The Nuts and Bolts of Community Support

Community Support????

The Big Questions! What is it? How do you do it?? How do you make it work for the different

disability groups (Child MH, Adult MH, SA)???

What is Community Support?

1. Community Support consists of mental health and substance abuse rehabilitation services and supports necessary to assist the person in achieving and maintaining rehabilitative, sobriety, and recovery goals. (NC Div. of MH/DD/SA)

So What does this really mean?

It means: Providing the appropriate service at the right time and the right place and in the right duration in order to facilitate the consumer’s physical survival, maximizing independence, increasing community tenure which enables the consumer’s recovery from and/or adaptation to his or her disability.

What is Community Support?

2. Community Support is designed to meet the mental health/substance abuse treatment, financial, social, and other treatment support needs of the recipient.

So What does this really mean?

Mental/Substance abuse treatment Coordination and monitoring of treatment services (funded &

non-funded) Financial

Coordination and monitoring of benefits Applications for SS, SSI, SSDI, Medicaid, Medicare, & other

available benefits Social

Activities that promote social interaction with friends, family, and other interactions that encourage recovery.

Identifying and linking to community resources Treatment Support needs

Coordination of other activities that aid the treatment process (i.e. transportation, outreach, etc..)

What is Community Support?

3. Community Support is also designed to assist the recipient in acquiring mental health/substance abuse recovery skills necessary to successfully address his/her educational, vocational, and housing needs.

So What does this really mean?

Educational needs Coordination with Vocational Rehabilitation GED, Literacy classes, Technical College

Vocational needs Coordination with Vocational Rehabilitation Completion of job applications Development of job related skills

Housing needs Budgeting issues Coordination of utilities or rental assistance Establishment of skills related to maintaining housing

Other activities of Community Support: Assessment of Consumers Coordination of movement across levels of care Crisis Response (“First Responder”) Assessing barriers to recovery Developing and updating the Person Centered Plan

and crisis plan Developing interpersonal and community coping skills Adaptation of home, school, and work environments

Other activities of Community Support: Therapeutic mentoring Symptom monitoring Monitoring Medications Obtaining appropriate service orders Conducting utilization review of current services Obtaining authorizations for services Involve stakeholders Monitor progress toward treatment goals Coordinate discharge planning

Staffing Requirements:

Qualified Professional (QP), Certified Clinical Supervisor (CCS), Certified Clinical Addiction Specialist (CCAS) Coordination and Oversight of Initial and

Ongoing Assessment Activities. Initial Development and Ongoing Revision of

Person Centered Plan (PCP) Monitoring of Implementation of PCP Additional Case Management Functions of

linking, arranging for services and referrals

Staffing Requirements:

Associate Professional (AP), Paraprofessional Various Skill Building Activities Training of the caregiver Daily and Community Living Skills Socialization Skills Adaptation Skills Development of Leisure Time Interests/Activities Symptom Monitoring and Management Skills Therapeutic mentoring Education substance abuse Behavior and anger management

Progression of Community Support Activities 1. Engagement of the consumer and

relationship building-it is important to have workers on the team that have the appropriate skill set and characteristics.

Helpful Community Support Relationships Require: EMPATHY HOPE ACCEPTANCE RESPECT GOOD COMMUNICATION

Helpful Communications Skills

NO JARGON CONCRETE FOCUS MINIMIZE COMPLEXITY OF INTERVENTION (KEEP IT

SIMPLE) EXPECT MISSED CUES ASK QUESTIONS IN DIFFERENT WAYS LISTEN TO VERBAL CUES AND BE AWARE OF

NONVERBAL CUES ACKNOWLEDGE THAT PEOPLE LEARN IN DIFFERENT

WAYS, BE CREATIVE REVIEW CONTENT OF DISCUSSION TO ENSURE THAT

THE CONSUMER HAS AN UNDERSTANDING OF TASKS AND FOLLOW-UP PLAN

Progression of Community Support Activities 2. Assessment of Needs-

A. Must be sensitive to cultural issues and address areas all life domains.

Why is Cultural and Linguistic Competency Important?

Research indicates that cultural and linguistic

competency leads to higher consumer

satisfaction and better treatment outcomes.

Progression of Community Support Activities 2. Assessment of Needs-

B. Must address all domains or areas in the consumer’s life

Medical Psychiatric Residential Vocational Social Recreational Spiritual Substance Abuse Others??

Progression of Community Support Activities 3. Person Centered Planning

Is a process, not an event. PCP development is ongoing as is the

recovery process.

Why do we do Person Centered Planning?

Effective PCP development and implementation leads to:

Fewer crisis Fewer relapses Higher consumer satisfaction Longer periods of stable

recovery Improved quality of life

Progression of Community Support Activities 4. Interventions-

Must be individually tailored to meet the consumer’s documented needs.

If a worker doesn’t have a plan of what to do or what goal to work on when they see a consumer, they don’t need to go!

Symptoms that can have an impact on CS Activities

PARANOIA CONFUSION ANXIETY HALLUCINATIONS DELUSIONS FATIGUE PERCEIVED LACK OF MOTIVATION

Important Questions to Consider …

Does your consumer have problems in thinking (disorganization, cognitive impairment), which lead to forgetting to take his or her medication every day as prescribed.

Does your consumer lack insight into his or her illness and the need for medication treatment?

Does your consumer have a history of recent relapse and rehospitalization?

When your consumer starts to feel better, does he or she feel that medication is no longer needed?

Does your consumer have ideas or beliefs that might lead to them stopping their medication, such as thinking the medication is poison?

Does your consumer currently abuse drugs or alcohol or have a history of such abuse?

A yes answer to one or more questions may indicate that your consumer may be at risk for missing or stopping medication, which could result in decomposition, hospitalization, or worse.

So when should I consult with the psychiatrist?  Significant deterioration in mental status e.g. mood, cognitive processing, suicidal ideation, etc.

Complaints by consumer or observation by others regarding any significant aspect of mental or physical functioning which is raised in the context of a medication side effect or adverse reaction.

Clinician/Community Support worker becomes aware that consumer is not taking medication as prescribed, unless this issue has been previously discussed with the physician and is specifically addressed in the consumer’s PCP.

Clinician/Community Support professional becomes aware of a consumer’s new physical complaint or change in the consumer’s physical status that the clinician/Community Support professional reasonably believes might be related to the consumer’s mental health condition.

Clinician/Community Support professional becomes aware that the consumer is using/abusing prescription/over the counter medications) and/or street drugs, unless this issue has been previously discussed with the physician.

Clinician/Community Support professional becomes aware that another physician is prescribing medication for the consumer or has modified the consumer’s medication.

Clinician/Community Support professional becomes aware that the consumer has been hospitalized.

Clinician/Community Support professional becomes aware that a hospitalized consumer has been /will shortly be discharged and a plan for psychiatric follow-up is needed.

  

Potential Barriers for Consumers

SYPMTOMS TRANSPORTATION POVERTY POTENTIAL LACK OF FAMILY SUPPORT POTENTIAL HIDDEN SUBSTANCE

ABUSE—(40-60% OF CONSUMERS WITH SERIOUS MENTAL ILLNESS ALSO HAVE COMPELLING CO-MORBID SUBSTANCE ABUSE ISSUES)

Weekly Meeting Structure

All members of each CS team meet at least on a weekly basis.

Team members will staff cases at this time with the supervising Q.

Team members will identify consumers who are at high risk for hospitalization and develop contingency and crisis plans.

The team will identify service needs for the upcoming week and will plan staffing to cover the consumer’s needs for the next week.

Supervision Requirements for Para and Associate Professionals Associate and Paraprofessionals must be

supervised by a QP Associate and Paraprofessionals must have a

supervision plan upon hire The supervision plan for paraprofessionals

must reference the 6 core competencies The QP must keep records of ongoing

supervision

A Supervision Plan Should Include

The number of hours per month of supervision, by whom and for whom

Skills needed in core skill areas required by the population served

A strategy or strategies used to acquire those skills

AND Don’t Forget…

The supervising QP MUST keep records of ongoing supervision provided to AP and para professional staff.

Because:• It is a requirement of the Division of MH/DD/SA.• It will promote positive consumer outcomes• It will promote further staff development• AND WHN will ask to see these records during the course

of a clinical/compliance review. Supervision for QP’s is not required but is a good

practice for delivering high quality consistent care throughout your agency.

The Top 5 Things That Will Make Your Practice Easier! 1. ASSESS, RE-ASSESS, THEN ASSESS SOME MORE.

THIS INCLUDES CURRENT PLAN, STRENGTHS, UTILIZATION REVIEW, AND INTERVENTIONS.

2. CONTINUE TO LOOK REALISTICALLY AT BARRIERS TO TREATMENT—(this includes you too. We all bring ourselves to our jobs!!)

3. TAKE INTO CONSIDERTION THE CONSUMERS PREFERENCES WHENEVER POSSIBLE.

Example: If you are assisting the consumer with getting groceries, go to the store they want to go to. Allow the consumer to have as much control as possible. This will make your life as a provider MUCH easier!

4. BE PRO-ACTIVE IN YOUR PLAN—EXPECT THE UNEXPECTED!!!

5. BE CONSISTEN WITH FOLLOW-UP AND THE IMPLEMENTATION OF THE PLAN—(this includes calling if you will be late, etc.)

And Don’t Forget the Most Important things are… Take care of yourselves! Use your supervision Laugh!!- The appropriate use of humor will

extend your clinical “shelf life” and will make you a lot less grumpy when you get home!

Questions?....