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Service Planning and Delivery: Introduction

Service Plans

Values That Shape Service Plans

Changing Roles of Persons Who Serve
People with Psychiatric Disabilities

Person-Centered Service Planning Benefits

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FL's Mental Health System's Services

Service Planning and Delivery:
Introduction

Many people in a community continue to view people with mental health or behavioral conditions as different. Too often, these negative perceptions have caused people with mental health conditions to be labeled, placed in very restrictive programs, and seen as a constant drain on an already overburdened social service system.

As a result, many people with psychiatric disabilities have had few opportunities to show their abilities, capabilities, and life preferences. Rather than placing people in restrictive settings that limit opportunities, it is now time to look at how people can best guide their own destinies, understand their conditions, and set their own paths to success. This Guide is meant to provide the paradigm shift from a negative focus on peoples' disabilities to a renewed focus on people's abilities and strengths.

Research has demonstrated that few people get better when they have little input into how they would like to change their lives. Almost 80% of people with mental health disabilities may refuse to take their medications. They may have a relapse and end up in psychiatric facilities. People can feel a loss of hope and feel disengaged unless they are supported in their life desires and have hope for their future.

We learn more about people by asking:

1. What amount and type of services does the person want?

2. From whom does he/she want to receive the services and supports?

3. Where does a person want to live?

4. With whom does he/she want to live?

5. What would someone like to do in his/her spare time? With whom?

6. What kind of job would he/she like?

Whenever possible, supports and services for people should focus on their interests and preferences within their community in ways that contribute to the individual's growth and personal reputation. John O'Brien (1987) in "Lifestyle Planning" defined five essential service accomplishments that are needed for people with disabilities:

1. sharing places,

2. making choices,

3. developing and enhancing skills;

4. developing a positive reputation;

5. building relationships with others.

TANF funding from the Department of Children and Families, Substance Abuse and Mental Health Program Office and the Department of Education have developed the document "Dare to Dream" for adults, that can be used to assist the individual in outlining what kinds of supports and/or services that person would like. This document may be accessed through the Florida State University, Mental Health and Substance Integrated Training Center website at http://mhsa.fsu.edu at no cost as of March 30, 2001.

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Service Plans

Service plans have changed over the years to serve many different functions, often depending on the funding source and the financial requirements that drive the service system. For people receiving mental health services from a publicly funded, Florida contracted provider of mental health services, the focus is now on the supports and service strategies needed and desired by the person to significantly improve his or her life. The plan is developed based on what the person tells people he or she wants, along with input from family, friends, advocates and other persons. The service plan is based on the person's dreams, hopes, interests, capabilities, and desires.

A service plan should:

• use comprehensive information from a person's life

• lace importance on supports and services that make sense for the person and family

• prepare the person for where he or she wants to go

• involve family members, friends and other people important in the person's life

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Values That Shape Service Plans

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Attitudes and values that influence and determine what kinds of supports and services are offered to people depend on how individuals are perceived and how the supports and services are delivered. It is imperative that people supporting individuals with mental health or mental illness conditions understand the importance of the following values:

• Supports and Services Are Person-Centered
  Supports and services for the person are based upon his or her strengths, interests, preferences and needs.

• Focus on Abilities and Assets
  People are to be provided opportunities to develop, use and retain skills and abilities in areas that interest them.

• Individuality
  Everyone has personal preferences. People are to be supported in their quest to express their individuality and uniqueness.

• Choice
  Options are to be offered so people have opportunities to indicate their choices in all areas of life to the maximum extent possible. The ability to exercise control over one's life can empower someone to set a direction and take responsibility.

• Respect
  Supports and services that are chosen by the person or his/her guardians, parents or significant others are to be delivered in manner that is dignified, appropriate and assists the person in living in the community of his/her choice.

• Social Connections
  People are to have opportunities to interact with members of their local communities and to be active, contributing members of their community, to the extent desired.

• Holistic Support
  People who serve individuals with mental health conditions are to provide supports and services that reflect the preferences of the person, based on input and experiences. Opportunities are to be provided for people to participate in work activities, social and recreational experiences that reflect their personal preferences. Faith-based involvement is very important for many people as well.

• Confidentiality
  Chapter 394, Florida Statutes, specifies the confidentiality requirements for professionals working with people with psychiatric disabilities. However, everyone has a right to privacy and respectful handling of information about someone is a crucial part of supporting someone. http://www.myflorida.com

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Changing Roles of Persons Who Serve
People with Psychiatric Disabilities

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The role of the mental health case manager will change dramatically over the next few years. With the implementation of Florida Assertive Community Treatment (FACT) teams and TANF Substance Abuse and Mental Health (SAMH) specialists and counselors, it will become more important that case managers for individuals with psychiatric disabilities know the person in a holistic manner. It will no longer be sufficient to direct a person toward programs that have available treatment slots.

It will be necessary to know what that person wants to do, depending upon his or her level of functioning and preferences for interactions.

Suggestions for Getting to Know the Individual

• Meet with the person informally. Have a cup of tea, go for a walk in the park, sit under a tree, spend time with the person, one on one.

• Ask the person what he or she would ideally like to be doing. (See if the person's life goal is to live in a hospital!)

• Talk with key people who know the person well. Family, loved ones, teachers, other case managers, doctors, religious leaders, and other individuals who care about the person.

Margaret has Alzheimer's. She lives at an Alzheimer's treatment center. Margaret's roommate, Belinda, is complaining that Margaret stays up all night pacing and talking to herself. After talking to Margaret, it became clear she enjoys staying up late. Phyllis' roommate had moved out a few weeks ago so facility staff introduce Phyllis and Margaret. Phyllis is a little hard of hearing and can sleep through anything. Margaret and Phyllis choose to be roommates and become close friends.

• See where the person has lived, worked and spent time. Too often, we forget that many people with psychiatric disabilities live in areas that are dangerous. Besides having people feeling afraid already, we can often make the situation worse by having people live in situations in which we wouldn't want our loved ones to live.

• Develop a road map where someone would like to go. (Remember his/her road to success is the person's road, not the professionals!)

  Suggestions to Connect Someone with the Community

• Link someone to Compeer. Compeer is a program that links volunteers who are interested in getting to know and assist someone with a mental health, mental illness or behavioral condition. There is a Compeer Program in West Palm Beach. Contact Compeer at: compeerp@rochester.rr.com.

• Go to the library, beach or somewhere that interests the person.

When June was teaching school in an urban community, one of students told her that he had never seen a cow. June arranged for the class to go on a field trip to a local farm. The student can now say he's seen cows, chickens, roosters, pigs and rabbits.

• Plan an event to bring together people who may need to be motivated to get together. Sometimes families have been "burnt out" by taking care of a loved one, but after some time apart, they are ready to reconnect.

• Introduce people with disabilities to others who have jobs that interest the person with a psychiatric disability. Mentoring has been found to be very effective. Spending time with someone at a job or visiting a job site can be very informative. How many of us still have the same job we started with?

• Attend a community event together.

• Get local newspapers and review the articles and want-ads together.

• Introduce people to "drop-in centers or clubhouses." Sharing experiences can be very helpful to some people so they realize they are not alone in their experiences.

• Introduce people to volunteer opportunities.

• Celebrate successes, meeting new people, and trying new things.

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Person-Centered Service Planning Benefits

Using the person-centered approach to service planning combines the following benefits:

• The person experiences the supports and services of his/her choice in the community of choice.

• The person builds decision making skills and works with others in making decisions that affect his/her life.

• The person becomes engaged in the decision-making process as early in the service delivery system as possible.

• The person participates in service planning by identifying individual and family preferences and by making choices at the initial time of information gathering.

• Case managers or others who provide supports and services become highly knowledgeable about their communities and the support systems they are a part of.

• Case mangers receive ongoing feedback about the quality and satisfaction with supports and services with constant input from persons receiving service/support, from families and from other advocates.

• Most importantly, the person receiving the supports and services assumes increasing levels of responsibility for his/her behavior by setting individual goals.