ACHARA CONSULTING,INC.

Developing a Recovery-Oriented Community

Ijeoma Achara PsyD ●

• Describe the Major Drivers Leading to the Focus on ROSC

• Discuss what we mean by “Recovery”

• Review some of the Key Elements of a ROSC • Explore what one person, provider,

and community can do to help people initiate and sustain their recovery

OVERVIEW

Personal recovery flourishes best in a climate of family health, cultural vitality, community health, and economic security

“The Community is the Treatment

Center” Andy Chelsea, Shuswap tribal Chief at

Alkali Lake Taken From Don Coyhis and William White

THE HEALING FOREST

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, New Haven CT

THE NEED FOR A COMMUNITY APPROACH

– Unmet Need: < 10 % who need Tx. seek treatment or if they do, arrive under coercive influences

– Low Pre-Treatment Initiation Rates – Low Retention: > 50 % do not successfully complete treatment – Inadequate Service Dose: significant % do not receive optimum dose

of Tx. as recommended by NIDA. – Lack of Continuing Care: only 1 in 5 receive post-discharge planning – Recovery Outcomes: most resume using within 1 year and most do

so within the first 90 days of discharge from Tx. – Revolving Door: > 60% one or more Tx. episodes, 24% 3 or more –

50% readmitted within 1 year.

CHALLENGES CURRENTLY FACING PEOPLE IN ADDICT ION SERVICE SYSTEMS

• Unmet Need 2001: less than one half of adults with SMI receive treatment (SAMHSA)

• Low Retention: a quarter of individuals have contact with the public systems for 8 days or less (Bray et al., 2004)

• High Retention: average length of stay in Day Programs for people with SMI is 15 – 20 years

• High Recidivism: in higher levels of care, often leading to policies that limit access to care

CHALLENGES FACING PEOPLE IN MENTAL HEALTH SERVICE SYSTEMS

What is Recovery?

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

SAMSHA

WHAT IS RECOVERY?

• Getting involved with things I enjoy ( e.g. church, friends, dating, support groups, etc)

• Learning what I have to offer • Seeing myself as a person with strengths • Taking one day at a time • Knowing my illness is only a small part of who I am • Having a sense that my life can get better • Having dreams again • Believing I can manage my life and reach my goals (bravery and hope) • Being able to tackle everyday • Having people I can count on

(Davidson et al,) Program for Recovery and Community Health - Yale

University

WHAT IS RECOVERY? NATIONAL FOCUS GROUPS

• My diagnosis is not a barrier • Overcoming challenges • Bouncing back stronger • Ongoing change • Having systems of support • Having a new way of living • Living a fulfilled life • Lifetime of growth • Being whole again • Abstinence • An awakening; healing of spirit, body, and

mind

WHAT IS RECOVERY? YOUR COMMUNITY’S PERSPECTIVE

WHAT HELPS TO PROMOTE RECOVERY?

What helped you get through something difficult?

A meaningful and fulfilling life in my Community

THE SHARED GOAL OF RECOVERY IN MENTAL HEALTH AND SUBSTANCE USE CONDITIONS

G PROCESSES of recovery, healing,

and community inclusion

Condition of Mental Health

Condition of Addiction

RECOVERY IS REAL!!!

THE GOOD NEWS

Mutual support groups Other peer support Professional treatment Nontraditional methods Medical interventions Family support Faith Having a sense of purpose and belonging Meaningful employment On your own and many more

THERE ARE MANY PATHS TO RECOVERY

Treatment and Medication Support

Employment Opportunities AA and NA

Family Education Faith-based Support Physical Health RCOs

Healthy relationships Life skills training

WHAT IS A RECOVERY-ORIENTED SYSTEM OF CARE (ROSC) ?

ROSC: Dispelling the Myths

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, group of people or committee • A closed network of services and supports

ROSC is: • Value-driven APRROACH to structuring behavioral health systems and a

network of clinical and non-clinical services and supports • Framework to guide systems transformation

A ROSC is a Network of Professional and Non professional services and supports

that allow people to find and follow their own path to recovery

No Two Journeys Look the Same

IT BOILS DOWN TO THIS

• Prevent the development of behavioral health conditions

• Intervene earlier in the progression of illnesses

• Reduce the harm caused by behavioral health conditions

• Help people transition from brief experiments in recovery initiation to recovery maintenance

• Actively promote good quality of life, community health and wellness for all

PRIMARY GOALS OF A ROSC

• Treatment Services aligned with a Recovery-oriented approach • Integration of peer support services • Mobilization of recovery advocacy community • Family support and education • Culturally competent services • Cross system collaboration (e.g. criminal justice system, child-welfare

system, housing departments etc.) • Community based supports that promote recovery and wellness (e.g.

faith community, local businesses, educational settings etc)

What are the implications for different stakeholders?

SOME OF THE BUILDING BLOCKS OF A ROSC

What would treatment in a ROSC look like? How would it be different?

LETS EXPLORE THE IMPLICATIONS FOR TREATMENT PROVIDERS. WHAT CAN THEY DO?

ASSERTIVE OUTREACH, ENGAGEMENT AND EARLY INTERVENTION

ASSERTIVE OUTREACH, ENGAGEMENT AND EARLY INTERVENTION

“My clients don’t 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)

• Pre-treatment Peer Support Groups

• Offer peer mentors as soon as contact is initiated

• For urban settings, 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

STRATEGIES TO PROMOTE ASSERTIVE OUTREACH AND ENGAGEMENT

What’s Going On? •Global vs. categorical assessment

•Continual assessments

•Assessing recovery capital

HOLISTIC SCREENING AND ASSESSMENT SUBTITLE CONTENT PAGE WITH TEXT AND PHOTO

• Can you tell me a bit about your hopes or dreams for the future?

• What kind of dreams did you have before you

started having problems with alcohol or drug use, depression, etc.?

• What are some things in your life that you hope you can do and change in the future?

• If you went to bed and a miracle happened while

you were sleeping, what would be different when you woke up? How would you

know things were different? Leads to Recovery Plans vs.

Treatment Plans

CLINICAL ASSESSMENTS CHANGING OUR QUESTIONS: EXAMPLES

FINANCIAL Advisors

Culturally Responsive Services

• Awareness of differences in worldview • Culturally competent assessment procedures • Diverse staff at all levels of the organization • Linguistic competence • Focus on empowerment with historically disenfranchised

communities • Recognition of the increased importance of natural supports

and family in collective cultures • Culture specific services

STRATEGIES FOR CULTURALLY RESPONSIVE SERVICES

• Develop peer volunteer programs and peer leadership

associations

• Integrate paid recovery coaches/peer specialists

• Use people with senior status to orient and serve as guides to those just entering a program

Peers In tegra ted In to Serv ice Teams THE SERVICE TEAM

Potential Functions of P-BRSS

• Assertive outreach • Pre-treatment support and motivation enhancement • Recovery capital and needs assessment of individual/family/community • Recovery planning • Community resource identification • Assistance with basic needs • Volunteer recruitment • Assertive linkages to natural supports • Recovery focused skill training aimed at full community integration • Companionship, cultivating hope and modeling • Recovery check-ups (sustained monitoring and support) • Recovery advocacy for individual/family needs • Continued engagement • Real world skill building in the natural environment (stress management,

etc) • Supporting multiple pathways to recovery • Problem solving obstacles

• Goals and strategies are

determined in partnership and are directed by the person in recovery

• Services are person centered and adapted to fit the needs and preferences of individuals.

• Menu of services and supports which promotes choice and individualized tx.

PARTNERSHIP-CONSULTANT RELATIONSHIPS INDIVIDUALIZED TREATMENT OPTIONS

CONTINUING SUPPORT AND COMMUNITY INTEGRATION in ADDICTION

Addiction/Chronic Illness

Compliance Rate (%)

Relapse Rate (%)

Alcohol 30-50 50

Opioid 30-50 40

Cocaine 30-50 45

Nicotine 30-50 70

Insulin Dependent Diabetes

Medication <50 30-50

Diet and Foot Care <50 30-50

Hypertension

Medication <30 50-60

Diet <30 50-60

Asthma

Medication <30 60-80

Slide Acknowledgment: William White. Data Source: O’Brien CP, McLellan AT. Myths about the Treatment of Addiction (1996). The Lancet, Volume 347(8996), 237-240.

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.

Example from Philadelphia’s MH Recovery Transformation • Day Program Transformation • 8 Agencies with approximately 2000 people in recovery enrolled since

2007 • Program Pillars

»Peer Culture »Community Inclusion »Recovery Planning »Family Inclusion »Evidence Based Practices

CONTINUING SUPPORT AND COMMUNITY INTEGRATION IN MENTAL HEALTH

Build competencies and confidence Facilitate the development of meaningful roles in the community Peers assist with life skills development Develop partnerships to build pathways of opportunity Don’t re-create resources that exist in the community Develop Recovery/Wellness Centers Provide information and education about resources and opportunities in

the community Conduct interest assessments Create partnerships with community stakeholders, organizations and

businesses to enhance access and reduce barriers to integration

STRATEGIES TO PROMOTE COMMUNITY HEALTH AND COMMUNITY INTEGRATION

DECREASE IN CRISES UTIL IZATION

36% decrease in Crisis Utilization for those with at least 1 year in program Study included 611 consumers that had at least one year in Day

LOWER COST OF INPATIENT PSYCHIATRIC SERVICES

• Recovery Community Organizations • Home visits • Peer Support groups • Linkage to mutual aid societies • Recovery check-ups • Peer leadership councils • Recovery centers • Sober Houses • Clinic based individual and group • sessions • Mail • Internet-based RSS • Assertive Linkages to natural supports • Telephone-based RSS • Embedded within primary care settings

A P P R OA C H E S TO C O N T I N U I N G S U P P O R T MULTI - MEDI A (FAC E TO FAC E, T EC HN OLOGY BA S ED, MA I L )

• Tell your Story!!!! Use it to fight stigma and discrimination. • Join an advocacy organization to stay informed e.g. Faces and Voices of

Recovery, National Association for Mental Illness, Mental Health Association

• Engage in training to become a recovery coach or mental health peer specialist

• Reach out to the media • Support other people in early recovery • Join or start a recovery rally • Seek ways to give back to your community • Start or support a recovery community organization in your area

WHAT CAN PEOPLE IN RECOVERY DO?

Advisors

40

THE RECOVERY COMMUNITY FROM TOM HILL – FACES AND VOICES OF RECOVERY

Organized in state, regional and local recovery community organizations

MH AND SUD ADVOCACY AND SERVICE ORGANIZATIONS

FROM TOM HILL, FACES AND VOICES OF RECOVERY

41

Recovery Community

Treatment Community

BRIDGE the gap!

Advisors

42

RALLY FOR RECOVERY

Achara Consulting

Detroit Recovery Project: Andre Johnson • Life Skills Workshops • GED workshops • Peer-led support groups • Adult Education and Employ-ability skills offered to

individuals on probation • Strengthening Families Program • Health Education : nutrition, HIV/AIDS testing,

education related to diabetes, physical fitness, high blood pressure

• Partnership with health department to provide flu vaccines

• C.O.P.E. (Co-Occurring Peer Empowerment Program) provides peer support to CJ population within jails and the community to assist with re-integration

• W.I.R.E.D. (Women in Recovery Enhancement Program) is a 90 day recovery support service for pregnant women and women with children designed to address gender and cultural barriers to sustained recovery.

EMERGING INNOVATIONS

• Recognize that you and your community do have resources and strengths • Look for opportunities to build relationships and partner • Share resources and information • Influence legislators • Combat stigma and discrimination • What skills, talents, information can you share? • Support the development of peer run organizations • Start an annual recovery walk Examples: • Small businesses • Faith-based recovery-ministries • Transportation support • Continue the dialogue • Mental health first aid trainings for first responders

WHAT CAN COMMUNITY MEMBERS DO?

Advisors

FINANCIAL Advisors

“When the community starts getting together around this process, other good things start to happening, too.”

FINANCIAL Advisors

FINANCIAL Advisors

“It gave addiction and recovery a real voice.”

FINANCIAL Advisors

FINANCIAL Advisors

FINANCIAL Advisors

“Oh my god, this is me putting up a mural.”

Advisors Achara Consulting, Inc

Philadelphia Department of Behavioral Health and Intellectual

disAbilities

Achara Consulting

Advisors Achara Consulting, Inc

Philadelphia Department of Behavioral Health and Intellectual

disAbilities

• Remember that there is hope for recovery and recovery is real. • Provide support and hold hope for/with other families that are going

through a tough time • Share your story! • Get involved with advocacy • Volunteer at peer and family run organizations and treatment facilities to

provide support to family members • Help to identify local community resources that can help others initiate

and sustain their recovery and help to build a network of allies • Address NIMBY barriers to community integration

WHAT CAN FAMILY MEMBERS DO?

CJ focus on intense initial period of tx does not often lead to long-term recovery

Opportunities • Increased Attraction: People typically referred after very long addiction

careers. ROSC = early intervention First offenders programs, Early diversion programs • Increased Access: finite capacity of the tx system leads to long waiting

lists. CJ has an opportunity to expand the use of and develop recovery natural supports.

• Increased Engagement • Reduced Recidivism

– 730,000 people admitted and released from prisons each yr – Two-thirds (68%) rearrested within 3 years of release (1997)

– Half (52%) returned to prison for new crime/ violation (1997)

IMPLICATIONS FOR CRIMINAL JUSTICE (CJ) SYSTEMS AND POPULATIONS

• Continued monitoring AND support that integrates natural community based supports

• Collaborative Opportunities: e.g. holistic assessments can identify prevention and early intervention opportunities for siblings and children.

• Recovery Capital Assessments • Relevance of Recovery Planning • Effectiveness of peer-support to assist with transitioning between

cultures and sustaining recovery • Empowerment, Hope and Choice • Rebuilding lives within the context of communities

IMPLICATIONS FOR CRIMINAL JUSTICE SYSTEMS AND POPULATIONS

• Assertive Linkages • Mobilization of natural

supports for early intervention and continuing support

• Implications of a chronic care

approach to treatment • Relevance of recovery planning

IMPLICATIONS FOR CHILD WELFARE SERVICES

• Stakeholders identified three priority areas: – Peer Support – Recovery-oriented Treatment – Focus on Community Integration &

Engagement

WHAT’S NEXT FOR TEXAS?

JOIN THE NATIONAL MOVEMENT TOGETHER YOU CAN TRANSFORM YOUR COMMUNITY!!!

BREAK

FOCUS GROUP FEEDBACK AND GROUP DISCUSSION

• Seven Sessions held between May 1 – June 21 • Locations Involved:

– San Antonio / Center for Healthcare Services – San Antonio / Family Services Association – San Antonio / SACADA – San Antonio / Haven for Hope – Victoria – Kerrville – Eagle Pass

• Total number of participants: 114

ROSC SURVEY MEETINGS

FINANCIAL Advisors

24%

6%

43%

27%

1. What do you think about when you hear "Recovery"? What does it mean to you?

Process Free from Drugs and Alcohol Change and Healing Holistic

Free from Drugs and Alcohol • Diagnosis not in the way • Diagnosis is not a barrier • Abstinence • To be away from drugs Change and Healing • Overcoming challenges • Difficult transitions • Ongoing change • Bouncing back stronger

Process • Systems of support • On-going • Lifestyle change • New way of living Holistic • Living a fulfilled life • Lifetime of growth • Be whole again

Advisors

49% 24%

27%

2. If you consider the supports needed to help a person's recovery journey, what resources and supports do they need?

Recovery Capital Family Support Other Resources

Family Support • Supportive friends and families • Telling people its ok to ask for help • Family counseling • Family education Recovery Capital • Health Insurance • Counseling • AA/other support groups/churches • Mentoring

Other Resources • Education and knowledge for the medical community • More community outreach at different public events • Financial counseling • Basic needs are met

Advisors

37%

36%

12%

15%

3. What kinds of services, or supports do you think would assist people in getting fully integrated into their communities?

Basic Needs/Services Sober Community Activities/Resources Recovery Coach/Mentoring Advocacy Community/Self

Basic Needs/Services • Affordable housing • Job assistance training • Childcare • GED/education and Recovery Coach/Mentoring • Mentoring • Recovery support coaches available • Case managers • Guidance/career counseling

Sober Community Activities/Resources • Schools like PDAP • Youth oriented detox • Gym facilities/ and other positive activities • Networking Community/Self Advocacy • Self-educate • Self-advocate • Media/social media • Stigma free environments

Advisors

15%

35%

50%

4. Are there things that providers or others might do that may be well intentioned but may potentially hinder the recovery

process? External Perceptions Improved Medical Therapy/Support

Internal/External Perceptions • Judgmental - stereotyping • Negative feedback, criticism • legal issues and legal system • mental illness –lack of understanding Improved Medical Resources • Doctors that listen to patient and family • Sterile questionnaire - no care • lack of education of non-recovery providers • no placement options

Therapy/Support • Peer pressure • Detention • Providers work in silos • Cookie cutter programs

Advisors

7%

33%

29%

29%

2%

5. What would you say is most helpful to you - it could be anything - even something that is not currently available.

Housing Community Programs Treatment Public Perception/Dialog Milestones

Treatment • Life Skills /coping • Case management • Easy access to treatment; no waiting lists Housing • Housing/ and independent living with help • Money management classes • Employment opportunities Community Programs • Sober activities • Churches

Milestones • Accountability • Acknowledgment • Celebrating milestone Public Perception/Dialog • More advocacy from those with influence • Reframing the dialog • Removing bias from community • More education

Advisors

40%

22%

8%

19%

11%

6. Are there any concerns or barriers that we should be aware of as we move in this direction?

Communication Understanding Acknowledgement Limited Resources Access to Services

Communication • with community and providers • Confidentiality of treatment Understanding • Be given a chance • Remember and include the voice of youth • Cultural sensitive material Acknowledgement • Knowledge of mental illness • Public awareness • Stigma

Limited Resources • Funding insurance • Dual diagnosis funding Access to Services • Accessibility • Limited providers • Funding • Sharing information

Advisors

74%

26%

7. In what ways do you see yourself supporting the "ROSC" movement in our community?

Advocacy Serving

Advocacy • Awareness campaign through the arts • Reach out to Juvenile Justice • Advocating for recovery • Community campaigns

Serving • Education • Mentoring • Giving back • Getting more ROSC info to the community

• What excites you about developing a ROSC in Texas and a recovery-oriented community right here?

• What reactions did you have to the focus group responses? Did anything really resonate with you or surprise you?

• Was there anything that you thought was missing? • What are some things that we’ve discussed that are already happening in your

community? What are you most proud of? What is going well? • What are your concerns related to developing a ROSC? What might hold you

back? • Was your thinking challenged or changed in any way? • What new insights or ideas have been generated for you?

LARGE GROUP DISCUSSION

LUNCH

TOPICS 1. Strategies to further integrate peer support services for adults 2. Strategies to increase the recovery supports available to youth 3. Strategies to strengthen community supports available to people with

substance use and mental health conditions 4. Strategies for addressing stigma and increasing community awareness 5. Strategies for increasing supports available to those in the criminal justice

system 6. Opportunities to increase the alignment of treatment with a recovery

orientation. What are some quick changes that can be made. How to engage providers in this process

7. Improving Collaboration and integration between the mental health and substance use disorder communities

8. Increasing supports to family members

CAFE CONVERSATIONS

BREAK

Panel of Recovery

Champions

THE PATH FORWARD

WHAT’S NEXT

Content developed by Ijeoma Achara Achara Consulting, Inc.

Not to be duplicated without permission ijeoma.achara@yahoo.com

AARI Planning Meeting • 3rd Monday of every month • Meets:

– 11:00 a.m. – SACADA Office, 7500 Hwy 90 West, AT&T Building, Ste. 100

• Contacts: – mlane@sacada.org – ckeebaugh@midcoastfamily.org

• Upcoming dates: – September 16 – October 21 – November 18