recovery principles

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10 Guiding Principles of Recovery

LEARNING OBJECTIVES

Look at the differences between people in recovery and people not in recovery.

Understand the concepts of risk factors, protective factors and resiliency.

Learn the Substance Abuse and Mental Health Services Administration’s (SAMHSA) new working definition of recovery.

Learn the four dimensions that support recovery.

Learn the 10 guiding principles of recovery.

Discuss how we can affect patient recovery.

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OUTDATED DEFINITIONS OF RECOVERY

An act of recovering.

The regaining of, or possibility of

regaining, something lost or taken away.

Restoration or return to health from sickness.

Restoration or return to any former and better state or

condition.

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Presenter

Presentation Notes

www. dictionary.com What works here? What is missing from these definitions as it relates to mental health and substance abuse?

MEDICAL VS. MENTAL HEALTH RECOVERY

Medical perspective: Recovery FROM illness

Mental health perspective: Recovery

WITH illness

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UNDERSTANDING RISK AND PROTECTIVE FACTORS

Risk and protective factors help us understand both

prevention and recovery of mental illness and substance use.

Although the impact of a single risk or protective factor may

not impact a person, a combination of risk factors and/or lack of protective factors may overwhelm a person to the point that they are not able to bounce back.

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DISCUSS before reviewing the slide: There is no vaccine for mental illness or substance use addiction. We cannot test for it, and there is no cure. But we can evaluate risk factors and protective factors, which have an affect on resiliency and successful recovery.

RISK FACTORS

Risk factors are attitudes, beliefs, or environmental circumstances that put a person in greater danger of developing a mental and/or substance use disorder:

Individual temperament characteristics

Family-related risk factors

Community or environmental risk factors

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Individual temperament characteristics related to locus of control (external versus internal), poor self-control, negative emotionality, a need for immediate gratification and even physical activity level Family-related risk factors, which may include parental and sibling drug use, poor child-rearing and socialization practices, ineffective parental supervision of the child, ineffective parental discipline skills, negative parent-child relationships, family conflict, marital discord, domestic violence, abuse and neglect, family disorganization and family social isolation Community/environmental risk factors or the social determinants of health, e.g., limited resources, low socioeconomic status and communities that lack the knowledge, skills and programming necessary to reach out to those in need of assistance

PROTECTIVE FACTORS

Protective factors, which may exist or be developed, reduce the negative influence of any risk factors and improve a person’s probability of recovery. Protective factors can include a situation, experience, or resource that if not present might lead to maladaptive behaviors and outcomes:

Individual factors

Family factors

Community factors

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Individual factors such as development of a desirable personal identity; a feeling of power and control over one‘s life; a feeling of self-worth; a sense of social justice; a sense of cohesion with others; good self-regulation skills; close relationships with competent adults; ; connections to prosocial organizations; tolerance for delayed gratification; a sense of humor; development of good coping and problem-solving skills; an ability to see and set long-term goals; and a positive outlook for the future Family factors such as consistent, appropriate parental involvement, discipline and supervision; good parenting skills; trusting relationships; a safe environment; well-defined and appropriate family roles and responsibilities; opportunities to learn to deal appropriately with criticism, rejection and silence; prosocial values and ethics; and good goal-setting and decision-making skills exhibited by parents Community factors such as participation in school, work and the community that create an environment in which an individual has opportunities to develop and practice social and cognitive skills, develop a sense of belonging, contribute to the work of the community, develop a social network of peers and learn to handle challenges and practice prosocial behavioral skills and self-efficacy

RESILIENCY

Resilience is the context-specific ability to respond to stress, anxiety, trauma, crisis or disaster:

Change over time

Results of internal and external factors

Increased opportunity for impact in early stages

It is the interaction of risk and protective factors that plays

the central role in the development, enhancement and activation of resilience.

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For those who develop mental and/or substance use disorders, the influence of both internal development and external environments converge to either promote or restrict the development of personal resilience.

CHARACTERISTICS OF A PERSON NOT IN RECOVERY

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Discuss that a person NOT in recovery looks like – think physical, emotional, social characteristics etc.

LIFE IN ADDICTION VS. LIFE IN RECOVERY

www.facesandvoicesofrecovery.org

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Also talk about MENTAL HEALTH recovery.... Note: This study is specific to substance use; data from Dec 2012; over 3200 people surveyed In summary, Faces & Voices of Recovery conducted the first nationwide survey of persons in recovery from drug and alcohol problems about their experiences in active addiction and in recovery. Survey findings document the many costs of active addiction to the individual and to society in terms of health, finances, work, family life and criminal justice involvement. Most notably, the survey is the first to document the dramatic improvements people experience in all areas of life once they are in addiction recovery and that improvements continue over time as recovery is maintained. Contrary to the stigmatizing stereotype society has of the individual in active addiction or recovery, survey findings show that people in recovery are employed, pay bills and taxes, vote, volunteer in their communities and take care of their health and their families. These findings underline the fact that recovery is good not only for the individual, but also for families, communities and the nation’s health and economy. The findings emphasize the call for policies, services and funding to help more people initiate and sustain recovery, and for additional research to identify effective and cost-effective recovery-promoting policies and services.

SUBSTANCE USE:

ADDICTION VS. RECOVERY

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Presentation Notes

((These are based on the survey discussed in the prior slide)) Review the higher rates of self-reported “positive” events by those in recovery – highest for those in recovery the longest; Point out “experienced untreated emotional/mental health problems” is 3x higher for those in active addiction

BACKGROUND AND GOAL OF SAMHSA’S NEW DEFINITION

Background Prior to 2010, SAMHSA had separate definitions for recovery from mental disorders and substance use disorders. Multiple definitions complicated the discussion as professionals worked to expand health insurance coverage for treatment and recovery support services. Goal A standard, unified working definition will help advance recovery opportunities for all Americans, and help to clarify these concepts for peers, families, funders and providers.

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CHARACTERISTICS OF A PERSON IN RECOVERY

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Ask for feedback from the group – what does a person in recovery look like? Consider: Physical? Emotional? Involvement of family or community? Static or changing? Linear?

NEW WORKING DEFINITION OF RECOVERY

A process of change through

which individuals improve their health and wellness,

live a self-directed life, and strive to reach their

full potential.

www.SAMHSA.gov

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FOUR DIMENSIONS THAT SUPPORT RECOVERY

1. Health

2. Home

3. Purpose

4. Community

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Health: Overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs and non-prescribed medications if one has an addiction problem— and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing. Home: A stable and safe place to live Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors and the independence, income and resources to participate in society Community: Relationships and social networks that provide support, friendship, love and hope

SAMHSA’S 10 GUIDING PRINCIPLES OF RECOVERY

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Centene has adopted SAMHSA’s new model of recovery. Recovery is a personal and complex process, and an approach that succeeds for one person may not work for another. Success typically depends on finding the right mix of services and supports that meet the specific needs of an individual.

RECOVERY EMERGES FROM HOPE

The belief that recovery is real provides the essential and motivating message of a better future - that people can, and DO, overcome the internal and external challenges, barriers, and obstacles that confront them.

Hope is internalized and can be fostered by peers, families, providers, allies and others.

Hope is the catalyst of the recovery process.

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RECOVERY IS PERSON-DRIVEN

Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.

Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling and exercising choice over the services and supports that assist their recovery and resilience.

In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.

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RECOVERY OCCURS VIA MANY PATHWAYS

Individuals are unique with distinct needs, strengths, preferences, goals, culture and backgrounds - including trauma experience - that affect and determine their pathway(s) to recovery.

Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources and inherent value of each individual. Recovery pathways are highly personalized.

Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families.

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Pathways may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.

RECOVERY IS HOLISTIC

Recovery encompasses an individual’s whole life, including mind, body, spirit and community.

This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks and community participation.

The array of services and supports available should be integrated and coordinated.

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RECOVERY IS SUPPORTED BY PEERS AND ALLIES

Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles and community.

Through helping others and giving back to the community, one helps oneself. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness.

Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.

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While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

RECOVERY IS SUPPORTED THROUGH RELATIONSHIPS AND SOCIAL NETWORKS

An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support and encouragement; and who also suggest strategies and resources for change.

Family members, peers, providers, faith groups, community members and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion and community participation.

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RECOVERY IS CULTURALLY-BASED AND INFLUENCED

Culture and cultural background in all of its diverse representations - including values, traditions and beliefs - are keys in determining a person’s journey and unique pathway to recovery.

Services should be culturally grounded, attuned, sensitive, congruent and competent, as well as personalized to meet each individual’s unique needs.

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RECOVERY IS SUPPORTED BY ADDRESSING TRAUMA

The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster and others) is often a precursor to or associated with alcohol and drug use, mental health problems and related issues.

Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment and collaboration.

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RECOVERY INVOLVES INDIVIDUAL, FAMILY AND COMMUNITY STRENGTHS AND RESPONSIBILITY

Individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires and aspirations.

Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery.

Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.

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Presentation Notes

Individuals, families and communities have strengths and resources that serve as a foundation for recovery.

RECOVERY IS BASED ON RESPECT

Community, systems and societal acceptance and appreciation for people affected by mental health and substance use problems - including protecting their rights and eliminating discrimination - are crucial in achieving recovery.

There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity and regaining belief in oneself are particularly important.

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WHAT DOES THIS MEAN TO YOU?

Which principle seems most important in your own life? Which do you think might be most crucial to our patients? Which area can you have a direct impact on? How?

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TRAINER NOTE: Invite the group to discuss the characteristics. Try to link that what is most important for us and our family, is also just as important to our patients… Be sure to talk about how the audience (either provider or staff) can affect several areas through their own actions

HOW CAN YOU IMPACT RECOVERY?

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CURRENT TREATMENT(S)

SUPPORT SYSTEMS IN

PLACE

CURRENT MEDS MEDICAL

NECESSITY CRITIERIA

DISCHARGE PLANNING

INDIVIDUAL SATISFACTION

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Presentation Notes

TRAINER NOTE: Areas to probe further to impact recovery…… Is the patient receiving individual and/or family therapy? Are the patient’s family and/or community supports involved? Is the patient working on goals in groups that are relevant to his/her situation? Is the patient involved in his/her medication management decisions? Is this med regime appropriate for patient OP? Is the hospital providing respectful & culturally competent care? Are the patient’s behavioral symptoms improving? If so, is MNC being applied appropriately to transition back home as soon as he/she is ready? If not, is feedback being given to the facility? Is discharge planning being done daily – is hospital helping to facilitate provider appointments, housing and transportation? Is CC/ICM involved and are they working on discharge plans

HOW CAN YOU IMPACT RECOVERY?

During every contact with the patient, look for opportunities to impact patient recovery:

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MOTIVATIONAL INTERVIEWING

SPIRIT OF MI

TECHNIQUES

CARE PLAN DIMENSIONS

HEALTH &

HOME

PURPOSE &

COMMUNITY

PATIENT

EMPOWERMENT

SATISFACTION

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Presentation Notes

TRAINER NOTE: Patient contacts: by phone, written, face-to-face, etc….. Are you using the Motivational Interviewing ‘spirit’ and techniques to assess for patient’s readiness to change, ask open-ended questions, explore pros and cons and ambivalence to change, as well roll with resistance if patient is not motivated to change? Is there a plan to address the four dimensions needed to support recovery – Health, Home, Purpose and Community? Is the patient being empowered to direct his/her own care? Is the patient satisfied with their IP and OP providers? Is IP and OP care being provided in a respectful and culturally competent fashion? Are medical co-morbidities being addressed and are you coordinating with the health plan and/or OP PCP?

RECOVERY BARRIERS AND SUPPORTS

BARRIERS Family Friends Stigma and shame Fear Lack of resources in school Lack of insurance Police and criminal justice system Child Protective Services and

inability to see children Wrong programs and lack of

programs Media

SUPPORTS Family Friends Community Insurance Therapy/therapists Spiritual teachers School Emergency room Drug court Police and criminal justice system

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Presentation Notes

For some, the same entities served as both a barrier and a support; for example, many people listed their family or the criminal justice system as both a barrier and a support. Another item appearing on both lists is insurance. One woman experienced an obstacle involving insurance when she tried to reach out and get help. She felt it was very important that she attend an inpatient program after other pathways had failed, but her insurance company did not consider her condition severe enough for inpatient services, and would not authorize payment for treatment. However, another woman in the same focus group had a very different experience with her insurance company: she called them when she was out of other alternatives and they immediately connected her to several affordable treatment options.

MANY POSSIBLE PATHWAYS TO RECOVERY

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OUTPATIENT THERAPY Individual, Family, Group

INPATIENT TREAMENT

MEDICATION MANAGEMENT

RESIDENTIAL TREATMENT

PEER SUPPORT MUTUAL AID GROUPS -12-step programs -Non-12-step programs

FAITH-BASED CRIMINAL JUSTICE INTERVENTION -Incarceration -Diversion Programs

BODY -Meditation -Yoga

OTHER -Art therapy -Music therapy -Volunteering

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Presentation Notes

Definitely not an all-inclusive list, but covers most traditional and non-traditional methods used currently

FINDING THE “RIGHT” PATHWAY TO RECOVERY

One size does not fit all.

You must have options to fit you at different stages, options appropriate to your age, your background, where you are in your recovery path; you may need different

things when you’re 22 than when you’re 40.

Social Worker, NY

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Presentation Notes

Although participants expressed that a combination of pathways may lead to healing or recovery, the likelihood of success is increased and the recovery process shortened if the pathway(s) are individualized. Many individuals try the wrong pathway one, two, three, four, or more times before achieving a state of long-term recovery. Different avenues work for different people depending on their addictions, the supports they need, the barriers they face, the places they are in their lives and other factors. Many participants pointed out that achieving recovery can be a long, arduous process that requires persistency.

LIFESAVER WHEEL

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Presentation Notes

This lifesaver recovery wheel was developed based on brainstorming from the director’s retreat summer 2012. The patient is in the middle, the first layer is the services that are most critical to the patient (you’ll notice significant overlap with SAMHSAs recovery wheel), the outside circle are the ways that we can affect the patient’s recovery. Discuss.

Thank you for participating,

and for playing an active role in patient recovery!

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THANK YOU

RESOURCES

Del Vecchio, Paolo. "SAMHSA's Working Definition of Recovery Updated." Web log post. SAMHSA Blog » Blog Archive »

SAMHSA's Working Definition of Recovery Updated. N.p., 23 Mar. 2012. Web. 22 Aug. 2013. <http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/>.

Laudet, Alexandre, comp. Faces and Voices of Recovery. Rep. N.p., 1 Apr. 2013. Web. 22 Aug. 2013.

<http://www.facesandvoicesofrecovery.org/>. Substance Abuse and Mental Health Services Administration (SAMHSA) Partners for Recovery Initiative by Cori Sheedy,

M.A., of Abt Associates Inc. under the guidance of Melanie Whitter of Abt Associates Inc, under contract number HHSS283200700008I,Task Order No. HHSS28300002T. Shannon Taitt, M.P.A., served as the Government Project Officer.

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