Substance Use Disorder Prevention Within a Recovery Oriented System of Care

Lawrence P Scott, Ed.S

Recovery Oriented Systems of Care (ROSC)

Integrating services to support an individual’s journey toward recovery and wellness by creating and sustaining formal and informal services and supports . . . through collaboration, partnerships and a broad array of services for individuals, families and communities (BSAAS, 2010).

Recovery Oriented Systems of Care (ROSC) (Cont’d.)

Example of an integrated system of care:

• Prevention services (individuals, families, groups and communities).

• Behavioral health services (mental health (MH) and substance abuse disorders (SUD)).

• Physical health services (primary and specialty). • Medication. • Supports: housing, employment, education, child

care, wellness, legal, crisis, support groups, etc.

Prevention Prepared Communities (PPC): A Prevention Component of the

Michigan ROSC StructureOffice of Recovery

Oriented Systems of Care (OROSC)

ROSC Transformation Steering Committee

(TSC)

ROSC Prevention Workgroup

Prevention Prepared Communities (PPC)

Inputs: Workgroups of TSC

Prepaid Inpatient Health Plans (PIHPs)

Prevention Prepared Communities

“Creating communities where individuals, families, schools, faith-based organizations, and

workplaces take action to promote emotional health and reduce the likelihood of mental illness, substance abuse . . . and suicide.”

(SAMHSA, 2011).

Prevention Prepared Communities

• Prevention services that use community collaboration and strategic partnerships to prevent and mitigate consequences of drug use, suicide and other health problems affecting our community.

• Prevention services that draw on the strengths of our community to promote the health and well-being of individuals and families in our community.

Guiding Steps to Develop & Implement PPC at the Local Level

• Use the data-driven Strategic Prevention Framework (SPF) process. Epidemiological data drives/guides decision and

action.

• Include key community entities and stakeholdersMultiple stakeholders encourage discussion,

sharing, and buy-in.

Guiding Steps to Develop & Implement PPC at the Local Level (Cont’d.)

• Coordinate substance abuse (SA) prevention initiatives with other government health promotion efforts (to plan and deliver specialized cost-effective prevention services that promote social and emotional well-being that align with Healthcare Reform outcomes).

• Use evidence-based services and interventions.

• Meet cultural and linguistic needs of diverse populations (Cultural/Linguistic Competency).

Guiding Steps to Develop & Implement PPC at the Local Level (Cont’d.)

• Ensure focus on communities facing behavioral and physical health disparities:

Racial and ethnic minorities; lesbian, gay, bi-sexual, transgendered people; people with disabilities; girls and transition-age youth; communities facing elevated levels of SUD and higher suicide rates.

PPC: Priority Areas & Deliverables

a) Prevent/Reduce Consequences of Under Age Drinking (UAD) and Adult Problem Drinking.

b) Reduce Prescription Drug Misuse and Abuse.

c) Eliminate/Reduce Under Age Smoking.

d) Prevent/Delay use/Reduce Consequences of SUD (emerging local trends).

e) Promote Behavioral and Physical Health.

f) Prevent Suicides/Attempted Suicides.

PPC: Operational & Conceptual Goals and Priorities

1. Prevent the onset, mitigate consequences of SUD and mental illness.

2. Develop effective institutional collaboration of entities, individuals and service functions that can provide and integrate services that address behavioral and health care needs.

3. Develop workforce capacity to provide integrated services and deliver specialized SA prevention services that promote health and well-being.

PPC: Operational & Conceptual Goals and Priorities (Cont’d.)

4. Develop creative and powerful collaborative efforts to address conditions that contribute to drug use and other risk behaviors.

5. Ensure focus on groups that have been disproportionally affected by the consequences of behavioral and physical health and by disparities in access to services.

Developing PPC Using the SPF Process

The five PPC development phases using the SPF process:

1. Assessment/Community Profile.2. Building Capacity.3. Planning.4. Implementation.5. Evaluation.

Five Infrastructure Steps

Prevention Prepared Communities: A Call to Community Action

Lifting the Community through Partnerships & Collaborative Projects

• Healthcare organizations (health depts, hospitals, medical professionals, pharmacists, health promotion services).

• Law enforcement, courts.• Schools and education organizations.• Government service agencies (e.g. Department of Human

Services). • Ethnic/tribal leaders.• Behavioral health providers.• Families, parents, parent groups. • Business.

Guidance for Inclusion of Stakeholders & Community Partners

Inclusion of Stakeholders & Community Partners (Cont’d.)

• Media.• Youth, student groups, services for youth.• Faith-based, fraternity organizations.• Civic, volunteer groups.• Suicide prevention groups/services.• Other government agencies (e.g. DEA, FDA).• Organizations involved in reducing SA (Prevention

Network, MI Coalition to Reduce UAD, Mothers Against Drunk Driving, etc.).

• Older adult organizations.

PPC: Integrated Service Approaches Supporting Recovery and Wellness

PPC, a community-based integrated prevention initiative designed to support recovery and wellness by:

1. Preventing/reducing use of drugs.

2. Mitigating consequences of SUDs to individuals, families and communities.

PPC: Integrated Service Approaches Supporting Recovery and Wellness (Cont’d.)

3. Forging partnerships that can foster collaborative efforts and develop an integrated service system that can sustain persons in recovery, and their families.

4. Promoting good quality of life and improving the health and wellness of the community.

Helping build a PPC Structure - SPE Grants

Strategic Prevention Enhancement (SPE) grantawarded to OROSC• One-year planning grant to implement SAMHSA’s

strategic initiative #1 (Prevention of SA and MH disorders).

Purpose:

Design a statewide comprehensive plan to develop a prevention Infrastructure that uses a multidisciplinary collaborative approach to prevention.

Helping build a PPC Structure - SPE Grants (Cont’d.)

Priority Areas:

Reduce UAD and Adult Problem Drinking. Prevent Suicide/attempted suicides (high-risk

populations). Prevent Rx Drug Misuse and Abuse.

Helping build a PPC Structure - SPE Grants (Cont’d.)

Approach: Targeted Planning effort with five high need regions selected based on epidemiological data related to the priority areas to participate in the development of a statewide model for:

1. Data-driven identification of community-level prevention needs, goals, objectives, and strategies.

Helping build a PPC Structure - SPE Grants (Cont’d.)

2. Collaborative initiatives between public and private sectors to facilitate delivery of care services (health, behavioral, etc.) in a more integrated environment at the community level.

3. Identification of strategies and practices that help develop and implement structures for PPCs.

Ashley’s Story

As a child, Ashley vowed never to be like her mother who was an alcoholic. Her mother had many boyfriends and never spent any time with Ashley. Ashely had plans to graduate from high school, get married, and have children that she would love and spend time with.

Ashley was exposed to her mother's boyfriends and often left alone with them, one day one of her mother's boyfriends raped Ashley. She was upset and began having problems at school. She confided in a teacher about what happened. The teacher reported the incident to Child Protective Services and Ashely was removed from the home.

Ashley's grandmother took her in to prevent her from being in placed in foster care. Ashely lived with her grandmother for some time and things appeared stable. Ashely’s mother was admitted to a treatment facility and was clean for a year when she decided

A Case Study in Recovery

Ashley’s Story continued

she wanted Ashely to come and live with her. She arrived one day and told the grandmother she had come to get Ashely back. Ashley was reluctant to leave her grandmother, but her grandmother said Ashley’s mother had legal custody and that Ashely had to go live with her mother. Ashley was unhappy about this.

In her new home with her mother, Ashely became involved in unhealthy and risky behaviors. She hung out with the wrong crowd and got drunk every now and then and experimented with her mother’s prescription drugs. She had sex with a guy at a party and became pregnant. It was the first time Ashley had consensual sex. Once he learned of her pregnancy, the father of the child didn't want anything to do with Ashley. Ashley had her baby when she was 16 years old. She had fallen behind in school and dropped out that year. She intended to go back but thought she needed a break.

A Case Study in Recovery

Ashley’s Story continued

Now Ashley has a baby, her own apartment, and she is feeling all alone. She parties and drinks, smokes marijuana and uses OxyContin to make herself feel better. She finds some work over the next couple of years but nothing consistent. She can't keep a job. Ashley starts using heroin because it’s cheaper than the OxyContin. When her child goes to sleep, Ashley goes out at night to party and to buy heroin. A neighbor notices Ashley is high all of the time and is concerned about the safety of Ashely’s child. The neighbor calls Child Protective Services. A social worker comes to the home and removes Ashley's child.

Ashley is crushed mentally by years of torment and unfulfilled dreams and promises. The worker calls the Women and Families Specialist at the regional community mental health entity to get Ashley in treatment so that Ashley can keep her child. Ashley is admitted into treatment. During the intake process, Ashley tested positive for HIV.

A Case Study in Recovery

How does prevention fit In a Recovery Oriented System of Care?

The goal of a recovery oriented system of care should be community wellness.

The role of prevention is to promote community wellness by delaying the onset and reducing the use of substances and related conditions that render the individual, family and community at risk for substance use disorders.

Evidence-based prevention employed in a recovery oriented system of care provides recovery capital that is essential to support and sustain recovery in our communities.

Recovery capital includes, but is not limited to: a) the reduction of intergenerational substance use and substance use disorders; b) an increase in healthy behavior; c) an increase in parenting skills; d) an increase in family reunification; and e) the strengthening of families.

An example of prevention within a Recovery Oriented system of Care

OROSC provides prevention support to a recovery project in Detroit, entitled Project Fair. The project provides treatment and recovery support services to persons who are at risk having their children removed to Wayne County Department of Human Service (WCDHS) Foster Care and Child Protective Services as a result of substance use and substance use disorders.

Participants of Project Fair are provided evidence-based prevention programs designed to improve parenting skills and life skills that are necessary to: strengthen families; family reunification; and sustain strength-based families for the purpose of reducing intergenerational substance use and substance use disorders.

An example of prevention within a Recovery Oriented system of Care continued

Detroit has incorporated a prevention component within Project Fair that targets children of Project Fair participants. The children, ages 6 – 16, are provided evidence-based prevention programming aimed at reducing individual, familial, family and community level conditions that increase the likelihood of future substance use and dependence.

Detroit has partnered with the Michigan Department of Human Services (DHS) funded Family Resource Centers (FRCs). FRCs are access points for families receiving DHS benefits including housing assistance, assistance with utilities, food assistance, mental health services and primary care. The City of Detroit has 13 FRCs, three of which have committed to interface with Project Fair participants and their children.

An example of prevention within a Recovery Oriented system of Care Continued

Project Fair’s prevention program is designed to: a) reduce intergenerational substance use and disorders; b) increase pro-social behavior; c) improve student academic performance; d) increase parental participation; and e) support family reunification. These intended outcomes are also considered recovery capital essential for supporting community-level recovery and; therefore, community wellness.

Evidence-based prevention programs provided in the FRCs include: Strengthening Families and Student Assistance Services.

Resource and Contact Information

Michigan Department of Community Health, Office of Recovery Oriented Systems of Care at www.michigan.gov/bhrecovery.

Contact:Lawrence P. Scott at ScottL11@michigan.gov or (517) 373-4700.