Strengthening Recovery in NH

At the start of Building Futures Together, we recognized the importance of creating a strong foundation for our trainees. To support this, we partnered with NHTI – Concord’s Community College to provide access to the Certified Recovery Support Worker (CRSW) course. We knew the skills, knowledge, and teaching methods offered through NHTI would give our trainees an exceptional foundation to build upon as they completed the Building Futures Together program. This course strengthens their professional development and opens an additional pathway for trainees to pursue state certification as CRSWs in New Hampshire.

To gain further perspective, professors and licensed alcohol and drug counselors, Pete Dalpra and Kelly Luedtke generously reviewed our questions about the course and shared how it impacts our trainees and contributes to the state of New Hampshire.

What core skills or knowledge do students gain from the CRSW course that will help them succeed out in the field?

The Certified Recovery Support Worker (CRSW) course core skills that the students will learn include a provisional skill of basic screening of persons with both a substance use disorder (SUD) and co-occurring mental health disorders. They will also learn the ability to differentiate when referrals are necessary and how to make appropriate referrals. They learn the basic recognition of signs and symptoms of addiction, intoxication, and withdrawal. They learn a series of interventions to ensure the immediate safety of clients. The discussion of family systems provides a picture of not only the genetic role, but also the generational role that SUD plays. They will comprehend provisional recovery services, including practical support, mentoring, and community peer support. They will become familiar with ethical standards and practices for certified recovery support workers. They will learn to establish appropriate boundaries and to develop a framework for evaluating and managing multiple relationships. They will develop an awareness of current professional issues, and they will be able to articulate the concept of cultural competence and acquire skills for practicing ethically with diverse populations.  This knowledge comes through the four domains of the Certified Recovery Support Worker, which include recovery and wellness, ethics, advocacy, mentoring, and education. They will also gain additional knowledge in suicide prevention, HIV/AIDS, and mental health first aid.

What makes the CRSW certification valuable for students entering the behavioral health field?

The Certified Recovery Support Worker (CSRW) certification makes the student employable in many behavioral health settings because the certificate allows the support worker to perform the following scope of practice:

• The provision of basic screening in persons with substance and occurring mental health disorders to determine whether further referral for further assessment and formal diagnosis is needed, and making appropriate referrals.
• The provision of monitoring of clients’ health and safety, including basic recognition of signs and symptoms of addiction, intoxication, and withdrawal, and the implementation of structured interventions to ensure the immediate safety of clients demonstrating such symptoms.
• A provision of recovery support includes practical support, mentoring, and education about addiction, community peer support, the role of medication, and core occurring disorders in addiction.
• Adherence to the clinical standards of substance use treatment professionals, as determined by the board of licensing for alcohol and other drug abuse professionals.
• The Certified Recovery Support Worker may also assist in promotions, monetary raises, and credibility in the profession since they are supervised, which may be more than the "recovery worker" without these credentials.

From your perspective, how does this course connect classroom learning to real-world practice?

The entire course, from week one to week eight, builds through the four domains. There are a number of ethical dilemmas and case studies that challenge the students. These are designed keeping Ethics, Confidentiality and Boundaries in the forefront.  When confronted with these issues, students begin to realize the value of clinical supervision and peer collaboration.

From my perspective in 2007, I was part of the Governor’s Commission on Addiction, Treatment, and Prevention’s workforce development committee. Having witnessed a significant influx of peer support workers in California, after discussing with officials of the California Counseling Association, we presented to the workforce development committee the idea of replicating a peer support credential here in New Hampshire. At that time, I was a clinical director at what was called a social detox, and my thought was to develop this credential to specifically include education in substance use counseling. I believed the most important person in those treatment facilities was the person who answered the phone. They would answer and say “This is 'ABC treatment, how can I help you?” I believed they needed to be able to answer the question to the best of their ability when asked.

When the suggestion was made that NHTI should create a Certified Recovery Support Worker (CSRW) education program to follow the four domains, we wanted it to be more than just a regular training. The experience that Professor Kelly Luedtke, Professor Michael O’Bryant, and I had as Clinical Directors in various substance use disorder (SUD) programs in NH was used in developing the curriculum, keeping in mind how we were training our new staff at those times. We also believed that the curriculum could be a stepping stone for some to advance their education to higher clinical levels, such as achieving a Licensed Alcohol and Drug Counselor (LADC), Master Licensed Alcohol and Drug Counselor (MLADC), Licensed Clinical Mental Health Counselor (LCMHC), and/or Licensed Independent Clinical Social Worker (LICSW).

Why is having a CRSW certification especially important for the State of New Hampshire right now?

The Certified Recovery Support Worker (CSRW) is regulated by the NH Board of Alcohol and Drug Abuse Professionals. The Board requires 24 CEU's every 24 months, and requires ongoing supervision. This helps keep recovery support services relevant, safe, ethical, and up to date with the latest advances in addiction.

The first person to receive the CRSW certificate did so in 2011 and still holds that certificate. Her number is 0001. The first 250 CRSWs received those certifications between 2011 and 2020. Of those 250 recipients, 80 still hold an active certification. The current number used by the Office of Professional Licensure and Certification for the certified recovery support worker credential is 0916. There are, however a number of expired or lapsed credentials in that grouping. My account showed 323 lapsed or expired credentials, showing approximately 600 active CRSWs in the state.

The state of New Hampshire is still showing a significant substance use disorder (SUD) problem, not only with opiates, including fentanyl. It is also being inundated with methamphetamine, and a significant resurgence of cocaine. The use of marijuana that has a higher concentration of THC than ever before, and continued use of alcohol in a dangerous manner, is driving the need for a greater number of SUD professionals. The number of residential treatment beds has been drastically reduced with the closing of the Farnum Center residential program. The number of recovery community organizations is continuing to increase; however, they appear to be short of staff. Many hospitals are now employing recovery support workers, and it seems that there is an increase in CRSWs needed not only for these programs but also for other various outpatient treatment programs in this state.

How do you see CRSW-certified professionals helping to address the unique behavioral health and recovery needs in New Hampshire communities?

Certified Recovery Support Workers are now being recognized as important cogs in the behavioral health profession. This can be demonstrated by training held by various mental health agencies. Certified Recovery Support Workers are now eligible for reimbursement by Medicaid in various agencies.

• Peer support services or nonclinical recovery support services that can be used to enhance substance use disorder (SUD) treatment, extend related services, and improve outcomes for people in or seeking recovery.
• Peer support services are increasingly being integrated into diverse SUD treatment settings as well as in settings that frequently coordinate care with formal SUD treatment programs, such as recovery, community organizations, recovery community centers, recovery residences, hospitals, and jails/prisons.
• Peer workers are nonclinical professionals who have lived experience with problematic substance use, behavior change, and recovery. These professionals deliver a range of recovery support designed to improve the treatment experience of individuals who have problematic substance use and their ability to continue on their chosen recovery pathways before, during, and after treatment.
• Peer workers fill a range of roles, such as providers of recovery support, educators, engagement facilitators, role models and mentors, resource navigators, and recovery advocates. In fulfilling these roles, peer workers serve not just individuals in or seeking recovery, but also their families and the community.
• To integrate peer support services (PSS) into SUD treatment programs, administrators should consider their organization’s culture, assess staff on their knowledge and attitudes about recovery and PSS, and examine their organization’s hiring and retention practices.
• Treatment program administrators and supervisors play key roles in helping peer workers integrate successfully into organizations and in helping other staff understand, accept, and respect their peer worker colleagues. This is extremely important because a lack of staff understanding about peer workers' values and roles can lead to role confusion, strain, and drift, all of which make it difficult for peers to enjoy and successfully perform their jobs.
• Supervision is a critical part of all roles to ensure delivery of high-quality services. Because the peer worker role is so different from that of a clinical professional, supervisors will need training focus on how to effectively oversee and work with peer workers.
• Serving as a peer worker can be a fulfilling career for individuals in recovery who want to support individuals with problematic substance use while enhancing their own recovery. Attending specialized training and seeking certification are often the first steps on this career path.
• Families affect, and are affected by, a family member’s problematic substance use treatment and recovery. Thus, families can also benefit from peer support services. Many family members need support, education, and resources to help them better understand their loved one’s problematic substance use, recovery, and how to help themselves and their loved one. Peer workers, like family peer specialists, can help fill these unmet needs.

(Substance Abuse and Mental Health Services Administration. Incorporating Peer Support Into Substance Use Disorder Treatment Services. Treatment Improvement Protocol (TIP) Series 64 Publication No. PEP23-02-01-001. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2023)

Do you feel programs like Building Futures Together make a positive impact on the support of the families and the trainees' professional growth?

Having been part of the Building Futures Together program for several years now, I have seen the quality of the students grow with each semester. The agencies supporting this program, I believe, are benefiting not only from the Certified Recovery Support Worker (CSRW) course but also from all the other courses Building Futures Together has in their program. Agencies like the Archway and Hope on Haven Hill have benefited from Building Futures Together and, as such, continue to support. In turn, these trainees, through their professional growth, are able to provide a more beneficial service, making that positive impact and support of the families they serve. Many of the families they serve are located in rural communities, especially in the North Country, where there is a significant need. These areas present opportunities that can continue to be cultivated for future trainees. It’s crucial to sustain our outreach and training efforts to address New Hampshire’s shortage of addiction professionals, even as the state continues to face a significant substance use crisis.