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Interviews: Battling Recidivism

Tuerk House is the only 28-day residential drug treatment facility in Baltimore City. With a 70-bed capacity, the program includes an onsite detoxification and outpatient service.

POV: What kind of help does Tuerk House offer to people with substance abuse problems?

Omar and Pete - Dr. John Hickey Dr. John Hickey: We offer a 28-day residential treatment program, which includes a range of services, such as a regular support group before people are admitted. We do a detoxification program for heroin or opiate patients as part of the 28-day program. We also provide psychiatric services and medical services to our residential clients. We're mostly publicly funded. There are 80 beds in total, and 55 of them are funded by the city through federal block grants. The rest of the beds are fee-for-service beds.

POV: How do the services provided at Tuerk House differ from those provided at other treatment facilities? What's distinctive about your approach?

Hickey: I think what's distinctive about it is that we have a state of the art detox program as part of the regular 28-day program, whereas at most places that's an extra cost. Our strength is in how focused and structured we are. The goal is to change how people think, and help them develop a value system. The other thing is that we also have an outpatient program, so a client can stay with us for the 28-day program and step down to an outpatient program. We also have two halfway houses for that purpose. The last piece that distinguishes us is our peer support program. That is set up so that people can stay involved with Tuerk House as long as they find it helps.

POV: Do many of the people served by Tuerk House have criminal histories other than drug abuse? Does Tuerk House approach those people differently? Do they face a distinct set of challenges?

Hickey: Many of them do have criminal histories, and drug abuse is a big part of that. Quite often that's a real cause of their crimes. Many of our clients will come in and they've got 15 to 20 years of being actively involved in the drug lifestyle. There's an individual treatment plan, where they have individual treatment during the week, where you can get into the housing issues. That's a big one for people coming out of the jails, and we often refer them to halfway houses, to longer-term treatment. But overall the program is the same for each person in terms of the group activity and the lectures and those kind of things. I'd also point out that over half of our patients at any one time are voluntary, in addition to the beds that are reserved for people referred on parole and probation. There are also a lot of people who are court-ordered to be here, as an alternative to incarceration.

POV: Is there a difference in the results for people who come voluntarily versus those who are court-ordered?

Hickey: Not really. The difference is between the people that show up for the initial appointment and those that don't. A lot of people from parole and probation don't show up, but once they get into the program, they seem to be as successful as anyone else. You have to have some level of motivation in order to come, because a lot of guys referred by the criminal justice system never even show up. The ones who come and get involved are at some level motivated. They've probably had enough of jails and prisons and all that. In general, the research says that coerced treatment works as well as anything else. And even the people that come in voluntarily are responding to pressure. Either their family's had it with them and they've got nowhere else to turn, or they've lost their job and they've lost their family; they've got nowhere else to go, and someone tells them about us. So there's a pressure on just about everyone that comes here.

POV: How successful is Tuerk House at helping its clients become drug-free? Is it common for them to return to their addictive behaviors?

Hickey: We've had about a 70 percent completion rate out of Tuerk House over the last ten years. The only really good follow-up data we have comes when we work with a partner or a program within the community. When we've done that, we see a success rate around 70 or even 80 percent. What we do know is that when clients go from us to another program, they usually do very well.

POV: How does Tuerk House prepare its clients for the return to their daily lives, and those times when they won't be surrounded by the resources and assistants available there?

Hickey: Discharge planning starts on day one. You have to find out, does the person have a drug-free environment to live in? And if they don't, you start talking to them about going to a halfway house, or some transitional housing, where they can be involved in treatment. We have a halfway house for 17 men, and a halfway house for 11 women, and there are others throughout the city. So you try not to send them back where they came from.

The hard part for people with a criminal record is getting a job. If you have a felony, that hurts. And we have relationships with places like Prisoner's Aid. The one thing I do know, from working with men and women that come out of prison, is that if they come here for the 28 days, and are in a program where they receive case management to get the help they need when they leave here, they're going to be very successful. So it's important to immerse them in an environment like Tuerk House where we really work on how you think about things, so you leave with a better attitude, and you really think about your own role in what happens. We really preach making "I" statements. What really works, is that combination of coming in to an environment like this when you leave the prison and then going into a case management system where someone's helping you deal with life until you're on your feet.

POV: What kind of resources are available for people once they've "graduated" from Tuerk House's program?

Hickey: Our rule is that no one leaves Tuerk House without a follow-up appointment, and if they're in a halfway house certified by the state, they can get their treatment there. Sometimes people go to transitional housing where it's not certified, they just go there to live, and there's usually support for Alcoholics Anonymous and Narcotics Anonymous. Those folks get another referral to an outpatient program, so they have a place to live, but they also have a place to keep their treatment going. We're kind of a hub where people from all over the city come and begin their recovery, and then we send them out to halfway houses and transitional housing all over town.

POV: Can Tuerk House meet the need in the local community for its services? What kind of additional community resources would help?

Hickey:There's a wait for our services. We usually have about 20 men or more who come to a support group two or three times a week while they're waiting for a bed to open. Usually it's about two weeks. For women there's less of a wait. But there's been a big increase in treatment in Baltimore over the last two years, although the increase has leveled off recently. There's a lot going on on the west side, but there's not a lot on the east side. The city needs more, but they've got a heck of a lot more than they had a few years ago. The state's put a lot of money in. So I give them credit for that.

John Hickey, Ph.D. is the executive director of Tuerk House.





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