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Taking on the formidable middle

February 01, 2008

Interesting, isn't it, how one word can start an evolution? Who knew that recovery would be the battle cry for the transformation sweeping the country? Some say not much has really changed, but think back just ten years ago: The people using our services had no idea they could recover—and neither did the service providers who worked with them.

We'll be the first to agree that we aren't where we need to be. We're all at different spots along the way through the paradigm shift, but that's not so bad considering the inevitable resistance that comes with any change.

So how can we keep up the momentum? How can we keep ourselves moving in the new direction long enough to reach the tipping point—where there's enough of us standing on the other end of the teeter-totter to shift the balance?

We attended a conference last year at which one of the key speakers discussed ways to change a system. Richard H. Beinecke, DPA, ACSW, an associate professor in Suffolk University's Department of Public Management and an internationally known expert on the dynamics of change, concluded his speech this way:

Once the top leaders in the organization get the vision, and once the receivers of the service or product at the bottom understand what they should be able to expect, all that's standing in your way to transformation is the formidable “middle.” Getting the middle of your organization onboard is the “deal breaker.” If you get them onboard, there will be no stopping you. If you don't, forget it. They can stop the whole show just by being passive.

Maybe this is where most of our organizations are now. Many of the top leaders are onboard, and many of the people who use our services are beginning to understand that they can expect more from us than stabilization. So how can we bring the “middle” onboard? Have we really done a good job helping our doctors, nurses, counselors, case managers, technicians, and other clinicians to understand and embrace recovery principles and practices? Or are they still reciting excuses such as:

  • “The people we work with are sicker than yours and can't recover.”

  • “We already do all this recovery stuff” (yet their outcomes don't reflect it).

  • “We'd like to start taking a recovery approach, but our doctors will never go along with it.”

  • “We really don't have time to do the extra work” (even though we know that overall it doesn't take more time).

If this is where your organization is, you aren't alone. We'll be focusing on ways to move the middle in our next few columns, so stay tuned. This month we want to share an example of how transformation worked for one program manager.

Michelle Bloss has spent the past ten years of her career being mostly in the middle. Below is Michelle's account of how she, as a “middle” person, traveled the road to transformation.

Michelle's Story

“From 1998 to 2000 I was employed as a direct-care technician. I considered myself good at my job, and my goal was to be recognized by my supervisors as ‘the best tech around.’

“During this time, our organization began to transform, shooting beyond the long-held goal of stabilizing patients to the goal of helping people recover. I wasn't impressed. I felt I already knew all of this. After all, I knew how to treat people the way I would want to be treated. I went along with it all just enough to look like I was onboard, but I really wasn't changing much of what I did or how I did it.

“Then our organization started to talk about hiring peers. I began to worry that the peers would take over my job. I thought the company might have a hidden agenda to phase us out and bring in peers. Selfish thoughts started to invade my mind, such as, ‘I can't compete with them because I have not had personal experiences.’ Then unkind thoughts arose: ‘Oh, this won't last long. The doctors will never let this last.’ I was wrong.

“The day came when talking about hiring peers was over and working with peers was reality. When I met our first peer-support crisis specialist, I must admit that unkind thoughts began to rear their ugly head again: ‘I have seen seasoned counselors quit this job before. That guy will never last. He is not like us.’ Not only did ‘that guy’ last, but he taught me more about my job and about recovery than all my years of experience combined.

“The first concept that my peer co-worker taught me was mutuality. He showed me that mutuality was not just being nice. And even more challenging to my personal goal, mutuality was not about me being ‘the best.’ I learned that everyone has strengths, including me, and seeing strengths was the key. My strengths were just as valuable as my new peer friend's strengths. We were equal, and what was important was that the person we supported during the crisis was successful. My goal of ‘being the best’ shifted to being about the person I was supporting being the best he or she could be.

“The next lesson I learned from working with peer-support specialists was humility. It is powerful to be in the presence of someone in recovery, who shares his story from a ‘hero perspective,’ and to watch that person impact the lives of others. During this process I began to learn that even a clinician like myself can ‘recover’ from being a clinician.

“One day I was assisting a person in our crisis program who was having a very difficult time. As I was sitting next to her, listening to her, I thought, ‘She is me.’ I realized that life has struggles and everyone has something that we are recovering from. I could actually offer a piece of me, like my peer-support friends offer. So I did and we connected.

“Years later I was given the opportunity to join our leadership team. My new role was to supervise a housing program that employed peer recovery coaches. I had a new challenge—to be accepted in a peer program when I did not meet my fellow employees’ definition of ‘peer.’ I had not received services from ‘the system’ and, unfortunately, I found myself in the exact position that I had put my new friend in years before—in the minority and needing to prove myself.

“I heard grumblings from my team of ‘She'll never last. She is not a peer. She does not understand us.’ I must admit that this experience was very difficult. I struggled with where my strengths fit in, and unkind thoughts began to fill my mind again. I look back now and realize that I did shut down for a few years at work. It actually took a transfer to another department for me to realize that I had not been practicing recovery concepts with peers who worked under my supervision.

“Another opportunity to create a recovery environment arose. I was asked to supervise counselors, nurses, doctors, and direct-care staff working in our crisis alternative program. I really had to think about my personal experiences and what barriers I felt the first time I heard about peer support and recovery in a crisis setting. The role-modeling my friend gave me when I ventured into recovery was crystal clear in my mind. That is what we had to do, role-model recovery, provide education, and then provide feedback. And never skip a beat with modeling, educating, and feedback.

“As a manager, I was able to strategically offer peer-support specialists tasks to assist doctors, nurses, and counselors that gave them the opportunity to demonstrate their strengths, and the message was clear to our ‘clinical staff.’ No one can question how amazing recovery is to watch. This was what turned my lightbulb on, and I continued to watch transformation happen within our medical staff.

“Today, almost ten years later, I continue to support employees to recognize what their recovery journey looks like and challenge them to practice the principles of recovery in their work. I believe it is the role of a supervisor in a recovery environment to challenge the status quo of employees. As clinicians, we tend to speak about our education, our licensures, and our liability when we feel insecure. I realized this through my own journey. As a manager, it is my role to challenge this type of distortion and build upon everyone's strengths, indiscriminately.”

Transforming the Middle

From Michelle's story we can extrapolate ideas to guide us in supporting transformation in our own organizational “middle”:

  • Be clear about what your organizational recovery values are so staff members will know the difference between what they think is “being good” and the organization's very specific recovery values.

  • Be clear about what typical types of outcomes your organization's service users expect.

  • Offer training that prepares staff to know the difference between what they think recovery looks like and what service users are hoping to achieve.

  • Provide training so staff understand the role and the value of peers in the workforce and don't see them as a threat.

  • Provide peer employees with training on how to work creatively with professionals and eliminate the “we/they” dynamic that can limit the effectiveness of an integrated team.

  • Provide training for supervisors and managers so they will be able to bring out the best in peer employees and show other professional staff how to take advantage of peers’ contributions.

  • Support supervisors and managers in challenging distortions in perceptions and offering “recovery reframing” to tough treatment situations. (We will address the important specifics of “recovery reframing” in a later column.)

We hope you've enjoyed this article and that by sharing Michelle's story, we have armed you with some support to take on your middle and be victorious. We have developed a “personal recovery assessment” that you can give your employees to assess the level of recovery they use in their day-to-day work. If you would like a copy, e-mail, and we will send it to you at no charge. Just let us know how it worked for you.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix, and she is a member of Behavioral Healthcare's Editorial Board. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.
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