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Recovery in the Community: An Emerging Framework- A Recovery-Oriented Systems Approach SAAS National Conference & NIATx Summit PowerPoint PPT Presentation


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Orlando, Florida June 22-25, 2008. Recovery in the Community: An Emerging Framework- A Recovery-Oriented Systems Approach SAAS National Conference & NIATx Summit. Partners for Recovery. Jack Stein Director, Division of Services Improvement CSAT. Shannon Taitt PFR Coordinator CSAT.

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Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Orlando, Florida

June 22-25, 2008

Recovery in the Community: An Emerging Framework- A Recovery-Oriented Systems ApproachSAAS National Conference & NIATx Summit

Partners for Recovery

Jack Stein

Director, Division of Services Improvement

CSAT

Shannon Taitt

PFR Coordinator

CSAT

Melanie Whitter

Senior Associate

Abt Associates Inc.

1


Presentation goals

Presentation Goals

  • To provide an overview of a recovery-oriented systems approach;

  • To discuss the benefits this emerging approach;

  • To engage you in the system change process;

  • To inform you about CSAT programs that support recovery-oriented activities; and

  • To answer your questions.

2


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Any problems faced by the individual substance user cannot be seen in isolation from their family, local community and society.

- Scottish Advisory Committee on Drug Misuse, 2008.

Society

Systems

Providers

Local

Communities

3


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

A Recovery-Oriented Systems Approach

4


Draft description

Draft Description

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 sustain health, wellness, and recovery from alcohol and drug problems.

5


Adoption of a public health approach

Adoption of a Public Health Approach

  • A public health approach is used to address substance use problems and related health conditions.

    The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations - public and private - communities and individuals.

  • C.E.A. Winslow,

  • Professor of Public Health,

  • Yale School of Medicine, 1920


Key elements of a public health approach

Key Elements of a Public Health Approach

  • Population-based

  • Holistic

  • Risk factor-oriented

    • With attention to vulnerable populations

  • Focused on:

    • Health promotion

    • Disease prevention

  • Evidence-based

7


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Describing Recovery-Oriented Systems

Recovery-oriented systems include:

  • A comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathway to recovery.

  • An ongoing process of systems-improvement that incorporates the experiences of those in recovery and their family members.

  • The coordination of multiple systems, providing responsive, outcomes-driven approaches to care.

8


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Outcomes

Evidence-Based

Practice

Employment/

Education

Systems of Care

Addictions

Child Welfare

Menu of

Services &

Supports

Reduced

Criminal

Involvement

Cost Effectiveness

Mental Health

Peer Support

Alcohol/Drug

Housing/

Transportation

Housing

Mental Health

Primary Care

Community Individual Family

Child Care

Health Care

Wellness

Recovery

Financial

Mutual Aid

Employment

Educational

Education

Stability in

Housing

Vocational

Perception

Of Care

Indian Health

Service

DoD &

Veterans Affairs

Spiritual

Civic Organizations

Legal

Case Mgt

Private Health

Care

Criminal Justice

Abstinence

Retention

Organized Recovery

Community

Human Services

Access/Capacity

Social Connectedness

Health

Ongoing Systems Improvement


Role of prevention treatment recovery providers

Role of Prevention, Treatment & Recovery Providers

  • Acts as one of the coordinating bodies for systems improvement

  • Provides person-centered/self-directed services and supports

  • Accesses services from other systems for clients

  • Supports improvement in addressing substance use issues within other systems

10


Why do we need this approach

Why do we need this approach?

The field faces many challenges:

Different values, approaches, & perspectives

Insufficient and inefficient use of resources

Cumbersome, fragmented, and inflexible systems

Access, engagement, retention and appropriate services

11


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

…but we have a lot to build upon

  • Factors contributing to the change movement:

    • Federal and State initiatives

    • Institute of Medicine (IOM) Report

    • Advances in science and technology

    • Growth of recovery communities

    • Emergence of recovery advocacy

    • Focus on collaboration and accountability

12


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Recovery-Oriented Systems Elements & Goals

13


Systems elements

Systems Elements

  • Person-Centered:

  • Individualized & Comprehensive Services Across the Lifespan

  • Responsive to Culture & Personal Belief Systems

  • Partnership-consultant Relationships

  • Strength-based

  • Community-based

  • Commitment to Peer Services

  • Involvement of Recovering Individuals, Families and other Allies

14


Systems elements cont d

Systems Elements (cont’d)

  • Efficiency and Cost-Effectiveness:

  • Outcomes-oriented

  • Integrated Services

  • Systems-wide Education and Training

  • Continuity of Care

  • Monitoring and Outreach

  • Research-based

  • Adequately & Flexibly Financed

15


Goals of recovery oriented systems

Goals of Recovery-Oriented Systems

  • To support preventive strategies related to substance use problems & disorders;

  • To intervene early with individuals with substance use problems;

  • To support sustained recovery for those with substance use disorders; and

  • To improve individual, family and community outcomes.

16


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Enhancing Current Systems

17


Enhancing current systems

Enhancing Current Systems

Many of the elements are not new.

Systems enhancements include:

  • Incorporation of ongoing prevention, early engagement and early intervention across systems;

  • Emphasis on recovery support services throughout the continuum of care;…

18


Enhancing current systems cont d

Enhancing Current Systems(cont’d)

Systems enhancementsinclude:

  • Adoption of individualized and flexible menu of services;

  • Inclusion of chronic care approaches (i.e., recovery management);

  • Emphasis on evidence-based practices; and

  • Incorporation of community networks & resources.

19


Enhancing the continuum of care to provide a recovery oriented approach

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

  • •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.


What are the benefits of a recovery oriented approach

What are the benefits of a recovery-oriented approach?

  • Increased responsiveness to individuals, families and communities

  • Application of recovery-oriented research

21


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Increased Responsiveness to Clients

22


Responsive to individuals families

Responsive to Individuals/Families

  • Systems and policies provide clients with options and the ability to make informed decisions regarding their care.

  • Systems and services are more welcoming and flexible.

  • In recovery-oriented systems, treatment is viewed as one of many critical resources needed for a client’s successful integration into the community.

  • Measures of satisfaction are collected routinely from people in recovery and their families.

23


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Applying Recovery-Oriented Research

24


Recovery oriented research

Recovery-Oriented Research

  • Preventive Strategies–Recovery management check-ups can significantly decrease relapse and re-admission (Dennis, Scott, & Funk, 2003).

  • Early Intervention – Early and brief interventions were found to be effective, up to four years later, in reducing alcohol use, days of hospitalization, and emergency department visits (Fleming et al., 2002).

  • Improving Treatment Outcomes and Sustaining Recovery – Long-term recovery outcome is enhanced by individual choice and commitment (Laudet & White, 2008).

  • Cost-effectiveness–Individuals with co-occurring substance abuse/medical problems randomized to integrated care had significantly lower total medical costs than those in independent care (Parthasarathy, Mertens, Moore, Weisner, 2003).

25


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Engaging You in the Change Process

26


Using a recovery oriented framework as a platform for

Using a Recovery-Oriented Framework as a Platform for:

Collaboration among informal & formal systems

Planning

Policy development

27


Planning recovery oriented system change

Planning Recovery-Oriented System Change

I. Conceptual

Framework

II. Assessment

III. Capacity

Building

VI. Evaluation

V. Development

and

Implementation

IV. Planning

28


I conceptual framework

I. Conceptual Framework

  • Vision

  • Principles

  • Definitions

29


Ii assessment

II. Assessment

  • Assessments of readiness

  • Inventories of current services & supports

  • Assessments of organizational and staff recovery-oriented capabilities

  • Assessments of strengths and gaps

  • Stakeholder Surveys

30


Iii capacity building

III. Capacity Building

  • Awareness raising strategies and materials for multiple audiences

    • Legislators, recovery community, etc.

  • Training and educational materials

    • Cross-systems, organizational, staff, volunteers

31


Iv planning

IV. Planning

  • Strategic Plan

  • Goals & Priorities

32


V development and implementation

V. Development and Implementation

  • Specify Roles within an Organization and with Participating Organizations

  • Develop and Implement an Action Plan

  • Implement New Regulations and Contracts

  • Develop Protocols for Person-Centered/Strength-based//Self-Directed Approaches

  • Provide or seek training on recovery-oriented approaches

33


V development and implementation cont d

V. Development and Implementation (cont’d)

  • Revise and Develop New Job Descriptions

  • Incorporate Workforce Competencies & Ethical Standards

  • Adopt Innovative Services and Supports, including Technology

  • Define Quality Control Standards and Develop Instruments

  • Develop Measures and Methodology to Assess performance and Outcomes

34


Vi evaluation

VI. Evaluation

  • Process evaluations

  • Outcomes evaluations

  • Quality improvement processes

35


Lessons learned from state and community activities

Systems change requires conceptual clarity, overcoming resistance, organizational commitment, strong leadership, definition of roles, transparency, and an infrastructure to support the process, including staff and education and training.

A perfect plan is not necessary to begin the process.

Change agents in your State will assist you with the implementation process.

Constant communication is essential.

Lessons Learned from State and Community Activities


Recommendations from states and communities

Pursue efforts where you can achieve early success and promote those accomplishments.

Use all tools available to you, such as peer-to-peer services and case management.

Conduct evaluation and performance measurement at the beginning of the implementation process.

Invest in a good grant writer to leverage resources.

Recommendations from States and Communities


Csat s regional recovery meetings noteworthy steps states are prepared to take

CSAT’s Regional Recovery Meetings: Noteworthy Steps States are Prepared to Take

  • Convene a Blue Ribbon Panel to create documents that describe the State’s plan for recovery-oriented services;

  • Offer mini-grants to build recovery-oriented capacity;

  • Make funding contingent on client-centered care;

  • Formulate recovery-oriented guidelines and competency-based credentials;…

38


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

CSAT’s Regional Recovery Meetings: Noteworthy Steps States are Prepared to Take (cont’d)

  • Design new RFPs to solicit recovery orientation – with an ultimate goal of developing recovery- oriented Centers of Excellence;

  • Define recovery-oriented job functions and services and develop a training curriculum to support those activities; and

  • Ensure that the State’s management information systems (MIS) can track recovery-oriented support activities.

39


Csat programs initiatives that support recovery oriented services activities

CSAT Programs & Initiatives that Support Recovery-Oriented Services & Activities

40


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

AK

WA

NH

VT

MT

ME

ND

MN

OR

ID

SD

WI

NY

WY

MI

MA

IA

PA

NV

NE

OH

RI

IL

IN

CT

UT

WV

NJ

CO

VA

CA

KS

MO

DE

KY

MD

NC

DC

TN

AZ

NM

AR

SC

OK

AL

GA

MS

TX

LA

Puerto Rico

FL

HI

Virgin Islands

2007 CSAT TCE/HIV Grantees

States with 2007 Grantees


Screening brief intervention and referral to treatment sbirt

Screening, Brief Intervention, and Referral to Treatment (SBIRT)


Alcohol drug related emergency department ed visits

Alcohol & Drug Related Emergency Department (ED) Visits

In 2005 there were an estimated 394,224 ED visits that involved alcohol in combination with another drug.

Alcohol was most frequently combined with one or more of the following: cocaine, marijuana, and heroin.

SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).


Traditional substance abuse intervention

Traditional Substance Abuse Intervention

5%

Alcoholics

20% At-Risk Drinkers

35% Low Risk Drinkers

40% Abstainers

Adapted from Babor,T,F., Higgins-Biddle,J.C., (2001), Brief Intervention for Hazardous and Harmful Drinking: A manual

for use in primary care . p 33. WHO/MSD/MSB/01.6b World Health


Screening brief intervention referral to treatment sbirt

Screening, Brief Intervention & Referral to Treatment (SBIRT)

Embeds screening, brief intervention & treatment of substance abuse problems within primary care settings such as emergency centers, community health care clinics, and trauma centers;

Identifies patients who don’t perceive a need for treatment;

Provides them with a solid strategy to reduce or eliminate substance abuse; and

Moves them into appropriate services.


Sbirt current state college grants

SBIRT Current State & College Grants

Massachusetts

Connecticut

Delaware

College/University Grants

State Grants


Sbirt core components

SBIRT: Core Components

Screening:Very brief screening that identifies substance related problems

Brief Intervention:Raises awareness of risks and motivation of client toward acknowledgement of problem

Brief Treatment:Cognitive behavioral work with clients who acknowledge risks and are seeking help

Referral:Referral of those with more serious addictions


Coding for sbi reimbursement february 2008

Reimbursement for screening & brief intervention is available through commercial insurance CPT codes, Medicare G codes and Medicaid HCPCS codes:

Coding for SBI ReimbursementFebruary 2008

  • HCPCS Codes (Medicaid)

    • H0049: Alcohol &/or Drug Screening ($24)

    • H0050: Brief Intervention:15 mins. ($48)

  • CMS G-Codes (Medicare)

    • G0396: 15-30 mins ($29.42)

    • G0397: > 30 mins ($57.69)

  • CPT Codes (Commercial Health Plans)

    • 99408: 15-30 mins ($33.41)

    • 99409: > 30 mins ($65.51)


Alcohol to intoxication illegal drug use sbirt outcomes

Alcohol to Intoxication & Illegal Drug Use – SBIRT Outcomes

The data below represent follow-up from the SBIRT programs as of 3/24/08. Sample selection was random and collected at intake and 6 months post intake.

Important to note: Results are from SBIRT early implementation and reflect a more severely involved substance abuse population.


Access to recovery a recovery oriented approach

Access to Recovery:A Recovery-Oriented Approach


Access to recovery atr

Access to Recovery (ATR)

  • The expansion of treatment capacity

  • The implementation of a voucher system, which allows most grantees to choose their target populations and geographic area(s) of coverage

  • The inclusion of non-traditional addictions treatment providers, such as faith- and community-based organizations

51


Atr cont d

ATR (cont’d)

Recovery support services in conjunction with clinical treatment help to establish a more comprehensive treatment response.

The recovery-oriented project focuses on reducing the acute and severe relapses that substance abusing clients often experience.


More choices for clients

More Choices for Clients

ATR has helped mobilize community networks and build collaborative partnerships that result in more choices and more services for clients with substance abuse issues.

Faith-based organizations have expanded the concept of choice by offering faith-based options to clients who may have a more spiritual approach to their recovery


Examples of services that can be paid for using atr vouchers

Examples of Services That Can be Paid for Using ATR Vouchers

Employment coaching

12-step groups

Recovery coaching

Spiritual support

Child Care

Housing Support

Literacy Training

Traditional Healing Practices, e.g.:

Sweat lodge

Sundance ceremony

Burning sage

Beading

Other


Helps build networks

Helps Build Networks

DOJ: Drug courts may be sources of referrals into the program

DOL: Prisoner Reentry Program

HUD: Housing services (direct housing services such as rent payments are not permissible under ATR)

ATR provides a platform to develop linkages with other federal agencies/programs which can help to leverage ATR funds or serve as a source of referrals/services:


Atr evidences of success

ATR Evidences of Success

74.3% of clients who reported using substances at intake into ATR were abstinent from substance abuse at discharge.

Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability

Improvement System (SAIS). 12/31/07


Federal recovery oriented activities

Federal Recovery-Oriented Activities

  • CSAT Cross-Cutting Work Group on Recovery –Representatives from all CSAT Divisions and Offices focus on coordinating recovery-related efforts to ensure a unified voice to the field

  • Regional Recovery Meetings – Five regional meetings, 220 participants representing 49 states, D.C., and Puerto Rico

  • White Papers–Three white papers describing a recovery-oriented systems approach in States and communities, one paper describing the role of recovery support services in recovery-oriented systems,one paper presenting research related to the recovery-oriented systems elements

  • Literature Review– A review of publications citing the need for recovery-oriented systems change, conceptual designs, literature related to recovery principles and systems elements, and implementation efforts.

Source: Bureau of Labor Statistics

57


Federal recovery oriented activities cont d

Annual Conference Report of the Recovery Community Services Program – Conference report discussing emerging indicators of quality for peer recovery support services. The report can be accessed via: http://rcsp.samhsa.gov/lessons/index.htm

Recovery-oriented Tool-kit – Tool-kit on policies, administrative rules, strategic plans, practice guidelines, vision statements, workforce competencies, training outlines, surveys, protocols, and literature review

Educating State Legislators on Recovery-Oriented Systems –Developing website, fact sheet, three web-assisted audioconferences, presenting at Health Chairs Meeting and drafting issue brief

Resources on the PFR website –Recovery-oriented resources will continue to be posted on the PFR website at www.pfr.samhsa.gov.

Federal Recovery-Oriented Activities (cont’d)

58


Samhsa csat resources

SAMHSA/CSAT Resources

  • Substance Abuse and Mental Health Services Administration

    SHIN 1-800-729-6686 for publication ordering or information on funding opportunities

    800-487-4889 – TDD line / www.samhsa.gov

  • National Alcohol & Drug Addiction Recovery Month www.recovery.month.gov

  • Recovery Community Services Program http://rcsp.samhsa.gov/about/overview.htm

  • Partners for Recovery

    www.pfr.samhsa.gov


Recovery in the community an emerging framework a recovery oriented systems approach saas national conference nia

Questions & Comments

60


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