Ijeoma Achara, PsyD April 27, 2010

1. NIATx Interest Circle CallRecovery Oriented Systems of Care: Developing Peer Based Recovery Supports Ijeoma Achara, PsyD April 27, 2010

2. Overview This presentation will: Explore the role of peer-based supports within a ROSC Identify options for structuring peer-based recovery support services Identify a conceptual framework to guide the implementation process Outline concrete implementation strategies Identify relevant resources to support planning and implementation

3. 3 Approaches to System Transformation Adding peer and community based recovery supports to the existing treatment system Additive Practice and Administrative alignment in selected parts of the system Selective 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. Transformational

4. Conceptual Framework Guiding the Transformation Process Aligning Concepts: Changing how we think, developing a vision Aligning Practice: changing practices at all levels; implementing values based change Aligning Context: changing regulatory environment, policies and procedures, community support The Importance of connecting the dots….. Aligning Practice Aligning Concepts Aligning Context

5. Desired Outcomes of Peer Support Increase connection to treatment Reduce obstacles to continued engagement in services and supports Increase people’s ability to sustain their recovery following treatment

6. Characteristics of Effective Peers • They have effectively sustained their recovery • They are able to support multiple pathways to recovery • They work in a partnership/consultation model with peers • They focus on the interpersonal rather than intrapersonal • In-depth knowledge of the local community and natural and formal recovery supports • Focus on the present, next steps and near future rather than resolving issues or feelings about the past • They are effective in using their personal lived experience to build hope and confidence • They are skilled at relationship building • They see possibilities where others may see problems….

7. Structuring Peer Support Services 2 Primary options with potential advantages and disadvantages • Separate organizational structure which trains, supervises and coordinates peer support services • Peer support services that are fully integrated into treatment settings.

8. Getting Started…. A Framework to Organize Peer Support Services • Pre-Recovery Initiation • Recovery Initiation and Stabilization • Recovery Maintenance and Quality of Life in the Community

9. Pre-Recovery Initiation 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)

10. Pre-Recovery Initiation Examples of peer-based supports that promote attraction and access and increase readiness • Street outreach • Pre-treatment peer support groups • Offer peer mentors as soon as contact is initiated • For urban settings, develop a welcome/recovery support center • “Intentional hospitality” • Develop a resource directory to meet basic needs • Instill hope and increase expectations of positive treatment outcomes (e.g. invite people to storytelling sessions) • Use the most charismatic and engaging staff in reception areas • Connect with people before initial appointments via phone when possible to reduce anxiety and establish rapport

11. Recovery Initiation and Stabilization High AD rates constitute a form of “creaming” The Reality: those least likely to complete are not those who want it the least, but those who need it the most- those with the most severe, complex problems, the least recovery capital and the most severely disrupted lives (Stark, 1992; Meier et al, 2006, quoted by W. White)

12. Recovery Initiation and Stabilization Examples of peer-based practices that promote engagement and retention • Recovery capital/needs assessment for individual/family/community • Person directed recovery planning with peer and professional support, helping people develop short-term steps to a long term goal • Encouragement, support, companionship and modeling of recovery lifestyle • Problem solving to eliminate obstacles to recovery (e.g. resources for child care, transportation, recovery homes) • Assertively linking clients to relevant community based resources and communities of recovery • Recovery focused skill training aimed at full community participation (education, employment, housing, leisure, pro-recovery social relationships) • Develop a menu of services and a philosophy of choice • Build strong linkages between detox services and treatment through peer-based recovery support services

13. Recovery Initiation and Stabilization Examples of peer-based practices that promote engagement and retention cont’d • Use telephone based PBRSS or tele-counseling or tele-video counseling to reach those in rural areas (Baca et al., 2007) • Utilize telephone calls, reminder notes, emails etc. to strengthen engagement following missed appointments (peers) • Change policies related to administrative discharge and work with criminal justice partners to develop graduated sanctions for relapse and/or low participation, and have peers work with people to adjust their recovery plans and provide increased support following relapse.

14. Recovery Maintenance Examples of peer-based practices that promote sustained recovery • Identify and engage the allies who will be a part of the person’s ongoing recovery plan EARLY in the treatment process • Peers begin developing a continuing care plan that is directed by the person and which addresses all life domains and utilizes all of the natural supports strengthened during treatment • Coach family members, friends and allies on supporting recovery • Develop a menu of options beyond an “alumni group” for individuals to receive ongoing support, monitoring and early re-intervention • Telephonic aftercare • Community-based check-ups • Based on recovery capital assessment, identify areas that need strengthening in the individual and community • Provide community based modeling and problem solving

15. Recovery Maintenance Examples of peer-based practices that promote sustained recovery • Use tracking technologies to promote high participation in post-treatment check-ups • Facilitate opportunities for belonging and development of meaningful roles in the community (volunteer opportunities, internships, group membership) • Provide hands on assistance with restructuring social networks • In areas that have few recovery resources, support the development of recovery support groups • Assertively connect people to substance free leisure activities in the community • Early re-intervention when needed

16. Recovery Initiation and Stabilization Diversifying the Service Team Must it be a Tug of War?

17. Robert Martin Peer Specialist In the beginning it was very degrading at times, it was very intense between peer support staff and traditional staff. Their attitude in the beginning was “these people have these 2 weeks CPS training and who do they think they are to tell us how to do our jobs.” It was split right down the middle. It was us vs. them for a minute. Now the respect is on both sides. We compliment each other. The therapists learned that the stuff they write on the paper about what the person needs, we can actually go out in the community and get those things started…. They don’t have to just be words on a paper anymore…

18. Anticipate Challenges

19. Recovery Initiation and Stabilization Diversifying the Composition of the Service Team: Strategies to Promote Success • Prepare the environment before diversifying the team • Involve staff in selection and recruitment of recovery coaches • Clarify Roles: Articulate the differences between a recovery coach, sponsor and counselor • Promote equality and team work via policies and practices • Provide appropriate training • Identify the appropriate supervisor to provide accountability and support • Ensure that the integration of recovery coaches or natural supports is embedded in other organizational changes • Ensure that those providing peers support have access to peer support

20. Peer Culture, Support and Leadership Create Pathways of Opportunity

21. Relevant Resources • GLATTC Recovery Monographs Peer-based Addiction Recovery Support: History, Theory, Practice and Scientific Evaluation, William White Website: www.attcnetwork.org/greatlakes • Philadelphia DBHMRS Tools for Transformation Series: Peer Support, Culture and Leadership Website:www.dbhmrs.org • GLATTC Interview with Mike Boyle (www.facesandvoicesofrecovery.org/pdf/recovery_symposium/GLATTCInterviewBoyle.pdf) • Fayette Companies Recovery Coach Resources www.fayettecompanies.org/RecoveryCoach • Sponsor, Recovery Coach and Addiction Counselor: The Importance of Role Clarity and Integrity. William White (www.facesandvoicesofrecovery.org)

22. Let’s go for it!!! Let’s Go For It !!!