Archways' Threads

Narrator 00:02
Welcome to Archways Threads, a show focusing on the threads of family and recovery support services that help make up the tapestry of life in recovery. Join us as we share stories from peers and participants in the field and practice of peer recovery support and family support and strengthening. And now your host, Archway CEO Michelle Lennon.

Michelle Lennon 00:28
Hi, everyone, and welcome back to Archways Threads, the podcast where we explore topics of interest to peer recovery support workers and family support specialists. If you missed our first episode, please go back and watch it before you watch the second episode. We had the privilege of sitting with Cheryle Pacapelli, the Project Director of the recovery centers throughout the state of New Hampshire. She's very well known as a trainer, and shares some of her insights on what has gone on in New Hampshire in the past 10 years or so that she has been involved in the peer recovery support movement here in New Hampshire. And we continue our conversation! Thank you.

Michelle Lennon 01:12
But some of the most generous and kind--I mean, don't get me wrong--people were jerks before they use, people can be jerks after they stop using, too, right? But some of the most profound impacts of generosity in my life have come from the recovery community. I think of Dean LeMire; we lost him a couple years ago. And I think to this day, it still rocks me to my core to think about it. I have to make sure I am putting my emotions on a shelf when I talk about Dean because I can get overwhelmed by that grief again. But he was another one who really spent some time supporting our organization and going through an accreditation process that we found miserable to go through at the time. But I think that's another area of a lack of knowledge that people have: Just how much we do go through with standards of excellence as recovery centers and as peers. And I think that's another place where people don't have a lot of understanding about how much education. I think of the peers that work at our centers: We have somebody with a Doctorate in education and communication, we have somebody with a Master's degree in family support work, and we have somebody doing a Master's degree in clinical social work, and we have numerous people with Associate's degrees that work for us and Bachelor's degree in psychology and all that. There's this understanding that peers haven't done education, or they're not, or they're somehow "less than," I guess. I wondered if you would talk about that a little bit, about what your experience has been as this movement has grown now and there are more and more people stepping up and saying: "Yeah, me too, I am part of this."

Cheryle Pacapelli 02:56
I'm so glad you brought that up because when we look back at some of the things we did in the early days, like we did an AmeriCorps project and we had 20 people who had recently been introduced to recovery, no long-term recovery at all. Many of them had experience homelessness within months of entering this AmeriCorps program, which we called RecoveryCorps. And today, five years later, many of them are who Michelle just talked about, going for their Master's degree now, and they had no educational experience then. Their first education was the Recovery Coach Academy or peer-assisted recovery training. I often think about this friend of mine who is maybe 66 years old, and maybe nine years ago he went to one of the academies, and he was like: "No, I can't do it. I haven't been to school in 40 years." And he made it through that academy and then he had the courage and the support behind him and now he's three months away from his Bachelor's degree in addiction counseling. It's just an amazing, amazing amount of work that people do. And I think many people understand that while using actively, we took from the system. And when we start to get well, we want to give back to the system that we took advantage of. It also makes us a perfect resource for people who don't know where to go to get things because we have done it. I could sit here for the next four hours and tell you stories about people in recovery that I trained 10 years ago on what they're doing today. Just recently, just yesterday, the new person who is the Recovery Support Specialist for the state of New Hampshire is someone that I trained in 2014.

Michelle Lennon 05:27
Working for the Bureau of Drug and Alcohol Services now that support the center?

Cheryle Pacapelli 05:31
Right.

Michelle Lennon 05:32
Nice.

Cheryle Pacapelli 05:34
Amazing, after she worked for seven years in Dartmouth as a CRSW in the emergency department.

Michelle Lennon 05:42
The CRSW is the Certified Recovery Support Worker in New Hampshire. Many states now have licensing requirements for peer recovery support workers. How do you feel about that?

Cheryle Pacapelli 05:54
You know, I got back and forth with it because again they try to put us into this medical clinical model that we don't fit into for supervision, and the rules about what peer recovery support can do are much different. People who, based on our administrative rules here are the ones who have to supervise us, don't really understand our role. Working now in New Hampshire, this has come to a head over the last several years to try to make some changes to that. Even SAMHSA has recognized that that model is not perfect.

Michelle Lennon 06:38
Yeah. It's interesting, because I just had a conversation with a federally qualified health care clinic about this as people are looking to get licensed to supervise peer support workers within federally qualified health care clinics. And I had said, the best supervisors out there are the ones who have bothered to take the recovery coach training, the peer-assisted recovery support services. Too often they're taking their clinical knowledge and applying it to peers because they only get six hours of apprenticing as part of the license to supervise. If you have like an MLADC or a LADC in New Hampshire, which is the Licensed Drug and Alcohol Counseling or Masters Licensed Drug and Alcohol Counseling, the boundaries are so different, so different. Thankfully, our relationship with our federally qualified health care clinic is awesome; we just have such a good relationship with them. And I can freely say that. I said, the ones that have the biggest trouble of understanding peer support, or think that we're acting outside of our guidelines, are the ones that don't know what the guidelines are usually.

Cheryle Pacapelli 07:45
In some states, actually, anybody who is going to supervise peer support needs to take that 30-hour training and the ethics training peer support so they understand what is the role and what's not.

Michelle Lennon 08:03
I wish we would do that. I would say that I did not get much out of our supervision training that's required, and it was done by a licensed clinician, very different than how we interpret the domains of peer recovery support services. We have gone to training our own staff at this point as well as sending them, but we're sending them basically to a training to check a box, not because we think they get anything out of it, which is tough. It's probably a taboo thing to talk about a little bit, but I think it's important to acknowledge that yes, we can go and we can check the box that we've done this, but there's more to supervising peers than that one-day training offers by a lot. Thinking about that and the peers that we train, one of the things that I love--and in New Hampshire we have a facilitating organization model, which means we have a resource to go to when we have ethical dilemmas, we have technical support when we have things that go on, and one of the things that we know about the stages of recovery is that people will come to awareness of different things as they heal, and go through a recovery process and that it takes time. So, I think for many of the directors in the recovery centers, we recognize that, so a lot of things that might be seen as insubordination or somebody losing their stuff in reaction to something, we often recognize we need to help with coping tools and to give some grace and to work with individuals because as the brain heals, we know that that reactive nature, it takes some time to work that out out of us.

Cheryle Pacapelli 09:52
It does and for many new peer supporters, they do not have a long history of work. So they have the skills to do peer recovery support, and are great at that but they don't exactly know how to work with others in an office setting, or what appropriate language is or what appropriate dress type is. Each recovery center has had to work through those policies themselves, too.

Michelle Lennon 10:35
It's tough, right? It's tough because we have things in the state of New Hampshire like mandatory reporting. We have things that we have to abide by, like sexual harassment law. We have things in the ethical guidelines, like you can't give money, even to somebody who needs a pack of cigarettes to get through the day.

Cheryle Pacapelli 10:53
Let someone sleep at your house.

Michelle Lennon 10:55
Let somebody stay at your house to keep them safe. Those are things that in the 12-step community were okay, but learning the new guidelines can be a challenge. And then there are some things that there's zero room for negotiation; I think that can be tough for directors to make those decisions that we have to let people go sometimes, and it's painful, awful painful, especially for the people that we really--and I think most of the directors really care about our staff.

Cheryle Pacapelli 11:24
Oh, hugely. And you will never find anywhere in this state of New Hampshire or across the country a set of 11 people, these directors, that help each other, assist each other, give each other funding if they have it, support their organizations at so many levels. It has just been amazing to work with all of you. It really has.

Michelle Lennon 11:53
I think that you have developed that culture, though. When I think about--our association meets twice a month, all the directors get together, and their center managers are also invited to that meeting, and we hash things out. You bring resources to that meeting. I'm just thinking even training. We provide a lot of training, SOS provides a lot of training. When we have funding, we can support each other that way. I know SOS has been doing a really amazing job training my staff with motivational interviewing. And it's been really neat to see the growth because I think a lot of people go through The Art and Science of Peer-Assisted Recovery or The Recovery Coach Academy, they get a just an introduction to motivational interviewing or the art of asking good questions or active listening. It's not the same thing as being trained fully in motivational interviewing at all. And no matter how many times I tell people it's just an introduction, oftentimes people think they know, but can do such a better job with that. And I was thinking about how John training my staff has been such a gift, because he knows the work that we do

Cheryle Pacapelli 13:04
And he's a MINT trainer. That's an acronym but I don't know what it stands for. But it means the highest level...

Michelle Lennon 13:13
...of motivational interviewing.

Cheryle Pacapelli 13:14
Yeah, he's just amazing at that.

Michelle Lennon 13:20
Yeah, we're blessed, really, in New Hampshire with some amazing trainings. I know for me, I trained with Priscilla Matos from Revive, and we've done harm reduction training for peer recovery support workers, because I think harm reduction has been another one of those controversial things within the recovery community. But Priscilla and I are both on the same page that you know what? Dead people cannot find recovery and we want to keep people alive. And if they're going to be actively using, how can we help them do it more safely so they're not spreading Hep C to all their friends or dying of an overdose or all of that. What has been your experience, because you are overseeing how many centers now?

Cheryle Pacapelli 14:08
21.

Michelle Lennon 14:09
21 recovery centers in the state of New Hampshire, and we all are different. I think one of the beautiful things about the FO is you let us be us in community. We all have these unique ways of responding to our community needs everywhere throughout the state. We're very fortunate that way, and we all fall onto this continuum when it comes to harm reduction. I know for our centers, we do a lot with providing education, we provide Naloxone kits to reverse overdoses, we provide test strips. We do a lot of what I would call "little h" harm reduction in that we have showers at our Plymouth center and at our Franklin center. Taking a shower and being clean for people experiencing homelessness is a real important thing at reducing harm; it reduces the risk of infection. And we can provide things like clean underwear and clean socks. Sometimes we don't think about those little things, or burn kits. In the wintertime, we were seeing people living in tents throughout New Hampshire and getting burns because they will use things like hand sanitizer to keep warm and light it up. So many things, we just don't realize how tough it is. Because as a culture in New Hampshire, we still blame people for carrying this. I think because my own family experience with my husband falling 40 feet from a roof and being prescribed Oxycontin 80s twice a day, I've never perceived blame, because I know physiologically he did not choose how his body reacted to this stuff when he developed the disease of addiction. So I've never had that blame in me because of that experience, but we've been washed over with stigma and this perception of blame. And we've seen even our state legislatures write op-eds in newspaper columns, saying, "It's a disease of their own choosing" at times, which has been heartbreaking to me. And I'm recognizing now that it is because we have been washed over with so much stigma really since the "Just Say No" movement came to be, because if it were that easy, we wouldn't be in the state of addiction that we're in.

Cheryle Pacapelli 16:22
Exactly. Yeah, you're right.

Michelle Lennon 16:28
So, thinking about harm reduction and the tension of recovery support services and harm reduction in the different centers that you support--what are your thoughts on that?

Cheryle Pacapelli 16:39
Yeah, like you said, we have all kinds of extremes. Every recovery center has to support multiple pathways of recovery.

Michelle Lennon 16:50
What do you mean by multiple pathways?

Cheryle Pacapelli 16:56
Dharma recovery, yoga for recovery, reduced use in recovery--if you say you are working towards a better life, whatever that is--that your better life means you have a tent today, instead of just a sleeping bag, that's a good thing. For some people, including myself early on, this was a hard concept to understand. Why do you want to live in that tent when I can get you into treatment and you have somewhere to stay? Then someone explained to me--again, someone who had experienced homelessness, which I had not--to say: "You're asking me to leave every single thing I own in the world, and I'm not doing it. We've got to find it another way." And harm reduction has helped with that, advocates like Dean LeMire. We talked about how Dean was such an amazing person. I had the pleasure of having him work for me for a year and a half and explain some of this harm reduction work to me because he was so passionate. And he used to go in the woods and give people clean needles and talk to them. There are people in long-term recovery today because of the work he did. So you have that spectrum, from other people having days that you can come to a recovery center and get clean needles and wound care kits and clean socks and things like that, to another end of the spectrum where they'll have Naloxone, but that's all. We make sure everybody has Naloxone, but they really think people should be abstinent in order to say they're in recovery. So sometimes that creates a bit of tension within the work, but that kind of tension also opens up for conversation and education and understanding.

Michelle Lennon 19:13
I think one of the things--having done the work, it's all the labels that we stick on everything. So, we talk about, like, moderation-based recovery and the idea being that if somebody has an issue with drinking, like their drinking is problematic for them, maybe they have missed work a couple of mornings and it's starting to get in the way. They're finding they're having a bit of trouble slowing down, but they can slow down enough that they can function well in society and it's no longer a problem for their family because they slowed down. Sometimes I wonder about the brain changes. Sometimes substance use is problematic and it's behavioral, and sometimes it's problematic and then the disease of addiction is accompanying the problematic use and so people can't stop without some type of medical support.

Narrator 20:09
Thank you for listening to Archways Threads. If there is a topic you'd like to see us cover, email us at podcast@archwaysnh.org or call us at 603-960-2128. Visit our website at archwaysnh.org to learn more about the Archways family of recovery and family resource centers.