RECOVERY Island Health Experience Faculty/Presenter Disclosure - - PowerPoint PPT Presentation

Island Health Experience

ADVANCING PSR AND RECOVERY

Faculty/Presenter Disclosure

• Presenter: John Braun
• Relationships with commercial interests:

–Employee with Mental Health and Substance Use Services, Island Health

Disclosure of Commercial Support

• This program has received financial support from Otsuka/Lundbeck,

Janssen and Mylan in the form of unrestricted educational grants.

• This program has received in-kind support from Lundbeck Inc, BMS in

the form of logistical support.

• Potential for conflict(s) of interest:

– None

Island Health MHSU Context

• Island Health Mental Health and Substance Use

Services is a region-wide program (includes Gulf Islands and Mainland across from our North Island)

• Approximately 1700 employees
• Provides direct services and oversees contracted

services

• All aspects of treatment and support are provided
• Tertiary care – Secondary care – Acute care
• Community and facility based programming
• Housing/Residential Supports

Examples of advancing a Recovery Orientation

SI Housing/Residential PSR Initiative

• Goal to imbed PSR and Recovery practices within the South Island

MHSU Housing and Residential sites

• Formation of Housing, Assessment, Rehabilitation and Transition

Team Vision Statement “The HART team creates a positive recovery-centered environment and works with MHSU residential clients to develop their individual strengths and resources to live increasingly healthy and fulfilling lives.”

• Adoption of Recovery Centred Clinical System

Never Sometimes Unsure Often Always 1 Feel Supported in the Recovery Process (connected, client focused)) p I never feel supported in recovery. We do not discuss my recovery goals p Sometimes we discuss my recovery, but usually I am told what to do. p I am unsure and want more information or I have felt a mix of control and recovery support p I often feel supported in my

• recovery. I feel staff
• ften refer to my

recovery goals. p I always feel supported in my of

• recovery. I see staff

consistently advocate for resident recovery 2 I feel supported in making choices p I never feel supported to make a

• choices. I often feel

controlled. p Sometimes staff help me to understand my choices but usually they tell me what to do. p I am unsure how many choices I have,

• r feel subject to an

even mix of choice and control. p I feel staff often support me to make choices. p I always feel my choices are presented and explained to me so I can make an informed decision. 3 Harm Reduction ..have you ever …what if you did p Staff never seem interested in my point

• f view. I feel

nagged to quit all drugs and alcohol (D&A) p Sometimes, staff will be open to discussing my ideas, and thoughts, but usually I feel nagged to abstain from D&A. p I am unsure of what harm reduction

• is. I want more

information p I often feel listened

• to. I am able to

discuss my thoughts about drug and alcohol use. p I always have a chance to talk about my understanding of the harm and the benefits I get from my D&A use. 4 Self Confidence pInteractions with staff always leave me discouraged or with decreased sense of confidence p Sometimes my interactions with staff leave me with a sense of self confidence p I am unsure of how I feel after talking with staff or I have an even mix of interactions with staff that leave me felling better or worse about myself. p My interactions with staff often leave me with more self confidence. p My interactions with staff always leave me feeling empowered with increased self confidence 5 Respect Honesty Fairness p I never feel we are spoken to with respect, honesty and fairness p I am aware that sometimes I, or my co- residents are being treated with respect, honesty and fairness. p I am unsure of whether I am spoken to with respect, honesty and fairness.

• p. I am often treated

with respect, honesty and fairness. p I consistently see staff interacting with myself and others with respect, honesty and fairness. 6 Staff Empathy p I see most staff as uncaring or lacking empathy; they never say things that are encouraging or convey a sense of hope. p Sometimes staff understand me, but I think many staff have sense of pessimism and discouragement about my future p I am unsure whether I am listened to with interest and positive encouragement. p I often feel understood and hear random words of encouragement from staff. p I always feel that staff are trying to understand my beliefs. I always feel that they encourage me to do my best. 7 Client Response to Staff Members p I never have good things to say about staff, I have a lot of complaints about staff. p I sometimes have positive feedback about staff, but more complaints. p I have an even mix of complaints and compliments about staff, or I am unsure. p Often I say positive things about staff. p I always have say positive things to say about staff. 8 Interactions with Co- Residents to Enhance Their Self- Confidence p I think I leave co- residents discouraged

• r with decreased

sense of self confidence after interactions with me p Occasionally I leave a co-resident feeling more confident after interactions with me. p I leave co-residents with a roughly even mix of both more & less self-confidence after my interactions with them, or am unsure p I often leave co- residents with an an increased sense of confidence after my interactions with them p I always leave co- residents with a sense

• f increased self

confidence after my interactions with them 9 Contribution to Team pI never feel part of a Recovery Team I do not know who or what a recovery team is. p Occasionally I am able to feel like part of my recovery team, and contribute to team meetings and conferences. p I am unsure of whether I am part of the team or half the time I am including and half the time feel excluded from the team. p Often I feel part of my Recovery team.. p I always feel like a full contributing member in my Recovery Team. 10 Acceptance of Feedback from Residents p Staff never like feedback from me. p Staff have trouble accepting feedback, but sometimes they listen p I am unsure about

• this. At times it is

difficult to give feedback, but I’ve had some success. p I often offer feedback to staff and it has helped to make changes. p Staff always welcome and encourage feedback, and then make changes

Assessment by staff and clients on recovery orientation

Keeping Recovery Front and Centre!

Booster Buddy

https://www.youtube.com/watch?v=2s7nQ1reXyM

Participation in Community Events

Challenges along the Road to Recovery

Agreeing on a definition of Recovery

• Is it possible/a reality for Mental Illness?
• What does it mean – cure, harm reduction, abstinence, etc.?

“[Recovery is] a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness…” (Anthony, 1993) “Doing the best you can with what you have” (Victoria Life Enrichment Society)

Working within a large system

• Systems and processes are generally designed for the acute care

system

• Care Plans versus Recovery Plans
• Expert versus coach/guide
• Electronic Health Record
• Environments are often clinical in nature
• Moving from doctor-centered decision making to team based

decision making (including service user and family)

• Employee/leader “churn”

Moving from a traditional approach while working within a medical system

Adapted from Ashcroft, 2012

Medical/Traditional Approach Recovery Oriented Approach Clinical Setting designed to treat sick people Designed to promote recovery and wellness Creates separation from community Designed to stay connected to community Expert directs care The individual directs care Risk adverse; paternalistic & protective Willing to let people learn and grow Sees setbacks as an indicator of problems Setbacks are opportunities for learning Staffed by medically trained “experts” Staffed by clinically trained individuals, peers, family, etc. Culture of low expectations and dependency Culture of hope, empowerment, growth Goal is to survive Goal is to thrive

Balancing Risk, Safety and Empowerment

• Worksafe BC and Union focus on violence prevention
• Clarifying Medical-Legal liability, ethical and team-based decision making
• Confidentiality and information sharing
• Freedom of Information and Protection of Privacy Act (FIPPA) (RSBC 1996)
• Adult Guardianship Act (RSBC 1996)
• Community Care and Assisted Living Act (SBC 2002)
• Continuing Care Act (RSBC 1996)
• Coroner’s Act (SBC 2007)
• Health Act (RSBC 1996)
• Health Authorities Act (RSBC 1996)
• Health Care (Consent) and Care Facility (Admission) Act (RSBC 1996)
• Hospital Act (RSBC 1996)
• Patients Property Act (RSBC 1996)
• Personal Information Protection Act (SBC 2003)
• Public Guardian and Trustee Act (RSBC 1996)
• Public Health Act [SBC 2008]

Change is in the Air!

Key Events

2006 - OUT OF THE SHADOWS AT LAST Transforming Mental Health, Mental Illness and Addiction Services in Canada

• called for recovery to be “placed at the centre of mental health

reform.” 2012 - CHANGING DIRECTIONS, CHANGING LIVES:THE MENTAL HEALTH STRATEGY FOR CANADA

• Strategic Priority 2 - Foster recovery and well-being for people of all

ages living with mental health problems and illnesses, and uphold their rights.

Key Events (cont)

2009: Release of “Healthy Minds, Healthy People: A Ten-Year Plan to Address Mental Health and Substance Use in B.C.” “Is about transforming our approach to mental health and substance use, and working together to support lifelong mental wellbeing of all British Columbians”

• The document emphasised empowerment, hope, building on strengths,

and commitment to a recovery based approach to care, that includes

• utcomes related to employment and community based treatment

resources

“With the appropriate psychosocial supports, people experiencing severe mental and/or substance use disorders can recover and lead fulfilling lives”

Key Events (cont) May 2012- March 2014: Development of BC PSR Service Framework

• The Service Framework is provided as a guide and resource to facilitate

the development and implementation of PSR services and programs for people living with serious mental illness and/or substance use problems.

• Provides recommendations for these services and programs which are

person-centered, strengths based and recovery oriented.

• Is based on the best and most current available evidence and provides an

understanding of how properly implemented PSR practices will result in

• ptimal care and outcomes.

“It is important that practitioners within Mental Health Centres, Community Care Teams and Substance Use Centres implement recovery oriented, strengths based approaches, which promote shared decision making in assessment and goal setting.”

Key Events (cont) June 2015: Release of the Mental Health Commission of Canada’s “Guidelines for Recovery Oriented Care and associated “Practice Competencies and Declaration documents.

• Three Tools
• The recovery declaration (a tool to facilitate dialogue)
• An online inventory of recovery resources
• The development of the recovery guidelines
• Six Dimensions of Recovery-Oriented Practice
• Creating a Culture and Language of Hope
• Recovery is personal
• Recovery occurs in the context of one’s life
• Responding to the diverse needs of everyone living in Canada
• Working with First Nations, Inuit and Metis
• Recovery is about transforming services and systems

Recovery is about transforming services and systems

• Implanting the recovery vision and culture across the organization
• Building recovery-promoting service partnerships
• Developing a recovery-oriented workforce
• Recovery orientation is built on the belief that people will recover, and that

people are able to identify what it is that they need.

• Providers need to work with clients at their own pace, so that they increasingly

take personal responsibility for their recovery.

• Addressing the tension between maximizing personal choice and supporting

positive risk taking on the one hand, and promoting safety on the other

• Recovery is not linear. Mistakes or setback are opportunities for insight and

personal growth. Resilience is developed by engaging rather than avoiding life’s challenges.

• Providers do not relinquish their professional accountability, but seek to empower

people and their supporters by providing information and acting as a “Coach” in shared decision-making rather than as an expert who directs care. This approach is compatible with application of existing criteria for assessing professional liability in all care settings

Key Events (cont)

Sept 2015: Release of the Higenbottam/Case Review of Greater Victoria Psychosocial Rehabilitation and Recovery Oriented Services: Promoting - Hope, Dignity, Inclusion.

Recommendations:

• Establishment of the PSR and Recovery Advisory Team
• Development of recovery-oriented evaluation process and practices.
• Increase engagement with family/caregivers
• Improve engagement opportunities for youth – develop a “social

gathering place”

• Increase Peer Support Services
• Improved education/training for staff in PSR and Recovery practices

October 2015 MoH: Establishing a System of Care for People Experiencing Mental Health and Substance Use Issues “The BC mental health and substance use system of care will be a responsive and integrated network of services which provides patients and their families with the treatment services and supports needed to enable them to live, work, learn and participate fully in their communities. It will be guided by core patient and family centered values and principles and supported by a provincial enabling infrastructure including a performance management and reporting framework.”

Key Events (cont)

MoH Specialized Care Program

• An SCP is an integrated coordinated set of community-based

specialized health services for a defined geographic clinical population, directed towards achieving common health and system

• utcomes. The SCP is designed to optimize a nimble response to

patients’ needs referred from a linked network of Patient Medical Homes.

• Recovery oriented care: An international best practice that

promotes strengths based, individualized, and self-directed care. Principles of psychosocial rehabilitation (PSR) include:

• i. A focus on clients’ ability to self-manage
• ii. Shared decision making between service providers, clients and families
• iii. Collaborative care planning
• iv. Peer involvement

Key Events (cont) 2015-Present: The South Island Review of MHSU Services.

• Embrace a “Recovery Oriented” philosophy incorporating PSR

competencies

• Integrated service provision with primary care throughout MHSU

services

• Central Access and Urgent Support
• Stepped Care System of organized services
• Recovery-based system of housing and residential care
• Access to key supports, tools and capacities to be successful

Key Current Work

Island Wide

• Recovery-oriented system of care working group
• Adopt a region wide recovery statement and philosopy
• Operationalize Recovery oriented care in programming, job descriptions, training,

contracts, etc.

• Family Engagement working group
• Ensure family engagement and support
• Work with IMIT to ensure electronic health record ability to reflect

recovery oriented approach

• Standardize Recovery planning process across programs

Current work (cont)

South Island

• PSR and Recovery Advisory Group
• MHSU Service User/Family Advisory Committees
• South Island Review recommendation implementation
• Implement MoH System of Care
• EPI/Youth Initiative
• Peer Support advancement
• Wellness Recovery Action Plans are being expanded through collaborative

work with our community partners

• Use of the Personal Recovery Outcome Measure (PROM) to evaluate the

PSR needs of service users at Day Hospital. This tool addresses meaningful activity, sense of belonging and engagementRenaming of programs – less

stigmatizing, recovery promoting

• Development of CM recovery oriented CM standards
• Promotion of monthly recovery-oriented training webinars for staff (6 so

far).