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Client-directed care, recovery are among watchwords in CRC clinical initiative

September 6, 2011
by Gary A. Enos, Contributing Editor
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Plans are for every counselor to be trained in four evidence-based practices

The nation’s largest network of addiction treatment operations has embarked on an effort to be looked at as the recognized leader in clinical excellence, and its executives insist that this will come with some vocabulary changes within the organization. Prescriptive approaches to treatment will give way to “client-directed care,” they say, and “aftercare” will be removed from the language entirely, in favor of more robust “recovery plans” for clients.

And the 10-member Clinical Advisory Board that will guide development of the company’s service delivery system is being positioned so it won’t just prove to be a lot of big names without a big impact. One of the newly announced panel’s members says he has been assured that he need not be concerned about the board becoming “window dressing.”

“I’ve been assured that the board will influence policy on the clinical experience,” says David J. Powell, PhD, president of the International Center for Health Concerns and the Clinical Supervision Institute. “I think the timing is right for this. All treatment facilities today are trying to balance economic imperatives—how to stay open—with an emphasis on clinical excellence.”

For CRC, a company that traditionally has allowed its 140 treatment facilities across the country to operate relatively autonomously, establishment of the Clinical Advisory Board signals a move toward more standardization at the clinical care level. CRC has undergone major organizational change in the past year, including the naming of a new CEO and the first-time creation of a chief clinical officer position for the organization.

“If we’re a clinical service company, we need to have somebody thinking about clinically what we do. We had nobody at the senior management table who woke up thinking about that,” says Phil Herschman, PhD, a nine-year CRC veteran who became chief clinical officer two months ago.

Clinical competencies

In an interview with Addiction Professional this week, Herschman explained that at this effort’s core is work toward developing a level of service that exceeds that of CRC’s competitors. He wants all stakeholders, from clinicians to consumers, to see CRC as the clinical leader.

Critical to this, he says, will be making sure that all counselors working in CRC facilities be trained in four evidence-based practices identified by the company as priority approaches:

  • Motivational Interviewing.
  • Stages of Change.
  • 12-Step treatment.
  • Dialectical behavior therapy (DBT)/cognitive-behavioral therapy (CBT).

The overall clinical strategy Herschman says he is promulgating is one of client-directed, outcome-informed care. “Whatever belief system you have about therapy doesn’t matter to me,” he says. “Treatment has to be client-centered. It has to examine why the client is there, and what the client wants to accomplish while there.”

Herschman adds that from the perspective of what the client hears, “This is not a model of, ‘I’m the doctor. I know what’s best for you. Do these things.’”

Of course, standardizing clinical operations in a treatment organization where all or most services are delivered under one roof would be one thing; doing this in a 140-facility family with members ranging from small methadone clinics to nationally known treatment centers such as Sierra Tucson is another matter entirely. This is why Powell is enthusiastic about being involved in a clinical supervision pilot effort that he considers critical to improving clinical practice organization-wide.

“Before you can begin in evidence-based practices, you need a system to monitor it,” Powell says.

CRC will pilot a clinical supervision system at three of its treatment facilities, beginning this fall. Elements of the plan will include direct monthly supervision of counselors by videotape, as well as “supervision of supervision” for the clinical supervisors, Powell says. “We’re seeking to build a core model of supervision that everyone can adhere to,” he says.

Regaining momentum

Herschman says CRC previously had made some progress toward a major clinical initiative in the past under former chief medical officer Thomas Brady, MD, but that effort “fell off the board” amid more immediate-term concerns brought on by the recession.

Herschman’s goal in establishing the composition of the Clinical Advisory Board was to “combine folks who know research with folks who know how to treat a client.”

Powell adds that in including members such as Norman G. Hoffmann, PhD (president of Evince Clinical Assessments) and Gerald Shulman (a nationally known behavioral health trainer and consultant), CRC has convened a group with a broad historical perspective on the clinical treatment of addictions. “CRC is right there on the edge of where the field is,” Powell says.

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