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
•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.
COMMUNITY BEHAVIORAL HEALTH
received the 1999 Innovations in American Government
Award, presented by the Ford Foundation and the John
F. Kennedy School of Government at Harvard
University.
Philadelphia’s School of
the Future
Ingredients For Change
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)
There Is Treatment
in 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
Why Not Just Tweak
The System?
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.
Why Not Just Tweak
The System?
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
Why Not Just Tweak
The System?
• 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.
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
1,755
1,533
1,362
2003
2004
2005
Number
RECIDIVISM WITH IN SIX MONTHS OF DISCHARGE
FROM DETOX OR RESIDENTIAL
DSS PERFORMANCE MEASURES IMPACT STATEMENT REPORT 2005
Deficit Based
Perspectives
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
Perspectives
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.
Provider Focused
System Approaches
In our traditional
systems of care
we seek to cure,
rehabilitate, rid
clients of their
problems as we
have assessed
them.
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
WE HOLD THESE
TRUTHS TO BE SELFEVIDENT
• 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 SELFEVIDENT
• 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.
WE HOLD THESE
TRUTHS TO BE SELFEVIDENT
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
Chameleons
Change
CHAMELIONS CHANGE
RECOVERY?
YEAH, WE DO
THAT, REALLY!
CATERPILLARS
TRANSFORM
Text
RECOVERY WILL BE
OUR ORGANIZING
PRINCIPLE
What It Means To
Transform
The Caterpillar Chronicles
From 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.
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.
Guiding Values and
Principles
• 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.
Guiding Values and
Principles
• 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.
Guiding Values and
Principles
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
Guiding Values and
Principles
• Consumer Leadership: People in recovery
have active leadership roles at all levels of
the system.
Guiding Values and
Principles
• 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.
Guiding Values and
Principles
• 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
Guiding Values and
Principles
• 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.
Guiding Values and
Principles
• 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.
Guiding Values and
Principles
• 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 VISION
TO TRANSFORM
OR
NOT TO TRANSFORM
Commitment must be verbalized, felt, and acted upon to
effect lasting change.
(Kafner 1986)
What Philadelphia
has 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.
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.
From "Core Elements of a Recovery Community
Center", CCAR 2006
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
FAMILY
SUPPORTS
LEGAL
RECOVERY
SUPPORTS
EDUCATIONAL
COMMUNITY &
FAITH BASED
EMPLOYMENT
MEDICAL
ACCESS
T
R HO
E
C S
O E
V IN
E
R
Y
• Supporting the
Empowerment of those in
Recovery to direct recovery
and treatment services
TREATMENT
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.