Richard Spence, Ph.D., M.S.S.W Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin Recovery Oriented Systems of Care for Substance Use Disorders

Compliance Relapse Chronic Illnesses/ Addictions Rate Rate Alcohol 30-50% 50% Opioid 30-50% 40% Cocaine 30-50% 45% Nicotine 30-50% 70% Insulin Dependent Diabetes Medication less than 50% 30-50% Diet and Foot Care less than 50% 30-50% Hypertension Medication less than 30% 50-60% Diet less than 30% 50-60% Asthma Medication less than 30% 60-80% Addiction is a Chronic Disorder -- Similar to other Chronic Health Problems

However, our addiction treatment system is built on an acute care model – short treatment at time of crisis – expected to cure the problem. A chronic care model is more continuous and places emphasis on the lifelong work of maintaining health and recovery. A recovery model focuses on long-term personal effort and on system support for achieving and maintaining health.

Recovery-Oriented Systems of Care: A Paradigm Shift “How do we support the process of recovery within the person’s environment?” 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?”

Person’s Entry into treatment Discharge Resource: Tom Kirk, Ph.D Symptoms A Traditional Course of Treatment for a Substance Use Disorder

Acute symptoms Discontinuous treatment Crisis management A Traditional Service Response Resource: Tom Kirk, Ph.D

Promote Self Care, Rehabilitation A Recovery-Oriented Response Continuous treatment response Resource: Tom Kirk, Ph.D

Improved client outcomes Recovery Zone Symptoms Time Helping People Move Into A Recovery Zone Resource: Tom Kirk, Ph.D

Benefits of Moving into a Recovery Zone Chronic care approaches, including self-management, family supports, and integrated services, improve recovery outcomes 2 Integrated and collaborative care has been shown to optimize recovery outcomes and improve cost- effectiveness 3 ¹ Dennis, Scott & Funk, Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)

Recovery-Oriented Systems of Care Approach In the 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 need to work in harmony with the client’s direction, so that all possible supports are working for and with the person in recovery. Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC.

V ROSC support person-centered and self-directed approaches to care that build on the personal responsibility, strengths, and resilience of individuals, families and communities to achieve health, wellness, and recovery from alcohol and drug problems. Individual Family Community Recovery Wellness Health

ROSC offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathways to recovery. Individual Family Community Family/ Child Care Housing/ Transportation Financial LegalCase Mgt VSO & Peer Support Physical Health Care PTSD &Mental Health Alcohol/Drug Services Vocational Education SpiritualHIV Services Services & Supports Recovery Wellness Health

Recovery-Oriented Systems of Care Support person-centered and self-directed approaches to care that build on the strengths and resilience of individuals, families and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems. Offer a comprehensive menu of services and supports to meet the individual’s holistic needs for continued recovery.

Elements of ROSC include the following: Person-Centered Individualized & Comprehensive Services Responsive to Culture & Personal Belief Systems Community-based Commitment to Peer Services Involvement of Family and other Allies Ongoing Monitoring & Outreach

Houston Recovery Oriented System of Care (H-ROSC) PLANNING INITIATIVE Funded by HHSC/ DSHS RESOURCES Addiction Technology Transfer Center (UT) Council on Alcohol and Drugs Houston Other Consultants and Resources Philadelphia Connecticut Chicago El Paso Dallas

Planning Participants: Conveners Council on Alcohol and Drugs Houston (Leonard Kincaid) Texas Dept State Health Services (Philander Moore) Gulf Coast ATTC (Dick Spence) Houston and surrounding area Agencies: ● Mayor’s Office (Houston Crackdown) ● City of Houston Health & Human Svcs ● Treatment (6 agencies) ● Coalition of Behavioral Health Services ● Drug Court and Veterans Court Program ● Vocational programs ● Universities ● Peer assistance coaches ● AIDS Foundation ● Customer representatives (persons in recovery).

1. Treatment Providers What is it like to provide treatment services in Houston? Barriers that limit good client outcomes What recovery oriented changes would be helpful 2. Customer Perspectives What is treatment and recovery like in Houston Barriers to recovery What changes would be helpful 3. Peer to Peer Recovery Assistance How are peer-to-peer workers organized and supported? What would help 4. Recovery Support Resources What exits What is needed 5. ­ Public Policy City Initiatives and programs Social Services and Health: (policies and plans) Funding and Regulatory issues Workgroups ---- Areas of INTEGRATED FOCUS

Workgroup Objectives ● Identify Needs for Improvement ● Identify New Directions to address those needs for future funding for implementation with little or no funding

ROSC Phases Phase I Consensus Building Phase II Planning and Organizing for Change Phase III Implementing and Sustaining Systemic Change Stakeholder Involvement Develop Guidelines for needed changes Address Stigma and other recovery barriers in the community Consensus on Recovery Roadblocks and Service Gaps Assess Agency Capacity and Readiness for Changes Training and Tech Assist for Technology Transfer Consensus on New Directions needed Preparation, including policy, funding, and regulatory planning Monitoring Outcomes and Supporting Implementation

ROSC Phases Phase I Consensus Building Phase II Planning and Organizing for Change Phase III Implementing and Sustaining Systemic Change Stakeholder Involvement Develop Guidelines for needed changes Address Stigma and other recovery barriers in the community Consensus on Recovery Roadblocks and Service Gaps Assess Agency Capacity and Readiness for Changes Training and Tech Assist for Technology Transfer Consensus on New Directions needed Preparation, including policy, funding, and regulatory planning Monitoring Outcomes and Supporting Implementation

H-ROSC Calendar May 10 Organizational Kickoff with Core Team of Key Stakeholders, Leaders, and Resource People May 21 Core Team meeting June 4Core Team meeting June 18Core Team meeting July 2Core Team meeting July 5Preliminary ROSC draft completed by CADH, ATTC July 30Major HROSC Stakeholder Meeting - National speakers and facilitators - community briefing and input on preliminary plan September 15 Final plan delivered to DSHS