The Connecticut Department of Mental Health and Addiction Services (DMHAS) has embraced the concept of recovery as the guiding framework for the services it provides. This has become part of a major initiative to transform adult behavioral health services in Connecticut. A variety of factors, including new research on treatment effectiveness and the expectations of people in recovery, have influenced this transformation. The DMHAS commissioner in a 2002 policy statement on recovery defined the concept as “a process of restoring or developing a positive and meaningful sense of identity apart from one's condition and then rebuilding one's life despite, or within the limitations imposed by that condition.”
The state's initiative includes aligning fiscal and administrative policies, developing a philosophical and conceptual approach, and seeking to build competencies and service structures to support the recovery orientation. One aspect of this initiative is the development of Centers of Excellence in Recovery-Oriented Programs and Practices. DMHAS's systems of care agencies have the opportunity to apply to become a Center of Excellence. These centers are learning laboratories in the development of new practices and programs.
The Telephone Recovery Support Project is one initiative in a Center of Excellence focusing on ways to move toward “Recovery Management”1 services, particularly in the provision of peer-to-peer recovery support services. While it is widely agreed that addiction is a chronic disease, it often is treated as an acute disease. Recovery Management shifts from brief episodes of treatment intervention to support over a longer period through monitoring, recovery coaching, linking people to communities of self-help and recovery, and engaging in early reintervention.2 The idea of telephone recovery support coordinates well with William White's recovery model:
Addiction recovery is a reality.
There are many paths to recovery.
Recovery flourishes in supportive communities.
Recovery is a voluntary process.
Recovering and recovered people are part of the solution; recovery gives back what addiction has taken.1
Mark Godley and colleagues at Chestnut Health Systems in Illinois, in an unpublished study embracing the values of Recovery Management, developed a Telephone Continuing Care program for patients with substance abuse problems. The program used Chestnut Health Systems staff and student interns. While telephone-based continuing care has been used increasingly in the management of chronic medical illnesses, it had not been used in recovery settings. In Godley's pilot investigation,3 participants had completed residential care and were linked to continuing care. The program's research goals were to maintain contact with patients after residential treatment for three months, and to prevent relapse or to shorten the duration of relapse.
DMHAS sought to replicate the Telephone Continuing Care program in Connecticut, with several significant adaptations. One community substance abuse treatment agency, Community Prevention and Addiction Services, Inc. (CPAS), would make client referrals to Connecticut Community for Addiction Recovery (CCAR), a recovery community organization. Both agencies agreed with this simple concept: A person recently released from a treatment setting would benefit from receiving a weekly phone call from another person in recovery. With that premise, CCAR would recruit volunteers who would be trained to call clients recently discharged from CPAS. DMHAS would provide technical assistance for implementation and monitoring of the program for the first 90 days.
The project was implemented initially as a collaboration between CPAS and CCAR to support individuals being discharged from residential treatment or in active outpatient treatment. A new term, “recoveree,” was developed to designate appropriately those persons who would receive the calls. The goal was to maintain contact with recoverees and offer support for their recovery. Tracking data and personal responses from the phone logs was designed to evaluate the effectiveness of telephone support. After the first 90 days, CCAR was exploring the expansion of recoveree participation by opening up the service to other agencies and programs in the community.
CPAS engaged the services of counseling staff at its programs to approach current enrollees about using the telephone support program. To begin implementation, CPAS management instructed staff on the purpose and design of the new service. Critical to successful implementation was agreement from management and staff that this was a valuable service. Through early, proactive discussion with CPAS staff and the ongoing development of a treatment and recovery culture focused on continuing care, staff was amenable to the new process.
During the 90-day pilot, a continuous flow of recoverees entering CPAS were offered the service. Representatives from CPAS and CCAR and other stakeholders formed a steering committee to monitor the project's progress.