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HOW MOPRA BEGAN--- THE MOPRA JOURNEY TO DATE--- MOPRA’S FUTURE

HOW MOPRA BEGAN--- THE MOPRA JOURNEY TO DATE--- MOPRA’S FUTURE. Missouri Psychiatric Rehabilitation Association Conference 25 th Annual Meeting Sept 16-17, 2010.

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HOW MOPRA BEGAN--- THE MOPRA JOURNEY TO DATE--- MOPRA’S FUTURE

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  1. HOW MOPRA BEGAN--- THE MOPRA JOURNEY TO DATE--- MOPRA’S FUTURE Missouri Psychiatric Rehabilitation Association Conference 25th Annual Meeting Sept 16-17, 2010

  2. “To know where we are going, my dear Watson, it is rather important that we remember where we have been.”A Quote I wish Sherlock Holmes had said.

  3. HOW MOPRA BEGAN: 1974-1982 • MOPRA Beginnings: Deinstitutionalization of Missouri state hospitals and the vision of community support services for state hospital patients. • Conflict of the deinstitutionalization mission with the mission, values and goals of the CMHC movement and the “workaround ” strategy—State Hospital Community Placement. • The partnerships of the Community Support Programs with state hospital community placement programs. • The Pioneering Gang of Five: (Cheung, Graue, Hawley, Melise, Van Sant). • Special connection of the CSPs with evolving advocacy organizations for people with serious mental illness—NAMI, State advisory councils, and the consumer movement • Beginnings of consumer empowerment and the clubhouse tradition.

  4. CREATION OF MOASPRS AND GROWTH OF THE CSP MOVEEMNT: 1982-1987 • The Community Support Network becomes the “Missouri Association of Psychosocial Rehabilitation Services” (MOAPSRS)--Chinese Hakka word for ‘Americans sure create stupid acronyms!’. • MOASPRS annual meetings begin: focused on best practice in community program design, building alliances with the state and developing peer support services. • MOASPRS consisted of 10 freestanding CSPs and a few PSR programs within CMHCs who embraced the deinstitutionalization movement.

  5. THE ERA OF MEDICAID CONVERSION: 1987-1994 • The state’s fear of cost overruns if Medicaid reimbursement is allowed for specialty mental health, Addiction and DD programs. • Development of CPRC and other Medicaid programs for DMH consumers. • Opposition of CMHCs to the loss of fund flexibility for their multipurpose mission. • The potential for conflict between MOASPRS and CMHCs--overlapping missions and dilution of the “Administrative Agent” role. • The diminished role of community placement programs in the state hospitals. • The uneasy alliance between CMHCs and “affiliated community support programs”.

  6. EXPANSIONIST ERA: 1994-2001 • Rapid growth of CSP/CPRC Services statewide. • Era of economic plenty for State and Nation. • The threat of risk-based, capitated managed care Medicaid carveouts for BH services. • Diversification of the MOAPSRS membership base and the potential loss of the pioneer spirit.

  7. HOLDING THE GAINS: 2002-2010 • The economic downturn in the first half of the decade: Risk to established programs. • The growth of “systems management”. • The shifting state-provider relationships. • Continued erosion of the CSP pioneer partnership perspective; and • Evolution of the era of state-to-provider program monitoring.

  8. THE FUTURE?: 2010-2020 • Severe economic downturn—possible “sea change” in state and national macro-economics? • The new deinstitutionalization movement? • The Olmstead Mandate • Affordability of psychiatric institutions without disproportionate share funding • National Healthcare reform: • What is the benefit? Does it include specialty MH services? Will Parity save us? • Who administers the plans? • What will happen to the ABD population? • Other New Frontiers?: • Supported living models—the DD influence? • Employment? • Consumer self-directed or peer supported services? • High Risk patient management: Health care homes for high risk consumers?

  9. MOPRA’S CALL TO ACTION? • Analyzing the environments: • Is America in a fundamental economic sea change? How would that affect MOPRA? • If the second wave of deinstitutionalization is real, how is MOPRA situated to take advantage? • What are the implications of National Health Care Reform for MOPRA? • Is Managed care still a risk? If so, how does MOPRA respond? • The interface of Physical and Behavioral Health? • Are there still new Frontiers? Does MOPRA still have pioneers? • Revisiting MOPRA’s uniqueness: strengths and weaknesses. • Renewing the state-MOPRA sense of partnership? • The engaged consumer? • Technology?

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