RECOVERY IS REAL! BACODA

Make sure you do the DOT activity.

Welcome

Who Do We Have In The Room?

Symposium Agenda

¨  Registration ¨  Welcome! ¨  Keynote ¨  Keynote ¨  Lunch- Film trailer ¨  Panel- Recovery Is Real! ¨  Networking Café’ Conversations ¨  Evaluations and Wrap up

Celebrate Recovery

Celebrate Recovery

Recovery is not simply about personal health, but the health and well being of the entire community… “This isn’t about me. I’m doing this for my children and my community. I have to build up my community because I need to know that if something happens to me, there will be resources and people in the community who can step in and take care of my girls.” AMIR participant

Recovery Oriented Systems of Care Dietra Hawkins, PsyD Galveston, Tx Bay Area Council on Drugs and Alcohol August 23, 2013

ROSC

Overview

¨  Let’s Imagine… ¨  Address Seven topics ¨  ROSC Elements, Principles,

& Strategies ¨  Share a few stories ¨  Q & A

Seven Questions

¨  What is Recovery? What is a ROSC? ¨  Why now? National overview ¨  What to do with no $$$ ¨  Stigma- what to do? (the Relationship cure) ¨  What can one person, community, provider do? ¨  Practical steps forward (Texas DSHS priorities) ¨  Resources

Imagine there is …

… to live an ordinary, meaningful life guided by their choices in a local community or neighborhood

¨  A Miracle has happened! ¨  Bill boards promote Recovery ¨  All Colleges offer Recovery

Housing ¨  2 minute clinics staffed by CPSs ¨  My pastor is in recovery ¨  My brother gets help

at the Barber Shop!

Dreaming

¨  Must have a vision for where we want to be

¨  Let’s recall… ¨  No Smoking Campaign- Seat Belts- the Civil Rights

Movement

Public Health Successes

¨  Raise awareness -People died

¨  New attitudes ¨  New behaviors ¨  New policies ¨  Vigilant ¨  Advocacy

¨  22 million in Recovery -25 million

¨  Attitudes ¨  Prevention, Treatment,

Hope ¨  Parity Act ¨  MH and AD Advocacy

What has helped you come back from something difficult?

What is Recovery?

Three questions

¨  What helps? What worked? ¨  What could be better? ¨  How do you keep going? (Hope)

Recovery

¨  Is what a person does ¨  It is living a meaningful life ¨  It is what we all want

What is Recovery?

Definitions: ¨  A process of change through which individuals improve their health and wellness, live a self directed life, and strive to reach their full potential.

v  The American Society of Addiction Medicine no

longer defines addiction as a behavioral problem, but instead as a problem with brain circuitry.

The Good News!

Recovery is Real!

¨  Over 22 million people ¨  Research- Brain & Longitudinal ¨  ASAM, WHO ¨  The White House- ONDCP ¨  National Advocacy MH & AD

What is a ROSC?

ROSC- Supports What Helped?

¨  Family ¨  Support ¨  Friends ¨  Forgiveness ¨  *Faith ¨  Compassion ¨  Resiliency ¨  *Helping others

¨  Meaningful work/career

¨  Time ¨  Education ¨  Hope ¨  New beginnings ¨  Taking action

Giving Back

Many AMIR and Amistad individuals echoed this statement

“giving something back was the main thing that helped me to get better.”

“They didn’t treat us like we had anything good to offer anyone else. They didn’t understand that I need to give back.”

They developed peer mentor and alumni initiatives which provided participants with formalized mechanisms for giving to others and developing leadership skills. Peer mentors were compensated for providing support to others who were at an earlier point in their recovery journey. The alumni organization also consisted of graduates of the program who coordinated some of the community based activities.

Guiding Principles of Recovery

¨  Hope   ¨  Person-driven  

¨  Many pathways

¨  Holistic

¨  Peer support and allies

¨  Relationships and social networks

¨  Culturally-based and influenced

¨  Trauma informed

¨  Strengths based and responsibility

¨  Respect

A female participant said that a holistic approach was missing from previously unsuccessful treatment experiences. “I’ve been struggling with trying to maintain recovery for fifteen years….I’ve 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 stay clean. Because it helped me to identify and realize what I need to do with my life after I’m clean. It’s given me a sense of purpose, you know. I spent all those years drinking and drugging and it was like, now that I’m clean what am I going to do with my life.

Recovery Oriented Systems of Care

ROSC is: ¨  Value-driven APRROACH to

structuring behavioral health systems and a network of services and supports

¨  Framework to guide services and supports

•  ROSC is not: •  A Model •  Primarily focused on the

integration of recovery support services

•  Dependent on new dollars for development

•  A new initiative •  A group of providers that

increase their collaboration to improve coordination

•  An infusion of evidence-based practices

•  An organizational entity •  A closed network of

services and supports

ROSC- Elements

n  Person-centered; n  Inclusive of family and other ally involvement; n  Individualized and comprehensive services across the

lifespan; n  Systems anchored in the community; n  Continuity of care; n  Partnership-consultant relationships; n  Strength-based; n  Culturally responsive;

n  Responsiveness to personal belief systems;

A Focus on Life

…everywhere else, all they talked about was

drugs, drugs, drugs, don’t do drugs, stay away from drugs, drugs are bad for you, drugs will fry your brain. Here they talk about other things that are important to me. We can go through a whole group and never even mention our addiction. We’re talking about like our families, our dreams, spirituality, getting skills. I have other parts to me other than drugs that are important and need help.”  

Recovery

“Not everybody thought it was a good idea for me to try to get my daughter back. But they realized that without her, I didn’t have a reason to be well. So, we figured out a plan for what to do if I couldn’t handle the stress, and my whole team has stood beside me every step of the way. Was it ‘too stressful’ at times? You bet! But every day is a blessing now that I wake up and see that smiling face!”

ROSC- Elements

¨  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;

¨  Research based; and

¨  Adequately and flexibly financed.

We Are A Family

……IT’S JUST LIKE A FAMILY…THEY ACCEPT YOU AS BROTHER AND SISTER. AT NO TIME DO YOU FEEL THAT YOU’RE THE CLIENT AND YOU’RE TALKING TO THE CLINICIAN AND NOT THE PERSON. IT’S NOT THAT. IT’S LIKE WHEN I TALK TO ANTHONY, I SEE HIM AS A BROTHER, I DON’T SEE HIM AS MY CASE MANAGER. BUT IT’S LIKE WHEN I LOOK AT HEATHER I DON’T SEE HER AS MY CLINICIAN, I SEE HER AS MY SISTER AND WHEN I HAVE A PROBLEM, I GO AND TALK TO HER, AND SHE’S NOT GOING TO LET THE POSITION STAND IN THE WAY….I DON’T HAVE TO FEEL SLIGHTED OR SHORTED THAT SHE’S WAY UP HER AND I’M WAY DOWN THERE. I DON’T FEEL LIKE THAT. SO HERE IT’S REAL FAMILY ORIENTED. AND THAT’S REAL IMPORTANT TO ME

ROSC transformation is more than:

a. New Skills b. New Paperwork c. Implementing Evidence Based Practices

(EBPs) d. Adding Peer Support Services

Stakeholders identified three priority areas:

Peer Support Enhanced Treatment Community Integration & Engagement

Texas ROSC

Recovery Oriented Systems of Care (ROSC)

Why Now?

The Likelihood of Sustaining Abstinence Another Year Grows Over Time

36%  

66%  

86%  

0%  10%  20%  30%  40%  50%  60%  70%  80%  90%  100%  

1  to  12  months   1  to  3  years   4  to  7  years  

Dura9on  of  Abs9nence  

%  Sustaining  Ab

s9ne

nce  

Anothe

r  Year        

.   A"er  1  to  3  years  of  abs/nence,  fewer  than  half  return  to  AOD  use  

A"er    about  5  years  of  abs/nence,  only  about  14%    resume  AOD  use  

Dennis,  Foss  &  ScoF  (2007).  An  eight-­‐year  perspec9ve  on  the  rela9onship  between  the  dura9on  of  abs9nence  and  other  aspects  of  recovery.  Evalua&on  Review,  31(6),  585-­‐612.  

Over  a  third  of  people  with    

less  than  a  year  of  abs/nence  will  

sustain  it    another  year  

Dennis,  M.L.,  Foss,  M.A.,  &  ScoF,  C.K  (2007).  An  eight-­‐year  perspec9ve  on  the  rela9onship  between  the  dura9on  of  abs9nence  and  other  aspects  of  recovery.  Evalua&on  Review,  31(6),  585-­‐612.  

What does recovery look like on average?

Dura9on  of  Abs9nence  1-­‐12  Months                                                    1-­‐3  Years                                                              4-­‐7  Years  

ü   More  social  and  spiritual  support  ü   BeFer  mental  health    ü   Housing  and  living  situa9ons  con9nue  to  

 improve      ü   Drama9c  rise  in  employment  and  income      ü   Drama9c  drop  in  people  living  below  the  

 poverty  line  

ü   Virtual  elimina9on  of    illegal  ac9vity  and    illegal  income    

ü   BeFer  housing  and    living  situa9ons      

ü   Increasing  employment    and  income    

ü   More  clean  and    sober  friends  

ü   Less  illegal  ac9vity    and  incarcera9on    

ü   Less  homelessness,    violence  and      vic9miza9on    

ü   Less  use  by  others    at  home,  work    and  by  social    peers  

Partial Recovery of Brain Dopamine Transporters in Methamphetamine User After Abstinence

Normal Control METH User (1 month detox)

METH User (14 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Recovery is real!

2010 Patient Protection & Affordable Care Law Dr. A. Thomas McLellan, Director, TRI

“Untreated”  Abuse/Dependent  ~  25  million  =  8%  

“Risky  Users”  ~60,000,000  

Abs/nent  &  Non-­‐Problem  AOD  Users  ~  83%  2008  Na/onal  Survey  on  Drug  Use  &  Health  

AOD Treatment in the US: 77% publically funded,

12% insurance

US  Popula/on  =  309,800,000  

13,000 AOD Specialty Treatment Programs Serve ~

2.3 million <1%

Healthcare Reform + Parity Law ~

Medicaid Expansion

Screening and Brief Intervention

Why Now?

American Disability Act

“Disability is a matter of perception. If you can do just one thing well, you're needed by someone.”- Martina Navratilova

¨  Chronic Disease ¨  People Do Recover! ¨  Civil Rights base ¨  Evidence Based

Interventions exists ¤ *disruptive Innovations

(2012, Am Psych. Rotheram-Borus, et.al.)

What do you do?

What if you have no $$$, few resources?

Strategies

Something is working here…

What you focus on you will find more of…

¨  Redefine Resources ¨  Build Trust ¨  Model Recovery

-start with strengths, interests ¨  Share Success Stories ¨  Lift up Lived Experience

No Money Examples

¨  AMIR ¨  Landlords ¨  Book store donation ¨  OMNI hotel ¨  Social Networking- FB, twitter, SBIRT,

messaging training, SOAR, daily reflection apps

No Money!!!

¨  Circle of influence ¨  Build Relationships! Example: Our Legislator Friend

Internal, External, what keeps people from getting help…

STIGMA

Stigma

Do you know a person in Recovery?

What helped them?

Dig Deep

¨  Raise Awareness ¨  Make safe to share ¨  Internalized ¨  Decision Makers

v  Relationships! ¨  Share accurate information ¨  Identify Allies!

¨  Community

If…

¨  Someone says- “they have to want it…” ¨  “there is only one way” ¨  We need money

¤ Share the brain science ¤ Note the 22 million in recovery ¤ National Survey on Recovery ¤ Relationships- example of car donation

Person in Recovery Family Member Provider

What Can One Person Do?

What Can You Do? Provider, Person in Recovery or Family Member

¨  Community Integration and Engagement: ¤ Primary care providers ¤ Criminal Justice ¤ Business Community ¤ Schools Colleges ¤ Housing ¤ Judges v Start a Book Club or Learning Community- Zappos

model

Providers

¨  Expand composition of your service team ¨  Ask a different question ¨  Advocate ¨  Optimize your service delivery approach, for

example… train all staff to be welcoming.

PIR or Family Member

¨  Recovery Messaging with Legislators •  Tell your story!

¨  Raise expectations- for Recovery Oriented Care ¨  Learn about your options- your rights! •  Develop advocacy skills ¨  Don’t assume your way is the Right way! •  There are many pathways to Recovery •  Do assume that people are doing the best with

what they know.

Practical Steps forward

DSHS priorities

¨  Peer Support ¨  Enhance Treatment ¨  Community integration

One System’s Activities to Integrate Peer-

Based Recovery Support Services (P-BRSS) ¡  Organizations required to develop peer leadership councils ¡  leadership development of peers

¡  Storytelling training

¡  Co-training of peers, providers, and dept. staff

¡  Developed peer-run advocacy/service community organizations

¡  Provider monitoring processes include peers on teams

¡  Practice guidelines and resource toolkits developed to support providers with successful implementation

Community Engagement

¨  Editorials for local paper ¨  Radio, PSAs, Social Media ¨  Listening Sessions/ Forums ¨  Recovery Month Events- art, music, spoken word ¨  Housing supports- outreach to landlords ¨  Community Celebrations

Enhance Treatment

¡  Peer support training for peers and supervisors ¡  Ongoing mechanism for peers across agencies to check in and

support one another

¡  Peers participate in the review of new RFPs

¡  Peers participate in the development of the vision for transforming levels of care (e.g. Day Program and IOP transformation processes)

¡  Peers integrated into ACT teams and Emergency Care Settings

¡  Hired people with lived experience in leadership positions throughout the department to represent that perspective

What Peers Can Do

•  Asser9ve  outreach  

•  Pre-­‐treatment  support  and  mo9va9on  enhancement  

•  Recovery  capital  and  needs  assessment  of  individual/family/community  

•  Recovery  planning  

•  Community  resource  iden9fica9on  

•  Assistance  with  basic  needs  

•  Volunteer  recruitment  

•  Asser9ve  linkages  to  natural  supports  

•  Recovery  focused  skill  training  aimed  at  full  community  integra9on  

•  Companionship,  cul9va9ng  hope  and  modeling  

•  Recovery  check-­‐ups  (sustained  monitoring  and  support)  

•  Recovery  advocacy  for  individual/family  needs  

•  Con9nued  engagement  

•  Real  world  skill  building  in  the  natural  environment  (stress  management,  etc)  

•  Suppor9ng  mul9ple  pathways  to  recovery  

•  Problem  solving  obstacles  

Lived Experience

She told me “you remind me a lot about myself.” And she told me personal things about herself and things that she had worked on and just the fact that she was sitting there and she was able to laugh about it and joke about it, I could see that there was like a light at the end of the tunnel. Her story relaxed me. It opened me up to having a lot more conversation with her and really putting myself out there.

Last Question: Resources

¨  YOU! ¨  Numerous resources- locally Rickie, Jeffrey, David,

Leonard, and Carie too start… ¨  Philander Moore, Laura Czepiel, and Kevin Klauber ¨  Social Media

Web-Based Recovery Resources

Substance Abuse &, Mental Health Services Administration

www.samhsa.gov

Bill White

www.williamwhitepapers.com

Life in Recovery Survey

http://www.facesandvoicesofrecovery.org/pdf/Life_in_Recovery_Survey3.pdf

Faces and Voices of Recovery

www.facesandvoicesofrecovery.com

Yale Program for Recovery and Community Health

www.yale.edu/PRCH

Asset Based Community Development

http://www.abcdinstitute.org/

Philadelphia Department of Behavioral Health

http://dbhids.org/

Recovery Reading Resources

“Philadelphia Practice Guidelines”- Philadelphia DBH “What’s Right With You?” – Barry Duncan

“Flourish”- Martin Seligman

“The Heroic Client” – Barry Duncan, Barry Miller, Jacqueline Sparks

“Tipping Point” – Malcolm Gladwell

“Understanding Poverty” – Ruby Payne “Leading Change”- John Kotter

“Slaying the Dragon: The History of Addiction Treatment and Recovery in America” – William White

Questions?

Summary

¨  What is working? What Helps? How do you stay Hopeful?

¨  Vision – Dream- Discover tangible steps forward ¨  Recovery is Real!

Thank You!

Thank You! Dr.dietrahawkins@gmail.com

Content developed by Ijeoma Achara Achara Consulting, Inc. and Dietra

Hawkins, Both And Partners, Inc. Not to be duplicated without permission

ijeoma.achara@yahoo.com Dr.dietrahawkins@gmail.com

Lessons Learned Assertive Outreach and Engagement Holistic Screening and Engagement Recovery Planning Expand Service Team Culturally Responsive

Specific Strategies

Lessons Learned Where to Start?

1.  Clarify priorities and align your resources 2.  Mobilize people with lived experience 3.  Start with those who are willing and engaged 4.  Establish a clear vision! 5.  Focus on how to promote culture change across ALL

organizations and community partners!

6.  Be aware of the tendency to develop two parallel structures and processes between treatment on the one hand and RCOs or Community Support Organizations on the other

7.  And focusing on administrative logistics e.g. developing formal MOUs, determining who is in “the ROSC” and who is not etc.

ASSERTIVE OUTREACH AND ENGAGEMENT

¨  Pre-treatment Peer Support Groups

¨  Offer peer mentors as soon as contact is initiated

¨  Develop a welcome/recovery support center

¨  Build strong linkages between levels of care through peer-based recovery support services

¨  Use the most charismatic and engaging staff in reception areas

¨  Connect with people before initial appointments via phone

¨  Screening and early intervention in primary care, child care and school settings

¨  Establish relationships with natural supports to promote early identification

¨  Utilize social media

HOLISTIC SCREENING AND ASSESSMENT

What’s Right With You? ¨ Screening in primary care settings

¨ Global vs. categorical assessment

¨ Continual assessments

¨ Assessing recovery capital

TREATMENT PLANS VS. RECOVERY PLANS OR PERSON-CENTERED PLANS

What’s the Difference? ¨  Expert driven versus collaborative team, driven by

PIR ¨  Timeframe: treatment episode versus sustained

recovery ¨  Focus on all life domains ¨  Holistic ¨  Process

¨  Integration of peer specialists and recovery coaches ¨  Integration with primary care »  Heavy drinking, for example, contributes to illness in each of

the top three causes of death: heart disease, cancer and stroke.

»  Substance use increases the risk for hypertension (x2), congestive heart failure (x9), and pneumonia (x12);

»  One out of every 14 hospital stays – 2.3 million stays – was related to substance disorders in 2004.

»  Integrated care provides better quality of care and is more cost-effective

¨  SERVICE TEAM

EXPANDED COMPOSITION OF THE

CULTURALLY RESPONSIVE SERVICES

¨  Worldview ¨  Culturally competent assessment ¨  Diverse staff at all levels of the organization ¨  Linguistic competence ¨  Focus on empowerment with historically disenfranchised

communities ¨  Recognized the role of natural supports and family ¨  Culture specific services ¨  Disaggregate utilization and outcome data