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Richard Spence, Ph.D., M.S.S.W Gulf Coast Addiction Technology Transfer Center,

Recovery Oriented Systems of Care for Substance Use Disorders. Richard Spence, Ph.D., M.S.S.W Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin. Addiction is a Chronic Disorder -- Similar to other Chronic Health Problems. Compliance Relapse

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Richard Spence, Ph.D., M.S.S.W Gulf Coast Addiction Technology Transfer Center,

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  1. Recovery Oriented Systems of Care for Substance Use Disorders Richard Spence, Ph.D., M.S.S.W Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin

  2. Addiction is a Chronic Disorder -- Similar to other Chronic Health Problems Compliance Relapse Chronic Illnesses/ Addictions Rate Rate Alcohol 30-50% 50% Opioid 30-50% 40% Cocaine 30-50% 45% Nicotine 30-50% 70% Insulin Dependent Diabetes Medication less than 50% 30-50% Diet and Foot Care less than 50% 30-50% Hypertension Medication less than 30% 50-60% Diet less than 30% 50-60% Asthma Medication less than 30% 60-80%

  3. However, our addiction treatment system is built on an acute care model – short treatment at time of crisis – expected to cure the problem. A chronic care model is more continuous and places emphasis on the lifelong work of maintaining health and recovery. A recovery model focuses on long-term personal effort and on system support for achieving and maintaining health.

  4. Recovery-Oriented Systems of Care: A Paradigm Shift Recovery-Oriented Systems of Care shift the question from “How do we get the client into treatment?” to “How do we support the process of recovery within the person’s environment?”

  5. Person’s Entry into treatment Discharge A Traditional Course of Treatment for a Substance Use Disorder Symptoms Resource: Tom Kirk, Ph.D

  6. A Traditional Service Response Acute symptoms Discontinuous treatment Crisis management Resource: Tom Kirk, Ph.D

  7. Continuous treatment response A Recovery-Oriented Response Promote Self Care, Rehabilitation Resource: Tom Kirk, Ph.D

  8. Recovery Zone Helping People Move Into A Recovery Zone Symptoms Improved client outcomes Time Resource: Tom Kirk, Ph.D

  9. Benefits of Moving into a Recovery Zone • Chronic care approaches, including self-management, family supports, and integrated services, improve recovery outcomes 2 • Integrated and collaborative care has been shown to optimize recovery outcomes and improve cost-effectiveness 3 ¹Dennis, Scott & Funk, 2003 2 Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001 3Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)

  10. Recovery-Oriented Systems of Care Approach • In the recovery-oriented systems of care approach, the treatment agency is viewed as one of many resources needed for a client’s successful integration into the community. • No one source of support is more dominant than another. • Various supports need to work in harmony with the client’s direction, so that all possible supports are working for and with the person in recovery. Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC.

  11. ROSC support person-centered and self-directed approaches to care that build on the personal responsibility, strengths, and resilience of individuals, families and communities to achieve health, wellness, and recovery from alcohol and drug problems. Recovery V Individual Family Community Wellness Health

  12. ROSC offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathways to recovery. Recovery Services & Supports Family/Child Care Alcohol/Drug Services Vocational Education Housing/ Transportation Individual Family Community PTSD &Mental Health Physical Health Care Spiritual HIV Services Financial VSO & Peer Support Health Wellness Legal Case Mgt

  13. Recovery-Oriented Systems of Care • Support person-centered and self-directed approaches to care that build on the strengths and resilience of individuals, families and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems. • Offer a comprehensive menu of services and supports to meet the individual’s holistic needs for continued recovery.

  14. Elements of ROSCinclude the following: • Person-Centered • Individualized & Comprehensive Services • Responsive to Culture & Personal Belief Systems • Community-based • Commitment to Peer Services • Involvement of Family and other Allies • Ongoing Monitoring & Outreach

  15. Houston Recovery Oriented System of Care (H-ROSC) PLANNING INITIATIVE Funded by HHSC/ DSHS RESOURCES Addiction Technology Transfer Center (UT) Council on Alcohol and Drugs Houston Other Consultants and Resources Philadelphia Connecticut Chicago El Paso Dallas

  16. Planning Participants: Conveners Council on Alcohol and Drugs Houston (Leonard Kincaid) Texas Dept State Health Services (Philander Moore) Gulf Coast ATTC (Dick Spence) Houston and surrounding area Agencies: ● Mayor’s Office (Houston Crackdown) ● City of Houston Health & Human Svcs ● Treatment (6 agencies) ● Coalition of Behavioral Health Services ● Drug Court and Veterans Court Program ● Vocational programs ● Universities ● Peer assistance coaches ● AIDS Foundation ● Customer representatives (persons in recovery).

  17. Workgroups ---- Areas of INTEGRATED FOCUS 1.  Treatment Providers             What is it like to provide treatment services in Houston?              Barriers that limit good client outcomes             What recovery oriented changes would be helpful 2. Customer Perspectives             What is treatment and recovery like in Houston             Barriers to recovery             What changes would be helpful          3.  Peer to Peer Recovery Assistance             How are peer-to-peer workers organized  and supported?             What would help 4. Recovery Support Resources             What exits             What is needed 5. ­ Public Policy             City Initiatives and programs Social Services and Health:  (policies and plans)             Funding and Regulatory issues

  18. Workgroup Objectives ● Identify Needs for Improvement ● Identify New Directions to address those needs for future funding for implementation with little or no funding

  19. ROSC Phases ROSC Phases

  20. ROSC Phases ROSC Phases

  21. H-ROSC Calendar - 2010 May 10 Organizational Kickoff with Core Team of Key Stakeholders, Leaders, and Resource People May 21 Core Team meeting June 4 Core Team meeting June 18 Core Team meeting July 2 Core Team meeting July 5 Preliminary ROSC draft completed by CADH, ATTC July 30 Major HROSC Stakeholder Meeting - National speakers and facilitators - community briefing and input on preliminary plan September 15 Final plan delivered to DSHS

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