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Pathways to recovery Worcestershire

Pathways to recovery Worcestershire. David Best 28.3.2011. What do we know about recovery?. 1. Personal predictors . Why do people recover? Moos (2011). When do people recover?. Maturing out Key life events / transition points Personal resources and skills Social supports

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Pathways to recovery Worcestershire

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  1. Pathways to recovery Worcestershire David Best 28.3.2011

  2. What do we know about recovery? 1. Personal predictors

  3. Why do people recover? Moos (2011)

  4. When do people recover? • Maturing out • Key life events / transition points • Personal resources and skills • Social supports • Positive aspirations and expectations • Opportunity

  5. Who are the people who recover?

  6. Recovery studies in Birmingham and Glasgow (Best et al, in press; Best et al, in press) • Ready access to populations • Untapped group of recovery champions • Glasgow: predictors of higher quality of life: • More meaningful activities in the last month • Greater number of non-using peers in the recovery network • Different levels of recovery in abstinent and maintained groups

  7. What do we know about recovery? 2. System models

  8. Areas for practice change in Philadelphia • Service engagement – via outreach and community education • Strength based assessment procedures • Rapid access with minimal waiting times • Client choice in decision-making – co-production, and service relationship that is based on partnership • Service delivery sites that are community-integrated • Peer-based recovery support services • Continuity of contact over time and across levels of care • Post-treatment checkups and supports • Collaborate with indigenous recovery support organisations

  9. 10 key lessons from Connecticut • Expanded care continuum • Person and family centred • Data-driven decision making • Finance reinvestment strategies • Local/regional service collaborations • Dynamic service / innovation approaches • Strong recovery community relationships • Strong multi-faceted communication strategy • Best practices tied to ‘episode of care’ model • Many recovery support and peer-directed services

  10. Chicago:Principles of recovery management • Maintaining a recovery focus • Promoting consumer empowerment and self-management • Support the de-stigmatisation of experience • Adopting evidence-based practices • Utilising emerging technologies • Integrating addiction, mental health and primary health-care services • Establishing recovery partnerships • Incorporating the ecology of recovery • Providing ongoing monitoring and support • Promoting the continual evaluation of the model

  11. NTA and the segmentation process • CSAT (2009) say that 58% of people with a substance dependence will eventually recover • Is that right? • Does it apply to the UK? • Who are they? • Is there anything you can do to make that figure go up or down?

  12. Hypothesis • There are naturally occurring turning points in all life trajectories – birth of a child, getting a job, getting married, moving house etc • It is also possible that turning points in trajectories can be ‘induced’, and one of those possible transitions is a successful treatment episode • It is hypothesised that the reason why some potential turning points are actualised is based on the reserve of recovery capital that the individual possesses

  13. Best and Laudet (2010)

  14. 09/10 data on % meeting all 3 criteria

  15. OVERALL MEASURE OF WELLBEING • 3 ‘OBJECTIVE FACTORS’ • STABLE HOUSING • NO HEROIN OR CRACK USE • MEANINGFUL ACTIVITY • 3 ‘SUBJECTIVE FACTORS’ • PHYSICAL WELLBEING • PSYCHOLOGICAL WELLBEING • QUALITY OF LIFE • ALL MADE EQUAL (0-1) • TOTAL SCORE OUT OF 6

  16. Changes in recovery capital on TOP forms baseline to 6 months

  17. Discharge reason by recovery capital at most recent review

  18. Predictors of a planned discharge • More objective recovery factors at baseline (abstinence, housing, activity); OR= 1.8 • Changes in overall recovery functioning to review 1 • Changes in overall functioning to review 4; OR = 2.7 • Changes in overall functioning to review 5: OR = 2.0

  19. Individual recovery stories (n=176) • The longer someone is in recovery, the more enablers they report (r=0.18, p<0.05) • There are consistent positive correlations between how many of the three enablers people in recovery report and their physical wellbeing (r=0.18, p<0.05), psychological wellbeing (r=0.32, p<0.001) and quality of life(r=0.17, p<0.05) • There are clear relationships between wellbeing and activity (training or employment): • Activities in last month and physical health (r=0.28, P,0.01) • Activities in last month and psychological health (r=0.44, p<0.001) • Activities in last month and overall quality of life (r=0.29, p<0.001)

  20. OVERALL CANDIDATE MODEL • BASELINE OF RC ENABLERS – possibly mediated by gender and age • PERSONAL RECOVERY CAPITAL • SOCIAL RECOVERY CAPITAL This creates an individual model that is then multiplied against: • COLLECTIVE RECOVERY CAPITAL IS ASSESSED AS A FRACTION BASED ON: • TREATMENT QUALITY AND ACCESS • RECOVERY CHAMPION VISIBILITY AND ACCESS TO GROUPS • SOCIAL COHESION, DEPRIVATION AND OPPORTUNITY

  21. MAINSTREAM VISIBLE RECOVERY COMMUNITY RECOVERY MUTUAL AID PROJECT COLT CONNECT 3 BASEMENT MAINSTREAM TREATMENT TTP DETOX CSMS BASEMENT ENTRY SOURCES CRIM JUSTICE SELF OTHER

  22. So what can we do about recovery? • Generate access to models of recovery; to activity; and to recovery hubs • Inspire the belief that recovery is possible • Offer early access to recovery pathways • Workers to be part of their own recovery community

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