“Some people want to use recovery coaches as cheap labor, and shame on the agency that does that,” adds Mather. “I am very clear that these are not clinicians.” But she notes that with additional education and training, the peer eventually could become a clinician.
“We’re training a lot of recovery coaches, but very few of them have jobs,” says Ginter. “It was never expected that people would make their living being recovery coaches.” Being a recovery coach is the first step in the career ladder toward being a counselor, he says. “The amount of money they get will be limited. Most people just want to give back. The recovery community is for giving back.”
Alexandre Laudet, PhD, senior staff member with New York City-based National Development and Research Institutes and one of the country’s top recovery researchers, says that the pioneering work done by CCAR in Connecticut is now being picked up by others. “Now that people realize there’s money to be made, the big organizations are jumping on it,” Laudet says.
She says it’s understandable if people, and agencies, want to get paid for the work they do. But she adds that helping people is also therapeutic to people in recovery. “It’s the embodiment of what Riessman called ‘helper therapy,’” Laudet says, referring to the work of Frank Riessman, first published in Social Work in 1965. “The peer is getting something out of it, too.”
Treatment provider's programs
There are two recovery support programs at the Hazelden Betty Ford Foundation, coming out of the two separate treatment organizations that merged. Nell Hurley, manager of recovery support with Hazelden Betty Ford, is in charge of the two programs: the Connection program and the MORE (My Ongoing Recovery Experience) program. Both are staffed by licensed alcohol and drug counselors (who also may be in recovery, but it’s not required), and both are for people who went through the Hazelden Betty Ford treatment program.
Connection is an 18-month monitoring program that includes random urine testing. The counselor, referred to as a recovery coach, calls the person on a weekly, biweekly or monthly basis depending on the stage of recovery. All contact occurs over the phone, in contrast to the recovery coaching that is happening face to face in the community.
“This is more like an extended case management program,” says Hurley. Hazelden Betty Ford sends a report every month to employers or other interested parties to indicate whether the person is following his/her continuing care plan. The patient—or sometimes the employer—pays for the Connection program, which insurance doesn’t cover. Currently there are about 190 active participants, says Hurley.
MORE is an online and over-the-phone recovery support program that is much less intensive than Connection, but is offered free of charge to anyone who goes through treatment at Hazelden Betty Ford.
Both programs reflect the movement in treatment toward recovery management, says Hurley. “We know that treating someone for 28 days or even 60 days and telling them, ‘Go to AA, and good luck’ doesn’t work all that well,” she says. Having only a continuing care plan doesn’t work either, she says. “People don’t follow the plan, until it’s hardwired, they know they feel better, and their lives are better,” she says.
The Medicaid dilemma
Advocates for Recovery, like most other community-based recovery organizations, targets “the population that doesn’t have a lot of money,” says Wheeler. This often means the people who can’t afford to pay for treatment that their insurance won’t cover. And most often, it means that Medicaid would be the most likely payer.
But Medicaid reimbursement is focused on states, and many states want a blended recovery coach—someone who can help both mental health and addiction clients.
Medicaid reimbursement remains on the distant horizon in Colorado, where certification is still nonexistent for addiction recovery coaches. To be reimbursed by Medicaid, the coach under current rules would have to be part of a behavioral health organization in the state, which poses another barrier.
“This is a lot of work,” says Wheeler. “I wish we had more people, and the grant doesn’t cover the rent.” For the first nine years, Advocates for Recovery operated without a geographic location.
“But you need a place to serve people, so it’s critical to have that space,” Wheeler says. “It’s somewhere someone can show up and say, 'I can’t find a job.’” For some, that job may end up being a recovery coach.
Alison Knopf is a freelance writer based in New York.
Managed care payer embraces recovery coaching
One of the first managed behavioral healthcare organizations to take an interest in recovery coaches is Optum Behavioral Solutions. This makes sense, with former Faces & Voices of Recovery director Dona Dmitrovic there running the recovery coaching network. The company currently contracts with two entities in the network to provide recovery coaching—one in Maryland and one in Rhode Island.
Optum relies on state credentialing requirements for recovery coaches that include state certification; if a state does not have certification available, it recognizes established programs such as that run by the Connecticut Community for Addiction Recovery (CCAR) in lieu of state certification.
“As a health plan, what can we do to support people making that long and difficult path to recovery?” says Martin Rosenzweig, MD, regional medical director for Optum and head of the substance use disorder treatment initiative across the behavioral health business. “You have to give individuals choices about how they will take that path.”