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Building Recovery Oriented Services
Chacku Mathai Associate Executive Director, NYAPRS
Why Focus on Recovery?
Expectations of consumers and people in recovery
Expanding research base on recovery and showing improved
effectiveness of recovery supports
Federal initiatives and expectations
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Recent Federal Legislation
• The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343, Section 511)
– Eliminates certain forms of discrimination in insurance coverage of mental health and addiction treatment benefits
– Expands access to treatment for people with mental illness and/or addiction
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Recent Federal Legislation
• Patient Protection and Affordable Care Act (PPACA, 2010) – Requires that all health plans include treatment for
substance use disorders among their basic benefits
– Greatly expands coverage to people for whom treatment is unavailable
– Hallmarks of the Act (access, quality, efficiency, effectiveness) may be able to be leveraged to provide services and supports to create the best opportunity for long-term recovery
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SAMHSA’s Strategic Initiatives
AIM: Improving the Nation’s Behavioral Health (1-4)AIM: Transforming Health Care in America (5-6)AIM: Achieving Excellence in Operations (7-8)
1. Prevention
2. Trauma and Justice
3. Military Families
4. Recovery Support
5. Health Reform
6. Health Information Technology
7. Data, Outcomes, & Quality
8. Public Awareness & Support
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Federal Strategy - SAMHSA
SAMHSA’s Strategic Initiatives (2011-2014)
#4 Recovery Support—Partnering with people in recovery from mental and substance use disorders and family members to guide the behavioral health system and promote individual-, program-, and system-level approaches that foster health and resilience; increase permanent housing, employment, education, and other necessary supports; and reduce discriminatory barriers.
• BRSS TACS (Bringing Recovery Support Services to Scale Technical Assistance Center)
• Recovery Month
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Recovery Construct
Individuals and Families
HOME ↑ Permanent
Housing
COMMUNITY ↑ Peer/Family/
Recovery NetworkSupports
PURPOSE ↑ Employment/
Education
HEALTH↑ Recovery
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Working Definition of RecoveryRecovery is a process of change through which individuals improve their health and wellbeing, live a self-directed life, and strive to achieve their full potential. – SAMHSA, 2011
SAMHSA Guiding Principles of Recovery
• Hope • Person-Driven• Many
Pathways • Holistic• Peer Support • Relational
• Culture• Addresses
Trauma • Strengths/
Responsibility • Respect
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Vision for Recovery Across Communities
• Recovery can be expected despite barriers and obstacles
• Recovery can flourish when barriers and obstacles are lifted
• We uncover abandoned and/or develop new hopes and dreams
• We discover our personhood through our culture, strengths, values, and skills
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Vision for Recovery (continued)
• We recover together and engage communities as life-sustaining forces
• We re-author the way we see ourselves • We (re)claim a meaningful life and roles• We give back to others what we have gained
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Program Design and Culture
FIRST CONTACT &
INTAKE
ASSESSMENT
SETTING GOALS &
TREATMENT PLANNING
PROVIDING & MONITORING
SERVICE
DISCHARGE
THE JOURNEY THROUGH SERVICES
Screening and Assessment
Person-Centered, Recovery-Oriented and Culturally
Competent Treatment Planning
Recovery – Oriented
Clinical Supervision
Continuous Quality Improvement
Program Evaluation
Program Evaluation
A traveler to a new land came across a peacock. Having never seen this kind of bird before, he took it for a genetic freak. Taking pity on the poor bird, which he was sure could not survive in such deviant form, he set about to correct nature’s error. He trimmed the long, colorful feathers, cut back the beak, and dyed the bird black. “There now,” he said, with pride in a job well done, “you look more like a standard guinea hen.”
Quality of Life Outcome Domains
Housing/HomeWork/CareerRelational: Family/Friends/RomanticEducationalLegalFinancial (Payee Status, e.g.)Conservatorship IncarcerationHospitalizationRecreation/LeisureCommunity/CitizenshipHealth/Physical WellbeingSpiritual/Religion
Observable Correlates of Recovery
1. Level of Risk
2. Level of Engagement
3. Level of Skills and Supports
MILESTONES OF RECOVERY
1. Extreme Risk
2. High Risk / Not Engaged
3. High Risk / Engaged
4. Poorly Coping / Not Engaged
5. Poorly Coping / Engaged
6. Coping / Rehabilitating
7. Early Recovery
8. Advanced Recovery
SAMHSA-Funded Initiatives and Opportunities
• http://www.samhsa.gov/recovery/
• Recovery to Practice Resource Center: http://www.dsgonline.com/rtp/resources.html
• Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS)http://beta.samhsa.gov/brss-tacs
• Resources for People with Co-Occurring Disorders
Engagement vs. Compliance
• What are the differences between engagement and compliance?
• What can we look for to determine if a person or family is engaged?
• What are they engaged with/to?
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What is PCP? Taking a Closer Look
Person-Centered Planning
• is a collaborative process resulting in a recovery-oriented treatment plan
• is directed by consumers and produced in partnership with care providers and natural supporters
• supports consumer preferences and a recovery orientation
Adams/Grieder
Literature References
• Adams, Grieder, (2005) Treatment Planning for Person-Centered Care• Anthony, W.A. (2000). A recovery-oriented service system: setting some system level
standards. Psychiatric Rehabilitation Journal, 24(2), 159–168. • Davidson, L & White, W. (2007). The concept of recovery as an organizing principle for
integrating mental health and addiction services. Journal of Behavioral Health Services and Research, Journal of Behavioral Health Services and Research, 34(2), 1094-3412.
• Drake, Mueser, Brunette, (2007) Management of persons with co-occurring severe mental illness and substance use disorder: program implications, World Psychiatry 2007; 6:131-136
• Gagne, C., White, W., & Anthony, W.A. (2007). Recovery: A common vision for the fields of mental health and addictions. Psychiatric Rehabilitation Journal, 31(1): 32–37.
• Hill, T. (2010). Addiction Recovery Peer Service Roles: Recovery Management in Health Care Reform. Faces and Voices of Recovery.
• Ragins, (2007) Concrete Approaches to Recovery Based Transformation• Sheedy C. K., and Whitter M. (2009). Guiding Principles and Elements of Recovery-
Oriented Systems of Care: What Do We Know From the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.
Literature References• Substance Abuse and Mental Health Services Administration. (2011).
Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014. HHS Publication No. (SMA) 11–4629. Rockville, MD: Substance Abuse and Mental Health Services Administration.
• Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services (2007).Systems Integration. COCE Overview Paper 7. DHHS Publication No. (SMA) 07-4295. Rockville, MD:
• White, W. (2008) Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices. Pittsburgh, PA: Institute of Research, Education & Training in Addiction.
• White, W. (2009). Peer-based addiction recovery support: History, theory, practice, and scientific evaluation. Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Mental Retardation Services.
Resources• Selected Papers of William White
– http://www.williamwhitepapers.com• Outreach and Engagement in Homeless Services: A Review of the
Literature – http://homeless.samhsa.gov/ResourceFiles/m1tifkgu.pdf
• Treatment Planning for Person-Centered Care (Adams, Grieder)• Practice Guidelines for Recovery-Oriented Behavioral Health
Care– http://www.ct.gov/dmhas/lib/dmhas/publications/
practiceguidelines.pdf• Getting in the Driver’s Seat of Your Plan
– http://www.ct.gov/dmhas/lib/dmhas/publications/PCRPtoolkit.pdf
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Resources• Faces and Voices of Recovery
– http://www.facesandvoicesofrecovery.org• Young People in Recovery
– http://youngpeopleinrecovery.org• NYAPRS Economic Self-Sufficiency Curriculum and Workbook
– http://www.nyaprs.org/community-economic-development/toolkit/
• Bringing Recovery Supports to Scale Technical Assistance Center– http://beta.samhsa.gov/brss-tacs/
• Recovery to Practice– http://www.samhsa.gov/recoverytopractice/
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Chacku MathaiAssociate Executive Director
New York Association of Psychiatric Rehabilitation Services, [email protected]
www.nyaprs.org
Joe Lunievicz, BA, RYTDirector Training Institute
Northeast & Caribbean Addiction Technology Transfer CenterNational Development & Research Institutes, Inc.
71 W 23rd Street, 8th FloorNew York, NY 10010
www.ndri.org, www.training.ndri.org
Contact Information
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