ARIZONA PEER & FAMILY COALITION
5025 E. Washington St., Ste. 112, Phoenix, AZ 85034
February 14, 2010
Ms. Ann Ronan Mr. Greg Honig
Arizona Center for Law in the Public Interest AZ Attorney General’s Office
202 McDowell Road, Suite 153 CIV /EHS
Phoenix, AZ 85004 1275 W. Washington Street
Phoenix, AZ 85007
Mr. Charles Arnold
Frazier, Ryan, Goldberg, Arnold & Glitter, L.L.P.
3101 N Central Avenue, Suite 1600
Phoenix, AZ 85004
Re: Arizona Peer and Family Coalition Position
We are pleased to present our position for resolution of Arnold vs. Sarn. As you know, the case has been active for many years and we believe it is time to settle our differences and implement needed changes. The settlement should focus on Recovery and a Principle-Guided System of Care, which preserves the rights of individuals and families receiving behavioral health care for people with serious mental issues. This position paper was prepared by the Arnold Vs. Sarn subcommittee and approved by the Arizona Peer and Family coalition Board of Directors and General Membership. The Arizona Peer and Family Coalition is a statewide alliance of Individuals united to improve Arizona’s healthcare outcomes, the majority of whom are class members of family members of the identified class.
Jim Dunn. President W. Philip Sawyer, Chairman
Peer and Family Coalition Arnold vs. Sarn Subcommittee
(602) 885-4146 (480) 838-3716
Members of the Subcommittee
Š Jim Dunn, Advocate, Individual and Family Member
Š Jill Hogan, Advocate, Individual
Š Vicki Johnson, Advocate, Family Member
Š Tom Kelly, Advocate, Individual
Š Phil Sawyer, Advocate, Individual and principle author
Members of the Coalition Board
Š Jim Dunn, President
Š James Russo, Vice President
Š Dan Haley, Secretary
Š Michael Donnelly, Treasurer
Š Cynthia Henry
Š Roberta Howard
Š Vicki Johnson
Š Jane Kallal
Š Suzanne Legander
Š Carol McDermott
Š Ann Rider
Š Mary Robson
Š Bob Tencer
Š Valorie Klein
Š Bill Schwartz
The Arizona Peer and Family Coalition was founded by a group of individuals who receive services (consumers), families and community leaders to better coordinate their relationships and act as a united voice for individual consumers and families across the state of Arizona. While the interests of the various members may vary, one of today’s top priorities is to deliver to the Court our opinion of what is required to resolve Arnold vs. Sarn. The Coalition has a variety of members, but we consider ourselves firstly individuals with a direct interest in the delivery of behavioral health services in Arizona. Individuals introduce themselves as a peer, family member or guest. The organizational rules do not permit individuals to disclose their agency affiliations, if any.
Arnold vs. Sarn status
We are extremely thankful for the many benefits members enjoyed largely due to the enforcement of this milestone lawsuit; and now join many in the community who agree today’s healthcare environment mandates collaboration, innovation, and transformation. We believe a Recovery and Principle-oriented System of Care is needed, verses one that emphasizes paperwork over people. Enforcement of this case has become a barrier rather than a resource to encourage recovery.
Nine Guiding Principles
A great deal of work has already been done in identifying Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and systems. We would like to see the system move away from its focus on paper and process and transform into an “individual informed/outcome-focused“ system of care that demonstrate increased life expectancy and greater quality, meaning, and purpose in life. These nine Guiding Principles should provide the framework for resolution of this case:
Respect is the cornerstone. Meet the person where they are at with great patience, compassion and withhold judgment.
2. Persons in recovery make informed choices regarding service utilization and are included in program decisions and program development efforts
A person in recovery has choice and a voice. Their self-determination in driving services, program decisions and program development is made possible, in part, by the ongoing dynamics of education, discussion, and evaluation; thus creating the “informed consumer” and the broadest possible palette from which choice is made. Persons in recovery should be involved at every level of the system, from administration to service delivery.
3. Focus on individual as a whole person, while including and/or developing natural supports
A person in recovery is held as nothing less than a whole being: capable, competent, and respected for their opinions and choices. As such, focus is given to empowering the greatest possible autonomy and the most natural and well-rounded lifestyle. This includes access to and involvement in the natural supports and social systems customary to an individual’s social community.
4. Empower individuals taking steps towards independence and allowing risk taking without fear of failure
A person in recovery finds independence through exploration, experimentation, evaluation, contemplation and action. An atmosphere is maintained whereby steps toward independence are encouraged and reinforced in a setting where both security and risk are valued as ingredients promoting growth.
5. Integration, collaboration and participation with the community of one’s choice
A person in recovery is a valued, contributing member of society and, as such, is deserving of and beneficial to the community. Such integration and participation underscores one’s role as a vital part of the community, the community dynamic being inextricable from the human experience. Community service and volunteerism is valued.
6. Partnership between individuals, staff and family members/natural supports for shared decision making with a foundation of trust.
A person in recovery, as with any member of a society, finds strength and support through partnerships. Compassion-based alliances with a focus on recovery optimization bolster self-confidence, expand understanding in all participants, and lead to the creation of optimum protocols and outcomes.
7. Persons in recovery define their own success.
A person in recovery -- by their own declaration -- discovers success, in part, by quality of life outcomes, which may include an improved sense of well being, advanced integration into the community, and greater self determination. Persons in recovery are the experts on themselves, defining their own goals and desired outcomes.
8. Strengths-based, flexible responsive services reflective of an individual’s cultural preferences
A person in recovery can expect and deserves flexible, timely, and responsive services that are accessible, available, reliable, accountable, and sensitive to cultural values and mores. A person in recovery is the source of his/her own strength and resiliency. Those who serve as supports and facilitators identify, explore, and implement tools. These tools enable individual to achieve greater autonomy and effectiveness in life.
9. Hope is the foundation for the journey towards recovery
A person in recovery has the capacity for hope and thrives best in associations that foster hope. Through hope, a future of possibility enriches the life experience and creates the environment for uncommon and unexpected positive outcomes to be made real. A person in recovery is held as boundless in potential and possibility.
Raise Your Voice Focus Groups
The System Transformation Committee was formed to plan, organize, lead and monitor changes in the publicly funded Behavioral Health System. 26 focus groups were held in November and December 2010 attracting 370 peers and family members. Key findings included:
Š Recovery is different for each individual
o Recovery is a process to fulfill personal goals
o Recovery helps individuals become independent
o Recovery is self-determined
o Level of support
o Recovery is a nonlinear process which entails achieving concrete outcome or goals which are easier to obtain when choice, support and respect are given to peers
Š SMI individuals have unique needs
o Respect is a right
o Choice is critical to choose what is best for each person
o Support is needed from friends and family, peers and service providers
o Guidance, encouragement, being heard, motivation, hope and acceptance are critical
Š Peers and Family members are concerned about System issues
o Individualized care is critical
o Supportive services include peer support, community based resources, living arrangements, transportation and crisis services
o Integrated Health Services require treatment services and care management
Š Participation is critical in recovery through informed choice including:
o Level of need
o Level of functioning
o Self determination
o Level of support
Treat each individual like we expect him or her to recover from the onset and allow their informed choice regarding current level of care and support requirements.
The system should be structured to allow some individuals to become their own care coordinator.
There is considerable concern about people stratified by the July 2010 decision to limit full services to those qualifying for Title XIX services. Resolution of this case should meet needs of all persons with Severe Mental Illness.
o Many services for Title XIX persons are currently unavailable to non-Title XIX persons at any price including:
§ Case Management
§ Integration of services including:
Š Case Management
Š Crisis services coordination
Š Individual Service Planning
§ Supportive housing and in-home services
§ Psychosocial rehabilitation services
§ Social services to prevent isolation
§ Access to care
§ Emergency care with same provider
o People with Serious Mental Illness require SMI services regardless of income. The conclusion of this suit must include a method for delivering full SMI services to everyone diagnosed with a Serious Mental Illness. Solutions may include:
§ Approval of the governor’s budget proposal to restore additional services to non-Title XIX individuals by the legislature
§ Encourage “Medicaid buy-in” such as the current Freedom to Work program
§ DHS should provide sufficient funding for all SMI individuals
§ As a last resort, include sliding-scale fees for non-Title XIX persons.
Š Upon intake, a newly diagnosed SMI individual needs immediate access to a peer-run organization. The individual should receive a comprehensive orientation. This will provide an immediate example of the recovery journey for the individual to receive this orientation from a peer. Doctors frequently diagnose people with Serious Mental Illness status without follow-up so the individual understands their situation. Support groups may also be very useful in delivering these important services.
Š While we are very interested in the following elements, we are not currently providing recommendations for the following:
o Services outside Maricopa County
o Child and adolescent services
o Services for non-SMI persons
o Court ordered treatment
Measurement and Compliance
We recognize that measurement of compliance with these issues require a different approach. Tracking and monitoring to assure current assessments and ISPs along with other required demographic and service delivery is valued and expected. The system must value, measure and reward effective relationships at least as much as the paper and process.
An ongoing process for measuring member satisfaction should be required to determine:
• How do peers and family members feel about respect received from the staff?
• Does this person feel they are moving towards recovery?
• Are necessary resources being provided?
• Has the quality of life for the person improved?
Individuals and family members (independent of the provider) must be in the process. For example, individuals and family members could conduct interviews, take action and prepare reports on the results.
It is also important that the resolution of this case is flexible enough to adjust to changes as the environment (political, recovery, and social) changes and even greater opportunities for innovation and transformation are nurtured and encouraged.
Resolution of this lawsuit must be based on individual success and recovery goals.
 These Guiding Principles were inspired by: the SAMHSA Consensus Statement; the U.S. Psychiatric Rehabilitation Association Core principles; the ADHS/DBHS Vision Statement; Arizona’s Five Principle for Person-Centered Treatment Planning; Arizona’s Twelve Principles for Children’s Behavioral Health Care and others, including Peers.
 Adapted from Raise Your Voice Focus Group report by ADHS/DBHS, July 2011