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.

Thanks to You, We’re On Our Way to Our Playground Goal

Last month, BCI invited all of you who support our work to help us build a playground for the children at The Lighthouse Program. Many of you answered our call with generous donations! So far, you’ve helped us raise a total of $1,782.37, nearly 18% of our goal!

We still have a ways to go to make our goal of $10,000, so let’s keep the contributions coming in! We accept donations using a printable mail-in form, or online through JustGive or American Express. Also, we can use your help in spreading the word, so please email this post to anyone who you think can help.

The Lighthouse Program has been open for just over a month now. Four women and five children are presently admitted and receiving services. Two of the babies are under six weeks old. Last week I had a chance to visit the program and meet all the staff. They are all set up in their offices at DCUSA, ready to move into our building (pictured) in a few weeks once renovations are complete. They are a great group of people who are excited to be starting up these important services.

Very soon, we’ll be announcing an open house during the month of February, so stay tuned for the details and make plans to join us!

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.

Alpha Mural - Day 10

Almost done...

BCI Welcomes New Board Members

The Brandywine Counseling Board of Directors announces the election of two new members on January 15, 2008.

Krista Dowling of Wilmington works for Nemours Health and Prevention Services as Special Assistant to the Senior Vice President/Intermediate Program and Policy Analyst. She received her Ph.D. in Drug Dependence Epidemiology from Johns Hopkins University in 2007, and her Bachelor’s in Foundations of Behavior from George Washington University in 2001. Krista looks forward to applying her extensive experience in substance abuse and infectious disease to support such a wonderful and important organization.

Sanjay Kotha of Middletown is a Product Development Engineer with Rohm and Haas. He received a Master’s degree in Polymer Science from Clemson University in 2001, and a Bachelor’s degree in Petrochemical Engineering from Pune University in 1999. Sanjay is excited to be a part of our board and looks forward to using his background in engineering and business development to help make a difference in our society.

The BCI Board supports our treatment services through fundraising activities and promotion of our mission to the community. We know that both of these new members will add much to the organization. Please join us in giving them a warm welcome to BCI!

Alpha Mural - Day 8

Now comes some more detail, and our phoenix is beginning to come to life...

Click to view full size.

Alpha Mural - Day 7

Caelen came by yesterday with a box of paints and did this...

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5 Questions for Jenn Kutney, Counselor

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: Jenn Kutney
Job: Counselor, Bridge Perinatal Program
Time with BCI: 2 years

1. Tell us about your job and the clients you work with.
I’m a counselor for pregnant women, [and] women with young kids, that have a lot of case management issues, a lot of people with dual diagnosis. I wanted to work with families, and women in particular, women with children. That’s really why I came here.

A lot of our clients are coming in with problems with Health and Social Services. They’re coming in pregnant. [They] don’t really understand methadone and how it reacts with pregnancy, that whole interplay. A lot of women need housing help.

These are people that are coming from very chaotic backgrounds. They bring a lot of that chaos here to get it out, and it makes it chaotic here sometimes, and if you take it personally, it’s gonna burn you out.

2. What is your biggest challenge in doing your job?
There aren’t a lot of services for women with young children. There’s not a lot of housing programs available for women with young children. There’s not a lot of treatment programs available for women with young children.

You can get a single woman into treatment a lot easier than you can get a woman with children into treatment. You have to deal with finding a place for the children to go while she’s in treatment. I’m so grateful for The Lighthouse Program, because it’s desperately needed! It’s a great concept for a treatment program and I think it could do wonderful things if it continues.

And also, one of the biggest challenges is providing addiction services to women with open Division of Family Services cases, because sometimes they don’t quite understand what addiction is, the disease of addiction, and things like relapse.

3. What has been the most rewarding moment for you at BCI?
I started as a case manager, and I had a client on my caseload from day one when I walked in the door. DFS had taken her kids, and terminated her rights to one of her children, and taken the baby right from the hospital. She was discharged almost a year ago now. And I actually hear from her now, and she’s doing wonderfully. She’s clean, she’s moving out of state to get away from everything, and she’s doing very, very well.

4. Many of our staff decorate their office with personal items – tell us what you have in your office.
I like to hold things for clients, apparently! Right now I have strollers, and clothes, and all sorts of stuff. I wasn’t originally in this office, so a lot of the things I have are inherited. I inherited a picture from Kathy Kelley. I have kids draw me pictures, I have pictures of the babies, and of my nieces and nephews, hand drawn pictures.

5. What is something people would be surprised to know about your job?
How dedicated a lot of these women are to their families. The biggest stereotype I’ve heard since I started working here is that these women really don’t care about their kids. And they really, truly do care about their kids, and how their kids are doing, and making their life better, so that their kids don’t have to go through a lot of the things that they went through.

Client Contest: Name Our Mural!

BCI Alpha is having a mural painted in our waiting area, and we're asking our clients to help choose a title for it.

Wilmington artist Caelen Bird is volunteering his time to create this mural. Check out his website here. Paint was generously donated for this project by several local vendors, including Mammele’s, Dulux Paints, MAB Paints, and Lowes.

The concept we decided on was the phoenix rising from the ashes. Below you can see a preliminary sketch and a “Before” photo of the waiting area.

























The Phoenix bird is often used as a symbol of recovery. This mythical bird is synonymous with rebirth, healing, and peace. According to legend, a beautiful, one of a kind bird lives for 500 years. At the end of its life it builds itself a funeral pyre on top of the highest mountain. Then at sunrise, the morning sun causes it to burst into flames and be consumed. As the ashes cool, a stirring in the coals is seen, and a newborn phoenix rises reborn from the ashes of the old one.

As a symbol of being reborn from the ashes of our addiction, several analogies can be seen in this story: Fire represents treatment and early recovery. Pain represents introspection, the process of taking a look at the kind of person we have become due to our addiction. The newborn phoenix represents the recovering addict building a new life out of the ashes of their former addict lifestyle.

BCI Alpha clients can submit their ideas for a title through February 1. The winning entry will be incorporated into the mural. The winner will also receive a prize.

We are excited to finally add some color to our white cinder block walls! Keep watching this space to see the work in progress!

Potholes in the Road to Treatment (Literally)

Happy New Year, BCI Blog readers! As we move into our second year, we’ll continue to bring you an inside look at how we provide treatment to people who need it, and show you how you can be a part of the work we do.

A couple of weeks ago, the News Journal drew attention to something that’s been a longtime problem for our Newark Center:

Fix It: Brookhill Drive at South Chapel Street

“PROBLEM: Brookhill Drive near Newark. Potholes about 50 feet from South Chapel Street are so bad that drivers are traveling onto the private parking area of a building to avoid the rough road. Potholes cover the entire width of the road and stretch for at least 40 feet. Morning traffic between 7-9 a.m. is treacherous.

“WHO'S RESPONSIBLE: The News Journal thought this road would fall under the jurisdiction of the Department of Transportation, but representatives from the Canal District maintenance staff said it is a private road leading into an industrial park. That means it is not the responsibility of the state to maintain it, they said. The map shows the land is in the South Chapel Industrial Park.”

What the story doesn’t mention is that this road is the only way to access the BCI Newark Center at 24 Brookhill Drive. The people affected include over 200 BCI patients who must travel this route every day to get their medication. I personally travel this road about once a month, and I can tell you, it’s some of the worst driving conditions I’ve ever experienced. I can’t imagine having to do it every day. I’ve heard from other staff here who have had damage to their vehicles.

BCI has tried for years to get the responsible party to repair this road, to no avail. Our patients do not deserve to deal with these hazardous conditions day in and day out. So, perhaps by mentioning the issue here, we will get the attention of someone who can do something about it.