Stop for a minute and think about your goals. Then take another moment and think about how you will work to meet those goals. It is this kind of reflective thinking that helps the participants in this month’s Grantee Spotlight project to succeed. The Providing Evidence-based Care for Substance Abusing Serious Mental Illness (SMI) Homeless in Birmingham project, also known as Enhancing Addiction Recovery Through Housing (EARTH), showcases the fruitful marriage of service provision and evidence-based practice. Using a contingency management and therapeutic goal management model, the project provides integrated treatment for mental and substance use disorders and housing services.
The project’s treatment model, Behavioral Day Treatment and Contingency Managed Housing and Work Therapy, is listed in SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP). EARTH uses these evidence-based programs and practices, which are based on their work in more than two decades of clinical research. Before describing the model, it is essential to look at some exciting elements of the project: the staff, peers, and partners. In addition to its professional staff, the EARTH model depends upon and is positively influenced by the staffing assistance provided by peer specialists.
EARTH's Staffing Assistance
Peer specialists are successful graduates who mentor new participants and model productive behavior. The complementary addition of peer specialists was a somewhat coincidental evolution of the project. In the earlier days of the program, clients received services and graduated. Some of these graduates later expressed an interest in returning to the program. Enhancing Addiction Recovery Through Housing (EARTH) used this desire and dynamic to set up training for the graduates and pay them for the services that they provided.
The project currently has three peer specialists, two paid and one volunteer. EARTH’s partners include the University of Alabama at Birmingham (UAB) Division of Preventive Medicine and Department of Psychology and three community-based agencies: Firehouse Shelter; Ministries of Greensprings at Southside Baptist Church; and Jefferson, Blount, and St. Clair Counties (JBS) Mental Health Authority. This partnership is staffed by three UAB employees, four staff members from Ministries of Greensprings, two staff from Firehouse Shelter, and one JBS staff member.
The collaborative partnership provides support and services for the target population. The partner agencies provide integrated housing, mental health, and substance use services. These collaborations, EARTH believes, increase the quality of support and the probability of sustainability. Students make up another component of EARTH’s staffing pattern and three students are currently in training. Students can be trained in clinical and research skills and may have opportunities to attend scientific meetings as a result of their affiliation with the project and the university. The training and mentoring of peers and students provide a wonderful capacity to enrich and energize service delivery by professional staff.
This writer had the opportunity to spend two days at the EARTH program during the summer of 2011. One of the most memorable program features at that time was the observation of two group meetings, the “community morning meeting” and a goal review and reward meeting. These meetings proved to be valuable cornerstones of the model as they showcased encouragement and affirmation of clients. The structure of the morning session was impressive because a client presided over the meeting. The encouraging and affirmative tone from the “good and welfare” process enhanced the content of the meeting. And finally, the participation and engagement of clients made the process lively.
EARTH's Project Treatment Model
The six-month program model, as outlined in NREPP, leads clients through the following phases. During the first two months, participants receive behavioral day treatment during the week and are provided lunch and transportation. Behavioral Day Treatment occurs five days per week. It includes psychological evaluation, individual and group counseling, psycho-education sessions, therapeutic goal management, weekend planning, and other services. Each participant works with a therapist to develop short- and long-term goals and to define outcomes related to these goals. Goal attainment is rated in a weekly review, and accomplishments are rewarded with vouchers that can be used to purchase social or recreational items and activities.
Additionally, as part of the contingency managed housing component, participants develop employment and housing goals with vocational rehabilitation and housing staff. After enrollment, participants are moved to a rent-free, furnished unit in an apartment or group house. In the subsequent three to six months, participants receive aftercare services two days per week. Aftercare provides an opportunity for participants to continue using the goals and psycho-educational content from the behavioral day treatment. Participants may also receive individual counseling to supplement group sessions. Participants are rewarded for living a drug- and alcohol-free lifestyle, as evidenced by biometric toxicology testing twice each week, with access to program-provided housing.
EARTH feels that the program is most successful when it:
- Improves the quality of life of its participants
- Fosters collaboration between community agencies
- Trains students and staff
- Delivers positive program evaluation findings
- Demonstrates caring, compassion, and love
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