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Delivering recovery-based services in a medical model funding environment: Can the round peg fit into the square hole?

October 6, 2009
by Ann Borders
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I’m assuming that most of you who are providing community-based care rely heavily on Medicaid funding to help finance services to those with the most acute behavioral health disorders. For years now, federal and state behavioral health authorities have urged us toward “transformation" (kind of brings to mind the waving of magic wands, doesn’t it?) to recovery-based services.

I don’t know of any provider organization that doesn’t embrace the notion of Recovery and the evidence-based practices associated with the philosophy. But I also don’t know of any organization (in this country, at least) that has discovered a way to deliver these services in a manner that meets the medical model requirements of the Medicaid program.

Have any of you found workable solutions?

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This is quite a challenge. It seems that there are fundamental conflicts especially when you consider the production levels that the reimbursement levels dictate. At least in the system in which I work, there is more focus on what the EBP calls for and what will be reimbursed vs. what it is the client desires/needs .

Recovery-oriented approaches are based in psychiatric rehabilitation (PR), which is working with the person to identify what is most important to them in their life & planning interventions & goals around those things. Many services incorporate PR concepts now, however as said above, funding and oversight is often at the CMS/Medicaid level - which is very medical model.. How can we get CMS to embrace recovery affirming practices as SAMHSA has already done?

check out the archived webinar on writing recovery-oriented plans that can meet MA requirements

https://ccbh.webex.com/ec0600l/eventcenter/recording/recordAction.do?the...

This looks like an excellent plan. Very sound.

I approach this by starting with the consumer's life/recovery goals (i.e. employment, going back to school, moving into own apartment, building a successful marriage, being a good parent, etc.). Then I identify how an individual's mental illness has impacted the person and interferes with his/her ability to achieve his/her goals (i.e. current symptoms, internalized stigma, self-concept, psycho-socio-economic and other consequences of past symptoms, etc.). The service plan is then written to address the current symptoms and consequences of past illness in a context and manner that specifically relates to fulfillment of the individual's goals.

Ann Borders

President and CEO, Cummins Behavioral Health Systems, Inc

http://cumminsbhs.org/

Ann Borders is president and CEO of Cummins Behavioral Health Systems, Inc., serving eight...