Pleiades Project – Completed February of 2021

Generous funding provided by:  Doree Taylor Charitable Foundation, Maine Health Access Foundation and The Bingham Program

Concept

The Pleiades Project began as a series of discussions among behavioral health providers, trainers and researchers.  The participants grew to represent a broad range of individuals with interest in the state of substance use disorder treatment in Maine.  The Alliance for Addiction and Mental Health Services, Maine agreed to host the groups work in designing a better approach to treatment.  The Maine Health Access Foundation funded a planning grant to develop a new model and the Pleiades Project was born.

The participants divided into a Working Group which met twice a month and a Steering Committee which met once a month.  The process involved the Work Group and Steering Committee reviewing the current state of treatment in Maine, identifying the parts of an effective model, reviewing and selecting those parts and creating a model that incorporated all the needed components.

The theory behind Pleiades is that a successful model would include a comprehensive assessment which includes an assessment of all of the support needs an individual may have as well as recovery capital.  The model uses a case manager to ensure that in addition to treatment that is evidence based, all support 8needs are adequately addressed and a strong connection is made with the recovery community and its services.

Multiple resources were reviewed including Evidence Based Practices, National Outcome Measures and research on recovery along with many data collection instruments.  The model is based on proven strategies that are combined into a comprehensive approach that is individualized and uses existing data collection instruments.

Pleiades Project Implementation

The Pleiades model of care is designed to replicate the strengths inherent in the unassisted recovery process (sometimes called natural recovery, spontaneous remission or solo recovery), focusing on three dynamics of self-correction that are evident throughout the literature on unassisted recovery: less severity (which clinically translates into stabilization, sufficient social/recovery capital to support the change, and “personal agency”, the mental capacity to spark and maintain behavioral change.

The model also allowed for a distribution of clinical tasks across a three-person care team: stabilization supported by a case manager, enhanced personal agency, supported by a counselor/therapist, and strengthening recovery capital, supported by a peer specialist or recovery coach). This involved hiring additional staff for several of the participating agencies and clarifying staff roles.

The model was tested in a pilot spanning one year for each site.  Four behavioral health agencies were selected as pilot sites:   AMHC is a large, comprehensive behavioral health organization which serves the most rural areas of Maine-Aroostook, Hancock and Washington counties.  It has significant partnerships with local health centers in it catchment area and those centers will partner with AMHC in this pilot.   Day One is a behavioral health organization in southern Maine specializing in services to adolescents.  Day One serves clients statewide and has close relationships with many schools and their health centers as well as the juvenile justice center at Long Creek, one of Maine’s two juvenile incarceration centers managed by Maine State government.   Crossroads is also located in southern Maine and specializes in services to women with underage children.  Crossroads serves clients statewide and is the only organization of its kind in Maine.  Wellspring is located in Bangor (central Maine) and serves clients statewide.  Specializing in services to adults, Wellspring provides, residential, sober housing and outpatient services in a variety of settings.  These four agencies represent a broad range of geographical, specialty populations, size and collaborative relationships with other health, education and support service organizations around the state.

In each agency one clinician was initially trained in the model and additional staff were trained as the pilot went on.  Approximately one half of the clinician’s caseload received services as identified in the comprehensive assessment as well as treatment services using appropriate Evidence Based Practices.  Each agency employed one case manager with an expertise in substance use disorders. The case manager was responsible for connecting each client in the pilot with the needed services identified in the initial assessment.  The case manager also followed up to assure that the client received the needed services as well as assuring the connection with the recovery coach.  The three person teams, clinician, case manager and recovery coach, were trained in the model’s approach and had access to regular coaching calls to discuss progress, challenges, etc.

Evaluation, Data and Outcomes:

• The overall evaluation was to be measured by client outcomes as articulated in the regularly reported NOMs. It was expected that Project participants’ outcomes would be analyzed against a similar group of treatment-as-usual (TAU) clients.
• Additionally, a more thorough measurement of change was to be measured by administering the Bangor Area Recovery Network (BARN) recovery assessment to all Project participants on a monthly basis along with a similar group of TAU clients. The NOMs provided data that was largely demographic while it was mostly the Barn and the Recovery Capital tools that were used for the qualitative analysis.

The outcomes of our activities showed improvement in all measured categories.  The reports from the teams involved indicated that agencies and team members were able to develop and adopt interactive protocols that proved beneficial to the clients and the teams.  There was significant reporting by the agency teams that having the ability to focus on multiple aspects of the treatment process, i.e., having a case manager to address critical living situations, a peer recovery specialist to assist in developing necessary sustainability skills and contacts, and a counselor to focus on building “change-ability” enhanced the treatment process and improved outcomes.

• Overall, the addition of the case manager and recovery coach was seen as a significant improvement in the ability of agencies to provide comprehensive services at the appropriate level to clients.
• Team based care really works.  Agencies uniformly experienced working in the team of clinician, case manager and recovery coach as a better way to provide services.  Communication was improved, collaboration with other providers was improved.  Team members had more flexibility due to the grant funded nature of the project.  Being liberated from the fee for service model allowed staff to reach out in more creative ways. 

Full Evaluation report available here, Project Pleiades Evaluation Report 2-5-21

Sustainability and Policy Influence:

The need for sustainability following any successful project is always important and a challenge.  One of the reasons we implemented the Pleiades pilot was to have data to encourage more permanent funding sources to support the model ongoing.  To that end we are arranging meetings with state funding sources, such as the Department of Health and Human Services and the Office of Innovation and the Future’s Opioid Response Initiative to discuss ongoing funding for the Model, especially through MaineCare, the state’s Medicaid program.  Additionally we will explore the inclusion of the Pleiades Model in the grant programs in both offices for clients who are not eligible for the MaineCare program.

The outcomes of the project are immediately useful to support upcoming Substance Use Disorder (SUD) treatment policy. We plan to use our outcomes to encourage Maine State leaders to support funding case management for ALL SUD clients under MaineCare. 

• Our work will specifically support Maine House Representative Madigan’s bill LD360 to To Reduce Barriers to Recovery from Addiction by Expanding Eligibility for Targeted Case Management Services. 
• We also plan to use the outcomes from our model to support Agencies working toward creating more client centered approaches and establishing some of the first Certified Community Behavioral Health Clinics (CCBHCs) in Maine. CCBHCs provide a comprehensive collection of services needed to create access, stabilize people in crisis and provide the necessary treatment for those with the most serious, complex mental illnesses and substance use disorders. CCBHCs integrate additional services to ensure an approach to health care that emphasizes recovery, wellness, trauma informed care and physical-behavioral health integration.

Project Leadership Team:

Evaluator: Turnaround  Achievement Network, Peter Gamache, PhD MBA, MLA, MPH,

Principal Investigator: Steven Gumbley, MA, LCDP

Project Coordinator: Lynn Duby, M.S.W

Project Manager, Jennifer Christian, Alliance for Addiction and Mental Health Services

For more information: please contact: Jennifer Christian:  jchristian@masap.org