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Recovery-Oriented Systems: Barriers and Challenges

Barriers to Recovery-oriented Systems:

As described in White and Kurtz (2006) the conceptual and institutional barriers include:

  • Difficulty in shifting thinking from problem focused approach to a strength-based approach and accepting the chronic model of care;
  • Professional pride and concerns about status and power by addictions professionals coupled with suspicion about the abilities of non-clinical peers to provide services;
  • Lack of protocols for recovery support services as well as a lack of financing for recovery support services; and,
  • Weak infrastructure of addiction treatment organizations and turnover of staff.

In addition to the barriers among providers and professionals in the field, most faith-based and peer recovery support services are grassroots organizations that lack the infrastructure needed to comply with Federal, State or local reporting requirements. (Unpublished, SAMHSA, 2007)

Challenges to Recovery-oriented systems:

The overall challenge to moving to a recovery centered system is maintaining quality assurance standards while at the same time preserving the uniqueness of the peer/faith- based services and integrating RSS into a more structured and regulated system. Additional challenges include:

  • Concerns about encroaching on professional services, lack of understanding about recovery support services, resistance to change, and basic philosophical differences about paths to recovery;
  • Developing a rate structure that sustains RSS;
  • Maintaining ongoing communication between licensed providers and non-traditional RSS providers;
  • Maintaining the “peer-ness” of peer recovery support services and resisting the pressure to “professionalize” RSS, while ensuring quality services; 
  • Resisting any pressure, due to budget constraints or other reasons, to replace clinical services with RSS as both are needed for a person-centered system;
  • Reviewing and modifying regulations and laws that are inconsistent with recovery-oriented system; and
  • The need for reliable evaluation data to support the efficacy of RSS.

(Unpublished, SAMHSA, 2007)

Possible Solutions to Barriers and Challenges:

Responding to Quality Assurance Concerns: 

  • At their Annual Technical Assistance Conference in August 2005, SAMHSA's RCSPs identified a set of twelve Common Indicators of Quality to use as guidelines for peer recovery services grantees; and,
  • States have been able to address quality assurance for RSS with a variety of responses and programs.

Enhancing and Increasing Access to Services:

  • Have Stakeholders work together to identify ways to ensure the quality of RSS while allowing them to grow and diversify;
  • Use a consensus building process and bring together all the stakeholders from the outset;
  • Keep the oversight of peer- and faith-based organizations flexible enough to be able to adapt to new challenges and lessons learned;
  • Provide adequate training that address new standards and other regulations that are established;
  • Recognize that this is a multi-year process; and,
  • Utilize existing partnerships to assist in the development and implementation of recovery-oriented services and systems.

(Unpublished, SAMHSA, 2007)

A Recovery Revolution in Philadelphia - Learn how the city of Philadelphia is working to overcome some of the challenges highlighed here.

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