Recovery Oriented Systems of Care (ROSC) Child Welfare & Behavioral Health Integration

Transcription

1 Recovery Oriented Systems of Care (ROSC) Child Welfare & Behavioral Health Integration 2016 Child Protection Summit September 7-9, 2016 JW Marriott Grande Lakes Orlando, FL Lonnetta M. Albright, CPEC Certified John Maxwell Coach-Trainer-Speaker Executive Director, Great Lakes ATTC President, Forward Movement Inc. One is too small a number to achieve significance John C Maxwell Florida s team: Laurie Blades, Wesley Evans, Dana Foglesong and Director Ute Gazioch People in Recovery who guide, advise and partner with us Joining us today are Sarah Sheppard and Jamie Campbell ROSC and Recovery Management content developed in partnership with Great Lakes ATTC lead subject matter experts, Dr. Ijeoma Achara and William (Bill) White Video link: Florida DCF Conference

2 A C T Increase Awareness & Understanding of the ROSC Framework Understand Recovery as a construct: Long term Recovery Management Describe how Behavioral Health looks different in a ROSC Framework Understand how the service team expands including peer specialists and individuals in Recovery Explore how to integrate ROSC principles into the FIT (Family Intensive Treatment) model Connect the Dots Florida s plan and priorities related to ROSC Transformation Share experiences, ideas, and opportunities for integration Aligning Concepts: Changing how we think CONCEPT PRACTICE Aligning Practice: Changing how we use language and practices at all levels; implementing values based change CONTEXT Aligning Context: Changing regulatory/physical environment, policies and procedures, enlisting community support Florida DCF Conference

3 Recovery from Mental Disorders and/or Substance Use Disorders is 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 s working Definition, 2012) Retrieved from: Health is a state of COMPLETE physical, mental and social wellbeing and not merely the absence of disease or infirmity. World Health Organization Florida DCF Conference

4 .the phases of recovery from serious mental illness and recovery from addiction have many parallels. In fact, the manner in which participants in different forms of recovery independently used the same or similar language to name and describe their own processes of recovery was striking. ~Davidson, et al., 2008, p. 235 Recovery Components and Principles A Handout What is recovery from co occurring disorders? this research suggests that recovery, be it from the hardships of addiction or problems of mental illness, rests on the same principles of human development as do other spheres of psychological and social functioning ~Davidson, et al., 2008, p.288 There is an identified risk period when prevention efforts may have their greatest impact (12 21 years of age) Half of all lifetime cases of mental and SUDs begin by age 14 and three fourths by age 24 Similar risk factors predict multiple interrelated problems (drop out, pregnancy, bullying, drug use) Youth are impacted by many spheres of influence Programs that can be delivered primarily by peer leaders have increased effectiveness Programs that have a focus on broader life skills have increased effectiveness (Source: ONDCP and IOM Report, 2009) Florida DCF Conference

5 Need holistic services that don t just focus on reducing unwanted behaviors but promoting healthy behaviors They are not saying that we need to ignore substance abuse... They are saying that we need to address substance abuse, but it has to be a part of a more comprehensive effort. Getting adolescents through life without using substances is not our end goal. We have to prevent adolescent substance use in order to promote healthy adolescent development, but we also have to promote healthy adolescent development in order to prevent substance abuse. ~Join Together Need continuous prevention supports and systems to be available (IOM, 2009) Need to articulate the connections among substance use within the family, adverse childhood experiences and later physical and behavioral health challenges (Felitti et al., 1998) Need to integrate peer support services (IOM, 2009) Need to be able to communicate the indirect effects of prevention efforts (e.g. academic achievement, physical health, mental health, etc.). 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 Davidson et al. Discovering who I am Lifelong effort to become the best we can be Change Regaining health physical / mental / spiritual / relationships New beginning becoming what you want to be Personal different for each person Hope Bravery facing a different way of life Repairing what is broken Re establishing oneself from crises Living life on life s terms Florida DCF Conference

6 Substance Abuse & Mental Health Legislative Action Senate Bill 12 Effective July 1 st 2016 The bill addresses Florida s system for the delivery of behavioral health services Within the bill, the term Recovery is mentioned 14 times Beginning in 2017, each managing entity is required to develop and submit a plan to the department describing the strategies for enhancing services and addressing three to five priority needs in the service area. The plans must be developed with input from consumers and their families, local governments, local law enforcement agencies, and other stakeholders. Services provided to persons in this state (shall) use the coordination of care principals characteristics of recovery oriented services and include social support services, such as housing support, life skills and vocational training, and employment assistance to live successfully in their community. Federal Emphasis and Expectation President s New Freedom Commission IOM Reports SAMHSA Growing body of MH and SUD research Expectations of people in recovery National Consumer and Recovery Advocacy Movement Trailblazing Systems of Care Achara Consulting, Inc Florida DCF Conference

7 To name a few, they include 1. Replicable, community based treatment modalities 2. Federal, state, local, private partnership to fund addiction treatment and ancillary support industries, e.g., research, training, etc. 3. Accessibility: From less than 50 to more than 13,000 U.S. specialty treatment programs 4. Professionalization of addiction medicine & counseling 5. Systems of early intervention, EAP, SAP, SBIRT 6. Screening/assessment/diagnostic tools 7. Continuum of care 8. Millions of lives touched and transformed The AC Model can achieve: biopsychosocial stabilization more effectively, more safely for more people than has ever been achieved in history and YES; Treatment Works, BUT Recovery initiation does not assure recovery maintenance especially for people with high problem severity / low recovery capital. Discovery that addiction shares many characteristics with other chronic medical disorders (McLellan, et al, 2000) Growing interest in: How would we treat addiction if we really believed that addiction was a chronic disorder?, e.g., how models of disease management in primary health care might be adapted to long term management of addiction Florida DCF Conference

8 Slide Acknowledgment: William White. Data Source: O Brien CP, McLellan AT. Myths about the Treatment of Addiction (1996). The Lancet, Volume 347(8996), Addiction/Chronic Illness Compliance Rate Relapse Rate Alcohol Opioid Cocaine Nicotine Insulin Dependent Diabetes Medication < Diet and Foot Care < Hypertension Medication < Diet < Asthma Medication < 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) 1. Cultural and political awakening of individuals/families in recovery * Growth/diversification of mutual aid * New recovery advocacy movement; New recovery support institutions 2. Frustration of frontline addiction professionals 3. Addiction science, particularly research on addiction/recovery careers, treatment outcome studies & treatment systems performance data 4. Addiction treatment payors 5. Need to counter growing cultural pessimism about treatment, e.g., effects of celebrity rehab recycling Resources: Let s Go Make Some History www:facesandvoicesofrecovery.org Florida DCF Conference

9 Research shows that over 50% of parents involved with the child welfare system have a substance use disorder and many have a co occurring mental health condition, particularly mothers. (Young, J. K., Boles, S. M., & Otero, C. (2007). Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12(2), ) Once maltreatment is verified, children of parents who abuse alcohol or drugs are more likely to be placed in out of home care and stay in care longer than other children (Barth, R., Gibbons, C., and Guo, S. (2006). According to Florida Safe Families Network (FSFN) data, in fiscal year there were 15,780 children were removed from their home. Parental substance misuse accounted for 7,838 of the children removed. ROSC focuses on building resilience, wellness and long term recovery Vs compliance with treatment better for families short and long term IF WE REALLY BELIEVED Our resource allocation wouldn t look like this: TREATMENT SUPPORT TO THE RECOVERY COMMUNITY Recovery Oriented systems support person centered and self directed approaches to care that build on the strengths and resilience of individuals, families, and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems. Recovery oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to sustain long term recovery for individuals and families impacted by severe substance use disorders. The system in ROSC is not a treatment agency, but a macro level organization of a community, a state or a nation. CSAT, SAMHSA William Bill White Florida DCF Conference

10 ROSC is not: Just about Substance Use Disorders 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 service and supports ROSC is: Value driven APPROACH to structuring behavioral health systems and a network of clinical and non clinical services and supports Framework to guide systems transformation Recovery Oriented Systems of Care shifts the question from How do we get the client into treatment? to How do we support the process of recovery within the person s life and environment? The Healing Forest Florida DCF Conference

11 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 Effectively addressing the behavioral health needs of parents and caregivers is critical to the safety and wellbeing of their children and to the functioning of the family The department has identified the integration of child welfare and the substance abuse and mental health service systems as a priority of effort, which is tracked ongoing by Secretary Carroll PoE Goal: To implement an integrated system for families served by child welfare Activities: Self assessment and peer review process occurring across the state Integrating ROSC principles into current practice of the Family Intensive Treatment teams, to include extensive family engagement, person centered planning, development of community supports and use of peers Trauma informed Services Judiciary and Justice System Prevention Treatment and Medication Support Employment Opportunities Child Welfare AA and NA Family Education Yt à{@utáxw fâññéüà Physical Health Recovery Community Organizations Healthy relationships Life skills training Florida DCF Conference

12 Supportive Housing Coordination as a priority The department seeks to increase and improve collaboration and coordination between Managing Entities, Local Homeless Coalitions, Designated Lead Agencies of Continuum of Care Plans, and other key state and local agencies related to housing related services; Find safe, affordable, stable housing for individuals with mental health and/or co occurring diagnoses; Ensure that these individuals receive the necessary support services to be successful in the community. 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! Florida DCF Conference

13 PERSON CENTERED Collaborative Preferences, life goals, choices define scope of services Quality of life Empowerment Community based Long term planning for life in the community Self determination is a fundamental civil right CONVENTIONAL Provider driven, compliance is valued Deficits, disabilities, and illness drive focus of services Maintenance, Safety, stabilization, symptom reduction Dependence Facility based Planning for treatment/service episode Self determination follows peoples demonstration that they are equipped with certain skills, or clinically stable PERSON CENTERED CONVENTIONAL High expectations Low expectations People choose from a flexible menu Professional services only are selected for the of services including natural and person professional supports Promotes trial and error growth in the Paternalistic approach avoids risk taking context of responsible risk taking Focuses on building positive sense of self, competence and confidence Can be punitive, shaming Evolving, living plan adjusts over time Static plan Encourages inclusion of family members/and/or natural supports Typically engages only the person receiving services Process Product Example: Western New York Care Coordination Program (Janice Tondora, Yale Program on Recovery and Community Health) Outcomes Achieved: 68% Increase in competitive employment 43% decrease in ER visits 44% decrease in inpatient days 56% decrease in self harm 51% decrease in harm to others 11% decrease in arrests Achara Consulting, Inc Florida DCF Conference

14 Rather than focusing solely on evidence based clinical practices that revolve exclusively around treatment government, health care and research entities would broaden their mission to include the dissemination of emerging models and promising practices for designing and delivering recovery support services and developing recovery community organizations. RECOVERY COMMUNITY ORGANIZATIONS Recovery Community Treatment Community BRIDGE the gap! Tom Hill, Faces and Voices of Recovery We wouldn t inadvertently attempt to colonize peer run organizations by exerting undue control, power and influence. For example, determining how funding we provide should be used rather than allowing the organization to make those decisions or use collaborative shared decision making processes. Florida DCF Conference

15 Partnering with the recovery community to identify advocates that with guidance can assume local leadership positions. Creating opportunities for local leaders ready to rise to the level of state, regional or national leaders. Facilitate mentoring relationships Support the development of recovery leadership institutes that can nurture future leaders at all levels of this movement. Recovering persons on agency boards Developing / empowering informal peer leadership Openly recruiting recovering persons as staff Paid peer specialists to provide formalized support Creating a sense of a community where recovering persons helping recovering persons is highly valued Infusing peer self help throughout the service continuum Understanding the unique learning advantages of peer delivered services Medicated Assisted Treatment Medicated Assisted Recovery Substance Abuse Substance Use Disorder Substance Misuse Mental Illness Mental Health Issues Recovery Management A philosophy for organizing treatment and recovery support services to enhance prerecovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery William (Bill) White Florida DCF Conference

16 Attraction, access & early engagement Screening, assessment & placement Composition of the service team Service relationship Service dose, scope & quality Locus of service delivery Assertive linkage to communities of recovery Post treatment monitoring, support and early reintervention Note, there are others, but these 8 are critical. AC Limitations Unmet Need: < 10 % who need TX. seek treatment or if they do, arrive under coercive influences Low Retention: > 50 % do not successfully complete treatment Revolving Door: > 60% one or more TX. episodes, 24% 3 or more 50% readmitted within 1 year RM Directions Assertive community education & outreach Assertive waiting list management Lowered threshold of engagement; rethinking motivation; institutional outreach Changes in administrative discharge policies 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. Outreach worker (Quoted in White, Woll, and Webber 2003) Florida DCF Conference

17 Pre treatment Peer Support Groups Offer peer mentors as soon as contact is initiated For urban settings, develop a welcome/recovery support center Tele health particularly in rural settings Build strong linkages between levels of care through peerbased recovery support services Use the most charismatic & engaging staff at reception Connect with people before initial appointments via phone Screening and early intervention in health care facilities Establish relationships with natural supports to promote early identification AC assessment is categorical, pathology focused, professionally driven, an intake function & focused on individual; placement based on problem severity. RM assessment is global, strengths based, client focused (rapid transition to recovery plans), continual and encompasses the individual, family and recovery environment; recovery capital factored into placement decisions. FIT assessments ASAM, ASI, Family Functional Assessment (FFA), Mental Health when indicated, AAPI 2, Initial Adverse Childhood Experience (ACE) Individualized service plans Menu of Options Based on Collaboration between clinician, person receiving services and peer support Integration of clinical and nonclinical recovery support services Focus on more than symptom reduction and abstinence FIT Comprehensive family care plan within 30 days of enrollment involving family, peers, support services, community and natural supports Florida DCF Conference

18 WHAT S GOING ON? Global vs. categorical assessment Continual assessments vs. only intake assessment Assessing recovery capital and other strengths Vehicle for building relationship, trust, and rapport FIT: Reviews comprehensive family care plan with family and revise as needed every three months, or more frequently to address changes in circumstances impacting treatment CHANGING OUR QUESTIONS: Can you tell me a bit about your hopes or dreams for the future? What kind of dreams did you have before you started having problems with alcohol or drug use, depression, etc.? What are some things in your life that you hope you can do and change in the future? If you went to bed and a miracle happened while you were sleeping, what would be different when you woke up? How would you know things were different? Leads to Recovery Plans vs. Treatment Plans Care Coordination as a priority Care Coordination is the organization of care activities between two or more participants including the person served and family (with consent) involved in an individual's care to facilitate the effective delivery of health care services. The Florida Department of Children and Families recognizes the need to better coordinate care for individuals with complex needs at the system and person levels. Because of this, the department has made high level recommendations to ensure the implementation of care coordination. Add Care Coordination as a billable, covered service Identify standardized level of care assessments and provide the monetary resources necessary for the Managing Entities (MEs) and providers to implement them. Implement data sharing agreements across providers and funders to ensure an effective flow of information that follows individuals through their care. Monitor implementation and outcomes of Care Coordination activities and adjust approaches as needed to maximize effectiveness. Florida DCF Conference

19 AC model uses disease rhetoric but few medical personnel; recovery rhetoric but decreasing involvement of recovering people. RM expands role of medical (including primary care physicians) and other allied professionals, recovering people (P BRSS) and culturally indigenous healers. Also emphasizes reinvestment in volunteer and alumni programs. Florida s FIT model is completely aligned with this framework! The question is not: Which of these roles is THE most important in the recovery process? The question is: How can such resources be bundled and sequenced in ways that widen the doorway of entry into recovery and enhance the quality of recovery? How long should a person be in recovery before serving in a peer support role? Florida DCF Conference

20 How long should a person be in recovery before serving in a peer support role and what about educational requirements?...rather than being legitimized through traditionally acquired education credentials, peer staff draw their legitimacy from experiential knowledge and experiential expertise. Experiential knowledge is acquired through the process of one s own recovery Experiential expertise requires the ability to transform this knowledge into the skill of helping others to achieve and sustain recovery. Many people have experiential knowledge but not experiential expertise (White and Sanders, 2006) COMMON CHALLENGES Working within a clinical environment and how not to become mini clinicians Differences and similarities between Mental Health and Substance Use Peers Ethics and Boundaries Finding their voice and the system making sure that voice is valued What to do in case of relapse? Peer The Value of Peer run organizations Florida DCF Conference

21 Preparation of all Staff "Create a Transitional Space and embrace resistance" (Michael A. Diamond) Cannot be successfully implemented in a vacuum, staff need an understanding of recovery and recovery oriented services Clear job descriptions are needed prior to hiring Supervisors need to have a clear understanding of roles and be advocates of peer support roles Peer providers need access to peer support both within and outside of their organization More than one peer provider should be hired in a setting Hiring needs to rely more heavily on selection vs. training Need to build in evaluation protocols Focus on building a CULTURE of peer support throughout the organization and system Provide clear guidelines and best practice recommendations for peer and recovery support services Source: Innovation and Diffusion of Technology: A Human Process, Michael A. Diamond Promotion of peer support services as a priority Florida has the capacity to train and certify individuals as Certified Peer Recovery Specialists through the Florida Certification Board in three areas: Adult peers, Family peers and Veteran peers. The inclusion of peer support is a beneficial companion to traditional treatment and is beginning to permeate Florida s behavioral system. To promote peer support as fundamental to engagement and recovery, the Department of Children and Families included peer support services as a required component of recently implemented community based mental health service models. Florida has a strong and engaged network of peer run organizations that advocate in multiple forums for movement toward a recovery oriented system. These organizations are critical partners in moving the behavioral health system forward and provide input and guidance at the state and local levels. Strong statewide network of peer specialist Two years ago, the department reestablished a position at the state office, held by a person in recovery with lived behavioral health experience. The primary responsibilities of the Statewide Coordinator of Recovery and Integration are to: Provide training and technical assistance to key stakeholders Assist with system wide implementation of ROSC Transform drop in centers to whole health centers Enhance the peer specialist workforce. Currently, five of the seven managing entities contracted by the department have chosen to hire at least one peer specialist to assist with their efforts. The Recovery and Integration Statewide Coordinator serves as a statewide facilitator for this network of peer specialist. Florida DCF Conference

22 CHANGE PROCESSES ADDITIVE SELECTIVE TRANSFORMATIONAL Adding peer and community based recovery supports to the existing treatment system Practice and Administrative alignment in selected parts of the system Cultural, values based change drives practice, community, policy and fiscal changes in all parts and levels of the system. Everything is viewed through the lens of and aligned with recovery oriented care HOW DOESTHE FIT MODEL WITHIN A ROSC FRAMEWORK? Intensive treatment interventions for parents with high risk child abuse cases Immediate access to SUD and Cooccurring services for parents Increase percentage of substance using parents who enter treatment Increase treatment retention and abstinence rates Integrate SUD treatment, parenting & therapeutic treatment for all family members regardless of payer Improve involvement in Recovery services to help parents recover Improve show rates for sessions; increase program completion In collaboration with the child welfare Community Based Care lead agencies and dependency case management agency partners: Increase safety of children Develop safe, nurturing and stable living situation as rapidly and responsibly as possible Provide information to inform safety plan Reduce number of out of home placements Reduce rates of re entry into the Child Welfare System Florida DCF Conference

23 Sarah Sheppard (Peer Specialist) Jamie Campbell (FIT team Peer) Laurie Blades, DCF Deputy Director Wesley Evans, Statewide Coordinator Integration & Recovery Services AC Model: Passive linkage, low affiliation and high early attrition, single pathway model of recovery RM model: Assertive linkage, multiple pathway model of recovery, linkage beyond recovery mutual aid groups; active relationship with local service committees, involved in recovery community resource development DEVELOPING A ROSC IN KANSAS Florida DCF Conference

24 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 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 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 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 Florida DCF Conference

25 Aligning Concepts: Changing how we think CONCEPT PRACTICE Aligning Practice: Changing how we use language and practices at all levels; implementing values based change CONTEXT Aligning Context: Changing regulatory/physical environment, policies and procedures, enlisting community support Florida DCF Conference

26 What excites you about shifting to a ROSC framework? What concerns do you have? Why is this shift necessary? What would help you become more recovery oriented? What outcome(s) are you seeking? How are you integrating Peers and Recovery Coaches into your workforce alongside your clinical team members; with your board, at all levels of the organization? How might you navigate the shift? What could get in your way obstacles, barriers? What do you need to make the shift? Michigan's Definition of ROSC: 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. Recovery Oriented System of Care Transformation Steering Committee _4871_ ,00.html 13_410502_7.pdf f_care_345240_7.pdf Florida DCF Conference

27 Many of the early publications on addiction recovery management (Arm) and recovery oriented systems of care (ROSC) focused on work underway in the State of Connecticut and the City of Philadelphia. Recently that work has expanded in states and cities across the country, adapting itself to widely diverse cultural settings and economic and political constraints. One such area of concentrated development is the State of Michigan. In June of 2014, I had the opportunity to interview several people about the work underway in this state.. William White ROSC in Michigan: An Interview with Deborah Hollis, Director Office of Recovery Oriented Systems of Care ROSC in Western Michigan: An Interview with Mark Witte and Kevin McLaughlin Recovery focused Addiction Medicine: An Interview with Dr. Corey Waller Seeking to align system transformation concepts, practice and context. 10 Core Values guided the development of transformation principles and strategies, and will continue to guide the implementation process 4 Domains in which the strategies will be carried out 7 Goals are concrete, actionoriented goals that organize and focus the strategies Monographs Recovery Management Peer based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation Recovery Management and Recovery Oriented Systems of Care: Scientific Rationale and Promising Practices Practice Guidelines for Resilience and Recovery Oriented Treatment Interviews Dr. Ijeoma Achara, ROSC Transformation Dr. Calvin Trent, ROSC in Detroit Grand Rapids 3 interviews ement_interviews/ Websites: tacs Florida DCF Conference

28 Questions? Contact: Lonnetta Albright 82 Florida DCF Conference

29 The A.C.T. Model The greatest challenge we face as leaders is leading ourselves John C. Maxwell Apply for me Change in me Teach others Now that you ve attended the ROSC Workshop--what will you do with all of the information, learning and ideas that were suggested? How will you take what you ve learned and use it to grow yourself and to add value to others (staff, team members, clients, communities)? This tool is for your use and thinking throughout the day. It is intended to jump start your follow up and adoption actions. A suggested strategy is below. Keep in mind that the tool is not proscriptive and can be revised to fit your unique needs and ways in which you work: 1 st : Use the codes A C T in the margins as you take notes 2 nd : When you return home or to your office compile a list of each code (3 separate lists) 3 rd : Prioritize each list 4 th : Using your priorities, take say the first one or two items and work on them for 2-4 weeks until it becomes a habit or instituted change or process 5 th : Continue working through your lists 6 th : This tool might also serve as a process for your team, steering committee, clients, families, recovery community, etc Child Protection Summit September 7-9, 2016

30 A.C.T. Worksheet Use a separate Worksheet for each Code ACTION ITEM A, C OR T WHAT WILL YOU DO? WITH WHOM? HOW WILL YOU KNOW IT IS MAKING A DIFFERENCE? 2016 Child Protection Summit September 7-9, 2016

31 Mental Health and Substance Use Disorders Recovery: Definitions, Components, and Principles Mental Health Recovery Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Components of Recovery Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals. Substance Use Disorders 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. Principles of Recovery Recovery is self-directed and empowering: While the pathway to recovery may involve one or more periods of time when activities are directed or guided to a substantial degree by others, recovery is fundamentally a self-directed process. The person in recovery is the agent of recovery and has the authority to exercise choices and make decisions based on his or her recovery goals that have an impact on the process. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Through self-empowerment, individuals become optimistic about life goals. Individualized and Person-Centered: There are multiple pathways to recovery based on an individual s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health. Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions including the allocation of resources that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life. There are many pathways to recovery: Individuals are unique with specific needs, strengths, goals, health attitudes, behaviors and expectations for recovery. Pathways to recovery are highly personal, and generally involve a redefinition of identity in the face of crisis or a process of progressive change. Furthermore, pathways are often social, grounded in cultural beliefs or traditions and involve informal community resources, which provide support for sobriety. The pathway to recovery may include one or more episodes of psychosocial and/or pharmacological treatment. For some, recovery involves neither treatment nor involvement with mutual aid groups. Recovery is a process of change that permits an individual to make healthy choices and improve the quality of his or her life. Recovery is self-directed and empowering: While the pathway to recovery may involve one or more periods of time when activities are directed or guided to a substantial degree by others, recovery is fundamentally a self-directed process. The person in recovery is the agent of recovery and has the authority to exercise choices and make decisions based on his or her recovery goals that have an impact on the process. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Through self-empowerment, individuals become optimistic about life goals. Page 1 of 3

32 Mental Health and Substance Use Disorders Recovery: Definitions, Components, and Principles Components of Recovery Holistic: Recovery encompasses an individual s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports. Principles of Recovery Recovery is holistic: Recovery is a process through which one gradually achieves greater balance of mind, body and spirit in relation to other aspects of one s life, including family, work and community. Non-Linear: Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery. Recovery exists on a continuum of improved health and wellness: Recovery is not a linear process. It is based on continual growth and improved functioning. It may involve relapse and other setbacks, which are a natural part of the continuum but not inevitable outcomes. Wellness is the result of improved care and balance of mind, body and spirit. It is a product of the recovery process. Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships. Peer Support: Mutual support including the sharing of experiential knowledge and skills and social learning plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community. Recovery is supported by peers and allies: A common denominator in the recovery process is the presence and involvement of people who contribute hope and support and suggest strategies and resources for change. Peers, as well as family members and other allies, form vital support networks for people in recovery. Providing service to others and experiencing mutual healing help create a community of support among those in recovery. Respect: Community, systems, and societal acceptance and appreciation of consumers including protecting their rights and eliminating discrimination and stigma are crucial in achieving recovery. Self-acceptance and regaining belief in one s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives. Page 2 of 3

33 Mental Health and Substance Use Disorders Recovery: Definitions, Components, and Principles Components of Recovery Principles of Recovery Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness. Recovery involves a personal recognition of the need for change and transformation: Individuals must accept that a problem exists and be willing to take steps to address it; these steps usually involve seeking help for a substance use disorder. The process of change can involve physical, emotional, intellectual and spiritual aspects of the person s life. Hope: Recovery provides the essential and motivating message of a better future that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Recovery emerges from hope and gratitude: Individuals in or seeking recovery often gain hope from those who share their search for or experience of recovery. They see that people can and do overcome the obstacles that confront them and they cultivate gratitude for the opportunities that each day of recovery offers. Recovery has cultural dimensions: Each person s recovery process is unique and impacted by cultural beliefs and traditions. A person s cultural experience often shapes the recovery path that is right for him or her. Recovery involves a process of healing and self-redefinition: Recovery is a holistic healing process in which one develops a positive and meaningful sense of identity. Recovery involves addressing discrimination and transcending shame and stigma: Recovery is a process by which people confront and strive to overcome stigma. Recovery involves (re)joining and (re)building a life in the community: Recovery involves a process of building or rebuilding what a person has lost or never had due to his or her condition and its consequences. Recovery involves creating a life within the limitation imposed by that condition. Recovery is building or rebuilding healthy family, social and personal relationships. Those in recovery often achieve improvements in the quality of their life, such as obtaining education, employment and housing. They also increasingly become involved in constructive roles in the community through helping others, productive acts and other contributions. Recovery is a reality: It is a reality testified to by the lived experiences of millions of individuals and their families who have struggled and triumphed over a substance use disorder and its accompanying hardship and distress. Recovery is a reality achievable by everyone. Page 3 of 3

34 Co-occurrences January 2009 Newsletter of the Minnesota Co-Occurring State Incentive Grant Project Volume 2, Issue 7 Recovery concept finds common ground in mental health and addiction Much like the fields of mental and chemical health in general, the recovery concept within each field grew from different roots, followed different growth patterns, and had different histories and advocates. In the past decade, however, practitioners from both fields have joined forces to find overlap in their respective recovery concepts, both as a way for individuals with co-occurring disorders to describe their recovery experiences and as a potential integrating mechanism for these traditionally divided fields. As an example of an integrated model, Larry Davidson and colleagues developed what they called a hopscotch model of dual recovery. First developing separate models of recovery from reviews of first-person recovery literature in each field, then revising them based on feedback from recovery advocates, they found remarkable similarity of recovery phases and language in each model. Their dual model combines these common elements, showing where in some phases there seems to be a single recovery goal, and in others dual goals to be tackled simultaneously with both feet. Unlike hopscotch, the phases may be nonlinear and of flexible order. Source: Davidson, L., et al From Double Trouble to Dual Recovery : Integrating models of recovery in addiction and mental health. Journal of Dual Diagnosis, 4(3): the phases of recovery from serious mental illness and recovery from addiction have many parallels. In fact, the manner in which participants in different forms of recovery independently used the same or similar language to name and describe their own processes of recovery was striking. Davidson, et al., 2008, p. 235 Becoming an empowered citizen Overcoming stigma, promoting positive views of recovery Understanding, accepting, redefining self Initiating recovery, assuming control Incorporating illness, maintaining recovery Renewing hope, confidence, commitment Assuming control Community involvement, finding a niche Establishing, maintaining mutual relationships Resources on co-occurring disorders A version of Dr. Davidson s hopscotch model is shown in a brief PowerPoint presentation, Recovery as an organizing principle for integrating mental health and addiction services at: < presentations.aspx> The two-part essay Recovery: The bridge to integration? by William White and Larry Davidson argues that the recovery concept may be the key to integrating the addiction and mental health treatment fields. Click on the Archives link and the November and December 2006 issues of BehavioralHealthcare at: < Recovery from addiction and from mental illness: Shared and contrasting lessons by William White, Michael Boyle & David Loveland describes shifts in the recovery movement and the history of mutual aid groups. Click on the chapter title at: < oregon.gov/dhs/addiction/recovery.shtml>

35 visit our website: Co-occurrences Page 2 Edited by pamela.adelmann@state.mn.us Multiple domains and measures of recovery O Connell and colleagues asked 974 individals to complete the Recovery Self- Assessment measure, and from the data identified five recovery domains. The scores at right are from mental health and addiction providers and persons in recovery on these domains. In later work, the researchers refined four versions of the Recovery Self-Assessment, one each for Person in recovery, Family member/advocate, Provider, and CEO/ Director (< tools/rec_selfassessment.html>). Severity score Providers Life goals Involvement Diverse treatment options Persons in recovery Choice Individually tailored svcs Source: O Connell, et al From rhetoric to routine: Assessing perceptions of recovery-oriented practices in a state mental health and addiction system. Psychiatric Rehabilitation Journal, 28(4), What is recovery from co-occurring disorders? Davidson and colleagues reviewed first-person accounts of recovery from addictions and mental illness and asked members of advocacy networks in both fields for feedback on their summaries. They arrived at this simple conclusion: In an age of evidence-based practice, this research suggests that recovery, be it from the hardships of addiction or problems of mental illness, rests on the same principles of human development as do other spheres of psychological and social functioning. Just like everybody else, people living with these problems require hope, a sense of self-efficacy and control, affiliation and connections with others, a sense of meaning and purpose, and the quiet integrity of leading a dignified life. [emphasis added; Davidson, et al., 2008, p. 288] Five video clips in which people talk about their experiences of living with co-occurring disorders can be viewed on the website of the Co-Occurring Collaborative Serving Maine. In his clip, Michael explains that what a person in recovery needs is similar to what everyone wants from life. < ccsmetraining.org/movies/ index.asp> Co-occurring glossary 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. (Center for Substance Abuse Treatment: < rosc.html>) Recovery: Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. (Center for Mental Health Services: < gov/publications/allpubs/sma />) Recovery: Recovery refers to the ways in which persons with or affected by a mental illness and/or addiction tap resources within and beyond the self to move beyond experiencing these disorders to actively managing them and their residual effects to build full, meaningful lives in the community. Recovery is more than the elimination of symptoms from an otherwise unchanged life. It is about regaining wholeness, connection to community, and a purpose-filled life. (Recovery: The bridge to integration, part one. See resources, p. 1.)