Transformation to a Recovery Focused

Mental Health CenterRoy Starks, MA

Mental Health Center of DenverLinda LaGanga, Ph.D.

Mental Health Center of Denver

What is Recovery?> Recovery takes on many meanings > We believe people can, and do, recover from mental

illness. > Appropriate and compassionate treatment for a mental

health problem > The individual can get back to living a happy and

productive life. > Consumers are involved in shaping their own recovery

and given the chance to regain control of their lives.

Pick your synonym for Transformation> Changeover> Metamorphosis> Transfiguration> Conversion> Other?

What is Your Center doing to transform to Recovery Focus

> How Do You Know it is happening?

> How Do You measure it?

Using Outcomes to Drive Recovery-Focused Practice

Development of Recovery-focused

Outcomes

The Four Measures of Recovery

Using Data and Reporting To Drive Recovery

Transformation

Mental Health Center of Denver

> Formed 1989> Combined four previous centers in order to obtain

Robert Wood Johnson funding for housing> Law suit settlement of 1993 ordering intensive

services including rehabilitation

The Mental Health Center of Denver

> Mandate to serve the hardest to serve• Persons who are homeless with a diagnosis

of Schizophrenia, Bi-Polar, or Major Depression

> Serve 4,200 adults at any point in time• Every day we admit 7 but must turn away 17• Our goal is to increase funding to be able to serve ALL

who need our services• Additional consumers served through special grants and

funding> Mission: Enriching Lives and Minds By Focusing

on Strengths and Recovery

Three Types of Adult Services

> Intensive Services (2,100) Three levels of case management

> Outpatient Services (2,100)

> Psychiatric Rehabilitation (1,000 per year)• Supported Education • Supported Employment

Recovery Conferences and Committee

> Annual Recovery Conferences> Decision following conference to work toward system

transformation> Created Recovery committee and proceeded with

Logic Modeling> Lead to Creation of Recovery Measures

Quick Poll: Which of the following is true of Logic Modeling?

A. It is a structured processB. It uses gap analysis and planningC. The goal is to achieve desired outcomesD. It is a rapid change process

Check in: Questions?

The Four Measure of Recovery

Recovery Marker Inventory(RMI)

Provider rating

Consumer Recovery Measure

(CRM) Consumer rating

Promoting Recovery in Organizations (PRO)

Consumer rates provider

To what degree is RECOVERY

happening? Multiple perspectives Multiple dimensions Change over time

Four Measures of Recovery

Recovery Needs Level (RNL)

Suggests best level of services for stage of recovery

Recovery Needs Level (RNL)

Suggests best level of services for stage of recovery

Measure #1: Recovery Needs Level> Assigns the right level of service to the consumers> The basic assumption being that people recover

and their needs change over time. > Completed by the primary clinician in electronic

record every 6 months in combination with their service plan

> Scored electronically according to algorithm> Algorithm weighted – based on clinical decision

Stretch Your Dollar

$ Denver admitted 400 new adults with serious mental illness into high intensity services the first year of implementation of the RNL with no additional resources.

$ Based on a cost of $12,500 per consumer

= Total public cost saving annually is $5 Million.

Measure #2: Recovery Marker InventoryEight dimensions that “tend to correlate” with

an individual’s recovery. They do not always correlate with recovery for everyone.

The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this presentation,receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the information you will receive.

1. Employment2. Learning/Education3. Active Growth Orientation4. Symptom Management5. Participation in Services (engagement) 6. Housing7. Substance abuse (level of use)8. Substance abuse (stages of change)

* Physical Health is being added within the year

The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this presentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the information you will receive.

Measure #3: Consumer Recovery Measure> Measures the consumer’s perception of their

recovery on 5 dimensions. > Is completed quarterly by the person receiving

services.

Level of Symptom

Interference

Personal Sense

of Safety

Satis

faction

with

Socia

l Netwo

rks

Active/Grow

th

Orientation

Hope1. Active Growth Orientation2. Hope 3. Symptom Management 4. Perceived Sense of Safety 5. Satisfaction with Social

NetworksThe Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this presentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the information you will receive.

Consumer Recovery MeasureGraphic representation of this data is shared with the consumer to initiate:

• clinical discussion about changes in these areas, • what the consumer attributes the changes to, and • possible relationships between categories. This process

promotes insight, and empowers the person to share their story in a new and different way.

Measure #4: Promoting Recovery in Mental Health Organizations (PRO)

Measures staff’s characteristics which promote recovery.

• Sections for each type of staff that interact with our members (front-desk staff, clinical, medical, case managers, rehabilitation, etc.)

PRO Survey Administration

> 10% stratified random sample > Collected annually for each type of staff a

consumer has dealt with in the last 6 months. > Only 10 to 15 questions per type of staff. > Administered to consumers by a Consumer

Survey Team. > Gift Card Incentives

PRO ResultsThe following graph displays a team’s scores compared to the overall score at the center. If the team scored higher than the average score for the center, then the team has more recovery-oriented skills than the average staff member. If the team scored lower than the average score for the center, then the team has less recovery-oriented skills than the average staff member.

3.05

2.25

3.06

2.15

3.78

3.45

0.95

1.73

1.31

3.23

0 1 2 3 4

Pro A: Therapist

Pro B: Case Managers

Pro C: Medical Staff

Pro D: Nursing Staff

Pro F: Front Desk Staff

MHCD AverageTeam 222

Using Data and Reporting to Drive Systems Transformation

Individual Outcomes Program Outcomes System Review

Consumer Outcomes –Changes in Recovery> Change Charts automatically flag when a

consumer has a substantial change in their recovery profile. • We can compare the consumer’s progress to

their own prior recovery outcome scores as well as compare their progress to the typical progress of their peers.

> Detection Charts automatically target outliers in recovery. • .

Recovery Focused Utilization Management Review

> If the control chart flags a consumer the consumer’s record is automatically a possible candidate for a utilization management review.

> This review consists of other clinicians reviewing notes, consumer outcomes, and service hours to determine if there are gaps in services and if other services should be considered. Recommendations are then forwarded to the program manager for review and implementation.

Program Outcomes > Evaluation and Fidelity

• Assessing how well our treatment and services are working

> Cost-Benefit Analysis • Exploring the most efficient allocation of time and

resources with the most successful results> Effective Program Components

• Identifying specific indicators that point to high performance

Evaluation and FidelityWe can utilize the recovery outcomes to ensure that goals and service standards of a program are being met. Below is the average recovery among all consumers in our Growth and Recovery opportunities for Women (GROW) Program

By reviewing these outcomes in conjunction with the fidelity level of the program, we are able to determine the overall effectiveness of the program and identify areas where service improvements can be made.

System Review> Measuring performance across an agency > Establishing realistic goals

• If changes in recovery are not occurring as expected then further investigation is done on program and consumer level outcomes.

> Recovery Metrics Report • Admissions, Discharges, Total consumers served• Consumer Service Level Transfers (RNL)• Increases and decreases in recovery environmental

factors (RMI) • Increases and decreased in consumer’s perception of

their recovery (CRM)

Benefits of Outcomes Reporting

For the Consumer

Increased likelihood of sustained mental health

recovery

Integration of own perception into treatment planning

Improved matching of services to individual needs

For the Clinician

More clinically significant information readily available

Greater recovery improvements for time

invested

Improved allocation of caseload balance

Tools to aid in identifying appropriate services for a

consumer

Question and Discussion:How do your staff influence consumer recovery?

Development of Wellness Culture

> Which of the following are elements of a Wellness Culture?A. Bringing out the best in everyoneB. Support and encouragementC. Celebration and funD. Believing anything is possible!E. All of the above

MHCD Wellness Culture> We intentionally bring out the best in ourselves and

others by:> Seeing everyone’s strengths> Supporting and encouraging one another> Celebrating staff, accomplishments, and diversity> Respecting ourselves and others> Listening to each other> Creating an environment of healthy and positive

relationships and community partnerships> Believing everyone wants to be great> Being passionate about our mission and having fun in

the process> Believing anything is possible!

How to Define and Develop YourWellness CultureA. Adopt MHCD’s definitionB. Have top management define itC. Use the authoritative definition from Who Moved My

Cultured Cheese?D. Take lots of time and many iterations to get it rightE. All of the aboveF. None of the above

Building our definition of Wellness Culture: How did we do it?

> After common experience of Pathways leadership training

> All Managers Meeting> Structured creative process

• Brainstorming• Flip charts• Table discussion groups• Organizing themes• Movement and discussion• Recording and projecting changes• Completed and accepted by the end of the meeting!

MHCD ValuesWe, the staff, consumers, and governing board of MHCD, value:> Consumer recovery and resiliency fueled by hope and

encouragement toward consumer goals> Compassion and empathy> Service excellence, efficiency, and effectiveness to meet the

needs of consumers and the community> A wellness culture that recognizes, respects, and develops the

strengths of consumers, staff, and our partnerships in the community;

> Honesty, integrity, and ethical behavior in all our actions, communication, and relationships;

> Diversity in our workplace, relationships, and community; > Innovation, creativity, leadership, and flexibility> Green sustainability to protect the environment and reduce waste

in all our valued resources.

Creation of our Values Statement: How many people participated in identifying values?

A. 1: The chairperson of the boardB. 2: Roy and Linda made it upC. 50-60 managersD. 300-400 employeesE. 300-412

Creation of our Values Statement

> How many people participated in identifying values?A. 1: The chairperson of the boardB. 2: Roy and Linda made it upC. 50-60 managersD. 300-400 employeesE. 300-412Facilitated group activity at All-Staff meetingsConsumer/Staff Partnership Council

Breaking Rules, Leading, and Putting Our Strengths to Work> First Break All the Rules

by Marcus Buckingham & Curt Coffman> The Gallup 12 = Q12 = “The Measuring Stick”> Simplest and most accurate way to measure the

strength of the workplace

First Break All the RulesMarcus Buckingham & Curt Coffman> The 12 questions:

1. Do I know what is expected of me at work2. Do I have the materials and equipment I need to do my work

right?3. At work, do I have the opportunity to do what I do best every

day?4. In the last seven days, have I received recognition or praise

for doing good work?5. Does my supervisor, or someone at work, seem to care

about me as a person?6. Is there someone at work who encourages my

development?

The 12 Questions: Continued

7. At work, do my opinions seem to count?8. Does the mission/purpose of my company make me

feel my job is important?9. Are my co-workers committed to doing quality work?10.Do I have a best friend at work?11. In the last six months, has someone at work talked to

me about my progress?12. This last year, have I had opportunities at work to

learn and grow?

Now Discover Your StrengthsMarcus Buckingham & Donald Clifton, Ph.D.> Describes in detail the strengths-finder process> Describes how to manage people with the different

strengths> Discusses how to build a strengths-based

organization

Go Put Your Strengths to WorkMarcus Buckingham> Set out format for how to maximize the use of your

strengths in the workplace> Sets course for how to build on the strengths of

others and to maximize their strengths in the workplace

Strength Based Leadership

> Strength Finder assessment of the 34 themes> Organizes themes into Domains

• Executing• Influencing• Relationship Building• Strategic Thinking

> Individuals don’t have to be well-rounded> Rounding out your teams

Example: Team Strengths by DomainTeamMember Executing Influencing Relationship Building Strategic Thinking

Kyle Achiever MaximizerStrategic, Learner,

Ideation

SandyResponsibility,

ArrangerRelator,

Individualization Learner

Mike Deliberative ConnectednessLearner, Intellection,

Input

Kim Deliberative

Individualization, Connectedness, Developer Intellection

Susan Achiever Maximizer Connectedness, Relator Strategic

Jerry ConnectednessLearner, Analytical,

Ideation, Intellection

Sam

Empathy, Positivity, Adaptability, Developer Context

Bob MaximizerIdeation, Strategic,

Learner, Futuristic

Catalytic CoachingGarold L. Markle> Provides detailed alternative to traditional

performance evaluation which enables people to create a course to maximize strengths and accomplishments• Employee input sheet• Coaches perception• Employee creates plan

Small groups—

> What is one thing we can implement at our center toward recovery-focused transformation?

> What will be the value of this action?> 15 minutes

Large Group—Report Out

Let’s Get Started…

>In transforming to a Recovery Focused Mental Health Center!

>Anything is possible>Enjoy your journey!