It’s an interesting challenge: What makes some programs become long-term successes while other don’t?
Short answer: Adequate resources, a focus on quality, and patience.
Naturally, I see things from the perspective of someone who over the years has helped found eight programs of various sizes and shapes from the ground up, and has been involved in the reconstruction (or resurrection) of many, many others. What do I need?
- Enough money, of course, to hire the right people;
- The ability to concentrate on providing quality services; and
- The willingness to wait on success while the program finds its way to its own unique character (which is a test of those resources).
Regardless of program level and structure (and demand keeps changing, based on a changing market) these are the tools that build a successful program. Which is not to say changing market demands don’t affect us. Take residential programs, for example.
We’re in the midst of a boom in residential substance abuse treatment. It seems to go in cycles. When managed care hit big in the 1980’s, most observers predicted the eventual end of residential rehab for addicts and alcoholics— to be replaced by an outpatient clinic in every neighborhood (possibly next to the bar). Instead, a whole new group of inpatient programs emerged, this time depending on private pay rather than insurance companies.
Gradually, aided by acceptance of the ASAM placement criteria, those same insurance companies liberalized restrictions on inpatient stays, leading to improved access for the working family. At the same time, groups like Oxford House pioneered a movement to bring recovery homes and transitional living into areas that had long succeeded in keeping them out. In a few states, the prevailing model has become intensive outpatient programming with supplemental housing – yet another workaround.
There’s always a need for residential services for some people with substance problems. Not all, but many. It’s up to us to figure out how best to provide it.
Where Not to Cut Costs
A critical lesson I learned along the way, on a variety of projects, in a range of extremely diverse settings: Addiction treatment, like any healthcare venture, depends on the public’s trust. Lose the community’s confidence in our ability to provide a safe, secure environment for their loved ones, and it’s over. Doesn’t much matter how profitable a particular business might be— once the community loses faith in a provider, it won’t be long before they’re writing its organizational epitaph.
Statistics count, but perhaps not as much to Jane Q Customer as our ability to prevent that one highly publicized incident from which the program simply can’t recover. That’s directly related to the number and quality of our staff. It may seem tempting during hard financial times, but never reduce staffing to the point where safety or security are compromised.
Doesn’t matter how much it costs. You can’t afford the alternative.