Intensive Outpatient Vocational Rehabilitation Program

Prevention Program Supervisor
Fayette County Drug and Alcohol Commission, Inc.
Uniontown, Pennsylvania

The Intensive Outpatient Vocational Rehabilitation Program (IOVRP) in Fayette County, Pennsylvania is designed to treat recovering clients in a holistic way. The program has the following major purposes:

• To provide a vocationally based intensive outpatient treatment program for alcoholics and other addicts while developing their work adjustment/readjustment skills
• To prepare recovering addicts to enter/reenter the workplace
• To give recovering addicts the opportunity to reenter the workplace with the extra support of the program staff and thereby increase the chances of a successful experience
• To give program participants, who are recovering residents of an economically depressed area, a sense of hope for the future

Program Overview

Rural Fayette County, Pennsylvania, has fallen deeper and deeper into economic depression as the coal and steel industries that once sustained it continue in a downward spiral. A sense of oppression has settled glumly over the county's 147,000 inhabitants. Oppression's companions–loss of self-esteem, depression, and alcohol and other drug use–are growing concerns. A heavy-drinking area for years (at 6percent, only 9 of Pennsylvania's 67 counties rank higher), crack cocaine has hit Fayette County hard.

The delivery of human services has always been a challenge here. Lying just north of the West Virginia border in the northern tip of the Appalachian Mountains, 21 percent of Fayette County's citizens live below the poverty level. Transportation is one of the bigger hurdles, with mass transit practically nonexistent. Concerns like these keep human services agencies talking. In the summer of 1993, the Fayette County Drug and Alcohol Commission, Inc. and the Washington, Pennsylvania, District Office of Vocational Rehabilitation (OVR) started talking about how they could best serve clients who needed the services of both agencies. By joining forces with yet another human services agency, Goodwill Industries, it was possible to develop an innovative pilot program which is now underway. The Intensive Outpatient Vocational Rehabilitation Program (IOVRP) was designed to provide a vocationally based program of recovery for alcoholics and other addicts as they prepare to enter or reenter the workplace.

This innovative program is a first for Pennsylvania and is being piloted in rural and economically depressed Fayette County. The intensive nature of the program is expected to have a greater impact on program participants than standard outpatient programs. The program helps participants examine holistically the complicated issues of the drug and alcohol recovery process leading to competitive employment. These include physical, emotional, and spiritual issues; family and relationship issues; and vocational issues.

The IOVRP is housed in Goodwill's shelter workshop located just outside the county seat of Uniontown's business district and is, at this point, funded by the OVR. In this structured environment, program participants follow a daily schedule that includes alcohol and other drug education, especially as it relates to their recovery and gaining employment; group therapy; individual therapy; and personal work adjustment training (PWAT).

Content/Methods

Phase I

Phase I of the IOVRP consists of several segments that constitute what is generally described as an intensive outpatient or partial hospitalization program. Each group is limited to approximately 10 members. This affords participants the amount and type of attention they need and ample opportunity for participation. The overall schedule design for the IOVRP is shown in table

Education Sessions

Although IOVRP participants are streetwise, they often operate under a certain naiveté regarding alcohol and other drugs. They also may continue to be in some denial or to lack understanding regarding the extent of the effect their usage has had on their lives. The education sessions are designed to give accurate, up-to-date information about alcohol and other drugs, addiction, and recovery issues.

Examples of lesson topics are:

• Physiological effects of alcohol and other drugs
• Genetic factors and progression of the disease of addiction
• Coping skills and stress management
• Developing support systems
• Life management skills for maintaining sobriety
• Family and relationship issues
• Communication skills

A certified prevention specialist who is employed by the Drug and Alcohol Commission conducts the education sessions in an informal classroom manner. Varying instructional and experiential techniques are used to accommodate different learning styles and ability levels. At every juncture, care is taken to include the importance of these topics and how they will come into play in the workplace.

Group Therapy

Group therapy aids participants in learning to apply the concepts taught in the education sessions to their lives. Participants also benefit from the feedback and collective wisdom of the group itself. Group is planned to allow interaction and to deal with both individual and group issues. Often there is a topic for the day that has been agreed upon by the group in advance.

Individual Therapy

Individual therapy provides individualized addiction treatment for program participantsCit gives an opportunity to deal with recovery and other issues on a more personal level, one to one with a trained drug and alcohol therapist. The therapist also works with each individual to establish personal goals that he or she hopes to achieve while in the program. These particular goals are usually in areas such as personal growth, family or relationship issues, solidifying the recovery process, or relapse prevention. A certified addictions counselor who is employed by the Drug and Alcohol Commission conducts both the group and individual therapy sessions.

Personal/Work Adjustment Training (PWAT)

Personal/Work Adjustment Training (PWAT) is where IOVRP participants spend most of their time. It is intended to provide an atmosphere where behaviors that are unacceptable or inappropriate for the workplace can be examined and modified. PWAT is also an opportunity for both social and vocational training as participants work alongside others who are having similar problems and who are working toward the same goalCemployment.

Goodwill Industries has appointed a program specialist who is responsible for the overall onsite management of the IOVRP and who facilitates the majority of the PWAT.

A Practicum Approach. As participants enter phase I of IOVRP, they are encouraged to view the program as a job. They are required to report they will be out in the event of illness or emergency just as they would if they were employed. They must also make arrangements to handle personal business, such as doctor or other appointments, in advance. Keeping a regular schedule is, in and of itself, a challenge for program participantsCsome of whom have reached their midthirties and never held a job. In their active addiction, they rarely had to be anywhere at a certain time and attendance itself is an adjustment for them. However, these are adjustments that must be made if they hope to achieve and maintain competitive employment.

In addition to preparing these recovering addicts for the responsibility of employment, common workplace policies are reviewed, highlighting such current workplace issues as sexual harassment. There are opportunities to hone new skills, such as strategies for managing stress and anger.

Because the program is located within Goodwill Industries shelter workshop and retail operation, participants have the opportunity to work at different job stations. There they can practice getting along with coworkers and supervisors, learning to follow a schedule and instructions, and coping with situations that may arise in the workplace.

Support from Staff. It is significant to understand that these opportunities occur while participants have the extra support of the program staff. Problems, questions, and concerns are thoroughly processed. Staff are careful to provide positive feedback along with noting any areas that are in need of improvement.

PWAT also provides an opportunity for program members to set personal employment goals. They develop a resumé and are helped to identify obstacles to getting or holding a job. They may need to complete a GED, renew or apply for a driver's license, make plans to purchase clothing or a car, or look for housing nearer to job opportunities. The Goodwill program specialist assists them in making these arrangements.

Group members participate in mock interviews, giving each other feedback and suggestions. Actual interviews have also been arranged during phase II.

Family Day

Based on the understanding of addiction as a family disease, a Family Day is held during the fifth week of the IOVRP's initial phase. Participants are strongly encouraged to bring an adult family member that day. An introduction and overview of the program is given, and both participants and family members have the opportunity to speak. Group members review some of the subject areas that have been covered and skills they have learned. A separate session is then held for family members during which they are encouraged to learn more about the effects of addiction on them and to learn about support groups and counseling.

Support Group Meetings

An important part of IOVRP has been the requirement that participants attend regular support group meetings. Because of Goodwill's proximity to a local recovery club, the group can attend lunchtime meetings together. Each participant is required to bring documentation of attendance at weekend support group meetings.

Staffings

Staffings are held individually with each client during the third and sixth weeks of the program. Staff from each agency are present and, along with the client, they review progress towards achievement of goals, recommend changes/improvements, and highlight strengths.

Phase II

This phase of the IOVRP includes a participant needs assessment and review of goals established during the first phase of the program. Job development, placement, job site training, and sustained job-site followup are also provided by the Goodwill program specialist and the Office of Vocational Rehabilitation (OVR).

Temporary or Supported Employment and Continuing Care

Participants continue as clients of the Drug and Alcohol Commission and are provided with continuing care groups and individual therapy on-site at the Goodwill facility for up to 4 months. After that, they may continue in therapy at the Drug and Alcohol Commission offices for as long as is therapeutically necessary.

Findings and Recommendations

The IOVRP is currently in its fifth cycle. In the first four groups, 27 participants completed the program, while 7 dropped out.

Initial Positive Results

Preliminary results are positive. Although each participant started at different points in terms of sobriety, maturity, and enthusiasm, each has achieved some measurable and/or observable growth. Several have actually flourished in the supportive environment.

Because of the ongoing assessment built into the program, we have uncovered underlying issues that may be compromising a client's recovery. In these cases, referrals for other services have been made and, in several instances, referrals to inpatient settings were indicated. This circumstance was viewed in a positive light by program staff, because clients were able to recognize the need for even more in-depth care and were able to contact needed resources (including IOVRP staff) as a result of their experience in the IOVRP.

Service Added Based on Program Experience

The continuing care groups were added at the completion of the fourth cycle. Program staff determined that some members of earlier groups floundered with only the individual counseling that was being offered during phase II. This indicates that perhaps group participants need to be "weaned" from the intensive support they receive during the initial phase of the program.

One weakness in the program was recognized as a pattern by the end of the third cycleCthat of the care of IOVRP participants as a community. Probably as a result of their similar lifestyles as addicts and their experience with support groups, most participants were familiar with group process. Add to that the element of rural and small town inhabitants often being acquainted and the amount of time spent together in IOVRP, and the result is that our new groups seem to mesh rather quickly. A mechanism was needed for the staff and participants to interact as a community.

To this end, the concept of community will be enhanced during the fifth cycle and, borrowing an idea from inpatient settings, a "community meeting" will be held weekly. This will ensure that a forum exists where participants can raise concerns, discuss problem areas, ask questions, plan, make suggestions, etc. It will also further the point that the staff work as a team, even though they represent different agencies. Staff will avoid using session time to deal with issues that are not necessarily appropriate for that setting. A mayor who can act as a spokesperson for the group will be appointed by the staff. The mayor will change periodically, with changes generally made for therapeutic reasons.

Other Lessons Learned

Because of addiction and the lifestyle they have led, most participants struggle with a lack of self-esteem and negative self-image. They often fail to recognize their strengths and skills. On several occasions, it has been near the end of phase I before staff have discovered that a participant holds a specialized job certification or license, such as plumber or forklift operator. Because such information can be important to job development, staff have learned to ask specific questions regarding this subject early on in the program. They then work with participants to identify job-related as well as personal strengths.

Staff have also recognized participants' goal setting as an area that needs improvement. Group members can set goals but cannot identify the steps necessary to achieve that goal. The addictive "I want it and I want it now" thinking mode seems to blur the vision of the step-by-step process to achievement. Oddly enough, most participants can understand and utilize a 12-Step approach in recovery, but fail to make that connection in other areas of their lives. During the fifth cycle, the staff will work with participants more closely to establish realistic goals both for career and personal life, and will assist participants in identifying the steps/process to reach these goals.

Importance of Staff

And finally, but perhaps most important to assure the success of the IOVRP, is the selection of staff. The representation and interaction of three different agencies can be a delicate matter. Fayette County, rural as it is, has achieved communication among its human services agencies that its urban counterparts can only imagine. This does not mean that all is consanguinityCbut there is an air of cooperation. Staff involved in such cooperative ventures as the IOVRP must believe that such ventures can work. A staff member who is simply going through the motions can undermine the success of the program. Insincerity is quickly recognized by group members.

Obviously, staff involved in such programs must possess better than average interpersonal and organizational skills. The best therapist may not possess the skills to iron out programmatic details that involve two other agencies. At any rate, perhaps the most important ingredient to the IOVRP's apparent success thus far is the communication that has developed among the three agencies involved. Since the program is still in its pilot year, there have been the basic startup issues to work out, in addition to the usual complications of running such a program. The staff has worked as a team, each respecting the others' areas of expertise. Participants' problem areas as well as achievements are thoroughly reviewed by all four staff membersCthis is discussed with new group members on the first day and release forms are signed.

The Record of Success

Of course, the bottom line question is, Has this program met its goals? To date, responses on participant evaluations have been positiveCmost are pleasantly surprised at the amount of recovery work they get to do. Some highlights follow:

• A participant who had maintained employment and entered IOVRP via an employee assistance program endured a difficult workplace incident with self-assurance and without relapse. (In her case, regular workplace visits by the Goodwill program specialist were substituted for the PWAT portion of the program.)
• One group member who had a college degree was hired by Goodwill and has already received a promotion.
• A participant who had completed phase I relapsed, became suicidal, and called IOVRP; staff were able to intervene.
• One participant was referred to a specialized inpatient program for sexual abuse issues and is now employed.

Overall, of the 26 persons who completed IOVRP, 12 are now in permanent jobs, 7 are in temporary employment, and 2 have entered college. To the best of our knowledge, all 21 of these are maintaining sobriety. Three of the remaining six have dropped out of the programCthe others are at various stages of being in between programs, jobs, and sobriety.

This means that over 75 percent of participants who completed or have remained in the IOVRP have achieved the stated goal of becoming employed or have moved on to further their education. Initial data indicate, therefore, that the IOVRP is a workable formula for assisting recovering addicts in maintaining sobriety and reentering the competitive employment market.

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