The Articles of Confederation
The Articles of Confederation, the first constitution binding the original 13 states, was instrumental in establishing a unified nation. However, it faced major challenges in governance, economics, and military matters, leading to its eventual downfall. Discover why America needed the Articles of Confederation and the significant problems that arose post-Revolutionary War. Explore the governing, economic, and military issues that plagued this early form of government, ultimately paving the way for the U.S. Constitution.
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Presentation Transcript
Stages of Change and Recovery Engagement Matthew Hill, BS, CPRC Program Manager, Washtenaw Recovery Advocacy Project
Objectives of this Session Goal: To educate participants about recovery engagement best practices Participants will be able to define the stages of change, and know how to access resources on them Participants will understand how to appropriately align recovery engagement with stages of change Participants will understand that the concept of multiple pathways is an understanding that no two people will have the same pathway to recovery Participants will understand how pathways change dynamically throughout the recovery process
What is engagement? Engagement is the process of establishing a mutually collaborative, trusting, and respectful helping relationship. Miller & Rollnick (2013) Mutually Collaborative: Involves input from both the person trying to engage AND the person we are engaging Trusting and Respectful: With out this, there is no chance it will be mutually collaborative
Is this engagement? Scenario: A person with substance use disorder (SUD) overdoses for the first time in their life. After being taken to a local ED, a social worker is brought in to talk with them. Patient is overwhelmed with what has happened and feeling physically ill. The social worker is pressing the patient on treatment resources and the process involved in accessing those resources.
Is this engagement? Problems: In the chaos of what just happened, the patient is in no shape to be thinking about treatment right away Limited time for engagement in the ED setting following an overdose Without recognizing these two facts, patient is many times discharged with follow- up is minimal
How should have a scenario like that gone? We cannot treat every overdose victim in the same, cookie-cutter, fashion To better assess how we can engage with people in active addiction, we must first understand where their INDIVIDUAL thinking is at Understanding the Stages of Change is the first step in making that assessment
Stages of Change Pre- Contemplation Maintenance Contemplation Action Preparation
Stages of Change Pre-Contemplation: A person is unaware, unable, or unwilling to change. They so do not recognize any problem. Contemplation: A person is ambivalent or uncertain, considering the possibility of change. Open-minded to looking at their substance use. Preparation: A person asks questions, indicates willingness and considers options to make specific changes. Are actively looking to make some kind of change. Action: The client takes steps toward change, but is still somewhat unstable. Typically this stage aligns with early recovery. Maintenance: Client has met initial goals, made changes in lifestyle and now practices on-going recovery strategies.
How do we determine stage of change? Motivational Interviewing: focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change (SAMHSA) This is a skill that takes a lot of time and practice to develop and use, however basic questions can help start a conversation. One of the keys in motivational interviewing is acceptance. We can accept what a person is feeling without agreeing with it. Successful motivational interviewing relies on asking open-ended questions How can I help you with ___? Help me understand ___? How would you like things to be different?
Matching Stage of Change with Engagement Strategies Pre-Contemplation Gather history and listen for any discrepancies between a person s stated goals and his or her lifestyle choices Educate about health risks related to substance use, suggest harm reduction strategies Instill hope by providing information about the possible mitigation of health risks through lifestyle changes Focus on lifestyle changes outside substance use, i.e. housing, employment, education (Source: Massachusetts Behavioral Health Partnership)
Matching Stage of Change with Engagement Strategies Contemplation Explore both the positive and negative aspects of a person s substance use Help people appreciate the disconnect between stated goals or concerns and substance use patterns using reflective listening Gently nudge the balance in the direction of change by reflecting back what the person has told you (Source: Massachusetts Behavioral Health Partnership)
Matching Stage of Change with Engagement Strategies Preparation Assess and reinforce the person s commitment to change Offer a variety of choices (e.g., self-help groups, treatment referrals, medications, online resources, referrals) and strategies Identify supports and barriers to change (Source: Massachusetts Behavioral Health Partnership)
Matching Stage of Change with Engagement Strategies Action Identify any unexpected hurdles and help people define healthy coping strategies Help identify new sources of support Track progress on recovery goals (Source: Massachusetts Behavioral Health Partnership)
Matching Stage of Change with Engagement Strategies Maintenance Continue to track gains associated with healthy change Identify people, places, and things which could pose triggers to relapse and continue to help people build skills to prevent relapse Assist people in actively maintaining the changes they have made (Source: Massachusetts Behavioral Health Partnership)
Relation to Multiple Pathways Philosophies Pathways to recovery begin in the pre-contemplation stage The steps a person with SUD takes to move through the stages of change are all a part of a persons individual pathway to recovery Pathways will be dynamically changing Harm-Reduction (Pre-Contemplation / Contemplation) Clinical Treatment (Preparation / Action) Mutual Support Groups (Maintenance)
Back to the Scenario How could we engage better? Show acceptance for what they are telling you Recognize time and follow-up limitations connect them to longer term engagement How we engage is centered on where the patient is at in the stages of change They don t have a problem Offer harm reduction education in a non-judgmental way They might have a problem or I have a problem, I don t know what to do Build on those motivations and connect them to a long-term engagement source, i.e. peer supports, assessment referrals, etc. Above all else, engagement is PERSON DRIVEN
How can we improve engagement in our roles?
