Recovery

Recovery-Oriented System of Care A recovery-oriented system of care incorporates these elements: • Encourage individuality; • Promotes accurate and positive portrayals of psychiatric disability while fighting discrimination; • Focuses on strengths; • Uses a language of hope and possibility; • Offers a variety of options for treatment, rehabilitation, and support; • Supports risk-taking, even when failure is a possibility; • Actively involves services users, family members, and other natural supports in the development and implementation of programs and services; • Encourages user participation in advocacy activities; • Helps develop connections with communities; and • Helps people develop valued social roles, interests and hobbies, and other meaningful activities.” Evidenced-based practices and services will be implemented by professional, para professional and peer supports who can demonstrate the skills to effectively maintain fidelity. Training needs will be identified and training and supervision with supports provided to ensure fidelity is maintained. The following evidenced-based practices and services, listed on the SAMSHA National Registry of Evidenced-based Programs and Practices (NREPP) shall be implemented: • Screening, Brief Intervention, Referral and Treatment (SBIRT) • Motivational Interviewing • Matrix Model for stimulant addictions • Adolescent Community Reinforcement Approach (A-CRA) for co-occurring and substance abuse disorders • Seven Challenges Early identification and connection with community resources are focuses of a recovery-oriented system of care. Staff shall outreach to health/medical facilities to introduce and teach the Screening, Brief Intervention, Referral and Treatment (SBIRT). “SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.” The screening will be incorporated into the medical or other setting and identifies individuals with problems related to drugs and/or alcohol. The screening can be self-reported or through an interview using best practices tools such as: • CAGE – a four question instrument best used with white middle aged males (C- have you ever felt you should cut down on your drinking', A – Have people annoyed you by criticizing your drinking' G Have you ever felt bad or guilty about your drinking' Eye-opener – have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover') Two or more “yes” answers may indicate an alcohol problem • T-ACE – a four question instrument for use with males and females (T- does it take more than three drinks to make you feel high' A- have you ever been annoyed by people’s criticism of your drinking' C- are you trying to cut down on drinking' E – have you ever used alcohol as an eye opener in the morning' Two or more “yes” answers may indicate a problem with alcohol. • AUDIT – the Alcohol Use Disorders Identification Test has been proven an accurate tool across ethnic groups and with both genders. This 10 multi-choice questionnaire is scored on a point system and a score of more than eight indicates problems with alcohol. This is a longer survey than others, which can be a disadvantage in some settings. • Five-Shot Questionnaire – is comprised of two AUDIT and three CAGE questions and has been shown to be accurate with both genders and across ethnic groups. Points are assigned to each multiple choice response. A score of 2.5 or more indicates possible alcohol problems. • DAST – Drug Abuse Screening Test is a 20 question survey that asks about the use of prescribed or over-the-counter drugs in excess of directions and any non-medical use of drugs over the past 12 months. The brief intervention is a motivation discussion to increase insight and awareness when a screening result indicates possible substance abuse problems. The referral to treatment provides more extensive evaluation and assessment, treatment planning and therapeutic interventions by a licensed clinician. SBIRT research has demonstrated that large numbers of individuals at risk of developing serious alcohol or other drug problems may be identified through primary care screening. SBIRT type interventions have shown: • Decrease the frequency and severity of drug and alcohol use, • Reduce the risk of trauma, and • Increase the percentage of patients who enter specialized substance abuse treatment. In addition to decreases in substance abuse, screening and brief interventions have also been associated with fewer hospital days and fewer emergency department visits. Cost-benefit analyses and cost-effectiveness analyses have demonstrated net-cost savings from these interventions. Motivation Interviewing (MI) is a cost effective therapeutic client-centered, goal directed method to engage ambivalent individuals in the process of change by enhancing intrinsic motivation to change by exploring and resolving ambivalence. MI prepares unmotivated individuals for change by encouraging talk and decreasing resistance to the notion of reducing the use of alcohol or drugs. It has been effective with young adults. MI is grounded in the transtheoretical model of change proposed by Prochaska and DiClemente where individuals vary with regard to change “readiness” by moving through six distinct stages, including pre-contemplation, contemplation, determination (or preparation), action, maintenance, and relapse. “The MI counseling style generally includes the following elements: • Establishing rapport with the client and listening reflectively. • Asking open-ended questions to explore the client's own motivations for change. • Affirming the client's change-related statements and efforts. • Eliciting recognition of the gap between current behavior and desired life goals. • Asking permission before providing information or advice. • Responding to resistance without direct confrontation. (Resistance is used as a feedback signal to the therapist to adjust the approach.) • Encouraging the client's self-efficacy for change. • Developing an action plan to which the client is willing to commit.” MI provides an option for individuals “who are not yet committed to the process of change by employing an empathic, egalitarian style that promotes self-efficacy.” Proficiency in MI skills requires extensive study and practice. Clinical practice and supervision will be provided to ensure therapists demonstrate the proficiency to use this clinical intervention.