Marge Hanna, MEd Beverly Haberle, MHS, LPC, CAADC

Rosa Davis, MSW, ACSW

Operationalizing the Role of Peers to Support Recovery from Substance Use

Disorders

RCPA Annual Conference October 8, 2014

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Objectives

1. Understand Recovery-Oriented Systems of Care (ROSC), Recovery Management and implications for treatment and recovery

2. Identify roles that peers might have in substance use disorder recovery management — pre, during and post treatment

3. Learn how one agency created a peer culture and its role in recovery for women

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Community Care Quick Facts

• Recovery-oriented behavioral health managed care company

• Provider owned (UPMC), Federally tax exempt non-profit 501(c)(3), Licensed as a Risk-Assuming PPO in PA

• Incorporated in 1996 and headquartered inPittsburgh, PA

• Providing Medicaid behavioral health services in 39 PA counties

Challenges for the Substance Use Disorder Service Systems

Why We Need Change Now

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Challenges for SUD Service Systems

• Minimal post treatment continuing care

• Narrow focus of treatment services & persons in recovery (PIR) need more than traditional services

• No one agency/system has enough resources to meet all of the needs of PIR

• Growing body of SUD research and recognition that service systems must be aligned to what we know and understand about addiction – what really works

• Many have lost hope that they can recover

• We are treating a chronic disease with an acute care model – often serial episodes of self-contained unlinked interventions

Recovery-Oriented Systems of Care & Recovery Management

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Recovery-Oriented Systems of Care

• Recovery-oriented systems of care (ROSC) are networks of formal and informal services developed and mobilized to promote community health and wellness for all

• Coordinated and collaborative multi-agency/community based system with goals:– Prevent the development of substance use disorders– Intervene earlier in the progression of the disease– Reduce the harm caused by addiction– Help individuals transition from brief experiments in

recovery initiation to sustained recovery maintenance– Promote good quality of life, community health and

wellness for all

Achara Consulting, Inc.

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A ROSC ….

• Builds on the strengths and resilience of individuals, families and communities as individuals take responsibility for their long-term recovery, health and wellness

• Makes services and resources more available that people can use to meet their needs

• Offers a variety of supports that work for and with each person to restore their lives (an ongoing process)

• Acknowledges the value of many pathways to and cultural aspects of recovery

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ROSC

…shifts the question from:

“How do we get the client into treatment”

to

“How do we support the process of recovery within the person’s life and

environment? “

Lonnetta Albright, BS, CPEC, Great Lakes ATTC, 2013

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Elements/Core Values of a ROSC…

• Person-centered and strength based

• Participation of family, caregivers, significant others, friends, community

• Individualized and comprehensive services and supports anchored in the community

• Continuity of services and supports

• Partnership-consultant relationships

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Elements of a ROSC…

• Responsiveness to culture and personal belief systems

• Commitment to peer recovery support services and inclusion of the voices and experiences of recovering individuals and their families

• System-wide education and training

• Ongoing monitoring and outreach

• Outcomes driven and research based

• Adequately and flexibly financed

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Recovery Management/ROSC

We are in the midst of a transition/ transformation…

• Shifting from a crisis-oriented, professionally-directed, acute-care approach with its emphasis on isolated treatment episodes

• To a person-directed, recovery management approach that provides long-term supports and– Recognizes the many pathways to health and

wellness– Acknowledges importance of individual, family

and community assets – recovery capital– Spans pre, and post acute care outreach and

supports

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Recovery Management

Recovery Management (RM)

A philosophy for organizing treatment and recovery support services to enhance pre-recovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery….

William White

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Stages of Recovery & Recovery Management

1. Pre Recovery Engagement - Sudden or unfolding opportunity for change, commitment to recovery experimentation

2. Recovery Initiation and Stabilization

3. Recovery Consolidation and Maintenance

4. Enhanced Quality and Meaning of Life in Long-Term Recovery

5. Breaking Intergenerational Cycles of Problem Transmission

White, 2009; White 2013, Community Care Presentation

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Domains of Recovery Management

• Assertive Outreach and Initial Engagement

• Screening, Assessment, Service Planning,

and Delivery

• Continuing Support and Early Re-

intervention

• Community Connection and Mobilization

Beverly Haberle, MHS, LPC, CAADC Executive Director

The Council of Southeast Pennsylvania, Inc.

Identifying Roles Peers Might Have in Recovery Management

Pre, During and Post Treatment

About PRO-ACT

• Hosted by NCADD Local Affiliate The Council of Southeast Pennsylvania, Inc., which has a 39-year history of community mobilizing, education and advocacy.

• PRO-ACT, Pennsylvania Recovery Organization – Achieving Community Together, was founded in 1997.

• Grassroots advocacy initiative promotes the rights of and ensures opportunities for those still suffering from the disease of addiction, members of the recovery community and their family members.

• Provides advocacy and peer-to-peer recovery support services throughout the 5 counties of Southeastern Pennsylvania.

• 1998, 2001 and 2007 RCSP recipient, helped to grow PRO-ACT.• Operates 5 Recovery Community Centers and a Recovery

Training Center providing peer recovery support services to an average of 2523 individuals and families monthly.

• Offers an average of 199 volunteer, peer identified, peer-driven or delivered skill building workshops and support programs monthly.

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Why Recovery Support is Needed

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Supporting Recovery can ProvideLong Term Benefits

Recovery Trajectories:Percent Achieving Another Year of

Abstinence

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Individuals in Addiction Recovery Follow Many Pathways

• Mutual Aid Groups• Faith Based Recovery• Traditional Treatment• Medication Assisted Recovery• Peer-to-Peer Recovery Support

Services• “Natural”• Acupuncture• Yoga/Meditation• Combination of Any of the Above

What Are Peer-Based Recovery Support Services?

• Services to help individuals and families initiate, stabilize, and sustain recovery

• Non-clinical services that assist in removing barriers and providing resources to those contemplating, initiating, and maintaining recovery

• Provide assertive linkages to professional treatment and indigenous communities of support

They are not:• Clinical addiction treatment services

• Mutual aid support

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Peer-Based Recovery Support Services

• Draws on the power of example and lived experience.

• Largely voluntary: draws on the desire to “give back.”

• Based on the notion that both people in a relationship based on mutuality are helped and empowered.

Social Support and Associated PeerRecovery Support Services

Type of Support Description Peer Support Service Examples

Emotional Demonstrate empathy, caring, or concern to bolster person’s self esteem and confidence.

Peer mentoringPeer-led support groups

Informational Share knowledge and information and/or provide life or vocational skills training.

Parenting classJob readiness trainingWellness seminar

Instrumental Provide concrete assistance to help others accomplish tasks.

Child careTransportationHelp accessing community health and social services

Affiliational Facilitate contacts with other people to promote learning of social and recreational skills, create community, and acquire a sense of belonging.

Recovery centersSports league participationAlcohol and drug free socialization opportunities

25© 2013 Community Care Behavioral Health Organization

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 Other

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Peer Recovery Coaching• Coaching is an evidence based therapeutic process that is a

highly supportive role that provides structured coaching to those who wish to make significant change happen within their lives.

• Coaches offer a supportive and motivating environment to explore what they want in life and how they might achieve their aspirations and fulfill their needs.

• By assisting the PIR in committing to action and by being a sounding board to their experiences

• Coaching allows the individual the personal space and support they need to grow and develop.

• The coach’s role often helps with skill building, assisting the PIR to maintain the motivation and commitment needed to achieve their Recovery Plan goals and sustain long term recovery.

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Role Clarification

This is not the same as person with lived experience filling treatment staff positions –

both are important but do not have the same goals

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The Development of Structured Peer-based Recovery Support Services (P-BRSS)

• Peer-based recovery support services meet the needs of people at different stages of the recovery process.

• Services may: Precede formal treatment, strengthening the

motivation for change Accompany treatment, offering a community

connection Follow treatment, supporting relapse

prevention Be delivered apart from treatment to someone

who cannot enter the formal treatment system or chooses not to do so

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P-BRSS are Specifically Designed to:

• Reach people earlier in their addiction careers

• Enhance recovery initiation and stabilization

• Improve linkage to recovery mutual-aid groups and other recovery support institutions

• Facilitate the transition to successful recovery maintenance

• Enhance the quality of personal and family life in long-term recovery

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Defining Structured Peer Roles

• Recovery Coach/Recovery Supporter/Recovery Advocate/Recovery Management Support

• Skill Building/Support Group Facilitators• Certified Recovery Specialist (CRS) D&A• Certified Peer Specialist (CPS) MH• Peers support/coach PIRs throughout the

treatment experience• Peers can be either community or agency based

– or a combination of both to provide support before, during and after a treatment experience

• Can be paid or volunteer positions

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Goals of the Recovery Specialist/Coach

• Assist individual in assessing their recovery capital

• Assist individual in building or rebuilding recovery capital

• Help PIR to develop recovery plan to manage and sustain long term recovery

• Document life issues and support to address

• Document progress in stages of recovery

• Guide the new person into the recovery community

• Supports motivation to change

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Recovery Capital

• The quantity and quality of internal and external resources that one can bring to bear to initiate and sustain recovery from addiction (Granfield and Cloud, 1991, 2001)

• Domains documented to promote reductions in substance use include: Internet resources: Motivation, self-efficacy, coping, spirituality

• External resources: Treatment, community-based social supports, especially peer-support and 12-step, mutual aid groups

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Assessing and Increasing Recovery Capital

• Peer-Based Recovery Support Services (PBRSS) are grounded in a strength-based approach that focuses on wellness and a full reengagement with the community. Building on capacities (recovery capital) that

already exist within individuals and communities.

Making it possible for people to gain stability and create better lives.

Supporting individuals and their families to gain overall wellness.

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Recovery Plan

A Recovery Plan is a living document used to navigate an individual’s recovery and measure and document progress towards goals set by the person receiving services.

• The Recovery Plan is used to organize CRS activities with each individual and structures the relationship

• Highlights strength-based, self-determination and empowerment values Participants are coached to choose “Smart” goals – specific, measurable, action-oriented, realistic and timely

• The construction and use of the Recovery Plan helps build confidence and increase motivation as individuals achieve goals they set.

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Recovery Planning Benefits

• Supports Self-Efficacy

• Strength Based

• Promotes Hope

• Relationship Building

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Recovery Plan Categories

The recovery plan is organized into four categories and ten life domains. The four categories are:

• Individual Goals and Aspirations• Resources, Strengths and Skills• Barriers and Opportunities• Action Steps/Dates

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Benefits of PRSS

Effective outreach and engagement Manages recovery from a chronic condition

perspective Stage-appropriate Cost-effective Reduce relapse Promote recovery reengagement Facilitate reentry and reduce recidivism Reduce emergency room visits Create stronger and accountable communities

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Concerns

• As peer-based services are integrated into the existing treatment system or offered by free-standing independent organizations, there will be pressure to emulate the culture and character of the existing treatment system, including the professional roles of counselors and others.

• Peer models of recovery support can be corrupted and devoured by larger systems of care.

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Operationalizing the Role of Peers

Rosa Davis, MSW, ACSWExecutive Director

POWER

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• Helping women reclaim their lives from the disease of addiction and reducing the incidence of addiction in future generations

– Gender-responsive– Trauma-informed– Treatment & Recovery Support– Women with Substance Use & Co-

occurring Disorders

POWER’s Mission

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Gen

der

Matt

ers

The treatment needs of women differ from those of men.

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OWER Line

POWER Line412.243.8755

• Central Intake– Screening– Assessment– Referral & linkage to treatment

Treatment & Recovery Support

Licensed D&A Treatment

Recovery Support

• POWER House– ~25-bed residential

treatment (halfway house)

• POWER New Day– ~Outpatient & IOP– ~Partial

~Hospitalization

• POWER Connection– ~Screening/

Assessment– ~Mentoring

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Operationalizing the Role of Peers to Support

Recovery from Substance Use Disorders

Using Individuals with Lived Experience to Enhance Treatment and Recovery

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Intervention & recovery support . . . Lived experience . . . Model & coach

Mentoring

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• Women are typically offered Mentors in one of two ways:– Direct referral to mentoring– Result of a D&A assessment

• Referral sources:– CYF– POWER staff – D&A treatment/other providers

Referrals

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• Use lived experience as a way to engage

• Encourage & support treatment & recovery

• Model healthy recovery

• Offer peer-to-peer coaching

• Inspire hope and help create a vision for the future

Role of Peer Recovery Support

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• Help develop supports in community

• Teach skills needed to maintain recovery– With a focus on overall health

• Collaborate with providers & other agencies on behalf of clients to develop recovery plans & support treatment plans

• Connect to community resources

• Empower & guide to self-sufficiency & independence

Role of Peer Recovery Support

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• Assertive outreach & engagement

Specific Strategies & Interventions

Mentors can play an important role have in substance use disorder recovery management pre-treatment

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• Use Motivational Interviewing to engage women– Meet the client where she is

• Collaborative, empathic, supportive, person-centered approach to strengthening motivation

– Look for low-hanging fruit

Specific Strategies & Interventions

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Work with client to identify

strengths & needs

This assessment drives service

planning

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• Develop Wellness Plans – Service/Recovery plans that reflect goals & emphasize holistic approach to recovery– Clients, together with Mentors, develop

Wellness Plans with specific action steps

– When clients are in treatment, Mentors work with treatment staff to encourage clients’ active participation in treatment planning

Specific Strategies & Interventions

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• Connect to community resources – Help clients identify needs & resources

– Model navigating & negotiating skills

– Support clients in accessing services like:

• Housing assistance• Family support • Childcare• Healthcare

Specific Strategies & Interventions

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• Accompany clients to critical appointments – supporting and advocating on their behalf– Treatment– Court hearings– Supervised visits with children– Public assistance– Doctor appointments

Specific Strategies & Interventions

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• Help establish sober supports & model healthy recovery– Accompany to 12-Step meetings or

other self-help/support groups

– Accompany to community-based events & service or job fairs

– Help identify sober/fun activities for their children & them

Specific Strategies & Interventions

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Specific Strategies & Interventions

When working with women during & post treatment

We offer women in our POWER House program a Mentor & especially focus on women with have long histories of multiple treatment attempts.

Focus for women in treatment includes: collaboration w/treatment provider planning maximizing opportunities what’s different this time? transitions

In addition to the many benefits,

there are challenges to a

system that includes peer

mentoring.

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Challenges

Inter- and Intra-Agency Collaboration Challenges

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• Lack of long work histories or relevant work experience

• Work can trigger cravings to use or old traumas

• Boundary issues

• “Old school” approach to recovery that can interfere with embracing evidence-based and promising practices

HR Challenges

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• Tendency to adjust standards for this unique employee group

• Danger of supervisors expecting clinical interventions from non-clinical staff

Supervision Challenges

There are strategies for proactively mitigating some of the challenges often experienced, and for responding to them as they arise.

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Solutions

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• Culture that values lived experience & understands & appreciates role of peer recovery support

• Strong HR program w/availability of EAP

• Sufficient training budget

• Clear policies & procedures

Strong Infrastructure

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• Clearly articulate position expectations

• Make sure job descriptions are clear

• Thorough screening

• Consider incentives

• Establish behavioral interview questions

Attention to Recruitment & Hiring Practices

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• Devote ample time to a structured orientation process

• Dedicate sufficient dollars for adequate training– Right training topics– Plenty of training!

• Reassess training needs annually– Individual training plans developed in

relation to performance reviews

Excellent Orientation & Training

In her words . . .

“I am very grateful for my Mentor! I am a single mother and I wouldn’t have known what to do without her support, guidance and faith in me. Thank you!”

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Questions & Answers

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Marge Hanna, Medhanname@ccbh.com

Senior Director, Substance Use Disorder Initiatives

Community Care Behavioral Health Organization

1 East Uwchlan Avenue, Suite 300, Exton, PA 19341

610-594-2845

Beverly Haberle, MHS, LPC, CAADCbhaberle@councilsepa.org

Executive Director, The Council of Southeast PA, Inc.Program Director, PRO-ACT

252 West Swamp Road, Unit 12, Doylestown, PA 18901215-345-6644

Rosa Davis, MSW, ACSWRdavis@power-recovery.com Executive Director , POWER

7501 Penn AvenuePittsburgh, PA 15208

412-243-7535 , ext. 223

Contact Information

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Resources

• Center for Substance Abuse Treatment. Implementing Change in Substance Abuse Treatment Programs. Technical Assistance Publication Series 31. HHS Publication No. (SMA) 09-4377. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009. http://store.samhsa.gov/product/TAP-31-Implementing-Change-in-Substance-Abuse-Treatment-Programs/SMA09-4377

• Guiding Principles and Elements of Recovery-Oriented Systems: What do we know from the research? http://partnersforrecovery.samhsa.gov/rosc.html

• Recovery as an Organizing Concept http://www.attcnetwork.org/regcenters/index_greatlakes.asp - Search products

• Building Resilience, Wellness and Recovery: A Shift from Acute Care to a Sustained Care Recovery http://www.attcnetwork.org/index.asp

– Go to Resources & Publications; Type ‘Building Resilience, Wellness and Recovery‛ in Search bar and press ‘Go.’

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Resources

• Connecticut Department of Mental Health and Addiction Services: Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions (2nd edition) & Appendices http://www.ct.gov/dmhas/cwp/view.asp?a=2913&q=376510

• Faces and Voices of Recovery: Guide to Mutual Aid Resources http://www.facesandvoicesofrecovery.org/resources/support/index.html

• ROSC & Recovery Management Resources http://www.williamwhitepapers.com/rm_rosc_library/

• Recovery Self-Assessment Tools: Family/Significant Others, Administrators, Providers, Person in Recovery http://www.ct.gov/dmhas/cwp/view.asp?a=2913&q=376510

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Resources

• Building the Science of Recovery http://store.ireta.org/ and search all products

• Ten Essential Elements of Public Health http://www.apha.org/programs/standards/performancestandardsprogram/resexxentialservices.htm

• Recovery Management & Recovery-Oriented Systems of Care: Scientific Rationale & Promising Practices http://store.ireta.org/ and search all products

• Recovery-Oriented Systems of Care (ROSC) Resource Guide, September 2010, SAMHSA

• National Association of Recovery Community Organizations (ARCO) http://www.facesandvoicesofrecovery.org/who/arco

• The Council on Accreditation of Peer Recovery Support Services (CAPRSS) www.caprss.com

• http://www.nattc.org/learn/topics/rosc/docs/AddicMsgVol.11,Issue6NEW.pdf – Impact of adding recovery coaches, etc.

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Resources

• Life Beyond Treatment: Recovery-Oriented Systems of Care with William White and Ijeoma Acharahttp://www.attcnetwork.org/regcenters/index_southeast.asp

• Overview of a Recovery Oriented System of Care: Characteristics, Structure and Development, Ijeoma Acharahttp://www.attcnetwork.org/regcenters/index_southeast.asp

• Peer-based Addiction Recovery Support History, Theory, Practice, and Scientific Evaluation, William L. White, MA, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Mental, Retardation Services http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=510&rcID=3

• Addiction Recovery Peer Service Roles: Recovery Management in Health Reform, Face and Voices of Recovery, September 2010. http://www.google.com/cse?cx=014138928708248406068:ery9jlsrqj8&cof=FORID:0&q=health+care+reform