Peer Perspectives

Options Counseling and the Collaborative Helping Model in Substance Use Disorder Treatment

By Ron Stankevich, MSW, MSA, AAP

Individuals in recovery from substance use disorders (SUDs) face many challenges reintegrating back into life after treatment. Early recovery can be overwhelming with obligations such as imposed schedules of counseling sessions, drug testing, medication-assisted treatment, 12-Step meetings, and probation and parole appointments. With multiple weekly commitments, individuals often don't have time to find or research resources and social support services designed to assist vulnerable populations.

As social workers, our job is to help individuals traverse the labyrinth of possibilities to ensure they gain access to the services and supports they need. How can we help those patients without case management obtain support when we don't serve in a traditional role? The solution may involve a method that is most commonly used within the aging and long term care population known as options counseling (OC).

A Brief History
OC is a person-centered treatment method that assumes clients themselves best understand their situation and where they want to be. In the words of Vermont's Aging Disabilities Resource Connections, "The process is directed by the individual and may include others that the person chooses or those that are legally authorized to represent the individual."

Options counselors strive to support clients, not their condition. According to the Central Vermont Council on Aging, "Based on an elder's unique situation, counselors help individuals and their families to explore and evaluate the various options for long term care that are available. Together, we work to make the choices that best meet your needs."

OC comprises three core components: engaging through relationship building, identifying client preferences, and introducing participant-directed options in an unbiased manner. The philosophy behind this model is that if professionals engage clients in exploring ways to feel more secure in their world, they can better support them in remaining fulfilled. OC allows us to shift away from the "we know what's best for you" approach to one that engages and empowers clients to explore and achieve their own goals.

This method, which I learned about during my time with the Central Vermont Council on Aging, has proven to be an effective tool in serving the aging population. According to Vermont's Adult Services Division, the traditional model recognizes the following steps:

• a personal interview to discover an individual's values, goals, and strengths;

• an exploration of service options available based on the individual's identified preferences and needs;

• building of an action or support plan;

• assistance with determining financial need and eligibility; and

• follow-up to ensure supports are in place and the plan is working.

By developing deep connections with our patients, we better understand their concerns and challenges. Informing them of the support services available from a pros and cons perspective, without dictating or inferring what we think is best, allows them to remain the true stewards of their destiny.

Correlation Between Aging Population and Individuals With SUDs
When I began working with individuals with SUDs, I saw a correlation between these two vulnerable populations. Like the aging population, individuals with SUDs often lack knowledge of the basic resources designed to support them. They may be too busy honoring commitments or there are too many pathways to navigate.

There is an opportunity for social workers employed in nontraditional treatment organizations such as drug testing facilities and laboratories to become that bridge to available supports. By using components of OC, we can empower individuals with SUDs and expand access to social service support resources. Patients in this setting are already engaged in their treatment plans and provide a captive audience in which to increase awareness.

Collaborative Helping Model
OC, when used with the collaborative helping model (CHM), enables our patients to assume control over their lives. CHM is based on four questions that compose the collaborative helping map (see figure). These questions help to determine patient vision, identify present obstacles as well as available supports, and develop a plan to realize that vision. Each patient is unique and different, and this is not a one-size-fits-all approach. By taking the time to understand a patient's vision and goals as well as the obstacles he or she faces, we are better equipped to provide information about resources and services that best address those goals and needs. A CHM map, as presented by William C. Madsen and Kevin Gillespie (2014) in Collaborative Helping: A Strengths Framework for Home-Based Services, appears as follows:

This type of collaboration is more in depth than simply asking four questions, but it enables individuals to proactively lean into the curve of discomfort: "The art and skill of this work lies in the ability to ask questions that are close to people's experience, are personally meaningful to them, and stretch them beyond their automatic responses to go further in their own thinking and feeling" (Madsen & Gillespie, 2014, p. 51).

As with OC, this model is strengths based to help reinforce the positive attributes a patient already possesses. Initiating future-oriented discussions has its foundation in solution-focused approaches (Berg, 1994; de Shazer, 1985), utilizing what is known as the miracle question: "Suppose one night there is a miracle while you are sleeping and the problem that brought you here is solved. What do you suppose you will notice different the next morning that will tell you that the problem is solved?" (Berg, 1994, p. 97).

Though patients might have no idea what that miracle might be initially, if we gently tease out additional information, it can give us insight into what matters most and how they hope their lives will unfold. This process does not focus on the negative; it probes vision and highlights supports. Like OC, this model follows a similar multipart process, including the following:

• Identify their vision and/or goals. Patients might share that their greatest concern is food insecurity, and that lack of employment is also problematic. Their goals are feeding the family and finding work.

• Determine whether they have a support system. Do your patients have a case manager or counselor? Showcasing current positive relationships in a patient's life can reignite hope. But if there is no support, this provides a piece of the puzzle we can help address.

• Understand what obstacles are present and preventing them from achieving their goals. Knowing that food insecurity and finding employment are the true obstacles, we can provide information on resources that can help them achieve pertinent goals.

• Help develop a patient-centered strategy based on presenting unbiased options to help them reach their goals. Using the example of food insecurity and employment concerns, our role would be twofold. First, provide contact information to local food shelves and soup kitchens as well as the local office of economic opportunity or the state economic services division. Second, provide a list of employment search engine hyperlinks for job searches and agencies that can help with résumé building and interview skills such as the local office of economic opportunity or recovery center.

"It's important in our efforts to advocate in partnership with people that we 'lead from beside' remembering this is their life and our job is to build on their resourcefulness and to interact with them in ways that contribute to their sense of competence and personal agency" (Madsen & Gillespie, 2014, p. 162). When trust is gained through mutual respect, patients feel validated and secure that the decision on what to pursue is indeed their choice and theirs alone. This then becomes an opportunity to share the resources best suited to meet client vision and goals, those that both overcome obstacles and honor client preference.

Small Pilot Study
We invited 34 individuals from five sober homes to participate in an OC pilot project, of which 38% participated. Of the 13 participants, 10 social needs were identified, and 21 resource options were presented. Social needs ranged from food insecurity, housing, health care, legal aid, job skills, and employment training. All participants expressed deep gratitude, with one individual disclosing that a drug testing facility is where she received the support she could not find elsewhere.

Final Thoughts
OC, an effective and collaborative tool used effectively with aging Americans, can also empower individuals in treatment for SUD. Resource connection is often limited to traditional roles, yet having a clientele engaged in drug testing presents the opportunity for laboratories and collection centers to serve as another point of entry. Access need not be restricted to traditional or primary therapeutic relationships. Laboratories may be an effective mechanism for increasing awareness of address social needs of individuals. Learning from our patients through deep and respectful relationships, we can serve as a potential warm handoff to those who provide the direct services our patients desire.

Discovering who our patients are can help us learn who they may need to know—not just based on needs, but more based on their talents and abilities. Listening is an art. Compassion is a virtue. Respect for individual vision, however, is perhaps one of the greatest gifts we can give.

— Ron Stankevich, MSW, MSA, AAP, is social impact coordinator for Aspenti Health.

References
Berg, I. K. (1994). Family based services: A solutions-focused approach. New York, NY: W. W. Norton.

de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W. W. Norton.

Madsen, W. C., & Gillespie, K. (2014). Collaborative helping: A strengths framework for home-based services. Hoboken, NJ: John Wiley & Sons, Inc.