NTN Responses (18) to Request from NASADAD

NTN Responses (18) to Request from NASADAD Regarding Recovery Oriented Systems of Care

Received & Compiled by NASADAD Staff by/on December 23, 2009

33. Request from NASADAD, 12/9/09 What kinds of Recovery Oriented Systems of Care (ROSC) services, and/or activities does your agency fund/support?

Summary: States with ROSC initiatives: AR, FL, ID, IL, KS, MN, MO, NH, OH, OR, RI, SC, UT, VA States in planning stages: LA, PA (effective July 1, 2010), WA (planning and offering trainings)

Documents Collected by NASADAD: IA Elements of ROSC and Language in Managed Care Contract Effective Jan.1, 2010 (Dean Austin, [email protected] ) OR Resilience and Recovery Policy Statement ([email protected]) OR Press Release on Portland Miracles Club OR Revised Administrative Rules’ Values and Functions OR Letter from Richard Harris re Peer-Delivered Services Curriculum Development OR Strategic Plan for 2008 OR Building Resilience and Recovery Based Systems of Care (PPT by Karen Wheeler)

See end of this paper for Resources provided by Dr. Michael Flaherty, Executive Director, Institute For Research, Education and Training in the Addictions (IRETA) and Northeast ATTC

AR, Garland Ferguson: The State of Arkansas is involved in a pilot program of Continuing Care with 4 of our comprehensive alcohol and drug treatment programs.

FL, Darran Duchene: The list below was developed originally under our Access to Recovery grant. It includes services that we developed to focus specifically on an individual's recovery and the needed long-term support. We continue to fund or support most of them (despite loss of ATR funding).

1. Screening / Assessment: Screening services screen potential clients for appropriateness and eligibility for program services and complete a preliminary assessment. Assessment services assess, evaluate, and provide assistance to individuals and families who have been determined to be eligible and appropriate for program services to determine level of care, motivation, and the need for services and supports to assist individuals and families identify their strengths. 2. Parenting/Child Development (Group): An intervention or treatment service that is provided in a psycho-educational group setting involving two or more participants and/or their families and one or two therapists or counselors. It is intended to facilitate the instruction of evidence-based parenting/child development knowledge and skills. 3. Parenting/Child Development (Individual or Family): An intervention or treatment service that is provided in a psycho-educational setting involving a participant and/or his/her families and one or two therapists or counselors. It is intended to facilitate the instruction of evidence-based parenting/child development knowledge and skills.

1 4. Family Support/Parenting: Family support/parenting is the provision of parenting training classes to participants and their families from a non-treatment provider. 5. Continuing Care/Aftercare: Continuing Care/Aftercare services, including but not limited to relapse prevention, are a vital part of recovery in every treatment level. These activities include client participation in daily activity functions that were adversely affected by substance abuse impairments. New directional goals such as vocational education or re-building relationships are often priorities. Relapse prevention issues are key in assisting the client’s recognition of triggers and warning signs of regression. Services help families and pro-social support systems reinforce a healthy living environment. 6. Recovery Support Specialist/Peer Specialist Coaching: Services coaching/Individual services coordination consists of activities aimed at linking the service system with the person, coordinating the various system components, monitoring service delivery, and evaluating the effect of the services received. These services are provided by a peer specialist/services coach who has been specifically trained regarding this function in a department-approved training through the Florida Certification Board for Addiction Professionals. 7. Transportation: Transportation is a service that is purchased through another entity, such as the public transportation system. The type of service must be clearly specified. 8. Residential Level 4/Transitional Housing: This type of licensed facility is appropriate for persons who have completed other levels of treatment, particularly residential levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting person responsibility and reintegrating the individual into the worlds of work, education, and family life. 9. Transitional Living Facility: This type of facility may have less than twenty-four (24) hours per day, seven (7) days per week on-premise supervision. This is primarily a support service and, as such, treatment services are not included in this cost center. Provided may be an array of ancillary, recovery support services in a transitional living environment. Total cost will not exceed $1000.00 for 30 days of service. 10. Supportive Housing/Living Services: Supportive housing/living services assist persons with substance abuse problems in the selection of housing of their choice. These services also provide the necessary services and supports to assure their continued successful living in the community and transitioning in to the community. Services include training in independent living skills. Services provide for the placement and monitoring of recipients who are participating in non-residential services, and recipients who have completed or are completing substance abuse treatment who need assistance and support in independent or supervised living within a "live-in" environment. 11. Support Groups: Support groups are important elements of recovery, especially in terms of relapse prevention where the giving and receiving of feedback regarding triggers and warning signs are essential. This includes faith-based group services. The groups provide peer support to facilitate problem solving, communication skills development and personal growth, leading to healthy living environments. 12. Support Counseling: Support counseling means a form of counseling that is primarily intended to provide information and motivation to clients. This service may be provided by faith-based or community-based recovery support providers. It may be provided to individuals or families and includes pastoral/spiritual counseling and support.

2 13. Employment Coaching: Employment Coaching services are community-based employment services that provide long-term, ongoing support for as long as it is needed to enable the recipient to gain and maintain employment. 14. Day Care: Day care services provide a structured schedule of activities for four (4) or more consecutive hours per day for children of persons who are participating in a substance abuse day-night or intensive outpatient treatment program.

ID, John Kirsch: We have the elements of ROSC with varying degrees of organization and systemization, depending on what part of the State. Idaho has extreme frontier and urban areas resulting in a variance of system implementation.

The following are the services currently provided in Idaho: I believe that our non-criminal justice, criminal justice, PWWC and specialty court programs offer an array of services which would serve to exemplify ROSC services providing for an increasing collaboration and cooperation among referral, treatment and RSS services. Elements of services that are funded though state, federal and community based auspices are: ASAM based LOC and continuum of care; mandated common SUD Assessment (GAIN) for all publicly funded treatment services; evidenced based practices; child welfare, housing; mental health services; case management (clinical for co-occurring and basic); adult transitional housing; family therapy (client present); transitional housing for PWWC services; family therapy; case management (clinical, intensive and basic); drug and alcohol testing; family/marital/life skills education (individual and group - client not present); adult safe and sober housing; client transportation; child care; after care; lodging; rent and deposits; personal care items; parenting class; nutrition classes; stress management classes, and; vehicle modification.

Services are provided through partnerships at the state and local level with and among state licensed treatment and RSS providers, a statewide management services contractor, child protective services, correctional agencies; faith and non-faith based community based organizations, schools, clinics and social service agencies.

IL, Gajef McNeill: In regard to ROSC, Illinois is currently developing the basis for the system. DASA has submitted a draft of its performance based contracting plan to the provider community and other stakeholders for comment and review where performance measures are tied to services including recovery management. A significant amount of progress has been made with Illinois's efforts to develop Oxford Houses. In the last 2 years, 14 houses have been developed and there are a total of 54 statewide. Just today, DASA hosted a celebration for the development of two Oxford Houses for veterans (men). The houses were named for two fallen soldiers in combat in the Middle East. These are the first Oxford Houses for veterans in the nation. The intent is to develop two more for women in the spring.

KS, Charley Bartlett: 1. We funded 911 TANF clients state wide with identified SUDs issues for strength based intensive case management through a program called Solutions Recovery Care Coordination in FY 2009. We receive TANF funding for this program and it provides services for up to a year in development of barrier reduction to engaging and retention in recovery services, and in economic and family stability. 2. We began a Peer Mentor services as a billable in outpatient level I and II treatment services in July of this year that is billable under Medicaid and SAPT grant as an outpatient service. Peer

3 mentors must be in long term recovery and complete a certification program of education requirements and supervision. Crisis intervention is included in the services. 3. We provide funding for Oxford House development including a revolving loan fund, and other services such as landlord negotiations, facilitation of marketing to treatment centers and other agencies, and Oxford House Alumni development. 4. We provide a system of community based intensive case management for one year for persons convicted of 4th time DUI. It provides services for engagement in the recovery community, and development of peer supports and recovery capital.

LA, Quinetta Womack: We are in the planning stages in Louisiana.

MN, Larry Burzinski: We just funded one grant in Southern Minnesota, dealing with persons with chronic CD issues.

MO, Nora Bock: I originally reported that Missouri was in the planning stages, but after reading other people’s submissions, MO would have a lot to report. We just feel like we’re not where we should be. Perhaps we’re further along than I’ve given us credit for. Or, perhaps the term “recovery-oriented system of care” is nebulous enough that I’m not sure when and if a system has achieved “it.” We have a strong ATR-funded system that includes a wide array of services provided through faith-based and non- traditional organizations. We are looking to strengthen and expand options for housing for those in recovery. We have a pretty good menu of clinical services to better meet the needs of consumers. We’re really pushing hard for providers to focus on the 5 domains of recovery. We have lots of good things in place that we can build upon and hope to do so in the near future.

NH, Rosemary Shannon: NH has 2 recovery support contracts. One funds a Women's Leadership Training Initiative (WLTI), teaching empowerment skills to recovering women and provides targeted AOD prevention for adolescent girls: http://www.nhtwr.org/

The second program is with Friends of Recovery - New Hampshire (FOR-NH) which provides support to parents and families of youth and adults involved with alcohol and drugs: http://www.fornh-faster.org/

OH, Joyce Starr: Currently, our ATR grant provides a Recovery Oriented Systems of Care. We currently have treatment providers and Recovery support services which includes faith based organizations and small businesses (including housing) that provide support services which may include job skills, life skills, housing, child care, travel etc… Throughout the three years, we have served over 4,500 individuals with both treatment and RSS services.

OR, Karen Wheeler: Below are some of my points about Oregon's policy, system and program development related to ROSC. Most importantly, from a state perspective, ROSC is not a "program" or one stand alone initiative. It is a complete transformation requiring a "fearless inventory" of every single structure that currently supports the infrastructure within a statewide addictions system.

Foundation / Public Vision Statement - Resilience and Recovery Policy Statement (attached) -

Governance and Alignment with the Recovery Community – The Addictions and Mental Health Division (AMH) formed an advisory committee comprised of people in addictions recovery and meets monthly with this group. AMH keeps this group informed about the following activities and solicits input and direction from this group about many areas of business concerning addiction treatment, funding, and program development. This group has become more and more "seasoned" and played a significant role advocating for addiction services during the 2009 legislative session. Several of the members have provided legislative testimony and met with key legislators through the legislative process.

Culturally Specific Strategic Partnerships: AMH had formed a strategic partnership with a culturally specific recovery group, known as "The Miracles Club" on NE Portland. AMH has co-sponsored at least three major events at "Miracles" focused on reducing stigma, promoting recovery oriented systems of care, and bringing African American and Hispanic / Latino recovery stakeholders together to celebrate Recovery Month and share successes and challenges (see attached press release).

Policy Structure - Revised administrative rules governing to addictions, gambling, mental health services and supports, which included definition and minimum standards for peer-delivered recovery support services for the first time. Values and functions for the rule are also attached.

Workforce Development - AMH developed a process for approving peer-delivered services curriculum. Established minimum standards for curriculum and developed application and review process. A letter signed by Richard Harris, AMH Assistant Director and SSA for Oregon is attached. On the addictions side, the counselor certification board is interested in developing a registry for qualified recovery peer mentors. AMH is having conversations with the board at this time.

Financing - Peer Delivered Services: Medicaid: On the MH side, encounter codes for peer delivered services have been opened and mental health organizations are able to make the decision to use the codes. This is in process on the addictions side. State General Funds/SAPT/Beer and Wine Tax: For non-Medicaid business, AMH recently added peer delivered services to a core set of services that may be reimbursed within a continuum of care for parents with dependent children. This service set is specifically designed for parents who are involved in the CW system or at risk of becoming involved in that system.

Recovery Housing: AMH funds housing development activities to grow capacity for Oxford Homes and other Recovery Housing opportunities through contract with a statewide group called "RAP" the Recovery Association Project. AMH also funds alcohol and drug free housing projects (bricks and sticks development) and rental assistance/vouchers.

Investment Strategy: What is currently funded is inadequate to support ROSC. Oregon embarked upon a very aggressive campaign in 2007 to seek input from a broad group of stakeholders and partners, use epidemiological data, and analyze the current system to come up with a strategic investment plan for the continuum of addiction services (final report attached). This work resulted in recommendations for

5 specific funding for recovery support services including peer delivered services and housing. AMH develops budget proposals each biennium that are aligned with this strategy.

Other related approaches promoted and supported by AMH include NIATx and promotion of the NQF Standards of Care for Substance Use Disorders, which are consistent with approaching addiction as a chronic, relapsing illness requiring a continuum of services across the lifespan.

PA, Steven Seitchik: BDAP Definition of RSS in Treatment Manual for 2010-2015 Grant Agreement Recovery Support Services (RSS) are non-clinical services that assist individuals and families to recover from alcohol and other drug problems. These services complement the focus of treatment, outreach, engagement and other strategies and interventions to assist people in recovery in gaining the skills and resources needed to initiate, maintain, and sustain long-term recovery. RSS are not a substitute for necessary clinical services.

Effective July 1, 2010, SCAs will be permitted to use BDAP funds for the following RSS Ø Mentoring Programs in which individuals newer to recovery are paired with more experienced people in recovery to obtain support and advice on an individual basis and to assist with issues potentially impacting recovery (these mentors are not the same as 12- step sponsors); Ø Training and Education utilizing a structured curriculum relating to addiction and recovery, life skills, job skills, health and wellness that is conducted in a group setting; Ø Family Programs utilizing a structured curriculum that provides resources and information needed to help families and significant others who are impacted by an individual’s addiction; Ø Telephonic Recovery Support (recovery check-ups) designed for individuals who can benefit from a weekly call to keep them engaged in the recovery process and to help them maintain their commitment to their recovery; Ø Recovery Planning to assist an individual in managing their recovery; Ø Support Groups for recovering individuals that are population focused (i.e. HIV/AIDS, veterans, youth, bereavement, etc.); Ø Recovery Housing (for parameters in funding this RSS, please see Section 6.04); and Ø Recovery Centers where recovery support services are designed, tailored, and delivered by individuals from local recovery communities.

SCA Treatment Needs Assessment & SCA Treatment Plan The 2009 SCA Treatment Needs Assessment includes an objective requiring the SCA to identify recovery support services that the SCA needs in developing a Recovery Oriented System of Care (ROSC) and to identify recovery support services that are currently available in the county or region. Additionally, the SCAs 2010 Treatment Plan includes a section to describe how the SCA will begin to move from an acute model of care to a recovery management model of care. The SCA must show which elements of a ROSC are being incorporated into its delivery system. The SCA may discuss how it is developing relationships with community recovery organizations, coordinating with multiple systems, establishing an ongoing process of systems improvement, including persons in recovery in program development, and involving families and other allies in the recovery process, etc. In addition, the SCA must specifically identify the use of BDAP-funded as well as non-BDAP funded recovery support services.

6 RI, Becky Boss: RI pays for ROSC thru the ATR and it covers the following services: Child Care Victims of Domestic Violence counseling Employment Services/Job training Family and marriage counseling Housing Assistance and Recovery Housing Interpreter Services Life Skills Parent Education/Child Development Mental Health counseling Psychiatric evaluations Recovery coaching Spiritual and faith-based support services Transportation Youth enrichment

We do cover some services through other contracts using general revenue and block grant funds which include: sober housing (revolving loan fund), child care, continuing care, and psych. services.

SC, Frankie Long: In South Carolina, we have gotten Peer Support approved by Medicaid as a reimbursable service. Right now our programs provide aftercare services to clients. We are in the process of developing a long term plan for how this should look in the future. Our statewide FAVOR chapter is applying for a Recovery Oriented Grant to open a Recovery Community Organization. We also are able to provide case management services for one year after the client is discharged from services.

UT, Dave Felt: In Utah, we provide $100,000 to USARA, which stands for Utah Support Advocates for Recovery Awareness... (Their choice... It used to be called Substance Abuse Recovery Advocates... but they wanted to get Substance Abuse out of the title...) They provide a variety of services under the acronym of making the CASE for recovery, with CASE standing for Celebrate, Advocate, Support and Educate. They organize and run Recovery Day Events, advocate with the Legislature, provide a speaker's bureau, speak at treatment centers etc.

We have a statewide clinical committee working on ROSC issues, following up the ROSC discussion we had at the SAPT Training in Denver.

Various initiatives to expand aftercare services have been implemented across the State, but as yet there is not a cohesive State directed strategy... that is what the committee is working on.

VA, Mellie Randall: Virginia DBHDS has has contracted with SAARA (Substance Abuse and Addiction Recovery Advocacy), a statewide advocacy organization for at least 10 years. Our current contract with SAARA is in the amount of $125,600 and has specific deliverables. SAARA has become increasingly involved in providing peer-to- peer services and currently has an ROSC grant from SAMHSA. SAARA also has a number of affiliates around the state (www.SAARA.org). In addition, we are currently supporting (at the level of $1 million), through competitive grants, an additional 5 peer-to-peer ROSC programs. Last fall, SAARA and DBHDS co-sponsored a 2 day statewide conference on ROSC that was attended by about 200 people, and we also sponsored an overnight planning retreat (focusing on strategic planning) for the 5 ROSCs that we

7 are funding. Virginia DBHDS is a strong believer in the power of ROSC to support persons seeking recovery.

VT, Peter Lee: In Vermont, we provided small grants (10k to 30k depending on the size of the grantee) to each of our providers to develop plans and begin implementation of a ROSC in their communities. We also fund 9 Recovery Centers throughout Vermont.

WA, John Taylor: Washington is in planning stages and we're in the process of offering trainings around the State.

WY, Laura Griffeth: The State of Wyoming is not yet involved with ROSC--- but if I have my way, we will be eventually.

Resources provided by Dr. Michael Flaherty, Executive Director, Institute for Research, Education and Training in the Addictions (IRETA) and Northeast ATTC: For the call next week, the attendees might want to visit the below web site and view the 3 papers recently posted there by SAMHSA/CSAT. These papers have only recently been released and were several years in review and forthcoming. They are now official. http://www.samhsa.gov/samhsanewsletter/Volume_17_Number_5/WhitePapers.aspx or www.ireta.org

Two Monographs and one new article are also key for the states:

“Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices” (2008) by William White and IRETA which lays out the scientific and clinical components of ROSC including suggested System process and outcome measures. Free for download at www.ireta.org and

“Peer-based Addiction Recovery Support – History, Theory, Practice and Scientific Evaluation” (2009) by William White and the GLATTC which clearly defines “roles” of professional and recovery support specialists with 19 state and city case studies of ROSC in action. This is also available free for download at www.ireta.org. Lastly, there is a paper featured at www.ireta.org on the “Role of Partnership in developing a ROSC of Care: The Philadelphia Experience” (2009) by Roland Lamb, Arthur Evans and William White that many are finding very useful in building ROSC in their states and communities.