Moving Forward: A Recovery-Oriented System of Care for Addiction Services NJ Division of Addiction Services
What Is Recovery? Recovery refers to the ways in which persons with or affected by addiction tap resources within and beyond the self to move beyond experiencing these disorders to managing them and their residual effects to build full, meaningful lives in the community. It is regaining wholeness, connection to the community, and a purpose-filled life. White, W. and Davidson, L. Recovery: The bridge to integration? Part one. Behavioral Healthcare, November 2006.
DAS Actions • New mission statement • Strategic planning systems change process – annual review • Sent delegation to CSAT Regional Forum • Invited to New York to share our plans and activities for transformation to chronic care model • Attended Recovery Symposium in Philadelphia • Invited to participate in the Mutual Assistance Program for States (MAPS) for technical assistance to SSAs interested in Recovery Oriented Systems of Care • Invited NJ counties to engage in the planning process with a renewed focus on recovery-oriented care
DAS Mission Statement The Division of Addiction Services (DAS) promotes the prevention and treatment of substance abuse and supports the recovery of individuals affected by the chronic disease of addiction. As the Single State Agency for substance abuse, DAS is responsible for regulating, licensing, monitoring, planning and funding substance abuse prevention, treatment and recovery support services in New Jersey. To achieve its mission, DAS provides leadership and collaborates with providers, consumers, and other stakeholders to develop and sustain a system of client-centered care that is accessible, culturally competent, accountable to the public, and grounded in best practices that yield measurable results.
CSAT Regional Summit Meetings 2007 - Background • To inform states about the National Summit on Recovery and build on the work initiated by the Summit participants • Agenda was “Planning and Implementing Recovery-Oriented Systems of Care within States and Communities” • Teams were to include SSA designee, treatment provider, representative of the recovering community, and researcher
Regional Summit Meetings 2007Questions Asked 1. What should recovery-oriented systems of care (ROSC’s) look like? 2. What steps are necessary to move toward ROSC’s? 3. What steps have you already taken to implement ROSC’s? 4. What challenges do you face in implementing ROSC’s? 5. What steps are you prepared to take to support this change in the next 12 months?
Overview • Client-Centered • Advocacy and stigma reduction • Partnership with consumers • Holistic approach and focus on wellness • Integrates with primary care and mental health • Strengths-based approach to services • Full continuum of care: • Prevention Early Intervention Treatment Recovery Support • Chronic Care Model • Case management • Clinically driven lengths of stay and placement • Response to relapse • Flexible funding – follows the client • Continuity of care
Overview (con’t) • Recovery Supports Supportive housing College recovery housing Phone outreach Mentors Recovery Support Centers • Recovery-Oriented Quality Care Evidence-based practices (pharmacological and psychosocial) Credentialing and competency Outcomes focused NIATx process improvement
Guiding Principles of Recovery • There are many pathways to recovery • Recovery is self-directed and empowering • Recovery involves a personal recognition of the need for change and transformation • Recovery is holistic • Recovery has cultural dimensions • Recovery exists on a continuum of improved health and wellness • Recovery emerges from hope and gratitude
Guiding Principles of Recovery (con’t) • Recovery involves a process of healing and self-definition • Recovery involves addressing discrimination and transcending shame and stigma • Recovery is supported by peers and allies • Recovery involves (re)joining and (re)building a life in the community • Recovery is a reality CSAT (2005), National Summit on Recovery Conference Report
DAS PROGRESSCLIENT-CENTERED • Working to minimize the stigma associated with the use of medications to support recovery • Client Advocate on staff who works with clients to resolve discrimination, advises on client advocacy issues and initiates anti-stigma campaigns • Citizen’s Advisory Council convened • Client satisfaction survey in July 2005
A Chronic Care Model • Substance dependence should be viewed as a chronic illness (such as hypertension, diabetes, asthma) and not as an acute illness • The system of care, including treatment and funding mechanisms, must reflect the best practices proven to effectively achieve chronic illness recovery • When treated as a chronic illness, the compliance and relapse rates of substance dependence are as good or better than other chronic illnesses (O’Brien & McLellan)
A Chronic Care ModelPRINCIPLES OF CARE • Must be evidence-based and jointly planned (i.e., client- centered) and support a healing relationship and lead to improved wellness and the opportunity for maintenance of recovery • Must be specific to the needs of individuals allowing for the treatment experience to be based on clinical need and offer a broad array of resources over a continuum of care • Must provide coordinated, continuous attention to the individual’s needs for information and readiness for behavioral change Flaherty, M. (2006), A Unified Vision for the Prevention and Management of Substance Use Disorders: Building Resiliency, Wellness and Recovery – A Shift from an Acute Care to a Sustained Care Recovery Management Model.
DAS PROGRESSCHRONIC CARE MODEL • Case management added as a reimbursable service in its newest FFS network, the Co-Occurring Network • Case Managers in NETI • NIATx focus on step down • Drug Court shift to clinically driven level of services • Philosophical change • Relapse is NOT a reason for discharge • Ask different questions • Why did the client fail treatment? • How did the system fail the client?
Implications for Systems Change • Greater focus on what happens BEFORE and AFTER primary treatment • Transition from professionally developed treatment plans to client-directed recovery plans • Greater emphasis on the physical, social and cultural environment in which recovery succeeds or fails • Integration of professional treatment and indigenous recovery support groups
Implications for Systems Change(con’t) • Increased use of peer-based recovery coaches (guides, mentors, assistants, support specialists), and • Integration of paid recovery coaches and recovery support volunteers within interdisciplinary treatment teams. Flaherty, M. (2007). CSATS Recovery Supports Services Meeting.
Recovery Support Services Continuing Care Relapse prevention Recovery Coaching Self-help and Support Groups Spiritual Support Other After Care Services Substance Abuse Education HIV/AIDS Education Other Education Services Peer Coaching or Mentoring Housing Support Alcohol- and Drug-Free Social Activities Information and Referral Other Peer-to-Peer Recovery Support Services • Family Services (including marriage education, parenting and child development services) • Child Care • Employment Services • Pre-employment Services • Employment Coaching • Individual Services Coordination • Transportation to and from treatment, recovery support activities, employment, etc. • Employment services and job training • HIV/AIDS services • Supportive transitional drug-free housing services • Other Case Management Services http://www.atr.samhsa.gov/downloads/atr_faq2008.pdf
DAS PROGRESSRECOVERY SUPPORTS • New Jersey Access Initiative (NJAI) Mentors: 500 Recovery mentors trained Choice: Client given choice of provider, including non- traditional faith-based and community-based programs Vouchers: Funds given to the client which reinforces choice and includes the client in fiscal management • When funds available, expand access to recovery support services, e.g., Recovery Mentors • Introduced two Supportive Housing pilot projects • Issued Request for Proposals (RFP) for a Recovery Center and held Bidders’ Conference • Planned system of phone outreach in the Recovery Center
DAS PROGRESSRECOVERY SUPPORTS (con’t) • Recovery Mentor Consortium created whose first task was convening a conference to promote Mentorship • Awarded two grants to develop recovery housing on college campuses • Expanded network of providers through the Office of Faith Based Initiatives (OFBI)
Recovery-Oriented Quality Care • Recovery-oriented care shifts the design of the addiction treatment system from an acute care model, focused on serial episodes of biophysical stabilization to a model of sustained recovery management. • Recovery-oriented care focuses on the acquisition and maintenance of recovery capital (internal and external assets required for recovery initiation and self-maintenance), global health (physical, emotional, relational, and spiritual), and community integration (meaningful roles, relationships, and activities). White, W. and Davidson, L. Recovery: The bridge to integration? Part one. Behavioral Healthcare, November 2006.
Recovery-Oriented System of Care Elements • Person-centered • Family and other ally involvement • Individualized and comprehensive services across the lifespan • Systems anchored in the community • Continuity of care • Partnership-consultant relationships • Strength-based • Culturally responsive
Recovery-Oriented System of Care Elements (con’t) • Responsiveness to personal belief systems • Commitment to peer recovery support services • Inclusion of the voices and experiences of recovering individuals and their families • Integrated services • System-wide education and training • Ongoing monitoring and outreach • Outcomes driven • Accountable to the public • Research based • Adequately and flexibly financed CSAT (2005), National Summit on Recovery Conference Report
DAS PROGRESSRECOVERY-ORIENTED QUALITY CARE • Provided training on the evidence-based treatment program, the SAMSHA/CSAT Family Centered Treatment Model • Incorporating requirements for best practices into design of DAS programs • Workforce Development program that will increase the competency and credentialing of clinical staff
DAS PROGRESSRECOVERY-ORIENTED QUALITY CARE (con’t) • Developed Provider Performance Reports which include NOMs information and conducted logistic regression to determine factors related to outcomes • Implementing a NIATx process improvement pilot • Exploring contract incentives • CCS Training through Central East ATTC • Dr. Baxter – information for Medical Directors regarding MAT • MAT as an enhancement across the continuum of care • Co-occurring initiative
Planning Conduct a needs assessment to identify recovery support services needs Public Information Create a “Recovery Corner” on DAS website that provides information for clients in recovery Asset Building Pilot an IDA asset building project County Collaboration Recovery research – collaboration with NY Expand Recovery Centers Contract incentives based on outcomes Early Intervention focus on integration with primary health care Quarterly “Grand Rounds” case presentations with Medical Directors for MAT, pain management, co-occurring, poly substances Increased Fee-for-Service Next Steps