Additive, Selective, and Transformative Approaches to ROSC Implementation
ROSC implementation can be roughly categorized under three approaches: additive, selective, and transformative.
An additive approach is based on a belief that recovery support services function primarily to sustain progress brought about by treatment. In an additive approach to implementing a ROSC, treatment services themselves do not change, but recovery support services—peer-based supports, family services, community-based recovery centers, and so on—are added as a supplement to treatment.
Many behavioral health systems operate with entrenched divisions between formal, clinic-based treatment providers and informal, nonclinical recovery supports. The additive approach to developing a ROSC does not challenge this fundamental division. As a result, the system’s numerous practices, policies, assumptions, and mindsets that are inconsistent with a recovery-oriented approach remain unchanged, and recovery-oriented and traditional philosophies remain separate and often at odds. When an additive approach is used in such an environment, both traditional and recovery-oriented service providers may experience increased stress around fundamentally different ways of interacting with individuals using services, and it may be difficult to see improved outcomes for such individuals. Without such outcomes, it is harder to make the case for more recovery-oriented services or trying a more integrated approach. Although the introduction of some recovery-oriented services is better than having no such services at all, better outcomes are possible when treatment providers, peer support providers, administrators, and other stakeholders are working with a shared set of principles toward common goals.
In a selective approach to developing a ROSC, stakeholders understand the value of bringing recovery-oriented approaches to treatment delivery and beyond, but transformation is restricted, to only certain programs or levels of care, while the rest of the system remains unchanged. Although people accessing treatment and services in the transformed part of the system may receive powerful support, as long as only discrete elements of the system are recovery-oriented, individuals and families will likely receive conflicting messages and contradictory approaches when they access other parts of the system. What’s more, in a selective approach, the behavioral health system itself does not benefit from the synergies and reinforcements made possible by a holistic, systems-level approach.
A transformative approach aligns the entire behavioral health treatment system as well as the policy, community, and social context in which it operates with recovery-oriented principles. This approach transforms what, where, and especially how treatment and other non-clinical support services are developed and delivered. A transformative approach to implementing a ROSC changes the goal from getting people into short-term treatment for a diagnosed condition to increasing an individual’s likelihood of sustaining recovery in the community setting over the long term. In a transformative approach, treatment and recovery services are person-driven and strengths-based from pre-treatment to sometimes years after treatment. Because treatment and peer-based recovery services are founded on recovery-oriented principles, they are viewed as equal. Clinicians and peers, for example, don’t merely coexist but are mutually supportive. In addition, a transformative approach takes a population health perspective, enhancing community capacity to provide long-term recovery, support, and prevention.
The comprehensive changes brought about by a transformative approach also include improvements to policy and reimbursement models, reduced stigma, increased personal and community empowerment, healthier communities, more effective and satisfied workforces, more effective organizational leadership, and an array of other benefits that serve to sustain the transformation. Such an approach brings widespread gains not only to individuals and their families, but also to clinical and nonclinical providers and the community at large.
Implementing a transformative approach to ROSC is for systems that desire change at a fundamental level, that want to implement a vision for behavioral health care that ultimately serves to reduce the number of people needing services as well as the intensity of services individual’s need to pursue meaningful lives. A transformative approach requires a willingness to forego the temptation of a “quick fix” and to commit instead to patiently, strategically implementing recovery-oriented systems of care deeply and thoroughly.
People across the country understand the phrase “recovery-oriented systems of care” in a variety of ways, so it is worthwhile to define the term.
“Recovery-oriented” refers to services and systems that are person-centered and self-directed. Such services provide a diverse array of nonclinical supports in addition to person-directed assessment and treatment services. In addition, recovery-oriented systems and services consciously assess and develop the strength and resilience of individuals, their families and allies, and their communities prior to, during, after—even in lieu of—formal treatment episodes.
A recovery-oriented approach views treatment in a clinical setting as a potential starting point to long-term recovery, but does not see clinic-based treatment as an end it itself, particularly for those with severe or advanced behavioral health conditions. Recovery-oriented services and systems are developed with an understanding that individuals are the experts of their own wellbeing, and that long-term recovery happens not in clinics, but in communities.
“Systems of care” conveys the important concept of scope. A ROSC is a network of clinical and nonclinical services and supports developed and mobilized to sustain long-term, community-based recovery. Developing a successful network entails aligning many aspects of a service system and community with a recovery-oriented approach, including treatment, peer and other recovery support services, system monitoring, performance improvement and evaluation strategies, prevention and early intervention, cross-system collaborations, and the fiscal, policy, and regulatory environments. All of these elements must become aligned with a recovery-oriented approach in order to create a strong, sustainable ROSC.
The “system” in ROSC does not refer to a particular local, state, or federal treatment agency, or to a steering committee, or any particular type of organization. Instead, it refers to a macro-level network of recovery-oriented organizations serving a community, a state, or a nation.
Because ROSCs are local and organic, a ROSC can’t be implemented in one place and then picked up and copied elsewhere. These systems are as unique as the communities that form them. An organization can’t “have” a ROSC or “be” a ROSC; it can only participate in a ROSC.
A ROSC benefits people with behavioral health conditions, but it also benefits the broader community by focusing on prevention and early intervention and promoting health and wellness for all.