jean lacour, phd., cpp cheryl a brown, mhr, sphr,...
TRANSCRIPT
Jean LaCour, PhD., CPP Cheryl A Brown, MHR, SPHR, CRSS NET Institute Center for Addiction & Recovery Education www.netinstitute.org www.recoverybeyond.com [email protected]
Trends in Addiction Treatment and Recovery Management
Purpose of Recovery Oriented Systems of Care (ROSC)
Roles: 12-Step Sponsors, Peer Recovery Specialists, Clinical Addiction Counselors
Current Practice Domains for Peer Recovery Specialists
Scope of Practice of Peer Recovery Specialists
In May 2009, SAMHSA announced its Recovery to Practice (RTP) Initiative. The RTP Initiative is designed to: ◦ hasten awareness, acceptance, and adoption of
recovery-based practices in the delivery of addiction-related services
◦ builds on SAMHSA’s definition and fundamental components of recovery (SAMHSA, 2011).
Will:
Educate addiction professionals about a recovery-oriented model of care;
Educate addiction professionals about addiction recovery (and their specific role in promoting it); and
Teach competencies needed to integrate addiction recovery concepts into practice.
9-Webinars: www.naadac.org/education/recovery
Sobriety – Abstinence from alcohol and all other non-prescribed drugs
Improved quality of life for self and others as measured by the following six domains:
Physical
Psychological
Independence
Social
Environment
Spiritual
Bonomi, A.E., Patrick, D.L., Bushnell D.M., & Martin, M. (1999). Validation of the United State’s Version of the World Health Organization Quality of Life (WHOQOL) Instrument.
Journal of Clinical Epidemiology, 53 (2000), 1-12.
Is a reality for millions of individuals and families
Recovery is a voluntary process
Recovery flourishes in supportive communities
Recovery gives back (to individuals, families and
communities) what addiction has taken away
Substance use treatment (individual behavioral
care) must move beyond emergency and palliative
care to care oriented to promoting long-term
recovery
White, W. & Davidson, L.: “Recovery: The Bridge to Integration?” Behavioral Healthcare, November, 2006
Mutual Support groups
Professional treatment
Nontraditional methods
Medical interventions
Faith and Spirituality Peer Recovery Support
Recovery Coach on your own
Current Service Response
0
100
Sy
mp
tom
s
TimeAcute symptoms
Discontinuous treatment
Crisis management
Severe
Remission
Recovery-Oriented Response
0
100
Sy
mp
tom
s
Time
Continuous treatment response
Promote Self-Care, Rehabilitation
Severe
Remission
coordinated network of community-based services & supports
person-centered: builds on strengths & resilience of individuals, families, communities
Goals:
achieve abstinence
improved health & wellness,
quality of life for those with or at risk of alcohol and drug problems. SAMHSA/CSAT
Treatment is part of recovery, which is the larger construct
End point of treatment - absence of symptoms of clinical disorder
End point of recovery - holistic health
Recovery support services are grounded in a strength-based approach that focuses on wellness and full reengagement with the community
Recovery support services build on capacities that already exist within communities
External Internal
Financial resources
Housing
Employment
Education resources
Safe Environment
Car/ Transportation
Access to healthy diet
Access to medical care
Access to hobbies, social activities
Pets
Spirituality
Self Esteem
Problem Solving/ Teachable
Coping Skills/ crises
Assertiveness, Choices
Social Connections:
family, church, recovery, ethnic, sports
Able to internalize information
Services designed to help people in recovery and/or their family members and significant others
Services that initiate and/or sustain recovery from alcohol and drug use disorders and related problems and consequences
Through the provision of support
Assistance in finding housing, educational, employment opportunities
Assistance in building constructive family and personal relationships
Life skills training
Health and wellness activities
Assistance managing systems (e.g., health care, criminal justice, child welfare)
Alcohol- and drug-free social/recreational activities
Spiritual/faith-based support
Research suggests that holistic, community-based support services enhance treatment outcomes (McLellan, 2003; Work Group on Substance Abuse Self-Help Organizations, 2003)
Experience shows that ongoing community support is important to sustaining recovery (White, 2000; 2002)
Lessons have been learned from mental health clients and HIV/AIDS peer communities
Lessons learned and research document impact of over 65 years of 12-step groups (e.g., Work Group on Substance Abuse Self-Help Organizations, 2003)
Motivation for lifestyle change exists along a continuum of readiness (Prochaska & DeClemente, 1994)
◦ Pre-contemplation
◦ Contemplation
◦ Preparation
◦ Action
◦ Maintenance
Social support appears to be a potent factor in moving people along the change continuum (Hanna, 2002)
Social support is correlated with numerous positive health outcomes, including reductions in drug and alcohol use (Cobb, 1976; Salser, 1998)
Four types of social support can be distinguished: ◦ Emotional
◦ Informational
◦ Instrumental
◦ Companion
Social support is one of the seven domains
Demonstrations of empathy, care, concern, such as: ◦ Mentoring
◦ Coaching
◦ Support groups
Assistance with knowledge, information, and skills, including: ◦ Life skills training
◦ Job skills training
◦ Citizen restoration
◦ Educational assistance
◦ Health/wellness information
Concrete assistance in helping others get things done, such as: ◦ Transportation to support groups
◦ Child-care
◦ Clothing
◦ Job application assistance
Feeling connected to others…having a social group and/or community, in the forms of: ◦ Alcohol and drug-free social and recreational
events
◦ Community and cultural events
◦ Connection with others of like faith & spiritual beliefs
Women
Self-defined groups by culture, ethnicity, or religion
Co-occurring disorders
Ex-offenders
Trauma survivors
Families
Recovery support activities clearly differentiated from professional treatment services
Protection of participants from harm
Ethical framework in operation
Program for recruiting, screening, training, and supervising peer volunteers
Compliance with community standards, laws and regulatory requirements
Risk management strategy
Recovery Community Support Programs (RCSP)
Access to Recovery (ATR) Support Providers
Faces and Voices of Recovery member organizations
Oxford houses, Recovery houses, Halfway houses
Communities That Care organizations
NCADD local affiliates
Salvation Army
Other faith-based or community organizations
Faith
Work or school
Social support
Belonging Family
Housing
Peer support
Treatment & rehab
Primary
Focus
Community Life
In the model. clinical care is viewed as one of many resources needed for successful integration into the community
Recovery-oriented System of Care
Faith
Work or school
Social support
Belonging Family
Housing
Peer support
Treatment & rehab
For example
Community Life
Client’s Risk and Resilience
What connections are not yet in place for this person and
what needs to be done to establish or cultivate them?
The legitimacy and credibility of the Peer Recovery Specialists springs from experiential knowledge and experiential expertise. (Lived Experience)
Recovery Coaches include people who have demonstrated their wisdom and skills as a recovery guide within the life of the community. (Lived Experience May Vary)
12-Step Sponsor
Peer Recovery Specialists
Recovery Coaches
Clinical Addiction Professional
Can be a staff position/responsibility
Can be part-time
Graduates of Treatment or Recovery programs
Volunteers
Requires training
ongoing contact (check-ups) and support
stage-appropriate recovery education
assertive linkage to communities of recovery
active problem solving of obstacles to recovery.
when needed, early re-intervention.
May Use testimony/self-disclosure
◦ Note: Self-disclosure has become increasingly
discouraged in the addictions counselor role.
◦ Part of a Peer Recovery Specialist role. Must be used with discretion.
◦ The focus is on the mentoree, not the Peer.
Length of Relationship: Where the addiction counselor has a relationship characterized by a clear beginning, middle and end
the Peer Specialist is expected to sustain contact with most clients following the completion of treatment.
…for months… even years!
Advocacy (ROSC orientation)
Mentoring/Education (peer interactions, no overt power differential)
Recovery/Wellness Support (various skills can be taught; Strengths-Based attitudes)
Ethical Responsibility (including peer self-care and self- development)
IC&RC Standard for Peer Support Training and Credentialing
Challenge/ Strengths Deficit/ Victim
Boundaries
Sense of Uniqueness
Sense of Morality
Role Models
Creativity
Communication Skills
Sense of Humor
Social Skills
Athletic Skills
Bad Family /Background Victim of Abuse Bad Neighborhood Poverty Ethnic Stigma Poor Communication
Skills Addicted Prison Poor Student
Depends upon: ◦ where the services are delivered ◦ how the services are delivered
Peer Recovery Specialist – Intricately a part of a Continuum of Care working within a treatment center. Medicaid Reimbursement.
Recovery Coaches can provide services: ◦ Independently (Fee for Service) ◦ Life Coach Model
Life Coaching Model
NET Institute
Center for Addiction & Recovery Education
www.netinstitute.org
www.recoverybeyond.com
407-236-9400