1. SERVICE CONFIGURATION AND CLIENT PHASES Eva Petoskey, MS Anishnaabek Healing Circle ATR Director 1

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3. TARGET POPULATION  Eligible clients are enrolled members of the collaborating tribes and members of other federally recognized, state recognized, and Canadian tribes residing in the project service area.  Non-native family members and descendants are also eligible.  The project will serve clients age 12 and older.  8752 clients over four years.  2188 clients/year. 3

4. ATR II CLIENTS BY AGE GROUP 4

5. ATR II GENDER 5

6. ATR II OUTCOMES 6

7. ATR CLIENT PROCESS  Client is registered in the voucher system and assigned an ATR number.  Client is screened (AUDIT/DAST/CRAFFT)  GPRA is completed  Client is assigned to an Anishnaabek Healing Circle Phase (Readiness Assessment)  Clinical and/or recovery support assessment is complete if the client is in Phase II or III. 7

8. ATR CLIENT PROCESS  Vouchers for access, care coordination, follow-up and discharge are auto-generated by the system.  Vouchers are requested based on the client needs.  Referrals are made to tribal umbrella providers or Tier II providers as necessary based on client needs and choices.  Vouchers are shared with Tier II providers as necessary. 8

9. ATR CLIENT PROCESS  Services are provided and documented in the client file.  Voucher transaction forms are completed to facilitate billing for services.  Documentation related to the transaction must be attached to or filed with the transaction form.  Voucher transactions are entered into the voucher system.  ITC reviews and completes electronic audits on the files prior to payment.  On-site file audits are completed by ITC randomly but with notice. 9

10. RECOVERY ORIENTED SYSTEMS OF CARE In a recent article on recovery in historically disempowered communities, White & Sanders (2004) discuss the importance of utilizing approaches in tribal communities that shift the model of intervention from acute care of individuals to a sustained recovery management approach that relies on partnerships with individuals, families and communities. 10

11. INDIVIDUAL AND COMMUNITY CHANGE  The stages of change are (DiClemenet & Prochaska 1982) Pre-contemplation Contemplation, Preparation, Action, Maintenance &Relapse  The nine stages of community readiness defined by the model include no awareness of the problem, denial, vague awareness, preplanning, preparation, initiation, stabilization, confirmation/expansion, and professionalization. (Edwards 2000) 11

12. Readiness to Change and Recovery Tasks ATR Screening, Intake, GPRA Phase I Pre- Treatment Readiness Limited to motivational development and recovery coaching Phase II – Clinical Treatment Full array of clinical and recovery support services Phase III – Aftercare Full array of recovery support services ANISHNAABEK HEALING CIRCLE PHASES

13. Phase I (New for ATR III)Phase IIPhase III Criteria=Positive Screen and willingness to participate in education or coaching. Criteria=Positive screen and willingness to complete a clinical assessment and enter treatment. Criteria= Willingness to continue to work on recovery tasks appropriate for the level of recovery. Motivational Services Educational services Recovery coaching Clinical treatment services Recovery Support Services Motivational services Recovery Support Services Motivational services Community outreach Engagement of clients Very early recoveryEarly, Middle, Late Recovery Thinking about RecoveryMaybe Engaged in RecoveryEngaged in Recovery 13 ATR III PHASES

14. VOUCHER STRUCTURE 14 VouchersPhase I VouchersPhase IIPhase III Client GPRA Follow-up** Auto Client GPRA Discharge** Auto Access Center** Auto Motivational Development and Readiness Available Care Coordination Voucher** Auto Brief Intervention Not AvailableAvailableNot Available Outpatient Not AvailableAvailableNot Available Intensive Outpatient Not AvailableAvailableNot Available Residential Treatment (Max 30 days) Not AvailableAvailableNot Available Sub-acute Detox (Max 3 days) Not AvailableAvailableNot Available Medical Services Not AvailableAvailable Housing Support Services Not AvailableAvailable Transitional Living Facilities Not AvailableAvailable Employment and Education Not AvailableAvailable Peer Support & Relapse Prevention Available Family & Parenting Support Not AvailableAvailable Financial/Basic Needs Not AvailableAvailable Legal Support Not AvailableAvailable Health & Global Wellness Not AvailableAvailable Spiritual / Cultural Support Not AvailableAvailable Transportation Available Mental Health Services / Co-Occurring Not AvailableAvailable

15. 15 References DiClemenet, C.C., & Prochaska, J.O. (1982). Self change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behavior. &: 133-142. White, W.L., & Sanders, M. (2004) Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities. Unpublished article posted at www.bhrm.orgwww.bhrm.org Edwards, R.W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., & Swanson, L. (2000) Community readiness: Research to practice, Journal of Community Psychology, 28(3), 291-307 Yellow Horse Brave Heart, M., & DeBruyn, L.M. (1998) The American Indian holocaust: healing historical unresolved grief. American Indian and Alaska Native Mental Health Research, 8, 60-82.

16.  Access to Recovery  Anishnaabek Healing Circle  2956 Ashmun, Suite A  Sault Ste. Marie MI 49783  (906) 632-6896  www.atrhealingcircle.comwww.atrhealingcircle.com Staff  Eva Petoskey, Director (231-357-4886) epetoskey@centurytel.netepetoskey@centurytel.net  Terri Tavenner, Associate Director ttav@itcmi.orgttav@itcmi.org  Donelda Harper, Training & Audit Specialist dharper@itcmi.orgdharper@itcmi.org  Lori McDonald, GPRA & Media Specialist lorimac@itcmi.orglorimac@itcmi.org  Aagii Clement, Provider Liaison Specialist aclement@itcmi.orgaclement@itcmi.org  Connie DePlonty, Voucher Coordinator connied@itcmi.orgconnied@itcmi.org  Cora Gravelle, Call In Center Client Access & Outreach cora@itcmi.orgcora@itcmi.org  Sheila Hammock, Call In Center Client Access & Follow-up shammock@itcmi.orgshammock@itcmi.org  Produced by the Inter-Tribal Council of Michigan with Access to Recovery (ATR) Anishnaabek Healing Circle Grant (1 H79 TI023118-01) funds from the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Administration (SAMHSA), U.S. Department of Health & Human Services (HHS). Content is solely the responsibility of the authors and does not necessarily represent the official views of the agency. 16