SAMHSA's CAPT Supports Michigan's New Model of Care

When Michigan began transitioning to a new substance abuse prevention and treatment model of care, it recognized that prevention and treatment specialists needed help in understanding how their activities dovetailed under the new model. To address this need, Michigan requested training from SAMHSA’s Center for the Application of Prevention Technologies (CAPT) to help the state’s workforce better understand the role of prevention in the new care system, and to increase collaboration between the prevention and treatment fields.

Over the past year, Michigan has been moving to a Recovery-Oriented System of Care (ROSC). The ROSC framework supports individual-centered and self-directed approaches that build on the strengths and resilience of individuals, families, and communities to take responsibility for their sustained health, wellness, and recovery from substance abuse and related behavioral health problems.

“ROSC provides a framework that encompasses prevention and treatment together,” says Larry Scott, manager of the Bureau of Substance Abuse and Addiction Services (BSAAS) for Michigan’s Department of Community Health. “Once practitioners understand the commonality of purpose behind this initiative, they will see that it’s just common sense to sit down together.”

Michigan’s previous system of care was based on an acute-care model that emphasized getting people diagnosed and into treatment. Its focus was on reducing the symptoms of substance use disorders. ROSC broadens the definition of recovery and widens the scope. “The ROSC recognizes that recovery affects multiple levels,” explains Rafael Rivera, behavioral health consultant for SAMHSA’s Great Lakes Addiction Technology Transfer Center (ATTC). “It affects the individual seeking a better life free from alcohol and drugs. But is also affects the family that is seeking stability after becoming accustomed to chaos, and the community that is seeking a way to promote healthy pathways for its youth away from alcohol and drug use.”

This broadened scope not only opens the door to collaboration among treatment and prevention practitioners, but requires it.

Understanding the Role of Prevention
To help practitioners understand the role of prevention in this new model of care, CAPT collaborated with Great Lakes ATTC to deliver the webinar Prevention and the Recovery-Oriented System of Care (ROSC) Framework on May 2 to 36 state leaders and community providers working in the areas of substance abuse prevention and treatment.

The ATTC provided background information on the ROSC, while the CAPT presented information on the Institute of Medicine’s Behavioral Health Continuum of Care model. The model is designed to help practitioners recognize that there are multiple opportunities for addressing the behavioral health problems and disorders of individuals, as well as to promote the general health and wellbeing of the community.

A key benefit of the ROSC is that it increases the opportunities for prevention services along the continuum of care, says Scott. He explains: “Prevention practitioners do not provide prevention services to a person receiving substance abuse treatment. But we could be involved if that person had a child—a child who would be at greater risk of using. Also, people who are using are often at higher risk for developing mental health disorders. So there’s another opportunity to intervene prevention-wise—even though these individuals have already crossed over onto the treatment side of substance abuse.

Nested in the Environment
The ROSC dictates that in order to support long-term recovery, services need to be nested within an individual’s environment. Treatment providers can’t focus solely on the individual receiving care; they must also acknowledge the role family members, caregivers, significant others, friends, and the community play in the recovery process. Treatment and prevention practitioners can work together to reduce those environmental factors that may place an individual at risk for continued substance use, and strengthen those factors that protect them from risk. This is familiar territory for prevention practitioners but new ground for treatment providers.

The ROSC also recognizes that family members, caregivers, significant others, friends, and other allies may have their own needs for supports or services. These individuals—such as the children of substance users who are at increased risk of developing their own substance-related problems—often require prevention services. But without a comprehensive system of care that includes both sides of the treatment/prevention aisle, these individuals are likely to slip through the cracks.

Increasing Collaboration
Michigan is working diligently to bring together under the ROSC umbrella the constellation of agencies that comprise the state’s prevention and treatment workforce. “We want to have all the influential agencies sitting at the table, talking to each other, and thinking about prevention,” Scott says.

To begin the process, at a recent meeting of state agency representatives Scott posed the hypothetical case of a pregnant teenage girl battling both substance abuse and behavioral health disorders. Scott challenged agency representatives to think through each phase of the teen’s life, asking: What could the state have done? When, and how, could it have intervened? Who should have been involved? And how might it intervene to prevent the teen’s future child from growing up to be a pregnant, substance-addicted teen? For each question, the possible solutions lay on both sides of the aisle.

The CAPT/ATTC webinar reinforced this goal of cooperation across agencies. “It helped people see that prevention is part of a much bigger picture,” says participant Marie Hansen, a BSAAS prevention enhancement coordinator. “Through collaboration, you get a sense of what both sides are doing, and you realize you’re targeting similar populations and communities.”

CAPT T/TA Coordinator Molly Ferguson concurred. “It was like a light bulb went off for participants. People realized that even though the primary activities of prevention and treatment providers remained separate, their activities were integrally linked. And they recognized that by working together they could make a real difference, improving the wellbeing of not only individuals, but of the community as a whole. Which is really what the ROSC is all about.”