Convergence

At the convergence of forces for change in recovery high schools – who’s ready?

If you’re an administrator in an existing recovery high school, or part of an effort to start one, your world is about to change in a big way.

First of all, there will be new funding mechanisms for services designed to treat co-occurring disorders. But to access that funding, you’ll need a staff that is trained and licensed in clinical and mental health. Chemical dependency licenses alone will no longer be sufficient for staffing in the co-occurring world that’s coming.

Secondly, with increased funding comes greater scrutiny, so it’s going to be incumbent on every recovery high school to provide evidence of improved outcomes.

Thirdly, it’s no secret that multicultural diversity has been lacking in the field of adolescent recovery. That’s about to change. Students who have not had the funds, ability or desire to access addiction treatment will have it soon, and you need to be ready to receive them in a way that meets their needs.

And finally, there’s going to be a demand for more startups. But no one just writes a check to start a recovery high school. You’re going to need data to justify the investment it takes to serve a relatively small enrollment – typically around 30-to-60 students.

What’s driving these changes is a convergence of forces. We have new insights from recent research on adolescent addiction, treatment and recovery. We have high-profile incidents such as the tragedy of Newtown and the outbreak of bullying both in person and through social media. We have revisions to the Diagnostic and Statistical Manuel (DSM-V) that will increase the number of qualifying youth. We have the Affordable Care Act, which will alter the way mental health and substance abuse services are provided and expand the base of adolescents seeking treatment. And we have a growing need for continuing care, as access to treatment increases.

Let’s take a closer look at these forces:

  • Research over the last decade has confirmed that adolescents can develop substance use and addictive disorders. While they may present differently from adults, adolescents do become addicted (Deas, Riggs, Langenbucher, Goldman, & Brown, 2000; Johnston, O’Malley, Bachman, & Schulenberg, 2009; Weinberg, Rahdert, Colliver, & Glantz, 1998.)

Research has also shown that the risk of addiction is worse the younger a person starts using, but the prognosis for recovery improves the younger a person stops using. Clearly, the key to a positive outcome is intervening earlier in the process (Hardin and Ernst, 2009; NIDA, 2010).

Thanks to research, we know that addiction is a chronic disease and recovery is not a linear process. This means it can take years – or a lifetime – to recover, and recovery is often marked by multiple relapses and treatment episodes (Dennis & Scott, 2007).

A highly impactful research finding is that co-occurring mental health and substance abuse disorders are more prevalent than substance use disorders alone (Davidson & White, 2007). At one time, it was thought a minority of adolescents with an addiction might have a co-occurring mental health disorder. Now we know it is a majority, and many young people in recovery are trauma survivors as well (Dennis, 2004).

Finally, very recent research tells us that treatment with a continuing care component has better outcomes than treatment with no continuing care component (Burleson, Kaminer, & Burke, 2012). While this appears to be common sense, there are now empirical studies to support the importance of continuing care – though the outcomes vary according to program quality and implementation (Godley, Garner, Passetti, Funk, Dennis, & Godley, 2010; McKay et al, 2009).

  • High profile incidents have generated an interest in school mental health.In the wake of Newtown and with a growing focus on bullying, schools have been called to address mental health issues. Studies have shown that social emotional learning and character development in schools enhance student learning and improve a student’s chance of earning a high school diploma (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Taylor & Dymnicki, 2007).

Many states have begun reviewing their school mental health policies, and in some cases authorizing funding to expand them. Sen. Al Franken has introduced federal legislation to address school mental health, and the most recent Race to the Top federal funding legislation offered incentives for schools to offer programs in social emotional learning.

  • The DSM-V may take some time to blanket the treatment community. However, some feel the new manual (and its revised “Substance Use & Addictive Disorders” label) will increase the number of youth who will receive a diagnosis and thus qualify for services. This is in part due to expansion of the list of recognized symptoms for addiction and the reduction in the number of symptoms needed for a diagnosis of substance use or addictive disorder.
  • Three major milestones of the Affordable Care Act (ACA) are staring us in the face.
  1. Starting at the beginning of this year, the law established a national pilot program to pay hospitals, doctors, and other providers a flat rate for an episode of care rather than billing for each service separately. The idea is to coordinate services, and ultimately providers will be paid for an episode and need to find the most efficient way to service the problem.
  2. On this coming October 1, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. This will keep children in the pipeline for services.
  3. Then, on January 1, 2014, most individuals who can afford it will be required to obtain basic health insurance coverage and people can start buying insurance in the Health Insurance Marketplace instead of through employer plans.

Each of these three milestones will increase the number of people with access to health care, though none of them call for growth in the number of service providers or programs. With more people seeking services than there are programs to serve them, this is a golden opportunity for innovation in mental health and substance use disorder programming – especially at access points like school-based clinics.

As more students access services in schools, districts will be compelled to offer continuing care. For many students, these services will require more than the traditional school can offer. The types of school-housed approaches that can address continuing care include:

  • After-school/after-care programs.
  • Assertive Continuing Care community-based program.
  • Recovery Classrooms (including school-day support group meetings)
  • Student Assistance Programs and counselors
  • Recovery High Schools (both schools-within-schools and stand-alone programs)

From this list, Recovery High Schools is the only approach that involves changing the environment for students. Evidence suggests peer influences and social environments play a role in sustained recovery for many young people (Teunissen et al, 2012; Tome et al, 2012; Dennis, Foss, and Scott, 2007).

So here we are – at the nexus of events that will generate calls for more recovery high schools. The issue is, are recovery high schools ready to heed that call? Who has a staff that’s trained and licensed in clinical and mental health? Who has the ability to track outcomes? Who has the sensitivity tomulticultural diversity you’re going to need? And who has the right data to justify all the new recovery high schools we’re going to need? The time to answer these questions is now.