Changing Models

When Arthur Evans Jr., PhD took on the role of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services in 2004, he had an agenda: He was seeking to transform the city’s entire system to one that focuses on recovery for adults, resilience for children and self-determination for all people who access intellectual disability services. This recovery-oriented model zeroes in on an individual’s personal journey and experiences rather than focusing on a predetermined outcome.

In his previous role as Connecticut’s deputy commissioner for the Department of Mental Health and Addiction Services, Evans and his colleagues helped transform the state’s behavioral health system by developing core values and principles based on several years of study and input from thousands of people in recovery nationwide. The commission concluded that existing mental health systems were not organized to reach the single most important goal for people receiving services — the goal of recovery.

This data informed Evans’ work to retrain Connecticut’s behavioral health workforce and revamp the state’s behavioral health system. The state replaced its acute care model of brief, episodic treatments for substance use disorders with a longitudinal recovery management model that goes far beyond the point of stabilization in an individual’s recovery. With the success of this model in Connecticut, Evans envisioned the same for Philadelphia’s $1 billion public sector behavioral health system and the 120,000 city residents it serves each year.

“We want to help people be a part of the community versus just being in the community,” says Evans.

Convincing Clinicians

Even with a clear plan in mind, Evans knew the difficult part was yet to come. He had to convince the city’s more traditional mental health professionals to embrace the recovery orientation, which encourages individuals to drive the process of their own recovery.

“[The model] challenges fundamentally the way clinicians view themselves, their role, and people with behavioral health conditions and their potential,” says Evans. This shift in focus can be threatening to professionals accustomed to being in charge, according to Evans. People may resist certain treatments or reject professionals’ advice about their relationships — forms of pushback that are good for individuals but may trouble providers.

“What we tell providers is that their professional role is enhanced in a recovery-oriented system because they have to have a much broader set of skills and much broader way of working with people,” says Evans. “It’s relatively easy to help people manage symptoms; it’s much more complex to help people figure out a pathway in life.”

Beginning the Transformation

Evans and his colleagues began implementation with the day programs, or treatment facilities, where many Philadelphia residents access services.

One simple but effective change has been to teach participants how to use public transportation rather than relying on Medicaid-funded vans to get to these programs. The reorientation of the day program from maintenance to recovery has resulted in fewer visits to crisis centers, fewer inpatient admissions and cost savings that the city can then reinvest in other community-based services.

Evans also made it a priority to base his plan for system-wide changes on the best available psychological science. As such, providers now receive evidence-based training in recovery orientation as well as previously underused techniques such as cognitive therapy and trauma-informed care.

The system has trained hundreds of providers to use cognitive therapy and its principles in inpatient and outpatient settings, with children and adults, and for mental health and substance use conditions.

Under Evans, Philadelphia now has one of the nation’s largest initiatives involving peer specialists — individuals who have firsthand experience with mental and substance use conditions. Allowing peers to work alongside professionals aligns with Evans’ philosophy of engaging the people he serves to be part of making decisions that affect them.

“Most people come into this field because they want to help people,” says Evans. “In a recovery-oriented system, professionals are much more likely to see that kind of progress.”