How do you incorporate recovery-oriented principles in therapeutic services/environments?
This is a great question. There are a number of values and practices to consider. In order to keep it simple, let’s consider five important principles and just a few of the ways they can be incorporated into any therapeutic service and/or environment:
- Hope – that recovery can be expected
- Program/service actions: share research and evidence on addiction and mental health recovery with individuals and families upon enrollment; introduce people enrolled in services to people in addiction and mental health recovery and past graduates of the program/service; share success stories of recovery through written stories, DVD’s, e.g. We Can Work/Save Campaigns for People in Recovery
- Person-Orientation – focusing on the person and family including strengths, values, skills, supports and culture rather than just on symptoms or illness.
- Program/service actions: program culture and policies expect the use person-first language, e.g. person in recovery rather than addict or schizophrenic; prioritize strengths-based assessment and service planning; ask questions about valued social and community roles;
- Person-Involvement – refers to the involvement and leadership of a person in recovery on the direction and activities of his or her own recovery process.
- Program/service actions: Individuals and families are directly involved in their own assessment and treatment planning and make decisions about their own goals, direction and types of services they will engage.
- Choice/Self-determination – The right of a person in recovery to choose what methods will and will not be part of their recovery process.
- Program/service actions: Individuals and families in recovery are given the opportunity to negotiate options and select what will work best from their perspective; Individuals and families are informed of their rights, including the use of advance directives, and supported to exercise their rights and self-advocate.
- Culture – A valuing of a person or family’s practices and beliefs that may influence the recovery process.
- Program/service actions: program requests information about the person’s culture, cultural experiences such as immigration and discrimination and supports engagement of cultural resources and communities.
While there are definitely many more, these values and suggested actions are widely recognized in both mental health and addiction recovery communities as meaningful areas that can facilitate the recovery process.
Some ways to get a start on reviewing a program or service is to look at a combination of sources such as written mission statements, program descriptions, policies and procedures as well as observing actual practices and environmental factors by conducting a “walkthrough” of your program experiences such as waiting rooms/reception areas, hallways, group rooms and even intake sessions. Looking at and encouraging the development of both written standards and improving practices of a program is important. Written standards in mission statements and policies can reflect intent and potentially a systematic approach to implementing recovery. Observing actual practice, such as the interpersonal environment may reflect what’s actually happening in the program but may be limited to the existing staffing or leadership and not yet be embedded in the program expectations.
For example, we can observe the interpersonal environment of a program or service for the presence of these values by noting if we observed people speaking to each other in ways that are empowering, hopeful, engaging, and/or honoring of diverse points of view and experience. You can also review written policies, procedures, supervision models and training plans to see if practicing skills such as welcoming, asking open-ended questions, summarizing or other motivational interviewing skills are formally expected by the program.
There are actually a growing number of checklists and instruments that can assist systems, programs and individuals to review progress in facilitating recovery.
Another primary theme that I like to keep in mind is to determine if a program supports people in addressing addiction and mental health needs in the context of pursuing specific quality of life areas such as work, education, family, relationships, community roles, economic self-sufficiency etc. Programs can easily get stuck focusing only on an illness orientation such as addiction or mental illness without considering where and when a person wants to succeed. Such programs have a tendency to emphasize stabilization approaches such as crisis and symptom management and often express not having the time to address the life goals that people may express concerns with.
What are the biggest remaining differences between the recovery communities and what is the likelihood that they will be resolved and how?
SAMHSA recently prepared and released an interesting summary report called Building Bridges: People in Recovery from Addictions and Mental Health Problems in Dialogue. The report refers to areas of discordance and hard questions. As one of the people involved in these dialogues I was grateful to see these categories explored by our respective communities. At the time they included:
- The different language and terminology of our communities
- Concept of and level of importance for abstinence as a marker for addiction recovery
- Use and meaning of medications in recovery
- Concept of coercion
My experience is that several of these categories were areas of discord primarily because our communities had not yet had the opportunity to engage and connect with each other, and much less opportunity to create dialogue and shared understanding about them. Since the release of this report, I have personally witnessed and facilitated dialogues with both addiction and mental health recovery communities where these issues were raised and some shared understanding and even common ground was reached. It turned out that some of these perceived differences were actually misconceptions derived from our use of language.
Actual differences in perspective and experience do exist and just as they exist in any community, our differences are just as important to embrace and honor as our commonalities. SAMHSA did convene a follow dialogue session with addiction and mental health recovery community leaders from across the country to further examine these differences and explore opportunities for collaboration and may be releasing a summary report in the near future.
Our differences in lived experience, for example, are actually tremendous strengths that we can bring to each other as a collaborative community. In this case, as we collaborate to advocate for an established peer support community across addiction and mental health in national health care reform, we have a greater capacity to support a much more diverse set of communities in need. Our differences are the actual strengths and diversity that we need and have to offer. Our common vision for recovery can be the organizing principle we use to build stronger collaborations and transformation across our systems and communities.
How is a recovery coach different from an NA or AA sponsor?
Just like a peer recovery coach is not a counselor, nurse or clergy, he or she is also NOT a sponsor. While peer recovery coaches as well as NA or AA sponsors are motivated in part by “giving back” and both have personal lived experience to share, there are clearly several factors that set them apart. A peer recovery coach may support the peer in exploring multiple pathways to recovery, where as a sponsor promotes the 12 Step framework. The sponsors’ role is to support the person in “working the steps”, while a peer recovery coach is supporting the person in building personal recovery capital, accessing community services, and/or working on a personal recovery plan. The coach focuses on a broader, more holistic wellness which may include healthcare, social inclusion, civic engagement and family relationships. A peer recovery coach works within recovery community organization structure and is bound by the organizations requirements and practices. A recovery coach works within a code of ethics determined by the peer recovery community, while a sponsor acts upon historical knowledge and traditions rather than formal training. Exploration of roles and boundaries is an area of focus in any training curriculum for peer recovery coaches. There certainly are some similarities between the two roles, such as sharing personal experience, however, as recovery advocates we need to be able to explain the differences to help define our role within the workforce and to maintain the “peerness” of recovery coaching as a peer-based recovery support service..
What do you think are the greatest advantages for a person in recovery to have peer support from someone with personal experience with mental health challenges and addiction?
The most significant factor is that the peer is looked at as someone being equal. The relationahip is based on trust, mutual respect, The authenticity of peers helping peers draws on the power of example, as well as the hope and motivation that one person in recovery can offer to another. Peer to peer support embraces the notion that both people in a relationship based on mutuality can be helped and empowered in the process.
The peer helper relationship is highly supportive rather than directive. The person providing the peer support “meets the person where they’re at”, supporting them while they identify the direction they want to go and what type of support they feel will be most helpful at the time.
The peerness of this relationship must be maintained, reflecting the recovery community principles, values, and culture, regardless of the setting in which peer services are being offered.
Because peer support services are designed and delivered by peers who have been successful in the recovery process, they embody a powerful message of hope, as well as a wealth of experiential knowledge.
Does gender matter?
Great question! My first thought is to ask “Does it matter to the person seeking peer support?” Since peer-based recovery support services are person-centered and peer-driven, it would be most appropriate to allow for flexibility in terms of gender. This is where peer services are unique in that the policies and procedures should not imply that we, as program administrators, know what is best for the individuals we serve.
In my experience, there is a tendency to assume that individuals in a recovery coaching program should be matched with same gender peers. In rethinking this, it seems that the most respectful approach would be to ask the individual seeking support what they feel most comfortable with. The answer may be influenced by personal trauma histories or prior experience receiving support from same-gender or opposite-gender helpers.
That being said, programs have been developed for gender specific peer-to-peer services and activities, such as those for mothers, fathers, women, men, and transgender. When designed and delivered by the “communities” they serve, engagement and retention will be better and peer participants are likely to have greater satisfaction and improved personal outcomes.
Chacku Mathai is Associate Executive Director @ New York Association of Psychiatric Rehabilitation Services, Inc.
Patty McCarthy is Director @ Friends of Recovery – Vermont