Recovery Oriented Systems of Care in Minnesota Fridays with ADAD May 21, 2010 Carol Falkowski Director, Alcohol and Drug Abuse Division Minnesota Department of Human Services

What is recovery? A process of change through which an individual achieves abstinence, improved health, wellness, and quality of life. 2 Source: CSAT National Summit on Recovery, 2005

ADAD’s Role in Supporting Recovery from Substance Use Problems & Disorders ADAD administers Substance Abuse Prevention and Treatment (SAPT) Federal Block grant dollars in the form of grants for recovery support, prevention, special populations ADAD encourages integration of addiction treatment with primary health care and mental health care services. ADAD partners with multiple organizations to reduce stigma and help advance addiction as a treatable chronic disease with behavioral components and works to enhance public acceptance of that treatment. 3 3

ADAD’s Role in Supporting Recovery from Substance Use Problems & Disorders ADAD works to ensure that science, rather than ideology or anecdote, forms the foundation for Minnesota’s addiction treatment system. ADAD serves health professionals and the public by disseminating scientifically sound, clinically relevant information on best practices in the prevention and treatment of addictive disorders. ADAD administers over $100 million in funds to pay for treatment services for those who could not otherwise afford it (CCDTF) 4 4 4

The Challenges: Reaching those in need of services Improving access to services Providing adequate resources Developing culturally-appropriate, and emerging evidence-based practices Building/sustaining a qualified workforce Integrating substance use disorder services into the primary health care paradigm 5 5

Challenges: Traditional Treatment Approach Traditional treatment approach presents challenges that translate into less cost-effective use of funds: 52.3% of those admitted to U.S. public substance abuse treatment programs in 2006 were re-entering treatment, 21.3% for the second time, 17.4% for the third or fourth time, and 13.6% for the fifth or more time. 1 One recent study found the that median time from first treatment to 1 alcohol- and drug-free year was 9 years – with 3 to 4 episodes of treatment.2 ¹SAMHSA, Office of Applied Studies. Treatment Episode Data Set (TEDS). Highlights - 2006. National Admissions to Substance Abuse Treatment Services 2 Dennis, M.L. et al, 2005. The duration and correlates of addiction and treatment careers, Journal of Substance Abuse Treatment 28 (Suppl. 1): S51-S62 6

Recovery-Oriented Systems of Care . . . . . .support person-centered, self-directed approaches to care that build on the strengths/resilience of individuals, families, and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems. 7 Source: CSAT National Summit on Recovery, 2005

Recovery-Oriented Systems of Care . . . shift the question from “How do we get the client into treatment?” to “How do we support the process of recovery within the person’s environment?”

A Traditional Service Approach Discontinuous treatment Severe Remission Acute symptoms Discontinuous treatment Crisis management 9 Resource: Tom Kirk, Ph.D 9

A Recovery-Oriented Approach Continuous treatment response Severe Remission Promote Self Care, Rehabilitation 10 Resource: Tom Kirk, Ph.D 10

Helps People Move Into a Recovery Zone Severe Recovery Zone Symptoms Improved client outcomes Remission Time 11 Resource: Tom Kirk, Ph.D 11

Recovery-Oriented Systems of Care Approach The treatment agency is viewed as one of many resources needed for a client’s successful integration into the community. No one source of support is more dominant than another. Various supports work with the client’s direction, so that all possible supports work for and with the person in recovery. Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC.

Recovery-Oriented Systems of Care Approach A chronic care approach, including self-management, family supports, and integrated services, improve recovery outcomes 1 Integrated and collaborative care has been shown to optimize recovery outcomes and improve cost-effectiveness 2 1 Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001. 2 Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001. 13 13

Recovery-Oriented Systems of Care Approach Encompasses a wide spectrum of State, local, community-based, faith-based, and peer-to-peer supports, services, and systems. Every resource, system, service, etc., that contributes to the recovery of an individual “owns” a piece of this approach. 14

Recovery Health Wellness Abstinence Evidence-Based Practice Employment Individual Family Community Family/ Child Care Housing/ Transportation Financial Legal Case Mgmt Peer Support Health Care PTSD &Mental Health Alcohol/Drug Treatment Vocational Educational Spiritual Addiction Services System Mental Health System Primary Care Child Welfare and Family Services Housing System Social Services Health Insurance DoD & Veterans Affairs Indian Health Criminal & Juvenile Justice System Abstinence Employment Crime Homelessness Evidence-Based Practice Cost Effectiveness Perception Of Care Social Connectedness Access/Capacity Retention Vocational Services HIV Services Faith Community Menu of Services Systems of Care Recovery Wellness Health Tribal Authorities Education System Organized Recovery Adolescent Svcs. Sober Schools

Goals: Recovery-Oriented Systems of Care Approach To support preventive strategies related to substance use problems & disorders; To intervene early with individuals with substance use problems; To support sustained recovery for those with substance use disorders; and To improve individual, family and community outcomes. 16