A Collaborative for Primary Prevention and Recovery

A Collaborative for A Collaborative for Primary Prevention Primary Prevention

and Recovery and Recovery Management Management

Initially presented at SAAS Initially presented at SAAS Conference Conference July 10, 2007July 10, 2007

Hyatt Regency Hotel Hyatt Regency Hotel Chicago, Illinois Chicago, Illinois

July 10, 2007Prepared by TopLine Professional

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PurposePurpose

1.1. To engage in a discussion with other To engage in a discussion with other members of the substance use disorder members of the substance use disorder field about the synergy that exists field about the synergy that exists between primary prevention and between primary prevention and recovery maintenance and management. recovery maintenance and management.

2.2. To share knowledge gained over the To share knowledge gained over the previous twelve months as we have previous twelve months as we have engaged in a dialogue about the engaged in a dialogue about the opportunities that exist for collaboration opportunities that exist for collaboration between prevention and recovery.between prevention and recovery.


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Agenda Agenda

• Background on Prevention First, Inc. (PFI) and Background on Prevention First, Inc. (PFI) and TASC, Inc. (Treatment Alternatives for Safe TASC, Inc. (Treatment Alternatives for Safe Communities)Communities)

• Current view of prevention Current view of prevention • Relapse predictorsRelapse predictors• History of strategic allianceHistory of strategic alliance• Principles of primary prevention and recovery Principles of primary prevention and recovery

maintenance/managementmaintenance/management• Mission, vision and goals of the strategic allianceMission, vision and goals of the strategic alliance• Next steps in the strategic allianceNext steps in the strategic alliance


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Prevention First, Inc. Prevention First, Inc. (PFI)(PFI)

• PFI is the leading statewide nonprofit PFI is the leading statewide nonprofit organization dedicated to the prevention organization dedicated to the prevention of substance abuse and related issues of substance abuse and related issues such as teen pregnancy, violence, such as teen pregnancy, violence, HIV/AIDS and juvenile delinquency. PFI HIV/AIDS and juvenile delinquency. PFI provides leadership, training and provides leadership, training and resources to professionals and citizens resources to professionals and citizens concerned with the science and practice concerned with the science and practice of prevention. of prevention.


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TASC, Inc. TASC, Inc. (Treatment Alternatives for Safe (Treatment Alternatives for Safe

Communities)Communities)• TASC works with criminal justice TASC works with criminal justice

populations and understands that populations and understands that substance use is prevalent and overarching substance use is prevalent and overarching within that population and is a significant within that population and is a significant contributing and exacerbating factor contributing and exacerbating factor towards recidivism, relapse, and family towards recidivism, relapse, and family and community cycles of violence and and community cycles of violence and criminal behavior. TASC strives to prevent criminal behavior. TASC strives to prevent relapse, decrease recidivism, and break relapse, decrease recidivism, and break the cycle of behavior that leads to the cycle of behavior that leads to involvement in the criminal justice system. involvement in the criminal justice system.


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Prevention Strategies: The Prevention Strategies: The IOM ModelIOM Model

Source: (SAMHSA, 2005)


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Relapse PredictorsRelapse Predictors

• IntrapersonalIntrapersonal– Coping with negative Coping with negative

emotional states emotional states (frustration and anger)(frustration and anger)

– Coping with negative Coping with negative physical-physiological physical-physiological states (dealing with states (dealing with withdrawals/physical withdrawals/physical cravings)cravings)

– Enhancement of positive Enhancement of positive emotional statesemotional states

– Testing personal controlTesting personal control– Giving in to temptations Giving in to temptations

or urgesor urges

• InterpersonalInterpersonal– Coping with Coping with

interpersonal conflict interpersonal conflict (families and peers)(families and peers)

– Social pressureSocial pressure– Enhancement of Enhancement of

positive emotional positive emotional statesstates

Source: “Clinical Guidelines for Implementing Relapse Prevention Therapy: A Guideline Developed for the Behavioral Health Recovery Management Project.” G. Alan Marlatt, Ph.D., George A. Parks, Ph.D., and Katie Witkiewitz, Ph.C.


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Substance Abuse Substance Abuse Continuum Continuum

Historically the field has viewed the Historically the field has viewed the continuum as linear through which an continuum as linear through which an individual progresses from point to pointindividual progresses from point to point

PreventiPrevention on

TreatmeTreatment nt

Early Early interventiointervention n

Recovery Recovery


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What’s wrong What’s wrong with the linear with the linear

view of the view of the field? field?


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Why Prevention and Why Prevention and Recovery?Recovery?

• Illinois hosted a Prevention, Treatment and Illinois hosted a Prevention, Treatment and Recovery conference in 2004Recovery conference in 2004

• It became clear at that conference how little It became clear at that conference how little we knew about how prevention and recovery we knew about how prevention and recovery could work togethercould work together

• The conference was designed to increase The conference was designed to increase communication and coordination across the communication and coordination across the continuum discussedcontinuum discussed

• There were obvious linkages between There were obvious linkages between prevention and treatment, and between prevention and treatment, and between treatment and recovery treatment and recovery

• Nothing linked recovery and preventionNothing linked recovery and prevention


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And then we And then we had an had an AhaAha moment!moment!


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BackgroundBackground

• Informal discussions between leadership of Informal discussions between leadership of TASC and PFI led to more formal TASC and PFI led to more formal discussions between key staff of each discussions between key staff of each organizationorganization

• Key staff recognized that each organization Key staff recognized that each organization had specific knowledge, skills and attitudes had specific knowledge, skills and attitudes to bring to a partnershipto bring to a partnership

• First meeting took place in June, 2006First meeting took place in June, 2006• Meetings have been held regularly over the Meetings have been held regularly over the

last 12 months (goal to meet minimum of bi-last 12 months (goal to meet minimum of bi-monthly)monthly)


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Background Background

• Historically worked together on as Historically worked together on as needed basisneeded basis

• In this effort, recognized the need for In this effort, recognized the need for formalized collaborationformalized collaboration

• More than an “accidental” partnership More than an “accidental” partnership • Intentional agreement with a strategic Intentional agreement with a strategic

plan plan • Clearly articulated vision, mission, goals Clearly articulated vision, mission, goals

and objectives and objectives


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Why Collaborate Now?Why Collaborate Now?

• There is a growing paradigm shift towards There is a growing paradigm shift towards recovery-oriented systems of care that recovery-oriented systems of care that recognizes the need to build capacity within recognizes the need to build capacity within systems to prevent relapsesystems to prevent relapse

• Many individuals in recovery return Many individuals in recovery return to/remain in the families and communities to/remain in the families and communities they were a part of prior to they were a part of prior to treatment/recoverytreatment/recovery

• Prevention has been working to build Prevention has been working to build capacity within communities for yearscapacity within communities for years

• Must stop individuals from getting lost in the Must stop individuals from getting lost in the “junctures of vulnerability” within the system“junctures of vulnerability” within the system


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Junctures of Junctures of VulnerabilityVulnerability

• Points in the system where Points in the system where individuals get “lost”individuals get “lost”

• Between high-risk behavior and Between high-risk behavior and early interventionearly intervention

• Between early intervention and Between early intervention and treatmenttreatment

• Between treatment and recovery Between treatment and recovery maintenance and management maintenance and management


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Prevention and Recovery—Prevention and Recovery—A Juncture of OpportunityA Juncture of Opportunity

• PFI and TASC identified a juncture of PFI and TASC identified a juncture of opportunity between recovery opportunity between recovery maintenance/ management and maintenance/ management and preventionprevention

• Primary prevention strategies should be Primary prevention strategies should be used to advance efforts to support used to advance efforts to support individuals, families and communities in individuals, families and communities in recovery recovery

• A concept that can bring together A concept that can bring together prevention organizations and recovery-prevention organizations and recovery-based organizations and servicesbased organizations and services


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The Alliance’s View of the The Alliance’s View of the SA Continuum SA Continuum

PFI and TASC view the continuum PFI and TASC view the continuum as a circle in which an individual as a circle in which an individual may enter the system at any point. may enter the system at any point.

This view also This view also places places prevention and prevention and recovery side-by-recovery side-by-side, visually side, visually demonstrating demonstrating the relationship the relationship between between prevention and prevention and recovery.recovery.

RecoveryRecovery

PreventionPrevention

Early Early InterventionIntervention

TreatmentTreatment


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The Heart Disease ModelThe Heart Disease Model

• Another chronic, progressive, relapsing Another chronic, progressive, relapsing diseasedisease

• Maintaining people in health—Maintaining people in health—preventive measures, increase preventive measures, increase protective factorsprotective factors

• Moving people towards health and then Moving people towards health and then helping to maintain health—increase helping to maintain health—increase protective factors, decrease risk factors protective factors, decrease risk factors

• Prevent use, prevent relapsePrevent use, prevent relapse


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Heart Disease ModelHeart Disease Model

• Universal prevention (targeting everyone): eat Universal prevention (targeting everyone): eat healthy, exercise regularly, decrease stresshealthy, exercise regularly, decrease stress

• Selected prevention (targeting those in a Selected prevention (targeting those in a population of demonstrated higher risk for population of demonstrated higher risk for heart disease—family history, etc): regular heart disease—family history, etc): regular check-ups, eat healthy, exercise regularly, check-ups, eat healthy, exercise regularly, decrease stressdecrease stress

• Indicated prevention (targeting those at high-Indicated prevention (targeting those at high-risk or exhibiting symptoms of heart disease): risk or exhibiting symptoms of heart disease): medication, regular check-ups and health medication, regular check-ups and health screenings, eat healthy, exercise regularly, screenings, eat healthy, exercise regularly, decrease stressdecrease stress


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Heart Disease ModelHeart Disease Model

• Treatment: angioplasty, cardiac Treatment: angioplasty, cardiac catheterization, heart surgery, etc. catheterization, heart surgery, etc.

• Post-op recovery/relapse prevention: Post-op recovery/relapse prevention: regular check-ups and health regular check-ups and health screenings, eat healthy, exercise screenings, eat healthy, exercise regularly, decrease stressregularly, decrease stress


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What are the key What are the key principles of principles of prevention?prevention?

What are the key What are the key principles of recovery principles of recovery

maintenance and maintenance and management?management?


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Primary Prevention & Primary Prevention & Relapse PreventionRelapse Prevention

• Like the heart disease model, strategies Like the heart disease model, strategies preventing first use/delaying onset are the preventing first use/delaying onset are the same as those that can be used to prevent same as those that can be used to prevent relapse and to manage and maintain relapse and to manage and maintain recovery recovery

• Increase protective factors and decrease risk Increase protective factors and decrease risk factors in the domains of:factors in the domains of:– IndividualsIndividuals – PeersPeers– Families Families – Communities/environmentCommunities/environment


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CommunityCommunity

Peer GroupPeer Group

FamilyFamily

IndividualIndividual

Pro

tective Facto

rsP

rotective F

actorsR

isk

Ris

k F

acto

rsF

acto

rsSchools/WorkplaceSchools/Workplace


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Examples of Risk/Protective Examples of Risk/Protective FactorsFactors

Individual Risk Factors Individual Risk Factors • Association with drug-

using peers • Certain physical, emotional

or personality traits • Less involved in

recreational, social and cultural activities

• Lack of information on positive health behaviors

• Loss of employment

Individual Protective Individual Protective FactorsFactors

• Knowledge regarding risks associated with substance abuse/use

• Negative attitudes toward substance use

• Bonding to pro-social culture • Positive relationships with

others • Social competence • Involvement in alternative

activities • Sense of well-being/self

confidence • Has positive future plans • Strong spiritual connections

Adapted from the Commonwealth of Massachusetts, Dept. of Public Health. Risk and Protective Factors.


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Peer Risk Factors Peer Risk Factors • Reinforcement of negative

norms and expectations within peer group

• Inappropriate sexual activity among peers

• Ties to deviant peers/gang involvement

Family Risk FactorsFamily Risk Factors• Family members with a

history of alcohol/drug abuse • No quality “family time” • Family conflict/abuse • Loss of employment

Peer Protective Factors Peer Protective Factors • Involved in substance-free

activities • Friends disapprove of

alcohol/drug use

Family Protective FactorsFamily Protective Factors• Close family relationships • Education is valued and

encouraged • Copes with stress in a positive

way • Share family responsibilities,

including chores, decision making and parenting

• Family members support each other



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Community Risk FactorsCommunity Risk Factors• Alcohol/drugs readily

available • Laws are unclear/not

enforced • Norms are unclear or

encourage use • Lack of “community”• Neighborhood

disorganization • High unemployment • Extreme economic

deprivation • Lack of strong social

institutions

Community Protective Community Protective FactorsFactors

• Opportunities for community involvement

• Community religious composition

• Laws/ordinances are consistently enforced

• Informal social control • Policies and norms

encourage non-use • Resources (housing,

healthcare, childcare, jobs, recreation, etc.) are available

• Recovery/education programs available



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Temperature checkTemperature check

How can prevention and How can prevention and recovery work together to recovery work together to build healthy individuals, build healthy individuals,

families and families and communities?communities?


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Changing PhilosophyChanging Philosophy

• TASC and PFI intend to advocate for and TASC and PFI intend to advocate for and advance the integration of primary advance the integration of primary prevention strategies into recovery prevention strategies into recovery maintenance and managementmaintenance and management

• PFI and TASC recognize that prevention and PFI and TASC recognize that prevention and recovery can collaborate and coordinate recovery can collaborate and coordinate efforts to promote healthy environments for efforts to promote healthy environments for individuals and familiesindividuals and families

• Eliminate the philosophical disconnect Eliminate the philosophical disconnect between primary prevention and relapse between primary prevention and relapse prevention and recovery management prevention and recovery management


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Strategic Alliance Strategic Alliance Vision, Mission, Goals and Vision, Mission, Goals and

Objectives Objectives


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Focus of the AllianceFocus of the Alliance

• Enhance existing junctures of Enhance existing junctures of opportunity between prevention and opportunity between prevention and recovery recovery

• Build capacity within communities, Build capacity within communities, organizations, agencies, and organizations, agencies, and coalitions coalitions

• Facilitate service delivery by Facilitate service delivery by providing case management, training, providing case management, training, research, resources, etc.research, resources, etc.


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VisionVision

Healthy individuals, families and Healthy individuals, families and communities by reducing or eliminating communities by reducing or eliminating substance use disorders through a substance use disorders through a system of care that incorporates primary system of care that incorporates primary prevention strategies and recovery prevention strategies and recovery maintenance and management efforts. maintenance and management efforts.


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Mission Mission

Advance the collaboration between Advance the collaboration between recovery maintenance and recovery maintenance and management efforts and primary management efforts and primary prevention strategies to inform best prevention strategies to inform best practices to support healthy practices to support healthy individuals, families, and communities. individuals, families, and communities.


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GoalsGoals

• Operating Goal 1: Operating Goal 1: Improve services for Improve services for individuals, families and communities by individuals, families and communities by coordinating primary prevention and coordinating primary prevention and recovery maintenance and management recovery maintenance and management systems. systems.

• Operating Goal 2Operating Goal 2: Align public and : Align public and private resources and local, state and private resources and local, state and federal policy to support a model that federal policy to support a model that uses primary prevention principles as a uses primary prevention principles as a strategy to support recovery strategy to support recovery maintenance and management efforts. maintenance and management efforts.


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GoalsGoals

• Operating Goal 3: Operating Goal 3: Increase public demand Increase public demand for support and services that employ primary for support and services that employ primary prevention principles in recovery prevention principles in recovery maintenance and management efforts for maintenance and management efforts for individuals, families and communities. individuals, families and communities.

• Operating Goal 4: Operating Goal 4: Engage individuals, Engage individuals, families and community members as families and community members as advocates for and actors in the advocates for and actors in the implementation of primary prevention implementation of primary prevention principles in support of community-based principles in support of community-based recovery maintenance and management recovery maintenance and management efforts. efforts.


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Methods/Programming Methods/Programming InitiativesInitiatives

• Develop concept paper that articulates Develop concept paper that articulates vision, mission and strategies; blueprint for vision, mission and strategies; blueprint for future initiatives (i.e. funding)future initiatives (i.e. funding)

• Conduct a comprehensive needs assessment Conduct a comprehensive needs assessment to articulate where resources can best be to articulate where resources can best be placedplaced

• Convene a think tank of prevention Convene a think tank of prevention specialists and recovery management specialists and recovery management specialists; build on the Illinois Prevention specialists; build on the Illinois Prevention Treatment and Recovery conferenceTreatment and Recovery conference

• Develop case studies of community coalitions Develop case studies of community coalitions already integrating recovery management already integrating recovery management and prevention strategiesand prevention strategies

• Develop proposal for conference grantDevelop proposal for conference grant


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Methods/Programming Methods/Programming InitiativesInitiatives

• Create research and white papers to assist in Create research and white papers to assist in developing partnerships between prevention developing partnerships between prevention organizations and recovery servicesorganizations and recovery services

• Develop legislation to drive policy change and Develop legislation to drive policy change and funding allocations (pilot projects)funding allocations (pilot projects)

• Provide training and technical assistance to Provide training and technical assistance to organizations interested in developing organizations interested in developing partnerships/alliancespartnerships/alliances

• Develop strategic communications plan to Develop strategic communications plan to inform comprehensive media communication inform comprehensive media communication effortsefforts

• Education through conferences and meetingsEducation through conferences and meetings


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Keys to a Successful Keys to a Successful AllianceAlliance

• Commitment of:Commitment of:– Time (12 months to date, planning for Time (12 months to date, planning for

another 12-24)another 12-24)– Personnel (key decision-making staff Personnel (key decision-making staff

involved)involved)– TravelTravel– Short-term financial resourcesShort-term financial resources

• Willingness to step “outside the box” Willingness to step “outside the box” and do something innovativeand do something innovative


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Alliance Next StepsAlliance Next Steps

• Develop proposal for long-term financial Develop proposal for long-term financial supportsupport

• Initial field survey to determine Initial field survey to determine knowledge, skills and attitudes of knowledge, skills and attitudes of practitionerspractitioners

• Create strategic communications planCreate strategic communications plan• Develop framework for pilot project Develop framework for pilot project • Continue education initiatives through Continue education initiatives through

regional meetings and conferencesregional meetings and conferences


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ResourcesResources

• Karel Ares, executive director of Karel Ares, executive director of Prevention First, Inc. based in Prevention First, Inc. based in Springfield, Illinois. Springfield, Illinois. www.prevention.orgwww.prevention.org; 217-793-7353; 217-793-7353

• Peter Palanca, vice president for Peter Palanca, vice president for TASC, Inc. in Chicago, Illinois. TASC, Inc. in Chicago, Illinois. www.tasc-il.orgwww.tasc-il.org; 312-573-8395.; 312-573-8395.

A Collaborative for Primary Prevention and Recovery

Documents

prevention organizations

practice of prevention

treatmentrecovery prevention

recovery conference

relapse prevention therapy

recovery managementinitially

linked recovery

prevention of substance