Transformative Change for Health Equity: Ideas and Inspiration from the ROSC Equity Summit, June 15-17, 2021
In a field that is increasingly aware of our need to promote greater health equity, behavioral health leaders are discovering that we have already begun to learn and use a powerful tool for forging equity: Recovery-Oriented Systems of Care (ROSC).
At a recent three-day ROSC Equity Summit, the Great Lakes ATTC, the Northwest ATTC, the South-Southwest ATTC, and the African American Behavioral Health Center of Excellence gathered behavioral health leaders from 15 states to explore the use of ROSC as a tool for promoting equity and addressing behavioral healthcare disparities.
SAMHSA defines a ROSC as 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 improved health, wellness and quality of life for those with or at risk of alcohol or drug problems."
Today, efforts to develop ROSCs and improve quality of life are underway across the country, in communities that have been devastated by substance misuse, by the opioid epidemic, and most recently by the COVID-19 pandemic. At the Summit, participants began to expand their vision to include yet another potential benefit of these approaches.
ROSC as a Tool for Transformative Change
Dr. Ijeoma Achara and Dr. Dietra Hawkins designed the Summit and served as the facilitators and subject-matter experts for the three-day session.
Dr. Hawkins holds a faculty appointment as an assistant clinical professor at the Yale Program for Recovery and Community Health, a project of Yale University School of Medicine, and is the Owner and Lead Consultant of Both And Partners, Inc., where she helps individuals, communities, and organizations apply research-based approaches to issues of diversity, equity, and inclusion.
Dr. Achara, a noted National expert on ROSC and systems transformation, opened the Summit with a keynote presentation on the ROSC framework as a vehicle for transformative change.
Dr. Achara has more than a decade of experience helping behavioral health systems adopt recovery-oriented approaches. As Director of Strategic Planning at the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (under the leadership of Commissioner Dr. Arthur C. Evans, Jr.), she facilitated the recovery-oriented system of care transformation effort that included empowering people in recovery to play integral roles in systems change, expanding peer services, and aligning policies and clinical practices with a recovery orientation.
"In a recovery-oriented system of care, we are looking at the whole person; we're not just looking at their symptoms," said Dr. Achara. "We're not just focused on the individual. We are focused on the context in which the individual lives, and we understand that people are only as healthy as the environment in which they're embedded."
During her presentation, Dr. Achara told participants that behavioral health disparities that have been documented for decades are still very much in evidence today. Though tenacious, these disparities are not inevitable. They persist partly because their complexity can leave even the most committed advocates for equity and social justice feeling overwhelmed and unsure about where to start.
Isolated interventions such as workforce development efforts or culturally rooted programming can be well-intended, but on their own, they may do little to improve outcomes for people of color. This is because disparities are rooted in systemic racism and long-standing, interlocking assumptions, beliefs, policies, regulations, laws, and service-delivery practices that shape every aspect of our behavioral health system.
The behavioral health community already has an asset that can be a significant part of the solution, explained Dr. Achara. Like the work to promote equity and racial justice, our efforts over the last decade to develop recovery-oriented systems of care were grounded in a social justice, human rights movement.
Even so, “While we have made much progress in promoting peer support and recovery-oriented approaches to treatment, our efforts to promote ROSC have not always remained centered in the promotion of equity and justice,” said Dr. Achara. “If they were, we would not have experienced an increase in the criminalization of substance use disorders for black and brown individuals, in spite of a simultaneous increase in resources devoted to the expansion of recovery support services.”
Dr. Achara maintained that now is the time for our collective ROSC efforts to return to their social justice roots. To promote equity and truly recovery-oriented systems, the need for transformative systems change is greater than ever. This type of change recognizes that a ROSC is more than just adding peer or recovery support services to the existing treatment system. It requires that we examine how systemic racism and inequities show up in behavioral health systems and that we intentionally lead efforts to align all aspects of the service system with a recovery orientation. Dr. Achara also discussed the need to focus on the building blocks of a ROSC (see “Tools for Change,” below) to promote equity and racial justice and to begin or strengthen efforts to dismantle systemic racism.
A Foundation for Action: Dr. Camara Jones
Another powerful component of the Summit was the presentation by Camara Jones, MD, MPH, PhD, a Senior Fellow and Adjunct Associate Professor at Morehouse School of Medicine, on "Achieving Health Equity: Naming Racism and Moving to Action." Knowing that a society’s or a field’s ability to address a problem is only as good as our ability to recognize and understand the problem, Dr. Jones has applied her genius for metaphor to the difficulty of grasping and encompassing issues of racial inequity that one has not experienced first-hand.
Dr. Jones offered a series of allegories that vividly illustrated the nature, mechanisms, and health effects of racism. One brief example highlighting differences in perception was a restaurant with the typical two-sided sign on the glass door, saying “Closed” to the people outside and “Open” to those inside. Having no idea they are looking at a two-sided sign and assuming the restaurant is open to everyone, the patrons having dinner in the restaurant only occasionally wonder why all those hungry people are still standing outside.
In her discussion of steps that we as a field must take in our equity efforts, Dr. Jones underscored the critical importance of learning history, addressing the systems that assign value and structure opportunity, maximizing our leadership roles, bursting the “bubbles” that keep us segregated, and being willing to “plant acorns so that our grandchildren can have shade.”
Panelists Share Lived Experience of Recovery from a Health Equity Lens
The second day of the Summit featured a panel of presenters in recovery.
Erica Salinas is a recovery coach who lives in south Texas, just 10 minutes from the U.S.-Mexico border. Erica began her recovery journey on her own, without support from medical professionals or a recovery community. "The doctor told me I needed to stop, but he didn't tell me how," she explained. After a few months, Erica realized she needed support and found a recovery support group at her church. Erica shared that she was not aware of mainstream treatment programs in her community and felt most comfortable accessing support in her natural community settings.
“I got connected with my church, and the more I went to the small groups, it was like wow! I’m not alone!” said Erica. “I was able to learn from them. I felt supported and decided I needed to go back to school.”
Erica enrolled at the University of Texas-Austin and got involved in the campus Collegiate Recovery Program. She completed her undergraduate degree—the first person in her family to do so—and recently earned her master's degree.
She described the many barriers that Hispanics and Latinos face in seeking treatment for mental health challenges and/or substance use disorders—including stigma, lack of culturally and linguistically appropriate services, and fear of deportation.
Panelist Colin Cash described his experience of getting into recovery on a reservation. A member of the Mille Lacs Band of the Ojibwe, Colin began a recovery movement known as Sober Squad, a movement that now has more than 8,000 members in its online group and 26 Sober Squad chapters across five states.
Colin talked about the impact of historical trauma on Native communities and the need for more Native staff working in healthcare, the legal system, and the peer recovery movement. "It's a huge barrier to treatment when you don't see anyone who looks like you," said Colin.
Experiencing the criminal justice system as a teen opened her eyes to systemic racism, said recovery advocate and final panelist Brooke Feldman. “I am always seen as more redeemable than somebody who has black or brown skin, simply just by virtue of the advantages and privileges I have because I'm white,” said Brooke, who believes that recovery stories need to be told from an equity lens.
“We need to do a far better job of really acknowledging the different advantages and privileges that we had along the way.”
Tools for Change: Dr. Arthur Evans
Arthur C. Evans Jr., PhD serves as the Chief Executive Officer and Executive Vice President of the American Psychological Association (APA). Before joining the APA, Dr. Evans led the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, where he spearheaded the city’s transformation guided by ROSC principles.
“What I want to suggest to you is that, when we talk about a recovery-oriented system, we have to think about not only treatment but all of the other things that people need to be successful,” Dr. Evans told the audience.
Using a recovery-oriented system framework can bring in all the things that can be helpful to a person’s recovery, said Dr. Evans. He also described essential building blocks that provide the foundation for a ROSC. These include:
- Optimizing clinical service delivery, including the use of evidence-based practices and tailoring treatment to individual needs;
- Increasing access to culturally competent services; and
- Meaningful inclusion of people in recovery and integration of peer support and professional services.
Dr. Evans also stressed the importance of working within communities to change attitudes and reduce stigma. “Work across systems so that, when people are served in other systems, they are treated in a recovery-oriented way.”
Peer Networking and Next Steps
Virtual breakout rooms on Day 3 brought people from the same states together to connect, sharing ideas for action steps and ways of implementing the ideas generated on Days 1 and 2. Participants discussed ways they could tell better stories, engage and inspire meaningful change, and identify and align their efforts with the principles of recovery to create a “collective impact.”
Ann Marie Roepke, a participant from the Northwest ATTC region, commented, "The Summit featured a brilliant and thoughtful set of speakers/facilitators who skillfully brought us both education and inspiration. As a result of the Summit, I feel much better equipped to facilitate conversations about racial equity and infuse this into my work as a trainer and consultant."
The hosting ATTC regional centers and African American Behavioral Health Center of Excellence were excited to provide the ROSC Equity Summit, with its focus on ROSC as a lens for examining health equity and the root causes of behavioral health disparities.
"The feedback we received from participants who attended the summit has been very positive, and they are expressing a renewed commitment to their ROSC efforts and addressing health disparities," said Denna Vandersloot, Co-Director of the Northwest ATTC. "People walked away feeling like they had practical ideas for addressing inequities at the individual, system, and community levels.”
"This content and the process this Summit has started are vitally important to the goals of the African American Behavioral Health Center of Excellence—particularly our first goal: behavioral health systems transformation,” said Principal Investigator Dawn Tyus, Ph.D., LPC. “We’ll continue to support these professionals in their efforts to address the policy and structural issues that drive inequity.”
The Summit sponsors hope the event will serve as a springboard for increasing providers’ and system administrators’ interest in ROSC and health equity. According to Vandersloot, “Future efforts will be targeted towards providing more intensive technical assistance in this area as providers, system administrators, and community leaders seek to implement ROSC with an explicit focus on health equity.”
- ATTC Network: Recovery Oriented Systems of Care
- ATTC Network page: Building Health Equity and Inclusion
- African American Behavioral Health Center of Excellence
- Great Lakes ATTC
- Northwest ATTC
- Southwest ATTC
- William White Papers: Defining Recovery Oriented Systems of Care
Contributing to this article:
Dr. Ijeoma Achara, Maureen Fitzgerald, Dr. Dietra Hawkins, Dr. Dawn Tyus, Denna Vandersloot, Pam Woll