Tom Hill Faces & Voices of Recovery October 8, 2013 Peer Support for Substance Use Disorders: The Future in Kentucky

Introduction and Setting the Context

Faces and Voices of Recovery  Organizing and mobilizing people in long-term recovery from addiction, our families, friends, and allies, to speak with one voice  Changing public perceptions of recovery  Promoting effective Federal and State public policy  Focusing on the reality of recovery that is making life better for over 23 million Americans, their families, and communities

Addiction Recovery Advocacy Movement  2001 Recovery Summit; St. Paul, MN  The recovery movement:  includes people in recovery from addiction from alcohol and other drugs, family members, friends, and allies  includes and honors all pathways to recovery  encompasses all the diverse perspectives, cultures, and experiences of the recovery community

Current Climate: The Perfect Storm  Recovery Advocacy Movement  Recovery-Oriented Systems of Care  Mental Health Parity and Addiction Equity Act  Affordable Care Act  Managed Care Expansion  Peer Recovery Support Services  Criminal Justice and Drug Policy Reform Movement

Recovery is the Focus

Focus: Recovery and Wellness Shifting from a crisis-oriented, professionally-directed, acute-care approach with its emphasis on discrete treatment episodes…. …to a person-directed, recovery management approach that provides long-term supports and recognizes the many pathways to health and wellness.

Recovery-oriented Systems of Care  Build the capacity of communities, organizations, and institutions to support recovery  Build on the strengths of individuals, families, and communities to foster long- term recovery, health, and wellness  Expand the menu of services and supports across the entire recovery continuum  Ensure people in or seeking recovery receive dignity and respect  Lift discriminatory policies and barriers to recovery

 Prevent the development of substance use conditions  Intervene earlier in the progression of illnesses  Reduce the harm caused by substance use and addiction  Help people transition from recovery initiation to recovery maintenance  Actively promote good quality of life, community health, and wellness for all Primary Goals of a ROSC Adapted from Ijeoma Achara

 Unmet Need: < 10 % who need Tx seek treatment or if they do, arrive under coercive influences  Low Pre-Treatment Initiation Rates  Low Retention: > 50 % do not successfully complete treatment  Inadequate Service Dose: significant % do not receive optimum dose of Tx as recommended by NIDA.  Lack of Continuing Care : only 1 in 5 receive post-discharge planning  Recovery Outcomes: most resume using within 3months to one year of discharge from Tx  Revolving Door: > 60% one or more Tx episodes, 24% 3 or more – 50% readmitted within 1 year. Challenges Currently Facing Addiction Service Systems Adapted from Ijeoma Achara

Service System Progression Arthur Evans

Service System Progression Arthur Evans

Service System Progression Arthur Evans

A New Model Arthur Evans

Looking Through a Different Lens We cannot solve our problems with the same thinking we used when we created them. Albert Einstein

 Change is from within  In order for development to occur, it must be preceded by a vision  A great learning must take place  You must create a Healing Forest The Four Laws of Change

The Healing Forest

 Outreach and engagement  Strength-based screening, assessment, and service planning  Expanded and service team composition and collaborative relationships  Focus on community integration  Linkages to recovery community  Post-treatment check ups Recovery-oriented Clinical Services Adapted from Ijeoma Achara

 Develop the capacity and infrastructure of the organized recovery community to become a full partner and participant  Explore range of options regarding paid and volunteer peers  Expand PRSS and increase service menu options and points of access  Integrate PRSS into recovery community and diverse service settings, including treatment Fully in the Mix: Peer Recovery Support Services

Setting the Context: Recovery Capital

What is Needed: Recovery Capital  Physical : includes health (access to care), financial assets, food/clothing/shelter, transportation  Human: includes culture, values, knowledge, education, inner- and interpersonal skills, judgment, and other capacities  Social: includes connectedness to social supports and resources, intimate/family/kinship relationships, and bonds to community and social institutions Recovery Capital is the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from addiction. (Granfield and Cloud, 1999, 2004; White, 2006)

Recovery Capital: Amber’s Story

Consequences of Addiction Can Deplete Recovery Capital  Limited education  Minimal or spotty work history  Low or no income  Criminal background  Poor rental history  Bad credit  Accrued debt and/or back taxes  Unstable family history  Inadequate access to health care

Creating and Reinforcing Recovery Capital Essential Ingredients for Sustained Recovery:  Safe and affordable place to live  Steady employment and job readiness  Education and vocational skills  Life and recovery skills  Health and wellness  Sober social support networks  Sense of belonging and purpose  Connection to family and community

With Many, a Need to Address:  Legal issues  Expunging criminal records  Financial status: debt, taxes, budgeting, etc.  Restoring revoked licenses: professional, business, driver’s  Regaining custody of children  Developing relationship and parenting skills  Developing sober social support networks and community connections Creating and Reinforcing Recovery Capital

Building Communities with Recovery Capital  Build on the strengths and resilience of individuals, families, and communities to be responsible for sustained recovery and wellness  Make services and resources available that help individuals and families throughout the recovery process  Build the capacity of communities, organizations, and institutions to support recovery: recovery-supportive rather than recovery-hostile  Lift discriminatory barriers that impede recovery and wellness

Peer Recovery Support Services

 Services to help individuals and families initiate, stabilize, and sustain recovery  Provided by individuals with “lived experience” of addiction and recovery  Non-professional and non-clinical  Distinct from mutual aid support, such as 12-step groups  Provide links to professional treatment, health and social services, and support resources in communities Peer Recovery Support Services

Elements of a Peer Relationship  Natural  Reciprocal  Accessible  Potentially enduring  Non-commercialized  Non-regulated William White

What Makes Peer Work Effective?  Focuses on establishing trust and building relationship  Builds on a person’s strengths to improve Recovery Capital  Promotes recovery choices and goals through a self-directed Recovery Plan  Utilizes recovery community resources and assets, especially volunteerism  Provides entry and navigation to health and social service systems  Models the benefits of a life in recovery

 Effective outreach, engagement, and portability  Manage recovery as a chronic condition  Stage-appropriate  Cost-effective  Reduce relapse and promote rapid recovery reengagement  Facilitate reentry and reduces recidivism  Reduce emergency room visits  Create stronger and accountable communities Benefits of Peer Recovery Support Services

When Are PRSS Delivered? Across the full continuum of the recovery process:  Prior to treatment  During treatment  Post treatment  In lieu of treatment Peer services are designed and delivered to be responsive and appropriate to all stages of recovery.

Continuum of Addiction Recovery Pre-Recovery Engagement Recovery Initiation & Stabilization Recovery Maintenance Enhancement of Quality of Life in Long- term Recovery William White

Where Are PRSS Delivered?  Recovery community centers  Faith and community-based organizations  Emergency departments and primary care settings  Addiction and mental health treatment  Criminal justice systems  HIV/AIDs and other health and social service agencies  Children, youth, and family service agencies  Recovery high schools and colleges  Recovery residences and Oxford Houses

Peer Recovery Coach  Personal guide and mentor for individuals seeking to achieve or sustain long-term recovery from addiction, regardless of pathway to recovery  Connector to instrumental recovery-supportive resources, including housing, employment, and other services  Liaison to formal and informal community supports, resources, and recovery-supporting activities

NOT Just Recovery Coaches…  Peer telephone continuing support  Peer-facilitated educational and support groups  Peer-connected and –navigated health and community supports  Peer-operated recovery residences  Peer-operated recovery community centers

Recovery Community Centers  Vision: creating a community institution like a Senior Center  Provides public and visible space for recovery to flourish in community: Recovery on Main Street  Serves as a “community organizing engine” for civic engagement and advocacy  Operates as a “hub” for PRSS and recovery activities  Includes participation of family members  Provides volunteer, service, and leadership opportunities  Positions the recovery community as a key stakeholder with the greater community

Establishing Accountability for Peer Recovery Support Services

Recovery Plans

Step 1: Recovery Capital Assessment Ten Domains: 1. Substance use and abstinence 2. Mental wellness and spirituality 3. Physical and medical health 4. Citizenship and community involvement 5. Meaningful activities: job/career, education, recreation 6. Relationships and social support 7. Housing and safety 8. Risk taking and independence from legal responsibilities and institutions 9. Coping and life functioning 10. Recovery experience

Examples  Can you tell me a bit about your hopes or dreams for the future?  What are some things in your life that you hope you can do and change in the future?  What kinds of activities make you feel happy and fulfilled?  If you went to bed and a miracle happened while you were sleeping, what would be different when you woke up? How would you know things were different? Changing the Questions Adapted from Ijeoma Achara

 Life Vision: What would you like your life to look like, be about?  Recovery Capital Domains: Explore what’s going well and challenges in each domain  Goals: document aspirations and goals for an improved quality of life  Priorities: What would you like to change over the next 3 – 12 months? Recovery Plans: Recommended Elements

What’s the Difference?  Who’s in charge: collaborative team vs. expert: driven by person in or seeking recovery  Timeframe: long-term recovery vs. treatment episode  Focus: recovery capital domains vs. clinical domains  Strategies: holistic vs. professional  Goal: process vs. product Recovery Plan: Not the same as a Treatment Plan Adapted from Ijeoma Achara

 Consult Recovery Capital Assessment  Articulate goals: short- and long-term  Identify strengths and areas of support  Determine and locate helpful resources  Explore challenges and strategies to overcome  Pre-action and action steps  Establish timeline  Recovery reengagement plan Critical Elements for Recovery Planning

 Peer service roles support people in making their own choices  Informed risk-taking is encouraged even when failure is an option  Goals and strategies are determined in partnership and directed by the person in recovery  Services are person-centered and adapted to fit individual needs, strengths, and preferences The Peer Relationship in Recovery Planning

Moving Forward

Foundational Principles of Collaboration  Complementary, rather than opposing, paradigms  Search for potent combinations and sequences  Mutual respect for different ways of knowing and types of experience  Philosophy of choice  Shared goal of people getting and staying well Adapted from Ijeoma Achara

Collaboration with Recovery Representation  Nothing about us without us (Inclusion as first thought versus afterthought)  Representation of multiple recovery pathways  Authenticity of representation  Avoiding problem of double agentry  Giving back versus cashing in William White

Common and shared elements:  To be active agents of change in our own lives – not passive recipients of services  To manage/eliminate and move beyond our symptoms  To participate in valued social roles and relationships  To embrace purpose and meaning in our lives and make worthwhile contributions  To not be defined by our illness  To live a self-actutalized life abundantly! Shared Vision for the Future Adapted from Ijeoma Achara

Vision Renewed  Recovery Works  Recovery is Possible  Recovery is an Expectation!

Tom Hill Director of Programs Faces & Voices of Recovery Thank you!