Feb 25, 2016

Mercy for Addicts

Pope Francis has recently declared a Jubilee Year of Mercy  If we care to give mercy a try, we can start with our brothers, sisters, and neighbors who are suffering and dying from addiction.

In the last few years we have learned that people who use heroin and other opiates are risky, traumatized, disordered, and distressed. They have pain, addiction, immaturity, and mental illness all mixed together. They are in deep trouble. They need rescue. They need treatment, safety, and support, not lectures, punishment, and scorn. They need mercy.

We can heal the sick, and offer treatment to everyone who needs it. Northern Kentucky treatment agencies receive 40 calls a day from people seeking admission to care. We can say yes to everyone who calls, and if half show up, that’s 20 people every day, 100 every week, 5000 in a year. That is everyone at risk of overdose death in Northern Kentucky, brought to treatment in one year. It is not that costly to fund that surge of treatment.

Most people who use opiates stabilize quickly with medication and day treatment, but they require support to recover long term. We can show these people mercy, and support them as they make progress in their lives. We can house the homeless, feed the hungry, and offer comfort to the afflicted. Treatment groups can team up with churches and volunteers to help people stay in treatment. Ordinary human trouble disrupts treatment. Guest rooms, church dinners, safe recreation, and basic friendship help people overcome loneliness, rejection, transportation issues, and relationship trouble, the top barriers to retention in treatment.

Don’t forget jobs. When people emerge from drug use they tend to be poor and unemployed. We can give alms to the poor by combining jobs with support. This is another way for volunteers and co-workers to pitch in.

A minority of people have great trouble stabilizing, even with treatment. They may be too immature, too traumatized, or just too far out of control. Many of the people in this last group become prisoners for their own safety. Some are in jail, others are in secure facilities. We can show these people mercy too, by offering them treatment and connecting them with community support as soon as they are ready.

Mercy is good public policy. It aligns with effective medical care for addiction. Why are we so stuck in suffering? Perhaps mercy is our greatest challenge.

This post previously appeared in the Cincinnati Enquirer and Cincinnati Community Voices

Jun 1, 2015

Church groups challenge social service systems

I’ve been approached by a former student to connect her church group with resources to help congregation members improve their daily lives. I visited the church and met the pastor and other church leaders. It’s a small African American congregation here in Cincinnati. The issues of interest to the members are familiar to anyone who works with poor and working class families:

  • Education
  • Childcare
  • Jobs
  • Personal health
  • Chronic illness
  • Diet
  • Healthy families

A congregation choosing to improve the health of its members is no rare thing. People have always found ways to support each other in church organizations. Those in the so-called “helping professions” consider church groups a key “natural support.”

Unfortunately, we seem to know little about leveraging natural support relationships to improve health. The science plainly demonstrates our society’s failure to deliver success to the populations at the heart of social service mission. Service systems have directed countless dollars and resources at church groups in poor communities over the course of decades. Poverty, poor health, and trouble persist.

My hypothesis is that the American approach to health promotion and health improvement within church groups in high-poverty areas has been fundamentally incorrect. We treat natural supports as targets for professionals to manipulate. Congregations become the “primary target” of health interventions designed to reach intended “secondary targets,” meaning people with diseases or risk factors. Again and again, we measure the initial state of the target group, catalogue their troubles, and enumerate their risk factors and ailments. Later, we measure them again. At the end of our program, we announce that there has been some marginal statistical improvement. But that improvement never spreads to the population as a whole, and it’s hard to find actual living people who embody whatever improvement is announced.

What might we accomplish if we reversed the process? What might happen if we started with the desires and intentions of people in church congregations? What are their dreams? What are their strengths? What skills do they want to improve? What is the kind of life they envision for their children?

A population-centered starting point changes the direction of social service work. It turns the logic model inside out. What was once the “target population” is now the “action population.”  The local service system becomes the “primary target.” Changing the service system changes the health of the action population, and impacts the broader population. The “secondary target” becomes the overall social and economic environment.

And here’s what’s most important. Delivering good results on personal goals actually improves a person’s life. Not some straw man, or statistical sort of person. A real person, with a real life, with blood in the veins. A person who has relationships, and perhaps even children, who influences other people every minute they draw breath.

Picture: WPA Church drawing

May 20, 2015

Redesigning Case Management Training

Supporting Success
The Pyramid of Personal Support
What might happen if case managers delivered person-centered, strength-based, and trauma-informed service to people enrolled in service systems?

People find themselves enrolled in service systems because they have experienced some sort of trouble or difficulty in life. The stress of that trouble carries some traumatic impact. If bad behavior was involved, the person may have experienced additional penalties with additional impact, and the person’s family circumstances may be disrupted. From a human development perspective, the effect of all this is to knock a person off their developmental path or at least slow the velocity of a person’s progress. People who find themselves enrolled in service systems need a boost to get back on course.

Unfortunately, most service systems have organized themselves around problem-solving, not person-boosting. This is a historical social remnant, a consequence of history. Less than one hundred years ago, it was common for people with behavioral health issues to be treated as less than fully human. The various service professions were complicit in this. Members of the so-called “helping professions” facilitated atrocities, delivered inhumane care, enforced social control measures, and heaped on social consequences. Enlightened problem-solving fixes some of this, but much more progress is possible. Even today, much of the literature of care is still written in dehumanizing terms.

Kentucky Certified Peer Specialist Chad Ponchot and I have redesigned case management training in an attempt to rid the system of "one size fits all" service.  Learn more, and sign up here. Twelve hours of training are spread across two days. The first day is experiential. Participants model relationship-building, communication strategies, strength-finding, and resource development. The second day applies that experience to issues encountered by the service population. Kentucky has approved our work -- we are rolling out our model this summer.

Supporting Success delivers person-boosting from start to finish, with rigor – but this is not some ditzy New Age approach. We see the case manager’s job as technical assistance that supports healthy self-determination.

Case managers can be among the best person-boosters within service systems. They operate closest to a person’s home. They serve as observers for systems and coaches for their clients. The strengths, aspirations, talents, and capacities of the person receiving the assistance are paramount, but subject to the ordinary constraints of life on Earth. Some choices are healthier than others. Some courses of action have more risk than others. Relationships have benefits, but are not without conflict and drama – including professional relationships. And within service systems, professionals may have more technical knowledge, but the client is still the boss.

If you are interested in Supporting Success, visit www.humanintervention.net

Sign up for the training at this link. http://casemanager1.eventbrite.com