Recovery-Oriented Systems of Care (ROSC)

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Recovery-Oriented Systems of Care (ROSC)

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The Substance Abuse and Mental Health Services Administration (SAMHSA) has published the Recovery-Oriented Systems of Care (ROSC) Resource Guide. A ROSC supports the premise that there are many pathways to recovery. Recovery-oriented activities include providing a menu of traditional treatment services and alternative therapies, including peer recovery coaching, acupuncture, meditation, and music and art therapy. Recovery support services, including employment assistance, child care, care management and housing support, may enhance the engagement of individuals and their families in achieving and sustaining recovery.[1] The following websites will provide you with background material to assist in understanding recovery-oriented activities and approaches:
  • Guiding Principles and Elements of Recovery-Oriented Systems: What do we know from the research?

[1]

  • Recovery as an Organizing Concept: [2]
  • Building Resilience, Wellness and Recovery: A Shift from Acute Care to a Sustained Care Recovery [3] Go to Resources & Publications; Type ‚Building Resilience, Wellness and Recovery‛ in Search bar and press ‘Go.’
  • Connecticut Department of Mental Health and Addiction Services: Proposed Model for Mental Health Recovery and Recovery-Oriented Services: [4]
  • The Institute for Research, Education, and Training in Addictions (IRETA): [5]

· Faces and Voices of Recovery: Guide to Mutual Aid Resources: [6]


Like other chronic health conditions, substance use disorders typically require long-term involvement with the health care system and parallel informal networks. Recovery-oriented services and supports include provision of continuing care following treatment, education regarding self-care, regular check-ups and linkage to community resources.

The following websites will provide you with information on the ROSC framework and health care reform:

  • Perspectives on Systems Transformation: How Visionary Leaders are Shifting Addiction Treatment Towards a Recovery-Oriented System of Care (ROSC): [7]
  • Coalition for Whole Health: Summary of Recommendations for Including Mental Health and Substance Use Disorder Prevention, Treatment, Rehabilitation, and Recovery in Health Reform: http://lac.org/doc_library/lac/publications/CWH--Healthcare_Reform_Recommendations-- summary.pdf
  • The Effects of Health Care Reform on Access to, and Funding of, Substance Abuse Services in Maine, Massachusetts, and Vermont [8]
  • Vermont Health Care Reform Legislation

[9]


In order to learn more about the guiding principles of recovery and the early conceptual work done to define the systems elements of a ROSC, refer to the following website:

  • National Summit on Recovery: Conference Report [10] Enter ‚National Summit on Recovery‛ in the Search bar.

Additional resources associated with the history of ROSC, including reports, research briefs, monographs, training manuals, and presentations can be found at:

  • The Institute for Research, Education, and Training in Addictions (IRETA) [11]

Recovery Support Services (RSS)

Each of the partners in a ROSC can play a role in the provision of recovery support services. When RSS are provided across the continuum of care, they support resiliency, open doors to service access and engagement, and support long-term recovery. Person-centered supports bolster successful individual and family outcomes.

Recovery support services are non-clinical services that assist individuals and families working towards recovery from substance use disorders. They incorporate a full range of social, legal, and other resources that facilitate recovery and wellness to reduce or eliminate environmental or personal barriers to recovery. RSS include social supports, linkage to and coordination among allied service providers, and other resources to improve quality of life for people in and seeking recovery and their families. RSS are provided by professionals and peers and are delivered through a variety of community and faith-based groups, treatment providers, and RSS providers. Provision of RSS is based upon the needs in a person’s individualized recovery plan.

While typically viewed as available post-treatment, recovery support services within the construct of ROSC can be offered before, during, or even in lieu of treatment. This approach and its supports are inclusive of pre-treatment, as well as promotion of resiliency in prevention and early or brief interventions. These are tenets that also form the basis of a public health model and are aligned with the principles of health care reform.

As a ROSC implements RSS, a few key steps can guide the process:

  • Secure a broad range of supports through leverage with all partner systems.
  • Focus on the specific needs of the individuals and families.
  • Engage peer recovery coaches who have a personal recovery focus.
  • Define competency guidelines. (Competency guidelines should reflect requirements of third- party insurance carriers if possible.)

Resources found below can assist States and providers to achieve these steps.

  • An RCSP Conference Report: Emerging Peer Recovery Support Services and Indicators of Quality [12]
  • Ethical Guidelines for the Delivery of Peer-based Recovery Support Services [13]
  • Manual for Recovery Coaching and Personal Recovery Plan [14] Select ‚Clinical Guidelines‛; select ‚Addiction Guidelines; scroll down to ‚Recovery Coach and Recovery Planning Manual
  • Center for Substance Abuse Treatment: What are Peer Recovery Support Services [15]
  • Recovery Coach Training Manual [16]
  • Financing Recovery Support Services: Review and Analysis of Funding Recovery Support Services and Policy Recommendations [17]
  • Vermont Substance Abuse Recovery - provides access to the Recovery Centers Website; Friends of Recovery-Vermont (consumer/advocacy network); and the Vermont Peer Resources Guide [18]

Role of Recovery Management

Within the framework of a ROSC, recovery management provides treatment and recovery supports to individuals with severe substance use disorders. This targeted approach to a specific population differs from the overarching role of a ROSC. As has been described, a ROSC serves those with or at risk for substance use problems. The persons served within a ROSC encompass the general population, at-risk populations, harmful users of alcohol and drugs, those with dependence, and those with chronic dependence.

To learn more about the role of recovery management within ROSC, please access the following websites:

  • Implementing Recovery Management Part 1: The Organizing Concept [19]
  • Implementing Recovery Management Part 2: Making the Philosophical Shift [20]
  • Frontline Implementation of Recovery Management Principles [21]
  • Recovery Management & Recovery-Oriented Systems of Care: Scientific Rationale & Promising Practices [22]
  • Recovery Management in Communities of Color [23]
  • Implementing Recovery Management Part 3: Recovery Coaching Pays Dividends [24]


The websites below will provide you with information on initiatives that are underway across the country:

  • National Summary of CSAT’s Regional Recovery Meetings [25]
  • A Recovery Revolution in Philadelphia [26] Enter the title in the Search bar and press ‘Go.’
  • Continuum of Services System Re-Engineering Report, September 24, 2008 [27]
  • Vermont Blueprint for Health [28]
  • Building a Recovery-Oriented System of Care: A Report of the NCIOM Task Force on Substance Abuse Services, January, 2009. [29]


The following three documents can be found at: [30]

  • Access to Recovery (ATR) Approaches to Recovery-Oriented Systems of Care: Three Case Studies
  • Provider Approaches to Recovery-Oriented Systems of Care: Four Case Studies
  • Approaches to Recovery-Oriented Systems of Care at the State and Local Levels: Three Case Studies

Planning and Implementing Steps

Creating a ROSC requires thoughtful and strategic planning, particularly as policymakers, providers, the recovery community, and the general public negotiate systems changes that involve the integration of substance use services within the general health care system. This evolution is ongoing, so be mindful of its implications as you plan and implement ROSC within your State or community. Identifying where you are in the ROSC planning and implementation process, while being cognizant of the new health care environment, will guide you in determining priorities and next steps.

Readiness Assessment

A Readiness Assessment should examine your willingness and ability to establish a platform for a ROSC. A coalition of stakeholders should be engaged to consider important questions that examine the level of commitment and feasibility for the effort. That dialogue may prompt divergent opinions before you reach a consensus. However, that is to be expected, given the time and effort needed to construct a functional ROSC. A facilitator with no vested interested in the outcome can play a key role in keeping the discussion moving and maintaining a record of the proceedings.


The next step in the assessment readiness process is to establish a Conceptual Framework. Use of focus groups and key participant interviews can ensure input from a broad spectrum of the community. Participation by persons in recovery, as well as family members and other allies, can provide valuable insights as stakeholders develop a vision for a system of care, clearly articulate values for how services should be delivered, and determine the desired outcomes for individuals, families and communities. Some of the questions posed to the stakeholder group during the assessment readiness exercise may help structure the conceptual framework. In addition, other important questions are:

  • What is your definition of recovery?
  • What should a ROSC look like in your community?
  • Why is a change needed?
  • What outcomes do you hope to achieve through a ROSC?


A discussion and consideration of these issues should result in a common vision, and in common values, system elements, outcomes, and definitions. Without general agreement on the conceptual framework for the ROSC, the process cannot successfully move forward. Below are additional resources to inform your dialogue when developing a conceptual framework:

  • Connecticut Recovery Core Value

[31]

  • Overarching Tenets of the Recovery Initiative [32]
  • A Recovery Revolution in Philadelphia

http://www.ireta.org/ Enter the title in the Search bar and press ‘Go.’


Needs Assessment

Completion of a Needs Assessment is another key step in developing an informed ROSC plan. Stakeholders must understand the extent of substance use problems, the populations affected, gaps in services and supports, and services and systems that require quality improvements. This information will allow you to target and maximize resources. Identifying community and organizational strengths is equally important, as they provide a strong foundation upon which to build. This identification can strengthen discussion among ROSC partners, and provide a path for support in your implementation plan. Stakeholders should also examine policies and practices to assess their alignment with ROSC elements, in order to determine what changes are required to structure a functional ROSC.

  • Assessment Primer: Analyzing the Community, Identifying Problems, and Setting Goals [33]
  • Yale Program for Community Health and Recovery: Recovery Self-Assessment (Provider Version)

[34]


Capacity Building

The needs assessment process has identified the strengths as well as gaps in services within the current systems. It should now be translated into a plan to enhance the capacity of your system where needed. Capacity Building is an integral part of successful systems change implementation. Does your ROSC have capacity at all levels, the staff or volunteer level, the organizational level, the broader systems level?

Each systems element should reflect a comprehensive, person-centered, and individualized approach to service provision. It is understandable that all systems may not initially align with this operational philosophy, but it’s important to determine what your capacity needs are so that they can be addressed. In addition to workforce capacity, technology and other resources should be considered. For further information on capacity building, see the resources below:

  • Capacity Primer: Building Membership, Structure and Leadership [35]
  • National Certified Recovery Specialist

[36]

· State HIE Resources [39]

Strategic Planning Process

The next step in ROSC planning and implementation is development of a Strategic Planning Process. After you have assembled a planning team that represents stakeholder interests, articulated a vision, conducted a needs assessment, and constructed a capacity building plan, it’s time to develop a strategic plan including specific ROSC goals. A critical step at this juncture is, once again, to ensure sufficient community representation, inclusive of individuals in recovery, family members and other allies.

Following that, the planning team should be charged with identifying measurable objectives for each goal, as well as strategies to support achievement of each goal. Other tasks that should be completed in order to reinforce a strategic planning process are:

  • Developing action steps,
  • Identifying timelines and parties responsible for completing each strategy,
  • Creating a resource plan, and
  • Documenting the entire plan.


To guide you further during the strategic planning process, refer to the information below:

· Getting to Outcomes 2004: Promoting Accountability Through Methods and Tools for Planning, Implementation, and Evaluation [42]


Implementation

Now that the planning is well underway, it’s time to begin assembling the resources for Implementation. Engagement of the community at large, as well as individuals in recovery, their families, and other allied members, will strengthen efforts to identify and garner resources for a ROSC. Implementation of ROSC will require changes to a number of institutional practices and processes. Trying to affect change in multiple levels of systems that interact with other multiple levels of systems can be overwhelming. You may initially focus on workforce development, financing, policy enhancement, technology changes to support data tracking and billing, or one of many other topics that will come into play when putting your plan into practice. Due to the complexity and challenges inherent in a major systems change, it may be wise to implement ROSC incrementally.

To further inform your implementation efforts, see the resources listed below:

  • Implementation Primer: Putting Your Plan into Action [43]
  • Implementing a Statewide Recovery-Oriented System of Care: From Concept to Reality [44]
  • Connecticut Department of Mental Health and Addiction Services: Proposed Model of Mental Health Recovery and Recovery-Oriented Services: [45]
  • Cultural Competence Primer: Incorporating Cultural Competence into Your Comprehensive Plan [46]
  • Connecticut DMHAS. Practice Guidelines for Recovery-Oriented Care for Mental Health and Substance Use Conditions [47]
  • Connecticut Implementation of Person-Centered Care [48]
  • California Access to Recovery (CARE) Recovery Support Services Screening and Assessment Tool http://www.californiacares4youth.com/downloads/RSS%20screening%20and%20assessment% 20tool.pdf
  • Practice Guidelines for Recovery-Oriented Behavioral Health Care [49]
  • Recovery Advocacy Toolkit: Resource Guide [50]

· Peer/Recovery Support Specialists within Behavioral Health Agencies: Desktop Guide [51]


As States and communities move toward implementation of ROSC, Financing may become a primary concern. Please read about the ways in which ROSC can be funded here. (page 24&25)


Having the necessary Policies and Regulations in place is critical to successful implementation of a ROSC. A thorough inventory of existing policies and regulations will determine which require amendment or modification. This process should also include identification and subsequent development of new policies and regulations that further support the framework for ROSC implementation and ongoing operation. A successful ROSC is made up of multiple stakeholders, representing multiple systems. Thus, the inventory must include a broad range of policies and regulations. These policies exist at the State level and local provider level, and will further unfold at the Federal level as national health care reform is realized. Please read more about this topic here: (page 25)


Below are resources to assist States and providers in developing guidelines, policies, and procedures to structure a ROSC:

· OMHAS Resilience and Recovery Policy Statement [54]


Evaluation

Evaluation is integral to a systems change process. It can promote sustainability of effective policies, programs, and practices. It can inform funding decisions, guide clinicians and other service providers when they are working with patients, assist in patient decision making, and educate peers. Evaluation approaches typically look at the processes as well as the outcomes, ranging from short- to long-term goals and objectives. Please read more about evaluation here: (page26)

For information pertaining to evaluation activity, see the resources below.

  • Institute for Healthcare Improvement: [55]
  • The Network for the Improvement of Addiction Treatment (NIATx): [56]
  • CDC Framework for Program Evaluation: [57]

· Connecticut DMHAS Recovery Self-Assessment: Executive Summary: [58]


Additional ROSC Resources

  • Is Your Drug Court Fit for Recovery? A Recovery Check-up [59]
  • A Conceptual Bridge Between the Mental Health and Addiction Fields [60]
  • The Recovery Revolution: Will it include children, adolescents, and transition age youth [61]
  • CDC. Principles of Community Engagement [62]

· Guiding Principles and Elements of Recovery-Oriented Systems: What do we know from the research? [63]


Additional Health Care Reform Resources

· Reports of Interest [68]









[69]