Using PCOMS with substance use: Mandated clients and group work challenges handout 140509b

Brauchtworks Consulting

www.brauchtworks.com Applying Science to Practice

2014 International Heart and Soul of Change Conference June 5 & 6 at the Sheraton Cavalier in Saskatoon, Saskatchewan

Using the Partners for Change Management System (PCOMS) with Substance Abuse: Mandated Clients and Group Work Challenges

with

George S. Braucht, LPC Brauchtworks Consulting &

The Georgia State Board of Pardons and Paroles Email: [email protected]

*Certified Trainer in Partners for Change Outcome Management System (PCOMS) services with the Heart and Soul of Change Project: www.heartandsoulofchange.org

*Co-Founder of the Certified Addiction Recovery Empowerment Specialist

(CARES) Academy: www.gasubstanceabuse.org

The Endless Vine: An ancient symbol of life, infinity or the interweaving wisdom of the flow of time and movement on the path with That Which Is Eternal

Using PCOMS with Substance Abuse www.brauchtworks.com of 13


with George S. Braucht, LPC

Brauchtworks Consulting & The Georgia State Board of Pardons and Paroles

Table of Contents Page Session Description ......................................................................................................................... 3

Learning Objectives ........................................................................................................................ 3

Recovery-Oriented Systems of Care Principles and Practices ....................................................... 4

Faces and Voices of Recovery Bill of Rights ................................................................................. 6

Three Skills of PCOMS-Informed Services ................................................................................... 7

Top 10 Practical Considerations for Conducting PCOMS-Informed Recovery Groups ............... 8

Materials Needed for PCOMS-Informed Recovery Action and Progress Groups ......................... 9

Recovery Action and Progress Group Handout ............................................................................ 10

Self-Completed Overview of Recovery Experience Board (SCORE Board) ............................... 11

Downloading Instructions for PCOMS and Brauchtworks Consulting Materials ......................... 12

References and Resources ............................................................................................................. 13





Session Description This 3-hour session covers the fundamentals of using the Partners for Change Outcome Management System’s (PCOMS) tools with groups of clients who have substance use recovery issues, many who are on criminal justice supervision. Following an overview of research-based recovery-oriented, client-directed and outcome-informed principles, participants will experience using the PCOMS tools during a Recovery Action and Progress Group.

Learning Objectives. Upon completion of this session participants will be able to:

1. Summarize eight recovery-oriented systems of care principles.

2. Identify three skills for facilitating PCOMS-informed services.

3. Administer and interpret the Outcome Rating Scale (ORS), the Group Session Rating Scale (GSRS) and the Self-Completed Overview of Recovery Experience Board (SCORE Board).

4. List the five steps in a Recovery Action and Progress Group session.

Notes, Doodles and My Top Three Takeaways: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________


Recovery-Oriented Systems of Care Principles and Practices

1. Empower people to pursue multiple pathways to recovery: plan, design, deliver, and evaluate

services while advocating for pro-recovery policies and programs in the wider community that target five zones of personal experience: 1) physical, 2) psychological, 3) relational, 4) lifestyle, and 5) spiritual.

2. Conduct strength-based assessments: identify and build on the strengths – called recovery capital - of individuals, families and communities while emphasizing the first-person voices of persons seeking or in recovery and their family members. Ask, “What’s right with you?”

3. Develop culturally-congruent recovery resources: guide individuals and family members into relationships with indigenous recovery communities; create physical, psychological and social space within the community in which recovery can occur; link personal, professional and community resources into recovery management teams.

4. Deliver recovery education and training: enhance the recovery-based knowledge and skills of individuals, family members, allies, service providers, and the larger community with The Science of Addiction & Recovery, Recovery Messaging, and other trainings/presentations

5. Monitor and support interaction continuity: sustain contact and support across three recovery phases: a) engagement and recovery priming (pre-recovery/treatment or no treatment), b) recovery initiation and stabilization (recovery activities and treatment), and c) recovery maintenance (post or no-treatment). Conduct Recovery Check-Ins.

6. Collect practice-based evidence of service effectiveness: while implementing evidence-based practices, eliminating barriers to recovery and delivering community in-reach services.

7. Advocate for recovery: promote institutional and social policies that counter stigma and replace discrimination with resources for building recovery capital and strengthening the individual person in recovery’s voice.

8. Model hope: display the research-grounded hope for recovery based on millions of people who have achieved full and partial recoveries from severe behavioral health problems.


Recovery-Oriented Systems of Care Principles and Practices (cont.) Adapted by George S. Braucht, LPC from: 1) Sheedy, C. K., & Whitter, M. (2009). Guiding principles and elements of recovery-oriented

systems of care: What do we know from the research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Available at http://partnersforrecovery.samhsa.gov/docs/guiding_principles_Whitepaper.pdf.

2) Stengel, K., Schwartz, E. & Mathai, C. (2012). Operationalizing recovery-oriented systems:

Expert panel meeting report. SAMHSA. Available at http://www.samhsa.gov/recovery/docs/Expert-Panel-05222012.pdf.

3) White, W. L., Boyle, M. G., Loveland, D. L. & Corrigan, P. W. (2008). What is behavioral

health recovery management? A primer. Available online at www.williamwhitepapers.com.

We will improve the lives of millions of Americans, their families and communities if we treat addiction to alcohol and other drugs as a publichealth crisis. To overcome this crisis, we must accord dignity to people with addiction and recognize that there is no one path to recovery.Individuals who are striving to be responsible citizens can recover on their own or with the help of others. Effective aid can be rendered by mutual support groups or health careprofessionals. Recovery can begin in a doctor’s office, treatment center, church, prison, peer support meeting or in one’s own home. The journey can be guided by religious faith, spiritualexperience or secular teachings. Recovery happens every day across our country and there are effective solutions for people still struggling. Whatever the pathway, the journey will befar easier to travel if people seeking recovery are afforded respect for their basic rights:

1. We have the right to be viewed as capable ofchanging, growing and becoming positively connected toour community, no matter what we did in the past because ofour addiction.

2. We have the right—as do our families and friends—to know about the many pathways to recovery, the nature of addiction and the barriers to long-termrecovery, all conveyed in ways that we can understand.

3. We have the right, whether seeking recovery inthe community, a physician’s office, treatmentcenter or while incarcerated, to set our ownrecovery goals, working with a personalized recovery planthat we have designed based on accurate and understandableinformation about our health status, including a comprehensive,holistic assessment.

4. We have the right to select services that build onour strengths, armed with full information about theexperience, and credentials of the people providing servicesand the effectiveness of the services and programs from whichwe are seeking help.

5. We have the right to be served by organizationsor health care and social service providers thatview recovery positively, meet the highest public healthand safety standards, provide rapid access to services, treat usrespectfully, understand that our motivation is related tosuccessfully accessing our strengths and will work with us andour families to find a pathway to recovery.

6. We have the right to be considered as more thana statistic, stereotype, risk score, diagnosis, label orpathology unit—free from the social stigma that characterizes usas weak or morally flawed. If we relapse and begin treatmentagain, we should be treated with dignity and respect thatwelcomes our continued efforts to achieve long-term recovery.

7. We have the right to a health care and socialservices system that recognizes the strengths andneeds of people with addiction and coordinates itsefforts to provide recovery-based care that honors and respectsour cultural beliefs. This support may include introduction toreligious, spiritual and secular communities of recovery, and theinvolvement of our families, kinship networks and indigenoushealers as part of our treatment experience.

8. We have the right to be represented by informedpolicymakers who remove barriers to educational, housingand employment opportunities once we are no longer misusingalcohol or other drugs and are on the road to recovery.

9. We have the right to respectful, nondiscriminatorycare from doctors and other health care providers and toreceive services on the same basis as people do for any otherchronic illness, with the same provisions, copayments, lifetimebenefits and catastrophic coverage in insurance, self-funded/self-insured health plans, Medicare and HMO plans.The criteria of “proper” care should be exclusively between ourhealth care providers and ourselves; it should reflect the severity,complexity and duration of our illness and provide a reasonableopportunity for recovery maintenance.

10. We have the right to treatment and recoverysupport in the criminal justice system and to regain ourplace and rights in society once we have served our sentences.

11. We have the right to speak out publicly about ourrecovery to let others know that long-term recovery fromaddiction is a reality.

Funding provided through an unrestricted educational grant from Reckitt Benckiser Pharmaceuticals Inc.

www.facesandvoicesofrecovery.orginfo@facesandvoicesofrecovery.org

ENDORSED BY: American Association for the Treatment of Opioid Dependence, Inc. • American Society of Addiction Medicine • Community Anti-Drug Coalitions of America • Ensuring Solutions to Alcohol Problems • Entertainment Industries Council • Johnson Institute • Join Together • Legal Action Center • NAADAC, the Association for Addiction Professionals• National African American Drug Policy Coalition • National Alliance of Advocates forBuprenorphine Treatment • National Alliance of Methadone Advocates • National Associationon Alcohol, Drugs and Disability • National Association of Drug Court Professionals • NationalAssociation for Children of Alcoholics • National Association of Addiction Treatment Providers• National Council on Alcoholism and Drug Dependence • National Council for CommunityBehavioral Healthcare • Rebecca Project for Human Rights • State Association of AddictionServices • TASC, Inc. • Therapeutic Communities of America • White Bison


Three Skills of PCOMS-Informed Services

1. Introducing the scales and the client’s voice in all services and all decisions Two key points to emphasize: 1) collaboratively monitor outcomes and do something

different if this is not work and 2) the client’s voice and perspective is what is needed to

direct what we do

Put into your own words:

a. I may do things a little differently than you have experienced before because your

ideas, goals and resources are most important for your long-term recovery.

b. I am committed to advocating for your self-directed care and the services that I

provide focus on getting what you need for recovery.

c. To do that, it would be helpful to find out how you are doing and how well I am

providing what you need.

d. Many others I have worked with have found the two scales that I use to be very

helpful in tracking how thing are going for you and whether we are on track.

e. It will really help me learn about you and it takes only a few minutes.

f. Are you willing to do that now?

2. Integrating client feedback into practice Provide feedback about the client’s ORS score in reference to the clinical cutoff then

allow the client to make sense of it.

Connect the client’s described experience with her/his marks on the ORS subscales –

allow revisions

Relate the client’s reasons for seeking services to marks on the ORS and SRS

At the end of the interaction, review the SRS scores and solicit feedback on how the next

interaction could be better or more useful to her/him.

3. Informing and tailoring services based on client feedback Compare the current and last ORS score and look at the change over time.

When positive change occurs on the ORS, listen for and empower the client’s self-

efficacy.

If no change or lowered ORS, discuss what needs to happen next. If persists over two

sessions, check SRS scores and discuss alliance issues then engage in an urgent

discussion to brainstorm options and entertain the possibility of a referral or transfer to

another helper.

If ORS change still does not occur, even if the SRS score(s) is high, fail successfully via

a warm handoff to another service provider or program.

Duncan, B. (2014, 2nd Ed.). On becoming a better therapist: Evidence based practice one client at a time. Washington, DC: American Psychological Association.


Top 10 Practical Considerations for Conducting PCOMS-Informed Recovery Groups

1. The PCOMS group facilitator’s job is to model relationship enhancement skills and evoke participant goals, tasks and plans.

2. Prepare participants for group by teaching the use of the Outcome Rating Scale (ORS), Session Rating Scale (SRS) and Self-Completed Overview of Recovery Experience Board (SCORE Board) during an individual session or an orientation group (Motivation, Assessment and Planning [MAP] Group).

3. Limit group size to 10 for a 1-hour group. Subdivide and separate larger groups within the group room when you have more than 10 and float between the groups.

4. Name tags or tents help everyone learn each other’s names. Also provides a place for

displaying individual contingency management rewards.

5. Making the ORS/Group Session Rating Scale (GSRS) available before group encourages participants to complete the scale before the group starts. If these materials are available, don’t be late for group because it will likely start without you!

6. Bring each individual’s file containing completed ORSs, S/GSRSs and SCORE Boards to each group.

7. A series of 40s or consistently high scores on the ORS does not necessarily mean that you are doing something wrong, especially during the first sessions. Assist each participant with connecting the ORS score with her/his lived experience regarding the issue for which s/he is seeking services. Encourage ORS sub-scale score revisions when disconnects are realized between described lived experience and scores.

8. Many clients like jotting down keywords from the past week around the sub-scale areas of the ORS – provides a written record of events when they look back at their ORSs.

9. Always process GSRS scores and thank participants for their feedback. Ask, “what would make the next group session better?”

10. If meeting with clients once a week, consider administering the ORS and GSRS at the beginning of alternate weeks’ sessions: ORS in weeks 1 & 3, GSRS in weeks 2 & 4.


Materials Needed for PCOMS-Informed Recovery Action and Progress Groups

1. Outcome Rating Scale*

2. Group Session Rating Scale*

3. Self-Completed Overview of Recovery Experience Board (SCORE Board)**

4. Recovery Action and Progress Group handout**

5. Ruler: centimeter side!

6. Optional: Recovery Capital Scale and Plan (WHAM)**

7. Optional: File folder for each participant

8. Optional: Name tags/tents

* = PCOMS scales available at www.heartandsoulofchange.com ** = available at www.brauchtworks.com


Recovery Action and Progress Group

Instructions: Begin group with everyone completing a (1) Outcome Rating Scale and 2) updating her or his SCORE Board. 3) Review the Group Guidelines. 4) One participant does a Recovery Check-In with another participant using the Relationship Enhancement OARS until everyone has checked in. 5) End group by completing then discussing today’s Group Session Rating Scale scores. Be sure to add the GSRS score to your SCORE Board.

A. Group Guidelines

1. Turn off cell phones, pagers, etc., and notify someone before leaving the room. 2. Vegas Rules: Say “Vegas Rules” before you say something that you do not want repeated

outside of this group. 3. No fixing! Instead, share what recovery activities have worked for you by using “I…”

statements. 4. What other guidelines will help make this a safe and respectful place?

B. Recovery Check-In. Use the Relationship Enhancement OARS (below) to ask… 1. What’s right with you today? 2. Describe your ORS score. What progress did you make since your last group on your

recovery goals? May show your Self-Completed Overview of Recovery Experience Board (SCORE Board).

3. From 0-10, what is your highest craving level since the last group, with 0 = Never thought of using alcohol or other drugs; 10 = Used

4. Do you have a safe and sober place to stay? 5. Would you like more group time today?

Relationship Enhancement OARS

Open-Ended Questions: Express concern, interest, puzzlement, etc.; Who, What, How Affirmation/Validation: Affirm appreciation for the other person and identify his or her

strengths; “You stayed sober last weekend!” instead of, “How did you manage to avoid drinking?” “You are concerned about…”

Begin with “You…” not “I” Describe behaviors Attend to solutions instead of problems Attribute interesting qualities to the person Focus on a strength or attribute, not the lack of something or what was not done

Reflective Listening: Make statements about what you heard the other person say instead of

asking questions Begin with: “You think (feel)…,” “You’re wondering if…,” “So you feel (think)…,”

Summaries: Short, clear statements that organize what’s been said; Use “and” instead of “but”

Authorized for Brauchtworks training only. See www.brauchtworks.com for reusable document.

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Downloading Instructions for PCOMS and Brauchtworks Consulting Materials

George S, Braucht, LPC; Email: [email protected]; Phone: 404-310-3941

The Partners for Change Outcome Management System (PCOMS) forms are FREE for individual users and an inexpensive group license must be purchased for agency or organization use. The forms are copyrighted and require completing a simple licensing agreement before downloading the scales. Access the SAMHSA’s National Registry of Evidence-based Programs and Practices’ PCOMS summary at:

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=250.

Professional versions: Outcome Rating Scale (ORS) Session Rating Scale (SRS) Group Session Rating Scale (GSRS)

Peer versions: Outcome Rating Scale (ORS) Relationship Rating Scale (RRS, the SRS adapted for peers) Group Session Rating Scale (GSRS)

Child, adolescent and telephone versions of the ORS and SRS/RRS are also available 1. Go to www.heartandsoulofchange.com 2. At the top of the page click on “Measures” 3. Review the licensing agreement 4. Click on “click here” to register your email address 5. Notice the different links for peer and professional versions of the forms and a separate link for the

Group Session Rating Scale

Additional forms for professionals and peers are available at www.brauchtworks.com/helper_toolkit:

A Comparison of Acute Care Treatment and Recovery-Oriented Systems of Care Addiction Treatment and Recovery Services Practices Overview Individual Assessment of this Recovery Environment (ICARE): Outpatient and Residential Knowing a Recovery Culture When You See One Monthly Recovery Report: Outpatient and Residential versions completed by the client Recovery Action and Progress Groups Handout Recovery Capital Scale and Plan Recovery Check-Ins Overview Recovery Check-Ins Telephone Practice Guides: Initial and Ongoing Recovery Coach Monthly Report Sample Recovery Coach Supervisor Monthly Report Sample Relationship Enhancement Skills Overview (OARS) Self-Completed Overview of Recovery Experience Board (SCOREboard)





References and Resources 1. Brauchtworks Consulting: www.brauchtworks.com 2. Duncan, B. (2014, 2nd Ed.). On becoming a better therapist: Evidence based practice one

client at a time. Washington, DC: American Psychological Association. 3. Duncan, B. L. (2005). What’s right with you: Debunking dysfunction and changing your life.

Deerfield Beach, FL: Health Communications. 4. Duncan, B. L. Miller, S. & Sparks, J. (2004). The heroic client: A revolutionary way to

improve effectiveness through client-directed, outcome-informed therapy. San Francisco: Jossey-Bass.

5. Faces and Voices of Recovery: www.facesandvoicesofrecovery.org 6. Heart and Soul of Change Project: www.heartandsoulofchange.com 7. Kelly, J. & White, W. (Eds., 2011). Addiction recovery management: Theory, research and

practice. New York: Springer Science. 8. Sheedy, C. K., & Whitter, M. (2009). Guiding principles and elements of recovery-oriented

systems of care: What do we know from the research? HHS Publication No. (SMA) 09-4439. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Available at http://partnersforrecovery.samhsa.gov/docs/guiding_principles_Whitepaper.pdf.

9. Stengel, K., Schwartz, E. & Mathai, C. (2012). Operationalizing recovery-oriented systems:

Expert panel meeting report. SAMHSA. Available at http://www.samhsa.gov/recovery/docs/Expert-Panel-05222012.pdf.

Using PCOMS with substance use: Mandated clients and group work challenges handout 140509b

Healthcare

Transcript of Using PCOMS with substance use: Mandated clients and group work challenges handout 140509b