Summary of NJ DMHS Wellness and Recovery Transformation Stakeholder Input Process

1
Summary of NJ DMHS Wellness and Recovery
TransformationStakeholder Input Process

• Presentation to Stakeholders
• Mercer County Community College
• March 2, 2007

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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

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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

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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.

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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.

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Consumer Definitions of Recovery

• Traditionally 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.

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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

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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

9
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

10
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

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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

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Improving Community Supports, Linkages, and
Services

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

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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

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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

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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

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Therapeutic Environment-Improved Treatment
Activities

• Recommendations
• 11 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

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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,

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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.

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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.

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Additional themes from Community-Based Consumer
Family Forums

1. Treatment Planning and Support
2. Staffing
3. Resource Allocation
4. Data Driven Decision Making
5. Methods of Disseminating Information

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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

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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

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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

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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

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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

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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.

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Evidence Based and Promising Practices
Recommendation Themes

• Core Competencies for all EBPs
• Training for Specific EBPs
• New Promising Approaches
• Monitoring of Implementation
• Funding and Regulatory Issues

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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

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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).

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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

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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

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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

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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

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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.

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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

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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.

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Recommendation Themes

• Pervasive Treatment Philosophy and Service
  Provision
• Evaluation of the Current System
• Documentation
• Consumer/Family Provider
• Advance Directives
• Joint Protocols and Cross Training
• Community and Staff Education
• Access Issues Point of Entry, Housing, Other

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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

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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

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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)

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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

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Joint Protocols and Cross Training

• Shared responsibilities for multiple service
  users
• Joint and cross training for providers of
  services for the shared populations

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Public and Community Education

• Anti-stigma, public information and education
  campaign
• Particularly for the medical community,
  legislators, and developers of college curricula

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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

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Access Housing

• Develop and maintain information clearinghouse
  for housing
• Wide spectrum of housing for all levels of the
  system
• Emergency assistance and housing subsidies

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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.

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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

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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

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Recruitment Retention Credentialing

• Certified Psychiatric Rehabilitation Practitioner
  (CPRP) as preferred credential
• Recovery-oriented
• Open to all educational levels/experience
• Upward mobility for those earn CPRPs and
  specified credentials

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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

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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

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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

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Increasing Staff Competency Standardized
Curricula

• 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

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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

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Methods for Increasing Staff Competency
Supervision

• Individual and group supervision
• Skills based, non-punitive
• Individual learning plans
• Performance appraisals, evaluations, PAR/PES
  based on WR principles and competency
  development
• WR survey tool for measuring staff application
  of WR principles

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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

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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

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Community Standardized Curriculum 12 Domains

• Personoriented 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

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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

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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

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Hospitals Curricula Content

• Echoed community recommendations
• Additional recommendations for hospital settings
• Basic therapeutic skills
• Accountability
• Communication
• Supervisory training
• Staff safety and security during WR introduction
• Hands on training to ease the transformation
  process

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HospitalsAdditional 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

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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.

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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
   consumers
6. Ensuring consumer input

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Establish Measurable Outcomes

• Operationalize NJs transformed system
• Identify system goals
• Create associated outcome measures
• Identify and/or create fidelity measures relevant
  to each modality or service.

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Develop Data Collection System

• Develop capacity, infrastructure, and funding
• Establish baseline data
• Provide initial and ongoing training

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Remove Systemic Obstacles Promote Cross System
Collaboration

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

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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

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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

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Provide performance information to consumers and
family members

• Performance report card
• Specify outcome data
• Publish on the Divisions website

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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