Examples of Consensus Processes in State Government
Department
of Behavioral & Developmental Services
Department of Environmental
Protection
Department of Transportation
Department of Marine
Resources
The Department of Mental Health, Mental Retardation, and
Substance Abuse Services (now the Department of Behavioral
and Developmental Services) was required, as part of its obligation
under the AMHI Consent Decree, to develop an Individualized
Support Plan (ISP) process and form to be implemented statewide.
The Department had made several attempts, since the early
1990’s. These prior attempts had failed, though they
were valiant and had also involved stakeholder processes.
In the Spring of 1997, the Department launched another attempt,
after having been threatened with contempt of the Court in
1996. There was a very short time frame for the development
and planning process, and the resulting product needed to
meeting the needs of the Department, its consumers, and its
service providers.
Members of the Office of Quality Improvement were tasked
with bringing together and facilitating a stakeholder group
that would develop a form, process, and implementation strategy.
The plan would then be implemented and monitored over time.
Stakeholder Groups:
Four groups were established to manage the planning process.
There was a Central Office (CO) group in Augusta. It was called
the ISP Development Group and was facilitated by Jay Yoe and
Lisa P. Wallace, as well as a mentor group in each of the
Department’s three regions. The region’s Mental
Health Team Leader and Consent Decree Coordinators facilitated
the three mentor groups. Each group was composed of representatives
of all stakeholder groups necessary to the process, although
they did not have direct Licensing or Medical representation:
- The Department of Mental Health, Mental Retardation,
and Substance Abuse Services; including all Programs, Systems
Operations, and the Office of Consumer Affairs and Quality
Improvement—All divisions of the Department would
need to be on board if implementation of the resulting plan
was to occur smoothly and efficiently.
- Licensing and Medicaid—Representatives from
both entities played a consultative role in this process.
Too often plans are developed and implemented prior to looking
at the barriers within Licensing and Medicaid rules and
regulations. All materials developed throughout this process
were reviewed by Licensing and Medicaid for compliance with
rules: the group did not want any surprises.
- Adult Consumers of Mental Health Services—This
process was developed to meet the needs of the individuals
that we served. They needed to be at the table to assist
us in identifying what would work best for them.
- Community Providers of Case Management/Community Support
Services—The Department contracts out for most
of the services provided to individuals who use adult mental
health services. Provider support was crucial to implement
the ISP process.
- The University of New England, ‘Training for
Sustainable Development’—UNE participants
acted as consultants to the Department regarding case management
and community support systems.
Processes:
The Central Office group was the ‘lead’ in the
process and was expected to set the agenda, develop materials
for review, convey information, and discuss issues with mentor
groups prior to decisions being made. The mentor groups reviewed
all materials and assisted the CO group in identifying issues
that needed to be addressed. No one was shy about making their
needs known—the communication loops developed between
and among the groups assured that all voices were heard and
considered.
The CO group met weekly on Friday afternoons and in subcommittees
between meetings. The Friday afternoon meetings continued
for over a year. Sometime during the second year, the meetings
were switched to every other week.
Everything done as part of the ISP process was mirrored in
stakeholder involvement. For instance, when the Department
provided training around the new form and process, the training
teams were composed of development personnel, consumers, providers,
and representatives from ‘Trainers for Sustainable Development’.
The ISP process was a group effort that focused on relationship-building
and how necessary that is for planning with the people the
Department serves. The groups, therefore, worked very hard
to mirror this in all of their work in the ISP process.
Timing:
- Spring 1997: New Individualized Support Plan in court
(approved in April)
- April 1997: All stakeholder groups begin to meet
- June/July 1997: Form and process developed by stakeholder
groups is piloted, Quality Improvement materials and tools
in development
- September 1997: Plan is fully implemented statewide for
all individuals receiving case management and/or community
support services—not just class members covered by
the AMHI Consent Decree.
- October 1998: Changes made to the form resulting from
ongoing monitoring of the process by the stakeholder groups.
The Central Office group continues to meet approximately
monthly, and the mentor groups generally meet two times per
month. The focus of the ‘agenda setting’ has not
shifted to the regional mentor groups, with the mentor groups
dealing with regional issues as well as their ongoing responsibility
to the ISP process.
Results:
The stakeholder process was successful in helping the Department
to develop an Individualized Support Plan process and form.
The plan was implemented statewide and continues to undergo
changes as necessary.
Lessons:
The group met several challenges, including:
- The large number of people involved, and in so many locations
- Communication: it was difficult to ensure that all voices
were heard, valued, and considered
- Identifying as many barriers as possible to implementation
prior to the actual implementation
- Specific Consent Decree requirements that were not negotiable
without seeking an amendment from the Court
- Paying customers for their participation: Most members
of the group participated as representatives of their organization
and were paid to be at the meetings and to give their time
and effort. No systems were in place to do so for consumers
who were asked to volunteer. There were arrangements for
milage and expenses to be paid, but not a stipend. This
remains a challenge for Departmental initiatives.
- Time is the major difficulty the group encountered in
utilizing a consensus process. Those involved must make
a commitment to a process that works slower than they might
like, given the hectic nature of our everyday work lives.
The group also identified some advantages to using the consensus
process:
- Ongoing structures to support the process over time were
a great help in implementation—this piece was missing
in the past. From the beginning, the Department was committed
to this being a ‘living’ process. Growth and
change will occur over time through the relationships that
have been and are being developed. The change can be managed
together.
- All of the stakeholders were on the same page from the
beginning. This did not mean that there weren’t problems
in implementation. These, however, were minimized because
the relationships were there to deal with the issues expeditiously.
- Barriers were identified and dealt with up front, to the
extent possible.
- The process contributed to the building of ties and a
greater understanding of the various groups and individuals
who participated.
Source: Lisa P. Wallace, Office of Quality Improvement
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