Most of us don't like change, so embracing it is difficult. But we can overcome this difficulty by, in effect, "changing the way we change." We have a shining example of this to share--about a program, a county, and a group of people who together went through a change process with grace and determination and, in so doing, transformed their program and their futures.
Making the case for change
Our story begins with a phone call from Steve Albrecht, administrator of a community mental health program (Oasis Rehabilitation Center, Indio, Calif.) that serves the people of small desert towns in south-east California. He has been told his peer support program (operated at The Harmony Center, also in Indio) was no longer in full alignment with the recovery-oriented objectives established by Riverside County. He's surprised, because he's doing what the County contracted with him to do two years earlier.
Albrecht explains that the County has offered to fund a year's worth of consultation that would focus on bringing his program into alignment with the county's recovery vision. That's the good news. The bad news? The Harmony Center program has a year to make fundamental changes and become a recovery-based peer center.
Now, we're hooked. After gathering our team around the speakerphone, we ask Albrecht for details about the program itself, the County's vision, the people served by the program, and how they feel about the change. By then, Steven Oppenheimer, the director of Harmony Center, has joined with Albrecht as well.
The two explain that Harmony Center began with the idea that it could be a welcoming environment for people diagnosed with a mental illness -- a comfortable, safe, drop-in center where members come for lunch, activities and events. While the Center's programs offered a welcome alternative to traditional clinical settings, they faced a basic problem: their results could not be measured using the County's metrics for success.
The County's key metrics included total monthly census, a fairly typical set of key indicators, and surveys of client, stakeholder, and staff satisfaction. In comments to Albrecht, County officials expressed concern as to whether members were receiving the focus and skills needed to navigate issues like having safe and stable housing, finishing school, starting vocational training, getting jobs and forming relationships. They weren't seeing that kind of improvement in the Center's results.
And, since their recovery vision hadn't materialized, the County officials wanted change. "We want you to turn yourself into a recovery center where members are trained in the life skills they need to participate fully in mainstream life," they said.
As they thought about these comments, the "Two Steves" recalled times when members wanted more guidance in specific areas and in specific ways and when they expected more from themselves and their members. They acknowledged that the County officials had a point and, in so doing, got over their initial anxiety and got motivated to make improvements. They asked to consult with them.
"Tell the County we'll take the job," we told them.
"I didn't want to come to The Harmony Center when it was a drop-in center. All people did was sit around and smoke, and since I was trying to quit smoking I found it difficult to be there. Now that it has transformed into an education center I have a reason to come. I enjoy hanging out there and feel I am learning something. Being around people who understand my illness makes me feel like I belong somewhere. I do not know what I would do without The Harmony Center." --Deidra, Regular Member
Seeing what was possible
Because organizations recover and transform the same way people do, we approach consultation first by giving staff hope that change is possible and showing them an example of what a recovery program looks and feels like. To this end, the "Two Steves" and Patsy (Harmony Center's program coordinator) attended the "metamersion" program offered by Recovery Innovations in Phoenix.
There, they participated in classroom training with people across the country and observed peer-run, recovery-based programs in action. From this experience, they realized that the Harmony Center had become a "destination" -- a "one-size-fits-all" drop-in center. They compared this approach to one that could offer customized classes and empower individual members to set recovery goals and take ownership of their own recovery. They realized that the Harmony Center's approach inadvertently perpetuated dependency -- the "soft bigotry of low expectations."
Seeing differences like these was all that it took for the trio to create a new vision for Harmony Center: a recovery community that promotes personal growth, personal empowerment and responsibility, and greater independence. Next, we made a visit to the site.
"As our program was changing, so was my management style: I invited our members to actively participate in staff meetings and training. I encouraged staff to solicit member opinions ... I changed my language from clinical terminology to that of a more humanistic approach, which I think made me both a better clinician and a more effective leader." --A Harmony Center Manager
At Harmony Center, we found the facilities pleasant and comfortable, and--with only minor changes--conducive to recovery programming. The Center's previous programs were based on a care-taking model, with no way to measure the progress of individual members. If Harmony Center was to become a recovery-focused program within a year, we determined they needed to:
* Teach leaders and staff how to use recovery principles and practices.
* Improve and streamline the referral and enrollment process for new members by reporting promptly to referral sources about the status of potential members. When initial contact fails, plan followup contact. Encourage referrals from local provider agencies.
* Enhance the welcoming environment of all three sites by visibly incorporating messages of wellness, discovery and recovery. Set a tone that empowers members to create a vision for their own lives.
* Transform programming and communicate the expectation for change with a learning center that features facilitated groups, structured classes that support specific outcomes and award Certifications of Completion.
* Introduce Self-Directed Recovery Plans (SDRP) that members develop with the help of their Peer Support Specialist. Help members connect their goals to specific Harmony Center course offerings or community resources and create a schedule for goal achievement.
* Create a tracking, reporting, and sharing framework that makes it easy to follow team, member, and center outcomes over time. Use member SDRPs to identify what's working, celebrate individual accomplishments, and make continuous program quality improvements.
* Network with provider agencies, community organizations, advocacy groups and county representatives to share practices, templates, experiences, and outcome that foster a recovery-oriented community of learning.
* Create opportunities members to "give back" to the community through volunteer work as "Harmony Helping Hands."
Overcoming the discomfort
Just like for people, it's hard for organizations to recover alone. So, the Harmony Center created a "Transformation Committee" to manage the process. Committee members included David Lundquist, PhD, Desert Region Administrator for Riverside County's Department of Mental Health; Alison Emery, its Director of Consumer Affairs, and Shannon Hooper, a Senior Peer Specialist. They were joined by Karyn Dresser, PhD, Director of Research and Program Practices from the Center's parent company, Stars Behavioral Health Group (Oakland, Calif.). Via monthly conference calls, this committee tracks the Center's progress toward transformation, sets new goals, and recommends action steps to the Harmony Center Advisory Board.
As with any change process, not everyone at Harmony Center was comfortable. For a time, staff turnover increased and membership dropped, but this happens when programs are serious about change. The Center's new approach requires higher levels of accountability from staff, who now must think hard about why and how each member is progressing (or not) and how best to engage each in creative problem solving. At the same time, staff now clearly distinguish the responsibilities of Peer Support Specialists (life coach) and from a member's responsibility for his or her own life. At first, however, it was hard for some staff to resist the urge to "take care of" or "save" members who felt uncomfortable.
"A number of members expressed discomfort ... We were asking people to become self-advocates ... a difficult concept for some. Likewise, many of our staff ... versed in the inpatient methodology of "taking care of patients," required assistance to reframe their thinking. It was critical in this process [to identify] resistance to change, validate concerns, overcome objections, while continuing to move the program along the path to transformation." --Manager
Why did it work?
Just over a year after their journey began, the Harmony Center's Transformation Committee and staff members have completed most of the items on their transformation agenda. The SDRP process began in July 2010, with the first outcome data to become available in early 2011. The Center remains committed to hiring and maintaining at least 80 percent peer staff (defined as people who have completed the County's "Peer Employment Training" program).
Today, the Center enjoys a stronger, more collaborative relationship with the County, reflecting a real spirit of partnership in which both parties respond and adapt to feedback. One example of this relationship is seen in the referral process between county clinics (the Center's main referral sources) and Harmony's Peer Support Specialists. In a fun and very human touch, the Center's specialists make surprise visits to the clinics and present clinicians who make the most referrals with balloons and a small gift card.
But there are many other reasons that the transformation effort has worked our well:
There were no big egos. Usually there are a few big egos in every group, but magically, there weren't any here. As a result, the transformation team members could seek solutions without taking things personally, making each other wrong, or needing to be right.
There were no hidden agendas. County officials were forthright in their message to the program -- they wanted change. At the same time, they supported that desire by sponsoring our consultation and participating on the transformation committee.
Partnerships were developed. Since all committee members sought the same result a more effective, recovery-based program -- there was a foundation for working together and partnerships naturally evolved.
All contributions were respected. Each person on the committee had a unique contribution to make and each made it. The Administrator could set expectations and pacing; the program staff could make changes within the program; the County staff could connect with referral sources to increase enrollment and cooperation; The Director of Research & Program Practices could connect the program with the parent company, draw from corporate resources, and communicate program changes to the rest of the company.
There was accountability. The monthly conference calls established a pattern of goal-focused accountability, with committee members expected to report on tasks agreed to in previous meetings.
Growth was expected. Because programs, like people, are sustained by hopes and dreams, Harmony Center's transformation leaders are looking ahead, planning growth that expands opportunities for member recovery and wellness. Here's what they have cooking for the near future:
* More partnerships with local job training programs, expanded adult education activities, and more wellness programs (smoking cessation, weight loss, healthy eating, fitness training).
* Greater empowerment for the Harmony Center's Advisory Board (e.g., give board members the keys to the facility) and a stronger role for Center alumni through expanded communications and engagement of alums as volunteer leaders.
* Supporting a recovery focused transformation at Oasis Recovery, a local sister center that offers inpatient and crisis services. Inspired by Harmony Center's progress, Oasis leaders attended metamersion training, Harmony Center peers facilitate WRAP groups and orient Oasis inpatients about post-discharge services, and staff from both facilities are seeking linkages between the Recovery and Medical models to ensure complimentary services at every level of care.
The transformation continues today, showing what can happen anywhere and anytime people are willing to make change happen by working together, sticking together, and utilizing their collective talents with spirit and integrity. We hope that this story will inspire you to do the same.
BY LORI ASHCRAFT, PhD, AND WILLIAM ANTHONY, PhD, WITH GUEST AUTHORS STEVE ALBRECHT, MSED, MBA, DAVID LUNDQUIST, PhD, STEVE OPPENHEIMER, LMFT, AND PATSY RAMIREZ…