oriented systems of care(rosc) integrationcenterforchildwelfare.fmhi.usf.edu › training ›...

Lonnetta Albright 9/07/2016

Florida DCF Conference 2016 1

Recovery Oriented Systems of Care (ROSC)Child Welfare & Behavioral Health Integration

2016 Child Protection SummitSeptember 7-9, 2016

JW Marriott Grande LakesOrlando, FL

Lonnetta M. Albright, CPECCertified John Maxwell Coach-Trainer-Speaker

Executive Director, Great Lakes ATTCPresident, Forward Movement Inc.

Florida’s team: Laurie Blades, Wesley Evans , Dana Foglesong and Director Ute Gazioch

People in Recovery who guide, advise and partner with us –Joining us today are Sarah Sheppard and Jamie Campbell

ROSC and Recovery Management content developed in partnership with Great Lakes ATTC lead subject matter experts, Dr. Ijeoma Achara and William (Bill) White

“One is too small a number to achieve significance” ‐‐ John C Maxwell

Video link: https://www.youtube.com/watch?v=LZe5y2D60YU



A

C

T

Increase Awareness & Understanding of the ROSC Framework

Understand Recovery as a construct: Long‐term Recovery Management

Describe how Behavioral Health looks different in a ROSC Framework

Understand how the service team expands including peer specialists and individuals in Recovery

Explore how to integrate ROSC principles into the FIT (Family Intensive Treatment) model

“Connect the Dots” – Florida’s plan and priorities related to ROSC Transformation

Share experiences, ideas, and opportunities for integration

PRACTICE

CONTEXT

CONCEPT

Aligning Concepts:Changing how

we think

Aligning Practice:Changing how we use language and

practices at all levels; implementing values

based change

Aligning Context:Changing regulatory/physical environment,

policies and procedures, enlisting community support



Recovery from Mental Disorders and/or Substance Use Disorders is a process of change

through which individuals improve their health and wellness, live a self-directed life,

and strive to reach their full potential. (SAMHSA’s working Definition, 2012)

Retrieved from: http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/

Health is a state of COMPLETE physical, mental and social well‐being and not merely the absence of disease or infirmity. World Health Organization



“….the phases of recovery from serious mental illness and recovery from addiction have many parallels. In fact, the manner in which participants in different forms of recovery independently used the same or similar language to name and describe their own processes of recovery was striking.”

~Davidson, et al., 2008, p. 235

Recovery Components and Principles

A Handout

What is recovery from co‐occurring disorders?

“…this research suggests that recovery, be it from the hardships of addiction or problems of mental illness, rests on

the same principles of human development as do other spheres of psychological and social functioning”

~Davidson, et al., 2008, p.288

There is an identified risk period when prevention efforts may have their greatest impact (12 ‐21 years of age)

Half of all lifetime cases of mental and SUDs begin by age 14 and three fourths by age 24

Similar risk factors predict multiple interrelated problems (drop out, pregnancy, bullying, drug use)

Youth are impacted by many spheres of influence

Programs that can be delivered primarily by peer leaders have increased effectiveness

Programs that have a focus on broader life skills have increased effectiveness

(Source: ONDCP and IOM Report, 2009)



Need holistic services that don’t just focus on reducing unwanted behaviors but promoting healthy behaviors“They are not saying that we need to ignore substance abuse... They are saying that we need to address substance abuse, but it has to be a part of a more comprehensive effort. Getting adolescents through life without using substances is not our end goal. We have to prevent adolescent substance use in order to promote healthy adolescent development, but we also have to promote healthy adolescent development in order to prevent substance abuse.” ~Join Together

Need continuous prevention supports and systems to be available (IOM, 2009)Need to articulate the connections among substance use within the family, adverse childhood experiences and later physical and behavioral health challenges (Felitti et al., 1998)Need to integrate peer support services (IOM, 2009)Need to be able to communicate the indirect effects of prevention efforts (e.g. academic achievement, physical health, mental health, etc.).

Getting involved with things I enjoy ( e.g. church, friends, dating, support groups, etc.)Learning what I have to offerSeeing myself as a person with strengthsTaking one day at a timeKnowing my illness is only a small part of who I amHaving a sense that my life can get betterHaving dreams againBelieving I can manage my life and reach my goals (bravery and hope)Being able to tackle everydayHaving people I can count on

‐‐Davidson et al.

Discovering who I am

Lifelong effort to become the best we can be

Change

Regaining health – physical / mental / spiritual / relationships

New beginning – becoming what you want to be

Personal – different for each person

Hope

Bravery – facing a different way of life

Repairingwhat is broken

Re‐establishing oneself from crises

Living life on life’s terms



Substance Abuse & Mental Health Legislative Action Senate Bill 12Effective July 1st 2016

The bill addresses Florida’s system for the delivery of behavioral health services Within the bill, the term Recovery is mentioned 14 times

• Beginning in 2017, each managing entity is required to develop and submit a plan to the department describing the strategies for enhancing services and addressing three to five priority needs in the service area. The plans must be developed with input from consumers and their families, local governments, local law enforcement agencies, and other stakeholders.

• ‘Services provided to persons in this state (shall) use the coordination‐of‐care principals characteristics of recovery‐oriented services and include social support services, such as housing support, life skills and vocational training, and employment assistance to live successfully in their community.’

© Achara Consulting, Inc. 2013

Federal Emphasis and Expectation

President’s New Freedom Commission

IOM Reports

SAMHSA

Growing body of MH and SUD research

Expectations of people in recovery

National Consumer and Recovery Advocacy Movement

Trailblazing Systems of Care



To name a few, they include…

• 1. Replicable, community‐based treatment modalities

• 2. Federal, state, local, private partnership to fund addiction treatment and ancillary support industries, e.g., research, training, etc.

• 3. Accessibility: From less than 50 to more than 13,000 U.S. specialty treatment programs

• 4. Professionalization of addiction medicine & counseling

• 5. Systems of early intervention, EAP, SAP, SBIRT

• 6. Screening/assessment/diagnostic tools

• 7. Continuum of care

• 8. Millions of lives touched and transformed

The AC Model can achieve: biopsychosocial stabilization more effectively, more safely for more people than has ever been achieved in history and YES;

“Treatment Works”, BUT Recovery initiation does not assure recovery maintenance especially for people with high problem severity / low recovery capital.

Discovery that addiction shares many characteristics with other chronic medical disorders (McLellan, et al, 2000)

Growing interest in: How would we treat addiction if we reallybelieved that addiction was a chronic disorder?”, e.g., how models of “disease management” in primary health care might be adapted to long‐term management of addiction



Addiction/Chronic Illness Compliance Rate Relapse Rate

Alcohol 30‐50 50

Opioid 30‐50 40

Cocaine 30‐50 45

Nicotine 30‐50 70

Insulin Dependent Diabetes

Medication <50 30‐50

Diet and Foot Care <50 30‐50

Hypertension


Diet <30 50‐60

Asthma


Slide Acknowledgment: William White. Data Source: O’Brien CP, McLellan AT. Myths about the Treatment of Addiction (1996). The Lancet, Volume 347(8996), 237‐240.

Among adults reportinga behavioral health condition, more than half report onsetin childhood or adolescence

Average delays in help seekingfor mental health challengesis more than a decade(National Comorbidity Study)

1. Cultural and political awakening of individuals/families in recovery

* Growth/diversification of mutual aid

* New recovery advocacy movement; New recovery support institutions

2. Frustration of frontline addiction professionals

3. Addiction science, particularly research on addiction/recovery careers, treatment outcome studies & treatment systems performance data

4. Addiction treatment payors

5. Need to counter growing cultural pessimism about treatment, e.g., effects of celebrity rehab recycling

Resources: Let’s Go Make Some History

www:facesandvoicesofrecovery.org



Research shows that over 50% of parents involved with the child welfare system have a substance use disorder and many have a co‐occurring mental health condition, particularly mothers. (Young, J. K., Boles, S. M., & Otero, C. (2007). Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12(2), 137‐149.)

Once maltreatment is verified, children of parents who abuse alcohol or drugs are more likely to be placed in out‐of‐home care and stay in care longer than other children (Barth, R., Gibbons, C., and Guo, S. (2006).

According to Florida Safe Families Network (FSFN) data, in fiscal year 2014‐15 there were 15,780 children were removed from their home. Parental substance misuse accounted for 7,838 of the children removed.

ROSC focuses on building resilience, wellness and long‐term recovery Vs compliance with treatment ‐ better for families short and long‐term

TREATMENT

SUPPORT TO THE RECOVERY

COMMUNITY

IF WE REALLY BELIEVED…Our resource allocation wouldn’t look like this:

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.

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

organization of a community, a state or a nation.

William “Bill”White



ROSC is not: Just about Substance Use Disorders

A Model

Primarily focused on the integration of recovery support services

Dependent on new dollars for development

A new initiative

A group of providers that increase their collaboration to improve coordination

An infusion of evidence‐based practices

An organizational entity, group of people or committee

A closed network of service and supports

ROSC is:Value‐driven APPROACH to structuring behavioral health systems and a network of clinical and non‐clinical services and supports

Framework to guide systems transformation

Recovery‐Oriented Systems of Care

shifts the question 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?”

The Healing Forest



Recovery is not simply about personal health, but the health and well being of the entire community… “This isn’t about me. I’m doing this for my children and my community. I have to build up my community because I need to know that if something happens to me, there will be resources and people in the community who can step in and take care of my girls.”

AMIR participant, New Haven CT

Effectively addressing the behavioral health needs of parents and caregivers is critical to the safety and wellbeing of their children and to the functioning of the family

The department has identified the integration of child welfare and the substance abuse and mental health service systems as a priority of effort, which is tracked ongoing by Secretary Carroll

PoE Goal: To implement an integrated system for families served by child welfare

Activities: Self ‐ assessment and peer review process occurring across the state

Integrating ROSC principles into current practice of the Family Intensive Treatment teams, to include extensive family engagement, person‐centered planning, development of community supports and use of peers

Trauma‐informed Services

Judiciary and Justice SystemPrevention Treatment and Medication Support

Employment Opportunities

Child WelfareAA and NA

Family Education Yt|à{@utáxw fâÑÑÉÜàPhysical Health

Recovery Community Organizations

Healthy relationships Life skills training



Supportive Housing Coordination as a priority

The department seeks to increase and improve collaboration and coordination between Managing Entities, Local Homeless Coalitions, Designated Lead Agencies of Continuum of Care Plans, and other key state and local agencies related to housing‐related services;

Find safe, affordable, stable housing for individuals with mental health and/or co‐occurring diagnoses; Ensure that these individuals receive the necessary support services to be successful in the community.

Mutual Support groups

Other peer support

Professional treatment

Nontraditional methods

Medical interventions

Medication‐assisted treatments

Family support

Faith

Comprehensive Continuing Care

On your own

And more!



PERSON‐CENTERED CONVENTIONAL

Collaborative Provider‐driven, compliance is valued

Preferences, life goals, choices define scope of services

Deficits, disabilities, and illness drive focus of services

Quality of lifeMaintenance, Safety, stabilization, symptom reduction

Empowerment Dependence

Community‐based Facility‐based

Long‐term planning for life in the community

Planning for treatment/service episode

Self‐determination is a fundamental civil right

Self determination follows peoples demonstration that they are equipped with certain skills, or clinically stable

PERSON‐CENTERED CONVENTIONAL

High expectations Low expectations

People choose from a flexible menu of services including natural and professional supports

Professional services only are selected for the person

Promotes trial and error growth in the context of responsible risk‐taking

Paternalistic approach avoids risk taking

Focuses on building positive sense of self, competence and confidence

Can be punitive, shaming

Evolving, living plan adjusts over time Static plan

Encourages inclusion of family members/and/or natural supports

Typically engages only the person receiving services

Process Product

© Achara Consulting, Inc. 2013

Example: Western New York Care Coordination Program (Janice Tondora, Yale Program on Recovery and Community Health)

Outcomes Achieved:68% Increase in competitive employment43% decrease in ER visits44% decrease in inpatient days56% decrease in self‐harm51% decrease in harm to others11% decrease in arrests



Rather than focusing solely on evidence based clinical practices that revolve exclusively around treatment ‐‐government, health care and research entities would broaden their mission to include the dissemination of emerging models and promising practices for designing and delivering recovery support services and developing recovery community organizations.

Recovery Community

Treatment Community

BRIDGE the gap!

RECOVERY COMMUNITY ORGANIZATIONS…

‐‐Tom Hill, Faces and Voices of Recovery

We wouldn’t inadvertently attempt to colonize peer run organizations by exerting undue control, power and influence. For example, determining how funding we provide should be used rather than allowing the organization to make those decisions or use collaborative‐shared decision making processes.



Partnering with the recovery community to identify advocates that with guidance can assume local leadership positions. Creating opportunities for local leaders ready to rise to the level of state, regional or national leaders.Facilitate mentoring relationships Support the development of recovery leadership institutes that can nurture future leaders at all levels of this movement.Recovering persons on agency boards

Developing / empowering informal peer leadership

Openly recruiting recovering persons as staff

Paid “peer specialists” to provide formalized support

Creating a sense of a community where recovering persons helping recovering persons is highly valued

Infusing peer self help throughout the service continuum

Understanding the unique learning advantages of peer delivered services

• Medicated Assisted Recovery

Medicated Assisted Treatment

Medicated Assisted Treatment

• Substance Use Disorder

• Substance MisuseSubstanceAbuseSubstanceAbuse

• Mental Health IssuesMental IllnessMental Illness

A philosophy for organizing treatment and recovery support services to enhance pre-recovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery

William (Bill) White

Recovery Management



Attraction, access & early engagement

Screening, assessment & placement

Composition of the service team

Service relationship

Service dose, scope & quality

Locus of service delivery

Assertive linkage to communities of recovery

Post‐treatment monitoring, support and early re‐intervention

Note, there are others, but these 8 are critical.

AC Limitations Unmet Need: < 10 % who need TX. seek treatment or if they do, arrive under coercive influencesLow Retention: > 50 % do not successfully complete treatmentRevolving Door: > 60% one or more TX. episodes, 24% 3 or more – 50% readmitted within 1 year

RM DirectionsAssertive community education & outreachAssertive waiting list managementLowered threshold of engagement; rethinking motivation; institutional outreachChanges in administrative discharge policies

“My clients don’t hit bottom; they live on the bottom. If we wait for them to hit bottom, they will die.

The obstacle to their engagement in treatment is not an absence of pain; it is an absence of hope.”

Outreach worker (Quoted in White, Woll, and Webber 2003)



Pre‐treatment Peer Support Groups

Offer peer mentors as soon as contact is initiated

For urban settings, develop a welcome/recovery support center

Tele‐health particularly in rural settings

Build strong linkages between levels of care through peer‐based recovery support services

Use the most charismatic & engaging staff at reception

Connect with people before initial appointments via phone

Screening and early intervention in health care facilities

Establish relationships with natural supports to promote early identification

AC assessment is categorical, pathology‐focused, professionally‐driven, an intake function & focused on individual; placement based on problem severity.

RM assessment is global, strengths‐based, client focused (rapid transition to recovery plans), continual and encompasses the individual, family and recovery environment; recovery capital factored into placement decisions.

FIT assessments ASAM, ASI, Family Functional Assessment (FFA), Mental Health when indicated, AAPI‐2, Initial Adverse Childhood Experience (ACE)

Individualized service plans

Menu of Options

Based on Collaboration between clinician, person receiving services and peer support

Integration of clinical and non‐clinical recovery support services

Focus on more than symptom reduction and abstinence

FIT Comprehensive family care plan within 30 days of enrollment involving family, peers, support services, community and natural supports



WHAT’S GOING ON?

Global vs. categorical assessment

Continual assessments vs. only intake assessment

Assessing recovery capital and other strengths

Vehicle for building relationship, trust, and rapport

FIT: Reviews comprehensive family care plan with family and revise as needed every three months, or more frequently to address changes in circumstances impacting treatment

CHANGING OUR QUESTIONS: Can you tell me a bit about your hopes or dreams for the future?

What kind of dreams did you have before you started having problems with alcohol or drug use, depression, etc.?

What are some things in your life that you hope you can do and change in the future?

If you went to bed and a miracle happened while you were sleeping, what would be different when you woke up? How would you know things were different?

Leads to Recovery Plans vs.Treatment Plans

Care Coordination as a priority• Care Coordination is the organization of care activities between two or more

participants including the person served and family (with consent) involved in an individual's care to facilitate the effective delivery of health care services.

• The Florida Department of Children and Families recognizes the need to better coordinate care for individuals with complex needs at the system and person levels. Because of this, the department has made high‐level recommendations to ensure the implementation of care coordination.

• Add Care Coordination as a billable, covered service

• Identify standardized level of care assessments and provide the monetary resources necessary for the Managing Entities (MEs) and providers to implement them.

• Implement data sharing agreements across providers and funders to ensure an effective flow of information that follows individuals through their care.

• Monitor implementation and outcomes of Care Coordination activities and adjust approaches as needed to maximize effectiveness.



AC model uses disease rhetoric but few medical personnel; recovery rhetoric but decreasing involvement of recovering people.

RM expands role of medical (including primary care physicians) and other allied professionals, recovering people (P‐BRSS) and culturally indigenous healers. Also emphasizes reinvestment in volunteer and alumni programs.

Florida’s FIT model is completely aligned with this framework!

The question is not:

“Which of these roles is THE most important in the recovery process?”

The question 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?”

How long should a person be in recovery before serving in a peer support role?



How long should a person be in recovery before serving in a peer support role and what about educational requirements?

...rather than being legitimized through traditionally acquired education credentials, peer staff draw their legitimacy from experiential knowledge and experiential expertise. Experiential knowledge is acquired through the process of one’s own recovery… Experiential expertise requires the ability to transform this knowledge into the skill of helping others to achieve and sustain recovery.

Many people have experiential knowledge but not experiential expertise

(White and Sanders, 2006)

COMMON CHALLENGES

PeerWhat to do in case of relapse?

Ethics and Boundaries

Working within a clinical environment

and how not to become mini clinicians

Differences and similarities between Mental Health and Substance Use Peers

Finding their voice and the system making sure that voice is valued

The Value of Peer run organizations



Preparation of all Staff – "Create a Transitional Space and embrace resistance" (Michael A. Diamond)

Cannot be successfully implemented in a vacuum, staff need an understanding of recovery and recovery‐oriented servicesClear job descriptions are needed prior to hiringSupervisors need to have a clear understanding of roles and be advocates of peer support rolesPeer providers need access to peer support both within and outside of their organizationMore than one peer provider should be hired in a settingHiring needs to rely more heavily on selection vs. trainingNeed to build in evaluation protocolsFocus on building a CULTURE of peer support throughout the organization and systemProvide clear guidelines and best practice recommendations for peer and recovery support services

Source: Innovation and Diffusion of Technology: A Human Process, Michael A. Diamond

Promotion of peer support services as a priorityFlorida has the capacity to train and certify individuals as Certified Peer Recovery Specialists

through the Florida Certification Board in three areas:

Adult peers, Family peers and Veteran peers.

The inclusion of peer support is a beneficial companion to traditional treatment and is beginning to permeate Florida’s behavioral system.

To promote peer support as fundamental to engagement and recovery, the

Department of Children and Families included peer support services as a required

component of recently implemented community‐based mental health service models.

Florida has a strong and engaged network of peer run organizations that advocate in

multiple forums for movement toward a recovery‐oriented system. These

organizations are critical partners in moving the behavioral health system forward and

provide input and guidance at the state and local levels.

Strong statewide network of peer specialist

Two years ago, the department reestablished a position at the state office, held by a person in recovery with lived behavioral health experience. The primary

responsibilities of the Statewide Coordinator of Recovery and Integration are to:

• Provide training and technical assistance to key stakeholders

• Assist with system‐wide implementation of ROSC

• Transform drop‐in centers to whole‐health centers

• Enhance the peer specialist workforce.

Currently, five of the seven managing entities contracted by the department have chosen to hire at least one peer specialist to assist with their efforts. The Recovery and Integration Statewide Coordinator serves as a statewide facilitator for this network of peer specialist.



Cultural, values based change drives practice, community,

policy and fiscal changes in all parts and levels of the system. Everything is viewed through the lens of and

aligned with recovery oriented care

Practice and Administrative alignment in selected parts of the system

Adding peer and community based recovery supports to the existing

treatment system

CHANGE PROCESSES

ADDITIVE SELECTIVE TRANSFORMATIONAL

HOWDOESTHE FIT MODELWITHINAROSC FRAMEWORK?

Intensive treatment interventions for parents with high‐risk child abuse cases

Immediate access to SUD and Co‐occurring services for parents

Increase percentage of substance using parents who enter treatment

Increase treatment retention and abstinence rates

Integrate SUD treatment, parenting & therapeutic treatment for all family members – regardless of payer

Improve involvement in Recovery services to help parents recover

Improve show rates for sessions; increase program completion

In collaboration with the child welfare Community Based Care lead agencies and dependency case management agency partners:

Increase safety of children

Develop safe, nurturing and stable living situation as rapidly and responsibly as possible

Provide information to inform safety plan

Reduce number of out‐of‐home placements

Reduce rates of re‐entry into the Child Welfare System



Sarah Sheppard (Peer Specialist)

Jamie Campbell (FIT team Peer)

Laurie Blades, DCF Deputy Director

Wesley Evans, Statewide Coordinator Integration & Recovery Services

AC Model: Passive linkage, low affiliation and high early attrition, single pathway model of recovery

RM model: Assertive linkage, multiple pathway model of recovery, linkage beyond recovery mutual aid groups; active relationship with local service committees, involved in recovery community resource development

DEVELOPING A ROSC IN KANSAS



Recognize that you and your community do have resources and strengths

Look for opportunities to build relationships and partner

Share resources and information

Influence legislators

Combat stigma and discrimination

What skills, talents, information can you share?

Support the development of peer run organizations

Start an annual recovery walk

Examples: Small businesses

Faith‐based recovery –ministries

Transportation support

Continue the dialogue

Mental Health first aid trainings for first responders

Remember that there is hope for recovery and recovery is real.

Provide support and hold hope for/with other families that are going through a tough time

Share your story!

Get involved with advocacy

Volunteer at peer run organizations and treatment facilities to provide support to family members

Help to identify local community resources that can help others initiate and sustain their recovery and help to build a network of allies

Address NIMBY barriers to community integration

Tell your Story!!! Use it to fight stigma and discrimination.

Join an advocacy organization to stay informed e.g. Faces and Voices of Recovery, National Association for Mental Illness, Mental Health Association

Engage in training to become a recovery coach or mental health peer specialist

Reach out to the media

Support other people in early recovery

Join or start a recovery rally

Seek ways to give back to your community

Start or support a recovery community organization in your area



PRACTICE

CONTEXT

CONCEPT

Aligning Concepts:Changing how

we think

Aligning Practice:Changing how we use language and

practices at all levels; implementing values

based change

Aligning Context:Changing regulatory/physical environment,

policies and procedures, enlisting community support



What excites you about shifting to a ROSC framework?

What concerns do you have?

Why is this shift necessary?

What would help you become more recovery oriented?

What outcome(s) are you seeking?

How are you integrating Peers and Recovery Coaches into your workforce alongside your clinical team members; with your board, at all levels of the organization?

How might you navigate the shift?

What could get in your way –obstacles, barriers?

What do you need to make the shift?

Michigan's Definition of ROSC: Michigan's recovery‐oriented system of care supports an individual's journey toward recovery and wellness by creating and sustaining networks of formal and informal services and supports. The opportunities established through collaboration, partnership and a broad array of services promote life enhancing recovery and wellness for individuals, families and communities.

Recovery Oriented System of Care Transformation Steering Committee

http://www.michigan.gov/mdch/0,4612,7‐132‐2941_4871_4877‐113480‐‐,00.html

http://www.michigan.gov/documents/mdch/ROSC_Newsletter_10_Winter13_410502_7.pdf

http://www.michigan.gov/documents/mdch/Recovery_Oriented_System_of_Care_345240_7.pdf



“Many of the early publications on addiction recovery management (Arm) and recovery oriented systems of care (ROSC) focused on work underway in the State of Connecticut and the City of Philadelphia. Recently thatwork has expanded in states and cities across the country, adapting itselfto widely diverse cultural settings and economic and political constraints.One such area of concentrated development is the State of Michigan. InJune of 2014, I had the opportunity to interview several people about thework underway in this state”. .‐‐‐William White

ROSC in Michigan: An Interview with Deborah Hollis, DirectorOffice of Recovery Oriented Systems of Care

ROSC in Western Michigan: An Interview with Mark Witte and Kevin McLaughlin

Recovery‐focused Addiction Medicine: An Interview with Dr. Corey Waller

Seeking to align system transformation concepts, practice and context.

10 Core Values guided the development of transformation principles and strategies, and will continue to guide the implementation process

4 Domains in which the strategies will be carried out

7 Goals are concrete, action‐oriented goals that organize and focus the strategies

MonographsRecovery Management

Peer‐based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation

Recovery Management and Recovery‐Oriented Systems of Care: Scientific Rationale and Promising Practices

Practice Guidelines for Resilience and Recovery Oriented Treatment

InterviewsDr. Ijeoma Achara, ROSC Transformation

Dr. Calvin Trent, ROSC in Detroit

Grand Rapids – 3 interviews

http://www.williamwhitepapers.com/leadership_interviews/recovery_management_interviews/

Websites: www.attcnetwork.org/greatlakes

http://www.facesandvoicesofrecovery.org/

http://beta.samhsa.gov/brss‐tacs

http://www.centerstone.org/



82

Questions?

Contact: Lonnetta Albright

[email protected]

2016 Child Protection Summit September 7-9, 2016

The A.C.T. Model “The greatest challenge we face as leaders is leading ourselves”

– John C. Maxwell

Apply for me

Change in me

Teach others

Now that you’ve attended the ROSC Workshop--what will you do with all of the information,

learning and ideas that were suggested? How will you take what you’ve learned and use it

to grow yourself and to add value to others (staff, team members, clients, communities)?

This tool is for your use and thinking throughout the day. It is intended to “jump start” your

follow up and adoption actions. A suggested strategy is below. Keep in mind that the tool

is not proscriptive and can be revised to fit your unique needs and ways in which you work:

1st: Use the codes A C T in the margins as you take notes

2nd: When you return home or to your office compile a list of each code (3 separate lists)

3rd: Prioritize each list

4th: Using your priorities, take say the first one or two items and work on them for 2-4 weeks

until it becomes a habit or instituted change or process

5th: Continue working through your lists

6th: This tool might also serve as a process for your team, steering committee, clients,

families, recovery community, etc.

2016 Child Protection Summit September 7-9, 2016

A.C.T. Worksheet Use a separate Worksheet for each Code

ACTION ITEM

A, C OR T

WHAT WILL YOU DO? WITH WHOM? HOW WILL YOU KNOW IT IS

MAKING A DIFFERENCE?

Mental Health and Substance Use Disorders Recovery: Definitions, Components, and Principles

Page 1 of 3

Mental Health Recovery Substance Use Disorders Recovery Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.

Components of Recovery Principles of Recovery Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

Recovery is self-directed and empowering: While the pathway to recovery may involve one or more periods of time when activities are directed or guided to a substantial degree by others, recovery is fundamentally a self-directed process. The person in recovery is the “agent of recovery” and has the authority to exercise choices and make decisions based on his or her recovery goals that have an impact on the process. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Through self-empowerment, individuals become optimistic about life goals.

Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

There are many pathways to recovery: Individuals are unique with specific needs, strengths, goals, health attitudes, behaviors and expectations for recovery. Pathways to recovery are highly personal, and generally involve a redefinition of identity in the face of crisis or a process of progressive change. Furthermore, pathways are often social, grounded in cultural beliefs or traditions and involve informal community resources, which provide support for sobriety. The pathway to recovery may include one or more episodes of psychosocial and/or pharmacological treatment. For some, recovery involves neither treatment nor involvement with mutual aid groups. Recovery is a process of change that permits an individual to make healthy choices and improve the quality of his or her life.

Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

Recovery is self-directed and empowering: While the pathway to recovery may involve one or more periods of time when activities are directed or guided to a substantial degree by others, recovery is fundamentally a self-directed process. The person in recovery is the “agent of recovery” and has the authority to exercise choices and make decisions based on his or her recovery goals that have an impact on the process. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Through self-empowerment, individuals become optimistic about life goals.


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Components of Recovery Principles of Recovery Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.

Recovery is holistic: Recovery is a process through which one gradually achieves greater balance of mind, body and spirit in relation to other aspects of one’s life, including family, work and community.

Non-Linear: Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

Recovery exists on a continuum of improved health and wellness: Recovery is not a linear process. It is based on continual growth and improved functioning. It may involve relapse and other setbacks, which are a natural part of the continuum but not inevitable outcomes. Wellness is the result of improved care and balance of mind, body and spirit. It is a product of the recovery process.

Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.

Recovery is supported by peers and allies: A common denominator in the recovery process is the presence and involvement of people who contribute hope and support and suggest strategies and resources for change. Peers, as well as family members and other allies, form vital support networks for people in recovery. Providing service to others and experiencing mutual healing help create a community of support among those in recovery.

Respect: Community, systems, and societal acceptance and appreciation of consumers—including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.


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Components of Recovery Principles of Recovery Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

Recovery involves a personal recognition of the need for change and transformation: Individuals must accept that a problem exists and be willing to take steps to address it; these steps usually involve seeking help for a substance use disorder. The process of change can involve physical, emotional, intellectual and spiritual aspects of the person’s life.

Hope: Recovery provides the essential and motivating message of a better future—that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process.

Recovery emerges from hope and gratitude: Individuals in or seeking recovery often gain hope from those who share their search for or experience of recovery. They see that people can and do overcome the obstacles that confront them and they cultivate gratitude for the opportunities that each day of recovery offers.

Recovery has cultural dimensions: Each person’s recovery process is unique and impacted by cultural beliefs and traditions. A person’s cultural experience often shapes the recovery path that is right for him or her.

Recovery involves a process of healing and self-redefinition: Recovery is a holistic healing process in which one develops a positive and meaningful sense of identity.

Recovery involves addressing discrimination and transcending shame and stigma: Recovery is a process by which people confront and strive to overcome stigma.

Recovery involves (re)joining and (re)building a life in the community: Recovery involves a process of building or rebuilding what a person has lost or never had due to his or her condition and its consequences. Recovery involves creating a life within the limitation imposed by that condition. Recovery is building or rebuilding healthy family, social and personal relationships. Those in recovery often achieve improvements in the quality of their life, such as obtaining education, employment and housing. They also increasingly become involved in constructive roles in the community through helping others, productive acts and other contributions.

Recovery is a reality: It is a reality testified to by the lived experiences of millions of individuals and their families who have struggled and triumphed over a substance use disorder and its accompanying hardship and distress. Recovery is a reality achievable by everyone.

Much like the fields of mental and chemical health in general, the recovery concept within each field grew from different roots, followed different growth patterns, and had different histories and advocates. In the past dec-ade, however, practitioners from both fields have joined forces to find overlap in their respective recovery concepts, both as a way for individuals with co-occurring disorders to describe their recovery experiences and as a potential integrating mechanism for these traditionally divided fields.

As an example of an integrated model, Larry Davidson and colleagues de-veloped what they called a “hopscotch” model of dual recovery. First de-veloping separate models of recovery from reviews of first-person recovery literature in each field, then revising them based on feedback from recov-ery advocates, they found remarkable similarity of recovery phases and lan-guage in each model. Their dual model combines these common elements, showing where in some phases there seems to be a single recovery goal, and in others dual goals to be tackled simultaneously with “both feet”. Unlike hopscotch, the phases may be nonlinear and of flexible order.

Source: Davidson, L., et al. 2008. From “Double Trouble” to “Dual Re-covery”: Integrating models of recovery in addiction and mental health. Journal of Dual Diagnosis, 4(3): 273-290.

Recovery concept finds common ground in mental health and addiction

A version of Dr. Davidson’s “hopscotch” model is shown in a brief PowerPoint presentation, “Recovery as an orga-nizing principle for integrating mental health and addiction services” at: <http://coce.samhsa.gov/products/cod_ presentations.aspx>

The two-part essay “Recovery: The bridge to integration?” by William White and Larry Davidson argues that the re-

covery concept may be the key to integrating the ad-diction and mental health treatment fields. Click on the “Archives” link and the November and Decem-ber 2006 issues of BehavioralHealthcare at: <http://www.behavioral.net/ME2/Default.asp>

“Recovery from addiction and from mental illness: Shared and contrasting lessons” by William White, Michael Boyle & David Loveland describes shifts in the recovery movement and the history of mutual aid groups. Click on the chapter title at: <http://www. oregon.gov/DHS/addiction/recovery.shtml>

Co-occurrences Newsletter of the Minnesota Co-Occurring State Incentive Grant Project Volume 2, Issue 7

January 2009

“….the phases of recovery from serious mental illness and recovery from addiction have many parallels. In fact, the manner in which participants in

different forms of recovery independently used the same or similar language to name and describe their own processes of recovery was striking.” —Davidson, et al., 2008, p. 235

Becoming an

empowered citizen

Overcoming stigma, promot-

ing positive views of recovery

Assuming

control

Incorporating illness,

maintaining recovery

Understanding, accepting,

redefining self

Community involvement,

finding a niche

Renewing hope, confidence,

commitment

Initiating recovery,

assuming control

Establishing, maintaining

mutual relationships

Resources on co-occurring disorders

Five video clips in which people talk about their experiences of living with co-occurring disorders can be viewed on the website of

the Co-Occurring Collaborative Serv-ing Maine. In his clip, Michael ex-plains that what a person in recovery

needs is similar to what everyone wants from life. <http://www. ccsmetraining.org/movies/index.asp>

What is recovery from co-occurring disorders?

Davidson and colleagues reviewed first-person accounts of recovery from addictions and mental illness and asked members of advocacy net-works in both fields for feedback on their summaries. They arrived at this simple conclusion:“In an age of evidence-based practice, this re-search suggests that recovery, be it from the hardships of addiction or problems of mental illness, rests on the same principles of human devel-opment as do other spheres of psychological and social functioning. Just like everybody else, people living with these problems require hope, a sense of self-efficacy and control, affiliation and connec-tions with others, a sense of meaning and purpose, and the quiet integrity of leading a dignified life.” [emphasis added; Davidson, et al., 2008, p. 288]

Multiple domains and measures of recovery

Co-occurrences Page 2

O’Connell and colleagues asked 974 indivi-dals to complete the Recovery Self-Assessment measure, and from the data identified five recovery domains. The scores at right are from mental health and addiction providers and persons in recovery on these domains.

In later work, the researchers refined four versions of the Recovery Self-Assessment, one each for Person in recovery, Family member/advocate, Provider, and CEO/Director (<http://www.yale.edu/PRCH/tools/rec_selfassessment.html>).

Edited by [email protected]

Co-occurring glossary

• Recovery: “Recovery from alcohol and drug prob-lems is a process of change through which an indi-vidual achieves abstinence and improved health, wellness and quality of life.” (Center for Substance Abuse Treatment: <http://pfr.samhsa.gov/rosc.html>)

• Recovery: “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” (Center for Mental

Source: O’Connell, et al. 2005. From rhetoric to routine: Assessing per-ceptions of recovery-oriented practices in a state mental health and addic-tion system. Psychiatric Rehabilitation Journal, 28(4), 378-386.

visit our website: http://www.dhs.state.mn.us/id_028650

Health Services: <http://mentalhealth.samhsa. gov/publications/allpubs/sma05-4129/>)

• Recovery: “Recovery refers to the ways in which per-sons with or affected by a mental illness and/or ad-diction tap resources within and beyond the self to move beyond experiencing these disorders to ac-tively managing them and their residual effects to build full, meaningful lives in the community. Re-covery is more than the elimination of symptoms from an otherwise unchanged life. It is about regain-ing wholeness, connection to community, and a pur-pose-filled life.” (Recovery: The bridge to integra-tion, part one. See resources, p. 1.)

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