ACA: Projected Enrollments(Centers for Medicare and Medicaid, 2012)

1

ACA Effect: NJ Coverage (Rutgers Center for State Health Policy, 2012)

Change in Coverage in NJ under ACA (ages 0-64)

New to NJ Medicaid: 234,000 ( = 23%)

2

Rate Ratio (Zuckerman et al., 2009)

US 0.72

WY 1.43AK 1.40DE 1.00PA 0.73CA 0.56NY 0.43

NJ 0.37

50t

h !

3

2. Providers: Supply = f(Rate Ratio) (Decker, 2012)

𝑥=𝑴𝒆𝒅𝒊𝒄𝒂𝒊𝒅 𝑟𝑎𝑡𝑒𝑀𝑒𝑑𝑖𝑐𝑎𝑟𝑒𝑟𝑎𝑡𝑒

% doctors accepting

4

The Future Treatment Room?...

5

The Family Experience

Titian, Sisyphus, 15496

60% live with or receive care from families

Objective

Subjective

Family Burden (Doornbos, 2001)

7

Monitoring

Managing

Maintaining

Encouraging

Socializing

Caregiver roles(Doornbos, M. M., 2001)

8

7 Core Family Needs (Power &

Dell Orto, 2004, p. 177)

Respect Support Strengths Flexibility Choice Empowerment Information

9

Partnering: Provider Guidelines (Power & Dell Orto, 2004, p. 181)

Share the responsibility. Focus on strengths. Hear all views.

10

Providers: How to help? (Clarke & Windsor, 2010)

Acknowledge; connect; engage

Offer coping mechanisms

Comprehensive involvement at discharge

Instill hope

11

Children’s System of Care

12

Family Support Organizations

13

Prevention, Early Intervention

14

Violence

15

16

I am Adam’s Lanza’s Mother!...

http://www.youtube.com/watch?v=Dgrr2jDcXAs

17

http://www.youtube.com/watch?v=UV5_306dWPc

Gus Deeds

18

19

Elbogen & Johnson (2009)

http://www.youtube.com/watch?v=wCeFEr5ioqo

“…if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any person in the general population.”

20

Stigma

21

Lack of recognition of prodomal symptoms

Shame less assessment, treatment

Less funding, lower reimbursements

Low status, marginal priority

Stigma Effects (Heflinger & Hinshaw,

2010)

22

Cognitive (stereotypes)

Emotional (prejudice)

Behavioral (discrimination)

Structural models of stigma (Larson & Corrigan, 2008)

23

Individual

Community

Societal

3 levels (Heflinger & Hinshaw, 2010)

24

The President Summons Us...

https://www.youtube.com/watch?v=UqnF3UicuQs 25

And so, in conclusion…

26

Nouwen’s Hope

http://www.youtube.com/watch?v=sW_6yXxoLQQ#at=10 27

The “Conspiracy of Hope”

We have chosen very difficult work...

Why? Because we are part of a conspiracy of hope and we see in the face of each person with a psychiatric disability a life that is just waiting for good soil in which to grow. We are committed to creating that good soil.

Patricia Deegan, Ph.D.

28

The Origins of Hope?

... Not only that, but we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not disappoint us, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us. [Romans 5:3-5 (RSV) ]

29

Blessings: The Fruits of Hope

30

31

References

Centers for Medicare and Medicaid Services. (2012). 2011 actuarial report on the financial outlook for Medicaid. Washington, DC: Centers for Medicare and Medicaid Retrieved from http://www.cms.gov/research-statistics-Data-and-Systems/research/actuarialstudies/downloads/medicaidreport2011.pdf.

Clarke, D., & Winsor, J. (2010). Perceptions and needs of parents during a young adult's first psychiatric hospitalization: “We're all on this little island and we're going to drown real soon”. Issues in Mental Health Nursing, 31(4), 242-247. doi: 10.3109/01612840903383992

Decker, S. L. (2013). Two-thirds of primary care physicians accepted new Medicaid patients in 2011–12: A baseline to measure future acceptance rates. Health Affairs, 32(7), 1183-1187. doi: 10.1377/hlthaff.2013.0361

Deegan, P. E. (1996). Recovery and the conspiracy of hope. Paper presented at the Sixth Annual Mental Health Services Conference of Australia and New Zealand [September 16, 1996], Brisbane, Australia. Retrieved on April 8, 2012 from http://www.patdeegan.com/pat-deegan/lectures/conspiracy-of-hope

Doornbos, M. M. (2001). The 24-7-52 job: Family caregiving for young adults with serious and persistent mental illness. Journal of Family Nursing, 7(4), 328-344. doi: 10.1177/107484070100700402

Elbogen, E. B., & Johnson, S. C. (2009). The intricate link between violence and mental disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 66(2), 152-161. doi: 10.1001/archgenpsychiatry.2008.537

Heflinger, C. A., & Hinshaw, S. P. (2010). Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 61-70. doi: 10.1007/s10488-010-0294-z

Larson, J. E., & Corrigan, P. (2008). The stigma of families with mental illness. Academic Psychiatry, 32(2), 87-91.

Lefley, H. P. (2009). Family psychoeducation for serious mental illness. New York: Oxford University Press.

Lucksted, A., McFarlane, W., Downing, D., Dixon, L., & Adams, C. (2012). Recent developments in family psychoeducation as an evidence‐based practice. Journal of Marital and Family Therapy, 38(1), 101-121. doi: 10.1111/j.1752-0606.2011.00256.x

Power, P. W., & Dell Orto, A. E. (2004). Families living with chronic illness and disability. New York: Springer Publishing Company, Inc.

Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2007). Psychiatric rehabilitation (2nd ed.). New York: Elsevier.

Rutgers Center for State Health Policy. (2012). Realizing the promise of the Affordable Care Act through outreach. New Brunswick, NJ: Rutgers Center for State Health Policy.

Schmidt, L., & Monaghan, J. (2012). Intensive Family Support Services: A consultative model of education and support. American Journal of Psychiatric Rehabilitation, 15(1), 26-43. doi: 10.1080/15487768.2012.655226

Torrey, E. F. (2006). Surviving schizophrenia: A manual for families, patients, and providers. New York: Harper Collins.

Zuckerman, S., Williams, A. F., & Stockley, K. E. (2009). Trends In Medicaid physician fees, 2003-2008. Health Affairs, 28(3), w510-w519. doi: 10.1377/hlthaff.28.3.w510