Accelerating the Collaborative Care Process Through Family Inclusion

Kathleen Cantwell, B.S.W.Coordinator

Family Resource Network***

Michelle Rodney Kahn, M.Ed.Mental Health Administrator of Transformation Policy & Planning,

City of Philadelphia, Department of Behavioral Health and Intellectual disAbilities Services

***Max Molinaro, Ph.D.

Coordinator Philadelphia Connections

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #D2bOctober 28, 20112:15 PM

Faculty Disclosure

We have not had any relevant financial relationships during the past 12 months.

Need/Practice Gap & Supporting ResourcesWhat is the scientific basis for this talk?

1. Multiple studies have shown that the involvement of families and other social support system members of a person with a major mental illness is beneficial to both the families and the person with the illness. a

2. Recent surveys and testing in the Philadelphia public behavioral health system suggests that significant numbers of care provider staff have misconceptions about confidentiality laws and regulations and communicating with families. Provider Agencies also have widely varying ideas about what family priorities are, since there is no widely recognized standard. b

3. Evidence on system-wide interventions has shown implementation problems; an approach developed and assessed by the Family Resource Network has shown promise as a way to approach the implementation of a standardized definition of family priorities in provider services and policies. c

REFERENCESa. See list of references in formal Powerpoint presentation, especially Attitudes and Perceived Barriers to Working with Families

of Persons with Severe Mental Illness: Mental Health Professionals’ Perspectives, Kim & Salyers, 2008.

b. Behavioral Health Staff Misconceptions About Confidentiality Policies and Practices in Regard to Family Involvement: Can Training Make a Difference? Solomon, P., Molinaro, M., Mannion, E., Cantwell, K. American Journal of Psychiatric Rehabilitation, in press.Development and Implementation of Family Involvement Standards for Behavioral health Provider Programs. Molinaro, M., Solomon, P., Mannion, E., Cantwell, K., Evans, A. American Journal of Psychiatric Rehabilitation, in press.

c. Development and Implementation of Family Involvement Standards for Behavioral health Provider Programs. Molinaro, M., Solomon, P., Mannion, E., Cantwell, K., Evans, A. American Journal of Psychiatric Rehabilitation, in press.

ObjectivesShould tie the Needs and Outcomes together

1. Insure that participants know that they should not avoid contacts with families and other social support people because of mistaken notions about confidentiality rules, by learning three facts about confidentiality regulations/laws:- That no law or regulation prohibits a service provider from listening to a caller without a release, as long as no information about any consumer is released

- That no law or regulation prohibits a service provider from providing resource information to a caller without a release, as long as no information about any consumer is released - That most states allow or require staff to breach confidentiality in the case of danger to self or others.

2. Insure that participants know that both the research on families of the mentally ill and the FRN presenters record reviews of provider charts provide evidence that family priorities include calls from staff that provide information and advice about the patient, and allow the family member to give key information to the provider.

3. Insure that participants know that the results of FRN record reviews concerning the availability of families and social support people in the lives of people with major mental illnesses who attend day programs and receive case management services: that

is, that almost all consumers identify someone who is supportive or important to them, as opposed to the misconception that people with long-term mental illnesses tend to have no family or other social supports.

4. Expose participants to the challenges of different approaches to improving family involvement practices and policies of provider staff.

Expected OutcomeWhat do you plan for this talk to change in the participant’s practice?

Changing participants’ practice with a brief presentation is, according to the research literature on training/education, both extremely unlikely and only measurable with an effort beyond the scope of either the presenters or conference staff. Therefore, this talk focuses on changing the level of competence of the participants by the end of the presentation—measured by pre-post test. In this case, the specific competency targeted for change is knowledge of:

1. Confidentiality requirements regarding family involvement

2. The top priorities of most family members and other social support people of those receiving mental health services

3. The results of record reviews concerning the availability of families and social support people in the lives of people with major mental illnesses who attend day programs and receive case management services.

Learning AssessmentA learning assessment is required for CE credit.

Attention Presenters:Please incorporate audience interaction through a

brief Question & Answer period during or at the conclusion of your presentation.

This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

Presenters: We use both a pre-post test and audience

participation in our presentation.

Accelerating the Collaborative CareProcess Through Family Inclusion

Presented Friday, October 28, 2011By

The Family Resource Network And

The Department of Behavioral Health and Intellectual disAbilities

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Introductions:Who We Are & What We Do

Family Resource Network (FRN): Collaboration of:

* Family support and training

* Advocacy groups

Helps:

* Behavioral health

*Justice *Psychiatric services

become more family inclusive

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Who We Are & What We Do Cont’d…

Philadelphia Department of Behavioral Health/ Intellectual disAbilities Services:

• Behavioral health and intellectual disability services in one comprehensive system.

• Collaborates with: School District, child welfare, judicial systems, other stakeholders.

• Embraces a vision of recovery, resilience, and self-determination.

Who We Are & What We Do Cont’d…

Philadelphia Connections:

Small, city-funded organization

Focus on workforce, education, & family involvement (FI) issues

Integrates FI in training/education of students and providers

DEFINITIONS “Significant People” (SP): Families and anyone who can have a significant negative or positive impact on someone’s health and recovery-not just biological relatives or legal kin.

“Participant”Adult receiving behavioral health services through one of the providers contracted with the Department of Behavioral Health

“Family Inclusion” (FI) Participant-provider- SP involvement supporting the participant and the SP

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Reasons for Family Inclusion

• Families: Often want more provider involvement, information, support, treatment, and support of family-participant relationship.

• Providers: Often perceive a lack of SPs or believe that participants don’t want them to be involved.

• Behavioral Health System: Difficulties with coordination and guidance of all parties.

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Reasons for Family Inclusion - 2

• Research: not translating into practice even though better outcomes are associated with evidence-based or best practices in family interventions

• Participants: rarely educated, asked or offered choices about these best practices

• Family resource providers: referrals are mostly from sources other than behavioral health providers 13

Steps in the Collaborative FI Process:DBH/IDS Efforts

•Focus Groups to assess needs & perceptions

•Funding & support of FRN

•Family Inclusion as “Pillar of Transformation”

•DBHIDS Practice Guidelines•Targeted Case Management Guidelines

•Policy on Confidentiality Including “No Release”

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Steps in the Collaborative FI Process: FRN Efforts

• Attend provider sponsored family events

• FI input into various DBH committees and departments

•Monitoring referrals from providers•Graduate students and cross systems staff trainings on the family perspective•Development of Participant-Driven Family Inclusion Standards for Providers

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Steps in the Collaborative FI Process: FRN Standards

1. Provider agency has formal policies & procedures concerning involving participant-approved significant people.

2. Staff ask participants to identify SPs and sign family-friendly release forms upon intake or first meeting.

3. Assigned staff contact identified SPs by phone within one week to answer questions & receive pertinent information.

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FRN Standards (continued)

4. Staff include appropriate SPs in treatment and recovery planning process.

5. Staff offer appropriate resources & referrals to SPs.

6. Staff document SP information & contacts in formal records.

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FRN Standards (continued)

7. Staff use Quality Assurance Review, discuss findings and implement improvements.

8. Staff who work with SPs have training, experience & ongoing clinical supervision.

9. Staff familiarize SPs with agency services and recruit SPs to serve on advisory boards or policy committees.

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FRN FI Provider Projects Need to customize FI for each program

Need to get top administrative support

Involve provider team and provider direct care staff at all steps

Assess staff practices and competencies

Assess training effectiveness 19

Physical/Behavioral Health Collaboration and FI Efforts

Distressed economy produces opportunities: 1. Provide physical/behavioral health services to

underserved populations who do not or are not able to consider their health needs

2. Help providers, participants, and families cope with the complexities and relation-ships between physical & behavioral issues

3. Collaborate with resources of support in the community

4. Establish standards for collaboration across health care systems.

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Collaborative Family Inclusion Systemic Impacts

Family Inclusion

Physical Health

Behavioral Health

Resources

Policy Develop-

ment

Lessons Learned from Collaborations

Department of Behavioral Health

1. Family advisory boards of SPs can help align program structure with family inclusion principles, practices and policies as consulting arm of any program.

2. Allowing families/SPs to share their stories will effect systemic change.

Lessons Learned from Collaborations - 2

FRN1. Collaboration with DBH/IDS has promoted a

family perspective in many systems issues.

2. DBH Practice Guidelines have promoted dialogue and efforts needed to include families.

3. Individual FI projects with providers are changing practices and policies to the benefit all parties.

Lessons Learned from Collaborations - 3

Providers SPs who see gain from recovery outcome are more likely to be a part of the recovery process. Education and psychotherapy have benefited both SPs andparticipants. Collaborative meetings with SPs are more effective if all involved know what is happening in treatment. Ongoing Outreach (e.g., telephone, face to face, etc.)

Evidence-based Publications• Attitudes and Perceived Barriers to Working with Families of Persons with

Severe Mental Illness: Mental Health Professionals’ Perspectives Hea-Won Kim & Michelle P. Salyers, Community Mental Health Journal, 44:337-345, 2008.

• Building Collaborative Relationships With Families of the Mentally Ill, Henry Grunebaum & Holly Friedman, Hospital and Community Psychiatry, Vol. 39, No. 11: 1183-1186, 1988.

• Confidentiality and the Family Caregiver, John Petrilla & Robert Sadoff, Hospital and Community Psychiatry, Vol. 43: 136-139

• Family Support and Substance Use Outcomes for Persons with Mental Illness and Substance Use Disorders, Robin E. Clark, Schizophrenia Bulletin, 27(1): 93-101,2001

• Overcoming Barriers in Working With Families, Alison M. Heru, Laura Drury, Academic Psychiatry, 2006, 30:379-384

• The Expanded Family Life Cycle: Individual, Family and Social Perspectives, (Chapter 26, Psychiatric Illness and the Life Cycle. Berman, E and Heru, A. and Chapter 7, Sexuality and the Life Cycle Berman, E and Wohlsifer, D.) 4th Edition. McGoldrick, M, Carter, B and Preto, NG, Boston, Allyn & Bacon. 2010.

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

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