Recovery-Oriented Systems of Care (ROSC) Update from The Field

Transcription

1 Recovery-Oriented Systems of Care (ROSC) Update from The Field

2 Recovery-Oriented System of Care (ROSC): a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families and communities to achieve improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. W. Clark, CSAT, Generic ROSC Talk and ATTC Network ROSC Manual 2

3 Goal of the Initiative To create a broader (get help to more people suffering from addiction) and deeper (provide more support for people needing help to maintain their recovery) safety net. 3

4 Key definitions Acute care model: assess, treat, discharge Chronic care model: disease cannot be cured but can be arrested or managed Recovery: a process of change through which an individual achieves improved health, wellness, and quality of life. (CSAT, 2010) 4

5 How are we treating addiction? Acute model of care (assess, treat, discharge) Focused on symptoms, not on promoting wellness Short-term episodes of intensive care are ill-suited to manage a chronic condition: High attrition rate (60% attrition from outpatient nationwide) Few achieve abstinence during treatment High relapse rates after treatment (50% - 60% within 6 months following treatment Costly cycling through multiple episodes of care (e.g., in one study in NYC, 80% of outpatient clients reported 1 or more previous episodes, 50% more than 3 episodes) People don t get better, some die, families and communities suffer Source: ATTC Network ROSC Manual 5

6 The Substance Abuse Problem We Face Source: Tom McLellan, Treatment Research Institute, 2012

7 Population Prevalence Very Serious Use In Treatment 2,300,000 Addiction 25,000,000 Harmful 60,000,000 Use Little/No Little or No Use Use Source: Tom McLellan, Treatment Research Institute, 2012

8 General Population vs. CJS G e n e ra l Po p u l a t i o n C r i m i n a l Ju s t i ce Syste m In Treatment Addiction Harmful Use In Treatment Addiction Little or No Use Harmful Use Little or No Use

9 A Best Practice Care System 9

10 A wind of change... Recovery is more than abstinence from alcohol and drugs; it is about building a full and productive life in the community. Our treatment systems must reflect and help people achieve this broader understanding of recovery. (Dr. W. Clark, 2007) Source: ATTC Network ROSC Manual 10

11 Recovery Support System Detox Residential After Care Support Groups O.P. Recovery Support Services S. U. D. Drug Free 3-5 years 11

12 After 5 years if you are sober, you probably will stay that way. Longitudinal Trends in Recovery (Pathways N=1326) It takes a year of abstinence before less than half relapse Dennis, ML Foss MA & Scott CK (2007). An eight-year perspective on the relationship between Pathways the duration of abstinence and other aspects of recovery. Eval. Rev. 12

13 What is Recovery? Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. CSAT National Recovery Summit, 2005 Recovery is not simply sobriety. While sobriety is considered necessary for recovery, it (alone) is not considered recovery. The WHO measures six domains of recovery: physical, psychological, independence, social, environmental and spiritual. Betty Ford Institute Recovery Consensus Panel,

14 What do We Know About Recovery? Chronic Course Stable alcoholism recovery is not reached until 4-5 years of sustained remission, longer for other drugs. Short periods of abstinence are really periods of brief dormancy and not sustainable recovery. Peer Support is Critical Enhances long-term recovery outcomes for a broad spectrum of individuals. Community Variables Impact Relapse Community recovery resources are just as important as individual factors in tipping the scales of recovery maintenance versus relapse Recovery can be initiated in an artificial environment, but successful recovery maintenance can only be achieved in a natural community environment William White 14

15 What do We Know About Recovery? (cont d) Family inclusion and support promotes long-term recovery Addressing basic needs is essential for long-term recovery A strong therapeutic relationship can overcome low motivation for treatment and recovery. Those who drop out of treatment or who are administratively discharged from treatment are those who need treatment the most. 15

16 Creating a Recovery-Oriented System of Care that identifies and builds upon each person s assets, strengths, and areas of health and competence to play & pleasure work or school social support faith belonging & civic life housing treatment & rehabilitation family & friends support the person s efforts to manage his or her condition while establishing or re-gaining a whole life and a meaningful sense of belonging in and to the community. Source: Thomas A. Kirk, Jr., Ph.D. 16

17 Recovery-Oriented Systems of Care: A Paradigm Shift Shifting the question from How do we get the client into treatment? to How do we support the process of recovery within the person s environment? 17

18 Recovery-Oriented Systems of Care Approach In recovery-oriented systems of care, treatment agency is viewed as one of many resources needed for client s successful (re)integration into the community. No one source of support is more dominant than another. Various supports need to work in harmony with client s direction, so that all possible supports are working for and with the person in recovery. Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC. 18

19 Primary goals of recovery-based care for addiction: Prevent addiction and intervene early with those who develop substance use problems; Support sustained recovery for those who are in recovery; and Improve the health and wellness of individuals, families and communities. National Conference of State Legislators (September 5, 2008). Recovery-Based Care for Addiction: Lessons From the States 19

20 Houston Recovery Initiative Our goal is to create a broader and deeper safety net for individuals with substance use disorders including those in recovery by: 1. Increasing access to housing 2. Establishing Recovery Community Centers 3. Building a stronger relationship with the 12-Step community 4. Educating the community on the Chronic Care Model and best practices for treatment 5. Developing and implementing a ROSC model for adolescents with substance use disorders 6. Developing and maintaining a web-based substance use disorder resource directory 7. Training Recovery Coaches/Peer Support Specialists 20

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