Community Integration Now

1
Community Integration Now!

• Consumer Involvement in State Community
  Integration Planning Under Olmstead

2
National and Statewide Coalitions

• Objective To support state-level coalitions
  aimed at eliminating the unnecessary
  institutionalization of children with severe
  emotional disturbance, and adults with serious
  mental illness.
• Funded and led by the Block Grant Branch of
  Center for Mental Health Services (CMHS)

Contractors Gallup Organization Advocates for
Human Potential, Inc. Enterprise Foundation
National Association of Protection and Advocacy
Systems, Inc. and Sawchuk, Brown, Associates.
3
Section I

• Background

4
Federal Community Integration Mandate

• The federal government has required states to
  treat people in the most integrated setting
  possible.
• Each state is looking for ways to treat people at
  home, in the community, instead of institutions.
• This process is called community integration
  planning or Olmstead Planning.

5
You Can Make a Difference!

• As a consumer, you know best what works and what
  doesnt.
• Make sure the state listens to you!

6
Legal Background

• Congress passed the Americans with Disabilities
  Act (ADA), which outlaws discrimination.
• The Supreme Court ruled that keeping people in
  institutions who dont need to be there is
  discrimination.
• The President and federal agencies have issued
  rules that enforce the Courts ruling.

7
The Americans with Disabilities Act of 1990 (ADA)

• Passed as a result of broad-based advocacy
  efforts nationwide.
• Prohibits discrimination
• Employment.
• Government services.
• Public accommodations.
• More information about the ADA is available from
  organization listed in the Participants Guide.

8
The Olmstead Decision

• Olmstead is a desegregation order based on the
  ADA.
• States must provide treatment in the most
  integrated setting possible.
• Institutionalization severely diminishes
  education, employment, social contacts, and other
  important activities.

9
Limits on Olmstead Ruling

• Professional must determine that community
  placement is appropriate.
• Person must want to live in community.
• Changes cannot result in fundamental alteration
  of states treatment program.

• States Defense
• A comprehensive, effectively working plan for
  placing qualified persons with mental
  disabilities in less restrictive settings, and a
  waiting list that moved at a reasonable pace not
  controlled by the States endeavors to keep its
  institutions fully populated.

10
President Bushs Order

• Administration is committed to community-based
  alternatives.
• Federal government will help states provide
  services in the most integrated setting.
• Applies to all people with disabilities.

• Agencies involved
• Justice
• Health and Human Services (HHS)
• Education
• Labor
• Housing and Urban Development (HUD)
• Social Security Administration (SSA)

11
Whos in Charge?

• States have designated officials in charge of
  community integration/Olmstead planning.
• Get to know the officials in your state.

12
Whos on Your Team?

• Youre not in this alone!
• Get to know the other advocates in your state who
  will work with you to make sure the plan works.

13
Where Are We Now?

• The status of community integration/Olmstead
  planning in this state.

14
Section II

• A Consumer-Centered Behavioral Health System

15
Discussion Core Values

• What are some core values of a consumer-centered
  behavioral health system?

16
Examples of Core Values

• Empowerment
• Recovery
• Consumer-centered outcomes
• Voluntary participation

• Cultural Competency
• Privacy
• Advocacy
• Strengths-based design
• Flexibility

17
Discussion Promising Practices

• What are some of the promising practices that
  make a mental health system consumer-centered?

18
Examples of Promising Practices

• Meaningful consumer input
• Consumer evaluation
• Consumer-run programs
• Consumer education
• Integrated services
• Hiring of consumers

• Organized supports
• Housing
• Employment
• Case management
• Income supports
• Crisis intervention
• Natural supports

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Section III

• Successful Community Integration/ Olmstead
  Planning

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Olmstead Plan Key Elements

• Measuring Outcomes and Target Dates
• Monitoring/Quality Assurance
• Resource Development (New Sources of Funding)
• Review and Revision

• Consumer Participation
• Needs Assessment
• Transition Planning
• New Community Support Services
• Data Collection

21
Consumer Participation

• Consumers are essential participants.
• Federal policy supports consumer inclusion, even
  though it is not mentioned in the Olmstead
  decision.
• Set a goal e.g., 51 consumers and family
  members.

22
Assessment Procedures

• Does the assessment process allow people to make
  informed choices?
• Is the person doing the assessment impartial,
  qualified, and understanding?
• Are advocates allowed to participate?
• Are assessments tailored to the individual?
• Are assessments based on needs rather than the
  resources that are already available?
• Does everyone receive an assessment?

23
Transition Planning

• Does the plan reflect the persons wishes?
• Are advocates and community providers involved in
  the planning?
• Has appropriate housing been arranged?
• Is case management included?
• Have potential barriers been addressed?
• Has family been involved appropriately?
• Is a time line in place and adhered to?

24
Discussion Community Supports

• What are some community supports that are needed
  for successful community-based treatment?

25
Examples of Community Supports

• Housing
• Income Supports/Entitlements
• Employment
• Peer Supports
• Behavioral and Primary Health Care
• Transportation

26
Section IV

• Advocating for Effective Community Supports

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Housing Strategies

• Increase state appropriations.
• Consolidated Plan
• Create affordable housing.
• Create housing for non-elderly people with
  disabilities.
• Continuum of Care Plan
• PHA Plan
• Section 8
• Public Housing
• Federal level advocacy
• Technical assistance is available!

See Section 3 of Overcoming Barriers
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Income Support/Entitlement Strategies

• Application, eligibility, and appeals process
• Better education of consumers.
• Training case managers, peer advocates, and
  providers.
• Do discharge planning.
• Integrate service systems.
• Improve employment opportunities.
• Technical assistance is available!

See Section 2 of Overcoming Barriers
29
Employment Strategies

• Focus on career jobs.
• Medicaid buy-in option.
• Outreach to businesses.
• Flexible services
• Transitional Employment
• Supported Employment
• Vocational Case Management
• Social Enterprises
• Supported Self-Employment
• Blended Strategies
• Access to Work Incentives.
• Technical Assistance is available!

See Section 4 of Overcoming Barriers
30
Peer Support Strategies

• Advocate for additional funds when institutions
  are downsized.
• Follow successful models.
• Take advantage of available technical assistance.
• Network statewide.
• Do outreach.
• Provide services that the system cant (or
  wont).
• Technical assistance is available!

www.mentalhealth.org www.mhselfhelp.org www.power2
u.org www.contac.org
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Behavioral Health Strategies

• Make advocates available.
• Medicaid
• Case Management
• Psychosocial Rehabilitation
• Medically Needy Spend-Down
• Needed Medications
• Redirect institutional spending.
• Increase state appropriations.
• Alternative crisis services
• Integrated services (MH/SA)
• Community health care
• Technical assistance is available!

See Section 5 of Overcoming Barriers
32
Transportation Strategies

• Support public transit.
• Local funding.
• Grant funding.
• Innovative solutions.
• Coordinate resources.
• Support telemedicine.
• Reduced fare programs.
• Train transit workers.
• Technical assistance is available!

33
Beyond the Planning Process

• Other advocacy ideas
• Letter/telephone campaigns
• Lobby days
• Public education
• Demonstrations
• Citizens can have a major impact on government.
• Technical assistance is available!

34
Critiquing a State Plan

• Does the plan address the key elements?
• Consumer Participation
• Needs Assessment
• New Community Supports
• Transition Planning
• Data Collection
• Outcomes/Target Dates
• Monitoring/Quality Assurance
• New Sources of Funding
• Review and Revision

35
Section V

• Getting Involved in Community Integration/Olmstead
  Planning

36
Consumer Participation

• President Bushs Executive Order calls for states
  to involve consumers.
• It is up to you to make this participation
  effective.
• The state mental health planning council should
  be involved.

37
Discussion Ideals for Consumer Participation

• What are some ideals for consumer involvement in
  state community integration/Olmstead planning
  groups?

38
Examples of Ideals

• Consumers are treated equally.
• Consumers form a majority.
• Cultural diversity is respected.
• Consumers are paid for service.
• Message of recovery spread.
• Balanced consumer and family representation.
• Accommodate disabilities and language barriers.
• Acronyms and jargon do not prevent participation.

39
Discussion Methods for Consumer Participation

• What are some methods for more effective consumer
  involvement in state community integration/Olmstea
  d planning groups?

40
Examples of Methods

• Dont be a one-trick pony.
• Remain connected to other consumers.
• Ask for clarification of jargon and acronyms.
• Insist on training.
• Get along on a personal level.

• Be a good listener.
• Educate others.
• Bring others with you.
• Insist that group exercises its authority.
• Beware co-optation.

41
Negotiation Skills

• Negotiate based on interests rather than
  positions.
• Aim for having your interests satisfied rather
  than having your specific demands met.
• Ask what the other parties interests are and
  figure out how you can meet them.
• Sticking to a position can stall negotiations.
• Try to maintain relationships.

42
One-on-one Negotiation

• Issue is involuntary outpatient commitment (IOC).
• Divide into groups of three.
• One person will represent group opposing IOC.
• One person will play a board chairperson who
  supports IOC.
• One person will observe.
• Follow directions on card.

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Section VI

• Organizing Consumers to Work on Community
  Integration/Olmstead Planning

44
Forming a Core Group

• In many groups, a small number of people do much
  of the work.
• Friends and peers are the best source.
• Other initial recruitment tactics include
  newspaper ads, flyers at programs, and public
  speaking.

See Consumer-Run Businesses and Services.
45
Planning a Consumer Group

• How big should the group be?
• What are the goals of the group?
• Self-help/mutual support?
• Self, peer, or systems advocacy?
• Social activities?
• Who is the audience?
• Consumers only, or others?
• Any specific demographics?
• Should the group affiliate?

See Consumer-Run Businesses and Services.
46
Getting the Group Going

• Possible meeting places
• Municipal buildings.
• Churches or schools.
• Rec. centers.
• Key characteristics
• Accessible to people with disabilities.
• Close to public transportation.
• Easy to find and park.
• Available at a set time on a regular basis.
• Consider advisors, but maintain consumer control.
• Technical assistance is available!

See Consumer-Run Businesses and Services.
47
Discussion Outreach

• What are some methods for doing outreach?
• Where are some places to reach out to other
  consumers?
• What are some key points to make about community
  integration planning?

48
Key Points for Outreach

• Community integration mandate.
• Right to treatment in the most integrated
  setting possible.
• States must plan services.
• Consumers have the right to be involved in
  planning.
• Tremendous opportunity to make change
• Expand community-based services.
• Promote a recovery vision.
• Protect individual rights.

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Section VII

• Coalition Building

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The Importance of Coalitions

• Individuals and even groups often do not have
  enough power to make change.
• Broad-based coalitions have this power.
• More money and human resources.
• Often come up with less controversial solutions
  that meet several needs.
• Show evidence of greater agreement.
• Especially important in Olmstead process.
• Federal government mandates coalition-building.
• Cross-disability groups have similar interests.
• States more likely to listen to broad-based
  stakeholder coalition.

51
Discussion Coalition-Building

• What are some of the barriers to a successful
  Olmstead coalition?
• How can we work to overcome those barriers?

52
Examples of Barriers

• Turf wars/bad blood
• Lack of concrete action
• Lack of consumer representation
• Isolation from community
• Lack of organization
• Lack of leadership
• Competing interests

53
Successful Coalitions

• Facilitation
• Cultural Competence
• Focus
• Consensus
• Conflict Resolution

• Grassroots Base
• Brainstorming
• Inclusiveness
• Member Outreach
• Staffing

54
Group Negotiation

• Issue is closing institutions and what to do with
  the funds.
• Divide into groups of four
• Consumer Network.
• Family Group.
• Psych Rehab Workers.
• Medical Association.
• Follow instructions on card.

55
Wrapping Up

• Set concrete goals for getting involved in
  community integration/Olmstead planning.
• Remember that people are counting on you.
• Technical assistance is available.
• Please complete evaluation form.