‘Rolls ROIS’ – What is one and how do we get there? Colin Wilkie-Jones

What is Recovery? Deliberately no single definition in 2010 Drug Strategy Set out three overarching principles: – Wellbeing – Citizenship – Freedom from Dependence A journey or process - ‘Recovering From’ not ‘Recovered’ Individual and person centred – ‘in recovery if you say you are’? ‘Helping People be the best that they can be’?

Individual Person Centred Process No right or wrong way to recover What works for one person, may lead to failure for another Individual needs sit at heart of any recovery system Range of services required to provide tailored care package Abstinence aspiration of vast majority of addicts entering treatment, suggesting need to rebalance in this direction Substitute prescribing key and harm reduction key components of recovery oriented system Medically assisted recovery can and does happen and must not be stigmatised

Outcomes more important than ‘how’ Freedom from dependence on drugs or alcohol; Prevent drug related deaths and Blood Borne Viruses; Reduced crime and re-offending; Sustained employment; Stable Housing Improved mental and physical health and wellbeing; Better relationships with family members, partners, friends Ability to be effective and caring parent.

Recovery as a Change Process George De Leon Denial - active addiction, no acceptance of problem Ambivalence - some recognition but ‘I’m not an addict’ Motivation (external) - acceptance driven by external influence Motivation (internal) - accepts personal responsibility Readiness for change – but not treatment related Readiness for treatment - ‘Whatever it Takes’ Deaddiction - detachment from active drug use, trial and error Substance-Free - continuous period, longer than previously Continuence – acquiring behaviours of substance free lifestyle Integration and Identity Change - validation through experience

Acute Care model Services - discrete programme of activities, which may include brief ‘aftercare’, followed by termination of relationship Focus - elimination of symptoms for single primary problem. Practitioners – experts who ‘direct and dominate’ Duration - relatively short period (e.g. 12 weeks). Expectation – ‘cure’ via single intervention Discharge - impression given “cure occurred” and long-term recovery self-sustainable without ongoing assistance. Evaluation - short-term, single-point-in time follow-up Relapse - viewed as ‘failure’, of individual or treatment system

Chronic Disease or ‘Recovery’ Model ‘Whole system’ approach - integrated services/care models Early identification/engagement - via assertive outreach Continuous assessment - against wider ‘recovery plan’ Client definition/support team -extend to family/social network Service goals – movement through recovery stages Duration – long term management via primary care Proximity – supported in community where possible. Isolation (e.g. prison/residential rehab) followed by intensive transition Service relationship – partnership not expert/dominator Recovery Communities - long term natural, supportive, enduring and reciprocal relationships Relapse - ‘error’, not ‘failure’ a learning experience. Evaluation – much longer (5-15year) periods ‘r

System Change Models Additive – ‘recovery’ services added to existing treatment system which rebrands but remains otherwise unchanged Selective – certain services transformed to recovery ethos, but system unchanged Transformational – fundamental change – whole system aligned with recovery principles. – Supporting individuals and families – peer support services of equal importance to professional ones

Conneticut Phase I: Determine Direction Phase II: Initiate and Implement Change Phase III: Consolidation and Continuous Improvement

Conneticut Phase I: Determine Direction ‘Big Conversation’ to define recovery – ‘Process’ not ‘event’ – Encourage hope and respect – Address needs over time – Asset based Agreed Core Values – Tailored to individual need – Equal access to treatment – Client centred care planning Develop Strategic Action Plan

Conneticut Phase II: Initiate & Implement Change ‘Spread the word’ Quality Improvement & Collaboration Tools for Change – Recovery Self Assessment – Recovery Action Plan – Recovery College and centres of excellence – Client satisfaction surveys – Cross agency collaboration – Local conferences/seminars Lessons Learned Review Diversify Funding Streams

Philadelphia Three Phases: – Phase I: Conceptual Alignment (values+principles) – Phase II: Practice Alignment – Phase III: Contextual Alignment

Philadelphia: Phase I - Conceptual Leadership – establish sense of urgency Recovery Advisory Group ‘Big Conversation’ – recovery definition & principles Communicate and over communicate Effectively manage change process Transparent and participative approach Forums for knowledge sharing Mobilize recovery champions

Philadelphia: Phase II - Practice Identify Priorities Develop Supporting Practice Changes Upskill Workforce – involving PIRs Empower Stakeholders – especially Peers – Story telling training – Peer mentors – Peer group facilitation & leadership training – Peer & frontline staff involvement in service planning Short Term Wins Celebrate Success

Philadelphia: Phase III- Context Align Funding models to: – Support choice from menus of services – Encourage flexible delivery approaches – Reward recovery outcomes (PBR) – Include and require recovery support services Build/Strengthen indigenous recovery commnunities Link to Other Political Agendas

Sefton – A Blueprint for Change? ‘Big Conversation’ User led needs assessment resulting in: – commissioning of community abstinence service – increased access to rehab and in patient detox – Commissioning of ‘clean and sober’ housing Independent single point of assessment Introduced accredited peer mentors Workforce development – Wholesale use of ITEP – Training in recovery captial and person centred planning Close links with E2E services to support reintegration Move towards an integrated whole system Facilitated growth of mutual aid groups

Common Themes Phase I: Direction – ‘Big Conversation’ locally with all stakeholders – Agree definitions, values and strategic direction Phase II: Implement – Communicate – Reconfigure system – Initiate practice change and upskill staff – Involve Peers and PIRs Phase III: Consolidate – evaluation and continuous learning – Align policy and funding streams

Key Features Uniform assessment Harm Minimisation Services – integrated gateway Stabilisation Services – avert crisis/buy time/motivation Choice of various types of : – detox services – abstinence-oriented community services – residential rehabs – medically Assisted Recovery Services Community Aftercare and recovery check-ups Reintegration – housing, employment, family Mutal Aid and peer support Integrated with Primary care (GPs)