Building a community of recovery se2012iii

517 views
420 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
517
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
12
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 1. Insert map regarding numbers served in outpatient or penetration rate of outpatient 2. Include counts for numbers served by outpatient
  • Just like the line in the road to guide how you drive we identified guides in creating recovery oriented systems, New Freedom Commission, SAMHSA, and……
  • Focusing in on transformation as it impacts on Systems, Data and Practices with respect to the outcomes that evidence Recovery Competence and Transformation Goals, Decision Making, Recovery Principles and Staff Behavior. Tools for change
  • As we have progressed in our transformative process the influence of our partnerships, i.e., NIATx, WRAP, Leadership Development etc. becomes aligned coordinated and integrated into the operational fabric of the DBH/MRS.
  • ACE/Hurford
  • How to Evaluate Where Your System Is In Transformation What is Your Role in Your System at Home
  • The Recovery Movement has helped a lot of people with behavioral health issues see that there is a possibility for a better life. However, sometimes other people in recovery or even professionals may put pressure on a person to experience their recovery in a certain way. It’s important that while you have experienced recovery in your own life, how another person experiences that or what they want for their life may still be very different than what you have chosen in your life. A good supportive peer specialist will help that person find what’s important to them rather than try to pressure them into being a certain way. We all have a different path in recovery. That is what makes it such an exciting and unique experience. As administrators and people who are concerned with the quality of the services we are funding, we are very aware that some of the outcomes we can demand of providers can inadvertently put pressure on people in recovery to be a certain way. So, we have to be really careful to listen to people in recovery and have them involved in developing what standards providers should be held to. As a peer specialist, you also have an opportunity to encourage other people in recovery to step forward and be a part of that process either by sitting on advisory boards and filling out surveys that determine if services are meeting their needs.
  • See your activities and value beyond a discrete (while important) program. Peer-Based service providers can and should make systems better because of their broader involvement. We need you to help with the broader agenda of recovery, because discrete programs in the end will not be enough, nor will they be sustainable without a systemic approach
  • I would like to leave you with this final thought. I like this quote from Jimmy Carter (read quote). We are in the business of helping people grow in their recovery. What we do is important. Let us do it to the fullest of our abilities.
  • Building a community of recovery se2012iii

    1. 1. BUILDING COMMUNITIES OF RECOVERY: PHILADELPHIA DBHIDS - OAS 1
    2. 2. Welcome to Philadelphia A City ofInnovation •We hold these truths to be self- evident, that all are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Recovery. COMMUNITY BEHAVIORAL HEALTH received the 1999 Innovations in American Government Award,presented by the Ford Foundation and the John F. Kennedy School of Government at Harvard University. Philadelphia’s School of the Future DBHIDS - OAS 2
    3. 3. We will stand as a people with a shared pastand a shared destiny declaring to all: “If we canheal, you can heal. If we and our families canheal, then neighborhoods and communitiescan heal. And if communities can heal, thenthe wounds of our country and the world canalso heal.”William WhiteAuthor, Slaying the Dragon: The History ofAddiction Treatment and Recovery in America DBHIDS - OAS 3
    4. 4. DBHIDS - OAS 4
    5. 5. Agenda Concept •The need to transformVision & Values •The future of the past and the present •What is important to consider •People in recovery & FamiliesHigh Performing •ProvidersCollaborations & Partnerships •Stakeholders •Systems •Identifying the different communities Assertive Community •Inclusion of all in the community Linkages •Community assests DBHIDS - OAS 5
    6. 6. Agenda Practice •Evidence Based Practice Focused •Practice validating evidence Interventions •Addressing disparities in care •Diversity acknowledging •Trauma informed •Behaviorally integratedIntegrated Health •Healthcare integrated Care •Recovery integrated Context Recovery •At every level organizationally Champions •At every level professionally •At every level politically •At every level financially DBHIDS - OAS 6
    7. 7. Historically, Philadelphia hasbeen a good system of care
    8. 8. Historically A Treatment RichEnvironment
    9. 9. Treatment Services (2004)In a city of what was then 1.4 mil: Detoxification (14 facilities /240 beds) Hospital-Based Residential Rehabilitation (4 facilities / 20 beds) Non-Hospital Residential Rehabilitation (62 facilities / 2058 beds) Halfway House (4 facilities / 92 beds) Outpatient – Drug Free (76/ 8,000 slots approx) Methadone (11 Providers / 4400 slots approx) Intensive Outpatient (50 facilities /5,648 slots approx ) .
    10. 10. Despite Our Richness, Approaching Problems
    11. 11. Philadelphia Census Data1,470,150 population (year 2004 update)53.8 % female47.0 % White41.7 % Black / African-American 4.4 % Asian 5.0 % Other Race 1.5 % Two or more races 7.3 % Hispanic or Latino origin (any race)Families below poverty level - 2000 = 18.4 %Families below poverty level – 2004 = 24.2%Sources: U.S. Census Bureau DBHIDS - OAS 11 2004 American Community
    12. 12. Prevalence survey: dependence or abuse in the past year, age 12 and older 2004 -2005- Philadelphia Pennsylvania Total US 2006Samhsa/OAS/ NSDUH Illicit Drug 3.39 2.56 2.91Dep/Abuse Past Year Alcohol 7.77 7.13 7.79Dep/Abuse Past Year illicit drug or 9.78 8.52 9.24 alcoholdependence or abuse DBHIDS - Ofc. of Addiction Svcs. 12
    13. 13. Mortality with thePresence of Drugs1970 to 2006 1153 904 158 129 Source: Philadelphia Medical Examiner’s Office 13
    14. 14. Addiction Services
    15. 15. Rational For TransformationThe systemprovides access ondemand, butmovement throughthe continuum isfragmented.Treatment thoughimproved, still doesnot adequatelyaddress long termrecovery needs. Recidivism within 60 days of Office of Addiction discharge in detox and residential Services DBHIDS - OAS
    16. 16. A Rational For TransformationThose seeking care are culturally and experientially diverse and thechallenge they present are not sustainable in our traditional systems of care DBHIDS - OAS 16
    17. 17. Rational For TransformationThe cost of not managing from a recovery perspective isunsustainable. For example the Co-Occurring are:32% of the Numbers But 65% of the Dollars DBHIDS - OAS 17
    18. 18. Rational For Transformation Office of Addiction Services DBHIDS - OAS
    19. 19. Rational For Transformation Office of Addiction Services
    20. 20. Rational For TransformationPhila. Prison System (FY 2005: 9000/5800) Office of Addiction Services
    21. 21. Stigma Driven CareIn our traditionalsystems of carewe seek to cure,rehabilitate, ridpeople of theirproblems as wehave assessedthem. DBHIDS - OAS 21
    22. 22. Impact of StigmaDBHIDS - OAS 22
    23. 23. We hold these truths to be self-evident, that all are createdequal,Perception vs. Reality Fix the client and send But estranged from them home recovery supports DBHIDS - OAS 23
    24. 24. DBHIDS - OAS 24
    25. 25. Surviving AddictionThe traditionalumbrella of servicesand supports thatare our systems ofcare are oftenfragmented andinaccessible.In many ways whenwe are seen to bebroken we cease tobe seen as a person DBHIDS - OAS 25
    26. 26. Traditional systems of care are like bridges constructed with the bridge upDisconnectsbetween:long term recovery &treatmentindividual/family &professionalcommunity & careself help & service DBHIDS - OAS 26
    27. 27. THE STRUGGLE 22 million need treatment 3 million get it TO USE OR NOT TO USEDBHIDS - OAS 27
    28. 28. The Struggle (Rethinking our use of resources) Spending in an Acute Care Model DBHIDS - OAS
    29. 29. Responding to warning signs Disconnects Between Community Based Supports & Professional Treatment >Stigma Driven Deficit Based Care > High Rates Of Recidivism > The Effectiveness Of Treatment Questioned > Cultures Of Helping vs. Serving
    30. 30. •The goal for individuals with substance use disorders is long-termrecovery from addiction, getting their lives back on track, improving theirhealth, wellness and quality of life.•Systems that support recovery-based care provide individuals receivingcare with a variety of services and options tailored to their specific needsto aid them in their process.•Multiple systems are engaged in coordination with traditional drug andalcohol treatment services. Some of these complementary servicesinclude education, housing, child care, financial planning, employmentassistance, health care and legal assistance.•The person seeking help’s family and support network are also engagedin these various systems, frequently in the decision-making process.•Public policies are also in place to assist—not hinder—individualsseeking jobs, housing and education once they are no longer usingalcohol or drugs. DBHIDS - OAS 30
    31. 31. Values of Recovery-Oriented MentalHealth and Addictions SystemsThe values of recovery-oriented mental health andaddiction systems are based on the recognitionthat each person must either lead or be the centralparticipant in his or her own recovery. All servicesneed to be organized to support the developmentalstages of this recovery process. Person-centeredservices that offer choice, honor each person’spotential for growth, focus on a person’s strengths,and attend to the overall health and wellness of aperson with mental illness and/or addiction play acentral role in a recovery-oriented system of care.These values can operate in all services for peoplein recovery from mental illness and/or addiction,regardless of the service type (i.e., treatment, peersupport, family education). DBHIDS - OAS 31
    32. 32. (White, Boyle, & Loveland, 2002).The drive to transform addiction treatment into arecovery oriented system of care includes substantialchanges in clinical practices, including:•assertive approaches to early problem identification and engagement,•streamlined access,•global, continual, and strength-based assessment protocol,•a broadened multidisciplinary team that includes a primary care physician and peer-basedrecovery support specialists,•integration of evidence-based and culturally indigenous therapies,•greater use of home- and neighborhood-based services,•assertive linkage to communities of recovery and other indigenous recovery support resources,•sustained post-treatment monitoring, support, and, when needed, early re-intervention, and•a shift in focus from managing and evaluating self-encapsulated service episodes tomanagement and evaluation of the long-term recovery process 32
    33. 33. ChameleonsChange
    34. 34. What It Means To TransformFrom the New Life represented inthe Egg, to the growth of theCaterpillar, to the Transformationwithin the Chrysalis, to the rebirththat is the Butterfly we appreciatelittle of the process if we don’tunderstand the relationship eachstage has to the next and owesto those before it.System Transformation requiresthat we appreciate each stageregardless how slow, painful andunpredictable, trusting that theend product is the foundation fora Community of Recovery.
    35. 35. System TransformationKey steps in Philadelphia’s addiction treatment system transformation effortsinclude:•establishment of a Recovery Advisory Committee,•articulation of a clear vision ( create an integrated behavioral health care systemfor the citizens of Philadelphia that promotes long-term recovery, resiliency, self-determination, and a meaningful life in the community ),•identification of core values that would drive the system transformation process(hope; choice; empowerment; peer culture, support, and leadership; partnership;community inclusion/opportunities; spirituality; family inclusion and leadership; anda holistic/wellness approach),•a shift in the relationships between service practitioners and service consumersand between DBHIDS and its local service providers from authority-basedrelationships to relationships based on mutual respect and collaboration,•a highly participatory planning process that established a system transformationblueprint,•the use of training and technical assistance to orient people at all levels of thesystem to the recovery-focused transformation process, and•evaluation and ongoing refinement of funding and regulatory policies to eliminateobstacles to system transformation and reward innovation in service design.36 DBHIDS - OAS
    36. 36. PHASE ONE Major Focus – Conceptual Alignment• Development of Philadelphia Recovery Definition• Guiding Values and Principles Identified by RAC• Numerous Conferences• Prevention and Day Transformation RFIs• Recovery Foundations Training• First Fridays Series• Transformation Documents
    37. 37. Voices of People in RecoveryHow Do You Understand Recovery?•To overcome, have a new life•Setting life goals, education, gym, learning todrive•Achieving independence from the system•Living a normal life•Finding people and groups that support me
    38. 38. Voices of People in RecoveryWhat would help in your recovery?•More Respect•It seems that the system is all about money anddx, not the person – we could change this•Opportunities to give back•Providers who see that my problems are only apart of me•Peer led support groups, and staff who are peoplein recovery and who know the community•Different kinds of groups that fit different people
    39. 39. Voices of People in RecoveryWhat would help in your recovery?•Increased focus on spirituality•Increased family involvement in my recovery•Need administrators to understand what it’s reallylike to be us…what the people at the top see assuccess is not what we see as success…•I want my life back….
    40. 40. Recovery Asset Baseline Assessment Objectives:•Identification of existing strengths•Measurement of baseline recovery orientation•Development of new channels of feedbackbetween community at large and DBH/MRS•Providing agency specific feedback for theirindividual development.
    41. 41. Recovery Asset Baseline Assessment: Challenges 1. Are top system leaders really invested in the transformation? 2. Will creativity/risk taking be rewarded or punished? 3. Is there an inherent conflict between the system transformation vision and managed care priorities? 4. Will communication open up to flow both ways and will input from those outside DBH/MRS be taken seriously? 5. Will providers create meaningful leadership roles for people in recovery?
    42. 42. Recovery Asset Baseline Assessment: Challenges1. Will the barriers that prevent people from moving into, within and out of the system be removed?2. Will disparities in location and availability of services be addressed?3. Will there be creative ways to fund additional training, technical assistance and increased salaries for direct care workers?4. Will the monitoring/credentialing/care management functions line up with the recovery vision?
    43. 43. Recovery Asset Baseline Assessment: Findings--Strengths•The system is ready for change.•There is already evidence of increasedtransparency and partnering in decision making.•Individual agencies are already developingrecovery oriented services and appreciateincreased opportunities to share successes withtransformation.•Increased interest in and movement towardincluding people in recovery as active members ofteams in planning and directing services.•Enthusiastic community of people in recovery whowant to support the transformation
    44. 44. Aligning our Concepts:The First Philadelphia Recovery Definition Recovery is the process of pursuing a fulfilling and contributing life regardless of thedifficulties one has faced. It involves not only the restoration but continued enhancement of a positive identity and personally meaningful connections and roles in ones community. Recovery is facilitated by relationships andenvironments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members. Philadelphia Recovery Advisory Committee
    45. 45. Philly Approach to ROSCRecovery As An Umbrella Concept
    46. 46. Recovery is the Umbrella under whicheverything fitsShedding thebifurcation ofRecovery andTreatmentSupporting theEmpowerment ofthose in Recoveryto direct recoveryand treatmentservices
    47. 47. Recovery PerspectivesRecovery refers to the waysin which persons with orimpacted by a mental illnessand/or addiction experienceactively manage thedisorders and their residualeffects in the process ofreclaiming full, meaningfullives in the community.■ Recovery-oriented care iswhat psychiatric andaddiction treatment andrehabilitation practitionersoffer in support of theperson’s own long-termrecovery efforts.Recovery as an Organizing Principle forIntegrating Mental Health and AddictionServices; Larry Davidson PhD YaleUniversity DBHIDS - OAS 48
    48. 48. Guiding Values and PrinciplesHope: People canand do recover.Change is alwayspossible, and theextent of change isoften beyond what wecan imagine. Hope isnurtured by seeingand hearing othersliving meaningful livesin recovery and givingback to their familiesand communities.
    49. 49. Guiding Values and Principles Choice: Each person’s opinions, wants, needs and individual recovery pathway are respected and elevated above all other considerations. Services are individualized and built around the person rather than fitting the person to a “program.” . There is recognition by all parties in the system that there are many pathways and styles of recovery and that clients have a right to choose a personal pathways and style of recovery.
    50. 50. Guiding Values and PrinciplesS elf-direction/empowerment:People in recovery lead theirpersonal path of recovery.They do this by optimizingautonomy and exercisingindependence and choice. Theindividual identifies personallife goals and in collaborationwith others, directs his or herrecovery by designing a uniquepath towards those goals.People have the opportunity tochoose from a range of optionsand to participate in alldecisions that affect their lives.
    51. 51. Guiding Values and PrinciplesPeer culture/Peersupport:There is recognition of thepower of peer support withincommunities of recovery asreflecting in, : 1) hiring personsin recovery into Certified PeerSpecialists and other positions,2) assuring representation ofpeople in recovery at all levelsof the system
    52. 52. Peer culture/Peersupport cont:3) forging collaborativerelationships betweentreatment institutions and theservice structures of localrecovery mutual aid societies,4) assertively linking peopleto peer based recoverysupport services (i.e. mutualself help groups, informal peersupport etc.), and 5)acknowledging the roleexperiential learning within acommunity of recovery canplay in initiating and sustaininga recovery process.
    53. 53. Guiding Values and Principles Consumer Leadership: People in recovery have active leadership roles at all levels of the system.
    54. 54. Guiding Values and Principles Partnership: Relationships of all parties within the behavioral health care system are based on mutual respect; service designs shift from an expert model to a partnership/consultation model where everyone’s perspective, experience and expertise is welcomed and considered.
    55. 55. Guiding Values and PrinciplesCommunityintegration/opportunities: Thefocus is on nestingrecovery in the person’snatural environment,integrating theindividuals/families inrecovery into the largerlife of the community,tapping the support andhospitality of the largercommunity, developing
    56. 56. Guiding Values and PrinciplesSpirituality: Beliefin the “God of one’sown choosing” is seenas a potentiallyvaluable resource forrecovery support andis respected as achosen component ofan individual’srecovery supportsystem. There isrespect for explicitlyreligious, spiritual andsecular pathways ofrecovery.
    57. 57. Understanding SupportsFetzer Institute, National Institute on Aging Working Group (1999). Multidimensional measurement ofreligiousness/spirituality for use in health research. A report of a national working group supported bythe Fetzer institute in collaboration with the national institute on aging Kalamazoo, MI: Fetzer Institute.Religiousness has specific Spirituality is concerned with thebehavioral, social, doctrinal, transcendent, addressing ultimateand denominational questions about life’s meaning, with thecharacteristics because it assumption that there is more to life thaninvolves a system of worship what we see or fully understand. (…)and doctrine that is shared While religions aim to foster and nourishwithin a group. the spiritual life–and spirituality is often a salient aspect of religious participation–it is possible to adopt the outward forms of religious worship and doctrine without having a strong relationship to the transcendent.
    58. 58. Guiding Values and Principles Family inclusion: Family members are actively engaged and involved at all levels of the service process. Families are seen as an integral part of the team of support with their input valued and respected.
    59. 59. Guiding Values and Principles Holistic and wellness approach: Services are designed to enhance the development of the whole person; care transcends a narrow focus on symptom reduction and promotes wellness as a key component of all treatment and support services.
    60. 60. Challenge Significantly improving long-term recoveryoutcomes will require a radical reengineering ofaddiction treatment as a system of care. Ratherthan system refinement, they are advocating a“fundamental shift in thinking”, a “paradigm shift”, a“fundamental redesign”, “a seismic shift rather thana mere tinkering”, and a “sea change in the cultureof addiction service delivery”.Bill White ATTC Draft
    61. 61. Questions? Need More Information?The Tools for Transformation Series are resource packets produced by the DBH/MRS toprovide tools and a greater understanding of key recovery concepts for persons inrecovery, family members, service providers and DBH/MRS staff as part of thePhiladelphia DBH/MRS Recovery Transformation.Each packet focuses on a system transformation priority identified as important bynumerous stakeholders. www.Philly.NetworkOfCare.Org Roland Lamb Philadelphia Department of Behavioral Health Intellectual disAbility Services Roland.lamb@phila.gov 1101 Market Street Philadelphia, PA 19107 Copyright 2009 62
    62. 62. The Tools for Transformation SeriesEach packet focuses on a system transformation priority identified asimportant by numerous stakeholders.Peer Culture/Peer Leadership/Peer Support Tools of Transformation isthe first in this series of resource packets. Peer culture and peer leadership isa pivotal force in advancing the development of a recovery-oriented system ofcare.Community Integration Tools for Transformation is the second in thisseries of resource packets. Connection to community is viewed as integral inlong-term recovery.Extended Recovery Support Tools for Transformation is the third in thisseries of resource packets. Extended Recovery Support includes connectionswith peer-based recovery support groups, recovery conducive educational,vocational and residential settings and recovery support from family andfriends.Person First Assessment/Person Directed Planning is the fourth in thisseries of resource packets. The concepts of assessment and planning havebeen artificially separated by behavioral health systems. Because assessmentand planning are an interlocking process they are presented here together.
    63. 63. William. W; Evans, A.; Ali, S.; Achara-Abrahams, I; & King, J. (2009)The Recovery Revolution: Will it Include Children, Adolescents,and Transition Age Youth? White, W. (2009), Long-TermStrategies to Reduce the Stigma Attached to Addiction,Treatment, and Recovery within the City of Philadelphia (WithParticular Reference to Medication-Assisted Treatment/Recovery ).McLaulin, J. Bryce, Evans, A.C, & White, W. L. (2009). The Role of AddictionMedicine in the Transformation of an Urban Behavioral Health Care System.The Net Consumer Council, Evans, A.C., Lamb, R.C., Mendelovich, S.,Schultz, C.J. & White, W.L. (2007). The Role of Clients in a Recovery-Oriented System of Addiction Treatment: The Birth and Evolution of the NETConsumer Council. Lamb, R., Evans, A.C, & White, W. (2009). The Role ofPartnership in Recovery-Oriented Systems of Care: The PhiladelphiaExperience. White, W., Schwartz, J. & The Philadelphia Clinical SupervisionWorkgroup (2007). The Role of Clinical Supervision in Recovery-OrientedSystems of Behavioral Healthcare. Johnson, R., Martin, N., Sheahan, T., Way,F. & White, W. (2009) Recovery Resource Mapping: Results of a PhiladelphiaRecovery Home Survey.White, W., The Recovery-Focused Transformation ofan Urban Behavioral Health Care System. (Interview with Arthur C. Evans,Ph.D.). White, W., Ethical Guidelines for the Delivery of Peer-Based RecoverySupport Services, White, W., Recovery Revolution in Philadelphia.White, W.(2006), Sponsor, Recovery Coach, Addiction Counselor: The Importance ofRole Clarity and Role Integrity.Haberle, B., White, W. (2007) Gender-SpecificRecovery Support Services: Evolution of The Womens Recovery CommunityCenter.
    64. 64. What’s Your Direction?There are many paths to getting there.
    65. 65. The Philadelphia Recovery OrientedSystem of Care1. Promotes Community Integration and Builds Recovery Capital in the Community2. Facilitates a Culture of Peer Support and Leadership and Family Inclusion3. Values Partnership and Transparency4. Provides Individualized, Holistic, Person Directed Treatment5. Driven by Outcome Data, Evidence Based Practices and the Experiences of People in Recovery6. Creates Mechanisms for Sustained Support (Evans, 2009) DBHIDS - OAS 66
    66. 66. Understanding the Process ADVANCING THE TRANSFORMATION:PRACTICE & CONTEXT
    67. 67. PHASE TWOMajor Focus – Practice + ContextualAlignmentIdentification of Priority areas through therecovery assessment process and theRAC•Community inclusion/opportunity•Holistic Care•Peer culture/peer support/peer leadership•Family inclusion and leadership•Partnership•Extended recovery support•Quality of care
    68. 68. Phase II:Implement initial practice priorities, reorient DBHIDS practices, identify areas in need of regulatory relief, increase leadership of people in recovery, increase community support
    69. 69. PHASE TWODBH/MRS Internal Practice Alignment • Alignment, Coordination and Integration of Insured, un/underinsured services • Unit Recovery Plans • Reconfigure existing services (e.g. Day transformation, addictions services..) • Hiring of people in recovery and family members as consultants • Systems Relationships • Internal Restructuring/ Internal Accountability
    70. 70. PHASE TWOAligning practices with a recovery orientation will impact the following domains: • Service Engagement • Service Access • Recovering Person’s Role • Service Relationship • Assessment and Clinical Care • Locus of Service Delivery • Post Treatment Checkups and Supports • Relationship to Community
    71. 71. PHASE TWOIn order to support practice alignment in the provider community, DBH/MRS will: • Provide Advanced Recovery Trainings • Offer Train the Trainers Trainings • Distribute Resource Packets • Support Demonstration Projects • Offer Site Based Technical Assistance • Host Community forums • Enhance organizational capacity through the development of change management teams • Provide incentives for innovation and alignment
    72. 72. Philly Recovery Walk 2011 15,000
    73. 73. PHASE TWODBH/MRS Context Alignment • Strengthening Partnerships with sister agencies, DHS, prisons, schools, etc.. • Developing new partnerships with organizations that provide vocational, educational and housing services • Active Partnership and advocacy with OMHSAS on day transformation • Advocacy with our SSA regarding co-occurring services • Developing financing mechanisms for peer specialists in D&A programs • Identification of additional areas of regulatory relief needed to support the advancement of our priorities
    74. 74. PHASE TWODBH/MRS Context AlignmentAnti Stigma Media CampaignIncreased Community Education (e.g. faith based Initiative)Collaborative relationships with Political LeadersStronger connections between formal and informal treatment supportsIncreased collaboration between physical and behavioral health
    75. 75. Are Recovery Oriented Systems Driving DBHIDS - OAS 77
    76. 76. The focus of outcomes center on:
    77. 77. System Transformation Problem SolvingProcess
    78. 78. At every stage there is much work,much fun and it is never easy,
    79. 79. Integration Of TransformationPhase III:Use evaluation data to modify priorities,enhance recovery oriented practices atDBH/MRS and providers based on lessonslearned, develop models of recovery orientedpractices, obtain broader community support,increase advocacy based on successes withinthe system and identified barriers, introducePractice GuidelinesPhase IV:Utilize the feedback cycle and evaluation datato continue enhancing the system, focus ondeveloping a data driven system of care
    80. 80. Philadelphia’s Recovery Definition 2010Recovery is the process of pursuing a fulfilling andcontributing life regardless of the difficulties one has faced. Itinvolves not only the restoration but continued enhancementof a positive identity and personally meaningful connectionsand roles in ones community. Recovery is facilitated byrelationships and environments that provide hope,empowerment, choices and opportunities that promote peoplereaching their full potential as individuals and communitymembers. Do we only recognize the State of Recovery or dowe acknowledge the struggle of those to overcome thechallenges of people, places, and things that ultimately lead tothe neurobiological condition we call addiction. Is there a placebefore the State of Recovery that we outreach engage andenlist for recovery?Preamble to Philadelphia’s 2010 Practice Guidelines DBHIDS - OAS 83
    81. 81. Integration Of TransformationPhase III:Use evaluation data to modify priorities,enhance recovery oriented practices atDBH/MRS and providers based on lessonslearned, develop models of recovery orientedpractices, obtain broader community support,increase advocacy based on successes withinthe system and identified barriers, introducePractice GuidelinesPhase IV:Utilize the feedback cycle and evaluation datato continue enhancing the system, focus ondeveloping a data driven system of care
    82. 82. Philadelphia’s Recovery Definition 2010Recovery is the process of pursuing a fulfilling andcontributing life regardless of the difficulties one has faced. Itinvolves not only the restoration but continued enhancementof a positive identity and personally meaningful connectionsand roles in ones community. Recovery is facilitated byrelationships and environments that provide hope,empowerment, choices and opportunities that promote peoplereaching their full potential as individuals and communitymembers. Do we only recognize the State of Recovery or dowe acknowledge the struggle of those to overcome thechallenges of people, places, and things that ultimately lead tothe neurobiological condition we call addiction. Is there a placebefore the State of Recovery that we outreach engage andenlist for recovery?Preamble to Philadelphia’s 2010 Practice Guidelines DBHIDS - OAS 87
    83. 83. DBHIDS - OAS 88
    84. 84. Giving Context to PracticePractice Guidelines: 10 Core Values, 7 Goals across 4Domains The practices outlined in this document are intended to guide providers as they strive to implement services and supports that promote recovery and resilience. It is clear that this document does not yet totally represent the system as it is but sets a vision and clear direction for practice in the system that is emerging and will continue to evolve. This document serves as the foundation document for the development of other guidelines that are more specific in terms of level of care requirements, credentialing etc. In order for these practices to become fully integrated into the system, however, there will need to be significant changes in the fiscal, policy, regulatory, and community contexts. As a result, while this document focuses on practices that need to occur in service and support settings, two additional documents will be developed which will detail the changes that will need to occur in other settings
    85. 85. DBHIDS - OAS 90
    86. 86. Domain 1: Assertive Outreach & InitialEngagement:How we support Providers and in turn how theysupport Assertively Outreaching, Engaging &Retaining those in need and seeking treatment byEnsuring that providers are Outreaching to those inneed.Ensuring providers are Engaging those seekingtreatment.Ensuring providers have in place practices central toretaining them in treatment and sustaining recovery.Ensuring providers are assisting those in care intheir communities and them as to how theycontributes to community health.
    87. 87. Domain 2: Screening, Assessment,Service Planning & DeliveryEnsuring providers are conducting: 1. Screening/Identification of people at risk, or who are in the early stages of a behavioral health challenge 2. Assessments of the Whole Person process leading to an exploration of the full breadth of a person’s life situation as well as clinical, developmental, and health challenges,
    88. 88. Domain 3: CONTINUING SUPPORT AND EARLYRE-INTERVENTIONHow do we support providers practicingContinuing support and early re-intervention as critical components ofbehavioral healthcare.Ensuring providers have a diverse array ofstrategies designed to provide continuing supportspanning very different types of assistance,provided by professionals, peers, and community-based allies.
    89. 89. Domain 4: Community Connection andMobilization:How do we support provider’s Executive AndAdministrative Strategies For Creating A CultureThat Supports Community ConnectionsEnsuring providers are committed to supportingpeople in moving beyond their problems andchallenges to developing a full and meaningful life inthe community.Ensuring providers recognize they can and musthave strong connections to the communities inwhich they are located.
    90. 90. Philadelphia Description 1,526,006 Population (2010) 53.2 % Female 43.4 % Black only 41.0 % White only 6.3 % Asian only 6.5 % Other Race only 2.8 % Two or more races 12.3 % Hispanic ethnicity (any race) ----------------------------------------- 11.4 % of adults in Philadelphia are in recovery (n = approximately 128,300). ----------------------------------------- Philadelphia Density = 9,999.9 per square mile (Pennsylvania density = 283.4 per square mile) ----------------------------------------- Philadelphia “in facility” prison census: adults = 7,750, juveniles = 53 (as of August 23, 2011)SOURCES: U.S Census Bureau, American Community Survey; PublicHealth Management Corporation – Community Health Data Base;Philadelphia Prison System DBHIDS - Ofc. of Addiction Svcs.
    91. 91. Prevalence survey: dependence or abuse in thepast year, age 12 and older SAMHSA, Philadelphia Pennsylvania Total U.S. NSDUH - 2006, 2007, 2008 combined illicit drug 3.27 % 2.27 % 2.82 % dependence or (n=42,440) abuse alcohol 6.71 % 6.32 % 7.53 % dependence or (n=87,087) abuse illicit drug or 8.88 % 7.64 % 9.07 % alcohol (n=115,251) dependence or abuse DBHIDS - Ofc. of Addiction Svcs. Source: SAMHSA, NSDUH - 2006, 2007, 2008 combined
    92. 92. Prevalence survey: dependence or abuse in the past year, age 12 and older 2004 -2005-2006 SAMHSA, NSDUH - 2006, Samhsa/OAS/NSDUH 2007, 2008 combined Phila. PA Total US Phila. PA Total U.S. illicit 3.39 2.56 2.91 illicit 3.27 % 2.27 % 2.82 % drug drugdepende depende nce or nce or abuse abuse alcohol 7.77 7.13 7.79 alcohol 6.71 % 6.32 % 7.53 %depende depende nce or nce or abuse abuse illicit 9.78 8.52 9.24 illicit 8.88 % 7.64 % 9.07 % drug or drug or alcohol alcoholdepende depende nce or nce or abuse abuse DBHIDS - Ofc. of Addiction Svcs. 97
    93. 93. Number of deaths with the presence of any drug and number of cases withat least one illicit drug detected,** in Philadelphia: 2004 to 2010% w/illicits 45.3 61.7 65.5 58.5 52.6 47.945.2 ‘04 ‘05 ‘06 ‘07 ‘08** Illicit ‘09 drugs include ‘10 cocaine, heroin, PCP, methamphetamine, MDA, and MDMA. SOURCE: Philadelphia Medical Examiner’s Office DBHIDS - Ofc. of Addiction Svcs.
    94. 94. Number of deaths with the presence of any drug in Philadelphia: 2004 to 2010 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10 SOURCE: Philadelphia Medical Examiner’s Office DBHIDS - Ofc. of Addiction Svcs.
    95. 95. DBHIDS - OAS 100
    96. 96. Rebuilding the Draw BridgeReconnecting:Long TermRecovery &TreatmentIndividual/Family &ProfessionalRelationshipsCommunity &AgencySelf Help & ClinicalServices
    97. 97. Questions? Need More Information?The Tools for Transformation Series are resource packets produced by the DBH/MRS toprovide tools and a greater understanding of key recovery concepts for persons inrecovery, family members, service providers and DBH/MRS staff as part of thePhiladelphia DBH/MRS Recovery Transformation.Each packet focuses on a system transformation priority identified as important bynumerous stakeholders. www.Philly.NetworkOfCare.Org Roland Lamb Philadelphia Department of Behavioral Health Intellectual disAbility Services Roland.lamb@phila.gov 1101 Market Street Philadelphia, PA 19107 Copyright 2009 102
    98. 98. The Tools for Transformation SeriesThe Tools for Transformation Series are resource packets produced by theDBH/MRS to provide tools and a greater understanding of key recoveryconcepts for persons in recovery, family members, service providers andDBH/MRS staff as part of the Philadelphia DBH/MRS RecoveryTransformation.Each packet focuses on a system transformation priority identified asimportant by numerous stakeholders.Peer Culture/Peer Leadership/Peer Support Tools of Transformation isthe first in this series of resource packets. Peer culture and peer leadership isa pivotal force in advancing the development of a recovery-oriented system ofcare.Community Integration Tools for Transformation is the second in thisseries of resource packets. Connection to community is viewed as integral inlong-term recovery.Extended Recovery Support Tools for Transformation is the third in thisseries of resource packets. Extended Recovery Support includes connectionswith peer-based recovery support groups, recovery conducive educational,vocational and residential settings and recovery support from family andfriends.Person First Assessment/Person Directed Planning is the fourth in thisseries of resource packets. The concepts of assessment and planning havebeen artificially separated by behavioral health systems. Because assessmentand planning are an interlocking process they are presented here together.
    99. 99. William. W; Evans, A.; Ali, S.; Achara-Abrahams, I; & King, J. (2009)The Recovery Revolution: Will it Include Children, Adolescents,and Transition Age Youth? White, W. (2009), Long-TermStrategies to Reduce the Stigma Attached to Addiction,Treatment, and Recovery within the City of Philadelphia (WithParticular Reference to Medication-Assisted Treatment/Recovery ).McLaulin, J. Bryce, Evans, A.C, & White, W. L. (2009). The Role of AddictionMedicine in the Transformation of an Urban Behavioral Health Care System.The Net Consumer Council, Evans, A.C., Lamb, R.C., Mendelovich, S.,Schultz, C.J. & White, W.L. (2007). The Role of Clients in a Recovery-Oriented System of Addiction Treatment: The Birth and Evolution of the NETConsumer Council. Lamb, R., Evans, A.C, & White, W. (2009). The Role ofPartnership in Recovery-Oriented Systems of Care: The PhiladelphiaExperience. White, W., Schwartz, J. & The Philadelphia Clinical SupervisionWorkgroup (2007). The Role of Clinical Supervision in Recovery-OrientedSystems of Behavioral Healthcare. Johnson, R., Martin, N., Sheahan, T., Way,F. & White, W. (2009) Recovery Resource Mapping: Results of a PhiladelphiaRecovery Home Survey.White, W., The Recovery-Focused Transformation ofan Urban Behavioral Health Care System. (Interview with Arthur C. Evans,Ph.D.). White, W., Ethical Guidelines for the Delivery of Peer-Based RecoverySupport Services, White, W., Recovery Revolution in Philadelphia.White, W.(2006), Sponsor, Recovery Coach, Addiction Counselor: The Importance ofRole Clarity and Role Integrity.Haberle, B., White, W. (2007) Gender-SpecificRecovery Support Services: Evolution of The Womens Recovery CommunityCenter.
    100. 100. Respect, Change and Lowering the Drawbridge
    101. 101. People Build Bridges DBHIDS - OAS 106
    102. 102. Take Every Opportunity To Celebrate
    103. 103. Philly Recovery Walk 2010: 11,000
    104. 104. Philly Recovery Walk 2011: 15,000
    105. 105. The History of Our PartnershipsThe Partnering of Partnering to Align a The Office ofLeadership Arthur C. Concept of Recovery Addiction ServicesEvans PhD Reaching out to People In Recovery and their Families, (OAS)Appointed Director of then A Single Point of accountability Advocates (PRO-ACT) Providers,Office of Behavioral Health and for all Addiction/Recovery through the Child and FamilyMental Retardation Services. He services and their development Task Force, Recovery Advisorybrings a message of recovery within the County Authority. The Committee, andand system transformation. OAS includes: Conferences:Hosting a series of meetings in 1.The Single County Authority 1.MH Conference (Mike Hogan)the community 2.Behavioral Health Special 2.Mayor’s Blue Ribbon Children’sCreating the Department of Initiative ConferenceBehavioral Health and Mental 3.D&A Case Management 3.Behavioral Health RecoveryRetardation Services, pushing 4.Data Management Management Conference (Billforward the partnership of the 5.Provider Development and White)County Authorities for Mental TransformationHealth, Addiction and Intellectualdisability and becoming theCommissioner of the Departmentof Behavioral Health andIntellectual disABILITY Services. PARTNERING TIMELINE
    106. 106. The History of Our PartnershipPartnering with the Partnering Around Partnering to ResolveCommunity & The Message issues of mutualProviders importance •Story Telling •Day Program Transformation DBH/Provider1.2005 Co-occurring programsRFP Conference Work-Groups •Certified Peer Specialist Kickoff2.2006Day Program •Health Disparities (King Davis) •A partnership with Providers toTransformation •Faith Based Conference address strategic planning,3.Peer Specialist •Asian Conference Length Of Stay/Authorization4.OAS Work groups •Latino Conference and documentation concerns.5.Issued RFP’s focused on •Psychiatrist Conference •Resulting in enhancedbuilding community coalitions •A new Day Recovery communication betweenacross Philadelphia Celebration Conference providers and the OAS6.Mini-Grants supporting •Recovery & Resilience in Action about policy and procedurerecovery activities Conference7.Facilities Improvement Grant •Mother and Father care Giver8.Mural Arts Program (Porch ConferenceLight Initiative) PARTNERING TIMELINE
    107. 107. The History of Our PartnershipPartnering to System Partnering toSpread the Transformation EnhanceMessage Document: Knowledge and1.Detroit Study Tour2.Hong Kong Delegation Blue Print for Change Performance3.Maryland Study Tours •Spelling out the direction, roles 1.Partnering with Aaron Beck4.New York Delegation and responsibility of our system Institute/University of5.United Kingdom Study transformation efforts. Born out Pennsylvania to bring CognitiveTours of our partnership with those in Behavioral Therapy to provider6.IRETA/ATTC recovery, providers and system network7.System Transformation stakeholders 2.NIATx /University of Wisconsintools DBHIDS and Bill White to develop managementdocuments approaches in provider network 3.Community College around : 1. First Fridays: Information for people in recovery from people in recovery. 2. College Recovery TV program PARTNERING TIMELINE
    108. 108. The History of Our PartnershipsPartnering with PA The release of the TransformationRecovery Organization – Philadelphia and BeyondAchieving Community Behavioral HealthTogether (PRO-ACT) to Servicesbuild TransformationThe Philadelphia Practice GuidelinesRecovery Community for Recovery andCenter (PRCC) Resilience-orientedA partnership with PRO-ACT beginningwith a road trip including DBHIDS staff Treatment in April of to visit the Recovery Centers in 2011.Connecticut, assembling a visionaryteam of people in recovery, and theeventual opening (December 2007) ofPhiladelphia’s first Recovery Center forpeople in recovery run by people inrecovery PARTNERING TIMELINE
    109. 109. Process of PartneringInitiate a collaborative planning process that includesadvocates, people in recovery, family members representativesfrom the provider system, funding systems, and key/supportivecommunity/government leaders.Go to the people and make it easy for them to come to youLeverage information from other systems and programs, don’treinvent the wheelBegin asset mapping of natural community resources (faithcommunities, school systems, recreation centers, etc…)Holistic, global assessmentsIdentification of natural supports & creating a network/menu of supportsRecovery Education, Awareness, & Celebration
    110. 110. Provider Staff who serve them City, State and Federal People in Stakeholders recovery and their families Community supports High Performing Collaborations & PartnershipsThe Philadelphia Experience Department of Behavioral Health Intellectual disABILITY Services
    111. 111. Be Inclusive of those in recovery and their families•Value the experience of those in recovery.•Respect their culture of recovery whatever it may be•Treat all family members of those in recovery, theircommunity as partners.•Reach out to other system/institutional stakeholdersinvested in those you serve.•Offer to help those in recovery direct their recovery.•Be responsible with property and belongings. DBHIDS - OAS 116
    112. 112. Traditional vs Recovery Oriented view of Peer ParticipationTRADITIONAL RECOVERY ORIENTEDPeers seen as an adjunct Peers seen by leaders as critical to the success of the systemRole of Peers defined by and Role is critical element of a system that createslimited to 12-step programs options and provides appropriate supportEthical Issues viewed through Ethical issues are raised purely within the workthe lens of the treatment of the peersprofessionalPeers separate from the Treatment Professionals and peers partner fortreatment process the good of those seeking recoveryAnonymity Promoted (hallmark) Putting a face on recovery DBHIDS - OAS
    113. 113. Knowing Where Your System is Re: TransformationStage of Readiness Activities of the Recoveryfor Transformation Community Motivate system leaders to initiatePre- changeContemplative Help shape the change process. EnsureContemplative that Peer Support Services are an integral part of the plan Propose Peer Support Services andAction advocate for support. Help design services that meet system needs Thank God you are in a ProgressiveSustain Change system!
    114. 114. What is required in order for aperson to have access to effectivetreatments and supports thatfacilitate living working, learning, andfull community integrations? A Service Delivery System that is embedded in the larger social context. DBHIDS - OAS 120
    115. 115. Principles of Recovery1. Person-driven;2. Occurs via many pathways;3. Is holistic;4. Is supported by peers;5. Is supported through relationships;6. Is culturally-based and influenced;7. Is supported by addressing trauma;8. Involves individual, family, and community strengths and responsibility;9. Is based on respect; and10. Emerges from hope.
    116. 116. Encouraging Citizens of Recovery to: Participate in recovery focused training Read on recovery topics, research and practice topics Volunteer to participate in on-going work groups Host opportunities for people in recovery to share their stories with agency staff and others Participate in Community Forums Request a system transformation presentation from the Speakers Bureau Share your successes, struggles and concerns so that we may learn from one another
    117. 117. Philly DBHIDS believes thatcollaboration and partnerships make usstrong….African Caribbean Task Force
    118. 118. and helps us to build bridges intothe communityDBHIDS Faith & Spiritual Affairs Advisory Board
    119. 119. ….while informing our work with thecommunity-at-large at all levels MuralArts: Bridging the Gap
    120. 120. creating ways in which to reducestigmaMural Arts: Personal Renaissance
    121. 121. and offering hope to people, familiesand communities who may have lost itMural Arts: Recovery & Transformation
    122. 122. The 4th Domain in the PhiladelphiaBehavioral Health ServicesTransformation Practice Guidelines forRecovery & Resilience OrientedTreatment states that we must……create an atmosphere thatpromotes strength, recovery andresilience through strongpartnerships while…building inclusive, collaborativeservice teams and processes
    123. 123. Partnerships and collaborationsequal Transformation… We can make it work…together!
    124. 124. Building Pathways The Role of PeersWhat do peers bring that is unique:• Wisdom – been there and know the path• Compassion – emotional support• Approachability – don’t look at people from a clinical perspective but rather as people like themselves• Flexibility to people’s needs – sometimes provision•Potential disadvantages:• Ethical issues – drawing the lines• Knowing the limits of abilities• Landscape changing without recognizing it DBHIDS - OAS
    125. 125. What is peer support?• Peer support is social and/or emotional support (frequently coupled with material support)- provided by persons who have psychiatric and addiction challenges to others who have similar conditions. The goal is to bring about a desired social or personal change.• Peer support  were once generally thought of as being provided through both one-to-one connections and self-help groups.• Self-help groups are defined as voluntary small group structures for mutual aid in the accomplishment of a specific purpose. Generally, these groups are formed by peers who get together to satisfy a specific need, overcome a specific problem, and/or bring about personal or social change..
    126. 126. What are peer-delivered services? However, there is an expanded definition of peer support, whichincludes one-to-one counseling (peer-to-peer), and peer-run orpeer-operated services (including residential and vocationalprogramming).Peer-delivered services are services provided by individuals whoidentify themselves as having mental illnesses, are receiving orhave received mental health services for their mental illnesses,and deliver services for the primary purpose of helping otherswith mental illnesses.Peer-delivered services may also include partnering with non-peers, but peers still maintain control of the service. These maybe called peer-partnership services.Peer-run or -operated services are services that are planned,operated, managed by people with psychiatric disorders.•Examples of peer-run services are drop-in centers, crisisservices, and employment services.Peer employees are individuals who identify as peers and arehired by non-peer agencies, e.g., community mental healthcenters. Peers may be hired into designated peer positions ortraditional clinical positions.Peers serve as case managers, outreach workers, and mobile
    127. 127. Type of Social Support and Associated PeerRecovery Support ServicesType of Support Description Peer Support Service ExamplesEmotional Demonstrate empathy, Peer mentoring caring, or concern to bolster Peer-led support groups person’s self-esteem and confidence.Informational Share knowledge and Parenting class information and/or provide life Job readiness training or vocational skills training. Wellness seminarInstrumental Provide concrete assistance Child care to help others accomplish Transportation tasks. Help accessing community health and social servicesAffiliational Facilitate contacts with other people to promote learning of Recovery centers social and recreational skills, Sports league participation create community, and Alcohol- and drug-free acquire a sense of belonging. socialization opportunities
    128. 128. Philadelphia’s Peer Initiative•Joint work with the Mental Health Peer organization• Developing a “behavioral health” peer specialist model, pilottraining 100 across system for now•Putting a Face on Recovery•Telephonic Aftercare•Medicaid reimbursement•Credentialing peer run providers•All funding decisions for new programs includedetermining if a program is committed to peer work•Evolving roles within the DBHIDS•Implementing Bill White’s 16 Principles of RecoveryManagement DBHIDS - OAS
    129. 129. Roles are defined by who?Sometimes therole ismisunderstoodby the peer, theemployer, aswell as thosereceivingservices DBHIDS - OAS 135
    130. 130. Peers As Prosumers vs. ProfessionalsFrom the work of Bill White As Peers in the context of a Recovery Oriented System of Care their role is not to be the: 1.Professional Clinician 2.Default disciplinarian 3.Savior DBHIDS - OAS 136
    131. 131. Peers of All Shapes and Sizes
    132. 132. Rationale P-BRSS in the addictions arena arebased on the following propositions:• Helpers derive significant therapeutic benefit from theprocess of assisting others(the “helper principle”) (Reisman, 1965, 1990; recoveryslogan: “To get it, you have to give it away.”).•People who have overcome adversity can developspecial sensitivities and skills in helping othersexperiencing the same adversity--a “wounded healer”tradition that has deep historical roots in religious andmoral reformation movements and is the foundation ofmodern mutual aid movements. DBHIDS - OAS 138
    133. 133. • The inadequacy of acute care models of treatment for people with high problem severity and complexity is evident in low engagement rates, high attrition rates during treatment, low aftercare participation, and high re-admission rates.6• Persons with high personal vulnerability (family history, low age of onset of use, traumatic victimization), AOD problem severity and complexity (co-morbidity) and low “recovery capital”7 do not fare well in acute models of intervention but can achieve recovery when provided sustained support. (P-BRSS constitute an essential element within new models of sustained recovery management) (White,• Boyle and Loveland, 2002, 2003).8 DBHIDS - OAS 139
    134. 134. • Many addicted people benefit from a personal “guide” whofacilitatesdisengagement from the culture of addiction and engagement in aculture ofrecovery (White, 1996).• Peer-based recovery support relationships that are natural,reciprocal, andenduring are not mutually exclusive of, but qualitatively superior to,relationshipsthat are hierarchical, commercialized and transient.• P-BRSS are an attempt to re-link treatment and recovery (Else,1999; White,2000b), to move the locus of treatment from the treatment institutioninto thenatural environment of those seeking treatment services (White,2002a), and tofacilitate the shift from toxic drug dependencies to “prodependenceon peers”(Nealon-Woods, et al, 1995). DBHIDS - OAS 140
    135. 135. P-BRSS services are congruent with research findings that:• Addiction recovery begins prior to the cessation of drug use; ismarked in its earliest stages by extreme ambivalence; is sustainedlong after the period of initial stabilization of sobriety; involvesdifferent types of age-, gender-, and culture-mediatedchange processes; and is often marked by predictable stages ofchange.• The achievement of stable recovery is determined, in part, byrecovery capital that can be enriched through support services.• Factors that sustain recovery are different than those that initiaterecovery.• Push factors (pain) and pull factors (hope) both play a role in therecovery process; P-BRSS have a direct effect on the latter.. DBHIDS - OAS 141
    136. 136. How Peer Recovery Support Solves Problems with the System:Increase AccessIncrease Retention and EngagementIncrease Effectiveness: peers are great recoveryguidesIncrease support options DBHIDS - OAS
    137. 137. What System Administrators Wantfrom Peer Recovery SupportProvidersSolve system problemsPartner on the Bigger PictureUnderstanding of the issues and AdvocacyDiversity and Outreach to underservedgroups DBHIDS - OAS
    138. 138. RESOURCES SUPPORTING RECOVERY MEDICALLYA C O N . MANAGED s TI TX N U D U TE M MEDICALLY ,O SIS F AS MONITORED R EC ED O V AT ER IC Y TRANSITIONAL EDM INTENSIVE OUTPATIENT & OUTPATIENT SELF HELP / COMMUNITY FOCUSED RECOVERY
    139. 139. Recovery Begets Recovery
    140. 140. A view from an administratorCharacteristics of good PeerRecovery Support Providers:Pursue Funding for sustainabilityPush the envelope/be creativeServices based on volunteerism or if paid, themoney does not corrupt the essence of peerbased serviceLearn the issues in the fieldPut a face on recoveryMeasure outcomes and demonstrateeffectivenessTie into the broader agenda to increase relevanceand collaboration DBHIDS - OAS
    141. 141. Refocusing on RecoveryKey to this model of care is the evolution of a system ofspecialized community-based programs.As envisioned these programs would not be providers per se,but rather offer an environment that offer citizens theopportunity to articulate their problems and contemplate whatpossible steps might be taken to address these problems.These community centers would be an enduring presence inthe lives of the individuals, serving as an entry point foraccessing the system of care and as a point of return whentreatment was completed.Long-term outreach and follow up would be expected of thecommunity centers as well as ongoing contact during atreatment experience.
    142. 142. What is a RecoveryCommunity Center (RCC)?An RCC is a “recovery-oriented sanctuaryanchored in the heart of the community. Itexists to:1.put a face on addiction recovery;2.build “recovery capital” in individuals,families and communities;3.serve as a physical location where[Addiction Services and PRO-ACT] canorganize the local recovery community’sability to care”; and4.help individuals who relapse back intotreatment and recovery supports. From "Core Elements of a Recovery Community Center", CCAR 2006 DBHIDS - OAS
    143. 143. DBHIDS - OAS 150
    144. 144. DBHIDS - OAS 151
    145. 145. Philadelphia Recovery PerspectiveRecovery is the process of pursuing a fulfillingand contributing life regardless of the difficultiesone has faced. It involves not only therestoration but continued enhancement of apositive identity and personally meaningfulconnections and roles in ones community.Recovery is facilitated by relationships andenvironments that provide hope, empowerment,choices and opportunities that promote peoplereaching their full potential as individuals andcommunity members. Do we only recognize theState of Recovery or do we acknowledge thestruggle of those to overcome the challenges ofpeople, places, and things that ultimately lead tothe neurobiological condition we call addiction. Isthere a place before the State of Recovery thatwe outreach engage and enlist for recovery?Preamble to Philadelphia’s Practice Guidelines DBHIDS - OAS 152
    146. 146. Survey: Ten Percent of American AdultsReport Being in Recovery from SubstanceAbuse or AddictionBy Josie Feliz | March 6, 2012 Data Show More Than 23 Million Adults Living in U.S. Once Had Drug or Alcohol Problems, But No Longer Do New York, NY, March, 6 2012 – Survey data released today by The Partnership at Drugfree.org and The New York State Office of Alcoholism and Substance Abuse Services (OASAS) show that 10 percent of all American adults, ages 18 and older, consider themselves to be in recovery from drug or alcohol abuse problems. These nationally representative findings indicate that there are 23.5 million American adults who are overcoming an involvement with drugs or alcohol that they once considered to be problematic. DBHIDS - OAS 153
    147. 147. “I have one life and one chance to make itcount for something….My faith demands…that I do whatever I can, wherever I am,whenever I can, for as long as I can withwhatever I have to try to make a difference.” -Jimmy Carter
    148. 148. Transformation is trusting notknowing what it will look like only thatwe are seeking to make it better.
    149. 149. “I have one life and one chance to make it count for something….My faith demands…that I dowhatever I can, wherever I am, whenever I can, for as long as I can with whatever I have to try tomake a difference.” -Jimmy Carter One Day At A Time
    150. 150. The Tools for Transformation SeriesPeer Culture/Peer Leadership/Peer Support Tools of Transformation isthe first in this series of resource packets. Peer culture and peer leadership isa pivotal force in advancing the development of a recovery-oriented system ofcare.Community Integration Tools for Transformation is the second in thisseries of resource packets. Connection to community is viewed as integral inlong-term recovery.Extended Recovery Support Tools for Transformation is the third in thisseries of resource packets. Extended Recovery Support includes connectionswith peer-based recovery support groups, recovery conducive educational,vocational and residential settings and recovery support from family andfriends.Person First Assessment/Person Directed Planning is the fourth in thisseries of resource packets. The concepts of assessment and planning havebeen artificially separated by behavioral health systems. Because assessmentand planning are an interlocking process they are presented here together.
    151. 151. William. W; Evans, A.; Ali, S.; Achara-Abrahams, I; & King, J. (2009)The Recovery Revolution: Will it Include Children, Adolescents,and Transition Age Youth? White, W. (2009), Long-TermStrategies to Reduce the Stigma Attached to Addiction,Treatment, and Recovery within the City of Philadelphia (WithParticular Reference to Medication-Assisted Treatment/Recovery ).McLaulin, J. Bryce, Evans, A.C, & White, W. L. (2009). The Role of AddictionMedicine in the Transformation of an Urban Behavioral Health Care System.The Net Consumer Council, Evans, A.C., Lamb, R.C., Mendelovich, S.,Schultz, C.J. & White, W.L. (2007). The Role of Clients in a Recovery-Oriented System of Addiction Treatment: The Birth and Evolution of the NETConsumer Council. Lamb, R., Evans, A.C, & White, W. (2009). The Role ofPartnership in Recovery-Oriented Systems of Care: The PhiladelphiaExperience. White, W., Schwartz, J. & The Philadelphia Clinical SupervisionWorkgroup (2007). The Role of Clinical Supervision in Recovery-OrientedSystems of Behavioral Healthcare. Johnson, R., Martin, N., Sheahan, T., Way,F. & White, W. (2009) Recovery Resource Mapping: Results of a PhiladelphiaRecovery Home Survey.White, W., The Recovery-Focused Transformation ofan Urban Behavioral Health Care System. (Interview with Arthur C. Evans,Ph.D.). White, W., Ethical Guidelines for the Delivery of Peer-Based RecoverySupport Services, White, W., Recovery Revolution in Philadelphia.White, W.(2006), Sponsor, Recovery Coach, Addiction Counselor: The Importance ofRole Clarity and Role Integrity.Haberle, B., White, W. (2007) Gender-SpecificRecovery Support Services: Evolution of The Womens Recovery CommunityCenter.
    152. 152. Questions? Need More Information?The Tools for Transformation Series are resource packets produced by the DBH/MRS toprovide tools and a greater understanding of key recovery concepts for persons inrecovery, family members, service providers and DBH/MRS staff as part of thePhiladelphia DBH/MRS Recovery Transformation.Each packet focuses on a system transformation priority identified as important bynumerous stakeholders. www.Philly.NetworkOfCare.Org Roland Lamb Philadelphia Department of Behavioral Health Intellectual disAbility Services Roland.lamb@phila.gov 1101 Market Street Philadelphia, PA 19107 Copyright 2009 159

    ×