Presented by Roy Starks and Linda LaGanga at National Council for Community Behavioral Health (5/3/11) and MHCD Recovery Conference (5/26/11)

1. Transformation to a
Recovery Focused
Mental Health Center
Roy Starks, MA
Mental Health Center of Denver
Linda LaGanga, Ph.D.
Mental Health Center of Denver

2. What is Recovery?
> Recovery takes on many meanings
> We believe people can, and do, recover from mental
illness.
> Appropriate and compassionate treatment for a mental
health problem
> The individual can get back to living a happy and
productive life.
> Consumers are involved in shaping their own recovery
and given the chance to regain control of their lives.

3. Pick your synonym for Transformation
> Changeover
> Metamorphosis
> Transfiguration
> Conversion
> Other?

4. What is Your Center doing to
transform to Recovery Focus
> How Do You Know it is happening?
> How Do You measure it?

5. Using Outcomes to Drive
Recovery-Focused Practice
Development of
Recovery-focused
Outcomes
The Four Measures of
Recovery
Using Data and Reporting
To Drive Recovery
Transformation

6. Mental Health Center of Denver
> Formed 1989
> Combined four previous centers in order to obtain
Robert Wood Johnson funding for housing
> Law suit settlement of 1993 ordering intensive
services including rehabilitation

7. The Mental Health Center of
Denver
> Mandate to serve the hardest
to serve
• Persons who are homeless with a diagnosis
of Schizophrenia, Bi-Polar, or Major Depression
> Serve 4,200 adults at any point in time
• Every day we admit 7 but must turn away 17
• Our goal is to increase funding to be able to serve ALL
who need our services
• Additional consumers served through special grants and
funding
> Mission: Enriching Lives and Minds By Focusing
on Strengths and Recovery

8. Three Types of Adult Services
> Intensive Services (2,100)
Three levels of case management
> Outpatient Services (2,100)
> Psychiatric Rehabilitation (1,000 per year)
• Supported Education
• Supported Employment

9. Recovery Conferences and Committee
> Annual Recovery Conferences
> Decision following conference to work toward system
transformation
> Created Recovery committee and proceeded with
Logic Modeling
> Lead to Creation of Recovery Measures

10. Quick Poll: Which of the following is true of
Logic Modeling?
A. It is a structured process
B. It uses gap analysis and planning
C. The goal is to achieve desired outcomes
D. It is a rapid change process

11. Check in: Questions?

12. The Four Measure of Recovery

13. Four Measures of Recovery
Recovery Marker Inventory
(RMI)
Provider rating
Recovery Needs To what degree is
RECOVERY
Level (RNL) happening?
 Multiple perspectives
Suggests best level of  Multiple dimensions
services for stage of recovery  Change over time
Promoting Recovery in Consumer Recovery
Organizations (PRO) Measure
Consumer rates provider (CRM) Consumer rating

14. Measure #1:
Recovery Needs Level
> Assigns the right level of service to the consumers
> The basic assumption being that people recover
and their needs change over time.
> Completed by the primary clinician in electronic
record every 6 months in combination with their
service plan
> Scored electronically according to algorithm
> Algorithm weighted – based on clinical decision

15. Stretch Your Dollar
$ Denver admitted 400 new adults with serious
mental illness into high intensity services the first
year of implementation of the RNL with no
additional resources.
$ Based on a cost of $12,500 per consumer
= Total public cost saving annually is $5 Million.

16. Measure #2:
Recovery Marker Inventory
Eight dimensions that “tend to correlate” with
an individual’s recovery. They do not
always correlate with recovery for everyone.
1. Employment
2. Learning/Education
3. Active Growth Orientation
4. Symptom Management
5. Participation in Services (engagement)
6. Housing
7. Substance abuse (level of use)
8. Substance abuse (stages of change)
* Physical Health is being added within the year
The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this presentation,
receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the information you will receive.

17. The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing
this presentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the
information you will receive.

19. Measure #3:
Consumer consumer’s perception of their
> Measures the
Recovery Measure
recovery on 5 dimensions.
> Is completed quarterly by the person receiving
services. Hope
1. Active Growth Orientation
P er
of sonal
2. Hope Sa
f et S e n s
y e ive/
Gr o
wth
Act tation
n
Or i e
3. Symptom Management
L e te r
Perceived Sense of Safety
rk th
4.
In
ve fe
wo w i
s
l o re
et n
N t io
f nc
Sy e
al c
ci fa
Satisfaction with Social
mp
5.
S o a t is
to
S
m
Networks
The Reaching Recovery Program is the intellectual property of the Mental Health Center of Denver. By viewing this
presentation; receiving these materials, etc. you agree not to infringe on or make any unauthorized use of the
information you will receive.

20. Consumer Recovery Measure
Graphic representation of this data is shared with the consumer
to initiate:
• clinical discussion about changes in these areas,
• what the consumer attributes the changes to, and
• possible relationships between categories.
This process
promotes
insight, and
empowers the
person to share
their story in a
new and
different way.

22. Measure #4:
Promoting Recovery in Mental
Health Organizations (PRO)
Measures staff’s characteristics which promote
recovery.
• Sections for each type of staff that interact with our
members (front-desk staff, clinical, medical, case
managers, rehabilitation, etc.)

23. PRO Survey Administration
> 10% stratified random sample
> Collected annually for each type of staff a
consumer has dealt with in the last 6 months.
> Only 10 to 15 questions per type of staff.
> Administered to consumers by a Consumer
Survey Team.
> Gift Card Incentives

24. PRO Results
The following graph displays a team’s scores compared to the overall
score at the center. If the team scored higher than the average score
for the center, then the team has more recovery-oriented skills than
the average staff member. If the team scored lower than the average
score for the center, then the team has less recovery-oriented skills
than the average staff member.
Pro F: Front Desk Staff 3.78
3.23
Pro D: Nursing Staff 2.15
1.31 MHCD Average
Pro C: Medical Staff 3.06 Team 222
1.73
Pro B: Case Managers 2.25
0.95
Pro A: Therapist 3.05
3.45
0 1 2 3 4

25. Using Data and Reporting to
Drive Systems Transformation
Individual Outcomes Program Outcomes System Review

26. Consumer Outcomes –
Changes in Recovery
> Change Charts automatically flag when a
consumer has a substantial change in their
recovery profile.
• We can compare the consumer’s progress to
their own prior recovery outcome scores as well
as compare their progress to the typical progress
of their peers.
> Detection Charts automatically target outliers
in recovery.
• .

27. Recovery Focused Utilization
Management Review
> If the control chart flags a consumer the
consumer’s record is automatically a
possible candidate for a utilization
management review.
> This review consists of other clinicians
reviewing notes, consumer outcomes, and
service hours to determine if there are gaps
in services and if other services should be
considered. Recommendations are then
forwarded to the program manager for
review and implementation.

28. Program Outcomes
> Evaluation and Fidelity
• Assessing how well our treatment and services
are working
> Cost-Benefit Analysis
• Exploring the most efficient allocation of time and
resources with the most successful results
> Effective Program Components
• Identifying specific indicators that point to high
performance

29. Evaluation and Fidelity
We can utilize the recovery outcomes to ensure that goals and
service standards of a program are being met. Below is the average
recovery among all consumers in our Growth and Recovery
opportunities for Women (GROW) Program
By reviewing these
outcomes in
conjunction with the
fidelity level of the
program, we are able
to determine the
overall effectiveness
of the program and
identify areas where
service improvements
can be made.

30. System Review
> Measuring performance across an agency
> Establishing realistic goals
• If changes in recovery are not occurring as expected
then further investigation is done on program and
consumer level outcomes.
> Recovery Metrics Report
• Admissions, Discharges, Total consumers served
• Consumer Service Level Transfers (RNL)
• Increases and decreases in recovery environmental
factors (RMI)
• Increases and decreased in consumer’s perception of
their recovery (CRM)

31. Benefits of Outcomes Reporting
For the Consumer For the Clinician
Increased likelihood of
More clinically significant
sustained mental health
information readily available
recovery
Greater recovery
Integration of own perception improvements for time
into treatment planning invested
Improved allocation of
Improved matching of services caseload balance
to individual needs
Tools to aid in identifying
appropriate services for a
consumer

32. Question and Discussion:
How do your staff influence consumer
recovery?

33. Development of Wellness Culture
> Which of the following are elements of a Wellness
Culture?
A. Bringing out the best in everyone
B. Support and encouragement
C. Celebration and fun
D. Believing anything is possible!
E. All of the above

34. MHCD Wellness Culture
> We intentionally bring out the best in ourselves and
others by:
> Seeing everyone’s strengths
> Supporting and encouraging one another
> Celebrating staff, accomplishments, and diversity
> Respecting ourselves and others
> Listening to each other
> Creating an environment of healthy and positive
relationships and community partnerships
> Believing everyone wants to be great
> Being passionate about our mission and having fun in
the process
> Believing anything is possible!

35. How to Define and Develop Your
Wellness Culture
A. Adopt MHCD’s definition
B. Have top management define it
C. Use the authoritative definition from Who Moved My
Cultured Cheese?
D. Take lots of time and many iterations to get it right
E. All of the above
F. None of the above

36. Building our definition of Wellness Culture:
How did we do it?
> After common experience of Pathways leadership
training
> All Managers Meeting
> Structured creative process
• Brainstorming
• Flip charts
• Table discussion groups
• Organizing themes
• Movement and discussion
• Recording and projecting changes
• Completed and accepted by the end of the meeting!

37. MHCD Values
We, the staff, consumers, and governing board of MHCD, value:
> Consumer recovery and resiliency fueled by hope and
encouragement toward consumer goals
> Compassion and empathy
> Service excellence, efficiency, and effectiveness to meet the
needs of consumers and the community
> A wellness culture that recognizes, respects, and develops the
strengths of consumers, staff, and our partnerships in the
community;
> Honesty, integrity, and ethical behavior in all our actions,
communication, and relationships;
> Diversity in our workplace, relationships, and community;
> Innovation, creativity, leadership, and flexibility
> Green sustainability to protect the environment and reduce waste
in all our valued resources.

38. Creation of our Values Statement:
How many people participated in identifying
values?
A. 1: The chairperson of the board
B. 2: Roy and Linda made it up
C. 50-60 managers
D. 300-400 employees
E. 300-412

39. Creation of our Values Statement
> How many people participated in identifying values?
A. 1: The chairperson of the board
B. 2: Roy and Linda made it up
C. 50-60 managers
D. 300-400 employees
E. 300-412
Facilitated group activity at All-Staff meetings
Consumer/Staff Partnership Council

40. Breaking Rules, Leading, and
Putting Our Strengths to Work
> First Break All the Rules
by Marcus Buckingham & Curt Coffman
> The Gallup 12 = Q12 = “The Measuring Stick”
> Simplest and most accurate way to measure the
strength of the workplace

41. First Break All the Rules
Marcus Buckingham & Curt Coffman
> The 12 questions:
1. Do I know what is expected of me at work
2. Do I have the materials and equipment I need to do my work
right?
3. At work, do I have the opportunity to do what I do best every
day?
4. In the last seven days, have I received recognition or praise
for doing good work?
5. Does my supervisor, or someone at work, seem to care
about me as a person?
6. Is there someone at work who encourages my
development?

42. The 12 Questions: Continued
7. At work, do my opinions seem to count?
8. Does the mission/purpose of my company make me
feel my job is important?
9. Are my co-workers committed to doing quality work?
10.Do I have a best friend at work?
11. In the last six months, has someone at work talked to
me about my progress?
12. This last year, have I had opportunities at work to
learn and grow?

43. Now Discover Your Strengths
Marcus Buckingham & Donald
Clifton, Ph.D.
> Describes in detail the strengths-finder process
> Describes how to manage people with the different
strengths
> Discusses how to build a strengths-based
organization

44. Go Put Your Strengths to Work
Marcus Buckingham
> Set out format for how to maximize the use of your
strengths in the workplace
> Sets course for how to build on the strengths of
others and to maximize their strengths in the
workplace

45. Strength Based Leadership
> Strength Finder assessment of the 34 themes
> Organizes themes into Domains
• Executing
• Influencing
• Relationship Building
• Strategic Thinking
> Individuals don’t have to be well-rounded
> Rounding out your teams

46. Example: Team Strengths by Domain
Team
Member Executing Influencing Relationship Building Strategic Thinking
Strategic, Learner,
Kyle Achiever Maximizer Ideation
Responsibility, Relator,
Sandy Arranger Individualization Learner
Learner, Intellection,
Mike Deliberative Connectedness Input
Individualization,
Connectedness,
Kim Deliberative Developer Intellection
Susan Achiever Maximizer Connectedness, Relator Strategic
Learner, Analytical,
Jerry Connectedness Ideation, Intellection
Empathy, Positivity,
Adaptability,
Sam Developer Context
Ideation, Strategic,
Bob Maximizer Learner, Futuristic

47. Catalytic Coaching
Garold L. Markle
> Provides detailed alternative to traditional
performance evaluation which enables people to
create a course to maximize strengths and
accomplishments
• Employee input sheet
• Coaches perception
• Employee creates plan

48. Small groups—
> What is one thing we can implement at our center
toward recovery-focused transformation?
> What will be the value of this action?
> 15 minutes

49. Large Group—Report Out

50. Let’s Get Started…
> In transforming to a Recovery
Focused Mental Health Center!
> Anything is possible
> Enjoy your journey!