Action Plan Guidelines for Regional Substance Abuse Coordinating Agencies. Fiscal Year

Transcription

1 Action Plan Guidelines for Regional Substance Abuse Coordinating Agencies Fiscal Year The Michigan Department of Community Health, Behavioral Health and Developmental Disabilities Administration Bureau of Substance Abuse and Addiction Services May 2011

2 TABLE OF CONTENTS Important Reminders Check List Introduction and Technical Requirements ii iii Guiding Principles and Performance Expectations 1 Guidelines for Action Plan Development Prevention 5 Treatment and Recovery 8 Quality Improvement Initiatives 10 Appendices ROSC Related Appendices: Appendix A Elements of Michigan s ROSC A-1 Appendix B Michigan s ROSC Guiding Principles B-1 Appendix C ROSC Implementation Plan Goals and Objectives C-1 Prevention Appendices: Appendix D Prevention Services Planning Chart for Prevention Prepared Communities D-1 Appendix D2 Prevention Services Planning Chart for Prevention Prepared Communities Instructions D2-1 Appendix D3 Twelve Community Sectors Checklist D3-1 Appendix E Youth Access to Tobacco (YATT) Services Planning Chart and Narrative E-1 Appendix E2 Youth Access to Tobacco (YATT) Services Planning Chart and Narrative Instructions E2-1 Appendix F Communicable Disease Provider Information Plan/Report Form F-1 Appendix F2 Communicable Disease Provider Information Plan/Report Form Instructions F2-1 Appendix G Communicable Disease Provider Contact Information Form G-1 Treatment and Recovery Appendices: Appendix H Treatment and Recovery Services Dashboard Form H-1 Appendix H2 Treatment and Recovery Services Dashboard Instructions H2-1 Appendix I Treatment and Recovery Narrative by Level of Care Forms I-1 Appendix I2 Treatment and Recovery Narrative by Level of Care Instructions I2-1 Other Related Information Appendices: Appendix J Eating Disorders and Chemical Dependency EDCD J-1 Appendix K Michigan Public Health Panel on Infant Mortality K-1 Appendix L University of Michigan Study: Teen Smoking, Pot Use Up L-1 Appendix M - NIATx Principles of Performance Improvement M Action Plan Guidelines i

3 Important Reminders! Required Components of Action Plan Submission: 1. Submission of transmittal letter - signed by the coordinating agency (CA) director. 2. Prevention, treatment and recovery services narratives for fiscal year 2012 (FY 2012), in required format. a. Prevention services planning chart for prevention prepared communities (PPCs) (limit two legal-sized pages per priority area). b. Youth access to tobacco (YATT) services planning chart and narrative. c. Communicable disease provider information plan/report form. d. Communicable disease provider contact information form. e. Treatment and recovery services dashboard form. f. Treatment and recovery services narrative by level of care form. 3. Narrative for quality improvement initiatives. Submission of Action Plan: All action plans (APs) are due electronically (in Microsoft Word or Adobe PDF format only) no later than 5:00 p.m. on Friday, July 10, 2011, to Sandra Bullard at bullards@michigan.gov. Technical Assistance: Technical assistance requests or questions related to this action plan guideline (APG) can be directed as follows: Prevention: Larry P. Scott, scottlp@michigan.gov Treatment and Recovery: Jeff Wieferich, wieferichj@michigan.gov Action Plan Guidelines ii

4 INTRODUCTION Section 6228(a) of the Public Health Code (P.A. 368 of 1978, as amended) requires a CA to develop a comprehensive plan for substance abuse prevention, treatment and recovery services that must be consistent with the guidelines established by the state. This APG document provides these guidelines and the comprehensive Action Plan (AP) submission, by the CA, serves to meet this requirement. The Michigan Department of Community Health (MDCH), Bureau of Substance Abuse and Addiction Services (BSAAS) agrees that an approved AP will suffice for purposes of Section 6228(a). The enclosed document and forms contain submission requirements for AP submission for prevention, treatment and recovery services, beginning October 1, 2012 and ending September 30, BSAAS review of the CA action plan will be focused on compliance with planning requirements as outlined in this document. Additional information from the CA may be required. The approved plan will be incorporated by reference in the annual contract between BSAAS and the CA, binding the CA to implement their plan. TECHNICAL REQUIREMENTS This document specifies the requirements, and provides forms, for submission of the AP for prevention, treatment and recovery services conducted from FY 2012 to FY The APs are expected to: Provide the opportunity for CAs to submit future plans and information consistent with guidelines established by BSAAS in this document. Provide data-driven evidence such as service need, utilization trends, and capacity in relation to demand. Provide for prevention plans and planned Synar activity for FY Due Date and Submission Format Requirements: The AP must be transmitted electronically (in Microsoft Word or Adobe PDF format only) no later than 5:00 p.m. on Friday, July 10, 2011, to Sandra Bullard at bullards@michigan.gov. Please note that transmittal of data dumps/downloads will not be accepted. Further detail regarding submission formatting is provided with the applicable information listed later in this document. A transmittal letter signed by the CA director is required, and must verify that the AP submitted has been reviewed and approved by both the CA director, and the CA s governing board. The signed letter may be scanned and transmitted via with the AP submission Action Plan Guidelines iii

5 GUIDING PRINCIPLES AND PERFORMANCE EXPECTATIONS These APG are intended to reflect the Michigan substance use disorder (SUD) service system: Transformation toward a recovery oriented system of care (ROSC) Strategic and practical alignment with the MDCH priority initiatives, including the reduction of obesity, infant mortality and tobacco use. Implementation of the Substance Abuse and Mental Health Service Administration (SAMHSA) strategic initiative regarding the prevention of substance abuse and mental illness. This process sets the planning direction for the FYs of 2012 through There will be an opportunity at the beginning of FYs 2013 and 2014 to modify the APs as regions make progress in implementing their initiatives. Michigan s ROSC Definition: 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. A ROSC Integrates Strategies To: Adopted by the ROSC Transformation Steering Committee, September 30, 2010 Prevent the development of new SUDs. Reduce the harm caused by addiction. Help individuals make the transition from brief experiments in recovery initiation to sustained recovery maintenance via diverse holistic services. Promote good quality of life and improve community health and wellness for all. A ROSC is not a program; it is a philosophical construct by which a behavioral health system (SUD and mental health) shapes its perspective on how they will address recovery from alcoholism, addiction and other disorders. A ROSC approach is the basis of the development of the SUD service system. Its philosophy completely encompasses all aspects of SUD prevention and treatment services, including program structure and content, agency staffing, collaborations, partnerships, policies, regulations, trainings and staff/peer/volunteer orientation. Within a ROSC, SUD service entities, as well as their collaborators and partners, cooperatively provide a flexible and fluid array of services in which individuals can move. People should be able to move among and within the system s service opportunities, without encountering rigid boundaries or silo-embedded services, to obtain the assistance needed to pursue recovery, and approach and maintain wellness. In Michigan we believe that behavioral health recovery is possible and can be achieved by individuals, families and communities. As CAs develop the action plans for their region, it is this type of system of care and this type of service array that should be considered Action Plan Guidelines 1

6 Additional information pertaining to Michigan s ROSC transformation initiative can be found in the appendices of this document and in the ROSC area of the BSAAS website at: Five Areas of Initial ROSC Priorities: These priority areas should be used to create the framework utilized to shape the FY AP process. 1. Behavioral health and primary healthcare integration. 2. Community health promotion. 3. Recovery support services that are peer-based. 4. Prevention services that are environmental and population-based. 5. Services and supports whose focus is expanded, including both the continuum of care (from pre-treatment services to post-treatment check-ups and support) and the content of care (beyond supporting abstinence to promoting community health and helping people build meaningful lives in the community). The CA submission of the AP is expected to reflect the ROSC guiding principles identified in Appendix B and must include objectives and strategies related to the ROSC implementation plan goals provided in Appendix C. Appendix C also includes each goal s objectives, as developed by the ROSC Transformation Steering Committee (TSC), to shape the transformation process. Please use these objectives as guide posts for AP development. MDCH Priorities: The MDCH also has priorities and expectations intended to condense this global delivery of services in Michigan. Accordingly, as part of MDCH, BSAAS is expected to address the appropriate priorities. Please include planning that will address the following selected MDCH priorities where appropriate in your AP: Investing in wellness and disease prevention by: o Reducing obesity. o Reducing infant mortality. o Reducing tobacco use. Preventing and controlling disease by: o Reducing the percentage of Michigan high school students who smoke cigarettes. o Increasing the percentage of Michigan children months of age who receive all recommended vaccines. Improve the health care provided to our population by: o Promoting patient-centered medical home concept. Example #1-a: MDCH priority: Reduce obesity Eating disorders, such as compulsive eating, binge eating, and compensatory eating disorders are addictions which can result in obesity. Eating disorders and alcoholism/drug addiction are frequent co-occurring disorders, and present Action Plan Guidelines 2

7 opportunities to impact obesity. (National Alcoholism and Substance Abuse Information Center March 2011) [See Appendix J] Related services within an AP may include: co-occurring disorder treatment, integrated primary health care services and youth/family prevention initiatives. Example #1-b: MDCH priority: Reduce obesity Related services within an AP may include adolescent and adult residential treatment services, movement and exercise requirements in treatment programs, and implementation of the Michigan Model for Comprehensive Health Education. Example #2: MDCH priorities: Increase the percentage of Michigan children months of age who receive all recommended vaccines and Reduce the Michigan infant mortality rate. The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to prenatal care for women and improving the quality of services (MMWR Recomm Rep. 2006;55[RR-06], Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry). Related services within an AP may include the Parent-Child Assistance Program, immunization requirements within women s treatment services, and Fetal Alcohol Spectrum Disorder efforts. Example #3: MDCH priority: Reduce the percentage of Michigan high school students who smoke cigarettes. Related services within an AP may include initiatives associated with Synar and implementation of the Michigan Model for Comprehensive Health Education. SAMHSA Strategic Initiatives: In the 2011 publication, Leading Change: A Plan for SAMHSA s Roles and Actions ( SAMHSA lists prevention of substance abuse and mental illness as strategic initiative number one. The promotion of mental health and prevention of SUDs are essential to SAMHSA s mission to reduce the severity of substance abuse, mental illness, and related conditions in communities across the country. Please note the following primary goals under this initiative. 1.1 Build emotional health, prevent or delay onset of, and mitigate symptoms and complications from substance abuse and mental illness. 1.2 Prevent or reduce consequences of underage drinking and adult problem drinking. 1.3 Prevent suicides and attempted suicides among populations at high risk, especially military families; Lesbian, Gay, Bisexual, Transgender or Questioning (LGBTQ); youth and American Indians and Alaskan Natives. 1.4 Reduce prescription drug misuse and abuse. The implementation of Prevention Prepared Communities (PPCs) will be the primary objective used to meet these goals. A PPC is a community equipped to use a comprehensive mix of data driven Action Plan Guidelines 3

8 prevention strategies, interventions, and programs across multiple sectors to promote emotional health and reduce the likelihood of mental illness, substance abuse (including tobacco), and suicide among youth, tribal communities, and military families. During the implementation of the Strategic Prevention Framework State Incentive Grant (SPF/SIG) and Drug Free Communities Support Grants, CAs began the process of building and developing PPCs. APs should reflect evidence of the development of PPCs for the prevention of SUDs and mental illness, and the promotion of mental health in support of ROSC implementation. This initial planning marks an evolutionary braiding of inter-agency services that integrates the strengths and resources of each Action Plan Guidelines 4

9 Guidelines for Comprehensive Action Plan Development PREVENTION SERVICES Prevention programming is intended to reduce the consequences of SUDs in communities by preventing or delaying the onset of use, and reducing the progression of SUDs in individuals. Prevention is an ordered set of steps along a continuum that promotes individual, family and community health; prevents mental and behavioral disorders; supports resilience and recovery; and reinforces treatment principles to prevent relapse. Prevention services are most effective when the services are conducted within a PPC. ROSC Implementation Plan goal four: To enhance our collective ability to support the health, wellness, and resilience of all individuals by developing prevention prepared communities. That goal underscores the value of PPCs as the cornerstones of a ROSC. It is evident that PPCs are designed to promote behavioral health and wellness, provide the multi-sector infrastructure necessary, and are critical to the successful implementation of a ROSC. This is consistent with SAMHSA s primary strategic initiative of preventing substance abuse and mental illness. In concert with implementation of the ROSC, SAMHSA s strategic initiative related to PPCs, and MDCH priorities related to obesity and infant mortality, CAs are expected to sustain a SPF process and a service delivery system that will show evidence of working toward community-level change. A role for prevention services directed toward individual behavior change remains for specific high-risk selective and indicated populations. CAs are expected to employ the six SAMHSA Center for Substance Abuse Prevention (CSAP) strategies to engage individuals and the community to effect population-based change. It is critical to note that, especially in the case of information dissemination and alternatives, multi-component community-based strategies are more effective than single-component strategies. The six strategies are as follows: Information dissemination. Education alternatives. Problem identification and referral. Community-based process. Environmental. Alternatives This multi-component and strategic approach should cover all age groups including support for children, senior citizens, all socio-economic classes, diverse cultures, minority and under-served populations, service men and women, gender-specific and targeted high-risk groups. The ultimate goal of implementing the six strategies would be the development of PPCs with community norms that reduce alcohol and other drug consumption, or modify the conditions under which they are consumed. This will, in turn, reduce SUDs. Prevention Services Planning Chart for Prevention Prepared Communities: All CAs must complete a Prevention Services Planning Chart for Prevention Prepared Communities (Appendix D) for each of the prevention priorities listed under Submission Requirements, with the Action Plan Guidelines 5

10 exception of the YATT priority. These priorities will require a separate planning chart. The instructions for completing the Prevention Services Planning Chart are provided in Appendix D2 of this document. The Prevention Services Planning Chart is designed to elicit a logical sequence of information from consequences, through planned outcomes, provider involvement, and training needs. Each chart is expected to represent summary information, and should be limited to two legal-sized pages, per priority. CAs must submit a three-year plan for prevention services conducted within a PPC for the following priorities: 1. Reduce childhood and underage drinking. 2. Reduce prescription and over-the-counter drug abuse/misuse. 3. Reduce youth access to tobacco (Synar and Synar-related activity). 4. Address a local priority identified based on epidemiological evidence. The preparation of the Prevention Services Planning Chart must show evidence of a data-guided planning process indicative of the collection and analysis of baseline data to validate the selection of primary problems (consequences) for each priority. Evidence of input from a regional community epidemiological workgroup, in concert with a community collaborative (e.g. Drug Free Communities, Community Strategic Prevention Planning Collaborative, etc.), is required. The workgroup and community collaborative must be representative of diverse community sectors as prescribed in Appendix D3. The Prevention Services Planning Chart must also indicate the evidence-based programs and strategies to be selected to; prevent substance use and SUDs; promote mental health; and reduce obesity and infant mortality. Evidence-based programs and strategies employed to reduce access to tobacco are required in the CA submission of the Youth Access to Tobacco Planning Chart. Plan Review Criteria: The Prevention Services Planning Chart will be reviewed based on the following criteria: Demonstrating use of a consequence-based, data-guided process for the multiple year planning format, including evidence of input from community epidemiological workgroups in concert with a community collaborative (e.g. Drug Free Communities, Community Strategic Prevention Planning Collaborative, etc.), representative of diverse community sectors. Identifying priority problems and target populations based on local epidemiological evidence. Implementing evidence-based interventions for priorities consistent with the implementation of the ROSC, MDCH priorities and the SAMHSA Strategic Initiative. Supporting development of PPCs by strengthening the regional prevention services system, based on the implementation of the ROSC. For more information on the prevention efforts linked to ROSC, refer to Michigan s ROSC Guiding Principles, Appendix B, numbers 11, 12, and 13; and to Appendix C, Michigan s ROSC Implementation Plan Goals - III, IV, V, and IX Action Plan Guidelines 6

11 Youth Access to Tobacco (YATT) Planning Synar Compliance: In accordance with federal requirements, CAs must develop and implement an annual plan to meet Synar compliance requirements, and reduce access to tobacco products by minors. Each CA must work toward maintaining a catchment area retailer violation rate (RVR) of less than 20% for the formal Synar survey, and must direct resources, as necessary, to meet this rate. CAs are encouraged to work toward the lowest RVR possible for their region. Agencies are encouraged to select tobacco use reduction as a priority, provided the primary intent of the focus is to reduce youth access to tobacco. CAs are also expected to participate in keeping their master retailer lists up to date. Those CAs with formal Synar RVRs above 20% in two or more of the last three years are required to include a minimum of 25% of catchment area outlets in both vendor education efforts and compliance checks. The Youth Access to Tobacco Planning Chart (Synar Plan) is required to be submitted annually (Appendix E). In addition to this chart, a brief narrative is required. Appendix E2 provides instructions for both the chart and the narrative. Plan Review Criteria: Plans will be reviewed for evidence of the use of local data in planning youth access to tobacco services, for use of best practice approaches, and in the context of the CA s official Synar survey results. Communicable Disease: CAs must develop and implement a communicable disease (CD) plan in accordance with Prevention Policy # 02- Addressing Communicable Disease Issues in the Substance Abuse Network, as updated. The plan is to highlight programs and interventions for the corresponding fiscal year, planned service providers, and a brief narrative description encompassing all CD-related activity to be conducted for the development of PPCs. CAs are to complete Columns B and C of Appendix F, as well as corresponding information about providers who will implement CD services on behalf of the CA. In addition, a brief narrative (no more than two pages) is required. The narrative must highlight other CD-related activities not indicated on this CD plan form, and may include items such as sexually transmitted diseases/sexually transmitted infections (STD/STI), tuberculosis, and/or hepatitis-related interventions and programs. The narrative should also include locations/venues where these specific planned services will occur. Additional requirements are a description of collaborative efforts with other local, community-based organizations offering similar and information on underserved populations Action Plan Guidelines 7

12 TREATMENT AND RECOVERY SERVICES Treatment programming is intended to assist individuals in establishing recovery from a SUD. Treatment is a component of the recovery process and varying levels of care should be made available to individuals at the time and place that an individual needs. Episodes of treatment should identify the needs, resources and supports that an individual needs, to establish and maintain recovery. As the state moves toward ROSC transformation, CAs are required to demonstrate transformation efforts at the regional level. In addition to ROSC efforts, regional planning must contain information on how MDCH goals and the SAMHSA initiatives will be addressed. CAs must provide the rationale for their proposed activities through the use of a data guided process. This process must demonstrate that the treatment and recovery services within the CA region are being established based on the actual needs of the population. The decisions made regarding how the MDCH goals and SAMHSA initiatives are addressed must also be completed utilizing a data-guided and informed process. Treatment and Recovery Services Dashboard Form (Appendix H): This form serves to provide an overview of the services and activities within the CA region. It identifies the current number of treatment providers by level of care along with specific initiatives or activities in the CA region. This form needs only to be completed for FY An updated dashboard will need to be submitted for 2013 and Appendix H2 provides instructions for completing this form. Treatment and Recovery Services Narrative Reports/Forms: CAs need to identify that specific steps are being taken to ensure that they and their provider networks are addressing transformation to a ROSC. In addition, the narrative information should reflect, where appropriate, how the MDCH goals and the SAMHSA initiatives are being addressed within the provider network. There should be a clear link as to how peer recovery support services, recovery support services and case management are supporting outpatient, residential, detoxification, methadone and other medication assisted treatment services. The narrative must illustrate a data-guided process for the selection and utilization of services that includes: Methodology used to identify the SUD treatment and recovery needs in establishing the treatment provider network. This methodology can include input from community epidemiology workgroups, community collaborative groups or other coordination and advisory groups. Data and data sources used to support the need for each SUD treatment and recovery area of service within the continuum of care. Narrative descriptions must be completed that provide a detailed description of the plans for each area of service. The narrative should clearly delineate activities for each year of the plan. For years two and three, CAs will have opportunities to make changes to the plans if necessary. Progress in each area will be reviewed and compared to the approved plan during scheduled site visits. Narratives must be completed on the forms provided in Appendix I, see Appendix I2 for instructions. CAs must report on each of the following areas of service, with special attention paid to the specific requirements that must be included Action Plan Guidelines 8

13 Continuum of Care for SUD Treatment and Recovery Services: Outpatient Residential Detoxification Methadone Other Medication Assisted Treatment Case Management Recovery Support Early Intervention Within the report on each of these service areas the following information must be included: Total number of providers (recorded on the dashboard). ROSC efforts within the service area. The role of specialty and supplemental services. Activities and efforts related to addressing MDCH goals. Indication of COD capable or enhanced services being available. For more information on treatment and recovery efforts linked to ROSC, refer to Michigan s ROSC Guiding Principles, Appendix B (specifically, numbers 2, 3, 5, 6 and 8 15) and to the Implementation Plan Goals, Appendix C (specifically numbers II, III, V, VI, VII, VIII, and IX). Treatment and Recovery Services Review Criteria: All submissions must be complete and will be reviewed using the following criteria: Submission must be completed on the forms provided. ROSC transformation initiatives within the treatment and recovery service system are made based on a review of the needs in the region and reliable data sources. Evidence that ROSC efforts utilized the goals, objectives and guiding principles of Michigan s ROSC Implementation Plan. MDCH goals and SAMHSA initiatives are being addressed through the appropriate service areas based on a review of the needs in the region and reliable data sources. Evidence that individuals receiving SUD treatment and recovery services, or who have received SUD treatment and receovery services, provided input in the development of the plan. Evidence that system change efforts within service areas are guided by evidence-based practices and methodologies Action Plan Guidelines 9

14 QUALITY IMPROVEMENT INITIATIVES During FY CAs will need to engage in initiatives, within the region, that seek to improve the quality of services and/or expand the ability to provide more quality services. CAs need to provide information for activities related to the following initiatives. 1. Describe how the region is building capacity for integration with primary health care and mental health in the SUD service system as part of the overall ROSC transformation efforts. Building capacity would include but not be limited to the following activities: Identifying and assessing resources available to undertake integration. Exploring knowledge and/or resource gaps (human and fiscal) and other barriers to integration. Convening meetings, defining roles and documenting activities that lead to integration. Assessing and addressing readiness issues concerning capacity that may inhibit or facilitate integration (strengths, weaknesses, political will). Identifying barriers for integration and steps that will be taken to address those barriers. This information should be provided as a separate document within the submission and should be labeled as Integration Efforts within the SUD Service System. It should be no longer than 2 pages, single spaced, size 12 Times New Roman font, with one inch margins all around. Review Criteria for Integration Efforts: Evidence of a clear description of capacity and asset building and associated factors. Evidence of recruitment and convening of stakeholders, including providers and coalitions. Evidence of stakeholder support. Evidence of human and fiscal assets and gaps. Evidence of an outreach plan to enhance assets and fill gaps. Evidence of, or plans for, a stakeholder/community readiness survey to gauge capacity for integration (strengths, weaknesses, political will). Evidence of strategies to apply readiness information to develop and/or enhance integration. Evidence that indicates the CA included both prevention and treatment in the QI initiative. Evidence that the efforts will span over the three years of the plan. Evidence that indicates the CA s planned initiatives fit with the ROSC Guiding Principles (Appendix B) and the Implementation Plan s goals and objectives (Appendix C). 2. Describe how the CA will utilize NIATx efforts to assist with system transformation. NIATx designed a model of process improvement specifically for behavioral health care settings to improve access and retention in treatment. At a minimum, CAs must describe efforts that will take place in the outpatient, residential, methadone and detoxification service areas for FY Planning for 2013 and 2014 does not have to be as specific as 2012, but those years must also include the areas of case management, peer support services, recovery support services and early intervention. CAs will have opportunities to update their 2013 and 2014 AP prior to the start of each fiscal year to provide their specific plans. Through a grant, BSAAS has invested a considerable amount of time in educating and training organizations and individuals on the NIATx principles. There is a cadre of trainers available to Action Plan Guidelines 10

15 assist CAs in implementing change efforts. More information on NIATx can be found in Appendix M, and at The NIATx information should be provided as a separate document within the submission and should be labeled as NIATx Efforts within the SUD Service System. It should be no longer than 2 pages, single spaced, size 12 Times New Roman font, with one inch margins all around. Review Criteria for NIATx Efforts: Evidence of a clear understanding of the NIATx principles and their overall purpose. Methodology used to identify what service areas are going to be addressed through NIATx efforts this may include data resources, results of a focus group, information from a survey, and other similar activities. Description of the expected outcomes for each project. Description of how the actual results of each project will be shared with BSAAS and other regions. Description of how the available NIATx coaches will be used. Evidence of plans to expand those efforts that are successful Action Plan Guidelines 11

16 Appendix A ELEMENTS OF MICHIGAN S ROSC From Michigan s ROSC, An Implementation Plan for SUD Service System Transformation, February 2011: Based on stakeholder feedback, the Transformation Steering Committee (TSC) has identified several core values and beliefs to guide Michigan s transformation process. The cornerstone of these values is the recognition that people recover, and individuals and families maintain their wellness, in healthy communities. Also, people with both substance use disorders and serious mental illnesses can and do recover. The recovery process can be facilitated by professional intervention, but professional services are not equally important for everyone, since in some cases recovery occurs outside the context of professionally based services. While only a small segment of people with SUDs need specialized addiction treatment services to support recovery, all members of the community benefit from prevention activities that promote resilience and community health for all. The TSC considers the promotion of community health a foundational element of Michigan s transformation process. The overall health of the community improves when fewer people develop SUDs, when the burden of substance use is reduced, and when recovery is effectively facilitated. As such, both prevention and treatment services play a critical role in promoting community health and building community recovery capital. The TSC further recognizes that recovery exists on a continuum of improved health and function. Along this continuum, there are diverse roles through which people can provide support. These roles include prevention and treatment providers, peer support specialists, and community-based support services. All of these roles are equally appreciated, valued, and needed to promote sustained health and wellness in our communities. Finally, people who are receiving services must have opportunities to assume leadership roles and participate in guiding the development of the system. At an individual level, rather than services being professionally directed, peers, family and community members are valued for their lived experiences, and collaborate with professionals to identify the most effective treatment or prevention approaches for their unique needs and preferences Action Plan Guidelines Appendix A, Page A-1

17 Appendix B MICHIGAN S ROSC GUIDING PRINCIPLES This APG reflects the following guiding principles related to the implementation of a ROSC as administered by CAs. It is the expectation of BSAAS that these principles will be embraced, utilized and reflected in the CA regional Action Plans. From Michigan s ROSC, An Implementation Plan for SUD Service System Transformation, February 2011: In addition to these core beliefs articulated by the TSC, stakeholders throughout Michigan have customized, expanded, and endorsed the elements of a ROSC that were developed during a SAMHSAsponsored National Summit on Recovery in The first 15 elements below are described in descending order of importance, based on a voting process in which approximately 80 stakeholders in Michigan participated. Number 16, the promotion of community health and wellness, was not prioritized as part of the original list; it was added as an additional priority based on stakeholders belief that universal prevention approaches benefit everyone in the community. These elements of a ROSC will be utilized by BSAAS and the TSC to support and guide the development of a ROSC in the state of Michigan: 1) Adequately and flexibly financed Our system will be adequately financed to permit access to a full continuum of services, ranging from prevention, early intervention, and treatment to continuing care and recovery support. In addition, we will strive to make funding sufficiently flexible to enable the establishment of a customized array of services that can evolve over time to support an individual's and a community s recovery. 2) Inclusion of the voices and experiences of recovering individuals, youth, family, and community members The voices and experiences of all community stakeholders will contribute to the design and implementation of our system. People in recovery, youth, and family members will be included among decision-makers and have oversight responsibilities for service provision. Recovering individuals, youth, family, and community members will be prominently and authentically represented on advisory councils, boards, task forces, and committees at state and local levels. 3) Integrated strength-based services Our system will coordinate and/or integrate efforts across service systems, particularly with primary care services, to achieve an integrated service delivery system that responds effectively to the individual's or the community s unique constellation of strengths, desires, and needs Action Plan Guidelines Appendix B, Page B-1

18 4) Services that promote health and wellness will take place within the community Our system of care will be centered within the community, to enhance its availability and support the capacities of families, intimate social networks, community-based institutions, and other people in recovery. By strengthening the positive social support networks in which individuals participate, we can increase the chances for successful recovery and community wellness. 5) Outcomes-driven Our system will be guided by recovery-based process and outcome measures. These measures will be developed in collaboration with individuals in recovery and with the community. Outcome measures will be diverse and encompass measures of community wellness as well as the long-term global effects of the recovery process on the individual, family, and community not just the remission of biomedical symptoms. Outcomes will focus on individual, family, and community indicators of health and wellness, including benchmarks of quality-of-life changes for people in recovery. 6) Family and significant other involvement Our system of care will acknowledge the important role that families and significant others can play in promoting wellness for all and recovery for those with substance use challenges. They will be incorporated, whenever it is appropriate, into needs-assessment processes, community planning efforts, recovery planning and all support processes. In addition, our system will provide prevention, treatment, and other support services for the family members and significant others of people with SUDs. 7) System-wide education and training Michigan will seek to ensure that concepts of prevention, recovery, and wellness are foundational elements of curricula, certification, licensure, accreditation, and testing mechanisms. The workforce also requires continuing education, at every level, to reinforce the tenets of ROSC. Our education and training commitments are reinforced through policy, practice, and the overall service culture. 8) Individualized and comprehensive services across all ages Our system of care will be individualized, person/family/community-centered, comprehensive, stage-appropriate, and flexible. It will adapt to the needs of individuals and communities, rather than requiring them to adapt to it. Individuals in treatment will have access to a menu of stage-appropriate choices that fit their needs throughout the recovery process. The approach to SUD services will change from an acute, episode-based model to one that helps people manage this chronic disorder throughout their lives. Prevention services will be developmentally appropriate and engage the multiple systems and settings that have an impact on health and wellness. Prevention efforts will be individualized based on the community s needs, resources, and concerns Action Plan Guidelines Appendix B, Page B-2

19 9) Commitment to peer support and recovery support services Our system of care will promote ongoing involvement of peers, through peer support opportunities for youth and families and peer recovery support services for individuals with substance use disorders. Individuals with relevant lived experiences will assist in providing these valuable supports and services. 10) Responsive to cultural factors and personal belief systems Our system of care will be culturally sensitive, gender competent, and age appropriate. There will be recognition that beliefs and customs are diverse and can impact the outcomes of prevention and treatment efforts. 11) Partnership-consultant relationship Our system will be patterned after a partnership/consultant model that focuses more on collaboration and less on hierarchy. Systems will be designed so that individuals, families, and communities feel empowered to direct their own journeys of recovery and wellness. 12) Ongoing monitoring and outreach Our system of care will provide ongoing monitoring and feedback, with assertive outreach efforts to promote continual participation, re-motivation, and re-engagement of individuals and community members in prevention, treatment, and other support services. 13) Research-based Our system will be informed by research. Additional research on individuals in recovery, recovery venues, and the processes of recovery (including cultural and spiritual aspects) will be essential to these efforts. Research related to SUDs will be supplemented by the experiences of people in recovery. Prevention efforts will use the Strategic Prevention Framework and epidemiologically-based needs-assessment approaches to identify behavioral health issues and community concerns. Individual, family, and environmental prevention strategies will be datadriven. BSAAS recently received a State Epidemiological Outcome Workgroup (SEOW) grant from the Center for Substance Abuse Prevention to expand and enhance the current substance abuse needs assessment collection and tracking processes by incorporating mental health data. This will allow us to create state and community profiles that share common indicators, intervening variables and consequences related to mental, emotional and behavioral disorders. The SEOW will support the work of the ROSC TSC and will inform the implementation of the ROSC in the Michigan Action Plan Guidelines Appendix B, Page B-3

20 14) Continuity of care Our system will offer a continuum of care that includes prevention, early intervention, treatment, continuing care, and support throughout recovery. Individuals will have a full range of stage-appropriate services to choose from at any point in the recovery process. Prevention services will involve the development of coordinated community systems that provide ongoing support, rather than isolated, episodic programs. 15) Strength-based Our system of care will emphasize individual strengths, assets, and resiliencies. 16) Promote community health and address environmental determinants to health Our system will strive to promote community health and wellness through strategic prevention initiatives that focus on building community strengths in multiple sectors of our communities Action Plan Guidelines Appendix B, Page B-4

21 Appendix C ROSC IMPLEMENTATION PLAN GOALS AND OBJECTIVES Goals were developed by the ROSC Transformation Steering Committee for the first three years of the ROSC transformation process, year two began February The objectives related to the goals follow each below. Note: Goal I is not included as it only is for use by the ROSC TSC. From Michigan s ROSC, An Implementation Plan for SUD Service System Transformation, February 2011: Goal II: To Develop a Shared Vision for ROSC in Michigan. Objective A: To develop a ROSC definition, guiding principles, and consensus regarding the types of services and supports that will be a part of Michigan s ROSC. Goal III: To Increase Stakeholders Understanding of Ways in Which Services and Supports that Promote Recovery and Wellness May be Similar to or Different from Current Services. Objective A: To enable stakeholders to distinguish current practices which are consistent with a recovery orientation from those that are not consistent. Goal IV: To Enhance our Collective Ability to Support the Health, Wellness, and Resilience of All Individuals by Developing Prevention-Prepared Communities. Objective A: To develop systems that provide continuing prevention services which promote individual, family and community health. Objective B: Reduce the development of SUDs among those at high risk by providing early intervention services to individuals and families with an increased risk of developing substance use challenges or disorders. Objective C: To prevent suicides and attempted suicides among those at risk. Goal V: To Promote Health Equity in Michigan s SUD Service System. Objective A: To reduce health disparities in Michigan s SUD service system. Goal VI: To Enhance the Ability of People with SUDs to Both Initiate and Sustain Their Recovery. Objective A: To increase the number of people in treatment who successfully initiate and sustain recovery, through the implementation of integrated, recovery-oriented services and supports. Goal VII: To Ensure that Michigan Residents in Need of SUD Treatment Receive Effective Services and Supports, Regardless of the Systems They Enter Action Plan Guidelines Appendix C, Page C-1

22 Objective A: To increase cross-system collaboration and coordination between public health, child welfare, mental health, criminal justice, education, the Department of Corrections, primary care, recovering communities and the SUD service system. Objective B: To ensure that individuals in need of care receive comprehensive services that address both their addiction as well as their physical health needs. Objective C: To assist the criminal justice system in aligning their approaches, resources and philosophical framework with that of recovery-oriented services and supports. Objective D: To increase access to services, promote retention in services, and improve the financial health of providers through the use of tele-health technologies. Goal VIII: To Mobilize the Recovery Community and Increase the Hope that Recovery is a Reality in Michigan. Objective A: To increase the number of people in recovery who are visible in leadership positions, within the system and throughout Michigan s communities. Objective B: To expand the voice of people in recovery in communities throughout Michigan. Objective C: To reduce stigma and discrimination against people in recovery in Michigan. Goal IX: To Ensure that Transformation Efforts Are Sustainable and Become Embedded in Systems and Communities Throughout Michigan. Objective A: To align fiscal, policy, regulatory, and community contexts with the provision of services and supports which promote recovery, resilience, and community health Action Plan Guidelines Appendix C, Page C-2

23 Appendix D PREVENTION SERVICES PLANNING CHART FOR PREVENTION PREPARED COMMUNITIES CA Name: Plan Fiscal Year: Contact Person s Name and Prevention Priority: NOTE: This section looks at how the CA is working toward community involvement. 1. Who are the CA s partners in this prevention priority, and what specific role(s) do the partners play? 2. What partners are missing, and what is the CA s strategy to get additional partners involved? 1. Consequence(s)/ (Primary Problem) Consequence Support Data (Include data sources) Associated Intervening Variable(s) to be Targeted Primary Federal Strategies (specific) and Evidence-based Services/Interventions (specific) for Each Strategy Geographic Area Served Population Type/ Service Population (Specify based on CSAP Priority Populations) Activity Related - Immediate Outcomes Performance Indicator Intended Long-term Outcome, including link to National Outcome Measures (NOMS) Provider Agency or Coalition Responsible for Activity Training and TA needs of the CA to implement this plan Action Plan Guidelines Appendix D, Page D-1

24 Appendix D2 PREVENTION SERVICES PLANNING CHART FOR PREVENTION PREPARED COMMUNITIES INSTRUCTIONS Appendix D, the Prevention Services Planning Chart for Prevention Prepared Communities, is designed to elicit a logical sequence of information from associated consequences, through planned outcomes, provider involvement, and identifying training needs for the priorities. The chart presents information in a horizontal manner. The consequence is identified in the first column (one per box), with all associated information following in the same row. When a box/column is reached in which multiple items may be listed, i.e., Associated Intervening Variables to be Targeted, and the information in the following five boxes/columns is directly related to each item in the previous box/column, please align the associated information adjacent to one another and assign a common number to both items of information. Please provide all necessary information in a concise manner. Note: Coordinating agencies (CAs) must use the chart provided with no modifications. It is designed for legal size paper. CA (Coordinating Agency) name and plan fiscal year: Enter the name of the coordinating agency who is submitting the prevention plan, and indicate which fiscal year the plan is intended. Contact person s name and Enter the name and address of the person who is responsible for the plan and responding to any questions or clarification that may arise. Prevention priority: Indicate the overall Prevention Priority: Each CA must complete separate planning charts for the following priorities that have been identified as statewide priorities: 1) Childhood and Underage Drinking 2) Prescription and Over-the-Counter Drug Abuse/Misuse Note: Different charts are provided to be used for youth access to tobacco (YATT) and communicable disease information. A third priority may be identified at the CAs discretion, however this priority must be based on data and may be related to either an emerging trend or known problem already identified in the region. While youth access to tobacco is a required priority, due to Synar requirements, only use YATT planning form provided in Appendix E for guidance and submission Action Plan Guidelines Appendix D2, Page D2-1