Maryland Department of Health and Mental Hygiene 201 W. Preston Street Baltimore, Maryland 21201

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1 STATE OF MARYLAND DHMH The Honorable Martin O Malley Governor State of Maryland Annapolis, MD Maryland Department of Health and Mental Hygiene 201 W. Preston Street Baltimore, Maryland Martin O Malley, Governor Anthony G. Brown, Lt. Governor Joshua M. Sharfstein, M.D., Secretary March 17, 2014 The Honorable Thomas V. Mike Miller, Jr. The Honorable Michael E. Busch President of the Senate Speaker of the House H-107 State House H-101 State House Annapolis, MD Annapolis, MD Re: 2013 Joint Chairmen s Report, Page 67, M00K02 - Recovery Support Services Dear Governor O Malley, President Miller and Speaker Busch: Pursuant to the 2013 Joint Chairmen s Report, the Department of Health and Mental Hygiene respectfully submits this report on Recovery Support Services for the Alcohol and Drug Abuse Administration (ADAA). Prior to fiscal year 2012, the State did not provide funding for recovery support services (such as peer support, housing, supported employment, community centers, and outreach and engagement activities). Since that time, State funding for these services has grown to over $14 million in fiscal year The ADAA is currently developing outcome measures and a data collection methodology for these services. Given the rapid growth in funding for these services, the committees requested that ADAA submit a report that includes the outcome measures it intends to collect, a detailed data collection methodology, and a timeframe for implementation. The report also includes an evaluation of the Access to Recovery Program which is supported by federal funds, and an appropriate key goal, objectives, and performance measures to be included in ADAA s annual Managing for Results (MFR) submission beginning in fiscal year I hope that this information is useful. If you have any questions regarding this report, please contact Ms. Allison Taylor, Director of the Office of Governmental Affairs at (410) Sincerely, Enclosure Joshua M. Sharfstein, M.D. Secretary cc: Gayle Jordan-Randolph, Deputy Secretary, Behavioral Health and Disabilities Kathleen Rebbert-Franklin, Acting Director, ADAA Allison Taylor, Director, Office of Governmental Affairs Toll Free MD-DHMH TTY/Maryland Relay Service Web Site:

2 2013 Joint Chairmen s Report Page 67 Recovery Support Services Prepared by the Alcohol and Drug Abuse Administration for the Maryland General Assembly Prior to fiscal year 2012, the State did not provide funding for recovery support services. Since that time, State funding for these services has grown to over $14 million in fiscal Given the rapid growth in funding for these services, the Alcohol and Drug Abuse Administration (ADAA) was charged with reporting the outcome measures it intends to collect for these services, a detailed data collection methodology, and a timeframe for implementation. Any baseline data from either State funded programs or the federally funded grant recovery supports program are to be included in the report, and details of any evaluations done of the State or federally supported programs in Maryland. Background: The creation and development of community services that support long term recovery from substance use disorders has been prompted both by a growing body of research and by national leadership from the Substance Abuse and Mental Health Services Administration (SAMHSA). In Maryland, the ADAA convened a team of stakeholders in 2009 that developed an implementation plan designed to transform the substance use disorder service delivery system into a recovery oriented system of care. The ADAA began developing standards for recovery oriented services and instituted continuing care recovery checkups, a service that endeavors to prolong clinical contact with patients in early recovery, beginning in In 2010, the ADAA received an Access to Recovery (ATR) grant from SAMHSA totaling approximately $3.2 million per year for four years that added significant resources to the process, primarily by funding two essential recovery support services: care coordination and recovery housing. Care coordination is designed to help patients at high risk of relapse to access and stay engaged in multiple services. Recovery housing provides a healthy, stable community of peer support in an environment that promotes recovery. These services became available in early 2011, specifically to the portion of the population at greatest risk of relapse. In early 2012, the ADAA encouraged jurisdictions to apply for supplemental funding to develop two additional recovery support services: recovery coaching and recovery community centers. Recovery coaching is provided by peers who self identify as being in recovery from a substance use disorder, and consists of activities designed to help their peers to make the life changes necessary to sustain recovery. These activities can be diverse but often focus on helping persons in early recovery fully engage in their local recovery communities. Although recovery coaching is not clinical in nature, recovery coaches may work in treatment programs as well as in non clinical settings such as homeless shelters and recovery community centers. Recovery 1

3 community centers offer resources to help members of the recovery community improve their quality of life, prevent relapse and sustain recovery activities such as connection to resources, life skills training, and sober social activities. During fiscal year 2013, the ADAA supported the following recovery support services: Recovery Service Number of Participants Served Continuing Care 1,635 Care Coordination 4,520 Recovery Housing 1,437 Recovery Service Number of Providers Recovery Coaching 77 Recovery Community Centers 25 (168,049 visits) Recovery Services Outcome Measures: The ADAA is planning to use a set of outcome measures to evaluate the state of an individual s recovery status after receiving recovery services and/or interventions. The outcome measures reflect domains that impact the individual s functioning and sense of wellness. The term that ADAA is using to describe this set of measures is the Client Outcome Measure (COM) form. The National Outcome Measures from which the measures are derived serve as performance targets for State and federally funded programs for substance use disorder prevention and mental health promotion, early intervention, and treatment services. The measures include the following: 1. Employment Status; 2. Living Arrangements; 3. Number of Arrests; 4. Participated in a Self Help Group in Past 30 Days; 5. Current Educational Activities; 6. Substance Use Past 30 Days; and 7. Current Mental Health Problems. COMs are designed to measure changes in status related to each queried domain from enrollment into a recovery service to six months post initiation of the recovery service (or at the point of discontinuation of the service). This provides a basis for comparative data that gauges the impact of the prescribed recovery service. 2

4 Data Collection Methodology: Continuing Care, Care Coordination, Recovery Housing, and Recovery Coaching: The data will be collected by a care coordinator or clinician for each individual as they are enrolled in the recovery service, using the COM form programmed into the ADAA s SMART data collection system. The data will be collected again at six months post initiation of the recovery service or at the time of the individual s disenrollment from the recovery service. Recovery Community Centers: The nature of this resource is different from the services described above in that it is a facility that provides a diverse array of recovery services to a varied group of participants. Most recovery community centers offer both drop in and scheduled activities to the entire recovery community in a given geographic area. Data that are currently collected measure the number of visits and frequency and types of services offered, but it is not feasible to measure the outcomes of individual visitors to the center. Implementation Timeframe: The administration of the COM tool became mandatory for all State funded care coordination services on August 1, It is anticipated that, in the next 12 months, the ADAA will have baseline data that will demonstrate improved outcomes reflecting the positive impact of care coordination. In September 2013, a Recovery Support Services module was developed by the ADAA to collect COM data within the SMART data collection system for continuing care, recovery housing and recovery coaching. The module was released in early November 2013, and Statewide training was begun. Collection of COM data will be required for all State funded continuing care, recovery housing, and recovery coaching beginning in January In the absence of research data that establishes benchmarks, the ADAA establishes Managing for Results (MFR) measures from baseline data. Once baseline data is established, improvement expectations in the form of percentages are developed. Therefore, the ADAA can develop MFR objectives that set target measures for recovery services once a sufficient quantity of baseline data is obtained. The ADAA expects to establish an MFR goal for these services for fiscal year 2016 (see Appendix for draft template of Recovery Support Services MFR). Access to Recovery Program Outcome Data: The data used to establish baseline is ATR cumulative Government Performance Results Act (GPRA) data from March 2010 September The GPRA Rate of Change is calculated from intake to six month follow up interview (the percentage at the six month follow up interview minus the percentage at intake divided by the percentage at intake; and then multiplied by 100 to calculate the percentage). Percentages are based on matched GPRA intakes with follow up GPRAs. The initial baseline addresses three domains: 1) abstinence, 2) employment/education, 3

5 and 3) stability in housing. These recognized National Outcome Measures are indicative of sustained recovery. The target population for the services provided by this grant comprises individuals leaving intensive residential treatment programs. GPRA Measures # Cases Rate of Change 1. Abstinence: did not use alcohol or illegal drugs 2. Employment/Education: were currently employed or attending school 3. Stability in Housing: had a permanent place to live in the community 3, % 3, % 3, % As the Access to Recovery data indicates, participants in the program have realized dramatic improvements in recovery outcome indicators, suggesting that recovery supports such as care coordination and recovery housing have contributed to these positive outcomes. The following case studies reflect the importance of recovery support services to those in early recovery: Client #1: The client, a 28 year old African American male, approached a Care Coordinator while he was in treatment for heroin addiction. He was excited about the possibility of receiving Access to Recovery (ATR) recovery support services, especially transitional housing. He was enrolled into the Access to Recovery program. Once discharged from Avery Road Treatment Center, he went out and re connected with his former friends and was subsequently arrested with charges of possession and intent to distribute CDS. He was sentenced to the Montgomery Co. Detention Center. When discharged from jail, he re entered Avery Road Treatment Center. He once again approached the Care Coordinator, stating he really needed the extra support of ATR. He requested transitional housing in a faith based program. Having used and abused substances since early adolescence, his path to recovery was going to be challenging. He was re enrolled and went to a house in Rockville, MD. While residing at the Great Compassion Ministries transitional house, he obtained a sponsor, established a home NA group, and began attending 12 Step meetings daily. He utilized the transportation services and with the assistance of gap support, purchased clothing so he could begin looking for employment. 4

6 He found employment and went on to reside in transitional housinge while he began working on reuniting with his family. He received family counseling through ATR and eventually moved back in with his family. Today, he is manager of the company that employed him, remains active in the 12 Step community, attends weekly bible studies at his former transitional house, and remains substance free. He recently told his Care Coordinator that all he needed was for someone to believe in him, especially when he was unable to believe in himself. Client #2: The client is an African American male with a history of drug dependence and incarceration. His former residence is in the Dundalk area. He was enrolled into ATR in 4/2013. The client benefited from services like housing, transportation, gap services as well as support services. The client needed housing assistance because he was released from jail, homeless, and did not want to return to the area where he participated in criminal activity. ATR helped him find alternative appropriate housing. ATR also assisted him with boots for work, and he is still employed. Transportation passes were a real benefit, helping him get to work and outpatient treatment. Client #3: The client is a Caucasian female who entered ATR in She was referred from Warwick Manor and received numerous services that she says helped her in recovery. Her drug of choice was alcohol, and she had been dependent for over 10 years. She received recovery housing at Second Chance Recovery, and she also received bus passes and cab services for transportation. She remained engaged in outpatient services through Adept and received Walmart gift cards to assist with personal items, food, and clothing for a job interview. She received job readiness training, counseling services and assistance with college expenses to complete a certificate in interior design and architecture. She says, Every aspect of my recovery was positively impacted by my involvement with ATR. ATR opened doors for me, relieved burdens and anxiety. Two and a half years later, I am grateful for ATR, my care coordinator and services. The biggest skill I learned with ATR services is how to communicate and build healthy relationships. Conclusion: Moving Maryland s substance use disorder delivery system to a system of care designed to more comprehensively support sustained recovery is clearly beneficial to individuals struggling with addictive illnesses. As new services are developed, it is critical that service providers and decision makers are informed regarding services that are contributing to sustained recovery. The outcome measures described in this report will provide a more comprehensive picture to accomplish our goal of improving services in an efficient manner. 5

7 Appendix Draft Template Recovery Support Services MFR Goal R. Provide recovery services that promote maintaining reduced substance use and improved social functioning. Objective R.1 By fiscal year 2016 the number of patients using substances at completion of continuing-care (CC) treatment or at six months post-enrollment in CC will increase no more than X percent from the number of patients who were using substances at enrollment in CC. Input: Number of patients using substances at enrollment in CC Output: Patients using substances at completion or at six months Outcome: Percent increase in substance use during CC Objective R.2 By fiscal year 2016 the number of patients employed/in educational activities at completion of care coordination (CC2) or at six months post-enrollment will increase by X percent from the number of patients employed/in educational activities at enrollment. Input: Number of patients employed/in educational activities at enrollment in CC2 Output: Patients employed/in educational activities at completion of CC2 or after six months with CC2 Outcome: Percent increase in employment/educational activities during CC2 Objective R.3 By fiscal year 2016 X percent of patients leaving recovery housing will progress to a stable living situation beyond recovery housing. Input: Number of patients leaving recovery housing Output: Patients who move on to a stable living situation Outcome: Percent who progress to a stable living situation Objective R.4 By fiscal year 2016 the number of patients participating in self-help groups at completion of recovery coaching or at six months post-enrollment will increase by X percent from the number of patients participating in self-help groups at enrollment. Input: Number of patients in self-help groups at enrollment in recovery coaching Output: Patients in self-help groups at completion of recovery coaching or after six months with recovery coaching Outcome: Percent increase in self-help-group participation during recovery coaching