Promoting A Person-

Centered
Recovery-Oriented
System of Care
FAVOR Upstate
 A New Paradigm for Addictions
Treatment

◼ Person-centered
◼ Chronic care model
◼ Recovery-oriented
 Problem
We can agree: Everyone
acknowledges “denial” as a
symptom or common
characteristic of addiction?

We can agree: Denial = Lack of

Awareness—”I don’t need help”?
Now Watch This—Has been this
way for 40 years (NHSDUH)
***Addiction (note: of those “getting help” most improve, many
recover fully)

10%

90%

90% Not getting help

10% Getting help
 Why?
◼ 90% “not getting help” were
asked why they are not getting
help?

◼ Theoverwhelmingly most
common response was “I don’t
need it”?
 But the generally accepted
approach to addiction
◼ Wait until the person seeks help…
◼ “If you want what we have to offer”…
◼ “Must hit bottom”…
◼ Person must admit they have a
problem
◼ They have to “want it”…
◼ Attraction versus promotion…
◼ Ambivalence is labeled as
“resistance”
 Ctrl---Alt---Delete

1) Addiction by definition involves

denial
2) 90% of people with addiction DO
NOT get help
3) But we are ok with it because the
main reason they don’t get help is
they believe they DO NOT NEED
HELP….
Is it time for
something
new?
 Guiding Principles ...
What works in a helping
relationship?
what works in therapy, coaching, counseling etc…

30%
40%

15%
15%

Relationship HOPE Technique Client Factors

9
 Recovery:
A Systems Perspective
(OVERVIEW)
The Prevailing Acute Care Model
◼ An encapsulated set of specialized service
activities (assess, admit, treat, discharge,
terminate the service relationship).
◼ A professional expert drives the process.
◼ Services transpire over a short (and ever-
shorter) period of time.
◼ Individual/family/community is given impression
at discharge (“graduation”) that recovery is now
self-sustainable without ongoing professional
assistance (White & McLellan, in press).
 Treatment (Acute Care Model)
Works!
Post-Tx remissions one-third, AOD use
decreases by 87% following Tx, &
substance-related problems decrease
by 60% following Tx (Miller, et al,
2001).
Lives of individuals and families
transformed by addiction treatment.

Treatment Works, BUT…

 1. AC Model Vulnerability:
Attraction
Only 10% of those needing
treatment received it in 2015
(Substance Abuse and Mental
Health Services
Administration, 2016); only
25% will receive such services
in their lifetime (Dawson, et al,
 Why People Who Need it Don’t
Seek Treatment
◼ Perception of the Problem, e.g., isn’t
that bad.
◼ Perception of Self, e.g., should be able
to handle this on my own.
◼ Perception of Treatment, e.g.,
ineffective, unaffordable, inaccessible
or “for losers”
◼ Perception of Others, e.g., fear of
stigma and discrimination
Source: Cunningham, et, al, 1993; Grant
1997
 Coercion vs. Choice
The majority of people who do enter
treatment do so at late stages of
problem severity/complexity and
under external coercion
(SAMHSA, 2015).
The AC model does not voluntarily
attract the majority of individuals
who meet diagnostic criteria for a
substance use disorder.
Recovery-oriented Systems of
Care
Recovery-oriented systems of care
(ROSC) are networks of formal and
informal services developed and
mobilized to sustain long-term
recovery for individuals and families
impacted by severe substance use
disorders. The system in ROSC is
not a treatment agency but a macro
level organization of a community, a
state or a nation.
 ROSC Video
https://peerrecoverynow.org/
 Then & Now

Vision 1973 Reality 2022

• Recovery • Treatment

TX Recovery
A Recovery Focus Would Be:
• Person Centered
• Strength Based
• Meet the client where they are at when they walk in
the door
• Services would be Trauma Informed
• Services would be culturally appropriate
• Counselor / Case Manager would be an ally not an
adversary
• Would focus on supporting the person’s recovery
within their community.
Describing Recovery Oriented System
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?”
H.Westley Clark, MD, JD, CAS, FASM
“Your job is not to tell people
what treatment they need, or
how to live their lives; but to
help facilitate people’s
dreams”
– Sheilah Clay, CEO, Neighborhood Service Organization,
Detroit
What is a Recovery Oriented
System?
A ROSC is NOT:
• A model or new initiative
• Primarily focused on the integration of recovery
support services
• Dependent on new dollars for development
• A group of providers that increase their
collaboration to improve coordination
• An infusion of evidence based practices
Key Concepts of a Recovery Oriented System

• Involves Individual,
Family & Community
• Recovery Management • Focuses on Recovery
• Recovery Capital • Strength/assets based
• Utilizes Peer Support • Meets patient where
they are
• “Nesting” Recovery
within the
Community
Outcomes for the Individual
Outcomes for the System
 SC ROSC Mission
To develop and mobilize formal and informal
networks of services to build on and sustain long
term recovery for individuals and families
impacted by substance use disorders.
 SC ROSC Vision
A South Carolina of healthy people, families and
communities where recovery from substance
use disorders is expected, honored and
celebrated.
 Recovery Capital Video

• https://peerrecoverynow.org/
 “Addiction professionals are in a unique position to witness all of
the things that drugs do to people, but it may be harder in that role
to understand what drugs do for these same people before the
crash and burn experiences that bring them to us. Understanding
that “doing for” dimension is critically important for within it can be
found the seeds of addiction and the ingredients that must be
discovered or forged to sustain recovery.
The same needs met through drug use must be met in recovery”

~William White, Recovery Rising pg. 9

Recovery Plans begin with
Learning About Recovery
Capital
FOUR COMPONENTS OF
RECOVERY CAPITAL

1.Social
2.Physical
3.Human
4.Community
 “Recovery capital constitutes the
potential antidote for the problems that
have long plagued recovery efforts”

-William White
 SOCIAL PHYSICAL HUMAN
Support, guidance & More palpable resources Values, knowledge,
sense of belonging such as; income, vehicles, educational/ vocational
that comes from housing, food, & clothes skills & credentials,
relating to others as well as health problem solving
capacities, self-efficacy
Connections from These can be found in
purpose
relationships often sober living, employment
found in memberships centers, temporary These are the internal
in family, groups & assistance, & access to resources that provide a
community reliable transportation sense of purpose & hope

COMMUNITY

W. White-2008
EXPLORING LIFE DOMAINS HOLISTICALLY
Plans using Recovery Capital as the foundations truly provide a
blueprint for recovery explore a wide range of life domains such as:

• Recovery/ wellness • Relationships & social

• Housing support
• Living independence • Physical health
• Financial independence • Leisure & recreation (fun)
• Employment and/or • Legal issues
education • Mental wellness &
spirituality
Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara
Consulting Inc. - 2017
 BEING RECOVERY ORIENTED
In How We Ask the Questions

• Can you tell me a bit about your hopes or dreams for

the future?
• What kind of dreams did you have before you
started having problems with alcohol or drug use,
depression, etc.?
• What are some things in your life that you hope to
do & change in the future?
• 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?
These types of questions support not only Treatment Planning, but a
broader whole-life Recovery Plan
Community Recovery Capital
Community attitudes/ policies/ resources related to addiction & recovery
that promote the resolution of alcohol and other drug problems
Community Recovery Capital includes:
• Active efforts to reduce addiction/ recovery-related stigma
• Visible & diverse local recovery role models
• A full continuum of addiction treatment resources
• Recovery mutual aid resources that are accessible and diverse
• Local recovery community support institutions (recovery
centers, treatment alumni associations, recovery homes,
recovery schools, recovery industries, recovery ministries/
churches)
• Sources of sustained recovery support & early re-intervention
(e.g. recovery checkups through treatment programs,
employee assistance programs, professional assistance
programs, drug courts, or recovery rganizations)
 KEEPING THE EYE ON THE PRIZE
Questions Focused on Future State

Housing
– Where do you live right now?
– Do you feel safe & secure in your current
home?
– Are you interested in living somewhere else in
the future
– How would you like your living situation to
look in the future: On your own? With other
people in recovery?
Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara
Consulting Inc. - 2017
 KEEPING THE EYE ON THE PRIZE
Questions Focused on Future State

Education & Employment

– Are you currently employed? Can you share where & what you are
currently doing?
– Are you happy with your current job? If not, what would you like to
look different?
– What is your ideal job?
– Is getting a job something you’re interested in at this point in time?
– What kind of support do you think would be helpful to around
employment?
– How far were you able to get in school?
– Is going back to school something you would be interested in either
now or in the future?
– What were some of the things you’ve learned in the past that have
interested you most?
Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara
Consulting Inc. - 2017
 RECOVERY CAPITAL SCALE
• High recovery capital + High problem
severity High
High
• Low problem severity + High recovery capital Problem
Recovery
• Low problem severity + Low recovery capital Severity/
Capital
Complexity
• High problem severity + Low recovery capital

Clients with high problem severity but Low

Low
Problem
very high recovery capital may require Recovery
Severity/
fewer resources to initiate and sustain Capital
Complexity
recovery than an individual with
moderate problem severity but very low
recovery capital.
~W. White
Tips For Using The Recovery Capital Scale
• Let the conversation unfold naturally – ask questions
beyond what is on your form
• Use the discussion to build relationship
• Be sure to ask open ended questions about family, allies,
constellation of support and naturalistic supports related to
parenting and children
• Keep the form (or computer) screen where the client can
see it – you are working on this together
• Be very familiar with the tool, make eye contact, don’t re-
ask questions that have already been answered in
conversation
• Open ended questions, genuine interest, and showing
empathy go a long way
• Be fully present – listen, respond, be sincere
 Connecticut Practice Guidelines for Recovery-Oriented Care for Mental
Health and Substance Use Conditions, Second Edition.

Tondora, Heerema, Delphin, Andres-Hyman, O’Connell, & Davidson (2008).

42
DEVELOPING RECOVERY PLANS
One Person at a Time
Person-Centered Recovery Planning

We’ve heard the term but: What is it, really?

Person-Centered Planning has been

identified as a cornerstone of a Recovery-
Oriented System of Care

Tondora et al
 RECOVERY ORIENTED CONCEPTS FOR
RECOVERY PLANNING
• Person-centered: The individual defines their own
goals and their unique path towards those goals
• Strengths-based: The service array has emphasis on
individual strengths, assets, and resilience
• Individually-tailored: Responsive to an individual’s
culture, ethnic, & racial identity affiliations. Also
geared toward connecting individuals to natural
community supports and activities of their choice
 PEER SUPPORTS’ ROLE IN
RECOVERY PLANNING:

Empower individuals to make Informed

Decisions about their own care and
direction forward
Participant Driven: Role of Peers

Practice Guidelines

• Peers uses personal lived experience to support

an individual during planning process
• Peers engages family supporters & allies as a
part of the process
• Peers emphasize strengths-based recovery
planning & person-centered goal development
 TO BE PERSON-CENTERED, A PLAN
SHOULD:
• Be about what promotes recovery (the solution) as
opposed to just reducing the disease (the problem)
• Be built from what is learned through an exploration of
Recovery Capital
• Be reflective of the individual’s interests and goals
• Include who individuals will seek out as supports (paid &
unpaid)
• Build on and mobilize strengths
• Include strategies for promoting recovery in the community
• Allow for the inevitable waxing and waning of priorities,
uncertainty in approaches and changes in goals
Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara
Consulting Inc. - 2017
 KEEP IT SIMPLE STANLEY (KISS)

• An important aspect of Recovery Planning is to keep goals

simple and manageable
• Bringing unmanageability as a result of goals that are too
complex defeats the purpose of doing them
• The Peer can help keep goals manageable looking in 1-2
areas to support the client on and then collaborating to
identify bite-sized action steps
• A Recovery Plan is not one and done it is a Roadmap for
Action
Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara
Consulting Inc. - 2017
 RECOVERY PLANS
• Integrate all the information shared to date
• A written document that guides the collaboration
between the Peer & participant
• Driven by the individual
• Help Peers focus on supporting the areas of
greatest importance to the client
• Go beyond discontinuing the use of substances by
focusing on “why” the client wants to quit – “what”
are the life changes they want because they quit
 RECOVERY PLANNING BEST PRACTICE IS
WHEN PEERS:
• Incorporate strengths as a central focus of every recovery plan
• Recognize the power of simple, yet powerful questions such as
“What happened?” & “What do you think would be helpful?”
• Include an individual’s most significant or most valued
accomplishment(s)
• Record the individual’s responses verbatim, including his or
her unique goals
• Facilitate Recovery Planning as a collaborative process
• Use personal lived experience to support an individual during
planning process
• Engage supporters & allies as a part of the process
“Self-determination & Self-direction are the
foundations for recovery as individuals
define their own life goals and design their
unique path(s) toward these goals.”
-SAMHSA 2012
 Strategies: Methods or Action Steps used
to Achieve Identified Goals
• Should be “bite-sized”
• Concrete
• Time-limited
• Developed in partnership with client
• Written on Recovery Plan
• Designed for successful completion
 My Recovery Plan – Where Dreams Get Real

I want to (goal):

I’d like it to happen by (date):

How I’m going to get there:
Strategies/Steps I’ll Need to Take Target Date My Strengths My Skills & My Challenges & My Allies & Supports How’s it Working?
Resources Stressors
 Current life priorities by abstinence duration stage
(Laudet & White, 2010)
ABSTINENCE DURATION STAGE
<6 mos. 6 – 18 mos. 18 – 36 m 3 yrs +

Recovery from substance use 49.9% 43.2 52.7 34.1

Employment 31.1 36.2 35.1 34.1

Family and social relationships 19.8 23.5 23.0 24.4

Education and training 17.9 16.0 23.0 14.6

Achieve and enjoy improved, ‘normal’ productive
17.0 19.3 26.8 27.9
life
Family reunification 15.1 11.7 18.9 7.3

Emotional health and self-work 15.1 14.8 21.7 6.1

Housing and living environment 12.3 21.3 13.6 8.6

Physical health 11.3 11.7 6.8 20.7

Spirituality and religion 9.4 9.6 2.7 2.4
Financial and material 6.6 14.9 8.1 7.3
Give back, help others 1.9 3.2 6.8 3.7
Legal
55 issues 0 1.1 1.4 0
 SUPPORTING STRENGTHS

By the time folks end up at our door they’ve usually

been pretty beat down and their deficits loom large
People often have strengths they don’t recognize as
strengths
Let’s do an activity using the strengths handout in
your participant manual & see for ourselves
Activity: Step into the Peer Support Seat!
1. Without looking at the Strengths worksheet, jot down
as many strengths of your own as you can think of – you
have 1 minute
2. Next, turn to the Strengths Handout in your manual and
take the next 30 seconds to check off which of these
strengths you possess:
• How many strengths did you identify in Step 1 vs. how
many in Step 2?
• How many of you saw qualities on the Handout that
you didn’t recognize as strengths?
 Provide
On-Going Support
Guided by Recovery Plan
Informed by Recovery
Recovery Plans Capital
Client-Driven Mobilize strengths
Future Focus Promote the solution
Goals
Assess/Learn Strategies
Strengths Guide Peer work
Recovery Capital
Changes over time
Assets
Dreams
Resources
Needs