Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Trilogy Behavioral Health

Name of Innovative Program: 
Integrated Occupational Therapy Program
Sponsoring Organization
Trilogy Behavioral Health
Name of Innovative Program Lead: 
John Mayes
E-mail Address of Innovative Program Lead: 
jmayes@trilogyinc.org
Physical Address of Innovative Program: 
1400 W Greenleaf Ave, Chicago, IL, 60626
Project Description: 

Trilogy's innovative Occupational Therapy Program was developed, as a part of our nationally recognized Integrated Healthcare program, to bridge a gap in services for individuals who are moving out of nursing homes and assisted living facilities into independent living, but lack the necessary independent living skills to make a successful transition. In order to ensure that all Trilogy clients have the skills they need for their individual paths to recovery, Trilogy employs three Occupational Therapists (OT) and leases a one bedroom apartment where any client can practice their independent living skills in a “real life setting.” This practice apartment gives each new Trilogy client who presents with little or no independent living experience a chance to preview a typical day of “living on their own” before they move out of the nursing facility. It also gives our OTs an opportunity to assess each Trilogy client on any strengths and weaknesses they may have in regards to living alone in an apartment setting. This innovative implementation of OT, which is traditionally offered as a supplemental, segregated treatment option, allows each person to receive the individualized supports they need to develop the independent living skills necessary to successfully live on their own.  

Creativity and Innovation: 

Trilogy is contracted by the State of Illinois to provide services to Williams and Colbert Consent Decree class members. The class action decrees require that the State move any interested individuals who, with reasonable accommodations, could thrive independently out of nursing facilities and into independent living arrangements. When Trilogy began working with this population, they observed that many class members needed individualized supports to address deficits in their day-to-day living skills. As a profession, OTs have skills to address strengths and barriers to independent living. Trilogy’s decision to develop an OT program is rooted in the belief that the best place to help someone develop the skills he or she needs to achieve a full and satisfying life is in a community-based, integrated healthcare setting.  Working with people in the community—where they are living and utilizing the skills they are developing—is essential to strengths-based, person-driven, models of care.

Leadership: 

Trilogy established its OT Program as a result of being a provider for the Williams and Colbert Consent Decrees for the State of Illinois. Trilogy was the first Williams or Colbert provider to offer OT to its clients and the Illinois Department of Human Services (DHS), the State department which oversees the implementation of the decrees, has recognized the increased retention rates for individuals who are moving out of nursing facilities and have access to an OT program. As a result of Trilogy's OT innovation, DHS now requires all Williams and Colbert providers to offer access to OTs.

Our OTs have published their findings and have been asked to speak at local professional conferences and universities, including the Illinois Occupational Therapy Association’s (ILOTA) 2014 Annual Conference and Midwestern University, about the importance of OT in behavioral healthcare. Our program was also highlighted in The Communiqué, the newsletter of ILOTA.

Sustainability: 

Since 2013, Trilogy's OT program has evolved from a program that was created through internal funding to being covered as an "enhanced service" through DHS's William and Colbert Consent Decrees. DHS currently provides Trilogy with partial funding for the salary of one OT. By covering OT services, DHS is giving each Williams or Colbert Class Member access to resources which increase the likelihood of a successful transition into independent living. Funding from DHS ensures sustainability for the program and has allowed us to expand the capacity of our OT team. In less than a year the program has grown from one OT to a team of three and Trilogy is currently in the process of hiring a fourth. Trilogy has also formed partnerships with the University of Illinois – Chicago and Rush University to be a practicum site for OT students who are interested in a career in public health.

Replicability: 

Trilogy is committed to increasing access to care for all individuals who are living with a serious mental illness and forged a groundbreaking OT program, which is the first to be incorporated into community based healthcare, in order to address barriers to care. After Trilogy’s OT program was established, the effectiveness of the program became apparent and DMH began requiring all of their Williams Consent Providers to provide access to OT for class members. Other organizations lacked the resources or experience necessary to establish their own OT programs immediately and Trilogy was approached by two other Concent Decree providers to contract for our OT services. Our collaboration with one of those organizations, Community Counseling Centers of Chicago (C4), has lead to C4 working to establish their own OT program which will replicate Trilogy's program through clinical observations, discussions with Trilogy's leadership team, and trial implementation.

Results/Outcomes: 

Trilogy's OTs conduct initial assessments of each client which covers 10 areas that correspond to the clients’ Activities of Daily Life (ADLs), including: medication management, home management, safety, cooking, cleaning, and processing skills. OTs also recommend any adaptive devices (shower grab bars), or education material (visual aids) that could benefit the client. Further client assessments are conducted using Best Practices, including: Assessment of Motor Process Skills (AMPS), a standardized, observation-based, evaluation of occupational performance and activities of daily living (ADL) and Montreal Cognitive Assessment (MOCA) which assesses cognitive functions.

DMH collects and analyzes performance information for Williams providers. In FY2014, Trilogy had received 168 referrals and successfully housed 148 individuals since the beginning of the contract with DMH. Trilogy only saw 9.5% of those 148 class members return to nursing facilities. This was the lowest percentage of returns for any provider, with the highest at 21.4%.

Nomination Tags: 
Access
Quality
Integration of Behavioral Health and Physical Health
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