consumer involvement recovery oriented systems of care

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Consumer Consumer Involvement Involvement Recovery Oriented Systems of Recovery Oriented Systems of Care Care

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Consumer Consumer InvolvementInvolvementRecovery Oriented Systems of CareRecovery Oriented Systems of Care

Multiple AreasMultiple Areas

Planning, delivering and evaluating Planning, delivering and evaluating servicesservices

While consumers:While consumers: Active partners in determining their own careActive partners in determining their own care Emphasis on development of self-management Emphasis on development of self-management

strategiesstrategies

Connecticut Department Connecticut Department of Mental Health and of Mental Health and Addiction Services Addiction Services

Practice Guidelines for Practice Guidelines for

Recovery-Oriented Recovery-Oriented Behavioral Health CareBehavioral Health Care

1. Recovery experiences are integrated into treatment and training

2. Representation of people in recovery on agency steering committees and work groups

3. Planning, provision of peer support and mentoring, and providing training is reimbursed

4. Patient receives an initial orientation to agency practices

5. Initial orientation is supplemented by the routine availability of information and agency updates

6. Policies that allow people in recovery maximum opportunity for choice and control in their own care

7.Measures of satisfaction are collected routinely and in a timely fashion

8.Formal grievance procedures are made readily available to people to address their dissatisfaction with services

9.Administration enforces ethical practice

10.Assertive recruitment of people in recovery for staff positions

11.Ongoing support for the development of a range of peer-operated services

12.Self-disclosure by employed persons in recovery is respected and not prohibited

13.Client exercise of rights is encouraged

14.The agency offers to host events and advocacy activities

Recovery CoachRecovery Coach

Role designed to bridge the chasm between brief professional treatment in an institution setting and sustainable recovery within each patient’s natural environment

Known as recovery coach, recovery mentor, recovery support specialist, recovery guide, personal recovery assistant

Recovery CoachRecovery Coach

Peer Credentials: experiential knowledge and experiential expertise

Variable models: clinical model - treatment aide community development model -organizer

and mobilizer of community recovery resources

Recovery CoachRecovery Coach

Variable providers delivered within existing treatment

institutions Delivered by other local community

institutions (church, school, labor union) delivered by a grassroots recovery

advocacy or recovery support organization

Recovery CoachRecovery Coach

The range of services provided with the framework of recovery coaching is indicated by the broad range of roles being proposed within “recovery coach” pilot studies. The recovery coach is a:

motivator and cheerleader (exhibits bold faith in individual/family capacity for change; encourages and celebrates achievement)

ally and confidant (genuinely cares, listens, and can be trusted with confidences)

Recovery CoachRecovery Coach

truth-teller (provides a consistent source of honest feedback regarding self-destructive patterns of thinking, feeling and acting)

role model and mentor (offers his/her life as living proof of the transformative power of recovery; provides stage-appropriate recovery education and advice)

problem solver (identifies and helps resolve personal and environmental obstacles to recovery)

Recovery CoachRecovery Coach

resource broker (links individuals/families to formal and indigenous sources of sober housing, recovery-conducive employment, health and social services, and recovery support)

advocate (helps individuals and families navigate the service system assuring service access, service responsiveness and protection of rights)

community organizer (helps develop and expand available recovery support resources)

Recovery CoachRecovery Coach

lifestyle consultant (assists individuals/families to develop sobriety-based rituals of daily living)

a friend (provides companionship)

Recovery CoachRecovery Coach

A recovery coach is NOT a:

sponsor (does not perform AA/NA service work on “paid time”)

therapist (does not diagnose, probe undisclosed trauma/“issues”; does not refer to their support activities as “counseling” or “therapy”)

Recovery CoachRecovery Coach

A recovery coach is NOT a:

nurse/physician (does not make medical diagnoses or offer medical advice), or a

priest/clergy (does not respond to questions of religious doctrine nor proselytize a particular religion/church)

Recovery CoachRecovery Coach

Should these functions be integrated into an existing role or within a new service role?

“Why do people need a recovery coach if they have access to a Twelve Step sponsor?”

“We don’t need recovery coaches. These functions are already being performed by addiction counselors, outreach workers and case managers.”

Recovery CoachRecovery Coach

The recovery coach role incorporates and refines some dimensions of existing roles (e.g., outreach worker, case manager) and is positioned between two other recovery support roles: the recovery support group sponsor and the addiction counselor.

Recovery Coach/ Recovery Coach/ Sponsor DifferencesSponsor Differences Link to Organization - accountabilityLink to Organization - accountability Philosophical FrameworkPhilosophical Framework Scope of those ServedScope of those Served

Recovery primingRecovery priming Nature of RelationshipNature of Relationship Scope of Services ProvidedScope of Services Provided CompensationCompensation Sponsor Limitations –anonymity, advocacySponsor Limitations –anonymity, advocacy

Recovery Recovery Coach/Addiction Coach/Addiction Counselor DifferencesCounselor Differences Service Goals and TimingService Goals and Timing Education and TrainingEducation and Training Use of SelfUse of Self Nature of Service Relationship – ethicsNature of Service Relationship – ethics Location of Service DeliveryLocation of Service Delivery Service Delivery Framework – recovery Service Delivery Framework – recovery

planplan

Recovery Coaches can…Recovery Coaches can…

increase the number of people entering addiction treatment

decrease the number of people “lost” from waiting lists to enter addiction treatment

divert individuals with lower problem severity and higher recovery capital into natural recovery support systems in the community (creating a better stewardship of limited treatment resources)

Recovery Coaches can…Recovery Coaches can… enhance recovery capital (e.g., employment, school

enrollment, stable housing, healthy family and extended family involvement, sobriety-based hobbies, financial resources) and self-defined quality of life

increase post-treatment abstinence outcomes

delay the time period from discharge to first use following treatment

Recovery Coaches can…Recovery Coaches can…

prevent lapses from becoming relapses

shorten the number, intensity, and duration of relapse episodes following treatment

decrease treatment readmission rates (slow the revolving door of treatment)

enhance treatment retention and completion

Recovery Coaches can…Recovery Coaches can… decrease the time between relapse and re-

initiation of treatment and recovery support services (preserving recovery capital and minimizing personal and social injury)

result in readmission to less intensive, expensive levels of care

reduce attrition in first year affiliation rates with AA and other sobriety based support groups

Peer Based Recovery Peer Based Recovery Support ServicesSupport Services The reciprocal, non-hierarchical nature of the

recovery coach relationship leaves open the danger of boundary violations and hidden abuses of power.

Rigorous screening and hiring procedures, training and supervision and the development of codes of ethical conduct governing the delivery of P-BRSS

Recovery Community Recovery Community CentersCenters

www.vtrecoverynetwork.org http://www.proact.org/recovery_centers/http://www.proact.org/recovery_centers/

the_philadelphia_recovery_community_centhe_philadelphia_recovery_community_center/ter/

ReferencesReferences

White, W. (2006). Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity. Philadelphia, PA: Philadelphia Department of Behavioral Health and Mental Retardation Services.