Moving Forward: A Recovery-Oriented System of Care for Addiction Services

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Moving Forward A Recovery-Oriented System of
Care for Addiction Services

• NJ Division of Addiction Services

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What Is Recovery?

• Recovery refers to the ways in which persons with
  or affected by addiction tap resources within and
  beyond the self to move beyond experiencing these
  disorders to managing them and their residual
  effects to build full, meaningful lives in the
  community. It is regaining wholeness, connection
  to the community, and a purpose-filled life.

White, W. and Davidson, L. Recovery The bridge
to integration? Part one. Behavioral Healthcare,
November 2006.
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DAS Actions

• New mission statement
• Strategic planning systems change process
  annual review
• Sent delegation to CSAT Regional Forum
• Invited to New York to share our plans and
  activities for transformation to chronic care
  model
• Attended Recovery Symposium in Philadelphia
• Invited to participate in the Mutual Assistance
  Program for States (MAPS) for technical
  assistance to SSAs interested in Recovery
  Oriented Systems of Care
• Invited NJ counties to engage in the planning
  process with a renewed focus on recovery-oriented
  care

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DAS Mission Statement

• The Division of Addiction Services (DAS)
  promotes the prevention and treatment of
  substance abuse and supports the recovery of
  individuals affected by the chronic disease of
  addiction. As the Single State Agency for
  substance abuse, DAS is responsible for
  regulating, licensing, monitoring, planning and
  funding substance abuse prevention, treatment and
  recovery support services in New Jersey.
•  
• To achieve its mission, DAS provides leadership
  and collaborates with providers, consumers, and
  other stakeholders to develop and sustain a
  system of client-centered care that is
  accessible, culturally competent, accountable to
  the public, and grounded in best practices that
  yield measurable results.

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CSAT Regional Summit Meetings 2007 - Background

• To inform states about the National Summit on
  Recovery and build on the work initiated by the
  Summit participants
• Agenda was Planning and Implementing
  Recovery-Oriented Systems of Care within States
  and Communities
• Teams were to include SSA designee, treatment
  provider, representative of the recovering
  community, and researcher

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Regional Summit Meetings 2007Questions Asked

• 1. What should recovery-oriented systems of care
  (ROSCs) look like?
• 2. What steps are necessary to move toward
  ROSCs?
• 3. What steps have you already taken to
  implement ROSCs?
• 4. What challenges do you face in implementing
  ROSCs?
• 5. What steps are you prepared to take to
  support this change in the next 12 months?

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Overview

• Client-Centered
• Advocacy and stigma reduction
• Partnership with consumers
• Holistic approach and focus on wellness
• Integrates with primary care and mental health
• Strengths-based approach to services
• Full continuum of care
• Prevention ? Early Intervention ? Treatment ?
  Recovery Support
• Chronic Care Model
• Case management
• Clinically driven lengths of stay and placement
• Response to relapse
• Flexible funding follows the client
• Continuity of care

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Overview (cont)

• Recovery Supports
• Supportive housing
• College recovery housing
• Phone outreach
• Mentors
• Recovery Support Centers
• Recovery-Oriented Quality Care
• Evidence-based practices
  (pharmacological and psychosocial)
• Credentialing and competency
• Outcomes focused
• NIATx process improvement

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• Client-Centered

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Guiding Principles of Recovery

• There are many pathways to recovery
• Recovery is self-directed and empowering
• Recovery involves a personal recognition of the
  need for change and transformation
• Recovery is holistic
• Recovery has cultural dimensions
• Recovery exists on a continuum of improved health
  and wellness
• Recovery emerges from hope and gratitude

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Guiding Principles of Recovery (cont)

• Recovery involves a process of healing and
  self-definition
• Recovery involves addressing discrimination and
  transcending shame and stigma
• Recovery is supported by peers and allies
• Recovery involves (re)joining and (re)building a
  life in the community
• Recovery is a reality

CSAT (2005), National Summit on Recovery
Conference Report
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DAS PROGRESSCLIENT-CENTERED

• Working to minimize the stigma associated with
  the use of medications to support recovery
• Client Advocate on staff who works with clients
  to resolve discrimination, advises on client
  advocacy issues and initiates anti-stigma
  campaigns
• Citizens Advisory Council convened
• Client satisfaction survey in July 2005

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• Chronic Care Model

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A Chronic Care Model

• Substance dependence should be viewed as a
  chronic illness (such as hypertension, diabetes,
  asthma) and not as an acute illness
• The system of care, including treatment and
  funding mechanisms, must reflect the best
  practices proven to effectively achieve chronic
  illness recovery
• When treated as a chronic illness, the compliance
  and relapse rates of substance dependence are as
  good or better than other chronic illnesses
  (OBrien McLellan)

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A Chronic Care ModelPRINCIPLES OF CARE

• Must be evidence-based and jointly planned (i.e.,
  client- centered) and support a healing
  relationship and lead to improved wellness and
  the opportunity for maintenance of recovery
• Must be specific to the needs of individuals
  allowing for the treatment experience to be based
  on clinical need and offer a broad array of
  resources over a continuum of care
• Must provide coordinated, continuous attention to
  the individuals needs for information and
  readiness for behavioral change

Flaherty, M. (2006), A Unified Vision for the
Prevention and Management of Substance Use
Disorders Building Resiliency, Wellness and
Recovery A Shift from an Acute Care to a
Sustained Care Recovery Management Model.
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DAS PROGRESSCHRONIC CARE MODEL

• Case management added as a reimbursable service
  in its newest FFS network, the Co-Occurring
  Network
• Case Managers in NETI
• NIATx focus on step down
• Drug Court shift to clinically driven level of
  services
• Philosophical change
• Relapse is NOT a reason for discharge
• Ask different questions
• Why did the client fail treatment?
• How did the system fail the client?

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• Recovery Supports

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Implications for Systems Change

• Greater focus on what happens BEFORE and AFTER
  primary treatment
• Transition from professionally developed
  treatment plans to client-directed recovery plans
  
• Greater emphasis on the physical, social and
  cultural environment in which recovery succeeds
  or fails
• Integration of professional treatment and
  indigenous recovery support groups

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Implications for Systems Change(cont)

• Increased use of peer-based recovery coaches
  (guides, mentors, assistants, support
  specialists), and
• Integration of paid recovery coaches and recovery
  support volunteers within interdisciplinary
  treatment teams.

Flaherty, M. (2007). CSATS Recovery Supports
Services Meeting.
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Recovery Support Services

• Family Services (including marriage education,
  parenting and child development services)
• Child Care
• Employment Services
• Pre-employment Services
• Employment Coaching
• Individual Services Coordination
• Transportation to and from treatment, recovery
  support activities, employment, etc.
• Employment services and job training
• HIV/AIDS services
• Supportive transitional drug-free housing
  services
• Other Case Management Services

• Continuing Care
• Relapse prevention
• Recovery Coaching
• Self-help and Support Groups
• Spiritual Support
• Other After Care Services
• Substance Abuse Education
• HIV/AIDS Education
• Other Education Services
• Peer Coaching or Mentoring
• Housing Support
• Alcohol- and Drug-Free Social Activities
• Information and Referral
• Other Peer-to-Peer Recovery Support Services

http//www.atr.samhsa.gov/downloads/atr_faq2008.pd
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DAS PROGRESSRECOVERY SUPPORTS

• New Jersey Access Initiative (NJAI)
• Mentors 500 Recovery mentors trained
• Choice Client given choice of provider,
  including non- traditional faith-based and
  community-based programs
• Vouchers Funds given to the client which
  reinforces choice and includes the client in
  fiscal management
• When funds available, expand access to recovery
  support services, e.g., Recovery Mentors
• Introduced two Supportive Housing pilot projects
• Issued Request for Proposals (RFP) for a Recovery
  Center and held Bidders Conference
• Planned system of phone outreach in the Recovery
  Center

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DAS PROGRESSRECOVERY SUPPORTS (cont)

• Recovery Mentor Consortium created whose first
  task was convening a conference to promote
  Mentorship
• Awarded two grants to develop recovery housing on
  college campuses
• Expanded network of providers through the Office
  of Faith Based Initiatives (OFBI)

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• Recovery-Oriented Quality Care

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Recovery-Oriented Quality Care

• Recovery-oriented care shifts the design of the
  addiction treatment system from an acute care
  model, focused on serial episodes of biophysical
  stabilization to a model of sustained recovery
  management.
• Recovery-oriented care focuses on the acquisition
  and maintenance of recovery capital (internal and
  external assets required for recovery initiation
  and self-maintenance), global health (physical,
  emotional, relational, and spiritual), and
  community integration (meaningful roles,
  relationships, and activities).

White, W. and Davidson, L. Recovery The bridge
to integration? Part one. Behavioral Healthcare,
November 2006.
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Recovery-Oriented System of Care Elements

• Person-centered
• Family and other ally involvement
• Individualized and comprehensive services across
  the lifespan
• Systems anchored in the community
• Continuity of care
• Partnership-consultant relationships
• Strength-based
• Culturally responsive

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Recovery-Oriented System of Care Elements (cont)

• Responsiveness to personal belief systems
• Commitment to peer recovery support services
• Inclusion of the voices and experiences of
  recovering individuals and their families
• Integrated services
• System-wide education and training
• Ongoing monitoring and outreach
• Outcomes driven
• Accountable to the public
• Research based
• Adequately and flexibly financed

CSAT (2005), National Summit on Recovery
Conference Report
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DAS PROGRESSRECOVERY-ORIENTED QUALITY CARE

• Provided training on the evidence-based treatment
  program, the SAMSHA/CSAT Family Centered
  Treatment Model
• Incorporating requirements for best practices
  into design of DAS programs
• Workforce Development program that will increase
  the competency and credentialing of clinical
  staff

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DAS PROGRESSRECOVERY-ORIENTED QUALITY CARE
(cont)

• Developed Provider Performance Reports which
  include NOMs information and conducted logistic
  regression to determine factors related to
  outcomes
• Implementing a NIATx process improvement pilot
• Exploring contract incentives
• CCS Training through Central East ATTC
• Dr. Baxter information for Medical Directors
  regarding MAT
• MAT as an enhancement across the continuum of
  care
• Co-occurring initiative

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Next Steps

• Planning
• Conduct a needs assessment to identify recovery
  support services needs
• Public Information
• Create a Recovery Corner on DAS website that
  provides information for clients in recovery
• Asset Building
• Pilot an IDA asset building project
• County Collaboration

• Recovery research collaboration with NY
• Expand Recovery Centers
• Contract incentives based on outcomes
• Early Intervention focus on integration with
  primary health care
• Quarterly Grand Rounds case presentations with
  Medical Directors for MAT, pain management,
  co-occurring, poly substances
• Increased Fee-for-Service

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• Questions?