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  • David Best, Ph.D.

Accessing and generating community capital: The role of residential treatment services

Introduction

In the last few weeks, I have been asked twice to reflect on accessing and generating community capital in the context of residential treatment. The first time was for the European Federation of Therapeutic Communities (EFTC) conference in Glasgow and the second time was for a partnership project on REC-CAP with a residential treatment facility in the southwest of England called the Nelson Trust. I am also honoured to be a part of the Scottish Government Residential Rehabilitation Working Group, chaired by the fabulous Dr David McCartney of the Lothians and Edinburgh Abstinence Project (LEAP). More about the Nelson Trust shortly, but I wanted to start with a couple of basic premises about residential treatment:


- In spite of growing scepticism among some academics and commissioners, the evidence would suggest a clear role for residential treatment and that it is an essential option in any comprehensive recovery-oriented system of care

- However, residential rehabs have often not maximised the gains they could achieve by not focusing enough on the concept of throughcare, in particular, what happens to people after they leave rehab

- Linked to this, there is a problem that often arises in the third and final residential stage of ‘emergence’ in residential programmes where there is some level of community engagement but it is not always linked to what comes next


Social capital and recovery capital

There is a wonderful book on social capital by Robert Putnam called ‘Bowling Alone’ which differentiates between bonding capital (the strength of associations in established and equal groups) and bridging and linking capital (which is about connections to new and different groups, that are both equivalent and different.


In my own work on recovery capital ‘ ‘Desistance and recovery capital: The role of the social contagion of hope’ , published in 2019, I argued that the way to build personal recovery capital (over the course of the recovery journey) is to generate social and community capital that creates the space for people to belong to new groups, learn new roles and rules and access the resources and activities that can generate hope and the belief that recovery is possible and realistic.


What I would now add to that, based on a paper called ‘Ice Cream and Ink Spots’ that I wrote with Jo-Hanna Ivers in 2021, is that the process starts with access to community capital (i.e. new groups in the community) that can generate (directly or indirectly) social networks and supports (social capital) that then allows the individual the time and space to build their own resilience, coping skills and the resulting self-esteem and self-efficacy that are at the heart of sustainable personal recovery capital.


So the conceptual starting point in creating a framework for recovery to happen is to build bridges to pro-social groups and activities. There are three types of community recovery capital:


1. Professional resources – for some people this will mean counselling and psychotherapy to address trauma, for others access to the dentist or primary care physician, as well as to mental health, housing and employment services

2. Recovery resources – this includes mutual aid groups like Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery (both face to face and online) as well as what are referred to in the US as RCOs (Recovery Community Organisations) and in the UK as LEROs (Lived Experience Recovery Organisations). This category will also include accessible, attractive and visible recovery champions and leaders

3. General community resources – which includes things like libraries, colleges and community centres, as well as the more local specific resources like clubs and associations (yoga classes, football teams, churches, environmental groups and so on).


Different people will need different combinations of these things and each person will need different combinations at different stages of their journeys, so diversity and richness in all three categories are essential.


What they do is to provide the two central pillars of recovery – meaningful activities and positive social networks. Each one affords the opportunity for positive human connection, new senses of belonging and identity and a sense of empowerment and purpose.


Nelson Trust: So what does this have to do with residential treatment?

Like many residential services, the Nelson Trust, who have a wonderful mission of helping residents to build recovery capital in a trauma-informed way, have developed a third stage of residential treatment that is built around their Recovery Hub, an activity centre that supports residents to engage in volunteering, community engagement and to give residents the resources they need for the next stage of their recovery journey.


The staff (the vast majority of whom are in their own recovery journey) have made huge endeavours to build diverse and interwoven connections into the local community that provides a wonderful continuity and set of supports for people who resettle into one of the recovery houses that are linked to the residential treatment facility. Their locations in Gloucestershire, Stroud and Gloucester, have become strongholds of recovery and there are vibrant recovery community capital resources and links to both the professional community and the local lived communities.


Furthermore, the Nelson Trust has also committed to implementing the REC-CAP as a commitment to the science of recovery and continuing to monitor their residents even after they have left the residences and returned to the community.


This is a crucial transition for a recovery residence moving from being a ‘house on the hill’ to a contributing and positive force and resource in the local community, challenging stigma and building bridges and links to the local community. These bridges provide the basis for building sustainable community recovery capital, and making it easier for each subsequent generation of residents to access community resources, supported by graduates of the programme already engaged and by community groups who acknowledge that the relationship is mutually beneficial.


What is the flaw in this plan?

But here is the rub for the Nelson Trust and for every other residential treatment provider. This is a great system for residents who are able and willing to permanently relocate to Gloucestershire, but not so good for those who, as a result of family commitments, and other personal reasons, have to return to other parts of the country, where the Nelson Trust (and all of the other rehabs) have limited ability to generate or even to corral recovery resources.


As the world of LEROs (and RCOs) grows in the UK and US, there may be growing opportunities for partnerships where residential treatments link to the LERO in the area that the resident returns to, but at present this is patchy.


Similarly, for some people, online resources may provide at least a partial solution to this challenge as would recovery management check-ups provided by the residential facility.


However, the challenge remains that for many people the departure from a residential rehab, is one from high social recovery capital (within the rehab) to low or negative social capital (particularly if returning to areas where most of the available network involves people who are still using). This is a problem not only for the providers of residential treatment but especially for those commissioners who allocate funding for distal placements.


Regardless of the effectiveness of the particular rehab, the impact on recovery capital will be contingent on a continuity of access to community recovery capital.


In conclusion, there are three (measurable) conditions for testing the likely benefits of referring people to residential treatment away from their home areas:


1. Only commissioning residential treatment providers who have a strategy for engaging community capital in their later stages of treatment

2. Building effective bridges from the recovery residence to local community recovery resources for those returning

3. Having an adequate set of recovery resources available and accessible in your area to sustain and further build the recovery capital gains achieved in residential treatment

391 views6 comments

6 תגובות


Andi Brierley
Andi Brierley
12 באוק׳ 2022

Wonderful and insightful piece that applies to both recovery and desistance from crime. Any institutional intervention that provides the opportunity for humans to grow and move away from problematic behaviours such as addiction and crime should never be short term or fragmented into disjointed phases.


Ensuring there is an accepting non-judgemental network of relationships that construct both community and social capital on the receiving end of both residential treatments, and as literature indicates resettlement from custody is fundamental to developing the identity shift required for both long term recovery and tertiary desistance.


The planning for release should take place upon entry and the transition should 'always' involve lived communities as the road to success is then both visual and achievable…

לייק
חבר/ה לא ידוע/ה
12 באוק׳ 2022
בתשובה לפוסט של

Thanks very much Andi - really appreciate the comment and feedback. What you are suggesting is something that i found very much about people who worked in the addictions field who were in long-term recovery that i reported in my 2014 book "Strength, Support, Setbacks and Solutions: The developmental pathway to addiction recovery" - most of them had time away in rehab followed by at least 2-3 years in the fellowships. In other words, time to build personal and social capital and then time to apply that back in the communities. And i do feel that residential rehab achieves poorer outcomes than it should because this continuity is more afterthought than aftercare!

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marina
12 באוק׳ 2022

Great to read this insightful piece. Residential Rehab is such a great opportunity for people to rebuild their lives, it's always a shame (and a relapse risk) when people aren't able to find a recovery community back in their hometown, potentially reducing their recovery capital. It is a missed opportunity when commissioners think only in the short term and don't plan for aftercare in the longer term. If commissioners fund distal residential placements, they could take the opportunity to think systemically and link those placements to their local recovery resources and organisations through additional investment.

לייק
חבר/ה לא ידוע/ה
12 באוק׳ 2022
בתשובה לפוסט של

Thanks Marina - as you know, one of the huge challenges for rehabs is not only building community capital in their local areas but also reaching out to the area of origin, and we need to do so much better to provide continuity - and i hope this article starts to raise both commissioners' awarenesss and the recognition that rehab outcomes are partly dependent on how effectively this is done.

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Jonathan Townshend
Jonathan Townshend
11 באוק׳ 2022

There’s some great insight and wisdom in here David.


The notion that different people need different things of varying intensity during their journey is clear. For people who benefit from residential rehab as an option, we have to do more to create the best chances for success in the community (especially as you say when people relocate to an area away from their residential treatment and support.


Linked to they I agree, making access to community resources (and community in general is something that we as a society need to work at; it’s the glue that holds things together and it’s the space where everyone spends their time.


Finally, your thoughts on how LERO’s might support sustained recovery in th…


לייק
חבר/ה לא ידוע/ה
12 באוק׳ 2022
בתשובה לפוסט של

Thanks very much Jon for your kind comments


i agree that we should always try to link people to the rehab (or other treatment option) that seems right to them and appears to best meet their needs. However a big part of that - for rehab providers and for commissioners - is working out continuity plans both for those who stay to completion and for those who drop out early. Relocating may be very tempting but should not be for everyone and we need to create the conditions that people can leave rehab as 'carriers' of the contagion of recovery and this requires the commissioning area to have clear and assertive (presumably peer-led) ways of sustaining and building the undoubted…


לייק
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