Administrating Recovery:

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Administrating Recovery New Rules for Staff to
Work By Roderick Shaner MD Medical Director Los
Angeles County Department of Mental
Health RShaner_at_lacdmh.org Mark Ragins,
MD Medical Director MHA Village Integrated
Service Agency www.village-isa.org mragins_at_mhala.o
rg David Pilon, PhD Director of Outcomes and
Training MHA-LA dpilon_at_mhala.org
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Recovery Based Treatment Relationships

• Patient driven, not professional driven
• Collaborative, not compliant or coercive
• Personal guide, not map handing expert
• More emotional, less professional distance
• More shared humanity and self disclosure
• More letting the patient under your skin
• More learning from our patients
• More team and milieu based than individual
  doctor patient based

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Administrative Purposes

• Support staff to manage potential risks
  successfully
• Serve as guidelines to understand recovery model
  concepts and the relationships essential to
  assist an individual through the stages of
  recovery successfully
• Clarify standard processes in the event of future
  legal actions,
• Avoid misunderstandings for staff and individuals
  who may be unfamiliar with Recovery Model
  concepts
• Become aware of needs for staff training and
  performance improvement
• State the departments written intentions as a
  resource and training tool for staff, managers
  and individuals and
• Improve morale by establishing an opportunity for
  individuals and staff to participate in and
  review the parameters as they currently exist and
  may evolve

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Existing Policies

• 1. Ethics (See DMH PP 100.1. Department of
  Mental Health Code of Ethics)
• 2. Compliance Policies and Programs (See DMH PP
  112.2 Compliance Program)
• 3. The Health Information Portability and
  Accountability Act (HIPPA) (See DMH PP 500.1 to
  500.10
• HIPAA)
• 4. Sexual Harassment Prevention (See DMH PP
  605.2 Sexual Harassment Prevention-Anti-Retaliatio
  n
• 5. Conflict of Interest (See DMH PP 608.2
  Conflict of Interest
• 6. Organizational Codes of Conduct (See DMH Code
  of Organizational Conduct
• 7. Illness and Injury Prevention Programs (See
  DMH Illness Injury Prevention Program)

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Overall Challenges

• To encourage recovery practices without staff
  breaking rules or changing existing policies
• To express rules positively instead of a series
  of thou shalt nots
• To go beyond value and belief statements to
  reasonably specific practice guidelines that can
  be used to guide individual situations
• To balance everyones needs

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Hug Policy

• Physical contact between staff and an individual
  may often contribute to emotional healing, but it
  carries special risks. Staff absolutely must
  avoid all inappropriate touching or other sexual
  contact with an individual. Sexual attraction or
  falling in love by either the staff or an
  individual dramatically increases the risk of
  inappropriate and/or unethical behavior on the
  part of staff. Therefore, these emotions must
  not be kept private. When confronted with these
  situations, staff must make their supervisor and
  teammates aware of them.

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1. Creating and Establishing a Recovery Milieu

• We wanted to move away from individual private
  practices in the clinics to promote a healing
  milieu
• We wanted supervisors to feel responsible for the
  culture of their programs

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2. Engagement and Understanding

• We wanted to emphasize the importance of
  welcoming and engagement, putting issues of
  dress, smoking together, friendliness, giving
  people things, and self disclosure into
  perspective
• We wanted to discuss confidentiality within the
  context of empowerment, rather than of privacy

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3. Emotional Healing

• We wanted to retain the healing of therapy while
  broadening the context and personnel involved
• We wanted to emphasize key reasons behind
  boundaries sex, aggression, protection of
  staff and people being served without requiring
  strict boundaries
• We wanted to clearly include consumer and family
  staff in the parameters

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4. Financial and Work Relationships

• We wanted to give guidance encouraging staff to
  provide new financial services - buying things
  for people, becoming their payees, and paying
  them to work while anticipating some of the
  issues and risks they may encounter
  transparency, accountability, exploitation,
  safety

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5. Medication Support

• We wanted to promote medication collaboration,
  moving away from meds as a prerequisite for other
  services and clearly discourage coercion
• We wanted non-medical and even paraprofessional
  staff to be part of supporting medication
  collaboration while delineating the restrictions
  on them

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6. Psychosocial Rehabilitation

• We wanted to encourage more rehabilitation
  services while anticipating and giving guidance
  regarding the inevitable issues that emerge
  including new and multiple roles, value-driven
  and consumer-driven, risk taking and supporting
  failures, and pursuing spiritual goals

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7. Substance Use and Abuse

• We wanted to strongly emphasize the need for all
  staff to competently serve people in all stages
  of their addictions and substance abuse directly
  confronting the tendency to exclude them or refer
  them to someone else - without condoning use and
  abuse
• We wanted to protect staff with behavioral rules,
  not use and abuse rules

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8. Working in the Community

• We wanted to strongly encourage working in the
  community (and not just for crisis interventions)
  while anticipating and giving guidance regarding
  the inevitable issues that emerge roles,
  confidentiality, safety, empowering vs.
  caretaking, family relationships, and advocacy

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9. Working with Law Enforcement

• We felt that working with law enforcement had
  special concerns beyond working in the community
  generally and we wanted to give staff a framework
  to make decisions regarding our departments
  respective missions and responsibilities
• We also wanted to directly address the
  relationships we want people with mental
  illnesses to have with law enforcement personnel

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Confidentiality Policy

• When an individual shares their story with staff
  they place themselves in a vulnerable position.
  It is imperative that staff protect their story.
  Staff must respect confidentiality rights and
  keep information within the confines of the
  mental health system. However, personal
  confidentiality or exclusively between an
  individual and a staff member is not a right and
  should be used cautiously and circumspectly.
  Keeping personal secrets may increase the risk of
  fragmented care, personal impropriety, and even
  danger, along with possible losses of staff
  accountability, documentation, and funding.
  Staff are expected to work as an integrated part
  of the entire mental health system, not as an
  individual practitioner.

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Consumer and family staff

• Inspired by our success, the medical directors
  office went on to use a similar process to create
  a set of parameters for peer advocates
• but thats a different presentation.

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Thank You!

• You can find the full text of the parameters for
  service relationships by clicking on 4.12 Service
  Relationships in a Recovery-Based MHS at
  www.rshaner.medem.com
• Contact Information
• Roderick Shaner at RShaner_at_lacdmh.org
• Mark Ragins at mragins_at_mhala.org
• David Pilon at dpilon_at_mhala.org