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Executive Director Corner: January 2017

It’s been a busy month for VCPI as we continue to discover the many ways we can have a positive impact on the Vermont system of care.  Our membership is increasing and, with bigger numbers, the benefits also grow. Our collaborative participation allows us to add to our initiatives and the opportunities for members to participate in professional development opportunities at no cost.  If you and/or your organization are not VCPI members yet, visit the Membership area of the VCPI website where you can learn more about the membership process and access a listing of current members.  Any of us are happy to talk with you further and you are welcome to call the VCPI office, as well.

To be specific regarding initiatives, we are very excited to announce that the Core Orientation for Direct Service Providers project is officially back underway. Some of you may be aware that this project hit a bump in the early developmental stages, but it has continued to be considered an essential offering for our members as it fills a very important need.   You can read more about the overall project on our website.  At present, a small work-group has established a work plan that allows us to feel confident we will be able to share the content of Module 1 by April 1, 2017.  It seems very appropriate to start with the module that focuses on the values, principles and beliefs that we share as the Vermont System of Care.  The module is being designed to give new staff the opportunity to hear about the importance of these directly from those who have participated in supports and services.  In addition to an on-line module, there will be supporting materials to assist in integrating the information into practice.  We will provide regular updates on our progress, but for those who would like to play a more active role in development, we are currently looking for advisory committee members who are willing to review our progress along the way.  If you’d like to talk more about this, please contact Rita Johnson at r.johnson11@snhu.edu.

Additionally, we are kicking off the second iteration of the successful Co-Occurring Competency E-Learning Community Project, piloted last year.  The information about that first round is available to you on the website and we will soon be updating with new logistical details.  However, we are intending to use much of the same format.  Absolute commitment to the number of sessions, scheduling, etc. will not be made without input of the potential participants.  We are currently asking those who may be interested in participating in this round to submit the form that can be found here.  Also, know that you can call the VCPI office for more information.  Click here to download the form.

Please feel welcome to keep in touch and share your thoughts and ideas about VCPI and the places we are headed.  Maybe you’d like to submit a commentary for the newsletter, or join a work group or just chat about some things.  Call or e-mail anytime:  (802) 503-2857  k.crowley@snhu.edu. Also, we welcome you to join us for our upcoming Steering Committee Meeting, January 24th from 10-1 at the Best Western Windjammer in South Burlington. Visit the VCPI Calendar for details and email us to be added to the invite list!

VCPI Welcomes a new Executive Director!

Meet the New Executive Director

VCPI is thrilled to welcome Karen Crowley, who started in her new role as Executive Director of the Vermont Cooperative for Practice Improvement & Innovation (VCPI) on October 17, 2016. In addition to offering her a warm welcome, VCPI thought it would be an excellent opportunity to interview Karen and learn more about who she is, her background, and what she brings to the Cooperative.  What follows is our interview.

A woman dressed in a bright teal-colored sweater stands and greets me with a warm handshake. Karen is both professional and confident in her demeanor, yet maintains a level of warmth and engagement that immediately puts one at ease. She is excited to discuss VCPI and spoke with me about how she envisions the cooperative living up to its name by working cooperatively toward achieving the goals its members collaboratively establish. She believes, “VCPI will continue to grow and is committed to helping lead the way towards increased membership and financial strength.”

Leading is nothing new to Karen. She has extensive experience working with diverse groups of stakeholders to put ideas into practice. For example, as an early member of the implementation team of the Integrating Family Services initiative, Karen worked with multiple internal and external stakeholders to design an integrated service system for children and families. This complex initiative hit many obstacles and the committee members would frequently wonder aloud if the goal was realistic and consider that, perhaps, the work might just be too hard.  Karen would ask how, as professionals, the team could say our system is too complex to work within, and yet ask Vermont’s children and families to do just that in order to access the services they need.  “It’s easy to see how simply reminding them of their shared vision of improving the lives of families and children was enough to get the group to charge ahead toward success,” she reports. Karen is clearly proud of the work done as part of this team and the progress the initiative has achieved.

Other organizations and initiatives led by Karen include the implementation of Act One, a legislative effort to mandate system-wide focus on the prevention of childhood sexual abuse, which resulted in materials used in schools and child care centers throughout Vermont; and the NIATx initiative at the Vermont Department of Health, Division of Alcohol and Drug Abuse Programs (ADAP), which achieved success by decreasing waiting lists and increasing access to services. She then expanded on this work and adapted the model to become AIM - the Agency of Human Service’s signature process improvement methodology. Her work as Director of the System of Care at the Family Services division included a leadership role in the transformation of the Woodside program to become a true treatment facility.

These are just some of the examples of the challenging work she has taken on during her career. As Karen talks about her experiences in these efforts, it is clear she has used her positive outlook and steadfastness to approach challenges, and there have, of course, been many throughout her years in human services work. Her obvious and passionate belief in the skills and abilities of both the individuals and families we serve and those of professional team members, coupled with her ability to remain curious about alternative approaches, has consistently led projects to success.

Karen’s leadership skills have been developed in numerous ways. She is the proud graduate of the Snelling Center for Government’s Leadership Institute. Prior to that she graduated from the Agency of Human Services Leadership Development Program and then conducted that program for others at the Agency.  Karen shares that she values data driven improvement efforts such as continuous quality improvement (CQI) and Results Based Accountability (RBA).  She is committed to being strategic in her approach and building on VCPI’s current success. “Using established mechanisms to remain on track and bring VCPI committees and sub-committees together to expand upon what VCPI offers its growing membership are my top goals,” she says.

She is an executive director who does not see herself directing so much as facilitating an environment that allows true collaboration, inclusive of all aspects of Vermont’s System of Care, and brings the best ideas to the forefront.  When it comes to change, she knows what she is talking about as she is a nationally certified Change Leader via NIATx and is coming to us from her position as Organizational and Human Resources Director at the Agency of Human services. In addition to organizational change, she also knows a few things about personal change from her 10 years as a private practitioner and almost as many years in residential settings, working with people struggling with substance use and related challenges.

Personal experiences also play a big role in what drives Karen to want to make the service system the best possible. She has both fostered and adopted via the Vermont child welfare system and has worked to ensure the needs of her children and family are met with the best possible services. She seeks out supports that share her values of integration and the belief that everyone can grow and change. Additionally, she has represented the stakeholder role of family member in various situations. She is a grandmother to a six-year old girl and a four-year old boy who she reports, “are wonderful reminders that play and fun are essential.” Play is also a large factor in her bee-keeping and honey-making business as well, now in its fourth year and expanding.

Running a business is not new for Karen. Besides her private practice, she helps her husband, a Coastguard Certified Captain, manage a sailing business that offers charters and lessons. Her business experience will be extremely useful in managing the financial side of VCPI as well as knowing how to market effectively and maintain relationships with various stakeholders in the public and non-profit worlds.

While Karen appears to easily talk to anyone about anything, she certainly understands the finite nature of time and prefers meaningful conversations with people versus small talk. When she needs to replenish her energy and spirit, she can be found spending time alone or among her bees. She is eager to get started in this important role and looks forward to meeting all the current members and reaching out to many new members. Please feel free to contact Karen at k.crowley@snhu.edu with questions or ideas at any time.

  • As reported by VCPI Steering Committee Member, Laura Flint, with the Vermont Department of Mental Health.

 

Read "Meet the New Executive Director" article

VCPI Presented on Co-op Model at National Council Conference

The Co-Op was invited to present at the National Council Conference in March 2016. The NATCON conference represents the largest gathering of mental health and addiction staff treatment providers in our industry. Our session,  Innovative Collaboration: Creating a Statewide Practice Improvement Cooperative highlighted the Co-op's development, the innovative work that is happening in Vermont, and the commitment and critical role of our statewide partners.

A big thank you to Ralph Provenza, Bob Thorn, and Vic Martini, members of our Leadership Team who were there in support of VCPI, as well as to Nick Nichols and Ken Minkoff who were co-presenters.

 

Click here to download the Presentation

Open Dialogue – Summer Gathering

Open Dialogue – Summer Gathering

Open Dialogue is gaining momentum in the Northeast. The evidence of this was acutely visible at the first ever Open Dialogue Gathering in the United States on July 24th and 25th at the picturesque Basin Harbor Club on the banks of Lake Champlain. Attending were 45 people who immersed themselves in collective introspection, reflection and dialogue from early morning into the late hours of the evening. While several people in attendance were experienced in gatherings in Europe, this was my initial exposure and I have come away with new enthusiasm, inspiration, hope and dedication to both improved and innovative individual practice and systems change in Vermont. I palpably feel that I am a part of something bigger than myself.

In reflecting on the gathering, three themes emerge for me: dialogism, regional adaptation and innovation, and systems issues. I’ll come back to those themes later in this piece.

The gathering was very different from most regional meetings in the manner in which it was organized. There was no topic or title. There was no agenda. There was no keynote speaker. There was no list of workshops. The very nature of this gathering modeled the principle of “tolerance of uncertainty”. Much like the way that an open dialogue meeting proceeds, the gathering started off with a question to all – how would we like to use this time together? While many cringe at the idea of spending valuable time at a meeting with no structure, I found the format excellent for our purposes. More than that – I found it rewarding. It set the tone for egalitarianism, polyphony of voices and viewpoints, capacity to diverge creatively and intuitively as the time unfolded and most importantly it respected the wisdom of the collective. I have always believed in the N + 1 rule in group dynamics – that is, there are always N + 1 individuals in any group – the +1 being the group itself. In parallel process, as open dialogue helps to identify and strengthen small networks, the Gathering helped to identify and strengthen a regional network.

The concept of polyphony is essential for great work to happen. And polyphony was present in abundance. Psychiatrists – at one point I counted 10 psychiatrists in attendance. Administrators – in numbers north of 6. People with Lived Experience/Advocates – more than 8. Clinicians – more than 8. Case Managers – several. Emergency Service workers – I’m not sure how many. We also included private practitioners. Regions of the Northeast – Metropolitan New York and the burrows, Outskirts of Boston, Cosmopolitan Burlington, Classic Middlebury, Historic Bennington – such a wide mixture of culturally diverse settings. This polyphony helped to create a voice larger than the confines of the space we all shared.

The initial shape of our space was not ideally conductive to the sort of event we had hoped to create. Several large round banquet tables seemed to arrange us in islands separate from one another. Quickly we pushed aside the tables and arranged some 45 chairs into a large circle. The room was just right – 5 or 6 more would not have been comfortable, 5 or 6 fewer would not have been enough. Not too hot, not too cold, just right. With assistance from the warm, exceptionally skilled and thoughtful staff of CSAC, a number of flip charts were set on easels upon which were written numerous suggestions for topics, themes, options for arranging large groups and small groups, break times, etc. The process, while somewhat laborious was great for encouraging dialogue. The day began to unfold in a natural cascade of interaction. The group arrived at a consensus of priorities and methods of beginning.

Several times during the Gathering, a small group of individuals agreed to be interviewed about a particular topic. They arranged themselves in a small inner circle within the larger circle of participants. Volunteers agreed to interview the small group about the particular topic of the moment. When the interview seemed to have progressed to a natural break in the conversation, the larger group was invited to comment or “reflect” on what they had observed. This second layer of dialogue seemed always to capture the essence of what had been discussed and to also superimpose alternate and multiple meanings and definitions of the subject matter. This method turned into a self-creating model of dialogic practice. At other times during the Gathering topics seemed to demand that we split into smaller groups. In one such group a private practitioner described a case example in which she had stretched her methodological tool box to be more interactive with her client. She described how she was becoming comfortable with presenting her own opinion with her client whereby in the past she would have left her view out of the conversation. Instead she would have worked to expand her client’s ability to brainstorm more possibilities. It struck me that I had not considered this as dialogical at first – I viewed it more as a throwback to the medical model wherein the professional was the expert and the client was engaging with the professional for access to their expertise. Now I had to re-think this. Was this dialogical – or was it a rationale for monological discourse? Such is the nature of dialogical meetings.

By the end of the second day it was clear that we had accomplished a miraculous transformation in our group. We had traversed several rivers of thought.

Dialogism

Open dialogue can be thought of as a method of interacting with others and it can also be considered a practice model with measures of fidelity, ratings of fidelity, administrative measures and outcomes, etc. In our Gathering we digested the many distinctions around dialogism. We considered the concept of “needs adapted treatment” within the open dialogue framework. We thought about the open framework of communication and reflection that are part and parcel of dialogism. We discussed interactionism within the frame of dialogue. These themes within the gathering were important. We were beginning to deconstruct dialogism as it is evolving in the United States. Of particular importance were several unique developments. Peer advocates/people with lived experience are necessary and important to dialogism as it evolves here in the U.S. Professionals, fully trained by the Institute for Dialogic Practice and/or future recognized institutions are extremely valuable yet impractical in the real-world environment in which community mental health practitioners work. Other workers are likely to emerge and receive training and skills in other ways. Dialogism may be diffused into the system of care in many new and unique ways.

This compelling theme was energizing and hopeful. We seemed to be opening the way for the development of a uniquely American adaptation of dialogism. While the hurdles to arriving at a viable and sustainable American model are many and daunting, the future appears to be bright and hopeful.

Regional Adaptation and Innovation

The Open Dialogue model as it was developed in Finland is an exciting and inspiring comprehensive network-based system of care. In that model professionals are fully trained and tested for competence, teams are inclusive of both inpatient and outpatient professionals as well as consistent members of each individual’s personal network, and continuity is assured both within the immediate episode of care and at future times of care. Sustainability seems to be partially attributable to a reliable and accessible public network of healthcare. Here in the northeastern region of the U. S. the public system is not supportive of the European-style of healthcare service delivery. Such a difference in systems necessitates the development of adaptation and innovation. Throughout the Gathering conversations emerged about new innovative developments. One consistent innovation involves inclusion of peer service providers. Advocates employs a core cadre of peer providers. Parachutes incorporates peer services into their program. Sandy Steingard, Medical Director of the Howard Center has used Act 79 funding to provide the STAR program that was designed around peer services and dialogism. People with Lived Experience who are providing these peer services are ideally suited to interact in a dialogic manner. The fact that they do share common experience with people who are in need of support uniquely qualifies them to dialogue in a genuine way.

Inclusion of non-therapists into dialogic practice has become standard. New staff are being introduced to dialogism as soon as possible. The idea that at least two professionals should be included in every open dialogue meeting has changed meaning among members of the Gathering. Dialogic skills are essential and those who are skilled can be instrumental in facilitating dialogic practice in our system of care.

Another innovation involves the use of dialogism in treatment team meetings, inter-agency meetings, staff meetings, clinical group supervision, etc. The “eureka” light flashed on several faces as the interactive nature of the gathering unfolded. The concept of reflecting teams seem to be evolving into new ways of incorporating feedback loops into the way we work with one another.

Reflections on innovation itself were constantly being heard in the meetings. Innovations may steer us in a unique direction in the future and we clearly embrace innovative ways of improving the way we work together.

Systems Issues

As thoughts evolved around the best possible practices in providing effective services, criticisms of the current delivery system abounded. While some members of the Gathering were able to sustain much of their efforts through special funding pools, others were discouraged by the fee-for-service restrictions that interfere with the practice pattern. One case example that was shared illustrated this conundrum. A meeting included a psychiatrist, a mental health crisis worker, a social worker, a case manager, a person and a spouse, a co-worker, a community service worker and a visiting nurse. The meeting lasted an hour and a half. At the conclusion of the meeting it was decided to re-convene the group in two weeks. The meeting was re-convened and the crisis worker as well as the psychiatrist were not able to fit the meeting into their busy schedules, but the others were all there. At the conclusion of the second meeting it was determined that things were improving but another meeting was scheduled in three weeks. At that third meeting the person’s co-worker was not able to attend, and neither was the community service worker, but everyone else from the second meeting showed up. All of the professionals participating in the three meetings are expected to bill for their time however only one person at each meeting would be allowed to bill. It turns out that the first person submitting a bill would preclude others from doing so. In total three and three quarters of an hour were billed out of an expected 19 ½ hours. Additionally, the psychiatrist, whose time is valued the highest, was not the first person to submit a bill and therefore her time was not billable and instead, the case manager’s time (the lowest valued time) was billed. Simply stated this is not a sustainable model and it does not support continuity of care. Additionally there is a lack of consistent funding for peer advocacy services.

Dr. Pablo Sadler, medical director of the bureau of mental health in NYC was quick to identify these systems funding issues. He is working with SAMHSA to identify ways in which Medicaid may be used to support funding for these comprehensive and costly services.

Future Gatherings

Near the end of the gathering, Pablo expressed what seemed to be a group sentiment. Perhaps the collective unconscious really does express itself when called upon. This, he said, is an historic event! Those in attendance overwhelmingly felt reified, refreshed, revered, reinvigorated and rewarded. Every voice was heard. Every utterance was responded to. Thoughts emerged about the second annual gathering. Stay tuned. There is much more to come.

Blog post submitted by Vic Martini: Director of Community Rehabilitation and Emergency Services, United Counseling Service/ VCPI Key Player & Founding Member

 

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