Moving Forward: A Recovery-Oriented System of Care for Addiction Services NJ Division of Addiction Services.

Moving Forward:Moving Forward: A Recovery-Oriented System A Recovery-Oriented System of Care for Addiction Servicesof Care for Addiction Services

NJ Division of Addiction ServicesNJ Division of Addiction Services

What Is Recovery?What Is Recovery?

Recovery refers to the ways in which persons with Recovery refers to the ways in which persons with or affected by addiction tap resources within and or affected by addiction tap resources within and

beyond the self to move beyond experiencing beyond the self to move beyond experiencing these disorders to managing them and their these disorders to managing them and their

residual effects to build full, meaningful lives in the residual effects to build full, meaningful lives in the community. It is regaining wholeness, connection community. It is regaining wholeness, connection

to the community, and a purpose-filled life.to the community, and a purpose-filled life.

White, W. and Davidson, L. White, W. and Davidson, L. Recovery: The bridge to integration? Part Recovery: The bridge to integration? Part one.one. Behavioral Healthcare, November 2006. Behavioral Healthcare, November 2006.

DAS ActionsDAS Actions New mission statementNew mission statement Strategic planning systems change process – annual Strategic planning systems change process – annual

reviewreview Sent delegation to CSAT Regional ForumSent delegation to CSAT Regional Forum Invited to New York to share our plans and activities for Invited to New York to share our plans and activities for

transformation to chronic care modeltransformation to chronic care model Attended Recovery Symposium in PhiladelphiaAttended Recovery Symposium in Philadelphia Invited to participate in the Mutual Assistance Program Invited to participate in the Mutual Assistance Program

for States (MAPS) for technical assistance to SSAs for States (MAPS) for technical assistance to SSAs interested in Recovery Oriented Systems of Careinterested in Recovery Oriented Systems of Care

Invited NJ counties to engage in the planning process Invited NJ counties to engage in the planning process with a renewed focus on recovery-oriented carewith a renewed focus on recovery-oriented care

DAS Mission StatementDAS Mission Statement

The Division of Addiction Services (DAS) promotes the The Division of Addiction Services (DAS) promotes the prevention and treatment of substance abuse and prevention and treatment of substance abuse and supports the recovery of individuals affected by the chronic supports the recovery of individuals affected by the chronic disease of addiction. As the Single State Agency for disease of addiction. As the Single State Agency for substance abuse, DAS is responsible for regulating, substance abuse, DAS is responsible for regulating, licensing, monitoring, planning and funding substance licensing, monitoring, planning and funding substance abuse prevention, treatment and recovery support abuse prevention, treatment and recovery support services in New Jersey. services in New Jersey.

    To achieve its mission, DAS provides leadership and To achieve its mission, DAS provides leadership and collaborates with providers, consumers, and other collaborates with providers, consumers, and other stakeholders to develop and sustain a system of client-stakeholders to develop and sustain a system of client-centered care that is accessible, culturally competent, centered care that is accessible, culturally competent, accountable to the public, and grounded in best practices accountable to the public, and grounded in best practices that yield measurable results. that yield measurable results.

CSAT Regional Summit Meetings CSAT Regional Summit Meetings 2007 - 2007 - BackgroundBackground

To inform states about the National Summit on To inform states about the National Summit on Recovery and build on the work initiated by the Recovery and build on the work initiated by the Summit participantsSummit participants

Agenda was “Planning and Implementing Agenda was “Planning and Implementing Recovery-Oriented Systems of Care within Recovery-Oriented Systems of Care within States and Communities”States and Communities”

Teams were to include SSA designee, treatment Teams were to include SSA designee, treatment provider, representative of the recovering provider, representative of the recovering community, and researchercommunity, and researcher

Regional Summit Meetings 2007Regional Summit Meetings 2007Questions AskedQuestions Asked

1. What should recovery-oriented systems of care 1. What should recovery-oriented systems of care (ROSC’s) look like?(ROSC’s) look like?

2. What steps are necessary to move toward 2. What steps are necessary to move toward ROSC’s?ROSC’s?

3. What steps have you already taken to 3. What steps have you already taken to implement ROSC’s?implement ROSC’s?

4. What challenges do you face in implementing 4. What challenges do you face in implementing ROSC’s?ROSC’s?

5. What steps are you prepared to take to support 5. What steps are you prepared to take to support this change in the next 12 months?this change in the next 12 months?

OverviewOverview Client-CenteredClient-Centered

Advocacy and stigma reductionAdvocacy and stigma reduction Partnership with consumersPartnership with consumers Holistic approach and focus on wellnessHolistic approach and focus on wellness Integrates with primary care and mental healthIntegrates with primary care and mental health Strengths-based approach to servicesStrengths-based approach to services Full continuum of care:Full continuum of care: Prevention Prevention Early Intervention Early Intervention Treatment Treatment Recovery Recovery

SupportSupport

Chronic Care ModelChronic Care Model Case managementCase management Clinically driven lengths of stay and placementClinically driven lengths of stay and placement Response to relapseResponse to relapse Flexible funding – follows the clientFlexible funding – follows the client Continuity of careContinuity of care

Overview (con’t)Overview (con’t) Recovery SupportsRecovery Supports Supportive housingSupportive housing College recovery housingCollege recovery housing Phone outreachPhone outreach MentorsMentors Recovery Support CentersRecovery Support Centers

Recovery-Oriented Quality CareRecovery-Oriented Quality Care Evidence-based practices (pharmacological and psychosocial)Evidence-based practices (pharmacological and psychosocial) Credentialing and competencyCredentialing and competency Outcomes focusedOutcomes focused NIATx process improvementNIATx process improvement

Client-CenteredClient-Centered

Guiding Principles of RecoveryGuiding Principles of Recovery

There are many pathways to recoveryThere are many pathways to recovery Recovery is self-directed and empoweringRecovery is self-directed and empowering Recovery involves a personal recognition of the Recovery involves a personal recognition of the

need for change and transformationneed for change and transformation Recovery is holisticRecovery is holistic Recovery has cultural dimensionsRecovery has cultural dimensions Recovery exists on a continuum of improved Recovery exists on a continuum of improved

health and wellnesshealth and wellness Recovery emerges from hope and gratitudeRecovery emerges from hope and gratitude

Guiding Principles of Recovery Guiding Principles of Recovery (con’t)(con’t)

Recovery involves a process of healing and self-Recovery involves a process of healing and self-definitiondefinition

Recovery involves addressing discrimination and Recovery involves addressing discrimination and transcending shame and stigmatranscending shame and stigma

Recovery is supported by peers and alliesRecovery is supported by peers and allies Recovery involves (re)joining and (re)building a Recovery involves (re)joining and (re)building a

life in the communitylife in the community Recovery is a realityRecovery is a reality

CSAT (2005), CSAT (2005), National Summit on Recovery Conference ReportNational Summit on Recovery Conference Report

DAS PROGRESSCLIENT-CENTERED

Working to minimize the stigma associated Working to minimize the stigma associated with the use of medications to support with the use of medications to support recoveryrecovery

Client Advocate on staff who works with Client Advocate on staff who works with clients to resolve discrimination, advises clients to resolve discrimination, advises on client advocacy issues and initiates on client advocacy issues and initiates anti-stigma campaigns anti-stigma campaigns

Citizen’s Advisory Council convened Citizen’s Advisory Council convened Client satisfaction survey in July 2005Client satisfaction survey in July 2005

Chronic Care ModelChronic Care Model

A Chronic Care ModelA Chronic Care Model Substance dependence should be viewed as a Substance dependence should be viewed as a

chronic illness (such as hypertension, diabetes, chronic illness (such as hypertension, diabetes, asthma) and not as an acute illnessasthma) and not as an acute illness

The system of care, including treatment and The system of care, including treatment and funding mechanisms, must reflect the best funding mechanisms, must reflect the best practices proven to effectively achieve chronic practices proven to effectively achieve chronic illness recoveryillness recovery

When treated as a chronic illness, the When treated as a chronic illness, the compliance and relapse rates of substance compliance and relapse rates of substance dependence are as good or better than other dependence are as good or better than other chronic illnesses chronic illnesses (O’Brien & McLellan)(O’Brien & McLellan)

A Chronic Care ModelA Chronic Care ModelPRINCIPLES OF CAREPRINCIPLES OF CARE

Must be evidence-based and jointly planned (i.e., client- Must be evidence-based and jointly planned (i.e., client- centered) and support a healing relationship and lead to centered) and support a healing relationship and lead to improved wellness and the opportunity for maintenance of improved wellness and the opportunity for maintenance of recoveryrecovery

Must be specific to the needs of individuals allowing for Must be specific to the needs of individuals allowing for the treatment experience to be based on clinical need and the treatment experience to be based on clinical need and offer a broad array of resources over a continuum of careoffer a broad array of resources over a continuum of care

Must provide coordinated, continuous attention to the Must provide coordinated, continuous attention to the individual’s needs for information and readiness for individual’s needs for information and readiness for behavioral changebehavioral 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 PROGRESSDAS PROGRESSCHRONIC CARE MODELCHRONIC CARE MODEL

Case management added as a reimbursable Case management added as a reimbursable service in its newest FFS network, the Co-service in its newest FFS network, the Co-Occurring NetworkOccurring Network

Case Managers in NETICase Managers in NETI NIATx focus on step downNIATx focus on step down Drug Court shift to clinically driven level of Drug Court shift to clinically driven level of

servicesservices Philosophical change Philosophical change

Relapse is NOT a reason for dischargeRelapse is NOT a reason for discharge Ask different questionsAsk different questions

Why did the client fail treatment? Why did the client fail treatment? How did the system fail the client?How did the system fail the client?

Recovery SupportsRecovery Supports

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 ServicesRecovery Support Services Family Services (including Family Services (including

marriage education, parenting and marriage education, parenting and child development services) child development services)

Child Care Child Care Employment Services Employment Services Pre-employment Services Pre-employment Services Employment Coaching Employment Coaching Individual Services Coordination Individual Services Coordination Transportation to and from Transportation to and from

treatment, recovery support treatment, recovery support activities, employment, etc. activities, employment, etc.

Employment services and job Employment services and job training training

HIV/AIDS services HIV/AIDS services Supportive transitional drug-free Supportive transitional drug-free

housing services housing services Other Case Management Services Other Case Management Services

Continuing CareContinuing 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

http://www.atr.samhsa.gov/downloads/atr_faq2008.pdf

DAS PROGRESSDAS PROGRESSRECOVERY SUPPORTSRECOVERY SUPPORTS

New Jersey Access Initiative (NJAI)New Jersey Access Initiative (NJAI) Mentors: Mentors: 500 Recovery mentors trained500 Recovery mentors trained

Choice:Choice: Client given choice of provider, including non- Client given choice of provider, including non- traditional faith-based and community-based traditional faith-based and community-based programsprogramsVouchers: Vouchers: Funds given to the client which reinforces Funds given to the client which reinforces

choice and includes the client in fiscal managementchoice and includes the client in fiscal management When funds available, expand access to recovery When funds available, expand access to recovery

support services, e.g., Recovery Mentors support services, e.g., Recovery Mentors Introduced two Supportive Housing pilot projects Introduced two Supportive Housing pilot projects Issued Request for Proposals (RFP) for a Recovery Issued Request for Proposals (RFP) for a Recovery

Center and held Bidders’ ConferenceCenter and held Bidders’ Conference Planned system of phone outreach in the Recovery Planned system of phone outreach in the Recovery

CenterCenter

DAS PROGRESSDAS PROGRESSRECOVERY SUPPORTS (con’t)RECOVERY SUPPORTS (con’t)

Recovery Mentor Consortium created whose first task Recovery Mentor Consortium created whose first task was convening a conference to promote Mentorshipwas convening a conference to promote Mentorship

Awarded two grants to develop recovery housing on Awarded two grants to develop recovery housing on college campusescollege campuses

Expanded network of providers through the Office of Expanded network of providers through the Office of Faith Based Initiatives (OFBI)Faith Based Initiatives (OFBI)

Recovery-Oriented Quality Recovery-Oriented Quality CareCare

Recovery-Oriented Quality CareRecovery-Oriented Quality Care Recovery-oriented care shifts the design of the Recovery-oriented care shifts the design of the

addiction treatment system from an acute care addiction treatment system from an acute care model, focused on serial episodes of biophysical model, focused on serial episodes of biophysical stabilization to a model of sustained recovery stabilization to a model of sustained recovery management.management.

Recovery-oriented care focuses on the acquisition Recovery-oriented care focuses on the acquisition and maintenance of recovery capital (internal and and maintenance of recovery capital (internal and external assets required for recovery initiation and external assets required for recovery initiation and self-maintenance), global health (physical, self-maintenance), global health (physical, emotional, relational, and spiritual), and community emotional, relational, and spiritual), and community integration (meaningful roles, relationships, and integration (meaningful roles, relationships, and activities). activities).

White, W. and Davidson, L. White, W. and Davidson, L. Recovery: The bridge to integration? Part Recovery: The bridge to integration? Part one.one. Behavioral Healthcare, November 2006. Behavioral Healthcare, November 2006.

Recovery-Oriented System of Recovery-Oriented System of Care ElementsCare Elements

Person-centeredPerson-centered Family and other ally involvementFamily and other ally involvement Individualized and comprehensive services Individualized and comprehensive services

across the lifespanacross the lifespan Systems anchored in the communitySystems anchored in the community Continuity of careContinuity of care Partnership-consultant relationshipsPartnership-consultant relationships Strength-basedStrength-based Culturally responsiveCulturally responsive

Recovery-Oriented System of Recovery-Oriented System of Care Elements (con’t)Care Elements (con’t)

Responsiveness to personal belief systemsResponsiveness to personal belief systems Commitment to peer recovery support servicesCommitment to peer recovery support services Inclusion of the voices and experiences of Inclusion of the voices and experiences of

recovering individuals and their familiesrecovering individuals and their families Integrated servicesIntegrated services System-wide education and trainingSystem-wide education and training Ongoing monitoring and outreachOngoing monitoring and outreach Outcomes drivenOutcomes driven Accountable to the publicAccountable to the public Research basedResearch based Adequately and flexibly financedAdequately and flexibly financed

CSAT (2005), CSAT (2005), National Summit on Recovery Conference ReportNational Summit on Recovery Conference Report

DAS PROGRESSDAS PROGRESSRECOVERY-ORIENTED QUALITY RECOVERY-ORIENTED QUALITY

CARECARE Provided training on the evidence-based Provided training on the evidence-based

treatment program, the SAMSHA/CSAT Family treatment program, the SAMSHA/CSAT Family Centered Treatment Model Centered Treatment Model

Incorporating requirements for best practices Incorporating requirements for best practices into design of DAS programsinto design of DAS programs

Workforce Development program that will Workforce Development program that will increase the competency and credentialing of increase the competency and credentialing of clinical staff clinical staff

DAS PROGRESSDAS PROGRESSRECOVERY-ORIENTED QUALITY RECOVERY-ORIENTED QUALITY

CARE (con’t)CARE (con’t) Developed Provider Performance Reports which include Developed Provider Performance Reports which include

NOMs information and conducted logistic regression to NOMs information and conducted logistic regression to determine factors related to outcomesdetermine factors related to outcomes

Implementing a NIATx process improvement pilotImplementing a NIATx process improvement pilot Exploring contract incentivesExploring contract incentives CCS Training through Central East ATTCCCS Training through Central East ATTC Dr. Baxter – information for Medical Directors regarding Dr. Baxter – information for Medical Directors regarding

MATMAT MAT as an enhancement across the continuum of careMAT as an enhancement across the continuum of care Co-occurring initiativeCo-occurring initiative

Next StepsNext Steps PlanningPlanning

Conduct a needs Conduct a needs assessment to identify assessment to identify recovery support recovery support services needsservices needs

Public InformationPublic Information Create a “Recovery Create a “Recovery

Corner” on DAS website Corner” on DAS website that provides information that provides information for clients in recoveryfor clients in recovery

Asset BuildingAsset Building Pilot an IDA asset Pilot an IDA asset

building projectbuilding project County CollaborationCounty Collaboration

Recovery research – Recovery research – collaboration with NYcollaboration with NY

Expand Recovery Centers Expand Recovery Centers Contract incentives based Contract incentives based

on outcomeson outcomes Early Intervention focus on Early Intervention focus on

integration with primary integration with primary health carehealth care

Quarterly “Grand Rounds” Quarterly “Grand Rounds” case presentations with case presentations with Medical Directors for MAT, Medical Directors for MAT, pain management, co-pain management, co-occurring, poly substancesoccurring, poly substances

Increased Fee-for-ServiceIncreased Fee-for-Service

Questions?Questions?