Recovery-Oriented Systems of Care (ROSC)

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines Recovery-Oriented Systems of Care (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 recovery and improve wellness, and quality of life for those served.”

ROSC uses a holistic, integrated approach to address the needs of individuals with substance use disorders (SUD). This approach supports patients through the full continuum of care — prevention, early intervention, treatment, continuing care, and long-term recovery. ROSC integrates mental health and primary care services and promotes whole-person, community-centered care, with most interventions taking place in everyday community settings to improve accessibility and engagement.

Person-centered principles guiding ROSC include:

Informed consent: Ensuring individuals understand and agree to their care plans.
Shared decision-making: Collaborating with individuals to tailor care to their unique needs.
Relationship building: Fostering trust and respect between providers and individuals.
Trauma-informed care: Recognizing and addressing the impact of trauma on recovery.
Resilience and strengths-based support: Leveraging personal and community resources to support recovery.
Patient-centered care: Aligning services with individuals' values and needs.
Peer and family support: Actively involving peers and families in the recovery process.

Research indicates that ROSC improves quality of life, health outcomes, and social support for individuals with SUD. By addressing social determinants of health, such as housing, employment, and transportation, ROSC also helps reduce stigma, enhances recovery engagement, and empowers individuals to maintain long-term wellness.

Examples of Rural Recovery-Oriented Systems of Care Programs

Discovery Place in Burns, Tennessee offers a long-term continuing care program for individuals who have completed a 30-day residential treatment program. It includes 12-step recovery meetings, lifestyle workshops, and guidance on maintaining healthy habits.
The Hazelden MORE (My Ongoing Recovery Experience) online recovery program is for individuals who have completed residential treatment for SUD. It features computerized modules, recovery coaching, and a licensed counselor to support ongoing recovery.
The Ecosystem of Recovery is a community-based model in New York's Appalachian region integrating prevention, treatment, and recovery support through healthcare partnerships. This system addresses five pillars: saving lives, engaging the community, expanding treatment access, screening and prevention, and supporting recovery.

Considerations for Implementation

Implementing ROSC in rural communities presents unique challenges, such as resource limitations, geographic isolation, and workforce shortages. To address these challenges, programs may use wraparound services, which provide comprehensive coordinated care, to help individuals receive needed support for long-term recovery. Wraparound services in ROSC may include case management, mental health services, transportation, and family or peer support.

Other recovery-oriented supports for holistic SUD recovery include:

Stable housing: Providing sober living options helps ensure stability in the recovery process. For example, programs may need to help patients in treatment establish stable housing. They may need to partner with other organizations, such as homeless services providers, to expand access to shelter or housing for patients while in treatment.
Family-centered approach to treatment including providing services like child care: For patients who have children, it can be difficult and expensive to find childcare coverage during appointments for treatment services. Programs can include childcare services as part of their program to reduce this barrier to care. This additional service allows parents to bring their child to their in-person appointment without having their child in the room while they are discussing treatment with a provider or attending a counseling session.
Nutritional support: Research indicates that nutritional counseling and education is an important aspect of recovery for individuals with SUD. Rural programs can leverage resources like the Supplemental Nutrition Assistance Program (SNAP), to provide financial assistance for food access. Educating beneficiaries about SNAP-Ed, which promotes healthy food choices, can further support recovery.
Complementary approaches: Mindfulness-based approaches, including meditation, yoga, and tai chi, can enhance both physical and psychological aspects of recovery. Meditation has shown promise as a supportive tool for recovery, with ongoing research in complementary and integrative medicine.

Solutions such as expanding access to care through telehealth and mobile health units can provide essential services, such as counseling, medication for treatment, and recovery support, directly to individuals in remote areas.

Building strong community partnerships with healthcare providers, schools, faith-based groups, and social services creates a comprehensive care network, while integrating SUD services into rural clinics improves accessibility. Additionally, peer recovery coaches and family support networks help engage individuals in their recovery journey. Training local peers to provide support and involving families through structured support groups can enhance recovery engagement. Strategies supported by wraparound services can help create effective and sustainable ROSC models that meet the unique needs of rural communities.

Program Clearinghouse Examples

Resources to Learn More

Housing Supports Recovery and Well-Being: Definitions and Shared Values
Document
Highlights how safe, stable housing is a critical component of recovery and overall health for individuals with substance use or mental health conditions. Compares recovery housing and permanent supportive housing models, outlining their definitions, core principles, and shared values.
Organization(s): Substance Abuse and Mental Health Services Administration

Recovery and Recovery Support
Website
Provides information about recovery-oriented care and recovery support systems to help individuals with substance use and mental health disorders manage and overcome their disease.
Organization(s): Substance Abuse and Mental Health Services Administration

What Is a Recovery-Oriented System of Care?
Document
Provides an overview of ROSC along with recovery community activities, toolkits, and resources for building resilience and promoting long-term recovery.
Organization(s): Prevention Technology Transfer Center Network
Date: 2/2020