Rule 132 New Services Clinical Overview April 2007

Rule 132 Rule 132 New Services New Services

Clinical OverviewClinical Overview

April 2007April 2007

Introduction & Introduction & OverviewOverview

Objectives for the DayObjectives for the Day

1.1. Understand the history and process of Understand the history and process of development for the new servicesdevelopment for the new services

2.2. Understand the role of new services in Understand the role of new services in supporting Recovery/Resiliencysupporting Recovery/Resiliency

3.3. Understand the clinical framework of Understand the clinical framework of new servicesnew services

Community SupportCommunity Support Psychosocial RehabilitationPsychosocial Rehabilitation Assertive Community TreatmentAssertive Community Treatment Non-Medicaid Vocational & OutreachNon-Medicaid Vocational & Outreach

History and Development History and Development ProcessProcess

System Restructuring Initiative (SRI) System Restructuring Initiative (SRI) Statewide advisory task group (consumer chaired, Statewide advisory task group (consumer chaired,

included consumers, providers, trade associations, included consumers, providers, trade associations, advocates, state)advocates, state)

SRI WorkgroupsSRI Workgroups ServicesServices FinancialFinancial Access and EligibilityAccess and Eligibility

Services WorkgroupServices Workgroup Approx. 130 individuals counting allApprox. 130 individuals counting all Individuals with mental illnesses, providers, trade Individuals with mental illnesses, providers, trade

associations, hospitals, state departments, associations, hospitals, state departments, consultantsconsultants


Services Workgroup ObjectivesServices Workgroup Objectives Review service array and Rule 132 with focus Review service array and Rule 132 with focus

on:on:• Supportive of recovery/resiliencySupportive of recovery/resiliency• Accessible to individuals with mental illnessesAccessible to individuals with mental illnesses• Compliance with Medicaid State Plan and other Compliance with Medicaid State Plan and other

guidanceguidance• Identify gapsIdentify gaps

FindingsFindings Current service definitions did not fully promote Current service definitions did not fully promote

recovery/resiliencyrecovery/resiliency Medicaid State Plan and Rule should be updatedMedicaid State Plan and Rule should be updated


Workgroup established service prioritiesWorkgroup established service priorities Community SupportCommunity Support Psychosocial RehabilitationPsychosocial Rehabilitation Assertive Community TreatmentAssertive Community Treatment

Subgroups formed for each of the above:Subgroups formed for each of the above: Researched Evidence-Based Practices Researched Evidence-Based Practices

(EBP)/Best Practices(EBP)/Best Practices Reviewed other states’ definitionsReviewed other states’ definitions Reviewed recent federal CMS/OIG Reviewed recent federal CMS/OIG

audits/actionsaudits/actions


Services Workgroup ResultsServices Workgroup Results Developed new definitions which Developed new definitions which

• promote recovery/resiliencypromote recovery/resiliency• support Evidence Based Practices/Best Practicessupport Evidence Based Practices/Best Practices• Minimize audit compliance riskMinimize audit compliance risk

New non-Medicaid servicesNew non-Medicaid services Recommended improvements to current Recommended improvements to current

definitionsdefinitions New definitions and recommendations were New definitions and recommendations were

used to develop revised Rule 132 and used to develop revised Rule 132 and Medicaid State Plan Amendment Medicaid State Plan Amendment

New Taxonomy – Rule 132 New Taxonomy – Rule 132 ServicesServices

Assertive Community Assertive Community TreatmentTreatment

Case Management – MHCase Management – MH Case Management – Case Management –

Transition Linkage, Transition Linkage, AftercareAftercare

Client Centered ConsultationClient Centered Consultation Community Support – Community Support –

IndividualIndividual Community Support – GroupCommunity Support – Group Community Support – TeamCommunity Support – Team Community Support – Community Support –

ResidentialResidential Comprehensive Mental Comprehensive Mental

Health Services*Health Services* Crisis InterventionCrisis Intervention

Mental Health AssessmentMental Health Assessment Mental Health Intensive Mental Health Intensive

OutpatientOutpatient Psychological EvaluationPsychological Evaluation Psychosocial RehabilitationPsychosocial Rehabilitation Psychotropic Medication Psychotropic Medication

AdministrationAdministration Psychotropic Medication Psychotropic Medication

MonitoringMonitoring Psychotropic Medication Psychotropic Medication

TrainingTraining Therapy/CounselingTherapy/Counseling Treatment Plan Treatment Plan

Development, review and Development, review and modificationmodification*Sunset 6-30-08

New Taxonomy – DHS/DMH New Taxonomy – DHS/DMH Non-Medicaid ServicesNon-Medicaid Services

Vocational AssessmentVocational Assessment Vocational EngagementVocational Engagement Job Finding SupportsJob Finding Supports Job Retention SupportsJob Retention Supports Job Leaving/Termination SupportsJob Leaving/Termination Supports Oral Interpretation and Sign Oral Interpretation and Sign

LanguageLanguage Outreach & EngagementOutreach & Engagement Stakeholder EducationStakeholder Education

Primary Changes to Primary Changes to Medicaid TaxonomyMedicaid Taxonomy

Service labels deleted and activities Service labels deleted and activities subsumed under new definitionssubsumed under new definitions Skills Training & DevelopmentSkills Training & Development Therapeutic Behavioral ServicesTherapeutic Behavioral Services Activity TherapyActivity Therapy Day TreatmentDay Treatment

New/expanded servicesNew/expanded services Community Support (Indiv., Group, Team, Community Support (Indiv., Group, Team,

Residential)Residential) Psychosocial RehabilitationPsychosocial Rehabilitation Assertive Community TreatmentAssertive Community Treatment

Status of Approval & Status of Approval & ImplementationImplementation

Medicaid State Plan Amendment Medicaid State Plan Amendment (SPA)(SPA) Accepted proposed languageAccepted proposed language Alignment between SPA and RuleAlignment between SPA and Rule

Revised Rule 132Revised Rule 132

Recovery and Recovery and ResilienceResilience

The Goal of Services in a The Goal of Services in a Transformed Mental Health Transformed Mental Health

SystemSystem

RecoveryRecovery

Refers to a processRefers to a process The outcome of the process of The outcome of the process of

recovery is that individuals are able recovery is that individuals are able to live, work, learn and participate to live, work, learn and participate fully in their communitiesfully in their communities

The life picture of recovery is unique The life picture of recovery is unique for each individualfor each individual

According to research, hope is an According to research, hope is an essential element in recoveryessential element in recovery

Facilitating Recovery: Facilitating Recovery: Ten Fundamental Ten Fundamental

ComponentsComponents1.1. Hope Hope

2.2. Self-DirectionSelf-Direction

3.3. Individual and Person-CenteredIndividual and Person-Centered

4.4. EmpowermentEmpowerment

5.5. HolisticHolistic

Facilitating Recovery: Facilitating Recovery: Ten Fundamental Ten Fundamental

Components (cont.)Components (cont.)

6.6. Non-LinearNon-Linear

7.7. Strengths-BasedStrengths-Based

8.8. Peer SupportPeer Support

9.9. RespectRespect

10.10. ResponsibilityResponsibility

Recovery Components: Recovery Components: HopeHope

The catalyst to the recovery processThe catalyst to the recovery process Provides the essential and motivating Provides the essential and motivating

message of a better futuremessage of a better future People can and do overcome the People can and do overcome the

barriers and obstacles that confront barriers and obstacles that confront themthem

Hope is internalized, but it can be Hope is internalized, but it can be fostered by peers, families, friends, fostered by peers, families, friends, providers and othersproviders and others

Recovery Components: Recovery Components: Self-DirectionSelf-Direction

By definition, the recovery process By definition, the recovery process must be self-directed by the must be self-directed by the individualindividual

The individual defines his or her own The individual defines his or her own life goals and designs a unique path life goals and designs a unique path towards those goalstowards those goals

Examples of Self-Examples of Self-Direction in Mental Direction in Mental

Health ServicesHealth Services Strengthening ACT service planning Strengthening ACT service planning

to be a participatory processto be a participatory process Community Support: promote active Community Support: promote active

participation in decision-makingparticipation in decision-making Psychosocial Rehabilitation: Psychosocial Rehabilitation:

participating in curriculum/strategy participating in curriculum/strategy choices and selectionchoices and selection

Recovery Components: Recovery Components: Individualized and Individualized and Person-CenteredPerson-Centered

There are multiple pathways to There are multiple pathways to recoveryrecovery

Services take into consideration: an Services take into consideration: an individuals’ unique strengths and individuals’ unique strengths and resiliencies; his/her needs, resiliencies; his/her needs, preferences and experiences; past preferences and experiences; past trauma; cultural backgroundtrauma; cultural background

Examples of Examples of Individualized and Individualized and

Person-Centered Mental Person-Centered Mental Health ServicesHealth Services

Community Support: point out Community Support: point out strengths and suggest ways to use strengths and suggest ways to use them; consider barriers and suggest them; consider barriers and suggest ways to overcome themways to overcome them

Community Support: include the Community Support: include the development of such examples as development of such examples as crisis contingency and Wellness crisis contingency and Wellness Recovery Action Plans (WRAP)Recovery Action Plans (WRAP)

Recovery Components: Recovery Components: EmpowermentEmpowerment

Individuals with mental illnesses Individuals with mental illnesses have the authority to choose from a have the authority to choose from a range of options range of options

Individuals with mental illnesses Individuals with mental illnesses have the authority to participate in have the authority to participate in all decisions that will affect their all decisions that will affect their lives, and are educated and lives, and are educated and supported in so doingsupported in so doing

Recovery Components: Recovery Components: Empowerment (cont.)Empowerment (cont.)

Individuals with mental illnesses Individuals with mental illnesses have the ability and opportunity to have the ability and opportunity to join with one another to collectively join with one another to collectively and effectively speak for themselves and effectively speak for themselves about their needs, wants, desires about their needs, wants, desires and aspirationsand aspirations

Through empowerment, an Through empowerment, an individual gains control of his or her individual gains control of his or her own destinyown destiny

Examples of Examples of Empowerment in Mental Empowerment in Mental

Health ServicesHealth Services ACT: person-centered service ACT: person-centered service

planning as evidenced by person’s planning as evidenced by person’s participation in service planning participation in service planning meetings with the teammeetings with the team

PSR: inclusion of individuals with PSR: inclusion of individuals with mental illnesses in program design, mental illnesses in program design, development, planning, development, planning, implementation, evaluationimplementation, evaluation

Recovery Components: Recovery Components: HolisticHolistic

Encompasses an individual’s whole Encompasses an individual’s whole life, including life, including MindMind BodyBody Spirit Spirit CommunityCommunity

Recovery Components: Recovery Components: Holistic (cont.)Holistic (cont.)

Embraces all aspects of life, including Embraces all aspects of life, including HousingHousing EmploymentEmployment EducationEducation Mental Health and Healthcare Treatment Mental Health and Healthcare Treatment

ServicesServices Complementary and Naturalistic ServicesComplementary and Naturalistic Services Addictions TreatmentAddictions Treatment Spirituality, Creativity, Social Networks, Spirituality, Creativity, Social Networks,

Community Participation, and Family Supports Community Participation, and Family Supports as determined by the personas determined by the person

Examples of Holistic Examples of Holistic Strategies in Mental Strategies in Mental

Health ServicesHealth Services Community Support: Encourage Community Support: Encourage

identification and enhancement of identification and enhancement of the existing natural supports in the the existing natural supports in the individual’s social systemindividual’s social system

Community Support: Assist the Community Support: Assist the individual to maximize the degree to individual to maximize the degree to which natural supports can be usedwhich natural supports can be used

Recovery Components: Recovery Components: Non-LinearNon-Linear

Not a step-by-step processNot a step-by-step process Based on continual growth, Based on continual growth,

occasional setbacks, and learning occasional setbacks, and learning from experiencefrom experience

Begins with an initial stage of Begins with an initial stage of awareness in which a person awareness in which a person recognizes that positive change is recognizes that positive change is possiblepossible

Examples of Non-Linear Examples of Non-Linear Components of Mental Components of Mental

Health ServicesHealth Services If a person is receiving Community If a person is receiving Community

Support and has a temporary Support and has a temporary increased need:increased need: Add PSR for a period of timeAdd PSR for a period of time Intensify Community SupportIntensify Community Support

When increased need has resolved When increased need has resolved or changed, the person can elect or changed, the person can elect discontinuance of PSR and/or discontinuance of PSR and/or reduction in Community Supportreduction in Community Support

Recovery Components: Recovery Components: Strengths-BasedStrengths-Based

Focuses on valuing and building on Focuses on valuing and building on the multiple capacities, resiliencies, the multiple capacities, resiliencies, talents, coping abilities, and talents, coping abilities, and inherent worth of individualsinherent worth of individuals

By building on strengths, individuals By building on strengths, individuals with mental illnesses leave stymied with mental illnesses leave stymied life roles behind and engage in new life roles behind and engage in new life roleslife roles

Examples of Strengths-Examples of Strengths-Based Focus in Mental Based Focus in Mental

Health ServicesHealth Services Designing ACT interventions to build Designing ACT interventions to build

on the strengths of the persons on the strengths of the persons servedserved

PSR: identifying, using and PSR: identifying, using and promoting strengthspromoting strengths

Recovery Components: Recovery Components: Peer SupportPeer Support

Mutual support, including the sharing of Mutual support, including the sharing of experiential knowledge and skills and experiential knowledge and skills and social learningsocial learning

Individuals with mental illnesses Individuals with mental illnesses encourage one another and engage each encourage one another and engage each other in recoveryother in recovery

Individuals with mental illnesses provide Individuals with mental illnesses provide each other with a sense of belonging, each other with a sense of belonging, supportive relationships, valued roles supportive relationships, valued roles and communityand community

Examples of Peer Examples of Peer Support in Mental Support in Mental

Health ServicesHealth Services Strengthening ACT teams to have Strengthening ACT teams to have

solid peer support opportunities for solid peer support opportunities for all persons servedall persons served

Peer support is encouraged Peer support is encouraged throughout the taxonomy via the throughout the taxonomy via the RSA credentialRSA credential

Recovery Components: Recovery Components: RespectRespect

Includes respecting persons’ rights Includes respecting persons’ rights and eliminating discrimination and and eliminating discrimination and stigmastigma

Ensures the inclusion and full Ensures the inclusion and full participation of persons in all participation of persons in all aspects of their livesaspects of their lives

Self-acceptance and regaining belief Self-acceptance and regaining belief in oneself are particularly vitalin oneself are particularly vital

Recovery Components: Recovery Components: ResponsibilityResponsibility

Individuals have a personal Individuals have a personal responsibility for their own self-care responsibility for their own self-care and journeys of recoveryand journeys of recovery

Taking steps toward one’s own Taking steps toward one’s own personal goals may require great personal goals may require great couragecourage

Identifying coping strategies and Identifying coping strategies and healing processes to promote one’s healing processes to promote one’s own wellnessown wellness

Examples of Examples of Responsibility in Mental Responsibility in Mental

Health ServicesHealth Services Community Support: Teaches “how,” Community Support: Teaches “how,”

does not “do for”does not “do for” Community Support: Assists the Community Support: Assists the

individual to do for self rather than individual to do for self rather than doing for the persondoing for the person

ResilienceResilience Refers to the ability to harness inner Refers to the ability to harness inner

strengths and rebound from setbacks or strengths and rebound from setbacks or challengeschallenges

People who are less resilient may dwell on People who are less resilient may dwell on problems, feel victimized, become problems, feel victimized, become overwhelmed and turn to unhealthy coping overwhelmed and turn to unhealthy coping mechanismsmechanisms

Allows individuals to go on with life with a Allows individuals to go on with life with a sense of mastery, competence and hopesense of mastery, competence and hope

If you aren't as resilient as you'd like, you If you aren't as resilient as you'd like, you can teach yourself to become more resilient.can teach yourself to become more resilient.

Building Resilience: Building Resilience: Eleven Essential SkillsEleven Essential Skills

1.1. Getting ConnectedGetting Connected

2.2. Using Humor and LaughterUsing Humor and Laughter

3.3. Learning From Your ExperiencesLearning From Your Experiences

4.4. Remaining Hopeful and OptimisticRemaining Hopeful and Optimistic

5.5. Taking Care of YourselfTaking Care of Yourself

Building Resilience: Building Resilience: Eleven Essential SkillsEleven Essential Skills

6.6. Accepting and Anticipating ChangeAccepting and Anticipating Change

7.7. Working Toward GoalsWorking Toward Goals

8.8. Taking ActionTaking Action

9.9. Learning New Things About Learning New Things About YourselfYourself

10.10. Thinking Better of YourselfThinking Better of Yourself

11.11. Maintaining PerspectiveMaintaining Perspective

Fundamentals of Fundamentals of Effective Community Effective Community

Support (CS)Support (CS)

Pop QuizPop Quiz

Of persons in the U.S. who have been Of persons in the U.S. who have been diagnosed with Schizophrenia, how diagnosed with Schizophrenia, how many function well with no or many function well with no or minimal professional supports?minimal professional supports?

A.A. 10%10%B.B. 20%20%C.C. 35%35%D.D. 50%50%

New Freedom Commission Report

Pop Quiz (cont’d)Pop Quiz (cont’d)

In what location do individuals with In what location do individuals with mental illnesses learn and retain mental illnesses learn and retain skills best?skills best?

1.1. Counselor’s/case worker’s officeCounselor’s/case worker’s office

2.2. ClassroomClassroom

3.3. Structured psychoeducational groupsStructured psychoeducational groups

4.4. Natural settingsNatural settingsNew Freedom Commission Report

Pop Quiz (cont’d)Pop Quiz (cont’d)

Do individuals with mental illnesses or Do individuals with mental illnesses or case managers better predict the case managers better predict the mental health outcomes for mental health outcomes for individuals?individuals?

1.1. Case managersCase managers

2.2. Individuals with mental illnessesIndividuals with mental illnesses

New Freedom Commission Report

OverviewOverview

1.1. Purpose of Community Support (CS)Purpose of Community Support (CS)2.2. What Does the Community Support What Does the Community Support

Worker Do?Worker Do?3.3. IL CS Definition/Core Service ActivitiesIL CS Definition/Core Service Activities4.4. Areas of Core Competence for Areas of Core Competence for

Community SupportCommunity Support5.5. Differentiating Community Support from Differentiating Community Support from

Case ManagementCase Management6.6. The Four Modalities of Community The Four Modalities of Community

SupportSupport7.7. 10 Common Denominators of Good 10 Common Denominators of Good

Community SupportCommunity Support

Purpose of Community Purpose of Community SupportSupport

ProvideProvide mental health rehabilitation mental health rehabilitation interventions and supports necessary interventions and supports necessary to assist individuals with mental to assist individuals with mental illnesses to achieve rehabilitative, illnesses to achieve rehabilitative, resilience and recovery goals resilience and recovery goals primarily in a person’s primarily in a person’s ownown environmentenvironment

Goes beyond just treating symptoms!Goes beyond just treating symptoms!

What Does the CS What Does the CS Worker Do? Worker Do?

Assists individuals with mental Assists individuals with mental illnesses and families with skills illnesses and families with skills teaching and support with teaching and support with respect to:respect to:

Symptom self-management and Symptom self-management and reductionreduction

Environmental modification for Environmental modification for stability and growthstability and growth

Resource acquisitionResource acquisition Recovery planningRecovery planning Development of resilienceDevelopment of resilience

What Does Community What Does Community Support Support

Consist Of?Consist Of?Necessary Mental health Necessary Mental health rehabilitation interventions and rehabilitation interventions and supports:supports:

To build capacity with the person to To build capacity with the person to achieve their self identified rehabilitative, achieve their self identified rehabilitative, resiliency, and recovery goalsresiliency, and recovery goals

Designed to meet the following types of Designed to meet the following types of treatment support needs of the person:treatment support needs of the person:

EducationalEducational VocationalVocational

ResidentialResidential Mental HealthMental HealthCo-occurring disordersCo-occurring disorders FinancialFinancialSocialSocial OthersOthers

Who Gets Community Who Gets Community Support? When & Where Support? When & Where

Do They Get It?Do They Get It? WhoWho: Services are directed toward: Services are directed toward

Adults, Children, Adolescents, FamiliesAdults, Children, Adolescents, Families The primary beneficiary of the services must The primary beneficiary of the services must

be the individual with the mental illnessbe the individual with the mental illness WhenWhen: The changing needs of the individual : The changing needs of the individual

dictate:dictate: Services hours, type, intensity, staff Services hours, type, intensity, staff

credentialcredential WhereWhere: Interventions are delivered: Interventions are delivered

Primarily in natural settings (off site)Primarily in natural settings (off site) By telephone, videoconference, face to faceBy telephone, videoconference, face to face

What are the Goals What are the Goals of of

Community Support?Community Support?Interventions and activities are targeted Interventions and activities are targeted

toward:toward: Development of person’s capacity to Development of person’s capacity to

manage his or her symptomsmanage his or her symptoms Fostering the ability of the person to Fostering the ability of the person to

reduce symptoms as much as possiblereduce symptoms as much as possible Assist the person in promoting stability Assist the person in promoting stability

in his or her life in his or her life Development of person’s ability to foster Development of person’s ability to foster

mastery & independence mastery & independence

IL CS Core IL CS Core Principles/ActivitiesPrinciples/Activities

Promote active participation in Promote active participation in decision-making.decision-making.

Build a context in which shared Build a context in which shared decision-making is the normdecision-making is the norm

Assist the person to:Assist the person to: Identify his or her strengths & ways to Identify his or her strengths & ways to

use themuse them Identify his or her barriers to recovery Identify his or her barriers to recovery

& ways to overcome them& ways to overcome them


Suggest strategies/interventions for Suggest strategies/interventions for greatest independencegreatest independence

Promote recovery-oriented treatment in Promote recovery-oriented treatment in the least restrictive settingthe least restrictive setting

Support self determinationSupport self determination Education, training and assistance in the Education, training and assistance in the

development of the individual’s strengths, development of the individual’s strengths, resources, preferences, and choices resources, preferences, and choices

Includes the development of such Includes the development of such examples as crisis contingency and examples as crisis contingency and Wellness Recovery Action Plans (WRAP). Wellness Recovery Action Plans (WRAP).


Assist the person to develop and maximize Assist the person to develop and maximize support from family and significant otherssupport from family and significant others

Consumer focused Consumer focused Support and consultation to the Support and consultation to the

individual’s family and their support individual’s family and their support systemsystem

Interventions must be to directed to the Interventions must be to directed to the primary well-being and benefit of the primary well-being and benefit of the individual and related directly to the individual and related directly to the individual’s treatment plan.individual’s treatment plan.


Psychoeducation and skill building for Psychoeducation and skill building for individuals’ families and their support individuals’ families and their support systemssystems With or without the individual being With or without the individual being

presentpresent Family or support system Family or support system

psychoeducation or skill building must psychoeducation or skill building must relate to a need identified in the relate to a need identified in the assessment of the individual and be assessment of the individual and be reflected on the Individual Treatment reflected on the Individual Treatment PlanPlan


Interpersonal, family, community and Interpersonal, family, community and functional skills training and supportfunctional skills training and support

Assist the person to develop:Assist the person to develop: Functional skills with respect to adaptation Functional skills with respect to adaptation

to the home, school, family, and work to the home, school, family, and work negatively impacted by the individual’s negatively impacted by the individual’s mental illness.mental illness.

The ability to cope at the following levels:The ability to cope at the following levels:• InterpersonalInterpersonal• FamilyFamily• Community Community


Assist the individual with mental illness(es) Assist the individual with mental illness(es) to develop tools to self-monitor, reduce and to develop tools to self-monitor, reduce and manage symptoms in order to improve the manage symptoms in order to improve the quality of life quality of life

Help to foster the ability to identify & Help to foster the ability to identify & minimize the negative effects of mental minimize the negative effects of mental illness, serious emotional disturbance, and illness, serious emotional disturbance, and co-occurring disordersco-occurring disorders

Assist the person in putting together a Assist the person in putting together a proactive relapse management planproactive relapse management plan

In conjunction with the individual, identify In conjunction with the individual, identify risk factors and related strategies to risk factors and related strategies to manage relapse.manage relapse.


Explore trauma management skillsExplore trauma management skills Assist the individual with mental Assist the individual with mental

illness(es) to develop skills for illness(es) to develop skills for coping with trauma and trauma coping with trauma and trauma issuesissues

Encourage the use of these skillsEncourage the use of these skills

Staff Competencies for Staff Competencies for CSCS

Embracing Recovery and Resiliency PrinciplesEmbracing Recovery and Resiliency Principles Designing & Delivering CS InterventionsDesigning & Delivering CS Interventions Recovery-supportive approachesRecovery-supportive approaches

Assisting with Assisting with skill-buildingskill-building Assisting individuals with mental illnesses to Assisting individuals with mental illnesses to

develop capacitydevelop capacity to acquire resources & supports to acquire resources & supports Training families & natural supportsTraining families & natural supports in effective in effective

support strategiessupport strategies Learning from individuals with mental illnessesLearning from individuals with mental illnesses

and their families/natural supportsand their families/natural supports Cultural literacy and competencyCultural literacy and competency

Differentiating Differentiating Community Support v. Community Support v.

Case ManagementCase ManagementCOMMUNITY COMMUNITY

SUPPORTSUPPORT Helping individual or Helping individual or

family build capacity family build capacity to assess, access, to assess, access, and self-monitorand self-monitor

Active, Active, rehabilitative, rehabilitative, recovery-oriented recovery-oriented set of interventions set of interventions

Teaches “how”Teaches “how” Limits “doing for”Limits “doing for”

CASE MANAGEMENTCASE MANAGEMENT(MH, TLA, CCC)(MH, TLA, CCC)

Assessment of Assessment of resource needsresource needs

Provide Provide Access/LinkageAccess/Linkage

MonitoringMonitoring Client-focused Client-focused

professional professional communicationscommunications

Expressly precludes Expressly precludes direct provision of direct provision of underlying serviceunderlying service

A Sidebar on Case A Sidebar on Case Management in ILManagement in IL

MENTAL HEALTH CASE MENTAL HEALTH CASE MANAGEMENTMANAGEMENT

Assessment Assessment Planning & CoordinationPlanning & Coordination Identifying/investigating Identifying/investigating

resourcesresources AdvocacyAdvocacy Clients with multiple service Clients with multiple service

needs needs Explaining options Explaining options Linkage (non-transition)Linkage (non-transition) Maximum 240 hours/year Maximum 240 hours/year

(including CCC)(including CCC) For persons who need For persons who need

assistance getting or using assistance getting or using services like:services like: - Mental health- Mental health - - HousingHousing- Social- Social - Vocational- Vocational- Public benefits- Public benefits

CLIENT CENTERED CLIENT CENTERED CONSULTATIONCONSULTATION

Client-focused Client-focused professional professional communicationcommunication

Maximum of 240 Maximum of 240 hours/year (including hours/year (including MH Case Manage.)MH Case Manage.)

Face to face or phone Face to face or phone contacts with other contacts with other professionals involved in professionals involved in treatment (internal and treatment (internal and external providers)external providers)

Contacts with SOF, Contacts with SOF, educational, medical educational, medical systemsystem

NOT supervision or NOT supervision or utilization reviewutilization review

A Sidebar on Case A Sidebar on Case Management in ILManagement in IL

TRANSITION LINKAGE, & AFTERCARETRANSITION LINKAGE, & AFTERCARE

Transition to different living arrangements consistent Transition to different living arrangements consistent with improvement & developmentwith improvement & development

Maximum of 40 hours/yearMaximum of 40 hours/year Includes when: Includes when:

The person is discharged from psychiatric hospital or The person is discharged from psychiatric hospital or psychiatric nursing home servicespsychiatric nursing home services

A young person is transitioning to adult servicesA young person is transitioning to adult services Assisting client’s family with transition related issuesAssisting client’s family with transition related issues

CS-ResCS-Res

CS-TeamCS-Team

CS-IndividualCS-IndividualCS-GroupCS-Group

• Extended high acuity• Multi-disciplinary• Intensity of service

Community Support Community Support OptionsOptions

(can flex to high intensity when needed)

Four Ways of Delivering Four Ways of Delivering CSCS

Choice of intensity, frequency and modality is Choice of intensity, frequency and modality is governed by a matrix of factors including governed by a matrix of factors including individual/family individual/family preferencepreference, level of , level of consumer consumer need need (medical necessity), types of (medical necessity), types of specific specific interventionsinterventions prescribed, and prescribed, and safetysafety considerations.considerations.

IndividualIndividual

(1 staff : 1 person)(1 staff : 1 person)GroupGroup

(1 staff : 2 or more (1 staff : 2 or more persons)persons)

TeamTeam

(Team : 1 person)(Team : 1 person)ResidentialResidential

(Individual and (Individual and Group)Group)

Community Support-Community Support-IndividualIndividual

A Core Service for the Target A Core Service for the Target PopulationPopulation Example… Assisting the client/family Example… Assisting the client/family

to build a natural support team, such to build a natural support team, such as working with the child’s parents to as working with the child’s parents to enroll the child in community enroll the child in community recreation activities or working with recreation activities or working with an adult to join a church, temple or an adult to join a church, temple or mosque.mosque.

Provided face to face, by phone or Provided face to face, by phone or via video conference in order to via video conference in order to maximize accessibilitymaximize accessibility

Community Support-Community Support-GroupGroup

Services to assist a group of Services to assist a group of individuals to achieve and practice individuals to achieve and practice rehabilitative, resilience and rehabilitative, resilience and recovery goals.recovery goals. Example… A group of consumers Example… A group of consumers

practicing appropriate social interaction practicing appropriate social interaction skills.skills.

Skill application and Skill application and integration/practice in the integration/practice in the community.community.

Community Support-Community Support-TeamTeam

Provided to persons with moderate to Provided to persons with moderate to severe mental health symptoms severe mental health symptoms meeting admission criteria, who need meeting admission criteria, who need more intense, coordinated and more intense, coordinated and complex intervention.complex intervention.

Services are delivered by a Services are delivered by a multidisciplinary team. multidisciplinary team. Example… Client loses their medication Example… Client loses their medication

and experiences a crisis then requires and experiences a crisis then requires support to problem solve on a weekend. support to problem solve on a weekend.

Interventions to address consumer’s Interventions to address consumer’s needs are divided among team needs are divided among team membersmembers

This is the first team intervention also This is the first team intervention also available to children and adolescents.available to children and adolescents.

Community Support-Community Support-TeamTeam

A strong vehicle to develop A strong vehicle to develop community-based supports for the community-based supports for the transition age (17-25) population.transition age (17-25) population.

A step-down from more intense A step-down from more intense services such as ACT, SASS or services such as ACT, SASS or supervised residential.supervised residential.

A step-up from less intensive A step-up from less intensive community support-individual.community support-individual.

Community Support-Community Support-ResidentialResidential

Interventions delivered to a person Interventions delivered to a person residing in a state-approved living residing in a state-approved living

arrangement.arrangement.““State-approved living arrangement” is a non-State-approved living arrangement” is a non-

Institutes for Mental Diseases (IMD) Institutes for Mental Diseases (IMD) residential setting that requires State-residential setting that requires State-authority approval and is funded in part authority approval and is funded in part with State (non-Medicaid) dollars (used to with State (non-Medicaid) dollars (used to pay for room, board, and non-Medicaid pay for room, board, and non-Medicaid services). Examples include crisis services). Examples include crisis residential, congregate living, and group residential, congregate living, and group home arrangements.home arrangements.

Community Support-Community Support-ResidentialResidential

For AdultsFor Adults Supervised & CILA Residential sitesSupervised & CILA Residential sites Crisis Residential Crisis Residential

For Children and AdolescentsFor Children and Adolescents Children who are wards of DCFS in residential Children who are wards of DCFS in residential

treatment facilitiestreatment facilities Youth placed in residential facilities by DCFS Youth placed in residential facilities by DCFS

and Department of Correctionsand Department of Corrections Persons served through Division of Mental Persons served through Division of Mental

Health’s Individual Care Grant Program.Health’s Individual Care Grant Program.

Ten Best Practices for CSTen Best Practices for CS

1.1. Primary worker delivers service Primary worker delivers service rather than ‘brokering’ referralsrather than ‘brokering’ referrals

2.2. Natural community supports are the Natural community supports are the primary partnersprimary partners

3.3. Interventions occur in the communityInterventions occur in the community

4.4. Both individual and team modalities Both individual and team modalities workwork

5.5. Individual has a consistent CS Worker Individual has a consistent CS Worker Rapp & GoshaRapp & Gosha

Ten Best Practices for Ten Best Practices for CSCS

6.6. Workers can be paraprofessionals. Workers can be paraprofessionals. Supervisors are experienced and fully Supervisors are experienced and fully credentialedcredentialed

7.7. Caseload size (and/or acuity mix) is Caseload size (and/or acuity mix) is small enough to allow frequent small enough to allow frequent contact, if necessarycontact, if necessary

8.8. Services are time unlimited, if Services are time unlimited, if medically necessarymedically necessary

9.9. Individuals have access to familiar Individuals have access to familiar staff on a 24/7 basisstaff on a 24/7 basis

10.10. Workers foster individuals’ choicesWorkers foster individuals’ choicesRapp & GoshaRapp & Gosha

Where is individual

now?

Where does

individualwant to

go?

Community Support Community Support Leads to ProgressLeads to Progress

Community Support Community Support interventions are the interventions are the “in-between” steps“in-between” steps

1.1. Start at individual’s current Start at individual’s current capacity. capacity.

2.2. Move toward capacities needed to Move toward capacities needed to meet recovery goalsmeet recovery goals

CS Summary CS Summary ConceptsConcepts

Builds CapacityBuilds Capacity Assists the individual to do for self Assists the individual to do for self

rather than doing for the personrather than doing for the person

Active Intervention Active Intervention Develops, teaches, and supports rather Develops, teaches, and supports rather

than simply observing and monitoringthan simply observing and monitoring

Core Service to Support Core Service to Support Recovery/ResilienceRecovery/Resilience 80% + of enrolled target population 80% + of enrolled target population

individuals should participate in some individuals should participate in some modality of this servicemodality of this service

Psychosocial Psychosocial Rehabilitation Rehabilitation

ServiceService(PSR)(PSR)

What Consumers What Consumers Identified as ImportantIdentified as Important“Being able to choose mental health “Being able to choose mental health services from among those the agency has services from among those the agency has to offer in order to best meet the identified to offer in order to best meet the identified treatment goals and priorities per the treatment goals and priorities per the individual is imperative in individual is imperative in learning/relearning and practicing the learning/relearning and practicing the skills necessary for the individual to gain, skills necessary for the individual to gain, sustain and maintain a healthy quality of sustain and maintain a healthy quality of life.”life.”

((Illinois Consumer Focus Group Report, 2006Illinois Consumer Focus Group Report, 2006))

What Are the What Are the Differences?Differences?

PSR SERVICEPSR SERVICE New PSR service is New PSR service is

defined in the defined in the revised Rule 132revised Rule 132

Focus on agency -Focus on agency -based skills based skills development development

Intensive service Intensive service that is a that is a supplement to CSsupplement to CS

PSR PROGRAM PSR PROGRAM Defined in the Defined in the

Mental Health Mental Health Program BookProgram Book

Comprised of 5 Comprised of 5 core servicescore services

Clinical home Clinical home

What Happens to the What Happens to the Other Four Core PSR Other Four Core PSR

Components? Components? Peer Support Peer Support Embedded in all mental health services Embedded in all mental health services

Community Resource Development Community Resource Development Incorporated into a Capacity GrantIncorporated into a Capacity Grant

PSR Engagement PSR Engagement New Non-Medicaid service New Non-Medicaid service

Vocational Skills Development Vocational Skills Development Included in PSR Service Included in PSR Service Included in new Non-Medicaid Services Included in new Non-Medicaid Services

The New PSR The New PSR ModelModel

PSR PSR ModelModel has two separate has two separate componentscomponents

Community practice, application, Community practice, application, & integration (Community Support & integration (Community Support Service)Service)

Agency-based psychoeducation Agency-based psychoeducation and skills training and and skills training and development (PSR development (PSR ServiceService))

What is the New PSR What is the New PSR ServiceService??

A recovery oriented skill-building A recovery oriented skill-building service to assist individuals to service to assist individuals to develop or regain skills to live, work, develop or regain skills to live, work, learn and participate fully in their learn and participate fully in their communities. communities.

What Consumers What Consumers Identified as ImportantIdentified as Important

Being able to Being able to choose …choose …

~ ~ whatwhat to practice ~ to practice ~

~ ~ wherewhere to practice ~ to practice ~

What does the New PSR What does the New PSR Service Consist of?Service Consist of?

Necessary individual or group skill Necessary individual or group skill building activities that focus on:building activities that focus on: Individual participation in setting goalsIndividual participation in setting goals Socialization, adaptation, problem solving and Socialization, adaptation, problem solving and

coping skills developmentcoping skills development Self management of symptoms and recoverySelf management of symptoms and recovery Prevocational and work readinessPrevocational and work readiness Education readiness Education readiness Identification of interests, strengths, and Identification of interests, strengths, and

resources to leisure, recreational, and resources to leisure, recreational, and community social activitiescommunity social activities

~Example~~Example~Several individuals have a goal to lose Several individuals have a goal to lose

weight that is associated with their weight that is associated with their psychotropic medication psychotropic medication

Module from Healthy Lifestyle Solutions: Module from Healthy Lifestyle Solutions: Guide to Weight Management Guide to Weight Management PSR skills training - developing a personal PSR skills training - developing a personal

healthy menu plan healthy menu plan Community support - shopping at their local Community support - shopping at their local

grocery store (natural setting) to purchase grocery store (natural setting) to purchase food items on their individual plans (in-vivo food items on their individual plans (in-vivo practice)practice)

~Example~~Example~

Individual(s) identify a goal to find Individual(s) identify a goal to find a different place to live that will a different place to live that will

support their recoverysupport their recovery PSR skills training - teaches how to PSR skills training - teaches how to

locate resources and select locations to locate resources and select locations to visit, identify questions, role play visit, identify questions, role play questionsquestions

Community support – support (go with) Community support – support (go with) individual(s) to tour available apartments, individual(s) to tour available apartments, ask questions and request applicationask questions and request application

What does the New PSR What does the New PSR Service Consist of?Service Consist of?

Cognitive-behavioral interventionsCognitive-behavioral interventions Interventions to address co-Interventions to address co-

occurring psychiatric disabilities, occurring psychiatric disabilities, medical issues, and substance medical issues, and substance abuse issuesabuse issues

Core PSR Core PSR Principles/Activities Principles/Activities

Create a recovery-oriented environment Create a recovery-oriented environment where hope is evident and success is where hope is evident and success is celebratedcelebrated

Provide interventions that are recovery Provide interventions that are recovery oriented, person driven, evidence-based, oriented, person driven, evidence-based, fully integrated, flexible, and available as fully integrated, flexible, and available as neededneeded

Assist individuals to achieve desired roles Assist individuals to achieve desired roles and activitiesand activities

Focus on skills development relevant to Focus on skills development relevant to the individual’s lifethe individual’s life

Core PSR Core PSR Principles/Activities Principles/Activities

Develop Empowerment through Develop Empowerment through Active Involvement in:Active Involvement in: one’s own rehabilitationone’s own rehabilitation setting personal recovery goalssetting personal recovery goals setting priorities setting priorities choosing strategies to meet personal choosing strategies to meet personal

recovery goalsrecovery goals

How Does the PSR How Does the PSR Service Relate to Service Relate to

Community Support Community Support Services?Services?

The new PSR Service is a The new PSR Service is a supplement to Community supplement to Community Support ServiceSupport Service

Community Support is the Community Support is the “clinical home”“clinical home”

Why Does PSR Require Why Does PSR Require Community Support Community Support

Services?Services?

Research indicates that skill Research indicates that skill transfer is best facilitated in the transfer is best facilitated in the individual’s natural living individual’s natural living environment and / or community environment and / or community

The emphasis of rehabilitation The emphasis of rehabilitation services needs to be shifted to services needs to be shifted to community integration and recoverycommunity integration and recovery

Who Receives the New Who Receives the New PSR Service?PSR Service?

Individuals who are receiving Individuals who are receiving community support services and need community support services and need some additional assistance to meet some additional assistance to meet one or more of their recovery goals. one or more of their recovery goals. Example:Example: Individual is not making progress toward Individual is not making progress toward

their self-identified recovery goals and their self-identified recovery goals and identifies a need for more assistanceidentifies a need for more assistance

~Example~~Example~Community Support + PSR Community Support + PSR

Client is severely depressed and at risk for hospitalization Client is severely depressed and at risk for hospitalization as evidenced by: lack of energy, increased anxiety, not as evidenced by: lack of energy, increased anxiety, not eating adequately, not caring for physical self, lack of eating adequately, not caring for physical self, lack of interests, difficulty sleeping and awakening. Community interests, difficulty sleeping and awakening. Community Support – Individual service has not resulted in Support – Individual service has not resulted in improvement over 4 months. Referral to PSR as an improvement over 4 months. Referral to PSR as an adjunct to Community Support.adjunct to Community Support.

Focused PSR interventions including helping person to learn and Focused PSR interventions including helping person to learn and practice relaxation and anxiety reduction techniques.practice relaxation and anxiety reduction techniques.

PSR Groups to identify strengths, interests, goals, barriers to PSR Groups to identify strengths, interests, goals, barriers to meeting goals, strategies (use of strengths, ways to avoid barriers, meeting goals, strategies (use of strengths, ways to avoid barriers, skills to develop natural supports)skills to develop natural supports)

Community Support – Individual/Group used to practice and Community Support – Individual/Group used to practice and integrate skills learned in PSR, into community. Once integrated, integrate skills learned in PSR, into community. Once integrated, PSR discontinues and Community Support continuesPSR discontinues and Community Support continues

Staff Competencies for Staff Competencies for PSRPSR

Embracing Recovery/Resiliency Embracing Recovery/Resiliency principlesprinciples

Orientation and integration of Orientation and integration of persons with mental illnesses as part persons with mental illnesses as part of the staff teamof the staff team

Inclusion of persons with mental Inclusion of persons with mental illnesses in service designillnesses in service design


Assessing skills and supportsAssessing skills and supports Identifying natural Identifying natural

environments/natural supports environments/natural supports Identifying, using and promoting Identifying, using and promoting

strengthsstrengths Using Motivational Interviewing Using Motivational Interviewing


Converting all areas of life into skills trainingConverting all areas of life into skills training Designing and implementing diverse skills Designing and implementing diverse skills

programprogram Planning program design Planning program design Including Evidence Based Practice Including Evidence Based Practice Introducing skills training modulesIntroducing skills training modules Adapting skills training Adapting skills training Individualizing skills sessionsIndividualizing skills sessions Engaging individualsEngaging individuals

Providing clinical supervision Providing clinical supervision

SummarySummary

The new PSR service is a supplement to The new PSR service is a supplement to Community SupportCommunity Support

The new PSR service is designed to help The new PSR service is designed to help individuals become fully-integrated individuals become fully-integrated members of their community thru:members of their community thru: Helping individuals identify their personal goalsHelping individuals identify their personal goals Providing individuals with services choices Providing individuals with services choices Providing Recovery oriented skills trainingProviding Recovery oriented skills training Integrating of skills training with Community Integrating of skills training with Community

SupportSupport

Assertive Assertive Community Community TreatmentTreatment

(ACT)(ACT)

Presentation GoalsPresentation Goals

1)1) Brief review on why the ACT Brief review on why the ACT definition is being changed.definition is being changed.

2)2) Describe who receives the new Describe who receives the new ACT service.ACT service.

3)3) Discuss ACT service interventions Discuss ACT service interventions and activities. and activities.

4)4) Define who delivers the new ACT Define who delivers the new ACT service.service.

Principles Driving the Principles Driving the Change to the New ACT Change to the New ACT

DefinitionDefinition 1)1) Belief in recovery driven services.Belief in recovery driven services.

2)2) Need to focus limited ACT Need to focus limited ACT resources on people with most resources on people with most acute needs. acute needs.

3)3) Compliance with Medicaid Compliance with Medicaid expectation that ACT services be expectation that ACT services be comprehensive, wrap-around comprehensive, wrap-around package.package.

Strengthening ACT to be Strengthening ACT to be Evidence-Based ServiceEvidence-Based Service

A.A. Admission criteria assure that Admission criteria assure that persons most in need receive ACT persons most in need receive ACT for the appropriate length of time.for the appropriate length of time.

B.B. Service planning is a participatory Service planning is a participatory process. process.

C.C. Interventions build on strengths of Interventions build on strengths of the person served.the person served.

D.D. Skills training to occur in natural Skills training to occur in natural settings as a strategy to restore settings as a strategy to restore functioning and promote recovery.functioning and promote recovery.

Strengthening of ACT Strengthening of ACT (cont.)(cont.)

E.E. The recipients receive comprehensive, The recipients receive comprehensive, wrap–around services & supports.wrap–around services & supports.

F.F. The team has the capacity to respond The team has the capacity to respond to emergency psychiatric needs to emergency psychiatric needs (24/7).(24/7).

G.G. The service includes solid peer The service includes solid peer support.support.

H.H. The documentation always supports The documentation always supports the medical necessity for ACT level of the medical necessity for ACT level of care. care.

About Evidence Based About Evidence Based ServiceService

To be an evidence based service, you To be an evidence based service, you must:must:

1)1) Deliver the service to the Deliver the service to the populationpopulation for for whom the service has been proven to be whom the service has been proven to be effective;effective;

2)2) Deliver the serviceDeliver the service interventions and interventions and activitiesactivities consistent with those that have consistent with those that have been tested and proven effective; and,been tested and proven effective; and,

3)3) Provide the service interventions by the staff Provide the service interventions by the staff who have the who have the qualificationsqualifications, , case loadscase loads,, and and integrated team-functioningintegrated team-functioning that that have been tested and proven effective.have been tested and proven effective.

Who To Enroll in ACT Who To Enroll in ACT

ACT to engage persons with:ACT to engage persons with: High acuity and/or complex needsHigh acuity and/or complex needs Episodes of repeat or chronic homelessnessEpisodes of repeat or chronic homelessness Episodes of incarceration in jail and prisons Episodes of incarceration in jail and prisons Multiple psychiatric hospitalizationsMultiple psychiatric hospitalizations History of poor engagement or response to History of poor engagement or response to

traditional approachestraditional approaches Documented functional impairments to Documented functional impairments to

community livingcommunity living Most severe and persistent mental illnessesMost severe and persistent mental illnesses

ACT is an Evidence Based ACT is an Evidence Based Practice for… Practice for…

SchizophreniaSchizophreniaSchizophreniform DisorderSchizophreniform DisorderSchizo-Affective DisorderSchizo-Affective Disorder

Delusional DisorderDelusional DisorderShared Psychotic DisorderShared Psychotic Disorder

Psychotic DisorderPsychotic DisorderBrief Psychotic Disorder NOSBrief Psychotic Disorder NOS

Bi-Polar DisorderBi-Polar Disorder

Core ACT InterventionsCore ACT Interventions& Activities& Activities

1)1) Comprehensive assessment by the team.Comprehensive assessment by the team.2)2) Individualized treatment/service and Individualized treatment/service and

recovery planning.recovery planning. Person’s participation in the service plan Person’s participation in the service plan

meeting;meeting; Person’s service priorities are addressed in Person’s service priorities are addressed in

service plan;service plan; Service plan has skills training activities that Service plan has skills training activities that

build on strengths; and, build on strengths; and, Service plan uses natural surroundings and not Service plan uses natural surroundings and not

the agency setting.the agency setting.

Core ACT Interventions & Core ACT Interventions & ActivitiesActivities

3)3) Assignment of primary service Assignment of primary service coordinator to:coordinator to:

Write the service plan with the Write the service plan with the individual;individual;

Ensure immediate changes to the Ensure immediate changes to the service plan are made as needs service plan are made as needs change;change;

Act as “point person” for family, and,Act as “point person” for family, and, Etc.Etc.

Core ACT Interventions & Core ACT Interventions & Activities Activities

4)4) Provide dual diagnosis substance Provide dual diagnosis substance abuse services, including :abuse services, including :

a.a. Stage-based approaches, such as:Stage-based approaches, such as: EngagementEngagement AssessmentAssessment Motivational enhancementMotivational enhancement Active treatmentActive treatment Continuous relapse preventionContinuous relapse prevention

Core ACT Interventions & Core ACT Interventions & ActivitiesActivities

5)5) Work and education related services. Work and education related services. 6)6) Peer Support Services:Peer Support Services:

a.a. Peer counseling and supportPeer counseling and supportb.b. Linking to self-help programs and Linking to self-help programs and

organizations that promote recovery.organizations that promote recovery.7)7) Environmental and other Support Environmental and other Support

Services:Services: Medical & DentalMedical & Dental HousingHousing BenefitsBenefits

DistinguishingDistinguishingACT RequirementACT Requirement

“Services must be available 24 “Services must be available 24 hours/day, 7 days a week with hours/day, 7 days a week with emergency response coverage, emergency response coverage,

including psychiatric coverage. including psychiatric coverage. Crisis services shall be provided Crisis services shall be provided 24 hours per day, seven days per 24 hours per day, seven days per week by the ACT team assigned week by the ACT team assigned

to the individual.”to the individual.”

Who Delivers ACT Who Delivers ACT ServiceService

““ACT team requires a minimum ACT team requires a minimum 6.0 FTE staff (excluding the 6.0 FTE staff (excluding the psychiatrist and the program psychiatrist and the program assistant).”assistant).”

ACT Team CompositionACT Team Composition Full-time team leader (licensed Full-time team leader (licensed

clinician)clinician) Full-time registered nurseFull-time registered nurse Four rehabilitation services Four rehabilitation services

associates (RSAs)associates (RSAs) Plus:Plus:

Psychiatrist (minimum 10 hrs/wk/60 Psychiatrist (minimum 10 hrs/wk/60 registered individuals) registered individuals)

A program/administrative assistant.A program/administrative assistant.

ACT Team Leader ACT Team Leader

““Full-time team leader who is Full-time team leader who is the clinical and administrative the clinical and administrative supervisor of the team and supervisor of the team and also functions as an ACT also functions as an ACT clinician. The team leader clinician. The team leader shall be a licensed clinician.”shall be a licensed clinician.”

ACT Registered NurseACT Registered Nurse “ “A full-time registered nurse who A full-time registered nurse who

provides services to all ACT individuals provides services to all ACT individuals and who works with the ACT team to and who works with the ACT team to monitor each individuals clinical status monitor each individuals clinical status and response to treatment. The and response to treatment. The registered nurse functions as a primary registered nurse functions as a primary practitioner. For a period of two years practitioner. For a period of two years following the adoption of this service, following the adoption of this service, existing ACT providers may use an LPN existing ACT providers may use an LPN with two years experience in mental with two years experience in mental health services as part of an ACT team…”health services as part of an ACT team…”

Other ACT Team Other ACT Team Positions…Positions…

“Four rehabilitation service associates “Four rehabilitation service associates who work under the supervision of a who work under the supervision of a licensed clinician and function as licensed clinician and function as primary practitioners for a caseload of primary practitioners for a caseload of individuals and who provide individuals and who provide rehabilitation and support functions”rehabilitation and support functions”

The ACT PsychiatristThe ACT Psychiatrist

““A psychiatrist who works on a full- or A psychiatrist who works on a full- or part-time basis for a minimum of 10 part-time basis for a minimum of 10 hours per week for every 60 hours per week for every 60 individuals. The psychiatrist must individuals. The psychiatrist must provide clinical and crisis services to provide clinical and crisis services to all team individuals, work with the all team individuals, work with the team leader to monitor each team leader to monitor each individual’s clinical and medical status individual’s clinical and medical status and response to treatment, and direct and response to treatment, and direct psychopharmacologic and medical psychopharmacologic and medical treatment…”treatment…”

ACT Program Admin ACT Program Admin AssistantAssistant

“…“…is responsible for organizing, is responsible for organizing, coordinating, and monitoring all non-clinical coordinating, and monitoring all non-clinical operations of ACT, including managing operations of ACT, including managing medical records; operating and coordinating medical records; operating and coordinating the management information system; the management information system; maintaining accounting and budget records maintaining accounting and budget records for individual and program expenditures; for individual and program expenditures; and providing receptionist activities, and providing receptionist activities, including triaging calls and coordinating including triaging calls and coordinating communication between the team and communication between the team and individuals.”individuals.”

Required CompetenciesRequired Competencies

A.A. At least one member of the team must be At least one member of the team must be trained and certified to provide substance trained and certified to provide substance abuse and/or co-occurring disorders.abuse and/or co-occurring disorders.

B.B. At least one member of the team should be a At least one member of the team should be a person in recoveryperson in recovery and, if available, and, if available, credentialed as a Certified Recovery Support credentialed as a Certified Recovery Support Specialist.Specialist.

C.C. At least one member of the team must have At least one member of the team must have training in rehab counseling, especially training in rehab counseling, especially vocational, work readiness, and educational vocational, work readiness, and educational support. support.

Requirements for the Requirements for the Whole ACT Team Whole ACT Team

1)1) Each ACT team is expected to Each ACT team is expected to maintain a staff to individual maintain a staff to individual ratio of ratio of no more thanno more than 1:101:10..

2)2) Each team is expected to reflect Each team is expected to reflect the language, culture, and the language, culture, and ethnicity of the population being ethnicity of the population being served.served.

Competencies for Successful Competencies for Successful ACT Team LeadersACT Team Leaders

1)1) Ability to lead a recovery-focused service Ability to lead a recovery-focused service planning process that fully includes the planning process that fully includes the person served.person served.

2)2) Leadership to assure clinical focus and Leadership to assure clinical focus and orientationorientation

3)3) Model for continuous learning.Model for continuous learning.

4)4) Good leadership skills with ability to keep Good leadership skills with ability to keep team members from different disciplines team members from different disciplines working together.working together.

5)5) Management to assure that documentation Management to assure that documentation supports medical necessity.supports medical necessity.

Competencies for Successful Competencies for Successful

ACT Team MembersACT Team Members1)1) Belief that people can and will recover.Belief that people can and will recover.2)2) Respect for individuals regardless of Respect for individuals regardless of

level of recovery.level of recovery.3)3) Ability to work as a team member.Ability to work as a team member.4)4) Ability to work and do assessments Ability to work and do assessments in-in-

vivovivo. . 5)5) Ability to be creative when engaging Ability to be creative when engaging

people in services and a corresponding people in services and a corresponding avoidance of “coercive” techniques. avoidance of “coercive” techniques.

6)6) Respect for an individual’s cultural and Respect for an individual’s cultural and trauma background.trauma background.

Competencies for Competencies for Successful Successful ACT TeamsACT Teams

Ability to Ability to support and train in in the basic community living skill the basic community living skill areas of:areas of:

Safe affordable housingSafe affordable housing Accessing entitlements and benefitsAccessing entitlements and benefits Activities of daily livingActivities of daily living Medication managementMedication management Health care needsHealth care needs

ACT Team vs. CS-TeamACT Team vs. CS-Team ACT TeamACT Team CS-TeamCS-Team

1:101:10 staff to persons staff to persons served ratioserved ratio

1:181:18 staff to persons staff to persons served ratio served ratio

Serves narrower range of Serves narrower range of people people

Serves broader range of Serves broader range of persons persons

Requires Requires at least at least 6.0 FTE6.0 FTE staffstaff

RequiresRequires at least at least 3.0 FTE3.0 FTE staffstaff

Requires Requires M.D., R.N., on M.D., R.N., on teamteam

MD, RN not required on MD, RN not required on teamteam

RequiresRequires person in person in recovery recovery

Person in recovery not Person in recovery not required required

RequiresRequires SA/MISA SA/MISA specialist specialist

SA/MISA specialist not SA/MISA specialist not required required

Requires Requires Rhb/Voc/Sp Ed Rhb/Voc/Sp Ed spcl spcl

Rhb/Voc/Sp Ed spcl not Rhb/Voc/Sp Ed spcl not rqrd rqrd

RequiresRequires 24/7 crisis 24/7 crisis intervention intervention

May use auxiliary crisis May use auxiliary crisis services. services.

Thank You!Thank You!

Non-Medicaid Non-Medicaid ServicesServices

DMH Contracted OnlyDMH Contracted Only

Evidence-Based SE Evidence-Based SE PrinciplesPrinciples

Find & keep competitive employmentFind & keep competitive employment Vocational interventions are fully Vocational interventions are fully

integrated w/mental health treatmentintegrated w/mental health treatment Anyone who wants to work is eligibleAnyone who wants to work is eligible Rapid job searchRapid job search Time unlimited serviceTime unlimited service Jobs seen as transitionsJobs seen as transitions Consumer preferences are importantConsumer preferences are important Benefits planningBenefits planning

Vocational EngagementVocational Engagement

Activities for a specific person to Activities for a specific person to engage them in making a decision to engage them in making a decision to actively seek actively seek competitive competitive employmentemployment or formal or formal credit/certificate bearing educationcredit/certificate bearing education..

NoteNote: this does not include pre-vocational : this does not include pre-vocational agency based work programs or agency agency based work programs or agency based education programs that do not based education programs that do not result in credentials recognized by an result in credentials recognized by an employer.employer.

Vocational AssessmentVocational Assessment

Developing a vocational profile to guide Developing a vocational profile to guide individual choices in seeking and individual choices in seeking and maintaining maintaining competitive employment.competitive employment.

Work history, interests, skills, strengths, Work history, interests, skills, strengths, education, impact of symptoms, job education, impact of symptoms, job preferences.preferences.

NoteNote: This does not include pre-vocational : This does not include pre-vocational work experiences or simulated/situational work experiences or simulated/situational work experiences at the agency.work experiences at the agency.

Job Finding SupportsJob Finding Supports

Activities for a Activities for a specific individualspecific individual, directed , directed toward helping them find and procure a job, toward helping them find and procure a job, when provided under the following when provided under the following conditions: conditions: placement based on consumer job placement based on consumer job preferences, competitive employment in preferences, competitive employment in integrated work settings, ongoing supports as integrated work settings, ongoing supports as needed and integration of supported needed and integration of supported employment services with other mental employment services with other mental health services.health services.

Note: does not include general job Note: does not include general job development. development.

Job Retention SupportsJob Retention Supports

Directed toward helping the individual keep Directed toward helping the individual keep his/her competitive integrated job. his/her competitive integrated job.

Interventions that are specific to work and Interventions that are specific to work and the job are considered job retention the job are considered job retention supports.supports.

NoteNote: therapeutic support to help individuals : therapeutic support to help individuals manage their mental health symptoms and manage their mental health symptoms and illness as they work toward achieving their illness as they work toward achieving their recovery goals is a Rule 132 service. recovery goals is a Rule 132 service. Recovery goals can include employment Recovery goals can include employment goals.goals.

Job Leaving/Termination Job Leaving/Termination SupportsSupports

Directed toward helping the person Directed toward helping the person leave a job in good standing, or view leave a job in good standing, or view unplanned job loss as transitional unplanned job loss as transitional and a learning experience that will and a learning experience that will help them with the next job.help them with the next job.

IntentIntent: Job loss is not seen as a reason : Job loss is not seen as a reason to discontinue participation in to discontinue participation in supported employment.supported employment.

Outreach and Outreach and EngagementEngagement

&&Stakeholder EducationStakeholder Education

Two related services…Two related services…

Outreach and EngagementOutreach and Engagement – Reaching out to – Reaching out to people with mental illnesses or emotional people with mental illnesses or emotional disorders and bringing them into the public disorders and bringing them into the public mental health system.mental health system.

Stakeholder EducationStakeholder Education – Going into – Going into community to speak/train/educate groups community to speak/train/educate groups about mental illnesses, treatment alternatives, about mental illnesses, treatment alternatives, access issues, etc.access issues, etc.

Outreach & Engagement:Outreach & Engagement: Activities & Activities & InterventionsInterventions Case findingCase finding to identify adults, adolescents, and to identify adults, adolescents, and

children suspected to have a mental illness or children suspected to have a mental illness or emotional disturbance who have not consented to emotional disturbance who have not consented to services, require engagement or re-engagement to services, require engagement or re-engagement to services.services.

Interventions to linkInterventions to link to emergency medical or to emergency medical or psychiatric care.psychiatric care.

Repeat contactsRepeat contacts over extended periods of time to over extended periods of time to engage.engage.

Developing strategiesDeveloping strategies to reduce or eliminate risk. to reduce or eliminate risk.

Facts About Facts About Outreach & Engagement Outreach & Engagement No prior authorization needed. No prior authorization needed. Funded with State dollars only.Funded with State dollars only. A new FFS option; however, NO new contract dollars A new FFS option; however, NO new contract dollars

involved in roll-out. involved in roll-out. This first iteration of the service is based on the This first iteration of the service is based on the

experience of Illinois providers working with these experience of Illinois providers working with these special populations.special populations.

Division has more freedom to revise the definition Division has more freedom to revise the definition and intends to monitor & modify as desired. and intends to monitor & modify as desired.

Outreach & Engagement:Outreach & Engagement:Service & Clinical Service & Clinical

ExclusionsExclusions People already engaged in DMH People already engaged in DMH

provider service not eligible for provider service not eligible for Outreach & Engagement.Outreach & Engagement.

Discontinuation of O&E should Discontinuation of O&E should happen when person found to have happen when person found to have certain non-MH disorders.certain non-MH disorders.

Not intended to cover activities of Not intended to cover activities of PATH or other federally funded PATH or other federally funded project staff. project staff.

Stakeholder Education:Stakeholder Education: Activities & Activities & InterventionsInterventions

Educational meetingsEducational meetings with stakeholder groups to with stakeholder groups to provide information about the signs and symptoms of provide information about the signs and symptoms of mental illnesses/emotional disturbances.mental illnesses/emotional disturbances.

Meetings to collaborateMeetings to collaborate with other community with other community service sites and build opportunities for referral and service sites and build opportunities for referral and engagement of people in need. engagement of people in need.

Public speaking engagementsPublic speaking engagements that strengthen the that strengthen the relationships among stakeholder groups and the relationships among stakeholder groups and the public MH system.public MH system.

Stakeholder Education:Stakeholder Education:GoalsGoals

To support collaboration between DMH To support collaboration between DMH providers and community stakeholders providers and community stakeholders that have regular contact with high risk that have regular contact with high risk populations.populations.

To fight stigma with information about To fight stigma with information about the signs and symptoms of mental the signs and symptoms of mental illnesses & emotional disturbances and illnesses & emotional disturbances and the availability of public MH services.the availability of public MH services.

To promote innovative service access To promote innovative service access strategies. strategies.

Stakeholder Education: Stakeholder Education: FactsFacts

No prior authorization needed. No prior authorization needed. Funded with State dollars only (non-Medicaid).Funded with State dollars only (non-Medicaid). A new FFS option; however, NO new contract A new FFS option; however, NO new contract

dollars. dollars. This first iteration of service is based on provider This first iteration of service is based on provider

history of performing these activities.history of performing these activities. Division has more freedom to revise the definition Division has more freedom to revise the definition

and intends to monitor & modify as desired. and intends to monitor & modify as desired.

Stakeholder Education:Stakeholder Education:Service ExclusionsService Exclusions

The following activities are not covered:The following activities are not covered:1.1. Ad hoc gatherings or impromptu Ad hoc gatherings or impromptu

presentations lacking advance presentations lacking advance preparation.preparation.

2.2. Repetitious trainings with regard to Repetitious trainings with regard to content or attendees.content or attendees.

3.3. The service is provided as an activity of a The service is provided as an activity of a Program to Aid in the Transition from Program to Aid in the Transition from Homeless (PATH) or any other federally Homeless (PATH) or any other federally funded project operated by the provider.funded project operated by the provider.

Thanks Again!Thanks Again!

SupplementalSupplementalMaterialsMaterials

Medicaid Medicaid OverviewOverview

Parameters and Medical Parameters and Medical NecessityNecessity

Medicaid OverviewMedicaid Overview Medicaid is a health entitlement program Medicaid is a health entitlement program

for people who are low-income and/or for people who are low-income and/or disabled that is jointly funded by the disabled that is jointly funded by the federal government and the state federal government and the state governmentgovernment

The federal government sets basic The federal government sets basic parameters and approves State parameters and approves State customization of a Medicaid plan (called customization of a Medicaid plan (called a ‘State Plan’)a ‘State Plan’)

The basic Medicaid plan primarily covers The basic Medicaid plan primarily covers in-clinic and in-hospital services.in-clinic and in-hospital services.

Three Primary Medicaid Three Primary Medicaid OptionsOptions

Clinic OptionClinic Option In clinic and in hospital servicesIn clinic and in hospital services Physician directedPhysician directed

Targeted Case Management (TCM) Targeted Case Management (TCM) OptionOption Specific populationSpecific population Assessment, planning, linkage, follow Assessment, planning, linkage, follow

upup No direct interventionsNo direct interventions

Rehabilitation (Rehab) OptionRehabilitation (Rehab) Option

IL Mental Health ServicesIL Mental Health Servicesby Medicaid Optionby Medicaid Option

Targeted Case Targeted Case ManagementManagement

Transition Linkage Transition Linkage & Aftercare& Aftercare

Mental Health Case Mental Health Case ManagementManagement

Rehabilitation Rehabilitation OptionOption

All other Rule 132 All other Rule 132 servicesservices

Medicaid Psychiatric Medicaid Psychiatric Rehabilitation OptionRehabilitation Option

Used with behavioral healthcareUsed with behavioral healthcare Focuses on community-based Focuses on community-based

services that actively encourage services that actively encourage rehabilitation and progress toward a rehabilitation and progress toward a returnreturn to optimal functioning to optimal functioning

Emphasizes participation and choiceEmphasizes participation and choice Requires rehabilitation from a Requires rehabilitation from a

psychiatric disabilitypsychiatric disability

Restoration of basic skills necessary Restoration of basic skills necessary to function to function independently/developmentally independently/developmentally appropriate in the communityappropriate in the community Examples: food planning and Examples: food planning and

preparation, maintenance of living preparation, maintenance of living environment, community environment, community awareness, mobility skills, awareness, mobility skills, academic participationacademic participation

Federal Guidance says Federal Guidance says Rehabilitation Is:Rehabilitation Is:


Redevelopment of communication Redevelopment of communication and socialization skillsand socialization skills Especially those skills that help Especially those skills that help

individuals with mental individuals with mental illnesses move toward illnesses move toward recovery/resiliency, maintain recovery/resiliency, maintain age appropriate community age appropriate community living, and achieve optimal living, and achieve optimal independence from disabilityindependence from disability


Family education and other Family education and other family services exclusively family services exclusively related to treatment or related to treatment or rehabilitation of the covered rehabilitation of the covered individual.individual.


Interventions which will assist Interventions which will assist individuals to build capacity to individuals to build capacity to gaining access to needed gaining access to needed medical, social, educational and medical, social, educational and other services. other services. These services might include These services might include

housing, social services, housing, social services, vocational training and vocational training and education. education.

Federal Guidance says Federal Guidance says Rehabilitation Is NOT:Rehabilitation Is NOT:

Vocational services (especially job Vocational services (especially job training)training)

Academic educationAcademic education Purely SocializationPurely Socialization Purely RecreationPurely Recreation TransportationTransportation Watchful OversightWatchful Oversight

BUT Rehabilitation BUT Rehabilitation CAN provide:CAN provide:

Skills teaching and support critical Skills teaching and support critical to successful job functioning, to successful job functioning, including ability to get along with including ability to get along with

peers and supervisors, peers and supervisors, concentrate on tasks at hand, concentrate on tasks at hand, work at a reasonable pace, persist work at a reasonable pace, persist at tasks, present self (cleanliness, at tasks, present self (cleanliness, attire and communication) attire and communication) appropriately for the work site, appropriately for the work site, maintain work schedule (show up maintain work schedule (show up on time), and follow instructions.on time), and follow instructions.

AND Rehabilitation AND Rehabilitation CAN provide:CAN provide:

Social skills and basic and daily-Social skills and basic and daily-living skills required for success in living skills required for success in an academic program. an academic program. Note: Academic goals can be Note: Academic goals can be

included in Service Plan as long included in Service Plan as long as focus is on rehabilitative skills as focus is on rehabilitative skills that allow person to complete that allow person to complete that education, reduce disability, that education, reduce disability, and restore the individual to his and restore the individual to his or her best functional level.or her best functional level.

AND Rehabilitation AND Rehabilitation CAN provide:CAN provide:

Skills development and practice of Skills development and practice of skills necessary to structure and use skills necessary to structure and use leisure time, recreational leisure time, recreational opportunities, and social occasions.opportunities, and social occasions. Improving natural support systemsImproving natural support systems Developing relationship skillsDeveloping relationship skills Planning skillsPlanning skills Reducing isolation and withdrawalReducing isolation and withdrawal

Federal Guidance says Federal Guidance says Rehabilitation Is Rehabilitation Is

Medically Necessary:Medically Necessary: What does that mean?What does that mean?

Focus on issues caused or Focus on issues caused or impacted by psychiatric impacted by psychiatric disability and directly related disability and directly related to the mental illnessto the mental illness

Not just beneficial – necessary Not just beneficial – necessary to remediate the disabilityto remediate the disability

Demonstrating Medical Demonstrating Medical Necessity:Necessity:

Five Basic StepsFive Basic Steps AssessmentAssessment documents psychiatric documents psychiatric

condition and impact on functioningcondition and impact on functioning Service PlanService Plan addresses areas identified on addresses areas identified on

assessment and includes steps to returning assessment and includes steps to returning to baseline (Signed by authorized person) to baseline (Signed by authorized person)

Service Plan Service Plan prescribesprescribes services in services in amountamount & & durationduration reasonably expected to foster reasonably expected to foster changechange

InterventionsInterventions (& notes) directly (& notes) directly relaterelate to to Service PlanService Plan

Notes demonstrate Notes demonstrate progressprogress

Building Building ResilienceResilience

Eleven Essential Skills Eleven Essential Skills

Resilience Skills: Getting Resilience Skills: Getting ConnectedConnected

Building strong, positive Building strong, positive relationships with family and friendsrelationships with family and friends

Getting involved in civic groups, Getting involved in civic groups, faith groups or volunteer faith groups or volunteer organizationsorganizations

Fulfilling the need for a sense of Fulfilling the need for a sense of belonging and banishing loneliness belonging and banishing loneliness through relationships/connectednessthrough relationships/connectedness

Resilience Skills: Using Resilience Skills: Using Humor and LaughterHumor and Laughter

Remaining positive/finding humor in Remaining positive/finding humor in distressing situations does not mean distressing situations does not mean a person is in deniala person is in denial

Humor is a helpful coping Humor is a helpful coping mechanismmechanism

Funny books and movies can add Funny books and movies can add humor to lifehumor to life

Resilience Skills: Resilience Skills: Learning From Our Learning From Our

ExperiencesExperiences Recalling how you have coped with Recalling how you have coped with

hardships in the past, either in hardships in the past, either in healthy or unhealthy wayshealthy or unhealthy ways

Building on what helped you through Building on what helped you through the rough times; not repeating the rough times; not repeating actions that did not helpactions that did not help

Figuring out what lessons you Figuring out what lessons you learned and how you will apply them learned and how you will apply them when faced with similar situationswhen faced with similar situations

Resilience Skills: Resilience Skills: Remaining Hopeful and Remaining Hopeful and

OptimisticOptimistic Looking toward the future, even if Looking toward the future, even if

it’s just a glimmer of how things it’s just a glimmer of how things might improvemight improve

Finding something in each day that Finding something in each day that signals a change for the bettersignals a change for the better

Believing things happen for a reason Believing things happen for a reason often helps to sustain peopleoften helps to sustain people

Resilience Skills: Taking Resilience Skills: Taking Care of YourselfCare of Yourself

Tending to your own needs and Tending to your own needs and feelings, both physically and feelings, both physically and emotionallyemotionally

Participating in hobbies you enjoy; Participating in hobbies you enjoy; exercising regularlyexercising regularly

Getting plenty of sleep; eating a Getting plenty of sleep; eating a well-balanced dietwell-balanced diet

Resilience Skills: Resilience Skills: Accepting and Accepting and

Anticipating ChangeAnticipating Change Being flexible: change and Being flexible: change and

uncertainty are part of lifeuncertainty are part of life Trying not to be so rigid that even Trying not to be so rigid that even

minor changes upset you or that you minor changes upset you or that you become anxious in the face of become anxious in the face of uncertaintyuncertainty

Expecting changes to occur makes it Expecting changes to occur makes it easier to adapt to them, tolerate easier to adapt to them, tolerate them, and even welcome themthem, and even welcome them

Resilience Skills: Resilience Skills: Working Toward GoalsWorking Toward Goals

Doing something every day that Doing something every day that gives you a sense of accomplishmentgives you a sense of accomplishment

Recognizing that even small, Recognizing that even small, everyday goals are importanteveryday goals are important

Having goals which help direct you Having goals which help direct you toward the futuretoward the future

Resilience Skills: Taking Resilience Skills: Taking ActionAction

Figuring out what needs to be doneFiguring out what needs to be done Making a plan to do itMaking a plan to do it Taking action to resolve your Taking action to resolve your

problemsproblems Wishing problems away, or ignoring Wishing problems away, or ignoring

them, does no goodthem, does no good

Resilience Skills: Resilience Skills: Learning New Things Learning New Things

About YourselfAbout Yourself Looking back on past experiences Looking back on past experiences

and thinking about how you’ve and thinking about how you’ve changed as a resultchanged as a result

Recognizing that you may be Recognizing that you may be stronger than you thoughtstronger than you thought

Exploring new interests, such as Exploring new interests, such as taking a cooking class or visiting a taking a cooking class or visiting a museummuseum

Resilience Skills: Resilience Skills: Thinking Better of Thinking Better of

YourselfYourself Congratulating yourself for enduring Congratulating yourself for enduring hard times, loss or stresshard times, loss or stress

Being proud of yourselfBeing proud of yourself Trusting yourself to solve problems and Trusting yourself to solve problems and

make sound decisionsmake sound decisions Thinking positive thoughts about Thinking positive thoughts about

yourselfyourself Nurturing your self-confidence and self-Nurturing your self-confidence and self-

esteem so that you feel you’re a strong, esteem so that you feel you’re a strong, capable and self-reliant personcapable and self-reliant person

Resilience Skills: Resilience Skills: Maintaining PerspectiveMaintaining Perspective

Recognizing that perspective is not about Recognizing that perspective is not about comparing yourself to otherscomparing yourself to others

Comparing yourself to someone who may be Comparing yourself to someone who may be worse off may only make you feel worse or worse off may only make you feel worse or feel guiltyfeel guilty

Perspective is about looking at your Perspective is about looking at your situation in the larger context of your own situation in the larger context of your own life, and the worldlife, and the world

It is about keeping a long-term perspective It is about keeping a long-term perspective and knowing that your situation can improve and knowing that your situation can improve if you actively work to make it betterif you actively work to make it better

A Brief Bibliography on A Brief Bibliography on Recovery/ResiliencyRecovery/Resiliency

Anthony, William. A Recovery-Oriented Service System: Anthony, William. A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Setting Some System Level Standards. Psychiatric Rehabilitation Journal, Vol. 24, No. 2. (2000).Rehabilitation Journal, Vol. 24, No. 2. (2000).

National Consensus Statement on Mental Health National Consensus Statement on Mental Health Recovery. U.S. Department of Health & Human Recovery. U.S. Department of Health & Human Services. Substance Abuse & Mental Health Services Services. Substance Abuse & Mental Health Services Administration. Center for Mental Health Services. Administration. Center for Mental Health Services. 20062006

New Freedom Commission on Mental Health, Achieving New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in the Promise: Transforming Mental Health Care in America. Final Report. (2003)America. Final Report. (2003)

Additional New Additional New Services Services

InformationInformation

4 Ways of Delivering 4 Ways of Delivering CS: Quick ReviewCS: Quick Review

Person Receiving:Person Receiving:

CS-Individual: An CS-Individual: An individual staff member individual staff member will work with you.will work with you.

CS-Group: One or two CS-Group: One or two staff members work with staff members work with you and other consumers you and other consumers together.together.

CS-Team: A team of staff CS-Team: A team of staff members will work with members will work with youyou

CS-Residential: You’ll CS-Residential: You’ll receive service in a receive service in a residential setting from residential setting from several staff membersseveral staff members

Factors common to all Factors common to all four ways:four ways:

ALL work toward mutually ALL work toward mutually agreed upon rehabilitative, agreed upon rehabilitative, resilience-oriented, and resilience-oriented, and recovery-focused goals.recovery-focused goals.

A minimum of 60% of all CS A minimum of 60% of all CS services must be delivered in services must be delivered in natural settings.natural settings.

CS occurs at locations that CS occurs at locations that reasonably accommodate the reasonably accommodate the person’s needs,and at hours person’s needs,and at hours that do not interfere with that do not interfere with work, educational, and other work, educational, and other community activities. community activities.

A Brief C.S. BibliographyA Brief C.S. BibliographyCenter for Psychiatric Rehabilitation, Sargent College of Center for Psychiatric Rehabilitation, Sargent College of

Health and Rehabilitation Sciences. Boston University: Health and Rehabilitation Sciences. Boston University: Recovery from Serious Mental Illness.Recovery from Serious Mental Illness.

Farkas & Anthony (Eds.). Psychiatric rehabilitation programs: Farkas & Anthony (Eds.). Psychiatric rehabilitation programs: Putting theory into practice. Baltimore, MD: Johns Hopkins Putting theory into practice. Baltimore, MD: Johns Hopkins University PressUniversity Press

The President’s New Freedom Commission: Goals and The President’s New Freedom Commission: Goals and Recommendations for a Transformed Mental Health Recommendations for a Transformed Mental Health System. System. available at: available at: http://www.mentalhealthcommission.gov/http://www.mentalhealthcommission.gov/

Rapp. The strengths model. NY: Oxford U. Press, 1998Rapp. The strengths model. NY: Oxford U. Press, 1998

Rapp and Gosha: The Principles of Effective Case Rapp and Gosha: The Principles of Effective Case Management; Psychiatric Rehabilitation Journal, Spring Management; Psychiatric Rehabilitation Journal, Spring 2004—Volume 27, Number 42004—Volume 27, Number 4

EVIDENCE-BASED ACT EVIDENCE-BASED ACT WEB SITEWEB SITE

SAMSHA' National Mental Health SAMSHA' National Mental Health Information CenterInformation Center

Evidence-Based Practices: Shaping Evidence-Based Practices: Shaping Mental Health Services Toward Mental Health Services Toward RecoveryRecovery

http://mentalhealth.samhsa.gov/http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cmhs/communitysupport/toolkits/

Documents

Rule 132 New Services Clinical Overview April 2007