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Peer-based recovery support services

Minneapolis, MNDavid Njabulo Whiters, PhD, MSW, NCAC II

Minnesota Institute

Turning Point Inc.

Presenter

Fundamental Components of Peer-based Addiction Recovery Support Services

David Njabulo Whiters, PhD, MSW, NCAC II

Founder and Former Director, Recovery Consultants of Atlanta, Inc.

Consultant and Trainer, Great Lakes Addiction Technology Transfer Center (GLATTC)

Great Lakes ATTC @ UIC• Housed under the Jane Addams College of Social Work at the University of Illinois at Chicago

• 1 of 14 ATTC Centers and a National Coordinating Office

• Funded by DHHS/SAMHSA/CSAT

• Other Sponsors (NIDA, IDHS‐DASA, CDPH, PEPFAR)

Key Focus Areas• Recovery Based Systems of Care

• Criminal Justice

• Behavioral Health and Primary Care Integrationy g

• Trauma Informed Care

• Returning Veterans

• Evidence‐based and Best Practices



The ATTC Network 2007‐2012ATTC Network Map 2012 – 2017

4

National Focus Centers• National Frontier and Rural ATTC

• National Hispanic and Latino ATTC

• National American Indian and Alaska Native ATTC

• National Screening, Brief Intervention, and Referral to Treatment (SBIRT) ATTC

Evaluation Procedure

ConsentConsent PostPostFollow up

Follow up



More Information

For products, resources, and more information please visit us online at: www.attcnetwork.org/greatlakes

You can also contact Tiffany Kilpatrick, Associate Director at [email protected]

Focus of Today’s PresentationFocus of Today’s Presentation

• Fundamental principles of Peer-based Addiction Recovery Support Services (P-BRSS), also referred to as peer services, peer-based services, and peer-to-peer services

Di i d il h i i i (b h d f h )• Discuss in detail their origin (by whom and for whom)

• Successes and challenges

• Provide some very specific examples of how they operate

• Value in promoting recovery and assisting in establishing long-term recovery

Language Used in Today’s PresentationLanguage Used in Today’s Presentation

The P-BRSS movement, in combination with Recovery-Oriented

Systems of Care (ROSC), has resulted in an overhaul of the recovery

language

• Recovery as opposed to Treatment

• Multiple approaches to addiction recovery

• Peer-based or peer-led

• Lived experiences or experientially credentialed

• Service recipients as opposed to clients

• Long-term or sustained recovery

• Faith-based and medication assisted recovery



Caution for Today’s Audience/ParticipantsCaution for Today’s Audience/Participants

• There are many critical research questions about P-BRSS that have yet to be studied

• There is little support in the literature for these i i (l k f d i d li i l i l )interventions (lack of randomized clinical trials)

• Arguments for these interventions are based on anecdotal evidence

• Many argue that P-BRSS are effective and cost efficient though there is little to no science to back these claims

IntroductionsIntroductions

• Addiction Treatment Professionals

• Mental Health Professionals

• Co-occurring ProfessionalsCo occurring Professionals

• Prevention Specialists

• Criminal Justice Professionals

• Recovery Support Service Experts

• Individuals who self-identify as persons in recovery

What is Peer-based Recovery SupportWhat is Peer-based Recovery Support

• ……. it is the process of giving and receiving non-professional, non-clinical assistance to achieve long-term recovery from alcohol and/or other drug-related problems

i i id d b l h i i ll • …….. it is provided by people who are experientially credentialed

• ……… it is fundamentally different from clinical support

• …….. it can be delivered through a variety of organizations and venues



What are Peer-based Addiction Recovery Support Services (P-BRSS)What are Peer-based Addiction Recovery Support Services (P-BRSS)

• Essentially they include “non-clinical” services provided by “members of 12-step, faith-based, medication assisted, gender-specific and other types of recovery communities.” In most cases, they are developed “by people in recovery for people seeking recovery” (For Us and By Us FUBU) people seeking recovery (For Us and By Us - FUBU). White et al. refer to this group as “experientially credentialed.”

• They are not intended to supplant addictive or mental disorder treatment programs, but instead are designed to augment, support, and is many cases operate independently of traditional treatment programs.

Critical elements of P-BRSSCritical elements of P-BRSS

• Peer-based – means that the supports and services are drawn from the experiences of individuals who have successfully achieved addiction recovery

• Recovery support – distinguishes the singular goal toward which all efforts are directed.

• Process – implies a series of events or activities and is relational rather than mechanical.

• Non-professional – means that the peer relationship is closer to the reciprocity of friendship than the fiduciary relationship one has with a physician, lawyer, banker, psychologist, etc.

Critical elements of P-BRSS cont’dCritical elements of P-BRSS cont’d

• Non-clinical – distinguishes P-BRSS from clinical services that involve diagnosis and treatment by health care professionals.

• Experientially credentialed – means that the knowledge drawn on to provide P-BRSS is acquired through lived experiences rather than formal education.

• Long term recovery support– refers to long-term availability and support as opposed to initial and acute support.

• Alcohol and other drug related problems – a phrase that defines the boundaries of experiential competence.



Rationale and JustificationRationale and Justification

• Estimated 20 million Americans in need of addictive disorder treatment [services or recovery]

• Incessant decrease in available residential treatment slots (30 percent over the past 20 25 years)(30 percent over the past 20 – 25 years)

• 50[365 days], 80, [90 days] Rule

• Problematic for ethnic minorities, women, single parents with young children, and individuals low in socio-economic status

• Estimated 5 million people in recovery who had developed a lived experience of sustaining long-term recovery

Vision 1880Vision 1880--19701970Vision 1880Vision 1880--19701970 Reality 2011Reality 2011Reality 2011Reality 2011

•Recovery

Vision Vs. Reality

TX Recovery

BREAK TIMEBREAK TIME

• Be back in 10 minutes

THANKS!



Rationale and Justification RevisitedRationale and Justification Revisited


• Incessant decrease in available residential treatment slots (30 percent over the past 20 25 years)(30 percent over the past 20 – 25 years)

• 60, 50, 80, 90 Rule

• Problematic for ethnic minorities, women, single parents with young children, and individuals low in socio-economic status

• Estimated 5 million people in recovery who had developed a lived experience of sustaining long-term recovery

The Birth of P-BRSSThe Birth of P-BRSS

• William (Bill) White – the mutual aid society movement of the 1800s

• Recovery Advocacy Meeting establishment of the • Recovery Advocacy Meeting - establishment of the recovery support movement (December 2001, Minneapolis, MN)

• SAMHSA/CSAT– October 2002, the birth of the Recovery Community Services Program (RCSP)

Among CSAT funded RCSPAmong CSAT funded RCSP

• New York-based organization focusing on LGBT

• Arizona-based organization focusing on Latino Americans

• Wisconsin-based organization focusing on Women

• Atlanta-based organization focusing on African Americans

• Approximately 15 other organizations focusing on general populations



P-BRSS Roles and Functions (what do we do and who does the doing)P-BRSS Roles and Functions (what do we do and who does the doing)

Titles of providers of services:

• Peers

• Peer Specialists

• Recovery Coaches

• Who could be a peer, peer specialists or recovery coach? Was this role limited to people in recovery and if so how long of a period of recovery would they have to have? Could a person in medication assisted recovery be a provider of services?

Discovery of Ethical IssuesDiscovery of Ethical Issues

See White et al. (Ethical Guidelines for the Delivery of P-BRSS)

P-BRSS Provided through RCA, Inc.’s Faith-based CoalitionP-BRSS Provided through RCA, Inc.’s Faith-based Coalition

• Instrumental Support

Assertive Street Outreach Program

Pre-recovery treatment model

Peer-led addiction treatment model

• Informational Support/Companionship

Faith-based Rapid HIV testing Program

Annual Faith-based Conference

SAVED SISTA Project

Celebrate Recovery - Faith-centered12 step support group

• Instrumental Support

Recovery at Work (RAW) Social Entrepreneurial Program for people in recovery

CAC training for people in recovery

Micro-enterprise program for people in recovery

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• Informational Support/Companionship

Better Parents = Better Kids – Mentoring Program

Transitional Housing Program



Recovery @ Work (RAW)

Street Outreach

Faith-basedRecovery ConferenceTransitional Housing

Prevention Education

Our Social Entrepreneurial Program

Integrating the faith community, recovery, and homelessness!

September 15, 2007 – Recovery Month Rally.Churches from our faith-based coalition transported more than 1000 homeless

substance users to this event!



Integrating homelessness and recovery!

Our Recovery Month Speaker - Atlanta Mayor Shirley Franklin -seated with RCA, Inc.’s Associate Director Cassandra Collins. Mayor Franklin shared a wonderful story about her Dad who

found recovery from his alcoholism at age 40 and died with 38 years of sobriety.

Outreach/Rapid Testing TeamOutreach/Rapid Testing Team

• Volunteer staff (38) all members of Atlanta’s12-step and faith-based addiction recovery community



Testing Collaborators

Simpson Street Church of Christ Churchs Chicken

Faith-based and Business Partner literally separated by a 40 foot parking lot

Addressing Related Disorders: HIV, STI, & Viral Hepatitis RealitiesAddressing Related Disorders: HIV, STI, & Viral Hepatitis Realities

• > 1 million Americans live with HIV and 13% are IDU related

• IDU leads to HIV and HCV, skin infections (abscesses) and bacterial and viral infections such as bacterial pneumonia and endocarditis, which, if left untreated, can lead to serious health problems

• Substance users are at risk for HIV infection due to behaviors such as trading sex for drugs and money and multiple sex partners for drugs and money and multiple sex partners

• All high risk substance using behaviors increase risk for contracting or transmitting viral hepatitis, TB, and STI.

• > 4 million Americans live with hepatitis C (HCV)

• HCV is highly transmissible through blood-borne exposure

• Within 3 years of beginning injection drug use, most IDUs contract HCV—and up to 90 percent of HIV-infected IDUs may also be infected with HCV

• HCV infection is accelerated in dually infected individuals (HIV and HCV) faster than in those with HCV alone

P-BRSS and Health Reform: What do we know? P-BRSS and Health Reform: What do we know?

• Estimated 34 million Americans without adequate health coverage


• Incessant decrease, upwards of 30 percent of the past 20 –25 years, in available residential treatment slots

• Problematic for ethnic minorities, women, single parents with young children, and individuals low in the socio-economic status

• In 2014, we are going to experience a major increase in the number of Americans with health coverage



SummarySummary

• We know P-BRSS help sustain long-term recovery

• Cost efficient

• Don’t lead to a reduction in clinical staff or treatment programsprograms

• That there are multiple approaches to addiction recovery and P-BRSS can be developed in a manner that addresses each approach

• In 2014, we are going to experience a major increase in the number of Americans with health coverage, resulting in a need for additional P-BRSS

THE ENDTHE END

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