Oxford House to Expand Delaware's Recovery Housing

In case you missed it, the News Journal ran an article on the planned expansion of Oxford House from 3 to 14 recovery houses in Kent and Sussex County. Included were some impressive stats on how effective the houses’ approach is:

A 2005 study by DePaul University tracked nearly 900 people in more than 200 Oxford House programs for 27 months, and found that more than 80 percent had stayed clean and sober, Malloy said.

Also, resident Jim Martin shared his inspiring success story.

"It's just an amazing gift, to wake up in the morning and be sober, and know my guys are going to help me keep sober," he said.

Oxford House is clearly making a difference. It’s good to know they will be expanding so more Delawareans in recovery can take advantage of what they offer.

The Great American Smokeout 2008

Today, the third Thursday of November, is the Great American Smokeout. This annual, nationally recognized health observance day was founded by the American Cancer Society in 1976. An estimated 15 million smokers are taking part.

Here are the rules according to quitsmoking.com:

You just quit smoking for the 24 hours of the Smokeout. The wonderful thing is that you won't be alone; you can swap advice, jokes and groans with the other "quitters," nonsmokers and the American Cancer Society volunteers who will be cheering you on. Even if you don't go on to quit permanently, you will have learned that you can quit for a day and that many others around you are taking the step, too.

And from SAMHSA, here is some information and resources to help smokers:

• The Centers for Disease Control and Prevention (CDC)offers many resources and tools such as RSS feeds, podcasts, and a public health image library. If you’d like more information on smoking and health, contact CDC at 1-800-232-4636 or tobaccoinfo@cdc.gov.


• The National Cancer Institute (NCI has many online resources and information regarding tobacco and cancer, including clinical trials, prevention, statistics, research, literature, and more. If you have a question about cancer, call NCI at
  1-800-4-CANCER.


• Smokefree.gov offers online guides about quitting, expert help via phone or instant messenger, and print resources. Visitors can chat with an NCI smoking cessation counselor using the LiveHelp system. Call from anywhere by dialing 1-877-44U-QUIT, or dial 1-800-QUITNOW for in-state assistance.

BCI Gets Out the Vote

This year, Brandywine Counseling helped give people in recovery a voice in the election. 23 of our clients at BCI Alpha registered to vote after counselor Susan Anderson posted instructions and a sample ballot. Today is the day! Vote!

SAMHSA's Public Attitudes Survey: What Does It Mean?

This week I received in my email box the press release for a new survey on public attitudes about substance abuse, treatment, and recovery, by the Substance Abuse and Mental Health Services Administration (SAMHSA). At a glance, it seems that the findings are encouraging. More than half of American adults know someone in recovery. A large majority believe recovering persons can live productive lives. About two-thirds of us would be comfortable being friends or co-workers with a recovering person.

Over at the Addiction and Recovery News blog, Jason Schwartz has a different and interesting take on these stats. He poses some thought-provoking questions about recovery and stigma. I encourage you to check it out and share your thoughts. What do you think is the real meaning behind these survey findings?

The Saying Goodbye to Addiction Tour at BCI

Brandywine Counseling has received a copy of HBO's "Addiction" DVD set from our friends at The Discovering Alcoholic, as part of "The Saying Goodbye to Addiction Tour." The idea is to send this excellent, award-winning documentary from program to program so that a wide audience may benefit from the information and first-person experiences.

What better way to close out Recovery Month here at BCI than to send the DVD on a mini-tour to all our different sites, and show it on a loop in our waiting area? So that is what we are doing starting Monday September 29. The package will make its way from Lancaster to Alpha, to Edgemoor, to Newark, and then to our Sussex County sites.

So be on the lookout for the “Addiction” tour when you’re at BCI in the coming week. Watch the film, take a look through the companion book, and leave your message in the logbook. If you happen to miss it, you can always catch it online.

Then after we’ve enjoyed and learned from it, join us in “saying goodbye” as we send “Addiction” on to the next deserving recipient, H.E.R.O.I.N. Hurts. This Delaware organization provides parents, family members, and friends of persons with addictions; with educational, emotional, and social support, which will enable them to advocate for health, security, education, and rehabilitation of people with substance addictions.

As TDA says, “Wouldn't it be nice if we all could say goodbye to addiction…”

5 Questions for James Harrison, Site Director

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: James Harrison
Job: Site Director, Lancaster Avenue
Time with BCI: 20 years

1. How did you get started working in the addiction treatment field?
I think mine was a unique situation. I was actually finishing up a three [year] mandatory prison term, and Kay Malone and Linda DeShields came to the Plummer Center in 1988, and at the time, the American Red Cross was providing HIV education in the prison. They had a gentleman that came in, and none of the inmates would respond to him. They were rowdy, they were disruptive. And so, the warden asked me if I would co-facilitate the group. And I agreed to it. And after his first presentation, I actually took control of the presentation.

All the inmates were extremely receptive. It was like hearing it from one of their peers. And this was a time when HIV and AIDS was at truly epidemic proportion in our city, and folks were dying within five years. And so I hollered out, “Listen up, people! I have some life-saving information!” And people were quiet. People listened. And that kind of opened the door for me to start doing some prevention education, after I was released. Of course, Kay and Linda DeShields agreed to hire me after I was released, waited five months for my release, and I’ve been here ever since.

Many people would be surprised to know that I’ve actually had a 30 year history with Brandywine. So, many folks, especially newcomers, oftentimes will not realize that I’ve spent ten years on the other side of the fence. And so, I’ve seen the changes we’ve made as an agency, particularly around process improvement and access, and just being kinder and gentler to the addict. I think what folks will not realize is that ten years as a consumer embedded an advocacy in me that will never leave. And so I carry with me, day to day, having to straddle both fences. I’m still in recovery, I will say that. I can always see the client’s view clearer in my head as I’m also trying to move our agenda, and move the agency to the next level. So when you first look at me, you don’t see the old James, and so that’s the piece that I carry with my job that many folks don’t know about.

2. What changes have you seen in your 30 years with BCI?
Part of what I’ve seen is a growing trend, that we’re seeing a younger, sicker population. And I look at all of the old-timers, for loss of a better analogy. They are the dying breed. I recall one consumer I saw yesterday, who has been with Brandywine [for] a 30 year history, is actually wheelchair bound, and blind. And that same person, I used drugs with, I hustled with, I participated in drug addict behavior with. And now this person is barely struggling to survive.

And I see on the other spectrum, young white females and young black males chronically addicted to opiates, but now struggling with HIV, mental illness, and addictions. And I think the most obvious change has been the severity of folks’ addictions and their problems, coupled with the social ills as well: increased gas prices, food, housing shortage. All those other issues, where I think years ago, folks could make it off of a year’s income of about $12,000, but now, that’s starving. And so, couple that with addiction that’s more severe in its nature, we’re seeing sicker and more violent individuals as well.

3. BCI was in the news last week because of the challenge of reaching black drug users with the needle exchange. What do you think it will take for this population to access these services?
There was a workshop I went to, years ago, that addressed this very issue. The name of it was, “Beyond Tuskegee.” And if you remember the Tuskegee experiments, blacks historically had a fear of public health systems, and the whole notion that, “This is suspect, in terms of, the government has its hands on it, and that law enforcement may use this as a vehicle to further disenfranchise us.” So getting beyond Tuskegee would say that, “No, this is not true. There’s not a great conspiracy theory around accessing needle exchange, or providing services in an outreach effort.”

I think we have to build a comfort zone for African Americans. It’s like, if they see me drink the water, then the water’s okay. But until they see it and watch me be okay, many times they won’t access. So I think the most valuable tool we’re going to have is our African American peers who currently work on the [needle exchange] van. For [drug users] to see, again for loss of a better analogy, that they too have drunk the water and the water’s okay. So there’s got to be a comfort level in saying, “You know what? Needle exchange is a good thing. It saves lives, it’s not connected to law enforcement, it’s not some sort of drug inside the syringes.” The belief that it is a good thing has to be kind of penetrated throughout the community.

And accessibility -- going into what we call the “red light district” of the city of Wilmington is challenging, especially with all the shootings. I don’t know if African Americans are truly the population who are now injecting at an alarming rate. Certainly we do have some folks injecting, but I also believe that this is a dying population as well. And more people, because of drugs being purer, are smoking and sniffing. And so, there may not be as great a need for syringes as we first thought. So I think a collective kind of effort with our Senator Margaret Rose Henry, who’s birthed this project, our community leaders, our naysayers, our people who advocate for this population, we all have to collectively come up with a strategy to keep pushing the message that the water’s okay.

4. You can tell a lot about a person from their office. Tell us what you have in your office.
My office is very eclectic. I sometimes am embarrassed about it! But I have jazz artwork here. I have New Orleans. The Nanticoke Indians, which never really got recognized during Mardi Gras, but they too decorated, and had the same kind of celebration, but never recognized. But then I also have one section that’s dedicated to family. I have pictures of my son who graduated from Villanova. I also have a collection of articles of the work we’ve done here at Brandywine, the projects where I grew up in as a kid, and articles saying, “A $10 bag of heroin approximate to the 95 exit [for] sale,” “Fewer resources spent on prevention,” and then one of Basha [Silverman] and a syringe-filled shooting gallery, which reminds me of the work that we do. And that’s in addition to the Comprehensive Accreditation Manual from Joint Commission, books around licensure, and policy and procedure manuals.

But I also have a snake to unclog many of the restrooms, and a quart of oil for some of our vehicles. And so, you can find anything from a light bulb to the 2007-2008 Delaware Psychiatric Residency program’s pictures, of which I’m also a part, doing some training with the residency. So I like to think of it as eclectic. I think there’s times when it’s more orderly than others, especially when visitors are around, but for the most part, it really depicts my work here at Brandywine. One minute I might be the janitor, one minute I am the clinical supervisor, the next minute I’m an administrative person, the next minute I am a client advocate. So it really depicts the changing roles I play.

I just recently described my job here at Brandywine to someone, and I said, “I can’t call it work, because it’s something I like to do.” Now, it just so happens I get paid for it, but even [in] absence of money, I would still be doing this type of work. So while the paycheck helps with the mortgage and the car payment and travel, absent of that I would still be doing the same thing I’m doing. So I’m fortunate and blessed that I can come and do something I was going to do anyway for the rest of my life, but get a paycheck for it.

5. If you had $30,000 to donate to BCI what would you do with it?
I think I would go to a learning institution and ask that we start a program specifically for addictions counselors to grow the work field. The major challenge is a workforce that’s declining. [BCI senior staff] will be leaving in a few years. We have a younger workforce, that I think for the most part, is not prepared for the challenges of a more sophisticated system, in terms of licensure, accreditation, and just maintaining a quality level of services.

So I would go to a Lincoln University, a Del State, or University of Delaware, and say, let’s have a name for a program specifically to grow the field. So I think that’s what I would do. While another clinic would be nice, a transitional house for recovering people would be nice, but I think if we don’t grow the field, we’re going to miss the opportunity to help people get better.

"Drugs Bring Death" - One Man's Sign Starts A Movement

In one Ohio city, a grass-roots movement against drugs has been started by one man with a handmade sign and a message that gets right to the point.

For about four hours, Jesse Lowe stood silently by himself holding a cardboard sign with three words scrawled in black marker: "Drugs Bring Death."

His message wasn't aimed just at the dealers or residents of the neighborhood scarred by shootings and fear. He wanted the city to hear him.
…

His wife, Cynthia, told him to take someone with him, but no one was willing to go along that first time. Neighborhood association leaders called his stand heroic while others said he was naive and putting his family at risk.
…

A week after that first protest, about 15 people stood with Lowe at another intersection in the same neighborhood.
…

"The courage of one man is spreading to everyone," said police Maj. Kevin Martin. "This is what the solution has to be. As police, we're limited in what we can do."

According to the article, there have been real results to come out of this campaign. Residents are more inclined to report suspicious activity; a coalition has formed among residents, police, and community leaders; and a website has been launched. You can’t help but admire the spirit of Mr. Lowe and those who later joined him to stand up to the drug dealers on their territory. The message certainly gets people’s attention as well. We wish them continued success in their efforts to clean up their city.

So is this the kind of “real solution” to drug-related crime that so many cities are looking for? And do you think it would work here?

An "Opioid Hit" From Your BlackBerry?

We in the addictions field like to say everyone is addicted to something, whether it be illegal drugs, alcohol, food, or caffeine. What about information? This article says that exposure to new and interesting information releases opioids in the brain, just as heroin does. We are biologically wired to seek out stimulating knowledge, news, or gossip because it gives us an “opioid hit.” But can this craving for information become harmful when done to excess, like compulsively checking your BlackBerry?

I am not a BlackBerry user myself, but I do have a habit of interrupting whatever I’m working on to open a new email. Even if I’m in the middle of something important, as soon as that email notification pops up, I need to find out what it is. Because you never know, it might be more something important than what I’m doing! Usually, it isn’t. But now I know why I do this. Darn you, opioids!

Friends & Families Picnic to Reunite Formerly Homeless Men with Their Families

You are invited to the Gateway House/Brandywine Counseling

Don Hofmann Memorial

FRIENDS AND FAMILY PICNIC

Saturday, July 19, from Noon until 5 pm

At Wilmington's Brandywine Park

(Next to the Wilmington Zoo)

BRING YOUR CHAIRS AND BLANKETS!!

If you would like to bring your favorite party dish

to share with the group that would be great!! (This is strictly optional)

The Friends and Family Picnic is a free, public event open to the community. The picnic gives Gateway House residents an opportunity to bring their families into their life in a non-threatening situation. Many residents need to mend relations with their families because of mistakes they made during their drug and alcohol addiction. The picnic is a welcome opportunity for friends and families to join in a resident’s new life.

Gateway House provides long-term, permanent housing for homeless men who are willing/ready to address the issues that caused or contributed to their being homeless. An estimated 29% of Delaware’s homeless report chronic substance abuse. With housing and treatment programs, many are able to overcome their addiction and become productive members of the workforce and society. Brandywine Counseling is proud to partner with Gateway House to put on this event.

Looking forward to seeing all our Friends and extended Family!!

5 Questions for Kim Ortiz, Nurse

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Kim Ortiz
Job: Nurse, Lancaster Center
Time with BCI: 2 years

1. What led you to work in addiction treatment rather than a doctor’s office or hospital?
Three experiences have prompted me to go into an addiction treatment center:

In addition to being a nurse, I am a musician also. I became acquainted with a fellow musician who started playing for one of my choirs years ago. I found out that he was an addict and learned about his cruel childhood and what triggered his drug use. We still managed to become the best of friends. On one occasion, I didn't hear from him for two days, which confirmed my suspicions that he must be using. By Monday, he came to my door, asking to take a shower. I refused to let him in my home. In fact, I packed his clothes, gave him $5 for gas, kissed him farewell, closed my door, and then slid to the floor in tears. He was as close to me as any brother could ever have been. It hurt to have to practice "tough love." But I did. The story goes on, [and] through his recovery process, we stayed in touch. It was this friend that taught me to have an open mind about people and not to be so judgmental.

Before I came to Brandywine, I worked at the Veterans’ Hospital. Many of the patients were current drug users. They were introduced to drugs while in the military, serving in various wars. While assessing some of my patients, I got to know many of them. I loved working there. To see the things they were having to struggle and deal with, it’s become a desire of mine to help people.

[Also,] I love psychiatry, getting to know people and what makes them tick. One of my dreams is to further my study so that I will better equip myself to counsel those that are in need. I play a major role in scheduling Dr. Tavani's appointments (the Psychiatrist here at Brandywine.) It's interesting to hear the experiences and challenges that our clientele have endured. The past-to-present stories of some of our clients would make the top best book seller's list and it wouldn't even be fiction! What better place to work than Brandywine, to touch these areas of interest for me?

2. The nursing staff sees our clients every day, when they come to your dispensing window. What’s your relationship like with your clients?
They feel like family to us. We get to know what's happening in their lives on a regular basis. They bring their children in, bring us pictures of their families. When a client comes to my window, if they’re having a problem with anything, I can talk to them. I think they feel comfortable at confiding in us about their lives, things that they might not tell other people here. I love talking with people and I love helping people, so I really count that as a privilege.

The thing that I value most in working here as a nurse is, that I am working with people that are the same as you and I. I believe most people have some type of addiction, whether it be food, sex, drugs, or working too much. It's what we do to try to make up for the off-balance that is reflected in our lives. I hate the stigma that's placed on [addiction]. We sometimes put people in this little box, and think that they all should be labeled as such, as an "addict." But the fact is, that these are real people, with real issues, real problems, and real concerns. If we treat them as such, I think we get back the same respect that we would expect. I wish our society would get out of the mindset that, "They are just addicts." Yuck!! No!!! A lot of them didn't ask to be in this position. If we could just be understanding about that, the world would be a much nicer place, as far as I'm concerned.

3. The BCI medical staff has been very involved in our P2R efforts to improve access to treatment. We’ve become less like a doctors’ office and more like an emergency room, with all walk-in intakes, no appointments. Do you think those changes have helped the clients?
I do. I think that it makes it easy. I can get a call on the phone today from someone asking, “How do I get into this program?" And I can say, "We're open every day of the week. Be here by 5:00 in the morning, Monday through Friday, first come, first served." If they want treatment right away, they know that we're available, we're flexible, and all they have to do is get here. Once they get in here, we take their names, and, 1-2-3-4-5-6! We take six people, Monday through Wednesdays, and two clients on Thursdays and Fridays. As long as they're willing to get here by 5:00 A.M., their chances of being seen are really good.

4. What advice do you have for someone who would like to do the job you do?
My advice would be to go in with an open mind, and to not have that judgmental stigma of people that are addicted to a substance. If they can block that out of their mind and realize with every client, there is a story. There's background history. And God knows, that if we read all of the background history that Dr. Tavani compiles on each client that she sees, some of our stigmas would definitely change. In many instances, it may not have been that client's fault that propelled them into substance abuse. What caused that client to use? Were they born addicted with an addicted parent to govern them?

If we could just get that stigma out, I mean, throw it out the window, and realize, these are people, just like those coming out of the hospital with physical ailments. Our clients have major physical impairments going on, maybe stemming from the experiences that have happened in their lives. Whether it was just choosing the wrong friends and someone starting them on the drug-use trail, as innocent as that may sound, now they're stuck with a habit that they wish they had never started. In all of this, remember that, many of our clients are here because they want help desperately. Do everything that you can to give them that help without enabling them.

5. What is the most rewarding part of your job?
There are several rewarding aspects of my job.

[First,] being able to run to emergencies. Just recently, we had somebody who had a seizure, and he fell out in the waiting room, and hit his head, and we had to call 911. I like trauma type settings, so when that kind of thing happens, it’s an adrenaline rusher for me. Being able to get that person revived, and get them back conscious. That’s firsthand nursing experience right there.

When a client comes to my window and tells me that they're going to a job interview, and they're afraid to reveal to the employer that they are on methadone, I feel their fear. I enjoy encouraging them, “Think positive! Hold your head up, and smile, smile, smile!” Reminding them that they are doing this for themselves, and they are doing all within their power to heal themselves, so they can do better in their lives. This is all that any of us want in our lives ... to do better. “So, go get that job! You're gonna do this for you!" Then, it really makes my day when they come back to report that they did indeed get the job, and thank me for being so supportive. Hallelujah!!!

Lastly, when a client finally gets to zero milligrams of methadone. It's a day of rejoicing!!! They've done their part in their treatment, and are finally able to walk away from here without any withdrawal symptoms. To God be the Glory!!!!

Alpha Program Shortens Wait Time, Reduces No-Shows

The BCI Alpha Drug Free Program is seeing our clients engage in treatment more quickly after admission. At the same time, we see the fewest no-shows we've ever had for appointments. These are our latest successes in Paths to Recovery, patient-focused process improvement without additional costs or staff.

In the month of April, our clients progressed from admission to their first unit of service (individual or group) in an average of 9 days, which is the fastest in two years. Our average had been 12 days.

These results came after we introduced a new service called the Meet & Greet. This is the first time the client returns after admission. On average, it's 4 days afterward. They meet their assigned counselor, review the program rules, view a ten-minute orientation video, and schedule their first individual appointment. It’s a much more streamlined version of how we used to do orientation. Previously, clients would not meet their counselor until the first individual, nearly a week later. Knowing how important it is to establish the therapeutic alliance, we made it a priority to push this meeting up as early as possible.

Also in the month of April, our no-show rate dropped to 19%, which is our lowest in two years. This is for individual appointments for all active clients. Our average had been 26%. Client retention is also better, with more people staying in the program past the 45 day benchmark.

This came about because of our new, retooled motivational incentives. Since February 2008, each client draws from the fishbowl once at every individual and every group. They can win credits of $1, $5, $10, or $50 which they can bank and redeem for prizes including gift cards, bus passes, and 12 Step items.

This is a real turnaround after we had used motivational incentives for a year without seeing improved no-shows. Before, there were fewer chances to win since draws were not done in groups. There were also “Good Job” certificates mixed in with the prizes which had no value in dollars, only as motivation. Turns out, they weren’t very motivational! So the “Good Jobs” are now gone, and every draw wins something. And the best part is, the cost to the program is about the same. Banking of credits is also new, giving clients a choice to cash in right away or save up for something they really need.

Both of these projects took a long time to fine tune and perfect. The Alpha change team worked at this week after week at our lunchtime meetings. Our ideas made sense, and we expected them to work, but if the numbers didn’t show it, it was back to the drawing board. In terms of the PDSA cycle, it seemed like we were stuck on "A" for “adapt.” It just shows that process improvement in addiction treatment is hard work. It doesn’t get any easier just because you’ve been working at it for nearly5 years.

So it is all the more rewarding when we do get the great stats we’ve been waiting for. Good Job! I mean, Good Work, team!

Video: The Joy of Being Normal

AATOD has produced a video on the benefits of methadone treatment called "The Joy of Being Normal." They hope to get the message out to a large audience that methadone helps people lead normal lives, and dispel the myths that persist. 3 patients and family members tell how their lives were saved. Nice work, AATOD, and hopefully this video will help change minds.

Video: BCI and the "Whole Patient" Approach

BCI is featured in a new video on SAMHSA's Recovery Month website called "Medication Assisted Therapies: Providing a 'Whole Patient' Approach to Treatment." Several patients talk about how methadone saved their life, plus comments from James Harrison and Dr. Glick. Also, a panel of experts discusses the many benefits of medication-assisted therapy. The BCI portion begins about 13 minutes in.

Walk-Through At North Wilmington, Day 1

Our mock client had her intake this morning, and it actually went really well! My co-worker Nicolle gave an Oscar-worthy performance as "Nicole Jones," a dual diagnosed, divorced mom on Level 2 probation, addicted to alcohol and cocaine. She said afterward her story was a conglomeration of different things she's heard as a BCI assessor at Probation and Parole.

The staff were a little surprised to see us, so they kind of thought it was real at first. Everyone was very welcoming and friendly, and our intake counselor Maria was very thorough and genuinely interested in all that was going on. If that's how they treat a real client, they should pat themselves on the back!

There was not much that jumped out as far as needing process improvement. We thought the initial paperwork took too long, but that was our biggest complaint. "Nicole" signed up for a group next week and scheduled her first individual session, so maybe we will find something on our return trip.

The thing that really struck me as I sat and observed the assessment was how much courage it must take to walk into an office and talk to a stranger about all that is going wrong in your life and all the mistakes you've made. It gives me new respect for anyone who gets up the nerve to come in our door, as well as for the staff who listen to story after story every day. So, good job Maria, and kudos to all the clients who took that first step.

It's Walk-Through Time: A Day In The Life of the Customer

One of the most interesting things I've gotten to do while working at BCI has been a walk-through of our treatment program from the client's perspective. Not only does it give me a point of view I rarely get to see, but it yields all kinds of useful information you just can’t get any other way. It’s been four years since we last did one, but now it is time again.

Tomorrow, at the Alpha North Wilmington Center, one of my co-workers will pose as a client seeking admission, and I will be their family member/observer. The idea is to experience the admissions process in order to more fully understand BCI’s strengths and limitations. Is the process working as intended? How easy is it to get treatment when you want it? Do we do as good a job as we think we do?

When we did this before, the answer has been, sometimes yes, sometimes no. Check out some of our actual findings:

From our methadone program in 2003: “Samantha called the Lancaster office to schedule a methadone intake. The receptionist told her to call back at 12 noon because ‘that’s when I make appointments.’ Samantha called a second time and said ‘I need to get on methadone.’ She was put on hold again, then disconnected.”

From our drug free program in 2004: “Diana attended orientation group at the Alpha Program. The group started fifteen minutes late, and the room was too hot. The facilitator read directly from the client handbook, gave rambling explanations, and did not have control of the group. The clients became frustrated and made disruptive outbursts like, ‘This program will take 10 years – it’s ridiculous!’”

We, the staff, were shocked that things like this were actually happening at BCI, but we went to work to fix it. At the methadone clinic, we shifted the triage process from the receptionist to the nurses, who could pre-screen people over the phone and direct them where to go. The result was that the wait for an appointment was reduced by half. At the Alpha program, we standardized the curriculum for orientation group, reassigned it to a more skilled facilitator, and began a streamlining process that eventually turned a 90 minute group into a ten minute video. This was how we launched the Paths to Recovery process improvement effort that continues today.

These were huge changes, and that is the payoff of going through the walk-through exercise. It is a must for any treatment program that truly wants to better understand its customer’s needs and do a better job at meeting them.

What will we find at North Wilmington? It’s anyone’s guess. Sometimes, the truth hurts, but it is worth it if it leads to real improvement.

The Lighthouse Dedication by Governor Minner

It was a great honor to have Governor Ruth Ann Minner dedicate The Lighthouse Program on February 21. Our work would not be possible without her support. The following are her complete remarks at the Open House.

"Good morning. Thank you for coming out on a cold nasty morning when we see all that snow out there on the ground. I wish I could tell you it was going to be real nice weather, but look out tomorrow! Another day where we’re going to get snow, and they’re saying 3-4 inches, so get ready this afternoon so you won’t have problems tomorrow and having to go out in that snow. I have a feeling it’s going to be probably be our worst storm of the winter. So at least we know when we get it over, spring’s coming, it makes a difference.

“Thank you for inviting me to be here. Renata’s right, I have enjoyed very much interacting with the agency and what they do in the community, because it makes a difference. I can only say to you that every one of us, at one time in our life, has a time that we’re down, whether it’s just because of the death of a loved one, or some huge problem that I wouldn’t even comprehend to know what to tell you what to do. But we have that time we’re down. And I think Renata Henry is one of those people who always has the broadest smile. It sort of makes you feel better just to see her. And so I know that people in the community have that same exposure to her, and it is the same pleasure in knowing how deeply she cares. There is not a more compassionate person in our state than Renata Henry. We are fortunate to have her at the state facility.

“I remember some of the things that we’ve talked about over the years, and her saying to me, ‘We really need to do more, we really need to do more.’ And I’ve had to say exactly what a lot of you say every day, when it comes to, what can you do: ‘Do you have any more money?’ And so when it came to the point where they explained to me how they could just do some different things, and use money in different ways, I said, ‘Go do it. That’s fine with me.’ And so, they have made a lot of changes within the department that mean so much to our community. And that’s what government is all about. It isn’t about our jobs or what we do. It’s about what we do for the community, the impact that it has on those of you here. And boy, what an impact they have in our community, there is no question.

“Brandywine Counseling has made a tremendous difference in the lives of so many people. There is no way that we could simply stand here and say thank you to them, and it would mean enough. Because the lives they touch, touch other lives in the community. It’s not just the mother, it’s the mother and the children. They said it right, it affects a whole family. But it isn’t just a family, it’s a community, it’s your neighbor, it’s the people you work with. What they have done in this state is something we could never say enough thank yous for. They’ve been doing it a long time. Twenty years, that I know of. If you look at the people that they have touched, they have changed their lives. And see how much they have changed after they’ve gone through one of the programs and worked with some of the counselors. There’s no way that the state could have done that without the volunteer hours they give, as well as their daytime jobs. Because they give those hours if it’s 1:00 in the morning or if it’s 4:00 in the morning, and they know that one of their friends is in trouble. And I haven’t ever heard them call the people they work with their ‘clients.’ You’re not ‘patients,’ you’re not ‘those people who have trouble,’ you’re their friends. And they want to make sure you reach your goal, and that’s why they’re there working with you.

“Substance abuse is a powerful disease, and it can ruin lives, there is no question. But Brandywine Counseling saves those lives. It helps those people to achieve, to regain their self respect. Each one of us in our own way is very important to this state, and that self respect means a great deal. Think about it. It’s difficult. I know how difficult it is for some people to break that cycle. But they, working with you, cheering you on, making sure that you have the advantage of working with them, whatever hours of day or night, it makes a difference. The counselors are trained. They do their job well. Many of us can have all the compassion in the world, but we don’t know how to achieve what needs to be done and what needs to be said. And I say ‘done’ and ‘said’ because it isn’t always something clear.

“I had a gentleman one time, who told me that he was having problems, and he said, ‘You know, my neighbor just came and sat with me. Didn’t talk to me, just sat with me. I just knew there was someone who cared because he was there.’ But when I think of this church, that’s what I think of, the people who are always there, and continue working together. I know we will achieve great things. Bishop Foster has done an outstanding job in this community, and Brandywine Counseling will do even more. So we’ll look forward to their continuing at helping people to get themselves back on the right track. You never know what they might achieve.

“I always tell the story of a young man that I met when I was with the Board of Pardons, and he came before us to get a pardon. He had been in jail and just gotten out. And I said to him, ‘Well, now that you’re out, you’ve got your troubles behind you, what do you intend to do?’ And he said, ‘I want to become a lawyer. I was a good student. I want to become a lawyer, and I want to help - legally help - those people who can’t afford it, to pay for a lawyer.’ That young man is working in our public defender’s office today. He helps people who cannot. I feel good about that. The people who work for Brandywine Counseling must feel good about that a hundred times a day, and they help all of you who need it.

“Not everyone could do that. I don’t think I could do what they do, I would be depressed after about the sixth or seventh one I had to work for. But they’ve always got a smile. They’re always out there. They’re always ready. And let me tell any one of you who is in one of their programs, or thinking about going into one of their programs, they’ll be there. Anytime that you need them, just give them a call. It is amazing how much they can do to make you understand what your problem is. They don’t tell you, they help you understand what your problem is, and achieve your goal of changing your life. I know that every one of them goes home from work every day feeling good about themselves, and well they should. Our state, our country, in fact, our world is a better place because they’re there, because they reach out and help. Lives are changed. People are different, and they move forward with their lives as well.

“Congratulations on the opening of the new facility. Congratulations on the achievement that you have. And I’m sure that, this close to Reverend Foster, you’re going to have all the support you need, and a heck of a lot of prayer going on to make sure that you succeed. It makes a difference. Thank you to all of you, and congratulations.”

Telephone Continuing Care: A Recovery Management Program

Over the past year, the BCI Alpha Program has been using motivational incentives as part of the Advancing Recovery project. We’re about to start our second evidence-based practice, telephone continuing care. The incentives project is not going away; in fact, we’re rolling out a new and improved procedure next month.

Telephone continuing care is intended to prevent relapse and support recovery for clients who have done well in treatment. Our clients who would be successfully discharged will now have the option to remain in extended care. If they enroll, they will call their counselor on the phone at least twice a month for 12 weeks. The counselor will ask them a series of questions to assess their risk for relapse, identify and reinforce protective factors, and assess and refer for case management needs.

The questions include: Have you used any alcohol or drugs? Have you had cravings? Have you spent time around your “people, places, and things?” How many AA/NA meetings have you gone to?

In addition, every client enrolled in extended care will have access to a recovery coach from the 1212 Club who can drive them to appointments, help them with housing, or give them any advice they need. We’re thrilled to be working with 1212 on this, and we know their strong connections to the recovering community will supplement the treatment the clients get at BCI.

As with the motivational incentives, the Delaware Division of Substance Abuse and Mental Health is working in partnership with BCI and other Delaware treatment providers to make the changes necessary so we can provide this new level of care. We’ve also had as our consultant Dr. Jim McKay of the University of Pennsylvania, who has done much research on telephone care and its benefits.

How will we know if this is successful? One measure we will look at is our readmission rate. Presently, about 32% of our admissions each month were here previously. If we can reduce recidivism, we should see this number go down. We will also see if average length of stay in the program increases from its current value of 102 days. Our long term goals are to better serve the clients while reducing repeat use of higher levels of care.

5 Questions for Chris Zebley, Nurse Practitioner

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Chris Zebley
Job: Nurse Practitioner
Time with BCI: 4 years

1. What is your job at BCI?
I’m a board certified adult nurse practitioner and HIV specialist. I actually work for Christiana Care Health System. My department is the Community HIV Program. I collaborate with Dr. Szabo, who’s an infectious disease physician, and we run an HIV clinic here at the Lancaster site every Tuesday morning. The whole idea was to allow a one stop shop to get your mental health, your substance abuse treatment, and if you’re HIV positive, to get your HIV medical care under one roof. We call it “nested services.”

2. What services do you provide to BCI clients?
A nurse practitioner can treat acute and chronic illnesses throughout the lifespan, along with having prescribing privileges. I can practice independently, whereas a physician assistant must have supervision.

The services I provide include case management and treating acute illnesses. The clients who come in to see me generally present with maybe a tooth abscess, bronchitis, a skin infection, sprains or strains. The client may be unable to see their primary care physician, or worse yet, because of their addiction, might not see it to be a priority to take care of their health. I make referrals to dentists, PCP’s, foot and eye appointments. On occasion I’ll refer them to the ER, and I can call people that I know in the emergency room. There’s many, many things that I’ve done for people as part of referrals and such.

In my HIV clinic I have around 35 clients. I get referrals from my department, from NSAFE upstairs, Outreach, or by word of mouth. The medical management of these clients is very intense, because the majority have “advanced disease,” so it’s my duty to assist them in maintaining optimal health. We treat patients with very, very heavy co-morbid conditions - Hepatitis C, heart failure, vascular problems. I may do pill planners to aid in the adherence of their medicines, treat any acute illnesses that may arise, and also provide health maintenance by making sure they have their necessary screenings, such as a colonoscopy, Pap smear, or mammogram.

On Fridays I usually do annual physicals for Dr. Glick, as well as intake physicals for methadone, Suboxone or Revia. I do part time work with the Medical Maintenance Level 2 program at Newark where the people come in once a month for their methadone.

I’ll be working hand in hand with Outreach on Safety Net Services. I’ll be providing case management, HIV medical care, and psychotropic medication management.

3. What drew you into a career in the addiction treatment field?
This is something that I grew into. In the hospital we’d always have people that were disadvantaged, and stigmatized in society - IV drug users, the homeless, HIV infected individuals. These were real people with real illnesses who never asked for anything, and were very appreciative of the care they received. And I always thought, I’d like to work with these individuals, because they had a lot of needs, simple needs, that could be fulfilled.

This was a job posting with Christiana Care. I was working in employee health as a nurse practitioner at the time. I happened to see this posting, and it was for the Riverfront. An HIV clinic, but you would be working in a methadone clinic. I didn’t even know what a methadone clinic was, really. I didn’t realize how many people actually go to these places.

There were many people telling me, “You’re not gonna like it. You’re gonna regret taking that job.” You can’t go on hearsay. If I’d really listened to people, I might not be here today. I would not even have taken the position. I had to experience that for myself. And from day one, it was fine, it was nothing like what people told me it was going to be. I enjoyed it from day one. Because we’re able to meet the people’s needs, that’s a big thing.

4. If you had $30,000 to donate to BCI, what would you do with it?
Certainly the Outreach. They’re the ones that get people in here. They do so much good, whether it’s the food closet, or the clothes closet, and to help for that needle exchange to grow. As we see the research and the data come down, I’m sure the federal government and the state will allow us to expand. But that’s been a plus here for Brandywine Counseling. I’ve done intakes and I asked them, “Well, how did you know to come here?” And they said, “Well, it was the needle exchange.” That’s an indicator that it’s working.

I’d also open more transitional housing, because recently the CDC announced that homelessness is now the single largest contributor to HIV infectivity.

5. What is it like to work with these clients?
You’ve really got to like people in their worst condition, and in their good condition. And that’s what nursing is about, the human response to illness.

These people are survivors. They’re very, very smart. They could be executives if they could put their mind to more positive things. Some of these people could have been very, very wealthy and rich, the way they’ve been able to hustle, to get money for drugs. People have written about, if we could only find out how these people, the disenfranchised, tick, and how they’ve been able to survive these harsh illnesses, without a lot of medicine, then we could treat a lot of other illnesses cost effectively without using medications.

My first patient that I ever saw [now] comes here for take-homes twice a week, so they’ve been drug free for almost two years. I have them come in for support, and they’re part of my HIV clinic too. To me that’s a success story, because they know that they can come in at any time, whether they can see their counselor or not. To really see this person get out of the deepest, darkest abyss, where they were constantly using, and she’s not now, so she’ll continue in her recovery. That was pretty cool, to actually see that.

5 Questions for Steve Burns, Housing Coordinator

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Steve Burns
Job: Housing Coordinator, Project Return Transition House
Time with BCI: 13 years

1. Tell us about your job at BCI and the clients you work with.
I’m the House Coordinator for the transitional residential program, where we have six individual Brandywine clients for housing. We help them get jobs, we help them save money, we help them get different skills, we help them go to school. Whatever they want to do, we try to help them better themselves, so when they leave, they’ll be in better shape than they were before they came.

We try to get clients that are already clean and already have some kind of positive outlook or some kind of direction. But sometimes, when a person’s in a homeless situation, none of that’s possible. So first, we try to stabilize the client with their methadone dose. Whatever street drugs they’re using, we get them to stop doing that. Then, in the first 30 days, we try to find out which direction they want to go in. Do they want to go to school, do they want to get a job? But this is not a shelter, it’s not emergency housing, this is a transition house, and we’re trying to help you do something more positive in your life.

2. What advice do you have for someone who would like to do the job you do?
You have to have patience, and you have to have knowledge of what it’s like to be homeless. You don’t have to be homeless, but at least have some knowledge, some background, some schooling, some conversation. Just being able to understand and identify with a homeless person. Because a lot of times, people are homeless for a reason, they’re not just homeless because they don’t have a job and money. 75% of people who are homeless have either alcohol or drug addiction problems. 80% of them have mental health issues. A lot of them come from broken homes, no parent in the home, abuse of some kind. It’s just a lot of things that factor into a person being homeless. So on any given day, you may find out something about one of your residents that you never knew, but now you see why they act the way they act.

3. Tell us about your favorite client success story.
We had a female client at the transition house who was there when I came. We didn’t get along. Being in recovery and doing this as long as I’ve been doing it, I can kind of see different behaviors. And so I always addressed her on her behaviors, because I thought that that would be one of her downfalls, as far as her staying clean or relapsing, and she could never understand.
But in the end, she graduated from the program. She has a job, she has an apartment, she has a bank account, and she’s still doing good. And we’re great now, because through it all, now when she sees me, she says, “Thank you for staying on me. You know, I couldn’t see it then, but I had never saved money, never had my own place, I’ve never had my own job. Now I have all those things. I have recovery, I have a sponsor.”

4. Your involvement with the recovering community goes beyond your job at Brandywine. You’re also the President of the 1212 Club. What does it mean to you to be involved in that work?
Being the President of the 1212 Corporation is very rewarding, because it’s a place where people can come. It’s a safe haven. You can just come, relax, look at TV, play cards, have meetings, get yourself something to eat. I have some other people that are in recovery that are on the board with me. We work together because we want the 1212 to be a place where it’s safe to come. We want people from Brandywine to come. We’re doing something right now [with Advancing Recovery and clients from the Alpha Program], where we’re going to do some recovery coaching stuff, to see how it works.

The majority of our people don’t have skills, they don’t have education, so they need housing, they need education, they need jobs. We have a job training program. It’s not just 12 Step meetings -- that’s the most important part -- but a lot of times people say, “What’s the purpose of me staying clean if I don’t have a job, if I don’t have affordable decent housing. If I have to go back to the projects where I came from, I’m doomed.” So at the 1212, we try to help people to get to that next level in their recovery.

5. If you had $30,000 to donate to BCI, what would you do with it?
I probably would put it into transitional housing and the great work that we do with HIV and AIDS. I think those are two important parts right now.

The transition house used to just be open to Hope clients, Assertive Treatment Team clients. Now, since it’s open to anybody who qualifies, it has broadened the scale, and I would like to see us get more houses, get more space. Because I’m filled now, but every day there’s another counselor asking me, “Steve, do you have a bed? Steve do you have a bed?” People leave me messages, “Steve, do you have a bed?” So I think would be another great feat for Brandywine if we could expand that program.

5 Questions for Karen Barker, Account Manager

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Karen Barker
Job: Account Manager, Lancaster Center
Time with BCI: 13 years

1. What is your job at BCI and what do you enjoy about it?
The job that I do is like information central. I take the money from the clients, but also, I try to keep everybody informed of what’s going on, including clients, staff, anybody that needs anything. [When a client comes to the window,] first they have to pay. Then they may need to see their counselor, so I page the counselors. They may have a doctor’s appointment, or they have lab work, or they need to go up front for some other reason. I try to just be in a million different directions, while standing in one spot.

As nasty and argumentative as it is, it’s still one of the most enjoyable things in my life.

2. What advice do you have for someone who would like to do the job you do?
Be patient, and understand that every person that steps up to your window is not the same person who was there thirty seconds before, and everybody deserves to be treated on their own basis, not in the space of someone else.

3. You give out a “thought of the day” to the clients on slips of paper. How did you get that idea and where do the thoughts come from?
I’ve done that for the past 15 years. I got the idea because one of my very favorite clients, when he first came on, said, “Miss Karen, I need to be told what to do every day.” And I just laughed at him, and so that actually became the first daily reading the next day. The very first reading said, “Sometimes I need direction, though I don’t like being told what to do.”

From that point on, I tried to do one every day, and they get very upset if there’s not one every day! “Yo, Miss Karen! Where’s my reading?” And the readings come from either my mind -- I think of something in the middle of the day, write it on a slip of paper, tape it on the wall – or someone says something to me that I know they need to hear again, come back at them, and I’ll just make that one of the readings.

4. What has been the most rewarding moment for you at BCI?
One specific client, and him finding the sobriety that he looked for, is always something that I carry around. When it gets tough and you think no one can do it, I just think back to that first person whose urine was clean.

He came directly from the hospital, and he was in the kind of state that, both mentally and physically, he was a beaten man. But he knew that it was up to him to pull himself up on his feet -- we’d stand behind him if he fell backwards -- but he had to pull himself up. And when I saw the kind of strength from how far down he was, I knew that, just being there for when they get straight, but also when they fall -- because he fell many times -- but every time he came up, he was ready to do it again, wholeheartedly. And it’s very emotional to watch, you get very attached.

5. If you had $30,000 to donate to BCI, what would you do with it?
I would start out with $10,000 straight off to the Bridge Perinatal division. I would take another $20,000 to start an outreach that is equal to the methadone piece, because I find that when people first come on the clinic, that’s the hardest time. They’ve already hit bottom. They are so done that their own mother is done with them. They have no one to borrow 4 dollars from, they have nowhere to find 4 dollars. But the clients willingly help the clients. And so I would start that to be available for clients during their first 30 days of treatment, and make it easier for them to stay in treatment.

Lighting The Path Home: Help Us Build a Children’s Playground

Dear Friends,

Season’s Greetings from Brandywine Counseling!

On behalf of the Board of Directors, the staff and those we serve, I would like to take this opportunity to wish you all the best this Holiday Season and say thank you for your support!

In the spirit of giving that permeates the holiday season, won’t you consider a gift of a donation to Brandywine Counseling?

This year, we have a very special project you can help with. Soon we will celebrate the opening of a first-of-its-kind program for Delaware, The Lighthouse residential program for women with children. We hope to be able to build a first class playground for the children, but the price tag is over $10,000. We need your help.

For the first time, parenting women in need of long term residential treatment will have a place to go, and their children can come with them. The Lighthouse Program will help families entrenched in a drug using lifestyle learn a healthy way of life. The mothers will get help for their addiction, trauma, and mental illness, while taking classes in life skills, computers, and parenting. The children will have a safe space where they can learn, grow and heal, including on-site licensed day care, therapeutic interventions, education, and recreation. For these families, Brandywine will truly be lighting the path home.

As 2007 winds to a close, The Lighthouse Program is under construction in Ellendale. Families will soon move in and begin their new life. Imagine a child seeing their new home, with a bright, colorful playground. Your gift will make their eyes light up!

Your gift will help the mothers and children in so many ways. And, you could solve the dilemma of those “hard to buy for” people in your life with a monetary gift in their honor. The moral and financial support of friends like you has made a difference in our patients’ lives. Today, your year-end gift can help ensure these important services continue. You may use a printable form or donate online on our web site. All donations are tax-deductible.

On behalf of the Board of Directors, the staff and especially those we serve, I wish you all the joys of the holiday season, and thank you in advance for your generosity.


Sincerely,

David A. Oppold, President
Board of Directors