THE NEW AGE OF PSYCHO-SOCIAL REHABILITATION

Roadmap to Outcome-Oriented

Treatmentand Recovery

THE NEW AGE OF PSYCHO-SOCIAL REHABILITATION

Today’s Objectives: How You Can…– Meet Payer Standards– Demonstrate People Improve– Develop a PSR program that

• helps people improve• enhances recovery

– Maintains/Builds Revenue Streams

THE NEW AGE OF PSYCHO-SOCIAL REHABILITATION

What Can You Get PAID For Providing?– Services

What Do You Have To Do To Get Paid?– Develop Outcomes– Delivery Services that Generate Anticipated Outcomes– Document Reached Outcomes

How Do You Get People Connected?– Without People:

• No Services• No Outcomes• No Payments

Meeting Payer Standards: Outcomes

Assessment and Planning (Rule 132):– Client’s preferences relating to services and

desired treatment outcomes.– Documenting goals &

anticipated outcomes.Clinical Recording Keeping (Rule 132):

– Discharge summary documenting the outcome of treatment and, as necessary, linkage to continued services.

Meeting Payer Standards: Outcomes

Utilization Reviews (Rule 132):– The expected short-term and

long-term outcome of each service needed by the client and

– Progress made in response to treatment.

THE NEW AGE OF PSYCHO-SOCIAL REHABILITATION

Do You View “Recovery” as a

Continuum:

or

Trend:

Developing a World Class PSR Program

Starts with a Philosophy of Recovery– Trend vs. Continuum– People ARE SMART– People KNOW What ISN’T WORKING– People KNOW What They WANT– People KNOW What HELPS– People ENGAGE When TREATMENT Has Quality– People IMPROVE the QUALITY of Their Life

Developing a World Class PSR Program

Presumptions– Staff Deserves To Be:

• Compensated for Expertise and Passion– Thus – Generate Income with Services

• Retention of Quality Staff– Clinically Challenge Staff – expect the best,– Pay Raises Through Increased Income

– Agency Deserves To Be:• Compensated for Services Provided• Remain OPEN to Serve Community Members.

Developing a World Class PSR Program

Assessment and Planning (from Rule 132):– Client preferences relating to services and desired

treatment outcomes.Getting Client’s Preferences Means PSR MUST:

– Get to Know the Person– Understand THEIR GOALS– Review Assessment Data– Bring the Person TO THE

PROGRAM: Community– Develop Motivation & Hope

Developing a World Class PSR Program

Assessment and Planning (from Rule 132):– Documenting goals & anticipated outcomes

Means PSR MUST:– Assess the Client’s Needs (baseline)

• DLA – Functional Measure• MHA – Tx History.

– Connect Treatment to DLA and MHA = Prescriptive

Question Seldom Occasionally Often Frequently Item Score Item DLA

I Take Risks By…

Telling Someone How I Feel 0 11 0

Asking Someone for Help 0 11

Telling Others What I Need 0 6, 11, 22

Listening to Other Peoples' Ideas and Suggestions 0 6

Identifying Options to Solve my Problem 0 11

Creating & Executing a Plan that Solves my Problem 0 2

Doing Something Fun That I Enjoy 0 17 0

Starting a New Relationship/Friendship 0 22 0

Going to the Doctor When I'm Sick or Hurt 0 2 0

Joining a NEW Social Group 0 20 0

Question Seldom Occasionally Often Frequently

I am Self-Confident and Can…

Prepare & Eat at Least 2 Meals Per Day 0 10 0

Pay My Bills On Time 0 9 0

Control My Spending and Budget my Monies 0 9

Manage My Daily Schedule and Keep Appointments 0 8 0

Clean My Home and Pay Rent/Mortgage on Time 0 4 0

Work Safely with Tools, Kitchen Knives & Razors 0 7 0

Choose from the Options I Have to Solve Problems 0 11

Use Public Transportation or Drive Myself 0 20

Shop for Myself 0 20

Tell My Family and/or Friends What I Need 0 6, 11, 13, 22, 27 0

DLA

L10 Have client Identify what they perceive as potential strengths and obstacles to their recovery?

Strengths Obstacles

(Check all that apply) (Check all that apply)

_____ History of treatment success _____ History of treatment disappointment

_____ Understanding of illness _____ Denies illness/problems or blames others

_____ Has decision making skills _____ Lacks decision making skills ability

_____ Good communication skills _____ Limited communication ability

_____ Adequate education _____ Limited education or learning difficulties

_____ Good physical health _____ Physical/medical problems

_____ Ability to manage finances _____ Financial difficulties

_____ Stable living conditions _____ Unstable living conditions

_____ Ability to form and maintain relationships _____ Difficulty with interpersonal relationships

_____ Ability to care for self/others _____ Lack of trust in others

_____ Vocational skills, some work history _____ Limited vocational skills and work history

_____ Transportation available _____ Lacks transportation

_____ Family support _____ Lack of family support

_____ Social support system present _____ Lacks friends and social outlets

_____ Has confidence in treatment provider _____ Doubts their capacity to improve/be helped

_____ Religious, spiritual or cultural beliefs _____ Religious, spiritual or cultural beliefs

_____ Other Strengths, specify: _____ Other Obstacles, specify:

MHA

Developing a World Class PSR Program

Means PSR MUST:– Deliberately Intervene: Development of

• Group: Evidenced Based, Curriculum Driven• Individual: “Supersize the Fries” Con-Current with Group• Milieu: Practice Socialization and Skills Lab.

– Connect Treatment to DLA and MHA = Prescriptive

PSR Treatment Team Therapists and Supervisor met for a 90 day treatment review session to evaluate the client's progress toward goals identified in the client's individual treatment plan (ITP) driven by assessed needs identified in a yearly mental health assessment. The review also determined and discussed the consumer's readiness to be transitioned and connected to less supportive therapeutic services and/or community-based and socially driven support activities. Prior to this review session, the consumer completed a self-report psychometric based on the Daily Living Assessment to determine a level of functional impairment that prevents the consumer from engaging in less supportive therapeutic services and/or community-based and socially driven support activities. Staff discussed their clinical observation of the consumer while in treatment and the data collected during the completion of the self-report psychometric, which assisted the staff in determining gains or decreases in functionality over the past 90 days of treatment. In addition, staff reviewed and discussed the client's compliance percentages and their levels of engagement with the treatment measured each week using an engagement matrix and the client's overall reported progress during each session of the treatment.

Recommendation: Continue PSR services.

Justification: During the review session, staff came to the decision that the consumer has reached very few of the goals identified in PSR services ITP as evidenced by the completion of a self-report psychometric and observations by the staff and the client's scores in compliance, engagement and progress toward goals. The client’s progress in the past 90 day session includes: XXXXX.

Anticipated continued therapeutic services: Staff observes and conceptualizes that XXXX. Client is encouraged to attend XXXX to learn XXXXX. Client is also encouraged to attend XXXX to start learning how to XXXXX.

Example of Note

Consumers will attend Anxious No More to acquire, practice, and use in natural/community settings skills including:

Coping Skills:

Will learn cognitive restructuring techniques that allow them to be more competent of their anxiety triggers and accompanying reactions measured through client self-reports and the completion of activities and worksheets provided in the group and as evidenced by at least 75% engagement in the group.

Will learn to be in control of their anxiety by identifying at least three healthier and more effective cognitive reactions associated with anxiety-provoking events measured by the completion of activities and worksheets provided in the group and as evidenced by at least 75% engagement in the group.

Problem Solving:

Will identify and respond to options about the way in which they interpret and react to anxiety-provoking events measured by the completion of activities and worksheets provided in the group and as evidenced by at least 75% engagement in the group.

Will learn to set realistic expectations related to anxiety-provoking events so that accompanying cognitive, emotional, and behavioral reactions are appropriate measured by the completion of activities and worksheets provided in the group and as evidenced by at least 75% engagement in the group.

What are You Attracting?

Have you wondered why you keep finding yourself in the same situations? Bad relationships, encountering “toxic” people, feelings of being out of control with the direction your life is taking? Shifting the manner in which you approach the world can be hugely empowering and give you the feeling of being more in control. We will explore, through activities and discussions, what YOU can do to feel that no matter what life throws at you, you are more powerful than you think you are!

*Family relationships, social network, coping skills, problem solving.

Coping including the following objectives: To be able to:

Identify three new ways in which the client can engage with and interact in their social, family and career/education environments measured by the client’s self-report and observation of the client in group as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

Identify at least 3 personal strengths that will enable the client to resolve daily living issues and communicate effectively with others measured by the client’s self-report and observation of the client in group as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

Anticipate and predict the potential outcome of a new behavioral approach to engagement with the client’s social, family and career/education environments measured by the client’s self-report and observation of the client in group as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

 

Problem Solving including the following objectives: To be able to:

Effectively emotional regulate while communicating needs, cognitions and emotional reactions to life stressor when engaged socially with others as measured by the client’s engagement with role plays and the discussion after the roll play evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

Developing a World Class PSR Program

Anticipating Outcomes Means PSR MUST:– Adapt to Changing Needs of Client

• Develop Progressive, Trend-Oriented Program• Offer Services That Meet Person on Multiple Levels of

Recovery.– Assist the Client in

Reaching Outcomes• Motivational• Hope Inspiring• Community-Based

Developing a World Class PSR Program

Clinical Recording Keeping:– Discharge summary documenting the outcome of

treatment and, as necessary, linkage to continued services.

Quarterly Conferences– Compliance, Engagement & Progress– DLA Completion and Reviewed– Face to Face Collaborative Meetings

Client 1 100%

ITP DUE: Engagement Relationships Worker Member Own Issues Empathy

MHA DUE: Payer: Medicaid 100% 2 2 2 2 2

Current DLA XX Progress Toward Goals

Original DLA: XX 100%

Attendance: May 31, 2013

1

0 = None, 1 = Minimum ; 2 = Moderate; 3 = Maximum

3

Data Sheet

Question Seldom Occasionally Often Frequently Item Score Item DLA

I Take Risks By…

Telling Someone How I Feel 0 11 0

Asking Someone for Help 0 11

Telling Others What I Need 0 6, 11, 22

Listening to Other Peoples' Ideas and Suggestions 0 6

Identifying Options to Solve my Problem 0 11

Creating & Executing a Plan that Solves my Problem 0 2

Doing Something Fun That I Enjoy 0 17 0

Starting a New Relationship/Friendship 0 22 0

Going to the Doctor When I'm Sick or Hurt 0 2 0

Joining a NEW Social Group 0 20 0

Question Seldom Occasionally Often Frequently

I am Self-Confident and Can…

Prepare & Eat at Least 2 Meals Per Day 0 10 0

Pay My Bills On Time 0 9 0

Control My Spending and Budget my Monies 0 9

Manage My Daily Schedule and Keep Appointments 0 8 0

Clean My Home and Pay Rent/Mortgage on Time 0 4 0

Work Safely with Tools, Kitchen Knives & Razors 0 7 0

Choose from the Options I Have to Solve Problems 0 11

Use Public Transportation or Drive Myself 0 20

Shop for Myself 0 20

Tell My Family and/or Friends What I Need 0 6, 11, 13, 22, 27 0

DLA

Developing a World Class PSR Program

Utilization Reviews: – The expected short-term and long-term outcome

of each service needed by the client and – Progress made in response to treatment.

Conferences and ITPs– All Progress Documented in ITP– Collaborative, Strengths Based Consultations

Activity and Wellness Center

Assessed Need After a Mental Health and Daily Living Activities (DLA) Assessment XXXX has received a DMV-IV tm diagnosis of XXXX and has been assessed to have a role functioning deficits which prevent the client from engagement and connectivity with natural and community supports.

Anticipated Outcome: Staff Client will acquire, practice and use in natural/community settings skills that will assist the client in mitigating impaired functioning and deficits identified in the Mental Health and Daily Living Activities (DLA) Assessment so that the client can live independently, manage illness with as little intervention as possible and achieve functional, social, educational and vocational goals.

Anticipated Outcome: Client “Gathered in the First Session/Registration”

Service Goals for Community Support Group Objective Progress

(see key below)

Objective Status

(see key below)

Level of Service

(see key below) XXXX will attend What You See Is What You Get to acquire, practice and use in natural/community settings skills including:

1. Communication including the following objectives: To be able to: a. Calmly and effectively relay their thoughts, opinions and emotions to family and friends as well as ask for

support when needed measured through client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

2. Social Network including the following objectives: To be able to: a. Effectively make connections to others and maintain those connections to form healthy and balanced

relationships as measured by observation in group of the client’s relational development as evidenced by an engagement matrix average score of 50%.

3. Coping including the following objectives: To be able to: a. Effectively evaluate the outcome of client’s behavior as well as other individual’s behavior and communicate

one’s cognitive and emotional response to the outcome and other’s responses to the outcome measured through client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

b. Routinely improve cognitive responses by remaining in control and restoring feelings of self-worth as evidenced by self-reports.

Progress Review: XXXX has been XX% compliant with treatment and engaged XX% of the time during session and has an overall progress of XXXXX. Recommend Service: Increase Community Support Group Justification/Why: Consumer Admitted to the Group due to MHA and DLA Assessments and perception of licensed staff that the consumer can and will benefit from the group and reach identified goals and outcomes.

0 N I

Key:

Progress: 0= None 1 = Minimal Progress 2 = Moderate Progress 3 = Maximum Progress 4 = Obtained

Status: N = New C = Continued E = Ended R = Revised A = Achieved

Service Level I = Increased C = Continued D = Decreased ITP

DLA Items

Activity and Wellness Center

Assessed Need After a Mental Health and Daily Living Activities (DLA) Assessment XXXX has received a DMV-IV tm diagnosis of XXXX and has been assessed to have a role functioning deficits which prevent the client from engagement and connectivity with natural and community supports.

Anticipated Outcome: Staff Client will acquire, practice and use in natural/community settings skills that will assist the client in mitigating impaired functioning and deficits identified in the Mental Health and Daily Living Activities (DLA) Assessment so that the client can live independently, manage illness with as little intervention as possible and achieve functional, social, educational and vocational goals.

Anticipated Outcome: Client “Gathered in the First Session/Registration”

Service Goals for Community Support Group Objective Progress

(see key below)

Objective Status

(see key below)

Level of Service

(see key below) XXXX will attend What You See Is What You Get to acquire, practice and use in natural/community settings skills including:

1. Communication including the following objectives: To be able to: a. Calmly and effectively relay their thoughts, opinions and emotions to family and friends as well as ask for

support when needed measured through client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

2. Social Network including the following objectives: To be able to: a. Effectively make connections to others and maintain those connections to form healthy and balanced

relationships as measured by observation in group of the client’s relational development as evidenced by an engagement matrix average score of 50%.

3. Coping including the following objectives: To be able to: a. Effectively evaluate the outcome of client’s behavior as well as other individual’s behavior and communicate

one’s cognitive and emotional response to the outcome and other’s responses to the outcome measured through client self-reports and therapeutic activities in session as evidenced by 75% or higher compliance with treatment, engagement matrix average score of 50% and a score of 66% or higher on the progress toward goal measure.

b. Routinely improve cognitive responses by remaining in control and restoring feelings of self-worth as evidenced by self-reports.

Progress Review: Bob has been 95% compliant with treatment and engaged 76% of the time during session and has an overall progress of Maximum. Recommend Service: Decrease Community Support Group Justification/Why: Bob has reached all of the goals associated with this service as evidenced by him compliance and engagement with treatment as well as his maximum progress scores.

3 E D

Key:

Progress: 0= None 1 = Minimal Progress 2 = Moderate Progress 3 = Maximum Progress 4 = Obtained

Status: N = New C = Continued E = Ended R = Revised A = Achieved

Service Level I = Increased C = Continued D = Decreased

ITP

DLA Items

Ecker’s PSR Program Particulars

Golden Corral of Treatment– Large and Diverse Team

Includes:• Staff• Interns• Clients

– Multi-Leveled Treatment Program• Varying Functional Skills• Varying Skill Development Needs

– Deliberate Program Design and Implementation

Ecker’s PSR Program Particulars

3-Tiered System to Meet Assessed Needs– Ecker Offers:

• Do Drop-Inn: Social Laboratory• 2 Hour Treatment Groups - Catalog• 4 Hour Treatment Cohort - Workbook• Individual Treatment

Therapy Service & Time 9:00 t o 9:30 9:30 t o 11:30 11:30 t o 1:30Anxious No More Room 3N5

Social Skills Time Room 3N5

Addiction Process Group Room 1S1

Change Your Life Room 1S1

Cohort

Therapy Service & Time 9:00 t o 9:30 9:30 t o 11:30 11:30 t o 1:30What are You Attracting? Room 1S1

What You See Is What You Get

Room 1S1

Please Don't Stop the Music

Room 3N5Kicking Addictions Room 1S1 Annex

KID-ing Around Room 1S1 Annex

Your Hero’s Journey Room 3N5

Cohort

Do Drop-InnThe Social 30 Room 3N1

Therapy Service & Time 9:00 t o 9:30 9:30 t o 11:30 11:30 t o 1:30Be Selfish Room 1S1

Anger Replay Room 1S1

Community Support Group

Community Support Group

Monday

Does Not Meet

Monday Movie Matinee in Room 3N1The Social 30 Room 3N1

Camp Steffani in Room 1N14

Community Support Group

Do Drop-Inn

Tuesday

Fun and Games, Writing the Mind Alive, Just Listen, Great Courses, & Reading Club Room 3N1

Room 1N14 (Admission Required Consult with Bob Zima)

Wednesday

Contact information:

• Rick Vander Forest, Director of Recovery• rvanderforest@eckrecenter.org• 847-695-0484 x 322

• Bob Zima, MA/LCPC, PSR Supervisor• rzima@eckercenter.org• 847-695-0484 x 347