Behavioral Health Recovery Management

The Behavioral Health Recovery Management (BHRM) project seeks to apply the principles of disease management to assist individuals with chemical dependency and/or serious mental illness to engage in a process of recovery from these illnesses. The major components include the application of evidence-based treatments coupled with longitudinal recovery support as an alternative to the acute interventions that characterize traditional behavioral health approaches. In addition, the project emphasizes a person-centered, strengths-based service delivery model.

The project is a partnership of Fayette Companies, Chestnut Health Systems headquartered in Bloomington, Illinois, and the Joint Research Programs in Psychiatric Rehabilitation at the Illinois Institute of Technology, Chicago, Illinois.

The project website is www.bhrm.org

Evidence-Based Practices

Fayette Companies is bringing science into services and utilizing treatments that have been proven by research to achieve the best outcomes. This requires systems of regular supervision combined with availability of consultation and learning resources. Implementation is being monitored by use of fidelity measures with regular feedback and team meetings.

The following list describes some of the evidence-based practices currently being implemented.

• Seeking Safety Groups at the women’s residential substance abuse treatment facilities for women who have both a substance use disorder and have been exposed to traumatic experiences (e.g., physical or sexual assault)
• Supported Employment using the Individual Placement and Support (IPS) model for individuals with a serious mental illness
• Strengths model of case management, which is used by all recovery specialists providing community mental health services
• Contingency management to keep men and women engaged in addiction treatment and encourage healthy behaviors for consumers receiving mental health services
• Cognitive behavioral therapy (CBT) for men and women receiving addiction treatment services
• Motivational Interviewing techniques throughout our programs
• Use of medication algorithms for persons with a serious mental illness
• Illness management and recovery (IMR) is a cognitive behavioral training program that helps individuals learn how to manage symptoms of their psychiatric disability; this is used with adults who have a serious mental illness
• The Assertive Community Treatment (ACT) program for adults with a serious mental illness, which is used to reduce hospitalizations and other forms of institutionalization (e.g., incarceration or nursing home placements) for individuals who are high-end users of these services
• Cognitive training and rehabilitation for adults with a serious mental illness who have cognitive impairments as a result of their psychiatric disability (this program is being used in conjunction with the supported employment program)
• Integrated treatment system for individuals who have co-occurring psychiatric and substance use disorders
• The Community Reinforcement Approach, a behavioral program for people with substance use disorders

CRAFT, a program that helps family members motivate a loved-one to enter addiction treatment (the family version of the Community Reinforcement Approach).

The Supported Employment program at the Human Service Center is modeled after the Individual Placement and Service (IPS) program, one of six evidence-based practices supported by the Substance Abuse and Mental Health Services Administration (SAMHSA). The IPS model of SE has seven principles: 1) Competitive employment is the goal, 2) Rapid job search is essential, 3) Rehabilitation and mental health support services must be integrated, 4) Job placement must be guided by consumer preferences, 5) Assessment must be continuous and comprehensive, 6) Support must be time-unlimited, and 7) Consumers receiving SSI or SSDI must be provided with benefits counseling.

How is IPS different than other employment services for persons with psychiatric illnesses? 

Traditionally, employment services for persons with mental illness utilized a “train then place” model whereby people would be put into sheltered workshop settings and paid an allowed training wage that was below the minimum wage. Another model involved extensive job preparation groups delivered by a mental health center. As noted above, the IPS model uses a “place/train” model of rapid job search for competitive employment.

Research has shown that the former model often did more harm than good. People internalized a message that “I am not capable of working.” This message was reinforced by mental health professionals who believed employment would be too stressful. Through the IPS research, these myths have been shattered.

How is it funded?

HSC, in collaboration with several Peoria organizations and the University of Chicago’s Center for Psychiatric Rehabilitation, acquired a five-year grant from the U.S. Department of Labor (DOL) for 3.3 million dollars in 2002 to implement a supported employment program for persons with psychiatric disabilities. The program was launched in 2003. Technical assistance to the project is provided by the University of Massachusetts and evaluation has been provided by the Center for Psychiatric Rehabilitation and Westat, Inc. HSC is now in the process of replacing DOL funds with other funding mechanisms. A grant of $50,000 was received in 2006 from the Illinois Division of Rehabilitation Services to fund SE services for 40 individuals. A contract for the Social Security Administration clinical trial of supportive employment began in July 2006 with  $1.5 million dollars over a 3.5 year period. Additionally, HSC has reorganized and eliminated some positions in order to continue funding the SE program.

Cognitive Training Project & Supported Employment at HSC

HSC is working with researchers at Dartmouth University to test a program designed to improve supported employment services for individuals with a psychiatric disability.  David Loveland (director of research at HSC) is working with Hilary Driscoll (research associate at HSC) and Trish Glenn (supervisor of supported employment at HSC) to combine supported employment services with cognitive training techniques to help people with a psychiatric disability return to the workforce.   The cognitive training project was first developed by Susan McGurk and Kim Mueser at Dartmouth.

Trish Glenn provides the cognitive training program.  Participants practice computerized exercises that help them improve on a wide range of cognitive functions, such as short-term memory, hand-eye coordination, processing speed (i.e., reaction time), and problem solving skills.  There are 24 training modules and each one requires approximately one hour to complete.  Each module provides participants with immediate feedback regarding their performance.  Participants are given an extensive battery of cognitive assessments before and after they complete the computerized training program to examine any changes in cognitive function as a result of the training.  Trish, Hilary, and David are planning on expanding the training program by adding other interventions, including compensatory training and cognitive behavioral techniques to help individuals learn how to manage the symptoms of their psychiatric disability.  

United Nations Project

Fayette is honored to be selected as a member of the International Network of Drug Treatment and Rehabilitation Resource Centres. This project of the United Nations Office of Drugs and Crime, headquartered in Vienna, Austria, seeks to improve the access to and provision of effective drug treatment worldwide.

Participants had to be nominated for consideration. One hundred of the nominees were selected to complete the application process and twenty were selected as participants. These twenty organizations are geographically located in all sections of the globe including Asia, Europe, Africa, South America, Australia and North America. 

The purpose is to use these organizations as the “seeds” in each region to promote the most effective drug treatments. Unfortunately, most of the drug treatments currently used around the world were exported from North America and were flawed models based on belief systems and folk lore rather than science. That is not to say these systems are bad, they just are significantly less effective than other models. Thus, the goal is to introduce the most effective treatments based on current research. 

A training center housed at UCLA coordinates the teaching these best practices from international experts to the participants. In turn, the participants will first train others within their organizations to implement the techniques and subsequently serve as trainers to other providers in their regions of the globe.

The twenty participating organizations have also been assigned to four work groups to develop best practice manuals in the following areas:

• Community Drug Treatment
• Drug Treatment in Prisons
• Role of Drug Treatment in HIV/Aids Prevention and Treatment
• Sustainable Livelihoods for Rehabilitation and Reintegration.

Fayette is serving on the Sustainable Livelihoods work group with organizations from India, Colombia, Nigeria, and Germany. The orientation of the work group is the identification of practices to support recovery following active treatment and the return of individuals to their communities.  This work will build on the principles of Behavioral Health Recovery Management, an initiative of Fayette Companies to develop a disease management approach to address addictions and serious mental illness. A second focus of the work group is the development of “recovery capital” that are the personal assets that can support ongoing addiction recovery such as family and social support and employment. 

Network for the Improvement of Addiction Treatment (NIATx)

Fayette has been working with the Robert Wood Johnson Foundation for the last four years on an initiative titled the Network for the Improvement in Addiction Treatment (NIATx). We were originally selected as one of 16 organizations to participate in this project from over 450 applicants. Through a second round of applications and collaboration with the Federal Center for Substance Abuse Treatment, the Network now has 50 members including five states.

The original goal was to increase access and retention in drug abuse treatment through learning process improvement techniques. We have achieved remarkable results by learning how to redesign our processes and undertake rapid change cycles. For example, in one of our residential addiction treatment facilities for women, 30% left against medical advice at some point during their treatment. This was reduced to 11% and the earnings increased by $166,000 compared to the same six month period in the baseline year. 

Leadership Excellence Network (LENS)

Fayette Companies has been selected by the American College of Mental Health Administration (ACMHA) to be part of a two-year leadership training and development program for behavioral health organizations. The Leadership Excellence Network (LENS) is a new initiative of ACMHA and the National Center for Healthcare Leadership (NCHL) and is funded by seed money from the Substance Abuse and Mental Health Services Administration (SAMHSA). As one of six behavioral health organizations invited to participate, Fayette Companies has a team of executives attending a series of in-depth training and coaching sessions between 2006 and 2008.

LENS is a collaborative learning network that:

• Promotes the sharing of best practices with leading behavioral health executives
• Applies a systems and competency-based approach to leadership development
• Utilizes a nationally researched and validated competency model for healthcare leadership as the foundation for its programming and assessment
• Reflects the skills and behaviors required for high performing, effective healthcare leaders in various stages of their career
• Benchmarks evidence-based results of healthcare leadership initiatives
• Fosters needs analysis, program co-development, continuous improvement, and evaluation in an environment of shared learning.

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