Program Background

The Mental Health Association of Southeastern Pennsylvania, along with other consumers, advocates, family groups, treatment providers, and government officials was instrumental in working toward the closing of Philadelphia State Hospital. Additionally, these groups were successful in lobbying the State of Pennsylvania to transfer $60 million from that closure to the city to develop new community-based services for people with severe mental illness. Ongoing needs assessments conducted with individuals residing in the hospital during the closing in 1989, revealed that a large number of people struggled with co-occurring disorders (mental illness and substance use disorders). The Friends Connection program was developed in the context of this recognition of the need for more creative and effective solutions for the treatment and support of people with co-occurring disorders.

The Friends Connection was adapted from a small program in Ohio known as OASIS. The OASIS program was geared specifically for African-American males who were struggling with both mental illness and addictions yet wanted to live fuller, addiction-free lives in their community. The program paired one recovering staff person, who acted as a role model and mentor, with one program participant.

The Friends Connection program was designed to bridge the gap between mental health and substance abuse services. Historically, individuals with mental illness and substance use disorders (co-occurring disorders) had difficulty seeking and accessing effective treatment interventions. Having to deal with two different systems (the mental health system and the addiction treatment system) people were often bounced back and forth between the two with little success of getting services in either system. Neither system knew how to treat people with both issues simultaneously and the notion of integrated treatment for co-occurring disorders was not fully conceptualized. For more information, read Treatment Approaches for the Dually Diagnosed.

Providing positive role modeling and one-to-one peer support counseling, program staff not only "talk the talk," but they "walk the walk" with individuals as they begin their journey to recovery. Recognizing that recovery is a long-term process and that individuals often need long-term support, the Friends Connection is designed as a multi-level program. The Friends Connection has adopted a stage-wise treatment perspective that has been adapted from Prochaska and DiClemente's Stages of Change theory. While there are variations on the exact stages in the literature, at a minimum the stages include:

1. engagement, the development of a trusting relationship;
2. persuasion, helping the engaged consumer develop the motivation to actively pursue goal specific, abstinence oriented treatment;
3. active treatment, helping the motivated consumer develop the necessary skills and supports to attain desired treatment goals related to both mental health stability and substance use reduction/abstinence; and
4. relapse prevention, helping the consumer maintain treatment gains and avoid relapse.

Consumers progress through the Friends Connection program at their own pace and according to the individual goals that they themselves set. Peer Support Counselors, in careful cooperation with their supervisor, help guide each consumer through the levels of recovery, social support, and recreation/leisure skill development that are outlined below.

The following outline suggests some of the kinds of activities that would be appropriate at the different levels and stages of treatment. Peer Support Counselors work closely with their supervisor and their program participant to creatively plan individual and group interventions to facilitate skill development and retention across the three levels described below.

Level 1: Engagement and Development of Rapport (Engagement/Persuasion Stages)

Development of rapport and relationship building between Peer Support Counselor (PSC) and Program Participant (PP).

1. focus on one-to-one interactions between PSC and PP.
2. focus on relationship building and identification of PP recreation preferences.
3. focus on participation in recreational preferences of PP.
4. focus on identification of PP's recovery supports.
5. focus on identification of recovery supports in PP's community (e.g., 12 Step meetings).
6. focus on participation in recovery support related activities (attendance at 12 Step meetings).
7. focus on expansion of recreation options for PP (encouragement to try new things!).
8. focus on expansion of recovery support options for PP.
9. focus on weekly scheduled Friends Connection group activities (e.g., bowling, billiards, etc.).

Level 2: Recovery and Socialization Skill Development (Active Treatment/Relapse Prevention Stages)

Expansion of recovery support network, continued development of social skills and leisure skills through participation in Friends Connection group activities.

1. focus on the development of peer relationships with other PPs.
2. beginning focus on independent accessing of recovery supports.
3. focus on PP participating in group activities planned by PSC with other PSCs.
4. focus on PP involvement in group activities planning and implementation.
5. continued participation in the Friends Connection group activities.

Level 3: Discharge Transition (Relapse Prevention Stage)

1. focus on PP participating in recovery support and recreational activities more independently.
2. focus on the gradual decrease in face-to-face contact between PSC and PP.
3. focus on PP attending Friends Connection group activities independently.
4. focus onPSC providing phone reminders to PP but not accompanying PP to Friends Connections activities (PSC meeting PP at activities or PSC not attending at all).
5. focus on introduction of PP to Alumni program.

The Friends Connection is committed to the philosophy that people with mental illness and substance abuse issues can recover and minimize the negative impact of the illness on their lives. Further, we believe that recovery is enhanced when people are actively engaged in decisions regarding their own rehabilitation activities. We operate on the premise that respect, engagement, relationship, skill development, and on-going support are the keys to the beginning of, and for long-term recovery from addiction and mental illness.

The Friends Connection focuses on (but is not limited to) two critical areas of skill development and support development for individuals with co-occurring disorders:

1. the development of social skills and community-based social supports, and
2. the development of recovery skills and community-based recovery supports.

The development of proficiency in these areas is crucial to the maintenance of psychiatric and residential stability for individuals with co-occurring disorders. After engagement and motivational strategies have been successful in moving the consumer to the "active treatment" stage, consumers develop psychiatric rehabilitation plans that address the skill development in the following areas: instrumental skills, social-emotional skills, and recovery skills. Providing the necessary support to accomplish these tasks, the education necessary to acquire these skills, and the role modeling and in-vivo practice to solidify and maintain the skill acquisition all serves to reduce the vulnerability to psychiatric and substance relapse.

Instrumental skills are those skills that will enable the consumer to meet basic needs (e.g., food, clothing, shelter, self-maintenance). Depending on the functional ability of the individual these skill building rehabilitation plans will focus on (the list below suggests examples and is not meant to be all inclusive):

• Activities of Daily Living
• Community Living Skills
• Money Management and Budgeting
• Medication Adherence
• Travel/Community Orientation
• Self-Monitoring
• Problem Solving

Social-emotional skills help to provide a sense of belonging to a group or community, well-being, and family/friendship. Depending on the functional ability of the individual these skill building rehabilitation plans will focus on (the list below suggests examples and is not meant to be all inclusive):

• Conversation Skills
• Conflict Management
• Problem Solving
• Assertiveness
• Recreation/Leisure Development
• Community Recreation Resources
• Travel/Community Orientation
• Developing Friendships

Recovery skills help to provide the cognitive and behavioral resources necessary to maintain psychiatric stability and substance reduction/abstinence. Depending on the functional ability of the individual these skill building rehabilitation plans will focus on (the list below suggests examples and is not meant to be all inclusive):

• Utilizing Recovery Community Resources (12 Step Fellowships)
• Finding a "Home Group"
• Finding a Sponsor
• Say "no" to Offers to Use Drugs/Alcohol
• Relapse Prevention
• Medication Adherence
• Symptom Management
• Problem Solving
• Conflict Resolution
• Self-Monitoring
• Identification of Relapse Triggers
• Mental Health Education
• Drug/Alcohol Education