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What a recovery organization looks like

June 1, 2009
by Lori Ashcraft, PhD and William A. Anthony, PhD
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Targets you should aim for to promote people's healing

In your quest to make your organization recovery oriented, you may feel like you are boldly going toward something, but aren't sure what. What does recovery look like? What does it feel like? How will you know when you get there? Perhaps a more controversial question is, How do we measure it?

We think these are pretty good questions. If you've been asking them, you probably are on the right track. So this month we describe some outcomes for you to aim for as you hurtle headlong toward that often elusive target called “recovery.”

Before we get started, you may be interested to know that several evaluation instruments have been developed to measure recovery in behavioral healthcare organizations. Bill and his team at Boston University have created some very helpful tools, and Priscilla Ridgway and Larry Davidson, both at Yale, each have developed sophisticated ways of measuring an organization's recovery progress. This article is not in that league. Its purpose is to provide you with sort of a Reader's Digest version of recovery targets you can take aim at within your organization.

A welcoming environment

First, it's important to realize that becoming a recovery-based organization involves a lot more than adding the word “recovery” to your front door. This has happened not infrequently across the country and has become a major disappointment to a variety of funding sources and service participants alike. Unfortunately, having “recovery” on the front door has become meaningless.

What we would look for instead is a welcome sign. Yes, a welcome sign-imagine that! What if your organization had a big welcome sign on the front door? A subtitle might be, “Thanks for giving us an opportunity to partner with you on your recovery journey!” Such a sign commits the organization to being welcoming and friendly, as well as sets the stage for a recovery partnership. If we saw a sign like this on your front door, we would know you are willing to step out and create opportunities and environments that support recovery.

A welcome sign would tell us that your organization is committed to shifting its culture toward recovery-not just for participants, but for your staff and the entire organization. Once we got inside, we would look for a comfortable setting that was not intimidating and that reflected respect and dignity for those who receive services. Ideally, it would be clean and fresh, and there would be greeters instead of security guards, friendly and respectful receptionists, and positive signs on the walls that don't start with the word “no” (as in no smoking, no loitering, and so on).

Recovery-minded staff

Next, we would check out the staff. Here are some questions we would ask ourselves as we talked to them:

  • Are they welcoming and friendly? What do they do to connect with people?

  • Do they understand and practice the importance of developing real relationships with people?

  • Are they hopeful and excited about each person's plans and goals?

  • Do they have high expectations for themselves and for the people they are serving?

  • Are they inspiring and encouraging?

  • Do they treat each other and the people they serve with dignity and respect?

  • Do they have knowledge of recovery values?

  • Do they use recovery language?

  • Do they offer people choices and avoid force and coercion?

  • Are they willing to partner with the person in “risky” choices?

  • Are service users trained and hired as peer employees?

In addition, we would look for shifts in practice. From what we can tell, most staff have not been trained to elicit recovery responses, although some of them do it despite their training. Teaching staff recovery practices should be a high priority for a recovery-oriented organization. Answers to four broad questions would give us an idea of practice priorities:

  • Have staff been trained in recovery practices, and is there a way for them to continue learning new recovery skills?

  • Do staff have confidence in their ability to help a person recover, as well as confidence in the person's ability to recover? If not, this is a major cause of burnout that can be addressed, usually through interesting and provocative training.

  • Are staff able to use negative or challenging circumstances as learning opportunities for both themselves and for the service user, instead of experiencing them as failures?

  • Is there an attitude of mutuality and partnership?

Inclusive documentation

Then we would take a look at the organization's paperwork and documentation. We would hope it wouldn't be boring and/or complicated. We would look for signs that the service user was the primary participant in the planning process, as well as that attention had been given to involving family and friends as supporters. Beyond this, we would ask ourselves these questions:

  • Does the treatment plan aim for self-determination?

  • Who seems to “own” the treatment plan? Is it the person? If so, does he/she know what is in the plan? Does it have any meaning for him/her? Or is it owned by the staff? The organization?

  • Is there an expectation that the person will recover and not just become “stable”?

  • Has the person been given information about the organization and its goals so he/she understands what is supposed to happen and what to expect?

  • Do forms use recovery language, and are they written in first-person language?