RECOVERY ORIENTED SYSTEM OF CARE AND THE ANISHNAABEK RECOVERY COACHING INITIATIVE September 2012 Prepared by: Eva L. Petoskey, MS Director Terri Tavenner, Associate Director Anishnaabek Healing Circle Access to Recovery

Inter-Tribal Council of Michigan The Inter-Tribal Council of Michigan (ITC) is a consortium of the federally recognized tribes in Michigan. The ITC has collaborated with the Michigan tribes on a wide range of health and human service initiatives over the past 40 years. The elected tribal Chairpersons from the consortium tribes serve as the ITC Board of Directors.

What is Access to Recovery and the Anishnaabek Healing Circle?

What is ATR ATR is a nationwide initiative of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT). The program provides vouchers to clients for the purchase of substance abuse clinical treatment and recovery support services.

ATR Goals The goals of the ATR program are to:  expand capacity of treatment & recovery support services,  support client choice,  and increase the array of services The Inter-Tribal Council of Michigan is the grantee for the program.  ATR II started 10/2007 and ended 9/2010  ATR III started 10/2010 and will end 9/2014

Target Population 6 Enrolled members of Michigan tribes and other federally recognized, state recognized, and Canadian tribes residing in the project service area, age 12+. Non-native family members and descendants are also eligible. All clients must have a current or past problem with alcohol or other drug abuse. Anishnaabek Healing Circle ATR II: (5228 clients) Anishnaabek Healing Circle ATR III: (8752 target)

Who are the Collaborators? Collaborating Tribes and Organizations  Bay Mills Indian Community  Hannahville Indian Community  Lac Vieux Desert Band of Lake Superior Chippewa Indians  Saginaw Chippewa Indian Tribe  Grand Traverse Band of Ottawa/Chippewa Indians  Sault Ste. Marie Tribe of Chippewa Indians  Keweenaw Bay Indian Community  Little Traverse Bay Bands of Odawa  Little River Band of Ottawa Indians  Pokagon Band of Potawatomi  Nottawaseppi Huron Potawatomi  Match-e-be-nash-she-wish Band of Potawatomi  American Indian Health and Family Services

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As Anishnaabek we have endured a remarkable journey over time carrying the seeds of healing deep in our hearts. The grief and trauma resulting from boarding schools, rapid cultural change, lack of economic opportunity, and loss of land have contributed to the high rates of substance abuse and mental health problems experienced by the Anishnaabek families and communities today. The Recovery Movement

Tribal Initiatives The seeds of healing have grown into a strong recovery movement with committed people. Tribal governments have created behavioral health departments along with policies and procedures to guide the delivery of services including indigenous healing services that are integrated with western approaches.

11 The Anishnaabek Healing Circle ATR has been able to effectively access funding to support this tribal vision for healing.

12 Jingle dress dancers, dance for healing. Anishnaabek people of Michigan. (Odawa, Potawatomi, and Ojibwa) Working with multiple tribes has challenges. There are multiple ways to collaborate. A shared vision is key to success.

Vision Statement: “The spiritual strength of our ancestors will live in the hearts of our people.” The Communication Network is a group of tribal behavioral health stakeholders. The group has been meeting for 30+ years. Tribal Behavioral Health Communication Network

“To advocate for and facilitate the development of indigenous methods for the prevention and treatment of substance abuse and mental health problems based on Anishnaabek values of Love, Respect, Honesty, Bravery, Humility, Truthfulness, and Wisdom; and to evaluate these methods based on indigenous indicators.” Behavioral Health Communication Network Mission Statement:

Winter Teaching Lodge Behavioral Health Cultural Service Expansion with ATR Saginaw Chippewa Tribe Behavioral Health Residential, Outpatient and Recovery Support Services

Tribal Recovery Oriented Systems of Care Shifting the model of intervention from acute care of individuals to a sustained recovery management approach relies on partnerships with individuals, families and communities. White & Sanders (2004). ATR II started the “process” of integrating services into a ROSC. ATR III continues that process by identifying key elements to integration.

Readiness to Change and Recovery Tasks ATR Screening, Intake, GPRA Phase I Pre- Treatment Readiness Limited to motivational development and recovery coaching Phase II – Clinical Treatment Full array of clinical and recovery support services Phase III – Aftercare Full array of recovery support services Anishnaabek Healing Circle Phases

ATR III Phases 18 Phase I (New for ATR III) Phase IIPhase III Criteria=Positive Screen and willingness to participate in education or coaching. Criteria=Positive screen and willingness to complete a clinical assessment and enter treatment. Criteria= Willingness to continue to work on recovery tasks appropriate for the level of recovery. Motivational Services Educational services Recovery coaching Clinical treatment services Recovery Support Services Motivational services Recovery Support Services Motivational services Recovery Coaching Community outreach Engagement of clients Very early recoveryEarly, Middle, Late Recovery Thinking about RecoveryMaybe Engaged in Recovery Engaged in Recovery

Voucher Structure 19 Vouchers Phase I VouchersPhase IIPhase III Client GPRA Follow-up** Auto Client GPRA Discharge** Auto Access Center** Auto Motivational Development and Readiness Available Care Coordination Voucher** Auto Brief Intervention Not AvailableAvailableNot Available Outpatient Not AvailableAvailableNot Available Intensive Outpatient Not AvailableAvailableNot Available Residential Treatment (Max 30 days) Not AvailableAvailableNot Available Sub-acute Detox (Max 3 days) Not AvailableAvailableNot Available Medical Services Not AvailableAvailable Housing Support Services Not AvailableAvailable Transitional Living Facilities Not AvailableAvailable Employment and Education Not AvailableAvailable Peer Support & Relapse Prevention Available Family & Parenting Support Not AvailableAvailable Financial/Basic Needs Not AvailableAvailable Legal Support Not AvailableAvailable Health & Global Wellness Not AvailableAvailable Spiritual / Cultural Support Not AvailableAvailable Transportation Available Mental Health Services / Co-Occurring Not AvailableAvailable

The Tribal Umbrella Every tribe has programs: every program and department is part of the circle of recovery for an individual. Whatever (and whoever) the individual needs to support their recovery is whatever (and whoever) should be integrated into the circle of recovery. Build on what already exists.

Track 1: Recovery Coaching 21 Strategies Research materials and adopt/modify/develop a curriculum for Recovery Coach training Develop a Cultural Competency Module specific to the needs of the Anishnaabek People of the Three Fires (the target population for ATR). Utilize the module in the RC curriculum and to train ATR network providers Conduct an Anishnaabek Recovery Coach Institute to train the first cohort of recovery coaches from Michigan tribes. Conduct a training for RC supervisors that includes “how to” integration of non-clinical approaches to recovery management

Track 2: A Recovery-Oriented System of Care 22 Identify program qualities that will support a ROSC Identify program qualities that will support Recovery Coaching Develop a strategic plan to obtain “buy-in” from tribal behavioral health and health administrations to implement a ROSC in each of 12 tribes in Michigan Implement the strategic plan to parallel the timeline for certification of the first cohort of Recovery Coaches

Outcomes: 23 Trained Recovery Coaches within each tribal community, who are from each tribal community, who can provide ATR billable recovery management services to the target population. A Recovery Oriented System of Care that includes programs, people and resources, with the consumer at the center of the circle.

Recovery Coach Institute The first Anishnaabek Healing Circle Recovery Coach Institute was held June 4-8, 2012 to train local recovery coaches, recovery coach supervisors and ATR liaisons. Fourteen peer recovery coaches from 8 tribes in Michigan and one in South Dakota completed the training, as did 13 supervisors and ATR tribal liaisons. Trainers came from the Detroit Recovery Program, from Michigan tribal communities and ITC/ATR staff.

Module 1: How to Be a Recovery Coach What is a Recovery Coach? What Do They Do? Strengths-based Recovery Management; Skill Building for the Recovery Coach Fitting the Recovery Coach into the Anishnaabek Healing Circle ATR

Module 2: How to Supervise the Peer Recovery Coach What makes supervising peer recovery coaches different than clinical staff? Role of supervision to recovery coaching Forming a learning community for Recovery Coach supervisors

Module 3: The ATR Tribal Liaison’s Role in Developing a ROSC Pulling it all together: Using ATR reimbursements to fund recovery activities and expand ATR options for consumers; developing tribal umbrellas; budgeting ATR recovery support activities; using recovery coaches as independent contractors

The first cohort of peer recovery coaches and recovery coach supervisors completed a 5 day training in June, They have returned to their tribal communities to integrate peer recovery coaching into their respective recovery-oriented systems of care.

Tribal Feedback Benefits ● Client Choice ● Client Empowerment ● Client Responsibility ● Reduction of Stress/Barriers ● Inclusion of cultural values/ceremonies for healing ● Holistic care ● Recovery Support Services-continuum of care ● Identification and reinforcement for long term sobriety ● Quarterly BH meetings with State Tribal BH-support ● Quality leadership and development with ATR Directors

Tribal Feedback Enhancement of Recovery Services ● Transportation ● Special Need Fund ● Alcohol Drug testing ● Acupuncture ● Physical Fitness & Well-being ● Traditional Healing Services ● Housing support ● Medical Care ● Alcohol/Drug Free Social Activities

Monitoring of Service Array

ATR is Effective ATR II client outcomes (N=2984). Improvements in abstinence, no arrests, no HBSC and socially connectedness were statistically significant (p<.001).

Access to Recovery Anishnaabek Healing Circle 2956 Ashmun, Suite A Sault Ste. Marie MI (906) Staff Eva Petoskey, Director ( ) Terri Tavenner, Associate Director Connie DePlonty, Voucher Coordinator Donelda Harper, Training & Audit Specialist Lori McDonald, GPRA & Media Specialist Aagii Clement, Provider Liaison Specialist Cora Gravelle, Call In Center Client Access & Outreach Sheila Hammock, Call In Center Client Access & Follow-up Produced by the Inter-Tribal Council of Michigan with Access to Recovery (ATR) Anishnaabek Healing Circle Grant (1 H79 TI023118) funds from the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Administration (SAMHSA), U.S. Department of Health & Human Services (HHS). Content is solely the responsibility of the authors and does not necessarily represent the official views of the agency. 33