (215) 525-9698