Introduction: Self-Management Support

Introduction

Purpose

The Self-Management Support Organizational Assessment Tool (SMS OAT) is designed to assist behavioral health organizations in delivering self-management support to clients managing serious mental illness and/or substance abuse conditions. These conditions often coincide or are dually diagnosed; an estimated 50 percent of individuals with a serious mental illness also have a substance abuse condition.1 Supporting clients in managing their health is the responsibility of front-line providers, administrators, and recovery support leaders. This tool allows organizations to assess their capacity for delivering self-management support and also outlines a quality assurance process that facilitates ongoing organizational improvements in self-management support.

Self-Management Support

The Institute of Medicine (IOM) describes self-management as “the tasks that individuals must undertake to live well with one or more chronic conditions.”1 When individuals gain self-management skills and use these skills over time they gain autonomy over their health and their health care choices, which may lead to longer, healthier lives. Providing self-management support is, therefore, a key activity for health care providers seeking to deliver integrated, high quality health care.

Self-management has been demonstrated to increase individuals’ satisfaction with health care, reduce the cost of care, and improve health outcomes for persons with a variety of chronic health conditions.6-11 Self-management is especially applicable to individuals with serious mental illness and to those with substance abuse conditions. Previous studies have demonstrated how self-management programs can improve health outcomes for those with serious mental illness and other comorbid chronic illness. Persons with serious mental illness or substance abuse conditions can use self-management skills to manage their behavioral and physical conditions, maintain their overall health, and maximize their quality of life.

For persons with serious mental illnesses and/or substance abuse disorders, self-management support is integral to promoting and sustaining recovery. The concept of recovery and peer support has been central to the self-management of addictive disorders. Health - defined as managing one’s disease and making informed, healthy choices that support physical and emotional well being - is one of four dimensions of recovery, along with home, purpose and community. A guiding principle of these dimensions is that recovery is person-driven with self-determination and self-direction as the foundations for recovery. Efforts to better support self-management are well aligned with the goals and processes many organizations are pursuing as they adopt the recovery model.

Delivering Self‐Management Support in Behavioral Health

For many providers, supporting self-management involves a paradigm shift away from the traditional medical model towards a shared decision-making model for encounters with clients. It means staff and organizations must structure and deliver care in ways that honors individuals’ perspectives on their health care, treatment, and relationships with providers. It may also mean the adoption of new organizational processes to teach individuals the skills to manage their conditions and health over time and to collaborate with their health care providers to make decisions about their care. Self-management support also involves actively engaging a client’s natural supports who can play a positive, but nonprofessional, role in recovery. Delivering self-management support and promoting recovery will require behavioral health organizations and other stakeholders to re-organize care processes and care delivery systems. Within any organization, this is likely to involve changing organizational cultures and setting new role expectations and service priorities. Behavioral health organizations can anticipate needing to innovate, acquire external support, dedicate time and resources, and commit to effect change and achieve this vision of person-centered and integrated care. This assessment tool was developed as a resource for prevention, treatment and recovery services. It aims to help service leaders, providers, and administrators in organizations that serve individuals with serious mental illness or substance abuse conditions to:

  • Raise awareness of the features of client-provider interactions and care processes consistent with self-management support in your organization.

  • Provide a ‘blueprint’ to assess self-management support activities in your organization.

  • Highlight examples your organization may consider to expand your capacity to integrate support for self-management.