Transforming to a Recovery Focused System of Care An Overview of The Philadelphia Experience Roland Lamb Philadelphia, Becoming A Community Of Recovery

Transforming to a Recovery Focused System of Care

An Overview of The Philadelphia Experience

Roland Lamb

Philadelphia, Becoming A Community Of Recovery

Philadelphia A City of Innovation

Philadelphia’s School of the Future

COMMUNITY BEHAVIORAL HEALTHreceived the 1999 Innovations in American Government Award, presented by the Ford Foundation and the John F. Kennedy School of Government at Harvard University.

•We hold these truths to be self-evident, that all are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Philadelphia has a long history of leading innovative change efforts that focus on the inclusion of people with behavioral health concerns in the life of the community.

• Closing the Philadelphia State Hospital

• Community Behavioral Health in 1997.

• These changes laid the foundation for a responsive, needs-driven service system at the Department of Behavioral Health and Mental Retardation Services (DBH/MRS)

Ingredients For Change

There Is Treatmentin Philadelphia

Detoxification (14 Facilities /240 Beds)

Hospital-Based Residential Rehabilitation (4 Facilities / 20 Beds)

Non-Hospital Residential Rehabilitation (62 Facilities / 2058 Beds)

Halfway House (4 Facilities / 92 Beds)

Outpatient – Drug Free (76/ 8,000 slots approx) – Methadone (11 Facilities / 4400 Slots approx)

Intensive Outpatient (50 Facilities /5,648 slots approx )

Why Not Just Tweak The System?

An Integrated Behavioral Health Care System?

– Over Two Hundred Providers operating several hundred facilities

– Access at every Level Of Care (LOC)– Diverse Service Types– Managing $1.2 Billion– Serving over 100,000 persons annually– 32% have co-occurring mental health problems


Providing Addiction Services for both Insured and Un/under insured

– Serving apporx. 25,000 to 30,000 unduplicated persons a year.

– Spending $130,000,000 on Addiction Treatment.

ADDICTION SERVICES– The same providers have been contracted for addiction

services by county authorities and our managed care organization separately

– Addiction/Dependence treatment services for children and adolescents are inadequate.

– The fragmented system results in• Gaps in levels of care• Inconsistent service delivery• Inadequate dosages of care• General difficulty accessing care in a timely fashion



• The system provides access on demand, but movement through the continuum is fragmented.

• Treatment though improved, still does not adequately address long term recovery needs.

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RECIDIVISM WITH IN SIX MONTHS OF DISCHARGE FROM DETOX OR RESIDENTIAL

DSS PERFORMANCE MEASURES IMPACT STATEMENT REPORT 2005

Deficit Based Assumptions

• “Addicts” don’t recover• Those seeking treatment have too many problems to

expect long term recovery• Recovery is distinct from treatment• Those with mental illness and addiction can only be

addressed in acute care settings• That prevention only needs to happen before treatment• That treatment can only get better if you throw more

money at it, otherwise you can change very little.

Deficit Based Perspectives

Deficit Based Assumptions• All the services anyone would need meet a diagnostic

code and can be billed for.• The role of the professional is to direct the care and the

client.• Recovery is some how going to undermine professionally

driven treatment.


Deficit Based Assumptions

• Recovery comes after treatment or one does not need treatment.

• Treatment relationships are helping relationships

• Treatment programs exist apart from the community and can’t afford to do outreach.


In our traditional systems of care we seek to cure, rehabilitate, rid clients of their problems as we have assessed them.

Provider Focused System

Approaches

Traditional Systems of Care are like Draw Bridges constructed with the bridge up, with• Disconnects

between– Long Term Recovery &

Treatment

– Individual/Family & Professional

– Community & Care

– Self Help & Service

• Addiction is a chronically relapsing disease/illness.

• The majority of people with drug and alcohol abuse or dependence seek and successfully find help out side of the professional treatment system.

• That for the last decades the focus of care has been treatment modeled after acute care medical approaches

WE HOLD THESE TRUTHS TO BE SELF-EVIDENT

• Not all drug use is abuse, dependence or addiction and therefore does not need the same intensity of care.

• Recovery is an umbrella term that can include self-help, treatment, support services, alternative activities, spirituality, prevention, early intervention, family and community.

• Recovery is a lifetime proposition.


Acute Care Models Unsustainable and Characterized By:

• Chronic Client Recidivism• Multi-Generational Chronic Care• Disconnects Between Treatment Interventions and

Recovery Supports• Top-Down Decision Making


Challenge

Significantly improving long-term recovery outcomes will require a radical reengineering of addiction treatment as a system of care. Rather than system refinement, they are advocating a “fundamental shift in thinking”, a “paradigm shift”, a “fundamental redesign”, “a seismic shift rather than a mere tinkering”, and a “sea change in the culture of addiction service delivery”.

Bill White ATTC Draft

RECOVERY?YEAH, WE DO THAT, REALLY!

CHAMELIONS CHANGE

Chameleons Change

RECOVERY WILL BE OUR ORGANIZING

PRINCIPLE

Text

CATERPILLARS TRANSFORM

The Caterpillar ChroniclesFrom the New Life represented in the Egg, to the growth of the Caterpillar, to the Transformation within the Chrysalis, to the rebirth that is the Butterfly we appreciate little of the process if we don’t understand the relationship each stage has to the next and owes to those before it.

System Transformation requires that we appreciate each stage regardless how slow, painful and unpredictable, trusting that the end product is the foundation for a Community of Recovery.

What It Means To Transform

The Beginning

The process takes time, does not always look as desired and begins as a crawl

Philadelphia’s Recovery Definition

• Recovery is the process of pursuing a fulfilling and contributing life regardless of the difficulties one has faced. It involves not only the restoration but continued enhancement of a positive identity and personally meaningful connections and roles in ones community. Recovery is facilitated by relationships and environments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members.

Guiding Values and Principles

• Hope: People can and do recover. Change is always possible, and the extent of change is often beyond what we can imagine. Hope is nurtured by seeing and hearing others living meaningful lives in recovery and giving back to their families and communities.

• Choice: Each person’s opinions, wants, needs and individual recovery pathway are respected and elevated above all other considerations. Services are individualized and built around the person rather than fitting the person to a “program.” . There is recognition by all parties in the system that there are many pathways and styles of recovery and that clients have a right to choose a personal pathways and style of recovery.


• Self-direction/empowerment: People in recovery lead their personal path of recovery. They do this by optimizing autonomy and exercising independence and choice. The individual identifies personal life goals and in collaboration with others, directs his or her recovery by designing a unique path towards those goals. People have the opportunity to choose from a range of options and to participate in all decisions that affect their lives.


Peer culture/Peer support:

• There is recognition of the power of peer support within communities of recovery as reflecting in:

• 1) hiring persons in recovery into Certified Peer Specialists and other positions,

• 2) assuring representation of people in recovery at all levels of the system

• 3) providing wisdom, compassion, approachability, flexibility and experiential learning


• Consumer Leadership: People in recovery have active leadership roles at all levels of the system.


• Partnership: Relationships of all parties within the behavioral health care system are based on mutual respect; service designs shift from an expert model to a partnership/consultation model where everyone’s perspective, experience and expertise is welcomed and considered.


• Community integration/opportunities: The focus is on nesting recovery in the person’s natural environment, integrating the individuals/families in recovery into the larger life of the community, tapping the support and hospitality of the larger community, developing


• Spirituality: Belief in the “God of one’s own choosing” is seen as a potentially valuable resource for recovery support and is respected as a chosen component of an individual’s recovery support system. There is respect for explicitly religious, spiritual and secular pathways of recovery.


• Family inclusion: Family members are actively engaged and involved at all levels of the service process. Families are seen as an integral part of the team of support with their input valued and respected.


• Holistic and wellness approach: Services are designed to enhance the development of the whole person; care transcends a narrow focus on symptom reduction and promotes wellness as a key component of all treatment and support services.


THE STRUGGLE

• COMMITMENT TO A VISIONTO TRANSFORM

ORNOT TO TRANSFORM

Commitment must be verbalized, felt, and acted upon toeffect lasting change. (Kafner 1986)

What Philadelphiahas done

• PRO-ACT, (Pennsylvania Recovery Organization- Achieving Community Together), was formed in 1997 by Bucks County Council on Alcoholism and Drug Dependence, which has been providing prevention, intervention, and recovery support services in the community for 31 years.

• PRO-ACT is a grassroots advocacy initiative founded to promote the rights of- and ensure opportunities for- those still suffering from the disease of addition, members of the recovery community, and their family members who wish to advocate in southeastern Pennsylvania.

From "Core Elements of a Recovery Community Center", CCAR 2006

What is a Recovery Community Center

(RCC)?

• An RCC is a “recovery-oriented sanctuary anchored in the heart of the community. It exists to:

1) put a face on addiction recovery;2) build “recovery capital” in individuals,

families and communities; 3) serve as a physical location where

[Addiction Services and PRO-ACT] can organize the local recovery community’s ability to care”; and

4) help individuals who relapse back into treatment and recovery supports.

Summary Points• The inclusion of the Recovery Community in System

Transformation efforts is critical to their success

• It is about more than Peer Recovery Support Services it is about the Recovery Community playing an active role in the transformation process

• The road to recovery has many obstacles, and Peer Support can help people move along and get where they want to be

At every stage there is much work, not much fun, and it is never easy…

Recovery is the Umbrella under which everything fits• Shedding the bifurcation of

Recovery and Treatment

• Supporting the Empowerment of those in Recovery to direct recovery and treatment services

FAMILY SUPPORTS

LEGAL

RECOVERYSUPPORTS

TREATMENT

EMPLOYMENT MEDICAL

COMMUNITY &FAITH BASED

EDUCATIONAL

ACCESS

Systems support individual recovery

Individual Paths to Recovery Reflected in Individualized Recovery Plans

Self Help, Peer Support,

Transformation is trusting, despite not knowing what it will look like, only that flying is always better than crawling.

Documents

Transforming to a Recovery Focused System of Care An Overview of The Philadelphia Experience Roland Lamb Philadelphia, Becoming A Community Of Recovery