Open Community Model of Care - CCSAD 2012
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Transcript of Open Community Model of Care - CCSAD 2012
04/12/2023 Colorado Model of Care
Shootout at the I’m Okay Corral
The “Open Community Model of Care” in the Treatment of Chronic Relapsing Addicts and Alcoholics
Bob Ferguson
CEO / Founder, Jaywalker Lodge
Cape Cod Symposium on Addictive Disorders
September 8, 2012
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04/12/2023 Colorado Model of Care
Disclosure
Jaywalker Lodge, LLC is a residential treatment program for men in Carbondale, Colorado.
It is a private, for-profit company.
I am the owner and founder of this company.
I represent this organization professionally.
I am paid by this organization.
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Personal Bio
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• Hazelden Foundation (1995 – 2001)
• Crossroads Antigua (2001 – 2003)
• Promises Treatment Centers (2003 – 2004)
• Jaywalker Lodge (est. 2005)
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William White, MAWith 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 pattern 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 publically funded treatment in the US have already had one or more prior treatments. And 50% will be readmitted to treatment within 2 – 5 years.
“Linking Addiction Treatment and Communities of Recovery” Article 2006
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How It Works Into Action
Working with
Others
A Vision
for You
The Open Community Model of Care provides relapsing addicts and alcoholics - some of whom are in very early recovery – with the prospect of a safe and sober transition from acute residential care into real life in recovery…
And yet, these gains are not achieved without significant exposure to real-world stressors and opportunities for relapse.
Overview
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How It Works Into Action
Working with Others
A Vision
for You
• Articulate the critical differences between primary care and extended care addiction treatment.
• Examine the milieu and transition strategies for transitioning patients from an acute care setting into real life recovery.
• Explore the vital and evolving role of alumni relations and community service in residential treatment today.
Objectives
How it worksYes or No?
There is a direct and indisputable correlation between length of stay in residential treatment and the sober outcomes.
How it worksYes AND No
Some clients DO require more time in an acute care setting… However, simply extending the length of treatment without moving the client into a real-life community setting assures only continuous abstinence, not recovery.
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PRIMARY CARE
Arresting Addiction Education Counselor directed Secluded setting Intro to 12 Steps Safe, secluded time out
from life’s distractions
Letting go of substances
EXTENDED CARE
Initiating Life in Recovery Application Peer directed Community setting 12 Step Immersion Structured, hectic re-entry
into real life recovery
Letting go of self
How it works
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How it works
It 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. As a professional field, we have oversold what a single episode of acute care can achieve…
- William White
“
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True or not true? Into
Action
Chronic relapsing addicts and alcoholics in early recovery require a treatment setting that is safe, secluded, and free from outside distractions and relapse triggers. It is therefore essential to maintain separation between a residential treatment program and the community around it.
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True or not true? Into
Action
In order to achieve lasting and sustainable sobriety, clients must learn to manage an environment which offers a daily choice between relapse or recovery.
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A – Extended Treatment811 Main Court (90 days)
B – Transitional Treatment725 Main Street (90 days)
C – Collegiate Recovery Program 734 Main St. (1 yr)
D – Outpatient Offices1152 Hwy 133 (90 days)
E – Sober Living / Landing872 Main St. (3 – 6 mos.)
A B
C
D
E
Carbondale, CO Population 6,412
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Myth or reality? Into
Action
The therapeutic alliance between counselor and patient is the most important relationship in any treatment episode.
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Myth or reality? Into
Action
In extended care programs, the counselor’s role is to facilitate strong relationships among the clients – not with the clients. These programs value the peer-to-peer relationship above all else.
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How it works
Body Mind
Spirit
DetoxStabilizationRest / Recover EducationDisease ModelDenial
Concept of HPSpiritual principals
RecreationExpeditionsTeam Building Step One FocusPeer EvaluationBuddy System
Group as HPAccountability to peers
Service WorkTeams / LeaguesHealth Club 12 Steps GroupsService PositionSponsorship
12 Steps in ActionService to others
Self Peers Community
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Open Community Milieu*Into
Action
• Admissions Red Flags
• Culture of Community
• 12 Step Immersion
• Atypical discharges * Lessons we’ve learned along the way…
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Into Action
Pre-Admissions Interview• Clinical assessment – Is this patient
appropriate?• Essential rite of passage for patient: i.e.
Asking for help!
Full disclosure: “no surprises”• Program milieu, philosophy, length of stay• Resident expectations – medications, relapse,
etc.
Admission Red Flags• No previous Primary Care episode• Acute MH Diagnoses – Trauma, Anti-social,
Axis 2• Suboxone
Open Community Milieu
Admissions Requirements for Open Community Model
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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!
Into Action
Sun Mon Tue Wed Thu Fri Sat Compliance %
AA Meetings 2 5 15 9 10 18 9 94%
TDA's 18 18 15 16 18 17 18 96%
Dinner attendance 18 18 18 17 18 18 17 98%
Beds Made 18 18 16 18 18 18 17 97%
DFS Sheets 16 16 13 18 18 10 14 83%
Morning Meditation 18 18 18 18 18 18 18 100%
Based on 18 clients
The spiritual dashboard...Dashboard
Into ActionOpen Community Milieu
Into ActionOpen Community Milieu
2009 2010 2011 Avg
153 145
178159
64 64 62 6371 65 71 69
14 7 10 10.3
Completion Rates – 90 day program
Census WSA % Avg LOS Relapse
Immersion in Local 12 Step Community
• Monitored engagement w. 12 Step community• FCSP – Weekly speaker meeting• NFL – No rides permitted & sponsor list• Safe Harbor House – Wednesday night alumni meeting
• Not all recovery communities are created equal• Prescott, Delray Beach, So. Cal., Twin Cities.
Into ActionOpen Community Milieu
Spiritual graffiti…Dashboard
Into ActionOpen Community Milieu
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Working with OthersAlumni Engagement
Role of Alumni in Open Community Model
Official DutiesAirport pickups
Meeting drivers
Expedition guides
Unofficial Duties12 Step sponsors
SWAT teams
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Working with OthersAlumni Engagement
Alumni-driven culture
• Peer directed aftercare groups• Wednesday night dinners• Expeditions (2x per year)• Reunions (annual)• Talent show• Open door policies for:
• Counselor check ins• Lunch or breakfast• Recreation activities
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Working with OthersCommunity Service
• Fundamental to recovery process
• Community Relations• Practical Programming• Mission and Adventure
Component
Therapeutic Benefits of Service Work
The Aspen Homeless ShelterCARE (Animal Rescue)Habitat for HumanityAspen Thrift Store (Clothes for the needy)Volunteer Outdoor ColoradoGrand Canyon TrustMission WolfPine Ridge ReservationAdopt a HighwayRoaring Fork Outdoor VolunteersExtended Table (Soup Kitchen for the Homeless)Assisting in the Rebuild of Joplin, MO
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Effective (+)
• Experience = educational• Adopt-A-Highway • Extended Table Soup Kitchen
• Organized, structured
• Staff and community participate with and among clients
• Prior preparation, supervision during, process experience afterwards
Ineffective (-)
• Experience = punitive• Sustainable Settings• Set up for sweat lodge
• Random, unprepared, disorganized, not structured
• Clients are separated, isolated, working alone.
• Lack of information
ServiceWorking
with others
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What’s next?• Friendship – our new
“goal-ed” standard?• Sober College Programs…
Everywhere!• Future focused care
A Vision
for You
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