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Philadelphia’s recovery-oriented service transformation

March 21, 2013
by Dennis Grantham, Editor-In-Chief
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Arthur Evans Jr., Ph.D.

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From the outset, providers heard Arthur Evans Jr., Ph.D., Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), “talk of a new role—the role of the peer—and of a new relationship with the consumer. Going forward, services would be shaped around consumer wants, needs, and outcomes,” recalled William Dinwiddie, CEO of the Mental Health Association of Southeastern Pennsylvania (MHASP). “All of this came as quite a surprise to the professionals that surrounded me. After decades of being recognized as the experts in treatment, this was a new variable.”

On hearing Evans' plans, providers asked, “‘If we’re going to change the programs, then where’s the money?’” said Dinwiddie. “But Arthur’s message was, ‘There isn’t any new money. There isn’t any rule book to follow.’ He said, ’If you want to be a provider long-term, you have to reorient your organization. You have to figure this out.’

“No one told us exactly what we had to do,” Dinwiddie remembered, explaining that conventional wisdom among providers was to “start small” and build on success. This experimental approach led providers to reach out to DBHIDS and to each other, across traditional boundaries and lines of service to talk about what they were learning.

“So,” Dinwiddie said, “the first tentative steps began—changes to waiting rooms, assessments, intake procedures.” There was also a move away from getting consumer input in occasional focus. More and more organizations chartered, created, and empowered new consumer advisory councils. Over time, these self-governing, responsibility-taking, peer-led groups develop an increasingly articulate and co-equal voice with that of the professionals.

Peer training and leadership

To equip peers with the skills needed to serve each other, a training program was formed with a local college to develop certified peer support and certified recovery support specialists. Then, to build on that, two organizations, PRO-ACT (Pennsylvania Recovery Organization- Achieving Community Together), and MHASP teamed up to create a “Peer Leadership Academy.” This curriculum would challenge some peers to apply new skills and knowledge in leadership roles.

Today, both peer specialists and peer leaders are part of the fabric at organizations throughout the city. Among these are four Recovery Community Centers (RCCs) operated by PRO-ACT. These peer-led centers offer recovery-sustaining resources to people in recovery and their families, along with hundreds of skill-building workshops and support programs each month.

“Given the short duration of current services, the key to promoting recovery is to help people develop post-treatment recovery strategies and resources,” said PRO-ACT CEO Beverly Haberle. The RCCs are part of that strategy, serving as recovery sanctuaries and resources, embedded in the culture, the neighborhood, and the community.

New working relationships

Incorporating the needs and voices of people-in-recovery into service processes has had profound effects. Professionals quickly realized that peers had plenty to say, while peers found that their ability to speak up was tempered by new realizations:  First, that they now had no one to blame for tolerating treatment that didn’t make sense. Second, that to play a meaningful rule, they would be challenged to grow through additional training. Third, that making meaningful  contributions to improvement depended in part on their ability to understand and appreciate the knowledge and practices of clinical professionals.

In time, both gained a new appreciation about what consumer insights could do to improve treatment. Joseph Schultz, a longtime substance abuse counselor at Northeast Treatment Centers (NET), a large regional SUD treatment provider, explained that “there were some raised eyebrows when professionals realized that peers were going to review what they had proposed as recovery-focused work processes. What did they know? What could they see that seasoned experts had missed? How could they know what we did better than we did ourselves?”

Schultz said that the review was thorough: “The peer council divided our work proposals, as well as themselves, into a series of small work groups.” The peer groups performed “consumer walk-throughs” of the proposed processes, examining clinical procedures and requirements from the patient’s point of view. In so doing, peers not only were able to see and understand clinical challenges and requirements, but also to express their own assumptions, questions, and concerns. 

Schultz said that what emerged from the reviews were two very important and profitable impacts on services at NET:

1) Peers proposed and obtained resources to develop and operate a resource center, complete with a website and phone lines, that consolidated practical advice, supportive help, and access to dozens of programs and resources for newly recovering individuals. This center provided just the kind of practical help needed by their peers when they stepped outside the treatment setting.

 2) Peers identified opportunities when they could serve in lieu of NET professionals. Today, peers conduct consumer outreach, new consumer orientations, offer a friendly voice throughout the treatment process, and provide regular follow-up and supports essential to keeping people-in-recovery connected and successful over the long-term.