Open Community Model of Care - CCSAD 2012
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The promise and perils of Open Community Models of Care in the treatment of chronic relapsing alcoholics and addicts.
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Open Community Model of Care - CCSAD 2012
- 1. Shootout at the I’m Okay Corral The “Open Community Model of Care” in the Treatment of Chronic Relapsing Addicts and Alcoholics Bob Ferguson CEO / Founder, Jaywalker Lodge Cape Cod Symposium on Addictive Disorders September 8, 2012 1 9/8/2012 Colorado Model of Care
- 2. Disclosure Jaywalker Lodge, LLC is a residential treatment program for men in Carbondale, Colorado. It is a private, for-profit company. I am the owner and founder of this company. I represent this organization professionally. I am paid by this organization. 2 9/8/2012 Colorado Model of Care
- 3. Personal Bio • Hazelden Foundation (1995 – 2001) • Crossroads Antigua (2001 – 2003) • Promises Treatment Centers (2003 – 2004) • Jaywalker Lodge (est. 2005) 3 9/8/2012 Colorado Model of Care
- 4. William White, MA With great sadness, the counselor reflects, “The patients who come here do SO WELL while they are in treatment, but so many of them relapse in the days and weeks following their discharge. We bring them back into treatment and they seem to do well again but often repeat the relapse pattern when they go back home. How can they do so well in treatment and so poorly in their natural environments?” Addiction treatment was birthed in part to eliminate the revolving door through which alcoholics and addicts cycled through the criminal justice system and the hospitals. Addiction treatment programs have now BECOME that revolving door. Today, 64% of clients entering publically funded treatment in the US have already had one or more prior treatments. And 50% will be readmitted to treatment within 2 – 5 years. “Linking Addiction Treatment and Communities of Recovery” Article 2006 9/8/2012 Colorado Model of Care 4
- 5. How It Into Action Overview Works Working A Vision with Others for You The Open Community Model of Care provides relapsing addicts and alcoholics - some of whom are in very early recovery – with the prospect of a safe and sober transition from acute residential care into real life in recovery… And yet, these gains are not achieved without significant exposure to real-world stressors and opportunities for relapse. 9/8/2012 Colorado Model of Care 5
- 6. How It Into Action Works Objectives A Vision Working with Others for You • Articulate the critical differences between primary care and extended care addiction treatment. • Examine the milieu and transition strategies for transitioning patients from an acute care setting into real life recovery. • Explore the vital and evolving role of alumni relations and community service in residential treatment today. 9/8/2012 Colorado Model of Care 6
- 7. Yes or No? How it works There is a direct and indisputable correlation between length of stay in residential treatment and the sober outcomes.
- 8. Yes AND No How it works Some clients DO require more time in an acute care setting… However, simply extending the length of treatment without moving the client into a real-life community setting assures only continuous abstinence, not recovery.
- 9. How it works PRIMARY CARE Arresting Addiction Education Counselor directed Secluded setting Intro to 12 Steps Safe, secluded time out from EXTENDED CARE life’s distractions Initiating Life in Recovery Application Letting go of substances Peer directed Community setting 12 Step Immersion Structured, hectic re-entry into real life recovery Letting go of self 9/8/2012 Colorado Model of Care 9
- 10. How it works “ It is important to define and distinguish between two very different models of care: an acute care (AC) model that focuses on bio psychosocial stabilization and a recovery management model (RM) that emphasizes sustained recovery support. As a professional field, we have oversold what a single episode of acute care can achieve… - William White 9/8/2012 Colorado Model of Care 10
- 11. Into True or not true? Action Chronic relapsing addicts and alcoholics in early recovery require a treatment setting that is safe, secluded, and free from outside distractions and relapse triggers. It is therefore essential to maintain separation between a residential treatment program and the community around it. 9/8/2012 Colorado Model of Care 11
- 12. Into True or not true? Action In order to achieve lasting and sustainable sobriety, clients must learn to manage an environment which offers a daily choice between relapse or recovery. 9/8/2012 Colorado Model of Care 12
- 13. E A – Extended Treatment 811 Main Court (90 days) B – Transitional Treatment A B 725 Main Street (90 days) C – Collegiate Recovery Program 734 Main St. (1 yr) D – Outpatient Offices C 1152 Hwy 133 (90 days) E – Sober Living / Landing 872 Main St. (3 – 6 mos.) Carbondale, CO Population 6,412 D 9/8/2012 Colorado Model of Care 13
- 14. Into Myth or reality? Action The therapeutic alliance between counselor and patient is the most important relationship in any treatment episode. 9/8/2012 Colorado Model of Care 14
- 15. Into Myth or reality? Action In extended care programs, the counselor’s role is to facilitate strong relationships among the clients – not with the clients. These programs value the peer-to-peer relationship above all else. 9/8/2012 Colorado Model of Care 15
- 16. How it works Self Peers Community Detox Recreation Service Work Body Stabilization Expeditions Teams / Leagues Rest / Recover Team Building Health Club Education Step One Focus 12 Steps Groups Mind Disease Model Peer Evaluation Service Position Denial Buddy System Sponsorship Concept of HP Group as HP 12 Steps in Action Spirit Spiritual principals Accountability to peers Service to others 9/8/2012 Colorado Model of Care 16
- 17. Into Open Community Milieu* Action • Admissions Red Flags • Culture of Community • 12 Step Immersion • Atypical discharges * Lessons we’ve learned along the way… 9/8/2012 Colorado Model of Care 17
- 18. Into Open Community Milieu Action Admissions Requirements for Open Community Model Pre-Admissions Interview • Clinical assessment – Is this patient appropriate? • Essential rite of passage for patient: i.e. Asking for help! Full disclosure: “no surprises” • Program milieu, philosophy, length of stay • Resident expectations – medications, relapse, etc. Admission Red Flags • No previous Primary Care episode • Acute MH Diagnoses – Trauma, Anti- social, Axis 2 • Suboxone 9/8/2012 Colorado Model of Care 18
- 19. Into Action Broken Windows Theory (1982) New York City saw a 50% reduction in violent crimes (such as murder, rape and robbery) as the result of a “community policing” campaign which focused repairing broken windows, cleaning up graffiti, and a crack down on minor offenses such as subway fare- scoffers and squeegee-wielding panhandlers. * But the Jets STILL didn’t make the playoffs! 9/8/2012 Colorado Model of Care 19
- 20. Into Open Community Milieu Action The spiritual dashboard...Dashboard Sun Mon Tue Wed Thu Fri Sat Compliance % AA Meetings 2 5 15 9 10 18 9 94% TDA's 18 18 15 16 18 17 18 96% Dinner attendance 18 18 18 17 18 18 17 98% Beds Made 18 18 16 18 18 18 17 97% DFS Sheets 16 16 13 18 18 10 14 83% Morning Meditation 18 18 18 18 18 18 18 100% Based on 18 clients
- 21. Into Open Community Milieu Action Completion Rates – 90 day program Census WSA % Avg LOS Relapse 178 153 159 145 64 71 64 65 62 71 63 69 14 7 10 10.3 2009 2010 2011 Avg
- 22. Into Open Community Milieu Action Immersion in Local 12 Step Community • Monitored engagement w. 12 Step community • FCSP – Weekly speaker meeting • NFL – No rides permitted & sponsor list • Safe Harbor House – Wednesday night alumni meeting • Not all recovery communities are created equal • Prescott, Delray Beach, So. Cal., Twin Cities.
- 23. Into Open Community Milieu Action Spiritual graffiti…Dashboard
- 24. Working Alumni Engagement with Others Role of Alumni in Open Community Model Official Duties Airport pickups Meeting drivers Expedition guides Unofficial Duties 12 Step sponsors SWAT teams 9/8/2012 Colorado Model of Care 24
- 25. Working Alumni Engagement with Others Alumni-driven culture • Peer directed aftercare groups • Wednesday night dinners • Expeditions (2x per year) • Reunions (annual) • Talent show • Open door policies for: • Counselor check ins • Lunch or breakfast • Recreation activities 9/8/2012 Colorado Model of Care 25
- 26. Working Community Service with Others Therapeutic Benefits of Service Work • Fundamental to recovery process • Community Relations • Practical Programming • Mission and Adventure Component The Aspen Homeless Shelter CARE (Animal Rescue) Habitat for Humanity Aspen Thrift Store (Clothes for the needy) Volunteer Outdoor Colorado Grand Canyon Trust Mission Wolf Pine Ridge Reservation Adopt a Highway Roaring Fork Outdoor Volunteers Extended Table (Soup Kitchen for the Homeless) Assisting in the Rebuild of Joplin, MO 9/8/2012 Colorado Model of Care 26
- 27. Working with others Service Effective (+) Ineffective (-) • Experience = educational • Experience = punitive • Adopt-A-Highway • Sustainable Settings • Extended Table Soup Kitchen • Set up for sweat lodge • Organized, structured • Random, unprepared, disorg anized, not structured • Staff and community participate with and among • Clients are clients separated, isolated, working alone. • Prior preparation, supervision during, process experience afterwards • Lack of information 9/8/2012 Colorado Model of Care 27
- 28. A Vision for You What’s next? 9/8/2012 Colorado Model of Care 28
- 29. 9/8/2012 Colorado Model of Care 29
Notas do Editor
- I want to leave you with FOUR key ideas at the end of our talk today.Start out with the iPod shuffle story. The morale: Extended Care is no more a step down from primary than the iPhone is a step down from a personal computer. We will be zooming in on the part of the continuum that lives in between primary acute care and independent living in the recovery community.Take some risks – who says they can’t?? Your patients are amazing if you just give them a challenge and if you’re willing to take a chance or two.It’s never over – alumni have been treated as an afterthought, but now we realize they are at the very center of our program. Do not simply focus on the recovery community – focus on the ENTIRE community at large. They provide your structure, your curriculum, and if you just pay attention to them, they will LOVE you!!Steve Jobs – famously said we are innovators, therefore we don’t have competitors.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- Here is the great news about the evolution of treatment as I see it unfolding in real time before our eyes: As an industry we have held fast to the holistic principals of Body, Mind, Spirit which take their roots in the Minnesota Model when a handful of recovering drunks and doctors left Wilmar State Hospital and founded the Hazelden program together in 1949. Body + Mind + Spirit = is a sacred and enduring principal in our field even today. Multidisciplinary teams continue to flourish, although outside factors such as managed care and an ever shifting payer mix have produced a dynamic tension between who leads that team… ie. The primary care addiction counselor of the guy in the white jacket with his prescription pad. But THAT is a talk for another day.The question for us today is how does – or how should – the holistic approach (body, mind, spirit) be adjusted or recalibrated as we move down the continuum of care from acute primary treatment to extended relapse treatment
- Here is the great news about the evolution of treatment as I see it unfolding in real time before our eyes: As an industry we have held fast to the holistic principals of Body, Mind, Spirit which take their roots in the Minnesota Model when a handful of recovering drunks and doctors left Wilmar State Hospital and founded the Hazelden program together in 1949. Body + Mind + Spirit = is a sacred and enduring principal in our field even today. Multidisciplinary teams continue to flourish, although outside factors such as managed care and an ever shifting payer mix have produced a dynamic tension between who leads that team… ie. The primary care addiction counselor of the guy in the white jacket with his prescription pad. But THAT is a talk for another day.The question for us today is how does – or how should – the holistic approach (body, mind, spirit) be adjusted or recalibrated as we move down the continuum of care from acute primary treatment to extended relapse treatment
- This is a discussion about the very fundamental differences between programs designed to stop addiction, and those designed to start recovery.William White puts it this way:Circa 2006 “Linking addiction treatment and communities of recovery”Completion of addiction treatment AND participation with recovery mutual aid groups is more predictive of long-term recovery than either one of these alone.
- PROBLEM STATEMENTMy dad once told me that treatment is just a very time consuming and expensive way for stubborn people to discover that AA meetings are free.TELL STORY HERE: My final and most spectacular relapse was filled with shame and desperation. The PARTY was OVER… (Tour and Travel News)But why? A. Failure to grasp step one and B. I was still on my own… emotionally isolated even in a room full of people.William White puts it this way in his2008 research findings entitled Recovery Oriented Systems of CareIt is important to define and distinguish between two very different models of care: an acute care (AC) model that focuses on bio psychosocial stabilization and a recovery management model (RM) that emphasizes sustained recovery support. The historical tension between these models is reaching a tipping point, and the stakes involve in the outcome are quite high. As a professional field, we have oversold what a single episode of acute care can achieve for the more than 2 million individuals enter addiction treatment programs each year in the US.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- Here is the great news about the evolution of treatment as I see it unfolding in real time before our eyes: As an industry we have held fast to the holistic principals of Body, Mind, Spirit which take their roots in the Minnesota Model when a handful of recovering drunks and doctors left Wilmar State Hospital and founded the Hazelden program together in 1949. Body + Mind + Spirit = is a sacred and enduring principal in our field even today. Multidisciplinary teams continue to flourish, although outside factors such as managed care and an ever shifting payer mix have produced a dynamic tension between who leads that team… ie. The primary care addiction counselor of the guy in the white jacket with his prescription pad. But THAT is a talk for another day.The question for us today is how does – or how should – the holistic approach (body, mind, spirit) be adjusted or recalibrated as we move down the continuum of care from acute primary treatment to extended relapse treatment
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- I am going to talk about the continuum of care – specifically that part of the continuum between the end of primary care treatment and before sustainable and autonomous recovery in the community at large. How it Works … is a discussion of the definitions and distinct differences between traditional treatment and the new open community models that are emerging. I will talk about how the open community model is uniquely positioned to specifically address the needs of the chronic relapsing client in early recovery. Into Action… is an examination of the lessons we’ve learned about the Open Community model since we began operating nearly seven years ago. There have been numerous mistakes and miscalculations, misplaced assumptions, adjustments and changes along the way. Hence, we will discuss the “evolution” of treatment on this leg of the continuum.Working with others… refers to best practices by other programs and services in the industry. Specifically, I will take a few minutes to discuss how other practioners and provides in other communities are implementing their own forms of the Open Community ModelFinally, in a Vision For You… I will recklessly propose where I think all of this is headed in the future. One part predictions of the inevitable, one part wishful thinking…Afterwards, I would really like to open the floor for questions and discussion about what you all have encountered and overcome in your communities.
- We’ve all been there: It’s QUIET in the dining room. That means one thing only… somebody’s holding onto a secret. Secrets in treatment are like termites, they eat away at the very foundation of the house. And with so many distractions, how can their NOT be secrets – girls in the AA community, porn or gambling, online or in the community… there is so much “leakage” possible in an open community model.How to root out the secrets?We learned that the solutions to these problems does not lie in root cause or family of origin issues or regressive trauma resolution work. You don’t work on making your bed. You don’t work on going to AA. You just make your bed and you go to AA. The spiritual dashboard is a peer-directed accountability index of made beds, meditation attendance, AA meetings, house chores, on-time dinner attendance, and daily focus sheets.
- I can’t drink = primary. I can’t NOT drink = extended careFocus = Relationship (Solution) vs Abstinence (problem)
- I can’t drink = primary. I can’t NOT drink = extended careFocus = Relationship (Solution) vs Abstinence (problem)
- I can’t drink = primary. I can’t NOT drink = extended careFocus = Relationship (Solution) vs Abstinence (problem)
- Service and recovery expeditions across the country:New Orleans and iowa for flood reliefPine Ridge SD to do a week of service work on Native American reservationsGrand Canyon restoration projects in Colorado and UtahWeekly or twice monthly:Feed the homelessHabitat for HumanityAnimal rescueHigh School wellness class speakersAdopt a highway