System Transformation In Philadelphia: A Recovery Revolution

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1 System Transformation In Philadelphia: A Recovery Revolution Philadelphia Department of Behavioral Health and Mental Retardation Implementation Strategies Roland Lamb, Director Office of Addiction Services State Systems Development Program (SSDP VIII) Conference: Partnering to Support Recovery- Oriented Systems of Care Washington D.C. August 20 22, 2008

2 Back Ground: The Philadelphia System! $1 Billion mental health and addictions system serving over 100,000 people annually! City (county) manages all behavioral health (adult & children) funding streams including Medicaid dollars

3 Back Ground: The Philadelphia System! Medicaid managed through a city-owned 501(c)3 Managed Behavioral Healthcare Organization! 5-year plan to completely transform the System of Care at all levels! Using multi-level approach which includes practice, program and policy level strategies

4 Building the Conceptual Framework A Declaration of Principles and a Blueprint for Change A Recovery Focused Transformation of Behavioral Health Services in Philadelphia

5 The Philadelphia Model Key Principles:! Overarching recovery framework for systems development! Emphasis on the voice of the consumer, family and community! Individualize treatment by addressing: " Trauma, " Co-occurring conditions, " Appropriate developmental stage, " Person First, " etc.! Using data, science and technology to inform policy and practice

6 The Philadelphia Model Key Principles:! Address known health disparities! Intervene and Build at the Community level! Change fiscal and administrative policy, as well as service delivery! Treatment + Recovery Support

7 Declaration of guiding principles and blueprint for change:! Built on the findings and recommendations of the recovery asset baseline assessment! Describes the long-term vision for the system! Identifies short-term priorities! Describes implications for diverse stakeholders! Outlines phases, goals and timelines

8 Declaration of guiding principles and blueprint for change:! Provides a conceptual framework for future planning:

9 Phases, Goals, and Timelines Phase I: January September 2006! Generate Consensus, Develop Conceptual Clarity, Identify Assets and Opportunities Phase II: September 2006 June 2008! Implement initial practice priorities, reorient DBH/MRS practices, identify areas in need of regulatory relief, increase leadership of people in recovery, increase community support

10 Phases, Goals, and Timelines Phase III: July June 2010! Use evaluation data to modify priorities, enhance recovery oriented practices at DBH/MRS and providers based on lessons learned, develop models of recovery oriented practices, obtain broader community support, increase advocacy based on successes within the system and identified barriers Phase IV: July 2010 June 2012! Utilize the feedback cycle and evaluation data to continue enhancing the system, focus on developing a data driven system of care

11 PHASE ONE Major Focus Conceptual Alignment! Development of Philadelphia Recovery Definition! Guiding Values and Principles Identified by Recovery Advisory Board (RAC)! Numerous Conferences! Prevention and Day Transformation RFIs! Recovery Foundations Training! First Fridays Series! Transformation Documents

12 Philadelphia Recovery Definition Recovery is the process of pursuing a fulfilling and contributing life regardless of the difficulties one has faced. It involves not only the restoration but continued enhancement of a positive identity and personally meaningful connections and roles in ones community. Recovery is facilitated by relationships and environments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members. Philadelphia Recovery Advisory Committee, 2006

13 Guiding Values and Principles! Hope! Choice! Partnership! Spirituality! Family inclusion! Self-direction/empowerment! Peer culture/peer support! Consumer Leadership! Community integration/opportunities! Holistic and wellness approach

14 PHASE TWO Major Focus Practice + Contextual Alignment! Identification of Priority areas through the recovery assessment process and the RAC! Community inclusion/opportunity! Holistic Care! Peer culture/peer support/peer leadership! Family inclusion and leadership! Partnership! Extended recovery support! Quality of care

15 PHASE TWO Cont d! DBH/MRS Internal Practice Alignment # Complete integration of CBH/BHSI # Unit Recovery Plans # Reconfigure existing services (e.g. Day transformation, addictions services..) # Hiring of people in recovery and family members as consultants # Systems Relationships # Internal Restructuring/ Internal Accountability # Strategic Planning Unit

16 PHASE TWO Cont d! DBH/MRS Context Alignment # Strengthening Partnerships with sister agencies, DHS, prisons, schools, etc.. # Developing new partnerships with organizations that provide vocational, educational and housing services # Active Partnership and advocacy with OMHSAS on day transformation # Advocacy with BDAP regarding co-occurring services # Developing financing mechanisms for peer specialists in D&A programs # Identification of additional areas of regulatory relief needed to support the advancement of our priorities

17 Transforming Addiction Treatment! We are a system focused on an Acute Care model # It s broke we fix it # Works well in the crisis! We are transforming to a Recovery Management focused model # Disease Management # Addresses complexity

18 Transforming Addiction Treatment Recovery Vision Practice Alignment Concepts Education Education & Training Training Workforce Coordination Community Initiatives Care Care Management Management Culture Culture and and Diversity Diversity Funding Funding Technologies Integration Decision Making Processes Processes

19 PHASE TWO Cont d DBH/MRS Context Alignment! Anti Stigma Media Campaign! Increased Community Education (e.g. faith based Initiative)! Collaborative relationships with Political Leaders! Stronger connections between formal and informal treatment supports! Increased collaboration between physical and behavioral health

20 PHASE TWO Cont d Provider Practice Alignment! Aligning practices with a recovery orientation will impact the following domains: # Service Engagement # Service Access # Partnership with Persons in Recovery # Service Relationship # Assessment and Clinical Care # Locus of Service Delivery # Post Treatment Checkups and Supports # Relationship to Community

21 PHASE TWO Cont d Provider Practice Alignment! In order to support practice alignment in the provider community, DBH/MRS will: # Provide Advanced Recovery Trainings # Offer Train the Trainers Trainings # Distribute Resource Packets # Support Demonstration Projects # Offer Site Based Technical Assistance # Host Community forums # Enhance organizational capacity through the development of change management teams # Provide incentives for innovation and alignment

22

23 Three Overarching Strategies 1. Build Community Capacity 2. Enhance the Quality of Treatment 3. Change Administrative Structures

24 1. Build Community Capacity! Purpose is to develop the non-treatment community resources to have the ability to effectively support long term recovery outside of treatment

25 Pathways To Recovery ONE GOAL RECOVERY Effective Clinical Care Faith Based Grassroots Natural Supports Prevention & Intervention Programming Housing Supports Expand Recovery House Network Initiatives Social Supports Peer Specialist Consumer Storytelling Employment Supports

26 Faith-Based Initiative! skskskks Locations of Faith-Based Community Forums Broad Geographic Coverage 28 Faith-Based Community Forums and 766 other outreach events

27

28

29 Example: Increasing the Voice of the Consumer! Support for Pro-Act and other organizations of Recovering People! Story Telling Training & developing leaders! People in Recovery s participation throughout the decision-making process

30 2006 Recovery Walk

31 2. The Quality of Treatment Enhancement! Purpose is to improve treatment services so that increase the probability of initiating long-term recovery! Examples: Evidence Based Practices, Network to Improve Addictions Treatment, Health Disparities/Cultural Competency initiative, Cross-Systems Collaboration, Peer Specialist

32 Example: Beck Initiative (Evidence-Based Practice) $ Partnering with Dr. Aaron Beck to Implement Cognitive Therapy throughout the Philadelphia service system $ Studying strategies for disseminating evidence-based practices Dr. Aaron T. Beck & Dr. Judith S. Beck, Director with 5-Day Cognitive Therapy Workshop participants Nov. 7, 2007

33 Example: Peer Specialist Initiative! Trained 200 persons in mental health and addictions recovery by end of 2008! Over 80% have obtained employment in the treatment system, to date! Highly effective in engaging and supporting people in treatment

34

35 Examples: Individualizing Services! Services must be tailored to the unique needs of individuals to be most effective.! Research shows which issues are important to address to improve outcomes.! Below are some examples of current initiatives: " Trauma Initiative " Person-First Initiative (cultural diversity) " Co-Occurring Initiative

36 3. Change Administrative & Fiscal Policy! Purpose is to change the way business is done to better align with and support the principles of recovery management! Examples: rate adjustments, Advisory Panels - integrate the voice of consumers, changing what is reimbursable, identifying and measuring recovery indicators, increasing use of technology to improve efficiency

37 Examples: Financial Strategies! Project and reinvest savings into innovative recovery oriented services! Help build provider infrastructure to increase efficiency of the service system (e.g., grants to computerize all data submission)! Provide incentives for support of Recovery! Change managed care rules to better address the treatment needs of special populations (e.g., homeless individuals receive longer length of stays)

38 Implementation Strategies Lessons Learned

39 Lessons Learned: Challenges and Opportunities! Systemic Approach! Need for Dedicated Infrastructure to implement change! Treatment Services Can be Enhanced (it s not just adding recovery support services)! Build consensus beyond the usual suspects

40 Lessons Learned: Challenges and Opportunities! Reconciling client choice and best practices! Resource allocation: more flexible funding streams! Changes in administrative infrastructure, particularly the policy of other state agencies

41 Lessons Learned: Challenges and Opportunities! Significantly improving long-term recovery outcomes will require a radical reengineering of addiction treatment as a system of care. Rather than system refinement, they are advocating a fundamental shift in thinking # [1], a paradigm shift # [2], a fundamental redesign

42 Lessons Learned: Challenges and Opportunities! Continued # [3], a seismic shift rather than a mere tinkering # [4], and a sea change in the culture of addiction service delivery # [5]. Bill White ATTC Draft [1] Moos, R.H. (2003). Addictive disorders in context: Principles and puzzles of effective treatment and recovery. Psychology of Addictive Behaviors, 17, [2] Dennis, M.L., Scott, C.K., Funk, R., & Foss, M.A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, S51-S62. [3] White, W. (2005a). Recovery management: What if we really believed that addiction was a chronic disorder? GLATTC Bulletin, September, 1-8. Chicago, IL: Great Lakes Addiction Technology Transfer Center. [4] Humphreys, K. (2006a). Closing remarks: Swimming to the horizon reflections on a special series. Addiction, 101, [5] Miller, W.R. (2007). Bring addiction treatment out of the closet, Addiction, 102,

43 CONTACT INFORMATION Roland Lamb Director of the Office of Addiction Services Philadelphia Department of Behavioral Health and Mental Retardation Services 1101 Market St, 8 th Floor Philadelphia, PA

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