A Collaborative for Primary Prevention and Recovery Management

1. A Collaborative for Primary Prevention and Recovery Management Initially presented at SAAS Conference July 10, 2007 Hyatt Regency Hotel Chicago, Illinois

2. Purpose • To engage in a discussion with other members of the substance use disorder field about the synergy that exists between primary prevention and recovery maintenance and management. • To share knowledge gained over the previous twelve months as we have engaged in a dialogue about the opportunities that exist for collaboration between prevention and recovery. Prepared by TopLine Professional Strategies, LLC

3. Agenda • Background on Prevention First, Inc. (PFI) and TASC, Inc. (Treatment Alternatives for Safe Communities) • Current view of prevention • Relapse predictors • History of strategic alliance • Principles of primary prevention and recovery maintenance/management • Mission, vision and goals of the strategic alliance • Next steps in the strategic alliance Prepared by TopLine Professional Strategies, LLC

4. Prevention First, Inc. (PFI) • PFI is the leading statewide nonprofit organization dedicated to the prevention of substance abuse and related issues such as teen pregnancy, violence, HIV/AIDS and juvenile delinquency. PFI provides leadership, training and resources to professionals and citizens concerned with the science and practice of prevention. Prepared by TopLine Professional Strategies, LLC

5. TASC, Inc. (Treatment Alternatives for Safe Communities) • TASC works with criminal justice populations and understands that substance use is prevalent and overarching within that population and is a significant contributing and exacerbating factor towards recidivism, relapse, and family and community cycles of violence and criminal behavior. TASC strives to prevent relapse, decrease recidivism, and break the cycle of behavior that leads to involvement in the criminal justice system. Prepared by TopLine Professional Strategies, LLC

6. Prevention Strategies: The IOM Model Source: (SAMHSA, 2005) Prepared by TopLine Professional Strategies, LLC

7. Intrapersonal Coping with negative emotional states (frustration and anger) Coping with negative physical-physiological states (dealing with withdrawals/physical cravings) Enhancement of positive emotional states Testing personal control Giving in to temptations or urges Interpersonal Coping with interpersonal conflict (families and peers) Social pressure Enhancement of positive emotional states Relapse Predictors Source: “Clinical Guidelines for Implementing Relapse Prevention Therapy: A Guideline Developed for the Behavioral Health Recovery Management Project.” G. Alan Marlatt, Ph.D., George A. Parks, Ph.D., and Katie Witkiewitz, Ph.C. Prepared by TopLine Professional Strategies, LLC

8. Early intervention Treatment Recovery Prevention Substance Abuse Continuum Historically the field has viewed the continuum as linear through which an individual progresses from point to point Prepared by TopLine Professional Strategies, LLC

9. ? What’s wrong with the linear view of the field? Prepared by TopLine Professional Strategies, LLC

10. Why Prevention and Recovery? • Illinois hosted a Prevention, Treatment and Recovery conference in 2004 • It became clear at that conference how little we knew about how prevention and recovery could work together • The conference was designed to increase communication and coordination across the continuum discussed • There were obvious linkages between prevention and treatment, and between treatment and recovery • Nothing linked recovery and prevention Prepared by TopLine Professional Strategies, LLC

11. And then we had an Aha moment! Prepared by TopLine Professional Strategies, LLC

12. Background • Informal discussions between leadership of TASC and PFI led to more formal discussions between key staff of each organization • Key staff recognized that each organization had specific knowledge, skills and attitudes to bring to a partnership • First meeting took place in June, 2006 • Meetings have been held regularly over the last 12 months (goal to meet minimum of bi-monthly) Prepared by TopLine Professional Strategies, LLC

13. Background • Historically worked together on as needed basis • In this effort, recognized the need for formalized collaboration • More than an “accidental” partnership • Intentional agreement with a strategic plan • Clearly articulated vision, mission, goals and objectives Prepared by TopLine Professional Strategies, LLC

14. Prepared by TopLine Professional Strategies, LLC

15. Why Collaborate Now? • There is a growing paradigm shift towards recovery-oriented systems of care that recognizes the need to build capacity within systems to prevent relapse • Many individuals in recovery return to/remain in the families and communities they were a part of prior to treatment/recovery • Prevention has been working to build capacity within communities for years • Must stop individuals from getting lost in the “junctures of vulnerability” within the system Prepared by TopLine Professional Strategies, LLC

16. Junctures of Vulnerability • Points in the system where individuals get “lost” • Between high-risk behavior and early intervention • Between early intervention and treatment • Between treatment and recovery maintenance and management Prepared by TopLine Professional Strategies, LLC

17. Prevention and Recovery—A Juncture of Opportunity • PFI and TASC identified a juncture of opportunity between recovery maintenance/ management and prevention • Primary prevention strategies should be used to advance efforts to support individuals, families and communities in recovery • A concept that can bring together prevention organizations and recovery-based organizations and services Prepared by TopLine Professional Strategies, LLC

18. Prevention Recovery Early Intervention Treatment The Alliance’s View of the SA Continuum PFI and TASC view the continuum as a circle in which an individual may enter the system at any point. This view also places prevention and recovery side-by-side, visually demonstrating the relationship between prevention and recovery. Prepared by TopLine Professional Strategies, LLC

19. The Heart Disease Model • Another chronic, progressive, relapsing disease • Maintaining people in health—preventive measures, increase protective factors • Moving people towards health and then helping to maintain health—increase protective factors, decrease risk factors • Prevent use, prevent relapse Prepared by TopLine Professional Strategies, LLC

20. Heart Disease Model • Universal prevention (targeting everyone): eat healthy, exercise regularly, decrease stress • Selected prevention (targeting those in a population of demonstrated higher risk for heart disease—family history, etc): regular check-ups, eat healthy, exercise regularly, decrease stress • Indicated prevention (targeting those at high-risk or exhibiting symptoms of heart disease): medication, regular check-ups and health screenings, eat healthy, exercise regularly, decrease stress Prepared by TopLine Professional Strategies, LLC

21. Heart Disease Model • Treatment: angioplasty, cardiac catheterization, heart surgery, etc. • Post-op recovery/relapse prevention: regular check-ups and health screenings, eat healthy, exercise regularly, decrease stress Prepared by TopLine Professional Strategies, LLC

22. ? What are the key principles of prevention? What are the key principles of recovery maintenance and management? Prepared by TopLine Professional Strategies, LLC

23. Primary Prevention & Relapse Prevention • Like the heart disease model, strategies preventing first use/delaying onset are the same as those that can be used to prevent relapse and to manage and maintain recovery • Increase protective factors and decrease risk factors in the domains of: • Individuals • Peers • Families • Communities/environment Prepared by TopLine Professional Strategies, LLC

24. Community Schools/Workplace Risk Factors Peer Group Protective Factors Family Individual Prepared by TopLine Professional Strategies, LLC

25. Individual Risk Factors Association with drug-using peers Certain physical, emotional or personality traits Less involved in recreational, social and cultural activities Lack of information on positive health behaviors Loss of employment Individual Protective Factors Knowledge regarding risks associated with substance abuse/use Negative attitudes toward substance use Bonding to pro-social culture Positive relationships with others Social competence Involvement in alternative activities Sense of well-being/self confidence Has positive future plans Strong spiritual connections Examples of Risk/Protective Factors Adapted from the Commonwealth of Massachusetts, Dept. of Public Health. Risk and Protective Factors. Prepared by TopLine Professional Strategies, LLC

26. Peer Risk Factors Reinforcement of negative norms and expectations within peer group Inappropriate sexual activity among peers Ties to deviant peers/gang involvement Family Risk Factors Family members with a history of alcohol/drug abuse No quality “family time” Family conflict/abuse Loss of employment Peer Protective Factors Involved in substance-free activities Friends disapprove of alcohol/drug use Family Protective Factors Close family relationships Education is valued and encouraged Copes with stress in a positive way Share family responsibilities, including chores, decision making and parenting Family members support each other Examples of Risk/Protective Factors Adapted from the Commonwealth of Massachusetts, Dept. of Public Health. Risk and Protective Factors. Prepared by TopLine Professional Strategies, LLC

27. Community Risk Factors Alcohol/drugs readily available Laws are unclear/not enforced Norms are unclear or encourage use Lack of “community” Neighborhood disorganization High unemployment Extreme economic deprivation Lack of strong social institutions Community Protective Factors Opportunities for community involvement Community religious composition Laws/ordinances are consistently enforced Informal social control Policies and norms encourage non-use Resources (housing, healthcare, childcare, jobs, recreation, etc.) are available Recovery/education programs available Examples of Risk/Protective Factors Adapted from the Commonwealth of Massachusetts, Dept. of Public Health. Risk and Protective Factors. Prepared by TopLine Professional Strategies, LLC

28. ? Temperature check How can prevention and recovery work together to build healthy individuals, families and communities? Prepared by TopLine Professional Strategies, LLC

29. Changing Philosophy • TASC and PFI intend to advocate for and advance the integration of primary prevention strategies into recovery maintenance and management • PFI and TASC recognize that prevention and recovery can collaborate and coordinate efforts to promote healthy environments for individuals and families • Eliminate the philosophical disconnect between primary prevention and relapse prevention and recovery management Prepared by TopLine Professional Strategies, LLC

30. Strategic Alliance Vision, Mission, Goals and Objectives Prepared by TopLine Professional Strategies, LLC

31. Focus of the Alliance • Enhance existing junctures of opportunity between prevention and recovery • Build capacity within communities, organizations, agencies, and coalitions • Facilitate service delivery by providing case management, training, research, resources, etc. Prepared by TopLine Professional Strategies, LLC

32. Vision Healthy individuals, families and communities by reducing or eliminating substance use disorders through a system of care that incorporates primary prevention strategies and recovery maintenance and management efforts. Prepared by TopLine Professional Strategies, LLC

33. Mission Advance the collaboration between recovery maintenance and management efforts and primary prevention strategies to inform best practices to support healthy individuals, families, and communities. Prepared by TopLine Professional Strategies, LLC

34. Goals • Operating Goal 1: Improve services for individuals, families and communities by coordinating primary prevention and recovery maintenance and management systems. • Operating Goal 2: Align public and private resources and local, state and federal policy to support a model that uses primary prevention principles as a strategy to support recovery maintenance and management efforts. Prepared by TopLine Professional Strategies, LLC

35. Goals • Operating Goal 3: Increase public demand for support and services that employ primary prevention principles in recovery maintenance and management efforts for individuals, families and communities. • Operating Goal 4: Engage individuals, families and community members as advocates for and actors in the implementation of primary prevention principles in support of community-based recovery maintenance and management efforts. Prepared by TopLine Professional Strategies, LLC

36. Methods/Programming Initiatives • Develop concept paper that articulates vision, mission and strategies; blueprint for future initiatives (i.e. funding) • Conduct a comprehensive needs assessment to articulate where resources can best be placed • Convene a think tank of prevention specialists and recovery management specialists; build on the Illinois Prevention Treatment and Recovery conference • Develop case studies of community coalitions already integrating recovery management and prevention strategies • Develop proposal for conference grant Prepared by TopLine Professional Strategies, LLC

37. Methods/Programming Initiatives • Create research and white papers to assist in developing partnerships between prevention organizations and recovery services • Develop legislation to drive policy change and funding allocations (pilot projects) • Provide training and technical assistance to organizations interested in developing partnerships/alliances • Develop strategic communications plan to inform comprehensive media communication efforts • Education through conferences and meetings Prepared by TopLine Professional Strategies, LLC

38. Keys to a Successful Alliance • Commitment of: • Time (12 months to date, planning for another 12-24) • Personnel (key decision-making staff involved) • Travel • Short-term financial resources • Willingness to step “outside the box” and do something innovative Prepared by TopLine Professional Strategies, LLC

39. Alliance Next Steps • Develop proposal for long-term financial support • Initial field survey to determine knowledge, skills and attitudes of practitioners • Create strategic communications plan • Develop framework for pilot project • Continue education initiatives through regional meetings and conferences Prepared by TopLine Professional Strategies, LLC

40. Resources • Karel Ares, executive director of Prevention First, Inc. based in Springfield, Illinois. www.prevention.org; 217-793-7353 • Peter Palanca, vice president for TASC, Inc. in Chicago, Illinois. www.tasc-il.org; 312-573-8395. Prepared by TopLine Professional Strategies, LLC