Assignment task:
Evaluate posts and provide them with at least one additional strategy you feel would be beneficial in advocacy to work in their plan of action and why that would be important to their agency
1. Description
The agency I started in Module 3 was a rural residential inpatient facility for women with substance use disorders and other mental health disorders. The staff for this residential facility are paid through a private practice clinical mental health agency. Envisioning mental health and medical health working together in this small facility means that instead of the clients scheduling transport to be taken to medical appointments, a nurse would travel to the house and provide routine check-ups with each new client in the house being seen on the same day bi-monthly. The house would have a computer with HIPPA-compliant software to be used when the nurse needs to confer virtually with a doctor. The computer would also be necessary for clients to meet with their prescribers monthly in the ongoing medication management process. The residential facility would begin by housing no more than ten clients and employ two licensed therapists for individual and group therapy, and two licensed social workers for case management. The remaining employees would be peer support specialists, two of whom would have to be on the premises during daylight hours; they would take turns with the counselors in leading groups throughout the day. Parenting skills classes would also be optional and offered virtually to clients planning to reunite with their children.
Plan of Action:
The first way I can envision an integrated system with medical and mental health working together would be having collaborative care through computer software that stores client data regarding their histories of physical health (and medications), mental health (and medications), in addition to case management services. After the client agrees to release their information among these service areas, service professionals would save time by referencing clients' charts through a secure database to help inform and provide well-rounded care. This strategy is important because integrating and standardizing client care among the medical and mental health professions would better inform how professionals deliver client care. Effects of an integrated system include "increasing engagement and adherence to treatment plans, provider flexibility," and a "shared knowledge base of providers increases and allows each professional to respond more broadly and adequately to any issue" (Heath, Wise, & Reynolds, 2013, p. 13).
This is an idealistic notion because for these areas of client care to merge into one system their practices need to be unified, and the mental health care system still has a long way to go.
It is worth noting that "in an effort to share costs and realize efficiencies," the Compact Commissions for the Audiology and Speech-Language Pathology, Occupational Therapy, and Counseling decided to create a unified data system (Compact Connect, n.d., para. 4). Many clients will have out of state histories, or may choose to move out of state during the process of counseling. Since North Carolina has enacted the Counseling Compact, ("an interstate compact [which] ... improves continuity of care [and] ... ensures cooperation among compact member states in regulating the practice of professional counseling" (Counseling Compact, n.d., p. 1),) it may be easier to provide continuity of care for clients. This contract gives clients in underserved areas access to mental health services "by allowing counselors to practice in other compact member states" (Sinclair, 2024, para. 3.1) and "will expand access to mental health services by allowing licensed professional counselors to be reimbursed by Medicare" (Sinclair, 2024, para. 3.3).
The second strategy for effective and efficient client care would be to have healthcare services (nurses) come to the inpatient facility instead of having clients undergo the confusing and often stressful experience of finding transportation to attend their appointments. Clients must attend substance use groups throughout the day, so this strategy is important because having consolidated medical attention would help refine the facility's schedule while helping maintain the physical health of our clients. This strategy is important because it will ease the process of obtaining medical care, decreasing clients' feelings of powerlessness and consequently increasing feelings of empowerment.
The third strategy for effective and efficient client care would be to have mental health care professionals (licensed counselors and credentialed substance abuse counselors) come to the residential facility to provide services instead of having clients travel to them. Reducing the cost of transportation and consolidating schedules, similar to that of healthcare services, would be beneficial results of this strategy. Another reason for having mental health services provided in the home is because it would promote the overall therapeutic nature of the facility. Issues that arise in the house could be discussed in group meetings and resolved there. Creating a therapeutic environment in the clients' home space can help clients practice various levels of awareness, respect, and healing through effective communication, assertiveness, adaptive coping, and community-member bonding as baseline behaviors that will enhance the quality of their recovery.
Client Understanding of Community Resources:
The clients at my agency will receive information about resources in the community through their social workers and through community outreach organizations who will travel to the facility to provide information about how to access services in the community.
The first strategy involves clients meeting with their social worker once a week. During these meetings, clients can request information and guidance regarding legal issues, education, job training, social security, food stamps, future housing, and relevant substance use groups for clients to attend in the future. Every client will have different needs based on their age, ability, life experiences, and goals. Individuals obtaining case management services will learn what resources are available to them and be guided through the processes of obtaining those services.
The second strategy involves clients being on the receiving end of community outreach organizations from other mental health agencies or religious organizations in the local community. An example of how I would facilitate mental health outreach would be if I coordinated social and psychoeducational events with other recovery facilities to "provide preventative services [and] build relationships with other providers" (American Mental Health Counselors Association, n.d., p. 5). In the rural setting of my imagined facility, local churches are common spaces for recovery communities, so community outreach events may be held at churches or facilitated by donations from church communities. These events could also be held at our facility, and I could give tours to members of local community organizations to simultaneously personalize our agency while highlighting our common values and goals. Increasing partnerships with local healthcare organizations and mental health agencies would encourage opportunities for greater community networking and funding, which would contribute to clients de-stigmatizing these services and therefore being more likely to access them.
2. Mapping Out a Plan of Action for An Integrated Agency:
Fairway Recovery Center is a non-profit inpatient substance abuse treatment facility that provides treatment for adults who are struggling with substance use addiction in the community of Southwest Virginia (serving Wise, Scott, and Lee Counties). The center is an integrated facility where medical and mental health services work together to provide comprehensive and holistic care in addressing the intricate needs of individuals struggling with substance abuse.
My role as supervisor would be multidimensional in developing and maintaining the successful functioning of the center and making sure that the staff are providing high-quality care. My responsibilities would include teaching and modeling the following skills to the staff: following agency policies, protocol, and procedures; assisting staff with making sure their records are organized and accurate, as well as managed efficiently; monitoring documentation and conducting regular audits; making sure reimbursement procedures are properly implemented to ensure the center receives timely payments for services provided; implementing effective and clear communication with all staff members; possessing strong interpersonal skills; assisting with program development and quality assurance; and ensuring the development and maintenance of community collaboration and partnerships (Turner, n.d., Integration, slide 4). To ensure these skills are developed, maintained, and properly executed, I will provide the staff with the following: trainings; workshops; seminars; regular meetings; daily briefings as needed; consultation sessions; ensuring the availability of online resources and guided materials; one-on-trainings as needed and/or when requested; and providing proficient technology trainings.
What this Integrated Agency Looks Like:
The professionals involved at Fairway Recovery Center include clinical staff (2-3 LPCs; 1-2 Psychiatrists; 2-3 Nurses; and 3-4 Certified Substance Abuse Counselors), medical staff (1 PCP; 1 NP; and 2-3 Medical Assistants), and support staff (2-4 Case Managers; 2-3 Peer Support Specialists; and 2-3 Administrative Staff). Other staff in the facility would include a program director, outreach coordinator, educational/vocational worker, cooking staff/dietary aides, and maintenance and housekeeping workers.
Fairway Recovery Center will include the use of a holistic treatment approach which would incorporate medical services (detox), medication management services, primary care, and mental health services (psychiatric care and counseling). First, it will be essential that a mission statement, work plan, and business plan are put into place as to ensure that staff, patients, and all partners have a clear picture of the desired outcomes for the center (National Council for Mental Wellbeing, n.d., p. 2). This will ensure that all facets of the center reflect the values of whole health, collaborative care, and the understanding that successful clinical outcomes are everyone's responsibility (National Council for Mental Wellbeing, n.d., p. 2). The team will meet regularly to discuss treatment planning and adjusting treatment plans as needed, collaborating and partnering with community organizations and social service agencies, implementing educational outreach to the community, and coordinating aftercare planning. Comprehensive services would also be implemented, including behavioral therapies, support groups, family involvement, and life skills education. The center will ensure a welcoming atmosphere that is safe and comfortable and fosters healing and recovery. Sufficient space for daily activities, sessions, and practices will also be provided.
Plan of Action:
One essential strategy to ensure effective and efficient client care would involve making sure Fairway Recovery Center implements a comprehensive process for universal/routine screening for substance use and mental illness. Integrated care starts with screening patients for other health conditions, in addition to the presenting problem (substance use) and arranging for more detailed assessments when indicated (National Council for Mental Wellbeing, n.d., p. 6). Other health conditions can trigger and/or complicate other health concerns if they are not actively identified and addressed. Through addressing and identifying co-occurring disorders and other health issues, patients can receive more qualitative care. Examples include screening and assessment for the following: risky, harmful or dependent use of substances; cognitive impairment; mental health problems; behaviors that compromise health; harm to self or others; and abuse, neglect, and domestic violence (National Council for Mental Wellbeing, 2014, p. 8). It is important that the medical and mental health staff work together and collaborate so patients' symptoms and treatments for major healthcare conditions are recognized and understood. It is additionally crucial that providers briefly assess the nature of the patients' family and social support system, as well as other socio-economic resources, as these factors have an impact on health and healthcare (National Council for Mental Wellbeing, 2014, p. 11). All these factors are significant in ensuring effective, efficient, and holistic care for the patients at the center.
A second essential strategy in ensuring effective and efficient client care involves the utilization of evidenced-based practices and interventions. The implementation of these types of practices and interventions (e.g., CBT, MI, and MAT) can ensure that clients receive high-quality treatment and assist them with increasing a desire to improve their health (National Council for Mental Wellbeing, 2014, p. 12). Additional interventions may include the following: brief, trauma-informed and problem-oriented treatment for mental conditions or problematic health behaviors; brief, trauma-informed treatment for risky or harmful substance use conditions; and brief, supportive interventions addressing the consequences of illness and injury (National Council for Mental Wellbeing, 2014, p. 12). It is also essential that the patients and their families receive education, information, guidance, and support related to the common effects, side effects, potential long-term adverse health effects, and interactions of pharmacological treatments for mental and substance use conditions, as well as the potential impact of and interaction of over-the-counter medications and other non-prescription remedies on health and healthcare treatments (National Council for Mental Wellbeing, 2014, p. 12). As medical and mental health staff work collaboratively together, clients can be assured their well-being is addressed and considered as high priority. Utilization of these types of interventions and evidence-based practices can additionally help in securing financial support as many funding entities may require or prefer their use in the treatment facility setting.
A third essential strategy in ensuring effective and efficient client care involves cultural competence and adaptation. Cultural competence and adaptation are defined as the ability to provide services that are relevant to the culture of the client and their family (National Council for Mental Wellbeing, 2014, p. 8). Some examples of this concept include the following: identifying and addressing disparities in healthcare access and quality; adapting services to language preferences and cultural norms; and promoting diversity among the providers working in interprofessional teams (National Council for Mental Wellbeing, 2014, p. 8). Utilization of these concepts would help ensure effective and efficient client care, as well as demonstrate respect and regard of Fairway Recovery Center's community and cultural environment.
The Counseling Compact and the Mental Health Access Improvement Act (HR 432) are vital legislative measures aimed at improving access and affordability to mental health services (Sinclair, 2024, para. 4). Through the new regulations for 2024 concerning the Counseling Compact, clients at Fairway Recovery Center can be ensured timely access to care as the compact allows counselors from other states to practice in Virginia. This would be beneficial for Southwest Virginia where mental health professionals are sparse and limited. Additionally, it would provide Fairway Recovery Center the ability to hire a diverse range of therapists to improve the quality and variety of services offered. This would especially be helpful to clients with substance abuse disorders.
Ensuring Client Understanding of Available Community Resources:
Two strategies I think will ensure client understanding of available community resources involve the following: 1. The creation of a resource information space; and 2. The organization and implementation of consistent resource sessions. Clients will receive information about resources available in the community via the utilization of an information space that would contain information materials, such as brochures, flyers, bulletin boards, newsletters, and handouts. This space will be available at all times. Informational resource materials will also be kept updated. These materials would detail available resources, including contact information and methods to access these services. If clients have questions or concerns, they can receive assistance from trained staff and/or volunteers available at the center. Clients will additionally receive information and resources available to them in the community via regular resource sessions. These sessions will take place bi-weekly to ensure clients have ample opportunity to attend, ask questions, and receive clarification as needed. Additionally, Case Managers will consistently discuss community resources with clients, as needed, during one-on-one meetings and sessions. Transportation to community resources will be provided to clients at designated times, via facility-owned vehicles, to ensure comprehensive care and support for the clients.