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RECOVERY IS REAL! BACODA
Make sure you do the DOT activity.
Welcome
Who Do We Have In The Room?
Symposium Agenda
¨ Registration ¨ Welcome! ¨ Keynote ¨ Keynote ¨ Lunch- Film trailer ¨ Panel- Recovery Is Real! ¨ Networking Café’ Conversations ¨ Evaluations and Wrap up
Celebrate Recovery
Celebrate Recovery
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
Recovery Oriented Systems of Care Dietra Hawkins, PsyD Galveston, Tx Bay Area Council on Drugs and Alcohol August 23, 2013
ROSC
Overview
¨ Let’s Imagine… ¨ Address Seven topics ¨ ROSC Elements, Principles,
& Strategies ¨ Share a few stories ¨ Q & A
Seven Questions
¨ What is Recovery? What is a ROSC? ¨ Why now? National overview ¨ What to do with no $$$ ¨ Stigma- what to do? (the Relationship cure) ¨ What can one person, community, provider do? ¨ Practical steps forward (Texas DSHS priorities) ¨ Resources
Imagine there is …
… to live an ordinary, meaningful life guided by their choices in a local community or neighborhood
¨ A Miracle has happened! ¨ Bill boards promote Recovery ¨ All Colleges offer Recovery
Housing ¨ 2 minute clinics staffed by CPSs ¨ My pastor is in recovery ¨ My brother gets help
at the Barber Shop!
Dreaming
¨ Must have a vision for where we want to be
¨ Let’s recall… ¨ No Smoking Campaign- Seat Belts- the Civil Rights
Movement
Public Health Successes
¨ Raise awareness -People died
¨ New attitudes ¨ New behaviors ¨ New policies ¨ Vigilant ¨ Advocacy
¨ 22 million in Recovery -25 million
¨ Attitudes ¨ Prevention, Treatment,
Hope ¨ Parity Act ¨ MH and AD Advocacy
What has helped you come back from something difficult?
What is Recovery?
Three questions
¨ What helps? What worked? ¨ What could be better? ¨ How do you keep going? (Hope)
Recovery
¨ Is what a person does ¨ It is living a meaningful life ¨ It is what we all want
What is Recovery?
Definitions: ¨ A process of change through which individuals improve their health and wellness, live a self directed life, and strive to reach their full potential.
v The American Society of Addiction Medicine no
longer defines addiction as a behavioral problem, but instead as a problem with brain circuitry.
The Good News!
Recovery is Real!
¨ Over 22 million people ¨ Research- Brain & Longitudinal ¨ ASAM, WHO ¨ The White House- ONDCP ¨ National Advocacy MH & AD
What is a ROSC?
ROSC- Supports What Helped?
¨ Family ¨ Support ¨ Friends ¨ Forgiveness ¨ *Faith ¨ Compassion ¨ Resiliency ¨ *Helping others
¨ Meaningful work/career
¨ Time ¨ Education ¨ Hope ¨ New beginnings ¨ Taking action
Giving Back
Many AMIR and Amistad individuals echoed this statement
“giving something back was the main thing that helped me to get better.”
“They didn’t treat us like we had anything good to offer anyone else. They didn’t understand that I need to give back.”
They developed peer mentor and alumni initiatives which provided participants with formalized mechanisms for giving to others and developing leadership skills. Peer mentors were compensated for providing support to others who were at an earlier point in their recovery journey. The alumni organization also consisted of graduates of the program who coordinated some of the community based activities.
Guiding Principles of Recovery
¨ Hope ¨ Person-driven
¨ Many pathways
¨ Holistic
¨ Peer support and allies
¨ Relationships and social networks
¨ Culturally-based and influenced
¨ Trauma informed
¨ Strengths based and responsibility
¨ Respect
A female participant said that a holistic approach was missing from previously unsuccessful treatment experiences. “I’ve been struggling with trying to maintain recovery for fifteen years….I’ve been in other programs, got some good treatment….but for me, for me this was the missing ingredient right here. This is what I needed to stay clean. Because it helped me to identify and realize what I need to do with my life after I’m clean. It’s given me a sense of purpose, you know. I spent all those years drinking and drugging and it was like, now that I’m clean what am I going to do with my life.
Recovery Oriented Systems of Care
ROSC is: ¨ Value-driven APRROACH to
structuring behavioral health systems and a network of services and supports
¨ Framework to guide services and supports
• ROSC is not: • 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 • A closed network of
services and supports
ROSC- Elements
n Person-centered; n Inclusive of family and other ally involvement; n Individualized and comprehensive services across the
lifespan; n Systems anchored in the community; n Continuity of care; n Partnership-consultant relationships; n Strength-based; n Culturally responsive;
n Responsiveness to personal belief systems;
A Focus on Life
…everywhere else, all they talked about was
drugs, drugs, drugs, don’t do drugs, stay away from drugs, drugs are bad for you, drugs will fry your brain. Here they talk about other things that are important to me. We can go through a whole group and never even mention our addiction. We’re talking about like our families, our dreams, spirituality, getting skills. I have other parts to me other than drugs that are important and need help.”
Recovery
“Not everybody thought it was a good idea for me to try to get my daughter back. But they realized that without her, I didn’t have a reason to be well. So, we figured out a plan for what to do if I couldn’t handle the stress, and my whole team has stood beside me every step of the way. Was it ‘too stressful’ at times? You bet! But every day is a blessing now that I wake up and see that smiling face!”
ROSC- Elements
¨ Commitment to peer recovery support services; ¨ Inclusion of the voices and experiences of recovering
individuals and their families;
¨ Integrated services;
¨ System-wide education and training;
¨ Ongoing monitoring and outreach; ¨ Outcomes driven;
¨ Research based; and
¨ Adequately and flexibly financed.
We Are A Family
……IT’S JUST LIKE A FAMILY…THEY ACCEPT YOU AS BROTHER AND SISTER. AT NO TIME DO YOU FEEL THAT YOU’RE THE CLIENT AND YOU’RE TALKING TO THE CLINICIAN AND NOT THE PERSON. IT’S NOT THAT. IT’S LIKE WHEN I TALK TO ANTHONY, I SEE HIM AS A BROTHER, I DON’T SEE HIM AS MY CASE MANAGER. BUT IT’S LIKE WHEN I LOOK AT HEATHER I DON’T SEE HER AS MY CLINICIAN, I SEE HER AS MY SISTER AND WHEN I HAVE A PROBLEM, I GO AND TALK TO HER, AND SHE’S NOT GOING TO LET THE POSITION STAND IN THE WAY….I DON’T HAVE TO FEEL SLIGHTED OR SHORTED THAT SHE’S WAY UP HER AND I’M WAY DOWN THERE. I DON’T FEEL LIKE THAT. SO HERE IT’S REAL FAMILY ORIENTED. AND THAT’S REAL IMPORTANT TO ME
ROSC transformation is more than:
a. New Skills b. New Paperwork c. Implementing Evidence Based Practices
(EBPs) d. Adding Peer Support Services
Stakeholders identified three priority areas:
Peer Support Enhanced Treatment Community Integration & Engagement
Texas ROSC
Recovery Oriented Systems of Care (ROSC)
Why Now?
The Likelihood of Sustaining Abstinence Another Year Grows Over Time
36%
66%
86%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1 to 12 months 1 to 3 years 4 to 7 years
Dura9on of Abs9nence
% Sustaining Ab
s9ne
nce
Anothe
r Year
. A"er 1 to 3 years of abs/nence, fewer than half return to AOD use
A"er about 5 years of abs/nence, only about 14% resume AOD use
Dennis, Foss & ScoF (2007). An eight-‐year perspec9ve on the rela9onship between the dura9on of abs9nence and other aspects of recovery. Evalua&on Review, 31(6), 585-‐612.
Over a third of people with
less than a year of abs/nence will
sustain it another year
Dennis, M.L., Foss, M.A., & ScoF, C.K (2007). An eight-‐year perspec9ve on the rela9onship between the dura9on of abs9nence and other aspects of recovery. Evalua&on Review, 31(6), 585-‐612.
What does recovery look like on average?
Dura9on of Abs9nence 1-‐12 Months 1-‐3 Years 4-‐7 Years
ü More social and spiritual support ü BeFer mental health ü Housing and living situa9ons con9nue to
improve ü Drama9c rise in employment and income ü Drama9c drop in people living below the
poverty line
ü Virtual elimina9on of illegal ac9vity and illegal income
ü BeFer housing and living situa9ons
ü Increasing employment and income
ü More clean and sober friends
ü Less illegal ac9vity and incarcera9on
ü Less homelessness, violence and vic9miza9on
ü Less use by others at home, work and by social peers
Partial Recovery of Brain Dopamine Transporters in Methamphetamine User After Abstinence
Normal Control METH User (1 month detox)
METH User (14 months detox)
0
3
ml/gm
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
Recovery is real!
2010 Patient Protection & Affordable Care Law Dr. A. Thomas McLellan, Director, TRI
“Untreated” Abuse/Dependent ~ 25 million = 8%
“Risky Users” ~60,000,000
Abs/nent & Non-‐Problem AOD Users ~ 83% 2008 Na/onal Survey on Drug Use & Health
AOD Treatment in the US: 77% publically funded,
12% insurance
US Popula/on = 309,800,000
13,000 AOD Specialty Treatment Programs Serve ~
2.3 million <1%
Healthcare Reform + Parity Law ~
Medicaid Expansion
Screening and Brief Intervention
Why Now?
American Disability Act
“Disability is a matter of perception. If you can do just one thing well, you're needed by someone.”- Martina Navratilova
¨ Chronic Disease ¨ People Do Recover! ¨ Civil Rights base ¨ Evidence Based
Interventions exists ¤ *disruptive Innovations
(2012, Am Psych. Rotheram-Borus, et.al.)
What do you do?
What if you have no $$$, few resources?
Strategies
Something is working here…
What you focus on you will find more of…
¨ Redefine Resources ¨ Build Trust ¨ Model Recovery
-start with strengths, interests ¨ Share Success Stories ¨ Lift up Lived Experience
No Money Examples
¨ AMIR ¨ Landlords ¨ Book store donation ¨ OMNI hotel ¨ Social Networking- FB, twitter, SBIRT,
messaging training, SOAR, daily reflection apps
No Money!!!
¨ Circle of influence ¨ Build Relationships! Example: Our Legislator Friend
Internal, External, what keeps people from getting help…
STIGMA
Stigma
Do you know a person in Recovery?
What helped them?
Dig Deep
¨ Raise Awareness ¨ Make safe to share ¨ Internalized ¨ Decision Makers
v Relationships! ¨ Share accurate information ¨ Identify Allies!
¨ Community
If…
¨ Someone says- “they have to want it…” ¨ “there is only one way” ¨ We need money
¤ Share the brain science ¤ Note the 22 million in recovery ¤ National Survey on Recovery ¤ Relationships- example of car donation
Person in Recovery Family Member Provider
What Can One Person Do?
What Can You Do? Provider, Person in Recovery or Family Member
¨ Community Integration and Engagement: ¤ Primary care providers ¤ Criminal Justice ¤ Business Community ¤ Schools Colleges ¤ Housing ¤ Judges v Start a Book Club or Learning Community- Zappos
model
Providers
¨ Expand composition of your service team ¨ Ask a different question ¨ Advocate ¨ Optimize your service delivery approach, for
example… train all staff to be welcoming.
PIR or Family Member
¨ Recovery Messaging with Legislators • Tell your story!
¨ Raise expectations- for Recovery Oriented Care ¨ Learn about your options- your rights! • Develop advocacy skills ¨ Don’t assume your way is the Right way! • There are many pathways to Recovery • Do assume that people are doing the best with
what they know.
Practical Steps forward
DSHS priorities
¨ Peer Support ¨ Enhance Treatment ¨ Community integration
One System’s Activities to Integrate Peer-
Based Recovery Support Services (P-BRSS) ¡ Organizations required to develop peer leadership councils ¡ leadership development of peers
¡ Storytelling training
¡ Co-training of peers, providers, and dept. staff
¡ Developed peer-run advocacy/service community organizations
¡ Provider monitoring processes include peers on teams
¡ Practice guidelines and resource toolkits developed to support providers with successful implementation
Community Engagement
¨ Editorials for local paper ¨ Radio, PSAs, Social Media ¨ Listening Sessions/ Forums ¨ Recovery Month Events- art, music, spoken word ¨ Housing supports- outreach to landlords ¨ Community Celebrations
Enhance Treatment
¡ Peer support training for peers and supervisors ¡ Ongoing mechanism for peers across agencies to check in and
support one another
¡ Peers participate in the review of new RFPs
¡ Peers participate in the development of the vision for transforming levels of care (e.g. Day Program and IOP transformation processes)
¡ Peers integrated into ACT teams and Emergency Care Settings
¡ Hired people with lived experience in leadership positions throughout the department to represent that perspective
What Peers Can Do
• Asser9ve outreach
• Pre-‐treatment support and mo9va9on enhancement
• Recovery capital and needs assessment of individual/family/community
• Recovery planning
• Community resource iden9fica9on
• Assistance with basic needs
• Volunteer recruitment
• Asser9ve linkages to natural supports
• Recovery focused skill training aimed at full community integra9on
• Companionship, cul9va9ng hope and modeling
• Recovery check-‐ups (sustained monitoring and support)
• Recovery advocacy for individual/family needs
• Con9nued engagement
• Real world skill building in the natural environment (stress management, etc)
• Suppor9ng mul9ple pathways to recovery
• Problem solving obstacles
Lived Experience
She told me “you remind me a lot about myself.” And she told me personal things about herself and things that she had worked on and just the fact that she was sitting there and she was able to laugh about it and joke about it, I could see that there was like a light at the end of the tunnel. Her story relaxed me. It opened me up to having a lot more conversation with her and really putting myself out there.
Last Question: Resources
¨ YOU! ¨ Numerous resources- locally Rickie, Jeffrey, David,
Leonard, and Carie too start… ¨ Philander Moore, Laura Czepiel, and Kevin Klauber ¨ Social Media
Web-Based Recovery Resources
Substance Abuse &, Mental Health Services Administration
www.samhsa.gov
Bill White
www.williamwhitepapers.com
Life in Recovery Survey
http://www.facesandvoicesofrecovery.org/pdf/Life_in_Recovery_Survey3.pdf
Faces and Voices of Recovery
www.facesandvoicesofrecovery.com
Yale Program for Recovery and Community Health
www.yale.edu/PRCH
Asset Based Community Development
http://www.abcdinstitute.org/
Philadelphia Department of Behavioral Health
http://dbhids.org/
Recovery Reading Resources
“Philadelphia Practice Guidelines”- Philadelphia DBH “What’s Right With You?” – Barry Duncan
“Flourish”- Martin Seligman
“The Heroic Client” – Barry Duncan, Barry Miller, Jacqueline Sparks
“Tipping Point” – Malcolm Gladwell
“Understanding Poverty” – Ruby Payne “Leading Change”- John Kotter
“Slaying the Dragon: The History of Addiction Treatment and Recovery in America” – William White
Questions?
Summary
¨ What is working? What Helps? How do you stay Hopeful?
¨ Vision – Dream- Discover tangible steps forward ¨ Recovery is Real!
Content developed by Ijeoma Achara Achara Consulting, Inc. and Dietra
Hawkins, Both And Partners, Inc. Not to be duplicated without permission
Lessons Learned Assertive Outreach and Engagement Holistic Screening and Engagement Recovery Planning Expand Service Team Culturally Responsive
Specific Strategies
Lessons Learned Where to Start?
1. Clarify priorities and align your resources 2. Mobilize people with lived experience 3. Start with those who are willing and engaged 4. Establish a clear vision! 5. Focus on how to promote culture change across ALL
organizations and community partners!
6. Be aware of the tendency to develop two parallel structures and processes between treatment on the one hand and RCOs or Community Support Organizations on the other
7. And focusing on administrative logistics e.g. developing formal MOUs, determining who is in “the ROSC” and who is not etc.
ASSERTIVE OUTREACH AND ENGAGEMENT
¨ Pre-treatment Peer Support Groups
¨ Offer peer mentors as soon as contact is initiated
¨ Develop a welcome/recovery support center
¨ Build strong linkages between levels of care through peer-based recovery support services
¨ Use the most charismatic and engaging staff in reception areas
¨ Connect with people before initial appointments via phone
¨ Screening and early intervention in primary care, child care and school settings
¨ Establish relationships with natural supports to promote early identification
¨ Utilize social media
HOLISTIC SCREENING AND ASSESSMENT
What’s Right With You? ¨ Screening in primary care settings
¨ Global vs. categorical assessment
¨ Continual assessments
¨ Assessing recovery capital
TREATMENT PLANS VS. RECOVERY PLANS OR PERSON-CENTERED PLANS
What’s the Difference? ¨ Expert driven versus collaborative team, driven by
PIR ¨ Timeframe: treatment episode versus sustained
recovery ¨ Focus on all life domains ¨ Holistic ¨ Process
¨ Integration of peer specialists and recovery coaches ¨ Integration with primary care » Heavy drinking, for example, contributes to illness in each of
the top three causes of death: heart disease, cancer and stroke.
» Substance use increases the risk for hypertension (x2), congestive heart failure (x9), and pneumonia (x12);
» One out of every 14 hospital stays – 2.3 million stays – was related to substance disorders in 2004.
» Integrated care provides better quality of care and is more cost-effective
¨ SERVICE TEAM
EXPANDED COMPOSITION OF THE
CULTURALLY RESPONSIVE SERVICES
¨ Worldview ¨ Culturally competent assessment ¨ Diverse staff at all levels of the organization ¨ Linguistic competence ¨ Focus on empowerment with historically disenfranchised
communities ¨ Recognized the role of natural supports and family ¨ Culture specific services ¨ Disaggregate utilization and outcome data