Monday, July 21, 2008

5 Questions for Jeremy Zane, Therapeutic Supervisor

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: Jeremy Zane
Job: Therapeutic Supervisor, Lancaster Center
Time with BCI: 4 years

1. Safety Net Services is one of the BCI programs you’re involved in. How are you addressing an unmet need for substance abuse treatment and HIV/AIDS services in Wilmington?
Our main focus is getting people into treatment. The [Christiana Care] infectious disease clinic, who is the largest HIV treatment provider in the city, was referring a lot of people to Brandywine, and a lot of people weren’t making it. The first thing that we’re doing is the seamless transition. A lot of times we get referrals from the infectious disease clinic the day people find out they’re HIV positive. In fact, in the first five months, there’s already been 4 or 5 where we were at the infectious disease clinic the moment they found out that they were positive. So from day one, we’re linking up these two services. We want people to understand that HIV is treatable, that it’s not a death sentence anymore, as long as a person takes care of their body, and takes their medication. Also, substance abuse treatment can coincide with HIV.

We’re talking about a population that is probably taking the bus everywhere, or needing to get rides. Transportation can be a very significant barrier in itself. We’re talking about a person who could be going, in one day, from substance abuse counseling, get on the bus, go downtown, go out to the infectious disease clinic, sit all day out there, get the things that they need to get done, and then go back into the middle of town to Connections or Community Mental Health for their mental health services. That’s a lot of running around. And if the person is in a lot of need, and needs services every week, the chances they will get those services consistently, decreases greatly, having to run around town that much.

Having Christiana Care’s remote site here, a person can come in, get their substance abuse treatment, see the nurse practitioner, get their HIV meds, and they’re able to do it all under one roof. The mental health component also can be contained here. A person with mental health issues can have their evaluation done here, can have their medication management done here, can get their prescription through here. Everything that person needs is contained under one roof.

2. You also helped start Recovery Counts for people who weren’t succeeding in the usual track of treatment. What is this program and how did it come about?
I remember the day, there was a particular client who came over and said, “They’re discharging me off the clinic, but right now, I’m clean. I can give a clean urine right now, but I’m being discharged.” And from that moment, Basha [Silverman] and I kind of looked at each other and thought, “I wonder how many other people there are like that, who are being told they’re discharged, and now, this is when they’re going to decide to make that change?” And after looking at it, we found it to be quite common. So what we wanted to do was to come up with a program that, we say in a very concrete way: This is your last chance at treatment. If you do not demonstrate changes now, you’re going to be referred to a higher level of care, and you’re going to be discharged from the opioid treatment program.

We started a pilot program of about a dozen people. And what we were able to do was, really offer them more intensive services. We’re going to have a couple of groups a week, we’re going to be meeting for an individual session every single week, until we get through this and over this hump. And from that point, it started to grow. And then what we started to realize was that, maybe we should start working with people at the beginning. Anybody who’s on contract at all is then going to go into this program.

The reason they’re not succeeding in treatment is because, maybe we’re not offering intensive enough services. This person needs to be seen more than once a month, and they need a case manager, they need to be coming to group. And the same person running the group needs to be running their individual counseling sessions, so they can incorporate what’s going on in group back in the individual session, in a seamless way.

We also look at an outcome questionnaire. By decreasing incarceration risk, housing need, [and increasing] interpersonal relationship skills, education and employment, it has a correlation with their urine screens. As negative urine screens go up, these factors improve.

3. Recovery Counts and Safety Net Services could both be described as harm reduction approaches to addiction treatment. Do you have an opinion of whether harm reduction or traditional treatment is more effective for clients?
I personally believe that a harm reduction model is more effective. Now, you have to really define what harm reduction means, because it means different things to different people. Some people who are on the liberal side of the harm reduction model say that no one should ever be penalized for urine screens, ever. That a person should never have negative consequences, should never have hard holds. I’m certainly much more on the conservative side than that. I believe that a person needs time to change. They’re going to be positive while they’re in treatment, and the day they walk in the door, you can’t possibly expect them to just, all of a sudden, start submitting negative urine screens. So where is that point? Is it two months into treatment, eight months into treatment? And from my point of view, that’s going to be different for everybody. That toleration, that acceptance that a person’s going to be positive while they’re beginning treatment here, in my opinion, is still part of the harm reduction model.

I also believe, however, that there’s also some point where, if we’re not demonstrating changes at this level of care, and allowing the person to continue their behaviors at this level of care, it’s more detrimental than it is helpful. And we need to make efforts to get a person into a higher level of care, which can be perceived as punishment. If we’re discharging a person because we believe they can’t succeed at this level of care, and they don’t want to go inpatient, then that person’s probably going to perceive what we’re doing as punishment, and I think some of the purest harm reduction model thinkers would also think that that’s punishment as well.

4. How did you get into the field of addiction treatment?
I got introduced to Brandywine when I was at Wilmington College with my undergrad degree. Basha had come in and was doing a presentation about the outreach services that Brandywine had to offer. And at that point, I really didn’t know what I was going to do with an undergraduate degree in psychology. And that was the first time that I became interested in outreach in general, and in getting into the substance abuse field. So I came in for an interview, and there was a project they had just gotten some funding for, and I just kind of fell into it that way.

And once I’d gotten involved and started working with the population… you grow into it. It became something that was very interesting to me. The substance abusing population has mental health issues, they have medical issues, and counseling people with substance use disorders, you get a little piece of everything. So, as opposed to just working with people with depression, or just working with people with post-traumatic stress, you get all that here, but the common thread is, everybody’s also abusing substances. So you get a more complete package, and a more dynamic caseload, in my opinion.

5. What is rewarding about your work at BCI?
I think everybody says that they’ve got a couple of clients who’ve really made changes, and with some of the clients that I’ve had now for 2-3 years, you see them struggle and struggle and struggle, and then finally get to this ultimate goal. The first time a particular client gets travel bottles. When somebody is detoxed successfully who was about to be kicked off the clinic a year ago. Everybody’s got those two or three clients that they’re always going to keep with them. That type of satisfaction, that type of reward and internal satisfaction that you get, I don’t see how you could possibly get that at any other job.

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