Overview

2. Overview • The role of recovery-support services (RSS) • The need for post-treatment RSS • Connecting RSS to the changing healthcare environment • Models and approaches to developing post-treatment RSS • Strategies for successful implementation

3. What are Recovery Support Services? • Non-clinical services that assist individuals and families to recover from alcohol or drug problems • Social support, allied service providers, and human services contributing to an improved quality of life • Flexibly staged prior to, during, and after treatment (Kaplan, SAMHSA, 2008)

4. Examples of Recovery Support Services? • Transportation • Employment services and job training • Outreach • Pre-treatment engagement services • Housing assistance and services • Child care • Family/marriage education • Peer support services • Recovery education and coaching • Life skills training and supports • Spiritual and faith-based support • Care coordination and assertive linkages to community resources • Parent education and child development; • Continuing care and post-treatment supports (recovery check-ups)

5. 4 Overlapping Stages of RSS Continuum of Recovery Enhancement of Quality of Life in Long-term Recovery Pre-Recovery Engagement Recovery Initiation & Stabilization Recovery Maintenance (William White)

6. Why Recovery Support Services? Systemic Challenges at Each Stage of Recovery Pre-Recovery Engagement • Unmet Need • Low Pre-Treatment Initiation Rates Recovery Initiation and Stabilization • Limited Engagement and Retention • Inadequate Service Dose Recovery Maintenance • Lack of Continuing Care • Recovery Outcomes • Revolving Door Enhancement of Quality of Life

7. Why Recovery Support Services? Evolving Trends and Future Directions • SAMHSA’s strategic Priorities • Redirection of Block Grants • Healthcare Reform • Service integration with primary care

8. What’s the Connection?

11. Emerging Healthcare Models Slide Acknowledgement: National Council on Community Behavioral Health

12. The Value of Specialty Addiction Treatment • The Value of specialty addiction providers will depend on their ability to: • Be accessible • Be efficient • Have the capacity for electronic health records • Produce Outcomes • Engaged clients and natural support network • Help clients self manage their wellness and recovery • Greatly reduce need for disruptive/high cost services • Effectively promote sustained recovery • Slide Acknowledgement: MTM Services, David Lloyd, Presented at National Council 2011 Conference

13. Post Treatment RSS What’s going well now?

14. Approaches to Post-Treatment RSS Multi-media (face to face, technology based, mail) • Home visits • Peer Support groups • Linkage to mutual aid societies • Recovery check-ups • Peer leadership councils • Recovery centers • Contingency Management • Clinic based individual and group sessions • Mail • Internet-based RSS • Assertive Linkages to natural supports • Telephone-based RSS • Recovery Community Organizations • Embedded within primary care settings

15. Implementing a Practice versus Developing a Culture What’s the Difference?

16. 3 Approaches to Integrating RSS 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/organization – e.g. pilot projects/programs. 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.

17. Setting the Stage • Aligning Concepts: Changing how we think • Aligning Practice: Changing how we use language and practices at all levels; implementing values based change • Aligning Context:Changing regulatory environment, policies and procedures, community support

18. Setting the Stage Conceptual Alignment: Recovery Management Approach • Attraction and Assertive Outreach • Global Assessment vs. Categorical Assessment • Recovery Planning • Expanded Service Team • Collaborative Service Relationships • Appropriate Service Dose, Scope and Quality • Expanded Locus of Service Delivery • Assertive Linkage to communities of Recovery and Natural Support • Post-Treatment, Monitoring, Support and Early Re-Intervention

19. Setting the Stage Conceptual Alignment: Chronic Care Philosophy Slide Acknowledgment: William White. Data Source: O’Brien CP, McLellan AT. Myths about the Treatment of Addiction (1996). The Lancet, Volume 347(8996), 237-240.

20. Setting the Stage Conceptual Alignment: Timing of Recovery Stability • Stability of alcoholism recovery is not reached until 4 to 5 years of sustained remission • Relapse in alcoholism recovery is rare after 7 years • Stability of recovery from other substances may take longer • People are particularly vulnerable during the first 90 days following treatment • Recovery is more sustainable with time in recovery

21. Setting the Stage Conceptual Alignment: Core Principles of Post-Tx RSS • Post-Tx RSS do not require longer Tx episodes but an extended period of check-ups and support • Create easy mechanisms for early re-intervention • Responsibility for continued contact lies with professionals • Support needs to be saturated within periods of greater vulnerability (e.g. the first 90 days after tx) • Focus on convenience • Provide ongoing assistance in building recovery and problem solving obstacles to recovery

22. Setting the Stage Conceptual Alignment: Core Principles of Post-Tx RSS • Flexible and individualized plan • Use assertive linkages, not passive referrals • Use multi-media approaches • Emphasize continuity of contact in primary service relationship • Embed Post-Tx RSS in the person’s natural environment • Facilitate delivery by counselors, recovery coaches, and trained volunteers

23. Characteristics of Effective Peers • Credibility with other peers • Creative with limited resources • Knowledge of individual/family addiction and recovery • Knowledge of the local community and recovery support resources • Knowledgeable about multiple pathways of recovery • Capable of initiating and sustaining healthy, respectful (non- exploitive) recovery support relationships • Able to work collaboratively with others • Has good self-care rituals and the ability to ask for and utilize supervisory guidance

24. Implementation of Post-Tx RSS Individual Level • Set Expectation • Explore past experiences with post-tx RSS • Identify and assemble recovery support team/ “recovery circle” • Conduct a recovery capital assessment • Increase your and client’s awareness of community-based resources • Review menu of post-tx RSS options • Support individual and family in developing a Continuing Care Plan • Clearly identify roles of all members of team • Clearly identify various contexts for Post-tx RSS • Assertively connect people to relevant resources in the community • Monitor and evaluate person’s initial and ongoing responses to resources/strategies

25. Implementation of Post-Tx RSS Organizational Level • Make the processes transparent and participatory • Identify a guiding group or point person/s • Create a sense of urgency – Why? • Establish a shared vision for post-tx RSS. What will your menu of services include? • Identify the resources available to you currently or in the future (counselors, recovery coaches, community partners, volunteers, peer leadership councils, recovery community organizations, etc) • Determine who will provide which types of support • Identify a few priorities “what’s the low hanging fruit?” • Determine how incentives may be used to support these priorities • Implement your prioritized strategies • Study the results (focus groups, outcome data, staff observations, etc) • Make the necessary changes Learn from implementation science: Staff need training, feedback and coaching (Miller, 2004)

26. Implementation of Post-Tx RSS Organizational Level: Factors to Consider • To what extent… • Has your organization shifted from an acute to a chronic care approach to tx? • Are peers integrated as a part of your service teams? • Do you have a mobilized cadre of volunteers to support a culture of continuing care? • Do you have a recovery-oriented work environment?

27. Spotlight on Telephone-based RSS • Benefits • Orientation Session • Timing of Calls • Wording of Questions • You didn’t drink, did you?’ • Have you drank any alcohol in the past seven days?’ • How many days in the past seven did you drink any alcohol? • (Carise)

28. Step by Step Telephone Session Overview • Acknowledge client and focus of call • Review Progress Assessment Worksheet • Provide feedback • Review client’s progress/goals • Identify future high-risk situations • Discuss focus for remainder of call • Problem-solving • Set goals • Schedule next phone call The Arkansas Continuing Care Program Telephone Monitoring and Adaptive Counseling - Clinician Manual (2008). The manual was adapted with permission from the work of James R. McKay, Ph.D. by the Mid-America ATTC

29. Case Study How might things look different?

31. Post Treatment RSS in Primary Care

32. Let’s Go For It!!!

33. Contact Information Ijeoma Achara, PsyD Achara Consulting Inc. ijeoma.achara@yahoo.com