How Recovery Oriented Systems of Care Programs Use Networks and Social Capital to Increase Equity in Substance Treatment Delivery Systems in the US

• In Event: Health Social Work with Precarious Groups

Abstract

Treatment of substance use disorders in the US is structured to function as an acute care model, whereby short, isolated treatment episodes using brief biopsychosocial stabilization and medication is the norm. People processing systems within the substance delivery system includes diagnosis of substance use disorder and reduction of symptoms through “credentialed” medical and behavioral healthcare professionals who dominate assessment, treatment planning and service delivery decision making. In order to respond to the incentives inherent in this orientation, more often than not the recommendations and referrals are focused on the short-term and designed to be time limited.
For individuals currently in recovery and the social workers and other behavioral health providers serving them, this has not been effective. This has led to the emergence of recovery movements and Recovery Oriented Systems of Care (ROSC). These movements are shifting strategic planning for substance prevention and treatment from an insurance and provider-centered definition of problems, to one that is more patient-centered, and recognizes that addiction and recovery involve a complex series of actions occurring over an extended period of time. Thus, the purpose of this study is to better understand the role of external and internal economic and political processes on the development and implementation of ROSCs.
Methods: I am from the critical realist epistemic community and seek to determine how these networks work in the real world. To better understand how ROSC systems work in the real world, we did a qualitative study of 5 different recovery-oriented systems of care in Illinois. Nineteen respondents completed individual interviews. Interviews were transcribed, de identified, open coded in the first stage, and deductive coding was completed in the second stage using previous research and networks and social capital. Constant comparative analysis was used to ensure that the theory generated was integrated, consistent and plausible.
Results: Out of 124 codes, 3 themes were identified: 1) State Performance Management focused on coalition building which encouraged ROSCs to change traditional power dynamics, and create lasting bridging social capital, through the inclusion of non-traditional partners, 2) ROSC facilitators played a very important role when it came to reducing power differentials and building linking social capital but their capacity to do so is often limited by the political economic environment, 3) ROSCs used “many paths to recovery” perspective to build the foundation to care coordination systems and internal culture where people with lived experience had leadership positions in the counsel but this approach was not always coherent to stakeholders.
Implications: These findings are important because they show how to use social capital – particularly bridging capital to increase equity within interagency networks focused on social service and behavioral health service delivery. It also shows where such approaches can have limitations and discourage some stakeholders from being more involved.

References

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Author

• Carissa van den Berk Clark, Saint Louis University