a recovery oriented system of care促进了面向恢复的系统的护理课件

Promoting A Recovery Oriented System of Care Arthur C. Evans, Ph.D. Director City of Philadelphia Division of Social Services Office of Behavioral Health/Mental Retardation Services 1 The Guiding Principles of the Philadelphia System of Care 2 “The time is always right to do what is right.” Martin Luther King, Jr. 3 Overview Historical context and Background Various Viewpoints on Recovery Principles, Core Values of Definition Program and Practice Models Implications for the System System Change Strategies and Next Steps 4 Philadelphia Office of Behavioral Health/Mental Retardation Services Arthur Evans, Ph.D. Director Office of Mental Health Coordinating Office of Drug and Alcohol Abuse Programs Community Behavioral Health Mental Retardation Services Michael J Covone Deputy Director Margaret Minehart, M.D. Medical Director 5 Division of Social Services Division of Social Services Julia Danzy Department of Health Prisons Department Department of Human Services Behavioral Health and Mental Retardation Recreation Department Office of Adult Services Mayors Office of Comm. Service 6 CAVEATS Recovery is not throwing the baby out with the bath water. Reorientation Recovery is not panacea it will not solve larger societal problems (i.e. inadequate housing, poverty, stigma, budget problems, etc.) Reorientation is a process. It is not something that will happen overnight. Public Sector Challenges are Real It takes a consensus process to move the system in the direction of recovery. 7 HISTORICAL HISTORICAL CONTEXTCONTEXT andand BACKGROUNDBACKGROUND 8 Factors Influencing the New Recovery Movement Recovery-Oriented Providers Addiction self-help movement Mental Health consumer/survivor movement Family movement - NAMI Advances in treatment approaches Recovery oriented research Mental health and addiction advocates 9 What has Been our Orientation? Focus primarily on symptom reduction or sobriety “Client” viewed passively as recipient of services Focus on “fitting into a program” Focus on client pathology and deficits Minimal individual and family voice or input in system Responsibility for change and control largely owned by programs Persons growth and sense of self is “constrained by “illness” 10 Relevant Mental Health Research Vermont Psychiatric Hospital Study Studied outcomes for 269 severely disabled patients discharged in mid-1950s 34% had achieved full recovery additional 34% had improved significantly in social functioning and psychiatric status findings replicated in WHO study where 45 -65% of person w/ schizophrenia recovered and only 20-25% showed classical deteriorating course 11 Preliminary Outcomes from a Peer Outreach Program Table 4. Inpatient and Outpatient Service Utilization for Engage vs. Standard Care Only Condition Mean Inpatient Service UseMean Outpatient Participation after 3 Months 1 Year Priorafter 3 Months Group Treatment Self-Help Groups Engage + Standard Care .54 admissions 3.3 days inpatient .5 admissions 4.4 days inpatient 44 hours.78 Standard Care Only .33 admissions 4.4 days inpatient .75 admissions 5.2 days inpatient 10 hours.30 12 Relevant Substance Abuse Research National Treatment Improvement Evaluation Study 5 year study of treatment effectiveness of almost 4500 addiction clients nationwide reduced substance use by 50% reduced criminal activity up to 80% increased employment and reduced homelessness improved physical and mental health New research concludes that the longer a person is in treatment for addiction, the better the odds that the patient will cut down on drug use (The study, entitled “Does Retention Matter? Treatment Duration and Improvement in Drug Use,“ is being published in the May 2003 issue of the journal Addiction. ) Researcher Bill White has documented spontaneous recovery of individuals who do not come into the formal Tx System 13 What Hinders: Mental Health Recovery Research by Steve Onken and Colleagues q The lack of helping factors and the resulting conditions e.g., poverty, apathy, isolation and hopelessness; q Stigma (internalized and external); q Discrimination; q Situations and structures which deny persons choices and control over their life; q Tenaciousness of the disorder itself; q Abuse and trauma. 14 What Helps:What Helps: Mental Health Recovery Research Mental Health Recovery Research by Steveby Steve Onken Onken and Colleaguesand Colleagues q Basic resources such as a livable income, affordable and safe housing and reliable transportation; q Positive attitudes, self-care and self advocacy where persons believe that recovery is possible for everyone; q A sense of meaning and purpose, for many hope or spiritual faith; q Choice in whether and what treatment to use and life options in general; q Relationships such as family and friends that sustain regular activities including fun; q Meaningful activities involving employment, education and/or volunteer and advocacy work; q Peer support in the form of groups, programs and role models; q Access to formal mental health services oriented toward the whole person where respectful staff partner with each person in achieving agreed upon goals 15 Implications of Research People can and do get better with the right supports, some of which are outside of formal treatment We need to understand and incorporate those other factors that are important in peoples recovery 16 VIEWPOINTS VIEWPOINTS ON RECOVERYON RECOVERY 17 Current Recovery Perspectives Recovery as Rehabilitation (Deegan) recovery is the task of individual, rehab one aspect of recovery, extend rehab beyond treatment to all areas of life Recovery as Political Process the gaining of civil rights, self-determination, dignity and respect Recovery as Something Gained functions, external things, internal states, (Ragins), more than absence of symptoms Recovery Management (White) permanent addictions recovery is possible, focus on solutions, open up natural pathways to recovery Recovery as Philosophy state of mind, belief system, 18 PRINCIPLES PRINCIPLES and and CORE VALUESCORE VALUES 19 Recovery Core Values Participation Entry at any time No wrong door Choice is respected Right to participate Person defines goals Programming Individually tailored care Culturally competent care Staff know resources Funding and Operations Income is tied to Outcomes Person selects provider Protection from undue influence Providers compete for business ParticipationFunding-Operations Programming 20 Equal opportunity for wellness Recovery encompasses all phases of care Entire system supports recovery Input at every level Recovery-based outcome measures New nomenclature System wide training culturally diverse, relevant and competent services Consumers review funding Commitment to Peer Support and to Consumer- Operated services Participation on Boards, Committees, and other decision-making bodies Financial support for consumer involvement Recovery Core Values Direction 21 Objectives of a Recovery System of Care To the extent possible, individuals should have responsibility and control over their personal recovery process Increase individual/family participation in all aspects of service delivery Expand recovery efforts to all aspects of individuals lives- social, vocational, spiritual through direct services or linkage to natural helping networks Promote highest degree of independent functioning and quality of life for all individuals receiving care in our system 22 Recovery Defined “We endorse a broad vision of recovery that involves a process of restoring or developing a positive & meaningful sense of identity apart from ones condition & a meaningful sense of belonging & then rebuilding a life despite or within the limitations imposed by that condition.” 23 TRANSFORMING TRANSFORMING PRACTICEPRACTICE 24 Practice Guidelines: Prevention/Health Promotion Persons in recovery will: be able to access information re health promotion and treatment options promote their own health and build Recovery Capital (resources for recovery) Agencies will: provide community and consumer education Utilize a range of community-based interventions to reduce risk factors and enhance resilience encourage access to resources or info, conduct anti-stigma campaigns 25 Practice Guidelines: Consumer Involvement Persons in recovery/Family participate on Boards participate in agency evaluations participate in planning structures know grievance procedures Agencies offer peer-run services hire peer staff routinely evaluate consumer satisfaction and solicit ideas on now to improve care 26 Practice Guidelines: Access and Engagement Persons in recovery can access services through any door are offered services where they live Agencies use: a range of pre-engagement strategies peer engagement specialists specialized outreach strategies for difficult to engage populations specialized procedures to rapidly admit people who relapse admission criteria that dont exclude people based on prior treatment failure, etc.27 Practice Guidelines: Continuity of Care Persons in recovery arent discharged just for being more symptomatic Agencies link people in recovery to: appropriate aftercare services upon discharge self-help resources or natural supports Agencies have mechanisms for: follow-up post-discharge people returning for services 28 Practice Guidelines: Individualized Recovery Planning Persons in recovery actively participate in the development of their recovery plans sign all plans attend all planning meetings designate meeting participants receive their plans Providers: develop holistic plans that include wishes, interests, goals, etc. regularly review plans with multi- disciplinary team (e.g., treatment, housing, work, natural supports) 29 Practice Guidelines: Recovery Support Staff Providers: offer people hope that recovery is “possible for me.” work collaboratively to develop relapse- prevention plans and advance directives assist persons in recovery with self- management strategies help engage and maximize use of natural supports such as friends, family, and neighbors promote autonomy and Recovery Capital aid in skill development as well as symptom management and treatment 30 Practice Guidelines: Community Inclusion People in recovery can be assisted to connect to community resources Agencies: identify and regularly update traditional and non-traditional resource directories integrate program activities into community life utilize community social, recreational, educational, vocational, faith resources 31 Practice Guidelines: Housing and Work Agencies: link people in recovery to safe affordable housing offer a range of work and educational opportunities to all persons in recovery eliminate work eligibility requirements strengthen linkages to vocational and educational providers 32 Practice Guidelines: Evidence-Based Practices People in recovery: Provide information to help shape local adaptation of EBPs Participate in program evaluations Help interpret data Provide ideas about promising practices that need more research Agencies implement and sustain recovery -oriented EBPs 33 Practice Guidelines: Cultural Competency Agencies: evaluate data to ensure that members of diverse cultural groups are receiving effective treatment provide services and materials that are linguistically and culturally appropriate establish and utilize relationships with local community institutions identify and eliminate health disparities conduct culturally competent assessments maintain staff composition that reflects diversity of population served 34 Practice Guidelines: Quality and Performance Agencies: regularly administer opinion and satisfaction surveys collect recovery-oriented performance measures have a Continuous Quality Improvement (CQI) process that seeks to eliminate barriers to recovery Persons in recovery participate on CQI committees inform service needs assessment identify effective practices 35 IMPLICATIONS IMPLICATIONS andand STRATEGIES STRATEGIES FOR CHANGEFOR CHANGE 36 Recovery Practice Guidelines Recovery-Oriented Value- Driven Practitioner (Clinical) Program (Provider) System (Policy) Culturally competent Fidelity to model Convey Hope and Respect Person-Centered 37 Phase 1: Determine Direction Develop Concepts & Design Model Principles and core values Recovery definition Literature reviews, outside consultation Develop Consensus Consumers/people in recovery Family members Service providers Advocates Spread the Word - Create Awareness 1 2 3 38 Create AwarenessCreate Awareness And Increasing depth of content Increasing numbers of people Consumers, Families, Advocates OBH Staff Executive Directors Medical Staff General PublicProgram Directors Boards of Directors Line Staff Legislators, Civic Leaders, Clergy 39 Phase 2: Initiate Change Focus on Quality Provider self-assessment Agency Recovery plans Plan approval and implementation Performance guidelines Performance measures and monitoring Workforce development Intensive skill-based training Consultation for providers Service system re-design: New funding and realignment of existing resour