Medical model treatment can be effective in symptom management of serious mental illness but the management of symptoms is not tantamount recovery and iatrogenic effects permeate the treatment system. People residing on the backwards of state hospitals in past decades to now living on disability in subsidized housing in great poverty and social isolation is a poor legacy for behavioral healthcare. The Cornerstone Consortium (Cornerstone), a peer organization, in collegial partnership with expert practitioners and researchers are developing policy to support:
- Enhanced whole health outcomes by tempering and focusing evidenced based recovery practices through person centered, trauma informed processes navigated by peer support anchored in people’s dreams and personal aspirations that promote personal strength, autonomy and dignity.
- Research with university partners to test the efficacy of the enhanced services that generates actuary usable data.
- Strategies to market enhanced services to MCO’s under sub-capitated pay for performance contracted care.
This process requires major shifts in practice, research, payment models, infrastructure development and policy that can only be accomplished through the melding of lived experience with expert practice. This process operationalizes the Cornerstone mission: Inspire people to reach for their dreams and believe recovery is not only a possibility but a reality…
Integration of medical model treatment and peer driven recovery paradigms requires systemic innovation in practice, research, payment models and policy. Such systemic innovation requires an innovative underlying systemic development process: This next generation of the recovery service system will be the result of expert practice anchored in the scientific method that is tempered and focused by lived experience so that the outcomes are evidenced based, cost effective and make real difference in people’s lives with minimal iatrogenic effects (Triple Aim). Many organizations bring peers and practitioners together but rarely is there an equal relationship that meets that definition of collegial. The relationship must be built on the epiphany that the development of the enhanced service system requires both perspectives to generate the desired health outcomes. Cornerstone is developing collegial relations through cross mentoring between peers and practitioners so each understands, respects and appreciates the others knowledge, insights and perceptions.
Through support of the Hogg Foundation for Mental Health, Cornerstone is bringing together a Learning Community comprised of peers, practitioners and researchers with technical assistance from the Yale-Program for Recovery and Community Health (PRCH) and the Texas Institute for Excellence in Mental Health to develop multi-faceted processes to build the enhanced service system. This approach requires pervasive systemic change that needs to be learned “by doing” with expert mentorship. The Learning Community core membership is developing and documenting innovations in practice, research and policy. After primary processes are developed then the Learning Community membership will be expanded so other organizations can join and innovate. Cornerstone has had conversations with PRCH to develop Peer Fellowships to support peer leadership in the development of innovative practices. Cornerstone presented at the 2014 Alternatives national conference, October 26, 2014, to recruit partners (“Preparing Peers to Drive Policy Development that Enhances Service Outcomes”).
Cornerstone has linked with Yale-PRCH, Texas Institute for Excellence in Mental Health, University of New Mexico-Department of Psychiatry and the National Council for Behavioral Health in addition to the Hogg Foundation to support the development of this project (letters of support included) but systemic change requires systemic funding. A Cornerstone goal is to demonstrate through research that collegial partnerships will develop services that lead to recovery outcomes that improve population health at reduced cost (CMS Triple AIM). Areas of focus are populations that are identified by the managed care organizations (MCO) as high health cost outliers (e.g. co-morbid bi-polar disorder, diabetes and alcohol abuse). If the newly developed recovery services demonstrate through medical school sponsored research better health at less cost in actuary usable data for these populations then the services will be marketed to MCO’s under sub-capitated pay for performance contracts. Systemic change requires systemic funding.
- Learning Community: Develop a recovery culture embedded within the Learning Community through reciprocal cross mentoring in which peers mentor expert practitioners on person centered, trauma informed recovery and expert practitioners mentor peers on the science of recovery.
Replicatability: Procedure manual for operations of the Learning Community inclusive of cross core competencies.
- Enhance/Expand Recovery Practices: Develop recovery services anchored in evidenced based practices tempered and focused through a person centered, trauma informed processes that leads to measured improved health outcomes and person centered enhanced quality of life.
Replicatability: Detailed procedure manualfor each discrete service developed/enhanced.
- Research: In partnership with university researchers test the impact of the innovative recovery practices under controlled conditions.
Replicatability: Publication in professional literature of research outcomes
- Policy: Develop policy based on the outcomes of practice and research.
Replicatability: Formal policy recommendations with detailed description of infrasture to support the policy.
Cornerstone shall generate the following outcomes:
- Practice: Documented and field tested enhanced evidenced based practices (e.g. Chronic Care Model, Seeking Safety, and InSHAPE) and the development of new services that infuse lived experience and scientific methods.
- Practice Outcomes: Enhanced service outcomes measured for improved health (e.g. BMI, ED contacts, A1C) and enhanced person centered quality of life (measures TBD by peers and clients).
- Research: In partnership with university researchers (e.g. Texas Institute or University of New Mexico) outcomes of enhanced or newly developed services tested under controlled conditions that generate actuarial useable data.
- Funding: Marketing services to MCO’s that improve population health and reduce costs.
- Policy: Formal policy developed on recovery practices focused and tempered through person centered, trauma informed processes navigated by peer support anchored in people’s dreams and personal aspirations that promote personal strength, autonomy and dignity.