Foundations for Building a Recovery Oriented Program

1. Foundations for Building a Recovery Oriented Program Chacku Mathai, CPRP Associate Executive Director New York Association of Psychiatric Rehabilitation Services April 28, 2011

2. Backdrop: High Cost of Medicaid Care for New Yorkers w/ Multiple ‘Chronic’ Conditions • New York’s Medicaid program serves over 4 million beneficiaries at a cost of over $47 billion annually (30% of all healthcare spending in NYS). • 20% of Medicaid beneficiaries (1,029,621 ) account for 75% of the program’s expenditures: $31.1 million • Average cost per year: $30,195 • These beneficiaries have “multiple co-morbidities, are medically complicated and require services across multiple provider agencies. Due to their multiple and intensive needs, their care can often be fragmented, uncoordinated and at times duplicative. “ • 40% of these beneficiaries are diagnosed with mental illness and chemical dependency.

3. Backdrop: NYS Ranks 50th in Avoidable Hospital Readmissions • NYS Department of Health estimated that $800 million was spent last year on ‘avoidable Medicaid hospital readmissions.’ • 70% of these involved beneficiaries with mental health, substance use and major medical conditions. • 65% of admissions for this group were for medical reasons.

4. Vision for Recovery Outcomes • Believe that recovery is possible, even from the most tragic circumstances or disabling conditions • Uncover abandoned hopes and dreams • Discover our personhood through culture, strengths, values, skills • Engage communities as life sustaining forces • Re-author the way we see ourselves • Reclaim a meaningful life and roles

5. Themes to Consider • Quality of life orientation as well as symptoms • Capacity to individualize interventions • Discharge planning with a focus on peer and natural supports • Moving from diagnostically focused tracks to fully integrated services • Supervision models to build hope and focus on recovery • Increased visibility of people in recovery and alumni as mentors and bridgers to community

6. Unemployment and poverty: A two-way street

8. EMPLOYMENT Human Capital: interviewing skills, job competencies, education, training, certifications, etc. Material Capital: work incentives, reliable transportation, stable housing, work attire, savings, assets, etc. Social Capital: Social connections community organizations, support networks, relationships/ connections “outside” mental health system, family supports, etc. Adapted from Potts’ definitions of: human, cultural and social capital (Potts, 2005)

9. Recovery Facilitation Capability

10. Observable Correlates of Recovery

11. RECOVERY-BASED ACCOUNTABILITY Quality of Life Outcome Domains • Housing/Home • Work/Career • Relational: Family/Friends/Romantic • Educational • Legal • Financial (Payee Status, e.g.) • Conservatorship • Incarceration • Hospitalization • Recreation/Leisure • Community/Citizenship • Health/Physical Wellbeing • Spiritual/Religion

12. Benefits of a New Workforce Culture • Reflects most basic values of recovery-oriented systems of care • Belief in recovery • Community inclusion • Economic self-sufficiency • Workforce diversity • Regular opportunities to see “recovery in action” for consumers and providers

13. General Workforce Roles for People in Recovery • Peer-run organizations, e.g. recovery centers • Peer counseling positions, e.g. bridgers • Regular employee positions such as therapist, practitioner, counselor, advocate, service coordinator, adminstrator… • Volunteer peer roles • Community citizen volunteers

14. Developing Jobs for People in Recovery • Review workforce needs throughout the agency (evaluate service needs and gaps) • Include experience as a consumer of services in qualifications or preferences • Create educational equivalencies to standard college requirements, e.g. work experience, related credentials, certificates • Remove discriminatory or stigmatizing language from all written materials

15. Creating diverse teams • Integrate peer positions in multi-disciplinary teams • Create flexible schedules • Career ladders with opportunities for advancement • Opportunities for recognized continuing education • Performance reviews

16. Preparing the Work Environment • Dual relationships, role definition, boundaries • Culture and standards for self-disclosure • Understanding reasonable accommodations • Will professional roles be diminished? • Will consumers require unreasonable amount of support or lack necessary skills? • Role of consumer and non-consumer staff in staff meetings and social events • Engaging people in recovery as colleagues

17. Preparing People in Recovery • Impact of employment on benefits • Fears about ability to do the job • Fear of not being liked or accepted • Potential loss of friendships with other consumers • Role of supervisor • Engaging other staff as colleagues

18. Education and Training • Experience as a consumer does not equal capacity to serve in the workforce • Review existing employee training programs for discriminatory or stigmatizing language • Revise training programs to include recovery-oriented, person-centered, culturally competent content • Recognize credentials, e.g. CASAC, Recovery Coaching, CPRP, etc.

19. NYAPRS Partnership with CEIC • Building Recovery Facilitation Capability • Integrating peer support • Natural community supports • Recovery Implementation Forums across NYS • Onsite Recovery Implementation Technical Assistance • Case studies of local implementation • Dual Diagnosis Capability Assessments

20. References • Adams, Neal, & Grieder, Diane M. (2005). Treatment Planning for Person-Centered Care. Amsterdam, The Netherlands: Academic Press. • Anthony, William A., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric Rehabilitation (2nd ed.). Center for Psychiatric Rehabilitation, Boston University. • Davidson, Larry, Courtenay Harding, & LeRoy Spaniol (Eds.). (2005). Recovery from Severe Mental Illnesses: Research Evidence and Implications for Practice. Boston, Mass.: Center for Psychiatric Rehabilitation, Boston University. • Davidson, Larry, Michael Rowe, Janis Tondora, Maria J. O’Connell, Martha Staeheli Lawless. (2009). A Practical Guide to Recovery Oriented Practice: Tools for Transforming Mental Health Care. Oxford, England: Oxford University Press. • Farkas, Marianne, Cheryl Gagne, William Anthony, & Judi Chamberlin. (2005). Implementing recovery oriented evidence vased programs: Identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–58. • Harding, C.M.; G.W. Brooks; T. Ashikaga; J.S. Strauss; and A Breier. (1987). The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718–26. • Mathai, Chacku. (2009). Building Integrated and Recovery Oriented Programs. • Ragins, Mark. (2007). Concrete Approaches to Recovery Based Transformation. • Ralph, Ruth, Kidder, Kathryn, Phillips, Dawna. (2000).Can We Measure Recovery? A Compendium of Recovery and Recovery-Related Instruments. Cambridge, Mass.: The Evaluation Center at HSRI. • Spaniol, Leroy, Nancy J. Wewiorski, Cheryl Gagne, & William A. Anthony. (2002). The Process of recovery from schizophrenia. International Review of Psychiatry,14, 327–36.

21. Contact Information Please go to our website www.nyaprs.org for a description of all our available trainings. To schedule a training, please contact the NYAPRS Main Office at (518)436-0008