I have been privileged to observe and participate in the Behavioral Health Systems Transformation Project from the perspective of a front-line service provider and Change Agent since 2005, when I began my employment at Kern County Mental Health. In this period, the department and contract providers adopted the principles of the Comprehensive Co-occurring Integrated System of Care (CCISC) framework. These partner agencies have committed significant effort to changing and improving the way programs operate to better serve complex individuals and families, even in the face of funding and staffing shortages.
Providers routinely encounter complex client presentations requiring interdisciplinary coordination. Fiscal realities, i.e. declining budgets, and emerging clinical evidence indicates that best practices for delivering comprehensive mental health and substance abuse treatment services and realizing improved outcomes occurs when helpers assume a recovery orientation with emphasis on efficacy promotion, peer, family, and community support involvement and less system reliance. It seems that for some these goals are attainable sooner, and for others these goals are further away and will be reached in smaller measures and increments. As helpers, our role is to advocate for access and services, extend support, offer encouragement, and reduce barriers to service access and utilization. We promote internal motivation and accountability for improvement in our clients; we also intervene and support them during periods of crisis when more support is required.
Systems transformation is being achieved at every level. We are becoming in my view a more recovery oriented, co-occurring, and culturally competent system of care. Change Agents strive to influence these three systemic priorities by advocating for integrated services and policies like the Co-occurring Pharmacology Guidelines, KCMH policy (5.2.10); integrated housing resources; staff development and trainings in Solution Focused Brief Therapy; Stages of Change and Motivational Interviewing; Assessment and Treatment Planning for COD populations; and other relevant trainings.
Change agents work actively and collectively to change staff perceptions, build awareness, and improve team response capability concerning co-occurring individuals and families. They do this by collaboratively identifying barriers with their teams using instruments like the COMPASS and in regular dialogue about how best to serve the population presenting at the clinic door. Change Agents play an active role in continuous quality improvement for complex individuals and families by sharing the information, skills and resources acquired from personal participation in the Change Agent Group with their teams routinely.
Optimally, Change Agents attend monthly meetings and select to participate in one or more sub-committees. These groups develop tangible products promoting COD competence; conduct research and participate in projects like development of COD Welcoming Statement, development of psycho-pharmacology guidelines, prescription drug abuse policies, anti-stigma, and drug test pilot projects, co-occurring pamphlets (creation and distribution). Change Agents continue to publish the Transformer, a monthly newsletter illustrating helpful treatment methods and techniques, and reviewing best practice information. The newsletter features contributing articles from a range of interdisciplinary authors including our physicians and highlights current drug trends in the section titled “Got Change?” Typically, a “client success story” is profiled in a staff submitted article illustrating the methods and benefits of comprehensive co-occurring care. Many teams use the Transformer as a brief training instrument that is reviewed and discussed on a routine basis.
In 2011, Change Agents are enthusiastically piloting a drug testing procedure at the central access point for adult mental health services, the Mary K. Shell Building and the Sagebrush Center, which serves as the centralized service environment for the Children’s System of Care. Change Agents remain actively committed and engaged in the sourcing and development of training materials, resources, and information dissemination to the teams and agencies employing us.
Ruben Varela, BS, RS III MHSA-ACT