A Behavioral Healthcare Perspective on Recovery International

Recovery International Interviews Jerome Vaccaro, MD

Jerome Vaccaro, M.D., on the Board of Directors of CNS Response, Inc., and is President and Chief Operating Officer of APS Healthcare, Inc. (APS), a privately held specialty healthcare company. Dr. Vaccaro has an extensive background in community mental health and public sector work. Dr. Vaccaro served on the full-time faculty of the University of Hawaii (1985-1989) and UCLA (1989-1996) Departments of Psychiatry. – Forbes

Recovery: How did you first become aware of Recovery International the effectiveness of the Method and the usefulness of it in your practice?

Vacarro: During my psychiatry residency at Albert Einstein College of Medicine in New York City, we had a lot of access to different kinds of self-help groups, partly because one of our faculty members was very interested in that field so we had a course on it. I participated in various support groups.

Unfortunately, Recovery International was not among them, but the experience allowed me to gain an appreciation from the patient's perspective that these were indeed valuable groups. It broadened my view of what is helpful from the treatment and therapeutic perspective of a patient.

I first became aware

Shortly after that, I sat in on several Recovery meetings and I found them very helpful. However, what was most encouraging was finding after referring patients to the meetings, they really got help from the techniques offered. They were able to manage their stress and anxiety. What was also important was the interaction with other people iof the importance of Recovery International in 1989 or 1990, when I came to the Los Angeles area. I was an assistant professor at UCLA and was at the Veteran's Medical Center as chief of their psychiatric rehabilitation services. It was Recovery's Celinda Jungheim and Harold Kowits who brought in a panel of Recoveryites to give a demonstration panel to our staff and show how the Method works and how the meetings are run. Eventually, Recovery started meetings at our mental health center.

n understanding that they were not alone and that they could gain control over their nervous symptoms and fears by sharing their difficulties, and thus sharing solutions with one another by applying the Recovery Method.

I feel these group settings are a powerful medium for a client to meet people who have had similar experiences and have found a way to conquer their symptoms and even find a better, workable way to do it.

Recovery: As we head into the new millennium, what are some of the things that you Q. believe the mental health field is facing and some new challenges?

Vacarro: For one thing, we as providers have really never been held accountable for what we do. I remember, going back to my own training, providers were never held accountable for the outcome of treatment. If there was a bad outcome, it was because the patient wasn't motivated. It's like the old light bulb joke - how many psychiatrists does it take to change a light bulb? The answer is one, but the light bulb has to want to change. So, I think we have never actually accepted accountability.

I think this is probably the greatest challenge we face. Now the health care field, in general, and the mental health community in particular, are being held accountable for outcomes and if patients don't get better, we have to change our techniques. We now have to explain to peers why and what we're doing. I believe that it is not only a challenge, but also a real advancement brought about in part by some of the elements of the managed care movements where basically better managed care organizations have said, `we're now going to look at outcomes.'

The accrediting body for Health Maintenance Organizations (HMO's) has always been all about looking at the process of care. This is a body called the Joint Commission for the Accreditation of Healthcare Organizations (JCHAO). Early in their development they were mainly involved in the process of care, but nothing about the outcome of care. In recent years, JCAHO and the National Committee for Quality Assurance (NCQA) are the main accrediting bodies, along with the Commission for the Accreditation of Rehabilitation Facilities (CARP). They are now saying, `It isn't enough that you just put stuff on charts. Things have to get better. there has to be quality improvement.

Recovery: And do you see this improvement coming about with providers being more persistent that patients start becoming participants in their own wellness?

Vacarro: I think that what will be happening is, providers, who are going to be focusing more on outcomes, are going to be looking for assistance from organizations like Recovery International to help them to help people get better.

If a therapist is seeing a patient whose first experience with Recovery was negative and the therapist knows that the Recovery Method is going to be helpful and will have a long-term good outcome, then he is more likely to become assertive in treatment and say, “You didn't like your first visit, but I think it was because of some fear or that of change and I want you to try it again. Go back and do it.”

In the past, therapists were more passive. A typical session was one where the therapist was mostly quiet and was not very directive or active. Now the scene is shifting. By being held accountable for outcomes, the therapists are becoming more active and directive.

Recovery: What can Recovery International do to help the professional become more aware, more active and persistent with the client?

Vacarro: I think Recovery can be more active with provider organizations, provider groups and individual providers by making it easier for the provider to refer people to the group meetings. Besides providing more panel demonstrations with written aids, opening groups within primary medical group buildings will be a great help. The physician then knows that on Tuesday there will be a Recovery group meeting in his building where he can refer his client.

This makes the referral process easier because today the average primary care doctor spends less than six minutes with his patient. This is not a lot of time and it's a very pressured environment. So what we all need to do for providers is to make it easier for them to integrate care, to make referrals.

Recovery: Besides getting the word out to providers through panel demonstrations and literature, what role can the website play in helping to inform the professional of Recovery International?

Vacarro: More and more practitioners are out on the web. So I think having Recovery information out there is helpful. But, when it comes to informing the physician, no one approach is going to be the magic bullet. It needs to be hit from multiple angles.

In our own work here, for example, in educating primary care doctors about behavioral health in general, is one where we make written materials available, have face to face conversations, plus put things on the Internet. Regarding the written materials some people are going to respond to lengthier articles, others are going to respond better to one-page flyers. You just put it all out there and see what sticks.

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