MHASP Consumer Recovery
Investment Fund: Self Directed Care
Delaware County, PA
Presentation to PA MHA Conference
April 27, 2011
Erme C. Maula, RN, MSN, CRRN, CPS
Program Manager
Mental Health Association of Southeastern Pennsylvania
4/27/11
1
CRIF SDC Definitions





CRIF: Consumer Recovery Investment Fund
SDC: Self Directed Care
CPS: Certified Peer Specialist
Recovery Coach: Certified Peer Specialist and
WRAP trained facilitator that accompanies
participants along their recovery journey
Freedom Funds: Funds in the SDC budget
used to purchase non-traditional goods and
services
4/27/11
2
Collaborators

Magellan Health Services –
Magellan Behavioral Health of Pennsylvania is an affiliate of Magellan Health Services

Office of Behavioral Health, Delaware County, Pennsylvania

Temple University Collaborative on Community Integration of
People with Psychiatric Disabilities

Mental Health Association of Southeastern Pennsylvania

National Institute on Disability and Rehabilitation
Research
4/27/11
3
Meet the Operations and Recovery
Coach Team
Evon Bergey,
General Manager,
Magellan Health Services
Bill Chambers
MH Program Director
Delaware County
Office of Behavioral Health
Joseph Rogers,
Director of Advocacy,
MHASP
Erme Maula,
Program Manager,
MHASP
Bob Waters,
National V.P., Account Management
Magellan Health Services
Mark Salzer
Professor and Chair
Department of Rehabilitation Sciences
Temple University
Bill Dinwiddie,
Tim Connors,
Recovery Coach,
MHASP
CEO MHASP
Rita Burns
Andrea Bilger
Jennifer Tripp
VP, Public Sector Program Innovation
Magellan Public Sector Solutions
Research Assistant
Temple University
Brett Diamond,
MHASP
CFO, MHASP
Richard Baron
Director, Knowledge Translation Activities
Temple University Collaborative on Community Integration of
Julie Brown,
People with Psychiatric Disabilities
Jeff Quick,
Recovery Coach,
MHASP
Delaware County Senior Account Executive,
Magellan Health Services
4/27/11
Not Pictured: Jonna DiStefano, Lisa Gardner, Dawn Berardinelli,
Lynne Baumeister, Donna Holiday
4
CRIF SDC Program Philosophy is
based on the following elements:
Recovery
 Peer Support
 Self Directed Care

4/27/11
5
Recovery



The program philosophy is based on the
fundamental belief that people can and do
recover from mental illness.
Recovery is a deeply personal process that
involves the restoration of hope, self-esteem,
creativity, and self-determination.
Recovery is a life-long journey that restores and
maintains individual dignity and control over
one’s own destiny.
4/27/11
6
Recovery Values
HOPE
INDIVIDUALITY
SELF-AWARENESS
SELF-DETERMINATION
MEANINGFUL LIFE
RESPECT
PEER SUPPORT
COMMUNITY FOCUS
ADVOCACY
4/27/11
7
Peer Support





All CRIF SDC Program Recovery Coaches are Certified Peer
Specialists.
Peers helping other peers has been identified as a critical part of
the recovery process.
The President’s New Freedom Commission on Mental Health
(2003) explicitly recognized the critical role of peer support.
People who are employed as Recovery Coaches have the unique
capacity to inspire hope, trust, personal responsibility,
empowerment, self-determination and social connectedness in
their fellow peers.
Recovery Coaches are able to use their own Recovery Journey as
an example of the possibility of recovery.
4/27/11
8
Self Directed Care




This approach supports individuals in developing their own
wellness goals and in controlling the funds that are used to
implement their self-directed behavioral health recovery plan.
Each person is responsible for making his or her own choices on
the recovery journey and must be responsible for the outcomes
of those choices.
Giving people decision-making power over their own behavioral
health-care budget is a concrete step toward self-determination
and responsibility.
The process of creating a recovery plan, identifying appropriate
services, and deciding how to spend service dollars encourages
independence and self-determination.
4/27/11
9
How exciting would it be if…






We can show that working with a Recovery Coach/CPS/WRAP
Facilitator moves people forward in their recovery
By allowing people to determine what best works for them, the
final cost to the Behavioral Health Care system is reduced or
equivalent to the cost of “Services as Usual”
By allowing people to direct their own care, they experience
significant movement forward in their recovery journey
We can model the possibility of four very different entities
successfully working together
We are able to create more CPS job positions
We are able to generate outcomes that help to establish a waiver
that allows for the establishment of similar programs in other
parts of the state
4/27/11
10
Goals of CRIF SDC



Individuals in the SDC condition will experience
greater levels of empowerment, recovery, and qualityof-life compared to those in the control condition.
Individuals in the SDC condition will experience
greater levels of community participation over time
compared to those in the control condition.
Individuals in the SDC condition will live more
independent lives, depending less on high cost,
acute/crisis services (e.g., inpatient hospitalization,
crisis service use) compared to those in the control
condition.
4/27/11
11
Criteria for Enrollment







Delaware County Resident
Member of Health Choices, Magellan Behavioral
Health
Diagnosed within either the schizophrenia or bipolar
family of disorders
60 – 90th percentile utilizer of services
No hospitalizations within the past 6 months
Randomized into Temple study
150 total in study: 75 in control, 75 in SDC
4/27/11
12
Process for Enrollment





Study group randomized by Magellan Health
Services—letters sent to 50 at a time
Temple University contacts potential participants for
enrollment
Participants enrolled in study are randomized into
either the Control, or “Services as Usual” group, or the
SDC group
SDC Group is enrolled by MHASP Recovery Coach
Team
Initial orientation period is followed by monthly visits
over the subsequent 24-month period
4/27/11
13
Process of Engagement









Establishing relationship
Exploring Dreams
Setting Goals from Dreams Exercise
Reviewing past 24-month utilization of traditional services with
peer
Setting budget from goal activities
Requesting authorization for purchases
Authorization for purchases approved or declined by Magellan
Health Services representatives
Approved purchase amounts placed on Allow Card
Monthly check-ins with Recovery Coach, or as determined by
Participant
4/27/11
14
MH Budget

Mental Health Budget includes
All In-Plan (traditional outpatient Medicaid
Reimbursable services, including Peer Support by
Recovery Coach)
 Non-traditional services (Freedom Funds)
 Equal to previous 24-month period mental health
costs

4/27/11
15
Recovery Goals




All activities and purchases must fit within the
Participant’s Recovery Plan
Recovery Plans can change over time
Recovery Coaches help to educate Participants
about the concepts and processes of recovery
The Recovery Coach team keeps track of
proposed monthly budget, as well as actual
utilization, over the next 24 months.
4/27/11
16
What we have learned





Similar to the Dallas, TX program, we found that some of the
first “asks” pertained to physical medical health care needs
As opposed to focusing on assessments, we focus on dreams.
Self Directed Care allows the peer to set the area of focus
This program really puts recovery into action
Participants may not have experienced recovery in such a
comprehensive way before
Some people focus on short-term needs and have not had the
opportunity to have a longer-term focus on their dreams and
hopes for their future
4/27/11
17
Sample “asks”














Back Rent
Electric Bill
Exercise Clothing and equipment
Gym Memberships
Computer Software to write poetry
Glasses after charges are made to Physical Health Insurance
Relocation Costs
Car Repair
Books for School
Social Activities
Lawnmower to start a lawncare business
Digital Camera and Printer
Transportation
Membership to the Philadelphia Museum of Art
4/27/11
18
Life Domains






Mental Wellness
Physical Health
Education (or learning something new)
Work or Meaningful Activities
Social Activities
Housing
4/27/11
19
Freedom Fund Categories
4/27/11
20
SDC Card, formerly Allowcard





Similar to a check/credit card
Decreases the stigma related to mental health
Allows participants to have responsibility of
funds
Allows restrictions to be placed on card from
Program Staff (certain items are not allowed to
be purchased: alcohol, illegal drugs, guns, cash,
pornography, etc.)
Allows monitoring of activity
4/27/11
21
Next Steps

120 people enrolled in study






63 in SDC
57 in Services as Usual Group
Moving forward with Recovery Process and Peer
Support with “enrollees”
Meeting with non-MH Providers to talk about
Recovery and ask for possibilities of services to
purchase
Operations Team meetings
On-going program evaluation
4/27/11
22
Policy Implications



Cross Disability work as a result of the Power to the
People Summit 2009
Presentations at Alternatives 2010, NYAPRS 2010,
NYAPRS Executive Summit 2011, Netherlands 2011,
and other
Enhancing People in Recovery being able to control the
amount of money being spent on their care in a way
that moves them forward in their recovery and teaching
self direction and hopefully decreasing costs to the
system
4/27/11
23
Quotes from Participants
How has your life been changed by being a
participant in the program so far?

I am far too busy to see a therapist;
I am very busy with school.
However, I do have coping skills
which help me. CRIF's coaches are
there for me whenever I need
them; they have given me new
coping skills that I can use and
what’s best about this is CRIF's
coaches are available to coach me
whenever I need them.
- Alicia, CRIF SDC participant
4/27/11
24
How has the CRIF SDC Project helped
you in your journey of recovery?

CRIF has helped me tremendously. I began treatment a few
years ago, when [Health Choices Physical Health Insurance]
stopped providing eye care benefits. I knew that I needed glasses
but I could not afford them as I am a student and I have plenty
of other priorities that I must take care of first. The CRIF
program, my coaches, have given me the opportunity to get the
eye glasses that I needed. In addition to this, my coaches have
worked as advocates, friends and have given me additional
coping skills. My coaches are currently helping me take care of
other issues that I otherwise would not have been able to take
care of. I love CRIF and my coaches.
4/27/11
25

"It [the CRIF SDC Project]
gives me perspective on where
I'm going. I may not have a
plan yet, but I do have hope"
- Roderick, CRIF SDC participant
4/27/11
26
Contact Information for CRIF Self
Directed Care Team:
Erme C. Maula, RN, MSN, CRRN, CPS
Program Manager, CRIF
Mental Health Association of Southeastern Pennsylvania
1211 Chestnut St., 11th Floor
Philadelphia, PA 19107
emaula@mhasp.org
Office: 267 507 3873
Secure Fax: (215) 525-9698
4/27/11
27