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  

Mar 8, 2015

An invitation for people in recovery

Someone from the local syringe exchange program sent me the following request. Looks worthwhile. Participate if you can.


Hello everyone, I am trying to get the word out about an upcoming project that I will be helping out with for the Cincinnati Exchange Project. Please feel free to forward the following info...

This Is Recovery – We Are So Much More Than Our Addiction.

Cincinnati Exchange Project is excited to launch our public/social media campaign, “This Is Recovery.” Our mission is to provide a platform for addicts to share the stories of their lives beyond their addictions.

We are looking for recovering addicts who are willing to participate in our photo campaign. You will be photographed but the photo does not need to show your face, it can be your hands, your feet, whatever you would like. You may chose to give us your name but that is not necessary either.

You are perfect for our project if you identify as an addict/former addict/recovering addict. We don't care what your addiction is/was and your recovery is self-defined. Your participation may help inspire other addicts to seek help and show the community at large that there is a life beyond addiction and that our lives matter.

We would like to begin photographing in March and hope to begin the campaign in April. For more questions or info please email cep.thisisrecovery@gmail.com.

Mar 2, 2015

Out for Justice -- for Addicts

Last week, the Cincinnati Enquirer published an opinion piece I wrote: Drug Courts Addicted to Ignorance. It has generated well over 500 Facebook shares and 30 comments. I know it is controversial. It was meant to generate discussion. Here are some of the comments.
I am an opiate addict of 16+ yrs . I've been to detox centers and rehab, and I've quit cold turkey more than a dozen times, only until I got into a medical treatment program coupled with meetings and 1 on 1 therapy , on March 11th I celebrate my first year in 16 year without taking 1 opiate, I also am a dual-diagnosis case , not only do I suffer from addiction I suffer from ptsd, bipolar, and anxiety disorder this medication based treatment as helped me regain myself, my children, I'm a productive member of society. I support this type of treatment 100 %
That is what I hear from people who have not been able to succeed on 12-step alone.  Another commentator saw things differently:
"When people switch to medicine instead of street drugs, criminal behavior stops." Anyone who knows anyone on methadone knows this just ain't the case. Why would the author make such a statement?
"...medication-assisted treatment is the only way to successfully keep people from relapsing on illegal drugs." Again, we all know numerous folks who have done it differently, and successfully. Again, why would the author make such a statement? Mr. Komarek himself acknowledges that at least "one out of 10 find recovery through an abstinence-based program."
"We've even learned that 12-step programs like AA and NA do not work for the population using heroin today." But we all know people for whom these programs have worked. More often than not the "heroin population" is not working the programs, not the other way around. So again , why would the author make such a negative blanket statement?
In my experience, people who have achieved recovery through 12-step methods see their own experience as typical. When someone fails, they say the person fails because they are not "working the program." What the research says, and what I have seen, is that working a program is not enough for most people. People try, and try, and some succeed, but too many lose their tolerance to the drug, relapse, and die --- after being shamed and blamed repeatedly for "failing to work their program."

Someone who works with local drug courts wrote an extensive criticism.  It started with this.
"Has the author ever even spoken with a drug court Judge or attended a drug court session. Has he asked the Judge's opinions about MAT. I know he hasn't in NKY."
I have not visited any of those drug courts, but I know of many people who have suffered because of them. I asked my advisory group to give me a reality check about this comment. They referred me to the recent Huffington Post expose on lack of access to evidence-based care. One sent me a copy of this sign found hanging in a northern Kentucky courtroom -- published in the same article.

This is serious stuff.  In many parts of the addiction treatment industry, medication assisted treatment is seen as a threat. One of my advisors told me someone lost their job at a local treatment agency after speaking with reporters about the need to include medicine as part of treatment.

This is an important concern -- truly life and death for many people in our communities. Let's keep working on it.