Episode 1: Women’s Recovery in New Jersey
In this episode we hear from Melissa O’Mara, who shares her experience of getting clean in C4’s New Jersey Program. This is followed by a panel discussion with Melissa and expert, Wayne Wirta.
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Jack O’Donnell Welcome to the first episode of the C4 Recovery Solutions podcast. I am your host, Jack O’Donnell. And some of you might know me as the CEO of C4 Recovery Foundation. As most of you might know, C4 is dedicated to improving access to high-quality, ethical treatment services for behavioral health and social wellness. We are fierce advocates for individuals who are often overlooked and populations that are underserved. Through innovation and forward-thinking, C4 has developed service delivery systems for addiction and recovery programmes throughout the world and the United States in some of the most challenging environments.
Each week, on this podcast, you will hear your stories from people who have benefited directly from programmes C4 developed as well as from those who have assisted C4 in the process. In some cases, some of those individuals will have been involved in the implementation of the programmes and some will have participated in the programmes.
On today’s episode, we’re discussing the issue of young adult addiction, particularly among women and indigent groups, and the inaccessibility of affordable public addiction programmes. And this is where our first guest, Melissa O’Mara, comes in. When she was struggling with her addiction, her low-income status meant she did not have access to public treatment. That is, until C4 helped set up a programme with the state of New Jersey to enable people like her to receive treatment. After graduating from our programme, Melissa entered law enforcement. And she is here today to tell her inspirational story.
Melissa O’Mara So, I’m twenty-eight years old. I grew up in Hackettstown, New Jersey, which is in Warren County. I currently live in Burlington County, New Jersey. And I’m an assistant prosecutor and have been since September of 2018. I’m a person in long-term recovery from drugs and alcohol since August 30th of 2011. I basically got involved with C4 before I even knew that I was involved with C4 based on their participation in building a programme in the state of New Jersey, which got me on the path to recovery.
In 2011, I was living in homeless shelters, living on the street, bouncing in and out of treatment for my drug use, and I was visiting the local welfare office in Warren County, New Jersey, where I grew up, trying to get services. And at that time, they said they had a programme that was for women who had substance use disorders who were seeking treatment. And I, at first, was hesitant. But they linked me up with the individual who was to be my guide through this programme that they had implemented in the welfare offices. And when I was ready, he helped me get into treatment. And I think, during that time, I was in a really acute phase of my addiction. I was using heroin and cocaine, IV drug use on a daily basis. I was not employed. I was unemployable. I was going to college at the time, but because of my use, the college was on the verge of kicking me out. And my family had completely disowned me. So, the only people that were on my side at this time was the individual who I met within the welfare office.
When I showed up unannounced on their doorstep on August 28th of 2011 and told them that I wanted to go to treatment for the umpteenth time and that I didn’t want to live—because the night before, I tried to kill myself—instead of just shooing me away like many others at that point were, because I was an individual who bounced in and out of treatment, they – they really didn’t look at me like a burden on society and they said, “We know what you’re facing. We know what you’re going through. And we have a treatment for that issue if you’re willing to take it at this time.”
What made me go back when I finally did want help was that they were kind to me. They were understanding. Something that was different this time, because I had been to many treatment programmes, both long-term adolescent treatment, other outpatient services before, this time, instead of going just to detox and being released or going just to inpatient and being released, I was met with a continuum of care. So, I went from the SAI office to a detox, to an inpatient programme, to a halfway house, to a sober living house, which really stepped me down and reintegrated me into the community and really helped me rebuild the skills that I didn’t have, because I never had them, because I was a teenager and never developed them. And then, really put me on a path where, once I was in remission from my substance use disorder, I was able to get back successfully into college, resume my classes, figure out who I was as a person, and figure out what I wanted to do and who I wanted to be, which, eventually, I realised I wanted to go into law enforcement. I wanted to work with people who were in my position, specifically with women who might not have the financial resources available to them when facing addiction.
In 2011, there was nothing available, really, besides for this programme. County funding was scarce. I really was trying to navigate a system that I didn’t understand. So, even if there were services out there, I wasn’t getting connected to them. And that’s why I think having the service in the welfare office was so powerful, because that’s where I ended up. I wasn’t being offered any services when I encountered law enforcement. I wasn’t being given any services by anybody else within the community at that time. So, this really had a direct impact and kind of got me at a point where they could intervene face-to-face.
The general public as well as, you know, the community really had a misunderstanding of substance use disorders. And, really, my view of how I was treated was that it was my moral failing. And I think, over time, as well as getting into recovery, I really was able to see a shift in the beliefs of my community and even the state of New Jersey and the organizations within it, because we’ve really moved to this addiction-as-a-disease model and that people who have the disease of addiction are not just people who are choosing to use, but really have these underlying conditions that are preventable and treatable. And so, that kind of growth has been really helpful.
The biggest impediment that I see to those women out there with children is really services for women and women with children, they’re hard to access. These barriers pop up. And without somebody being able to assist in overcoming those barriers, women are deterred from getting recovery. So, having a programme like this is something that will help women across the board, no matter where you stand in your life.
I think my experience going through addiction and being in recovery has made me a better law enforcement officer, has made me a better prosecutor. SAI changed my life and put me in a place where I had the ability and opportunity to recover. I’d been given many chances to recover before, but I wasn’t presented the opportunity with the actual backup of the services to actually successfully do that.
Jack O’Donnell As Melissa touched on, there are often huge barriers to entry into addiction recovery programmes. This is often due to underinvestment and inefficiencies in service delivery. The end result is that those who need help the most aren’t getting it. C4 worked with the state of New Jersey to design an addiction treatment programme for them to execute. This was known as the WorkFirst New Jersey Substance Abuse Initiative, which has serviced over a hundred and fifteen thousand clients in its over twenty-two year history.
The New Jersey SAI was the result of five-plus years of effort by C4’s predecessor, COB. Beginning in 1986, COB convened dozens of meetings of all stakeholders in addiction treatment at the time. These included payers, insurance, MCO companies on the reimbursement side; clinicians, researchers, and actuaries on the service side; and user groups, advocacy groups, unions, and EPAs on the consumer side to develop innovative systems of care.
COB managed to get these sometimes incredibly antithetical interest groups to cooperate and brainstorm. Basically, C4 promoted five crucial ideas. One: Tenants based on accountability of treatment practices results in costs that can be adapted into a wide variety of settings. Two: Payers must have the ability to measure the cost of services against actual outcomes. Three: All care coordination must be devoid of clinical and financial conflicts. And number four: Drive acceptance and implementation of validated tools and methodologies by the widest cross-section of providers and purchasers of addiction treatment services. And five: Funds must follow the client across both the access of medical services as well as social recovery support services.
In the 1980s and nineties, the medical field was not talking in these terms. That all changed with this new programme, SAI. For today’s panel, we have Melissa O’Mara, who you’ve already heard from. In addition, we have Wayne Wirta, the president and CEO of the National Center for Advocacy and Recovery for Behavioral Health.
So, Wayne, I want to start with you. What was the original purpose of the SAI programme in New Jersey? Who were you trying to serve?
Wayne Wirta Well, we were part of welfare reform, which required that people on welfare within a limited amount of time either receive training or get a job. And Governor Christie Whitman, at the time, was one of only fourteen governors who thought that if the welfare client had an addiction problem, they might not be able to benefit from training or hold a job. And so, she set aside $20,000 of new money to be spent specifically on addiction treatment for people who are on welfare, both people who are needy families and single men and women who are on welfare.
Jack O’Donnell Well, an ambitious programme for sure. What kind of obstacles did you face right out of the box, Wayne?
Wayne Wirta There were two problems that had been identified by a study done by Rutgers University. One had shown that about sixty-five percent of people on welfare had used illicit substances. The other study showed was an analysis of what kind of treatment those people got specifically. And it turned out that they were going into detox with repeated episodes throughout the year, but without any further treatment beyond detox, what we call revolving door—detox in and out, in and out with no treatment follow-up. So, the problem was to, you know, identify those people, engage them into treatment, and make sure that they stayed in the continuum of care as opposed to bouncing in and out of the detox door.
Jack O’Donnell Yeah. I mean, today, we know that, obviously, the longer people stay in treatment, the better it is. And if you’re just putting somebody into a four-day detox programme, I guess, the odds were pretty slim that they would survive that very long back out on the street.
So, you realise that there was a problem here. And, you know, how did you solve it? What, you know… Why and when did you bring C4 into this process to help you?
Wayne Wirta I met the founder of C4 at a board meeting of the National Council on Alcoholism and Drug Dependence. We were affiliate with them at the time. He came on the board specifically to start the committee on benefits or COB as – as C4 was called back then. And it was to address the general problem that, in the nineties, for-profit managed care was decimating the addiction treatment system by arbitrarily denying services, because for every dollar they saved by denying a service, it went into their pocket. It was extremely conflicted model of organization.
And so, he formed that committee. I asked to be on it. It sounded very interesting. And they developed the tenants that you mentioned earlier in this programme. I was friends with the head of the New Jersey Division of Addiction Services. And there was some talk that they were going to do what’s called a carve-out, where they were going to manage mental health and addiction care, which, up to that point and to this day, has not been managed. And I thought it would be beneficial to bring a group of people from the C4 organization to New Jersey to meet with senior staff of the division to talk about the tenants that you explained earlier. And they did. And the carve-out didn’t happen for many political reasons.
But a year, year and a half later, WorkFirst New Jersey came down, and the Division of Addiction Services has got a mandate to put together a request for proposals to do it. And when that request for proposals came out, I realised that a lot of the C4 tenants were built into it. At least, certainly the non-conflicted care management was built into it. And after looking at it for a few days, it kind of struck me that, Gee, you know, We might be able to do it to make sure it’s done right. ‘Cause I wouldn’t trust some of the big for-profit managed care companies to do it correctly or as it was intended.
And I called Rick Ohrstrom, who was the head of C4, and said, “Hey. I think we can do this. And you know, we’ll make sure it’s done right.” And he says, “What do you need?” I says, “Well, I’ve written grants before, but we could use some help. And who do you know that knows about this stuff around the country?” “Well, the best person is this. The best person is that. The best person is that.” And we ended up meeting at Rick’s house. He was living in Greenwich, Connecticut, at the time. And all these people came together. And the grant writer helps out. I knew her. And we wrote it together. You know, we basically kind of took it and ran and got it off the ground.
Jack O’Donnell Yeah. That’s a great story, Wayne. And, you know, it’s kind of what C4 has done, you know, all this time, is we bring, really, the various groups to the table. And I think that we’ve been allowed to do that, because people view C4, like it or not, as kind of honest brokers in this process. We really have nothing at stake. We just want to make the situation better.
Before we get into the weeds about how you solved some of these problems, I would just like to ask Melissa quickly: By the time you got into the programme, I assume it was a well-oiled machine. Did you literally go through from detox to extended care?
Melissa O’Mara Yeah, I did. So, I ended up entering a detox facility. Actually, funny timing. During the time that I actually went into treatment through SAI, it was during Hurricane Irene in New Jersey, and the treatment centre I was going to was underwater. But I still was connected to detox, still got there, and then went right into a thirty-day programme, continued into a halfway house, and eventually made my way into sober living. So, I sailed right through. And as I had discussed earlier, I had never done that before. I was that person who was in the revolving door of detox, IOP, just never being able to get a continuum of care or get the services that I required.
Jack O’Donnell And you’ve just breezed right through it.
So, Wayne. So, you finally win this RFP, which is just amazing in and of itself, because I understand you had some great competition. What was the reaction of the people that you were already working with, say, at the welfare office? Were they thrilled? Were they jumping for joy that you finally had some solutions?
Wayne Wirta We were, at the time, a five-person public policy agency, and we beat AmeriHealth and Magellan. So, the fact that we got it was beyond remarkable. Well, you know, we hadn’t been involved with welfare. And it unfortunately came at a time when there was rumors that the governor, Christine Whitman, was going to prioritise welfare. And so, when we showed up, they thought we were coming in to take their jobs. So, there was a lot of resistance. One welfare department gave us all broken furniture and said, “If you want your better furniture, you have to buy it yourself.” They were supposed to have provided it. They didn’t. You know, it was our staff bringing donuts and coffee to meetings and being friendly. And, you know, it took a year in some places for them to realise that we weren’t a threat. If anything, we were there to make their jobs easier by… You know, “We’ve got this problem. We don’t know what to do with them.” “Oh, great. Send them to us. We’ll take care of it.”
I have to say one of the great things that New Jersey did is we’ve never had an arbitrary limitation on how long we keep anybody in any single level of care. The traditional twenty-eight-day. If they need fifteen, they get it. You know, if they need twenty days in detox, which is inconceivable, but they get it. You know, whatever they need based on their clinical needs is what they get.
Jack O’Donnell Yeah. Listen, I think that that’s really critical in this process. It’s my understanding, if you look at the tenants here that we discussed earlier, you know, all care coordination must be devoid of clinical and financial conflicts. It sounds to me like the development of this new programme took away those conflicts that I think existed early on, where if they just got someone into detox, they only had to pay a small amount of money and they could do whatever they wanted with the rest of the money. Now, they had funds available to take them as far as they wanted. But the care providers weren’t going to get any more or any less based on how long somebody was in the programme. Is that true?
Wayne Wirta You know, so, if they need thirty days in intense rehab versus twenty, the programme does get more money. We do continuing care reviews. So, we’ll call the residential programme, for instance, and we will say, “Okay. How are they doing on the five issues that we sent them there for?” And one of the problems early on was the programmes were mostly programme-driven and not clinical-driven. You know, we call it advocacy with the checkbook, because we advocate for the programme to address the specific needs of the client and we pay for it when they do. And if they don’t do it, we move them somewhere else and pay somebody else to do it.
Jack O’Donnell Knowing that early on in this programme, they wasted a lot of money—and I hate to use that word “wasted,” because, in my mind, if one person came through your programme successful, you know, that to me is worth it. But knowing that they had spent a lot of money before this got straightened out, you know, how are they monitoring this on an ongoing basis?
Wayne Wirta We developed a very sophisticated data system. We developed it ourselves. And we issue reports to the state on how long the person was in. All the clinical is tied into the financial. So, you know, they get… They can get a report and virtually anything they want to know. You know, how many times we talk to the person, how many times we call the person. They, you know… It’s all – all documented. As a matter of fact, we were told, at one time, in a budget crisis that one reason we didn’t lose our money was that we were giving them more documentation than anybody else. So, you’ve got to document what you do.
Jack O’Donnell You know, when we talk about the legacy of a programme like this, you know, Melissa, obviously you’re a shining example. I mean, you are – you are a legacy of this. But I’m curious, in your new life, have you had reason at any time to continue to be involved or have you seen other people that you know go through the programme?
Melissa O’Mara Funny that it was only on a call when we were educating about addiction and recovery services that I learned the big role that C4 had in really getting me to where I am. I joked that almost ten years ago, I stumbled into a welfare office asking for help and ten years later, I was in a call with the people who made that happen. And so, I think that’s a beautiful thing. There’s plenty of people who have gone through this programme. But I think that story really illustrates the impact that it has and how someone can be intertwined with SAI even a decade later.
Jack O’Donnell Yeah. It really – it really is a terrific story. I happened to have been on that call when you put the pieces together. And I think everybody got little chills, you know, as you were saying, “Wait a minute. I didn’t know you guys were involved with that programme.”
So, Wayne, obviously from your perspective, you’ve been there from the star. You’ve put a hundred and fifteen thousand people through this programme. I mean, what’s next? Does this continue on? Does this programme grow? What’s needed to keep this going? And how does it improve from here?
Wayne Wirta Well, hopefully, it does. You never know with state government. But, you know, certainly, they have no reason, based on our performance, to – to do anything different than to continue it.
I’ll get on my little soap box here. You know, addiction has been treated as an acute illness for a long time, and it’s really a chronic disease. And unlike other chronic diseases where the small part of the treatment is the acute care and the large part is the recovery support, you know, in our field, we put tons of money into the acute care and almost nothing into the recovery support.
And, you know, I think that the – the system has to become more recovery-oriented as opposed to treatment. I think that the recovery support should be the biggest part of a person’s experience in recovery as opposed to the acute care, you know, episodes that they’ve had. And, you know, and I think there needs to be a new way of measuring outcomes.
Up ‘til now, you’d look at somebody going through a thirty-day programme and then they say, “How are they doing six, eight, twelve, fifteen months later?” Well, what happened in those six, eight, twelve, fifteen months? You can’t look at somebody a year and a half after they went through a programme, like Melissa did, and say, “How are you doing today?” without asking what’s been going on in the meantime. And there’s not been an effective way to do outcomes on an ongoing basis to treat it more as a chronic condition as opposed to an acute care condition, where you get a Band-Aid and you’re better the next day, you know.
Jack O’Donnell Well, the model itself is really, you know, one of equity, it sounds like, for sure. And, you know, it’s one that is customised to include community and more organizations than just the treatment providers. So, it really is a unique programme that – that quite frankly, I – I – I would think, could and should be modeled in many other places.
Wayne Wirta Yeah. That was my goal. You know, my goal was, really, to establish the efficacy of a new model of payment for treatment that would benefit the client to the maximum degree. But one of the things we do is not just manage the care, but we’re sort of a safety net. So, if someone doesn’t get from programme A to programme B, we reach out to them and say, “What’s going on?” You know? “You need help. Come back and we’ll talk to you.” We’re measured by our engagement and retention. And so, we do everything to keep people. You know, once we’ve engaged them, to keep them retained through the various levels of care and not just detox, not just residential, but also outpatient. And, like, seventy-five percent of the clients that we have that go through a residential actually enter the door of an outpatient programme. So, we try and make sure that we… You know, it takes work, ‘cause the programmes themselves aren’t going to do that. I can guarantee you that.
Jack O’Donnell Yeah. Well, look, I, you know, I think Melissa, being a great example, Wayne, your dedication to this programme for all these years, you just can’t deny the fact that you’ve put a hundred and fifteen thousand people through this programme. I mean, that’s gotta be the biggest takeaway that really should impress anyone. And it, you know, it – it just proved that – that you can create low cost treatment programmes with effective solutions, with an investment, you know, on return, and efficient service delivery systems. I mean, it – it’s undeniable.
And whether New Jersey’s attitude has changed or not, I think it really is a testament to their forward thinking, the bold vision that New Jersey has had, you know, to make this programme a reality and to have helped so many people that, in most cases, probably would have not gotten help. And you just can’t translate that, you know, into anything more positive because when people don’t get help, it really is a bleak picture. So, hats off to New Jersey for what they’ve been doing.
Melissa O’Mara For me, having NCADD there and the staff within the welfare offices really had an impact on me being able to move forward with my life, because of their compassion and their understanding of addiction, so much that not only did I want to contact them as I went through the process early and treatment, but to this day I have the business card of that counselor who put me in to that treatment back in 2011. And so, after five years, I called him and thanked him for being there in that welfare office and giving me the ability and the opportunity to recover. And then, you know, almost ten years later, I didn’t want to throw it away, because it meant so much to me for someone who understood and cared to be there.
Wayne Wirta Yeah. We – we tell our employees to advocate on behalf of the client to get the most appropriate level of care for the most appropriate amount of time and to advocate with other systems to get rid of the barriers that keep them out of entering treatment and staying in treatment. And, Melissa, you’re one of our advocates. Correct?
Melissa O’Mara Yeah. So, I started advocating with NCADD early on in my recovery, in about 2014. Being able to participate as an advocate and then go to law school and then be in my job today, advocating for individuals in a different sense with substance use disorders, I’ve been able to carry a little piece of SAI and C4 and NCADD with me in everyday life over the last decade, which is really meaningful to me.
Wayne Wirta Jack, I don’t know if you know it, but we have over a thousand volunteer advocates throughout the state that, before COVID, met in ten regional teams that would meet with public officials to advocate for policies that promoted recovery and, sometimes, meet with officials to testify on legislation. You know, we put a face and voice on recovery in New Jersey.
Jack O’Donnell Wow. That’s terrific. That outreach is just so important for programmes like this. That’s terrific.
So, listen, I really want to thank both of you, Wayne Wirta and Melissa O’Mara, for your time today. C4 is proud to have been associated with both of you, your shining stars in this programme. And it’s certainly without Wayne, it doesn’t happen. You know, we say it all the time. Rick told me. You know, you picked up the ball and ran with this thing once we helped you create it. And it’s a testament to your dedication. And so, I want to thank you. And, Melissa, obviously, you still are out there as a great example. We’re proud of you and thank you for your time today.
Jack O’Donnell Well, thank you for listening to this week’s episode of the C4 Recovery Solutions podcast, Brought to you by C4 Recovery Foundation. For more information, please visit our website at c4recoveryfoundation.org or email us firstname.lastname@example.org or call us at +1 800-451-6835.
Be sure to rate, review, and subscribe on Apple Podcasts, Spotify, Stitcher, or wherever you like to listen. I’ll see you the next time. Have a great day. Goodbye.