Since its organization shortly after World War II, the Mental Health Association of Westchester County (MHA) has provided services to meet the changing needs of our county. MHA quickly became known as the agency which provided services to those most in need, in an atmosphere of respect and focus on the individuals’ goals for their lives.
It is no wonder that in the Spring of 2008 MHA jumped at the chance to join with the Westchester County Department of Community Mental Health (DCMH) to participate in “Care Coordination” an innovative recovery-focused service for individuals with mental health conditions who historically were not well-served by the mental health system. As previously implemented by the Western New York Care Coordination Program (WNYCCP), Care Coordination had achieved astonishing outcomes including improving quality of life while also reducing ER visits and days in the hospital as well as days incarcerated or homeless – all resulting in decreased Medicaid costs. We knew immediately that this initiative was for MHA when we saw Commissioner Mitchell’s Power Point slide that asked the key question “Service-resistant Clients OR Client-resistant Services?” This resonated with us. Fundamental elements of Care Coordination are 1) emphasis on person-centered planning and recovery; 2) empower individuals through promotion of choice and partnership with provider; 3) participation of peer mentors; 4) preference for use of evidence-based best practices; 5) coordination of services by multiple providers and 6) availability of self-directed service dollars. Once launched, the staff and individuals enrolled in Care Coordination immediately experienced very high levels of satisfaction working in partnership toward goals that were identified and driven by the person receiving the service; and steeped in the values of respect, dignity, choice, self-determination and shared decision making. It was a win-win for everyone.
Heartened by positive outcomes and super-enthusiastic feedback from the individuals enrolled in Care Coordination, it was a no-brainer for MHA to embark on an agency-wide culture change. . .embracing the person-centered approach throughout all of our services. We intended to create revolutionary change, rather than simple re-engineering or restructuring. Using the five key elements of the SAMSHA matrix, Vision, Leadership, Alignment, Culture and Continual Process, we designed a roadmap to guide our five-year strategic plan for the MHA transformation process, which ultimately very much resembled a person-centered treatment or service plan.
Vision
We started by forming a trans-organizational Steering Committee to lead the process – comprised of people using different services within MHA, Board members, staff, including direct service staff, human resources, information technology, intake & referral and finance. Our Steering Committee agreed that mental health recovery is a highly personal, individualized journey of healing and self-discovery which includes regaining control of one’s life and engaging in meaningful roles in the community – or in the words of Patricia Deegan, “attaining a life worth living.” Our stated vision was that MHA would promote recovery using the principles, values and practices of person-centeredness. In short order we adopted the principles of a person-centered approach including; individuals identifying their own hopes, dreams, and goals, belief that growth and recovery is possible and expected, all people are treated with respect and dignity using self-determination, choice and an outcome based orientation, people with lived experience must be included in the service system, diversity of language and culture and beliefs are honored, etc.
Leadership
Acknowledging the importance of buy-in of leadership, our Steering Committee included influential Board members and key executive staff. Our transformation initiative kicked off with presentations to MHA leadership by experts in person-centered approach and received with excitement and enthusiasm.
Alignment
We have all learned from experience that meaningful and lasting change requires much more than staff training. It is necessary to align all of an agency’s systems, policies, procedures & physical environment to ensure successful culture change. Without systems alignment, organizational change is doomed to failure…and this is where the bulk of the work of organization or culture change lives. The Steering Committee identified the following processes that would need strategic and thoughtful planning and managing; clear definition of a recovery culture, roles & expectations of leadership, program managers, board of directors, direct service staff, all staff, psychiatrists, people using MHA services, training and supervision needs, human resources, referral, billing, documentation/forms, reception, intake, physical environment, developing performance measures, including self-evaluation and finally communication with stakeholders. Let us offer some examples of what unexpectedly worked very well. Our human resource manager recognized immediately the critical nature of HR processes and procedures. First, all the job descriptions were rewritten to reflect the expectations for performance. We wanted to be sure anyone applying for a job at MHA would be clear about the skills and attitudes we value and require. Second, all job postings/ads were re-crafted, using language that would clearly signal our values and expectations in order to attract staff that would be a good fit (e.g.; “patience, flexibility, compassion, deep belief in recovery-oriented values necessary, knowledge of person-centered practice a plus. People with the lived experience of mental health conditions and recovery are encouraged to apply”). Annual performance evaluations were re-designed to reflect the importance of a person-centered orientation. (e.g., “Please describe practitioner’s level of understanding & practice of person-centered planning. Describe practitioner’s ability to partner with individuals, treat them with respect and dignity, accomplish treatment or service planning collaboratively with the individual, include significant others in the planning process, develop goals that are driven by the client & client consistently receives a copy of the plan”). Additionally, new-staff orientation was re-created to reflect our person-centered approach and now includes a presentation and subsequent discussion regarding the importance of recovery-based language that we all use. Who would predict that a human resource manager would become the greatest champion for a person-centered culture?
Culture
Our new culture had to become part of the fabric of MHA. It wasn’t enough that direct service staff adopted a new language and way of working…our finance department and their accounting practices needed to understand and support it. Same with information technology. We all needed a new common language.
Continual Process
Everyone connected with MHA recognized a change in less than 3 years. Even OMH in the 2010-2014 Statewide Comprehensive Plan for Mental Health Services acknowledged that our efforts paid off! The postscript to this strategic initiative is that we think and talk about our practice frequently and make shifts as needed. We even administer an annual Recovery Self-Assessment evaluation (Adams & Grieder), which elicits feedback on how we’re doing – from; 1) the people we provide serves to; 2) executive staff and 3) direct service staff. It has been a boatload of work, but those of us who are part of MHA are vastly more satisfied with our roles and our work. While we don’t ask staff to push aside their years of training and experience, they report it is more effective and more deeply human to partner with someone on their own goals, rather than having to be ‘the expert’. And of course, the people who we work with experience MHA as the go-to service to help them attain lives worth living.
