Scott County, IN: Where It's Cool to Be In Recovery

February 4, 2019
Maureen Fitzgerald
Great Lakes ATTC

In spring 2015, the HIV outbreak caused by injection drug use in rural Scott County, Indiana, made headlines around the world. More than 200 cases were confirmed in the town of Austin, affecting one-fifth of its population of 4,200. This rural county faced multiple challenges in addressing the outbreak: poverty, high unemployment, and limited access to medical care, compounded by a devastating shortage of substance use disorder treatment and recovery services.

The Centers for Disease Control sent researchers to investigate. The state declared a public health emergency, with the governor authorizing a temporary Syringe Services Program. At the same time, local efforts to tackle the crisis were gaining momentum. Community leaders began to meet to talk about the the underlying issues that had triggered the skyrocketing rates of HIV infection in the area.

ROSC to the Rescue

When the news of the Scott County public health emergency first hit, Lonnetta Abright, director of the Great Lakes ATTC at the time, contacted Tom Cox.

Cox is a consultant for the Great Lakes ATTC and a life-long Indiana resident. He's dedicated his career to substance use disorder treatment and recovery services in the state. Cox serves on the Indiana Recovery Council and is also the Vice Chair of Mental Health America of Indiana.

"ROSC allows our community to have a conversation that centers everyone around the idea of recovery. They're starting to hear from other people that recovery is cool." Dr. Will Cooke, Austin, IN

"Lonnetta called and asked if there was any chance that I could attend a community meeting that a local doctor was trying to organize the next day in Austin," says Cox. 

The doctor was Will Cooke, Austin's only physician at the time. Cooke was looking for community input and help in addressing the crisis; the community meetings were to take place every couple of weeks.

See related story: Austin, Indiana's Will Cook, MD, is AAFP Family Physician of the Year

Cox went to Scott County to see if the community might be ready to start building a Recovery Oriented System of Care (ROSC).

Get Healthy Scott County Coalition

Even though Cox also hails from a small town in Indiana, he recognized that Scott County residents might be wary of an outsider coming in to offer solutions. He made it a point to wait to be asked for his input, rather than offer unsolicited advice.

"I slowly began to introduce ROSC, which was a new concept for this community," explains Cox. "People started to ask questions, and after a few months, a local group called Get Healthy Scott County (GHSC) Coalition asked me do to some formal training on ROSC, and things really took off after that."

Get Healthy Scott County Coalition Vision: "Together Scott County will be a community of abundant life and dignity where recovery is always possible." 

In 2016, the GHSC Coalition, the Coalition to Eliminate the Abuse of Substances (CEASe), and the recovery community developed a strategic plan based on ROSC principles. Today, that strategic plan guides a wide-ranging local effort to rebuild Scott County into a community of recovery and transformation.

The goal of the ROSC strategic plan is to to see all of Scott County embrace a culture of recovery through a coordinated network of community-based services and supports. This person-centered support network builds on the strength and resilience of individuals, families and local communities.

Read the Get Healthy Scott County Path to Recovery report.

The community approach is working: new cases of HIV have decreased, multiple paths to treatment and recovery are available, and being in recovery is “cool” in Scott County.

A video produced in summer 2017 gives a glimpse of the transformation that was underway:

Other accomplishments include:

• One Stop Shop-Syringe Service Program: In 2016, the Syringe Service Program referred 40% of their active participants to substance abuse treatment or a recovery group. In 2017, this increased to almost 75% of active participants. 
• Recovery support groups increased from 30 people attending 1 recovery support group with 3 weekly meetings, to more than 330 attending 18 weekly meetings at 9 locations: an increase of 1000% in the number of people making long-term recovery efforts. 
• Community Outreach: 37 recovery coaches (representing 18.5% of Indiana's recovery coaches) active in Scott County help support people in recovery. 
• New cases of HIV decreased from 154 in 2015 to 8 in 2017: a decrease of 95%

Lori Croasdell, who helps lead the GHSC Coaltion, credits Tom Cox and the Great Lakes ATTC with providing guidance on ROSC as the framework for Scott County's transformation. "At the time of the outbreak, we were getting a lot of negative attention in the press," says Croasdell. "Now, we're getting a lot of invitations to go out and speak about the positive impact of our collective community effort."

What's Next for Scott County?

Tom Cox continues to support ROSC efforts in Scott County as a consultant for the Great Lakes ATTC.  Here's his update:

"The Scott County Recovery community is in the early stage of developing an official Recovery Community Organization (RCO), named Scott County Thrive. The RCO will begin to take on more of the current strategic plan items under the Get Healthy Scott County coalition. Items high on the list for development are recovery housing options, recovery coach connections in the emergency room, and a Recovery Engagement Center. The entire GHSC Coalition will be entering into a reassessment phase. The hope is to engage the business community in the overall recovery and wellness process, with a connection to the state Chamber of Commerce. GHSC Coalition has already decided to apply the philosophies of ROSC to further work in the areas of mental health, trauma, and physical health."

ATTC Network Resources for Recovery Oriented Systems of Care: 

ATTC Network Coordinating Office
Recovery-Oriented Systems of Care

Northwest ATTC: 
Best Practices in Recovery-Oriented Systems of Care: The Case of Pioneer Human Services

South Southwest ATTC:

Recovery Support Fiscal Services Project Fiscal Year 2017 Final Evaluation Report

Mid-America ATTC, Northwest ATTC, Pacific Southwest ATTC:
Recovery-Oriented Systems of Care PSA