Community Care, a nonprofit behavioral health managed care company headquartered in Pittsburgh, believes in recovery. Specifically, Community Care understands that the transformation of the behavioral healthcare delivery system to a recovery model can make a real difference in its members’ quality of life. In conjunction with managing behavioral healthcare services, Community Care works diligently to support the use of the recovery model to improve outcomes, and Community Care promotes recovery-oriented service delivery systems for its membership. For example, the organization has hosted multiple recovery conferences and funded nontraditional services.
Community Care recently led a three-year initiative to encourage the effective use of peer employees in community-based agencies to assist individuals dealing with substance use disorders. The Peer Supports Capacity Building Project was created to further the development of four grassroots agencies offering peer supports to people early in recovery from addiction disorders and people with active addictions.
Community Care's partners in the project were the University of Pittsburgh Medical Center's Western Psychiatric Institute and Clinic (WPIC) and the Institute for Research, Education and Training in Addictions (IRETA). They assisted the agencies in improving outcomes tied to the delivery of nontraditional peer services. The Pittsburgh Foundation not only generously funded the three-year initiative, but it also was instrumental in the project's creation.
Deb Wasilchak, director of Community Care's Medicaid Behavioral Health Managed Care Program in the Pittsburgh area, reflects that “Community Care's participation in this project evolved from the recognition that in order for recovery services and supports to thrive, even those with grassroots origins, agencies must demonstrate that desired outcomes are being achieved.” Unfortunately, many of the agencies with peer employees are not equipped with the expertise and infrastructure to develop an effective performance management system. Therefore, Community Care committed to offering emerging grassroots agencies assistance in effectively demonstrating their value.
The four agencies involved in the project were:
Center for Spirituality in 12-Step Recovery
East Liberty Family Health Care Center
Pennsylvania Organization for Women in Early Recovery
All are in the Pittsburgh area, have unique missions, and offer nontraditional services to consumers who have substance use disorders, including many who have coexisting psychiatric disorders. Their services usually are not available through traditional addiction treatment programs but are examples of services expected to be essential in a transformed system.
The project aimed to develop the skills within the agencies to clearly delineate the core components of their services and establish strategies to measure and improve performance. Education and training were the vehicles for achieving these goals, with special attention given to co-occurring disorders and effective engagement strategies. In addition, the agencies received assistance to develop and implement outcomes projects that could be accomplished with minimum staff burden.
Project consultation was provided by Dr. Frank Ghinassi, vice-president of quality and performance improvement at WPIC, and Dr. Dennis Daley, an associate professor of psychiatry at the University of Pittsburgh. Drs. Ghinassi and Daley, along with Ms. Wasilchak, not only ensured that a high level of technical support was available, but also that mutual respect and collaboration (key tenants of the recovery model) were embedded in the process developed for managing improvement. The Pittsburgh Foundation's Program to Aid Citizen Enterprise (PACE) provided the agencies executive management and business development technical assistance.
After three years it was clear that the project had made a difference. The project helped each agency document its mission and services. It was essential that these descriptions reflect the value of the life experiences that peer employees offer, as well as the approach that gives them as much time as needed to build trusting, helping relationships.
The importance of providing peer employees flexibility and time is illustrated by a peer staff member who accompanied a newly sober consumer at high risk for relapse to 12-Step meetings on Saturday evenings and Sundays. This mentoring reduced relapses while increasing the consumer's motivation to attend 12-Step meetings.
Training was provided in the following areas identified by peer staff:
motivational and adherence-improvement strategies;
understanding and helping consumers with substance use and co-occurring psychiatric disorders; and
promoting a recovery model of change and evidence-based psychological and pharmacological treatments for addiction and co-occurring disorders.
The agencies worked with project consultants to select measures to track consumers’ outcomes. Community Care worked with project team members to create a methodology for assessing rates of entry, engagement, and retention in treatment using claims data. A workgroup discussed strategies to evaluate and/or improve performance.
This outreach resulted in increased knowledge and skills for improving treatment engagement and retention. Agency staff members were provided the latest educational resources on client motivation and adherence. One staff member reflected that she now views a consumer's low motivation to address substance abuse as an issue to address during meetings rather than a reason to confront the consumer or discharge him/her.