Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Co-Occurring Recovery: Supporting Recovery from Substance Use and Mental Disorders Conference
May 25, 2007
New Orleans, LA
Thank you, Deputy Commissioner Rehmer, for that gracious introduction. And welcome everyone. It is my pleasure to be a part of your inaugural conference on Co-Occurring Recovery. There is so much potential in this moment as we set out on a critically important mission…and look expectantly toward a future full of promise for people living with addictions and mental illnesses.
As I look out at this audience, I see the future of behavioral health. With a show of hands, who in the audience is a substance abuse practitioner? Who is a mental health practitioner? Do we have primary health care providers here? How about individuals in the recovery community? Policymakers? Faith-based organizations? We may each have different titles, and different roles to play, but we are all here today because we share a common belief—the belief that people can and do recover from mental illnesses and substance use disorders. This morning, I urge each of you to join forces…to form an unbreakable bond…a bond that will help us confront a serious problem that we face. This problem is the co-occurrence of mental illnesses and substance use disorders.
Co-occurring disorders are a serious public health problem…and a growing one. Dr. Brown will examine the extent of the problem more closely, but I want to look at one statistic in particular because it underscores our reasons for being here today. The number of adults with co-occurring serious mental illnesses and substance use disorders in America grew by one million people between 2003 and 2005. That’s like someone in nearly every household in every city across the state of Connecticut being diagnosed with a co-occurring disorder over a two-year period.
The implications for Connecticut…and for the Nation…are profound. This trend cannot continue. This is a problem that we can do something about…that we must do something about. Whether we are in federal, state or local government…addiction treatment, mental illness treatment, or primary health care…we all have a stake in this. Co-occurring disorders are a shared problem demanding a shared solution. To confront this problem, each of us must own it.
We must accept and embrace the fact that we are not treating addiction or depression. We’re treating people…real men, women and children who are walking through our doors with a host of real problems with them. Research suggests, and our own practice confirms, that each of these individual’s best hope for recovery lies in integrated treatment. The question is no longer if we need to be prepared to deliver integrated treatment…but how can we best prepare ourselves to meet this challenge.
I have heard my good friend, and your esteemed Commissioner, Tom Kirk, describe this issue in a way that makes the point perfectly clear: Suppose, in the course of a visit to your healthcare provider, they said ‘I think I know what disorder or condition you have…but I just haven’t had the time to secure training or skills in that area.’ What would you do? It’s simple. You’d change providers.
Persons with co-occurring disorders deserve much better. One hallmark of a recovery-oriented service system is quality, effective care. Attention to competence in recognizing and treating CODs is absolutely essential to recovery-focused care.
That’s what I want to focus on this morning…how essential it is for us to move from thinking about…and talking about…improving our response to co-occurring disorders…to doing what it will take to ensure that individuals with co-occurring disorders have access to the care that is most effective in promoting recovery.
So, where do we start? How do we make this change happen? How can we ensure that integrated treatment for co-occurring disorders becomes the norm, not the exception?
To borrow a metaphor from physics, I believe we have to focus on the levers of change—the forces, that when properly utilized, can produce movement beyond that which could be expected if the same amount of force were applied in less strategic ways.
This “levers of change” metaphor was used in a report SAMHSA prepared, in collaboration with the Annapolis Coalition, which presented a blueprint for strengthening the behavioral workforce as a strategy for transforming our country’s behavioral health system of care. The report—the Action Plan for Behavioral Health Workforce Development—pointed to you—the behavioral health care workforce—as one of the most critical levers of change for improving the quality of care and, ultimately, improving outcomes for individuals who receive treatment for addictions and mental illnesses, including those with co-occurring disorders.
Like the levers that are used to do the “heavy lifting” in physics, you can exert enormous influence on this problem. The most important resources we have to help individuals with co-occurring disorders achieve recovery are human resources. Adequately supported, and equipped with the tools you need to deliver care of proven effectiveness, you are the agents that can push this change movement forward. Armed with a clear vision, a practical blueprint, and a carefully crafted plan for strengthening your own skills, each of you has the power to change the way we deliver care…and to literally, change lives.
The Action Plan described the need for increased competency-based training and credentialing for behavioral health professionals—two of the key issues that the Connecticut Certification Board has been working on for many years now. Recovery-based standards of care—like those that the State agencies here in Connecticut have been developing—are another change strategy that the report says warrant focused attention. The fact that you have come together at this conference to explore these very issues is real cause for optimism…a sign that you are asking the right questions…you are on the right track.
I want to spend a few minutes examining the seven action goals the Action Plan for Behavioral Health Workforce Development offers as strategies for strengthening the workforce and improving behavioral health care. But, first, I want to take a moment to salute the Connecticut Certification Board and the State agencies and providers here in Connecticut for the action steps that you are already taking…steps that are already yielding measurable results. You are true vanguards in this movement.
I commend the Connecticut Certification Board for being on the leading edge of credentialing for co-occurring disorders. You were out there…eight years ago, when much of the field was “pre-contemplative”…advocating for quality certification programs specifically designed to address the competencies required for professionals working with people in recovery from co-occurring substance use and mental disorders. The co-occurring specialty credential that you’ve established here in Connecticut is cutting edge. Now, the tireless efforts of Marshall Rosier and others are paying dividends beyond the Connecticut state lines…beyond our national borders…to literally advance this movement around the globe. With the announcement of the IC&RC’s new international and reciprocal credentials for practitioners working with co-occurring disorders, practitioners worldwide will benefit from standardized skill sets, core competencies and credentialing processes. This development is historic. It represents an unprecedented advancement in the behavioral health field.
I applaud the Connecticut Certification Board for looking at another difficult issue—the emerging trend toward unified licensing—and for bringing in the contingent from a State that is near and dear to me…Rhode Island…to share wisdom around this challenging topic at this conference.
The language, spirit and culture of recovery are embedded throughout Connecticut’s system of services. As one of the few States that has earned both SAMHSA’s transformation state incentive grant and the co-occurring state incentive grant, Connecticut is a model for the nation. I applaud the strong connection you have forged between your transformation grant and your State’s COSIG—especially in the areas of promoting evidence based practices and workforce development.
Connecticut’s workforce development efforts are increasing training, clinical supervision, and implementation support activities in the area of co-occurring disorders. Your focus on multidisciplinary teams as the key to integrated treatment efforts is a sound strategy. I know that you have chosen to recognize multiple paths for preparing staff and the service system to be more responsive to the needs of persons with co-occurring disorders. The number of recognized COD credentials—including the Connecticut Certification Board’s Co-Occurring Specialty Credential…the American Board of Psychiatry and Neurology’s (ABPN) Subspecialty of Addiction Psychiatry…the College of Professional Psychology’s Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders…NASW’s Certified Alcohol, Tobacco and Other Drugs Social Worker (C-CATODSW) credential…and ASAM’s Certification in Addiction Medicine—is evidence of that strategy at work.
I look forward to seeing the Co-Occurring Enhanced Program Guidelines that you are preparing. I know that you are expecting that multiple methods of measuring co-occurring competency will continue to be accepted.
I want you to know that I am prepared to support these important efforts to the fullest extent possible. Co-occurring disorders and integrated treatment is, and will continue to be, a high priority for SAMHSA and CMHS. It is SAMHSA’s belief that co-occurring disorders are the expectation and not the exception. We have a number of materials that you may find useful—and all are free of charge, and readily available via our Web site: samhsa.gov.
Our TIP 42 addresses the treatment of co-occurring disorders from the substance abuse treatment perspective, and provides state-of-the-art treatment guidelines and case examples. Our Co-Occurring Disorders toolkit includes all of the resource materials you need to replicate the evidence-based practice, including implementation guidelines and fidelity measures. You’ll find many more resources on our Co-Occurring Center for Excellence, or COCE, Web site—at coce.samsha.gov. COCE offers cross training, technical assistance, publications, meetings, conferences, and a wealth of useful information for clinicians. Dr. Brown will give a thorough overview of COCE. I encourage you to explore the site to find out more about these resources.
Every resource we can provide…every strategy we can devise to strengthen the workforce and improve your ability to provide integrated, recovery-oriented care…is an investment in the future of the entire behavioral health field. The SAMHSA Action Plan for Behavioral Health Workforce Development that I mentioned earlier is one such investment. We developed this Plan to serve as a resource document that can help guide you and your agencies as you move toward the integrated system of care you envision.
The Plan recommends seven action goals—
Goals 1 and 2 focus on broadening the concept of workforce to significantly expand the role of individuals in recovery, their families, and communities. These individuals can provide a unique perspective that enhances the relevance and value of the care provided. Persons in recovery and their families should play critical roles in caring for themselves and for each other…whether through formaI peer- and family-support services, or through more informal self help and family caregiving. I encourage you to seek out these individuals as full partners as you think about how to improve the care you provide.
Goals 3, 4, and 5 are more “traditional” workforce development goals that focus on implementing systematic recruitment and retention strategies…increasing the relevance, effectiveness, and accessibility of training…and actively fostering leadership development. Agencies must actively support and reinforce the kinds of competencies that are needed to build the workforce of the future.
Goals 6 and 7 involve creating improved structures to support the workforce, including greater use of information technology and a national research and evaluation initiative to yield improved information on effective workforce practices.
Each of these goals provides a guide to action…stepping stones toward our overarching goal: a recovery-oriented system of care here in Connecticut and across the nation.
I’d like to take a moment to describe what we mean when we say, “recovery.” As we move towards operationalizing recovery and creating recovery-focused standards, I think it is critical that we have a shared understanding of what we are trying to achieve.
Last year, SAMHSA unveiled a consensus statement outlining the principles necessary to achieve mental health recovery. This statement was developed through deliberations by over 110 experts representing mental health consumers, families, providers, advocates, researchers, managed care organizations, state and local public officials and others. I want to emphasize that this was done with mental health consumers in mind…there may be other elements that should be considered when we think more broadly about behavioral health.
At the end of this consensus building process, we agreed that…
Recovery is Self-Directed. Consumers must lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life.
Recovery is Individualized and Person-Centered. There are multiple pathways to recovery based on an individual's unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background.
Recovery is based on Empowerment. Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives.
Recovery is Holistic. Recovery encompasses an individual's whole life, including mind, body, spirit, and community. Therefore, recovery must embrace all aspects of life, including housing, employment, education, mental health, addictions, healthcare treatment and services, spirituality, social networks, and family supports.
Recovery is Non-Linear. It is a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience.
Recovery is Strengths-Based. Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (such as partner, caregiver, friend, student, or employee).
Recovery flourishes with Peer Support. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
Respect is crucial in achieving recovery. Societal acceptance as well as self-acceptance and regaining belief in one's self are particularly vital.
Recovery is about consumers taking Responsibility. Consumers must identify coping strategies and healing processes to promote their own wellness.
And, finally, recovery is about Hope. Recovery provides the essential and motivating message of a better future…that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but it can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process.
In science, a “catalyst” is a substance that increases specific chemical reactions. In a larger sense, a catalyst is a force that provokes or speeds significant change or action. Each of you in this audience is a catalyst…a force that provokes change in the systems of care in which you operate. This conference is a wonderful opportunity to hear from professionals and organizations from across the State about the cutting edge work that is taking place. It’s an opportunity to develop new skills…and to learn more about how to better serve this complex population.
Your presence here today suggests that you are ready to take this on…to do things differently…to collaborate with partners across substance abuse treatment and prevention, mental health, general health, and the recovery community to make tangible improvements in the way you and your organizations screen, assess, diagnose, and deliver recovery-oriented care for persons with co-occurring disorders.
We at SAMHSA applaud the progress you have made and the forward-thinking leadership you continue to show. We have great expectations for the future. I urge you to continue to use your skills and talents—as key levers of change—to contribute to our national efforts to improve treatment for all Americans with co-occurring disorders. Archimedes, the Greek mathematician, physicist and engineer whose work on levers and the first machines was well ahead of his time, said, "Give me a lever long enough, and a place on which to rest it, and I will move the world." I urge you to use your power…your leverage…to advance this movement toward integrated care and change the world for people living with co-occurring disorders. Thank you.
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