Palm Beach County Florida has been at the center of the opioid crisis for many years. In an effort to address the complex challenges of the opioid epidemic, the County initiated a comprehensive opioid response plan.
With so many lives impacted by substance use disorder, County leaders and stakeholders knew they needed a more integrated and collaborative approach to care. They also recognized that outcomes data needed to be unified across all agencies, more recovery-oriented, and representing the full recovery experience.
The need for a more meaningful solution, one that established a pulse of someone’s recovery journey no matter where they were in the continuum of care, led them to the Recovery Capital Index® (RCI). The County’s shift to a more person-centered and recovery-oriented approach is complex, but the RCI and its secure platform are helping move the strategy in the right direction.
Palm Beach County Community Services Department Office of Behavioral Health and Substance Use Disorders coordinates strategies, services, policy, and funding in Palm Beach County.
Palm Beach County needed a validated and shared outcomes measure that aligned with its shift to a person-centered and recovery oriented system of care from a treatment-centered system.
The Recovery Capital Index® (RCI) delivered by automated SMS and email to clients through a web-based platform giving all networked providers visibility to results maintaining continuity of outcomes throughout the system of care.
West Palm Beach, FL
Recovery Capital Index Survey and Platform
INCREASING VISIBILITY AND COORDINATION.
When Palm Beach County launched its opioid response plan, it set out to use a recovery capital measure. But all recovery capital measures are not equal. The County needed more than a survey. It needed the ability for the data collected to be visible to all participants in their new coordinated care model or recovery oriented system of care. The County did not want important recovery data to go into an agency-by-agency black box; essentially making it impossible for subsequent providers in the network delivering care to the same individuals unable to see a client’s past or continued recovery capital data.
The RCI is built upon a platform designed for and used by many states and institutions for their health information exchange. This meant that Palm Beach County could invite onto the platform all of its funded agencies who are part of their coordinated care system. With proper case management and informed consent at the beginning of a client’s journey, all of their RCI scores and responses could be viewed by any other network provider. This means that a client’s recovery is constantly measured throughout their journey and any service they connect with in the network can see their progress and engage in an informed and personalized way.
“This is truly individualized and personal care on a level we’ve never had before,” said John Hulick, Palm Beach County’s Senior Program Manager with the County’s Office of Behavioral Health and Substance Use Disorders.
Hulick was tapped to lead the County’s opioid epidemic response efforts in 2018. He’s been in the behavioral health field for nearly 35 years, mostly in policy-making roles. Hulick also served in New Jersey Governor Christopher Christie’s administration as Policy Advisor for Human Services, Children and Families. He was subsequently appointed by Gov. Christie to be the State’s Drug Czar.
Palm Beach County chose the RCI just as much for the scientific strength of the instrument as it did for full visibility and security the platform provided to each agency using the tool. This visibility is good and critical to individuals receiving services too.
While other recovery capital instruments were considered, none met the scientific rigor nor statistical validation the County’s move toward a recovery-oriented and person-centered system of care demanded.
“Living with substance use disorder is challenging, and building recovery is complicated, and then having to share and re-share what’s going on is frustrating for people,” Hulick said.
Because the RCI is a 360-degree view of a person’s life and completed every 30 days, care providers can focus and plan in a progressing nature. This improves the client experience by eliminating frustration in the coordinated care process.
Key to coordinated care is the ability to see all of an agency’s data in one place, but more importantly, to see their results in context with other providers in the network.
The RCI platform gives each agency the ability to see how they are performing and how other agencies are performing. It also allows other agencies insight into various recovery determinants that may be affecting care and driving outcomes.
“We cannot possibly know all the things that make it difficult for people to recover, but the more our agency clients report their recovery capital, we start to see what they see and can engage sooner, apply appropriate resources in the right places, and craft better policies,” said Joanna Reid, Palm Beach County Community Services Department Grant Compliance Specialist.
A MORE MEANINGFUL INSTRUMENT.
Recovery is complicated and it cannot be captured in 10 questions alone, according to Hulick. If Palm Beach County is to be successful it needs deeper and more meaningful outcomes data.
“There’s a desire to make survey assessments short, I understand this, but what we might gain in time, we lose exponentially more when we don’t go deeper and make the surveys easier to complete on a client’s own time,” he said.
The 68 items that make up the full validated Recovery Capital Index provide 22 indicators of a person’s recovery. These indicators are always changing through early recovery and life, generally. As the County builds out their person-centered and recovery-oriented system of care, they are seeing a wider view recovery from the diverse demographics of those they serve. They are also seeing a real-time pulse of people’s recovery that represents the circumstances in the community.
“Unlike other instruments and systems out there, the RCI platform is giving the County, our agencies, and their clients flexibility in capturing the survey data,” said Hulick.
From the moment Palm Beach County went live with the RCI, clients would receive a secure link to the survey through SMS and email, whichever was their preference. Every survey thereafter is automated to send every 30 days.
Agencies are beginning to save valuable time during intake processes and ongoing appointments by having their clients complete the survey outside the facility on their on devices, often in the comfort of their own home and lives.
“COVID obviously limited face-to-face care, but now that we’re getting back to in person services, time should not be spent completing surveys in the office—and that’s not necessary with the email and SMS functionality of the RCI platform,” Hulick said.
Time is really valuable in early recovery, Hulick explained. Nobody wants to be filling out surveys all the time. The full RCI takes less than 10 minutes to complete. That’s only 10 minutes every 30 days to get the most comprehensive picture of recovery that exists to providers and stakeholders in near real-time.
“We love the direction we’re going with the RCI and the rigor of science behind the instrument,” said Hulick. “The rigor has been applied to create shorter versions of the RCI and we look forward to seeing the increased flexibility with such a strong tool.”
SEEING RECOVERY IN A PANDEMIC.
While the County is still early in getting all the agencies it wants on the RCI platform, early use is proving promising with longitudinal data starting to accumulate the longer agencies use the tool.
Palm Beach County launched the RCI with agencies at the end of 2019 and into 2020. Then COVID hit. The entire landscape of providing care changed. Care became more digital overnight.
The RCI, as a web-based and automated tool, was ready for the shift. Providers could push the assessment by email and SMS and gather critical recovery data with the clients they were able to care for.
Longitudinal data at the individual level is key to demonstrating the effectiveness of specific interventions and to guide ongoing recovery planning. What might be happening in the community, however, may tell a different story. Recovery capital isn’t just what a person can bring into their recovery, but it is also the collection of assets available to a person in a particular environment.
“The people we serve are some of the most vulnerable and during the pandemic they showed us through the RCI areas of their life in our County that were affecting their recovery the most.” Hulick said.
As individuals came into various programs supported by the County and who were using the RCI, collective recovery capital began to emerge in a time-series view.
Regular and ongoing engagement with treatment and services providers was disrupted during the year. But from month-to-month, the County captured a community-based pulse of recovery capital from a diverse population experiencing the pandemic as it moved through its stages of intensity across the County.
It was rather unexpected to see just how widely and intensely the pandemic impacted and continues to impact people’s recovery capital in Palm Beach County.
Hulick and his team were anticipating systems level data by using the RCI, but what they can actually see in the data is something more profound. “It was hard to miss the profound deficits in housing and employment in our early data analysis, Hulick said. “We were also pleased to see strengths in social and cultural capital.”
Recovery capital can be broken down into three key domains: Personal Capital, Social Capital, and Cultural Capital. Personal Capital are the collection of tangible and intangible assets available to or part of an individual like mental well-being and employment. Social Capital is the totality of an individual’s relationship assets like family support and social mobility. And, Cultural Capital encompasses our values, beliefs, and connection to other social and community specific norms like sense of purpose and cultural relevance.
“Our sense of ‘system’ has been in the context of care and providers and direct services,” Hulick said. “Those we serve are telling us what elements of the community are impacting them most—this is a new kind of recovery advocacy and the future of communities being truly recovery-oriented.”
As the use of the RCI progresses and expands, the County will continue to focus at the individual level. At this level, the County expects the RCI to inform recovery planning, inform care processes, and improve long-term recovery outcomes. The County will achieve these aims by ensuring that front-line staff and clients alike are well-versed on how the RCI can aid an individual’s recovery.
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