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Webinar by Dr. Paul Poplawski addressing Recovery-Oriented Systems of Care and the Partners for Change Outcome Management System. The similarities in values make them a natural fit--ROSC and PCOMS.
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https://heartandsoulofchange.com 3/31/2014
ROSC & PCOMS:TRANSFORMING DELIVERYDELIVERY SYSTEMS
Paul Poplawski, PhD LLC
302/737-8738
htt // li k di /i / l l kihttp://www.linkedin.com/in/paulpoplawski
https://heartandsoulofchange.com 3/31/2014
WEBINAR PRESENTER
32 years in the State of Delaware SUD & MH public system; member of the executive staff; directed the statewide professional
f Sdevelopment function; directed the Summer Institute in partnership with the U of DE
Psychologist in private practice from 1976 through the early 2000s
10 years as a fulltime independent consultant with a focus on public behavioral health system transformation
More than a passing acquaintance with PCOMS – assisting with the implementation of PCOMS in the Philadelphia DBHIDS
http://www.linkedin.com/in/paulpoplawski
Personal transformation
PAUL POPLAW SKI , PHD LLC [email protected] 3
AFFINITY GROUP
Colleagues who are making both individual and collaborative
contributions to what is contained in this presentation.
William White > www.williamwhitepapers.com
Arthur Evans, Ph.D. > dbhids.org/arthur-c-evans-jr-ph-d/
Ijeoma Achara, Psy.D. > http://www.attcnetwork.org/userfiles/file/GreatLakes/Webinars/Ijeoma%20Achara%20Bio.pdf
Joan King > joankkingconsulting.com Joan King joankkingconsulting.com
Barry Duncan, Psy.D. > heartandsoulofchange.com
PAUL POPLAW SKI , PHD LLC [email protected] 4
https://heartandsoulofchange.com 3/31/2014
OBJECTIVES
Provide definitions and the underlying value base of a recovery-oriented system of care (ROSC) and recovery/resilience oriented servicesrecovery/resilience-oriented services
Present the features of a recovery-oriented service approach
System Transformation Examine the relationship of ROSC and PCOMS Present the Philadelphia story of recovery system
transformation and the adoption of PCOMS for one level of carecare
Provide time for discussion and questions.
PAUL POPLAW SKI , PHD LLC [email protected] 5
WHY ROSC, WHY NOW
Communities of peers, advocacy groups, families, communities demanding choice, a voice, self-determination
Access to services – unmet need
Insufficiency of “therapy” for those in the public system
Myopic view of the policies and practices necessary for healing and recovery
Lack of continuing care
Low retention
Lacking a commitment to peer support
PAUL POPLAW SKI , PHD LLC [email protected] 6
https://heartandsoulofchange.com 3/31/2014
PARADIGM SHIFT
System Transformation >
Create a system of care that accomplishes the following:Create a system of care that accomplishes the following:
Provides the necessary supports that are “actually” individualized, meaningful and sufficient in addressing the clinical, social, emotional, interpersonal, aspirational domains of a person’s life and do so through authentic partnership, the communication of hope, the igniting of individual strengths, with an overall goal of achieving a solid interdependent relationship with people and resources in the community – a quality of life that we all desire!!
PAUL POPLAW SKI , PHD LLC [email protected] 7
DEFINING ROSC
A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk for substance use and all other behavioral health challenges. (adapted from CSAT)
Achieving this requires transformation at the system (financing, regulations, etc.), provider, staff, participant and community levels to accomplish
https://heartandsoulofchange.com 3/31/2014
ROSC – A DEEPER DIVE
The phrase recovery-oriented systems of care (ROSC) refers to the complete network of indigenous and professional services and relationships that can support the long-term recovery of individuals and families and the creation of values and policies in the larger cultural and political environment that are supportive of these recovery processes. The system in this phrase is not a federal, state, or local agency, but a macro level organization of the larger cultural and community environment in which long-term recovery is nested.
William White, 2008
PAUL POPLAW SKI , PHD LLC [email protected] 9
PRIMARY GOALS OF A ROSC
Prevent the development of behavioral health conditions (e.g. Mental Health First Aid)
Intervene earlier in the progression of illnesses (e.g. Assertive outreach practices)
Reduce the harm caused by behavioral health conditions (e.g. rapid engagement)
Help people transition from brief experiments in recovery initiation to recovery maintenance (e.g. recovery planning driven by the person)
Acti el promote a holesome q alit of life comm nit health and Actively promote a wholesome quality of life, community health and wellness for all (public health orientation)
PAUL POPLAW SKI , PHD LLC [email protected] 10
https://heartandsoulofchange.com 3/31/2014
ROSC VALUES & PRINCIPLES
Person-centered; person-driven
Many pathways to recovery Many pathways to recovery
Family & other ally involvement; peer support
Individualized; communicate hope
Systems anchored in the community
Continuity of care
Partnership-consultant relationships
Strength-based Strength based
Culturally responsive, culturally-based & influenced
Responsiveness to personal belief systems
Embedded in social networks and relationships
ROSC ORIENTATION TO SERVICES
Integration of primary healthcare and behavioral health treatment
Peer culture, peer support, recovery coachingPeer culture, peer support, recovery coaching
Life domain orientation
Employment, education, opportunities
Real community involvement
Recovery/treatment plans live in the community
Involving everyone in the change process
https://heartandsoulofchange.com 3/31/2014
PrimaryFocus
Traditional Treatment Model
Love,
Work, & Play
ocus
Community Life
Treatment
13
Housing, Faith, & Belonging
Primary
In the model. clinical care is viewed as one of many resources needed for successful integration into the community
Recovery and Resilience Oriented System of Care
Faith
Work or school
Social Peer
support
Treatment &rehab
yFocus
Community Life
14
support
Belonging Family
Housing
support
https://heartandsoulofchange.com 3/31/2014
3 APPROACHES TO RECOVERY-FOCUSEDSYSTEM CHANGE (HANDOUT)
1. Additive Approach: adds non-clinical recovery support services1. Additive Approach: adds non clinical recovery support services
2. Selective Approach: a focus on treatment practices of select programs or in particular LOC and incorporating recovery support services into the system
3. Transformative Approach: entire system change including the context in which it operates – clinical, non-clinical, fiscal, policy, community and social contexts within which the system operates
15
KOTTER’S STRATEGIES FOR SYSTEM TRANSFORMATION
1. Establishing a sense of urgency
2. Forming a powerful guiding coalition
3. Creating a vision
4. Communicating vision
5. Empowering others to act on the vision
6. Planning for and creating short-term wins
7. Consolidating improvements and producing still more change
8. Anchoring new approaches in the culture
John Kotter, Leading Change, 1996
PAUL POPLAW SKI , PHD LLC [email protected] 16
https://heartandsoulofchange.com 3/31/2014
4 ROSC Building Blocks
Optimize clinical service delivery
Add and integrate recovery
support services
Fiscal and Administrative Policy
& Procedures
Build Cross-Systems Partnerships and Community Recovery Capital
PAUL POPLAW SKI , PHD LLC [email protected] 17
Community Recovery Capital
OPTIMIZE CLINICAL SERVICE DELIVERY Provide Recovery-Oriented Services
Attraction via Assertive Outreach and Engagement
Holistic Screening, Assessment and Service Planning
Expanded Composition of the Service Team
Collaborative Service Relationships
Focus on Community Integration
Assertive Linkages to Communities of Recovery
Post-treatment Monitoring Support and Early Re-intervention
Clinical Supervision & PCOMS
PAUL POPLAW SKI , PHD LLC [email protected] 18
https://heartandsoulofchange.com 3/31/2014
FAILURE TO MEASURE BENEFIT IN A TRADITIONAL SYSTEM OF CARE
System focus on volume
System focus on individual service achievement – poor designs, System focus on individual service achievement poor designs, unworkable, inaccurate and rarely support the clinical process
System focus on accountancy not clinical progress
We are not in the business of “manufacturing” recovered persons
“Outcomes” are typically understood through data that serves as proxies of program or provider performance and almost always from the perspective of the provider – proxies are important but insufficientinsufficient
PAUL POPLAW SKI , PHD LLC [email protected] 19
ROSC & OUTCOMES
Infancy
Continued use of traditional methods – volume dataContinued use of traditional methods volume data
Presence of ROSC alignment tools
Anecdotal, self-report
Peer stories
Poor quality in service organizations’ use of data
Lack of clinical supervision – changing with ROSC
Prior ROSC History of collecting information documentation Prior ROSC - History of collecting information, documentation, etc. that reinforced traditional approach to services or that laid dormant
PAUL POPLAW SKI , PHD LLC [email protected] 20
https://heartandsoulofchange.com 3/31/2014
WHAT DO ROSC & PCOMS SHARE?
Values base: empowered service recipients; voice; self-determination
Focus on multiple life domains > PCOMS reinforces this
Dynamic, in motion, useful, feasible
Recovery work and PCOMS connect to the person’s aspirations and are purposeful – another way of saying this ….
Both identify issues that are occurring in the foreground without losing sight of the person’s aspirations
Both squarely focus on achievement, progress, goals, and the work necessary by both the person and helper
Serve to ignite the clinical supervisory process
PAUL POPLAW SKI , PHD LLC [email protected] 21
SHARE, CONTINUED
Quality of the relationship is underscored
Failure to progress is almost always a shared responsibilityFailure to progress is almost always a shared responsibility
ROSC is undergirded by an expectation of the person’s choice for what, how and with whom services are to rendered – PCOMS provides the data to analyze the outcomes of those choices
Both are action oriented
Both are strength-based
PAUL POPLAW SKI , PHD LLC [email protected] 22
https://heartandsoulofchange.com 3/31/2014
ROSC & PCOMS AS SYMBIOTIC
ROSC provides a healthy environment to seed an implementation of PCOMS
PCOMS provides a persistent reinvigoration to the underlying intentions of a ROSC
The process of discussing ORS/SRS findings between service recipient and staff person enlivens and informs the intensity believed to be necessary in using recovery plans as roadmaps to a preferred future
PCOMS and ROSC form their own accountability partnership PCOMS and ROSC form their own accountability partnership
PCOMS and ROSC require a change in thinking on everyone’s part
Reinforcing of one another
PAUL POPLAW SKI , PHD LLC [email protected] 23
PHILADELPHIA STORY
One billion dollar behavioral health organization
Arthur Evans, Ph.D. – a vision of a transformed system and the courage to drive it forward
Concept – Practice - Context
Intentional & Organized: Blueprint for Change
Multidimensional – work at the all levels of the system
Pioneers, early adopters, emphasis on experimentation & learning
Community Integrated Recovery Centers (CIRC)
Practice Guidelines Practice Guidelines
PCOMS
PAUL POPLAW SKI , PHD LLC [email protected] 24
https://heartandsoulofchange.com 3/31/2014
LESSONS LEARNED FROMIMPLEMENTING A ROSC
Resilient leadership Conceptual clarity Non-linear, non-sequential, many balls in the air – ability to tolerate
ambiguity Preparation is important but often you must just pull the trigger Requires rethinking the role and relationship between the funding
agency and the organizations supported Some people don’t make it A change in thinking is fundamental to success The critical role of peers can not be overstatedp CDOI, PCOMS along with solid recovery-oriented clinical practice is
a recipe for success
PAUL POPLAW SKI , PHD LLC [email protected] 25
ROSC RESOURCES
Transformation of Behavioral Health Services in Philadelphia: Practice Guidelines for Recovery and Resilience Oriented Treatment (http://www.dbhids.org/assets/Forms--Documents/transformation/PracticeGuidelines.pdf)
Peer Culture, Peer Support, and Peer Leadership > http://www.dbhids.org/assets/Forms--Documents/4.2.1.3-PDF-8.pdf
Community Integration > http://www.dbhids.org/assets/Forms--Documents/4.2.1.3-PDF-10.pdf
Person First Assessment and Person Directed Planning > http://www.dbhids.org/assets/Forms--Documents/personFirst.pdf
The Recovery Revolution for Children and Adolescents http://www.dbhids.org/assets/Forms--Documents/personFirst.pdf > http://www.dbhids.org/assets/Forms--Documents/transformation/BillWhite/2009RecoveryRevolutionChildAdolescents.pdf
http://partnersforrecovery samhsa gov/docs/Guiding Principles Whitepaper pdf http://partnersforrecovery.samhsa.gov/docs/Guiding_Principles_Whitepaper.pdf
PAUL POPLAW SKI , PHD LLC [email protected] 26