Summary of NJ DMHS Wellness and Recovery Transformation

Stakeholder Input Process

Presentation to StakeholdersMercer County Community College

March 2, 2007

Sources of Recommendations 120 stakeholder committee and

subcommittee participants including community practitioners, advocates, state employees, family members, consumers, and others

More than 200 consumer and families in focus groups

Five Broad Areas of the Stakeholder Summary

Consumer and Family Input Evidence-Based and Promising Practices

will Promote Recovery System Enhancements Workforce Development: Education,

Training, Supervision, Retention Data-Driven Decision Making and other

Contractual/Regulatory Processes

I. Consumer and Family Input

The value of consumer and family input at every level of service development, provision, and monitoring was highlighted. All stakeholders believe that input from consumers and family members is integral to a system that emphasizes Wellness and Recovery principles.

Consumer Definitions of Wellness from Consumer Input Forums

In general, wellness was understood by consumers to be related to: taking care of oneself and a state of physical

and emotional health. statements that defined wellness as, “a state

of mind, attitude, staying drug free, keeping busy and getting enough nutrition, exercise and rest,”

“an overall condition of being healthy, not being emotional nor physically down.”

Consumer Definitions of RecoveryTraditionally oriented definitions of recovery related to

becoming free of symptoms and illness. In these statements, recovery was large defined as an outcome of a process. “symptoms to disappear,” and “medicine, stabilize, and get

back to your life.”

Consumer-driven recovery was understood as a process and/or Identified community supports as vital in this process, for

example, having supports in the community to stay out of hospital,”

“ Learning about your illness, taking your time to get better, getting enough love,” “family support,” “and ,”recovery you have to work on. If you do not work on it, it will go away. “

Consumers’ Recommendations for Wellness and Recovery

Improving Community Supports, Linkages, and Services

Improving Staff/Consumer Interactions Securing Physical and Emotional Safety Creating Therapeutic Environments Supporting Autonomy, Choices, and

Personal Goals Overcoming Personal Barriers – Self-

management

Improving Community Supports, Linkages, and Services

Better community services to prevent long-term hospital services

Upper management more accountable and accessible

Get patients out of the hospital faster

Improving Community Supports, Linkages, and Services

Improve linkage between inpatient and aftercare: make sure each consumer has a doctor schedule several community agency

appointments in Advance provide information on which

community agencies to contact assist with Section 8 and Social Security

paperwork

Improving Community Supports, Linkages, and Services

connect consumers with addiction services and community twelve-step programs

strengthen ICMS and PACT

offering additional support groups, resources, general support, individual therapy, and personalized treatment plans

Improving Community Supports, Linkages, and Services

Address stigma and the relationships between various public service employees better linkages between inpatient and

outpatient providers improved training for police and mental health

screeners more community staff increase in emergency 911 cell phones live contact support person 24 hrs a day education on mental illness for general public

and MH providers

Improving Community Supports, Linkages, and Services

Barriers to remaining in the community Lack of employment, Lack of transportation, Inadequate housing, Few educational opportunities

Improving Staff/Consumer Interactions

Hospital staff should be more caring and understanding offer hope through better

communication make the hospital a calmer place be receptive to needs, respectful, and

nurturing

Improving Staff/Consumer Interactions

Staff should understand that consumers still had to take care of personal business in the community while hospitalized

Create a business day – a day outside of the hospital to handle bills and other things

Physical and Emotional Safety A lack of physical and emotional safety

from peers and staff was a concern identified by several consumers

Experiences ranged from bullying to physical attacks

Many recommendations that consumers be grouped by diagnosis/ functioning level

Therapeutic Environment-Improved Treatment Activities

Recommendations: 1:1 therapy employment

activities music/game rooms outdoor activities, more exercise educational movies

topic specific groups more relaxation time

(less “forced” socialization)

Community transition activities

Attending church of their choice

Therapeutic Environment-Improved Treatment Activities

Improving physical aspects of the environment improved lighting and painting the

walls in the bedrooms Less noise

Individual interventions ear plugs, dental floss, and hygiene

products,

Autonomy, Choices, and Personal Goals

Consumers have little choice over small things such as phone calls, wake up times, food choices, or when to meet with the team.

The forums recommended increases in choices.

Overcome Personal Barriers – Self-management

Consumers acknowledged that taking responsibility for their behavior and illness is important for recovery

Consumers comments reflected a level of hopelessness and isolation in their experiences

Consumers identified building and maintaining relationships with others as barriers to their recovery.

Additional themes from Community-Based Consumer Family Forums

1. Treatment Planning and Support2. Staffing3. Resource Allocation4. Data Driven Decision Making5. Methods of Disseminating

Information

Treatment Planning and Support

Involvement of family members in wellness and recovery planning and support of plans

Include the input of significant paid and unpaid supporters in all aspects of service planning, care, and evaluation.

Addressing perceived HIPAA and confidentiality concerns may be necessary

Input into Staffing Decisions Mechanism for consumer input into

Hiring Supervision, and Firing decisions

Recruitment and retention include consumers and family members

as part of the interviewing process as well as supervision of evaluation plans

Resource Allocation Include more consumers and

families on county mental health boards and other committees increase statewide input into the

development and evaluation of programs and services

Evaluation of the adequacy of consumer/family representation on board and policy making groups

Data Driven Decision Making Mechanisms be developed to assure

consumers they can: Rate the value the services that they receive

and have sufficient decision making input

Utilize surveys in which resulting feedback would be incorporated into operational decision making consumers administer surveys to increase

likelihood of genuine responses

Methods of Disseminating Information

Consumer advocacy educational forums Consumer dedicated website Informational newsletter

provide updates on the transformation including consumer written articles

Input solicited via written comment on specific issues focus groups and consumer/family survey

information

II. Evidence-Based and Promising Practices

“An ideal system is one that is wellness and recovery oriented and has access to a full array of evidence based practices as well as an array of programs that are promising models of exemplary practice.”

Evidence Based and Promising Practices: Recommendation Themes

1. Core Competencies for all EBPs2. Training for Specific EBPs3. New Promising Approaches 4. Monitoring of Implementation5. Funding and Regulatory Issues

Core Competencies Training for mental health clinicians

in the following areas would support several EBPs: Motivational Interviewing Stages of Change/Recovery model of

readiness Cognitive-behavioral techniques

Core Competencies Those competencies outlined above are used in most of the

following approaches Illness Management and Recovery (IMR), Assertive Community Treatment (ACT/PACT), Integrated Dual Diagnosis Treatment (IDDT), Supported Employment, Family Psychoeducation, Motivational Interviewing, Peer Support and Self-Help, Cognitive Behavioral Therapy (CBT), Supported Education (SEd), Supported Housing

(SH) Wellness and Recovery Action Plans (WRAP).

Training Training

Current training efforts will need to be expanded

Training packages used should be user- friendly

Sites determined to be “centers of exemplary practice” should pilot the materials

State should collaborate with professional societies and academic institutions for training and certification of the workforce

New Promising Practices Development of funding for:

clubhouse models, self-help centers, and other consumer preferred models

Training for implementation of the shared decision making model improve communication between

providers and consumers

New Promising Practices (cont.)Integration of Physical and Mental Health Services

Integrated primary health and mental health services Education on physical illnesses Regular assessment of health measures

(BMI, BP, AIMS, etc.) All programming should include

exercise, fitness and nutrition and physical wellness

Alternative & complementary medicines

Monitoring Advisory Committee to assist DMHS in

efforts to implement, expand, and monitor practices

Utilization of scientifically derived fidelity scales, both existing and new scales Fidelity of funded programs to wellness and

recovery principles be evaluated Data collection systems at the state level

need to be developed

Funding and Regulatory Issues DMHS

provide seed money and develop training and implementation plans

further support and expand EBPs and Promising Practices

Financial incentives and/or regulatory relief for agencies who adopt EBPs.

Inter-agency collaboration Collaboration between:

Dept. of Human Services, and Dept. of Labor & Workforce Development in order to expand EBPs and Promising Practices

NJ Division of Medical Assistance to address Medicaid funding of EBPs

Practitioners and provider agencies to involve providers in the development of regulations

III. System Enhancements

“To complement new and expanded services, stakeholders felt that improvements to the current service systems would contribute to the development of a wellness and recovery-oriented system.”

Recommendation Themes

1. Pervasive Treatment Philosophy and Service Provision

2. Evaluation of the Current System3. Documentation4. Consumer/Family Provider5. Advance Directives6. Joint Protocols and Cross Training7. Community and Staff Education8. Access Issues: Point of Entry, Housing,

Other

Evaluation of Current System Systems Mapping

Compare the existing system with an ideal system designed by stakeholders

Service Duplication Evaluate services for duplication and create

regulations that clearly articulate in which multiple programs consumers can participate

Recovery Oriented System Indicator (ROSI) Baseline of consumer satisfaction and a

method for ongoing systems’ evaluation

Documentation The Virtual Individualized Electronic

Wellness/Recovery Action Plan (The VIEW) Electronic record including Advance directives

Integrated Recovery Plan (IRP) To replace the multiple treatment plans in

multiple programs

Uniform Wellness and Recovery documentation requirements

Consumer/Family in New Roles Navigator

Member of a community support team to help consumers navigate the system

Peer Educator Provide self-help training and mentoring

Consumers provide training on mental health issues for members of the workforce (hospital and emergency personnel)

Advance Directives Continued training and education on

use of Advance Directives Make sure Advance Directives are

being honored in times of need Navigator and Peer Educator

positions can help with training and education

Joint Protocols and Cross Training

Shared responsibilities for multiple service users

Joint and cross training for providers of services for the shared populations

Public and Community Education Anti-stigma, public information and

education campaign Particularly for the medical

community, legislators, and developers of college curricula

Access: Point of Entry Eligible for services without having

been hospitalized No Wrong Door

Single point of entry for all services needed: physical, social services, vocational, educational, etc.

No exclusionary criteria Matching of consumers with needed

services

Access: Housing Develop and maintain information

clearinghouse for housing Wide spectrum of housing for all

levels of the system Emergency assistance and housing

subsidies

IV. Staff Development: Recruitment, Retention,

Education, & Supervision

Implementing EBPs and promising practices, as well as service system enhancements will require a highly competent workforce making recruitment, retention, and continued development of a qualified, competent, caring workforce as essential.

Recommendation Themes Recruitment and Retention Methods for Increasing Staff Competency

Standardized curricula Training for Evidence Based Practices (EBPs) &

Promising Practices Supervision

Consumers as Providers Policy Changes Hospital-Specific Recommendations

Recruitment & Retention Salary and benefit parity with state

employees for Community Staff Annual true Cost of Living

Adjustments Salary differentials for additional

credentials Career ladders

Recruitment & Retention: Credentialing

Certified Psychiatric Rehabilitation Practitioner (CPRP) as preferred credential Recovery-oriented Open to all educational

levels/experience Upward mobility for those earn

CPRP’s and specified credentials

Some educational programming ideas

Pre-paid tuition program Expand existing academic programs

to all state psychiatric hospitals Expand existing academic programs

to all regions of state Use flex-time to attend classes Time off for work-related educational

programs

Recruitment of Like-Minded Individuals

Involve consumers in hiring, supervision, firing

Liaison with colleges for recruitment and influencing of curricula

Support consumer employment in field Centralized website for job listings Market loan forgiveness program Use exit interviews in QA initiative

Increasing Staff Competency: Standardized Curricula

Developed & delivered by academic entity, SME, or national experts

Core content identified by Workgroups Centralized and coordinated training vs.

On-site and customized Follow-up with TA, consultation, and

monitoring Core courses approved for state licenses

and national certifications Establish incentives for attending training

Cross Training Infuse Wellness & Recovery in all

state funded training Cross train staff in DD, Aging In, Jail,

DAS, Elderly Cross train and co-train hospital and

community staff

Increasing Staff Competency: Standardized Curricula

Methods for Increasing Staff Competency: EBPs

Academic entity develop and deliver standardized, replicable training

Develop Centers of Excellence and Centers of Exemplary Practice as training and consultation sites

Develop agency leadership coalition to promote EBPs

Ongoing evaluation

Methods for Increasing Staff Competency: Supervision

Individual and group supervision Skills based, non-punitive Individual learning plans Performance appraisals, evaluations,

PAR/PES based on W&R principles and competency development

W&R survey tool for measuring staff application of W&R principles

Consumers as Providers Receive training for administration

of ROSI Deliver training to general

community workers, e.g., police, EMTs, screeners

Deliver training on Advance Directives

Navigator

Policy & Procedure Changes New policies & procedures will

require training for implementation Data collection and reporting Electronic records, e.g., VIEW Service access based on need

Community: Standardized Curriculum – 12 Domains

Person–oriented attitudes, values, knowledge and behavior

Engaging families and significant paid and unpaid supporters in all aspects of service planning, care and evaluation

Knowledge of clinical and biological aspects of mental and physical illness and developmental disabilities

Knowledge of addictions and mental illness as co-occurring disorders

Assessment, recovery planning and documentation Intervention and support strategies

Community Competencies 12 Domains (Continued)

Community resource development and acquisition

Legal issues and civil rights Systems collaboration Ethics and Professional Behavior Cultural competence Methods of evaluation

Hospitals: Standardized Curricula Contract with academic entity to develop

standardized curricula for Core Competencies and EBPs

Conduct train-the-trainer sessions for training coordinators

Training coordinators will offer ongoing access to training for existing and new employees

Ongoing support and TA available to training coordinators through academic entity

Hospitals: Curricula Content Echoed community recommendations Additional recommendations for hospital

settings Basic therapeutic skills Accountability Communication Supervisory training Staff safety and security during W&R

introduction Hands on training to “ease the transformation

process”

Hospitals:Additional Recommendations

Hospital Workforce Subcommittee continue to meet for competency development and implementation monitoring

Allocate FY2008 resources to assure equivalent training resources throughout the hospital system

Consistent staff development plan Monitor and re-evaluate after one year

V. Data-Driven Decision Making: Contracts,

Regulations, and Outcomes

“Critical to all the recommendations outlined above will be the appropriate administrative structures and processes to support the wellness and recovery transformation effort and sustain this new orientation.”

Recommendation Themes

1. Establishing measurable outcomes 2. Developing a data collection system 3. Removing systemic obstacles 4. Evaluating service outcomes and basing

funding on performance 5. Providing service performance

information to consumers6. Ensuring consumer input

Establish Measurable Outcomes

Operationalize NJ’s transformed system

Identify system goals Create associated outcome

measures Identify and/or create fidelity

measures relevant to each modality or service.

Develop Data Collection System Develop capacity, infrastructure,

and funding Establish baseline data Provide initial and ongoing training

Remove Systemic Obstacles Promote Cross System Collaboration

System-wide needs assessment Data sharing Include “physical” health data Hospitalization data Employment data

Evaluate Service Outcomes Performance Based Funding

W & R outcome measures in all contracts Tie service outcomes first to monitoring

and later to reimbursement and contracting decisions

Establish consequences and incentives Redirect resources from

lesser-valued/lower priority to higher priority services

Ensure Consumer Input In transformation and resource allocation

gather input provide support for participation include reticent groups

Support consumer being well-informed informational newsletter educational forums interactive website

Provide performance information to consumers and family members

Performance report card Specify outcome data Publish on the Division’s website

Other Regulatory Issues Work with Medicaid

Share data on “physiological measures’, other illness/diagnoses, and hospitalization

With DMAHS review and if needed revise regulations to support wellness and recovery approaches within federal guidelines

Working with DHS Licensing & Inspections Engage Office of Licensing staff Review and revise regulations