4-3-14 rosc definition webinar v2 (1) · 4/3/2014 · 4/2/14 1 defining recovery-oriented systems...
TRANSCRIPT
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DEFINING RECOVERY-ORIENTED SYSTEMS OF CARE (ROSC)
Presented by Cherie A. Hunter Executive Director, Hunter Communications Group, Inc.
April 3, 2014
Download the PowerPoint slides & access CE quiz here:
www.naadac.org/definingrecovery-orientedsystemsofcarerosc
A presenta*on by the NAADAC, the Associa*on for Addic*on Professionals
Misti Storie, MS, NCC
WEBINAR ORGANIZER
Director of Training & Professional Development
NAADAC, the Associa3on for Addic3on Professionals
USING GOTOWEBINAR
• Control Panel
• Asking Ques:ons
• PowerPoint Slides
• Polling Ques:ons
• Audio (phone preferred)
www.naadac.org/definingrecovery-‐orientedsystemsofcarerosc
A presenta*on by NAADAC, the Associa*on for Addic*on Professionals
A COMPONENT OF THE RECOVERY TO PRACTICE (RTP) INITIATIVE
www.naadac.org/recovery
OBTAINING CE CREDIT
o The educa3on delivered in this webinar is FREE to all professionals.
o 1.5 CEs are FREE to NAADAC members who aJend this webinar. Non-‐members of NAADAC receive 1.5 CEs for $20.
o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)
www.naadac.org/definingrecovery-‐orientedsystemsofcarerosc
www.naadac.org/webinars
A CE cer3ficate will be emailed to you within 21 days of submiZng the quiz and payment (if applicable) – usually sooner.
o Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.
Free to NAADAC Members!
4/2/14
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WEBINAR LEARNING OBJECTIVES
o Define ROSC; its principles, values, characteris3cs, and implica3ons for services
o Understand the importance of role clarity: The addic3on counselor within a ROSC
o Understand the role of clinical supervision
o Iden3fy two examples of how ROSC is being implemented around the country (Michigan and Philadelphia)
o State how to connect the dots between ROSC and Recovery Management
Cherie A. Hunter
WEBINAR PRESENTER
Execu:ve Director
Hunter Communica3ons Group, Inc.
(Great Lakes ATTC Consultant)
INTRODUCTION TO ROSC AUDIENCE POLLING QUESTION
How much do you currently understand ROSC?
ROSC: A PARADIGM SHIFT
Recovery-‐Oriented Systems of Care (ROSC) shics the ques3on from:
“How do we get the client into treatment?”
to
“How do we support the process of recovery within the person’s life and
environment?”
A ROSC is NOT:
WHAT IS A ROSC?
o A model or an ini3a3ve
o Primarily focused on the integra3on of recovery support services
o Dependent on new dollars for development
o A group of providers that increase their collabora3on to improve coordina3on
o An infusion of evidence-‐based prac3ces
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A ROSC:
WHAT IS A ROSC?
o Is a value-‐driven APPROACH to structuring behavioral health systems and a network of services and supports
o Bridges labels, taxonomies and philosophies
o Focuses on returning people to “Life in the Community”
o Is comprehensive and holis3c
o Focuses on essen3als (jobs, housing, child and family)
o Is a framework to guide systems change
Recovery-‐oriented systems of care (ROSC) Is a process of change through which individuals improve their health and wellness, live a self-‐directed life, and strive to reach their full poten3al.
-‐ CSAT, SAMHSA
Recovery-‐oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to sustain long-‐term recovery for individuals and families impacted by severe substance use disorders. The system in ROSC is not a treatment agency, but a macro level organiza3on of a community, a state or a na3on.
-‐ William “Bill” White
WHAT IS A ROSC?
WHY ARE WE SHIFTING? ROSC: A PARADIGM SHIFT
“If my neighborhood’s tore up, what’s going to happen to me when I go out there. Some programs tell you to stay away from people, places and things that’ll trigger you. I can’t do that. I live in a sober house. Next door’s a crack house and across the street is the package store. The place is tore up! What am I supposed to do? If my community don’t get beNer, I ain’t geOng beNer.”
Person in Recovery, Amir
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
SUBSTANCE USE DISORDER (SUD)
Unmet Need:
< 10 % who need treatment seek it or if they do, arrive under coercive influences
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
SUBSTANCE USE DISORDER (SUD)
Low Pre-Treatment Initiation Rates
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HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
SUBSTANCE USE DISORDER (SUD)
Lack of Continuing Care:
Only 1 in 5 receive post-discharge planning
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
SUBSTANCE USE DISORDER (SUD)
Recovery Outcomes:
Most resume using within 1 year and most do so within the first 90 days of discharge from treatment
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
MENTAL HEALTH DISORDER (MHD)
Unmet Need 2001:
Less than one half of adults with SMI receive treatment
(SAMHSA)
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
MENTAL HEALTH DISORDER (MHD)
Low Retention:
A quarter of individuals have contact with the public systems for 8 days or less
(Bray et al., 2004)
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
MENTAL HEALTH DISORDER (MHD)
Low Dose of Treatment:
Insufficient doses of medication and short length of treatment have all been associated with poorer outcomes
(DHHS, 1999, Young et al., 2001)
HISTORICAL FORCES LEADING TO RECOVERY TRANSFORMATION IN THE U.S.
MENTAL HEALTH DISORDER (MHD)
High Recidivism:
In higher levels of care, often leading to policies that limit access to care
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(SAMHSA)
Treatment and Medica*on Support
Employment Opportuni3es AA and NA
Family Education Faith-based Support Physical Health RCOs
Healthy rela3onships Life skills training
RECOVERY GOES BEYOND SUBSTANCE ABUSE WHAT IS RECOVERY?
WHAT IS RECOVERY? FROM NATIONAL FOCUS GROUPS
o GeZng involved with things I enjoy ( e.g. church, friends, da3ng, support groups, etc)
o Learning what I have to offer o Seeing myself as a person with strengths o Taking one day at a 3me o Knowing my illness is only a small part of who I am o Having a sense that my life can get beJer o Having dreams again o Believing I can manage my life and reach my goals (bravery and hope) o Being able to tackle everyday o Having people I can count on
-‐-‐Davidson et al.
WHAT IS RECOVERY? FROM A COMMUNITY’S PERSPECTIVE
o Discovering who I am o Lifelong effort to become the best we can be o Change o Regaining health – physical / mental / spiritual /
rela3onships o New beginning – becoming what you want to be o Personal – different for each person o Hope o Bravery – facing a different way of life o Repairing what is broken o Re-‐establishing oneself from crises o Living life on life’s terms
One of the great liabilities of history is that all too many people fail to remain awake through great periods of social change. Every society has its protectors of status quo and its fraternities of the indifferent who are notorious for sleeping through revolutions. Today, our very survival depends on our ability to stay awake, to adjust to new ideas, to remain vigilant and to face the challenge of change. – Martin Luther King, Jr.
CHARACTERISTICS OF A ROSC
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SAMHSA’S GUIDING PRINCIPLES OF RECOVERY
Emerges from hope
Person-‐driven
Occurs via many pathways
Holis3c
Supported by peers and allies
Supported through rela3onship and social networks
Culturally based and influenced
Supported by addressing trauma
Involves individual, family and community strengths and
responsibili3es
Based on respect
VALUES UNDERLYING A ROSC
o Person-‐centered
o Self-‐directed
o Strength-‐based
o Par3cipa3on of family members, caregivers, significant others, friends, community
VALUES UNDERLYING A ROSC
o Individualized, comprehensive services and supports
o Community-‐based services and supports
OPERATIONAL ELEMENTS OF A ROSC
o Collabora3ve decision-‐making
o Con3nuity of services & supports
o Service quality & responsiveness
OPERATIONAL ELEMENTS OF A ROSC
o Mul3ple stakeholder involvement
o Recovery community/peer involvement
INCLUSIVE OF FAMILY AND OTHER ALLY INVOLVEMENT
o Most addic3on treatment programs are ins3tu3on based – minimal contact to natural environment
o Post-‐treatment family environments influence long-‐term recovery outcomes
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INCLUSIVE OF FAMILY AND OTHER ALLY INVOLVEMENT
o “Trauma of Recovery”
o Coach spouses
o Relapse preven3on training for couples
PARTNERSHIP-CONSULTANT RELATIONSHIPS
o Goals and strategies are determined in partnership and are directed by the person in recovery
o Services are person-‐centered and adapted to fit the needs and preferences of individuals. Menus of services and supports exist.
RECOVERY SUPPORT
The process of giving and receiving non-‐professional, non-‐clinical assistance to achieve long-‐term recovery
from severe alcohol and/or other drug-‐related problems. Provided by people who are experien3ally creden3aled to assist others in ini3a3ng recovery, maintaining recovery, and enhancing the quality of personal and family life in long-‐term recovery.
(Peer-‐based Addic3on Recovery Support , William White with Great Lakes ATTC)
IMPLICATIONS FOR SERVICES
The ques3on is not:
“Which of these roles is THE most important in the recovery process?”
The ques3on is:
“How can such resources be bundled and sequenced in ways that widen the doorway of entry into recovery and
enhance the quality of recovery?”
(White, W. (2006). Sponsor, Recovery Coach, Addic3on Counselor: The Importance of Role Clarity and Role Integrity. Philadelphia, PA: Philadelphia Department of Behavioral Health and Mental Retarda3on Services.
ROLE DELINEATION ROLE DELINEATION
ü Service goals & 3me
ü Educa3on & Training
ü Use of Self
ü Service Rela3onship
ü Locus of Service Delivery
ü Service Philosophy
ü Dura3on of Contact
ü Core Competencies
ü Service Delivery Framework
ü Service Language
ü Non-‐possessiveness
How does Addiction Counseling differ from Recovery Coaching?
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Strategies for Counselors
ON SELF-DIRECTION
o Professionals support people in making their own choices
o Risk taking is supported even when failure is an op3on
o Goals and strategies are determined in partnership and are directed by the person in recovery
o Services are person centered and adapted to fit the needs and preferences of individuals. Menus of services and supports exist.
CLINICAL SUPERVISION
Recovery-‐focused clinical supervision (RFCS) is the process through which a clinical supervisor assures that services to AOD-‐impacted individuals, families and communi3es are directed toward their ul3mate goals: the permanent resolu3on of AOD problems and the enhancement of global health and func3oning.
(The Role of Clinical Supervision in Recovery-‐oriented Systems of Behavioral Healthcare, Monograph Series -‐ January 2007, Philadelphia Department of Behavioral Health and Mental Retarda3on Services with William White)
RECOVERY-FOCUSED CLINICAL SUPERVISION
o program development
o staff recruitment, orienta3on and training (knowledge, skills and aZtudes)
(The Role of Clinical Supervision in Recovery-‐oriented Systems of Behavioral Healthcare, Monograph Series -‐ January 2007, Philadelphia Department of Behavioral Health and Mental Retarda3on Services with William White)
CLINICAL SUPERVISION
Mechanisms through which these goals are achieved include:
o modeling core recovery values
o case consulta3on
o fidelity monitoring
(The Role of Clinical Supervision in Recovery-‐oriented Systems of Behavioral Healthcare, Monograph Series -‐ January 2007, Philadelphia Department of Behavioral Health and Mental Retarda3on Services with William White)
CLINICAL SUPERVISION
Mechanisms through which these goals are achieved include:
o performance evalua3on
o liaison with community recovery support resources
o program evalua3on & policy advocacy
(The Role of Clinical Supervision in Recovery-‐oriented Systems of Behavioral Healthcare, Monograph Series -‐ January 2007, Philadelphia Department of Behavioral Health and Mental Retarda3on Services with William White)
CLINICAL SUPERVISION
Mechanisms through which these goals are achieved include:
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ROSC AND RECOVERY MANAGEMENT
RECOVERY MANAGEMENT
A philosophy for organizing treatment and recovery support services to enhance pre-‐recovery engagement, recovery ini:a:on, long-‐term
recovery maintenance, and the quality of
personal/family life in long-‐term recovery.
-‐ William White
CONSISTENT THEMES OF ROSC AND RM
ü Increased focus on recovery support services
ü Holis3c or whole person approaches
ü Sustained healing rela3onships
ü Care coordina3on among professionals and community-‐based organiza3ons – strategic partnerships
ü Strength-‐based approaches
ü Individualized approaches
ü Person-‐directed approaches
ü Focus on quality and outcomes
ü Increased focus on wellness, preven3on and early interven3on, and expanded con3nuum of care
RM & ROSC SCIENTIFIC RATIONALE & PROMISING PRACTICES
ü Treatment AJrac3on & Access
ü Screening, Assessment and Level-‐of-‐Care Placement
ü Composi3on of the Service Team
ü Service Rela3onship (Engagement & Reten3on)
ü Service Dose, Scope and Quality
ü Locust of Service Delivery: Influence on the Post-‐treatment Recovery Environment
ü Asser3ve Linkage to Communi3es of Recovery
ü Post-‐treatment Monitoring, Support and Early Re-‐interven3on
William White, MA with Philadelphia DBHMRS, Great Lakes and Northeast ATTCs, 2008
My clients don’t hit boNom; they live on the boNom. If we wait for them to hit boNom, they will die. The obstacle to their engagement in treatment [recovery] is not an absence of pain; it is an absence of hope.
(White and Woll)
CHALLENGE RELATED TO ACCESS
© Achara Consulting, Inc. 2013
What if we really believed?
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TREATMENT
PEER SUPPORT SERVICES
SUPPORT TO THE RECOVERY
COMMUNITY
IF WE REALLY BELIEVED, Our resource allocation wouldn’t look like this:
RECOVERY AND RESILIENCE ORIENTATION SYSTEM OF CARE
TWO EXAMPLES MICHIGAN & PHILADELPHIA AUDIENCE POLLING QUESTION
Can one agency alone develop a ROSC?
ONLINE DEMONSTRATION: MICHIGAN ONLINE DEMONSTRATION: MICHIGAN
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ONLINE DEMONSTRATION: MICHIGAN
Michigan's Defini*on of ROSC: Michigan's recovery-‐oriented system of care supports an individual's journey toward recovery and wellness by crea:ng and sustaining networks of formal and informal services and supports. The opportuni:es established through collabora:on, partnership and a broad array of services promote life enhancing recovery and wellness for individuals, families and communi:es.
Recovery Oriented System of Care Transforma*on Steering CommiWee • hJp://www.michigan.gov/mdch/0,4612,7-‐132-‐2941_4871_4877-‐113480-‐-‐,00.html • hJp://www.michigan.gov/documents/mdch/ROSC_NewsleJer_10_Winter13_410502_7.pdf
• hJp://www.michigan.gov/documents/mdch/Recovery_Oriented_System_of_Care_345240_7.pdf
PHILADELPHIA: PRACTICE GUIDELINES FOR PROVIDERS
OUTCOMES FOR THE INDIVIDUAL
I got help with the kinds of things that were most important to me – like geOng my daughter back, and puOng food on the table for her. Since they were willing to help me with what I needed, I figured, “Hey
maybe I should listen to what they’ve been trying to tell me and
try out that program they keep talking about.” Today I’ve been
clean for nine months...
-‐ Davidson et al., 2008
OUTCOMES FOR THE SYSTEM
o Increased access/capacity
o Proper placement and quality of care
o Reten3on
o Percep3on of care
o Cost-‐effec3veness
o Use of evidence-‐based prac3ces
MESSAGE OF HOPE
“Addic:on is visible everywhere in this culture, but the transforma:ve power of recovery is hidden behind
closed doors. It is :me we all become recovery carriers. It is :me
we helped our community, our na:on, and our world recover…
Recovery is contagious. Get close to it. Stay close to it. Catch it. Keep catching it. Pass it on.”
William White, Author and Recovery Advocate – www.williamwhitepapers.com
CLOSING THOUGHTS
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THANK YOU!
ASKING QUESTIONS
Ask ques3ons through the Ques3ons Pane
OTHER RTP WEBINARS
www.naadac.org/webinars
Defining Addic*on Recovery • Thursday, January 9, 2014 @ 3-‐4:30pm ET
What Does Science Say? Reviewing Recovery Research • Wednesday, February 5, 2014 @ 3-‐5pm ET
The History of Recovery in the United States and the Addic*on Profession • Thursday, March 6, 2013 @ 3-‐4:30pm ET
Defining Recovery-‐Oriented Systems of Care (ROSC) • Thursday, April 3, 2014 @ 3-‐4:30pm ET
Understanding the Role of Peer Recovery Coaches in the Addic*on Profession • Thursday, May 1, 2014 @ 3-‐4:30pm ET
Including Family and Community in the Recovery Process • Thursday, May 29, 2014 @ 3-‐5pm ET
Collabora*ng with Other Professions, Professionals, and Communi*es • Thursday, June 26, 2014 @ 3-‐4:30pm ET
Using Recovery-‐Oriented Principles in Addic*on Counseling Prac*ce • Thursday, July 24, 2014 @ 3-‐5pm ET
Exploring Techniques to Support Long-‐Term Addic*on Recovery for Clients and Families • Thursday, August 21, 2014 @ 3-‐5pm ET
WEBINARS ON DEMAND
• Medica:on Assisted Treatment • Building Your Business with SAP/DOT • SBIRT • Billing and Claim Submission • Ethics • Co-‐occurring Disorders • Test-‐Taking Strategies • Conflict Resolu:on • Clinical Supervision • ASAM Placement Criteria • DSM-‐5 Proposed Changes
www.naadac.org/webinars
CE credit s:ll available!
Free to NAADAC Members!
WWW.NAADAC.ORG OBTAINING CE CREDIT
o The educa3on delivered in this webinar is FREE to all professionals.
o 1.5 CEs are FREE to NAADAC members who aJend this webinar. Non-‐members of NAADAC receive 1.5 CEs for $20.
o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)
www.naadac.org/definingrecovery-‐orientedsystemsofcarerosc
www.naadac.org/webinars
A CE cer3ficate will be emailed to you within 21 days of submiZng the quiz and payment (if applicable) – usually sooner.
o Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.
Free to NAADAC Members!
4/2/14
13
Thank You for Par*cipa*ng!
www.naadac.org/recovery
NAADAC, The Associa*on for Addic*on Professionals 1001 N. Fairfax St. Suite 201 Alexandria, VA 22314 p 800.548.0497 f 800.377.1136
NAADACorg
Naadac
NAADAC
Cherie A. Hunter Hunter Communica*ons Group, Inc [email protected] www.Huntercommunica*onsgroupinc.net