Transcript Resilience:

Recovery Management:
Presentation Guidelines
Bill White
[email protected]
www.williamwhitepapers.com
Presentation Goal
Enhance each participant’s abilities to
prepare and deliver presentations on RM &
ROSC via conference keynotes &
workshops, inservice trainings, and
meeting presentations with key individuals
and groups.
Learning Objectives: Participants
will be able to
• Define & distinguish recovery
management (RM) and recovery-oriented
systems of care (ROSC)
• Identify and discuss 8 areas of RM-related
changes in service practice
• Discuss tasks and tools for each of the 3
stages of effective RM presentations
Personal Perspective
• Work in addictions field since 1969
• 1998-2003: Behavioral Health Recovery
Management Project
• 2002-2008: presentation & consultations
on RM & P-BRSS
• 2005-present ATTC/Philadelphia DBH/MRS
monograph series
• Gratitude to leadership team members
Your Personal Perspective
Each of you who present on this subject will
need to build your own credentials and
reputations on this subject.
• No substitute for preparation: You must
become a serious student of this subject
to avoid “flavor of the month” perception
• I will suggest resources as we proceed
that will help with this process.
Topical Resources
• RM/ROSC Monograph Series, particularly the
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•
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“science monograph” (2008)
RM/ROSC Papers at
www.williamwhitepapers.com
Book: Kelly, J. & White, W. (Late 2010)
Addiction recovery management: Theory,
science and practice. New York: Springer
Science.
Video of presentations from Philadelphia &
Atlanta & PowerPoint Slides
Resources to Enhance Presentation
Skills
• Training of Trainer opportunities
• The Training Life: Full text available at
www.williamwhitepapers.com
• Menu of presentation slides
• Availability of email/phone consultation
with resource team, White, Achara,
Laudet, etc.
Conceptual & Language Clarity
“Recovery management” (RM) is a philosophical
framework for organizing addiction treatment
and recovery support services across the stages
of pre-recovery identification and engagement,
recovery initiation and stabilization, long-term
recovery maintenance, and quality of life
enhancement for individuals and families
affected by severe substance use disorders.
Recovery Management & Stages of
Recovery
1. Pre-recovery identification and
engagement (recovery priming)
2. Recovery initiation and stabilization
3. Transition to successful recovery
maintenance
4. Enhancement of quality of
personal/family life in long-term recovery
Conceptual & Language Clarity
Recovery-oriented systems of care (ROSC)
are networks of formal and informal
services developed and mobilized to
sustain long-term recovery for individuals
and families impacted by severe substance
use disorders. The system in ROSC is not
a treatment agency but a macro level
organization of a community, a state or a
nation.
RM & ROSC Focus Today
• My focus will be on how you as individuals and
•
as teams can serve as presenters within a
variety of educational venues within your
respective regions to introduce the concept and
practices of RM.
Dr. Achara will focus on how you can serve as
facilitators and resource brokers for groups
interested or involved in ROSC-related systems
transformation processes.
Stages of Effective RM/ROSC
Presentations Are Like other
Effective Presentations
1. Pre-presentation Planning (It’s all about the
details—setting, audience, message refinement)
2. Clear Presentation Stages
--Opening
--Middle
--End
3. Post-presentation Follow-up (information & TA)
Stage One: Opening
• Spans 30-60 minutes prior to presentation
through first 10% of presentation time
• Multiple tasks to be achieved in narrow
window of time
• RM/ROSC-related material can be
threatening to multiple parties: Opening
tasks essential to enhance receptiveness
Tasks and Tools for Presentation
Opening
1. Resolve problems with presentation
environment
2. Early audience contact, assessment &
welcoming (refine message & diminish distance)
3. Engage
* Initial presentation of self—warmth,
humility, respect, curiosity, confidence
* Speaker identification with audience
Tasks and Tools for Presentation
Opening
4. Equalize presenter-participant power
--evaluate degree of power discrepancy
--increase or decrease your power
--control the introduction
--gage formality based on
organizational/cultural context
--early participant involvement
Tasks and Tools for Presentation
Opening
5. Reduce resistance by acknowledging
achievements of modern addiction treatment
(See forthcoming slides as sample)
--Given such achievements, why does treatment
need to be “transformed”?
6. Create clear expectations via goals and learning
objectives: Let audience know you will answer
the why question using treatment systems
performance data and their own experience
(where time & format allows the latter)
Tasks and Tools for Presentation
Opening
7. Honor the participants contributions and
ideas via praise & gifts (resources, e.g.,
handouts, monographs, links, etc.)
8. Create sense of historical & personal
urgency via your own commitment &
energy
Achievements of Modern Treatment
Include Elimination of Below
Achievements of Modern Treatment
Include (To name a few):
• Replicable, community-based treatment
•
•
modalities
Federal, state, local, private partnership to fund
addiction treatment and ancillary support
industries, e.g., research, training, etc.
Accessibility: From less than 50 to more than
13,000 U.S. specialty treatment programs
Achievements of Modern Treatment
Include:
• Professionalization of addiction medicine &
addiction counseling
• Systems of early intervention, EAP, SAP,
SBIRT
• Screening/assessment/diagnostic tools
• Continuum of care
• Millions of lives touched and transformed
Background Source: Slaying the Dragon
Core Presentation Tasks
Core of Presentation Must Answer 7 Questions
1. Why does addiction treatment need to be
transformed?
2. What changes in frontline service practices
occur in the shift to recovery management?
3. What changes in administrative, regulatory,
funding practices can be anticipated as part of
an RM/ROSC transformation process?
Core Presentation Tasks
4. How will this process of systems
transformation be achieved?
5. Who will be involved in systems
transformation (and how will it affect my
role)?
6. When will this process begin and how
long will it take?
7. What obstacles should we anticipate?
Core Presentation: Tools
Craft a presentation using a mix of the following
based on the audience characteristics and the
time available
• Findings from scientific research
• Treatment systems performance data (localize
where possible)
• Video & Internet Resources
• Self-disclosure / Stories
• Structured discussions and learning exercises
Critical Content Areas
I will focus in this first presentation on how
you can best answer:
• Why does addiction treatment need to
be transformed?
• What changes in frontline service
practices occur in the shift to RM?
Impetus for Change
1. Cultural and political awakening of
individuals/families in recovery
* Growth/diversification of mutual aid
* New recovery advocacy movement
* New recovery support institutions
Tell this story in pictures
Resources: Let’s Go Make Some History
www:facesandvoicesofrecovery.org
Impetus for Change
2. Frustration of frontline addiction
professionals
3. Addiction science, particularly research on
addiction/recovery careers, treatment
outcome studies & treatment systems
performance data
Impetus for Change
4. Addiction treatment payors
5. Need to counter growing cultural
pessimism about treatment, e.g., effects
of celebrity rehab recycling
RM & ROSC Part of Shift in
Emphasis within 3 overlapping
Governing Constructs
• Pathology Paradigm: Knowledge drawn from
•
•
study of the etiology and epidemiology of
substance use disorders
Intervention Paradigm: Knowledge drawn from
study of social and clinical interventions into
severe AOD problems
Recovery Paradigm: Knowledge drawn from the
study of long-term addiction recovery
Limitations of Acute Care Approach
to Addiction Treatment
• Modern treatment has focused on an acute care
•
•
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model of addiction treatment
Define AC Model
Extol what the AC Model can achieve:
biopsychosocial stabilization more effectively,
more safely for more people than has ever been
achieved in history
“Treatment Works”, BUT Recovery initiation does
not assure recovery maintenance for people with
high problem severity / low recovery capital—
antibiotics analogy
Limitations of Acute Care Approach
to Addiction Treatment
• Discovery that addiction shares many
•
characteristics with other chronic medical
disorders (McLellan, et al, 2000)
Growing interest in: How would we treat
addiction if we really believed that addiction was
a chronic disorder?”, e.g., how models of
“disease management” in primary health care
might be adapted to long-term management of
addiction
AC. RM & key recovery
performance measures
Each of you will need to personalize and
localize presentation of this material, but
following 8 elements are essential
• Review current AC model performance
limitations
• Outline current & future directions of RMmodels of care
8 Key Performance Arenas Linked
to Long-term Recovery Outcomes
• Attraction, access & early engagement
• Screening, assessment & placement
• Composition of the service team
• Service relationship
• Service dose, scope & quality
Key Performance Arenas Linked to
Long-term Recovery Outcomes
• Locus of service delivery
• Assertive linkage to communities of
recovery
• Post-treatment monitoring, support and
early re-intervention
NOTE: There are others but these 8 are
most critical
1. Attraction, Access & Early
Engagement
AC Limitations
• 10% & 25% data; late stage and under
coercion; waiting list drop-out data; attrition
data (more than 50% will not complete)
RM Directions
• Assertive community education & outreach
• Assertive waiting list management
• Lowered threshold of engagement; rethinking
motivation; institutional outreach
• Changes in administrative discharge policies
2. Screening, Assessment &
Placement
AC assessment is categorical, pathology-focused,
professionally-driven, an intake function &
focused on individual; placement based on
problem severity.
RM assessment is global, strengths-based, client
focused (rapid transition to recovery plans),
continual and encompasses the individual, family
and recovery environment; recovery capital
factored into placement decisions.
3. Composition of the Service Team
AC model uses disease rhetoric but few medical
personnel; recovery rhetoric but decreasing
involvement of recovering people.
RM expands role of medical (including primary
care physicians) and other allied professionals,
recovering people (P-BRSS) and culturally
indigenous healers. Also emphasizes
reinvestment in volunteer and alumni programs.
4. Service relationship
Acute Care: Dominator model; emphasis on
professional authority; great power discrepancy;
role of client is one of compliance.
Recovery Management: Sustained recovery
partnership (long-term consultation) model;
emphasis on prolonged continuity of contact;
client as co-leader; philosophy of choice; greater
use of personal/professional self; contrasting
ethical guidelines.
5. Service Dose, Scope & Quality
AC model has become ever briefer, narrower via
reimbursable services & continues to incorporate
methods lacking scientific support.
RM model emphasis on importance of dose (NIDA
principles—90 days), role of ancillary services
and weeding out practices that are not linked to
recovery outcomes or that may produce
inadvertent injury.
6. Locus of Service Delivery
AC model locus is the institution: How do we get
the individual into treatment—get them from
their world to our world?
* Problem of transfer of learning
RM model emphasizes the ecology of long-term
recovery: “How do we nest recovery in the
natural environment of this individual or create
an alternative recovery-conducive environment?”
* Healing forest metaphor (Coyhis)
* Concept of “community recovery”
7. Assertive linkage to communities
of recovery
AC Model: Passive linkage, low affiliation and high
early attrition, single pathway model of recovery
RM model: Assertive linkage, multiple pathway
model of recovery, linkage beyond recovery
mutual aid groups; active relationship with local
service committees, involved in recovery
community resource development
8. Post-treatment Monitoring,
Support and, if needed, Early Reintervention
• 50-80-90 rule: More than 50% of clients
•
discharged from Tx will return to some use in
the next year—80% of those will do so in first
90 days after discharge.
15-25 rule: The stability point of recovery (risk
of future lifetime relapse drops below 15%) isn’t
reached until 4-5 years for alcohol dependence;
25% of opioid dependent persons who achieve
five years of abstinence will later resume
narcotic addiction.
8. Post-treatment Monitoring,
Support and, if needed, Early Reintervention
25-35% of clients who complete addiction
treatment will be re-admitted to treatment
within one year, 50% within 2-5 years (Hubbard,
et al, 1989; Simpson, et al, 2002).
An Acute Revolving Door: Of those admitted to
the U.S. public treatment system in 2003, 64%
were re-entering treatment--23% accessing
treatment the 2nd time, 22% for the 3rd or 4th,
and 19% for 5 or more times (OAS/SAMHSA,
2005).
8. AC Model: “Aftercare” as an
Afterthought
Post-discharge continuing care can enhance
recovery outcomes (Johnson & Herringer, 1993;
Godley, et al, 2001; Dennis, et al, 2003).
But only 1 in 5 (McKay, 2001) to 1 in 10 (OAS,
SAMHSA, 2005) adult clients receive such care
(McKay, 2001) and only 36% of adolescents
receive any continuing care (Godley,et al, 2001)
8. RM Model: Assertive Approaches
to Continuing Care
• Post-treatment monitoring & support
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•
•
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(recovery checkups)
Stage-appropriate recovery education &
coaching
Assertive/continued linkage to recovery
resources
Early re-intervention & re-linkage to Tx
and recovery support resources
Recovery community building
Closing of Presentation:
Summation
• Outlined 5 sources of impetus for shift to a
•
•
•
model of sustained recovery management
Outlined 8 areas of service practice that
significantly change in the transition from AC to
RM model
RM/ROSC do not eliminate AC model, but wrap
the AC model in RM technologies for those with
severe AOD problems and low recovery capital
Add ROSC points from Dr. Achara’s presentation
on RM/ROSC transformation process.
Closing of Presentation: Express a
Sense of Historical Urgency
It will take years to transform addiction
treatment from an exclusively AC model of
intervention to a RM model of sustained
recovery support.
The future of addiction treatment and
recovery will hinge on well how we are
able to achieve this task.
Closing of Presentation: Make It
Personal & Open It Up
• The personal/professional destinies of some of
you in this room are linked to leadership in this
emerging movement. For some of you, your
whole lives have prepared your for this unique
moment in the field’s history. (Extend invitation
for involvement.)
• Again expression your gratitude for the invitation
to present & open for further questions,
comments and personalization of material
Concluding Note on Preparation
and Presentation Process
Parallel Process: What you want to convey
to your audience is the very essence of
the transformation experience, e.g., focus
on engagement, tolerance, respect,
personal and system strengths,
partnership, honesty (transparency), and
commitment to continuity of support).