RC Scan Provider Readiness

1. RC Scan Provider Readiness Massachusetts Department of Public Health Bureau of Substance Addiction ServicesJulia Ojeda – julia.ojeda@state.ma.usDMA Health StrategiesDeborah Strod - deborahs@dmahealth.comJinna Samara Halperin - jinnah@dmahealth.com

2. Provider Readiness: RC Implementation Step by Step – Respondent Guidance • Build system from the bottom up and tailor it to the setting and population. • Identify high risk populations and determine their unique needs. • Work slowly and deliberately through startup. Communication is essential. • “First couple months are difficult. After been there 12 months, it is like ordering labs… How to make it through the 12 months? The monthly meetings were important.” • Identify one or more internal champions to promote RCs and RC services. • “If a physician has a positive experience, likely to reach out again.” • “[Need] designees in each department of the PD that work on this. “ • Hold monthly meetings to assess progress and make adjustments as needed. • “Talk about trends. Talk about success with the teams. They track repeat overdoses (one woman has overdosed 15 times). Try to get the experts at the provider level to try to [use] new tactics- to connect them to help.”

3. Provider Readiness: RC ImplementationRespondent Guidance – Continued… • Establish infrastructure to supervise and integrate RCs and recruit recoverees. • “[Recovery Coaching is] very effective, so everyone wants it, but if they don’t have the infrastructure to support people… they’re left to their own and unsupported and then they’re doing case management and mental health well outside of their lane.” • Develop amended CORI policies so they do not serve as barriers to hiring RCs. • Hiring RCs with lived experience means that some individuals may have records. • Policies should be reviewed before commencing interviews with RC applicants.

4. Provider Readiness: Needs and Concerns • Significant concerns exist around maintaining fidelity to the RC service model with many reports of RCs being asked to perform tasks inconsistent with the role, including clinical services. • “As the workforce is developing and learning, continue to clarify what it means to [Recovery] Coach vs. other ways to support people.” • “More and more [RCs are being] used as junior counselors, [which is]not their role.” • RC programs require flexibility given the diverse needs of recoverees, range in services provided, and setting types where RCs work. • “Programs can’t be too prescribed, would have trouble meeting parents needs where they are. Flexibility is important. It needs to be a long term model. Six months is not enough. Flexibility allows long engagement periods, real building of trust and rapport, and meeting moms’ stated needs. [Needs] expand over time.”

5. Provider Readiness: Needs and ConcernsContinued… • Programs using community collaborations reported anecdotal success, increasing demand, and growing support. These programs can be a resource. • “This is a good model for other communities. No one community can exist anymore. It is all about partnerships. As much as we work with individuals, we help build coalitions in each community.” • “There is no clear blueprint for providers.”

6. Provider Readiness: Lessons Learned • Providers need training on what RCs are and what role they serve. They need to understand and respect the role of Recovery Coach. • "Medical systems value high productivity, quick problem identification, and formal education. [Recovery coaching] is tough in this environment - creates barriers to acceptance and respect." • “Staff don’t know who RCs are and what they are doing – takes time for people to understand... [and] depends upon [RCs]. Some are better able to break down barriers.” • Providers need to view RCs as a recovery subject matter expert and consider them as an integral part of the treatment team. • “Bring RCs to leadership and [give them] a seat at the table. They are professionals and need to have a voice in policy decisions.”

7. Provider Readiness: Lessons LearnedContinued… • Providers need to build appropriate infrastructure to support the RC service delivery model as well as individual RCs. • "[Providers] need to understand that this is not a quick fix. This is a profession like any other profession that requires standards, education, training, quality supervision, attention, money, and planning.“ • "Creating the right environment for RCs to operate in can’t be an afterthought."

8. Provider Readiness: Recommendations Provider Responsibilities • Convene key stakeholders, including people in recovery, to discuss program development, implementation, outreach, sustainability, and data collection. • Work towards ensuring sustainability of the RC service, monitoring relative benefits, challenges, billing, and projected demand increases. • Create a data collection system to track and inform RC service activities. • One program and the EDRC evaluator described exemplary data collection systems.