Engagement, Activation and Recovery-oriented Practice

with

Elizabeth Whitney, RTP Technical Assistance LeadAdvocates for Human Potential, Inc. August 7, 2105

The Role of the New Behavioral Health Workforce in Whole Health Care

40% of general population lacks skills, knowledge, and confidence to manage personal healthcare.

Hibbard, J. et al. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Service Research, 39(4 pt 1), 1005-1026.

fail to take prescribed

meds

skip appointments

return to hospital soon

after discharge

Georgia’s Story

What are some of the challenges and stressors that Georgia is facing?

Mental H

ealth Conditions

Substa

nce U

se Conditions

0%10%20%30%40%50%60%70%80%90%

100%

Not Receive Treatment or Services

Receive Treat-ment or Services

At the same time….

Georgia’s Story

How would YOU approach engaging Georgia in

services?

Create dependency

Discourage self-care

Ignore preferences

Do not encourage healthy behaviors

Lead to fragmented care

What if we….. Truly collaborated WITH

her on a plan that “fits” her needs and

preferences, rather than simply expecting her to adhere to our plans for

her?

What if we…..

Addressed the whole person…

…not just the diagnosis?

SAMHSA’s 8

Dimensions of Wellness

Science has rendered untenable the artificial division of people into parts,

particularly mental and physical parts.

Whole Health

• Personal spending burden

• Population spending burden

• Individual engagement

• Community engagement

• Preventive services• Care access• Patient safety• Evidence-based care• Care match with

patient goals

• Life expectancy• Well-being• Obesity• Addictive behavior• Unintended pregnancy• Healthy communities

Healthy People

Care Quality

Lower Cost

Engaged People

Source: (Committee on Core Metrics for Better Health at Lower Cost, 2015)

Now, we are focusing on

preparing, equipping, and supporting people in taking

care of their own behavioral health needs,

and themselves, while remaining in the

community.

A growing body of evidence demonstrates that people who are more actively involved in their health care experience

better health outcomes and incur lower costs.

Health Affairs, 2013

Engagement in care typically means

connecting people with needed behavioral

health care.

Engagement in self-care involves activating people

to manage their own conditions, their own

care, and their own lives.

Informed, empowered people

Have knowledge, skills, and

confidence to better manage

their own health and health care

And tend to …Make informed and personally relevant

decisions about treatment and care

Follow through with treatment and self-

care regimens

Experience fewer adverse events

SAMHSA’s Vison for Recovery to Practice

Through education, training, and resources

the Recovery to Practice (RTP) program

supports the expansion and integration of

recovery-oriented behavioral health care

delivered through multiple service settings.

4 Major Dimensions That Support a Life in Recovery

Health Home

Purpose Community

Recovery in Behavioral Health

A process of change through which individuals

improve their health and wellness, live a self-directed life, and

strive to reach their full potential.21

SAMHSA’s 10

Components of Recovery

in Behavioral

Health

22

23

People with mental health and substance use conditions have been – and still are – subject to prejudice and

discrimination.

Reducing and eliminating prejudice and discrimination is necessary for people to live full, meaningful, and self-determined lives in the communities of their choice.

Importance of person-first language

Learning from perspective of people in recovery

Centrality of autonomy, self-determination, and choice

System of care includes access to treatment, medication, and recovery supports

Recovery takes place in a social context: community and social inclusion are key

Principles of consumer and family-driven care embrace cultural competence

Engagement in treatment or

services

Engagement in healthcare

decision making Engagement in self-care

Stage-wise growth in activation

passive recipient of

care

basic knowledge

about health and treatments

skills and confidence to manage

illness

maintain positive health

changes over time

Taking an active role in my own health care is the most important thing that affects my health.I know what each of my prescribed medications does.I am confident that I will tell a doctor about concerns I have even when he or she doesn’t ask.I know how to prevent problems with my health.

Insignia Health. Landro, L. New Vital Sign to Gauge: The patient’s Activation Level. Wall Street Journal. April 1, 2014. D1

Practices that Can Support Engagement and Activation

• Person-centered planning

• Inviting people to read doctor’s notes

• Use of peer coaches

• Tailoring support to activation levels

Supporting people to manage their health: An introduction to patient activation, Judith Hibbard Helen Gilburt, May 2014; The King’s Fund

Georgia’s Story

Patient (behavioral) Activation

Help people prepare for health care visits and ask questions

Identify health-related goals that “fit”

Plan do-able action steps to move toward goals

Assist in daily management tasks

Problem solving

Provide social and emotional support and feedback

Follow-up over time

Asking questions is a skill!

Parent of child with fever

Type of question Person with back pain

“Why doesn’t she need antibiotics?”

Reason “If surgery solves the problem, why wouldn’t

I choose it?”

“How is this different from 3 months ago

when she got antibiotics?”

Process “Do I need to choose one today?”

“What should I do if the fever doesn’t go

down?”

Role “Before I choose one, what else do I need to

know?”

Copyright, The Right Question Institute, 2013

Engagement in health care

decision making

Georgia’s Story

Person and clinician begin consultation

Person and clinician discuss medications

Person leaves with a prescription

Person makes decision about medication

What intervenes?

From Dr. Annie LeBlanc, PhD; Mayo Clinic

Medical knowledge

Years of education

Practice experience

Clinician preferences

Breslin 2011

Expert on their life

Personal health view

Lifestyle preferences

Own experiences

Breslin 2011

Shared decision making is about “changing the

conversation”.

Making collaborative decisions that “fit”

Client

focused

tools

Provider focused

tools

Dialogue

Person and clinician begin consultation

Person and clinician discuss medications

Person leaves with a prescription

Person makes decision about medication

From Dr. Annie LeBlanc, PhD; Mayo Clinic

Engagement in self-care

Promoting self-careInvite in

Explore understanding

Provide information, education, and role modeling

Connect self-care to personally-relevant goals

Introduce peers who are experienced in self-care

Georgia’s Story

What worked well?

What else could the clinician do?

“Now I take it step by step. I have learned to hurry slowly and do it in stages and set partial goals when I have discovered that it makes sense … doing it by partial goals and making it manageable, then you get positive feedback that it’s going okay and then you don’t hit the wall.

That’s my strategy, the strategy for success: partial goals and sensible goals and attainable goals, and that’s something I’ve learned to do in order to achieve things. When I have been able to deal with something that’s been a struggle and feel secure, I move on. Step by step, put things behind me.”

Objective Informatio

n

Finding Voice

Health Literacy

Practitioner Skills

Building Skill

Coaching

Example recovery practice competencies from CSWE

• Prioritize client voice and right to self-determination.• Recognize that individuals, their families and significant others

are critical sources of support, resources, and information. Engage them with individuals’ consent.

• Assist individuals to integrate meaningful cultural and spiritual practices into recovery and wellness activities.

• See individuals’ lived experience with behavioral health conditions as triumphs and resiliency, rather than failures.

For the full set of CSWE Advanced Social Work Practice Competencies:

http://www.cswe.org/cms/42850.aspx

Where can practitioners learn these skills and practices that help support recovery in behavioral health?

Recovery to Practices (RTP) Resources

American Psychological Association (APA) RTP resources

American Psychiatric Association (APA) RTP resources

International Association of Peer Supporters (iNAPS) RTP resources

American Psychiatric Nurses Association (APNA) RTP resources

NAADAC—the Association for Addiction Professionals RTP resources

Council on Social Work Education (CSWE) RTP resources

RTP Training Resources On EngagementTopic Area Available Curricula

Introduction/overview and fundamentals of recovery-oriented practice; applying recovery to behavioral health

American Psychological Association American Psychiatric Association &

American Association of Community Psychiatrists (AACP)

iNAPS NAADAC CSWE

Partnership and Engagement American Psychological Association American Psychiatric Association &

American Association of Community Psychiatrists (AACP)

iNAPSPerson-Centered Planning & Shared Decision Making

American Psychological Association American Psychiatric Association

&American Association of Community Psychiatrists (AACP)

Health and Wellness American Psychiatric Association & American Association of Community Psychiatrists (AACP)

iNAPS

http://www.naadac.org/rtp-certificate-program

http://www.naadac.org/recovery

Recovery to Practice Sample Resources

Recovery resources for addictions disordershttp://www.naadac.org/recovery-resources

Facilitating goal setting handout for clients/consumers www.psychiatry.org/File%20Library/Practice/Professional%20Interests/Recovery/Facilitating-Goal-Setting.pdf

Listening, persuading and supporting change tips sheetfrom the iNAPS Recovery to Practice Participant

Workbook– v1 April 2014, Page 2-22, Module 2: The Complex Simplicity of Wellness

New Directions for RTP

• Promoting recovery practices in ALL behavioral health services and disciplines

• Multidisciplinary practice• Integrated settings• Diverse applications• New resources

Multidisciplinary Practice Manual and eLearning

Module

Peer Specialist Manual and eLearning

Module

RTP Training and Technical Assistance

Recovery-oriented Behavioral Healthcare

Decision Support for Clinicians and

Physicians

Coming up!

• August 10 – Peer Services: Creating an Environment for Success

• August 12 - Evidence-based Practice and Recovery-oriented Care

• August 17 – Building Recovery-oriented Systems

• August 19 – Whole Health and Recovery (part 1)

• August 26 - The Role of Medication and Shared Decision Making in Recovery

• August 31 - Partnership, Engagement and Person-Centered Care

• September 2 - RTP Applications: Incorporating Recovery-oriented Practice Competencies in Practitioner Training

• September 3 – Whole Health and Recovery (part 2)

• September 9 - Health Care Reform and Recovery

Join Recovery to

Practice!

RTP@ahpnet.com

http://www.samhsa.gov/recovery-to-practice58

Please provide feedback and comments by clicking on the Participation Evaluation link

below in the link box.59