Presentation on theme: "NJ Division of Addiction Services"— Presentation transcript:
1NJ Division of Addiction Services Moving Forward: A Recovery-Oriented System of Care for Addiction ServicesNJ Division of Addiction Services
2What Is Recovery?Recovery refers to the ways in which persons with or affected by addiction tap resources within and beyond the self to move beyond experiencing these disorders to managing them and their residual effects to build full, meaningful lives in the community. It is regaining wholeness, connection to the community, and a purpose-filled life.White, W. and Davidson, L. Recovery: The bridge to integration? Part one. Behavioral Healthcare, November 2006.
3DAS Actions New mission statement Strategic planning systems change process – annual reviewSent delegation to CSAT Regional ForumInvited to New York to share our plans and activities for transformation to chronic care modelAttended Recovery Symposium in PhiladelphiaInvited to participate in the Mutual Assistance Program for States (MAPS) for technical assistance to SSAs interested in Recovery Oriented Systems of CareInvited NJ counties to engage in the planning process with a renewed focus on recovery-oriented care
4DAS Mission StatementThe Division of Addiction Services (DAS) promotes the prevention and treatment of substance abuse and supports the recovery of individuals affected by the chronic disease of addiction. As the Single State Agency for substance abuse, DAS is responsible for regulating, licensing, monitoring, planning and funding substance abuse prevention, treatment and recovery support services in New Jersey.To achieve its mission, DAS provides leadership and collaborates with providers, consumers, and other stakeholders to develop and sustain a system of client-centered care that is accessible, culturally competent, accountable to the public, and grounded in best practices that yield measurable results.
5CSAT Regional Summit Meetings 2007 - Background To inform states about the National Summit on Recovery and build on the work initiated by the Summit participantsAgenda was “Planning and Implementing Recovery-Oriented Systems of Care within States and Communities”Teams were to include SSA designee, treatment provider, representative of the recovering community, and researcher
6Regional Summit Meetings 2007 Questions Asked 1. What should recovery-oriented systems of care (ROSC’s) look like?2. What steps are necessary to move toward ROSC’s?3. What steps have you already taken to implement ROSC’s?4. What challenges do you face in implementing ROSC’s?5. What steps are you prepared to take to support this change in the next 12 months?
7Overview Client-Centered Chronic Care Model Advocacy and stigma reductionPartnership with consumersHolistic approach and focus on wellnessIntegrates with primary care and mental healthStrengths-based approach to servicesFull continuum of care:Prevention Early Intervention Treatment Recovery SupportChronic Care ModelCase managementClinically driven lengths of stay and placementResponse to relapseFlexible funding – follows the clientContinuity of care
8Overview (con’t) Recovery Supports Recovery-Oriented Quality Care Supportive housingCollege recovery housingPhone outreachMentorsRecovery Support CentersRecovery-Oriented Quality CareEvidence-based practices (pharmacological and psychosocial)Credentialing and competencyOutcomes focusedNIATx process improvement
10Guiding Principles of Recovery There are many pathways to recoveryRecovery is self-directed and empoweringRecovery involves a personal recognition of the need for change and transformationRecovery is holisticRecovery has cultural dimensionsRecovery exists on a continuum of improved health and wellnessRecovery emerges from hope and gratitude
11Guiding Principles of Recovery (con’t) Recovery involves a process of healing and self-definitionRecovery involves addressing discrimination and transcending shame and stigmaRecovery is supported by peers and alliesRecovery involves (re)joining and (re)building a life in the communityRecovery is a realityCSAT (2005), National Summit on Recovery Conference Report
12DAS PROGRESS CLIENT-CENTERED Working to minimize the stigma associated with the use of medications to support recoveryClient Advocate on staff who works with clients to resolve discrimination, advises on client advocacy issues and initiates anti-stigma campaignsCitizen’s Advisory Council convenedClient satisfaction survey in July 2005
14A Chronic Care ModelSubstance dependence should be viewed as a chronic illness (such as hypertension, diabetes, asthma) and not as an acute illnessThe system of care, including treatment and funding mechanisms, must reflect the best practices proven to effectively achieve chronic illness recoveryWhen treated as a chronic illness, the compliance and relapse rates of substance dependence are as good or better than other chronic illnesses (O’Brien & McLellan)
15A Chronic Care Model PRINCIPLES OF CARE Must be evidence-based and jointly planned (i.e., client- centered) and support a healing relationship and lead to improved wellness and the opportunity for maintenance of recoveryMust be specific to the needs of individuals allowing for the treatment experience to be based on clinical need and offer a broad array of resources over a continuum of careMust provide coordinated, continuous attention to the individual’s needs for information and readiness for behavioral changeFlaherty, M. (2006), A Unified Vision for the Prevention and Management of Substance Use Disorders: Building Resiliency, Wellness and Recovery – A Shift from an Acute Care to a Sustained Care Recovery Management Model.
16DAS PROGRESS CHRONIC CARE MODEL Case management added as a reimbursable service in its newest FFS network, the Co-Occurring NetworkCase Managers in NETINIATx focus on step downDrug Court shift to clinically driven level of servicesPhilosophical changeRelapse is NOT a reason for dischargeAsk different questionsWhy did the client fail treatment?How did the system fail the client?
18Implications for Systems Change Greater focus on what happens BEFORE and AFTER primary treatmentTransition from professionally developed treatment plans to client-directed recovery plansGreater emphasis on the physical, social and cultural environment in which recovery succeeds or failsIntegration of professional treatment and indigenous recovery support groups
19Implications for Systems Change (con’t) Increased use of peer-based recovery coaches (guides, mentors, assistants, support specialists), andIntegration of paid recovery coaches and recovery support volunteers within interdisciplinary treatment teams.Flaherty, M. (2007). CSATS Recovery Supports Services Meeting.
20Recovery Support Services Family Services (including marriage education, parenting and child development services)Child CareEmployment ServicesPre-employment ServicesEmployment CoachingIndividual Services CoordinationTransportation to and from treatment, recovery support activities, employment, etc.Employment services and job trainingHIV/AIDS servicesSupportive transitional drug-free housing servicesOther Case Management ServicesContinuing CareRelapse preventionRecovery CoachingSelf-help and Support GroupsSpiritual SupportOther After Care ServicesSubstance Abuse EducationHIV/AIDS EducationOther Education ServicesPeer Coaching or MentoringHousing SupportAlcohol- and Drug-Free Social ActivitiesInformation and ReferralOther Peer-to-Peer Recovery Support Services
21DAS PROGRESS RECOVERY SUPPORTS New Jersey Access Initiative (NJAI)Mentors: 500 Recovery mentors trainedChoice: Client given choice of provider, including non- traditional faith-based and community-based programsVouchers: Funds given to the client which reinforces choice and includes the client in fiscal managementWhen funds available, expand access to recovery support services, e.g., Recovery MentorsIntroduced two Supportive Housing pilot projectsIssued Request for Proposals (RFP) for a Recovery Center and held Bidders’ ConferencePlanned system of phone outreach in the Recovery Center
22DAS PROGRESS RECOVERY SUPPORTS (con’t) Recovery Mentor Consortium created whose first task was convening a conference to promote MentorshipAwarded two grants to develop recovery housing on college campusesExpanded network of providers through the Office of Faith Based Initiatives (OFBI)
24Recovery-Oriented Quality Care Recovery-oriented care shifts the design of the addiction treatment system from an acute care model, focused on serial episodes of biophysical stabilization to a model of sustained recovery management.Recovery-oriented care focuses on the acquisition and maintenance of recovery capital (internal and external assets required for recovery initiation and self-maintenance), global health (physical, emotional, relational, and spiritual), and community integration (meaningful roles, relationships, and activities).White, W. and Davidson, L. Recovery: The bridge to integration? Part one. Behavioral Healthcare, November 2006.
25Recovery-Oriented System of Care Elements Person-centeredFamily and other ally involvementIndividualized and comprehensive services across the lifespanSystems anchored in the communityContinuity of carePartnership-consultant relationshipsStrength-basedCulturally responsive
26Recovery-Oriented System of Care Elements (con’t) Responsiveness to personal belief systemsCommitment to peer recovery support servicesInclusion of the voices and experiences of recovering individuals and their familiesIntegrated servicesSystem-wide education and trainingOngoing monitoring and outreachOutcomes drivenAccountable to the publicResearch basedAdequately and flexibly financedCSAT (2005), National Summit on Recovery Conference Report
27DAS PROGRESS RECOVERY-ORIENTED QUALITY CARE Provided training on the evidence-based treatment program, the SAMSHA/CSAT Family Centered Treatment ModelIncorporating requirements for best practices into design of DAS programsWorkforce Development program that will increase the competency and credentialing of clinical staff
28DAS PROGRESS RECOVERY-ORIENTED QUALITY CARE (con’t) Developed Provider Performance Reports which include NOMs information and conducted logistic regression to determine factors related to outcomesImplementing a NIATx process improvement pilotExploring contract incentivesCCS Training through Central East ATTCDr. Baxter – information for Medical Directors regarding MATMAT as an enhancement across the continuum of careCo-occurring initiative
29Next Steps Planning Recovery research – collaboration with NY Conduct a needs assessment to identify recovery support services needsPublic InformationCreate a “Recovery Corner” on DAS website that provides information for clients in recoveryAsset BuildingPilot an IDA asset building projectCounty CollaborationRecovery research – collaboration with NYExpand Recovery CentersContract incentives based on outcomesEarly Intervention focus on integration with primary health careQuarterly “Grand Rounds” case presentations with Medical Directors for MAT, pain management, co-occurring, poly substancesIncreased Fee-for-Service