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Recovery Oriented Systems of Care

(ROSC)

September 14, 2017 Lexington, Kentucky

Presented by Sharon A. Hesseltine

Intentional Beginnings, LLC

A Note of Deepest Thanks

• Great Lakes ATTC

• Lonnetta Albright, Forward Movement Consulting

• Dr. Ijeoma Achara, Achara Consulting

Personal recovery flourishes

best in a climate of family

health, cultural vitality,

community health, and

economic security

“The Community is the Treatment

Center”

Andy Chelsea, Shuswap tribal Chief at

Alkali Lake

Taken From Don Coyhis and William White

THE HE A L I NG FO REST

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

THE NEED FO R A CO M M UNI TY AP P R O ACH

GENDER

RACE/ ETHNICITY

Historical Context CHALLENGES IN BEHAVIORAL HEALTH SYSTEMS

Failure to Attract/Limited Access: Duration of Use Among Adult First Time Admissions – 2009

16.5

13.8

17.4

17.2

15.5

14.3

13.3

13.8

0 5 10 15 20

Male

Female

American Indian/Alaskan Native

Non-Hispanic/Black

Non-Hispanic/White

Hispanic

Asian/Pacific Islander

Other

DURATION OF USE (IN YEARS)

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ACHARA CONSULTING

Among adults reporting a behavioral health condition, more than half report onset in childhood or adolescence

Average delays in help seeking for mental health challenges is more than a decade (National Comorbidity Study)

Why ROSC: National Challenges FAILURE TO ATTRACT SUD System Challenges

• UNMET NEED: < 10 % who need Tx seek treatment or if they do, arrive under coercive influences

• LOW PRE-TREATMENT INITIATION RATES: 40% of individuals who initially request or are referred for treatment do not connect to care

• LOW RETENTION: > 50 % do not successfully complete treatment

• INADEQUATE SERVICE DOSE: significant % do not receive optimum dose of Tx as recommended by NIDA

• LACK OF CONTINUING CARE: only 1

in 5 receive post-discharge planning

• RECOVERY OUTCOMES: most

resume using within 1 year and most

do so within the first 90 days of

discharge from Tx

• REVOLVING DOOR: > 60% one or

more Tx episodes, 24% three or more

50% readmitted within 1 year

Similar Cross System Challenges

High Recidivism in Criminal Justice • “Within three years of release, about two-thirds (67.8 percent)

of released prisoners were rearrested.

• Within five years of release, about three-quarters (76.6 percent) of released prisoners were rearrested.

• Of those prisoners who were rearrested, more than half (56.7 percent) were arrested by the end of the first year.”

National Institute of Justice, June 17, 2014

Bureau of Justice Statistics Special Report, April 2014

• Multiple and complex needs require attention for successful re-integration

Similar Cross System Challenges

Child Welfare

• Families have complex needs, but CW agencies do not have control over all of the services needed

• “Often, there is a mismatch between services offered and what families actually need to resolve their difficulties.”

• Increasing caseloads

• Shortage of foster care

Community Challenges

• Countless families are often devastated by the disease of addiction

• People with MH conditions are often isolated and not living life to the fullest

• People don’t know where to turn for help for loved ones or how to get loved ones into treatment

• High stigma keeps people isolated and suffering alone

• Community members who want to help don’t know how to help

• We often only see the disease, we never see recovery. Therefore families and individuals don’t have hope that recovery is a real reality for them.

Intersecting Challenges: Analysis of the Current State

• Disjointed, fragmented systems and approaches can’t provide the holistic array of services and supports that are needed

• Reactive systems: Majority of resources focused on those with the most severe, chronic illness and challenges with limited focus on keeping people well or addressing the needs of those who are vulnerable

• Deficit-focused approaches, address the urgent need but don’t address the root issues, the associated challenges, and are not solution focused

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ACHARA CONSULTING

The Black Box – Dr. Arthur Evans “If we as a field really truly believe that severe and

complex SUD’s are “chronic disorders,” the resources we invest in

early screening and intervention and post

treatment recovery maintenance and support would be commensurate

with the resources we now repeatedly invest to

support recovery initiation/stabilization”

William White

What is Recovery?

It depends on who you ask

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

W HAT I S RECO V E R Y?

• Getting involved with things I enjoy ( e.g. church, friends, dating, support groups, etc.)

• Learning what I have to offer • Seeing myself as a person with strengths • Taking one day at a time • Knowing my illness is only a small part of who I

am • Having a sense that my life can get better • Having dreams again • Believing I can manage my life and reach my

goals (bravery and hope) • Being able to tackle everyday • Having people I can count on

What is Recovery? From a National Focus Group

• My diagnosis is not a barrier

• Overcoming challenges

• Bouncing back stronger

• Ongoing change

• Having systems of support

• Having a new way of living

• Living a fulfilled life

• Lifetime of growth

• Being whole again

• Abstinence

• An awakening; healing of spirit, body, and mind

What is Recovery? From a Community Perspective

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RECOVERY IS REAL!!!

THE G O O D NEW S What Do You Think Of

When you hear recovery?

What does it mean to you?

Many Paths to Recovery

• 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!

• Hope

• Person-Driven

• Many Pathways

• Holistic

• Peer Support

• Relational

• Culture

• Addresses Trauma

• Strengths/Responsibility

• Respect

SAMSHA’s 10 Guiding Principles of Recovery

Treatment and Medication Support

Employment Opportunities AA and NA

Family Education Faith-based Support Physical Health RCOs

Healthy relationships Life skills training

W HAT I S A RECO VERY- O RI ENTED SYSTEM

O F CARE ( RO SC) ?

ROSC: Dispelling the Myths

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, group of people or committee • A closed network of services and supports

ROSC is: • Value-driven APRROACH to structuring behavioral health systems and a

network of clinical and non-clinical services and supports • Framework to guide systems transformation

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A ROSC is a Network of Professional and Non professional services and supports

that allow people to find and follow their own path to recovery

No Two Journeys Look the Same

IT B OIL S DOW N TO THIS

Its about how each of us as individuals, and recovery advocates within our community

and organization, promote recovery in each of our interactions

How Do We Support The Journey?

It Starts With Us!

• Prevent the development of behavioral health conditions

• Intervene earlier in the progression of illnesses

• Reduce the harm caused by behavioral health conditions

• Help people transition from brief experiments in recovery initiation to recovery maintenance

• Actively promote good quality of life, community health and wellness for all

PRI M ARY G O ALS O F A RO SC

Some of the Values and Guiding Principles

• Person-centered

• Holistic approaches

• Family and other ally involvement

• Individualized and comprehensive

• Anchored in the community

• Continuity of care

• Partnership-consultant relationships

• Strengths-based

• Culturally responsive

• Commitment to peer recovery support services

• Inclusion of those with lived experience and their families

ACHARA CONSULTING

COMPARISON OF VALUES Are We Recovery Oriented or Not?

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 life Maintenance, 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

Process

Product

• Treatment Services aligned with a Recovery-oriented approach

• Integration of peer support services

• Mobilization of recovery advocacy community

• Family support and education

• Culturally competent services

• Cross system collaboration (e.g. criminal justice system, child-welfare system, primary and speciality medical care etc.)

• Community based supports that promote recovery and wellness (e.g. faith community, local businesses, educational settings etc)

What are the implications for different stakeholders?

S O M E O F T H E B U I L D I N G B LO C K S O F A RO SC

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ROSC Across Systems

“And Suddenly You Just Know It’s Time To Start Something New And Trust In The

Magic Of Beginnings”

CJ focus on intense initial period of tx does not often lead to long-term recovery

Opportunities

• Increased Attraction: People typically referred after very long addiction careers. ROSC = early intervention First offenders programs, Early diversion programs

• Increased Access: finite capacity of the tx system leads to long waiting lists. CJ has an opportunity to expand the use of and develop recovery natural supports.

• Increased Engagement

• Reduced Recidivism

– 730,000 people admitted and released from prisons each yr

– Two-thirds (68%) rearrested within 3 years of release (1997)

– Half (52%) returned to prison for new crime/ violation (1997)

IMPLICATIONS FOR CRIMINAL JUSTICE ( CJ) SYSTEMS AND POPULATIONS

• Continued monitoring AND support that integrates natural community based supports

• Collaborative Opportunities: e.g. holistic assessments can identify prevention and early intervention opportunities for siblings and children.

• Recovery Capital Assessments

• Relevance of Recovery Planning

• Effectiveness of peer-support to assist with transitioning between cultures and sustaining recovery

• Empowerment, Hope and Choice

• Rebuilding lives within the context of communities

IMPLICATIONS FOR CRIMINAL JUSTICE SYSTEMS AND POPULATIONS

• Assertive Linkages

• Mobilization of natural

supports for early intervention and continuing support

• Implications of a chronic care

approach to treatment • Relevance of recovery

planning

I M PLI CATI O NS FO R CHI LD W ELFARE S E R VI CES

• Assertive Linkages

• Mobilization of supports for

early intervention and continuing support

• Early screening, referral and coordination for treatment

• Coordinated care extending beyond health system

• Inclusion of broad systems of support

I M PLI CATI O NS FO R HEALTH CARE S E R VI CES Implications for Schools

• Recognizing prevention as part of the broader continuum

• The majority of individuals with the disease of addiction began substance use during adolescence

• Promoting an atmosphere of health and wellness as part of a broader life strategy

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Implications for Treatment Services LETS E XP LO RE THE I M PLI CATI O NS FO R TREATM ENT PRO VI D E RS

W HAT CAN THEY DO ?

• Assertive outreach, engagement and early intervention

• Holistic screening and assessment

• Culturally responsive services

• Peers integrated in service teams

• Partnership-consultant relationships – individualized treatment options

• Continuing support and community integration

• Innovative approaches to continuing support

ACHARA CONSULTING

Assertive Outreach, Engagement and Early Intervention

Outreach Worker (quoted in White, Woll, and Webber 2003)

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.

“

”

ACHARA CONSULTING

Assertive Outreach, Engagement

and Early Intervention

Meeting People Where They Are • No Administrative Discharges

for Set-Backs

• No “come back when you are clean”

• Looking for Opportunities to assertively connect people to resources

• Pre-treatment Peer Support Groups

• Offer peer mentors as soon as contact is initiated

• For urban settings, 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

STRATEG I ES TO PRO M O TE ASSERTIVE OUTREACH AND ENGAGEMENT

Potential Functions of Peer Based Recovery Support Services

• Assertive outreach • Pre-treatment support and motivation enhancement • Recovery capital and needs assessment of individual/family/community • Recovery planning • Community resource identification • Assistance with basic needs • Volunteer recruitment • Assertive linkages to natural supports • Recovery focused skill training aimed at full community integration • Companionship, cultivating hope and modeling • Recovery check-ups (sustained monitoring and support) • Recovery advocacy for individual/family needs • Continued engagement • Real world skill building in the natural environment (stress management,

etc) • Supporting multiple pathways to recovery • Problem solving obstacles

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Cultural, values based change drives relationships, practice, policy and fiscal changes in all parts and levels of the organization. Everything is viewed through the lens of and aligned with recovery oriented care.

Practice and Administrative alignment in selected parts of the organization – e.g. pilot “recovery projects”

Adding peer and community based recovery supports to the existing treatment.

Moving Towards ROSC 3 Approaches

ADDITIVE SELECTIVE TRANSFORMATIONAL • 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

W HAT CAN CO M M UNI TY M EM BERS DO ?

• 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

W HAT CAN PEO PLE I N RECO VERY DO ?

• 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 and family 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

W HAT CAN FAM I LY M EM BERS DO ?

Recovery Capital

• Recovery Capital can be defined as internal and external assets that can be brought to bear to initiate and sustain recovery from alcohol and other drug problems.

• Recovery Capital interacts with SUD severity to shape the intensity and duration of supports needed to achieve recovery

Recovery Capital Includes:

• External Resources such as: • Financial resources • Personal transportation or access to public • Safe and secure home and/or neighborhood • Environment free from alcohol and other drugs • Supportive family members and/or friends • Stable job (that is enjoyable) • Education or work environment conducive to long-

term recovery • Friends and/family in recovery • Reasonably good health and primary care

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Recovery Capital Includes:

• Internal Resources such as:

• Goals and great hope for the future

• Problem solving skills and resources

• Meaningful, positive participation in family and community

• Clear sense of self

• Sense of purpose

• Personal values and sense of right and wrong

What Can Schools Do

• Build resilience

• Promote protective factors

• Provide opportunities for students for form meaningful, reliable mentoring relationships with emotionally healthy adults

• Look for opportunities to build Recovery Capital

Exploring How Your Community Can Move Forward

• ROSC Steering Committees

• Start with the Vision of What You Would Like to See

• Engage diverse stakeholders to partner together in this process

• Identify short-term wins to establish momentum

• Work simultaneously in multiple domains

• Activate and Mobilize the Recovery Community

Detroit Recovery Project: Andre Johnson

• Life Skills Workshops

• GED workshops

• Peer-led support groups

• Adult Education and Employ-ability skills offered to individuals on probation

• Strengthening Families Program

• Health Education : nutrition, HIV/AIDS testing, education related to diabetes, physical fitness, high blood pressure

• Partnership with health department to provide flu vaccines

• C.O.P.E. (Co-Occurring Peer Empowerment Program) provides peer support to CJ population within jails and the community to assist with re-integration

• W.I.R.E.D. (Women in Recovery Enhancement Program) is a 90 day recovery support service for pregnant women and women with children designed to address gender and cultural barriers to sustained recovery.

EMERGING INNO VATIONS

Scott County Indiana

• Austin – Population 4,000

• 20% of residents with income below the poverty level

• Less than 10% of population with a college degree

• February 2015 1st 30 cases of HIV

• Mid March identified HIV cases number 55

• At peak of epidemic 22 new HIV cases were diagnosed each week

In 2015

• Limited SUD services

• Four (4) 12-Step Meetings a week

• Intergenerational culture of substance use

• Community in decay

• Largest HIV outbreak in ……….

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September 6, 2017

Get Healthy Scott County "Blueprint For Transformation" has 70 Scott County citizens and leaders attend to work on Scott County's Strategic Plan this past Wednesday! Thanks to all who came out to provide input.

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Strategies for Successful Implementation

Don’t underestimate what the implementation process entails

Change almost never fails because it’s too early. It almost always fails because it’s too late. – Seth Godin The Time for Continued Change is NOW!

If there is no transformation inside of us, all the structural change in the world will have no impact on our institutions.

Peter Block

Content developed by Ijeoma Achara Achara

Consulting, Inc.

ijeoma.achara@yahoo.com