“The culture of recovery in American has deep historical roots, is growing daily, and is becoming even more heterogeneous. The ‘recovery community’ today is made up of diverse individual and groups who, while differing in their views on how best to initiate and sustain sobriety, speak with a united voice about the hope for permanent recovery from addiction.”

W.L White. Slaying the Dragon: The History of Addiction Treatment and Recovery in America.

Recovery-oriented Systems of Care and Peer-led Services

Catherine McAlpine, Ph.D., LCSW-CManager, Behavioral Health and Crisis Services

401 Hungerford Drive, Rockville, MD 20850Catherine.mcalpine@montgomerycountymd.gov

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We Face Multiple Challenges

We Face Multiple Challenges

• Reaching those in need of services

• Providing adequate resources

• Developing culturally-appropriate, evidence-based interventions

• Building and sustaining a qualified workforce

• Integrating substance use disorder services into the public health paradigm

Workshop Objectives

• Understand the local, State and federal efforts to support people in recovery beyond providing treatment.

• Learn the new language of recovery management as we shift to focus on long-term support for a chronic disease over brief support during acute episodes.

• Learn about the growing role for Peer Leaders in recovery support and how Maryland is moving toward credentialing Peer Mentors and Peer Support Specialists.

Trends in Attitudes & Social Policy

Old Think …• Punishment • Legal consequences • Blame – moral failing • Choice or lifestyle• Hitting bottom • Self-starting, being ready

• Abstinence • Behavior• 12 Steps

New Think …• Aid & understanding• Treatment/care• Victim of disease• Brain circuits &

compulsion• Motivation enhancement• External sanctions• Harm reduction• Social or Role functioning

Standard Treatment

• Medical Model of Care (1st 3 tasks of treatment)• Patient receives treatment• Limited family or community intervention• No change in work or home environment• Patient responsible for building peer group• Recovery is to be immediate (in all areas)• Punishment for relapse, little empathy• Limited support for stress of change itself• Limited attention to grief and loss issues

What is Recovery?

• Recover (ri-kūv’ar), v.: 1) to regain, get back;

2) to regain or return to an original condition.

Vision Statement from SAMHSA

• A Life in the Community for Everyone.

• Prevention Works.

• Treatment is Effective.

• People Recover.

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CSAT’s Public Health Approach

• Population-based

• Comprehensive and holistic

• Incorporates early intervention, treatment, recovery support, and health promotion

• Works across systems and professions

• Involves people in recovery, the community, the public and private sectors

• Evidence-based

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Enhancing the Continuum of Care to Enhancing the Continuum of Care to Provide Recovery-Oriented ApproachProvide Recovery-Oriented Approach

Prevention

Intervention Treatment Post-Treatment

Across the Lifespan

Community, Individual, & Family Focused

Evidence-based

Recovery Individual & Community Involvement

Screening, Brief Intervention, Referral to Treatment

Early Intervention

Pre-treatment

Evidence-based

Recovery Support Services

Menu of Services

Individualized & Strength-based Care

Evidence-based

Client-Informed decision-making

Recovery Support Services

Recovery Individual & Family Member Involvement

Continuing Care

Recovery Support Services

Follow-up Communication

Self-Monitoring

Early Re-intervention

Recovering Individual,Family Member, Ally and Community Involvement • A full continuum should be made available through coordination with multiple systems.

• Individuals should have access to a full continuum of care regardless of the system they enter or the community in which they live.

From Yahara House From Yahara House Recovery: A Working DefinitionRecovery: A Working Definition

– Recovery is a process, not a place.– It is about recovering what was lost: rights, roles,

responsibilities, decisions, potential and support, and discovering new potentials in life, and possibilities for growth

– It is about rekindling hope for a productive present and a rewarding future, and believing that one deserves it!

– Recovery involves people having vision of the life they want to live, seeing and changing patterns, discovering symptoms can be managed and doing it, finding new ways and reasons, doing more of what works and less of what doesn’t.

– Recovery is about getting there.

Recovery is …

• Grounded in resilience

• Supported by a foundation of hope

• An ongoing, dynamic, interactive process

• An interplay of a person’s strengths and vulnerabilities

• A personal journey

• Continuous, even when symptoms recur

Recovery-oriented System of Care (ROSC)

• Includes a wide spectrum of services • Supports all stages and pathways of recovery• Addresses access to services• Includes treatment, alternatives to treatment,

and recovery support services• Coordinates multiple services• Building bridges, strengthening communities

and promoting public health

A Recovery Oriented System of Care is …

• Person centered

• Family and other ally involvement

• Individualized and comprehensive services across the lifespan

• Anchored in the community

• Continuity of care

Basic to ROSC Are …

• System-wide education and training• Ongoing monitoring and outreach• Outcomes driven• Research based

• Adequately and flexibly financed

Core Concepts of ROSC are …

• Partnership-consultant relationships• Strength-based

• Culturally responsive• Responsive to personal belief systems

Developing ROSC requires …

• Commitment to peer recovery support services

• Inclusion of voices and experiences of recovering individuals and families

• Integrated services

Treatment System

Recovery System

Housing/Supportive and Independent Living

MedicalDentalMental HealthFamily Therapy

Employment

Faith OrganizationsSenior/Child Day Care

Public Transportation

Community SupportSelf-Help GroupsSocial/RecreationBuilding Life Skills

LegalJudgesLawyersParole/Probation

VocationalEducational

DSS/DJS

Internet

Outpatient Treatment

Residential Programs

Evaluation

What changes move us toward ROSC?

• Intervene earlier

• Improve treatment outcomes

• Support sustained recovery

Changing Our Perspective

Evolving Language Reflects Changes

• Rosc• Encounter Notes• Continuing Care• Learning Collaborative• Access to Recovery• Primary Adult Care• Expanding Access• Trainer Network• Recovery Management

Community Integration is Organic

• Recognize that people recover in communities, not in programs.

• Focus on services that support life in the community.

• Locate services/supports in the community, not in a tx program or institution.

• Support what exists in the natural community, don’t re-created in the system.

• Focus government on strengthening communities, families and individuals.

One Theory is a Hierarchy of Needs

Consider the transition from active addiction as a lifestyle change. Similar to other health needs.

Mainstream social and psychological supports meet individual needs for :

• Safety and survival• Basic needs for food, clothing & shelter• Affection, interpersonal comfort & contact• Sense of belonging, group affiliation• Self-efficacy

Social Forces Support Change• Successful recovery often includes:

– connections to family – stable sober housing – employment – follow-up on healthcare & nutrition – extended course of treatmentThe longer people participate in a treatment

regimen, the more likely they are to remain abstinent and achieve a sustained recovery. This has been verified via case study and research data.

Our Challenge• How must treatment programs

change to become more recovery- friendly?

– Shifting from an acute care model to a chronic care model

– Shifting from a sole focus on remission of symptoms to a focus on wellness

– Shifting from abstinence-only to managing relapse and understanding harm reduction

– Adopting principles from Prevention – universal, targeted & individual interventions

Concepts of RM

• Pathology model has low rates of compliance while increasing stigma.

• Natural recovery happens and is a process we can learn from.

• Effective treatment combined with self-management and peer support conveys a message hope, wellness & on-going care.

• Treatment is more effective using proven practices and principles that get results.

Faith

Work or school

Social support

Phys. Health Family

Housing

Peer support

Treatment & rehab

For example

Community Life

Risk and Resilience Model

What resources are not yet in place for this person and what needs to be done to establish or cultivate them?

Stages of Recovery

• Pre-recovery

• Initial Stabilization

• Recovery Maintenance

• Quality of Life Enhancements– Build individual & community recovery capital.

These are informal connections as well as Recovery Support Services.

Exercise

• Think about a recent or significant change in your life.– How were you feeling? – What coping skills did you use?– Did you seek out support? Where?– Who helped you most?

• Now think of one word to fill in the blank:– I ___________________ change

Now, What Can You Do?

Everyone can …

• Remove personal and environmental barriers to recovery.

• Facilitate participation in the recovery community.

• Enhance the quality of life of the person in recovery.

Recovery Partners Montgomery

• Partners– Wells/Robertson House– Maryland Treatment

centers, Inc.– Alcohol and Drug Abuse

Administration– Avery House for Women– Journey to Self

Understanding– Adult Behavioral Health– Outpatient Addiction and

Mental Health Services– On Our Own of Maryland

• Strategic Plan– ADAA Learning

Collaborative– Change Leadership Team– Stigma reduction (stories)– Recovery Community

Center Activities• The Front Porch• Peer-led groups• Peer-led education• Book Clubs/Story-telling

– Youth Drop-in Center– Peer Leadership Institute

• Recovery Coach Academy• PLI Manual & Training

International Consortium of Reciprocal Certification (ICRC)

Connecticut Community for Addiction Recovery (CCAR)

• Recovery Coach Academy

• Recovery Community Centers

• Telephone Outreach

• Employment Curriculum

• Recovery Walk & Other Events (Stigma)

• How to start a recovery House

• http://www.ccar.us/

PRO-ACThttp://www.councilsepa.org/programs/pro-act/

• PRO-ACT  is a grassroots advocacy and recovery support initiative of The Council covering Southeastern Pennsylvania. PRO-ACT works to reduce the stigma of addiction, ensure the availability of adequate treatment and recovery support services, and to influence public opinion and policy regarding the value of recovery.

• PRO-ACT is developing, educating and mobilizing a constituency of Ambassadors for Recovery – those in recovery, their family members and friends, professionals working in the field, and others with a special interest in and knowledge of recovery. We have over 400 volunteers in the five county area.

• Our one-to-one recovery support services and trainings occur primarily in our Recovery Community Centers.  Our special programs and events are driven by Volunteer Committees.

• PRO-ACT supports all pathways to recovery and embraces the Recovery-Oriented System of Care. Recovery-oriented systems support person-centered and self-directed approaches to care that build on the strengths and resilience of individuals, families, and communities to take responsibility for their sustained health, wellness and recovery from alcohol and drug problems.

Change Leadership Begins Here

• Treatment is often focused on the individual.

• Treatment outcomes improve with use of evidence based-practice.

• The #1 practice? Rapport, relationship.

• ROSC is systemic and focused on the whole.

Resources• www.nrepp.samhsa.gov National Registry of Evidence-based Programs/ Practices

– National Clearinghouse on Alcohol and Drug Information• ADAA http://adaa.dhmh.maryland.gov/SitePages/Home.aspx for information on ROSC in Maryland & ATR Grant

• http://www.niatx.net for improving business practices

• www.glattc.org click on Recovery Management Resources. The Great Lakes ATTC Network has many ROSC and training resources, including articles & mongraphs.

• www.ibr.tcu.edu/resources/rc-trtprocess.html Institute for Behavioral Research

• http://partnersforrecovery.samhsa.gov/docs/Summit-Report.pdf Summit Report

• http://www.williamwhitepapers.com/papers/ William White is a prolific writer on this subject.

• www.facesandvoicesofrecovery.com

• http://pfr.samhsa.gov click on Recovery, then Resources. Information about the national movement

• http://rcsp.samhsa.gov Recovery Community Services Program on CSAT'S website

• www.ct.gov/dmhas/site.default.asp Connecticut's Practice Guidelines for Recovery-Oriented Behavioral Health Care booklet can be accessed on this site

• www.bhrm.org Behavioral Health Recovery Management