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Are volunteers welcome?

November 1, 2009
by Peter Edis
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Careful planning can overcome pitfalls for a center seeking to use volunteer help

The addiction field has undergone many changes in the last two decades, with the most substantial being a steady trend toward professionalizing the industry. One need only skim through newspaper “Help Wanted” ads to get a sense of the value agencies place on professional certification and licensure. Although I support credentialing of counselors, I sometimes wonder if we have regulated ourselves to the point of excluding certain people from serving clients. Volunteers are among this group, and they presently face several systemic barriers to offering their assistance in addiction treatment settings.

One of the first things many clients want to know is if their counselor is in recovery. It is a popular belief among clients that a counselor cannot truly understand them unless he/she has “been there.” Yet while the client might value this characteristic, it is not necessarily a quality everyone embraces. While most staff members who work in the clinical program understand the dynamics of addiction and recovery, employees working in other areas, as well as many administrators, do not. Certification and licensure tell this group that the staff is competent and professional.

We must also recognize that third-party payers have tightened their requirements; some would argue that they look for the slightest reason at times to deny payment. And it is also true that the industry has become much more regulated than it once had been. Accreditation standards require treatment staff to meet certain levels of experience, education and credentialing, and might also require that staff receive a certain amount of direct supervision.

Healthcare systems also require employees to complete what is referred to as “mandatory education;” this includes yearly updates in a number of areas, from patient rights to corporate compliance to blood-borne pathogens. Quite frequently, individuals with direct care responsibilities are also required to maintain current CPR and First Aid certifications. These are among the minimum requirements that an employee (or a volunteer) must know before being permitted to interact with patients.

Benefits for clients

Now that we have covered some of the background issues, we can talk more specifically about volunteers. Most of us who have been in the profession for a while remember when addiction programs were staffed nearly exclusively by former addicts-on both a paid and volunteer basis. I can recall a local 28-day program in which program graduates used agency-owned vans to drive current patients to off-site 12-Step meetings. In this particular situation, staff did not accompany the volunteers. Former patients also led 12-Step recovery meetings for patients, and many even acted as Alcoholics Anonymous/Narcotics Anonymous (AA/NA) sponsors.

Volunteers are generally well-received by patients, particularly when the volunteers are in recovery and are open about it. One of the core principles of 12-Step programs is the concept of one alcoholic/addict helping another. Depending on the characteristics of the local recovering community and its relationship with the treatment program, it would not be uncommon for a couple of AA/NA group members to volunteer at the treatment center. Sometimes a local AA/NA group will “sponsor” a meeting for the center's patients. What this means is one or more group members will take responsibility for leading an AA/NA meeting held at the center, anywhere from once a week to every day.

Most of the time these are closed meetings for patients only, but some treatment programs also permit the local recovering community to hold regular AA/NA meetings at their facility, and some even allow their current patients to attend those meetings with staff supervision. While both of these arrangements can have their benefits, I would not recommend the latter because of security issues that occur when mixing members of the general community with current patients, even when this is supervised.

A treatment center should be certain of who from AA/NA will be leading the meeting. One would want to exclude recently discharged patients. While well-meaning, they do not have the experience in recovery needed to handle this type of meeting on their own. It is recommended that the volunteer have at least two years of sobriety with regular 12-Step attendance.

Also, centers want to avoid having new people show up each week. I would suggest not allowing anyone except the designee unless it has been arranged in advance. It is also a good idea to assign a staff member to sit in on the weekly meeting with the volunteer. This person also could serve as the volunteer's designated contact.

Liability concerns

Allowing the general public into a secure treatment facility carries obvious risks; many facilities have stopped altogether and others allow it on a very limited basis with facility staff coordinating patient-volunteer interactions. This cautiousness is indicative of the changes that have taken place in the treatment industry. Programs walk a fine line when using volunteers in a capacity that regulators and insurers could consider “clinical.”

Every insurance entity that has an investment in the addiction treatment industry publishes clinical guidelines to which it expects providers to adhere. On the federal level these rules are Conditions of Participation. They clearly define the elements necessary to qualify as “active treatment.” The guidelines do not prohibit programs from using volunteers, so long as the volunteers are not being used in place of paid clinicians.