The Challenge of Change: Creating a Recovery- Oriented System of Care Carlo C. DiClemente Professor...

The Challenge of Change:The Challenge of Change:Creating a Recovery- Creating a Recovery-

Oriented System of CareOriented System of Care

Carlo C. DiClementeCarlo C. DiClementeProfessor of PsychologyProfessor of PsychologyUniversity of Maryland, University of Maryland,

Baltimore CountyBaltimore Countywww.umbc.edu/psych/habitswww.umbc.edu/psych/habits

www.mdquit.orgwww.mdquit.org

Behavior Change is Critical to the Growth Behavior Change is Critical to the Growth and Development Organizations, Societies, and Development Organizations, Societies,

and Individualsand Individuals

OrganizationsOrganizations and and societies must adapt societies must adapt their practices in order their practices in order to survive and thriveto survive and thrive

Even very successful Even very successful organizations must organizations must continue to change to continue to change to survive (GM, IBM, Rolls survive (GM, IBM, Rolls Royce)Royce)

Key questions are Key questions are what, whether, and what, whether, and how to change how to change

IndividualsIndividuals must must constantly change constantly change behaviors in response behaviors in response to shifting demands of to shifting demands of the life contextthe life context

Failure to change is Failure to change is often a sign of often a sign of stagnation, pathology stagnation, pathology and declineand decline

Key questions are Key questions are what, whether and what, whether and how to change how to change

CANCER PREVENTION INITIATION

CHRONIC ILLNESS MANAGEMENT

SAFETY AND INJURY MODIFICATION

PREVENTION

MENTAL HEALTH

SUBSTANCE ABUSE CESSATION

HEALTH PROMOTION & REQUIRE BEHAVIOR

DISEASE PREVENTION CHANGE

NEW DISCOVERIES/PHILOSOPHIES INITIATION

CHRONIC ILLNESS MANAGEMENT

NEW POLICY OR PROCEDURES MODIFICATION

CHANGES IN PROVIDERS

CHANGES IN FUNDING CESSATION

SHIFTS IN MANAGEMENT

COMMUNITY & HEALTH ORGANIZATIONAL

SERVICE DELIVERY REQUIRE & INDIVIDUAL SYSTEMS BEHAVIOR CHANGE

A Broader Process PerspectiveA Broader Process Perspective

The process of intentional behavior The process of intentional behavior change is relevant for understanding change is relevant for understanding – Multiple Health and Protective BehaviorsMultiple Health and Protective Behaviors– Individuals and OrganizationsIndividuals and Organizations– Providers and PatientsProviders and Patients– Leaders and Those They LeadLeaders and Those They Lead– Policy Makers and Program DevelopersPolicy Makers and Program Developers

WHAT DO WE NEED TO WHAT DO WE NEED TO CHANGE?CHANGE?

CHANGE IS DISRUPTIVE

PEOPLE, PROGRAMS AND SOCIETIES DO NOT WANT TO CHANGE EVERYTHING and, AT TIMES, ANYTHING

CHANGE IS MOST OFTEN BEHAVIOR SPECIFIC; FEW SEEK TO CHANGE EVERYTHING AT ONCE

DEFINING EXACTLY WHAT IS TO BE CHANGED IS CRITICAL TO UNDERSTANDING THE CHALLENGE

WHY DON’T PEOPLE OR WHY DON’T PEOPLE OR ORGANIZATIONS CHANGE?ORGANIZATIONS CHANGE?

NOT CONVINCED OF THE PROBLEM OR NOT CONVINCED OF THE PROBLEM OR THE NEED FOR CHANGE – THE NEED FOR CHANGE – UNMOTIVATEDUNMOTIVATED

NOT COMMITTED TO MAKING A CHANGE – NOT COMMITTED TO MAKING A CHANGE – UNWILLINGUNWILLING

DO NOT BELIEVE THAT THEY CAN MAKE A DO NOT BELIEVE THAT THEY CAN MAKE A CHANGE - CHANGE - UNABLEUNABLE

HOW PEOPLE CHANGE

Other Models of How to get People Other Models of How to get People to Changeto Change

How Do People Change?How Do People Change? People change voluntarily only whenPeople change voluntarily only when

– They become They become interested andinterested and concernedconcerned about the need for changeabout the need for change

– They become They become convinced convinced the change is the change is in their best interest or will benefit in their best interest or will benefit them more than cost themthem more than cost them

– They organize a They organize a plan of actionplan of action that that they are they are committed committed to implementingto implementing

– TheyThey take the actionstake the actions necessary to necessary to make the change and sustain the make the change and sustain the changechange

Stage of Change TasksStage of Change Tasks PrecontemplationPrecontemplation

– Not interestedNot interested

ContemplationContemplation– ConsideringConsidering

PreparationPreparation– PreparingPreparing

Action Action – Initial changeInitial change

MaintenanceMaintenance– Sustained Sustained

changechange

Interested and Interested and Concerned Concerned

Risk-Reward Analysis Risk-Reward Analysis & Decision making& Decision making

Commitment & Commitment & Creating an Creating an Effective/Acceptable Effective/Acceptable PlanPlan

Implementation of Implementation of Plan and Revising as Plan and Revising as NeededNeeded

Consolidating Change Consolidating Change into Lifestyleinto Lifestyle

Understanding Barriers to Change and the Tasks of the Stages of Change

UNMOTIVATED UNWILLING UNABLE

Precontemplation Contemplation Preparation Action Maintenance

The Transtheoretical Model of Intentional Behavior Change

STAGES OF CHANGE

PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE

PROCESSES OF CHANGECOGNITIVE/EXPERIENTIAL BEHAVIORAL Consciousness Raising Self-LiberationSelf-Revaluation Counter-conditioningEnvironmental Reevaluation Stimulus ControlEmotional Arousal/Dramatic Relief Reinforcement ManagementSocial Liberation Helping Relationships

CONTEXT OF CHANGE

1. Current Life Situation2. Beliefs and Attitudes3. Interpersonal Relationships4. Social Systems5. Enduring Personal Characteristics

MARKERS OF CHANGEDecisional Balance Self-Efficacy/Temptation

Tasks and goals for each of Tasks and goals for each of the Stages of Changethe Stages of Change

PRECONTEMPLATION - PRECONTEMPLATION - The state in which The state in which there is little or no consideration of there is little or no consideration of change of the current pattern of behavior change of the current pattern of behavior in the foreseeable future.in the foreseeable future.

TASKSTASKS: Increase awareness of need : Increase awareness of need for change and concern about the for change and concern about the current pattern of behavior; envision current pattern of behavior; envision possibility of change possibility of change

GOALGOAL: Serious consideration of : Serious consideration of change for this behaviorchange for this behavior

WHAT INDIVIDUALS OR WHAT INDIVIDUALS OR ORGANIZATIONS HAVE TO ORGANIZATIONS HAVE TO

REALIZE REALIZE MY BEHAVIOR IS MY BEHAVIOR IS

PROBLEMATIC/EXCESSIVEPROBLEMATIC/EXCESSIVE

MY DRUG USE IS CAUSING MY DRUG USE IS CAUSING PROBLEMS IN MY LIFE PROBLEMS IN MY LIFE

I HAVE OR AM AT RISK FOR I HAVE OR AM AT RISK FOR SERIOUS PROBLEMSSERIOUS PROBLEMS

MY BEHAVIOR IS MY BEHAVIOR IS INCONSISTENT WITH SOME INCONSISTENT WITH SOME IMPORTANT VALUESIMPORTANT VALUES

LIFE IS OUT OF CONTROLLIFE IS OUT OF CONTROL

WHAT WE ARE DOING IS WHAT WE ARE DOING IS NOT EFFECTIVE IN NOT EFFECTIVE IN MEETING THE NEEDS OF MEETING THE NEEDS OF OUR CLIENTSOUR CLIENTS

OUR APPROACH IS OUR APPROACH IS COSTING TOO MUCH FOR COSTING TOO MUCH FOR THE OUTCOMES WE ARE THE OUTCOMES WE ARE GETTINGGETTING

THERE ARE SERIOUS THERE ARE SERIOUS PROBLEMS IN OUR PROBLEMS IN OUR PROCEDURES, PROCEDURES, PROGAMMMING, OR PROGAMMMING, OR PRODUCTPRODUCT

Key Issues and Intervention Key Issues and Intervention ConsiderationsConsiderations

Coercion or Courts cannot do it aloneCoercion or Courts cannot do it alone Confrontation breeds ResistanceConfrontation breeds Resistance Motivation not simply Education is Motivation not simply Education is

neededneeded Intrinsic and Extrinsic MotivationsIntrinsic and Extrinsic Motivations Proactive versus Reactive ApproachesProactive versus Reactive Approaches Smaller versus Larger goals and Smaller versus Larger goals and

MotivationMotivation

Tasks and goals for each of the Tasks and goals for each of the Stages of ChangeStages of Change

CONTEMPLATION CONTEMPLATION – The stage where the – The stage where the individual or society examines the current individual or society examines the current pattern of behavior and the potential for pattern of behavior and the potential for change in a risk – reward analysis.change in a risk – reward analysis.

TASKSTASKS: Analysis of the pros and : Analysis of the pros and cons of the current behavior pattern and cons of the current behavior pattern and of the costs and benefits of change. of the costs and benefits of change. Decision-making.Decision-making.

GOALGOAL: A considered evaluation that : A considered evaluation that leads to a decision to change.leads to a decision to change.

Decisional Balance Worksheet

NO CHANGE

PROS (Status Quo)_____________________________________________

CONS (Change)_____________________________________________

CHANGE

CONS (Status Quo)_____________________________________________

PROS (Change)_____________________________________________


Decisional Considerations are Personal Decisional Considerations are Personal Increase the Costs of the Status Quo and Increase the Costs of the Status Quo and

the Benefits of Changethe Benefits of Change Challenge and Work with AmbivalenceChallenge and Work with Ambivalence Envision the ChangeEnvision the Change Engender Culturally Relevant Engender Culturally Relevant

Considerations that are MotivationalConsiderations that are Motivational See how families and larger organizations See how families and larger organizations

can influence change by providing can influence change by providing incentives or putting up barriersincentives or putting up barriers

Multiple problems or issues interfere and Multiple problems or issues interfere and complicatecomplicate

MOTIVATED TO CHANGEMOTIVATED TO CHANGE

Admit that the status quo is Admit that the status quo is problematic and needs changingproblematic and needs changing

The pros for change outweigh the The pros for change outweigh the conscons

Change is in our own best interestChange is in our own best interest The future will be better if we make The future will be better if we make

changes in these behaviorschanges in these behaviors


PREPARATION – PREPARATION – The stage in which the The stage in which the individual or society makes a individual or society makes a commitment to take action to change the commitment to take action to change the behavior pattern and develops a plan and behavior pattern and develops a plan and strategy for change.strategy for change.

TASKSTASKS: Increasing : Increasing commitment and creating a change plan. commitment and creating a change plan.

GOALGOAL: An action plan to be : An action plan to be implemented in the near term.implemented in the near term.


Effective, Acceptable and Accessible Effective, Acceptable and Accessible Plans Plans

Setting Timelines for ImplementationSetting Timelines for Implementation Building Commitment and Building Commitment and

ConfidenceConfidence Creating IncentivesCreating Incentives Developing and Refining Skills Developing and Refining Skills

Needed to Implement the PlansNeeded to Implement the Plans Treatment Plan and Change PlanTreatment Plan and Change Plan

WILLING TO MAKE CHANGEWILLING TO MAKE CHANGE

COMMITMENT TO TAKE ACTIONCOMMITMENT TO TAKE ACTION SPECIFIC ACCEPTABLE ACTION PLAN SPECIFIC ACCEPTABLE ACTION PLAN TIMELINE FOR IMPLEMENTING PLANTIMELINE FOR IMPLEMENTING PLAN ANTICIPATION OF BARRIERSANTICIPATION OF BARRIERS


ACTIONACTION – – The stage in which the individual The stage in which the individual or society implements the plan and takes or society implements the plan and takes steps to change the current behavior steps to change the current behavior pattern and to begin creating a new pattern and to begin creating a new behavior pattern.behavior pattern.

TASKSTASKS: Implementing strategies for : Implementing strategies for change; revising plan as needed; sustaining change; revising plan as needed; sustaining commitment in face of difficultiescommitment in face of difficulties

GOALGOAL: Successful action to change current : Successful action to change current pattern. New pattern established for a pattern. New pattern established for a significant period of time (3 to 6 months).significant period of time (3 to 6 months).


Flexible and Responsive Problem Flexible and Responsive Problem Solving Solving

Support for ChangeSupport for Change Reward ProgressReward Progress Create Consequences for Failure to Create Consequences for Failure to

ImplementImplement Continue Development and Refining Continue Development and Refining

Skills Needed to Implement the PlanSkills Needed to Implement the Plan


MAINTENANCEMAINTENANCE – – The stage where the new The stage where the new behavior pattern is sustained for an behavior pattern is sustained for an extended period of time and is consolidated extended period of time and is consolidated into the lifestyle of the individual and into the lifestyle of the individual and society.society.

TASKSTASKS: Sustaining change over time : Sustaining change over time and across a wide range of situations. and across a wide range of situations. Avoiding going back to the old pattern of Avoiding going back to the old pattern of behavior.behavior.

GOALGOAL: Long-term sustained change of : Long-term sustained change of the old pattern and establishment of a new the old pattern and establishment of a new pattern of behavior.pattern of behavior.


It is Not Over Till Its OverIt is Not Over Till Its Over Support and ReinforcementSupport and Reinforcement Availability of Services or Resources Availability of Services or Resources

to Address Other Issues In to Address Other Issues In Contextual Areas of FunctioningContextual Areas of Functioning

Offering Valued Alternative Sources Offering Valued Alternative Sources of Reinforcementof Reinforcement

Institutionalization of changeInstitutionalization of change

ABLE TO CHANGEABLE TO CHANGE

Continued CommitmentContinued Commitment Skills to Implement the PlanSkills to Implement the Plan Long-term Follow ThroughLong-term Follow Through Integrating New Behaviors into Integrating New Behaviors into

Lifestyle or OrganizationLifestyle or Organization Creating a New Behavioral NormCreating a New Behavioral Norm

Relapse and Recycling - Slipping Relapse and Recycling - Slipping Back to Previous Behavior and Back to Previous Behavior and

Trying to Resume ChangeTrying to Resume Change

Characteristics:Characteristics: The person or organizations has failed to The person or organizations has failed to

implement the plan or is re-engaged in the implement the plan or is re-engaged in the previous behaviorprevious behavior

After failing to implement or reverting to After failing to implement or reverting to previous behavior, there is re-entry to previous behavior, there is re-entry to precontemplation, contemplation, precontemplation, contemplation, preparation stagespreparation stages

Sense of failure and discouragement about Sense of failure and discouragement about motivation or ability to changemotivation or ability to change


Blame and Guilt Undermine Blame and Guilt Undermine Motivation for ChangeMotivation for Change

Determination despite delays and Determination despite delays and defeatsdefeats

Support Re-engagement in the Support Re-engagement in the Process of ChangeProcess of Change

Recycling or just Spinning WheelsRecycling or just Spinning Wheels Hope and a Learning PerspectiveHope and a Learning Perspective

Theoretical and practical considerations related to movement through the Stages of Change

Motivation Decision-Making Self-efficacy

Precontemplation Contemplation Preparation Action Maintenance

Personal Environmental Decisional Cognitive Behavioral OrganizationalConcerns Pressure Balance Experiential Processes

(Pros & Cons) Processes

Recycling Relapse

PrecontemplationIncrease awareness of need to change

ContemplationMotivate and increase confidence

in ability to change

ActionReaffirm commitment

and follow-up

Termination

Stages of Change Model

RelapseAssist in Coping

MaintenanceEncourage activeproblem-solving

PreparationNegotiate a plan

STAGES OF CHANGE AND INTERVENTION TASKS STAGES OF CHANGE AND INTERVENTION TASKS

RELAPSE

CONTEMPLATION

PRECONTEMPLATIONRaise doubt - Increase the client’s perception of risks and problems with current behavior

Tip the decisional balance - Evoke reasons for change, risks of not changing; Strengthen client’s self-efficacy for change of current behavior

PREPARATIONHelp the client to determine the best course of action to take in seeking change; Develop a plan

ACTIONHelp the client implement the plan; Use skills; Problem solve; Support self-efficacy

MAINTENANCEHelp the client identify and use strategies to prevent relapse; Resolve associated problems

Help the client recycle through the stages of contemplation, preparation, and action, without becoming stuck or demoralized because of relapse

WHO IS THE CLIENTWHO IS THE CLIENT

Most of the time we think of clients Most of the time we think of clients as individual patients in a systemas individual patients in a system

However, clients from a process of However, clients from a process of change perspective are anyone who change perspective are anyone who needs to make a behavior changeneeds to make a behavior change

The challenge from a systems The challenge from a systems perspective is who needs to change perspective is who needs to change to make a system changeto make a system change

Important Considerations about Important Considerations about System ChangeSystem Change

Usually when you change a system Usually when you change a system everyone needs to make changeseveryone needs to make changes

Roles may be differentiated: decision Roles may be differentiated: decision makers, implementers, etc.makers, implementers, etc.

However, most parts of a system However, most parts of a system have to make some behavioral have to make some behavioral changes in procedure, process, changes in procedure, process, protocol, or personnelprotocol, or personnel

Some ExamplesSome Examples

HIV/AIDS Compliance enhancementHIV/AIDS Compliance enhancement Trauma Unit Screening and Trauma Unit Screening and

Interventions for Risky DrinkingInterventions for Risky Drinking Peoplesoft at UMBCPeoplesoft at UMBC Think of some of your examples of Think of some of your examples of

when changes went well and when when changes went well and when they failed. What contributed to they failed. What contributed to success or failuresuccess or failure

Multiple Problems Multiple Problems Complicate the Process of Complicate the Process of

ChangeChange

The Context of Change:The Context of Change:A Figure Ground A Figure Ground

PerspectivePerspective

CONTEXT OF CHANGECONTEXT OF CHANGECONTEXT OF CHANGECONTEXT OF CHANGE

I. SITUATIONAL RESOURCES AND PROBLEMS

II. COGNITIONS AND BELIEFS

III. INTERPERSONAL RESOURCES/PROBLEMS

IV. FAMILY & SYSTEMS

V. ENDURING PERSONAL CHARACTERISTICS

Typical Complications forTypical Complications forIndividual and OrganizationsIndividual and Organizations

Symptom/SituationSymptom/Situation– PsychiatricPsychiatric– FinancialFinancial

BeliefsBeliefs– Religious viewsReligious views– Cultural beliefsCultural beliefs

InterpersonalInterpersonal– MaritalMarital

SystemicSystemic– EmploymentEmployment– Family/ChildrenFamily/Children

IntrapersonalIntrapersonal– Self-EsteemSelf-Esteem

SituationSituation– Inadequate facilitiesInadequate facilities– FinancialFinancial

BeliefsBeliefs– Only one right wayOnly one right way

InterpersonalInterpersonal– Leadership ConflictsLeadership Conflicts

SystemicSystemic– Funding SourcesFunding Sources– Political forcesPolitical forces– Subgroup conflictsSubgroup conflicts

InstitutionalInstitutional– TraditionsTraditions– Organizational CultureOrganizational Culture

PROBLEM FOCUSPROBLEM FOCUS

Since change goals and motivations are often Since change goals and motivations are often behavior specific, it is critical to be specific behavior specific, it is critical to be specific about the focus of interventionsabout the focus of interventions

We need to evaluate in collaboration with the We need to evaluate in collaboration with the client what is the primary target behaviors client what is the primary target behaviors that needs to be changed and the client goalsthat needs to be changed and the client goals

Target behavior is figure and additional Target behavior is figure and additional problems become the ground or context for problems become the ground or context for that changethat change

Multiple Problems Need an Multiple Problems Need an Integrated Approach to CareIntegrated Approach to Care

Multi-Service Center

Homeless Encampment



Sheltered Employment

Day Rehabiliation

Community Living

HHISN

Residential Treatment

Crisis Residential

Emergency Shelter

Stages by Context AnalysisStages by Context Analysis

PreC Cont Prep Action Maint

I Sit

II Cog

III Rel

IV Sys

V Per

Experiential Processes

Behavioral Processes

Evaluating Client ProblemsEvaluating Client Problems

How serious is the How serious is the problem?problem?– Not EvidentNot Evident– Not SeriousNot Serious– SeriousSerious– Very SeriousVery Serious– Extremely Extremely

SeriousSerious

When and What When and What Intervention is needed?Intervention is needed?– Needs no Needs no

interventionintervention– Needs intervention in Needs intervention in

the futurethe future– Needs Secondary Needs Secondary

InterventionIntervention– Needs primary Needs primary

intervention but can intervention but can waitwait

– Needs immediate Needs immediate interventionintervention

Intervention StrategiesIntervention Strategies SEQUENTIAL – start with initial symptom or SEQUENTIAL – start with initial symptom or

situation and try to resolve that and work way situation and try to resolve that and work way down.down.

KEY AREA OR LEVEL – Find problem or area where KEY AREA OR LEVEL – Find problem or area where you have the most leverage or client or system is you have the most leverage or client or system is most motivatedmost motivated

MULTI-LEVEL OR MULTI-PROBLEM –Work back and MULTI-LEVEL OR MULTI-PROBLEM –Work back and forth across the context identifying and forth across the context identifying and addressing client stage and processes of change addressing client stage and processes of change for each separate problemfor each separate problem

Approaches that Pay Attention Approaches that Pay Attention to the Process of Changeto the Process of Change

Clearly identify the target behavior and the Clearly identify the target behavior and the contextual problemscontextual problems

Evaluate stage of readiness to changeEvaluate stage of readiness to change Evaluate beliefs, values and practices Evaluate beliefs, values and practices

related to target behaviorrelated to target behavior Examine routes and mechanisms of Examine routes and mechanisms of

influence in the culture and for the individualinfluence in the culture and for the individual Create sensitive stage based multi-Create sensitive stage based multi-

component interventions component interventions Re-evaluate regularly the change process Re-evaluate regularly the change process

VENTIONSFORMAL INTER

PROCESS OF

CHANGE

Application to Application to Organizations that Deal Organizations that Deal

with Co-Occurring with Co-Occurring DisordersDisorders

Some Final thoughtsSome Final thoughts

Addictions, Mental Illness and the Addictions, Mental Illness and the Process of ChangeProcess of Change

Both Mental Illness and Addictions are Both Mental Illness and Addictions are frustrating and fascinating behavior frustrating and fascinating behavior problems involvingproblems involving– Social influences, support and policiesSocial influences, support and policies– Physiology, biology, genetics, and Physiology, biology, genetics, and

chemistrychemistry– Psychological and motivational factorsPsychological and motivational factors

Comprehensive and multidimensional Comprehensive and multidimensional models to understand them and to models to understand them and to provide careprovide care

Facing the ChallengeFacing the Challenge

Mental Illness and Addictions Mental Illness and Addictions challenge courts, treatment challenge courts, treatment providers, educators, families, social providers, educators, families, social services and society to create services and society to create – policies policies – prevention programs prevention programs – treatments treatments – harm reduction strategies harm reduction strategies that hinder initiation and facilitate that hinder initiation and facilitate

recoveryrecovery

Organizational Challenges for Organizational Challenges for Change for Addiction InterventionsChange for Addiction Interventions

Dual Diagnosis: Addiction and Mental Dual Diagnosis: Addiction and Mental Health – a conceptual integrationHealth – a conceptual integration

Integrating treatments among multiple Integrating treatments among multiple providers for multi-problem patientsproviders for multi-problem patients

Legal Sanctions and Treatment DecisionsLegal Sanctions and Treatment Decisions Implementing Empirically Based Implementing Empirically Based

TreatmentsTreatments Burnout and TurnoverBurnout and Turnover

THE CHALLENGE FOR THE CHALLENGE FOR PROVIDER ORGANIZATIONSPROVIDER ORGANIZATIONS

To Create Successfully Sustained Organizational Change to Meet the Needs of Clients, Organization, and Society

To Use a Process Perspective as opposed to a simply a Content Perspective

The Content or Product to Change in a Change Enabling Organization can be SERVICES, SAFETY, EDUCATION, RESEARCH, OR POLICY

WHAT IS NEEDED: WHAT IS NEEDED: ORGANIZATIONAL LEADERSHIPORGANIZATIONAL LEADERSHIP

THAT INSPIRES, MOTIVATES, AND PROVIDES THAT INSPIRES, MOTIVATES, AND PROVIDES INCENTIVES FOR EXCELLENCE AND CHANGEINCENTIVES FOR EXCELLENCE AND CHANGE

NOT ONE THAT ORDERS, IMPOSES, AND NOT ONE THAT ORDERS, IMPOSES, AND PUNISHES TO ENFORCE IMPOSED CHANGEPUNISHES TO ENFORCE IMPOSED CHANGE

SETS A TONE, AN EXPECTATION THAT THE SETS A TONE, AN EXPECTATION THAT THE CHANGE IS VALUEDCHANGE IS VALUED

MODELS BEHAVIORS, VALUES, ETHICS THAT MODELS BEHAVIORS, VALUES, ETHICS THAT SUPPORT THE CHANGESUPPORT THE CHANGE

CREATING A SHARED VISION CREATING A SHARED VISION TO SUPPORT CHANGETO SUPPORT CHANGE

A VISION OF WHAT WE CAN BE AND WHAT WE CAN DO

A VISION THAT CREATES HIGH BUT ACHIEVABLE OUTCOME AND EFFICACY EXPECTATIONS

A VISION THAT STRIVES FOR EXCELLENCE AS APPROACHED NEVER ACCOMPLISHED

A VISION SHARED AT ALL LEVELS OF THE ORGANIZATION

CREATING AND SUSTAINING CREATING AND SUSTAINING CHANGE REQUIRES A TEAMCHANGE REQUIRES A TEAM

CREATE A TEAM OF INDIVIDUALS WHO HAVE THE RESPONSIBILITY AND AUTHORITY TO ENGAGE IN THE PROCESS AND ATTAIN THE GOALS

THESE ARE THE INDIVIDUALS WHO PERFORM THE BEHAVIORS ARE THE CHANGE TARGET

LONE RANGERS RARELY CREATE EXCELLENT, SUSTAINABLE ORGANIZATIONAL CHANGE

CREATING THE TEAMCREATING THE TEAM

GET AND KEEP THE RIGHT PEOPLEGET AND KEEP THE RIGHT PEOPLE USE INCENTIVES (RECOGNITION, USE INCENTIVES (RECOGNITION,

RESPECT, REINFORCEMENT)RESPECT, REINFORCEMENT) TRUST AND MONITORTRUST AND MONITOR PLAN AND IMPLEMENTPLAN AND IMPLEMENT BUILD NORMS & SUPPORT SYSTEMSBUILD NORMS & SUPPORT SYSTEMS SHARE RESPONSIBILITY AND SHARE RESPONSIBILITY AND

AUTHORITY AUTHORITY

IN MAKING AN INDIVIDUAL OR IN MAKING AN INDIVIDUAL OR ORGANIZATIONAL CHANGEORGANIZATIONAL CHANGE

Pick a target behavior or constellation Pick a target behavior or constellation of behaviorsof behaviors

Make a solid decisionMake a solid decision Prioritize and PreparePrioritize and Prepare Make a plan and revise as neededMake a plan and revise as needed Keep going and do not get discouragedKeep going and do not get discouraged Find and build a network of support Find and build a network of support Make the change a new normMake the change a new norm

Built to Last: Successful Habits of Built to Last: Successful Habits of Visionary CompaniesVisionary Companies

Be a clock builder –an architect- not a time Be a clock builder –an architect- not a time tellerteller

Embrace the “Genius of the AND”Embrace the “Genius of the AND” Preserve the core values/stimulate Preserve the core values/stimulate

progressprogress Seek consistent alignment of core values Seek consistent alignment of core values

and purpose with current practice and and purpose with current practice and future goalsfuture goals

Key ConceptsKey Concepts– Core ideology, values, purposeCore ideology, values, purpose– Envisioned Future: Big Hairy Audacious GoalsEnvisioned Future: Big Hairy Audacious Goals

Collins JC & Porras, JI (1994) Harper Business Books

Some Final ThoughtsSome Final Thoughts

Treating those needing to change as Treating those needing to change as consumers who can choose to use consumers who can choose to use our servicesour services

The reality of recoveryThe reality of recovery

What is a Consumer?What is a Consumer? A person who has the A person who has the powerpower to buy, to to buy, to

choose from among options, to demand choose from among options, to demand service, to decide, and to manage their service, to decide, and to manage their choices and liveschoices and lives

Individuals with an Individuals with an array of interestsarray of interests, , values, tastes, opinions, attitudes and values, tastes, opinions, attitudes and intentions intentions

A A valued commodityvalued commodity to those who offer to those who offer products and servicesproducts and services

Not just an alternate or politically correct Not just an alternate or politically correct term for client or patientterm for client or patient

Two Sides of the CoinTwo Sides of the Coin

Consumer Consumer – MotivationMotivation– Change Change

mechanismsmechanisms– AdherenceAdherence– Hope Hope – EfficacyEfficacy– Managing co-Managing co-

existing existing problemsproblems

Treatment ServicesTreatment Services– ProgramsPrograms– Types of Types of

ServicesServices– Treatment Treatment

Strategies and Strategies and typestypes

– Development of Development of New Approaches New Approaches and Medications and Medications

A Consumer PerspectiveA Consumer Perspective

A Consumer Perspective shifts the emphasis A Consumer Perspective shifts the emphasis from an intense concentration on our from an intense concentration on our treatments to a unique focus on our treatments to a unique focus on our consumers and their processesconsumers and their processes

Most treatment services provide good, Most treatment services provide good, effective action-oriented treatmentseffective action-oriented treatments

Many of our consumers are unmotivated, Many of our consumers are unmotivated, overwhelmed with multiple problems, feeling overwhelmed with multiple problems, feeling hopeless, or simply not interested or hopeless, or simply not interested or engaged by our servicesengaged by our services

DiClemente & Velasquez. Motivational interviewing and the stages of change. In: Miller & Rollnick, eds. Motivational Interviewing, 2nd ed. NY: Guilford Publications; 2002:201.

The ChallengeThe Challenge

Meet our consumers where they areMeet our consumers where they are Understand their needs, preferences, Understand their needs, preferences,

and perspectivesand perspectives Develop products and services that Develop products and services that

are attractive and effectiveare attractive and effective Engage the consumer in the creation Engage the consumer in the creation

of the optionsof the options Plan to be there for the long termPlan to be there for the long term

The Reality of RecoveryThe Reality of Recovery Change is not only possible, it is a reality. Change is not only possible, it is a reality.

– There are over 40 million former smokers in There are over 40 million former smokers in the U.S.the U.S.

– Many individuals with serious psychiatric Many individuals with serious psychiatric disorders are working in government and disorders are working in government and business, in education and entertainment and business, in education and entertainment and leading productive livesleading productive lives

– Large numbers of alcohol and drug addicted Large numbers of alcohol and drug addicted individuals from varied level of socioeconomic individuals from varied level of socioeconomic status are in recovery and provide models and status are in recovery and provide models and support for those whose journey of change lies support for those whose journey of change lies ahead of themahead of them

– Providers must be careful not to engage in a Providers must be careful not to engage in a self-fulfilling prophecy self-fulfilling prophecy

Thank YouThank You

My contribution to helping you to My contribution to helping you to create a recovery based system of create a recovery based system of care for individuals suffering from care for individuals suffering from mental illness and addictionsmental illness and addictions

Each person you reach and help to Each person you reach and help to manage these problems affects the manage these problems affects the lives of many otherslives of many others

Your work and efforts are Your work and efforts are appreciatedappreciated

The Challenge of Change: Creating a Recovery- Oriented System of Care Carlo C. DiClemente Professor...

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