We are pleased to welcome and congratulate the following Telecare employees:
By Anne Bakar, President & CEO
Telecare’s new mission statement is moving us forward on many fronts: health, effectiveness, and complex needs. But it’s also intended to move us forward in the care of people with serious mental illness (SMI) and substance use issues.
At Telecare, we estimate that at least 75% of the people we serve have a serious mental illness and a co-occurring substance use issue.
At least 75%.
That means that at least 75% of our clients are trying to manage two very daunting recovery challenges. At least 75% are at risk of having their health compromised and their lives cut short. At least 75% may be facing shame, stigma, and punitive program rules that make it hard for them to be honest about their lives and get the help they need.
Our new mission statement reflects our focus not just on mental illness but on substance use as well.
We are focusing on bridging systems and closing gaps in care by training our staff about evidenced-based approaches to integrated care. This includes things like motivational interviewing and recognizing there are “stages of change” in substance use recovery: times when clients are ready to consider treatment for their addiction and times when they are not.
In addition to training staff about new tools and interventions, we are introducing Medication Assisted Treatment (MAT) to our practice. This is a vital intervention that we are well suited to provide as a professional organization with a wholly owned Physician Services Organization led by Dr. Jeff Gould. Consistent with this direction, we recently completed a pilot program on how detox could be accomplished through outpatient telemedicine.
In this month’s newsletter, you will learn more about how we are moving this aspect of our mission forward. You can read about our three-year SUDS plan, meet our new SUDS Director, and get more detail about these new approaches.
We hope you enjoy this preview, and we look forward to sharing our learning and growth.
Erin "Wesa" Arthur is a PSC III Substance Abuse Specialist at Telecare’s Santa Maria ACT program.
Wesa specializes in addiction and co-occurring conditions among members and helps them through psychoeducation, assists in detox treatment, and conducts general case management. She uses harm reduction, the RCCS, and shares her story to instill hope.
"That is why I am so passionate about recovery and the work that I do—I’ve been there," said Wesa. "I have 28 years of sobriety and I am living with a mental illness and co-occurring disorders. I think that it helps clients when I open up with them about my own experiences."
Having the ability to have the challenging conversation surrounding substance use in a non-judgmental fashion is key for building trust and hope among our clients. "I think there is so much doubt that many people who are struggling with co-occurring disorders face and that it is something that is destined to hinder them, and that’s not true," Wesa said. "Like anything in recovery, it’s a process and it’s unique to every individual."
This year, Telecare has been expanding and improving the way we inform our staff about co-occurring disorders. With our online learning portal, we are now able to offer staff training sessions on substance use that they can access at any time to help with their understanding of dual diagnosis among clients and how to start conversations around these topics. More than 70% of Telecare programs successfully completed COEG facilitator training and launched COEG groups for the people they serve.
Wesa had the opportunity to share her own experiences when COEG was first being developed. "I feel so strongly that until someone is clean and sober, it’s extremely difficult to treat the psychiatric disorder,” she said. "Substance use can have such an impact on mental health symptoms. To provide adequate treatment for people who have a co-occurring disorder, you have to take the time to understand how the two are affected by one another."
Today, Wesa continues her interest in psychology and writes about her experience. Her recovery journey is a reminder to those she works with that anything is possible.
"People gave up on me when I was diagnosed with bipolar disorder, and I proved them wrong," she said. "The thing I love is being able to instill hope and show them by example that anything is possible. And I love the clients. I absolutely love the clients we serve."
Recovering from addiction can be an extremely stigmatizing and isolating experience for many of our clients. Telecare recently conducted a pilot on Telemedicine Detoxification (Tele-Detox) to see if we could help clients overcome this isolation, while getting the right treatment support at their own pace, in the safety of their own home or within a program.
“Tele-Detox is detox treatment provided via live video calls at the convenience of where our clients are,” said Scott Madover, Director for Specialty Product Services, Substance Use Disorder Services (SUDS). “Through this online process, clients can get connected with an addiction physician who can walk them through their detox, answer any of their questions, and prescribe medications so that their substance use withdrawal symptoms can be as mild as possible.”
The nine-month pilot started June 2016 and was conducted at our CHANGES program in Oakland, CA. CHANGES is Telecare’s first co-occurring program and has been instrumental in helping Telecare identify effective and collaborative ways to treat co-occurring substance use disorders. CHANGES clients receive both mental health and substance use services, but in this program, are not required to be abstinent. Staff encourage clients to reduce their substance intake through a harm reduction model and can refer clients to more robust inpatient detox services.
The Tele-Detox program came about because we wanted to help clients overcome the isolation of addiction recovery, while getting the right treatment support at their own pace, in the safety of their own home or within a program.
The Tele-Detox approach is promising because it supports these goals, as well as offers other system benefits. It’s less expensive than inpatient detox, enables clients to start the detox process faster because it does not require waiting for an available inpatient bed, and alleviates pressures on those inpatient beds for people who need inpatient care the most.
Through the Tele-Detox process, clients are screened and connected with an addiction physician through Clinics On Demand. Clients are loaned a personal computer or a tablet if they do not already have one, a blood pressure cuff, and a finger oxygen device. The blood pressure and finger oxygen devices connect automatically and wirelessly with a monitoring system at Clinics On Demand.
Clients who participated in the demo had regularly scheduled telephone visits with physicians and clinical staff to discuss progress, address concerns, resolve problems, and refer to higher level of care if needed. CHANGES staff could contact the client’s physician to report any change of condition they observe during the detox treatment. Once detox treatment was completed, CHANGES staff would help and support clients in their chosen Intensive Outpatient Programming (IOP) treatment in addition to the services at CHANGES.
“Although the turnout for the pilot program was modest, the support and encouragement clients received by participating really helped them understand their addiction,” Scott said. “As a company, we are looking to continue to have the opportunity to build expertise within Telecare around substance use for our staff.”
Michelle Norris worked on the Tele-Detox program pilot when she was a Personal Service Coordinator II at CHANGES. As someone with lived experience herself, she knows that there is a lot of stigma surrounding addiction, and that having more personalized access to help can make taking those first steps towards recovery a little easier.
“There's still a lot of misconceptions around addiction, like the thought that people could just stop if they wanted to,” she said. “You know what? If I could've stopped, I would have, but I couldn't until I got more education. Having the right education and being provided the steps you need to take to help the client is so important because recovery can be a lot harder than you think.”
Michelle uses the experience from her own recovery to help guide others on their journey. She is now a Licensed Clinical Social Worker (LSCW) at Telecare’s Villa Fairmont Mental Health Rehabilitation Center.
Our Plan for Building Skills, Staff, Practices & Programming
In January 2017, Telecare finalized a three-year plan to enrich and expand our substance use disorder services (SUDS) capabilities, with a specific focus on people who have a serious mental illness (SMI) and co-occurring substance use issues.
"Traditional substance use agencies are not necessarily prepared to serve people who have SMI," said Faith Richie, SVP of Development. "We have a 50-year history of working with SMI and complex needs and in the last few years, have made major steps forward in our ability to recruit, retain and support licensed staff, particularly psychiatrists, through our TLC Physician Services Organization. This will make it easier for us to step into more direct SUDS care, deliver Medication Assisted Treatment, and meet all of the site certification and staff licensing requirements to do this work and do it well."
We are pleased to introduce the highlights of this plan here and will continue to share enhancements and updates as we move forward in this work.
Our vision for our SUDS plan is ambitious. We want to:
- Increase quality of care
- Increase access to care
- Increase strategies for effective care
- Reduce the stigma of care
- Nurture a safe space for change
- Create many options and avenues for clients to make positive behavioral change
- Enable staff and clients to work proactively and collaboratively toward recovery
SUDS Plan at a Glance
What's New in SUDS
To help us better address co-occurring conditions company-wide, we appointed Scott Madover, Ph.D., to take on the role of Telecare’s Director for Specialty Product Services, Substance Use Disorder Services (SUDS).
"We knew we really needed to focus on substance use, and ensure that we were capable and doing our very best to meet those needs. We thought the best way to do that was to hire a dedicated leader, and that's Scott Madover," said Faith Richie, SVP of Development at Telecare.
In addition to working with the Development and Operations departments at Telecare to create plans for how co-occurring programming could better serve our clients, Scott will also assist with Telecare’s planning efforts so that our services are aligned with parity requirements and SUDS funding in multiple states. He will also ensure that Co-Occurring Education Groups (COEG) curriculum is available at all our product types, and recommend new standards for our existing programs so that they are co-occurring capable.
Scott’s clinical training and program leadership experience coupled with his wealth of knowledge in co-occurring disorders positions him very well for this role.
Before accepting his role as the new SUDS Director, Scott has helped lead many of Telecare’s integrated care efforts, including the development and roll out of COEG, our first company-wide substance use education program, and the design and implementation of Telecare’s first pay for success program. He also helped design and oversee the CHANGES program, our first program specifically designed to support people with co-occurring mental illness/substance use needs. Scott has also served as Regional Director of Operations in the Bay Area.
Telecare has been named a Best Place to Work (BPTW) in the Bay Area by the San Francisco Business Times. Staff from STRIDES/STEPS/STAGES, Villa Fairmont, Redwood Place, Sausal Creek, Cordilleras, Willow Rock, Gladman Mental Health Rehabilitation Center, Heritage Psychiatric Health Center, Morton Bakar Center, and CHANGES attended the celebration in San Francisco on Tuesday, April 18.
Out of 537 applicants, only the top 130 companies were chosen for this award based on BPTW employee engagement survey responses. This is the 15th time we have been recognized on this list.
This year, we ranked ninth in the Largest Employer category. We would like to say thank you to all our staff for making Telecare a great place to work! We are truly honored.
May is Mental Health Month. Show that you are #IntoMentalHealth and check out the following for awareness events taking place next month:
Telecare has a long-range plan for expanding and deepening its Whole Person Care (WPC) efforts. We began by examining
co-occurring conditions—educating providers and ensuring that Telecare’s Co-Occurring Education Group is available in all our programs. Right now, we are laying the foundation for future efforts by focusing on health literacy.
We recognize that behavioral health providers need support as they work with clients to address their physical and substance use issues. In May 2016, Telecare introduced Phase 2 of our Whole Person Care initiative: health literacy. The Health & Wellness Curriculum consists of eight online modules on topics such as Diabetes, Cholesterol, Blood Pressure, Managing Our Stress Response, Tobacco Use, and more. Each module is accompanied by visually engaging and easy-to-follow handouts that staff can use to engage clients in conversation about these health concerns.
Though we’re still early in our company-wide implementation, the feedback so far is promising. Here is an update on our progress, as of April 2017. Below, you’ll find:
- Where We’re Going: Implementation Timeline & Status Update
- What We’re Seeing: Early Discoveries From the Field
- More Info: Whole Person Care Goals
Implementation Timeline & Status Update
Right now, we are working on Phase 2: health literacy. Telecare’s programs have the flexibility to implement the health and wellness literacy curriculum at their own pace, but all programs must complete the curriculum by April 2018. Here is a snapshot of our progress over the last year.
Early Discoveries from the Field
We spoke to staff at three Telecare programs that are moving quickly to fully implement the Health & Wellness Curriculum, a 16-hour, online training program that provides staff with basic knowledge about the chronic health conditions that our clients most commonly face. Here’s what staff have told us about the curriculum’s impact so far.
We're Increasing Linkages to Primary Care
Erich Stevens, Registered Nurse
San Diego Gateway to Recovery
- More conversations happening
- More linkage to primary care
- More physical health therapy
How the curriculum has helped:
- "I think the modules and quick reference tools for use in the field have been extremely helpful to case managers and other non-nursing staff in better understanding these health issues and how to assist clients with them, which has typically been up to the nursing staff alone."
Why do it:
- “It gives us more ways to help clients reach a higher level of wellness.”
Clients Are Taking More Initiative in Setting Doctor Appointments
Tienna Jackson, Team Lead
Gateway to Recovery
- Clients willing to make primary care appointments
- More physical health therapy
- Increase in health conversations
How the curriculum has helped:
- “The worksheets that were available with each module were given to members to help support them in whatever their hopes and dreams are in regards to their health and wellness.”
Why do it:
- "It reinforces to our staff the importance of addressing both the medical and mental health aspects of recovery with our members, and really, it has been working. Our clinicians and nurses are coming back with stories of how they tell people the importance of seeing a doctor, and members are open to making appointments with their primary care provider on the spot."
We’re About to Help Clients Better Understand How Physical Health & Mental Health are Connected
Rocio Perez, Clinician, Los Angeles Older Adults
- Handouts help show clients how mental and physical health are connected
- Increased efforts towards self-care
How the curriculum has helped:
- “The Health & Wellness Curriculum has been especially helpful partnered with psychoeducation. One example is around diabetes. Many of our members are diabetic, and they don’t know what it is to be diabetic, or how it affects your mental health. Having the handouts have made it easier to talk with clients about the different ways to address living and dealing with physical ailments.”
Why do it:
- “For me, being mentally OK and being physically OK go together, which is how we have implemented it in our office, and I see it working.”
Whole Person Care: Big Picture
By Anne Bakar, President & CEO
We hear so much about the need for integrated mental and physical healthcare these days, that we sometimes forget all the reasons why this is absolutely imperative for the wellness of individuals and communities.
It is not only the higher mortality rate among individuals with serious mental illness due to physical health issues that is cause for alarm. The concern is also rooted in the untreated mental illness that frequently underlies chronic health conditions such as diabetes, metabolic syndrome, obesity, pain management, and addictions.
At Telecare, our new mission statement is focused on building awareness of how these health problems overlap, as well as how we can treat them more effectively.
Historically, our recovery philosophy focused on helping those we serve to recover their hopes and dreams. And now, the language in our new mission statement speaks to engaging clients in recovering their “health, hopes and dreams,” a clear reference to the fact that recovery involves the whole person: body and mind.
We are operationalizing this new vision today primarily with an “education initiative” as our SVP of Operations, Anita Barnas says. Through e-training, we are educating our 3,200+ employees on the physical health conditions that are most common among our members, as well as providing tools to support healthy lifestyle changes.
This month’s newsletter provides detailed information about our education curriculum, along with some profiles of how our leaders are thinking about this new mission and direction. We hope you enjoy this preview, and we look forward to sharing our learning and growth.
This month, Telecare and other health and mental health organizations from around the country came together for NatCon17 in Seattle, WA. It was Telecare's third year hosting a booth at the conference, which is sponsored by the National Council for Behavioral Health.
“Telecare was honored to support the behavioral health community at the recent NATCON Conference,” said Robert Klar, Talent Acquisition Director at Telecare. “Telecare representatives from Operations, Development, Quality and HR were proud to speak with industry leaders about our mission, our products, and of course to encourage them to think about joining our organization.”
Thank you to everyone who stopped by the Telecare booth!
- "When you are emotionally connected to your peers in recovery, you stand the best chance of being protected from the compulsion to use and do things that get you into trouble with your illness." Patrick Kennedy and Glenn Close discuss mental health and advocacy work with the New York Times.
- Mental Health America (MHA) has partnered with Booster.com, a free crowdfunding platform, to launch its first campaign to inspire individuals to "Fight in the Open."
Telecare is pleased to announce that we will be opening eight new programs in the coming months. We are beginning recruitment efforts now for leadership positions at six of these new sites.
If you'd like to learn more about career opportunities at these programs or Telecare in general, please contact Robert Klar, Director, Talent Acquisition and Workforce Planning, at email@example.com.
Orange County, CA—Pacifica House
Pacifica House will be a 6-bed, short-term crisis residential program that will provide stabilization services to members who are experiencing acute mental health crisis and need additional assistance without resulting in the member being admitted to an inpatient program.
Kern County, CA—Eastern Kern County Crisis Stabilization Unit (CSU)
The Eastern Kern County CSU will be a 12-chair, short-term crisis unit that will provide 24/7 individualized services to help consumers stabilize acute psychiatric symptoms and avoid inpatient hospitalization.
Riverside County, CA—Riverside Crisis Stabilization Unit (CSU)
The Riverside CSU will be a 12-chair, short-term crisis unit that will provide 24/7 community-based emergency services for adults and youth experiencing crisis related to a mental health condition.
Thurston and Mason Counties, WA—Thurston Mason Mobile Outreach (MOT) and Intensive Case Management (ICM) Teams
The Thurston Mason MOT and ICM program serves two locations—Shelton and Olympia—with four teams at each site. They were developed to provide specialized, recovery-focused services to help individuals during times of mental health or substance use related crisis, so they can regain stability, stay safe in the community, and prevent incarceration or unnecessary hospitalization.
Thurston and Mason Counties, WA—Thurston Mason Evaluation & Treatment (E&T) and Crisis Stabilization and Treatment Unit (CSTU)
The 15-bed E&T and 10-bed CSTU will be co-located in Olympia, WA. The CSU is a 24/7 voluntary program for individuals who are experiencing a mental health crisis and who need immediate treatment and support. The E&T will provide services to individuals experiencing severe psychiatric symptoms who may benefit from more structured supports and a secure setting.
In April 2017, Telecare will begin training and preparation to use the FROST assessment in all criminal justice-based programs to help identify people at high risk of recidivism.
“We’re testing the FROST because we need to know which criminogenic needs are highest for our members, so that we are able to drive the appropriate interventions and treatment,” said Gary Hubbard, Vice President of Operations of Southern California and Arizona.
“Studies have shown that programs that target high criminogenic needs with members have a higher success rate and reduced recidivism.”
What Is FROST?
The assessment is called the Field Re-Assessment of the Offender Screening Tool (FROST).
Why the FROST Assessment?
Telecare’s Justice Involved Mental Health (JIMH) subcommittee chose the FROST because:
- It is quick to complete
- It can be administered by non-licensed staff
- It measures for criminogenic risks
- It is reasonable in cost
According to Hubbard, the subcommittee chose the FROST over another potential tool used by the Arizona court system— the Offender Screening Tool (OST) — because the OST was a pre-release measure. The FROST, by contrast, is used in the community and measures the eight criminogenic need areas that can lead to recidivism.
Telecare’s clinical leadership team will attend a free FROST training provided by the Arizona Supreme Court staff on April 11. Telecare's leadership will also participate in a train-the-trainer event that will be offered in the fall to build the expertise to distribute the FROST more widely to our existing JIMH programs.
On January 30, we opened ASSIST, the first Assisted Outpatient Treatment (AOT) program in Ventura County, CA. The program aims to provide recovery-oriented, evidence-based Assertive Community Treatment (ACT) services to adults with serious mental illness who might otherwise not have the opportunity to engage in services.
The Laura’s Law program is the first of its kind in the county, and was made possible through a Substance Use and Mental Health Services Administration (SAMHSA) grant.
“We are the only SAMHSA granted AOT program in California, which is exciting,” said Shana L. Burns, Administrator at ASSIST. “This means that the program is being evaluated by both the federal government and the county in terms of services. The SAMHSA grant helps to ensure that the ASSIST program is in alignment with Laura’s Law.”
The ASSIST program works with Ventura County Behavioral Health Department’s (VCBHD) Rapid Integrated Support & Engagement (RISE) program with the referral process. RISE program staff are responsible for conducting outreach and engagement to ensure that individuals with severe mental illness are connected to VCBHD for mental health and other supportive services.
“We meet with the RISE team on a weekly basis for an hour,” Shana said. “The RISE team screens the referral calls for ASSIST, goes out to meet with the individual in question to see if they meet all nine AOT criteria, and sends them to us if they do. Once they are referred, we start our engagement process.”
“I think what I am really excited about is that we have that opportunity to try to outreach and engage with individuals to see if the different types of services that we at Telecare can provide to them is something that they would be willing to undergo voluntarily versus being required by a court order to do that,” said Crystal Eastburn, Clinical Director at ASSIST.
Outreach and engagement is a unique component to the program. Unlike other AOT programs that receive individuals after they have been court-ordered, ASSIST has a 90-day engagement period before a court petition has been made for services.
“It speaks to the whole RCCS in terms of respecting the individual and their choice and allow them to be making a choice to participate veruses being required to participate. We try to give them as much opportunity to maintain their right,” Crystal said.
Explore our Roundup of Telecare’s Court-Ordered Care Programs.
On March 7, Telecare’s Orange County Assisted Outpatient Treatment (AOT) program in Santa Ana, CA, moved into its new facility to accommodate their recent service capacity increase from 25 to 120 persons.
"Our amazing team will continue to offer services in the community, but we are so excited to have this new program site for members to feel included, safe, and valued," said Anna Bowes, Administrator for the Orange County AOT program. "The team is really looking forward to creating a community with our members. We plan to start an art gallery and offer gardening on our patio."
The space will serve as an important resource for providing more personalized care. "Now that we are closer to the Central Justice Center, we can offer hearings with an AOT judge at the program for our members who are not as comfortable at the courthouse,” Anna said. “We are also currently working with Orange County Health Care Agency and Genoa Healthcare to have an on-site pharmacy. We hope this service will increase access and efficiency in getting members connected with their medications.”
For many members in the program, access to the proper care and resources can mean a world of difference. "I have been with other programs in the county and have left the state because I had a difficult time with the program rules," said an AOT graduate. "I felt like I as being pushed around a lot and I had a hard time living."
"Ever since I’ve been with AOT, I began making a comeback," he said. "I like AOT program a lot— it has been easy and the staff are very nice. I haven’t been to the hospital in almost five months and I received psychiatry and medication services with the help of AOT."
The member's mother is especially thankful for the services her son has received. "I feel like I have my son back," she said. Although the member graduated, he has chosen to remain in the program voluntarily.
The Orange County AOT program launched in October 2014. It was Telecare’s first Laura’s Law program and has seen eight clients graduate since it opened—one of which has been connected with outside Full Service Partnership (FSP) programs or psychiatrists for continued support in their recovery, while the other seven remain with the program on a voluntary basis.
The information below compares hospitalization and incarceration statistics of members before and after they have been admitted to the OC AOT program from July 2016 to February 2017.
By Anne Bakar, Telecare President & CEO
Over the past 30 years, Telecare has developed a specialized reputation for serving individuals with more serious and complex mental health needs. These are individuals that often come out of acute care settings or state hospitals, and have a hard time finding appropriate treatment in the community. These individuals frequently incur expensive system-wide costs due to repeated hospitalizations and/or incarcerations.
Telecare has provided many successful interventions to serve individuals with complex needs through evidence-based Assertive Community Treatment (ACT) programs, and our Recovery-Centered Clinical System (RCCS). These service models have reduced system-wide costs and have helped thousands of individuals each year regain their sense of hope, acquire stable housing, reduce their substance use, and move forward towards their educational or vocational aspirations.
At the same time, our success in achieving these goals has been limited by our expertise in serving the whole person, whether their needs include justice involvement,
co-occurring substance use, developmental disabilities, or co-occurring physical health care problems. Our ongoing commitment to broaden our capacity to meet these needs is at the heart of our new mission statement when we reference engaging those with "complex needs."
This newsletter is specifically focused on justice-involved endeavors: How do we better serve individuals with serious and complex needs coming out of the criminal justice system?
We hope you enjoy hearing about some of our early work, and look forward to sharing our continued journey in this area of great national importance. Please feel free to reach out to us and let us know your thoughts and ideas.
Last month, we introduced Telecare's new mission statement. This month, we offer a deeper view into what it means to provide excellent and effective services.
By Anne Bakar, Telecare President & CEO
To be an excellent service organization, we have always focused on learning and growing our capabilities.
In particular, we continuously work to improve in three major areas:
- Providing excellent clinical quality,
- Delivering excellent services to our partners, and finally,
- Creating an environment that is a great place for employees to work.
Although we measure our progress in these priority areas over time, with the additional focus on effectiveness we see the opportunity to be more systematic and rigorous in our approach.
This means delivering care that makes a measurable difference in people’s lives, and can be demonstrated with outcomes. Internally, we also recognize that data can be used operationally to make more informed decisions and improve practice.
While this is a long-term focus that will involve new technology and tools, there are specific ways we are working on excellence and effectiveness right now: from new program models, to new leadership, and more. This issue includes several of our latest efforts and we will continue to share more in the months ahead.
Please feel free to reach out to us and let us know your thoughts and ideas. We encourage and welcome your feedback.
Stock images of people living with mental illness range from insensitive to downright cringe-worthy. The organization Be Vocal: Speak Up for Mental Health created the Be Vocal Collection, a selection of free photos that counteract the often grim, one-dimensional portrayals of people with mental health conditions. You can read more about the inspiration behind the project here.
Every month, Sidewalk Talk, a community listening project based in San Francisco, sets up listening events in various cities, where trained volunteers make themselves available for mini therapy sessions with anyone who needs someone to talk to. Sidewalk Talks will be hosting numerous listening events in San Francisco and Oakland in March.