pcoms and rosc

https://heartandsoulofchange.com 3/31/2014

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ROSC & PCOMS:TRANSFORMING DELIVERYDELIVERY SYSTEMS

Paul Poplawski, PhD LLC

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302/737-8738

htt // li k di /i / l l kihttp://www.linkedin.com/in/paulpoplawski


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WEBINAR PRESENTER

32 years in the State of Delaware SUD & MH public system; member of the executive staff; directed the statewide professional

f Sdevelopment function; directed the Summer Institute in partnership with the U of DE

Psychologist in private practice from 1976 through the early 2000s

10 years as a fulltime independent consultant with a focus on public behavioral health system transformation

More than a passing acquaintance with PCOMS – assisting with the implementation of PCOMS in the Philadelphia DBHIDS

http://www.linkedin.com/in/paulpoplawski

Personal transformation

PAUL POPLAW SKI , PHD LLC [email protected] 3

AFFINITY GROUP

Colleagues who are making both individual and collaborative

contributions to what is contained in this presentation.

William White > www.williamwhitepapers.com

Arthur Evans, Ph.D. > dbhids.org/arthur-c-evans-jr-ph-d/

Ijeoma Achara, Psy.D. > http://www.attcnetwork.org/userfiles/file/GreatLakes/Webinars/Ijeoma%20Achara%20Bio.pdf

Joan King > joankkingconsulting.com Joan King joankkingconsulting.com

Barry Duncan, Psy.D. > heartandsoulofchange.com



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OBJECTIVES

Provide definitions and the underlying value base of a recovery-oriented system of care (ROSC) and recovery/resilience oriented servicesrecovery/resilience-oriented services

Present the features of a recovery-oriented service approach

System Transformation Examine the relationship of ROSC and PCOMS Present the Philadelphia story of recovery system

transformation and the adoption of PCOMS for one level of carecare

Provide time for discussion and questions.


WHY ROSC, WHY NOW

Communities of peers, advocacy groups, families, communities demanding choice, a voice, self-determination

Access to services – unmet need

Insufficiency of “therapy” for those in the public system

Myopic view of the policies and practices necessary for healing and recovery

Lack of continuing care

Low retention

Lacking a commitment to peer support



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PARADIGM SHIFT

System Transformation >

Create a system of care that accomplishes the following:Create a system of care that accomplishes the following:

Provides the necessary supports that are “actually” individualized, meaningful and sufficient in addressing the clinical, social, emotional, interpersonal, aspirational domains of a person’s life and do so through authentic partnership, the communication of hope, the igniting of individual strengths, with an overall goal of achieving a solid interdependent relationship with people and resources in the community – a quality of life that we all desire!!


DEFINING ROSC

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk for substance use and all other behavioral health challenges. (adapted from CSAT)

Achieving this requires transformation at the system (financing, regulations, etc.), provider, staff, participant and community levels to accomplish


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ROSC – A DEEPER DIVE

The phrase recovery-oriented systems of care (ROSC) refers to the complete network of indigenous and professional services and relationships that can support the long-term recovery of individuals and families and the creation of values and policies in the larger cultural and political environment that are supportive of these recovery processes. The system in this phrase is not a federal, state, or local agency, but a macro level organization of the larger cultural and community environment in which long-term recovery is nested.

William White, 2008


PRIMARY GOALS OF A ROSC

Prevent the development of behavioral health conditions (e.g. Mental Health First Aid)

Intervene earlier in the progression of illnesses (e.g. Assertive outreach practices)

Reduce the harm caused by behavioral health conditions (e.g. rapid engagement)

Help people transition from brief experiments in recovery initiation to recovery maintenance (e.g. recovery planning driven by the person)

Acti el promote a holesome q alit of life comm nit health and Actively promote a wholesome quality of life, community health and wellness for all (public health orientation)



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ROSC VALUES & PRINCIPLES

Person-centered; person-driven

Many pathways to recovery Many pathways to recovery

Family & other ally involvement; peer support

Individualized; communicate hope

Systems anchored in the community

Continuity of care

Partnership-consultant relationships

Strength-based Strength based

Culturally responsive, culturally-based & influenced

Responsiveness to personal belief systems

Embedded in social networks and relationships

ROSC ORIENTATION TO SERVICES

Integration of primary healthcare and behavioral health treatment

Peer culture, peer support, recovery coachingPeer culture, peer support, recovery coaching

Life domain orientation

Employment, education, opportunities

Real community involvement

Recovery/treatment plans live in the community

Involving everyone in the change process


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PrimaryFocus

Traditional Treatment Model

Love,

Work, & Play

ocus

Community Life

Treatment

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Housing, Faith, & Belonging

Primary

In the model. clinical care is viewed as one of many resources needed for successful integration into the community

Recovery and Resilience Oriented System of Care

Faith

Work or school

Social Peer

support

Treatment &rehab

yFocus

Community Life

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support

Belonging Family

Housing

support


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3 APPROACHES TO RECOVERY-FOCUSEDSYSTEM CHANGE (HANDOUT)

1. Additive Approach: adds non-clinical recovery support services1. Additive Approach: adds non clinical recovery support services

2. Selective Approach: a focus on treatment practices of select programs or in particular LOC and incorporating recovery support services into the system

3. Transformative Approach: entire system change including the context in which it operates – clinical, non-clinical, fiscal, policy, community and social contexts within which the system operates

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KOTTER’S STRATEGIES FOR SYSTEM TRANSFORMATION

1. Establishing a sense of urgency

2. Forming a powerful guiding coalition

3. Creating a vision

4. Communicating vision

5. Empowering others to act on the vision

6. Planning for and creating short-term wins

7. Consolidating improvements and producing still more change

8. Anchoring new approaches in the culture

John Kotter, Leading Change, 1996



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4 ROSC Building Blocks

Optimize clinical service delivery

Add and integrate recovery

support services

Fiscal and Administrative Policy

& Procedures

Build Cross-Systems Partnerships and Community Recovery Capital


Community Recovery Capital

OPTIMIZE CLINICAL SERVICE DELIVERY Provide Recovery-Oriented Services

Attraction via Assertive Outreach and Engagement

Holistic Screening, Assessment and Service Planning

Expanded Composition of the Service Team

Collaborative Service Relationships

Focus on Community Integration

Assertive Linkages to Communities of Recovery

Post-treatment Monitoring Support and Early Re-intervention

Clinical Supervision & PCOMS



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FAILURE TO MEASURE BENEFIT IN A TRADITIONAL SYSTEM OF CARE

System focus on volume

System focus on individual service achievement – poor designs, System focus on individual service achievement poor designs, unworkable, inaccurate and rarely support the clinical process

System focus on accountancy not clinical progress

We are not in the business of “manufacturing” recovered persons

“Outcomes” are typically understood through data that serves as proxies of program or provider performance and almost always from the perspective of the provider – proxies are important but insufficientinsufficient


ROSC & OUTCOMES

Infancy

Continued use of traditional methods – volume dataContinued use of traditional methods volume data

Presence of ROSC alignment tools

Anecdotal, self-report

Peer stories

Poor quality in service organizations’ use of data

Lack of clinical supervision – changing with ROSC

Prior ROSC History of collecting information documentation Prior ROSC - History of collecting information, documentation, etc. that reinforced traditional approach to services or that laid dormant




WHAT DO ROSC & PCOMS SHARE?

Values base: empowered service recipients; voice; self-determination

Focus on multiple life domains > PCOMS reinforces this

Dynamic, in motion, useful, feasible

Recovery work and PCOMS connect to the person’s aspirations and are purposeful – another way of saying this ….

Both identify issues that are occurring in the foreground without losing sight of the person’s aspirations

Both squarely focus on achievement, progress, goals, and the work necessary by both the person and helper

Serve to ignite the clinical supervisory process


SHARE, CONTINUED

Quality of the relationship is underscored

Failure to progress is almost always a shared responsibilityFailure to progress is almost always a shared responsibility

ROSC is undergirded by an expectation of the person’s choice for what, how and with whom services are to rendered – PCOMS provides the data to analyze the outcomes of those choices

Both are action oriented

Both are strength-based




ROSC & PCOMS AS SYMBIOTIC

ROSC provides a healthy environment to seed an implementation of PCOMS

PCOMS provides a persistent reinvigoration to the underlying intentions of a ROSC

The process of discussing ORS/SRS findings between service recipient and staff person enlivens and informs the intensity believed to be necessary in using recovery plans as roadmaps to a preferred future

PCOMS and ROSC form their own accountability partnership PCOMS and ROSC form their own accountability partnership

PCOMS and ROSC require a change in thinking on everyone’s part

Reinforcing of one another


PHILADELPHIA STORY

One billion dollar behavioral health organization

Arthur Evans, Ph.D. – a vision of a transformed system and the courage to drive it forward

Concept – Practice - Context

Intentional & Organized: Blueprint for Change

Multidimensional – work at the all levels of the system

Pioneers, early adopters, emphasis on experimentation & learning

Community Integrated Recovery Centers (CIRC)

Practice Guidelines Practice Guidelines

PCOMS




LESSONS LEARNED FROMIMPLEMENTING A ROSC

Resilient leadership Conceptual clarity Non-linear, non-sequential, many balls in the air – ability to tolerate

ambiguity Preparation is important but often you must just pull the trigger Requires rethinking the role and relationship between the funding

agency and the organizations supported Some people don’t make it A change in thinking is fundamental to success The critical role of peers can not be overstatedp CDOI, PCOMS along with solid recovery-oriented clinical practice is

a recipe for success


ROSC RESOURCES

Transformation of Behavioral Health Services in Philadelphia: Practice Guidelines for Recovery and Resilience Oriented Treatment (http://www.dbhids.org/assets/Forms--Documents/transformation/PracticeGuidelines.pdf)

Peer Culture, Peer Support, and Peer Leadership > http://www.dbhids.org/assets/Forms--Documents/4.2.1.3-PDF-8.pdf

Community Integration > http://www.dbhids.org/assets/Forms--Documents/4.2.1.3-PDF-10.pdf

Person First Assessment and Person Directed Planning > http://www.dbhids.org/assets/Forms--Documents/personFirst.pdf

The Recovery Revolution for Children and Adolescents http://www.dbhids.org/assets/Forms--Documents/personFirst.pdf > http://www.dbhids.org/assets/Forms--Documents/transformation/BillWhite/2009RecoveryRevolutionChildAdolescents.pdf

http://partnersforrecovery samhsa gov/docs/Guiding Principles Whitepaper pdf http://partnersforrecovery.samhsa.gov/docs/Guiding_Principles_Whitepaper.pdf


pcoms and rosc

Education

phd llc

rosc pcoms

recovery initiation

recovery planning

recovery maintenance

community health

recovery family

recovery processes