In 2004, Wisconsin created a new statute to administer comprehensive community services for persons with severe mental illness. The statute establishes a scope of psychosocial rehabilitation services with standards for certification and criteria for determining need under Medicaid rules. The emphasis is on recovery, measured by decreases in dysfunctional symptoms and increases in level of health, well-being, stability, self-determination, and self-efficacy.
Wisconsin mandated county-funded mental healthcare systems to perform continuous quality-improvement activities to meet the higher accountability and certification standards, and the state offered grants for implementing recovery-oriented evidence-based practices (EBPs). In early April last year, the Kenosha County Department of Human Services (KCDHS) implemented an EBP called Wellness Management and Recovery (WMR), which was created by SAMHSA. KCDHS chose this EBP by analyzing service users’ demographics and their existing comorbidities (many have high health risk factors related to sedentary lifestyles).
WMR aims to empower consumers with severe mental illness to manage their wellness, define their own recovery goals, and make informed treatment decisions by teaching them the necessary knowledge and skills. WMR strongly emphasizes that individuals determine and pursue personal goals and implement action strategies in their daily living to achieve them. The program employs interventions to help consumers improve their ability to overcome the debilitating effects of mental illness on social and role functioning. WMR sets a positive and optimistic tone, conveying confidence that people with psychiatric symptoms can and do move forward in their lives.
The EBP consists of a series of biweekly group and individual sessions over six months. Case managers, referred to as “service facilitators,” assist participants with developing strategies for managing their mental illness and moving forward in their lives. Service facilitators work collaboratively with participants, offering information, strategies, and skills they can use to enhance their unique recovery plans.
“Evidence-based practices are not intended to be exclusive, mandatory, or rigid,” notes Dennis Schultz, KCDHS director. “Rather, they imply self-knowledge, self-determination, choice, individualization, and recovery.” To that end, service facilitators are expected to empower consumers to use the most helpful knowledge and strategies for their individual needs.
KCDHS used quantitative indicators to measure the first 30 participants’ progress, including biweekly progress notes and attendance records as well as scores on pre/post-quality-of-life assessments and quarterly client reports. Service facilitators administered the Recovery Oriented System Indicators (ROSI) to collect pre/post-program results. Qualitative data, the best source of participant input received, were documented after each session in progress notes.
WMR group sessions were held at regularly scheduled times at a central location. Each consumer was at the group sessions on time and actively participated. There was a 31% increase in participants reporting that staff “almost always” see them as equal partners in the treatment program, and 44% more participants reported that staff “often” or “almost always” view them as able to grow, change, and recover. Participants also reported having a better understanding of their mental illness and medications, having an improved recovery strategy, and using coping skills and relapse-prevention strategies to detect early warning signs and triggers of potential relapse, as well as to identify stressors and tendencies to think negatively.
During the initial implementation of the EBP, there was only one psychiatric hospitalization, which occurred early in the program (this population had a history of repeated hospitalizations). Qualitative feedback will help improve the EBP as it is used in other community programs.
Implementing WMR has been an excellent way to create a recovery-oriented delivery system. KCDHS plans to expand the use of the EBP throughout the Comprehensive Community Services Program this year.
Gerald A. Theis, LCSW, is the Service Director for the Kenosha County (Wisconsin) Department of Human Services’ Comprehensive Community Services Program. He is the founder and President of Recovery Management and Wellness Consultants, LLC. He can be reached at (262) 605-6506.
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