Putting Theory into Practice

In 1997, I had the opportunity to put these theories into practice. I became the Executive Director of a new Community Behavioral Health Center. The Center resulted from privatization of a loose array of county-run programs and services into a single, integrated nonprofit agency. The success of this agency would require a transformation of organizational culture and staff competencies to truly deliver recovery-oriented services.

Recovery-oriented services for people with behavioral health issues are based on the principles of recovery and wellness, as well as on the belief that all individuals can recover and can set and reach their desired life goals. Recovery-oriented services offer opportunities for active participation in treatment and service planning, self-direction, and shared decision-making. Individuals working on behavioral health issues are involved in all aspects of their own service planning, as well as in all aspects of progam planning and development. Services are delivered in a positive atmosphere of respect, hope, growth, and support and are culturally competent, trauma-informed, and person-centered. Services are designed to be readily accessible, with easy entry and exit. Recovery-oriented services are not seen as an endpoint, but rather as a means by which a person can attain valued life roles while remaining a full participating member of his or her community.

By the time I became Executive Director, I had developed my vision and values for a recovery-oriented service system, and I could envision some outcomes to strive for if those values were put into action. Now I was faced with the task of getting from vision and values to actually changing the culture and practice of this newly formed agency. I have always believed that an organization is a living and breathing organism, operating most effectively when its needs are satisfied, as described by Morgan. 8 Relying on this theory, I assumed that to assess this organization’s readiness to change, we could implement techniques similar to those we use to assess an individual’s readiness to change.

In the 1990s, I first learned about psychiatric rehabilitation theory 2,3 during the period when New York state was promoting this philosophy and practice to facilitate a change in its service delivery system. The New York State Office of Mental Health was trying to retrain staff in an effort to shift from a medical model to a recovery-based model. Part of the practice of psychiatric rehabilitation is to assess an individual’s readiness to change, intervene to increase that readiness if needed, and increase the skills and supports that the individual needs to function successfully in the community. 3

With my values and vision for recovery clear and this massive culture and practice change before me, I began to use these psychiatric rehabilitation techniques to assess my agency’s readiness to change. Change is motivated by some level of dissatisfaction with things as they are. Without that dissatisfaction, we are not motivated to create a new vision to strive toward. The old is comfortable and known, and the new can be scary and unsettling. However, if we are unhappy with the current situation, we begin to search for where we want to be and plot a path to get there.

Sometimes, the dissatisfaction is external, as is the situation with our current health care system. Some among us may be content with the way things have been for many years, but the Affordable Care Act emphasizes the inadequacies of our system, and there is a demand to provide services in a more efficient and cost-effective way. In New York State, the move to fully capitated managed care payments in 2015 means that we can no longer depend on business as usual but must create new ways to provide services that will meet the new demands for efficiency and effectiveness that the Affordable Care Act demands.

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