WHO’S ON FIRST?: ADOPTION OF A ROSC PARADIGM AS SUD AND MH SYSTEMS OF CARE BEGIN TO INTEGRATE MATT CLUNE, RECOVERY SUPPORT SERVICES MANAGER, ADAA MAY Mid Atlantic Behavioral Health Conference

SUD Treatment Acute Care Paradigm Treatment (Acute Care Model) Works, Right?! Post--Tx one--third, AOD use decreases by 87% following Tx, & substance--related problems decrease by 60% following Tx (Miller, et al, 2001) BUT, Only 10% of those needing treatment received it in 2002 (SAMHSA, 2003) & access compromised by waiting lists (Donovan, et al, 2001) Inadequate doses of Tx contribute to risk of relapse & future readmissions LACK OF CONTINUING CARE (Only 1 in 5 adult clients participated in continuing care (McKay, 2001) and only 36% of adolescents received any continuing care (Godley, Godley & Dennis, 2001) The majority of people completing addiction treatment resume AOD use in the year following treatment (Wilbourne & Miller, 2002)

Shift to Recovery Oriented Systems of Care (ROSC) and Recovery Management Paradigm “A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems (SAMHSA, 2009). Calls for a “chronic-care” model of addiction treatment grew out of and in turn intensified a shift in the organizing paradigm of the addictions field from one of pathology (focus on the etiology and patterns of AOD problems) and intervention (focus on professional-directed addiction treatment) to a focus on the lived solution (focus on long-term addiction recovery). This emerging recovery paradigm is evident in calls to reconnect addiction treatment to the larger and more enduring process of addiction treatment, and to growing scientific interest in AA, other Twelve Step programs, and secular and religious alternatives to Twelve Step programs (White,2008). At the treatment system level, it is also evident in: the emergence of recovery as an organizing fulcrum for national, state, and urban addiction treatment policy; efforts to define recovery; calls for a fully developed recovery research agenda; federal programs promoting peer-based recovery support services, such as CSAT’s Access to Recovery (ATR) and Recovery Community Services Program (RCSP); and calls to use recovery as an integrating bridge for the addiction and mental health fields (White, 2008).

State ROSC (RSS) Supported Initiatives January $2M  Funded ROSC Activities in 23 of the 24 jurisdictions  Recovery/Sober House Beds  Peer Recovery Support Specialist (PRSS)  Recovery Community Centers (RCC’s) January $2M ROSC Supplemental Awards June FY 13 -An additional $1.5M ROSC Awarded in June FY13 - $1.75M Adolescent Club Houses FY 14 - $5.1M ROSC (will include additional dollars for Care coordination as well) Total - $10.35M (this number is much larger when adding other Alcohol tax initiatives (Recovery support services for women, co-occurring forensic supportive housing, ATR, and Care Coordination)

New Statewide Recovery Support Services Initiatives 70 Paid Peer Recovery Support Specialists (PRSS) An additional 130 volunteers (approximate)  Roles:  Recovery Coach  Engagement Specialist  System Navigator Approximately 150 paid and volunteer peer support specialists working in the Public Mental Health System New Workforce totaling 350 peers Placement:  Treatment Programs  Shelters  Supportive/Recovery Houses  Recovery Community Centers or Wellness and Recovery Centers

Peer Workforce Development For the past year the MHA Peer Medicaid Certification Committee has been working with ADAA staff on Peer Certification ADAA wins SAMHSA BRSS-TACS Policy Academy Award (May-September, 2013) Goals:  Peer Certification - Use Policy Academy to work with the MAPCB to completely articulate and roll our their Peer Credentialing Model (will include MH and SUS Specializations as well as a co-occurring credential.  Defining Medicaid Reimbursable Services – Of the larger universe of peer responsibilities, which services are best suited to MA reimbursement  Two Day Peer Conference – Sept Workforce Development, Workshops, Speakers, Celebration

Recovery Community Centers or Wellness and Recovery Centers? ADAA gave Recovery Community Center (RCC) funds to support 19 Centers. Fifteen (15) off these are operational and of the 15 that are operational, 8 (53%) are collaborative models with On Our Own of MD, Chesapeake Voyagers, and Lower Shore Friends. Of those in the pipeline, I’m also aware that more will be collaborations with Mental Health. They seem to follow three behavioral healthcare frameworks:  Purist Addictions Recovery Framework (William White) where peer supports are coming from a strict addictions recovery background  Braided Operational Framework working with a Wellness and Recovery Community Center (peer supports from both MH and Addictions working in the same Center)  Blended Operational Framework working with a Wellness and Recovery Community Center (peer supports from both MH and Addictions working with more operational cohesion)  None of these Centers has a blended financial framework

Peer Support Specialists in Recovery Community or Wellness and Recovery Centers The integration of MH-oriented peers and SUD oriented peers working in the same milieu (not that they are mutually exclusive) is a fairly novel approach not just in MD, but nationally. Challenges Ahead:  In a mixed revenue facility, who directs the facility? Does the answer depend upon who has the largest revenue share??  How do operational issues get resolved in this integrated approach (e.g. who resolves personnel issues, disagreements between staff, directs the orderly flow and business activity of the Center?)  Would integration and smoother operations be facilitated by forming an a new and integrated board?  Should the Board explore issues like developing new Articles of Incorporation that better define the new mission of the Center?  Should new operational manuals be written?  Should budgets be blended and funded out of a single source, particularly as MHA and ADAA merge?  What outcomes do we measure to ensure that they the Center is effective – are they the same for those who self -identify as MH consumers as they are for the population that self identifies as SUD recoverees?; what about co-occurring participants? (THE WORLD HEALTH ORGANIZATION QUALITY OF LIFE (WHOQOL) –BREF)

So How Do These Collaborative Center’s Operate? Pat