Colorado Model Of Care

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Shootout at the "I'm Okay" Corral - Open Community Models of Care for Treatment of Relapsing Addicts and Alcoholics

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  • 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.
  • 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.
  • 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.
  • This is only a small chunk of the larger continuum. Intervention is not represented here, for instance… nor is outpatient aftercare and mutual help groups after that. And yet – as the industry has evolved, we are slowly discovering that each level of care here is discreet and distinct unto itself, with a need for its own setting, its own dedicated staff, its own goals set, and most importantly… its own distinct and separate peer group.William White puts it this way:Circa 2006 “Linking addiction treatment and communities of recovery”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 patter 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 publicaly funded treatment in the US have already had one or more prior treatments. And 50% will be readmitted to treatment within 2 – 5 years.
  • 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
  • Relapse and Atypical DischargesThe Problem: We are STILL evolving the model w respect to this area. Consistently discovered that about 1/3 of the clients who begin our program will not complete our program. Of the group that gets kicked out, 75% are for non-compliance, and 25% are for chemical relapse. The Solution:We Believe StatementsSpiritual DashboardDiscreet levels of careContinuous Process ImprovementsThe Lesson:A paradigm shift away from Atypical discharges as a measure of a failed outcome. In our attempts to solve the atypical dc issue, we have seen our conversions increase year to year, to the point that 80% of our WSA graduates will remain in the community after treatment, and 55% will re-engage in some level of supported care along our continuum. So the focus is no longer on the guys who don’t complete level one, it’s on our graduates and alumni.
  • 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.
  • LESSONS LEARNED (continues to EVOLVE!!) Trust and Service = both issues where you need to strike a “delicate balance” – will talk about some of the LESSONS LEARNED in the next slide.COMMUNITY MEETING:Who’s your sponsor, when did you last meet, and what step are you working onWe Believe Statements: Core Values shared out loud over and over again. (Spiritual grafitti.) ALUMNI INOLVEMENT: William White’s research on the importance of Alumni programs:Peer based recovery support system (P-BRSS) is the basis for our JWL Alumni programAlumni in our community have been identified the single most important resource for recovery in our model of care.Volunteer Program (60+)Peer directed aftercare groupsWednesday night dinnerFriday Speaker meetingSandwich and Salad Bar open at all timesAlumni SWAT teams…. The alumni SWAT team consists of JWL alums with over 1 year of sober time, who are actively working the 12 steps, and are active JWL volunteers. 1. When word hits Jaywalker that an alum is having a hard time I (alumni coordinator) gets a call from the concerned party.2. Coordinator gathers info from individual and community and consults with his supervisor and IP’s counselor to determine next steps.3. If the alum is in immediate danger or risk to harming himself or others the police will be called.4. Where appropriate a team of no fewer than 3 JWL SWAT alums will then reach out and visit in person.5. The alum in trouble must agree to a few things before my guys take him, he must ask for help, he must be willing to do anything, and he must come immediately. 6. Where the alum goes after extraction is dependent upon extenuating circumstances, detox, sober house, treatment, hospital, are all options, my primary concern is the alums safety.
  • TRUST: Balance 80/20 containment to community in first 90 days.Morphs to 20/80 ratio over the next 90 days.Expeditions – Adventure, challenge but never defeatedSkiing, but no terrain parksMtn biking, but only after being certifiedSign out onto Main Street campusRec CenterAlano ClubhousePot Shops, Liquor Stores and Casual Culture off limits12 Step conferences in San Diego, San Antonio and across the state. 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 UtahKICKER: Solutions clients drive a box truck, for instance – would you allow that?
  • 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
  • ALUMNI INOLVEMENT: William White’s research on the importance of Alumni programs:Peer based recovery support system (P-BRSS) is the basis for our JWL Alumni programAlumni in our community have been identified the single most important resource for recovery in our model of care.Volunteer Program (60+)Peer directed aftercare groupsWednesday night dinnerFriday Speaker meetingSandwich and Salad Bar open at all timesAlumni SWAT teams…. The alumni SWAT team consists of JWL alums with over 1 year of sober time, who are actively working the 12 steps, and are active JWL volunteers. 1. When word hits Jaywalker that an alum is having a hard time I (alumni coordinator) gets a call from the concerned party.2. Coordinator gathers info from individual and community and consults with his supervisor and IP’s counselor to determine next steps.3. If the alum is in immediate danger or risk to harming himself or others the police will be called.4. Where appropriate a team of no fewer than 3 JWL SWAT alums will then reach out and visit in person.5. The alum in trouble must agree to a few things before my guys take him, he must ask for help, he must be willing to do anything, and he must come immediately. 6. Where the alum goes after extraction is dependent upon extenuating circumstances, detox, sober house, treatment, hospital, are all options, my primary concern is the alums safety.
  • Quote from William White: One of the brightest stars in this rising culture of recovery is Phoenix Multisport (PM)—a community of recovering people who share strenuous physical activity as a support for and expression of their addiction recovery process.
  • Colorado Model Of Care

    1. 1. Shootout at the I’m Okay Corral The Case for “Open Community Care” in the Treatment of Chronic Relapsing Addicts and Alcoholics Bob Ferguson CEO / Founder, Jaywalker Lodge© Jaywalker Lodge, LLC. All rights reserved. Shootout at the I’m Okay Corral
    2. 2. William White, MA“The collaboration that once existedbetween treatment agencies and localrecovery communities has dissipated in theprofessionalization of addiction counselingand the industrialization of addictiontreatment.”© your company name. All rights reserved. Title of your presentation
    3. 3. An “Open Community” Model of Care How It Into Action Works Working A Vision with Others for You© Jaywalker Lodge,LLC. All rights reserved. Shootout at the I’m Okay Corral
    4. 4. How it works© Jaywalker Lodge, LLC. All rights reserved. Shootout at the I’m OkayCorral
    5. 5. 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© your company name. All rights reserved. Title of your presentation
    6. 6. How it works Primary Extended Transitional Care Care Care 30 – 45 90+/- days 90+/- days days© your company name. All rights reserved. Title of your presentation
    7. 7. How It WorksA – Extended Treatment811 Main Court (90 days) A BB – Transitional Treatment725 Main Street (90 days)C – Admin & Sober Living734 Main Street (3-6 mos) CD – Outpatient Offices1152 Hwy 133 (90 days) D
    8. 8. How it works Transitional Primary Care Extended Care Care30 – 45 days 90+/- days 90+/- days Self Group Community© your company name. All rights reserved. Title of your presentation
    9. 9. How it works…© your company name. All rights reserved. Title of your presentation
    10. 10. How it works…© your company name. All rights reserved. Title of your presentation
    11. 11. Into Action Rehab -itation The migration of “traditional treatment” from the mountain top to Main Street...© your company name. All rights reserved. Title of your presentation
    12. 12. Into Action Hurdles • Relapse / Atypical Discharges • New Concepts • Boundaries • Financial • NIMBY© your company name. All rights reserved. Title of your presentation
    13. 13. Into Action Completion Rates – 90 day program Census WSA % Avg LOS 178 153 159 145 71 71 64 64 65 62 63 69 2009 2010 2011 Avg© your company name. All rights reserved. Title of your presentation
    14. 14. 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!© your company name. All rights reserved. Title of your presentation
    15. 15. Into Action Keys to the Kingdom • Trust & Consequences • Community meeting • Alumni Involved • Intimacy • Service© your company name. All rights reserved. Title of your presentation
    16. 16. Into Action Trust: • Phase 1: 80/20 containment to community in first 90 days… • Phase 2: Trust ratio “evolves” to 20/80 containment to community© your company name. All rights reserved. Title of your presentation
    17. 17. Into Action 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© your company name. All rights reserved. Title of your presentation
    18. 18. Into Action Alumni: • Networking (social/recovery) • Events Calendar • Volunteer programs • Outcomes© your company name. All rights reserved. Title of your presentation
    19. 19. Into Action Alumni After Treatment 3 mos (35) 6 mos (31) 6 - 18 mos (25) 100 100 100 91 80 80 80 71 75 65 60 60 AA sponsor Home Group Volunteer FT job/school© your company name. All rights reserved. Title of your presentation
    20. 20. Working with Others The model evolves… • New Found Life – Long Beach, CA • The Right Door – Aspen, CO • Phoenix Multisport – Front Range, CO© your company name. All rights reserved. Title of your presentation
    21. 21. Working with OthersNew Found Life• Ocean Blvd., Long Beach, CA• Separate Men’s / Women’s Houses• Primary and extended care residential© your company name. All rights reserved. Title of your presentation
    22. 22. Working with OthersRides to AA Meetings • You cannot: • walk / ride a bike • take public transportation • take a taxi •You can: • call known alcoholics and addicts with time • When you ride with an alcoholic • meeting before meeting • meeting at a meeting • meeting after a meeting© your company name. All rights reserved. Title of your presentation
    23. 23. Working with OthersThe Right Door• Aspen, CO• Non-profit agency established in 2003• Provides low cost intervention, case management, treatm ent and scholarships© your company name. All rights reserved. Title of your presentation
    24. 24. Working with OthersRoots in Recovery • Started by AA members driving defendants from jail to detox to meetings. • Battles addiction at the intersection of public safety and public health • Sliding scale, no client turned away. • Random UA’s and daily phone check ins.© your company name. All rights reserved. Title of your presentation
    25. 25. Working with OthersPhoenix Multisport• Boulder, Denver, an d Colorado Springs• Sober Activities• Recovery Network• NO Charge for services, events!© your company name. All rights reserved. Title of your presentation
    26. 26. Working with OthersAction, Action, Action! • Since 2007, Phoenix had provided programs to 3,620 people… • Hosts 40 – 50 events a week, all at NO charge to the participants! • Average age: 34 years • Gender split: 40% women, 60% men • No treatment… Just recovery!© your company name. All rights reserved. Title of your presentation
    27. 27. A Vision for You What’s next?© your company name. All rights reserved. Title of your presentation
    28. 28. Shootout at the I’m Okay Corral Bob Ferguson bferguson@jaywalkerlodge.com www.jaywalkerlodge.com www.slideshare.com KEYWORD: “Colorado Model of Care”© your company name. All rights reserved. Title of your presentation

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