An Interview with Arthur C. Evans, Jr., PhD Dr. Arthu - William L. White

More documents

Recommendations

Info

experience is a big Achilles heel. For those of us who are in policy positionsor are in government administrating large systems of care, most of our effortis spent keeping the system functioning. We don’t spend enough timestepping back, reflecting on the work we are doing, and documenting whatwe’ve learned. That failure is forcing communities to reinvent the wheel asthey begin their own transformation attempts. That is unfortunate.I think the other Achilles heel is developing outcome measures thatallow us to articulate with data what we mean by recovery-oriented care andthe indicators by which such care should be evaluated. We are trying veryhard to develop such measures and to use them for systems evaluation and toguide the future or transformation efforts and to link our efforts to what isunfolding in the broader healthcare arena.Bill White: I would add one additional point and that is the stability ofleadership needed at multiple levels of the community to sustain ROSCtransformation efforts—stability I think has been critical to what has beenachieved in Connecticut and Philadelphia.Dr. Evans: Let me speak to one issue that is of great concern to me. One ofthe great vulnerabilities of the addictions field, and the broader behavioralhealth care field, is its aging leadership. Even in my own agency, I am goingto lose half of my executive team to retirement in the next three years. Thatis an enormous brain drain on an organization and a field. It’s good that wewill bring in new and younger people with fresh ideas, but we are at risk oflosing a lot of valuable institutional knowledge. We need immediate effortsaimed at leadership development and succession planning to carry the fieldforward, to sustain ROSC transformation efforts already underway and togenerate the new leaders that will guide tomorrow’s ROSC transformationefforts. And we need that leadership at all levels of the system.Bill White: When you were recently asked about the next stage of systemtransformation in Philadelphia, you responded with the phrase “wider anddeeper.” Could you share with our readers what you meant by that?Dr. Evans: By “wider” I mean that we must extend the transformation effortbeyond the core of the treatment system. We must scan the environment tosee who was left out or not fully engaged in earlier stages of thetransformation process. We are beginning to ask: What are the specificimplications of RM and ROSC to children and adolescent services? Whatwill this look like in our criminal justice programs? What does enhanced22
ecovery orientation mean for methadone maintenance and othermedication-assisted treatment? We have focused on some specific levels ofcare, particular parts of our provider community, particular clientpopulations. Wider means that we are now extending the reach of thetransformation process, applying lessons learned to date and learning newlessons as we go.I think “deeper” means that we move from a shift in philosophies ofcare to changing frontline service practices and on to the lives of people inneed of recovery. We think of this as taking systems transformation fromthe policy level to “the corner.” It means we go from superficial changes tochanges that make profound differences in people’s lives. Deeper meansthat we institutionalize the change in such a way that it doesn’t matter whocomes and goes, the change is going to last.Bill White: When you went broader in Philadelphia with the transformationprocess you found yourself needing to connect the concepts of recovery andresilience and self-determination. Could you comment on that?Dr. Evans: I’ve always seen prevention as an essential part of a recoveryorientedsystem of care. I don’t think we’ve articulated that as strongly as wecould, but it’s essential. In a recovery-oriented system, what you are reallydoing is changing more than a treatment system. You are changing an entirecommunity. And what you do to change a community so that recovery canflourish encompasses the same things you do to enhance community healthto reduce the incidence and prevalence of alcohol and other drug problems.People don’t recover in treatment programs. They recover in a community,and that’s why so much of our focus is on the community itself. Primaryprevention and early intervention are not afterthoughts—superficialappendages to the system; they are a fundamental part of a recovery-orientedsystem of care.Bill White: There seems to be a larger vision emerging in Philadelphiaaround the question: How do we move beyond the focus on the care ofindividuals (adults, adolescents, children each treated as a discrete unit ofcare) to the development of sophisticated, family- and community-focusedstrategies aimed at breaking intergenerational cycles of alcohol and drug andrelated problems.Dr. Evans: Yes, this ecological perspective is emerging as a fundamentalelement of the Philadelphia model. We stress that we can’t just work with23
Page 3: done recovery management in Philade
Page 6 and 7: inquiring about my potential intere
Page 8 and 9: a self-replicating image. So if the
Page 10 and 11: their behavioral health condition t
Page 14 and 15: areas in which we are not focusing
Page 16 and 17: you don’t have a lot of resources
Page 18 and 19: these concepts and this way of work
Page 20 and 21: Dr. Evans: I think it’s very impo
Page 24 and 25: the individual, but instead have to
Page 26: Dr. Evans: Well, I think we all hav

An Interview with Arthur C. Evans, Jr., PhD Dr. Arthu - William L. White

Create successful ePaper yourself

Delete template?

Save as template?