UNDERSTANDING THE ROLE OF PEER RECOVERY COACHES IN THE ADDICTION PROFESSION Presented by Phil Valentine August 21, 2013
A presentation by the NAADAC, the Association for Addiction Professionals
DEFINING PEER RECOVERY COACHES
DEFINING PEER RECOVERY COACHES
SAMHSA Service Definition o Peer Recovery Coaching is a set of nonclinical, activities, based on shared lived experience, that engage, educate and support an individual to successfully recover from mental and/or substance use disorders. Peer Recovery Coaches act as a recovery and empowerment catalyst: guiding the recovery process and supporting the individual’s recovery choices, goals, and decisions.
RECOVERY COACH DEFINITION
From Connecticut Community for Addiction Recovery: A Recovery Coach is anyone interested in promoting recovery by removing barriers and obstacles to recovery by serving as a personal guide and mentor for people seeking or in recovery.
RECOVERY COACH DEFINITION
From William White: A Recovery Coach is a person who helps remove personal and environmental obstacles to recovery, links the newly recovering person to the recovering community, and serves as a personal guide and mentor in the management of personal and family recovery. Such supports are generated by mobilizing volunteer resources within the recovery community, or provided by the recovery coach where such natural support networks are lacking.
RECOVERY COACH DEFINITION
From CCAR Recovery Coach Academy: A Recovery Coach is someone interested in promoting recovery by assisting recoverees to identify and overcome barriers to recovery, develop recovery capital and serve as a recovery guide and companion for those seeking or sustaining recovery.
RECOVERY COACH ROLE
MOTIVATOR & CHEERLEADER o Believes in capacity for change o Motivates o Encourages o Celebrates
Adapted from William White
RECOVERY COACH ROLE
ALLY & CONFIDANT o Loyal o Cares for Recoveree o Actively Listens o Trustworthy o Stable and Consistent
Adapted from William White
RECOVERY COACH ROLE
TRUTH TELLER o Provides honest and helpful information o Offers suggestions o Helps to identify patterns of behavior o Does not sugar coat things
Adapted from William White
RECOVERY COACH ROLE
ROLE MODEL & MENTOR o Offers their own life as an example of healthy living o Shows how . . . Walks the talk o Provides stage-appropriate recovery information
Adapted from William White
RECOVERY COACH ROLE
PROBLEM SOLVER o Identifies potential problem areas o Assist recoveree to problem solve o Does not tell the person the right way but helps person with options o Non-judgmental
Adapted from William White
RECOVERY COACH ROLE
RESOURCE BROKER o Provides linkages to recovery community, treatment and other supports o Knows system of care and how to navigate the system o Has established contacts and recovery partnerships in the community
Adapted from William White
RECOVERY COACH ROLE
ADVOCATE o “A” = Advocate for the recovery community o “a” = Advocate for the recoveree o Assists recoveree to protect their rights o Acts as a representative for the recoveree when requested
Adapted from William White
RECOVERY COACH ROLE
COMMUNITY ORGANIZER o Helps establish support network for recoveree
o Serves as a connector
Adapted from William White
RECOVERY COACH ROLE
LIFESTYLE CONSULTANT o Offers feedback on recovery lifestyle o “How’s that working for you?” o Focus on recovery and wellness o Discuss healthy choices
Adapted from William White
RECOVERY COACH ROLE
FRIEND & COMPANION o An equal o Peer-to-peer
o Reduced power differential
Adapted from William White
DEFINING PEER RECOVERY COACHES
A RECOVERY COACH IS NOT: o Sponsor o Counselor o Nurse/Doctor o Clergy
STAYING IN YOUR LANE: DISTINGUISHING THE ADDICTION COUNSELOR, RECOVERY COACH AND SPONSOR
Adapted from the writings of Bill White
DISTINGUISHING CHARACTERISTICS: STARTING POINTS FOR DISCUSSION
o Contrast professional addiction counseling, peerbased recovery coaching and sponsorship on key characteristics o Recognizing that these characteristics exist on a continuum across organizations and groups that evolve over time.
FOUNDATIONAL KNOWLEDGE
Counselor
• Emphasis on formal education (theory and science) • Vetted by the profession
Recovery Coach
• Emphasis on experiential knowledge and training • Vetted by the community
Sponsor
• Emphasis on experiential knowledge • Vetted by reputation within a community of recovery
ORGANIZATIONAL CONTEXT Counselor
Recovery Coach
Sponsor
• Works within organizational hierarchy of treatment organization • With direct supervision
• Organizational settings span treatment organizations, allied service organizations and recovery community organizations • Varied degree of supervision
• Minimal hierarchy • No formal supervision
SERVICE/SUPPORT FRAMEWORK
Counselor
Recovery Coach
Sponsor
• Works within a particular organizational treatment philosophy
• Works across multiple frameworks of recovery via choices of those with whom they work
• Works within beliefs and practices of a particular recovery fellowship
SERVICE/SUPPORT RELATIONSHIP Counselor
Recovery Coach
• Significant power differential • Extreme separation of helper/helpee role • Explicit ethical guidelines • High external accountability
• Minimal power differential • Ethical guidelines being developed • Moderate external accountability
Sponsor • Minimal power differential • Support is reciprocal • Relationship governed by group conscience • No external accountability
STYLE OF HELPING
Counselor • Formal • Personally guarded • Strategic
Recovery Coach • Variable by organizational setting but generally personal and informal
Sponsor • Informal • Open • Spontaneous
USE OF SELF
Counselor
• Selfdisclosure discouraged or prohibited
Recovery Coach
Sponsor
• Strategic use of one’s own story; role model expectation
• Strategic use of one’s own story • Role model expectation
TEMPORAL ORIENTATION
Counselor • Considerable focus on past experience
Recovery Coach • Focus on present: • What can you do today to strengthen your recovery?
Sponsor • Variable by fellowship and stage of recovery of sponsee
DURATION OF SERVICES/SUPPORT RELATIONSHIP
Counselor • Brief and ever briefer
Recovery Coach • Measured in months or years (via sustained recovery checkups)
Sponsor • Variable but can span years
ROLE OF COMMUNITY IN RECOVERY
Counselor
Recovery Coach
Sponsor
• Intrapersonal & interpersonal focus • Minimal focus on ecology of recovery • Minimal advocacy
• Focus on linking to community resources and building community recovery capital • Significant advocacy work
• Intrapersonal & interpersonal focus • Minimal focus on ecology of recovery • Minimal advocacy
DOCUMENTATION
Counselor • Extensive and burdensome
Recovery Coach • Minimal but growing
Sponsor • None
MONEY
Counselor
Recovery Coach
Sponsor
• Works as paid helper • Client or third party pays for service
• Works in paid or volunteer role • Service may be paid for by person being coached or a third party
• Provides support only as part of one’s own service work • No fees paid to sponsor or recovery fellowship
For more distinguishing characteristics, see the following at www.williamwhitepapers.org White, W. (2006). Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity. (Monograph) Philadelphia, PA: Philadelphia Department of Behavioral Health. White, W. (2009). Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation. Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Mental Retardation Services.
DEFINING PEER RECOVERY COACHES
PRIMARY TARGET POPULATION
Individuals who have already initiated recovery and are seeking support for long-term recovery from addiction to alcohol, gambling and/or other drugs.
DEFINING PEER RECOVERY COACHES
Individuals receiving this service should see movement through the stages of recovery: Stage 1: Stabilization
Stage 2: Deepening
Stage 3: Connectedness
Stage 4: Integration
Adapted from the work of Kathleen R. O’Connell, RN, MPH, PhD
STAGE ONE: STABILIZATION Year 1 tasks include: learning about addiction
physical detox and stabilization
developing role models for healthy recovery
learning to socialize in a group setting
staying away from risky places, situations and people
staying clean and sober
learning to break the pattern of isolation
developing selfresponsibility
anxiety management
learning to ask for help and support
STAGE TWO: DEEPENING Year 2 tasks include: increase in the quality of physical health
increase in the ability to tolerate feelings
beginning to make distinctions between and among feeling states
increase commitment to working on recovery
identifying old behaviors that don’t feel right anymore
emotional detox
changes in verbal attitude, feeling and behavior
STAGE THREE: CONNECTEDNESS
Year 3-5 tasks include: the depth of joy and misery can be profound
the need to go back and redo some earlier tasks in recovery
learning to avoid the creation of drama in one’s life
the outer world of the person is beginning to reflect the inner world
connections are made to a wider circle of people both in and out of recovery
there is an increase in honesty
STAGE FOUR: INTEGRATION
Year 6-10 tasks include: base relationships on love rather than need
avoid stuckness
the automatic use of tools of recovery
an ability to act on knowledge and insight and follow through
self-forgiveness
having fun and joy in life
STAGE FIVE: MATURATION
Years 10+ tasks include:
finding purpose and meaning in life
becoming confident
becoming more humble
understanding that you are both precious and insignificant
developing your legacy
allowing gratitude to penetrate every aspect of your life
DEFINING PEER RECOVERY COACHES
SERVICE SUGGESTIONS
This service is delivered primarily face-to-face, secondarily by telephone or via social media. Some places are beginning to use a learning community model as well.
FOUR GOALS OF A RECOVERY COACH
Promote recovery
Remove barriers
Connect recoverees with recovery support services
Encourage hope, optimism and healthy living
STAGES OF CHANGE: RECOVERY COACH’S ROLE AND THE ROLE OF THE RECOVEREE
PRECONTEMPLATION TO CONTEMPLATION Recoveree Task Person must decide to act and commit to change target behavior
Person must begin to take preliminary steps towards making change Ambivalence around decisional balance is resolved
Coach’s Role To raise doubts and increase concern and awareness around the target behavior Develop hope and optimism
CONTEMPLATION TO PREPARATION Recoveree Task Person must decide to act and commit to change target behavior
Coach’s Role To examine the impact of the target behavior and to consider the pros and cons in order to tip the decisional balance in favor of a commitment to change
Person must begin to take preliminary steps towards making change
Ambivalence around decisional balance is resolved
PREPARATION TO ACTION Recoveree Task Person must begin to set goals and priorities to achieve change
Coach’s Role To strengthen the commitment to change and to develop an action plan and strategies that facilitate the desired change.
Person must begin to develop a change plan
Person may not have stopped using alcohol and/or other drugs at this point. Change in using behavior may not occur until person reaches action stage.
ACTION TO MAINTENANCE Recoveree Task Person must apply behavior change methods and techniques for at least 6 months
Person continues to develop selfefficacy around behavior change and continually refines change behavior
Person must be actively meeting their recovery goal to be considered in action stage.
Coach’s Role To support the implementation of the change plan, modifications of the plan as needed and development of new behaviors and attitudes conducive to change.
MAINTENANCE Recoveree Task Develop routines
Coach’s Role Encourage! Celebrate!
Become aware of the positives associated with the change
Practice healthy attitudes (gratitude, service, hope, encouragement, etc.)
Reinforce positives Notice the progress made by the recoveree Focus on quality of life issues
STAFFING REQUIREMENTS
Most peer recovery coaches will have lived experience in recovery from addiction. Organizations vary whether or not this is “required.” Recovery coaching is both art and science. o The “science” will require sufficient education and training. o The “art” of recovery coaching draws on one’s experience and the ability to actively listen, ask good questions and discover and manage one’s own personal stuff.
SETTINGS
Peer Recovery Coaching can be delivered wherever individuals obtain services including: o
Free-standing peer recovery support locations such as Recovery Community Centers
o
Facilities where inpatient services are provided, such as hospitals, crisis centers, detoxification units
o
Facilities where outpatient treatment services are provided, such as clinics, psychosocial rehabilitation center, treatment centers, etc.
o
Some preliminary planning sessions in CT are talking about Recovery Coaches in nursing homes and emergency departments
SETTINGS
Peer Recovery Coaching can be delivered wherever individuals obtain services including: o
Primary care settings as well as emergency rooms, health homes
o
Natural community settings where mobile services may appropriately meet the individual, such as coffee shops or a person’s home, library, prison/jail, forensic facilities, college settings or job site
o
Other community and faith-based settings
o
Telephonic and other electronic communication
DOCUMENTATION
o There is a lot of discussion as to what documentation may be required and will be dependent on where the recovery coach service is delivered.
o In many cases, Recovery Plans are kept by the individual receiving the support, NOT by the peer recovery coach or the organization providing the service.
REIMBURSEMENT INFORMATION
States are using a variety of funding streams for peer workforce development, including: o
Medicaid
o
Managed care
o
o
o
Access to Recovery grant program
o
State, county, and local funding
o
Other sources (TANF, drug court funds, & private funding)
Recovery Community Services Program
Substance Abuse Prevention and Treatment Block Grant
VOLUNTEERISM – GIVING BACK
Reciprocal Benefit (Win-Win): o Peer recovery coaches, particularly those serving in this capacity as volunteers, are also quite explicit in what they get out of this service process. o
“I feel I am giving back by helping assist others in their recovery process. By practicing what I preach, I am able to build and nurture areas of spiritual growth in my life. I am able to maintain a sense of integrity and character. Working as a [peer] recovery coach has helped me evaluate strengths and weaknesses and improve my listening skills. I feel trusted and valued as a mentor when people allow me to help them reach their goals. I feel special.”
BIG QUESTIONS
RECOVERY COACHING – BIG QUESTIONS
Big Question #1 • How are Recovery Coaches “supervised”? “every coach needs a coach,” groups Big Question #2 • How do we measure outcomes? “keep the bureaucracy to a minimum yet assure accountability and quality” Big Question #3 • How will recovery coaching services be funded?
DEBUNKING MYTHS
MYTH: “THEY ARE COMPETITION�
FACT: Peer work is distinct and separate from professionally delivered clinical treatment. Peer workers are viewed as a vital, unique, and autonomous component of the addictions service workforce, and the essential qualities that they bring are valued as transformative, rather than merely additive.
MYTH: “THEY ARE COMPETITION�
o Some peer recovery coaches serve as volunteers while also working at a paying job. o Some volunteer for a limited time period as a way of strengthening their own recovery. o Some become certified for personal reasons or as a requirement of the setting they work in.
MYTH: “THEY ARE TAKING OUR JOBS”
o Some peer recovery coaches opt to work as a volunteer “giving back” as a component of their own recovery. o This trend of peer recovery coaches serving as volunteers is evolving as the field broadens and more opportunities for people to pursue careers as recovery coaches emerge. o As more peer recovery coaches seek paid employment there will need to be a track for training and credentialing for them.
AUDIENCE POLLING QUESTION Do you feel peer recovery coaches should have personal experience with addiction recovery?
MYTH: “HAVE TO BE IN RECOVERY TO BE A PEER RECOVERY COACH”
FACT: Peer recovery coaching is mostly provided by individuals with personal recovery experience but you don’t have to be in recovery to be a peer recovery coach. There are many factors that determine “peerness”.
• And even though peer support is based on the belief that people who have faced, endured and overcome adversity can offer useful support, encouragement, hope and perhaps mentorship to others facing similar situations. • Who determines if a person has personal recovery experience? • What about family members?
AUDIENCE POLLING QUESTION Do you feel the ethics guidelines for addiction counselors should be the same for peer recovery coaches?
MYTH: “PEER RECOVERY COACHES ARE NOT BOUND TO A CODE OF ETHICS�
FACT: Individual programs have developed ethical guidelines for peer recovery coaching. However, no national code of ethics exists at this time. Peer ethics are codes and guidelines that are developed in a peer context and incorporated in peer and community settings. Peer ethics are fundamental to all levels of policy, practice, and program development.
AUDIENCE POLLING QUESTION Do you feel that supervision should be the same for addiction counselors and peer recovery coaches?
MYTH: “THEY ARE NOT SUBJECT TO SUPERVISION�
FACT: Every coach needs a coach. Peer-run recovery community organizations have established peerto-peer supervision models.
To be most effective, peer workers will be guaranteed regularly scheduled supervision that is non-clinical, facilitated by a qualified and trained peer supervisor (some places referring to this role as a Master Coach.
MYTH: “THEY ARE NOT SUBJECT TO SUPERVISION”
Peer recovery coaches should not receive “clinical” supervision o Peer recovery coaches are doing non-clinical work o While peers may need administrative supervision to help them manage the demands of the workplace (e.g., recordkeeping, work schedule), they also need supervision from senior, experienced peers/coaches who can teach and reinforce critical competencies and help with problem solving. o A peer supervisor can also share experience, strengths, and hope when the job seems overwhelming.
MYTH: “THEY ARE NOT SUBJECT TO SUPERVISION”
✓ ✓ ✓ ✓
Supervision can be viewed as a peer-to-peer “coaching” model within itself Peer-to-peer supervision and/or co-supervision in individual and group format are accepted models Peer supervisors should have experience providing peer recovery coaching Ideally, peer supervisors will have completed a peer recovery coach training program
MYTH: “ITS DEPROFESSIONALIZING THE ADDICTION PROFESSION”
FACT:
Peer recovery coaches respect and value the role of professional treatment in the recovery process and in a recoveryoriented system of care.
PEER RECOVERY COACHES BENEFITING THE ADDICTION PROFESSION
PEER RECOVERY COACHES IN HISTORY
The addiction profession has a strong foundation of peer involvement. In fact, the earliest addiction professionals were the first peer recovery coaches informed by Alcoholics Anonymous.
Webinar #4 in RTP Series: The History of Recovery in the United States and the Addiction Profession www.naadac.org/education/webinars
BENEFITS TO THE ADDICTION PROFESSION
Evidence suggests that peer support and peer recovery coaching . . . o Reduces use of acute services (e.g., emergency rooms, detoxification centers) o Increases engagement in outpatient treatment o Increases active involvement in care planning and self-care o Reduces average service costs per person
PEER RECOVERY COACH RESEARCH
More research on recovery and peer involvement is outlined in this webinar: Webinar #2 in RTP Series: What Does Science Say? Reviewing Recovery Research www.naadac.org/educatio n/webinars
SUPPORT FOR A FULL CONTINUUM OF CARE
o In a recovery-oriented system of care, treatment is one component in a larger paradigm of recovery
Historical context...
Recovery Community
Treatment Community
SUPPORT FOR A FULL CONTINUUM OF CARE
o Peer-based recovery support services can constitute an adjunct to addiction treatment (for those with high problem severity and low recovery capital) or an alternative to addiction treatment (for those with low or moderate problem severity and moderate or high recovery capital). o This requires considerable vigilance in determining service needs and providing services only within the boundaries of one’s competence, and skill in making necessary referrals in a timely manner.
SUPPORT FOR A FULL CONTINUUM OF CARE
o Many see the implementation of peer support services and peer recovery coaching as viable alternatives to more expensive specialty addiction treatment. o The challenge is to ensure that decision makers are aware of and support a continuum of care which is holistic and accessible to individuals with substance use disorders, spanning from use to dependency and addiction.
SUPPORT FOR A FULL CONTINUUM OF CARE
o To be effective across this spectrum of disorders, services much be supported and include education, assessment, early intervention, treatment, and long-term recovery supports across the life span of individuals to produce a community focused on health and well-being for all who reside there.
THANK YOU!