Oriented Systems Of Care(ROSC) Integration
Lonnetta Albright9/07/2016Recovery Oriented Systems of Care (ROSC)Child Welfare & Behavioral Health Integration2016 Child Protection SummitSeptember 7-9, 2016JW Marriott Grande LakesOrlando, FLLonnetta M. Albright, CPECCertified John Maxwell Coach-Trainer-SpeakerExecutive Director, Great Lakes ATTCPresident, Forward Movement Inc.“One is too small a number to achieve significance” ‐‐ John C MaxwellFlorida’s team: Laurie Blades, Wesley Evans , Dana Foglesongand Director Ute GaziochPeople in Recovery who guide, advise and partner with us –Joining us today are Sarah Sheppard and Jamie CampbellROSC and Recovery Management content developed inpartnership with Great Lakes ATTC lead subject matter experts,Dr. Ijeoma Achara and William (Bill) WhiteVideo link:https://www.youtube.com/watch?v LZe5y2D60YUFlorida DCF Conference 20161
Lonnetta Albright9/07/2016ACTIncrease Awareness & Understanding of the ROSC FrameworkUnderstand Recovery as a construct: Long‐term Recovery ManagementDescribe how Behavioral Health looks different in a ROSC FrameworkUnderstand how the service team expands including peer specialists andindividuals in RecoveryExplore how to integrate ROSC principles into the FIT (Family IntensiveTreatment) model“Connect the Dots” – Florida’s plan and priorities related to ROSCTransformationShare experiences, ideas, and opportunities for integrationAligning Concepts:Changing howwe thinkCONCEPTPRACTICEAligning Practice:Changing how weuse language andpractices at all levels;implementing valuesbased changeCONTEXTAligning Context:Changing regulatory/physical environment,policies and procedures, enlisting community supportFlorida DCF Conference 20162
Lonnetta Albright9/07/2016Recovery from Mental Disorders and/orSubstance Use Disorders is a process of changethrough which individuals improve theirhealth and wellness, live a self-directed life,and strive to reach their full potential. (SAMHSA’sworking Definition, 2012)Retrieved from: overy-updated/Health is a state ofCOMPLETE physical,mental and social well‐being and not merelythe absence of diseaseor infirmity.World Health OrganizationFlorida DCF Conference 20163
Lonnetta Albright9/07/2016“ .the phases of recovery from serious mental illness andrecovery from addiction have many parallels. In fact, themanner in which participants in different forms of recoveryindependently used the same or similar language to nameand describe their own processes of recovery was striking.” Davidson, et al., 2008, p. 235Recovery Components and PrinciplesA HandoutWhat is recovery from co‐occurring disorders?“ this research suggests that recovery, be it from thehardships of addiction or problems of mental illness, rests onthe same principles of human development as do otherspheres of psychological and social functioning” Davidson, et al., 2008, p.288There is an identified risk period when prevention efforts mayhave their greatest impact (12 ‐21 years of age)Half of all lifetime cases of mental and SUDs begin by age 14and three fourths by age 24Similar risk factors predict multiple interrelated problems (dropout, pregnancy, bullying, drug use)Youth are impacted by many spheres of influencePrograms that can be delivered primarily by peer leaders haveincreased effectivenessPrograms that have a focus on broader life skills have increasedeffectiveness(Source: ONDCP and IOM Report, 2009)Florida DCF Conference 20164
Lonnetta Albright9/07/2016Need holistic services that don’t just focus on reducing unwantedbehaviors but promoting healthy behaviors“They are not saying that we need to ignore substance abuse. They are sayingthat we need to address substance abuse, but it has to be a part of a morecomprehensive effort. Getting adolescents through life without usingsubstances is not our end goal. We have to prevent adolescent substance use inorder to promote healthy adolescent development, but we also have topromote healthy adolescent development in order to prevent substance abuse.” Join TogetherNeed continuous prevention supports and systems to be available (IOM,2009)Need to articulate the connections among substance use within thefamily, adverse childhood experiences and later physical and behavioralhealth challenges (Felitti et al., 1998)Need to integrate peer support services (IOM, 2009)Need to be able to communicate the indirect effects of prevention efforts(e.g. academic achievement, physical health, mental health, etc.).Getting involved with things I enjoy ( e.g. church, friends, dating,support groups, etc.)Learning what I have to offerSeeing myself as a person with strengthsTaking one day at a timeKnowing my illness is only a small part of who I amHaving a sense that my life can get betterHaving dreams againBelieving I can manage my life and reach my goals (bravery andhope)Being able to tackle everydayHaving people I can count on‐‐Davidson et al.Discovering who I amLifelong effort to become the best we canbeChangeRegaining health – physical / mental /spiritual / relationshipsNew beginning – becoming what you wantto bePersonal – different for each personHopeBravery – facing a different way of lifeRepairing what is brokenRe‐establishing oneself from crisesLiving life on life’s termsFlorida DCF Conference 20165
Lonnetta Albright9/07/2016Substance Abuse & Mental Health Legislative ActionSenate Bill 12Effective July 1st 2016The bill addresses Florida’s system for the delivery of behavioral health servicesWithin the bill, the term Recovery is mentioned 14 times Beginning in 2017, each managing entity is required to develop and submit a planto the department describing the strategies for enhancing services andaddressing three to five priority needs in the service area. The plans must bedeveloped with input from consumers and their families, local governments, locallaw enforcement agencies, and other stakeholders. ‘Services provided to persons in this state (shall) use the coordination‐of‐careprincipals characteristics of recovery‐oriented services and include social supportservices, such as housing support, life skills and vocational training, andemployment assistance to live successfully in their community.’Federal Emphasis andExpectationPresident’s New FreedomCommissionIOM ReportsSAMHSAGrowing body of MH and SUDresearchExpectations of people inrecoveryNational Consumer andRecovery Advocacy MovementTrailblazing Systems of Care Achara Consulting, Inc. 2013Florida DCF Conference 20166
Lonnetta Albright9/07/2016To name a few, they include 1. Replicable, community‐based treatment modalities 2. Federal, state, local, private partnership to fund addictiontreatment and ancillary support industries, e.g., research,training, etc. 3. Accessibility: From less than 50 to more than 13,000 U.S.specialty treatment programs 4. Professionalization of addiction medicine & counseling 5. Systems of early intervention, EAP, SAP, SBIRT 6. Screening/assessment/diagnostic tools 7. Continuum of care 8. Millions of lives touched and transformedThe AC Model can achieve: biopsychosocial stabilization moreeffectively, more safely for more people than has ever been achievedin history and YES;“Treatment Works”, BUT Recovery initiation does not assure recoverymaintenance especially for people with high problem severity / lowrecovery capital.Discovery that addiction shares many characteristics with otherchronic medical disorders (McLellan, et al, 2000)Growing interest in: How would we treat addiction if we reallybelieved that addiction was a chronic disorder?”, e.g., how models of“disease management” in primary health care might be adapted tolong‐term management of addictionFlorida DCF Conference 20167
Lonnetta Albright9/07/2016Slide Acknowledgment: William White. Data Source: O’Brien CP, McLellan AT. Mythsabout the Treatment of Addiction (1996). The Lancet, Volume 347(8996), 237‐240.Addiction/Chronic IllnessCompliance RateRelapse 5Nicotine30‐5070Medication 5030‐50Diet and Foot Care 5030‐50Medication 3050‐60Diet 3050‐60 3060‐80Insulin Dependent DiabetesHypertensionAsthmaMedicationAmong adults reportinga behavioral health condition,more than half report onsetin childhood or adolescenceAverage delays in help seekingfor mental health challengesis more than a decade(National Comorbidity Study)1. Cultural and political awakening of individuals/families in recovery* Growth/diversification of mutual aid* New recovery advocacy movement; New recovery support institutions2. Frustration of frontline addiction professionals3. Addiction science, particularly research on addiction/recovery careers,treatment outcome studies & treatment systems performance data4. Addiction treatment payors5. Need to counter growing cultural pessimism about treatment, e.g., effects ofcelebrity rehab recyclingResources: Let’s Go Make Some Historywww:facesandvoicesofrecovery.orgFlorida DCF Conference 20168
Lonnetta Albright9/07/2016Research shows that over 50% of parents involved with the child welfare systemhave a substance use disorder and many have a co‐occurring mental healthcondition, particularly mothers. (Young, J. K., Boles, S. M., & Otero, C. (2007).Parental substance use disorders and child maltreatment: Overlap, gaps, andopportunities. Child Maltreatment, 12(2), 137‐149.)Once maltreatment is verified, children of parents who abuse alcohol or drugs aremore likely to be placed in out‐of‐home care and stay in care longer than otherchildren (Barth, R., Gibbons, C., and Guo, S. (2006).According to Florida Safe Families Network (FSFN) data, in fiscal year 2014‐15 therewere 15,780 children were removed from their home. Parental substance misuseaccounted for 7,838 of the children removed.ROSC focuses on building resilience, wellness and long‐term recovery Vs compliancewith treatment ‐ better for families short and long‐termIF WE REALLY BELIEVED Our resource allocation wouldn’t look like this:TREATMENTSUPPORT TO THERECOVERYCOMMUNITYRecovery Oriented systemssupport person centeredand self‐directedapproaches to care thatbuild on the strengths andresilience of individuals,families, and communitiesto take responsibility fortheir sustained health,wellness, and recovery fromalcohol and drug problems.CSAT, SAMHSAFlorida DCF Conference 2016Recovery‐oriented systems ofcare (ROSC) are networks offormal and informal servicesdeveloped and mobilized tosustain long‐term recovery forindividuals and familiesimpacted by severe substanceuse disorders. The system inROSC is not a treatmentagency, but a macro levelorganization of a community,a state or a nation.William “Bill” White9
Lonnetta Albright9/07/2016ROSC is not:Just about Substance Use DisordersA ModelPrimarily focused on the integration of recovery support servicesDependent on new dollars for developmentA new initiativeA group of providers that increase their collaboration to improvecoordinationAn infusion of evidence‐based practicesAn organizational entity, group of people or committeeA closed network of service and supportsROSC is:Value‐driven APPROACH to structuring behavioral health systems anda network of clinical and non‐clinical services and supportsFramework to guide systems transformationRecovery‐Oriented Systems of Careshifts the question from“How do we get the client into treatment?”to“How do we support the process of recovery withinthe person’s life and environment?”The Healing ForestFlorida DCF Conference 201610
Lonnetta Albright9/07/2016Recovery is not simply about personal health, butthe health and well being of the entirecommunity “This isn’t about me. I’m doing thisfor my children and my community. I have to buildup my community because I need to know that ifsomething happens to me, there will be resourcesand people in the community who can step in andtake care of my girls.”AMIR participant, New Haven CTEffectively addressing the behavioral health needs of parents and caregivers iscritical to the safety and wellbeing of their children and to the functioning of thefamilyThe department has identified the integration of child welfare and the substanceabuse and mental health service systems as a priority of effort, which is trackedongoing by Secretary CarrollPoE Goal: To implement an integrated system for families served by childwelfareActivities: Self ‐ assessment and peer review process occurring across thestateIntegrating ROSC principles into current practice of the Family Intensive Treatmentteams, to include extensive family engagement, person‐centered planning,development of community supports and use of peersTrauma‐informed ServicesJudiciary and Justice SystemPreventionTreatment and Medication SupportEmployment OpportunitiesChild WelfareAA and NAFamily EducationYt à{@utáxw fâÑÑÉÜàPhysical HealthRecovery Community OrganizationsHealthy relationshipsFlorida DCF Conference 2016Life skills training11
Lonnetta Albright9/07/2016Supportive Housing Coordination as a priorityThe department seeks to increase and improve collaboration andcoordination between Managing Entities, Local Homeless Coalitions,Designated Lead Agencies of Continuum of Care Plans, and other keystate and local agencies related to housing‐related services;Find safe, affordable, stable housing for individuals with mental healthand/or co‐occurring diagnoses; Ensure that these individuals receivethe necessary support services to be successful in the community.Mutual Support groupsOther peer supportProfessional treatmentNontraditional methodsMedical interventionsMedication‐assisted treatmentsFamily supportFaithComprehensive Continuing CareOn your ownAnd more!Florida DCF Conference 201612
Lonnetta aborativeProvider‐driven, compliance is valuedPreferences, life goals, choices definescope of servicesDeficits, disabilities, and illness drive focus ofservicesMaintenance, Safety, stabilization, symptomreductionQuality of ‐basedLong‐term planning for life in thecommunityPlanning for treatment/service episodeSelf‐determination is a fundamentalcivil rightSelf determination follows peoples demonstrationthat they are equipped with certain skills, orclinically stablePERSON‐CENTEREDHigh expectationsPeople choose from a flexible menuof services including natural andprofessional supportsPromotes trial and error growth in thecontext of responsible risk‐takingFocuses on building positive sense ofself, competence and confidenceCONVENTIONALLow expectationsProfessional services only are selected for thepersonPaternalistic approach avoids risk takingCan be punitive, shamingEvolving, living plan adjusts over timeStatic planEncourages inclusion of familymembers/and/or natural supportsTypically engages only the person receivingservicesProcessProductExample: Western New York Care CoordinationProgram (Janice Tondora, Yale Program on Recoveryand Community Health)Outcomes Achieved:68% Increase in competitive employment43% decrease in ER visits44% decrease in inpatient days56% decrease in self‐harm51% decrease in harm to others11% decrease in arrests Achara Consulting, Inc. 2013Florida DCF Conference 201613
Lonnetta Albright9/07/2016Rather than focusing solely onevidence based clinicalpractices that revolveexclusively around treatment ‐‐government, health care andresearch entities wouldbroaden their mission toinclude the dissemination ofemerging models andpromising practices fordesigning and deliveringrecovery support services anddeveloping recoverycommunity organizations.RECOVERY COMMUNITYORGANIZATIONS RecoveryCommunityTreatmentCommunityBRIDGE the gap!‐‐Tom Hill, Faces and Voices of RecoveryWe wouldn’t inadvertentlyattempt to colonize peerrun organizations byexerting undue control,power and influence. Forexample, determining howfunding we provide shouldbe used rather thanallowing the organization tomake those decisions or usecollaborative‐shareddecision making processes.Florida DCF Conference 201614
Lonnetta Albright9/07/2016Partnering with the recoverycommunity to identifyadvocates that with guidancecan assume local leadershippositions.Creating opportunities forlocal leaders ready to rise tothe level of state, regional ornational leaders.Facilitate mentoringrelationshipsSupport the development ofrecovery leadership institutesthat can nurture futureleaders at all levels of thismovement.Recovering persons on agencyboardsMedicated AssistedTreatmentDeveloping / empoweringinformal peer leadershipOpenly recruiting recoveringpersons as staffPaid “peer specialists” to provideformalized supportCreating a sense of a communitywhere recovering persons helpingrecovering persons is highlyvaluedInfusing peer self help throughoutthe service continuumUnderstanding the uniquelearning advantages of peerdelivered services Medicated AssistedRecovery Substance Use Disorder Substance MisuseSubstance Abuse Mental Health IssuesMental IllnessRecovery ManagementA philosophy for organizing treatment andrecovery support services to enhance prerecovery engagement, recovery initiation,long-term recovery maintenance, and thequality of personal/family life in long-termrecoveryWilliam (Bill) WhiteFlorida DCF Conference 201615
Lonnetta Albright9/07/2016Attraction, access & early engagementScreening, assessment & placementComposition of the service teamService relationshipService dose, scope & qualityLocus of service deliveryAssertive linkage to communities of recoveryPost‐treatment monitoring, support and early re‐interventionNote, there are others, but these 8 are critical.AC LimitationsUnmet Need: 10 % who need TX. seek treatment or if they do,arrive under coercive influencesLow Retention: 50 % do not successfully complete treatmentRevolving Door: 60% one or more TX. episodes, 24% 3 ormore – 50% readmitted within 1 yearRM DirectionsAssertive community education & outreachAssertive waiting list managementLowered threshold of engagement; rethinking motivation;institutional outreachChanges in administrative discharge policies“My clients don’t hit bottom;they live on the bottom. If wewait for them to hit bottom,they will die.The obstacle to theirengagement in treatment isnot an absence of pain; it isan absence of hope.”Outreach worker (Quoted in White,Woll, and Webber 2003)Florida DCF Conference 201616
Lonnetta Albright9/07/2016Pre‐treatment Peer Support GroupsOffer peer mentors as soon as contact is initiatedFor urban settings, develop a welcome/recovery supportcenterTele‐health particularly in rural settingsBuild strong linkages between levels of care through peer‐based recovery support servicesUse the most charismatic & engaging staff at receptionConnect with people before initial appointments via phoneScreening and early intervention in health care facilitiesEstablish relationships with natural supports to promote earlyidentificationAC assessment is categorical, pathology‐focused,professionally‐driven, an intake function & focused onindividual; placement based on problem severity.RM assessment is global, strengths‐based, client focused(rapid transition to recovery plans), continual andencompasses the individual, family and recoveryenvironment; recovery capital factored into placementdecisions.FIT assessments ASAM, ASI, Family FunctionalAssessment (FFA), Mental Health when indicated,AAPI‐2, Initial Adverse Childhood Experience (ACE)Individualized service plansMenu of OptionsBased on Collaboration betweenclinician, person receiving servicesand peer supportIntegration of clinical and non‐clinical recovery support servicesFocus on more than symptomreduction and abstinenceFIT Comprehensive family careplan within 30 days of enrollmentinvolving family, peers, supportservices, community and naturalsupportsFlorida DCF Conference 201617
Lonnetta Albright9/07/2016WHAT’S GOING ON?Global vs. categorical assessmentContinual assessments vs. only intakeassessmentAssessing recovery capital and otherstrengthsVehicle for building relationship, trust, andrapportFIT: Reviews comprehensive family care planwith family and revise as needed every threemonths, or more frequently to addresschanges in circumstances impacting treatmentCHANGING OUR QUESTIONS:Can you tell me a bit about your hopes or dreams forthe future?What kind of dreams did you have before you startedhaving problems with alcohol or drug use, depression,etc.?What are some things in your life that you hope you cando and change in the future?If you went to bed and a miracle happened while youwere sleeping, what would be different when you wokeup? How would you know things were different?Leads to Recovery Plans vs.Treatment PlansCare Coordination as a priority Care Coordination is the organization of care activities between two or moreparticipants including the person served and family (with consent) involved inan individual's care to facilitate the effective delivery of health care services. The Florida Department of Children and Families recognizes the need to bettercoordinate care for individuals with complex needs at the system and person levels.Because of this, the department has made high‐level recommendations to ensurethe implementation of care coordination. Add Care Coordination as a billable, covered service Identify standardized level of care assessments and provide the monetaryresources necessary for the Managing Entities (MEs) and providers toimplement them. Implement data sharing agreements across providers and funders to ensure aneffective flow of information that follows individuals through their care. Monitor implementation and outcomes of Care Coordination activities andadjust approaches as needed to maximize effectiveness.Florida DCF Conference 201618
Lonnetta Albright9/07/2016AC model uses disease rhetoric but few medicalpersonnel; recovery rhetoric but decreasinginvolvement of recovering people.RM expands role of medical (including primary carephysicians) and other allied professionals,recovering people (P‐BRSS) and culturally indigenoushealers. Also emphasizes reinvestment in volunteerand alumni programs.Florida’s FIT model is completely aligned with thisframework!The question is not:“Which of these roles is THE most important in therecovery process?”The question is:“How can such resources be bundled andsequenced in ways that widen the doorway of entryinto recovery and enhance the quality of recovery?”How long should a person be in recoverybefore serving in a peer support role?Florida DCF Conference 201619
Lonnetta Albright9/07/2016How long should a person be in recovery before serving in a peersupport role and what about educational requirements?.rather than being legitimized through traditionally acquirededucation credentials, peer staff draw their legitimacy fromexperiential knowledge and experiential expertise. Experientialknowledge is acquired through the process of one’s ownrecovery Experiential expertise requires the ability to transformthis knowledge into the skill of helping others to achieve andsustain recovery.Many people have experiential knowledge but notexperiential expertise(White and Sanders, 2006)COMMON CHALLENGESWorking within aclinical environmentand how not tobecome minicliniciansDifferences andsimilarities betweenMental Health andSubstance Use PeersFinding their voiceand the systemmaking sure thatvoice is valuedEthics andBoundariesWhat to do incase of relapse?Florida DCF Conference 2016PeerThe Value of Peerrun organizations20
Lonnetta Albright9/07/2016Preparation of all Staff – "Create a Transitional Space and embraceresistance" (Michael A. Diamond)Cannot be successfully implemented in a vacuum, staff need anunderstanding of recovery and recovery‐oriented servicesClear job descriptions are needed prior to hiringSupervisors need to have a clear understanding of roles and beadvocates of peer support rolesPeer providers need access to peer support both within andoutside of their organizationMore than one peer provider should be hired in a settingHiring needs to rely more heavily on selection vs. trainingNeed to build in evaluation protocolsFocus on building a CULTURE of peer support throughout theorganization and systemProvide clear guidelines and best practice recommendations forpeer and recovery support servicesSource: Innovation and Diffusion of Technology: A Human Process, Michael A. DiamondPromotion of peer support services as a priorityFlorida has the capacity to train and certify individuals as Certified Peer Recovery Specialiststhrough the Florida Certification Board in three areas: Adult peers, Family peers and Veteran peers.The inclusion of peer support is a beneficial companion to traditional treatmentand is beginning to permeate Florida’s behavioral system.To promote peer support as fundamental to engagement and recovery, theDepartment of Children and Families included peer support services as a requiredcomponent of recently implemented community‐based mental health service models.Florida has a strong and engaged network of peer run organizations that advocate inmultiple forums for movement toward a recovery‐oriented system. Theseorganizations are critical partners in moving the behavioral health system forward andprovide input and guidance at the state and local levels.Strong statewide network of peer specialistTwo years ago, the department reestablished a position at the state office, heldby a person in recovery with lived behavioral health experience. The primaryresponsibilities of the Statewide Coordinator of Recovery and Integration are to: Provide training and technical assistance to key stakeholdersAssist with system‐wide implementation of ROSCTransform drop‐in centers to whole‐health centersEnhance the peer specialist workforce.Currently, five of the seven managing entities contracted by the departmenthave chosen to hire at least one peer specialist to assist with their efforts. TheRecovery and Integration Statewide Coordinator serves as a statewide facilitatorfor this network of peer specialist.Florida DCF Conference 201621
Lonnetta Albright9/07/2016CHANGE PROCESSESADDITIVESELECTIVETRANSFORMATIONALAdding peer andcommunity basedrecovery supportsto the existingtreatment systemPractice andAdministrativealignment inselected partsof the systemCultural, valuesbased change drivespractice, community,policy and fiscalchanges in all partsand levels of thesystem. Everythingis viewed throughthe lens of andaligned with recoveryoriented careHOW DOESTHE FIT MODELWITHIN A ROSC FRAMEWORK?Intensive treatment interventionsfor parents with high‐risk childabuse casesImmediate access to SUD and Co‐occurring services for parentsIncrease percentage of substanceusing parents who enter treatmentIncrease treatment retention andabstinence ratesIntegrate SUD treatment, parenting& therapeutic treatment for allfamily members – regardless ofpayerImprove involvement in Recoveryservices to help parents recoverImprove show rates for sessions;increase program completionFlorida DCF Conference 2016In collaboration with the childwelfare Community BasedCare lead agencies anddependency casemanagement agencypartners:Increase safety of childrenDevelop safe, nurturing and stableliving situation as rapidly andresponsibly as possibleProvide information to inform safetyplanReduce number of out‐of‐homeplacementsReduce rates of re‐entry into theChild Welfare System22
Lonnetta Albright9/07/2016Sarah Sheppard (Peer Specialist)Jamie Campbell (FIT team Peer)Laurie Blades, DCF Deputy DirectorWesley Evans, Statewide Coordinator Integration & Recovery ServicesAC Model: Passive linkage, low affiliation and highearly attrition, single pathway model ofrecoveryRM model: Assertive linkage, multiple pathwaymodel of recovery, linkage beyond recoverymutual aid groups; active relationship with localservice committees, involved in recoverycommunity resource developmentDEVELOPING A ROSC IN KANSASFlorida DCF Conference 201623
Lonnetta AlbrightRecognize that you and yourcommunity do have resourcesand strengthsLook for opportunities to buildrelationships and partnerShare resources andinformationInfluence legislatorsCombat stigma anddiscriminationWhat skills, talents, informationcan you share?Support the development ofpeer run organizationsStart an annual recovery walk9/07/2016Examples:Small businessesFaith‐based recovery –ministriesTransportation supportContinue the dialogueMental Health first aidtrainings for first respondersRemember that there is hope for recovery and recovery is real.Provide support and hold hope for/with other families that aregoing through a tough timeShare your story!Get involved with advocacyVolunteer at peer run organizations and treatment facilities toprovide support to family membersHelp to identify local community resources that can help othersinitiate and sustain their recovery and help to build a network ofalliesAddress NIMBY barriers to community integrationTell your Story!!! Use it to fight stigma and discrimination.Join an advocacy organization to stay informed e.g. Faces andVoices of Recovery, National Association for Mental Illness,Mental Health AssociationEngage in training to become a recovery coach or mental healthpeer specialistReach out to the mediaSupport other people in early recoveryJoin or start a recovery rallySeek ways to give back to your communityStart or support a recovery community organization in your areaFlorida DCF Conference 201624
Lonnetta Albright9/07/2016Aligning Concepts:Changing howwe thinkCONCEPTPRACTICEAligning Practice:Changing how weuse language andpractices at all levels;implementing valuesbased changeCONTEXTAligning Context:Changing regulatory/physical environment,policies and procedures, enlisting community supportFlorida DCF Conference 201625
Lonnetta AlbrightWhat excites you about shifting toa ROSC framework?What concerns do you have?Why is this shift necessary?What would help you becomemore recovery oriented?What outcome(s) are you seeking?9/07/2016How are you integrating Peersan
We have to prevent adolescent substance use in order to promote healthy adolescent development, but we also have to promote healthy adolescent development in order to prevent substance abuse." Join Together Need continuous prevention supports and systems to be available (IOM, 2009)
OHCA SURVIVAL 1) Bystander Witnessed OHCA patients presenting in a shockable rhythm --33% Survival 2) Bystander CPR more than doubles survival 3) The most powerful predictor of survival is ROSC in the field, 35X greater chance of survival compared to non-ROSC 4) Unequivocal evidence that the battle to save an OHCA patient is won or lost at the
ROSC Reports on the Observance of Standards and Codes Assessment of a country regime based on The World Bank Principles for Effective Insolvency and Creditor/Debtor Regimes [incorporating the recommendations of the UNCITRAL Legislative Guide on Insolvency Law]
“Data-Oriented Design and C ”, Mike Acton, CppCon 2014 “Pitfalls of Object Oriented Programming”, Tony Albrecht “Introduction to Data-Oriented Design”, Daniel Collin “Data-Oriented Design”, Richard Fabian “Data-Oriented Design (Or Why You Might
Research on Innovative Application-oriented Talent Training Mode in Private Colleges A-ling LUO 1,a,*, Yue WANG. 1,b. and Hui LIU. . goal-oriented Education, ability-oriented Education or demanoriented Education. OBE is an d-advanced educational concept of the results-oriented, student-oriented and reverse thinking .
Reusability, CK Metric, Object - Oriented. 1. INTRODUCTION Object oriented systems continue to share a major portion of software development and customer base for these systems is on the rise. This is because there are many advantages in taking the object oriented concept. The weakness though is that most object oriented systems tend to be .
the architecture and design of service-oriented systems as a key activity in the implementation of service-oriented systems. Our report builds on this existing work to provide guidance for archi-tects that need to make design decisions in service-oriented systems. 2.1 SOA Design Patterns
Systems of Care for Improving Post–Cardiac Arrest Outcomes Post–cardiac arrest care is a critical component of advanced life support (Figure). Most deaths occur during the first 24 hours after cardiac arrest.5,6 The best hospital care for patients with ROSC after card
modern slavery:classical and Bayesian approaches Bernard W. Silverman University of Nottingham, UK [Read before The Royal Statistical Society on Wednesday, November 13th, 2019, Professor R.HendersonintheChair] Summary. Multiple-systems estimation is a key approach for quantifying hidden populations such as the number of victims of modern slavery.The UK Government published an estimate of 10000 .
