CLINICAL QUALITY OF CARE – PRACTICE PARAMETERS 

Office of the Chief Medical Officer 
Clinical Operations 


Recovery Model and Clinical Care 
 

GC-1

Category: General Considerations
Published Date: July 2023
  1. PARAMETER GOAL
     
    1. To provide a framework for utilizing recovery-oriented tools in all mental health service delivery.
       
    2. To educate staff that the recovery model is different yet not in opposition to a clinical approach to care. 
      1. The extent of integration of recovery tools with clinical care should be driven by client preference. 
      2. The modes of treatment approaches, both clinical and recovery oriented, may be used independently of each other.
      3. These modes may be used together at the same time.
      4. Both modes have value to address treatment needs of clients.
      5. Staff should not assume that clients and families are familiar with recovery, nor that they have access to recovery tools.
         
  2. TERMINOLOGY
     
    1. Clinical: Relating to the assessment, observation and treatment of disease or illness. 
       
    2. Mental Health Recovery: A process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential according to the Substance Abuse and Mental Heatlh Services Administration (SAMHSA).
       
    3. Recovery Model:  A holistic, person-centered approach to mental health care.
       
    4. Medical Model: In mental health refers to a course of treatment that impacts disease which may include medication, blood work, safety measures for dangerous behavior, and detoxing from substance intoxication in a controlled medical setting.
       
    5. Recovery: As a concept is a return to a normal state of health, mind, or strength.
       
    6. Resilience: The ability to bounce back from challenges, misfortunes, or changes. Clients build resiliency with experience and development of coping skills. Resilience is a term used in mental health recovery applying more generally to children who are in various stages of growth; the term can be interchanged with recovery as an ability to recover and is more generally applied to trauma experiences.
       
  3. MEASURES
     
    1. A comprehensive overview of recovery and clinical care should include these wellness domains:
      1. Physical
      2. Intellectual
      3. Emotional
      4. Spiritual
      5. Employment
      6. Education
      7. Finance
      8. Social support
      9. Environment
         
    2. Historical information on influences that contribute to recovery and clinical care may include:
      1. Medical conditions
      2. Socioeconomic factors
      3. Legal status
         
    3. Staff should ask clients and families about their understanding of clinical interventions and recovery tools.
      1. Initial interviews are appropriate times to assess the client and family belief that recovery is possible.
      2. Psychoeducation on outcomes of recovery tools and clinical interventions should include concepts of resiliency.
         
  4. TREATMENT STRATEGIES AND PROVISION OF SERVICES
     
    1. All mental health service delivery should use the recovery model approach which emphasizes hope.
       
    2. Medical model interventions should include recovery tools by referral to supports, education, self-help and peer support.
       
    3. The four focus strategies which support recovery work:
      1. Health: Managing or recovering elements of personal health by making informed, supported and healthy choices for wellness.
      2. Home: Having a stable and safe place to live.
      3. Purpose: Conducting meaningful daily activities and having the independence and resources to participate in society.
      4. Community: Relationships and social networks that provide support, friendship, love, and hope.
         
    4. Services should include psychoeducation on the potential of recovery for each individual.
      1. Staff should not assume everyone knows about recovery potential.
      2. Staff should keep cultural differences, disparities, and socioeconomics in mind when addressing recovery potential.
      3. Increasing knowledge of ways clients control their own recovery is essential to positive outcomes.
         
    5. Clinical interventions which are based in the medical model should adhere to factual based content.
       
    6. Recovery model interventions based should emphasize the process and self-empowerment of clients.
       
    7. Family members should be included in service delivery of psychoeducation when available and appropriate to care.
      1. Family inclusion in psychoeducation does not violate HIPAA when general psychoeducation is provided.
      2. Referral of family to community-based programs is encouraged as a means to strengthen client positive outcomes.
         
    8. Every practitioner should maintain a strong belief that people with mental illness can regain a meaningful life, despite persistent symptoms.
      1. When a practitioner notes doubt within themself that a person with mental illness will recover, they should consult with a supervisor in order to do no harm in their practice.
      2. When a supervisor notes either by observation or request of the client to change providers, that the mental health working relationship is not a good fit, the supervisor should consider alternative options to assure client success, including additional staff training.
         
    9. Recovery approach service delivery should incorporate these 10 guiding principles:
      1. Self-direction: Clients determine their own path of recovery with their autonomy, independence, and control of resources.
      2. Individualized or Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths as well as their needs, preferences, experiences, and cultural background.
      3. Empowerment: Clients have the authority to participate in all decisions that will affect their lives, and they should be educated and supported in this process by staff.
      4. Holistic: Recovery involves an individual’s whole life, including mind, body, spirit, and community, and all aspects of life, including housing, social networks, employment, education, mental health, physical health, and family supports.
      5. Nonlinear: Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience.
      6. Strengths-based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals.
      7. Peer support: Mutual support by those who are in recovery plays an invaluable role in recovery. Staff should encourage clients to engage with others in recovery and provide each other with a sense of belonging. Peer support builds camaraderie and is a source of hope, inspiration and witnessing to the recovery model.
      8. Respect: Every person will be treated with respect thereby eliminating discrimination and stigma. Clients should be encouraged to have self-acceptance and regain belief in their own worth to live a productive life.
      9. Responsibility: Clients have a personal responsibility for their own self-care and journeys of recovery. Clients identify coping strategies and healing processes to promote their own wellness according to what works best for them uniquely.
      10. Hope: Hope is the catalyst of the recovery process and provides the essential and motivating message of a positive future. Peers, families, friends, providers, and others can help foster hope.
         
  5. OUTCOMES AND MONITORING
     
    1. Client choice and self-determination should be valued among staff and supervisors.
       
    2. Clients should express that they are encouraged to make choices for their own mental health care.
       
    3. There should be evidence of collaboration between staff who utilize clinical treatment strategies and staff who provide a recovery model approach to client care.
       
    4. Staff should be well versed in the usefulness of both medical/clinical approaches and recovery approaches to care.
       
  6. STAFF TRAINING
     
    1. Staff should attend trainings and follow guidelines that are consistent with the County Policy of Equity and Federal Regulations on Protected Health Characteristics for mental health the same as any other equity status.
       
    2. Webinars, current research, and best practices are available via the department and various web resources to develop recovery practices.
       
    3. SAMHSA and other Peer Support Specialist trainings are available throughout the department.
       
  7. SUPERVISION AND CONSULTATION
     
    1. Staff should have administrative supervision directed toward performance of duties.
       
    2. Recovery approaches to supervision include co-reflection processes where staff with lived experience are supported in assisting clients toward recovery.
       
    3. Supervision should include both clinical and recovery approaches based on staffing patterns and payroll titles.
       
  8. RESOURCES