Download - UAW-GM Center For Human Resources

Stages of Recovery
Shannon Rozell, MPA
Tom Ghena, MSW
Henry Ford Health System
Maplegrove, Behavioral Health Services
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Presentation Overview
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Brief History of Inpatient Addiction
Treatment
Regulatory Compliance: How the
EAP/CDR and Treatment Provider can
best serve the client
Clinical Pathways
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Transitional
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Primary
Case samples (Group story-problems)
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History of Addiction Treatment
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Documented records of alcoholism 2400 BC.
Cave drawings one million yrs old.
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Treatment was “containment”: ie family
contained until a threat to family, then person
was disposed of: leper colonies, burned at
stake, prison ships, mental hospitals, prisons…
Late 19th century until 1979: alcoholics/drug
addicts contained in mental hospitals
(“committed”) and prisons.
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1938: AA starts
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1956:AMA labels alcoholism a “disease”.
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History of Addiction Treatment
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1979: federal law change: cannot be kept in
mental hospital involuntarily unless “danger to
self or others”. Thousands discharged after
years of institutionalization. Studies show high
percentage of them are alcoholics and drug
addicts…
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1981: major treatment centers begin after
insurances start to pay.
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1990s: Managed care begins: Insurance
coverage began to reduce inpatient days
covered. Treatment centers must find ways to
efficiently use limited inpatient days.
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Employers Partner with Providers Regulatory Compliance
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GM strives to redefine the way a team surrounds the
afflicted employee with resources, support and
compliance monitoring for sustained recovery from
substance use disorder and mental health concerns.
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The team is comprised of: The employee, Immediate
family/significant other, CDR, Work/Family Rep.,
Treatment provider, Inpatient & Outpatient therapist,
Primary Care Physician (any prescribing physician or
psychiatrist), Insurance Provider.
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Collectively, the team circles the employee and family to
design, implement and monitor progress or need for
changes to the treatment care plan.
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Partnerships Improve
Outcomes
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GM Insurance Policies and typical
LOS when CDR is NOT involved
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Case Manager at treatment provider
contacts insurance provider for recert
approval to treat patient
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Treatment provider case manager reviews
6 dimensions of ASAM criteria with
insurance provider to determine level of
care approved
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Insurance provider range of authorizations;
4 days detox and 7 days residential, detox
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GM Insurance Policies and typical
LOS when CDR IS involved
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Provider Case Manager is notified of CDR
for the patient. Case Manager contacts
CDR and is usually approved for 4/7, then
update as the patients care continues.
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LOS with CDR involvement typically
include therapist/patient/CDR collaboration
and additional days are approved when
CDR believes it to be beneficial to patient.
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GM Insurance Policies and typical
LOS when Magellan manages case
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Magellan Behavioral Health (MBH) case
managed care:
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Almost never approves beyond the level of
detox
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MBH audits (post care delivery) often disallow
the admission and/or length of stay of care
based on medical necessity and continued
stay criteria
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Clinical Pathways
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Although each client and family has a unique life
path, the developmental stages they go through
to become fully ready to engage in recovery
change are predictable.
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Pathways: designed to anticipate stages and to
maximize the ability to offer evidence-based,
practice-based and stage specific, clinical
interventions.
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The right treatment at the right time (efficient and
effective)
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For the patient
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For the family (these stages often differ)
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Transitional Pathway
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Transitional Pathway: this pathway
provides clinical treatment to client and
family in a pre-contemplative or
contemplative stage of readiness for
change.
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Transitional Pathway integrates the work
of Gorski, Prochska and DiClemente
models
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Goals of Transitional Pathway
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Improve the client and family’s awareness of the
disease of addictive disorder
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Improve awareness of the tools and supports
available to arrest the disease and, for the family
to cope with the disease in a healthy and
productive manner
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Engages patients to connect the SA crises and
consequences to the progression of their illness.
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Engages patient and family in their plan to
manage the red-flags of addictive disorder,
co-occurring disorders, life stressors
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Goals of Transitional Pathway
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Increase awareness of discrepancies between
quest for personal goals and values versus the
continued use of mood altering substances
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Develop a therapeutic relationship that fosters
return for care if “control or arrest” plans do not
work as they thought may
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Develop a contingency plan by ensuring a
method to review the outcomes of their plan and
evaluate (in partnership) the next steps needed.
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Levels of care for
Transitional Pathway
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Use overnight level of care to ensure a safe and
medically supervised detox and/or to facilitate a
brief separation from pts living environment to
interrupt the addiction cycle before admission to
an outpatient treatment program.
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After a brief stay in inpatient care for detox
and/or stabilization, client and family will begin
outpatient, psycho-educational treatment
designed to provide education and a
contingency plan.
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Levels of care for Transitional
Pathway (continued)
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Effective level of care matching for patients in
transition is an important decision
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In general more is not better. We are learning
that we must be sensitive to poorly timed and
invasive interventions that disengage patients
and confuse family members
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The family component teaches how to patiently
and consistently set boundaries and effectively
respond to a client in this stage of recovery
readiness
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Primary Pathway
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This pathway provides clinical treatment to the
patients and their family who are in the:
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Preparation stage of readiness for recovery
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Action stages of readiness for recovery
(Prochaska & DiClemente model)
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Late transition and Early Recovery stages
(Gorski model)
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At this stage of readiness, the client and family
begin what is referred to as “Recovery”
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Goals of Primary Pathway
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Improve the client and family’s awareness of the
disease of addictive disorder
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Improve awareness of the tools and supports
available to arrest the disease and avoid relapse
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Complete a comprehensive assessment of
clients relationship with mood-altering
substances
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Focus on symptoms of addictive disorder and
potentially co-occurring disorders and life
stressors
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Goals of Primary Pathway
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Increase “urge management” awareness, skills
and supports
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Increase awareness of relapse warning signs
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Develop and commit to an ongoing relapse
prevention plan
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Develop and commit to a comprehensive health
plan including a physical health plan, safe
housing plan and psychiatric care as needed
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Levels of Care for Primary
Pathway
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Primary pathway clients may benefit from longer
lengths of stay in the more intensive levels of care
(inpatient and intensive outpatient programs)
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Long-term residential treatment and/or transitional
housing programs are very effective for CD clients
in this stage of readiness for change
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Some greatly benefit from safe housing and/or
longer period of time in a structured living
arrangement to stabilize abstinence and other
co-occurring conditions in early stages of
recovery.
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Levels of care for Transitional
Pathway (continued)
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Intensive Outpatient and traditional outpatient
services are also very helpful for primary
pathway clients who, while needing the support
and structure of treatment, may have supportive,
safe living arrangements and may not meet the
ASAM severity of illness criteria for inpatient
levels of care.
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These outpatient levels of care can provide a
“step-down” relapse prevention service for
primary CD clients and their family who have
been recently discharged from inpatient care
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Story Problem for GroupThink and Discussion
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Distribute copy of ASAM criteria to each
group
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Distribute copy of qualifying (drug/alcohol)
questions to each group
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Distribute brief description of levels of care
discussed in this session
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QUESTIONS?
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