RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE

Transcription

1 RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE An Introduction to the Approach Lisa Muré, NH Center for Excellence

2 RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE 1. An Introduction to the Approach (Lisa Muré, NH Center for Excellence) 2. NH s Current Approach to Addiction Treatment (Rosemary Shannon, NH BDAS) 3. ROSC: Treatment Providers Perspective (Stephanie Savard, Families in Transition) 4. Developing NH s Vision and Implementation (Lindy Keller, NH BDAS)

3 Resiliency is an innate capacity a self-righting tendency, that operates best when people have resiliency-building conditions in their lives. (

4 Recovery from alcohol and drug problems is a process of change through h which h an individual id achieves abstinence and improved health, wellness, and quality of life. (National Summit on Recovery: Conference Report)

5 DEFINITION Recovery-oriented systems of care are networks of organizations, agencies, and community members that coordinate a wide spectrum of services to prevent, intervene in, and treat substance use problems and disorders. d ( G idi Pi i l del t fr Oi t ds t fc Wh td k f th h? ( Guiding Principles and Elements of Recovery Oriented Systems of Care: What do we know from the research? SAMHSA publication, August 2009)

6 ROSCs 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 (ATTC Presentation, June 2011)

7 Recovery-Oriented Systems of Care Are person centered Expand the community s ability to be responsive to its members who are in or seeking recovery Offer a comprehensive array of services that can be combined and adjusted to meet an individual s needs and chosen pathway to recovery (ATTC Presentation, June 2011)

8 Recovery-Oriented Systems of Care Is A paradigm shift An approach to service delivery that fosters community support systems and opportunities Is Not A program A direct service array in and of itself An approach that thrives in integrated care systems Limited to a single system of care Research-based Care planning driven by professionals Person- and family-centered Supports a chronic disease model for treatment An acute care model of treatment A SAMHSA and NH priority

9 Recovery-Oriented Systems of Care Person-centered Supported by addressing trauma Involves individual, family and community strengths and responsibility Occurs via many pathways Holistic Culturally based and influenced Based on respect Supported by peers Supported through relationships lti Emerges from hope

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11 NH System Model

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13 RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE NH s Current Approach to Addiction Treatment t Rosemary Shannon, NH BDAS

14 Current funded BDAS Treatment Services 17 agencies are funded for various treatment services 1 agency is funded for Recovery Support Services The Center For Excellence has a dedicated staff The Center For Excellence has a dedicated staff person for evidence based treatment practice initiatives

15 Current Array of Residential Services 7 Stabilization sites (clinically managed residential detoxification programs) 3 Clinically managed high intensity residential programs (long term treatment) Includes the Cynthia Day Family Center for pregnant and parenting women and children One program for adolescents

16 Current Array of Residential Services (continued) 5 Medium Intensity (short term) residential programs, two for co-occurring disorders (Manchester and Keene) 6 Transitional Living/Halfway House programs

17 Intensive Outpatient Patient Services 12 Intensive Outpatient Programs (IOPs) One specializing in adolescents 2 working specifically with parents involved with DCYF (Manchester and Nashua) Two specializing in the treatment of pregnant and parenting women and their children (Manchester and Dover) One program working with individuals released from Dept of Corrections facilities, probation, or drug court (Nashua) One Drug Court IOP (Dover)

18 Outpatient Services 14 agencies in 22 locations Two programs specializing in treating adolescents (Manchester and Nashua) One specializing in pregnant and reproductive age women and their partners (Portsmouth) One in a county House of Correction (Grafton)

19 Important relationships Two programs (one OP, one IOP) in partnership with Federally Qualified Community Health Centers (FQHC) (Portsmouth and Dover) One program with a FQHC Health Care for the Homeless (Nashua) Four in partnership with Community Mental Health Centers (Northern, West Central, Monadnock and Manchester)

20 Evidence Based Practice Initiatives Implementation of an Electronic Health Record (EHR): Web Based Infrastructure Treatment System (WITS) Includes a standardized assessment the Addiction Severity Index (ASI) or the Global Appraisal of Individual Need (GAIN) Implementation in August of 2011

21 Access to Recovery (ATR) Overview Four year grant (3 million dollars per year) Targeted populations 4600 over 4 years Care Coordination Focus is CLIENT CHOICE Expanded Treatment and Recovery Supports Provider System

22 ATR Target Populations Re-Entry: Offenders coming back into communities from State correctional facilities Multiple DWI : Multiple Driving While Intoxicated (DWI) offenders Military: NH Military personnel at any stage of the Deployment Cycle who have served, or are serving in Iraq or Afghanistan and all National Guard and their families

23 Guiding Principles of ATR Increased Capacity (Non-traditional = Non- BDAS treatment and recovery support providers,* including other community, individual and faith-based) Increased Access Client Choice * BDAS treatment providers may participate, but ATR can not supplant other funds

24 Other BDAS Clinical Service Unit Responsibilities i Oversight and certification of 8 Opiate Treatment Programs serving approximately 1400 patients. (medication-assisted recovery is an evidence based practice)

25 RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE ROSC: Treatment Providers Perspective Stephanie Savard, Families in Transition

26 Components of ROSC in PRE-TREATMENT (to enhance recovery readiness) Motivation: essential ingredient of ROSC in screening is to meet the person where they are at. Client preference and readiness for change determines level of care. Collaboration across systems i.e. Corrections, Education, Healthcare S-BIRT: Screening, Brief Intervention & Referral g, to Treatment

27 Components of ROSC in TREATMENT (to enhance strength & stability of recovery initiation) Identify and connect person in recovery to health home (i.e. community health center, PCP) upon initiation of treatment provides on-going support of whole person and their recovery Family & supportive others involvement: collaborating with them throughout treatment specially focusing on recovery supports and planning Person-centered: individual & family preferences and choices are honored whenever possible

28 Components of ROSC in TREATMENT (continued) Address barriers by making connections with systems that are not the usual collaborators (i.e. child care centers, employers, YMCA) Specialized programming to address needs and preferences: gender-specific, Trauma informed, co-occurring substance use and mental health disorders, cultural competence of staff and program EBPs used whenever possible and indicated

29 Components of ROSC in TREATMENT (continued) Ensuring care coordination which is intrinsic to the treatment, stabilizing the whole person Recovery support workers or recovery coaches in pre-treatment, during treatment and after Increase visibility, connection and attendance at support groups and community organizations (faith-based organizations, 12-step, etc).

30 Components of ROSC in POST-TREATMENT (to enhance durability &quality of recovery maintenance) Continuity of care beyond treatment (ie. Follow up calls, face to face check-ups, warm line) allowing for early re-intervention if necessary Recovery coaches available even if they leave against treatment recommendation Social media Facebook, blogs, websites

31 Components of ROSC in POST-TREATMENT (continued) Personal recovery er plans that are client-driven and is a continuation of recovery Connections to social & recreational sober activities iti Maximize use of natural supports and setting Recovery community centers a centralized community venue that provides social connection, access to resources and judgment free zone

32 RESILIENCY AND RECOVERY ORIENTED SYSTEMS OF CARE Developing NH s Vision i and Implementation ti Lindy Keller, NH BDAS

33 RROSC Requires a System and Service Coordination for Purposes of: Determining needs and assets at community level Health promotion Prevention Screening and early intervention Treatment Recovery supports Building resilient communities with increasing recovery capital

34 Clinical Treatment Intervention Care Coordination Recovery Support Community based Services

35 Requires Reconfiguration of Direct Services Systems Transition from acute care to recovery model (chronic care model) Client-driven and family-focused Service based on recovery plan Use of electronic health record

36 Requires Reconfiguration of Direct Services Systems Entry into system at any level of care Bi-directional client movement through levels of care Increase availability of recovery supports, including Peer Recovery Coaching and transitional housing Emphasis on Continuous Recovery Monitoring/recovery check-ups

37 RROSC Direct Services Emphasis Regional integrated or collaborative systems of care Blended rate across levels of care Supported by electronic health record Regional coordination with health and mental health systems

38 BDAS Development of RROSC First Steps Prevention transformation to Regional Networks (community level) Restructuring of Impaired Driver Programs Access to Recovery Electronic Health Records and common assessment tools

39 BDAS Development of RROSC Next Steps Release Direct Services RFP for SFY13 Release in December, 2011 One year contract with optional one year renewal Performance-based with benchmarks and incentives Re-allocation of existing resources with infusion of ATR funds

40 BDAS Development of RROSC Next Steps Inclusion in Medicaid essential benefits package SUD intervention SUD treatment Health promotion

41 BDAS Development of RROSC Next Steps BDAS system preparation for RROSC Vet with providers and partners Work through GC taskforces Meet with providers requiring significant change Provide technical assistance to providers to enroll as Medicaid id providers Collaborate with partners

42 NH Development of RROSC How might other systems be affected by RROSC? Resources for direct services Programs Staff Financial Referral guidelines for RROSC services Involvement in Regional Networks

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