Substance Use Disorder Recovery Efforts in the States

Substance Use Disorder Recovery Efforts in the States

Project Report

Substance Use Disorder Recovery Efforts in the States:

Analysis of SABG 2016-17 Block Grant Applications

And 9 Case Studies of State Recovery Initiatives

September 2017

Submitted by:

The National Association of State Alcohol and Drug Abuse Directors, Inc.

Developed with Funding From:

The Center for Substance Abuse Treatment

Substance Abuse Mental Health Services Administration

Rockville, MD

Table of Contents

Page

Introduction.………………………………………………………..………………….……… 3

Methodology……………………………………………………….…………………….…… 4

Findings from the SABG Block Grant Applications.………………………...……….……… 5

State Recovery Case Studies …………………………………………...... 8

Colorado: Recovery Advocates on State Advisory Council………………….……….9

Hawaii: Culturally Distinct Services Recovery Supports…………………………….13

Massachusetts: Recovery Centers…………………………………………………….17

Massachusetts: Recovery High Schools ……………………………………………...20

New Jersey: Recovery Services for Women………………………………………….23

New York: Recovery Supports for Youth…………………………………………….25

Ohio: Recovery Housing ……………………………………………………………..28

Tennessee: Recovery Centers…………………………………………………………32

Texas: Recovery Model……………………………………………………………….35

Bibliography…………………………………………………………………………………..39

APPENDICES

Definitions of Recovery Services, Initiatives, Policies, etc. ………………………………. 40

Recovery Initiatives Supported by State Substance Use Disorder Agencies (SSAs) ………42-93

Figures

Figure 1: The Types of Recovery Support Services States are Supporting …………………………6

Figure 2: How States are Investing in their Recovery Workforce …………………………………..6

Figure 3: Settings/Locations where States are Supporting Recovery Support Services…………... 7

Figure 4: Vulnerable Populations are the Focus of Recovery Support Efforts…………………….. 7

Figure 5: Number of Types of Recovery Initiatives per State ………………………………………. 8

Figure 6: Case Study Discussion Questions about Recovery High Schools…………………………. 9

Substance Use Disorder Recovery Efforts in the States:

Analysis of SABG 2016-17 Block Grant Applications

And 9 Case Studies of State Recovery Initiatives

Introduction

According to the 2015 National Survey on Drug Use and Health (NSDUH), approximately 20.8million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year (Center for Behavioral Health Statistics and Quality, 2016). Recovery is an integral aspect of the continuum of care and the goal of treatment is to give patients the tools to enter into long-term recovery. In 2010, SAMSHA created a working definition of recovery from mental disorders and/or substance use disorders. They defined recovery as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, 2017).

There is little disagreement in the substance use treatment literature describing substance use disorders as a cyclic, chronic disease consisting of alternating episodes of treatment, recovery and relapse.Common measures of SUD treatment programs tend to assess outcomes during treatment, mainly reduced drug use. However, patients spend a short time in treatment while substance use disorders recovery is a lifelong phase, with a continuing threat of relapse. SUD treatment follows a disease model and by moving patients into recovery this does not mean they are healed or fixed. Similar to a diabetic patient, people in recovery still need support, medications and maintenance check-ups. Proctor and Herschman found the vast substance use treatment literature all point to the value of some form of continuing care following the primary phase of treatment (ProctorHerschman, 2014). Therefore, States are working hard to identify and eliminate barriers to long term recovery and allow their patients to lead long healthy successful lives.

States have worked to provide Recovery Supports and in 2014, SAMHSA increased national funding to help States increase their Recovery Supports by offering three rounds of Access to Recovery Grants. According to the Access to Recovery Application, the purpose of this program is to provide funding to Single-State Agencies (SSAs) for substance abuse services in the states, territories, tribes, and tribal organizations to carry-out voucher programs for substance abuse clinical treatment and recovery support services (including faith-based providers). Intended outcomes include increasing abstinence, improving client choice, expanding access to a comprehensive array of treatment and recovery support service options, strengthening an individual’s capacity to build and sustain a life in recovery, and building sustainability (Department of Health and Human Services, 2014).

The purpose of this document is to highlight some of the recovery efforts underway in the States. States are working continuously to provide recovery supports and be innovative with their budgets and available resources. During the interview portion of this project, every State continued to highlight how important recovery is and how they would always like to do more. States support recovery work in their area and we hope this documents allows everyone to learn from the States in order to continue the process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Methodology

A reviewwas performed for recovery support services in all 50 State (plus the District of Columbia) by using the State SABG applications available to the public through WebBGAS, SAMHSA’s online block grant application system. Within each State’s FY2016-2017 SABG application, Recovery is asked aboutunder “Environmental Factors and Plan.” Project staff developed a key of recovery initiatives and supports to scan for. These initiatives can be broadly broken down into three categories: recovery services (e.g. recovery housing, vocational programs, peer coaching); special populations (e.g. women, veterans, youth, LGBT) and workforce development factors (recovery trainings, peer specialist credentialing).

Staff conducted a primary scan and then switched States with another staff member and performed a second scan to ensure validity. Any disputes between the first and second scan were discussed between staff members and unanimously agreed upon. Staff used an Excel spreadsheet to record their findings while conducting both scans. During the initial scan, staff would record a “yes” if a State specifically mentioned using SABG funds for a service or initiative; or, they would mark “no” if there was no mention. If a State discussed other recovery efforts, each staff member would make a list of “other topics” at the bottom of the excel sheet. At the conclusion of the initial scan, staff reviewed all notes in the “other topics” section. Any topics that were listed at least twice were added to the list of topics to be included in the second scan. This additional set of factors included topics such as evidence of consumer helplines, family supports and relapse prevention.

The information and charts presented in the next section are an overview of the agreed upon data abstracted from the SABG applications. Forty-Seven States (excluding MD, SD, and WA) and the District of Columbia are accounted for in this report.

It should be noted that the data presented may not fully be representative of the State’s recovery services. First, the recovery section of the SABG application is optional. Moreover, just because a State did not mention a specific service or initiative, it does not mean a State may not be engaging in a specific recovery service or initiative. The data reported below may be considered conservative in terms of how many or whether or not particular States are supporting particular recovery initiatives.

Findings from the SABG Block Grant Applications

During this project, it was learned that 47 States and the District of Columbia had included some information in section 16, the Recovery Section, of their 2016-2017 State Block Grant Application. Three States (Maryland, South Dakota, and Washington) did not complete section 16, as it was an optional section, and not required. It is important to note that this section is not required and should be treated as an incomplete summary of the States recovery efforts. States could be doing more but may not have chosen to include the information in section 16 of their 2016-2017 State Block Grant Application.

Figure1 can be a lot to digest due to the vast array of recovery supports funded in the States. States are trying to blanket their areas with services and meet the many need of their clients and their communities. Substance Use Disorders are complex and effect everyone, therefore recovery supports also need to reach everyone. Below you will see graph three illustrates the recovery supports offered in most State. Recovery Housing, Family Support and Wellness Promotion are the top three funded recovery supports in the States right now.

Figure1: The Types of Recovery Support Services States are Supporting

One of the main points of feedback we have heard from the States over the last two years is that they need an educated workforce to meet the needs of their States. This year, States are investing in their workforce by providing trainings, peer support specialist credentials, and research recovery and data initiatives. At least 45 States provide Recovery Trainings, at least 37 States have Advisory Boards for their block grant application process and at least 36 States have peer support specialist credentials displayed in graph 3 below.

Figure 2: How States are Investing in their Recovery Workforce

States have become innovative by bringing recovery supports to where the patients are. At least 21 States have recovery community centers, 13 States have recovery supports in outpatient treatment centers, 10 States have recovery supports in community mental health centers and 4 States offer recovery supports in school settings, along with 3 States supporting recovery high schools, and 2 States supporting recovery services at colleges/universities, as shown in Figure 3.

Figure3: Settings/Locations where States are Supporting Recovery Support Services

States variously fund programs for vulnerable populations. 34 States reported prioritizing veterans or funding special programs targets toward their veteran populations. 30 States have special programing for youth and adolescents, including New York, which was the only State to report public funded Club Houses, which were discussed in detail in their State interview on page 79 and Massachusetts which has Recovery High Schools, discussed in their State interview on page 73. 21 States reported funding women specific recovery programs, including New Jersey, which is discussed in their State Case Profile interview below on page 76.

Figure4: Vulnerable Populations are the Focus of Recovery Support Efforts

Of the 35 recovery initiatives reviewed for, 17 States indicated that they are doing 20 or more, 30 States reported they were doing between 10 and 20, and 4 States said they were doing fewer than 10 of the recovery initiatives scanned for, as seen in the Figure below. Tennessee was the State that highlighted the most recovery initiatives, with 32.

Figure 5: Number of Types of Recovery Initiatives per State.

Case Studies of Selected State Recovery Initiatives

Based on the results from the SABG scan, project staff selecteda preliminary list of eleven States to interview on a one hour call in order to learnmore details about specific State recovery initiatives. Staff contact the National Treatment Network (NTN) representative in each State to be interview. Some NTNs extended our invitation to their recovery specialists and Single State Authorities (SSA) to join the interview.Ultimately, nine States were able to participate and were interviewed. The nine States/Recovery Initiatives were Colorado (Persons in Recovery on Advisory Board); Hawaii (Culturally Distinct Recovery Services); Massachusetts (Recovery Centers); Massachusetts (Recovery High schools); New Jersey (Recovery Services for Women); New York (Recovery Supports for Youth); Ohio (Recovery Housing); Texas (Recovery Model) and Tennessee (Recovery Centers).

Projectstaff collaborated to create questions for each State. Due to the different topics, each State had different questions and additional questions were asked during each call for clarification or more detail. An example of the questions used in the first interview (Massachusetts) are included in this document. The interviews were the final step in this project.

Figure 6: Case Study Discussion Questions about Recovery High Schools

  • Why did your State decide to start Recover High Schools?
  • How many Recovery High Schools do you have? When did you open the first one? Where are they located? Do you offer/coordinate transportation for students?
  • How are recovery high school funded? Are you using STR dollars?
  • What services are offered in your Recovery High schools? Do you have peer certifications for any peer services? How many students do you have?
  • Tell us about the living arrangements for students? at home, at school, supervised residence, etc?
  • What is the protocol of RHS: is this treatment, recovery or both? how much “treatment”, (individual/group therapy); what method(s) of treatment; how much education; is there drug testing (random, cause)?
  • Is there a typical length of stay?
  • Has your State collected data about recovery high school enrollees? Completion rates? Relapse rates?
  • What lessons have you learned that you would like to pass onto other States that might want to open recovery high schools?

Colorado:Persons in Recovery on the Advisory Council

The Colorado Behavioral Health Planning and Advisory Council (BHPAC), in accordance with federal law and directed by SAMHSA, was established to recommend ways the federal block grant could be used to address key statewide policy and funding issues related to behavioral health. This council includesmembers with lived experience, family members of people with lived experience, state agencies, treatment providers, advocates and other individuals who have a vested interest in Colorado’s behavioral health systems. The BHPAC is a fully integrated planning and advisory council, equally inclusive of people with lived experience representing mental health and substance use disorder (SUD) issues.

The structure of the Colorado advisory board changed when SAMSHA allowed States to submit a combined mental health and SUD block grant application. Previously, the State had two separate advisory council, one for each block grant. However, with one combined application, there was no longer a need to have two separate advocacy councils, so Colorado integrated both councils into one large councils, known as BHPAC. The mental health block grant previously required the advisory council to include at least 51% of membered to have lived experience, or the family members of someone with lived experience. When the SUD and Mental Health advisory boards integrated, the State maintained this requirement with equal representation of the Mental Health members and SUD members with lived experience.

The BHPAC has helped to push forward initiatives and recommendations for the block grant. For example, the State has been supportive of the individual placement support model, which is an evidence based supported employment program to help people with mental health as well as co-occurring disorders to find supported employment. The recovery subcommittee made recommendations to expand access to supported employment programs in all seventeen community mental health centers. The State started with a grant to provide the programs in three community mental health centers and now block grant funds have expanded that to twelve, as of September of 2017, with plans to continue to expand access to this program.

Another recommendation was to expand the role of peers. In Colorado, all of their community mental health centers employ peers but not all SUD treatment providers have peers. Other State have included peers in contractual agreements so anyone using block grant funds have to employ peers. The State is listening to the recommendation and doing their research to see how they can do this effectively. Sometimes the State will go back to the subcommittee and report on their challenge and their efforts to make progress towards the desired recommendation. At times the State is limited due to the scope or work and funding. In these situations, the State works with the council and the subcommittees to find common ground or make recommendations to other agencies if an area, like housing, is outside of their normal scope of work.

BHPAC meets monthly for report outs from the various subcommittees, SAMHSA updates, State legislative updates, National Legislative updates and reviewing the block grant application for comments. Each subcommittee also meets monthly to discuss their block grant recommendations and other work they might have. There are a healthy number of people that sit on the advisory council. The council tries to represent all demographics including young people, all ages, various backgrounds, interested stake holders, providers, government, child welfare, probation, and anyone else that wants their voice heard. Participating on the advisory council is voluntary and most stake holders consider it part of their daily jobs. Therefore, participation in council and subcommittee meetings has been high and consistent across the council. The State contracts with an organization to host the advisory council meetings. This organization tries to eliminate barriers to participation by providing stipends to the participants with lived experience. These stipends compensate participants for their time and mileage. If a member is not able to travel to the meeting, the organization also has the appropriate technology to webcast a member into a meeting.

The advisory board includes four subcommittees to cover all aspects of care across the continuum. They have a recovery subcommittee that work on topics like peer recovery services, reimbursable recovery services and peer run organizations. In the last block grant application, the State set money aside to prioritize recovery initiatives and gave preference to consumer run agencies. Six agencies were awarded funds for 1 rural community mental health center peer services in a rural location, one was coalition for the homeless doing peer services, one smaller agency recovery supports for women, the other three are peer run organizations with creative approaches to connecting people with the services they need. Some of these programs are in libraries targeting homeless populations.