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Integrating Treatment, Integrating Consumers: Baltimore Health Care for the Homeless
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Multi-disciplinary teams can help to create flexible, welcoming environments to engage consumers. HRC Recovery Specialist Gloria Dickerson talks with Betty Kavanagh, Behavioral Health Officer of Health Care for the Homeless in Baltimore, MD, about their integrated treatment programs, and how they involve consumers as staff.
imagee of Betty Kavanaugh

Betty Kavanagh is a LCSW-C, Behavioral Health Officer of Health Care for the Homeless in Baltimore, MD. She works with a multi-disciplinary team using integrated treatment models for people who are homeless with primary medical care, mental health and substance abuse needs.

Q: Please tell me a little about your program.
A: We integrate primary health, behavioral health and addiction treatment. This model includes outreach workers, doctors, nurses, therapists, case managers, and addiction counselors. We use the stages of change model, motivational interviewing, and cognitive behavioral therapy.

Our program meets clients where they are. We address basic needs and also share information about other services that we offer. As an example, someone might come in for a pair of socks. We give him the socks and also actively engage him to begin building a relationship. When we feel that we have a strong relationship in place, we begin to discuss other services that we offer, such as substance abuse treatment.

Q: What are some of the challenges of working in an integrated model of service delivery?
A: Many of our clients are in the pre-contemplation or contemplation stages of change, meaning they have not yet committed to changing. However, our addiction programs are state certified and subject to state standards. One such standard is that an Addictions Severity Index (ASI) be completed within one week of “admitting the client into the program.” To work around this, we developed our own Addiction Consultation and Evaluation Services (ACES) category for clients who are not yet ready to commit to treatment. We then used our data on the clients served in the ACES category to negotiate changes in our contract, which took several years.

Q: How are consumers involved in your agency?
A: We have several projects that involve consumers. In our Housing First program we have a staff person who was formerly a client. We are always looking for more opportunities to hire consumers. We place a consumer in one of our waiting rooms to help people register to vote. We also facilitate consumer involvement through advocacy. Each February we take a group of consumers to Maryland to share their stories with policy makers. We also have an art group that culminates in an art show where consumers can display their art and poetry.

Q: What have been some of the challenges in hiring consumers?
A: Boundaries are challenging because many times consumers identify with the person seeking services. We have found that using supervision to teach appropriate professional boundaries is effective. Other challenges arise with staff members who are in recovery. It can be difficult to show those staff members that there are multiple paths to recovery and that their own routes are not the only way. Another problem is tension between new staff in recovery and clients who are pre-contemplators or contemplators about addiction treatment. The stages of change model is extremely useful in helping staff to identify interventions and explore ambivalence with these clients.

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