MSDP Training

1. MSDP Training May 5, 2009 Day One 1

2. Welcome and Introductions 2 Housekeeping – cell phones, pagers on silent – Rest rooms Breaks Lunch CEU’s – hand in evaluation Q&A – end of each section – during lunch, index cardsHousekeeping – cell phones, pagers on silent – Rest rooms Breaks Lunch CEU’s – hand in evaluation Q&A – end of each section – during lunch, index cards

3. Presenters Jordan Oshlag, LICSW, Vice President of Operations, Community Healthlink, Inc. Vic DiGravio, CEO, MHSACM David Lloyd, President, M.T.M. Services & Senior National Council Consultant Stephanie Sladen, LICSW, Asst. Vice President: Outpatient Mental Health & Substance Abuse Services, Health & Education Services, Inc. Bill Schmelter, Ph.D., M.T.M. Services & National Council Consultant Kathleen Janssen, BSN, RN, MS, Director of Quality Management, Riverside Community Care Joe Passeneau, LMHC, Director of Health Record Review and Audit, MBHP Marcia Webster, Consultant to The Transformation Center Susan Schneider, Member of MOAR Thanks to everyone that has volunteered their time to present. Thanks to everyone that has volunteered their time to present.

4. Thank you! DMH DPH/BSAS MHSACM MBHP CHD Presenters Countless volunteers DMH – very involved in process of creation, supporting the use of the forms, continuing training, DPH/BSAS – same MHSACM – great support, leadership, Training committee, Leadership, QMC, SDT, CRT, DMH – very involved in process of creation, supporting the use of the forms, continuing training, DPH/BSAS – same MHSACM – great support, leadership, Training committee, Leadership, QMC, SDT, CRT,

5. Morning Agenda

6. MSDP - Overview Terms -

7. Terms

8. More terms

9. Paradigm Shift

10. New Language

11. MSDP Initiative Overview A New Direction… Leading the Way! Vic DiGravio, CEO, MHSACM

12. Purpose of the MSDP Initiative Conceived as part of MHSACM e-Health Initiative Sub-committee process in Fall 2006 identified need to bring order/structure to how providers document care Essential interim step in transition from paper to electronic based records- “e-Health Readiness”

13. Goals of MSDP Develop standardized set of clinical forms that will lead to: Improved quality of patient care Increased compliance More efficient business practices

14. MSDP Initiative Stakeholders Mental Health and Substance Abuse Corporations of Massachusetts (MHSACM) Executive Office of Health and Human Services (EOHHS) Department of Mental Health (DMH) MassHealth Department of Public Health Bureau of Substance Abuse Services DPH/BSAS Massachusetts Behavioral Health Partnership (MBHP) Medicaid Carve Out Medicaid Managed Care Organizations (MMCOs): BMC HealthNet, Neighborhood Health Plan, Fallon Community Health Plan Network Health. Consumer/Families and Advocate Organizations: National Alliance for the Mentally Ill of Massachusetts (NAMI) The Consumer Quality Initiative (CQI) Massachusetts Organization for Addiction Recovery (MOAR) Massachusetts People/Patients Organized for Wellness, Empowerment and Rights (M-Power)

15. MSDP Initiative Operational Structure

16. Why Would You Not Want to Use the MSDP Processes? – Benefits at the Local Program Level Presented by: David Lloyd, President M.T.M. Services

17. Benefits of Participating Quality of Care Benefits Promotes consistent assessment, planning & service documentation Person-Centered and Strengths focus Recovery/Resiliency focus Promotes Information Sharing Promotes effective collaboration with other providers & shared terminology for use by different disciplines Less room for error; Decision support

18. Benefits of Participating Business Benefits Compliant with Federal Mandate for Electronic Health Records by 2014 & a wide variety of regulatory and payer requirements Protection against federal audits Wide array of funders/payers support this initiative Enhances Measurement & Outcomes Focus

19. Benefits of Participating Financial Benefits Free training and forms Compliant with a wide variety of regulatory and payer requirements Some protection against federal audits Saves time and money Reduces redundancy in collecting information Concurrent documentation possible Standardized revisions and updates in future

20. Statewide MSDP Pilot Study Completed: Twenty-six MHSACM member provider agencies submitted a request to participate in the MSDP Pilot Study in March and April 2008. A total of 70 different local programs at these member agencies representing twenty-six different statewide funded program types participated

21. Evaluation Levels and Tools Program Level Evaluations Completed after local pilot trainings Assessed Local Program Pilot Training and “Kickoff” Evaluate quality of training and supports received Evaluate success of agency training One evaluation per program participating in the pilot

22. Evaluations Levels and Tools Direct Staff Form “Mark-up” Process Completed during pilot study Evaluation of pilot forms Notations made directly on blank forms by participating program staff Each participating staff member required to mark up one form for each mandatory type piloted Direct staff members’ chance to influence the final product Commented on form layout, data elements, spacing issues, etc.

23. Program Evaluation Focus Areas Identified of how many times each pilot form/process was used by direct care staff during the pilot study. Evaluated to what extent each pilot form used collected the data elements direct care staff need to do their job well Evaluated to what extent each pilot form used contained unnecessary data elements Evaluated to what extent each pilot form supported compliance with regulations and payer requirements (DMH, MBHP, Medicare, MCOs, CMS, etc)

24. Program Evaluation Focus Areas Evaluated to what extent each pilot form used supported compliance with accrediting body standards (CARF, JCAHO, COA, NCQA, etc) Evaluated to what extent each pilot form used supported a ‘Person Centered, Recovery Oriented” approach to services Evaluated the overall clinical flow/ clinical content of the MSDP forms/documentation processes Compared each new pilot form used with the equivalent form being used just prior to the pilot in terms of support for quality clinical/ recovery focused services Evaluated to what extent the pilot forms used unnecessarily collected information more than once

25. Ongoing Support for the MSDP Process EHR Vendor Certification Process to help ensure that the EHR product you purchase is compliant with the MSDP data elements Data mapping for all forms/processes has been completed and will be used to develop gap analysis between the EHR vendor’s data elements and the data elements identified as required in the MSDP process for each form type

27. Ongoing Support for the MSDP Process Ongoing Annual Review of the MSDP processes and manuals to ensure continued compliance with revised standards Eliminates local costly efforts to revise and maintain forms/training manuals

28. MSDP Data Elements and Forms Processes: How Did We Get From There to Here? Presented by: David Lloyd, President M.T.M. Services

29. MSDP Scope of Work The identified scope of work for the MSDP includes documentation requirements for services identified below: All Department of Mental Health community services Medicaid Mental Health acute services, regardless of health plan, carve out or Fee For Service status Services purchased by the Bureau of Substance Abuse Services Substance Abuse services purchased by Medicaid EATS, CBATS and Supported Education and Employment Services are included in the scope of work for the project. Programs that do not have an individual record will not be included in the scope of work (i.e., Disaster Response, Training, Trauma Response, Consultation Programs, etc.)

30. MSDP Project Management Model The Project Management Model used in the MSDP Initiative includes: Empowered Project Teams 70% Super Majority Decision Making Compliance Grid Development Statewide Pilot Study of all developed processes/data elements Three levels of evaluation Training Manual Development Implementation Training Plan Development

31. MSDP Project Management Scope of Work Develop the data elements necessary in each clinical form type to support an integrated standardize documentation approach statewide based on Ohio’s SOQIC standardized documentation initiative refocused to Massachusetts requirements 2. Develop a data element dictionary and cross walk for all data elements in each form type 3. Provide compliance review to ensure the created form processes meet applicable state, federal and national accreditation requirements/standards Develop a statewide documentation training manual based on the model used in the SOQIC initiative in Ohio Use the MH/SA providers’ technical assessment level survey completed by MHSACM to develop interim documentation solutions for community providers based on possible paper processes, electronic forms and/or EHR specifications 6. Provide technical assistance for the development of an RFP to select a vendor to create EHR specifications for application statewide with all vendor types (i.e., XML code model, etc.) 7. Provide training to support the documentation model and data elements developed to facilitate an understanding of how to use the new processes to support: Medical Necessity linkage requirements Recovery/Rehabilitation service delivery focus Move to more fidelity between “what we do, versus what we write”

32. MSDP Documentation Processes Within the Scope of Work

33. MSDP Development Timeline

34. Decision-Making Process to Support Core Organizational Principles The following decision-making process that was utilized for the MSDP Initiative: Primary emphasis will be placed on gaining consensus and support from all stakeholders Preliminary straw votes will be taken to determine the position of QMC, Compliance Review and Project Team members on specific issues/initiatives If consensus cannot be reached in a reasonable time frame, then a final vote will be taken with a super majority (70% of members attending the meeting) being required to act on any issues/initiative that needs leadership. The minutes will accurately reflect the vote of members.

35. Empowered Team Membership and Scope of Work Quality Management Council: Membership on the QMC consists of: Eight representatives from MHSACM, two representatives from EOHHS, two representatives from DMH, two representatives from MassHealth, two representatives DPH/BSAS, two representatives of consumers, family members, and/or advocates and two at large members will be selected and empowered to represent stakeholders. A MHSACM Senior Administrator will serve as the Chair of the QMC to facilitate the business activities of the Council. A consultation team member will serve as facilitator consultant to the QMC. Guides the project and is charged with ensuring data element development and implementation occurs

36. Quality Management Council

37. Quality Management Council (Cont’d)

38. Empowered Team Membership and Scope of Work Compliance Review Team: Membership on the CRT consists of fourteen members and be comprised of representatives each from: MHSACM, EOHHS, DMH, MassHealth, DPH/BSAS, MMCOs and MBHP who have experience and expertise with HIPAA, CMS Corporate Compliance, state and federal standards, and JCAHO, CARF and COA Accreditation compliance. The CRT will be required to provide a full review all data element recommendations developed by the Project Teams to confirm full compliance with all HIPAA, CMS Corporate Compliance, state/federal requirements and Accreditation standards.

39. Compliance Review Team

40. Five MSDP Compliance Areas

42. Empowered Team Membership and Scope of Work Standardized Documentation Team: Membership on the SDT consists of fourteen members comprised of representatives each from: MHSACM, EOHHS, DMH, MassHealth, DPH/BSAS, MMCOs and MBHP who have experience and expertise with clinical documentation for all levels of MH/SA services contained in the scope of work The SDT will develop new documentation models, protocols and processes, pilot the newly developed models, send recommendations to the CRT for compliance review and submit reviewed recommendations to the QMC for approval and implementation.

43. Standardized Documentation Team

44. Standardized Documentation Team

45. Standardized Documentation Team

46. Empowered Team Membership and Scope of Work Consumers, Families, and Advocates Advisory Committee: Membership on CFAAC consists of ten representatives from statewide consumer and advocacy agencies/groups/individuals. CFAAC is to provide feedback to the SDT regarding documentation needs of consumers/families and review all documentation processes developed by SDT prior to piloting.

47. CFAAC Membership

48. MSDP Leadership Team

49. Break

50. MSDP Training Manual, Resources and User Website Presented by: Stephanie Sladen MSDP Leadership Team David Lloyd, President M.T.M. Services

51. Access to Forms/Manuals Each Provider Program will be provided all of the following files electronically via the MSDP Website: MSDP User Training Manual Electronic Version of each MSDP Form type PDF Version of each MSDP Form Type MSDP Compliance Grids MSDP Training PowerPoint Slides

52. MSDP User Training Manual Section 1: Simplifying and Standardizing the Mental Health/Substance Abuse Treatment Process. Contains background information about the MSDP effort, the forms development process, and the benefits MSDP documentation processes provide. Also, this section provides specific information regarding Medical Necessity, payer, signature and compliance requirements and a discussion of a person-centered Recovery/ Resiliency approach to services. Section 2: Using the MSDP Assessment Group Documentation Processes/Forms. This section provides a sample of each Assessment form type, guidelines for the use of each form, and instructions for completion of the forms, including definitions for each data field. Section 3: Using the MSDP Individualized Action Plan (IAP) Group Documentation Processes/Forms. This section provides a sample of each Action Plan Group form type, guidelines for the use of each form, and instructions for completion of the forms, including definitions for each data field. Section 4: Using the MSDP Progress Note Group Documentation Processes/Forms. This section provides a sample of each Progress Note form type, guidelines for the use of each form, and instructions for completion of the forms, including definitions for each data field. Section 5: Appendix This section contains supporting reference information.

53. Case Studies Adolescent Adult Where located – MSDP Web site http://www.mtmservices.org/MSDP/2009forms.html

58. Stakeholder Information Provided via E-Mailed UPDATES

59. MSDP Forms and Manual Website Each of the MSDP 2009 version of the paper forms, e-forms and manuals can be downloaded by program type at the website: http://www.mtmservices.org/MSDP/2009forms.html   MSDP UPDATE Website: http://www.mtmservices.org/MSDP-Update.html Technical Assistance will be provided by the MSDP Leadership Team. Email at MSDPHelp@Earthlink.net

60. Medical Necessity SupportDocumentation Linkage Capabilities Bill Schmelter PhD

68. MSDP Implementation Strategies Presented by: David Lloyd, President M.T.M. Services

69. The Change Rules Have Changed… Behavioral healthcare community providers are facing an increased emphasis on delivering services that support rehabilitation/recovery, outcome based quality services, compliance, performance based funding, and change management requirements like no other time in our industry’s history. The MSDP Documentation Process is a SOLUTION…

70. Change Challenges That Require Active Leadership… Quality Improvement Process Focus (QI) – Typically Supports Lack of Forward Movement/ Attainment – Process based discussions of the need to change Vs. Continuous Quality Improvement Solution Focus (CQI) – Implies Movement Forward/Action Has Happened to Provide Continuous Improvement

71. Key CQI Pre-Implementation Evaluation Areas How many styles/processes of Diagnostic Assessments, Service/Action Plans, Progress Notes, etc. are currently being used by staff in the Organization? What is the level of “ownership” in the current processes/documentation models? Emotional response level from staff when faced with change needs Willingness/support of Senior Managers to move forward

72. Key CQI Pre-Implementation Evaluation Areas 5. Assess core competency levels of direct care staff regarding: Ability for staff to provide a more focused/objective information gathering/recording model/clinical formulation. Level of narrative intensity in current documentation model versus focused check off/short narrative is critical through structured MSDP Clinical Tools EHR Conversion: Computer hardware and software skills for electronic recording of documentation

73. Top Eight MSDP Implementation Challenges 1. Change Itself… Change is hard “We’ve always done it another way.” “I like my way better.” Individualized documentation perspectives and professional pride Lack of understanding of WHY we should change Big changes might affect competencies of some staff Concern that the MSDP forms will not keep up with accreditation changes

74. Top Eight MSDP Implementation Challenges 2. Training costs/Learning curve/Productivity issues Initially it takes more time to use new forms Don’t know where to find info or where to put info in the forms New forms might alter some internal processes Training is needed to adapt to new forms system

75. Top Eight MSDP Implementation Challenges 3. Lack of commitment by top management Perception that this is something we have to do, that this is being done to us, rather than looking for how it helps us. Focus on rules, requirements and mandates Lack of recognition of the changing business climate (increased scrutiny) Focus on the perception that this will cost us money to implement, not seeing the potential for saving $$

76. Top Eight MSDP Implementation Challenges 4. Forms don’t accommodate everyone’s current way of doing business Asking clinicians to code billing strips on Progress Notes Person Served name and # at the top of page, not the bottom Some info on CA we’ve always put on Demographic form or Health History form, etc. At first, clinical staff disagreed with the CA

77. Top Eight MSDP Implementation Challenges 5. New processes Lack of understanding of important linkages necessary in the documentation A CA Update and IAP Review/Revision processes are not understood Lack of recognition that new forms will require some processes to be changed or reinvented Need to look at whole system of documentation rather than just pieces and focus on integration of services and documentation

78. Top Eight MSDP Implementation Challenges 6. Technology issues Investments in current systems Costs to make changes in current systems Forms don’t accommodate our existing business model; need to be integrated into how we do business

79. Top Eight MSDP Implementation Challenges 7. Issues with the forms themselves Not enough space to write on the forms No lines in the text boxes We can’t change the forms They are not in our local software which I know and love (They are in WORD!)

80. Top Eight MSDP Implementation Challenges 8. Incorporating a recovery culture Shifting from a culture of doing for clients to a culture of empowering persons served Lack of understanding what recovery/ resiliency is Lack of understanding the Medicaid rehabilitation option

81. Acceptance Levels of Change Process Keep in mind the stages of acceptance of change staff typically go through with this process: Denial Negotiation Anger (Blaming) Drop Out Acceptance of the need to change

82. Key Challenges To Address before Implementation of MSDP Forms Begins The trainer needs to believe in the MSDP documentation process and come across to the staff that way – Select Trainers that really believe MSDP process is a positive change. Be aware of individualized documentation perspectives and professional pride Be aware big change may affect the competency of some staff – Plan ahead to provide core competency training (i.e., Motivational Interviewing, Objective Recording Using Structured Form Process, etc.)

83. Key Challenges To Address before Implementation of MSDP Begins Change is hard for some to accept – may need to provide an enhanced Coaching/Mentoring Supervision Model during implementation Management of an agency needs to feel confident and support the documentation processes if the agency is going to implement– need buy in of top management Initially will need to do a closer review of quality of notes and clinical forms

84. Some Identified Solution Focus Areas to Assist Focus on MSDP Forms are a “Tool not a rule”. As a tool it can address compliance and audit concerns. Focus on what MSDP documentation can do FOR staff instead of what it will do TO staff. Look for the potential benefits. Talk about the benefits. Continue to remind staff that MSDP documentation: Meets all three national accreditation standards (JCAHO, CARF and COA) Provides available documentation solution without having to develop local form design efforts Prepares us to move towards electronic medical records Senior management/leadership need to be visibly proactive about the MSDP forms. Communicate, communicate, communicate. Share “learnings”, “aha’s” and success stories

85. Some Identified Solution Focus Areas to Assist in Implementation of MSDP Forms Be proactive about training and re-training needs (i.e., schedule additional core competency support). Provide coaching sessions on documentation. Develop and provide to staff a written implementation plan including a change management strategy. Whether you decide to implement one form at a time or a group of forms (i.e. Progress notes), or all the forms at once, be planful about the approach. Provide training and support. Develop post implementation monitoring and coaching plans. Tie monitoring to CQI efforts.

86. Some Identified Solution Focus Areas to Assist in Implementation of MSDP Forms With staff, look at processes that could be improved and how the transition to MSDP forms can help improve them. View MSDP implementation as an opportunity to take a look at the things that are problematic in your system and perhaps make changes. Use MSDP data for internal process Improvements. Try the MSDP e-forms. Talk to your software vendor about integrating the forms into your systems (Several vendors are in the process). Try each form at least 7 times and then keep track of issues, problems, suggestions for improvement.

87. Implementation Timeframes and Supports Establish a completion date before the initiative begins. Develop a full implementation plan with action work plans to ensure operational readiness. Recommend a pre-announced evaluation process to ensure all feedback regarding implementation process is given consideration ScottScott

90. Lunch Questions on Index Cards

91. Afternoon Agenda

92. Afternoon Agenda - Continued

93. How do We Know that these Forms Meet All the Requirements of our Funders/Licensures and Accrediting Bodies? Presenter: Kathleen Janssen, BSN, RN, MS, Director of Quality Management, Riverside Community Care

94. Compliance Review Team Beason, Grace Department of Mental Health Becker, Madeline Vinfen Boardman, Judith Health & Education Services, Inc. Gaudette, Craig Advocates Haughey, Jim Behavioral Health Network Eckert, Jane MSPCC Janssen, Kathy Riverside Community Care Kress, Carol MBHP Markle, Fran High Point Treatment Center Morgenbesser, Marcy Network Health Paschal, Christine Wayside Youth & Family Savage, Michele Baycove Human Services Thompson, Doug Beacon Health Wagner, Michael North Suffolk Mental Health

95. List of Programs in MSDP

96. List of Programs in MSDP (con’t)

97. List of Programs in MSDP (con’t)

98. List of Regulators / Licensers / Accrediting Bodies - MSDP

99. List of Regulators / Licensers / Accrediting Bodies - MSDP

100. List of Regulators / Licensers / Accrediting Bodies - MSDP

101. List of Regulators / Licensers / Accrediting Bodies - MSDP

102. List of Regulators / Licensers / Accrediting Bodies - MSDP

103. Compliance Grids Compliance Girds SDT – Form Creation CRT – Form Review

104. Compliance Reviews MHSACM Compliance Committee

105. The Compliance Challenge in Massachusetts and the Potential of the MSDP Standardized Forms and Processes Joseph Passeneau, EdM, LMHC Director of Health Record Review and Audit Massachusetts Behavioral Health Partnership

106. In 2001, MBHP Began Quality Initiative: Statewide Record Review Since then: Over 29,000 records reviewed; More than 1,900 MA site visits; Recovered more than $950,000.

107. State of Behavioral Health Recordsin Massachusetts : 2001

108. In 2001, we found isolated examples of superior documentation. Generally, however, record keeping: Low Priority; Poor Quality; Confusing Forms / Terminology; Multiplicity of Forms.

109. Recovery of Payment: Administrative Issues Missing Records / Notes; Notes Do Not Match Paid Claims; Exceed Authorization Parameters; Illegible.

110. Recovery of Payment: Medical Necessity Issues As found in a record: “played tiddly-winks, he got a score of 2600, told him it was the highest I ever saw. He was happy and I was happy. Plan: return next week.”

111. When Clinical Forms are Not Standardized: Labor-Intensive Form Revision Process Staff Training Difficulty Reconciling Payer Requirements Existence Of Multiple Forms, Same Facility Frustration

112. Is it an exaggeration… to say that across the state, there are at least 1,000 versions of each sheet of paper, for each form?

113. Lack of Standardization, At What Cost? 8 most common clinical forms per OP record*: Personal Info. Assess. (1p) Comp. Assessment (4pp) Individ. Action Plan (1p) Progress Note: therapy (1p) Progress Note: group (1p) MDT Review (2pp) Discharge Summary (1p) Psychopharm. Eval. (2pp) TOTALS: *8 forms = 13 pages @ 1,000 versions = 13,000 pages = 26 reams = 2.6 cases of paper 8 MSDP Forms: 1 version, 23 pages

114. Advice from The Joint Commission “When the problems/need statements are well written, the development of care goals and objectives is easy. If problems/need statements are vague and unclear, the development of observable care goals and objectives is laborious or impossible. Staff attitudes about the wastefulness of documentation then become self-reinforcing.” A Practical Guide to Documentation in Behavioral Health Care, 2nd Edition, The Joint Commission, 2002, p. 64

115. MSDP Forms are Tools All tools take time to learn. They are not substitutes for professional judgment and are not perfect. Designed to: Clearly Identify Assessed Needs Decrease Confusion Fix Documentation Problems Address Risk Management Document Quality of Services

116. The Potential of MSDP Forms Designed to bring clarity to roles of: Person Served, Provider, Payer, in the documentation of behavioral health services.

117. Compliance and Clinical QualityIs There a Relationship? Bill Schmelter PhD

118. Compliance and Quality Is Compliance Related to Quality? Strongly Moderately Poorly

119. Compliance and Quality Is compliance effort and cost proportional to the clinical benefit? Yes No

120. Compliance and Quality Let’s throw out the paper! Walk through the process you would use to work with a person. Woudl you want to write it down?Walk through the process you would use to work with a person. Woudl you want to write it down?

121. Compliance and Quality

122. Compliance and Quality Yet despite the fact that we have to document everything – we fail to accomplish the real Golden Thread.Yet despite the fact that we have to document everything – we fail to accomplish the real Golden Thread.

123. Compliance and Quality Assumption ?? “We do good work… We just don’t document well.”

124. Compliance and Quality How much of the Behavioral Health System’s problem with compliance audits is due to documentation?

125. Compliance and Quality Summary of Findings OIG Audit of Medicare Part B Outpatient MH Services 41% billed inaccurately: wrong code, non-covered services, excessive billing 11% unqualified providers 65% poor documentation 23% medically unnecessary 22% receiving more services than necessary 8% not receiving enough services

126. Compliance and Quality Is Our Documentation Worthwhile? Worthwhile Documentation Models Should Support: Quality – Person Centered Services and Positive Outcomes Compliance Efficiency

127. Compliance and Quality If our documentation was Worthwhile we would not resent doing it!

128. Compliance and Quality Do we miss the point? Examples: Strengths of person served Relationship between assessment information, planned services and services provided Misplaced person centeredness

129. Compliance and Quality Documentation should just be an accurate account of what we do The goal is effective and compliant interventions (positive outcomes) We should not need to Bend our documentation to meet compliance standards Our documentation forms and processes should help guide quality services

130. Compliance and Quality Independence of Clinical Process and Paper Processes

131. Compliance and Quality Integration of Clinical Process and Paper Processes

132. Compliance and Quality Integration of Clinical Process and Paper Processes

133. Compliance and Quality The MSDP Forms and Processes Provide a High Level of Support for Worthwhile Documentation Support for Quality - Person Centered Services and Positive Outcomes Compliance Efficiency As long as we don’t miss the point !

134. Break

135. How New Therapeutic Issues Are Documented ..Use of the Assessment Update Processes.. Bill Schmelter PhD

136. How New Therapeutic Issues Are Documented What do we do when new therapeutic issues are identified?

137. How New Therapeutic Issues Are Documented Cannot document new information in progress notes only if it has implications for services! Cannot wait until scheduled Assessment Update or Action Plan Review/Update!

138. How New Therapeutic Issues Are Documented

144. Person Centered Planning and the Importance of Documentation Support Using the MSDP Processes Presenters: Marcia Webster, CFAAC Susan Schneider, MOAR

145. Documentation that Supports People and their Recovery  Standardized forms and processes can help you do work that is: Increasingly, energized and driven by the person or family you want to support. Oriented toward recovery. Sustainable over time and with limited resources. The 3 points we want to make over and over and over Examples of questions, belief statements Confident that staff can not be discouraged, maintain hope - even someone who doesn’t care, doesn’t have goals, can’t ID strengths, feels powerless What about people who have neorological or physical limits (TBI, Asbergers...) The 3 points we want to make over and over and over Examples of questions, belief statements Confident that staff can not be discouraged, maintain hope - even someone who doesn’t care, doesn’t have goals, can’t ID strengths, feels powerless What about people who have neorological or physical limits (TBI, Asbergers...)

146.  “Language, structures and decisions that are driven and fueled by the person using services, the whole of the person, are essential to effective care [and support].” p. 28, MSDP Training Manual The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

147.  “Last month there was a huge reduction in my ‘no show’ rating and to me, that’s an indication that my clients like my attention and my approach... Ninety-five per cent of the time I leave work on time - I could never do that before [I started completing notes in session].” Catherine A. Main, MSW, LCSW, SOQIC (Ohio) Documentation Process Implementation Manual p. 62 The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

148. Recovery-oriented Documentation The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

149. Recovery and Peer Support Practitioners, Researchers and Writers to explore... Bill Anthony, Boston University, MA Mary Ellen Copeland, VT Pat Deegan, MA Dan Fisher, The Empowerment Center, MA Larry Fricks, GA Ed Knight, Value Options, CO Renee Kopache, OH Shery Mead, NH Mark Ragins, The Village, CA Peggy Swarbrick, NJ-CSP Nowhere near a complete list!  The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

150. Sustainable Documentation Establishing a goal and pursuing a purpose over time and in the context of local community. Answers the question “what happened?” instead of “what is wrong?”. Affirms the individual’s power, control and connections in the present and future. The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

151. Role Play! The 3 points we want to make over and over and overThe 3 points we want to make over and over and over

152. Documentation that Supports People and their Recovery Marcia Webster, The Transformation Center marciaw@transformation-center.org 413-626-6968 Susan Schneider susan.shr@gmail.com 617-429-7398

153. Recap and Next Steps

154. Questions / Comments

155. Adjournment