LOS ANGELES COUNTY MENTAL LOS ANGELES COUNTY MENTAL HEALTH SYSTEM HEALTH SYSTEM

TRANSFORMATION:TRANSFORMATION:The Role of Recovery-Oriented The Role of Recovery-Oriented

LeadershipLeadershipand the Milestones of Recovery and the Milestones of Recovery

ScaleScale

Dave Pilon, Ph.D.Dave Pilon, Ph.D.

Director of Training, Consultation and Director of Training, Consultation and EvaluationEvaluation

Mental Health Association of Greater Mental Health Association of Greater Los AngelesLos Angeles

dpilon@mhala.org

Recovery-Recovery-Oriented Oriented

LeadershipLeadershipCan the experience of ourCan the experience of our

members in recovery inform members in recovery inform usus

in how we lead our in how we lead our organizations?organizations?

The ROL FormatThe ROL Format

Provide novel and challenging ideas and Provide novel and challenging ideas and frameworks for thinking about the relationship frameworks for thinking about the relationship between recovery, leadership and organizational between recovery, leadership and organizational change.change.

Present and use self-assessment tools for evaluating Present and use self-assessment tools for evaluating the current status of an organization within each of the current status of an organization within each of the four ROL target areas.the four ROL target areas.

Provide a forum for frank dialogue between leaders Provide a forum for frank dialogue between leaders which surfaces common struggles and achievements which surfaces common struggles and achievements in their organizations within the ROL framework.in their organizations within the ROL framework.

Plan for organizational change using the experience Plan for organizational change using the experience and help of other leaders.and help of other leaders.

STAGES OF RECOVERYSTAGES OF RECOVERY(Mark Ragins, M.D.)(Mark Ragins, M.D.)

HOPEHOPEEMPOWERMENTEMPOWERMENTSELF-RESPONSIBILITYSELF-RESPONSIBILITYMEANINGFUL ROLESMEANINGFUL ROLES

The translation of the The translation of the four recovery “stages” four recovery “stages”

into four corresponding into four corresponding leadership tasksleadership tasks

Hope = HopeHope = Hope Empowerment = AuthorityEmpowerment = Authority Self-Responsibility = HealingSelf-Responsibility = Healing Meaningful Roles = Community Meaningful Roles = Community

EngagementEngagement

HOPEHOPE

Having a vision that is worth working Having a vision that is worth working towards.towards.

Communicating a compelling vision/mission Communicating a compelling vision/mission that resonates among clients, staff and the that resonates among clients, staff and the community.community.

Acknowledging the significant barriers to Acknowledging the significant barriers to system change, including the possible doubts, system change, including the possible doubts, disappointments and cynicism from past, disappointments and cynicism from past, failed change efforts.failed change efforts.

Believing that things can improve and the Believing that things can improve and the vision is achievable.vision is achievable.

AUTHORITYAUTHORITY

Believing that we have the power Believing that we have the power to decide our future and take to decide our future and take meaningful action based on our meaningful action based on our beliefs and desires.beliefs and desires.

Practicing empowerment Practicing empowerment strategies that promote strategies that promote responsibility and risk-taking responsibility and risk-taking among our clients, staff and among our clients, staff and stakeholders in moving forward stakeholders in moving forward despite uncertainty.despite uncertainty.

HEALINGHEALING

Acknowledging the parts of us that Acknowledging the parts of us that need healing and receive compassion need healing and receive compassion and encouragement as we work and encouragement as we work towards finding wholeness and health.towards finding wholeness and health.

Helping staff and clients to discover Helping staff and clients to discover and use their passions, life and use their passions, life experiences, struggles and core values experiences, struggles and core values in receiving or providing services.in receiving or providing services.

COMMUNITY COMMUNITY ENGAGEMENTENGAGEMENT

Believing that we can be a part of Believing that we can be a part of the community in which we live, the community in which we live, make a contribution and be make a contribution and be accepted for who we are.accepted for who we are.

Initiating routine, systematic Initiating routine, systematic interactions and forming interactions and forming relationships with community relationships with community resources that support access to resources that support access to meaningful roles for clients and meaningful roles for clients and staffstaff

Los Angeles County DMHLos Angeles County DMHRecovery-Based System Recovery-Based System

TransformationTransformation Domain One: Staff TransformationDomain One: Staff Transformation

Goal One: Develop and enhance staff belief Goal One: Develop and enhance staff belief in recoveryin recovery

Goal Two: Energize and instill hope in staffGoal Two: Energize and instill hope in staff Domain Two: Staff-Consumer Domain Two: Staff-Consumer

InteractionsInteractions Develop welcoming environmentsDevelop welcoming environments Develop successful strategies to work with Develop successful strategies to work with

challenging individualschallenging individuals

Los Angeles County DMHLos Angeles County DMHRecovery-Based System Recovery-Based System

TransformationTransformation Domain Three: Organizational Structures Domain Three: Organizational Structures

and Processesand Processes Goal One: Collect and use Goal One: Collect and use Quality of LifeQuality of Life and and

Recovery-BasedRecovery-Based Outcomes Outcomes Goal Two: Develop structures to promote Goal Two: Develop structures to promote

consumer consumer flowflow through the system through the system Domain Four: Available Services / CapacityDomain Four: Available Services / Capacity

Goal One: Develop quality of life support Goal One: Develop quality of life support servicesservices

Goal Two: Strengthen collaboration with other Goal Two: Strengthen collaboration with other social service agenciessocial service agencies

Goal Three: Develop community belonging and Goal Three: Develop community belonging and connectionconnection

Domain One: Employee AwarenessDomain One: Employee AwarenessGoal One: Goal One: Develop and enhance staff Develop and enhance staff

belief in recoverybelief in recovery

Stories of Hope and Recovery. Quarterly, Stories of Hope and Recovery. Quarterly, one consumer/staff pair, chosen by the team, one consumer/staff pair, chosen by the team, will dialogue about the recovery process will dialogue about the recovery process from the perspective of hope, authority, from the perspective of hope, authority, healing, and community engagement. healing, and community engagement. Present at next staff meeting and March 9 Present at next staff meeting and March 9 first one.first one.

Weekly leadership meetings and weekly Weekly leadership meetings and weekly team meetings will discuss an aspect of team meetings will discuss an aspect of Recovery Oriented Leadership. XXXXX and Recovery Oriented Leadership. XXXXX and leadership team will decide on a weekly topic leadership team will decide on a weekly topic to bring up with the staff. Begin Dec. 28.to bring up with the staff. Begin Dec. 28.

Domain Two: Employee/Client Interactive Domain Two: Employee/Client Interactive ProcessesProcesses

Goal One:Goal One: Create a more welcoming Create a more welcoming environmentenvironment

Improve waiting area with stuff for Improve waiting area with stuff for kids, make it “homey”, decorate for kids, make it “homey”, decorate for holidays, add illness information holidays, add illness information brochures brochures

Have a consumer greeterHave a consumer greeter Create a large display board that lists Create a large display board that lists

current wellness activities and other current wellness activities and other social and community events relevant social and community events relevant to consumersto consumers

Domain Three: Organizational Structures & Domain Three: Organizational Structures & ProcessesProcesses

Goal Two: Develop structures to promote Goal Two: Develop structures to promote consumer flow through the systemconsumer flow through the system

Establish a client’s “stage of Establish a client’s “stage of recovery” at intake screening, with recovery” at intake screening, with six months’ goalssix months’ goals

Based on stage of recovery, develop Based on stage of recovery, develop levels of care protocols on when/how levels of care protocols on when/how to make referrals to different to make referrals to different programs within the clinicprograms within the clinic

Domain Four: Available Services & Domain Four: Available Services & CapacityCapacity

Goal One: Develop quality of life Goal One: Develop quality of life support servicessupport services

Change the entire clinic operating system to Change the entire clinic operating system to a modified ACT format, to better serve a modified ACT format, to better serve clients needing immediate and intense clients needing immediate and intense service delivery effort. Target “meds only” service delivery effort. Target “meds only” early recovery cases and move them early recovery cases and move them towards wellness. Utilize client peer towards wellness. Utilize client peer counselors as a key resource. Establish a counselors as a key resource. Establish a time-limited ACT-like client caseload for time-limited ACT-like client caseload for clinical staff.clinical staff.

Features of a Recovery Features of a Recovery Community (CULTURE)Community (CULTURE)

WelcomingWelcoming Charity (Giving things away)Charity (Giving things away) TreatmentTreatment RehabilitationRehabilitation AdvocacyAdvocacy GraduationGraduation

MILESTONES OF RECOVERY MILESTONES OF RECOVERY SCALE: A System for Measuring SCALE: A System for Measuring

RecoveryRecovery

The Mental The Mental Health Services Health Services

ActAct““Planning for services shall be Planning for services shall be consistent with the philosophy, consistent with the philosophy, principles, and practices of the principles, and practices of the Recovery Vision for mental health Recovery Vision for mental health consumers…” (Section 7)consumers…” (Section 7)

Recovery (New Freedom Recovery (New Freedom Commission Final Commission Final

Report)Report)

Recovery refers to the process in which Recovery refers to the process in which people are able to live, work, learn, and people are able to live, work, learn, and participate fully in their communities. participate fully in their communities. For some individuals, recovery is the For some individuals, recovery is the ability to live a fulfilling and productive ability to live a fulfilling and productive life despite their disability. For others, life despite their disability. For others, recovery implies the reduction or recovery implies the reduction or complete remission of symptoms. complete remission of symptoms. Science has shown that having hope Science has shown that having hope plays an integral role in an individual’s plays an integral role in an individual’s recovery.recovery.

SAMHSA SAMHSA Consensus Consensus StatementStatement

““Recovery must be the common, recognized Recovery must be the common, recognized outcome of the services we support.”outcome of the services we support.”

……Charles Curie, Former Director, 2/6/06Charles Curie, Former Director, 2/6/06

What is Recovery?What is Recovery?

Many consumers speak about the Many consumers speak about the “process” of recovery in terms of their “process” of recovery in terms of their own internal experience – this is often own internal experience – this is often phrased in such terms as “becoming phrased in such terms as “becoming empowered,” “taking charge of my own empowered,” “taking charge of my own life,” “improving my self-esteem,” or life,” “improving my self-esteem,” or “becoming responsible for myself.”“becoming responsible for myself.”

The mitigation of psychiatric symptoms The mitigation of psychiatric symptoms and improvement in functioning.and improvement in functioning.

Finding and taking on meaningful roles Finding and taking on meaningful roles in one’s life.in one’s life.

Recovery Definition MatrixRecovery Definition MatrixService Provision/PracticesService Provision/Practices OutcomesOutcomes

ServiceServiceRecipientRecipientPerspectivePerspective

Recovery Self-Assessment (RSA)Recovery Self-Assessment (RSA)““Staff at this agency listen to and follow my Staff at this agency listen to and follow my

choices and preferences.”choices and preferences.”Consumer Recovery Outcome System Consumer Recovery Outcome System

(CROS) “How do I feel about the (CROS) “How do I feel about the choices I get about my care?”choices I get about my care?”

Recovery Oriented System IndicatorsRecovery Oriented System Indicators(ROSI) “I do not have enough good service (ROSI) “I do not have enough good service

options to choose from.”options to choose from.”

Internal Experience of the Client Internal Experience of the Client Consumer Recovery Outcome System Consumer Recovery Outcome System

(CROS) “I am coping better in my life” (CROS) “I am coping better in my life” Recovery Measurement Tool (RMT)Recovery Measurement Tool (RMT)““I participate in meaningful activities”I participate in meaningful activities”Spirituality Index of Well Being (SIWB)Spirituality Index of Well Being (SIWB)““There is not much I can do to make a There is not much I can do to make a

difference in my life”difference in my life”

ServiceServiceProvider/Provider/FamilyFamilyMember/Member/SystemSystemPerspectivePerspective

Fidelity to Specific PracticesFidelity to Specific PracticesEvidence-Based PracticesEvidence-Based PracticesClinical Strategies Implementation ScaleClinical Strategies Implementation ScaleAssertive Community Treatment (ACT)Assertive Community Treatment (ACT)Supported Employment (SE)Supported Employment (SE)

Symptom ReductionSymptom ReductionImprovement in FunctioningImprovement in FunctioningReductions in Adverse Impact Reductions in Adverse Impact

(hospitalization, incarceration, (hospitalization, incarceration, homelessness, mortality)homelessness, mortality)

Improved Quality of Life (Increases in Improved Quality of Life (Increases in independent living, employment, independent living, employment, education rates, more supportive social education rates, more supportive social network)network)

Components and Components and Milestones of RecoveryMilestones of Recovery

Components of RecoveryComponents of Recovery

1.1. Level of RiskLevel of Risk2.2. Level of EngagementLevel of Engagement3.3. Level of Skills and Level of Skills and

SupportsSupports

Milestones of RecoveryMilestones of Recovery

1.1. Extreme RiskExtreme Risk2.2. High Risk/UnengagedHigh Risk/Unengaged3.3. High Risk/EngagedHigh Risk/Engaged4.4. Poorly Coping/ Poorly Coping/

UnengagedUnengaged5.5. Poorly Poorly

Coping/EngagedCoping/Engaged6.6. Coping/RehabilitatingCoping/Rehabilitating7.7. Early RecoveryEarly Recovery8.8. Advanced RecoveryAdvanced Recovery

(Early) Recovery(Early) RecoveryThese individuals are actively managing their These individuals are actively managing their mental health treatment to the extent that mental health treatment to the extent that mental health staff rarely need to anticipate or mental health staff rarely need to anticipate or respond to problems with them. They are rarely respond to problems with them. They are rarely using hospitals and are not being taken to jails. using hospitals and are not being taken to jails. They are abstinent or have minimal impairment They are abstinent or have minimal impairment from drugs or alcohol and they are managing from drugs or alcohol and they are managing their symptom distress. their symptom distress. With minimal support With minimal support from stafffrom staff, they are setting, pursuing and , they are setting, pursuing and achieving many quality of life goals (e.g., work achieving many quality of life goals (e.g., work and education) and have established roles in the and education) and have established roles in the greater (non-disabled) community. They are greater (non-disabled) community. They are actively managing any physical health disabilities actively managing any physical health disabilities or disorders they may have (e.g., HIV, diabetes). or disorders they may have (e.g., HIV, diabetes). They are functioning in many life areas and are They are functioning in many life areas and are very self-supporting or productive in meaningful very self-supporting or productive in meaningful roles. They usually have a well-defined social roles. They usually have a well-defined social support network including friends and/or family.support network including friends and/or family.

Recovery-Based Service Recovery-Based Service DeliveryDelivery

UnengagedUnengaged Engaged, but poorly self-directedEngaged, but poorly self-directed Self-responsibleSelf-responsible

Measuring Recovery – Measuring Recovery – The Future?The Future?

Service Provision based on Service Provision based on MORSMORS

Case Rates based on MORSCase Rates based on MORS Mathematical Modeling of Mathematical Modeling of

RecoveryRecovery