Recovery oriented systems of care and peer led services
“The culture of recovery in American has deep historical roots, is growing daily, and is becoming even more heterogeneous. The „recovery community‟ today is made up of diverse individual and groups who, while differing in their views on how best to initiate and sustain sobriety, speak with a united voice about the hope for permanent recovery from addiction.” W.L White. Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
Recovery-oriented Systems of Care and Peer-led Services Catherine McAlpine, Ph.D., LCSW-C Manager, Behavioral Health and Crisis Services 401 Hungerford Drive, Rockville, MD 20850 Catherine.email@example.com
We Face Multiple Challenges• Reaching those in need of services• Providing adequate resources• Developing culturally- appropriate, evidence-based interventions• Building and sustaining a qualified workforce• Integrating substance use disorder 3 services into the public health paradigm
Workshop Objectives• Understand the local, State and federal efforts to support people in recovery beyond providing treatment.• Learn the new language of recovery management as we shift to focus on long-term support for a chronic disease over brief support during acute episodes.• Learn about the growing role for Peer Leaders in recovery support and how Maryland is moving toward credentialing Peer Mentors and Peer Support Specialists.
Trends in Attitudes & Social PolicyOld Think … New Think …• Punishment • Aid & understanding• Legal consequences • Treatment/care• Blame – moral failing • Victim of disease• Choice or lifestyle • Brain circuits &• Hitting bottom compulsion• Self-starting, being ready • Motivation enhancement• Abstinence • External sanctions• Behavior • Harm reduction• 12 Steps • Social or Role functioning
Standard Treatment• Medical Model of Care (1st 3 tasks of treatment)• Patient receives treatment• Limited family or community intervention• No change in work or home environment• Patient responsible for building peer group• Recovery is to be immediate (in all areas)• Punishment for relapse, little empathy• Limited support for stress of change itself• Limited attention to grief and loss issues
What is Recovery?• Recover (ri-kūv‟ar), v.: 1) to regain, get back; 2) to regain or return to an original condition.
Vision Statement from SAMHSA• A Life in the Community for Everyone.• Prevention Works.• Treatment is Effective.• People Recover.
CSAT’s Public Health Approach• Population-based• Comprehensive and holistic• Incorporates early intervention, treatment, recovery support, and health promotion• Works across systems and professions• Involves people in recovery, the community, the public and private sectors• Evidence-based 9
Enhancing the Continuum of Care to Provide Recovery-Oriented ApproachPreventio Intervention Treatment Post-Treatment nAcross the Screening, Brief Menu of Services Continuing CareLifespan Intervention, Referral to Individualized & Recovery SupportCommunity, Treatment Strength-based Care ServicesIndividual, &Family Early Intervention Evidence-based Follow-upFocused Communication Pre-treatment Client-InformedEvidence-based Evidence-based decision-making Self-MonitoringRecovery Recovery Support Recovery Support Early Re-interventionIndividual & Services ServicesCommunity Recovering Individual,Involvement Recovery Individual & Family Member, Ally Family Member and Community• Involvement Involvement A full continuum should be made available through coordination with multiple systems.• Individuals should have access to a full continuum of care regardless of the system they enter or the community in which they live. 10
From Yahara House Recovery: A Working Definition– Recovery is a process, not a place.– It is about recovering what was lost: rights, roles, responsibilities, decisions, potential and support, and discovering new potentials in life, and possibilities for growth– It is about rekindling hope for a productive present and a rewarding future, and believing that one deserves it!– Recovery involves people having vision of the life they want to live, seeing and changing patterns, discovering symptoms can be managed and doing it, finding new ways and reasons, doing more of what works and less of what doesn‟t.– Recovery is about getting there.
Recovery is …• Grounded in resilience• Supported by a foundation of hope• An ongoing, dynamic, interactive process• An interplay of a person‟s strengths and vulnerabilities• A personal journey• Continuous, even when symptoms recur
Recovery-oriented System of Care (ROSC)• Includes a wide spectrum of services• Supports all stages and pathways of recovery• Addresses access to services• Includes treatment, alternatives to treatment, and recovery support services• Coordinates multiple services• Building bridges, strengthening communities and promoting public health
A Recovery Oriented System of Care is …• Person centered• Family and other ally involvement• Individualized and comprehensive services across the lifespan• Anchored in the community• Continuity of care
Basic to ROSC Are …• System-wide education and training• Ongoing monitoring and outreach• Outcomes driven• Research based• Adequately and flexibly financed
Core Concepts of ROSC are …• Partnership-consultant relationships• Strength-based• Culturally responsive• Responsive to personal belief systems
Developing ROSC requires …• Commitment to peer recovery support services• Inclusion of voices and experiences of recovering individuals and families• Integrated services
Recovery System Medical Dental Public Transportation Mental Health Family Therapy Community Support Self-Help Groups Social/Recreation Internet Building Life Skills EvaluationDSS/DJS Treatment SystemHousing/Supportive Legaland Independent JudgesLiving Outpatient Treatment Lawyers Parole/Probation Residential Programs Vocational Educational Faith Organizations Senior/Child Day Care Employment
What changes move us toward ROSC?• Intervene earlier• Improve treatment outcomes• Support sustained recovery
Community Integration is Organic• Recognize that people recover in communities, not in programs.• Focus on services that support life in the community.• Locate services/supports in the community, not in a tx program or institution.• Support what exists in the natural community, don‟t re-created in the system.• Focus government on strengthening communities, families and individuals.
One Theory is a Hierarchy of NeedsConsider the transition from active addiction as a lifestyle change. Similar to other health needs.Mainstream social and psychological supports meet individual needs for :• Safety and survival• Basic needs for food, clothing & shelter• Affection, interpersonal comfort & contact• Sense of belonging, group affiliation• Self-efficacy
Social Forces Support Change• Successful recovery often includes: – connections to family – stable sober housing – employment – follow-up on healthcare & nutrition – extended course of treatment The longer people participate in a treatment regimen, the more likely they are to remain abstinent and achieve a sustained recovery. This has been verified via case study and research data.
Our Challenge• How must treatment programs change to become more recovery- friendly? – Shifting from an acute care model to a chronic care model – Shifting from a sole focus on remission of symptoms to a focus on wellness – Shifting from abstinence-only to managing relapse and understanding harm reduction – Adopting principles from Prevention – universal, targeted & individual interventions
Concepts of RM• Pathology model has low rates of compliance while increasing stigma.• Natural recovery happens and is a process we can learn from.• Effective treatment combined with self- management and peer support conveys a message hope, wellness & on-going care.• Treatment is more effective using proven practices and principles that get results.
Risk and Resilience ModelWhat resources are not yet in place for this person and what needs to be done to establish or cultivate them?For example Faith Treatment & Work or rehab school Community Life Peer Social support support Phys. Health Housing Family
Stages of Recovery• Pre-recovery• Initial Stabilization• Recovery Maintenance• Quality of Life Enhancements – Build individual & community recovery capital. These are informal connections as well as Recovery Support Services.
Exercise• Think about a recent or significant change in your life. – How were you feeling? – What coping skills did you use? – Did you seek out support? Where? – Who helped you most?• Now think of one word to fill in the blank: – I ___________________ change
Everyone can …• Remove personal and environmental barriers to recovery.• Facilitate participation in the recovery community.• Enhance the quality of life of the person in recovery.
Recovery Partners Montgomery• Partners • Strategic Plan – Wells/Robertson House – ADAA Learning – Maryland Treatment Collaborative centers, Inc. – Change Leadership Team – Alcohol and Drug Abuse – Stigma reduction (stories) Administration – Recovery Community – Avery House for Women Center Activities – Journey to Self • The Front Porch Understanding • Peer-led groups – Adult Behavioral Health • Peer-led education – Outpatient Addiction and • Book Clubs/Story-telling Mental Health Services – Youth Drop-in Center – On Our Own of Maryland – Peer Leadership Institute • Recovery Coach Academy • PLI Manual & Training
International Consortium ofReciprocal Certification (ICRC)
Connecticut Community for Addiction Recovery (CCAR)• Recovery Coach Academy• Recovery Community Centers• Telephone Outreach• Employment Curriculum• Recovery Walk & Other Events (Stigma)• How to start a recovery House• http://www.ccar.us/
PRO-ACT http://www.councilsepa.org/programs/pro-act/• PRO-ACT is a grassroots advocacy and recovery support initiative of The Council covering Southeastern Pennsylvania. PRO-ACT works to reduce the stigma of addiction, ensure the availability of adequate treatment and recovery support services, and to influence public opinion and policy regarding the value of recovery.• PRO-ACT is developing, educating and mobilizing a constituency of Ambassadors for Recovery – those in recovery, their family members and friends, professionals working in the field, and others with a special interest in and knowledge of recovery. We have over 400 volunteers in the five county area.• Our one-to-one recovery support services and trainings occur primarily in our Recovery Community Centers. Our special programs and events are driven by Volunteer Committees.• PRO-ACT supports all pathways to recovery and embraces the Recovery- Oriented System of Care. Recovery-oriented systems support person- centered and self-directed approaches to care that build on the strengths and resilience of individuals, families, and communities to take responsibility for their sustained health, wellness and recovery from alcohol and drug problems.
Change Leadership Begins Here• Treatment is often focused on the individual.• Treatment outcomes improve with use of evidence based-practice.• The #1 practice? Rapport, relationship.• ROSC is systemic and focused on the whole.
Resources• www.nrepp.samhsa.gov National Registry of Evidence-based Programs/ Practices – National Clearinghouse on Alcohol and Drug Information• ADAA http://adaa.dhmh.maryland.gov/SitePages/Home.aspx for information on ROSC in Maryland & ATR Grant• http://www.niatx.net for improving business practices• www.glattc.org click on Recovery Management Resources. The Great Lakes ATTC Network has many ROSC and training resources, including articles & mongraphs.• www.ibr.tcu.edu/resources/rc-trtprocess.html Institute for Behavioral Research• http://partnersforrecovery.samhsa.gov/docs/Summit-Report.pdf Summit Report• http://www.williamwhitepapers.com/papers/ William White is a prolific writer on this subject.• www.facesandvoicesofrecovery.com• http://pfr.samhsa.gov click on Recovery, then Resources. Information about the national movement• http://rcsp.samhsa.gov Recovery Community Services Program on CSATS website• www.ct.gov/dmhas/site.default.asp Connecticuts Practice Guidelines for Recovery-Oriented Behavioral Health Care booklet can be accessed on this site• www.bhrm.org Behavioral Health Recovery Management