Motivational Incentives: Counselors Have the Final Say

If you’ve been following our Advancing Recovery experiment to reward attendance in treatment with motivational incentives, you know it’s been a challenge. While it hasn't yet proven successful at retaining clients in treatment longer, I can say we’ve learned a lot from this project. The number one lesson may be that there must be counselor buy-in for there to even be a chance for this strategy to work. All the focus groups you can offer, or all the detail you put in your training manual, may not make a difference.

To give out a prize at the end of a counseling session seemed so simple, but it turned out to be much more complex. Our counselors are great at what they do because of their own personal philosophy that guides their sessions and their interactions with clients. To implement motivational incentives, they had to alter their preferred way of doing things in a way we might think was insignificant, but to them was not. What if you had five minutes left in your session to do a prize drawing and you were in a middle of a meaningful discussion with a client? What if a client won a “Good Job” certificate but really needed a bus pass?

I believe everyone tried their best to make the project work, but ultimately, counselors will do what they think is in the client’s best interest. This is why our counselors overruled a decision to change the group drawings. We proposed a new random drawing process in which three clients would win a prize at every group, because an immediate reward is the best reinforcer of attendance. But the counselors recognized that not everyone would win. They preferred that every client who attended their required groups get a reward, even if they had to wait days or weeks later to get that reward.

To be fair, many of our counselors do support the incentives and report that their clients enjoy the program. But if we had one suggestion for treatment providers planning to implement motivational incentives, it would be to pilot test with a few counselors rather than all.

There is some good news to report. For the first time, we surpassed our target 5% improvement in retention at one milestone. 90% of clients admitted in the month of July completed their first individual session. We will continue the project at least another two months and see if this improvement can be sustained, and extended to other milestones; namely, the second and third individual sessions.

5 Questions for Edna Maldonado, Case 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: Edna Maldonado
Job: Case Manager, NSAFE
Time with BCI: 1 year

1. Tell us about your job at BCI.
I’m a case manager. I help clients that are HIV/AIDS positive remain healthy and live productive lives. Clients may come to our office very depressed after learning they are HIV positive or diagnosed with AIDS. The diagnosis alone can devastate a client. Some think they have received a “death sentence;” for others it may lead to feelings of suicide. I have to reassure them this is not the case because of today’s advances in medicine. So part of my job is to educate the clients about their disease.

In order to have a successful relationship with my clients, I must first develop a trusting relationship. I allow them to know they are in a safe environment where all conversations are confidential. Once the clients are stable, I develop an individualized care plan to prioritize their needs. I will then provide advocacy and linkages to a wide array of community services like food, shelter, and clothing.

I am also bilingual. My caseload consists of Hispanic HIV infected clients and the general population as well. Frequently, I have to accompany my clients to their medical, dental, or social security appointments to assist them with the language barrier. On many instances, they bring me letters to translate into Spanish from other agencies, including from immigration services. It does take much physical and mental energy switching from one language to another, but I love what I do. I enjoy helping my clients and providing these culturally competent services.

2. What drew you to a career in social services?
In my heart I always wanted to be a social worker, even though my degree is in Education. When residing in Connecticut, ten years ago, I was given the opportunity to work with the homeless population. This was an experience of a lifetime. To be able to help the most unfortunate people you can find and making a difference in their lives, that is what drew me to continue working in social services, so here I am.

3. What advice do you have for someone who would like to do the job you do?
I believe a case manager’s most important characteristic is to be compassionate and caring for others. Many people are afraid to work with the problem of HIV. I believe that we have to face the problem and be willing to help it, and be compassionate.

4. If you had $30,000 to donate to BCI, what would you do with it?
I would like to have a job training center for our clients who have difficulty getting jobs because of their histories. To give these people an opportunity to get some training, learn something, and at the same time, in that place, being able to employ them. I believe that would be a great empowerment tool for our clients.

5. What is rewarding about your work?
Since I have been here, the most rewarding thing for me is to be able to reach these clients that otherwise have no one else to help them. The fact that I can help these clients to become very productive, and empower them to live a successful life, that’s a big satisfaction for me.

The Lighthouse Wish List

Do you want to help out with the startup of The Lighthouse residential program for women and children? The Program Director passed along to me a list of items they need.

If you have items to donate, please contact Matt Friedman at (302) 472-0381 or email me at contact[at]brandywinecounseling[dot]org.

Plus, watch for an announcement in the coming months about how you can help with a special project for the children at the program.

Thanks!

A Supervised Shooting Gallery?

This interesting article was passed along to me yesterday. It's about supervised drug injection centers, where users bring their drugs, shoot up in a sterile booth, and leave without fear of arrest. The goal is to prevent overdose and infectious disease. Such a facility already exists in Vancouver, and some benefits have been seen. San Francisco is now looking at establishing the first facility in the U.S.

What do you think about this approach? Is it a logical progression of the harm reduction philosophy, or is it going too far? Would you like to see a supervised shooting gallery in our area someday?

5 Questions for Evelyn Handley, Receptionist

Welcome to a new feature on the BCI Blog called 5 Questions. Here, we’ll introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Evelyn Handley
Job: Receptionist, Alpha program
Time at BCI: 12 years

1. What is something people would be surprised to know about your job?
How much I do! From the time I open the door at 7:00, it’s on. There’s work to be done. People are sometimes lined up outside to come in. Anyone that walks in to the front door, I’m the first person they see. So I more or less help them out, getting their name, their information, showing them how to fill out their packet. A lot of people aren’t capable of reading or writing. I help them with that. I get the packet to the assessor, I chart, I discharge, run the machines, whatever needs to be done, I take care of it.

I hear as much about a person’s problem coming in the door as the counselor they sit down with. I talk to people every day about rape issues, divorces, DFS, people coming into their home, taking their children, the drug and alcohol, a little bit of everything. When they’re done talking to me and they end up coming back, “The information you gave me was wonderful, it was so helpful, I enjoyed talking to you,” I know what I do at the front desk makes a big difference.

2. What advice do you have for someone who would like to do the job you do?
You have to be a people person, for real. You really do. Everyone’s not capable of sitting at that front desk. It can become overwhelming, because your clients come in the door. Some people have good days and bad days. If they’re having a good day, you know it, if they’re having a bad day, you definitely know it because they give you all their stuff. You have to be able to swallow that, keep smiling, and be able to help them at the same time. Also, you have some people that are very aggressive. You need to know how to back them down professionally and with a caring heart, and if that doesn’t work you need to know what next step to take.

3. What has been the most rewarding moment for you since you’ve been at BCI?
When you see a person come in the door crying, and their children have been taken from them, and they admit that they’re on drugs and alcohol, and they stay here for 9 months to a year, and within that time, DFS and Family Court have given their children back to them, you know that our work is really important, that we’ve done all we could to help them build up their self esteem and put them on the right road to recovery. When you see a person that doesn’t have a job, they’re homeless, 9 months from now, they have it all or they’re on their way to getting it, that’s rewarding.

4. If you had $30,000 to donate to Brandywine Counseling, what would you do with it?
It would have to go to two different places, I would split it. Our Bridge Perinatal, and our HIV [Outreach]. I started out with the HIV department. Street outreach is important - that was said to me maybe my second year by [Executive Director] Sara Allshouse. I didn’t know just how important it was. I knew the job I was doing, I went out on the street, I talked to people about HIV, about BCI and what we do here, we wore the T-shirt. But once that was said to me, I went a little further.

There were people that didn’t have rides, they lived in very harsh places in the city of Wilmington. We would get out of our bed at 5:00 in the morning, and go to these people’s homes and pick them up, just to get them in, because these people were either HIV positive or AIDS defined. And once getting them through the front door, we were able to have the assessment done to get the type of treatment they really needed.

5. Many of our staff decorate their office with personal items – tell us about what you have at your desk.
First of all, I’m lucky to have this job. I’m a recovering addict, and I had said, “There’s no way in the world these people would hire me because of my background.” The question was asked of me, being a recovering addict, what did I want out of life? I said I wanted an opportunity to build a life for myself and my son. And [Medical Director] Kay Malone, and Sally Allshouse, God bless her soul, said, we’re going to give you the opportunity to do so, and they did. I have actually built a life here. I’ve bought a home here. I have my son in my life, cars, a mortgage. I’ve built a life here.

The only thing that means more to me than anything else in this world is my son. His name flows across my computer [on the screensaver]. That’s all I need. That reminds me why I changed my life. It reminds me why I’m still here, raising him and making a better life for him than I had for myself. That’s important to me, and whenever I turn around to that computer, I see his name come across, it makes all the difference in the world. I don’t need a picture of him, he’s in my mind all the time.

1212 Corporation Marks 41 Years As Delaware's Recovery Clubhouse

Yesterday I attended the 1212 Corporation’s first annual banquet and fundraiser at Cranston Fire Hall in Wilmington. About 100 people including many Brandywine staff enjoyed food, fellowship, and guest speakers.

For me, this was my first chance to learn what this organization is all about and why it means so much to Delaware’s recovering community. For 41 years, the 1212 Club has provided a safe haven for those seeking recovery from alcoholism and drug addiction. It is literally a recovery clubhouse, run by recovering persons for recovering persons, and is the only facility of its kind in Delaware. Support and a “recovery atmosphere” is available seven days a week, year-round. Services include AA, NA, and special meetings; therapeutic support; transportation to and from drug rehab; educational/recreational activities; and transitional housing for men and women.

Many speakers last night credited 1212 with helping them through the earliest stages of their recovery and beyond. It is easy to understand why. A treatment program like BCI can only take one so far in recovery. A social support system is vital because it’s there for you in your everyday life, whenever the urge strikes to return to your old behaviors. So many people found this support at 1212 when they had nowhere else to turn. Some, now successful professionals in the addiction treatment field, started their first job in recovery as a counter assistant at 1212.

BCI congratulates the 1212 Corporation on 41 years of service, and looks forward to watching them expand their services. And if you are in need of a safe haven, stop by the Clubhouse at 27th and Washington. You might find the support you need and much more.

Join BCI's Board of Directors

Do you want to make a difference in the lives of addicted persons and persons with HIV/AIDS? Do you want to work alongside BCI's leadership to support our mission of helping people achieve meaningful, long-term recovery?

Brandywine Counseling seeks talented and dependable individuals to serve on our Board of Directors. Put your talents to use in a place where your voice will be heard. We ask that members attend regular quarterly meetings in addition to active involvement in one of our committees.

Our most important area of need is development/fundraising. Desired skills include:

• Experience with non-profit fundraising activities, including: campaigns, strategic planning, donor relations.
• Ability to work as a member of a team.
• Ability to build consensus and garner support of other members for board initiatives.

Please send a copy of your resume, and anything you would like to tell us about your interests and what you hope to bring to the Board, to:

Matt Friedman, Executive Assistant
Email: contactbci[at]brandywinecounseling[dot]org
Fax: (302) 472-0392
Or apply online

Sober Softball Tournament

About 75 people from BCI, Thresholds, Fellowship Health, the Delaware Division of Substance Abuse and Mental Health, Aquila, Hudson Health, and Ellendale Detox attended the second annual Sober Softball Tournament September 20.

There were hot dogs and cracker jacks and fun for all. Elimination games were played and the final teams were Fellowship Health and BCI. BCI was leading 9-1 till the last inning. Fellowship had a strong comeback, scoring 6 runs in the 9th. But thanks to two Thresholds players joining the BCI team, we held them off to secure the win! Final score: BCI 9, Fellowship 7. BCI brings home the trophy for the second year.

The 2nd annual games have sparked interest by the Fellowship Health team and their coach in starting a recovery league.

Missing from the crowd was Jack Kemp of DSAMH who was unable to play this year - we missed you Jack!

Thanks to the Outreach crew and to Krystal Cooper from the Georgetown office for a great job putting it all together this year.