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Overview%20of%20a%20Recovery%20Oriented%20System%20of%20Care:%20Characteristics,%20Structure%20and%20Development

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Title: Overview%20of%20a%20Recovery%20Oriented%20System%20of%20Care:%20Characteristics,%20Structure%20and%20Development


1
Overview of a Recovery Oriented System of Care
Characteristics, Structure and Development
  • Ijeoma Achara PsyD

2
Overview
  • Identify the characteristics of a
    recovery-oriented system of care.
  • Explore the implications for multiple levels of
    the system
  • Examine frequent concerns
  • Explain the advantages and limitations associated
    with different models of recovery oriented
    systems.

3
What is a ROSC
  • Recovery-oriented systems of care (ROSC) are
    networks of formal and informal services
    developed and mobilized to sustain long-term
    recovery for individuals and families impacted by
    severe substance use disorders. The system in
    ROSC is not a treatment agency but a macro level
    organization of a community, a state or a nation.
  • William White

4
Why Transformation A Persons Perspective
  • Ive been struggling with trying to maintain
    recovery for fifteen years.Ive been in other
    programs, got some good treatment.but for me,
    for me this was the missing ingredient right
    here. This is what I needed to not just get
    clean but stay clean. Because it helped me to
    identify and realize what I need to do with my
    life after Im clean. Its given me a sense of
    purpose, you know. I spent all those years
    drinking and drugging and it was like, now that
    Im clean what am I going to do with my life?
  • Barbara, person in recovery, Amistad Village
    Project

5
What Helps?
6
Elements of a ROSC
  • Promotes community integration and mobilizes the
    community as a resource for healing
  • Facilitates family inclusion
  • Facilitates a culture of peer support and
    leadership
  • Values partnership and transparency
  • Provides holistic, individualized, person
    directed tx which supports multiple pathways to
    recovery
  • Creates mechanisms for sustained support
  • Is informed by data and the experiences of PIR
    and families
  • Promotes hope
  • Provides services in a strengths-based manner

7
How is this different?
  • and wheres
  • the manual?

8
Holistic Approach
  • ROSC
  • Symptom reduction with a purpose a means to an
    end
  • Other domains are a priority - including
    employment, housing, recreation, spirituality etc
  • Traditional System
  • Focused on symptom reduction/stabilization
  • Other life domains are not addressed

9
A Persons Perspective

10
Strategies
  • System Level
  • Partnerships with relevant systems
  • Relevant Initiatives
  • Organizational/Administrative
  • Services in non-stigmatized settings
  • Mutually beneficial collaborations
  • Gospel Fests
  • Internships
  • Resource
  • Mapping

11
Strategies
  • Programmatic
  • Holistic assessments
  • Recovery plans versus treatment plans
  • Flexible Menu of Services
  • Recovery Community
  • Peer specialists assist others with recovery
    planning
  • Recovery resource identification/ mobilization
  • Facilitating linkages

12
Attending to Culture
13
And the village was happy..
14
Sustained Recovery Supports
  • Traditional System
  • Focus on action stage of change
  • Client is blamed/discharged for relapse
  • Limited Aftercare
  • ROSC
  • Emphasis is on pre-action stages of change also
  • Responsibility is placed on the service milieu
  • Continued support and early re-engagement

15
Perspectives
  • My clients dont 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)
  • I got help with the kinds of things that were
    most important to me like getting my daughter
    back, and putting food on the table for her.
    Since they were willing to help me with that
    stuff, I figured, Hey maybe I should listen to
    what theyve been trying to tell me and try out
    that program they keep talking about. Today
    Ive been clean for nine months
  • Davidson et al., 2009

16
Strategies
  • System
  • Reimbursement of pre-treatment supports
  • Peer Group Facilitation Training
  • Collaborations with other systems - critical
    transitions
  • No restrictions for high utilization
  • Organizational
  • Welcoming/comfortable environment
  • Address organizational barriers to treatment
  • No fail policies
  • Barbara, women and childrens programs

17
Strategies
  • Programmatic
  • Informed consent
  • Persistence
  • Street outreach
  • Multi-media continuing care
  • Telephone prompts
  • Recovery Community
  • PIR in critical locales
  • Volunteers and employed PIR providing outreach
    and continued care
  • New Pathways

18
Community Integration
  • Traditional System
  • intra-psychic orientation
  • Community supports are recreated in the system
  • Individual is the unit of intervention
  • Stabilization before reintegration
  • ROSC
  • inter-psychic orientation
  • Existing community supports are accessed
  • Individual, family and community are all units of
    intervention
  • Life helps to initiate and sustain recovery

19
A Persons Perspective
  • If my neighborhoods tore up, whats going to
    happen to me when I go out there. Some programs
    tell you to stay away from people, places and
    things thatll trigger you. I cant do that. I
    live in a sober house. Next doors a crack house
    and across the street is the package store. This
    place is tore up! What am I supposed to do? If
    my community dont get better, I aint getting
    better.
  • Client in Amistad Village Project,
  • New Haven, CT

20
Peoples Perspectives
  • I just wanted to get back to my life my family,
    and my job, and my church activities. My
    recovery was important, but it didnt matter so
    long as I didnt have those things in my life to
    look forward to. It was those things that kept
    me going in my darkest days
  • Nobody wanted anything to do with me before. It
    was always, Come back and see us when you get
    serious about your recovery when youve got some
    clean urines. But then this program tried to
    help me out with getting this job I had wanted
    for a really long time. Now, I am working part
    time and Ive finally got a reason to be sober
    every day.
  • Davidson et al, 2009

21
Strategies
  • System
  • Develop initiatives that promote community
    integration and strengthen the community
  • Leadership academy
  • Community Coalitions
  • offsite tx
  • Organizational
  • Reciprocal relationships with other organizations
  • Giving back to the community
  • Community based events

22
Strategies
  • Programmatic
  • Services taking place in the community
  • Community asset mapping
  • Build competencies
  • Recovery Community
  • Assertively link people to opportunities
  • Assisting with life skills

23
Peer Culture, Support and Leadership
  • Traditional
  • Peer support is limited to AA/NA groups
  • PIR may be in leadership, but not identified as
    such
  • Community based peer support services are not
    connected to the formal tx system
  • ROSC
  • Diverse mechanisms for peer support and
    LEADERSHIP exist
  • PIR are in leadership positions at all levels
  • Seamless integration of formal tx system and
    peer/community supports

24
More Perspectives
  • Id been doing drugs for something like 30 to 35
    years. When I came here I was broke, I was
    using, and I was sick. I was a broken shell of a
    woman and thought about dying all the time. They
    let me come here everyday and do little things.
    You know I felt welcome and I felt a sense of
    purpose again. But I started to think that if I
    could do a little thing, then maybe I could do a
    big thing.
  • Barbara, person in recovery.
  • Once youve completed treatment you need to know
    what to do. We need to find out how to live
    after treatment. The peer services help people
    figure out how to have a life!!
  • Wanda, Peer Specialist, NET

25
Provider Perspective Joe Schultz, NET
  • Theres been a huge turnaround in outcomes.
    Consumers do betterWe have more people
    completing treatment than weve ever had!
    ..Even when they leave early the peer
    specialists are able to reengage a lot of them.
    That didnt happen before. The attendance rate
    has gone from 50 to over 75... And
    clientsstay connected. Thats something we
    never saw beforenow counselors feel they are
    actually helping people. They can actually see
    the results of all the work they do

26
Peer Culture, Support and Leadership
  • System Level Strategies
  • Developing Pathways of Opportunity
  • Training and Job Fair

27
Perspectives
  • Equips people with the skills to effectively
    share their recovery story in public settings,
    including Tx
  • Gloria
  • After participating in all of the trainings I
    began to find power in sharing my story with
    others at the Consortium where I was going to get
    help for my mental illness issues. Now I am a
    presenter for Taking Recovery to the Streets, a
    two-day WRAP facilitator, member of Enon
    Tabernacle Baptist Church, have a new home, new
    car. I am employed as a file clerk, and I am a
    full-time student at the University of Phoenix
    online with a GPA of 4.0 in pursuit of my
    Associates Degree in Psychology. I am thankful
    to God and the Recovery Foundations (Training).
    I am living Life to the Fullest!

28
Strategies
  • Peer Culture and Leadership
  • Its more than having peers or per led
    services.its a cultural thing!
  • Example North East Treatment Center
  • NET Consumer Council
  • Recovery Resource Center
  • Monthly Consumer Appreciation Dinner
  • Peer Specialists, volunteers
  • Program Development and Evaluations
  • Proyecto Nueva Vida

29
Strategies
  • Programmatic
  • Assertive Outreach
  • Recovery Capital assessment at individual/family/c
    ommunity levels
  • Facilitating linkages
  • Recovery Check-ups and early re-engagement
  • Companionship and modeling of recovery lifestyle
  • Recovery Planning
  • PIR led groups

30
Anticipate Challenges
31
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
    dont have to just be words on a paper anymore

32
Organizational Readiness
  • Dialogue
  • Role Ambiguity
  • Role Conflicts
  • Supervision good fit
  • Valuing the work and the person
  • Opportunities

33
A Word about Partnership
  • Traditional Systems
  • Expert model, hierarchical
  • Professionals determine course of action
  • Treatment planning goals and strategies are
    determined by the professional based on the
    presenting problems
  • ROSC
  • Coaching, collaborative model
  • Professionals support people in making their own
    choices
  • Goals and strategies are determined in
    partnership and are directed by the person in
    recovery

34
Implications for Criminal Justice System
  • Recidivism and limited community connections
  • Connecting to meaning
  • Implications of prison culture
  • Innovative practices
  • Non-confrontational approaches

35
  • For someone like me just getting out. The last
    thing I wanted to hear was you cant do this, you
    gotta do that. I wasnt hearin all that. I
    just been locked up and told when to get up, when
    to eat, when to sleep. I didnt need that. I
    woulda been outta here.
  • Mike, person in recovery,

36
(No Transcript)
37
How do You Structure a ROSC?
38
The Additive Model
39
The Interactive Model
40
(No Transcript)
41
Where is Your System?
42
N0! No! and a Thousand Times No!
43
Top Concerns
  • Dont P-BRSS approaches devalue the role of
    professional intervention?
  • Doesnt recovery oriented care increase provider
    exposure to risk and liability?
  • Whats all the hype about, weve been doing this
    for years?
  • How will we pay for implementing recovery
    oriented care and supports?

44
  • NIATx
  • Founded in 2003, NIATx works with behavioral
    health treatment providers to make more efficient
    use of capacity and develop strategies to improve
    access and retention in outpatient services
  • Purpose Improve Outcomes in Outpatient Tx

Activities Implement process improvement
strategies through the use of existing resources,
rather than additional expenditures
45
Niatx Projects
  • Northeast Treatment Center
  • Increased peer supports, involvement and
    activities
  • Up to 70 of new admissions continued after 30
    days in treatment
  • Northeast Community Mental Health Center
  • Initiated earlier clinical involvement versus
    filling out papers, which resulted in 80
    returning to the clinic after the first visit

46
Niatx Projects
  • CO-MHAR
  • Reduced wait time from 6-7 weeks to 2-3 weeks at
    one site
  • Improved same day service including having 50 of
    clients seen the same day
  • Confirmation calls to clients
  • Casa de Consejeria
  • Reduced wait time for first appointment from 19.8
    days to 4.5 days
  • All staff received training on conducting intakes

47
Yearly Additional Revenue from 1 Change Cycle
  • Intercommunity Action
  • 18,000
  • Joseph J. Peters Institute
  • 150,000 less associated costs
  • Thomas Jefferson University
  • 84,000 less 1 intake staff person salary
  • CO-MHAR
  • 30,000
  • Community Council
  • 12,000

48
Cost Neutral Strategies
  • Mobilizing the community of people in recovery
  • Holistic assessments
  • Recovery planning
  • Satisfaction surveys/focus groups
  • Reciprocal community partnerships
  • Consultation Approach
  • Continued Care

49
Challenge
  • The need for HOPE at all levels

50
You can do this, we can help!!
51
Break
52
Strategies for Developing a ROSC
53
Overview
  • Discuss the nature of transformational change
  • Explore the implications for leadership
  • Describe a framework to guide the transformation
    of systems and organizations
  • Small group discussions

54
Three Types of Change
55
Three Types of Change (contd.)
Reemergence Through Visioning and Learning
Wake-Up Calls
Growth
Chaos
Mindset Forced to Shift
Birth
56
How Transformational Change is Different
  • Transformational change is unique in three
    critical ways
  • The future is unknown and only through forging
    ahead will it be discovered.
  • The future state is so different than the
    traditional state that a shift of mindset is
    required to invent it.
  • The process and the human dynamics are much more
    complex, partnership is critical!

57
What Kind of Leadership is Necessary to Promote
Transformational Change?
  • Leaders who
  • Establish direction and a vision for the future
  • Motivate inspire, and energize people to overcome
    challenges
  • Promote participatory, inclusive processes
  • Tolerate ambiguity, rather than predictability
    and control
  • Lead by example - live by key values
  • Empower the people around them
  • Create an organizational culture consistent with
    recovery values

58
Conceptual Framework Guiding the Transformation
Process
  • 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

59
Starting the Journey to a ROSC
60
Where is Your System?
  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance

61
Corresponding Focus
Stages of Change Major Focus of Alignment
Pre-Contemplation Conceptual
Contemplation Conceptual
Preparation Conceptual and Practice
Action Practice and Contextual
Maintenance Practice and Contextual
62
Strategy One Promote Conceptual Alignment
63
Conceptual Alignment
  • Set the Context and Establish a Sense of Urgency
  • 2. Form Powerful Guiding Coalitions

64
Conceptual Alignment
  • 3. Create a shared vision for change and
    over communicate the vision X 10
  • 4. Develop a conceptual framework for
    transformation that encompasses all related
    initiatives

65
Conceptual Alignment
  • 5. Develop participatory and transparent
    approaches
  • 6. Create forums for knowledge sharing and
    exploration of new ideas
  • 7. Address perceived loss and facilitate
    engagement

66
Learning Activity I Conceptual Alignment
  • What excites you about developing a ROSC?
  • What is one of your greatest concerns about
    developing a ROSC? What are you confused about
    or what dont you agree with?
  • Which recovery values do you think are most
    important for this system?
  • On a scale of 1 to 10, to what extent do you
    believe stakeholders in this system understand
    what a ROSC is?
  • Based on strategies you heard this morning, or
    ideas that were triggered, what do you think can
    be done to increase everyones understanding and
    commitment to this transformation?

67
Lunch
68
Strategy Two Practice Alignment
69
Practice Alignment
  • 1. Identify your recovery transformation
    priorities
  • 2. Identify initiatives/practices to support the
    implementation of each priority
  • 3. Examine the implications of these priorities
    for all levels of the system/organization (in
    partnership)

70
Practice Alignment
  • 4. Invest in the enhancement/development of model
    programs/practices
  • 5. Develop mechanisms for skill building
  • Tools for Transformation

71
Practice Alignment
  • 6. Empower all stakeholders
  • 7. Identify and mobilize the early adopters
  • 8. Tackle the tough issues (regulatory changes,
    fiscal alignment, risk and liability)
  • 9. Create short-term wins
  • 10. Celebrate the successes

72
  • Strategy Three
  • Aligning the Context

73
Aligning the Context
  • Align organizational structure/processes
  • 2. Learn what the barriers to recovery oriented
    care are from your emerging practices
  • 3. Address policy and fiscal issues for long-term
    sustainability

74
Batten Down the Hatches?
  • Maximize existing service capacity
  • Achieve savings by interrupting cycle of repeated
    crises and acute care admissions
  • Reinvest savings into recovery supports and
    clinical services
  • DMHAS, CT

75
Examples from CT (DMHAS)
  • 1. Focus on community life and natural supports
    - development of supportive housing units for 550
    individuals. Over 60 now working or in training
    and inpatient costs decreased by 70.
  • 2. Urban Initiative (Housing) 600 decrease in
    ER visits, 375 decrease in detox days
  • 3. Recovery House 69 connect to care versus
    39 without recovery house stay
  • 4. Reduced utilization of high end services and
    increased utilization of inpatient services

76
Aligning the Context
  • 4. Address stigma
  • 5. Strengthen the community and build Indigenous
    recovery capital
  • 6. Move beyond the choir link it to other
    political agendas

77
Challenges along the Way
78
Stabilization or Transformation?
79
Lets go for it!!!
80
Stakeholder Discussion Groups
81
Commit to a Next Step
  • What are the things that YOU will commit to
    do/change to help advance recovery transformation
    in your system or organization?
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