ADVERTISEMENT
Save our staff
During this time period it is crucial that we cultivate all good help we can get. We cannot afford to blindly accept changes to credentialing standards that one day might threaten the careers of our most valuable employees. These include the dedicated men and women who traditionally staffed our facilities when nobody else would: entry-level employees lacking the college degrees many states are beginning to designate as prerequisites to certification.
Included among this group are recovering addicts and trauma victims who entered the field for deeply personal reasons. When our industry goes into a tailspin from staff shortages, it is often these individuals who feel invested enough to remain on board. In order to ensure the longevity of addictions counseling, we must pave the way for these individuals to gain credentials and enter into the college system.
We recently were fortunate to participate in an on-site workplace-based training and educational program called Jobs to Careers (J2C) that allowed us to help these employees remain on the radar. The three-year program was funded by a grant from the Robert Wood Johnson Foundation and the Hitachi Foundation, and provided 17 of our front-line workers with classroom training, college credits and career counseling. The program exceeded all of our expectations. It helped provide our employees with a leg up to attain certification and pursue higher degrees in the future, as well as the knowledge they needed to thrive in the workplace now.
Perhaps just as importantly, the program helped our administration to understand who our most important employees were, and some of the obstacles to pursuing higher education that they faced. We learned why our attempts to institute previous training programs failed, and ways we could hone more successful programs bridging the gap between work and education in the future.
Though the grant has officially ended, we regularly use the lessons we learned through the program to collaborate with our staff. Participants attained higher positions, including supervisory roles, in the many divisions of our outpatient facility. They have been responsible for developing new programs to serve clients better. We have presented this program as a model for other organizations in our region to use, and at conferences that have included a United Nations Masterclass in Russia and a NIATx summit in Florida.
Dedicated employees
At SSTAR we always have had a large contingency of dedicated people who entered the profession simply because they wanted to help. One woman with addictions first decided she wanted to become a counselor while in a jail cell for charges related to her opiate addiction. Another, after remaining silent for close to two decades about a brutal gang rape she was the victim of while she was pregnant, was inspired to help others tell their stories in order to heal from traumas. By the time each of these individuals walked through the door to interview for positions at SSTAR, they knew exactly what they wanted to do.
Our administration did not always realize that our front-line employees were so motivated.
“I think that when you have gotten to that place in your life and you are living in a dark place like that, once you make that decision, if you are motivated, there is no stopping you or what you are capable of,” says Dawn Cantara, an SSTAR clinical supervisor and a recovering addict.
Will alone does not always ensure that one finds one's way, however. SSTAR was the first agency in our region to establish an inpatient alcohol and drug detoxification unit, and the first to open an HIV/AIDS walk-in clinic. We were able to hire entry-level staff, from milieu therapists to administrative and intake assistants, for our diverse programs.
Whenever possible, we offered trainings for these employees. Likewise, supervisors have always had substantial training roles. However, many of the entry-level employees in our facilities learned to perform aspects of their jobs largely through trial and error. Without advanced knowledge, they struggled to treat clients.
Employees, particularly those who suffered from trauma, often had a tough time establishing clear boundaries between themselves and clients. They did not always understand the true nature of clients' diseases. Accordingly, turnover rates remained high.
Just as these counselors did not always understand what to do to help clients, we did not always understand what to do to help them. Our administration did not always realize that our front-line employees were so motivated. After failing to convince them to get the education and training necessary for Certified Alcohol and Drug Addictions Counselor (CADAC) or Certified Addictions Counselor (CAC) certification in Massachusetts, we made incorrect assumptions. We believed that they were not interested, or that their commitment to the profession was fleeting. We became frustrated, watching them struggle in the same positions, burn out, and then leave.
Obstacles
SSTAR brought J2C on line largely to help get our counselors certified. We were able to offer staff the 270 hours of coursework they needed to attain CAC and CADAC certifications through a collaboration with Bristol Community College and the Trundy Institute for Addictions Counseling.
When these courses were offered on-site at SSTAR and our workers began to sign up, we realized some of the obvious reasons they had not previously pursued certification. These courses were heavily subsidized, alleviating financial concerns for employees. The courses were offered on-site in our conference center and became an extension of employees' workday, helping them logistically in allowing them to juggle parenting, work and school successfully.
As the courses progressed, the participants began to reveal less obvious reasons employees had ignored our pleas to get certified. Problems ranged from many not having entered a classroom for decades to many suffering past traumas that had riddled their self-esteem. Participants had not previously gone back to school because they didn't believe they could do it. Perhaps just as importantly, nobody wanted to do it alone.
What worked
We deliberately created a sensitive, supportive environment for our students. Courses were offered at our on-site conference room and were taught jointly by professionals from all three institutions. For many, this was a significantly less threatening environment than an unfamiliar classroom on a college campus.
The support of the group helped to provide many of the women with the “kick” they needed to go back to school. Gail Fernandes, a 48-year-old grandmother, had left high school during her senior year. She had spent decades working in the office of one of our city's textile mills-an industry that once sustained the city's population-prior to working at SSTAR. Though she had dreams of becoming a counselor, she never really believed she would go back to school. The influence of the group helped her decide to join and kept her going.
“Because we were together so much, we got to know each other a lot,” says Fernandes. “We worked together, studied together, ate together. We were all going through the same thing, and so we formed bonds. I am not sure we would have all made it through without the support of each other.”
Interacting with colleagues who were in different departments, and in separate buildings, helped these employees to function more collaboratively in their daily work as well.
In addition, participants were required to keep a daily journal of their experiences both at the workplace and at school. The journal allowed them to process what they were learning, and to pinpoint some of the problems they had faced in the workplace in the past. They shared these journals with their supervisors every week. This also helped inform our administration about what skill sets we needed to reinforce in both settings.
Counseling people suffering from addictions can be brutal to anyone entering the field. Dangers of countertransference, sublimation, or susceptibility to relapse are higher for recovering addicts or others who have experienced trauma.2
“We worked together, studied together, ate together. We were all going through the same thing, and so we formed bonds. I am not sure we would have all made it through without the support of each other.”
The journals allowed staff to admit problems they had in establishing boundaries between themselves and clients, and helped them develop new techniques to learn how to do so. Accordingly, staff admitted less resentment toward clients, and felt less frustrated at their jobs.
The coursework that participants were provided with included basic parapsychology, dual diagnosis, family dynamics, and individual and group therapy. This allowed students to gain a comprehensive set of tools necessary to perform their jobs. Participants were able to get past the tunnel vision they had toward clients in the past, simply by learning about the disease of addiction and mental illness. Problems they had dismissed as behavioral in the past were now recognized as mental illness.
Professors brought real-life experiences of clients into the group. Examples of clients with concurrent disorders were brought into class. This helped to empower staff to treat clients. Perhaps more importantly, it helped them to understand their clients, and to take better care of themselves.
“I can say with all honesty there is no way I would have stayed at SSTAR without this training,” says counselor Laura Washington. “That is why there is such a high turnover here. Without the education you don't understand why clients are the way they are and you take things personally. You don't understand mental illness. You can't rationally detach from a situation because you don't understand what's going on.”
For Cantara, who had always appreciated the challenge of working with dual diagnosis clients, her classroom training allowed her to draw on a whole new set of resources and really delve into her work. Previously, she admitted, the combination of guesswork and instinct she relied on to treat clients was limited. The coursework helped her become more passionate in her career. Cantara completed her master's degree in psychology in May 2010 at the University of Phoenix.
A hybrid course developed by front-line workers, SSTAR supervisors and Bristol Community College professionals called “Changing Substance Abuse Behaviors Through the Group Process” was particularly inspiring to many participants. The course was offered both online and one day per week at the facility. Through discussion of the online work and role play, participants honed the skills needed to run groups. We hoped this course would help reduce the number of clients who leave the facility AMA, before completing detox.
Results
By the end of the program, 19 of our employees obtained their CAC and/or CADAC certificates. Many who were now eligible to bill our insurance companies for outpatient work moved to new positions, including supervisory positions at SSTAR.
The CAC certification was transferred directly into 15 college credits at Bristol Community College. This, combined with the confidence employees gained in their ability to do college-level work through the program, helped participants believe they were capable of pursuing higher education. Thirteen participants transferred directly into Bristol Community College, and others pursued associate's, bachelor's and master's degrees at other institutions.
Our administration is confident that in the future many of these participants will go on to obtain the master's-level clinician, social work, psychology and nursing positions we will continue to need filled.
Conclusion
The National Institute on Drug Abuse (NIDA) estimates that there were 25.6 million people over age 12 requiring treatment for drug or alcohol problems in 2008. The number of people suffering from these problems tends to escalate in a poor economy, and is not likely to be reduced anytime soon. At the same time there is a severe shortage of certified addiction professionals throughout the country.
New credentialing standards being drafted in some states to require counselors to obtain bachelor's degrees prior to certification do little to ease this shortage. New students are more likely to be drawn to better-paying, less stressful disciplines in the counseling field. Likewise, these abrupt changes could devastate our most committed and passionate employees before they have a chance to build their careers.
We must acknowledge barriers that could prevent these employees from pursuing higher education independently, and we must proactively seek out alternative programs such as 2JC that provide them with the resources they need to thrive in the classroom and the workplace.
Nancy Paull is the CEO of Stanley Street Treatment and Resources (SSTAR), a nonprofit health and social services agency based in Fall River, Massachusetts. She has been with the agency since 1977 and has pioneered cutting-edge programs in addiction treatment. Her email address is npaull@sstar.org. Danielle Wolffe is SSTAR's Communications Specialist, working on a federal grant to provide treatment services to people in long-term unemployment due to the current economy.References
- Bureau of Labor Statistics.
- O'Mara EM. A counselor's own ‘treatment plan.’ Addiction Professional 2006; 4:35-9.
