the use of recovery coaches and peer supports

The Use of Recovery Coaches and Peer Supports

Introduction to Recovery Oriented System of Care and The many

Pathways to Recovery

Today's Schedule

• Intro to ROSC • More on ROSC and Peer Supports• Ethics and Boundaries• Lunch• Cultural Competence• The Stages of Change Model and Motivational

Interviewing• The many Pathways to Recovery

Hello

• Chris O’Droski• Education• Experience• Affiliations• Leisure

Treatment Systems Change and Need for Peer Support ROSC Development and Its Implications for

the Recovery Community

ROSC- A National Movement• ROSC is the acronym for Recovery Oriented

Systems of Care• ROSC is a systems change which affects how

substance abuse treatment services are delivered to consumers

• ROSC is a philosophy shift that focuses on Recovery Management over the lifespan, instead of acute treatment episodes

• ROSC is a culture shift that invites increased reliance on persons in recovery and their experience.

SYSTEMS CHANGEOld System

A screening is done and person is given acute treatment option. (e.g. Outpatient, Intensive Outpatient, Inpatient Residential) at any number of different treatment centers. Upon discharge, if needs are not met, consumer would need to reapply for different option.

This model created gaps in service (limited pre-treatment engagement, little after treatment care) as well as a disconnect between treatment episodes.

System focused on meeting acute needs not long term recovery management.

Assessment focused exclusively on presenting symptoms instead of holistic approach.

Relies mostly on the expertise of treatment professionals as the primary means of providing services.

SYSTEMS CHANGEROSC system

Care is now localized and Core Providers are responsible for the consumers total recovery needs. Services include Pre-Treatment Engagement, Case Management, Peer Support, Support Groups, as well as Outpatient, Inpatient, and Detox.

Enables CORE PROVIDERS to coordinate and manage care across the lifespan of the consumers need

Assessment looks not only at treatment needs but also motivation to change, long term recovery management, and holistic needs.

RECOGNIZES THE NEED TO INVOLVE PERSONS IN RECOVERY in the treatment system.

PHILOSOPHY SHIFTOld Model-Acute Treatment Focus

Treatment was designed around medical model. Consumer presents with symptoms (i.e. using behaviors) entered treatment and symptoms abated (i.e. sobriety/clean time)

If consumer in treatment presented with symptoms while in care. (i.e. relapsed) it was the consumer that was the problem and they were expelled from services

Treatment was limited to time under care (10-90 days) with little or no aftercare plan

Research has proven that addiction is a chronic disease and needs extend throughout the lifespan. Acute Model is NOT THE MOST EFFECTIVE METHOD OF TREATMENT

PHILOSOPHY SHIFTROSC- Chronic Model

Treatment is designed around RECOVERY MANAGEMENT Model. Takes into consideration that addiction is a chronic disease and needs long term care.

If treatment option is not working for consumer ( abstinence is not being achieved) then it is the treatment that is the problem and perhaps another method needs to be attempted.

Looks closely at the STAGES OF CHANGE and attempts to fit consumers with the level of care that is most appropriate given where they present.

Treatment ends when the consumer decides they no longer require services with the option to come back when they do.

CULTURE SHIFT

Treatment is no longer provided strictly by professionals

ROSC seeks to expand services by ADDING PEER SUPPORT to the treatment system, not subtract by disengaging from professional based services. Both are needed to address consumers needs.

PEOPLE IN RECOVERY are needed to become EQUAL PARTNERS in the treatment process.

RECOVERY COACH is a new position in the ROSC that uses the EXPERIENCE, STRENGTH, AND HOPE that persons in recovery have to offer. Training is provided to help the aspiring coach use these skills effectively.

CULTURE SHIFT

Return to our roots in recovery traditionMORE OUTREACH- carrying the message to those that

are still suffering (i.e. using) instead of waiting for the treatment system to provide them to us.

CONTINUOUS ENGAGEMENT- Keeping in touch with people that may relapse, quickly reintroducing them to the path of recovery

UNITING THE RECOVERY COMMUNITY- recognizing the value of working together regardless of recovery philosophy and acting in the interest of the COMMON good. ( NA vs. AA etc.)

ROSC BENEFITS

• Consumers receive comprehensive care without gaps in services

• New Opportunities for the Recovery Community– BE PIONEERS IN A NATIONAL MOVEMENT

• Michigan is a national leader in the ROSC movement

– PERSONAL AND PROFESSIONAL DEVELOPMENT• Recovery Coaching is two sided

– Coaches both help recoverees and gain positive recovery identity that keeps them from reentering the system

• Recovery coaches bring unique perspective and strengths that professionals can gain insight from and vice versa

LOCAL ROSC PROGRAM DEVELOPMENT – PEER RECOVERY PARTNERS AND

STRENGTH-BASED CASE MANAGEMENTWASHTENAW COUNTY

OBJECTIVES:• ROSC Overview and Washtenaw Evolution• Principles of Strength-based Case Management• Recovery focused practices used in this project• Peers• Challenges and Barriers identified during

implementation• Tools used to measure progress in the outcomes

evaluation• Data

ROSC OVERVIEWThe Washtenaw Evolution

Elements of Recovery Oriented System Of Care

• Person-Centered• Family and other ally involvement • Individualized and comprehensive services

across the lifespan• Systems anchored in the community• Continuity of care• Partnership-consultant relationships

Elements of Recovery Oriented System Of Care Con’t

Strength –based Culturally responsive Responsive to personal belief systems Commitment to peer recovery support services Inclusion of the voices and experiences of

recovering individuals and their families Integrated services System wide education and training

Elements of Recovery Oriented System Of Care Con’t

• Ongoing monitoring and outreach• Outcomes driven• Adequately and flexibly financed

OUR MODEL FOR ROSC

• This integrated community-based model has, at its core, the recognition that substance abuse is a chronic problem; and that recovery requires patience, persistence, and ongoing and consistent relationships that are crucial to success. The model was designed both by professionals and individuals from within the recovery community, and is strongly valued as a partnership to improve the system of care by layering resources. In joining together, we bring unique and effective methods to impact and improve the lives of our vulnerable homeless citizens.

PURPOSE/GOALS

• Originally set up to help empower homeless individuals with substance abuse disorders to engage in treatment

• utilize community resources that will lead to stabilized housing

• develop relationships within the recovering community that will be consistent, meaningful and long-lasting, thereby helping to prevent relapse and promote sustained recovery from alcohol and drug use.

• Program has evolved and is now available to all programs and departments at Home of New Vision

FUNCTIONS• Engagement and relationship –

develop a collaborative helping partnership

• Strengths assessment- gather info on 6 life domains

• Personal planning - setting goals and options for achievement

• Integration into the larger recovery community

• Collective, continuous collaboration and graduated disengagement – monitoring and adaptation ongoing

ENGAGEMENT

PURPOSEFUL RECIPROCAL FRIENDLY TRUSTING EMPOWERING CONVERSATIONAL

Integration & Normalization

• Incorporation into society or organization on the basis of common and equal membership of individuals differing in some group characteristic– Requires equal access to resources– Equal access to options and opportunities– Equal power of individuals to choose from the

array of options and direct their own lives, having the same rights of others

RESILIENCE People manage to become successful despite very adverse

conditions growing up. Seven Resiliencies: insight, independence, relationships, initiative, creativity,

humor, and morality Development from adversity and allow or explain a person’s

ability to overcome.

PEER RECOVERY PARTNER ROLE

• Advocate for, and empower clients to voice their needs and concerns to case managers and providers

• Take clients to meetings, visit clients • Take clients to appointments• Introduce to sponsors and supports• Encourage sobriety and become active in non-using

activities – soft ball, gardening • Creative use of time

PEERS• Recruit Peer Recovery Partners from the existing

recovery community• Peer Recovery Partners have at least 6 months

of continuous sobriety and be actively involved in the recovery process.

• The primary challenge has been building a commitment to the idea of a program itself. The recovery community has a long standing tradition of supporting the newcomer once they have found recovery, but it has been a task to get everyone on board with helping struggling addicts and alcoholics get to that stage of readiness.

Peer Support or Sponsor?• Peer supports are not affiliated with a

specific fellowship outside of using that specific recovery experience as a tool

• Peer supports are to provide basic recovery assistance and to support an individuals overall health and wellness using the recovery techniques that they have learned

• A peer support is a first line introduction to working a recovery program. They should not be actively working the steps with the clients in the way a sponsor should.

Peer Support or Sponsor? Continued

• A peer support works with individuals in pre-recovery. A sponsor works with someone that is already in a fellowship.

• Peer supports work with the case managers and other community partners to help individuals acquire resources and meet a strengths based goal plan in which sobriety may not be the first objective. A sponsor shows someone how to work the steps in order to achieve sobriety.

Why be a Peer Support?• Promoting one’s own recovery by helping others. Peer supports get

the opportunity to give back what was so freely given to them• Becoming a true member of the larger community. Peer supports

have the opportunity to reach out and collaborate with social service agencies, police departments and the jail, and community businesses as well as members of the community not in recovery

• Becoming part of something special. Being a peer support means building something new and exciting and developing friendships that will last.

• FUN!!!! Peer Supports plan all different types of social activities. BBQs, softball team, bowling nights, and getting together regularly to celebrate recovery and the part they play in the lives of others are all part of being a peer.

Expectations• Attend all required trainings• Adhere to ethics and established

boundaries (training will be provided)• Maintain client confidentiality• Document all activities and maintain

accurate mileage logs. Turn in mileage and activity logs on time.

• Peer Support Advisory meetings held once a month plus individual supervision.

• HAVE FUN!!!!!

Benefits of being a Peer Support

• Comprehensive Training: Enhance one’s own recovery knowledge and gain skills

• Certified Addictions Counselor credit: Valuable for anyone pursuing a career in substance abuse treatment

• Mileage reimbursement: the expense of getting the client where they need to go is covered

• Employment opportunities in the future: Peer Supports are the wave of the future. Paid positions are inevitable. Great experience for any resume.

Key peer program components

• Recruitment from the community• Peer orientation and ongoing meetings• Peer Role development • Create new ways for peers and clients to

interact...sports activities, topical workshops, picnics, outreach to dispense personal care items

PEER SUPPORT BASIC COMPETENCIES

• The ability to establish rapport quickly

• An awareness of how to maintain appropriate boundaries

• Willingness to be non-judgmental toward clients

• Ability to draw on personal recovery experience and relate to client with empathy and compassion

• Willingness to guide a person in early recovery through the stages of change and engage with them even though sobriety may be elusive at first.

Competencies, cont’d:• Recognizing the importance of family, social networks,

and community systems in the treatment and recovery process

• Understanding diverse cultures and incorporating the relevant needs of culturally diverse groups, as well as people with disabilities, into recovery practices

• The value of working together with case managers and other staff in developing long term relationships

Break?

LOCAL ROSC PROGRAM DEVELOPMENT – PEER RECOVERY PARTNERS TRAINING

ETHICS AND BOUNDARIES

OBJECTIVES:• To present the code of ethics established

by the Home of New Vision• Proper boundaries when interacting with

participants• To give peers a chance to discuss possible

ethical dilemmas and discuss proper responses

ETHICSHome of New Vision Standards

Peer Ethics: William White, 2005

What Are Ethics?

At its basic level, aspiring to be ethical means to prevent harm or injury to those whom we have pledged our loyalty

This meaning is best revealed through four terms: Iatrogenic, Fiduciary, Boundary Management, and Multi-Party Vulnerability.

IATROGENIC • Unintended, treatment caused harm or injury• Actions taken, even with the best of intentions, that resulted in harm or

injury to the individual (e.g. treating someone with electroshock therapy) • Given that recovery coaching is a new frontier it is important that we

quickly identify, and discontinue those actions that cause harm to others• Important to receive feedback from other peers and peer supervisor

Fiduciary

Fiduciary is a term describing relationships in which one party has assumed a special duty and obligation to the other While recovery coaching and peer support is a

partnership, it is not an equally supportive friendship. Fiduciary implies that one party enters with increased

vulnerability requiring the objectivity, support, and protection of the other. The relationship between a coach and the

participants are held to a higher standard of obligation and duty than a friendship.

Boundary Management • Boundaries involve those decisions that

determine the level on intimacy in a relationship• While professionals practice detachment, peer-

based services try to minimize the social distance between helper and person receiving services.

• When thinking about proper boundaries potential problems must be considered as well as immediate ones.

MULTI-PARTY VULNERABILITY

• Multi-Party Vulnerability refers to how multiple parties can be affected by unethical behavior

• Includes the participants, their family and support network, the coach, the organization, the field of treatment, and the recovery community as a whole.

FLAWED ASSUMPTIONS1. Long term sobriety ensures that persons will act ethically.2. Ethics is common sense3. Breaches of ethical conduct are made by bad people intentionally4. Adhering to existing laws and regulations ensures ethical conduct5. Ethical standards held by professionals can be indiscriminately applied

to recovery coaches and supports6. Ethics don’t apply to volunteers only paid positions7. If a recovery coach or support gets into a ethical dilemma they will

always notify the proper authority.

Countering Assumptions• Long term sobriety

– Recovery no matter how strong, is not perfection. We are all prone to errors in judgment, especially in situations not previously faced

• Common Sense– because we work within a diverse population common experiences

are not the reality• Breaches are made by “bad” people

– most breaches are made by good intentions gone awry. Making ethical decisions requires a sense of heightened awareness.

• Adhering to existing laws and regulations will prevent a breach– what is legal is not always ethical. Ethics is often situational

dependent.

Countering Assumptions• Professional ethics apply unilaterally to recovery coaching

– While there is significant overlap, the uniqueness of the peer positions demand a different set of ethical standards

• Ethics do not apply to volunteers– Volunteering within a peer structure implies that the volunteers

hold many positions of trust and therefore are accountable to the same ethical standards as the paid positions. There are higher standards for the staff, but that falls into the differences between peer-based and professional services

• Recovery coaches will always report potential ethics breaches– Often times many peers struggle with the idea of what needs to

be reported and what constitutes a breach of trust. Regular self evaluation and consulting with peer leaders and the supervisor are necessary to maintain good ethical practices.

Core Values That Guide Ethical Practices

• Gratitude and Service– carry hope to individuals, families, and communities

• Recovery– all service hinges on personal recovery

• Use of self– Know thyself, know how and when to use your story

• Capability– Improve yourself. Give your best always

• Honesty– Tell the truth, separate fact from opinion, admit when

you are wrong


• Authenticity– Accurately relate your recovery

• Credibility– follow your own advice

• Fidelity– if you make a promise, keep it.

• Humility– Know your limitations and understand

your role, work within your boundaries


• Loyalty– Don’t give up. Give recovery a chance

• Hope– Offer yourself and others as proof that

recovery works• Dignity and Respect– Express compassion. Accept

imperfection• Tolerance– Learn about and respect diverse

pathways and styles of recovery


• Autonomy and Choice– Recovery is voluntary: it must be chosen. Enhance choices

and encourage choice making• Discretion

– respect privacy, don’t gossip• Protection

– Do no harm, Do not exploit. Protect yourself and others. Avoid conflicts of interest

• Advocacy– Challenge injustice. Be the voice for the voiceless.

Empower others to speak.• Stewardship

– use resources wisely.

Personal Conduct• Self-care: Remember that the primary function of a peer or coach

is to provide an example– your private behavior is just that; until it begins to effect your ability

to serve as an example to those you support (e.g. you are generally unhealthy and your mentees pick up negative behaviors from you)

• Personal Impairment– Your life is being negatively impacted and as a result your recovery is

suffering (e.g. a difficult divorce or loss of someone close- this applies only when you exhibit signs of distress)

• Relapse– You have a one day or short period of using behavior. Ethically you

are responsible for disclosing this to your supervisor. The consequences of such actions will be determined by the discretion of the supervisor of the program

Personal Conduct• Personal Bias

– We all have biases. It is important to identify and disclose these as soon as we are aware of them. The supervisor will work to overcome these with the coach and determine if they are for the purpose of continuing within the role of support.

• Pre-Existing Relationships– It may be the case that someone from your addiction may become a

participant. There are many risks involved in this situation• Use of Information across Roles

– because of the roles we play in the greater recovery community sometimes we may get information from our role in coaches that has an impact on someone else we are involved with in a different context. Discretion is the rule of thumb here.

• Advocacy– It is important to remember that when advocating, you often represent

recovery

Integrity

• Integrity is a key component of being a successful peer support and recovering individual

• Integrity means simply that you conduct yourself ethically when no one is watching you.

Confidentiality• All participant information is confidential to our

program. Any information that needs to be shared outside of our program needs the consent of the participant. This includes any family or friends, outside agencies, or other service providers.

• A signed release of information is required to share information.

• Exceptions are limited to homicidal or suicidal ideations or intent, certain medical information in an emergency, and cases involving abuse and neglect of a child or vulnerable adult

Finance• Some of the ethical dilemmas are concerned with

all matters financial• It is the best policy to never directly lend,

borrow, or exchange money, gifts, or anything of value with the persons you work with.

• It is important to remember that you should never do anything for any participant that you wouldn’t do for another. (e.g. if you take someone out for coffee and pay vs. buying someone clothing)

Romance• It is against the policy of the Home of New Vision and

the ROSC peer team to ever engage in any type of sexual relationship with a person that you are working with.

• This includes any behavior that could be construed as sexual harassment, sexual intimidation, or overly friendly overtures that could be misconstrued as sexual in nature.

• If in the course of duty, sexual feelings are arising for or from a participant, contact the supervisor for appropriate measures to be taken

• DO NOT ASSUME THAT INAPPROPRIATE BEHAVIORS ARE INNOCENT!

Romance• In the case that a participant enters the program that

you have had an intimate relationship with, let the supervisor know immediately.

• Peer to Peer mentoring is gender specific. The participants you work with should be the same gender as yourself. In the event that this is not possible, consult with the supervisor for proper handling of the situation

• The rules apply to all participants that have been engaged with program. Exceptions only apply to those who have been discharged for over two years.

Abuse and Neglect• Michigan law states that in the case of suspected

physical or sexual abuse or neglect of a minor child or disabled adult, social workers are among those REQUIRED to report their suspicions to the proper authorities.

• For the purposes of the peer network, it is your responsibility to report ANY suspicion to the supervisor of the program. The supervisor will conduct an investigation and report to the authorities.

• DO NOT report allegations directly to the authorities unless there is a direct threat of harm

Self Care• Ethics also apply to how you care for yourself.

Because peer mentors are models for right behavior, it is important that your own recovery comes first.

• Be aware of when your limits are being reached, no is an answer.

• Police yourself through contact with other peers and with the peer supervisor

• The peer supervisor, as well as Home of New Vision maintains an open door policy. Feel free to bring any concerns, both personal and in your capacity as a peer to the attention of anyone you think can help.

Conclusions• Ethical behavior is the most important part of

being a peer support• Ethics can be difficult. No question is a wrong

one. When in doubt ASK!• Before you can help someone you must first

be ok yourself• NO MONEY, NO SEX!!!!!!!!!• We are a team, how we conduct ourselves

effects everyone. Therefore it is our duty to help each other as well as our participants.

LUNCH!!!

• Cultural Competence• Stages of Change & Motivational Interviewing• Pathways to Recovery

http://www.youtube.com/watch?v=iUI2irVtKxQ

LOCAL ROSC PROGRAM DEVELOPMENT – PEER RECOVERY PARTNERS TRAINING

CULTURAL DIVERSITY

OBJECTIVES:• To examine bias and techniques for

overcoming it• To understand the role of culture in

personal recovery• To gain understanding of cultural

differences and raise awareness of how those differences effect how services are delivered

Cultural Diversity

Examining Cultural Implications in Peer Based Service Delivery

Cultural Diversity Mission Statement

• The ROSC Peer Team’s mission is to effectively and efficiently address the treatment and psychosocial needs of consumers and families with diverse values, beliefs, and sexual orientations, in addition to backgrounds that vary by race, age, ethnicity, religion, abilities, and language.

• Home of New Vision offers a vast array of services to a diverse and dynamic population.

CULTURAL COMPENTENCY • Culture generally refers to “shared values, norms,

traditions, customs, art history, folklore and institutions of a group of people.” (Orlandi, Weston, & Epstein, 1992)

• Cultural Competency is defined as an ongoing process by which individuals and systems respond that affirms the worth, and preserves the dignity, of each.

• It is the responsibility of Peer Supports and Recovery Coaches to develop an awareness of cultural considerations with respect to the recovery of the participants.

C-CAR • C-CAR stands for the Connecticut Community for

Addiction Recovery. C-CAR provides, among other services, Recovery Coach training and is regarded, along side William White, as the architect of the ROSC model.

• C-CAR envisions a world where the power, hope and healing of recovery from alcohol and other drug addiction is thoroughly understood and embraced.

• By promoting recovery from alcohol and other drug addiction through advocacy, education and service, CCAR strives to end discrimination surrounding addiction and recovery, open new doors and remove barriers to recovery, maintain and sustain recovery regardless of the pathway, all the while ensuring that all people in recovery, and people seeking recovery, are treated with dignity and respect.

C-CAR definition of Cultural Competence

• A set of behaviors, attitudes and policiesthat come together in a system, agency, orprogram or among individuals, enablingthem to function effectively in diversecultural interactions and similarities within,among, and between groups.”Sources: U.S. Department of Health and Human Services

C-CAR definition of Cultural Competence

• Cultural Competence is a point on acontinuum that represents thePOLICIES and PRACTICES of anorganization, or the VALUES andBEHAVIOR of an individual whichenable that organization or person tointeract effectively in a culturallydiverse environment.

• The Continuum

Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Cultural Pre-Competence

Cultural Proficiency

Adapted with permission from: Cross T.L. B.J Bazron, K.W Dennis and M.R. Issacs: Towards a Cross Cultural System of Care. Technical Assistance, Center for Health and Mental Health Policy. Georgetown University 1983

Cultural Continuum• Cultural Destructiveness: This

represents the most negative end of the continuum. Example: Culturally destructive people and/or agencies are those that support attitudes, policies and practice that are destructive to a particular culture.

Cultural Continuum• Cultural Incapacity: In this instance,

the agency or individual does not intend to be destructive to a culture; rather, it simply lacks the ability to be responsive. In this instance, there is a basic assumption of superiority of the dominant culture.

Cultural Continuum• Cultural Blindness: An agency or individual

that falls at this point along the continuum is one that purports to be totally unbiased. Its philosophy is the well-intended view that all people are the same. “We are all equal.” This view does not allow for modification strategies to meet the needs of clients, but rather feels that those strategies that apply to most should apply to all.

Cultural Continuum• Cultural Pre-Competence: The pre-

competent individual or agency recognizes its inability to provide appropriate services to clients of a different culture as it is currently structured and attempts to improve some aspects of its service delivery in order to do so.

Cultural Continuum

• Cultural Proficiency: All of the concepts of cultural competence are incorporated into an agency’s policy, practice and attitude. This agency or individual has the ability to add to the body of knowledge and to teach those concepts to others.

CREATING CULTURALLY COMPETENT SYSTEMS

A Peer Support should… Respect the unique, culturally defined needs of

the participant population Acknowledge culture as a predominant force in

shaping behaviors, values, and institutions View natural systems (family, community,

church, etc.) as primary mechanisms of support Start with the “family” as defined by each

culture as the primary and preferred point of intervention


A Peer Support should also…• Function with an awareness that the dignity of the

person is not guaranteed unless the dignity of his or her people is preserved.

• Acknowledge that minority populations are served in varying degrees by the natural system.

• Recognize that “family,” “community,” and the like are different for various cultures and even for subgroups within cultures.

• Believe that diversity within cultures is as important as diversity between cultures.


• Understand that participants are best served by someone that is in tune with or part of their culture.

• Acknowledge that cultural differences exist and have an impact on service delivery.

• Treat client in the context of their minority status, which impacts self esteem, identity formation, isolation, and role assumption.

• Respect the family as indispensible to understanding the individual because the family provides the context within which the person functions and is the primary support network.

Ethnocentrism

• Ethnocentrism is how different cultures and behavior associated with those cultures are assessed according to one’s own cultural standards– Behaviors and ideas are “good” or “bad”

according to how similar they are to our own cultures

Personal Bias

• Bias implies partiality or distortion of individual judgments based on a consistent mental leaning in favor of or against persons or things of certain kinds of classes. – Webster’s Dictionary-

• Everyone has certain biases, it is important to raise your awareness of these and take measures to overcome them

Overcoming Bias

• Overcoming bias is a process. There are actions involved in overcoming certain biases Self-Awareness- be aware of your own culture

and cultural blind spots Awareness and acceptance of cultural differences Understanding and working with the dynamics of

cultural difference Gaining knowledge of participants’ culture Adapting skills to cultural contexts.

ETHNORELATIVISM

• Ethnorelativism is understanding a culture in the relationship between it and your own. – This changes thinking away from judgment and

instead recognizes behaviors and ideas not as “good” or “bad”, just different

FELLOWSHIPCENTRISM• Fellowshipcentrism is the belief that one’s

own recovery program is the only one that is effective.– The ROSC Peer Team recognizes that there are

many pathways to recovery and we need to respect the individuals right to recover the way that works best for them

– This does not invalidate your own experience strength and hope

– For the purpose of peer recovery supports, AA and NA, as well as any other recovery program that is working for the recovering person, are respected by the Home of New Vision and WCHO.

CULTURES TO BE CONSIDERED

• What do we think of when we hear culture?– Race and Ethnicity– Sexual Orientation and Gender Identity– Disability– Age– Socio Economic Status– Drug(s) of choice

CULTURES TO BE CONSIDERED• Some other cultural considerations that may effect

someone’s recovery

– Incarceration in jail or prison, especially for extended periods of time

– Adoption or foster care situations– Homeless for extended periods of time– Co-occurring disorders– Religious or Spiritual identity– Family- siblings or only child– Parents- single, mixed race or same gender

WORKING WITH DIVERSE POPULATIONS

• Peer based services are effective because of the shared (like to like) perspectives of addiction providing common ground between participant and peer.

• When working with culturally diverse populations focus first on the commonalities (similarities vs. differences).

• Learn about how the participant thinks and relates to the world around them. Practice empathy.

• R-E-S-P-E-C-T is the key

CONCLUSION

• Cultural competency is a process of overcoming bias and learning about how others view the world

• Empathy is the cornerstone of cultural competency

• Respecting diversity as different instead of “good” or “bad”

• Cultures include more than race, gender, ethnicity, age, and sexual orientation

LOCAL ROSC PROGRAM DEVELOPMENT – TRAINING 5

MOTIVATIONAL INTERVIEWING AND STAGES OF CHANGE

Stages of Change and Motivational Interviewing

Increasing motivation to enter recovery

The Stages of Change Model

• Developed by Polchaska and DiClemente• Individuals progress through stages of change • Movement may be forward or backward• Movement may be cyclical

Stages of Change

• Pre-contemplation• Contemplation• Preparation• Action• Maintenance• Relapse/Lapse

Pre-contemplation

• Lack of awareness of the problem• Little or no thought about changing behavior• Things to focus on include: engagement,

developing trust, accepting the client where they are at, and providing concrete care

Contemplation

• Some awareness of the problem• Some thought about changing behavior in the near

future• Things to focus on include: instilling hope, positive

reinforcement for reducing harm, discussion of consequences, raising ambivalence, and motivational interviewing

Preparation

• Making plan to change behavior• Setting gradual goals• Things to focus on include: Assisting in

development of concrete action plan, problem solving, building skills, encouragement of small steps, and treatment planning

Action

• Specific changes in lifestyle have been made in the past 6 months

• Things to focus on include: combating feelings of loss, emphasizing long-term benefits, enhancement of coping skills, teaching how to use self-help, treatment planning, developing healthy living skills, and development of relapse prevention plan

Maintenance

• Continuation of desirable actions• Things to focus on include: assistance in

coping, finding alternatives, and relapse prevention

• Getting involved in recovery oriented programs and social activities

Relapse/Lapse

• THIS STAGE IS PART OF THE PROCESS• Things to focus on include: re-engagement,

determining triggers, and planning for future relapse prevention

• Encourage acknowledgement of some mistakes offering counter-solutions to reoccurring problems

Motivational Interviewing• Developed by William Miller and Stephan Rollnick in the early

1980’s for Alcohol problems.• In 1990’s expanded its use with other health problems.• A process to activate client’s own motivation for change and

adherence to treatment.• Guiding vs. directing, dancing vs. wrestling and listening more

than telling.• Involves collaborative partnerships between client and

counselor, utilizing current client resources.• Honors patient autonomy and counselor’s detachment from the

outcomes. The client presents the arguments to change or not to change.

Motivational Interviewing• Motivational interviewing helps

individuals identify their own goals and then to recognize, through a systematic examination of ambivalence, that a behavior interferes with attaining those goals.

Goal of MI• To elicit self motivational statements from the client about

change, and direct these statements towards change. • As practitioners we seek out statements that reflect 5 key

motivational areas:1. Self-Esteem: Statements from the client that they are OK. Raising self-esteem is the cornerstone of MI. Statements reflecting strategies for change.2. Concern: Statements from the clients that express concern about their behavior.

Goal of MI3. Competence: Statements from the client reflecting the ability to do something.4. Knowledge of Problem: Statements from the client recognizing problem behavior. Knowledge of strategies. 5. Desire to change: Statements that reflect a desire for things to be different.

Change• The likelihood that change will occur is influenced by

interpersonal interactions• An empathic style seems to facilitate change• People who believe they can change and who have

counselors who believe they can change, do change• An interpersonal style, a subtle balance of directive and

client-centered components. If it becomes a trick or manipulative technique, its essence has been lost.

Principles of Motivational Interviewing

• Express Empathy• Support Self-Efficacy• Roll with Resistance• Develop Discrepancy


• Listen to your client- the answers lie within the client and to find them requires listening.

• Understand your client’s concerns, values and motivations: The client’s reasons for change trigger the change, not your reasons. Ask why they want to change and how they might make a change vs. telling them they should.

• Empower the client- assist clients to explore how they can make a difference in their own actions/life. The client’s own ideas and resources are most important.

• Avoid Judgments, Arguments, Conflict and Coercion.


• Operate from the Strengths and Empowerment Perspectives with all clients.

• Resist wanting to set things right: do not argue that client is in trouble and needs to change. Let the client voice the change - help them through the ambivalence.

• Assist the client in identifying where there is a mismatch in “where they are with where they want to be” – gently and gradually without confrontation or coercion help them to increase their awareness of how current behavior may be leading them away from important goals.

Express Empathy• Share experiences and perspectives• Understand feelings and emotions• Use active and reflective listening skills- stay

focused, ask questions and paraphrase.• Always Be Honest- if you can’t relate to a

particular situation, experience or event…DON’T!

We can always relate to reactions such as pain, anger and depression.

Support Self-efficacy

• Maintain and convey faith in the person’s ability to change

• Ask about previous successes• Ask about positive qualities• Make interventions consistent with his/her goals and

values• Support autonomy

Roll with Resistance

• Confrontation breeds defensiveness• Labeling is unnecessary• Never argue with client• Resistance is natural…don’t fight it.

Develop Discrepancy• Finding or building the bridge between behaviors and

consequences. • Help the person see the difference between where they

currently are and where they would like to be in the future. • explore how important personal goals (e.g., good health,

marital happiness, financial success) are being undermined by current (past or future) substance use patterns.

Triggers to Change

• Able: A person has the necessary skills, resources, and confidence to carry out a change

• Willing: A person places an importance on changing• Ready: A person decides to change a particular

behavior and makes it a priority

Spirit of Motivational Interviewing

• Motivation to change is elicited from the person, not externally

• It is the person’s task, not the peers to resolve ambivalence

• Direct persuasion is not an effective method for resolving ambivalence

• The peer relationship is more like a partnership than an expert/client relationship

Motivational Interviewing Skills

• Affirmations• Reflective listening• Open-ended questions• Summaries• Elicit change talk

Motivational Interviewing:Techniques

To prepare someone for change, use basic listening and speaking strategies (OARS).

– Open ended questions to encourage more productive talk.

– Affirmation: Affirm Positive talk and behavior.– Reflective listening: Reflect what you hear and

see.– Summaries: Summarize what has been said.

Show that you understand. Understanding is not agreeing, and takes you out of the equation and puts focus on client’s own issues.

Questions that Encourage Productive Talk

Drawbacks of current behavior:• What concerns do you have about you behavior?• What concerns does your (spouse, friends, etc.) have

about your behavior?• What has your behavior cost you?Benefits of Change:• You talk a lot about your family. How would

stabilizing your (substance use, diabetes, gambling, etc.) benefit your family?

• How would that make things better for your kids?

Questions that Encourage Productive Talk

Desire to change:• How badly do you want that?• How does that make you feel?• How would that make you feel differently?Perceived ability to change:• How would you do that, if you wanted to?• If you decide to change, what makes you think you

could do it?• What would that take? How are you going to do

that?

Conclusions• The stages of change model can be cyclical. • Meet clients where they are at, not where you

think they should be; Not where society, media or their family think they should be.

• Express empathy, support self-efficacy, roll with resistance and develop discrepancy.

• Practice-Practice-Practice Motivational Interviewing skills.

• Encourage and guide change, do not force it.

BREAK???

Recovery Happens

• “You were sick, but now you're well again, and there's work to do.” ― Kurt Vonnegut, Timequake

• “Karl Marx: "Religion is the opiate of the masses."Carrie Fisher: "I did masses of opiates religiously.” ― Carrie Fisher, Postcards from the Edge

Recovery Happens

• “Habit is habit, and not to be flung out of the window by any man, but coaxed down-stairs one step at a time.” ― Mark Twain

• “Life is very interesting… in the end, some of your greatest pains, become your greatest strengths.”Drew Barrymore Quote for Overcoming Addiction

The Many Pathways to Recovery

• Alcoholics Anonymous• Narcotics Anonymous• Other 12-step Groups• SMART Recovery• Celebrate Recovery• Church Groups• Faith Based Treatment• Faces and Voices of Recovery

More Pathways to Recovery

• Life Ring• White Bison• Secular Organization for Sobriety (SOS)• HAMS• Rational Recovery• Women for Sobriety• And many more- There are mutual aid groups

for every condition or addiction out there.

Thank You

• Always remember…Recovery is a Journey not an event.

the use of recovery coaches and peer supports

Documents