Core Concepts of the Model Clyde HarperChris Budnick Louisville, KYRaleigh, NC Working Together for What Works 3 rd Annual Healing Place Summit October 13 – 14, 2011 Richmond, VA

Replicating Success Since 1993, consistently high sobriety outcomes have been achieved very cost efficiently for persons with:  High problem severity/problem complexity; and  Low recovery capital

Replicating Success Replicating success begins with having the right elements in place:  This can be done while being flexible with the model to account for various differences between communities

Community resources Recovery resources Alcohol Opiates Crack cocaine Methamphetamine Social Political Economic Urban Rural LocationLandscape Capital Patterns of Addiction

Replicating Success Chronic Illness Perspective

Addiction as an acute illness  Similar to treatment for an infection or broken bone  Expect people to achieve complete & enduring sobriety following a single, brief episode of treatment  Crisis-oriented responses  Professionally dominated decision making  Punitively discharge clients for becoming symptomatic  Terminate the service relationship following treatment  Treatment in serial episodes of self- contained, unlinked interventions  Similar to treatment for hypertension or diabetes  Does not limit the number of recovery attempts  Focus on interventions to increase readiness and to support recovery initiation  Emphasis on peer and indigenous recovery supports  Do discontinue help when a person is symptomatic  Continuing care interventions to enhance the durability and quality of recovery maintenance  Emphasize a sustained continuum of pre- recovery, treatment and post-treatment recovery supports Addiction as chronic illness

“As many times as it takes”  Clients are always given a way to get back into the recovery program Outreach and engagement Assertive linkage to recovering communities Continuing-care support Integration of alumni in the program and milieu What this looks like at THP

Replicating Success Chronic Illness Perspective Low Threshold/ Services on Demand

Based upon certain beliefs: 1.Individuals present with different levels of readiness for change 2.It is unrealistic to expect someone to resolve their problems before receiving services 3.Eliminate unnecessary barriers  i.e. waiting lists, pre-admission abstinence/sobriety requirements 4.Provide help when someone presents in need of help Low Threshold for Engagement/ Services on Demand

Wet shelter Motivational component of the program Community Assistance Program (CAP Van) 24/7 admissions into SUC Open referral for law enforcement What this looks like at THP

Replicating Success Chronic Illness Perspective Low Threshold / Services on Demand Long-term and Peer Driven

Based upon certain beliefs: 1.Sobriety is the first and foremost focus  Other services are provided as a person becomes capable of assuming these responsibilities  (i.e. employment/housing/legal assistance) 2.Attraction is essential  For many people, what is missing is hope 3.Current treatment services (i.e. 7 – 14 days inpatient treatment) are inadequate for individuals with high problem severity and low recovery capital Long-term, Peer-driven Social Model Recovery Program

Utilizes the shared experiences of those who have found a common solution to a seemingly hopeless condition Provides mentoring Networking in the community Not clinical/professionally conducted treatment Long-term, Peer-driven Social Model Recovery Program

Important concepts of social model recovery programs:  Recovery is the responsibility of the recovering person within the context of peer support  Primary relationship is between the participant and their peers, not the participant and therapist/MD  Increased program responsibilities result in increased input into program decisions Long-term, Peer-driven Social Model Recovery Program

Important concepts of social model recovery programs:  Recovery is self-paced  Program participation is voluntary  Few professional clinicians within the program  Mentoring  Responsibility and ownership for the physical and recovery environment Long-term, Peer-driven Social Model Recovery Program

Decision to initiate participation in the program rests with the individual Peer mentors Working with new clients Community process Job assignments What this looks like at THP

Hiring alumni into key positions Diversity in lengths of time to complete the program Responsibility of participants to maintain, reinforce and support a culture conducive to recovery What this looks like at THP

Replicating Success Chronic Illness Perspective Low Threshold/ Services on Demand Long-term and Peer Driven Twelve Step Based

Recovery is firmly rooted in the program and fellowship of Alcoholics Anonymous and other mutual aid societies (CA/NA) Assertive linkage into the 12-step communities Exposure to 12-step fellowships is not limited to meetings held at THP Twelve Step Based

Participants begin attending 12-step meetings, both at THP and in the community, from the beginning Sponsorship/home group requirements as participants advance in the program Sponsors are able to visit at THP What this looks like at THP

Replicating Success Chronic Illness Perspective Low Threshold/ Services on Demand Long-term and Peer Driven Twelve Step Based Teach a Twelve Step Curriculum

Integral to the success of The Healing Place model has been intensive instruction and study of the Twelve Steps of Alcoholics Anonymous Teach a 12-Step Curriculum

Replicating Success Chronic Illness Perspective Low Threshold/ Services on Demand Long-term and Peer Driven Twelve Step Based Teach a Twelve Step Curriculum Community Process

The “Community Process” is a vehicle for change in a recovery program that significantly shifts the dynamics from staff to peer accountability Community Process

Replicating Success Chronic Illness Perspective Low Threshold/ Services on Demand Long-term and Peer Driven Twelve Step Based Teach a Twelve Step Curriculum Community Process Program Components and Size

All components of the program must be present and sized proportionately in order to:  Provide services on demand  Operate cost-efficiently  Operate effectively Program Elements and Size

Program components need to include:  Non-medical detoxification  Motivational Component (Off The Street)  Educational Component (Phase I)  Transitional Component (Phase II)  Continuing Care Component (Silver Chip) Program Elements and Size

The right leadership One new Core Concept