The Use of Recovery Coaches and Peer Supports Introduction to Recovery Oriented System of Care and The many Pathways to Recovery
Today's Schedule • Intro to ROSC • More on ROSC and Peer Supports • Ethics and Boundaries • Lunch • Cultural Competence • The Stages of Change Model and Motivational Interviewing • The many Pathways to Recovery
Hello • Chris O’Droski • Education • Experience • Affiliations • Leisure
Treatment Systems Change and Need for Peer Support ROSC Development and Its Implications for the Recovery Community
ROSC- A National Movement • ROSC is the acronym for Recovery Oriented Systems of Care • ROSC is a systems change which affects how substance abuse treatment services are delivered to consumers • ROSC is a philosophy shift that focuses on Recovery Management over the lifespan, instead of acute treatment episodes • ROSC is a culture shift that invites increased reliance on persons in recovery and their experience.
SYSTEMS CHANGE • Old System • A screening is done and person is given acute treatment option. (e.g. Outpatient, Intensive Outpatient, Inpatient Residential) at any number of different treatment centers. Upon discharge, if needs are not met, consumer would need to reapply for different option. • This model created gaps in service (limited pre-treatment engagement, little after treatment care) as well as a disconnect between treatment episodes. • System focused on meeting acute needs not long term recovery management. • Assessment focused exclusively on presenting symptoms instead of holistic approach. • Relies mostly on the expertise of treatment professionals as the primary means of providing services.
SYSTEMS CHANGE • ROSC system • Care is now localized and Core Providers are responsible for the consumers total recovery needs. Services include Pre-Treatment Engagement, Case Management, Peer Support, Support Groups, as well as Outpatient, Inpatient, and Detox. • Enables CORE PROVIDERS to coordinate and manage care across the lifespan of the consumers need • Assessment looks not only at treatment needs but also motivation to change, long term recovery management, and holistic needs. • RECOGNIZES THE NEED TO INVOLVE PERSONS IN RECOVERY in the treatment system.
PHILOSOPHY SHIFT • Old Model-Acute Treatment Focus • Treatment was designed around medical model. Consumer presents with symptoms (i.e. using behaviors) entered treatment and symptoms abated (i.e. sobriety/clean time) • If consumer in treatment presented with symptoms while in care. (i.e. relapsed) it was the consumer that was the problem and they were expelled from services • Treatment was limited to time under care (10-90 days) with little or no aftercare plan • Research has proven that addiction is a chronic disease and needs extend throughout the lifespan. Acute Model is NOT THE MOST EFFECTIVE METHOD OF TREATMENT
PHILOSOPHY SHIFT • ROSC- Chronic Model • Treatment is designed around RECOVERY MANAGEMENT Model. Takes into consideration that addiction is a chronic disease and needs long term care. • If treatment option is not working for consumer ( abstinence is not being achieved) then it is the treatment that is the problem and perhaps another method needs to be attempted. • Looks closely at the STAGES OF CHANGE and attempts to fit consumers with the level of care that is most appropriate given where they present. • Treatment ends when the consumer decides they no longer require services with the option to come back when they do.
CULTURE SHIFT • Treatment is no longer provided strictly by professionals • ROSC seeks to expand services by ADDING PEER SUPPORT to the treatment system, not subtract by disengaging from professional based services. Both are needed to address consumers needs. • PEOPLE IN RECOVERY are needed to become EQUAL PARTNERS in the treatment process. • RECOVERY COACH is a new position in the ROSC that uses the EXPERIENCE, STRENGTH, AND HOPE that persons in recovery have to offer. Training is provided to help the aspiring coach use these skills effectively.
CULTURE SHIFT • Return to our roots in recovery tradition • MORE OUTREACH- carrying the message to those that are still suffering (i.e. using) instead of waiting for the treatment system to provide them to us. • CONTINUOUS ENGAGEMENT- Keeping in touch with people that may relapse, quickly reintroducing them to the path of recovery • UNITING THE RECOVERY COMMUNITY- recognizing the value of working together regardless of recovery philosophy and acting in the interest of the COMMON good. ( NA vs. AA etc.)
ROSC BENEFITS • Consumers receive comprehensive care without gaps in services • New Opportunities for the Recovery Community • BE PIONEERS IN A NATIONAL MOVEMENT • Michigan is a national leader in the ROSC movement • PERSONAL AND PROFESSIONAL DEVELOPMENT • Recovery Coaching is two sided • Coaches both help recoverees and gain positive recovery identity that keeps them from reentering the system • Recovery coaches bring unique perspective and strengths that professionals can gain insight from and vice versa
LOCAL ROSC PROGRAM DEVELOPMENT – PEER RECOVERY PARTNERS AND STRENGTH-BASED CASE MANAGEMENT WASHTENAW COUNTY
OBJECTIVES: • ROSC Overview and Washtenaw Evolution • Principles of Strength-based Case Management • Recovery focused practices used in this project • Peers • Challenges and Barriers identified during implementation • Tools used to measure progress in the outcomes evaluation • Data
The Washtenaw Evolution ROSC OVERVIEW
Elements of Recovery Oriented System Of Care • Person-Centered • Family and other ally involvement • Individualized and comprehensive services across the lifespan • Systems anchored in the community • Continuity of care • Partnership-consultant relationships
Elements of Recovery Oriented System Of Care Con’t • Strength –based • Culturally responsive • Responsive to personal belief systems • Commitment to peer recovery support services • Inclusion of the voices and experiences of recovering individuals and their families • Integrated services • System wide education and training
Elements of Recovery Oriented System Of Care Con’t • Ongoing monitoring and outreach • Outcomes driven • Adequately and flexibly financed
OUR MODEL FOR ROSC • This integrated community-based model has, at its core, the recognition that substance abuse is a chronic problem; and that recovery requires patience, persistence, and ongoing and consistent relationships that are crucial to success. The model was designed both by professionals and individuals from within the recovery community, and is strongly valued as a partnership to improve the system of care by layering resources. In joining together, we bring unique and effective methods to impact and improve the lives of our vulnerable homeless citizens.
PURPOSE/GOALS • Originally set up to help empower homeless individuals with substance abuse disorders to engage in treatment • utilize community resources that will lead to stabilized housing • develop relationships within the recovering community that will be consistent, meaningful and long-lasting, thereby helping to prevent relapse and promote sustained recovery from alcohol and drug use. • Program has evolved and is now available to all programs and departments at Home of New Vision
FUNCTIONS • Engagement and relationship – develop a collaborative helping partnership • Strengths assessment- gather info on 6 life domains • Personal planning - setting goals and options for achievement • Integration into the larger recovery community • Collective, continuous collaboration and graduated disengagement – monitoring and adaptation ongoing
ENGAGEMENT • PURPOSEFUL • RECIPROCAL • FRIENDLY • TRUSTING • EMPOWERING • CONVERSATIONAL
Integration & Normalization • Incorporation into society or organization on the basis of common and equal membership of individuals differing in some group characteristic • Requires equal access to resources • Equal access to options and opportunities • Equal power of individuals to choose from the array of options and direct their own lives, having the same rights of others
RESILIENCE • People manage to become successful despite very adverse conditions growing up. • Seven Resiliencies: • insight, independence, relationships, initiative, creativity, humor, and morality • Development from adversity and allow or explain a person’s ability to overcome.
PEER RECOVERY PARTNER ROLE • Advocate for, and empower clients to voice their needs and concerns to case managers and providers • Take clients to meetings, visit clients • Take clients to appointments • Introduce to sponsors and supports • Encourage sobriety and become active in non-using activities – soft ball, gardening • Creative use of time
PEERS • Recruit Peer Recovery Partners from the existing recovery community • Peer Recovery Partners have at least 6 months of continuous sobriety and be actively involved in the recovery process. • The primary challenge has been building a commitment to the idea of a program itself. The recovery community has a long standing tradition of supporting the newcomer once they have found recovery, but it has been a task to get everyone on board with helping struggling addicts and alcoholics get to that stage of readiness.
Peer Support or Sponsor? • Peer supports are not affiliated with a specific fellowship outside of using that specific recovery experience as a tool • Peer supports are to provide basic recovery assistance and to support an individuals overall health and wellness using the recovery techniques that they have learned • A peer support is a first line introduction to working a recovery program. They should not be actively working the steps with the clients in the way a sponsor should.
Peer Support or Sponsor? Continued • A peer support works with individuals in pre-recovery. A sponsor works with someone that is already in a fellowship. • Peer supports work with the case managers and other community partners to help individuals acquire resources and meet a strengths based goal plan in which sobriety may not be the first objective. A sponsor shows someone how to work the steps in order to achieve sobriety.
Why be a Peer Support? • Promoting one’s own recovery by helping others. Peer supports get the opportunity to give back what was so freely given to them • Becoming a true member of the larger community. Peer supports have the opportunity to reach out and collaborate with social service agencies, police departments and the jail, and community businesses as well as members of the community not in recovery • Becoming part of something special. Being a peer support means building something new and exciting and developing friendships that will last. • FUN!!!! Peer Supports plan all different types of social activities. BBQs, softball team, bowling nights, and getting together regularly to celebrate recovery and the part they play in the lives of others are all part of being a peer.
Expectations • Attend all required trainings • Adhere to ethics and established boundaries (training will be provided) • Maintain client confidentiality • Document all activities and maintain accurate mileage logs. Turn in mileage and activity logs on time. • Peer Support Advisory meetings held once a month plus individual supervision. • HAVE FUN!!!!!
Benefits of being a Peer Support • Comprehensive Training: Enhance one’s own recovery knowledge and gain skills • Certified Addictions Counselor credit: Valuable for anyone pursuing a career in substance abuse treatment • Mileage reimbursement: the expense of getting the client where they need to go is covered • Employment opportunities in the future: Peer Supports are the wave of the future. Paid positions are inevitable. Great experience for any resume.
Key peer program components • Recruitment from the community • Peer orientation and ongoing meetings • Peer Role development • Create new ways for peers and clients to interact...sports activities, topical workshops, picnics, outreach to dispense personal care items
PEER SUPPORT BASIC COMPETENCIES • The ability to establish rapport quickly • An awareness of how to maintain appropriate boundaries • Willingness to be non-judgmental toward clients • Ability to draw on personal recovery experience and relate to client with empathy and compassion • Willingness to guide a person in early recovery through the stages of change and engage with them even though sobriety may be elusive at first.
Competencies, cont’d: • Recognizing the importance of family, social networks, and community systems in the treatment and recovery process • Understanding diverse cultures and incorporating the relevant needs of culturally diverse groups, as well as people with disabilities, into recovery practices • The value of working together with case managers and other staff in developing long term relationships
LOCAL ROSC PROGRAM DEVELOPMENT – PEER RECOVERY PARTNERS TRAININGETHICS AND BOUNDARIES
OBJECTIVES: • To present the code of ethics established by the Home of New Vision • Proper boundaries when interacting with participants • To give peers a chance to discuss possible ethical dilemmas and discuss proper responses
ETHICS Home of New Vision Standards Peer Ethics: William White, 2005
What Are Ethics? At its basic level, aspiring to be ethical means to prevent harm or injury to those whom we have pledged our loyalty This meaning is best revealed through four terms: Iatrogenic, Fiduciary, Boundary Management, and Multi-Party Vulnerability.
IATROGENIC • Unintended, treatment caused harm or injury • Actions taken, even with the best of intentions, that resulted in harm or injury to the individual (e.g. treating someone with electroshock therapy) • Given that recovery coaching is a new frontier it is important that we quickly identify, and discontinue those actions that cause harm to others • Important to receive feedback from other peers and peer supervisor
Fiduciary • Fiduciary is a term describing relationships in which one party has assumed a special duty and obligation to the other • While recovery coaching and peer support is a partnership, it is not an equally supportive friendship. • Fiduciary implies that one party enters with increased vulnerability requiring the objectivity, support, and protection of the other. • The relationship between a coach and the participants are held to a higher standard of obligation and duty than a friendship.
Boundary Management • Boundaries involve those decisions that determine the level on intimacy in a relationship • While professionals practice detachment, peer-based services try to minimize the social distance between helper and person receiving services. • When thinking about proper boundaries potential problems must be considered as well as immediate ones.
MULTI-PARTY VULNERABILITY • Multi-Party Vulnerability refers to how multiple parties can be affected by unethical behavior • Includes the participants, their family and support network, the coach, the organization, the field of treatment, and the recovery community as a whole.
FLAWED ASSUMPTIONS 1. Long term sobriety ensures that persons will act ethically. 2. Ethics is common sense 3. Breaches of ethical conduct are made by bad people intentionally 4. Adhering to existing laws and regulations ensures ethical conduct 5. Ethical standards held by professionals can be indiscriminately applied to recovery coaches and supports 6. Ethics don’t apply to volunteers only paid positions 7. If a recovery coach or support gets into a ethical dilemma they will always notify the proper authority.
Countering Assumptions • Long term sobriety • Recovery no matter how strong, is not perfection. We are all prone to errors in judgment, especially in situations not previously faced • Common Sense • because we work within a diverse population common experiences are not the reality • Breaches are made by “bad” people • most breaches are made by good intentions gone awry. Making ethical decisions requires a sense of heightened awareness. • Adhering to existing laws and regulations will prevent a breach • what is legal is not always ethical. Ethics is often situational dependent.
Countering Assumptions • Professional ethics apply unilaterally to recovery coaching • While there is significant overlap, the uniqueness of the peer positions demand a different set of ethical standards • Ethics do not apply to volunteers • Volunteering within a peer structure implies that the volunteers hold many positions of trust and therefore are accountable to the same ethical standards as the paid positions. There are higher standards for the staff, but that falls into the differences between peer-based and professional services • Recovery coaches will always report potential ethics breaches • Often times many peers struggle with the idea of what needs to be reported and what constitutes a breach of trust. Regular self evaluation and consulting with peer leaders and the supervisor are necessary to maintain good ethical practices.
Core Values That Guide Ethical Practices • Gratitude and Service • carry hope to individuals, families, and communities • Recovery • all service hinges on personal recovery • Use of self • Know thyself, know how and when to use your story • Capability • Improve yourself. Give your best always • Honesty • Tell the truth, separate fact from opinion, admit when you are wrong
Core Values That Guide Ethical Practices • Authenticity • Accurately relate your recovery • Credibility • follow your own advice • Fidelity • if you make a promise, keep it. • Humility • Know your limitations and understand your role, work within your boundaries
Core Values That Guide Ethical Practices • Loyalty • Don’t give up. Give recovery a chance • Hope • Offer yourself and others as proof that recovery works • Dignity and Respect • Express compassion. Accept imperfection • Tolerance • Learn about and respect diverse pathways and styles of recovery
Core Values That Guide Ethical Practices • Autonomy and Choice • Recovery is voluntary: it must be chosen. Enhance choices and encourage choice making • Discretion • respect privacy, don’t gossip • Protection • Do no harm, Do not exploit. Protect yourself and others. Avoid conflicts of interest • Advocacy • Challenge injustice. Be the voice for the voiceless. Empower others to speak. • Stewardship • use resources wisely.