Michael Liimatta

In our last installment in this series we discussed, briefly, the importance of meeting the needs of each individual in the recovery program. To do this most effectively, a process of documentation is essential, using paper forms or computer-based data collection.   In residential recovery programs for the homeless, it is also important to adopt a team approach to working with our clients.

A.  Developing a system of documentation.     The essential elements include:

1. Regularly updated recovery plans/contracts
2. Daily progress notes
3. Summaries of one-on-one counseling sessions

When all of these elements are in place, supervisors can get a good picture of what each counselor or chaplain is doing with each of the individuals with whom he or she is assigned work.   Besides serving as a measure of job performance, proper documentation makes it easier for another counselor to step in and keep working with the client if that is necessary.   Good documentation provides a permanent record that can be accessed if the individual leaves the program and returns at a later date.   And, it provides valuable information that may be used by other ministries or agencies that work with the client in the future.

B.         Developing a team approach – The centerpiece of the team approach is a weekly meeting that involves all staff members who work with program participants.   IN this meeting, each chaplain or counselor updates the rest of the team on the progress of his or her clients.   This includes the issues each client is working on, any special challenges her or she faces, and the specific recovery-oriented tasks that have been assigned.   Time is afforded for feedback from other team members. Combining a simple written documentation system with this sort of team approach creates an important level of accountability.   Best of all, counselors and chaplains benefit from the insight and advice of their peers.   This is sure to result in more effective approaches to meeting the needs of people they are helping.   Does a team approach violate confidentiality?   The answer is “no” if clients are informed of the team approach when they first start the program and as long as team members do not discuss what is shared

C.         Why a written recovery plan? – To truly meet needs on an individual, we must first know what his or her needs are!   We know homeless addicts need food and shelter.   They need a personal relationship with Christ and need to stop using alcohol and drugs. After this, things much more complex.   If we don’t help them to walk through their deeper problems, we are in danger of “missionizing” our clients.   By this I mean teaching them to live successfully in the mission but not preparing them to live a healthy, sober Christian life when they leave.

D.       An effective recovery plan begins with a comprehensive intake process— In the first week of an individual’s stay, it is vital that his or her primary counselor — or a staff member specializing in intakes — spend adequate time with them for program orientation and data gathering.   Instead of hand out list of rules and expectations, staff members need to discuss each one of them with the new program participant. This should be in the form of a contract that is signed by both client and counselor.   The new program member must indicate that he or she agrees to the expectations and understands that noncompliance to certain requirements can lead to dismissal. After this understanding is reached, the data gathering process begins.

The best approach is what might be called a “diagnostic interview” where the staff member uses a questionnaire to obtain information that will be used later in the counseling process.   The intake process needs to be very thorough. We certainly don’t want to learn after two weeks in the program that the person has AIDS or that they have an outstanding warrant in another state or county.   These issues, and many others, need to be discussed in a process that can that more than one session.

The intake/diagnostic interview should gather information address all of the following areas:

1. Family, cultural and ethnic background
2. Family of origin relationships
3. Use history – alcohol
4. Legal/criminal history:
5. Medical history
6. Treatment history
7. Suicide assessment
8. Current emotional status
9. Nutritional assessment
10. Education
11. Employment history
12. Financial assessment
13. Military experience
14. Social relationships
15. Significant life experiences
16. Marital/relationship history
17. Client’s impression of problem
18. Counselor’s impressions/observations

For downloadable forms and other helpful information for creating recovery plans, see theGuide to Effective Rescue Mission Recovery Programs

  For the rest of this series go to the  Organizing the Counseling Process Index

Most rescue recovery programs for homeless addicts have no trouble filling up their beds. Yet, it is better to have a smaller program with committed participants than to have a large one filled with people who are not serious about changing their lives. A well-organized long-term recovery program is —  “A planned, organized, and systematic delivery of services — using both internal and external resources— with the goal of meeting the unique needs of each individual.”.

A 30-day “pre-program” can be instituted to serve as a trail period where prospective program members can demonstrate their commitment to recovery.   Inevitably, this approach will promote stability in the long-term program by avoiding the turmoil that occurs when men and women come and stay for just a few days or weeks.   A more consistent, serious group of people who can support one another on the road to recovery will surely develop.

So, what are some of the essentials of an effective long-term program?   Let me offer a simple definition.   A well-organized long-term recovery program is:

“A planned, organized, and systematic delivery of services — using both internal and external resources— with the goal of meeting the unique needs of each individual.”

Let’s look at the basic elements of this definition:

A.   Planned, organized, and systematic delivery of services — Without good planning, rescue mission programs can experience real problems.   For instance, in too many cases, the specifics of the long-term program have been based upon personalities instead of established policies.   So, from year to year, as staff members change so does the program – often in radical ways!   While staff members must be free to tweak and improve the program, top management must establish the essentials through well-thought out policies and hire accordingly.   These policies answer questions such as; Are the 12 Steps used? Do we use secular support groups? What is our core curriculum? When do program members begin outside jobs?   When can they date?   And so forth.

B.  Using both internal and external resources — The most effective services are provided when we understand the capabilities that staff members bring to the table.   Knowing their unique skills, specialized training, and special gifts allows us to work with clients using a team approach.   While every person in the program needs a primary counselor, good programs bring other team members in to work with their clients on those areas where they need special help.   Additionally, to truly meet the needs of those who participate in our long-term programs, we have to look for resources outside of the mission.     The best approach to making such referrals is to make those individuals and agencies as much a part of the recovery team as possible.   This means lots of communication with them before and after they work with our clients.

C.    The goal of meeting the unique needs of each individual — Does everyone in your program get at least one hour of one-on-one counseling or case management each week?     If not, your program is understaffed!   In which case, you need to hire more people or reduce the number of people in the program.   We cannot begin to meet the needs our clients if we do not spend the time that is needed to really get to know them.   This begins with a thorough intake process that makes use of forms and questionnaires that enable us to identify their unique needs and challenges.   And, as long as they remain in the program, we must maintain an accurate written record that documents their progress in meeting their individual goals and objectives.

With this last thought in mind, our next installment will deal with the issue of creating and updating a simple written recovery plan that can be used by rescue mission counselors and chaplains.

For downloadable forms and other helpful information for creating recovery plans, see the Guide to Effective Rescue Mission Recovery Programs

  For the rest of this series go to the  Organizing the Counseling Process Index

Because they do not receive government and insurance monies, rescue missions that serve the homeless are not bound to strict time limits on the days of service they can render.   There is no magic to 30-day, 90-day 120-day programs.   These have always been set by the people who provided the dollars.

That’s why I recommend a program for  homeless addicts that is  based totally on accomplishing a set of treatment goals — instead of one based on the calendar.   Still, there are some special considerations for the first 30 days of sobriety to which we need to pay special attention.   If we make a special effort to help a newly recovering people through them, more of them will stay around longer and go forward in recovery. A “pre-program” program has definite advantages.

A. Taking time to assimilate into the program – Most rescue mission workers will tell you that new people walk away from a recovery program within the first few weeks. Some leave because they are not ready to stop using drugs and alcohol — something over which we have little control.   On the other hand, jumping directly into an intensive program from a life on the streets can be overwhelming. A 30—day transition period is one way to provide newly sober addicts a chance to build up their health and become oriented to a life without drugs and alcohol. Many rescue missions have instituted month-long “pre-program” programs where time is spent in less intense activities focusing on daily support groups, work therapy and preparing for the next step in the life of recovery.

B. The issue of detoxification — While alcohol and drugs normally pass through the human body in about 72 hours, it takes a full thirty days for the brain to begin functioning normally.   Until then, newly sober addicts have problems with logical thinking, short-term memory, and motor coordination.   With this in mind, in this first month, detailed reading and writing assignments and job assignments that could be potentially dangerous to such people like work on ladders, handling of potentially hazardous materials, etc. should be avoided.

C. Medical/optical/dental screening — By the time homeless addicts find their way to a rescue mission program, it has usually been a long time since they have had a physical or a dental or optical examination.   Every program participant must receive this sort of assistance before beginning the intensive phase of the recovery program.   If not properly addressed, health problems will have a negative impact on an individual’s ability to recover from addiction.   A new pair of glasses or the right prescription for a medical condition can do a lot in assisting newly sober addicts become fully functioning recovery program participants.

D. Mental health screening — Every recovery program must establish a working relationship with community mental health providers.   Some studies estimate that one-third or more of homeless adults suffer from a debilitating mental illness, ranging from depression to schizophrenia.   This is especially a person comes in with a bag of pills with prescriptions that have been written by several different physicians.

E. Legal assistance — The majority of people who come to rescue mission recovery programs have had run-ins with the law.   They come with outstanding warrants, court dates, child support and marital issues and so on   If they are going to be able to concentrate on the program and a commitment to spiritual growth, we need to be sure they don’t have theses sorts of issues hanging over their heads.

F. Daily support groups — While their brain functions are returning to normal, support groups are more effective than direct counseling.   For the pre-program, mandatory daily attendance at addiction recovery support groups is essential, along with chapel attendance and one-on-one case management sessions   is way to help the new person remember not to drink or use drugs.   Hearing the stories of those who a living a sober and successful life provide hope, plus it helps them to feel a part of the recovery community.

G. A chance to show they are serious — Most rescue mission recovery programs have no trouble filling up their beds.   Still, it is better to have a smaller program with committed participants than a large one with people who are not serious about changing their lives.   For this reason, setting aside a special part of the building dedicated to the pre-program makes sense.   A 30-day trail period provides prospective program members a means by which they can demonstrate their commitment to recovery.   If that desire is truly there, they will go on to enter a program with others who are just as serious are they are

For downloadable forms and other helpful information for creating recovery plans, see the Guide to Effective Rescue Mission Recovery Programs.

  For the rest of this series go to the  Organizing the Counseling Process Index