Case Management to Care Management: Trends and Lessons 2015 Subtitle Joan Kenerson King RN, MSN, CS Senior Integration Consultant joank@thenationalcouncil.org Objectives: Identify emerging roles for new and existing members of the behavioral health workforce. Describe the challenge for staff of managing traditional understandings of their role and new expectations and two strategies to address this challenge. 1
What have we learned? In times of change, learners inherit the Earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists (Eric Hoffer) 2
Three Approaches to Organizational/System Change: Additive Starting an integrated care program Selective Extending integration to different programs within the organization, aligning some policies, practices. Cultural, values based change drives practice, community, policy and fiscal changes in all parts and levels of the system. Everything is viewed through the lens of and aligned with a whole health approach from the front door to the back. Achara-Abrahams,I., Evans, A., King, Joan Kenerson : Recovery Focused Behavioral Health Care System Transformation: A Framework for Change and Lessons Learned, In Kelly, J. & White, W. Addiction recovery management: Theory, science and practice. New York: Springer Science (2010) 4 Transformation of Behavioral Health: www. T h e N a t i o n a l C o u n c i l. o r g Whole Health Wellness Recovery/Resilience Integrated and coordinated care Primary care partnerships: Inside and outside Prevention and screening Population health management Data driven care Knowledge of mind/body connections Increased Health Literacy Care Coordination Care Transitions Organizational culture of wellness Health Behavior Change Activation Stage Wise Interventions Motivational Interviewing Person Centered Planning Community Connections Cultural Humility Activated Hope 3
Health Literacy is key Using the resources you have: prescribers, nurses Reinforcing the message: monthly emphases, focus in team meetings Community connections increase learning Helping staff balance both is key Shifting not adding: how many things can staff focus on? Helping staff focus on the connections, not on the either or. Using the whole team to find the balance 4
Expanding the members of our team: community health workers CHW Definition Community health workers are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language,socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, promotores(as), 1 outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening. (HRSA) What is a Community Health Worker? Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. (World Health Organization, January 2007) 5
Workforce Complementarity CHW Lived experience, community knowledge, skills and abilities CPS RS Modeling the change you want: the key role of supervision What went well since last time (going for the strength) What is your agenda for today (collecting what is important) Where can I help, what do we want to brainstorm about? What people are particularly challenging for you right now? What plans might we make for you to try between now and when we meet? (applying rapid cycle change principles) What else do you need from me? Appreciations 6
Using data to help people learn to ask better questions Count, count, count Target Keep it simple Help staff learn to ask questions. Celebrating successes, tracking progress Individual, team and organizational measures Stories and statistics 7
Supporting care transitions: the next frontier Who does it? How do they do it? What kind of relationship supports a care transition? What skills are needed? What questions need to be asked? Cultural humility; knowing we don t know Adherence is a complex thing ask the why and the what? Our culture around sickness, health, food, movement and priorities impact us Understanding someone s apparent inability to change requires getting to the underside 8
Creating opportunities: Cutting the curbs People can t change what they don t know People can t change without a plan and the skills to adapt the plan People can t connect to the community to support their health if they don t know where to go Balancing Change: Building Resilience "Highly resilient people are best suited for a world of constant change. They don't fight against disruptive change because they adjust to new situations quickly. They accept change and deal with it. Resilient people's flexibility and adaptability lets them adjust their responses to achieve positive outcomes in new situations. -- Al Siebert, Theresliencycenter.com 9
Resources to support your change Case management to care management Adult Child Supervisor Behavioral health training for community health workers Brief intervention Motivational interviewing Contact: Dawn Tenia (dawnt@thenationalcouncil.org) Safe Travels Home and Thank you!!! 10