Improving Substance Use Disorder Treatment and Recovery … · Improving Substance Use Disorder Treatment and Recovery Outcomes Using Peer-Based Recovery Supports Marge Hanna, MEd

A Pennsylvania Medicaid Managed Care Company

and a Drug Treatment Center Share Perspectives

© 2014 Community Care Behavioral Health Organization

Improving Substance Use Disorder Treatment and Recovery Outcomes Using Peer-Based

Recovery Supports

Marge Hanna, MEdRosa Davis , MSW, ACSW

ASAP 2014 Conference

Objectives

• Understand urgency of adoption of ROSC and Recovery Management principles including collaboration with community-based recovery supports and resources

• Learn one process for designing a Learning Collaborative for substance use disorder treatment providers as relates to ROSC and Recovery Management with a specific focus on peer-based recovery support services (P-BRSS)

• Learn how P-BRSS can improve initiation, early engagement and retention in treatment and recovery

2© 2014 Community Care Behavioral Health Organization

Community Care Quick Facts

• Recovery-oriented behavioral health managed care company

• Provider owned (UPMC), Licensed as a Risk-Assuming PPO in PA

• Incorporated in 1996 and headquartered inPittsburgh, PA

• Federally tax exempt non-profit 501(c)(3)

• Provides behavioral health managed care for Medicaid eligibles in 39 counties in PA


Challenges for the Substance Use Disorder Service Systems

Why We Need Change Now


Recovery-Oriented Systems of Care & Recovery Management


Recovery-Oriented Systems of Care

• Recovery-oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to promote community health and wellness for all

• Coordinated and collaborative multi-agency/community based system with goals:– Prevent the development of substance use disorders– Intervene earlier in the progression of the disease– Reduce the harm caused by addiction– Help individuals transition from brief experiments in

recovery initiation to sustained recovery maintenance– Promote good quality of life, community health and wellness

for all

Achara Consulting, Inc.


A ROSC ….

• Builds on the strengths and resilience of individuals, families and communities as individuals take responsibility for their long-term recovery, health and wellness

• Makes services and resources more available that people can use to meet their needs

• Offers a variety of supports that work for and with each person to restore their lives (an ongoing process)

• Acknowledges the value of many pathways to and cultural aspects of recovery


ROSC


…shifts the question from:

“How do we get the client into treatment”

to

“How do we support the process of recovery within the person’s life and environment? “

Lonnetta Albright, BS, CPEC, Great Lakes ATTC, 2013

ROSC Elements


Recovery Management/ROSC

We are in the midst of a transition/ transformation…

• Shifting from a crisis-oriented, professionally-directed, acute-care approach with its emphasis on isolated treatment episodes

• To a person-directed, recovery management approach that provides long-term supports and– Recognizes the many pathways to health and

wellness– Acknowledges importance of individual, family

and community assets – recovery capital– Spans pre, and post acute care outreach and

supports


Recovery Management


Recovery Management (RM)

A philosophy for organizing treatment and recovery support services to enhance pre-recovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery….

William White

Stages of Recovery & Recovery Management


1. Pre Recovery Engagement - Sudden or unfolding opportunity for change, commitment to recovery experimentation

2. Recovery Initiation and Stabilization

3. Recovery Consolidation and Maintenance

4. Enhanced Quality and Meaning of Life in Long-Term Recovery

5. Breaking Intergenerational Cycles of Problem Transmission

White, 2009; White 2013, Community Care Presentation

Domains of Recovery Management

• Assertive Outreach and Initial Engagement

• Screening, Assessment, Service Planning,

and Delivery

• Continuing Support and Early Re-intervention

• Community Connection and Mobilization


Peer-Based RecoverySupport Services (PBRSS)


Recovery Support Needs & Peers

• Recovery support needs span the periods of pre-recovery engagement, recovery initiation, recovery stabilization, and recovery maintenance

• Peer-based recovery support interventions can enhance treatment outcomes…– Draws on the power of example and lived experience.– Largely voluntary: draws on the desire to “give back”– Based on the notion that both people in a relationship

based on mutuality are helped and empowered

• They are not:

– Clinical addiction treatment services

– Mutual aid support


Social Support and Associated PeerRecovery Support Services

Type of Support Description Peer Support Service Examples

Emotional Demonstrate empathy, caring, or concern to bolster person‟s self esteem and confidence.

Peer mentoring

Peer-led support groups

Informational Share knowledge and information and/or provide life or vocational skills training.

Parenting class

Job readiness training

Wellness seminar

Instrumental Provide concrete assistance to help others accomplish tasks.

Child care

Transportation

Help accessing community health and social services

Affiliational Facilitate contacts with other people to promote learning of social and recreational skills, create community, and acquire a sense of belonging.

Recovery centers

Sports league participation

Alcohol and drug free socialization opportunities


Community Care ROSC Centers of Excellence Initiative

A Multi-Stakeholder Partnership…


Community Care ROSC Centers of Excellence Initiative

Process improvement initiative focused on system wide alignment with the elements of Recovery-Oriented Systems of Care (ROSC) and principles of Recovery Management (RM)

• Pre-initiative meetings

• Advisory Committee formation

• Committee Work

• Report Out/Conference

• Learning Collaborative


Learning Collaborative

Mission:

Agencies will improve engagement and retention rates, increasing the number of days in active treatment of our members to a minimum of 90 days post initiation of treatment (minimum one year for MAT).


Learning Collaborative Model - IHI


Institute for Healthcare Improvement (IHI) www.ihi.org

http://www.ihi.org/

Learning Collaborative Model


Mission: primary focus of the Collaborative

Aims: written statements of accomplishments expected

PDSA Cycles: how Aims are achieved

Run Charts: how change efforts measured

Final Report: summarizes work of RLC II

Learning Collaborative Phase I

Challenge: workforce issues which necessitate a ramp-up period – Phase I

• For agencies that do not as yet have P-BRSS

• Any treatment agency, Single County Authority (SCA) or approved P-BRSS agency can apply

• Not a prerequisite for Phase II

• November learning session and follow-up TA

• November-April 2015


Learning Collaborative Phase I – Learning Session

Learning session and follow-up TA will focus on:• Overview of ROSC/RM

• How to develop an intervention that may impact on engagement and retention in treatment

• Recruitment and hiring of persons with lived experience

• HR issues to consider

• Supervision

• Preparing the agency culture for a recovery coach program

• Creating a peer culture in your agency

• Forming cross agency/community partnerships to enhance engagement and retention, e.g. across levels of care

• Other topics as participants my request


Learning Collaborative Phase II

• Separate application process (December)

• Residential agencies are applicants, but encouraged to partner with an ambulatory care agency, and/or an SCA, and/or agency delivering P-BRSS

• Identify an executive leader to serve as the champion, host and sponsor for the Quality Improvement Team (QIT).

• Develop a QIT to oversee the implementation of changes needed to achieve competency



• Pre-work after acceptance includes committing to Aims, their specific intervention and metrics.

• Team attends all learning sessions and is on monthly sharing calls with other residential agencies

Will have three learning sessions and monthly calls beginning May 2015 through April 2016



Outcome AIM:

By April 2016, 80% of members receiving P-BRSS will report feeling highly supported by their provider to continue substance use disorder treatment.

Process AIM:

By April 2016, 80% of members receiving P-BRSS will have a recovery plan developed with a peer.

By April 2016, 80% of members receiving P-BRSS services will have at least one face-to-face meeting with a recovery coach every 30 days throughout their first 90 days of treatment.


Operationalizing the Role of Peers

Rosa Davis, MSW, ACSWExecutive Director

POWER

41

• Helping women reclaim their lives from the disease of addiction and reducing the incidence of addiction in future generations

– Gender-responsive

– Trauma-informed

– Treatment & Recovery Support

– Women with Substance Use & Co-occurring Disorders

POWER’s Mission

29

Ge

nd

er

Ma

tte

rs

The treatment needs of women differ from those of men.

30

OWER Line

POWER Line

412.243.8755

• Central Intake– Screening

– Assessment

– Referral & linkage to treatment

31

Treatment & Recovery Support

Licensed D&A Treatment Recovery Support

• POWER House– ~25-bed residential

treatment (halfway house)

• POWER New Day– ~Outpatient & IOP

– ~Partial ~Hospitalization

• POWER Connection– ~Screening/Assessment

– ~Mentoring

32

33

Operationalizing the Role of Peers to Support

Recovery from Substance Use Disorders

Using Individuals with Lived Experience to Enhance Treatment and Recovery

Intervention & recovery support . . . Lived experience . . . Model & coach

Mentoring

34

• Women are typically offered Mentors in one of two ways:

– Direct referral to mentoring

– Result of a D&A assessment

• Referral sources:

– CYF

– POWER staff

– D&A treatment/other providers

Referrals

35

• Use lived experience as a way to engage

• Encourage & support treatment & recovery

• Model healthy recovery

• Offer peer-to-peer coaching

• Inspire hope and help create

a vision for the future

Role of Peer Recovery Support

36

• Help develop supports in community

• Teach skills needed to maintain recovery

– With a focus on overall health

• Collaborate with providers & other agencies on behalf of clients to develop recovery plans & support treatment plans

• Connect to community resources

• Empower & guide to self-sufficiency & independence

Role of Peer Recovery Support

37

• Assertive outreach & engagement

Specific Strategies & Interventions

Mentors can

play an

important role

in substance

use disorder

recovery

management

pre-treatment

38

• Use Motivational Interviewing to engage women

– Meet the client where she is• Collaborative, empathic, supportive, person-

centered approach to strengthening motivation

– Look for low-hanging fruit


39

Work with client to identify

strengths & needs

This assessment

drives service

planning

40

• Develop Wellness Plans –Service/Recovery plans that reflect goals & emphasize holistic approach to recovery

– Clients, together with Mentors, develop Wellness Plans with specific action steps

– When clients are in treatment, Mentors work with treatment staff to encourage clients‟ active participation in treatment planning


41

• Connect to community resources

– Help clients identify needs & resources

– Model navigating & negotiating skills

– Support clients in accessing services like:

• Housing assistance

• Family support

• Childcare

• Healthcare


42

• Accompany clients to critical appointments – supporting and advocating on their behalf

– Treatment

– Court hearings

– Supervised visits with children

– Public assistance

– Doctor appointments


43

• Help establish sober supports & model healthy recovery

– Accompany to 12-Step meetings or other self-help/support groups

– Accompany to community-based events & service or job fairs

– Help identify sober/fun activities for their children & them


44


When working with women during & post treatment

We offer women in our POWER

House program a Mentor &

especially focus on women with

long histories of multiple

treatment attempts.

Focus for women in treatment includes:collaboration w/treatment provider

planning

maximizing opportunities

what’s different this time?

transitions

45

In addition to the many benefits, there

are challenges to a system that includes

peer mentoring.

46

Challenges

Inter- and Intra-Agency Collaboration Challenges

47

• Lack of long work histories or relevant work experience

• Work can trigger cravings to use or old traumas

• Boundary issues

• “Old school” approach to recovery that can interfere with embracing evidence-based and promising practices

HR Challenges

48

• Tendency to adjust standards for this unique employee group

• Danger of supervisors expecting clinical interventions from non-clinical staff

Supervision Challenges

49

There are strategies for proactively mitigating some of the challenges often experienced, and for responding to them as they arise.

50

Solutions

• Culture that values lived experience & understands & appreciates role of peer recovery support

• Strong HR program w/availability of EAP

• Sufficient training budget

• Clear policies & procedures

Strong Infrastructure

51

• Clearly articulate position expectations

• Make sure job descriptions are clear

• Thorough screening

• Consider incentives

• Establish behavioral interview questions

Attention to Recruitment & Hiring Practices

52

• Devote ample time to a structured orientation process

• Dedicate sufficient dollars for adequate training

– Right training topics

– Plenty of training!

• Reassess training needs annually

– Individual training plans developed in relation to performance reviews

Excellent Orientation & Training

53

In her words . . .

“I am very

grateful for my

Mentor! I am a

single mother

and I wouldn’t

have known

what to do

without her

support,

guidance and

faith in me.

Thank you!”

54

Questions & Answers

55


Marge Hanna, [email protected]

Senior Director, Substance Use Disorder Initiatives

Community Care Behavioral Health Organization

1 East Uwchlan Avenue, Suite 300

Exton, PA 19341

610.594.2845

www.ccbh.com

Rosa Davis, MSW, [email protected]

Executive DirectorPOWER (PA Organization for Women in Early Recovery)

7501 Penn Avenue, Suite 8 Pittsburgh, PA 15208412.243.7535, x-213

www.power-recovery.com

Contact Information

mailto:[email protected]

http://www.ccbh.com/




http://www.power-recovery.com/



Resources

• Center for Substance Abuse Treatment. Implementing Change in Substance Abuse Treatment Programs. Technical Assistance Publication Series 31. HHS Publication No. (SMA) 09-4377. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009. http://store.samhsa.gov/product/TAP-31-Implementing-Change-in-Substance-Abuse-Treatment-Programs/SMA09-4377

• Guiding Principles and Elements of Recovery-Oriented Systems: What do we know from the research? http://partnersforrecovery.samhsa.gov/rosc.html

• Recovery as an Organizing Concept http://www.attcnetwork.org/regcenters/index_greatlakes.asp - Search products

• Building Resilience, Wellness and Recovery: A Shift from Acute Care to a Sustained Care Recovery http://www.attcnetwork.org/index.asp

– Go to Resources & Publications; Type „Building Resilience, Wellness and Recovery‛ in Search bar and press „Go.‟


http://store.samhsa.gov/product/TAP-31-Implementing-Change-in-Substance-Abuse-Treatment-Programs/SMA09-4377



















http://partnersforrecovery.samhsa.gov/rosc.html

http://partnersforrecovery.samhsa.gov/rosc.html

http://www.attcnetwork.org/regcenters/index_greatlakes.asp



http://www.attcnetwork.org/index.asp

http://www.attcnetwork.org/index.asp

Resources

• Connecticut Department of Mental Health and Addiction Services: Proposed Model for Mental Health Recovery and Recovery-Oriented Services http://www.ct.gov/dmhas/lib/dmhas/recovery/mhmodel.pdf

• Connecticut Department of Mental Health and Addiction Services: Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions (2nd edition) & Appendices http://www.ct.gov/dmhas/cwp/view.asp?a=2913&q=376510

• Faces and Voices of Recovery: Guide to Mutual Aid Resources http://www.facesandvoicesofrecovery.org/resources/support/index.html

• ROSC & Recovery Management Resources http://www.williamwhitepapers.com/rm_rosc_library/

• Recovery Self-Assessment Tools: Family/Significant Others, Administrators, Providers, Person in Recovery http://www.ct.gov/dmhas/cwp/view.asp?a=2913&q=376510


http://www.ct.gov/dmhas/lib/dmhas/recovery/mhmodel.pdf



http://www.ct.gov/dmhas/cwp/view.asp?a=2913&q=376510



http://www.facesandvoicesofrecovery.org/resources/support/index.html




http://www.williamwhitepapers.com/rm_rosc_library/




Resources

• Building the Science of Recovery http://store.ireta.org/ and search all products

• Ten Essential Elements of Public Health http://www.apha.org/programs/standards/performancestandardsprogram/resexxentialservices.htm

• Recovery Management & Recovery-Oriented Systems of Care: Scientific Rationale & Promising Practices http://store.ireta.org/and search all products

• Recovery-Oriented Systems of Care (ROSC) Resource Guide, September 2010, SAMHSA

• National Association of Recovery Community Organizations (ARCO) http://www.facesandvoicesofrecovery.org/who/arco

• The Council on Accreditation of Peer Recovery Support Services (CAPRSS) www.caprss.com

• http://www.nattc.org/learn/topics/rosc/docs/AddicMsgVol.11,Issue6NEW.pdf – Impact of adding recovery coaches, etc.


http://store.ireta.org/



http://www.apha.org/programs/standards/performancestandardsprogram/resexxentialservices.htm







http://www.facesandvoicesofrecovery.org/who/arco

http://www.caprss.com/

http://www.nattc.org/learn/topics/rosc/docs/AddicMsgVol.11,Issue6NEW.pdf



Resources

• Life Beyond Treatment: Recovery-Oriented Systems of Care with William White and Ijeoma Acharahttp://www.attcnetwork.org/regcenters/index_southeast.asp

• Overview of a Recovery Oriented System of Care: Characteristics, Structure and Development, Ijeoma Acharahttp://www.attcnetwork.org/regcenters/index_southeast.asp

• Peer-based Addiction Recovery Support History, Theory, Practice, and Scientific Evaluation, William L. White, MA, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Mental, Retardation Services http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=510&rcID=3

• Addiction Recovery Peer Service Roles: Recovery Management in Health Reform, Face and Voices of Recovery, September 2010. http://www.google.com/cse?cx=014138928708248406068:ery9jlsrqj8&cof=FORID:0&q=health+care+reform


http://www.attcnetwork.org/regcenters/index_southeast.asp




http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=510&rcID=3

http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=510&rcID=3

http://www.google.com/cse?cx=014138928708248406068:ery9jlsrqj8&cof=FORID:0&q=health+care+reform




Documents

Improving Substance Use Disorder Treatment and Recovery … · Improving Substance Use Disorder Treatment and Recovery Outcomes Using Peer-Based Recovery Supports Marge Hanna, MEd