1. Continuing Care Recovery Oriented Systems of Care

2. Principle  Health care professionals should remain involved and available to those they serve until long term recovery can be self-managed by the patient, family, and extended support network  Community is the ultimate healing agent, not treatment

3. Recovery Stability  Stability of recovery not reached until 4-5 years of sustained remission  Post-treatment monitoring and support can significantly elevate long-term recovery outcomes

4. Recovery Stability  Extended period of check-ups and support rather than longer periods in primary treatment  Emotional support and mental health service needs that were not present during initial treatment may present during post-treatment monitoring

5. Critical Elements of Continuing Care  For a five year period:  post stabilization monitoring,  stage-appropriate recovery education,  active recovery coaching, and  re-intervention when needed

6. RM Continuing Care 1.Provided to all clients, not just those who “graduate” 2. Responsibility for contact shifts from client to the treatment agency

7. RM Continuing Care 3.Timing: Capitalizes on critical windows of vulnerability (first 30-90 days following treatment) and power of sustained monitoring (Recovery Checkups)

8. RM Continuing Care 4.Intensity: Ability to individualize frequency and intensity of contact based on clinical data 5.Duration: Continuity of contact over time with a primary recovery support specialist

9. RM Continuing Care 6.Location: Community-based vs. clinic-based 7.Staffing: May be provided in a professional or peer-based delivery format 8.Technology: Increased use of phone & Internet-based support services

10. Evidence Based Practice  The Effectiveness of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence.  James R. McKay, PhD; Kevin G. Lynch, PhD; Donald S. Shepard, PhD; Helen M. Pettinati, PhD

11. Telephone Based Continuing Care Research  Intensive Outpatient completion  12-week continuing care protocol  weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks

12. Telephone Based Continuing Care Research  Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions  However, high risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs

13. Phone Contact  Initial face to face session to orient client  One 15 minute phone call per week  Began with brief review of progress toward one to two goals identified in prior session  Plans for achieving goals over next week were then discussed, along with any other pressing issues

14. References  Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices. White, 2008.