There’s a reason why efforts to replace a traditional system of behavioral healthcare with a recovery oriented system of care (ROSC) is referred to as a “transformation.” It is because organizations large or small involved in such an effort face an all-encompassing challenge. And, it’s a challenge that they cannot meet by themselves.
Almost nine years ago, the appointment of psychologist Arthur Evans Jr., Ph.D., as Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) marked the start of a huge effort. In time, the effort would touch every aspect of a system that today has a $1.2 billion service budget, encompasses more than 200 provider organizations, and has a responsibility to more than a half-million Philadelphians—over 140,000 of whom receive behavioral health services annually.
So, how did Commissioner Evans and the DBHIDS team go about making a transformation to ROSC based on core principles of recovery, resiliency, and self-determination “real”? Behavioral Healthcare went to Philadelphia, met with Commissioner Evans and his team, and took a first-hand look.
The key to a successful evolution to ROSC, said Evans, “is engagement. Being a payer is easy,” he added, “but administering a recovery focused system is different. How do we ensure that the most people in our system have a chance for recovery?” The only way, in a ROSC, is to create opportunities for people to engage individually with the prospect of change, to feel the pull of hope in recovery, to act on this hope with the help of DBHIDS resources, and to sustain recovery with the help of an understanding and supportive community.
The first step in the process was a recognition: Outcomes would no longer be the sole responsibility of professionals, but a shared responsibility between professionals and newly engaged and empowered service recipients, families, providers and organizations, neighborhoods and others.
At the outset, to bring these stakeholders into the process, DBHIDS launched a new workgroup that combined not only professionals but many community stakeholders, to define key principles of the new recovery-focused transformation effort. This group defined recovery and selected core recovery values for Philadelphia’s transformation effort:
• Self direction/empowerment
• Peer culture/support/leadership
• Community inclusion/opportunities
• Family inclusion and leadership
• Holistic/wellness approach
The transformation process itself, Evans explained, was shaped through ongoing focus on three variables:1
• How do we want thinking (concepts and ideas) to change?
• How do we want behavior (work processes, relationships) to change?
• How do we want the overall context (fiscal, policy, administration) to change?
This focus, practiced at all levels in DBHIDS and provider organizations, helped to drive the ongoing evolution. Changes in concept or philosophy would drive changes in training, practices, and relationships, which would in turn demand adjustments in policies, regulations, funding, or reimbursement. The goal throughout was not only to talk change, but to ensure that current and available tools, processes, and incentives aligned with and encouraged all involved to pursue the path of change.
Walking the talk
The need to demonstrate change wasn’t just a provider requirement, but a primary responsibility of DBHIDS leadership, said Evans, who recognized that “the relationship that we want to see between direct-care providers and those they serve must be mirrored inside our department, in the relationships that we have with providers and the community organizations. We had to make sure that we weren’t just ‘telling them’ how to do business, but modeling that behavior as well.”
Making and reflecting this big cultural shift within DBHIDS—from a traditional role as payer and policeman of vendors to a new role as a supporter and collaborator—was essential to building collaborative relationships and convincing providers that transformation was real.
Establishing and sustaining a tone of dignity, respect, and inclusion was essential to the system-wide effort to tap into the needs, expertise, and abilities of all. Within DBHIDS, it necessitated creation of additional strategic planning resources and a new Systems Transformation Steering group. The group’s task was to prioritize key programs for transformation, then with the help of other work groups and task forces, re-envision what the transformed programs would look like and how to implement them.
1. White, W. The Recovery-Focused Transformation of an Urban Behavioral Health Care System. Great Lakes Addiction Technology Transfer Center. Accessed at: http://dbhids.org/assets/Forms--Documents/transformation/BillWhite/ACE-G...