Recovery in the Community: An Emerging Framework- A Recovery-Oriented Systems Approach SAAS National Conference NIA

1. 1 Recovery in the Community: An Emerging Framework- A Recovery-Oriented Systems Approach SAAS National Conference & NIATx Summit Partners for Recovery

2. 2 Presentation Goals To provide an overview of a recovery-oriented systems approach; To discuss the benefits this emerging approach; To engage you in the system change process; To inform you about CSAT programs that support recovery-oriented activities; and To answer your questions.

3. 3 Any problems faced by the individual substance user cannot be seen in isolation from their family, local community and society. - Scottish Advisory Committee on Drug Misuse, 2008.

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5. 5 Draft Description

6. 6 Adoption of a Public Health Approach A public health approach is used to address substance use problems and related health conditions. The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations - public and private - communities and individuals.

7. 7 Key Elements of a Public Health Approach Population-based Holistic Risk factor-oriented With attention to vulnerable populations Focused on: Health promotion Disease prevention Evidence-based

8. 8 Recovery-oriented systems include: A comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual�s needs and chosen pathway to recovery. An ongoing process of systems-improvement that incorporates the experiences of those in recovery and their family members. The coordination of multiple systems, providing responsive, outcomes-driven approaches to care.

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10. 10 Role of Prevention, Treatment & Recovery Providers Acts as one of the coordinating bodies for systems improvement Provides person-centered/self-directed services and supports Accesses services from other systems for clients Supports improvement in addressing substance use issues within other systems

11. 11 Why do we need this approach? The field faces many challenges: Different values, approaches, & perspectives Insufficient and inefficient use of resources Cumbersome, fragmented, and inflexible systems Access, engagement, retention and appropriate services

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14. 14 Systems Elements

15. 15 Systems Elements (cont�d)

16. 16 Goals of Recovery-Oriented Systems To support preventive strategies related to substance use problems & disorders; To intervene early with individuals with substance use problems; To support sustained recovery for those with substance use disorders; and To improve individual, family and community outcomes.

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18. 18 Enhancing Current Systems

19. 19 Enhancing Current Systems (cont�d)

20. 20 Enhancing the Continuum of Care to Provide a Recovery-Oriented Approach

21. 21 What are the benefits of a recovery-oriented approach? Increased responsiveness to individuals, families and communities Application of recovery-oriented research

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23. 23 Responsive to Individuals/Families

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25. 25 Recovery-Oriented Research

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27. 27 Using a Recovery-Oriented Framework as a Platform for: Collaboration among informal & formal systems Planning Policy development

28. 28 Planning Recovery-Oriented System Change 

29. 29 I. Conceptual Framework Vision Principles Definitions

30. 30 II. Assessment Assessments of readiness Inventories of current services & supports Assessments of organizational and staff recovery-oriented capabilities Assessments of strengths and gaps Stakeholder Surveys

31. 31 III. Capacity Building Awareness raising strategies and materials for multiple audiences Legislators, recovery community, etc. Training and educational materials Cross-systems, organizational, staff, volunteers

32. 32 IV. Planning Strategic Plan Goals & Priorities

33. 33 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/Strength-based//Self-Directed Approaches Provide or seek training on recovery-oriented approaches

34. 34 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

35. 35 VI. Evaluation Process evaluations Outcomes evaluations Quality improvement processes

36. 36 Lessons Learned from State and Community Activities Systems change requires conceptual clarity, overcoming resistance, organizational commitment, strong leadership, definition of roles, transparency, and an infrastructure to support the process, including staff and education and training. A perfect plan is not necessary to begin the process. Change agents in your State will assist you with the implementation process. Constant communication is essential.

37. 37 Recommendations from States and Communities Pursue efforts where you can achieve early success and promote those accomplishments. Use all tools available to you, such as peer-to-peer services and case management. Conduct evaluation and performance measurement at the beginning of the implementation process. Invest in a good grant writer to leverage resources.

38. 38 CSAT�s Regional Recovery Meetings: Noteworthy Steps States are Prepared to Take Convene a Blue Ribbon Panel to create documents that describe the State�s plan for recovery-oriented services; Offer mini-grants to build recovery-oriented capacity; Make funding contingent on client-centered care; Formulate recovery-oriented guidelines and competency-based credentials;�

39. 39 Design new RFPs to solicit recovery orientation � with an ultimate goal of developing recovery- oriented Centers of Excellence; Define recovery-oriented job functions and services and develop a training curriculum to support those activities; and Ensure that the State�s management information systems (MIS) can track recovery-oriented support activities.

40. 40 CSAT Programs & Initiatives that Support Recovery-Oriented Services & Activities

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42. 42 Screening, Brief Intervention, and Referral to Treatment (SBIRT)

43. 43 Alcohol & Drug Related Emergency Department (ED) Visits In 2005 there were an estimated 394,224 ED visits that involved alcohol in combination with another drug. Alcohol was most frequently combined with one or more of the following: cocaine, marijuana, and heroin.

44. 44 Traditional Substance Abuse Intervention At risk population could potentially successfully reduce drug use through �early intervention.� At risk population could potentially successfully reduce drug use through �early intervention.�

45. 45 Screening, Brief Intervention & Referral to Treatment (SBIRT) Embeds screening, brief intervention & treatment of substance abuse problems within primary care settings such as emergency centers, community health care clinics, and trauma centers; Identifies patients who don�t perceive a need for treatment; Provides them with a solid strategy to reduce or eliminate substance abuse; and Moves them into appropriate services.

46. 46 SBIRT Current State & College Grants

47. 47 SBIRT: Core Components Screening: Very brief screening that identifies substance related problems Brief Intervention: Raises awareness of risks and motivation of client toward acknowledgement of problem Brief Treatment: Cognitive behavioral work with clients who acknowledge risks and are seeking help Referral: Referral of those with more serious addictions

48. 48 Reimbursement for screening & brief intervention is available through commercial insurance CPT codes, Medicare G codes and Medicaid HCPCS codes: Coding for SBI ReimbursementFebruary 2008

49. 49 Alcohol to Intoxication & Illegal Drug Use � SBIRT Outcomes

50. 50 Access to Recovery:A Recovery-Oriented Approach

51. 51 Access to Recovery (ATR) The expansion of treatment capacity The implementation of a voucher system, which allows most grantees to choose their target populations and geographic area(s) of coverage The inclusion of non-traditional addictions treatment providers, such as faith- and community-based organizations

52. 52 ATR (cont�d) Recovery support services in conjunction with clinical treatment help to establish a more comprehensive treatment response. The recovery-oriented project focuses on reducing the acute and severe relapses that substance abusing clients often experience.

53. 53 More Choices for Clients ATR has helped mobilize community networks and build collaborative partnerships that result in more choices and more services for clients with substance abuse issues. Faith-based organizations have expanded the concept of choice by offering faith-based options to clients who may have a more spiritual approach to their recovery

54. 54 Examples of Services That Can be Paid for Using ATR Vouchers Employment coaching 12-step groups Recovery coaching Spiritual support Child Care Housing Support Literacy Training Traditional Healing Practices, e.g.: Sweat lodge Sundance ceremony Burning sage Beading Other

55. 55 Helps Build Networks DOJ: Drug courts may be sources of referrals into the program DOL: Prisoner Reentry Program HUD: Housing services (direct housing services such as rent payments are not permissible under ATR)

56. 56 ATR Evidences of Success 74.3% of clients who reported using substances at intake into ATR were abstinent from substance abuse at discharge.

57. 57 Federal Recovery-Oriented Activities

58. 58 Annual Conference Report of the Recovery Community Services Program � Conference report discussing emerging indicators of quality for peer recovery support services. The report can be accessed via: http://rcsp.samhsa.gov/lessons/index.htm Recovery-oriented Tool-kit � Tool-kit on policies, administrative rules, strategic plans, practice guidelines, vision statements, workforce competencies, training outlines, surveys, protocols, and literature review Educating State Legislators on Recovery-Oriented Systems � Developing website, fact sheet, three web-assisted audioconferences, presenting at Health Chairs Meeting and drafting issue brief Resources on the PFR website � Recovery-oriented resources will continue to be posted on the PFR website at www.pfr.samhsa.gov. Federal Recovery-Oriented Activities (cont�d)

59. 59 SAMHSA/CSAT Resources Substance Abuse and Mental Health Services Administration SHIN 1-800-729-6686 for publication ordering or information on funding opportunities 800-487-4889 � TDD line / www.samhsa.gov National Alcohol & Drug Addiction Recovery Month www.recovery.month.gov Recovery Community Services Program http://rcsp.samhsa.gov/about/overview.htm Partners for Recovery www.pfr.samhsa.gov

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