Setting the Direction for Kentucky’s RecoveryOriented System of Care

June 2022
Table of Contents

The RESTORE Leadership Team ....................................................................................................................1

Problem Statement.......................................................................................................................................4

Setting the Stage for Implementation of a Recovery-Oriented System of Care...........................................7

Vision.........................................................................................................................................................7

Values........................................................................................................................................................7

Goals .........................................................................................................................................................8

Outcomes..................................................................................................................................................9

Public Safety Outcomes......................................................................................................................10

Health Outcomes................................................................................................................................11

Quality of Life Outcomes ....................................................................................................................12

Key Terms................................................................................................................................................13

Statewide Committee .................................................................................................................................14

ROSC Development Framework .............................................................................................................14

Policy and Partnership Changes..........................................................................................................15

Services and Supports.........................................................................................................................15

Financing .............................................................................................................................................16

Workforce and Training ......................................................................................................................16

Communication...................................................................................................................................16

Pilot Site Selection ..................................................................................................................................16

Conclusion...................................................................................................................................................18
1

The RESTORE Leadership Team

The Kentucky Court of Justice (KCOJ) established the Responsive Education to Support Treatment in 

Opioid Recovery Efforts (RESTORE) Leadership Team in 2019 in conjunction with a statewide initiative to 

address substance use. Recognizing the prevalence of substance use and co-occurring1 disorders among 

court-involved populations, the RESTORE Leadership Team’s role is to provide Kentucky courts with 

evidence-based resources, best practices, training, local action planning, and implementation tools to 

support substance use treatment across the state. Kentucky’s Administrative Office of the Courts (AOC)

provides support for the RESTORE Leadership Team, which is comprised of Circuit, District, and Family 

Court Judges.

1 The Substance Abuse and Mental Health Services Administration defines Co-occurring disorders as including any 

combination of two or more substance use disorders and mental disorders identified in the Diagnostic and 

Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
2

MEMBERS OF THE RESTORE LEADERSHIP TEAM (FY 2022)

Honorable Denise DeBerry Brown, Judge, Jefferson County, 30th Judicial Circuit, Family Division 7

Honorable J. Foster Cotthoff, Judge, Christian County, 3rd Judicial District, Division 2

Honorable Lisa Jones, Judge, Daviess County, 6th Judicial Circuit, Division 2

Honorable William “Bo” Leach, Judge, Estill, Lee, and Owsley Counties, 23rd District

Honorable Lucinda Masterton, Judge, Fayette County, 22nd Judicial Circuit, Family Division 5

Honorable Janie McKenzie-Wells, Judge, Johnson, Lawrence, and Martin Counties, 24th Circuit, Family Division 1

Honorable Kevin Mullins, Judge, Letcher County, 47th Judicial District

Honorable Melissa Murphy, Judge, Fayette County, 22nd Judicial District, Division 4

Honorable Rebecca Phillips, Judge, Carter, Elliott, and Morgan Counties, 37th Judicial Circuit, Division 1

Honorable Brian Privett, Judge, Woodford, Scott, and Bourbon Counties, 14th Judicial Circuit, Division 2

Vincent Riggs, Circuit Clerk, Fayette County

Honorable Karen Thomas, Judge, Campbell County, 17th Judicial District, Division 2

The RESTORE Initiative is led by Chief Justice John D. Minton, Jr. with support from Supreme Court Chief of Staff 

and Counsel Katie Shepherd. Additional AOC support team members include:

Laurie Givens, Director, Administrative Office of the Courts

Jason McGinnis, Deputy Director, Administrative Office of the Courts

Rachel Bingham, Director, Office of Statewide Programs

Shawna Mitchell, Compliance Administrator, Office of Statewide Programs

Kathy Reed, Behavioral Health Liaison, Office of Statewide Programs

Angela Darcy, Executive Officer, Pretrial Services

Amy Gamble, Manager, Division of Risk Assessment, Department of Pretrial Services

Elizabeth Nichols, Manager, Division of Operations, Department of Specialty Courts

Eboni Blackford Thompson, Manager, Division of Family Services, Department of Juvenile and Family Services

Ashley Clark, Operations Supervisor, Family and Juvenile Services

Nathan Goins, Family Court Liaison, Department of Family and Juvenile Services
3

To improve the court system’s response to substance use, the KCOJ is transitioning to a RecoveryOriented System of Care (ROSC) model, which is “networks of organizations, agencies, and community 

members that coordinate a wide spectrum of services to prevent, intervene in, and treat substance use 

problems and disorders.”2 At the AOC’s request, the Crime and Justice Institute (CJI) conducted a 

qualitative assessment of Kentucky’s court system to examine the current system in relation to the 

principles of an ROSC. CJI staff interviewed judges, other court personnel, prosecutors, defense 

attorneys, behavioral health professionals, community service providers, parole and probation staff, and 

law enforcement to gain an understanding of their experiences working with people with substance use 

and co-occurring disorders. The assessment focused on perceived barriers to accessing behavioral 

health services that court-involved individuals face, as well as existing opportunities to connect people

to evaluation and treatment. 

At the conclusion of the assessment in March 2021, CJI issued a report titled “Recovery-Oriented 

Systems of Care: Needs and Opportunities for Kentucky’s Court Systems.” Among the recommendations 

were the following: 

• Convening an AOC Working Group to develop a vision, goals, values, and key definitions;

• Forming a statewide steering committee to address the gaps between Kentucky’s current 

system and the system outlined by the AOC Working Group; and

• Identifying key areas of the state in which to pilot local Recovery-Oriented System of Care 

efforts.

In alignment with these recommendations, the AOC appointed the RESTORE Leadership Team as the 

AOC Working Group and invited CJI to support the group’s efforts. The RESTORE Leadership Team 

convened five times over the course of nine months to develop a shared understanding, vision, and 

framework for implementation of Kentucky’s ROSC. 

2 Sheedy C. K., and Whitter M., Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do 

We Know from the Research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration, 2009. Guiding Principles and Elements of 

Recovery-Oriented Systems of Care: What do we know from the research? - August 2009 (naadac.org), accessed 

at: https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf 
4

Problem Statement

Substance use disorder (SUD) is a well-documented public health issue in the United States. According 

to the Center for Disease Control and Prevention (CDC), 103,598 people died of a drug overdose during 

2021.

3 In particular, opioids have contributed to overdose deaths since the late 1990s, in what is now 

known as a national epidemic. According to the CDC, nearly half a million people died of an opioid 

overdose between 1999 and 2019.4 While this public health crisis has impacted the entire United States, 

it has hit some states particularly hard.

Kentucky had the 8th highest overdose death rate in the nation in 2019 according to the CDC.5

 The 

COVID-19 pandemic appears to have exacerbated this problem, as Kentucky saw a 49% increase in 

people dying of an overdose between 2019 and 2020.6 Following that, between May 2020 and May

2021, the state saw a 37.6% increase in reported overdose deaths. This was the 7th largest percent 

increase in the U.S.7

The leading causes of overdose deaths in Kentucky are opioids, including fentanyl, and 

methamphetamine. In 2020, opioids were involved in nine of every ten overdose deaths. A main driver 

of this is the growing presence of illicit fentanyl, a potent synthetic opioid. Fentanyl, which may be 

combined with other substances, was involved in approximately 71% of overdose deaths in 2020. The 

Kentucky Office of the Medical Examiner detected methamphetamine in the death of 801 people in 

2020, up from 517 in 2019.8 Methamphetamine was the most identified substance in drug laboratories 

in the South in 2020.9

 

Beyond the overdose statistics are the scores of people struggling daily with SUD. The 2019 Kentucky 

Health Issues Poll (KHIP), published by the Foundation for a Healthy Kentucky, reported that 38% of 

people indicated knowing someone who has experienced a problem related to prescription drugs and 

22% of people reported knowing someone who has experienced a problem resulting from

3 Ahmad F. B., Rossen L.M., Sutton P. (2021). Provisional Drug Overdose Death Counts. Centers for Disease Control 

and Prevention: National Center for Health Statistics: National Vital Statistics System. Accessed at: 

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm 4 Centers for Disease Control and Prevention. Rise in Opioid Overdose Deaths in America. Accessed at: 

https://www.cdc.gov/drugoverdose/images/3-waves-inforaphic-medium.jpg?noicon 5 Centers for Disease Control and Prevention. (2021, March 22). 2019 drug overdose death rates. Centers for 

Disease Control and Prevention. Accessed at: https://www.cdc.gov/drugoverdose/deaths/2019.html 

6 Noble, C. M., Ingram, V. (2020). 2020 Overdose Fatality Report Kentucky Office of Drug Control Policy. 

Commonwealth of Kentucky Justice & Public Safety Cabinet. Accessed at: 

https://odcp.ky.gov/Documents/2020%20KY%20ODCP%20Fatality%20Report%20%28final%29.pdf 7 Ahmad F. B., Rossen L.M., Sutton P. (2021). Provisional Drug Overdose Death Counts. Centers for Disease Control 

and Prevention: National Center for Health Statistics: National Vital Statistics System. Accessed at: 

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm 8 Noble, C. M., Ingram, V. (2020). 2020 Overdose Fatality Report Kentucky Office of Drug Control Policy. 

Commonwealth of Kentucky Justice & Public Safety Cabinet. Accessed at: 

https://odcp.ky.gov/Documents/2020%20KY%20ODCP%20Fatality%20Report%20%28final%29.pdf

9 National Forensic Laboratory Information System. NFLIS- Drug 2020 Annual Report. Accessed at: 

https://www.nflis.deadiversion.usdoj.gov/nflisdata/docs/NFLISDrug2020AnnualReport.pdf
5

methamphetamine.10 The need to address SUD stems not only from the risk of overdose death, but 

from the associated consequences for those living with SUD.

Substance use can have detrimental short-term and long-term impacts on an individual’s health and 

overall wellbeing. Slowed breathing caused by opioid misuse can lead to hypoxia, which results from 

lack of oxygen to the brain. Hypoxia can be deadly, and other effects include coma and brain damage. 11

Long-term effects of methamphetamine use include psychosis, violent behavior, change in brain 

structure, mood disturbances, and severe dental problems.12 Risky behaviors associated with substance 

use, such as driving while impaired, can result in harm or death, contact with law enforcement and 

subsequent justice-system involvement. 

Substance use can also negatively affect interpersonal relationships. American Addiction Centers refers 

to SUD as a “family disease” because of its significant impact on the entire family unit.13 Research 

indicates that the children of adults combating SUD may be more at risk for various types of abuse and 

trauma. These children may also face an increased risk of future substance use challenges themselves.14

Additionally, substance use while pregnant can greatly endanger the pregnancy. For example, 

methamphetamine use may result in premature deliveries, placental abruption, and various 

abnormalities.15 For those with SUD, it has the potential to impact nearly every facet of a person’s life. 

Court systems are uniquely positioned to tackle this public health issue. The prevalence of SUD among 

the court-involved population is evident; 64% of state and federal prisoners reported using at least one 

drug in the 30 days prior to arrest according to the 2016 Survey of Prison Inmates.16 Adults with SUD 

may encounter the court system through arrests and justice system processing or family court 

proceedings. According to the Kentucky Citizen Foster Care Review Board Annual Report, substance use 

presented as one of the three top barriers to child permanency in FY2020.17 Because the courts can 

10 Interact for Health: A Catalyst for Health and Wellness. Substance Use in Ohio and Kentucky. Accessed at: 

https://www.interactforhealth.org//upl/media/ohip-khip_substance_use_for_print__01282020.pdf 11 National Institute on Drug Abuse. (2021) Prescription Opioid DrugFacts. Accessed at: 

https://nida.nih.gov/download/37633/prescription-opioidsdrugfacts.pdf?v=7e5209dd2a0356d596862911eb963a2b

12 National Institute on Drug Abuse. (2019). Methamphetamine Research Report. Accessed at: 

https://nida.nih.gov/download/37620/methamphetamine-researchreport.pdf?v=59d70e192be11090787a4dab7e8cd390

13 Patterson, E. (2020, December 30). Addiction is a Family Disease and Possible Treatment Options. American 

Addiction Centers. Accessed at: https://rehabs.com/addiction/family-disease/ 14 Kaliszewski, M. PhD. (2022, March 15). The Link Between Child Abuse and Substance Abuse. American Addiction 

Centers. Accessed at: https://americanaddictioncenters.org/blog/the-link-between-child-abuse-and-substanceabuse

15 National Institute on Drug Abuse. (2019). Methamphetamine Research Report. Accessed at: 

https://nida.nih.gov/download/37620/methamphetamine-researchreport.pdf?v=59d70e192be11090787a4dab7e8cd390

16 Saloner, B., Bandara, S. N., McGinty, E. E., & Barry, C. L. (2016). Justice-involved adults with substance use 

disorders: Coverage increased but rates of treatment did not in 2014. Health Affairs, 35(6), 1058–1066. Accessed 

at: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2016.0005 17 Kentucky Citizen Foster Care Review Board. 2020 Annual Report. Accessed at: https://kycourts.gov/CourtPrograms/Family-and-Juvenile-Services/Documents/CFCRBannualreport2020.pdf
6

encourage and compel people to participate in assessment and treatment, the judiciary can play a 

critical role in addressing substance use and other behavioral health disorders by intentionally 

coordinating with providers and community partners to support recovery pathways. 
7

Setting the Stage for Implementation of a Recovery-Oriented System of Care

The RESTORE Leadership Team had eight primary tasks related to its work to prepare the state to design 

and implement an ROSC in Kentucky. These tasks included:

1. Creation of a vision statement for the system of care

2. Identification of values that should underlie all activities and conduct within the system of care

3. Establishment of overarching goals for the system of care

4. Identification of desired outcomes for the system of care 

5. Creation of definitions for key terms 

6. Development of framework to guide implementation of the system of care

7. Recommendations for membership for the statewide steering committee responsible for 

implementation of the system of care

8. Guidance for pilot site selection 

The RESTORE Leadership Team completed these activities in May 2022. This report documents the work 

of the team and sets the stage for the Statewide Committee to operationalize the system of care 

approach.

Vision 

A vision is a clear, aspirational, and compelling picture of what an organization or system will look like 

and how people will benefit from it in the future. The RESTORE Leadership Team developed the 

following vision to which those working in and with the ROSC should aspire.

A multidisciplinary system that intentionally collaborates to offer holistic, equitable and empowering 

pathways to recovery for people with substance use and other behavioral health18 challenges.

Values

Building on the vision for the system of care, the RESTORE Leadership Team identified core values. 

Values are the “principles we care about that guide our behavior” and decision-making and aid in 

bringing the vision to life.19 The core values for Kentucky’s Recovery-Oriented System of Care will act as 

a guide for all people working within the system as they create, lead, and operate Kentucky’s system of 

care. When Kentucky’s system of care is functioning as intended, every person that has a part in the 

18 The Substance Abuse and Mental Health Services Administration (SAMSHA) defines behavioral health as “a 

general term used to refer to both mental health and substance use.” 19 Resources to Recover. (2020, November 3). The Importance of Values in Mental Health Recovery. Accessed at: 

https://www.rtor.org/2020/11/03/importance-of-values-in-mental-healthrecovery/#:~:text=Values%20are%20principles%20we%20care,%2C%20independence%2C%20and%20financial%2

0security

Kentucky Recovery-Oriented System of Care Vision
8

system will be expected to uphold these values in their everyday work, including all interactions with 

people involved in the justice system.

Goals

A goal is an observable result. It is important that leaders within a system of care identify goals to set 

direction for system functioning and serve as measures of progress and success. 

While the vision statement paints a picture of what overall system success will look like and the values 

guide the behavior of leaders and staff as they work to achieve the vision, goals function as benchmarks 

for success within specific areas. The RESTORE Leadership Team considered what the goals Kentucky’s 

system of care would ideally achieve for individuals involved in the court system, for the court system 

itself, and for state and local partners. RESTORE team members decided upon three goals and 

articulated how they can be achieved.

1. Create a sustainable system of care

Creating a sustainable system is achieved by identifying and securing long-term funding sources; 

establishing formal partnerships that include ‘warm handoffs’ between agencies; promoting crosssystem information sharing; providing ongoing education to the court and its partners, developing 

working councils in each county; and establishing sufficient staffing levels to meet the needs. 

Additionally, to sustain an effective system of care, it is key to identify performance measures so 

that the system can be consistently evaluated. Through consistent evaluation, system leaders can 

identify gaps within the system and address areas that need improvement. 

2. Ensure buy-in from court and community partners 

Gaining buy-in from court and community partners is key to the successful implementation of the 

system of care. It is important that partners across the state employ the same model so that 

responses are consistent and equitable. 

Kentucky Recovery-Oriented System of Care Values

Individualized: We acknowledge that each pathway to recovery is unique, and that people have 

varying needs, goals, and expectations. 

Strengths-based: We empower people in recovery by emphasizing their individual strengths, 

abilities, and resiliencies.

Flexible: We prioritize non-punitive responses when appropriate, while ensuring people are 

connected to the supports and services they need.

Supportive: System partners embrace their role in aiding in the recovery process and helping to 

set people up for success.
9

The RESTORE Leadership Team identified a number of ways to ensure buy-in: emphasizing the 

benefits of cross-system collaboration; engaging partners from the beginning, including using 

targeted messaging; providing education to all partners, recognizing judicial discretion and the 

expertise of judges and all partners, using peer-to-peer learning, and encouraging engagement 

amongst the courts; and communicating ‘the why’ and the benefits of the shift in philosophy to 

different stakeholders, and regularly sharing system of care successes and outcomes.

3. Improve outcomes for individuals with substance use disorders and other behavioral health 

needs

Better outcomes for people with SUD and other behavioral health needs are at the center of a shift 

to a recovery-oriented system of care. Because people with these needs may become courtinvolved, courts are uniquely situated to effect positive change. Improved outcomes may be 

achieved through early identification and intervention; adopting a strengths-based/harm-reduction 

approach; ensuring equitable opportunities to participate in treatment at each contact point within 

the court system and across the state; ensuring staff can dedicate sufficient time to each individual; 

focusing on measuring recidivism reduction; reduction of stigma and other negative consequences 

of SUD; and incorporating and encouraging positive family and social supports.

The outcomes and framework described in the next sections of this report directly tie to measuring 

achievement of the goals and specific activities that need to occur to successfully implement Kentucky’s 

Recovery-Oriented System of Care.

Outcomes

Outcomes are the results or benefits of an action or intervention. The RESTORE Leadership Team 

identified desired outcomes across three categories: public safety, health, and quality of life. The 

outcomes identified within each category include the following three types:

1. Short-term outcomes: changes in skills, attitudes, and knowledge

2. Intermediate outcomes: changes in behavior and decision-making

3. Long-term outcomes: changes in life conditions or status

 
10

Public Safety Outcomes 

The courts play an integral role in the justice system and in upholding public safety. The RESTORE 

Leadership Team identified a set of short, intermediate,- and long-term outcomes, including increased

knowledge of those involved with the ROSC, increased availability of services, and engagement of 

resources and supports for those with SUD and other behavioral health needs, that will help achieve the 

longer-term public safety outcome of reduced recidivism. 

Short-term Intermediate-term Long-term 

• System partners identify 

what ROSC data to collect 

and report 

• Increased knowledge of 

existing resources among 

system partners 

• Increased understanding of 

effective SUD treatment and 

recovery best practices 

among system partners

• Increased knowledge by the 

legislature about the scope 

of the SUD problem and 

impacts

• System partners collect, 

report on and review ROSC 

data

• Increased investment or 

shift of funding to SUD 

treatment and recovery 

best practices

• Increased access to SUD 

treatment and recovery 

best practices

• Increased referrals to case 

management services20

• Increased referrals to SUD 

and other behavioral health 

services 

• Increased engagement and 

re-engagement in services 

at each point in the judicial 

system 

• Increased information 

sharing and communication 

across system and 

community-based partners 

• Increased family 

engagement 

• Increased public perception 

that the courts help 

improve people’s quality of 

life in addition to holding 

them accountable 

• Decreased jail populations

• Fewer arrests 

• Reduced recidivism

• Reduced charge severity 

when recidivism occurs

20 “Services” includes treatment, support services.
11

Health Outcomes 

RESTORE Leadership Team members utilized their expertise working with people with SUD and other

behavioral health challenges within court settings to identify short, intermediate, and long-term healthrelated outcomes. Members considered outcomes related to increasing knowledge among ROSC leaders 

and staff, development of SUD metrics, improved methods for determining appropriate levels of care

and increased enrollment in community-based services to increase access insurance and reduce 

overdose deaths.

Short-term Intermediate-term Long-term 

• Increased understanding of 

recovery as a process 

among system partners 

• System partners prioritize 

SUD and other behavioral 

health issues as public 

health issues 

• Increased understanding 

among system partners 

about levels of care

• System partners develop 

SUD metrics in addition to 

abstinence 

• Increased use of screening 

and assessment to 

determine appropriate 

levels of care 

• Increased enrollment of 

people in the judicial system 

in health-related services in 

the community

• Reduced overdose deaths 

for people in the judicial 

system 

• Increased % of people with 

medical insurance

 

 

 

 

 

 

 

 

 
12

Quality of Life Outcomes 

In identifying quality of life outcomes related to housing, employment, identification, food security, 

keeping families together, and streamlined services, RESTORE Leadership Team members recognized the 

need for increased understanding among system of care partners related to: positive supports, stigma 

and increased awareness and coordination of services in the short term. Additionally, the members 

recognized the need for a focus on reducing barriers and use of case management, incentives and 

positive family engagement in the intermediate term.

Short-term Intermediate-term Long-term 

• Increased understanding by 

system partners of the 

benefits of family/natural 

supports 

• Increased understanding of 

SUD-related stigma by 

system partners and the 

public

• Increased coordination in 

the delivery of services and 

awareness of available 

services across system 

partners 

• Increased use of case 

management and 

supervision methods that 

are less disruptive to a 

person’s life (e.g., use of 

virtual appointments)

• System partners use nonstigmatizing language

• System partners 

consistently identify service 

barriers (e.g., lack of 

transportation) to provide 

options (rather than 

penalize people)

• Reduced barriers to gaining 

employment by adjusting 

court requirements when 

needed

• Increased access to medical 

disability/social security (if 

people have a custodian to 

be recipient)

• Increased opportunities for 

visitation with children

• Increased positive family 

engagement activities 

• Reduced overreliance on 

sanctions

• Increased use of incentives 

to reinforce positive 

behavior

• Increased employment 

retention

• Reduced removal of 

children of adults involved 

the court system

• Increased permanency for 

children, including 

custody/visitation 

• Reduced redundancy in 

services across multiple 

systems

• Increased % of people who 

possess driver’s 

licenses/state-issued 

identification 

• Increased access to housing, 

including recovery housing

• Increased food security
13

Key Terms 

The vision for Kentucky’s system of care is grounded in the intentional collaboration among 

multidisciplinary system stakeholders. One aspect of supporting successful collaboration of system 

stakeholders is to establish a common language, particularly across different disciplines that may think 

of, or talk about, the same concepts in slightly different ways. This common language is also essential for 

clear messaging to the public about the shift to a system of care. The RESTORE Leadership Team 

collectively defined three key terms: recovery, recovery capital, and recovery-oriented system of care. 

Kentucky Recovery-Oriented System of Care Definitions

Recovery

A process that encourages individuals to be free from substance misuse, manage mental health 

challenges, improve their overall health and wellbeing, and reach their full potential.

Recovery Capital

A roadmap for building long-term recovery and self-sufficiency using internal strengths and 

available community resources.

Recovery-Oriented System of Care

A system-wide approach that improves outcomes for people involved with the court system by 

supporting an individual on their path to recovery, assessing their needs, removing barriers, and 

coordinating appropriate treatment and services.
14

Statewide Committee 

Design and implementation of Kentucky’s Recovery-Oriented System of Care will be led by a statewide, 

multidisciplinary committee, the Judicial Commission on Substance Use Disorder and Mental Health

(JCSUDMH). The RESTORE Leadership Team had the opportunity to provide recommendations for 

membership to that committee, which will include representatives of agencies across the system, 

community providers, and members of the public. The Chief Justice will make the final decision on 

appointments to that committee. 

The RESTORE Leadership Team’s vision and values documented in the first part of this report are 

intended to guide the work of the JCSUDMH to implement the system of care across the state. 

Additionally, the statewide committee will build upon and possibly refine the goals and outcomes as 

they get into the details of operationalizing the ROSC. 

ROSC Development Framework

After reviewing the guidance of the RESTORE Leadership Team and honing the goals and outcomes, the 

statewide committee will need to create a detailed design for the ROSC and corresponding

implementation plan. The RESTORE Leadership Team developed a framework with key steps and 

activities for consideration by the statewide committee as it designs the system of care. The 

components of this framework expand upon and support the goals for the system of care and address 

the ways in which data collection and reporting on defined outcomes can be achieved. The framework is 

structured around five strategy areas and includes recommended steps within each for consideration by 

the statewide committee.

21,22 Each of the five strategy areas is a critical piece of the implementation 

process. 

• Policy and partnership changes help to institutionalize the ROSC approach, establish new 

interagency partnerships, and formalize partnerships. This may necessitate updating existing 

policies as well as creating new ones.

• A broad array of services and supports are needed, as well as identifying any gaps.

• Financing entails identifying and/or establishing long-term funding mechanisms to support 

infrastructure changes and needed services. 

21 Stroul, B. & Friedman, R. (2011). Issue brief: Strategies for expanding the system of care approach. Washington, 

DC: Technical Assistance Partnership for Child and Family Mental Health. Accessed at: https://www.fredla.org/wpcontent/uploads/2016/01/SOC-ExpansionStrategies-Issue-Brief-FINAL.pdf 22 Stroul, B. & Friedman, R. (2011). Effective strategies for expanding the system of care approach. A report on the 

study of strategies for expanding systems of care. Rockville, MD: Center for Mental Health Services, Substance 

Abuse and Mental Health Services Administration. Accessed at: 

https://gucchd.georgetown.edu/products/SOC%20Expansion%20Study%20Report%20Final.pdf
15

• Training and workforce are about providing training and coaching for all ROSC personnel on 

evidence-based approaches to recovery, and strategies to prepare the workforce for integration 

into Kentucky’s ROSC model.

• Effective and ongoing communication about the shift to a recovery-oriented system of care is 

needed to generate sustained support from partners and the community. 

The recommended steps are not laid out in the order in which they are intended to be implemented. 

They are organized by strategy area and when planning for implementation, multiple steps may be 

implemented simultaneously, and in some cases, that will be necessary. It is important that the detailed 

implementation plan includes any specific tasks or activities associated with each recommendation, 

identification of person(s) responsible for each activity, and timelines for completion. 

Policy and Partnership Changes 

1. Decide which state and local agencies should be formal ROSC partners, determine what 

information can and should be shared across partners, develop draft MOUs for the partners

2. Identify what training is needed to prepare leaders and staff for the policy and partnership 

changes

3. Determine what data collection and other infrastructure and tools need to be developed to 

implement and monitor the ROSC policies and partnerships to track goals and outcomes 

4. Research and articulate the benefits of cross system collaboration

5. For the overarching ROSC communications plan, determine what needs to be communicated 

and to whom about policies and partnerships and when 

6. Develop targeted and timed messaging to explain ROSC goals and benefits

Services and Supports 

1. Research services and supports commonly available in ROSCs 

2. Determine what services and supports KY needs to add or expand and where

3. Develop and maintain a list of available services and supports and identify how to distribute and 

regularly update that list 

4. Determine what screenings and assessments are needed, who should administer them and 

when to ensure early identification and intervention 

5. Determine at what points in the judicial process referrals for assessment, services and supports 

can be bolstered 

6. Develop, improve, and document the referral processes

7. Explore ways to build natural positive supports (family and non-family members) and 

incorporate them as a tenant of case planning 

8. For the overarching ROSC communications plan, determine what needs to be communicated, 

when, and to whom about services, supports and referral processes 

9. Determine how case information can be shared across partners 

10. Establish a structure of county ‘working councils’ and define responsibilities
16

11. Create a communications process for local working councils to share needs, challenges, and 

successes

Financing 

1. Document state and local level needs and costs to meet those needs, including costs associated 

with staffing, training, services/supports, data collection and reporting, and information sharing

2. Explore funding mechanisms for the identified needs

Workforce and Training 

1. Determine needed staffing to coordinate across agencies and to support individuals throughout 

their recovery 

2. Create a role for peer supports to be involved in supporting individuals in recovery 

3. Establish appropriate caseload sizes 

4. Develop a basic ROSC training for all existing system partner staff and for any new staff and local 

providers 

5. Identify trainings needed for system partners in approaches to support recovery, engage

prosocial family/natural supports, administer selected screening and assessment tools and use 

the results appropriately, and identify levels of care and make appropriate referrals

Communication 

1. Develop an ROSC communications plan that includes what needs to be communicated, by 

whom, to what audience, how and when 

2. Develop core messages about what ROSC is, why Kentucky is developing and implementing the 

ROSC, how it will benefit people, and how success will be measured 

3. Create a public information portal explaining the ROSC, and available resources and how to 

connect to them, and who to contact for assistance

In support of the above outlined framework to implement a system of care, the AOC created the Office 

of Statewide Programs in August 2021. The office was created to focus on managing three statewide 

programs – the Departments of Family and Juvenile Services, Pretrial Services and Specialty Courts. 

Shortly after the establishment of the Office of Statewide Programs, a Behavioral Health Liaison position 

was created to expand and improve judicial response to behavioral health, co-occurring disorders, and 

substance use needs for court-involved individuals. The liaison is a resource to statewide departments 

to assist overcoming system barriers and mobilizing opportunities for solutions. This will include working 

strategically with system stakeholders to support implementation of the ROSC in Kentucky. 

Pilot Site Selection 

A major task following the Statewide Committee’s design of the system of care, guided by the 

framework in the prior section, will be to plan for a pilot phase as part of implementation planning and 

to select local pilot sites to test the model. Key steps in pilot programs include:
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1. Planning and design of the pilot

2. Staff training 

3. Supporting and monitoring the pilot

4. Evaluating the pilot

5. Making recommendations to improve the model23

Each of these steps has many associated tasks. For example, the planning and design of the pilot can 

include tasks such as identification of the target population for the pilot, establishment of screening and 

assessment protocols, and possibly completing a process, such as Sequential Intercept Mapping, to take 

inventory of programs and resources and identifying where gaps need to be filled.

The main purpose of a pilot program is to determine whether a program or model is feasible24 in a 

smaller context before rolling it out on a larger scale.25 In this way, launching the ROSC in a selection of 

pilot sites is a key step toward statewide implementation. 

Implementing a system of care approach requires coordination and trust-building among courts and 

justice agencies, behavioral health treatment providers, community resource providers, and individuals 

in recovery and their family members. Trust-building requires that people know one another and work 

towards a shared vision; thus, it often works better when localized. Certain courts in Kentucky, including 

those represented by the RESTORE Leadership Team members, have already developed close 

relationships with local treatment providers, and in some cases, recovery collaboratives.26 Those 

relationships can be leveraged to build support for transitioning to and piloting an ROSC.

23 Kasunic, M. (2004). Conducting Effective Pilot Studies. Carnegie Mellon Software Engineering Institute. Accessed 

at: https://resources.sei.cmu.edu/asset_files/presentation/2004_017_001_22829.pdf 24 National Center for Complementary and Integrative Health. Pilot Studies: Common Uses and Misuses. Accessed 

at: https://www.nccih.nih.gov/grants/pilot-studies-common-uses-and-misuses 25 Guthrie, G. (2021, January 6). Everything you need to know about pilot projects. Backlog. Accessed at: 

https://backlog.com/blog/everything-need-know-pilot-projects/ 26 HEAL. Accessed at: 

https://www.healky.org/?fbclid=IwAR3DtXNDBUigSA5FqthIPV61PpSjAmI_ShmSxqP5GyDHBdm76i-r6DQthig
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Conclusion

The RESTORE Leadership Team approached this effort with a commitment to improving responses to 

individuals in Kentucky affected by substance use and co-occurring disorders. Their vision will be 

achieved by shifting to a Recovery-Oriented System of Care. This model, including the integration of the 

newly established Behavioral Health Liaison, will streamline service connections, provide opportunities 

to divert people to treatment, and maximize the use of natural supports and settings by partnering with 

community providers. This report lays the foundation for what it will take to design and operationalize a 

system of care and realize the vision of “a multidisciplinary system that intentionally collaborates to 

offer holistic, equitable and empowering pathways to recovery for people with substance use and other 

behavioral health challenges.”