Presentation on theme: "Recovery: The Family’s Process of Healing and Hope"— Presentation transcript:
1 Recovery: The Family’s Process of Healing and Hope CMHACY ConferenceSteve Hornberger, MSWMay 2014Pacific Grove, CA
2 Three QuestionsGenerally, in my community when someone hears a family has an alcohol or drug problem they believe…Working with a family in need of alcohol or drug treatment is challenging because…I have been successful working with a family receiving drug treatment when I …
3 Why are we here today 1 in 10 Americans 1 in 5 families 1 in 7 workers 1 in 20 newborns35% of ALL school children1 in 8 veterans1 in 2 homeless1 in 4 elderly80% of those in jail60% of families in children and youth services
4 Unmet PrevalenceIn 2012, 23.1 million people aged 12 or older needed treatment for an AOD problem.Of those, only 2.5 million received any treatment.
5 The System GapsOf the million who needed treatment but did not receive it, only 1.1 million (5%) felt they needed it (denial gap)Of that 1.1 million, 347,000 (31%) said they made an effort but were unable to get it (treatment gap)753,000 (69%) reported making no effort (motivation gap).
6 Why are we here todayIn 2005, federal, state and local government spending as a result of substance abuse and addiction was a least $467.7 billion or 10.7 % of their combined $4.4 trillion budget.For each dollar of the $467.7 billion spent,95.6 cents went to shoveling up the wreckage and only1.9 cents on prevention and treatment,0.4 cents on research,1.4 cents on taxation or regulation and0.7 cents on interdiction.
7 Impact½ of all children (35.6 million) live in a household where a parent or other adults use tobacco, drink heavily or use illicit drugs.13% of children under 12 live in a household where a parent or other adults use illicit drugs.1 in 4 children under the age of 18 has a family member who abuses alcohol or has alcoholism.
8 Intergenerational Connections Approximately 45% of all NYS clients admitted to being a “child of an alcoholic or substance abuser”A child of an AOD abuser is 3 to 4 times more likely to develop AOD problems as well as negative health, educational and employment outcomesOver 90% of all women in residential substance abuse treatment report history of child abuse and/or neglect
9 Some CA BH Facts 1 Beliefs: About 3 in 5 (58.9%) 12- to 17-year-olds in California in perceived no great risk from drinking five or more drinks once or twice a week.About 7 in 9 (77.9%) 12- to 17-year-olds in California in perceived no great risk from smoking marijuana once a monthAbout 3 in 10 (31.9%) 12- to 17-year-olds in California in perceived no great risk from smoking one or more packs of cigarettes a day
10 Some CA BH Facts 2Usage:Among 12- to 17-year-olds in California, the mean age of first marijuana use was 13.8 years, and the mean age of first cigarette use was 13.2 years. about 195,000 youths (6.2% of all youths) per year in * reported using cigarettes within the prior month about 353,000 youths (11.2% of all youths) per year in * reported using illicit drugs within the prior month
11 Some CA BH Facts 3 Treatment: among persons aged 12 or older with illicit drug dependence or abuse, about 117,000 persons (12.4%) per year in received treatment for their illicit drug use within the yearamong persons aged 12 or older with alcohol dependence or abuse, about 212,000 persons (9.1%) per year in received treatment for their alcohol use within the yearabout 947,000 persons aged 12 or older (3.1% of all persons in this age group) per year in * were dependent on or abused illicit drugs within the year
12 Some CA BH Facts 4 Mental health: about 259,000 youths (8.4% of all youths) per year in * had at least one MDE within the year prior to being surveyedabout 83,000 youths with MDE (32.0% of all youths with MDE) per year in received treatment for their72% of youths reported improved functioning from treatment received through the public mental health system
13 Parent who is abusing alcohol or other drugs May be less attentive to the child while drunk or highMay be unable to fulfill their role as a parent, including providing medical treatmentIs more likely to be diagnosed with a co- morbid psychological problemMay be less attentive to the child while drunk or highMay be unable to fulfill their role as a parent, including providing medical treatmentIs more likely to be diagnosed with a co morbid psychological problem
14 Parent who is abusing alcohol or other drugs May be chronically physically ill from using drugs or alcoholSpends times procuring, using, and recovering from the alcohol or drug use instead of parentingMay be engaged in illegal activitiesPlaces financial stress on the family systemA Parent who is using drugs and alcohol affects the children around him or her in many ways.May be chronically physically ill from using drugs or alcoholSpends times procuring, using, and recovering from use of the chemicalMay be engaged in illegal activities to obtain their substancesPlaces financial stress on the family system
19 Priorities Tobacco Free Living Preventing Drug Abuse and Excessive Alcohol UseHealthy EatingActive LivingMental and Emotional Well-beingReproductive and Sexual HealthInjury and Violence Free LivingSource: National Vital Statistics Report, CDC, 2008
20 EXTERNAL ASSETS Support Empowerment 1. Family support 2. Positive family communication3. Other adult relationships4. Caring neighborhood5. Caring school climate6. Parent involvement in schoolingEmpowerment7. Community values youth8. Youth as resources9. Service to others10. SafetyThose in bold, CF! addresses and impacts.
21 EXTERNAL ASSETS (2) Boundaries & Expectations Constructive Use of Time 11. Family boundaries12. School boundaries13. Neighborhood boundaries14. Adult role models15. Positive peer influence16. High expectationsConstructive Use of Time17. Creative activities18. Youth programs19. Religious community20. Time at home
22 INTERNAL ASSETS Commitment to Learning Positive Values 21. Achievement motivation22. School engagement23. Homework24. Bonding to school25. Reading for pleasurePositive Values26. Caring27. Equality and social justice28. Integrity29. Honesty30. Responsibility31. Restraint
23 INTERNAL ASSETS (2) Social Competencies Positive Identity 32. Planning and decision making33. Interpersonal competence34. Cultural competence35. Resistance skills36. Peaceful conflict resolutionPositive Identity37. Personal power38. Self-esteem39. Sense of purpose40. Positive view of personal future
24 A complex behavioral and neurobiological disorder HISTORICALPHYSIOLOGICAL- previous history - expectation - learningDRUGS- genetics - circadian rhythms - disease states - genderENVIRONMENTAL- social interactions - stress - conditioned stimuliBRAIN MECHANISMSNow here’s where we start to understand the complexity of addiction, and this could be for any person. Each of us starts out with a certain set of genes and other biological factors (point to physiological) Then we are exposed to historical factors like our expectations about a drug or our social condition (point to historical) and of course the environmental factors (point to environmental). These factors affect the brain and how it functions, even before we start using alcohol or other drugs. When the drug enters the brain, it creates its own set of new conditions and adaptations for the brain. These affect behavior and environmental cues. Do you see how this all plays together?BEHAVIORENVIRONMENTSource: National Institute on Drug Abuse Presentation
25 Risk and Protective Factors What is a Risk Factor? Something in a person’s life that increases the chance of a problem occurring.Risk Factors include:Availability of ATODFamily history of addiction – 4XParental use or positive attitude toward useOther problems in the family: abuse, poverty, domestic violenceBehavior/learning problemsFriends who use and think it is fun or “cool”Early use
26 Risk Factors in Families Lack of love, caring, and supportLow expectations for children’s success and school performanceLack of adult supervision and severe or inconsistent disciplineLack of family rituals (e.g. family gatherings)Poor family management or communicationSexual and physical abuse
27 Risk and Protective Factors What is a Protective Factor? Something that increases the likelihood that substance abuse can be resisted.Protective Factors include:Relationship to an adult outside the familyInvolvement in activities: clubs, scoutsPositive self esteemInvolvement in religious activities, providing hope, purpose, see beauty in the world, connection to Higher Power
28 Risk and Protective Factors Family Protective Factors include:Strong bonds between children and parentsInvolvement in children’s livesClear limits/rules with consistently enforced consequencesClear, honest respectful communicationChores for all family membersFamily Rituals
29 Primary Conclusions1. People were always more important than programs.2. Often just one person made the difference.3. Programs that helped simulated living in a healthy family.4. Gandhi’s Story
30 Wellness Models Are Emerging HEALTHY l I NOT ILL l ILL NOT HEALTHY
31 A Person/Family Centered Approach Is Strengths Based –Assumes people have abilities, capacitiesRole focused, not problem focused (problems interfere with performing desired roles, diagnosis is not a role)Promotes direction of the process by the person/familyAdopts an individualized approach to services (not a cookie cutter set of programs)Where changes made in individual circumstances may have system wide implications that benefit others (innovations)
32 CMS Definition“...identify and access a PERSONALIZED mix of paid and non-paid services and supports that will assist him/her to achieve PERSONALLY-DEFINED OUTCOMES in the most inclusive community setting. The individual identifies planning goals to achieve these outcomes in COLLABORATION with those that the individual has identified , including medical and professional staff ….”
33 Putting the Pieces Together in a Person-Centered Plan GOALas Defined by PersonStrengths to Draw UponBarriers Which InterfereShort-Term ObjectiveBehavioralAchievableMeasureableInterventions/Action StepsProfessional/”Billable” ServicesClinical & RehabAction Steps by Person in RecoveryRoles/Actions by Natural Supporters
35 What Do They Need? Children: Caregivers: Words to say what happened Words to share experiencesUnderstanding of family diseaseTime with their children for healingMaking amends and forgivenessChildren:Words to say what happenedUnderstanding of family diseaseTime with their caregivers to healKnowledge that it isn't their fault35
36 Family engagement/involvement: Why is it important? Because it works!Because it is the right thing to doStakeholders are advocating for itSystem reforms are mandating itChanged the order . Most important is because it works! Don’t know where you wanted to put this slide.
37 Family Involvement Works Treatments involving families result inHigher levels of abstinence (50 vs. 30%)Fewer drug related arrests (8 vs. 28 %)Fewer inpatient episodes (13 vs. 35%)Science Practice Perspectives. Vol. 2 No 2 August 2004 NIDA
38 Family engagement/involvement Increased involvement equals increased ownership equals improved outcomesServices can be organized on a continuum from family friendly to family focused to family centered to family driven.Collaborative partnership of expertise, resources and experience.
39 What Do They Need? Caregivers: Children and Youth: Words to share experiencesUnderstanding of family diseaseTime with their children for healingMaking amends and forgivenessChildren and Youth:Words to say what happenedUnderstanding of family diseaseTime with their caregivers to healKnowledge that it isn't their fault39
40 Talking Helps to Break the Silence Talk with the children and family members affected by alcohol and drug addicts and explain the disease and 7 CsI didn’t Cause itI can’t Cure itI can’t Control itI can take better Care of myself:by Communicating my feelingsmaking healthy Choicesby Celebrating myself.
41 What families must re-learn Authority and disciplineRoles and responsibilitiesProblem solvingCommunicationHaving fun togetherShowing affection
42 Parent’s SupportWho in your family is already supportive of your recovery?Who in your family is in recovery too?Who keeps a healthy distance from family members who are not so stable?How has your child’s caregiver been helpful in your recovery?Who could help identify when you are headed in a negative direction? Who would see the warning signs?How can these people help you maintain your recovery? How can you ask them for help?
44 HealthcareInstitute of Medicine 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,”Respect patients’ values, preferences and expressed needsCoordinate and integrate care across boundaries of the systemProvide the information, communication, and education that people need and wantGuarantee physical comfort, emotional support, and the involvement of family and friends
45 Healthcare contInstitute for Patient and Family Centered Care lists the following core concepts of patient and family centered care:Respect and dignityInformation SharingParticipationCollaboration
46 Child Welfare Child Welfare Information Gateway family-centered and strengths-based approachpartnering with families in making decisions,setting goals, and achieving desired outcomesmotivating and empowering families- to recognize their own needs, strengths, and resources- to take an active role in working toward change
47 Juvenile Justice National Juvenile Justice Network Engage in deliberate outreach to meet familiesEnsure family members are an integral part of advocacyEmpower families to participate in advocacy through education and trainingAssist families with individual and system advocacyListen to familiesCreate a clear structure for engagement and participationLevel the field by providing adequate information and support
49 What is Recovery Perspective Substance dependence, while often manifested by socially unacceptable behavior (for which there must be responsibility), is an illness. This illness can best be prevented when science is used to inform family and community-based efforts to protect and build resiliency.The illness is best treated by early identification and intervention or, if not halted before its acute development, by a continuity of care over a lifetime that is built on measures of individual wellness and ongoing opportunities for recovery
50 What does the science say Millions of Americans today receive health care for mental health or substance use problems and illnesses. These conditions combined are the leading cause of disability and death among women and the second highest among men. Institute of Medicine, 2006Treatment is effective: When given a continuum of care, relapse rates for the treatment of alcohol, opioids, and cocaine are less than those for hypertension and asthma and are equivalent to those of diabetes (all of which are also chronic illnesses). Compliance to addiction treatment is greater than compliance rates for treatment of hypertension and asthma. O’Brien and McLellan, 1996
51 What does science say 2 Treatment is Effective and Sustainable Addictions treatment has resulted in:67% reduction in weekly cocaine use,65% reduction in weekly heroin use,52% decrease in heavy alcohol use,61% reduction in illegal activity, and46% decrease in suicidal ideation one yearpost treatment.These outcomes are generally stable for the same clients five years post treatment.
52 Continuing Care is Cost Effective A recent study of a lifetime simulation model (multiple episodes of treatment over a lifetime) shows that for every $1 spent on treatment (chronic care provided in a continuum of care) society accrues $37.72 in benefits.Zarkin et al., 2005
53 What does the recovery research say Recovery Supports:Increase entry and involvement in treatment– Moos & Moos, 2005Can be the basis for self and peer care shown to be effective in addressing any illness requiring continuing care – Flaherty, 2006Are often low-cost or free (such as peer-support groups, recovery mentors, recovery check-ups, et al.)– McKay, 2005Reduce chronicity (reoccurrence/relapse) and diminish stigma – Moos & Moos, 2005
54 Addiction and Chronic Care Compliance Relapse RateAddiction/Chronic Illness Rate (%) (%)AlcoholOpioidCocaineNicotineInsulin Dependent DiabetesMedication <Diet and Foot Care <HypertensionMedication <Diet <AsthmaMedication <
56 Recovery definitionsRecovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. (CSAT 2005 National Recovery Summit)Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. (Betty Ford Institute, 2007)My definition of recovery is life. Cause I didn’t have no life before I got into recovery. (Pathways study participant H.W. 42 years old African-American male)
57 SAMHSA’s new working definition A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potentialHealth: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;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.
58 Recovery oriented systems of care 2 Recovery-Oriented Systems of Care shifts the question fromHow do we get the client into treatment?toHow do we support the process of recovery within the person’s life and environment?
59 Recovery and Resilience Oriented System of Care
61 The VisionA community where all members of a family affected by alcohol and other drugs know there are knowledgeable and caring others who:understand what they are experiencing,care about them and are available,can help them find emotional and physical safety,can support their healing, health and wellness.
62 Opportunities and Challenges of a Lifelong Health System Goal of system to optimize health outcomes and lower costs over much longer time horizonsPayers, including Medicare and Medicaid, increasingly responsible for care for longer periods of timeHealth trajectories modifiable and compounded over timeImportance of early years of lifeSource: Halfon N, Conway PH. The Opportunities and Challenges of a Lifelong Health System. NEJM 2013 Apr 25; 368, 17:
63 Quality Care as Driver of Change The next generation of measures will:Define quality as improving the life of a person;Place functional outcomes on par with clinical outcomes;Create measurement processes that track outcomes over time since functional needs and personal goals changeBruce Chernof, MD, Pres and CEO The SCAN Foundation March 2014
64 What you can do personally Take good care of yourself, family, friends and colleaguesLearn about addiction and recovery, advocate for system collaboration and become a change agentDefine and monitor outcomes at four levels, the status quo is not good enoughBe bold, imagine a community where people live better lives, where children are safe, healthy, happy and educated, where people achieve their aspirationsProvide hope
65 What we can do together Raise awareness, Find allies, Take action to end:SilenceStigmaDisparitiesPromote the many roads to recovery
66 Proposed Shared Vision A community where all are safe, healthy and well, where each has a sense of belonging, purpose and opportunities to achieve their aspirations.
67 Web Resources Al-Anon and Alateen www.al-anon.alateen.org Faces and Voices of RecoveryFederation of Families for Children’s Mental HealthJoin TogetherNational Association for Children of Alcoholics (NACoA)National Center on Substance Abuse and Child Welfare (NCSACW)
68 Web Resources 2National Center on Addiction and Substance Abuse at Columbia (CASA)National Clearinghouse for Alcohol and Drug Information (NCADI)National Institute on Alcohol Abuse and Alcoholism (NIAAA)National Institute on Drug Abuse (NIDA)Substance Abuse and Mental Health Services Administration (SAMHSA)
69 Web Resources 3National Center on Addiction and Substance Abuse at Columbia (CASA)National Clearinghouse for Alcohol and Drug Information (NCADI)National Institute on Alcohol Abuse and Alcoholism (NIAAA)National Institute on Drug Abuse (NIDA)Substance Abuse and Mental Health Services Administration (SAMHSA)
70 Additional ResourcesNW ATTC Addiction Messenger seriesSeries 16 (2004) on Recovery,Series 17 (2005) on Family Treatment,Series 29 (2008) Family Participation in Addiction TreatmentSE ATTC and Florida Certification Board, Engaging Family Members Into Adolescent Drug Treatment (2008)
71 Additional Resources 2Generational Patterns of Resistance and Recovery Among Families with Histories of Alcohol and Other Drug Problems: What We Need to Know (2008)Addiction recovery: Its definition and conceptual boundaries (2007)
72 Additional Resources 3The Institute for Health ImprovementInstitute for Patient and Family Centered CareChild Welfare Information GatewayNational Juvenile Justice Network“An Advocates Guide to Meaningful Family Partnerships”I think we should trauma resources and MH resources.. We seem to be hitting JJ and Child Welfare but what about Schools? Given that we find our children in all these child serving places we should give some resources that get them connected to those agencies or fileds. …. What do you all think?
73 Additional Resources 4 PCORI Engagement Rubric IHI High Impact Leadership 2013 Behavioral Health Barometer CA Motivational Interviewing with Adolescents