Cenpatico Blog

As we, who work in the behavioral health system, examine our processes and track and trend outcomes, we recognize that many who come into our system aren’t really engaged in their own recovery.  We have providers complaining about the high incidence of missed appointments and the follow up needed to ensure medication is taken and appointments are kept.  But what is it that prevents these people who came to us for help from being invested in their own recovery?  The answer is engagement.  If we don’t connect with the person at the time they are asking for help, we will not be successful in the treatment and may never get them to come back.

I have come to this conclusion from a personal experience I had with the system I knew and the struggle to get it to work for my family. I can only imagine what would happen to those who come to us without knowing they should expect more.

When my niece was going through a hard time and needed some help to get through it, her mother came to me because I work in the behavioral health field.  She asked me to help her adult daughter get the treatment she needed, and I, of course, assured her that I could.  I found an agency that would do an initial assessment, made the appointment for her, and went with her to that appointment.  What a grueling and torturous process that was for both of us, but especially for my niece who was feeling awful about being there in the first place.  There we sat, in front of a person she went to high school with (small, rural communities face this kind of problem all the time), feeling ashamed and embarrassed and answering a barrage of questions like name, address, phone number, primary care doctor…and so on, and so on.  We were there for 2 1/2 hours before she was even asked why she was there.

We spent about 15 minutes talking about her problem, when the girl, who was polite but detached, handed her a schedule of outpatient group sessions she should start attending, handed her some forms to sign, and gave her a form that had the girl’s name and phone number to call on it “…if she had any questions”.  We walked out feeling exhausted and not at all comforted that her problems would be addressed by this agency or their schedule of group sessions.  Needless to say, my niece never wanted to go back there again.

I called to complain, and was immediately given a follow up appointment.  Too little, too late, my niece was not interested.  I spoke to everyone I knew to try to figure out how to improve the process so that the next person who went in would not encounter the same thing, but barriers went up everywhere.  If the agency was going to bill us for the services, they needed to have all that information.  They could not wait until the next appointment to complete it because many times a client didn’t come back for the second appointment and that meant they would not get paid for the first.  Imagine that!  The process itself was causing the problem, a fact I thought was clear, but the agency disagreed.

Not long after this experience, we signed a contract with a new agency in the area that didn’t have their occupancy certificate yet, so were providing services in the community.  This was the model of care we wanted, but had a difficult time getting the provider agencies on board.  The new agency started the intake process using peers instead of intake coordinators, and they met the client where they were and the same day they called, not waiting to schedule an appointment a week out.  So I called the agency and spoke with the Peer Support Specialist myself.  I explained our previous experience, and asked for his help.  He explained that he could only help if my niece wanted his help, but he was willing to call her, meet with her, and then take it from there.  What a difference this man made to our family!

Not only did he keep his promise and call her, but he then drove over to her house, met with her and her family, and immediately started her in services that very day!  She has been in intensive outpatient services for over 6 months now and doing great.  I asked her what made the difference to her.  She explained that when the peer called and talked to her, he started with questions about what she wanted.  Did she want help?  Did she want to get better? Is she ready to do what it takes to be better for herself – not her family – because she needs to make that commitment?  He promised her that if she did, he would be there to help her every step of the way, and he has kept his promise.

Now, 6 months later, he calls or stops by to see her once or twice a week, even though he is not part of her treatment team.  With her permission, he lets me know she is doing well.  He connected with her the way no one, but someone who has been where she has been, could have done.  He knew how he felt when he was in that place of desperation and he could look past the paperwork, at her, and ask the important questions that needed to be asked before the next steps could be taken.  This is engagement.  This is what our system needs.

Utilizing Peer Support Specialists and Family Support Partners to help those seeking treatment and their families is a perfect way to improve outcomes.  These are the people who can say what needs to be said to get the commitment needed for recovery.  These are the people who speak from their own experiences, and from their heart, without any question of their sincerity and with no judgment.  To walk down a difficult and scary path alone is much harder than walking with someone who knows the way.  As we at Cenpatico of Arizona train our peers and family members to be that partner down the path of recovery, we are seeing better outcomes and better engagement than ever before.  We are hearing the success stories that would not be there were it not for that one person who “held the hope”.  Let us look at this valuable resource that is all around us and make the most of it.

Peers and family members are the interpreters who speak the language we and our clinical staff have not yet mastered.  As we use them to move us to a more successful place, let’s learn from them.  Let us learn that essential skill of connecting with the person coming to us for help.  Let us learn to look at them with the care and concern they need us to feel to really help them.  Let us talk first and “fill in the blanks” later.  It doesn’t take long to make the connection.  A short 15 minute conversation, asking the important questions; “Why are you here today?” and “What do you think you need to be in a better place?”  Let us start there before we print out a treatment plan from a cookie cutter formula.  I know there are “best practices” and proven strategies for care, but first there is that person, sitting in front of you, looking for answers…asking for help.  Can you be that one person that holds the hope for them?  That person that will make a difference in their life?  Let’s try.  Together we can inspire hope for a better life.

This entry is filed under Blog.

A Member became known to Cenpatico Intensive Case Management in 2007 following three psychiatric hospital admissions related to suicide threats, alcohol and cocaine dependence, and bipolar disorder. He had abused substances since the age of 14, had been abused himself as a child, and was raised in an orphanage for much of his youth.

Our Intensive Case Manager (ICM) knew changes needed to be made if the Member had any hope of recovering. The first step was seeking a new Community Case Manager, since the prior one seemed unable to help. The Member was discharged home with a referral to a new community mental health center set up by the Cenpatico ICM. Unfortunately, the member never got there – returning to the hospital within just a few days after another suicide attempt.

The ICM worked to assist the Member in reaching the health center on discharge, but things took a turn for the worse. Within two weeks the Member was readmitted yet again to the hospital and had lost his place to live. He was now homeless.

At this point, the Member finally began to respond and decided to turn his life around. He began making references to wanting to be sober. Though he was irritable with hospital staff and other patients during his last hospital stay, he was started on new treatments to help him recover.

Meanwhile the ICM continued to encourage the Member to keep trying. The ICM was able to begin a referral process for a residential chemical dependency program for more intense substance abuse treatment as well as a place to go.

The Member completed the 30 day chemical dependency program – doing well there working on early recovery tasks.  In time he became less irritable and better able to relate to others than in the past. At the end of the program he was interested in continuing his recovery; however, he was still homeless.  The Cenpatico ICM identified a publicly funded program for homeless men in recovery from chemical addiction. The Member went directly into that program to begin a 90 day intensive group component, followed by continued housing for up to 2 years.

After one month, the Member reported to the ICM that he liked the program very much, was going to daily Alcoholics Anonymous (AA) meetings and had an AA sponsor with 8 years of sobriety.  He was working the AA steps with his sponsor and was looking forward to plans for seeing his family at Thanksgiving.

Soon after, the Member reported a very happy and moving experience to the ICM.  He had his first sober New Year’s Eve in over 20 years.  He went to an AA dance, had a “great time” and was so happy that he cried.  He was also looking for a minister to help him complete his AA “5th Step”.

The Member is still working the chemical addiction housing program and continues to be in contact with the Cenpatico ICM team.

Recovery. Resiliency. Results. These are more than just words. These become real when people come together to make a difference.

This entry is filed under Blog.

Providers, please take a look at our Winter 2009 Provider Newsletter by clicking on it below.

This entry is filed under News.

Like most Americans, I am caught up in the excitement of a new administration and the hope that our new President will guide this country well. One of the issues I focus on, of course, is his stance on health care, particularly behavioral health care. President Obama has a good track record of being an advocate for mental health and has been a strong supporter, along with the managed care industry, of establishing parity, that is equivalent benefits for mental health and substance disorder treatment in all health insurance. I wonder if you were surprised that the managed care industry, as I mentioned in the previous sentence, was also such a strong advocate and supporter of the parity law recently passed by Congress?

I, too, am very concerned about the fact that upwards of 40 million Americans or more currently do not have adequate health care coverage. No one that I know of disagrees that we must make this a priority to ensure that everyone in this country has access to affordable, quality health care. What I am worried about is the direction that the country might take in response to this problem. Clearly there is the belief growing out there that for-profit companies are “taking money out of the health care system.” I have to tell you that working for a managed care company is kind of like wearing a Velcro suit all the time.  If it is negative and one states/writes it about managed care, then “of course it must be true.” Anything negative just sticks without regard to facts or data. Conversely, if you are a non-profit company, you get to wear the Teflon suit since accusations of waste or misspending rarely, if ever, stick. I know, because I have worked for both profit and non-profit health care entities.

First of all, “non-profit” is simply an IRS tax code distinction. It does not mean that non-profits spend all the money on health care costs, nor that they don’t make a lot of money. One only has to see, (when you can even get a glimpse of non-profits’ financials since they are not required, nor do they make public their financials), some of the huge medical and behavioral health systems reserves held by some of these massive non-profit companies. Second, I challenge anyone to find an industry MORE regulated than for-profit health care. The scrutiny and oversight simply is not there for non-profits.  In contrast, my parent corporation discloses publically it’s financials on a regular basis and is heavily over sighted by agencies like the SEC and Sarbanes-Oxley. Our industry is so regulated that even the size and type of font for some of the information we send to members is proscribed by regulation.  Third, we pay taxes, not only back into the federal system, the same system that pays for public health care, but also locally wherever we operate, to states and communities.

And finally, is it really true that because of profits, that for-profit companies take more money out of the system and are less efficient? A report recently released by the McKinsey Global Institute in December, 2008 reports that U.S. health administration and insurance costs account for 7% of overall spending. And, when you take out private, employer paid insurance, and look at the administrative costs for the publically funded system (Medicare and Medicaid) we are at 6% of overall spending.* In other words, 94 cents of every dollar is spent on health care delivery and treatment.  Other countries spend about 4% but these government plans severely limit choice on when and where you can be seen by a health care provider, what drugs you can take, what procedures and tests you have access to, etc.

Look, I am not trying to say we should not be looking at reducing costs, or that all non-profits are wasteful and not accountable in the same way that for-profit companies are. I would just like to see an end to these broad brush depictions of both non-profit and for-profit health care companies.  Under this new administration, I hope to see a more informed American public, looking at all the facts, looking at data, and not leaping on 10 second sound bites about the sins of for profit health care companies. I hope to see the same scrutiny applied to non-profits as are applied to for-profit health care.

Time for me to put on my Velcro suit and get back to work!

*”Accounting for the cost of US health care:  A new look at why Americans spend more”, December, 2008, McKinsey Global Institute

This entry is filed under Blog.

Many people who work in the behavioral health industry struggle with seeing the human experiences that connect each of us compared to the challenges and struggles that the people we serve overcome.

Last month I came across an editorial in the January 2007 issue of Psychiatric Services regarding recovery being an opportunity to transcend our differences. In the editorial, President of the American Association of Community Psychiatrists Wesley Sowers, M.D. states, “(w)e all have something to recover from, whether it is mental illness, addiction, physical disability, loss of loved ones, victimization, or loneliness. The list could go on.”1

Recovery is a common human experience. In order to overcome any of the challenges mentioned above we must use similar strategies to move forward in our recovery.

We need to appreciate that the challenges we face are no different from the challenges that face the people we serve.  For any of us to move forward we have to have hope and the belief that things will get better. It is with that hope and belief that people find the courage to accept responsibility for taking the necessary steps to move forward in their recovery.

When people recover from any of the challenges that life puts in our path we become part of a community in which we share the human experience.

As people who work in the behavioral health field and people who have received services move forward in their recovery it is important to remember the common human experience we all share.

People have stated that recovery from mental illness is different than recovery from substance abuse which is yet different from recovery of many of the challenges mentioned earlier. No matter the challenges that all of us face, the truth of the matter is that recovery from anything connects us to one another if we allow it to happen.

Recovery does not discriminate because of race, ethnicity or creed.  Recovery joins us in our common humanity. Dr. Sowers concludes his editorial with the following “(i)f we fail to recognize this capacity for recovery to unite us, we will have squandered a great opportunity to integrate our highly fragmented and siloed service systems. If we fail to understand that we are all engaged in a similar struggle, we will miss the opportunity to empathically engage those who seek comfort and hope.”1

As a person who has recovered from a serious mental illness, I continue to believe that “Together We Can Inspire Hope for a Better Life”.

Tom Kelly
Recovery and Resilience Advisor
Cenpatico Behavioral Health of Arizona

1. [(http://ps.psychiatryonline.org/cgi/reprint/58/1/5 retrieved December 4, 2008. PSYCHIATRIC SERVICES ? ps.psychiatryonline.org ? January 2007 Vol. 58 No. 1 (Taking Issue page 5)]

This entry is filed under Blog.