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  1. Visit with ........................... Scotch Plains, NJ, January 24, 2014

  2. What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves.

  3. What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Psychosocial

  4. What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Schizophrenia Bipolar Schizoaffective Borderline Depression

  5. What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Coping Relaxation Living Financial Social Employment Education Housing

  6. What is PsyR? Friends Lover Spouse Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. College Grad School Tech School Social life Clubs Church Worker Manager Volunteer

  7. What is PsyR? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. Choice Community

  8. What is PsyR? Programs Doctors Hospitals “Interventions” Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. “Disability” supports SSI / SSD

  9. What is PsyR? ... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves. “Stabilization” Remission “Normal” Adjustment Actualization Autonomy

  10. Recovery Principles...

  11. What Is PsyR? • A goal • A role • A specialty • A discipline • Evidence-based

  12. Who Provides PsyR? Consumer

  13. Where is PsyR? • Programs • Residences • Service support • PACT (Programs of Assertive Community Treatment) • Workplaces • Schools • Hospitals • Families • Self-help Centers

  14. Why PsyR? • Psychiatric disabilities can be... • Lengthy • Recurrent • Difficult • Disruptive (of life) • Interruptive (of development) • Debilitating (of capacity) • PsyR thus advances... • Long-term recovery • Community integration • Quality of life • HOPE

  15. PsyR Principles • Person-centered • Partnership • Peer support • Natural supports • Strengths based • Work • Goal-related • Integration of treatment and rehabilitation • Sustained, coordinated services • Empirical orientation 

  16. Challenges to PsyR • Institutional pessimism • Organizational barriers • Training demands • Funding shortages • Quick-fix thinking • “Courtesy” stigma

  17. The National Organization Since 1975 Formerly IASPRS Formerly USPRA 8000 members

  18. What Is A CPRP? • “Certified Psychiatric Rehabilitation Practitioner” • Supervised by the Commission • Partly “founded” in NJ • Transdisciplinary

  19. The State Organization • 1000 members • 30 org members • Leading state chapter • Annual conference • Various trainings • Advocacy work

  20. Sector Analysis Government, Industry, Market, Customer, Product...

  21. Government of New Jersey

  22. Government of New Jersey

  23. Government

  24. Government • Increasing regulations • Electronic Medical Records • “RAC” Audits • Capricious and arbitrary administration

  25. Industry: 120 Agencies Of which... • Bridgeway • Catholic Charities • Drenk • Easter Seals • Family Services • Greater Trenton • Mental Health Assn Essex • Twin Oaks • ...others...

  26. Industry: Specialty Providers • Supported Housing: 46 agencies • Supported Employment: 22 agencies • Consumer-operated: 33 centers • State Hospital patients: ~1500 per year

  27. Market: NJ Medicaid Enrollment

  28. Market: Medicaid Enrollments(Centers for Medicare and Medicaid, 2012)

  29. Customer: Consumers DMHAS BG appl. says... Governor’s budget says.. • 285,000 “unduplicated consumers in community settings”, of which... • 123,000 with SMI

  30. Product: PsyR Evidence-Based Practices • Illness Management and Recovery • Integrated Dual Disorder Treatment • Assertive Community Treatment • Family Psychoeducation • Supported Employment • Supported Education • Supported Housing • Other “promising” practices PsyR  Recovery

  31. Recovery: As Outcome RECOVERY time

  32. Recovery: As Process RECOVERY time

  33. Recovery: 3 Models of Care Psychiatric Rehabilitation Medical RECOVERY Individual Empowerment time

  34. Models of Care Psychotherapy Psychiatric Rehabilitation Medical RECOVERY Individual Empowerment time

  35. Models of Care Psychotherapy Psychiatric Rehabilitation Illness Management & Recovery Medical RECOVERY Individual Empowerment time

  36. Models of Care Psychotherapy Psychiatric Rehabilitation Illness Management & Recovery Supported Housing Medical RECOVERY Individual Empowerment time

  37. Models of Care Psychotherapy Psychiatric Rehabilitation Illness Management & Recovery Supported Housing Supported Education Medical RECOVERY Supported Employment Individual Empowerment time

  38. Models of Care Psychotherapy Psychiatric Rehabilitation Illness Management & Recovery Supported Housing Supported Education Medical RECOVERY Supported Employment Assertive Community Treatment Family Psychoeducation Individual Empowerment time

  39. Finance: Rate Ratio (Zuckerman et al., 2009) US 0.72 WY 1.43 AK 1.40 DE 1.00 PA 0.73 CA 0.56 NY 0.43 NJ 0.37

  40. Finance: Rate Ratio (Zuckerman et al., 2009) US 0.72 WY 1.43 AK 1.40 DE 1.00 PA 0.73 CA 0.56 NY 0.43 NJ 0.37

  41. Finance: Rate Ratio (Zuckerman et al., 2009) US 0.72 WY 1.43 AK 1.40 DE 1.00 PA 0.73 CA 0.56 NY 0.43 NJ 0.37 50th!

  42. Industry: Providers = f(Rate Ratio) (Decker, 2013) % doctors accepting

  43. Competition (“Stakeholders”)

  44. Competition (“Stakeholders”)

  45. Issues and Positions

  46. 3 Mega Issues affecting PsyR • “Reductionism” • Managed Care • Medicaid Expansion • Paternalism • “Brain” over “mind • ST over LT • “Evidence”: only RCTs... Problems: Stigma. Pharmacology.

  47. 3 Mega Issues affecting PsyR • “Reductionism” • Managed Care • Medicaid Expansion • Paternalism • “Brain” over “mind • ST over LT • “Evidence”: only RCTs... Problems: Stigma. Pharmacology.

  48. 3 Mega Issues affecting PsyR • “Reductionism” • Managed Care • Medicaid Expansion • Administrative Services Organization (ASO) • Fee-for-service Problems: Cost “containment” Incremental care Stressed operations .

  49. 3 Mega Issues affecting PsyR • “Reductionism” • Managed Care • Medicaid Expansion • Medicaid: 65% of public mental health • Enrollment:  25% • 234,000 in NJ • No provider increase... Problems: Access, Availability, Quality, Cost, Innovation

  50. Advocacy: 6 Development Domains • Workforce • Agency • Sector • Practice • Client/Consumer/Family • Government