Implementation Evaluation: A Recovery Oriented Roadmap for Crisis

Background   Parachute NYC was developed to expand local opportunities for people in crisis and their support networks to engage in relationship centered, recovery oriented care. Parachute aimed to change crisis response by shifting the focus of 4 mobile crisis teams, creating 4 respites, training 198 staff in dialogic approaches and creating 64 FTE peer positions. Because these services are emblematic of emerging Medicaid funding categories, it was essential to document Parachute’s implementation  - to support quality improvement and make proactive changes that would inform system-wide implementation of this pilot.

Methods Using a developmental evaluation design, we designed real-time feedback for program staff and leadership to support Parachute adaptation and development. Close ethnographic observations of all aspects of implementation provided qualitative data for a Roadmap to support replication of key aspects of the model: peer integration; crisis alternatives; dialogic approaches.

Results Team leadership and ongoing collaborative training are essential to build team cohesion. Creating a continuum of recovery services requires more providers attuned to alternative approaches; support to negotiate recovery focused connections with multiple systems; and a dialogic practice community to hone skills. Human resource policies must adapt to recruit and retain psychiatrists and peers, both with unique skills and team roles. Transportation and scheduling challenge provision of home based services in NYC.

 Implications Implementing dialogic, need adapted approaches that integrate peers in a large complex service system requires close attention and rapid response to implementation difficulties. Broadly based structural solutions are required to successfully implement and sustain recovery oriented, peer-integrated systems of care.