To each professional, a recovery-oriented system of care (ROSC) may carry a slightly different meaning. To Jeffrey Gary, PhD, clinical director of First Step (Baltimore County, Md.), a ROSC is important because of the need to move away from the traditional thinking of treatment being acute to the concept of treating addiction as a chronic illness.
Gerald A. Fishman, PhD, a New York state licensed psychologist and certified school psychologist with additional post-doctoral training in areas such as public health and chemical dependency, agreed and noted that “even in recovery, the brain is still highly susceptible to relapse.”
These comments were part of a panel discussion about recovery-oriented systems of care that occurred among addiction professionals in Cleveland on August 13. Gary and Fishman were two of three panelists at the event who discussed what a ROSC means to them, the obstacles and challenges involved in implementation, and the resources for achieving this system of care.
Doug Edwards, publisher of Addiction Professional and moderator for the event, gave the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) definition of a ROSC:
“A ROSC, or a recovery-oriented system of care supports person-centered and self-directed approaches to care that builds on the strengths and resilience of individuals, families, and communities to take responsibility to sustain their health, wellness and recovery from alcohol and drug problems.”
The evolution of the treatment model
Over the years, the treatment model has changed as new practices and modalities were proven effective. Fishman described sequential treatment, which was utilized for a great period of time and sought to take care of addiction first, then mental health, and then possibly take a look at housing, employment, etc.
“We found that that wasn’t comprehensive enough because we weren’t building a balanced approach,” he said. The next step was a system of parallel treatment in which addiction and mental health were both treated, but never truly intersected with each other.
Now, the approach is integrated and evidence-based and “argues that there’s no wrong doer or no wrong path into recovery,” Fishman explained.
“The beauty of a ROSC is that we need to partner with our clients. In a partnership/consultant model, we can develop recovery plans versus primarily looking at relapse prevention. A ROSC is a document that’s going to continue to evolve as changes occur in the individual’s lifespan. It’s getting away from the traditional treatment plan of looking at things episodically,” Fishman continued.
The new model allows all providers to be more accountable within and between systems. For example, if someone is running a job group or club, they are also sensitive to potential relapse dynamics and are coordinating and working with addiction treatment services. That person is also monitoring an individual’s housing stability and can coordinate with someone in terms of ensuring housing.
The main challenge with this is getting the systems to communicate and adopt a sense of coordination and case management, said Fishman.
“With this type of model, it’s really allowed us to be much more comprehensive and take into consideration that we’re not building an isolated skill. We’re trying to build self-efficacy across areas. Our clients have to recognize that to do that, [they must] have the skills and the knowledge to manage their recovery, which is a lifelong endeavor as far as I’m concerned. We have to look at it similar to a medical disease, like you’re treating diabetes or cardio vascular disease,” Fishman explained.
Creating a ROSC
The panelists offered these ideas and resources for creating a ROSC: