IOTA Group is an international company recognized in the oil, energy, and construction industries that has been in business for nearly 30 years. It prides itself on prioritizing employee health, safety, and well-being, and has been rewarded with high employee loyalty. The company uses internal communication tools to stay connected to employees around the world. IOTA is involved in all phases of projects, from engineering and feasibility studies to procurement and construction management.
This is the presentation from our workshop during the StartSummit at HSG St. Gallen. Our topic was: Sustainovation – Which innovations are required for corporations to actually become sustainable?
Ovation has created a centralized online resource called "My Ovation" for its payroll clients. In My Ovation, clients can find forms, training assistance, product demos, payroll updates, and a link to order supplies. It contains everything needed to easily process payroll. My Ovation is the client's own personalized payroll toolbox courtesy of Ovation. Clients can also contact their Ovation representative directly for assistance anytime.
This document discusses the benefits of corporate daycare and estimates a 400% return on investment. It notes that office daycare can reduce attrition of women employees, attract women talent, improve morale, and reduce extended leaves. Specific benefits listed include reducing hiring and training costs from lower attrition, as well as lowering absenteeism. The document estimates that for a company with 20 employees using daycare, the savings in the first year would be over Rs. 14 million, resulting in a 413% return on the Rs. 3.44 million investment in daycare. It projects similar high returns in subsequent years.
Jim Davis, Senior Vice President and Chief Marketing Officer, SAS, presented at the Premier Business Leadership Series, 2010. http://www.sas.com/theserieshk.
Organisations today are dealing with diverse issues, a wider range of regulations and heightened global competition. There has never been a greater urgency for proactive, evidence-based decisions and agile strategies.
By delivering insights that are gleaned from data about customers, suppliers, operations, performance and more, Davis will explore how leading organisations are solving complex business problems, lifting performance and driving sustainable growth through business analytics.
What employers need to know ppaca 9 26-12Damon Lee
This document outlines various requirements and their applicability based on employer size. It provides the effective date of each requirement, whether it applies to large, small, or very small employers, as well as fully insured, self-funded, and grandfathered plans. For each requirement, it identifies if additional guidance is needed, what action is required, and potential penalties for non-compliance.
The document provides details on the experiences of two motorcycle journalists living with and modifying Ducati Hypermotard 1100 and Harley-Davidson XR1200 motorcycles over several thousand miles. For the Ducati, modifications included a larger gas tank, air filter, exhaust, and ECU upgrades. Suspension was retuned by Race Tech. The Harley received no modifications yet but the writer plans to upgrade components. Both bikes proved reliable with expected maintenance needs over tens of thousands of miles.
IOTA Group is an international company recognized in the oil, energy, and construction industries that has been in business for nearly 30 years. It prides itself on prioritizing employee health, safety, and well-being, and has been rewarded with high employee loyalty. The company uses internal communication tools to stay connected to employees around the world. IOTA is involved in all phases of projects, from engineering and feasibility studies to procurement and construction management.
This is the presentation from our workshop during the StartSummit at HSG St. Gallen. Our topic was: Sustainovation – Which innovations are required for corporations to actually become sustainable?
Ovation has created a centralized online resource called "My Ovation" for its payroll clients. In My Ovation, clients can find forms, training assistance, product demos, payroll updates, and a link to order supplies. It contains everything needed to easily process payroll. My Ovation is the client's own personalized payroll toolbox courtesy of Ovation. Clients can also contact their Ovation representative directly for assistance anytime.
This document discusses the benefits of corporate daycare and estimates a 400% return on investment. It notes that office daycare can reduce attrition of women employees, attract women talent, improve morale, and reduce extended leaves. Specific benefits listed include reducing hiring and training costs from lower attrition, as well as lowering absenteeism. The document estimates that for a company with 20 employees using daycare, the savings in the first year would be over Rs. 14 million, resulting in a 413% return on the Rs. 3.44 million investment in daycare. It projects similar high returns in subsequent years.
Jim Davis, Senior Vice President and Chief Marketing Officer, SAS, presented at the Premier Business Leadership Series, 2010. http://www.sas.com/theserieshk.
Organisations today are dealing with diverse issues, a wider range of regulations and heightened global competition. There has never been a greater urgency for proactive, evidence-based decisions and agile strategies.
By delivering insights that are gleaned from data about customers, suppliers, operations, performance and more, Davis will explore how leading organisations are solving complex business problems, lifting performance and driving sustainable growth through business analytics.
What employers need to know ppaca 9 26-12Damon Lee
This document outlines various requirements and their applicability based on employer size. It provides the effective date of each requirement, whether it applies to large, small, or very small employers, as well as fully insured, self-funded, and grandfathered plans. For each requirement, it identifies if additional guidance is needed, what action is required, and potential penalties for non-compliance.
The document provides details on the experiences of two motorcycle journalists living with and modifying Ducati Hypermotard 1100 and Harley-Davidson XR1200 motorcycles over several thousand miles. For the Ducati, modifications included a larger gas tank, air filter, exhaust, and ECU upgrades. Suspension was retuned by Race Tech. The Harley received no modifications yet but the writer plans to upgrade components. Both bikes proved reliable with expected maintenance needs over tens of thousands of miles.
Making good cents out of quality & productivity by mr brian tan (fairmont sin...shupeiong
This document discusses various productivity initiatives at Fairmont Singapore and Swissôtel the Stamford. It outlines challenges such as rising costs and increasing guest expectations. Productivity programs introduced include the Fii program, ISO certifications, cross deployment of employees, the Watson Labour Management System, an ideas suggestion scheme called Ideas Count, and an Inclusive Growth Program to improve productivity. Examples of successful projects under each program are provided, demonstrating savings in time, costs and improved revenue. The initiatives have led to estimated total savings of $8.7 million and over 547,000 manhours.
A customer was injured while visiting your business and now you\'re stuck with a pretty expensive medical bill. General Liability covers contractual, personal and advertising injury, as well as liability protection
It\'s vitally important that dental practices and team members are as visible and memorable as possible. In this article, I suggest ways of achieving it.
This document provides guidance to employers on setting up with NEST, a workplace pension scheme in the UK. It outlines the key steps an employer needs to take which include: contacting NEST to discuss signing up and setting a timeline, signing up online and setting up payment schedules, enrolling workers using an employer toolkit, and making regular contributions payments. The guidance is designed to make setting up with NEST easy for employers and help them meet their new legal duties to provide workplace pensions to employees.
You arrive to work early one morning, only to realize that your business property was vandalized during the night. Fortunately, you had customized Property insurance to cover such a loss. Your business is up and running again, and you hardly missed a beat.
The document provides an overview of lean principles and practices. It begins with a brief history of lean thinking from Taylor's scientific management principles to Deming's emphasis on continuous process improvement. It then outlines the Toyota Production System and its focus on eliminating waste to achieve smooth and efficient flow. The rest of the document details core lean goals and values like respect for people, continuous improvement through kaizen, and identifying and eliminating muri, mura, and muda - sources of overload, unevenness, and waste in processes.
The document provides an introduction to systems thinking as a consulting tool. It discusses key concepts like dynamic complexity, reinforcing and balancing feedback loops, and how these concepts can be applied to analyze business problems. Systems thinking allows consultants to consider interrelated causes of issues rather than isolated factors, address root problems, and avoid short-term fixes that shift problems over the long run.
The document discusses strategies for motivating people to exercise through guidance, accountability, and making exercise fun and achievable. It notes that people lack motivation, guidance and face barriers like cost, time and accessibility issues. It suggests using tactics like bite-sized instruction, multimedia, gaming rewards and social elements to engage people. Triggering small, achievable exercises and celebrating tiny successes can help people start an active lifestyle through baby steps.
Auto-Owners Insurance Group enjoyed a successful 2005, with over $4.5 billion in net written premiums, an increase of over $112 million from 2004. The Group's companies received top financial ratings from A.M. Best and Demotech and were recognized for consistent performance over many years. Auto-Owners opened two new offices and continued construction on a regional office to better serve its growing customer base in 24 states.
The document discusses various insurance products offered by PPS Insurance for graduate professionals. It summarizes different types of coverage including life insurance (PPS Professional Life Provider), health insurance (PPS Professional Health Provider), sickness and disability coverage (PPS Sickness and Permanent Incapacity Benefit). Additional benefits like accidental death coverage and hospital cash benefits are also described. Key features highlighted are flexible coverage options, tax benefits on claims, and members sharing in company profits through a surplus rebate account.
The document discusses various insurance products offered by PPS Insurance for graduate professionals. It summarizes different types of coverage including life insurance (PPS Professional Life Provider), health insurance (PPS Professional Health Provider), sickness and disability coverage (PPS Sickness and Permanent Incapacity Benefit). Additional benefits like terminal illness coverage, accident benefits and critical illness riders are also described. Key features highlighted are flexible coverage amounts, tax benefits for sickness claims, and members sharing in company profits through a Surplus Rebate Account.
India's Largest Analytics Forum held in Grand Hyatt dated 12th March 2013. Arun V. Chearie, Practice Head - South East Asia spoke on topic - Evolution & the Changing dynamics of Customer Value Management.
LEA is helping lean pioneers in many sectors
8 years leading proof of concept experiments in healthcare
In search of a robust do-it-yourself methodology – which we published
Now helping hospitals follow this in the UK, Italy and the USA
Alpha 180 - A Sober Fraternity for College StudentsAlpha 180
"It's All Greek to Me" - A behind-the-scenes look at the growing, grass roots collegiate recovery movement in America; and the launch of the nation's first sober fraternity at the University of Texas, Austin.
This document summarizes an ethics symposium discussing challenges in the addiction treatment industry. It outlines concerns about misleading marketing practices like patient brokering for referrals, deceptive online practices, and a lack of oversight. It discusses the need for treatment centers to prioritize ethics over profits by avoiding black hat SEO techniques, unregulated referral practices, and exploiting client privacy. The NAATP code of ethics aims to address these issues and improve transparency and accountability in the industry.
FREEDOM CENTER Presentation - Top 10 Classic Mktg MistakesAlpha 180
This document discusses various topics related to marketing and operations for an addiction treatment center called Jaywalker Lodge. It addresses challenges like changing advertising rules, the importance of website design and content management, and tips for branding including using "We Believe" statements and principles of attraction. The document also outlines the primary and extended care programs at Jaywalker Lodge and emphasizes integrating marketing and operations.
The Colorado Model - or Open Community Model of Care - in treatment of chronic relapsing addicts and alcoholics.
Presented 1-31-12 at the Colorado Springs Symposium on Addictive Disorders
This document discusses using social media for behavioral health professionals and addiction treatment providers. It defines social media and Web 2.0, explaining that Web 2.0 allows for more interaction between users and two-way communication. The document outlines the benefits of social media for businesses, including increased brand awareness and traffic. However, it also notes challenges for the addiction treatment field in using social media, such as issues with transparency and not appealing to fence-sitters. Overall, the document argues that while social media may not immediately boost profits, it can synergize well with 12-step programs if used strategically over time through first-person stories and word-of-mouth growth.
Making good cents out of quality & productivity by mr brian tan (fairmont sin...shupeiong
This document discusses various productivity initiatives at Fairmont Singapore and Swissôtel the Stamford. It outlines challenges such as rising costs and increasing guest expectations. Productivity programs introduced include the Fii program, ISO certifications, cross deployment of employees, the Watson Labour Management System, an ideas suggestion scheme called Ideas Count, and an Inclusive Growth Program to improve productivity. Examples of successful projects under each program are provided, demonstrating savings in time, costs and improved revenue. The initiatives have led to estimated total savings of $8.7 million and over 547,000 manhours.
A customer was injured while visiting your business and now you\'re stuck with a pretty expensive medical bill. General Liability covers contractual, personal and advertising injury, as well as liability protection
It\'s vitally important that dental practices and team members are as visible and memorable as possible. In this article, I suggest ways of achieving it.
This document provides guidance to employers on setting up with NEST, a workplace pension scheme in the UK. It outlines the key steps an employer needs to take which include: contacting NEST to discuss signing up and setting a timeline, signing up online and setting up payment schedules, enrolling workers using an employer toolkit, and making regular contributions payments. The guidance is designed to make setting up with NEST easy for employers and help them meet their new legal duties to provide workplace pensions to employees.
You arrive to work early one morning, only to realize that your business property was vandalized during the night. Fortunately, you had customized Property insurance to cover such a loss. Your business is up and running again, and you hardly missed a beat.
The document provides an overview of lean principles and practices. It begins with a brief history of lean thinking from Taylor's scientific management principles to Deming's emphasis on continuous process improvement. It then outlines the Toyota Production System and its focus on eliminating waste to achieve smooth and efficient flow. The rest of the document details core lean goals and values like respect for people, continuous improvement through kaizen, and identifying and eliminating muri, mura, and muda - sources of overload, unevenness, and waste in processes.
The document provides an introduction to systems thinking as a consulting tool. It discusses key concepts like dynamic complexity, reinforcing and balancing feedback loops, and how these concepts can be applied to analyze business problems. Systems thinking allows consultants to consider interrelated causes of issues rather than isolated factors, address root problems, and avoid short-term fixes that shift problems over the long run.
The document discusses strategies for motivating people to exercise through guidance, accountability, and making exercise fun and achievable. It notes that people lack motivation, guidance and face barriers like cost, time and accessibility issues. It suggests using tactics like bite-sized instruction, multimedia, gaming rewards and social elements to engage people. Triggering small, achievable exercises and celebrating tiny successes can help people start an active lifestyle through baby steps.
Auto-Owners Insurance Group enjoyed a successful 2005, with over $4.5 billion in net written premiums, an increase of over $112 million from 2004. The Group's companies received top financial ratings from A.M. Best and Demotech and were recognized for consistent performance over many years. Auto-Owners opened two new offices and continued construction on a regional office to better serve its growing customer base in 24 states.
The document discusses various insurance products offered by PPS Insurance for graduate professionals. It summarizes different types of coverage including life insurance (PPS Professional Life Provider), health insurance (PPS Professional Health Provider), sickness and disability coverage (PPS Sickness and Permanent Incapacity Benefit). Additional benefits like accidental death coverage and hospital cash benefits are also described. Key features highlighted are flexible coverage options, tax benefits on claims, and members sharing in company profits through a surplus rebate account.
The document discusses various insurance products offered by PPS Insurance for graduate professionals. It summarizes different types of coverage including life insurance (PPS Professional Life Provider), health insurance (PPS Professional Health Provider), sickness and disability coverage (PPS Sickness and Permanent Incapacity Benefit). Additional benefits like terminal illness coverage, accident benefits and critical illness riders are also described. Key features highlighted are flexible coverage amounts, tax benefits for sickness claims, and members sharing in company profits through a Surplus Rebate Account.
India's Largest Analytics Forum held in Grand Hyatt dated 12th March 2013. Arun V. Chearie, Practice Head - South East Asia spoke on topic - Evolution & the Changing dynamics of Customer Value Management.
LEA is helping lean pioneers in many sectors
8 years leading proof of concept experiments in healthcare
In search of a robust do-it-yourself methodology – which we published
Now helping hospitals follow this in the UK, Italy and the USA
Alpha 180 - A Sober Fraternity for College StudentsAlpha 180
"It's All Greek to Me" - A behind-the-scenes look at the growing, grass roots collegiate recovery movement in America; and the launch of the nation's first sober fraternity at the University of Texas, Austin.
This document summarizes an ethics symposium discussing challenges in the addiction treatment industry. It outlines concerns about misleading marketing practices like patient brokering for referrals, deceptive online practices, and a lack of oversight. It discusses the need for treatment centers to prioritize ethics over profits by avoiding black hat SEO techniques, unregulated referral practices, and exploiting client privacy. The NAATP code of ethics aims to address these issues and improve transparency and accountability in the industry.
FREEDOM CENTER Presentation - Top 10 Classic Mktg MistakesAlpha 180
This document discusses various topics related to marketing and operations for an addiction treatment center called Jaywalker Lodge. It addresses challenges like changing advertising rules, the importance of website design and content management, and tips for branding including using "We Believe" statements and principles of attraction. The document also outlines the primary and extended care programs at Jaywalker Lodge and emphasizes integrating marketing and operations.
The Colorado Model - or Open Community Model of Care - in treatment of chronic relapsing addicts and alcoholics.
Presented 1-31-12 at the Colorado Springs Symposium on Addictive Disorders
This document discusses using social media for behavioral health professionals and addiction treatment providers. It defines social media and Web 2.0, explaining that Web 2.0 allows for more interaction between users and two-way communication. The document outlines the benefits of social media for businesses, including increased brand awareness and traffic. However, it also notes challenges for the addiction treatment field in using social media, such as issues with transparency and not appealing to fence-sitters. Overall, the document argues that while social media may not immediately boost profits, it can synergize well with 12-step programs if used strategically over time through first-person stories and word-of-mouth growth.
Social Media Ethics and Boundaries for Addiction Treatment Providers - overview of social media basics, along with sample guidelines and policies for treatment centers.
Social Media 101 for Addiction ProfessionalsAlpha 180
Intro to Social Media: Tips and Tactics for Addiction Treatment Professionals seeking to gain a foothold in the fast changing world of Facebook, Tweets, Blogs and Videos. Presented by Bob Ferguson, Founder and CEO Jaywalker Lodge, LLC, at the 37th Annual Colorado Springs MidWinter Symposium on Feb. 2, 2011
CCSAD - Social Media for BH ProfessionalsAlpha 180
Intro to Social Media for Addiction Treatment and Behavioral Health Professionals - presentation from Cape Cod Symposium for Addiction Disorders - Sept. 10, 2010
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
7. How It
Works
A – Extended Treatment
811 Main Court (90 days) A B
B – Transitional Treatment
725 Main Street (90 days)
C – Admin & Sober Living
734 Main Street (3-6 mos) C
D – Outpatient Offices
1152 Hwy 133 (90 days)
D
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.