SelfRefind: Leading the Way in Recovery Oriented Systems of Care July 23 rd and 24 th, 2015 SelfRefind Jim Clarkson, MA, LADAC SelfRefind 1
SelfRefind ROSC Steering Committee David Hayden VP of Operations Rob Durham Regional Manager E. KY Peggy Gemperline Regional Manager Ohio Beth Brown Regional Manager W. KY 2
WELCOME! Today s Training Logistics: 1 Hour Presentation Recovery Oriented Systems of Care 15 Minutes Break 45 Minutes Group Discussions & Feedback
Please note: Please note any insights questions or comments that might come up for you during the presentation today and, if you want, write them down to help remember them for the discussion after this presentation. Please turn off cell phones & refrain from text/email unless emergency or client related. An e-copy of this presentation will be provided to you. This is an introductory seminar meant to help familiarize us with the ROSC concept and common terms. There will be additional training and planning. Right now we are only asking for your attention, consideration and initial feedback for the Steering Committee in the follow up discussion.
For Many Opiate Dependent People 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 [recovery] Is not an absence of pain; it is an absence of hope. (White and Woll)
What is a Recovery Oriented System of Care? An overview 6
7 Recovery Language
Recovery Definition 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 2012)
What is a ROSC? Recovery Oriented Systems of Care is a framework for coordinating multiple systems, services and supports that are person centered and designed to readily adjust to meet the needs of the individual s needs and chosen path to recovery. It is a powerful nexus of the intrinsic healing powers present in nearly every community.clinicians and treatment providers, recovery support services providers, the faithbased communities, and the recovery community
ROSC Definitions Continued 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. William Bill White
3 Integrated Care: From Silos.
To Systems
Two Studies Access to Recovery & TRI Study 13
The Original Model Access to Recovery 2004 President Bush announced in the 2003 State of the Union Address a new substance abuse treatment initiative, Access to Recovery developing a Recovery Oriented System of Care. This new initiative was to provide people seeking drug and alcohol recovery with funding to pay for a range of appropriate community-based services rarely, if ever paid for by federal funding before and specifically included the opportunity for faith-based providers to be a part of the recovery process. The goals of the program were to expand capacity, support client choice, and increase the array of faith-based and community based providers for clinical treatment and recovery support services. 14
Dental & Medical Navigation CRA for families Employment Opportunities Transportation Family Education Financial Coaching Physical Health RCOs Recovery Coaching Literacy Training AA and NA Vocational Training Faith-based Support Childcare Healthy relationships Life skills training 15 Social Support Business Coaching Peer Support Housing
Program Results 89% used recovery support services. 49% of dollars expended on recovery support services. 28% of dollars paid to faith-based organizations. Faith-based organizations accounted for 33% of Recovery Support and 31% of Clinical Treatment services. 16
Outcomes (measured at 6 months post intake) 80.4% abstinent/sober from substance use. 46.5% reported being stably housed. 49.8% reported being employed. 90.8 % reported being socially connected. 90.6% reported no involvement in the criminal justice system. 17
TRI Study Studies show that clients in SA treatment, who also have problems in other areas of their lives (e.g. medical, employment & psychiatric), have better outcomes when those other problems areas are also addressed McClellan compared 2 groups of SA clients Standard group received treatment as usual Enhanced group received treatment as usual, plus referrals for help with other problems (e.g. medical screening & parenting classes) Enhanced group had better outcomes at 6 months Stayed in tx longer & had higher tx satisfaction Had fewer psychological & physical problems Had less substance use 18
TRI Study Specifically, McLellan found: After 30 days 39% of Standard group clients still in treatment 68% of Enhanced group clients still in treatment After 60 days 12% of Standard group clients still in treatment 49% of Enhanced group clients still in treatment After 6 months (unexpected finding) 60% of Standard group counselors left job 20% of Enhanced group counselors left job 19
TRI Study Continued Motivational Interviewing Helpful Give Your Clients Names & Phone Numbers of Free & Low Cost Service Community Referrals! Costs you close to nothing Improves treatment outcomes 20
Principles of Recovery Oriented Systems of Care Four Major Dimensions and 10 Principles of ROSC
Recovery 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, 2011)
Four Major Dimensions of Recovery I. Health II. Home III. Purpose IV. Community
I. Health Overcoming or managing one s disease(s) or symptoms for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.
Disability Weights Stouthard et. al (1997) published weightings for 53 illnesses of public health importance. The World Health Organization has compared the relative impact of different illnesses across the world. According to this data, mental disorders rank as the biggest health problem in North American ahead of both cardiovascular disease and cancer. 25
The Impact of Mental Illness Mental illnesses can be more disabling than many chronic physical illnesses. For example: The disability from moderate depression is similar to the impact from relapsing multiple sclerosis, severe asthma, or chronic hepatitis B. The disability from severe post-traumatic stress disorder is comparable to the disability from paraplegia. Disability refers to the amount of disruption a health problem causes to a person s ability to: Work Carry out daily activities Engage in satisfying relationships 10
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Compensation Continuum for Performance-based Payments A shift toward increased collaboration and outcome-based payment Requires several steps to achieve full integration This modular set of performance-based contracting options align with a provider s risk readiness Compensation Continuum (Level of Financial Risk) Small % of financial risk Moderate % of financial risk Large % of financial risk Fee-forservice Performancebased Contracting Physician Hospital Patientcentered Medical Home Bundled and Episodic Payments Shared Savings Shared Risk Capitation Capitation + Performancebased Contracting Limited Integration Moderate Integration Full Integration
II. Home a stable and safe place to live.
III. Purpose Meaningful daily activities, such as a job, school, church, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.
Person Centered Assessment 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 you good at? What are you most proud of? What are some things in your life that you hope you can do and change in the future? How satisfied are you with the quality of your friendships and relationships? 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? What would your ideal job be?
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Engagement and Training of FBOs Ensure that faith-based organizations are engaged, partnered with where possible and trained to understand and help individuals and families with substance use disorders. Bliss lists
IV. Community Relationships and social networks that provide support, friendship, love, and hope.
36 10 Principles of Recovery
1. Hope Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.
2. Person Centered Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.
3. Many Pathways to Recovery Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery.
4. Holistic Recovery is holistic: Recovery encompasses an individual s whole life, including mind, body, spirit, and community.
5. Supported by Peers and Allies Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.
6. Relationship and Social Network Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
7. Recovery is culturally-based and influenced Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are keys in determining a person s journey and unique pathway to recovery.
8. Addresses Trauma The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
9. Individual, Family and Community Strengths and Responsibilities Recovery involves individual, family and community strengths and responsibilities: Individuals, families, and communities have strengths and resources that can serve as a foundation for recovery.
10. Respect Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems including protecting their rights and eliminating discrimination are crucial in achieving recovery.
Steps to Developing a ROSC One step at a time 47
Planning Recovery-Oriented Systems of Care I. Conceptual Framework II. Assessment III. Capacity Building VI. Evaluation V. Development and Implementation IV. Planning 48 48
I. Conceptual Framework Vision Principles Definitions 49 49
II. Assessment Assessments of readiness Inventories of current services & supports Assessments of organizational and staff recoveryoriented capabilities Assessments of strengths and gaps Stakeholder Surveys 50 50
III. Capacity Building Awareness raising strategies and materials for multiple audiences Legislators, recovery community, etc. Training and educational materials Cross-systems, organizational, staff, volunteers 51 51
IV. Planning Strategic Plan Goals & Priorities 52 52
V. Development and Implementation Specify Roles within an Organization and with Participating Organizations Develop and Implement an Action Plan Implement New Regulations and Contracts Develop Protocols for Person-Centered/Strengthbased//Self-Directed Approaches Provide or seek training on recovery-oriented approaches 53 53
V. Development and Implementation (cont d) Revise and Develop New Job Descriptions Incorporate Workforce Competencies & Ethical Standards Adopt Innovative Services and Supports, including Technology Define Quality Control Standards and Develop Instruments Develop Measures and Methodology to Assess performance and Outcomes 54 54
VI. Evaluation Process evaluations Outcomes evaluations Quality improvement processes 55 55
Mission:We exist to save lives, instill hope and restore relationships. Vision: We will pioneer a local and affordable medical treatment model that transforms the individuals, families and communities impacted by the disease of addiction. Values: We treat people with kindness, compassion, dignity and respect. This is the heart and soul of our company. We use cutting edge medicine, education, counseling, training and technology to achieve high quality of life, outcomes and growth. We are strategic, responsible and generous with our resources.
Additional ROSC Resources http://www.williamwhitepapers.com/leadership _interviews/recovery_management_interviews/ Websites: www.attcnetwork.org/greatlakes http://www.facesandvoicesofrecovery.org/ http://beta.samhsa.gov/brss-tacs http://www.centerstone.org/
Thank You! Jim Clarkson (505) 944-5284 jccquesta@prodigy.net