As we, who work in the behavioral health system, examine our processes and track and trend outcomes, we recognize that many who come into our system aren’t really engaged in their own recovery. We have providers complaining about the high incidence of missed appointments and the follow up needed to ensure medication is taken and appointments are kept. But what is it that prevents these people who came to us for help from being invested in their own recovery? The answer is engagement. If we don’t connect with the person at the time they are asking for help, we will not be successful in the treatment and may never get them to come back.
I have come to this conclusion from a personal experience I had with the system I knew and the struggle to get it to work for my family. I can only imagine what would happen to those who come to us without knowing they should expect more.
When my niece was going through a hard time and needed some help to get through it, her mother came to me because I work in the behavioral health field. She asked me to help her adult daughter get the treatment she needed, and I, of course, assured her that I could. I found an agency that would do an initial assessment, made the appointment for her, and went with her to that appointment. What a grueling and torturous process that was for both of us, but especially for my niece who was feeling awful about being there in the first place. There we sat, in front of a person she went to high school with (small, rural communities face this kind of problem all the time), feeling ashamed and embarrassed and answering a barrage of questions like name, address, phone number, primary care doctor…and so on, and so on. We were there for 2 1/2 hours before she was even asked why she was there.
We spent about 15 minutes talking about her problem, when the girl, who was polite but detached, handed her a schedule of outpatient group sessions she should start attending, handed her some forms to sign, and gave her a form that had the girl’s name and phone number to call on it “…if she had any questions”. We walked out feeling exhausted and not at all comforted that her problems would be addressed by this agency or their schedule of group sessions. Needless to say, my niece never wanted to go back there again.
I called to complain, and was immediately given a follow up appointment. Too little, too late, my niece was not interested. I spoke to everyone I knew to try to figure out how to improve the process so that the next person who went in would not encounter the same thing, but barriers went up everywhere. If the agency was going to bill us for the services, they needed to have all that information. They could not wait until the next appointment to complete it because many times a client didn’t come back for the second appointment and that meant they would not get paid for the first. Imagine that! The process itself was causing the problem, a fact I thought was clear, but the agency disagreed.
Not long after this experience, we signed a contract with a new agency in the area that didn’t have their occupancy certificate yet, so were providing services in the community. This was the model of care we wanted, but had a difficult time getting the provider agencies on board. The new agency started the intake process using peers instead of intake coordinators, and they met the client where they were and the same day they called, not waiting to schedule an appointment a week out. So I called the agency and spoke with the Peer Support Specialist myself. I explained our previous experience, and asked for his help. He explained that he could only help if my niece wanted his help, but he was willing to call her, meet with her, and then take it from there. What a difference this man made to our family!
Not only did he keep his promise and call her, but he then drove over to her house, met with her and her family, and immediately started her in services that very day! She has been in intensive outpatient services for over 6 months now and doing great. I asked her what made the difference to her. She explained that when the peer called and talked to her, he started with questions about what she wanted. Did she want help? Did she want to get better? Is she ready to do what it takes to be better for herself – not her family – because she needs to make that commitment? He promised her that if she did, he would be there to help her every step of the way, and he has kept his promise.
Now, 6 months later, he calls or stops by to see her once or twice a week, even though he is not part of her treatment team. With her permission, he lets me know she is doing well. He connected with her the way no one, but someone who has been where she has been, could have done. He knew how he felt when he was in that place of desperation and he could look past the paperwork, at her, and ask the important questions that needed to be asked before the next steps could be taken. This is engagement. This is what our system needs.
Utilizing Peer Support Specialists and Family Support Partners to help those seeking treatment and their families is a perfect way to improve outcomes. These are the people who can say what needs to be said to get the commitment needed for recovery. These are the people who speak from their own experiences, and from their heart, without any question of their sincerity and with no judgment. To walk down a difficult and scary path alone is much harder than walking with someone who knows the way. As we at Cenpatico of Arizona train our peers and family members to be that partner down the path of recovery, we are seeing better outcomes and better engagement than ever before. We are hearing the success stories that would not be there were it not for that one person who “held the hope”. Let us look at this valuable resource that is all around us and make the most of it.
Peers and family members are the interpreters who speak the language we and our clinical staff have not yet mastered. As we use them to move us to a more successful place, let’s learn from them. Let us learn that essential skill of connecting with the person coming to us for help. Let us learn to look at them with the care and concern they need us to feel to really help them. Let us talk first and “fill in the blanks” later. It doesn’t take long to make the connection. A short 15 minute conversation, asking the important questions; “Why are you here today?” and “What do you think you need to be in a better place?” Let us start there before we print out a treatment plan from a cookie cutter formula. I know there are “best practices” and proven strategies for care, but first there is that person, sitting in front of you, looking for answers…asking for help. Can you be that one person that holds the hope for them? That person that will make a difference in their life? Let’s try. Together we can inspire hope for a better life.
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But, outside our walls, Baron’s instrument of choice is the guitar which he has been playing for nine years, though that wasn’t his first preference. “I started out drumming, but had to switch because a full drum set in an apartment isn’t the easiest thing to make work and doesn’t make you friends with the neighbors.” Baron’s parents saw how interested he was in music so they pointed him in a new direction. “My parents gave me my first guitar,” Baron said. “They are very supportive of me. I wouldn’t be doing this if it wasn’t for them.”
