In 2005 I stepped out of residential treatment work because I was shocked. I was as a freshly minted grad student working in a men’s treatment facility and I was admittedly doe-eyed and I was appalled by how abysmal the treatment outcomes were and how everybody seemed okay with it, or at least resigned to the fact that this was par for the course.
I started doing community-based, in-home clinical case management and coaching before “recovery coaching” was a thing. We deployed the old-school house call doctor or assertive community treatment social work model to work with clients and families in the environment that triggered their maladaptive responses. We trained them to start seeing and experiencing this same environment as the healing milieu.
We started largely as a post-treatment, reintegrative transition, case management and coaching service. As we teamed up more and more with treatment centers, detox facilities, hospitals, psychiatrists and psychologists we found ourselves working with providers in such a fluid and integral way that we allowed ourselves to grow in the way the clients, families, providers and market determined. Our working relationships with all of the above began to blossom and we started hearing that our work and team were a value add to the treatment centers we were working with and that they were selling our aftercare services on the front end of their treatment program. We began to team up more consistently with the best treatment centers and providers, formed some partnerships, and it became crystal clear why most treatment outcome numbers haven’t changed in decades. (It’s obviously a very complex topic and a comprehensive exploration or analysis is not what is intended here. But moving the needle and a simple, efficient and effective way is.)
What we learned in 2005 is the same as it is today. We can’t do what we do without these treatment centers, detox facilities, psychiatrists and psychologists. Our populations are notoriously difficult to work with. Whether it be primary mental health, drug and alcohol dependence or abuse, or co-occurring. But what is clear is that we can’t do it alone. Active Recovery Network is typically the anchor leg in this relay and very often outcomes are measured in this relay race only looking at the detox, hospitalization or residential treatment legs. This is not how an effective relay works. You can’t win the race without all parts of the team. You also can’t win it if you bobble/botch the handoff. If we work as part of any continuum of care, which most of not all of us do, effective and efficient care coordination is essential. All to often, it does not happen. This is one of many places the baton can be dropped. Even if there is a mental health or drug/alcohol relapse, if the client is partnered with or has access to the appropriate level of care, this baton can be picked back up and we can help that client quickly get back to the right level of care. For some this might be a failed effort, for others this is part of how a great network of providers supports our clients and families on their recovery journey.
In short, your treatment outcomes suck because “It takes a village.” “It takes a village to raise a child” is reportedly an African (Nigeria) proverb that means it takes and entire community, working together and interacting with the child in supportive ways and at teachable moments for them to feel safe and nurtured enough to grow into their own.
We can’t work in silos anymore. People’s lives depend on us fostering more collaborative, more communicative and more reciprocal relationships in the treatment industry. “One hand does not nurse a child” is a Swahil saying that we can apply to our field and our work. When we are looking out our best practices and our outcomes, let’s also be sure to see how efficiently our handoffs to other treatment providers are going. This is where all can be lost. I can’t tell you how many times a provider has said, “I gave them your contact info and I hope they call you.” If our clients called us on their own, more often than not, they are not our clients. Our clients are the ones who don’t call, that’s why we started going to their homes in 2005. Many if not most relapse before calling, some have died.
Treatment outcomes are obviously complex and there’s some oversimplification here. But what is true is that we have to look at how we all play a very specific role in this relay race to help our clients and families recovery and heal. Let’s all double down on taking a look at where we are in the continuum of care and make sure that we have practiced these handoffs so when it’s race day and lives are on the line, it is automatic, repeatable, and effective. If “it takes a village”, let’s be that village and each play our role in raising our clients and families up.