For years, the health care system treated addiction as an acute condition: an individual battling addiction would be diagnosed, treated, guided to support and then left to their own devices on whether to succeed, or fail, in recovery. The good news is: for New York State, that is no longer the case. The New York State Office of Alcoholism and Substance Abuse Servicers (NYS OASAS) acknowledges addiction for what it is: a chronic disease. As a result, our system of care has undergone a complete metamorphosis; it now focuses more on the individual needs of each patient, and the recovery phase of our continuum of care will be successful in part due to the input and dedication of communities across the state.
Our overall recovery efforts align with the vision of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Recovery-Oriented Systems of Care (ROSC). SAMSHA says, “An ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improve health, wellness, and quality of life for those with or at risk of alcohol and drug problems.” (SAMHSA- ROSC Resource Guidebook-September 2012). By using non-clinical supports to augment clinical recovery services, individuals will get the guidance they need as they move through our continuum of care. Through our ROSC in New York State, we are helping individuals with substance use disorders to overcome their condition and provide them with the tools and support they need to get their lives back on the right track.
Moving in the Right Direction
Recovery services are increasingly becoming a more vital part of the continuum of care model in New York. Our Residential Redesign and Medicaid managed care for substance use disorder services are part of Governor Andrew M. Cuomo’s Medicaid Redesign initiative. Providers in New York City have already transitioned to the new reimbursement model under Medicaid managed care in October 2015 and the rest of New York State will implement the new model by July 2016. In addition, OASAS is transitioning to a new treatment paradigm that includes residential treatment options to divert appropriate individuals from higher intensity levels of care to more appropriate community-based options. This will allow for bedded addiction treatment programs that provide both short-term crisis and respite care, as well as longer term rehabilitation options, making the treatment system more responsive to individual needs.
In addition, we have fundamentally changed outpatient care so that it includes a continuing care component after treatment discharge and enables providers to offer services outside the walls of an outpatient program. These changes are part of OASAS’s plan to develop New York’s ROSC capacity, by allowing providers to see patients where they are in the community, and to have some of those services provided by Certified Recovery Peer Advocates (CRPAs) with the ability of providers to bill Medicaid for those services. These changes create new opportunities for CRPAs to assume a more integral role in substance use disorder care and recovery.
OASAS is leading the way nationally by using these opportunities to drive change in the health care system and aligning our services to better meet the treatment and recovery support needs of those with substance use disorders. We are continually working to bring services to New Yorkers in their communities, to provide residential services that meet the needs of individuals, and to develop peer services to help individuals gain better access to care and aftercare.
Combating an Epidemic: Connecting People in Need to Treatment
You may have seen it in the headlines. The nation is in the middle of an opioid/heroin epidemic, and New York State has not been immune. NYS OASAS is doing everything in its power to help New Yorkers battle all addictions, and recovery remains a key part of our comprehensive strategy. To better connect individuals with treatment and get them on the path toward recovery, we launched the new OASAS Bed Availability dashboard (https://bi1.oasas.ny.gov/oasasbed). The new, online resource allows New Yorkers to find available treatment services anywhere in the state, in real time. We are working to expand the tool to include outpatient and other services. In another multi-agency effort to address the prescription opioid and heroin epidemic, NYS OASAS continues to work with the Health Department and other State agencies, to train more New Yorkers on how to administer Naloxone, a medication which can reverse an opioid overdose. Currently, more than 100,000 people have been trained. This is a crucial step in the continuum of care. We must reverse an overdose first, so that there is an opportunity to connect individuals to care, the beginning step in helping individuals along the path to recovery.
Guiding People to Care
NYS OASAS is also making investments to support New Yorkers’ recovery from addiction through our new Family Support Navigator and On-Call Peer Support Advocate initiatives. The family support navigator program assists families as they access care for their loved one and work their way through the OASAS system. Under the On-Call Peer Advocate program, a peer, with experience in accessing addiction services, will work with hospital Emergency Department personnel to help connect individuals in a substance use disorder crisis to appropriate treatment services within the OASAS system before they are discharged from the hospital. We also recently released a new “Access Treatment” video series on our website (https://www.oasas.ny.gov/treatment/index.cfm) to help individuals and families navigate their way through the addiction treatment system and obtain the services they need.
OASAS also works with primary care providers to ensure they are trained to use Screening, Brief Intervention and Referral to Treatment (SBIRT). The SBIRT evidence-based approach to identifying patients who use alcohol and other drugs at risky levels is aimed at reducing and preventing substance use disorder related health consequences, diseases, accidents and injuries. Substance use is a health issue that often goes undetected. In July, OASAS released a video which provides general information about SBIRT (https://www.oasas.ny.gov/AdMed/sbirt/index.cfm) so that more primary care and other healthcare disciplines can utilize the approach with their patients.
OASAS also recognizes that safe, affordable and permanent housing for families suffering from a substance use disorder is an integral piece of successful recovery. Supportive housing is as critical a component of the recovery process as opportunities for employment, education and access to health care services. The OASAS Housing Bureau is dedicated to providing housing options for individuals through rental subsidies and case managed supportive services. The Housing Bureau currently administers a portfolio of housing contracts funding more than 1,900 permanent supportive apartment units.
Recovery Community and Outreach Centers
NYS OASAS currently oversees four Recovery Community and Outreach Centers. These centers offer information and education to communities on how to access addiction treatment support; assist with the navigation of insurance and treatment issues; and engage peers and volunteers to assist those in recovery on their path toward wellness. Because this initiative has proven successful OASAS will expand it with funding awards for 6 new centers across the state to be announced soon.
In January, Governor Cuomo announced more than $1.6 million in annual funding to create adolescent substance use disorder clubhouses. These first-of-their-kind clubhouses will be based in seven regions across the state and will promote peer-driven supports and services in a non-clinical setting for young New Yorkers in recovery or at risk for substance use disorders. The organizations receiving funding will help young individuals in recovery develop social skills that promote long-term health, wellness, recovery and a drug-free lifestyle.
Recovery Peer Advocates
OASAS is also working with Certification Boards to increase the number of Certified Recovery Peer Advocates (CRPAs) across the state. So far, the Boards have certified 265 peer advocates. OASAS is also collaborating with the New York Alliance for Careers in Healthcare and CUNY to explore additional ways to work together to help fulfill the growing need of CRPAs at OASAS treatment providers. We are continually working to address barriers for CRPA certification and to create additional areas of expertise for certain populations. We will be establishing two new peer specialties: family and youth peer specialists. Families faced with a loved one’s addiction often feel scared and alone. Family peers, through their lived experience and training will be able to provide needed support and assistance. Youth peer specialists will also be a much-needed resource for young people entering treatment or who are working on recovery.
There are many exciting initiatives underway focused on recovery from the grasps of the disease of addiction. The first step in recovery is to recognize the addiction problem and to step forward for help. To access help, New Yorkers struggling with addiction, or whose loved ones are struggling, can call the State’s toll-free, 24-hour, 7-day-a-week HOPEline at 1-877-8-HOPENY (1-877-846-7369). You can also find information on our website: www.oasas.ny.gov.