2. • 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
3. 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
4. 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
5. – 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
ADDICTION SERVICE SYSTEMS
6. • 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
8. 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?
9. • 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
10. • 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
11. WHAT HELPS TO PROMOTE RECOVERY?
What helped you get through
something difficult?
15. 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
16. 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) ?
17. 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
18. 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
19. • 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
20. • 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
21. What would treatment in a ROSC look like? How would it be different?
LETS EXPLORE THE IMPLICATIONS FOR
TREATMENT PROVIDERS. WHAT CAN THEY DO?
23. 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)
24. • 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
25. What’s Going On?
•Global vs. categorical
assessment
•Continual assessments
•Assessing recovery capital
HOLISTIC SCREENING AND ASSESSMENT
SUBTITLE CONTENT PAGE WITH TEXT AND PHOTO
26. • 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
28. • 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
29. • 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 Integrated Into Service Teams
THE SERVICE TEAM
30. 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
31. • 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
32. 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.
33. 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.
34. 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
35. 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
36. DECREASE IN CRISES UTILIZATION
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
38. • 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
APPROACHES TO CONTINUING SUPPORT
MULTI-MEDIA (FACE TO FACE, TECHNOLOGY BASED, MAIL)
39. • 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?
41. MH AND SUD ADVOCACY AND SERVICE
ORGANIZATIONS
FROM TOM HILL, FACES AND VOICES OF RECOVERY
41
Recovery
Community
Treatment
Community
BRIDGE the gap!
44. 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
45. • 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?
55. • 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?
56. 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
57. • 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
58. • 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
59. • Stakeholders identified three priority areas:
–Peer Support
–Recovery-oriented Treatment
–Focus on Community Integration &
Engagement
WHAT’S NEXT FOR TEXAS?
60. JOIN THE NATIONAL MOVEMENT
TOGETHER YOU CAN TRANSFORM YOUR COMMUNITY!!!
63. • 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
64. 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
65. 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
66. 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
67. 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
68. 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
69. 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
70. 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
71. • 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
73. 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
