Recovery Oriented Systems of Care Sean Bear, BA, CADC National American Indian/Alaskan Native ATTC Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover Funded by: The National American Indian and Alaska Native Addiction Technology Transfer Center is supported by a grant from SAMHSA/CSAT. The content of this publication does not necessarily reflect the views or policies of SAMHSA or HHS. 1
Overview of the Presentation Introduction to the National American Indian and Alaska Native Addiction Technology Transfer Center Project/Program Design Community buy-in Assessing Needs of the Community Alternative methods of engagement ROSC Best Practices Learning Objectives By the end of the workshop participants will be able to: 1) List two challenges that can impede the process of ROSC when working in Native Communities 2) List two effective approaches to complete a CBPR-based needs assessment, intervention, an evaluation for the use of ROSC with Native Communities 3) List two methods of integrating/utilizing ROSC with Native Communities. 2
ATTC Network 2012 2017 National Focus Areas 2012-2017 3
National American Indian and Alaska Native ATTC 2012 to 2017 Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover Our Mission Serve as the national subject expert and key resource on adoption of culturally legitimate and relevant addiction treatment/recovery services to support professionals working with AI/AN clients with substance use and other behavioral health disorders and the AI/AN behavioral health workforce. 4
Target Population Behavioral health workforce providing treatment for American Indian and Alaska Native clients Recovery support specialists Trainers Educators Clinical supervisors Future leaders in behavioral health organizations ROSC with Native Communities Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover 5
Program Philosophy A Holistic recovery model of care, influenced by current science surrounding addiction treatment Whole Person care deflects the stigma associated with substance use and mental health issues, and allows for a broader understanding of behavior and beliefs Promote and facilitate health and overall wellness through the provision of medically-monitored treatment, evidence-based clinical approaches, and in respect to the community beliefs and practices through recognizing and responding to social determinants of health and well-being Program Overview Design a safe environment that assist clients in reducing physical, cognitive, social, and environmental barriers to improved overall health Collaborate with other programs, providers, and local traditional, spiritual, or medicine peoples to fill specialized service needs within a continuum of care that seeks to promote positive change, integrate service delivery, and facilitate client referrals to needed services Partner with a local organizations or programs to provide long term programs for men, women, women with children, and youth with 6
Holistic Healing Environment Holistic health care environment should reflect the value placed on client care Work with local artists, potters, craftsman, quilters, traditional attire making, pow-wow outfit making peoples Recognize research that indicates a healing environment can: reduce client stress, reduce the need for medications, and provide for the improved psychological well being of clients and staff Needs Assessment Assessing client needs and developing program goals and objectives involves the collection of various data and input from both clients and staff: Formal assessment of client health domains and addiction severity, as well as review of aggregate data gathered by DAANES (Drug and Alcohol Normative Evaluation System) Incorporate input from clients through the use of questionnaires (before, during, and after), groups, client suggestion box, and surveys (i.e.,. satisfaction) Use of clinical staff meetings and staff suggestion box to illicit ideas and strategies pertaining to systems improvement, client-centered care and workforce development 7
Tribal Cultural and Spiritual Assessment Cultural Assessments Songs Dances Dress Ethnic Identity Ethnic Self-esteem Special Knowledge and Skills Stories and legends Art work Quill work Beading Program Development Develop programming specific to the population served Programming may include: Daily client orientation groups Nurse-led health education groups Facilitation of Stages of Change, motivational enhancement, psycho-educational and interactive groups Activities groups Community-led self-help groups Peer support through volunteer Peer Advocates Sweat Lodges, Talking Circles, Walk, Exercise 8
Program Design Provide clients with skills development, information, structure, and the opportunity to engage in the change process Program content, intensity and design based on length of stay as well as the physical, developmental, emotional, cognitive, and social characteristics of clients Utilize current science in the Behavioral and Public Health fields, but also traditional, spiritual, and medicine practices and beliefs to serve as a guide to program design, with the vision of providing Holistic Health care Relationship Issues and Context Age Ethnicity Recovery Status Religion Sexual Orientation Disability Gender Race Education 9
Evaluation Programs and services should be monitored and evaluated to determine their effectiveness in reducing the recurrence and amount of substance use among those served. Outcome Evaluation involves the on-going collection of input from clients and staff to develop and refine specific program goals and objectives Outcome data (such as that collected from DAANES reports) assist in measuring trends and the long term impact of interventions A combination of process and outcome evaluation methods can be used to measure program effectiveness Integration Coordinate client care with chemical dependency assessment teams, case managers, and mental health service teams (Urgent Care & Crisis Stabilization), all co-located at one location if possible Pursue options to better integrate behavioral health services with primary health care that are respectful and utilize Native practices, values, and beliefs 10
Integration (cont.) Current science in behavioral health indicates that an ecological model of care is a promising practice and a driving force behind the Affordable Care Act Pursue a Health Home model that attends to the diverse influences on client health Detoxification services should not operate in a vacuum, separate from other health care in order to assist in reducing stigma Health Homes An Ecological Model of care can be operationalized within the framework of a Health Home Health Homes attend to whole person care, with the proper dosage of service delivery, with a longitudinal approach Health Homes strive to meet the physical, psychological, environmental, social and spiritual needs of clients Detoxification services should be fully integrated with other medical and social services 11
Chronic Disease Many agrees with current science that has established addiction as a chronic disease of the brain As with other chronic diseases, addiction has a physical genesis that often leads to a maladaptive pattern of behavior with physical, emotional and psychological consequences The disease creates the behavior, not the other way around Chronic Disease(Cont.) Treatment of addiction requires behavior change, similar to the treatment of other diseases Current theories surrounding behavior change assist in recognizing obstacles to achieving and maintaining better health 12
Summary Be diligent in evolving to better meet client needs through evaluation, program development, use of evidence-based practices, improved service integration, and the use of Best Practices, such as Experienced based practices that have been utilized with local Native tribes Prevention Strengthen relapse prevention skills Rebuild positive support networks Old habits must be broken and remade Sustain one s connection to traditional practices Make this a daily practice Rebuild trust with loved ones For client and their loved ones Seek employment, education, or trade Stay busy, don t stagnate Attend to one s overall health care/needs 13
Positive Prevention and Intervention Strategies for Reservation Settings Youth prevention activities Juvenile Detention Centers School and after-school programs Summer programs Increasing number of cultural programs: Learning the language, wacipi dancing, learning songs for various occasions, equine therapy, canoe program, ropes program etc. Increasing number of spiritual ceremonies being attended by various age groups Other Chronic disease and continuum of care RECOVERY ORIENTED SYSTEM OF CARE (ROSC): IT TAKES A VILLAGE 14
From Intake to continuum of care and sustained recovery Detox : acute care Addiction is not an acute illness, but oftentimes a chronic illness Acute treatment + Aftercare= Improvement Acute treatment with no aftercare= poor outcome Continuing care= Improvement No Continuing care = Poorer outcomes Thinking beyond treatment: It tales a village Recovery takes place in a community Community involvement Toward integrated care Mental health, physical health, emotional and spiritual health Important other factors for recovery The longer people stay in treatment the likely it is that the person will recover Other factors Natural recovery Lack of dose effect More expensive treatments were not generally more effective Evidence based approaches Experienced based approaches Culturally informed approaches 15
Other issues in treatment and prevention of substance use disorders Expert model: Treatment delivered to correct a deficiency Sometimes overlooking the protective factors Important to not overlook strengths in the person In the family In the community Treatment works Recovery oriented system of care Treatment agencies are considered one of many resources for the client No one source is more important than another Various support systems need to work together very closely with the client 16
ROSC support person-centered and self-directed approaches to care that build on the personal responsibility, strengths, and resilience of individuals, families and communities to achieve health, wellness, and recovery from mental disorders. Recovery Individual Family V Community Wellness Health ROSC offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual s needs and chosen pathways to recovery. Recovery Services & Supports Family/ Child Care Education Alcohol/Drug Services Vocational Housing/ Individual PTSD &Mental Health Transportation Family Community Physical Health Care Spiritual HIV Services Wellness Financial Legal VSO & Peer Support Case Mgt Health 17
ROSC encompass and coordinates the operations of multiple systems Recovery Social Services Housing System Child Welfare and Family Services Faith Community Indian Health Services Wellness Educational Family/ Child Care Housing/ Transportation Spiritual Systems of Care Services & Supports Financial Legal Individual Family Community Health Insurance DoD & Veterans Affairs Alcohol/Drug Treatment Vocational VSO & Peer Support Case Mgt Addiction Services System PTSD & Mental Health Health Care HIV Services Criminal Justice System Mental Health System Primary Care System Vocational Services Health It takes a village Recoveryoriented care Continuum of care Recovery schools Community engagement 18
An Integrated Behavioral Health Healing and Recovery Model with Native American Populations Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover Best Practices in Counseling Native Americans Build Relationships with local Native communities Incorporate attention to spirituality into counseling Reduce administrative obstacle to receiving care Inform clients of confidentiality rights Coordinate community resources with prioritized clients needs in a manner consistent with the client s diagnoses Thomason, Timothy (2011). Best Practices in Counseling Native Americans, Journal of Indigenous Research. Vol. 1, issue 1, Article 3. 19
An Integrated Behavioral Health Healing and Recovery Model with Native American Populations Navajo Way Red Road Cultural Spiritual Relative (Client) AA Acupuncture Alternative Healing Art Therapy Behavioral Cognitive Emotional Meditation Motivational Interviewing Other Western Eastern Other Culture Informed Best Practices 20
The Red Road Approach The innate cultural/spiritual resources of an indigenous (Native American) person are a focus of this treatment approach. Cultural and spiritual information are a normal part of the treatment regimen. When and where appropriate, spiritual ceremonies are included in treatment and aftercare plans. Teaching Spiritual Road that we all travel (Individualized) through Life in order to Learn what we have come to Learn Brain-Heart Connections Male-Female Androgynous Longest and Hardest path one will ever take 21
Evidence-Informed Culture- Based Intervention in American Indian and Alaska Native Communities Evidence-Based Practice in Tribal Communities Lessons on Evidence-Based Practice in Tribal Communities: Utilizing Tribal leadership and community input into the adaptation of intervention Cultural sensitivity and competence of staff Building programs on cultural strengths and customs of community Walker, R. D., Bigelow, D. A. (2015). Evidence-Informed, Culture-Based Intervention and Best Practices In American Indian and Alaska Native Communities. 22
Culture Informed Best Practices This approach respects and accommodates Culture-based knowledge, skills, ceremonies, values stories etc. Ways of knowing Practices, social services in AI/AN communities Facilitates the derivation of new and improved culturebased intervention Walker, R. D., Bigelow, D. A. (2015). Evidence-Informed, Culture-Based Intervention and Best Practices In American Indian and Alaska Native Communities. 23