CHCS Article in SAMSHA Newsletter

SAMSHA Recovery to Practice Newsletter Volume 3, Issue 31

One Agency's Journey to Be Recovery Oriented
by Mary Susan Haynes, Ph.D.

In November 2002, Community Health and Counseling Services began a journey to implement Client-Directed, Outcome-Informed (CDOI) practice1 in its social work services. CDOI is a truly collaborative way of providing services that acknowledges the voice of the client to the greatest degree possible. Not only are clients' goals prioritized above those of providers, but the methods for reaching these goals also take precedence.
In addition, through the administration of two simple empirically validated scales, which take less than 3 minutes to complete, score, and discuss, feedback is often collected from clients on their progress toward goals and the status of their alliance with providers. These measures allow us to make immediate changes when services are not working, and to quickly make repairs to the alliance.

In CDOI practice, it is not enough to simply measure outcome and alliance. So we ask clients to help us understand the meaning of their ratings. We have learned to highlight the client's heroism in the face of adversity, and to help clients capitalize on their strengths, resources, and resiliencies to overcome personal challenges.

We didn't make this change because we wanted to foster client recovery. In fact, we talked little about the potential for recovery because everything we knew about the Recovery Movement seemed to suggest providers were superfluous at best, and hindrances or even saboteurs at worst, when it came to people's recovery journeys. We didn't see a place for ourselves in clients' recovery, but we were proud of our ability to help clients maintain their lives in the community without a high likelihood of rehospitalization.

We made the change because we needed a common approach throughout our services—given our wide variety of programs and the fact that many clients worked with different staff members. Prior to CDOI practice implementation, we described ourselves as an agency that used a psychosocial rehabilitation approach. However, we only loosely defined what that was, and had not determined a way to communicate how to put the philosophy into action. Thus, we believed having CDOI practice as a single sanctioned way of working (a method in which all staff would be well-trained) would provide a more consistent treatment experience for clients, and help them better maintain their lives in the community.

This was a laudable goal in itself, but an even more amazing thing happened once we got our footing with CDOI practice. Clients began to feel empowered to take control of their lives and decided maintenance was not enough—they wanted recovery. They came to see themselves as strong and capable. Although they were surprised when providers asked for ideas about implementing change, clients were delighted when we modified our approach based on their preferences. Many reported they had never truly experienced collaboration with providers.

We expected big changes in our agency's culture as a result of implementing CDOI practice, but we didn't expect CDOI practice would help us become a recovery-oriented organization. Inadvertently, we had found a way to operationalize what had once been an ill-defined path for helping clients create their recovery journeys. Until that point, we hadn't determined what our role in clients' recovery might be, but now we had a roadmap to guide us.

We've learned many things in 10 years of CDOI practice and our subsequent shift to becoming a recovery-oriented agency. Here are just a few:
• Being a recovery-oriented system often calls for us to be braver than is comfortable. Clients sometimes take actions that seem destined to fail, and some stakeholders will criticize us for not preventing the failure. It takes courage to hold to a client-directed philosophy in these situations.
• Many times when we think we are being fully collaborative with clients, we really are not. We have to unflinchingly review our actions to ensure we don't impose our ideas and opinions on clients, or fall too readily into the role of "societal cop."
• If recovery is our mission, it is not enough to only help clients obtain needed resources. We also have to help them understand they are the ones who will make use of those resources. We need to emphasize that their actions are responsible for bringing about real change.
• The decision to use psychotropic medication needs to be as collaborative a process as other interventions. Clients' preferences about medication should be privileged, and clients should be fully informed about the potential benefits and risks.
• We need to communicate to clients that recovery is possible and probable. Almost all of our clients have been told by a helping professional that they have an illness from which they will never recover. This message contradicts research findings on recovery, and we need to stop contributing to its continuation.
1CDOI practice has given rise to a system that is undergoing review by SAMHSA for national evidence-based treatment designation. The Partners for Change Outcome Management System is an intervention that uses the measures of outcome and alliance. For more information, visit

Dr. Haynes is the Clinical Director of Community Health and Counseling Services in Bangor, Maine. Contact her at 207-947-0366 or

Barry L. Duncan. (2012). The Partners for Change Outcome Management System (PCOMS): The Heart and Soul of Change Project. Canadian Psychology, 53, 93–104.

CHCS Mission

Community Health and Counseling Services will provide community health services that are needed and valued by the communities and individuals we serve.