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Inside Recovery Innovations: What I learned
Not long ago, I mentioned briefly to Lori Ashcraft, PhD—a regular contributor and member of the Behavioral Healthcare editorial board—that I was headed to Phoenix for a conference. At that point, she invited me to visit Recovery Innovations, one of the founding organizations in the “recovery” movement. I accepted, hoping to resolve my own questions (and frankly, ignorance) about what “recovery” really means, how it feels, how it happens and for whom, and what it can do for people’s lives.
Over the next two days, I really got an education.
The people who taught me about recovery weren’t the usual suspects: CEOs, CFOs, CIOs or licensed clinical personnel, though all of these at Recovery Innovations-Arizona were certainly willing and open to talking. Instead, I learned from “peers,” “participants,” “citizens,” and “guests,” who, with the help of these C-level individuals and administrators (many of whom are peers as well), pretty much run the place.
The atmosphere at Recovery Innovations-Arizona (and, I expect, at RI locations serving California, Washington, and North Carolina) is positive: smiles are everywhere and hugs are not at all uncommon. Yet this outward ease and camaraderie coexists with a culture that fosters and expects constant and urgent change in the lives of everyone who walks through the door. This change is embodied in everyone, at all stages of recovery:
- With the help of peer support specialists, individuals new to RI immediately engage in peer relationships that encourage and empower them to tell their own stories, acknowledge the wisdom and value of their “lived experience,” and realize that recovery is possible.
- Next, individuals begin work on their wellness recovery action plans (WRAP), which are rooted in the work of Mary Ellen Copeland. These individualized processes and plans, developed with the support of a peer coach, challenge each to recognize his or her own strengths, draw wisdom from the past, and consider new ways that he or she can master their own symptoms and crises with available recovery tools and supports, rather than, for example, a hospital admission.
- Individuals who’ve progressed through WRAP are then invited to take RI’s Peer Support Training, an 80-hour program that teaches them how to be peer support specialists for other individuals. Completion of this coursework opens the potential for employment as peer support specialists, an opportunity that hundreds of RI participants have leveraged into part-time or full-time employment at RI. This is possible because Arizona’s state Medicaid system is one of many nationwide that reimburse for peer support services. (Many move on to other employment as well.)
Among the peer roles at RI are:
- Recovery educators, who share a range of recovery, health, wellness, and practical skills through daily courses available at one of Recovery Innovations-Arizona’s three “Wellness City” campuses in the Phoenix area (east, central, west). Similar Wellness City campuses are found at RI locations in California, Washington, and North Carolina, too. In Phoenix, RI-Arizona works with Glendale Community College (GCC) to make college-level offerings available to the citizens of Wellness City with on-campus peer support.
- Recovery coaches, who support individuals in various stages of recovery, notably in the creation and practice of WRAP.
- Recovery coaches for individuals who access RI’s supportive and transitional housing programs.
- Peer Advocacy Specialists, who encourage and empower individuals in hospitals or institutions to recognize the hope of recovering control and power in their lives by responding to their circumstances with recovery-focused tools and approaches.
Peers “connect” with people in crisis treatment and recovery
I saw the emotional impact of peer support throughout my visit. But I didn’t realize its practical financial value until I spoke with psychiatrist Jacqueline Pynn, MD, Florence Wolfe, LCSW, and Kathy, an RI-trained peer advocacy specialist working at the Maricopa Integrated Health System’s Behavioral Health Annex in central Phoenix. This is one of the hospitals to which individuals in crisis are referred, typically for 10 days, after an initial evaluation at RI’s Psychiatric Recovery Center—the region’s primary “evaluating center” for individuals in a behavioral health crisis.
Pynn explains that while psychiatrists get involved with every admission, much of their time is occupied with individual history, medications, and elements of court ordered evaluations. The same holds for licensed clinical staff like Wolfe, who notes that much of her time is occupied with generating detailed, individual service plans. To both of these professionals, the impact of peer advocates like Kathy is priceless. In the eyes of the individuals admitted for treatment, professionals may be seen as faces of “the system,” providing an opening for peer advocates like Kathy to relate in a more personal way. According to Kathy, peer advocates offer the hope that the individual can regain control of his or her circumstances as well as a peer “partner” that knows how to help, based on his or her own experience of a similar hospital admission.
Often, Kathy says that sharing a story about her own admission experience is sufficient to get the patient to open up and respond more cooperatively to treatment. Efforts like hers are one reason why the use of physical restraints has virtually disappeared in Maricopa County. It’s also why individuals who’ve experienced peer coaching and training are dramatically less likely to seek future hospital admissions.
Shared faith—and entrepreneurial culture
The glue that holds all of this together is a culture that’s built around a shared belief—really a faith—that everyone can recover. High expectations are communicated not only through every individual’s WRAP, but in day-to-day exchanges at places like RI’s Wellness City, one of three wellness/education sites in Maricopa County.
Every individual in recovery is welcomed to Wellness City, but the language and manner of this environment makes it gently clear that each individual is expected to grow and graduate in time. Hoi Mai, RI’s director of peer support services, likens Wellness City to a kind of restaurant in which individuals may choose the courses that they would like to enjoy. While each is entitled to “get” from the available programs, each is also expected to “give” by sharing experience, encouragement, friendship, and support with others. And, while all are welcome through the critical period of their recovery—normally until they attain individual goals and achieve greater self-sufficiency—all know that sooner or later, their “table” at the restaurant must open so that others may be served.
Transforming tragedy to “lived experience”
Perhaps the most unique aspect of the whole recovery experience is what it does to the life history of an individual. So that you can see this transformation, let me give you some idea of the people I met in the hallways, at lunchtime, at Wellness City, or at other RI facilities:
- I rode halfway across Phoenix with Dexter, a peer team leader who shared that he got his first job—as a peer specialist—four years ago at age 52 after spending much of his life in prison.
- I got a quick lesson in Wellness Recovery Action Planning (WRAP) from Spencer, a young man who, when not busy with his own recovery, is a peer coach in charge of a dozen units of transitional housing for participants being discharged from court-ordered and crisis psychiatric admissions.
- Tracy, a former Bank of America credit analyst and transitional housing resident, who stopped by to say good morning and talk about her 15-year odyssey as a homeless, angry, and mentally ill “couch surfer” who, smiling, looks forward to completing peer assistance training and “giving back” to the community.
The list goes on:
- Vicki—a onetime meth user who now provides peer support, attends college, and is buying a home;
- Robert, an articulate, would-be evangelist who’s now back in college;
- Dana, a young woman studying to become a substance abuse counselor;
- Art , a now-sober, 60-something, Vietnam-era Navy veteran who attended his first yoga class that morning.
- Christine, the engaging, serial entrepreneur who taught the yoga class and who, five years ago, put in a full morning’s work in her Dallas-area massotherapy practice before jumping off a bridge during her lunch break.
- Nick, a peer services administrator, who recounted years lost to schizophrenia and drug abuse before he learned to tame his mind, taper his meds, and, ultimately, win a letter from Magellan of Arizona psychiatrists that found him free of any symptoms.
After a day or two at Recovery Innovations, all of these deeply painful, but remarkable individual journeys begin to sound familiar, even routine. And, as individuals share their stories with others, each story is transformed. What was once hopeless, awful, or painful becomes a source of hope. Each says, “If we recovered from this, then you can recover too.”
P.S.: Thanks to all who took time to share a story or answer a question: Christopher, Julie, Steve, Kasondra, Eileen, Antonio, Jeannie, Trey, Brian, Melissa, David, Judy, John, Todd, Michelle, Peggy, Jennifer, Susan, Randy, Gene, Lori, and many, many more.
