The Behavioral Health Recovery Management (BHRM) Project: Overview and Practice Guidelines

In the coming days I’ll be posting some of the practice guidelines that were developed during the Behavioral Health Recovery Management (BHRM) project.  The guidelines were developed with public dollars for free dissemination to the public.   

The BHRM project was an effort that existed inside my workplace from around 1998 – 2007. 

Concerning the project itself, I’ve carefully chosen four resources that explain what it was, its history, and encapsulate some of its results.  Those resources are found in the four links that follow:

1. Tribute to a Recovery Management Pioneer. A short read that will give you a good idea of what the project was all about.
2. Frontline Implementation of Recovery Management Principles: Interview with Michael Boyle. A long but interesting read that is a deep dive into the project purpose, implementation, and lessons learned.
3. Behavioral Health Recovery Management: A Statement of Principles. A brief piece with a very condensed list of principles. This document was like a sourdough starter or packet of seeds for sparking innovation and guiding change during the project. If you read nothing else, read this.
4. Addiction Recovery Management: Theory, Research and Practice. A book written after the project was concluded and published in 2011. It’s the first book written on the recovery management approach to addiction treatment.

The guidelines I’m going to post are the original documents written for public dissemination and created during the project’s lifespan.  Since the BHRM website was taken down some years ago, it’s always seemed to me it would be good to find a way to make these accessible again.  More intrepid users of the internet with time to spare can find the guidelines using the Internet Archive Wayback Machine.  But I’ve decided to post them here on Recovery Review, figuring someone might appreciate having access to them in this location. 

If you would like to, you can skip the material below and scroll down to the bottom where I list the practice guidelines that I plan to post here on Recovery Review in the coming days.

For those that might be interested, here’s a more detailed overview of the project and my involvement in it.

My initial clinical workplace from the time of my clinical internship in 1988 onward into 2008 (The Human Service Center/White Oaks/Fayette Companies) in Peoria, Illinois, was the community agency within which the Behavioral Health Recovery Management (BHRM) project was begun and operated.  The BHRM project’s lifespan was around 1998-2007.

The project was the living clinical laboratory where the principles and practices of recovery orientation for clinical services, recovery coaching, and approaches that later came to be known as “Recovery-Oriented Systems of Care” and “Recovery Management” were innovated and developed.  The four members of the think-tank that led the innovation of this project were our CEO Michael “Mike” Boyle, one of our PhD psychologists David Loveland, William “Bill” White (the trainer, historian and more) from the Lighthouse Institute (the training and research division inside Chestnut Health Systems in Bloomington, IL), and Patrick “Pat” Corrigan from the University of Chicago’s Center for Psychiatric Rehabilitation.

The aim of the BHRM project was to innovate across substance use and mental health sectors by applying disease management models (rather than acute models), develop and apply recovery management principles (rather than merely pathology focused perspectives), and develop methods for service integration including primary health for those populations.  To do so, public funding was secured for identification of national experts in best practices and promising practices and contracting those experts in: authorship of clinical practice guidelines for the organization: provision of training within the organization; on-going consultation in implementation of their protocols in a multi-year state-funded effort within that organization: and for the guidelines to be distributed for free public-access out to the field. 

The storehouse of papers summarizing these principles and change strategies, practice guidelines, historical materials, and more was the BHRM.org website built for the project and launched on 09/10/2001.  It served as an informational hub and way of disseminating these materials to the public.

Inside our agency a BHRM steering committee was formed.  The purpose of the steering committee, chaired by Mike Boyle, was to steer and guide implementation of the BHRM principles and practices, and real-world clinical implementation within our agency of the practice guidelines as they were developed by various national authors over the years.  I should note we had dozens of programs – some serving primary MH patients, and others serving primary SUD patients, in a vast array of residential, outpatient, and community-based services.  Thus, some of the guidelines applied more to some programs than to others.

The steering committee expanded and sharpened its focus when our agency was chosen to participate in the Network for the Improvement of Addiction Treatment (NIATx) at the start of Round 2 in the Robert Wood Johnson Foundation-funded portion of NIATx’s history.  The area of knowledge and skill provided by our involvement in NIATx – specifically “change management” at the program and organizational levels – was immensely helpful for our steering committee in leading change inside our agency.

Throughout its 10-year lifespan (roughly 1998 – 2007) the BHRM steering committee led change in the area of co-occurring SUD and MH disorders by taking responsibility for initial clinical fidelity at the clinician, program and organizational levels based on the guideline, related protocols and consultation by some of the authors, ongoing clinical supervision and sustainability of fidelity in those practices, continuous quality improvement of service delivery, and a focus on change management integrating those clinical practices with BHRM principles and NIATx change methods in the dozens of programs across the organization.

I served on the BHRM implementation steering committee for the entire 10-year lifespan of the BHRM project.  Our steering committee met every other Friday for the entire ten years, in an open-ended framework that averaged around 2.5hrs for each meeting.  We were detailed, careful, and decisive in our planning and leadership of change management. We centered our focus on matters of fidelity to protocols, clinical supervision, customer-centered policy and procedure development (even including organizational-level HR and administrative matters) and mentoring by several of the authors of the guidelines for those inside our agency – especially on leadership, clinical supervision, and train-the-trainer content that helped ensure sustainability of change.  Suffice it to say I learned a tremendous amount during the lifespan of that project and remain very grateful for it.

My plan is to at least post the following documents from the Project:

1. The Behavioral Health Recovery Management Project.  Project Summary and Concept.  Michael Boyle, William White, David Loveland, Mark Godley, Patrick Corrigan & Russell Hagan.
2. What is Behavioral Health Recovery Management?  A Brief Primer.  William White, Michael Boyle, David Loveland & Patrick Corrigan.
3. A Clinician’s Guide for Implementing Contingency Management Programs.  Nancy Petry.
4. Assertive Community Treatment for People with Serious Mental Illness:  Gary Bond
5. Behavioral Couples Therapy for Alcoholism and Drug Abuse.  Timothy O’Farrell.
6. Best Practice Guidelines for Behavioral Interventions.  Patricia Bach & Stanley McCracken.
7. Best Practice Guidelines for Cognitive Rehabilitation for People With Serious Mental Illness:  Myla Browne, Jason Peer & Will Spaulding
8. Best Practice Guidelines for Consumer-Delivered Services.  Mark Salzer.
9. Clinical Guidelines for Implementing Relapse Prevention Therapy.  G. Alan Marlatt, George Parks & Katie Witkiewitz.
10. Cognitive-Behavior Therapy for Substance Dependence:  Coping Skills Training.  Ronald Kadden.
11. The Community Reinforcement Approach.  Robert Meyers & Daniel Squires.
12. Comprehensive Continuous Integrated System of Care.  Psychopharmacology Practice Guidelines for Individuals with Co-Occurring Psychiatric and Substance Use Disorders (COD).  Kenneth Minkoff.
13. Family Services for Severe Mental Illness.  Kim Mueser.
14. Guidelines for Linking Addiction Treatment with Primary Healthcare.  Michael Boyle & Thomas Murphy.
15. Illness Self-Management Strategies.  Patrick Corrigan.
16. The Impact of Stigma on Service Access and Participation:  Amy Watson & Patrick Corrigan
17. Implementing Seeking Safety therapy for PTSD and substance abuse:  Clinical Guidelines.  Lisa Najavits.
18. Manual for Recovery Coaching and Personal Recovery Plan Development.  David Loveland & Michael Boyle.
19. The Matrix Model of Intensive Outpatient Treatment.  Richard Rawson & Michael McCann.
20. Motivational Enhancement for Dually Diagnosed Consumers.  Daniel Squires & Theresa Moyers.
21. Provision of Protective Payee Status.  Daniel Luchins, David Roberts & Patricia Hanrahan.
22. The Recovery Perspective and Evidence-Based Practice for People with Serious Mental Illness: Ruth Ralph, David Lambert & Kathryn Kidder
23. Service Planning Guidelines:  Co-Occurring Psychiatric and Substance Disorders. Kenneth Minkoff.
24. Social Skills Training:  Paul Liberman & Tracey Martin
25. Supported Employment for People with Serious Mental Illness.  Deborah Becker & Robert Drake.

After the first two papers (for the main group of practice guidelines), I’ll probably post one in the morning, one around noon, and one in the early evening each day until they are all out.

Thanks to Jason Schwartz for sending me some of the guidelines I didn’t have in my personal collection, and for teaching me how to use the Wayback Machine.

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10/05/23 update:

Jason Schwartz was kind enough to build a “Special Series” navigator for easy retrieval of the BHRM practice guidelines. When you scroll down on the right hand side of any Recovery Review page, you will see a list titled “Special Series”. If you click on the phrase “Behavioral Health Recovery Management”, all the BHRM guidelines will come up in one easy location. Also, if you’re here reading this, you can click here and the list of guidelines will appear.