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Vision and licensure, key to success in HOPE’s model

April 28, 2014
by Lori Ashcraft, PhD
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Dan Haley, CEO of HOPE, Inc. in Tucson, Ariz. worked in the Tucson behavioral health system for many years before becoming CEO of Hope, a small peer-run program. In 2010, he realized that HOPE was under-utilized and unrecognized because it was not well known. If he could publicize it, he reasoned, many more people could take advantages of the services it offered.

In 2009 peer-run programs in Arizona were required to begin encountering and billing for services. But drop-in centers usually don’t offer billable services, so Dan began the transformative process of becoming a recovery center. Although he hoped the shift would increase the meager flow of referrals necessary for encountering and billing, little progress was made on that front. The problem is—and continues to be--obtaining referrals from case managers, as is required. It is a serious issue for all peer-run programs and starves many of them close to extinction.

The next evolutionary step came when Dan realized the center was providing services such as case management that were not reimbursable because the center wasn’t licensed. He told me, “Members were telling us they couldn’t get in to see their therapist or they didn’t know who their case manager was. So we asked them if they wanted to receive those services from HOPE and they said yes. We began looking into what it would take to become licensed as an outpatient clinic. We hired a clinical director with experience. I hoped we could reverse the priorities that drive traditional outpatient programs by making recovery services our first priority and clinical services secondary.”

Then began the tedious process of qualifying for an outpatient license. Dan wasn’t sure it was possible but he kept putting one foot in front of the other in 2012 and within a surprising 90 days, HOPE received its outpatient license. “We already had an electronic record and we knew how to bill for encounters so the biggest challenge was just waiting for the green light. We were told we would have a hard time getting clinicians who would be willing to disclose, but once they understood what we were trying to achieve there was no resistance,” he notes.

Dan had listened to what people said they wanted. They weren’t being unreasonable. They wanted to see a therapist who cared about them; a case manager they could contact easily; and a doctor they could talk to when they needed consultation. They didn’t want to wait long periods of time for assistance. “So we created teams –modified Act teams--so each person could be assigned to a team composed of many professionals and peers,” he reports. “This way a person could almost always reach someone who knew them and their situation. We vowed to never let anyone come in that wasn’t touched by at least one of us before they left.”

I thought Dan was finished telling me of his accomplishments but I was wrong.

He had yet a bigger dream. He wanted to extend what he was doing to families and children. To do this he would need a different license to become a comprehensive service provider. And he did.

“We got our new license last October and we are the first peer-run peer-driven comprehensive service provider in Arizona. Within the year HOPE Inc. will be adding primary healthcare. HOPE Inc. has also rolled out a new concept to provide member services. The organization intends to provide members integrated recovery services in a peer-supported, member-driven and recovery-focused model of care designed to assist members in forming supportive relationships, developing and utilizing social supports, living independently in the community and accessing community education and resources.

The unique model of care HOPE, Inc. Dan Haley proposes will address the four major domains of the recovery process:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
  • Home: a stable and safe place to live that supports recovery;
  • Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
  • Community: relationships and social networks that provide support, friendship, love, and hope.

All HOPE’s services will be coordinated through continual collaboration with members and focus on inclusion of family members. Right now HOPE has about 100 employees and about 145 members and expects to increase to 700 members by the end of September.

I wondered how HOPE was getting referrals. Were all those case managers who didn’t make referrals before suddenly sending their own members to HOPE? “Well, no,” Dan told me. “We found a way to move up stream by getting involved with people in crisis programs and in jails. We pick people up who are being discharged and give them a ride home. On the way we stop by HOPE and offer them a hot meal and whatever else they might need. We introduce them to our staff and to other members and we ask if they would like to come back and receive services from us.” Also as a comprehensive service provider HOPE doesn’t need referrals from other providers as members are given a choice and or assigned by our regional behavioral health authority (RBHA).

It's a win-win for all stakeholders.