Self-Assessment/Planning Tool for Implementing Recovery-Oriented Mental Health Services (SAPT)

Briefing: Agency for Health Care Administration

Friday, March 16, 2012

James Winarski, M.S.W.

Louis de la Parte Florida Mental Health Institute

What’s Different in a Recovery-Oriented Mental Health System?

Assumptions about the nature and course of mental illnesses

Expanded range of possible outcomes

Evolution of roles and responsibilities for consumers and practitioners

Louis de la Parte Florida Mental Health Institute

Recovery As Policy – 3 Pillars

Americans with Disability Act of 1990

Mental Health: A Report of the Surgeon General - 1999

New Freedom Commission: Achieving the Promise Report - 2003

Louis de la Parte Florida Mental Health Institute

Major Findings from Prior AHCA Studies

Agencies are in transition: consumers and staff are in a process of defining new roles and responsibilities.

Programs lack the conceptual frameworks and service implementation tools needed to support this transition.

There is no systematic way to ensure that the services described in the AHCA Handbook are being delivered at an acceptable level.

Florida has a range of disparate service activities that are recovery oriented, but there is currently no framework to coordinate these efforts.

(Winarski, J., Thomas, G., Dhont, K., & Ort, R. 2006)

(Winarski, J., Thomas, G., DeLuca, N. 2007)

Louis de la Parte Florida Mental Health Institute

The Self-Assessment/Planning Tool for Implementing Recovery-Oriented Mental Health Services (SAPT)

Baseline for Understanding: Provides clear definitions of the principles and practices of recovery-oriented services.

SAPT Survey: Describes a process (self-assessment) for establishing a baseline of performance (recovery-oriented services capability). 50 Items – Web Based Method

SAPT Planning and Implementation Guide: Provides a guide to assist agencies with establishing service priorities and the development of strategic plans.

Linkage to Outcomes: Supports the achievement of outcomes described in the Recovery Oriented Systems Indicators measure (ROSI).

(Winarski, J., Thomas, G., Hendry, P., and Robinson, P., 2008)

Louis de la Parte Florida Mental Health Institute

SAPT Organization

The SAPT Survey and Planning and Implementation Guide are organized under three categories:

Administrative

Treatment

Community Integration

Louis de la Parte Florida Mental Health Institute

Administrative Domains

1. Philosophy

2. Continuous Quality Improvement (CQI)

3. Outcome Assessment

4. Staff Support

5. Consumer and Family Support

Louis de la Parte Florida Mental Health Institute

Treatment Domains

1. Validation of the Person

2. Person Centered Decision Making

3. Self Care/Wellness

4. Advance Directives

5. Alternatives to Coercive Treatment

Louis de la Parte Florida Mental Health Institute

Community Integration Domains

1. Access

2. Basic Life Resources

3. Meaningful Activities and Roles

4. Peer Leadership

Louis de la Parte Florida Mental Health Institute

Major Pilot Findings

Agencies with a high SAPT score tend to have a high ROSI score – agency perspective corresponds to consumer perspective.

Recommend revision to ROSI survey: in current version consumers may select a does not apply option, which becomes missing data for the item analysis.

Web-based methods for SAPT and ROSI data collection are viable – provides real time feedback.

Applying methods with consumers in ROSI survey requires some special considerations:

• Access to computers• Access to peer support when needed

(Winarski and Dow, 2010)

Louis de la Parte Florida Mental Health Institute

Recommendations

Development of SAPT and ROSI Surveys

1. SAPT is a reliable instrument and demonstrates a linear relationship to ROSI and is ready to be implemented with service provider agencies.

2. ROSI should be revised prior to implementation:

♦ Reconsideration of does not apply option

♦ Select items that are relevant for each level of analysis, e.g., state, circuit, county, agency, etc.

Louis de la Parte Florida Mental Health Institute

Recommendations

Implementation Strategies

1. It is critical to establish a lead organization to plan for and support implementation:

♦ Recovery treated as a priority

♦ Data should be applied as part of planning and implementation strategy

♦ Provide support for service providers• TA and training

Louis de la Parte Florida Mental Health Institute

Recommendations

Implementation Strategies (continued)

2. Develop plan for data collection:

♦ Engage managing entities and other managed care organizations as part of a regional/circuit based strategy.

♦ Lead organizations should acquire licenses for web based survey software.

♦ FMHI could provide technical assistance in devleoping and implementing web based protocols.

Louis de la Parte Florida Mental Health Institute

Recommendations

Implementation Strategies (continued)

3. Peer Specialists at mental health service provider agencies should play a central role in ROSI implementation.

4. Integrate SAPT/ROSI findings into agency planning

♦ Most agencies already implement quality improvement procedures that can easily integrate recovery-oriented services outcomes.

♦ Recovery QA subgroup to inform planning

♦ Implement training & technical assistance activities based on findings.

♦ FMHI could provide technical support regarding planning/implementation strategies.

Louis de la Parte Florida Mental Health Institute

Recommendations

Implementation Strategies

5. Solicit consumer input and participation.

6. Include recovery in managed care contracts:

♦ Use SAPT/ROSI to define expectations about delivery of recovery-oriented services and achieving recovery oriented services outcomes.

7. Utilize SAPT/ROSI website to support implementation activities.

WWW.SAPTRECOVERY.ORG

Louis de la Parte Florida Mental Health Institute

Questions/Comments

Contact Information:

James Winarski, M.S.W.

University of South Florida

College of Behavioral & Community SciencesDept. of Mental Health Law & Policy,Louis De La Parte Florida Mental Health Institute13301 Bruce B. Downs Blvd.Tampa, FL 33612-3807(813) 974-6490jwinarski@fmhi.usf.edu