Second Opinion is an integrated treatment group for people with co-occurring disorders at Baltimore’s Healthcare for the Homeless (HCHMD). It welcomes all individuals who qualify for services at the agency and who have a history of substance use and who experience symptoms of mental illness.
The group runs for one hour, three days a week. There are no set topics. The discussion topics are decided upon by participants, and may include: medical problems, insomnia, substance use, relapse triggers, or the rewards of recovery, like family reunification, employment, and stable housing. Participants in the group are asked to respect each other’s rights to share opinions and to be open to feedback.
Alternating staff members facilitate the group. They include the agency’s Director of Addictions, a mental health therapist, the Director of Mental Health and Social Work, and a Co-Occurring Disorders Therapist. While different staff members rotate through facilitation, the format of Second Opinion remains the same.
“We meet people where they are. We collaborate in order to integrate work around both mental illness and substance use,” says Dr. Alan Sofranko, a staff psychiatrist. He shares that Second Opinion works well because it offers a non-threatening environment. While the group leaders worry when members miss sessions, they always maintain an open door policy.
The approach used by the Second Opinion Group is derived from the Phases of Treatment Framework developed by Dr. Kofoed and Dr. Fred Osher in 1989. Second Opinion represents one element of the Integrated Dual Disorders Treatment approach. To learn more about this best practice, see SAMHSA’s Evidence Based Practice KIT on Integrated Treatment for Co-Occurring Disorders.
Alan appreciates the fact that physicians at his agency have a full thirty minutes for medication checks and follow-up appointments, and a full hour for new patients. “We are fortunate to have enough time to talk about housing, emotional and personal stressors, mental illness, health insurance, addiction and recovery concerns, as well as employment,” says Alan.
Alan speaks with praise about his own exposure to expert faculty and other physicians along the way. “I have seen so many doctors who are willing to be flexible and adapt to meeting people where they are at. If that means they need to engage people at stores, shelters, or apartments, I have seen that many people are willing to do this,” says Alan.
Many of his mentors have set important examples of how to meet with family members in order to integrate treatment well beyond medication. This might include the entire community and involves viewing treatment as something that affects individuals, families and communities. Alan hopes to be an excellent communicator, an advocate, and a physician who removes the stigma from mental illness and substance use. He shares that the most important mentors in his medical career have been people who are humble, caring, non-judgmental and also very practical.
Working with people is the thing that sustains Alan. He has seen that many people would rather look the other way and pretend that people who experience homelessness, mental illness and substance use do not exist. He has learned many lessons from people he has worked with. “People I have worked with have taught me they that are looking to see if I have true empathy, and if I am a good listener,” says Alan. As Alan works to see the whole person, he also understands that he needs to be open to alternative solutions that will complement medication management, solutions that include community resources, education, rehabilitative services, employment services, and families.
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