Revisiting the Work of William White. Behavioral Health Recovery Management: Statement of Principles

I encourage everyone to take a few minutes and carefully read this 2 1/2 page document from 2001.

I can think of no single paper Bill has been involved in that has impacted my day-to-day clinical life and activity more than the BHRM Statement of Principles. That brief document is immediately below.

I’d like to point out that there’s language in the introductory paragraph that’s critical for context and relevance. Notice it states that Behavioral Health Recovery Management is a model of intervention for severe mental illness and severe substance use disorders.

Backstory:

My workplace from the time of my graduate internship (1988-1989) to my first job (1989) after internship, through 2008, was the Human Service Center (HSC), located in Peoria, Illinois. HSC’s administration was called Fayette Companies (so-named as our administrative headquarters building was located on Fayette Street).

The BHRM project was an effort that existed inside HSC/Fayette from around 1998 – 2007.

The BHRM 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” (macro/system-level) and “Recovery Management” (mirco/individual person-level), 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 short-term and 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. 

(Bill writes about the “ah-ha” moment of deciding to study long-term trajectories of those doing well, and having that information inform treatment, in his memoir called “Recovery Rising”. Bill contrasts that approach with the long-standing method of evaluating treatment outcomes using a pre/post measure, where short-term outcomes of competing treatments can be compared. He notes that in those methods, even outcome studies of a 1 or 2 year duration are very short compared to the length of the illness and of recovery).

For the BHRM project, 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. 

Inside our agency a BHRM steering committee was formed.  The purpose of the steering committee, chaired by Mike Boyle, was to 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. Recovery Coaching was innovated and developed in our agency during this time.

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.

From the day of this document’s publication on the BHRM website onward through the lifetime of the BHRM project, we literally used the names of these principles as a checklist to help us bring needed changes into view. What does a program or service (that is doing just fine, by the way) need to change? We would run through the list of the principles by name, to help make a determination. Or we would focus group the program staff using these principles by name. And at other times we would carefully re-read the principles fully or perhaps one or two of them in particular, to help guide our change efforts in a way that is much deeper than the names on the checklist would reveal. In those years of early change effort, the checklisted names of the Principles alone would often suffice.

By the way, 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.

Unfortunately, that website is now gone. Thus, I have posted most of the practice guidelines here on Recovery Review. They are well worth scrolling through. One of the guidelines you will find there is the original recovery coach manual.

Bill’s thinking, as consolidated here in this document (the BHRM statement of principles), was then and remains now, nothing short of revolutionary on both conceptual and practical grounds.

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Related Readings

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. Addiction Recovery Management: Theory, Research and Practice. A book (John F. Kelly and William L. White, Eds.) written after the project was concluded and published in 2011. It’s the first book written on the recovery management approach to addiction treatment.