Aftercare Planning
Welcome to the Family Support Group Program.
Here you can download the session PDF below by clicking on the button or continue scrolling to the online version. The videos password is craft.
Session Online Version
CHECK IN SECTION – Maximum time 20 minutes
Mindful Minute -- take a break from what you have been doing, breathe deeply, relax and recharge.
Step 1: Find a comfortable seated position with both feet grounded on the floor. Put a hand on your stomach. Close your eyes.
Step 2: Take a deep breath in through your nose and out through your mouth. Notice your thoughts and feelings and any tensions in your body.
Step 3: As you inhale and exhale, breathe deeply so your belly fills and empties with air. The hand on your stomach helps you practice belly – not chest breathing.
Step 4: or the next minute make breathing in and out your only focus. Let your thoughts come and go without trying to control them. If you find an area of tension in your body, relax it and let the tension go.
Step 5: At the end the minute slowly open your eyes. Gently bring your presence back to your surroundings.
Our Purpose
CRAFT Connects’ Family Support groups are for parents, partners, families and other Concerned Significant Others (CSOs) who have a loved one that is struggling with a substance use or mental health disorder. We know from first-hand experience that loving someone with these challenges can be a difficult, lonely journey. To create a safe place for honest sharing of our lived experience we use appropriate language and behavior. We are empathetic, nonjudgmental, genuine, respectful, steer clear of confrontation and imposing our own solutions. We encourage hope and compassion for all. CRAFT Connect helps to reframe and energize connections between you, your loved one and behavioral health professionals into a “therapeutic alliance” that leads to progress and healing. There is a lot we can learn from one another.
Last week we studied the “FS14.Supporting Treatment” session.
A. Were you able to follow through on these commitments?
Follow the five building blocks highlighted in the “Treatment Collaboration Handout”. (Circle one) Yes, No
(Circle one) Yes, NoDevelop a plan on how, when and where you will show your support.
B. What experience did you have practicing or sharing last session’s principles and skills? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________
C. What did you do to purposefully take care of yourself? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________
LEARN SECTION – Maximum time 30 minutes
1. In all areas of medicine, it is not good practice to discharge patients from the Intensive Care Unit to an unstructured, unsupported setting. “Where the patient goes next often determines whether or not the gains made in inpatient treatment will be retained or lost. Some patients feel so improved after completing treatment that they go straight home – with no Aftercare in place. Aftercare allows the patient to capitalize on the gains made in inpatient treatment. I consider inpatient treatment without Aftercare to be worthless.” (“Ten Tips for the First Year of Recovery”, Kevin McCauley, M.D.)
2. Aftercare or discharge planning with the behavioral health care professionals treating your loved one should begin at the time of their admission. This process should be person-centered and driven by outcomes related to the successful transition of your loved one. Creating a written Aftercare plan and assembling the post treatment team should ideally be completed at least four weeks before graduation or discharge from treatment. Depending on your loved one’s disorders their Aftercare team could include doctors, therapists, addiction specialists, recovery coaches, peer groups, programs, friends, employers, etc. As graduation or discharge approaches, if you have been involved with your loved one’s treatment, and neither your loved one or a member of their treatment team has talked with you about Aftercare then you need to be proactive and ask, “What’s the plan?”
Discuss: Where does your loved one think you fit in their recovery? If they don’t see you as a key member of the post treatment team, what role can you play? ____________________________________________________________________________________________________________________________________________________________________________________________________________
3. The discharge planning process is a unique opportunity for your loved one to discover where they want to “go next”. If they have not yet started to plan their future, this is the time to begin. This kind of planning will be most effective if it happens in a “safe place” as an open discussion involving equal amounts of listening and talking. The best way to facilitate such a conversation is to ask open-ended, probing questions and listen closely to your loved one response.
· Where do they want to live? Describe what life at home will be like.
· What kind of individual, family, group treatment therapy and medications are part of their Aftercare?
· Are there obstacles to their transition from treatment?
Questions for young adults could include:
· Do they want to pursue further education? What would they like to study?
· What kind of job or career do they want to do?
· Do they need financial support, and for how long?
Think: How well do you think you understand your loved ones’ current hope and dreams? If not, what can you start doing today to help them feel comfortable sharing their future plans?
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4. If your loved one plans on living with you or another Concerned Significant Other (CSO) you or that CSO should be included as full partners in the discharge planning process. Key areas should be discussed and agreed to while your loved one is still in treatment – not after they graduate or are discharged. The first year after treatment is all about risk management, how do we improve the chances for our loved one achieving long term recovery. A well thought out Aftercare plan should provide increasing levels of independence and responsibility while retaining the margin of safety that treatment provided for your loved one. This kind of “continuity of care” thinking has proven to be the best way to maximize your loved one’s chances of achieving long-term recovery.
5. “Effective treatment should not strip your loved one of personal responsibility, but rather do the opposite. Most people take responsibility to the extent that they know how. The best way to help your loved one manage their disease is to show them how by treating them as thinking, capable adults. Treating them like infirm infants is not only unwarranted, it’s dangerous – they buy into it quickly, adopt the sick role, and use it to continue unwanted behaviors.” (“Ten Tips for the First Year of Recovery”, Kevin McCauley, M.D.). Something like the “Weekly Recovery Activity Checklist Handout” accompanying this session could become a helpful self-assessment tool supporting your loved one’s long-term recovery.
6. Encourage your loved one to follow through on their plan helping them return to full functioning incrementally and safely, but as quickly as possible after treatment. Even if your loved one is not going to live with you or another CSO, maintaining what they learned in treatment needs regular, ongoing support.
Please turn to and let’s review the “Recovery Maintenance Handout” included with this session.
7. You may still be blaming yourself, thinking that you missed important warning signs before your loved one entered treatment. Making sense of behaviors we see when our loved one is out of treatment, wither they are living or not living with us, can be challenging. Is this behavior part of our loved ones growing, learning, self-discovery, finding themselves in post-treatment? Is this a sign or indication of deeper maladaptive or self-harming behavior? Accepting that you will have many "worry" moments after your loved one completes treatment is a key step in your helping them make this transition. The “Common Unwanted Behaviors Handout” included with this session may be helpful as you think about these moments. The better prepared you are the more effective you can respond.
SHOULD I WORRY ACTIVITY
Step 1: Describe your loved one’s “moments” that make you feel worried. ____________________________________________________________________________________________________________________________________________________________________________________________________________
Step 2: What emotions could you have during these moments? What skills could you use to navigate these feelings?
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Step 3: Of the moments listed in Step 1 which ones require you to respond appropriatley, and why?
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Step 4: Of the moments in Step 1 which ones don’t need a response from you?.
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Step 5: Share what you learned from doing this activity.
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8. Your loved one should have a relapse plan in place prior to discharge from treatment. If relapse occurs, they can go immediately to their plan and do exactly as it says. Relapse is not the end of the world – it is a common feature of early recovery and it is important to have realistic expectations about it. Look at the “Cycle of Change Handout” included with this session. Relapse does not mean that your loved one is back at the starting point, that they are not motivated or that treatment was a failure and a waste of time and money. The person who relapses and then goes to a meeting, calls their doctor, or comes back to treatment has a functioning program of recovery. Eventually, these relapses will become less frequent as your loved learns what they need to do to prevent them. Recovery is a process in which unwanted behaviors gradually comes to an end – provided your loved one “keeps coming back.” (“Ten Tips for the First Year of Recovery”, Kevin McCauley, M.D.)
Discuss: What does your loved one’s relapse plan consist of? When you observe the early warning signs of relapse, what does your loved one want you to do?
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GROUP SHARING SECTION – Maximum time 30 minutes
9. We will now begin the sharing portion of the meeting. You are invited to share from 3 to 5 minutes about your experience as it relates to your loved one’s recovery, this week’s session or what you are currently working on. Please focus your sharing on potential solutions rather than the problems. We will conclude the sharing five minutes before the end of the meeting. Who would like to begin?
MY COMMITMENTS SECTION – Maximum time 10 minutes
10. Please remember that what has been shared here is confidential and that the opinions expressed are of the individuals who shared them. These are the group commitments, we will start the next CRAFT Connect session by reporting on our commitments. This week I will:
A. Do the in-between session assignments
· Become familiar with my loved ones’ relapse plan.
· Review the “Recovery Maintenance Ideas Handout” and “Weekly Recovery Activity Checklist Handout” with my loved one.
B. Share what I am learning with my family, friends and community.
C. Show kindness for myself by self-care.
As you listen to this “Song About Connection”, quietly think about what you learned in this session. Write your thoughts and personal commitments below.
Watch: “Cyndi Lauper - Time After Time Lyrics” video.
What are the most important things I learned?
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What will I do differently because of what I learned?
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Recovery Maintenance Handout
Remember to discuss any recovery maintenance ideas FIRST with your loved one to make sure you get their “buy in” -- before sharing them with any other Concerned Significant Others (CSO’s).
A. Set Expectations -- Limits and Supports.
Write out the list of things you will do to support them, and create a schedule providing structure for both you and your loved one. Write down your limits. Talk about what has changed as a result of treatment? What still needs to change? Assign everyone in the household roles to play according to their abilities.
B. Involvement in meaningful, structured activities.
Involvement in work, school, or other personally important roles right now -- not waiting until other problems are "solved" -- helps let your loved one know that personally important and meaningful goals are achievable, despite their disorders and any previous setbacks.
C. Resume "normal" activities
Don't let family life revolve around your loved one’s disorder. Practice living life with a behavioral health condition, rather than struggling against the disorder. Wherever possible spend time together on activities unconnected to your loved one’s illness.
D. Set up a simple follow through system
Because daily prodding can easily insult or anger an adult, some families have found a regularly scheduled weekly recovery meeting virtually or in person can be helpful. If your loved one commits to maintaining some kind of weekly checklist, this would be a good place to share that. Questions to ask in weekly meetings could include:
· What’s been working individually and in the family?
· What’s something you are proud of?
· Areas to improve?
· What are things that you can work on for upcoming meetings? .
· How did this meeting go? Did we achieve its purpose?
E. Work together as a group learning “Life Worth Living” skills.
Well supported scientific evidence shows that studying with others makes a big difference in our learning. Use part of a weekly recovery meeting to work together on developing practical skills that help meet everyone’s physical and social emotional health needs. These groups work like a council, there is no teacher or expert. Just follow the materials as written and trust in the group. Twelve 20-minute skills training sessions are found at https://www.craftconnectfs.com/skills-for-a-life-worth-living.
Weekly Recovery Activity Checklist
Date:____________________________________
It is helpful to monitor on a regular basis the degree to which you are involved in activities that support your treatment and aftercare. In the space below, place a check mark before each activity that reflects your activities during the past seven days.
Sharing your activities with those involved in supporting your treatment and aftercare has proven to help you achieve long term stable recovery.
___ I set personal positive goals for myself.
___ I applied recovery concepts to my daily life.
___ I successfully used my skills to cope with memories or trauma.
___ I attended at least one recovery support group.
___ I spent leisure time with others in recovery.
___ I tried to do something positive to improve my relationship with my Concerned Significant Others (CSOs)
___ I read recovery-related literature.
___ My diet and exercise will enhance my physical health.
___ I tended to any physical problems I experienced.
___ I stayed on my medication regime.
___ I included a mindfulness practice in my daily routine.
___ I was involved in meaningful structured activities e.g., work, school, service, etc.
___ I carry one or more objects with me every day that remind me of my commitment to recovery.
___ I had individual contact with my sponsor/trusted advisor.
___ I enjoyed time with friends this week who support my recovery.
___ I avoided people, places and things I associate with my unwanted behaviors.
After reviewing my activities this past week, I want to make sure I do the following this next week.
1._____________________________________________________________________________________________________2._____________________________________________________________________________________________________3._____________________________________________________________________________________________________4._____________________________________________________________________________________________________5. ____________________________________________________________________________________________________
Common Unwanted Behaviors Handout
Mental Health Disorders
Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn't always easy. There's no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness. Because they are disorders of the brain, many symptoms of mental illness are expressed as complex behaviors. Although each illness has its own symptoms common behaviors of mental illness in adults and adolescents can include the following (https://www.nami.org/learn-more/know-the-warning-signs):
Excessive worrying or fear
Feeling excessively sad or low
Confused thinking or problems concentrating and learning
Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
Prolonged or strong feelings of irritability or anger
Avoiding friends and social activities
Difficulties understanding or relating to other people
Changes in sleeping habits or feeling tired and low energy
Changes in eating habits such as increased hunger or lack of appetite
Changes in sex drive
Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality)
Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)
Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
Thinking about suicide
Inability to carry out daily activities or handle daily problems and stress
An intense fear of weight gain or concern with appearance
Abuse of substances like alcohol or drugs
Watch: “10 Common Warning Signs of a Mental Health Condition in Teens and Young Adults” video, https://www.youtube.com/watch?v=zt4sOjWwV3M
Substance Use Disorders
Figuring out if your loved one is using drugs or alcohol can be challenging. Many of the signs and symptoms are, at times, typical teen or young adult “unwanted” behavior. Many are also symptoms of mental health issues, including depression or anxiety disorders which appear to be under our loved one’s control, but are not (https://drugfree.org/article/look-for-warning-signs/):
Behavioral Changes
Has changed relationships with family members or friends
Uses chewing gum or mints to cover up breath
Often uses over-the-counter preparations to reduce eye reddening or nasal irritation
Frequently breaks curfew
Has cash flow problems
Drives recklessly, and has car accidents or unexplained dents in the car
Avoids eye contact
Locks doors
Goes out every night
Makes secretive phone calls
Makes endless excuses
Has the “munchies” or sudden appetite
Exhibits uncharacteristically loud, obnoxious behavior
Laughs at nothing
Has become unusually clumsy: stumbling, lacking coordination, poor balance
Disappears for long periods of time
Has periods of sleeplessness or high energy, followed by long periods of “catch up” sleep
Mood & Personality Shifts
Exhibits mood changes or emotional instability
Sullen, withdrawn, depressed
Shows loss of inhibitions
Silent, uncommunicative
Hostile, angry, uncooperative
Deceitful or secretive
Less motivated
Unable to focus
Hyperactive
Unusually elated
Hygiene & Appearance Problems
Smells of smoke or other unusual smells on breath or on clothes
Messy appearance
Poor hygiene
Red, flushed cheeks or face
Track marks on arms or legs (or long sleeves in warm weather to hide marks)
Burns or soot on fingers or lips (from “joints” or “roaches” burning down)
Health Issues
Unusually tired
Lethargic movement
Unable to speak intelligibly, slurred speech, or rapid-fire speech
Nosebleeds
Runny nose, not caused by allergies or a cold
Frequent sickness
Sores, spots around mouth
Seizures
Vomiting
Wetting lips or excessive thirst (known as “cotton mouth”)
Sudden or dramatic weight loss or gain
Skin abrasions/bruises
Accidents or injuries
Depression
Headaches
Sweatiness
School and Work Concerns
Absenteeism or loss of interest
Loss of interest in extracurricular activities, hobbies, or sports
Failure to fulfill responsibilities at school or work
Complaints from teachers or supervisors
Reports of intoxication at school or work
At Home and in the Car
Disappearance of prescription or over-the-counter pills
Missing alcohol or cigarettes
Disappearance of money or valuables
Receiving unusual packages in the mail
Smell in the car or bottles, pipes or bongs on floor or in glove box
Appearance of unusual containers or wrappers, or seeds left on surfaces used to clean marijuana
Appearance of unusual drug apparatuses, including pipes, rolling papers, small medicine bottles, eye drops, butane lighters, or makeshift smoking devices, like bongs made out of toilet paper rolls and aluminum foil
Hidden stashes of alcohol
Cycle of Change Handout
For over 35 years researchers have found that individuals move through a series of six stages (precontemplation, contemplation, preparation, action, maintenance, relapse) in the adoption of healthy behaviors or cessation of unhealthy ones. Research on a variety of different problem behaviors has also shown that there are certain predictors of progression through the stages of change (e.g., Prochaska & DiClemente, 1983), including decisional balance (Prochaska, 1994); self-efficacy (e.g., DiClemente, Prochaska, & Gibertini, 1985); and the processes of change (Prochaska & DiClemente, 1983).
Where do you think your loved one is at in the Cycle of Change, and why?
Precontemplation, not yet acknowledging that there is a problem behavior that needs to be changed. The stage in which an individual has no intent to change behavior in the near future, usually measured as the next 6 months. PR contemplators are often characterized as resistant or unmotivated and tend to avoid information, discussion, or thought with regard to the targeted health behavior (Prochaska et al., 1992).
Contemplation, acknowledging that there is a problem but not yet ready or sure of wanting to make a change. Individuals in this stage openly state their intent to change within the next 6 months. They are more aware of the benefits of changing, but remain keenly aware of the costs (Prochaska, Redding, & Evers, 1997). Contemplators are often seen as ambivalent to change or as procrastinators (Prochaska & DiClemente, 1984).
Preparation, getting ready to change. The stage in which individuals intend to take steps to change, usually within the next month (DiClemente et al., 1991). Preparation is viewed as a transition rather than stable stage, with individuals intending progress to Action in the next 30 days (Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994).
Action, changing behavior. An individual has made overt, perceptible lifestyle modifications for fewer than 6 months (Prochaska et al., 1997).
Maintenance, maintaining the behavior change. These are working to prevent relapse and consolidate gains secured during Action (Prochaska et al., 1992). Maintainers are distinguishable from those in the Action stage in that they report the highest levels of self- efficacy and are less frequently tempted to relapse (Prochaska & DiClemente, 1984).
Relapse. Returning to older behaviors and abandoning the new changes.
This Transtheoretical Model (TTM) of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made. TTM — currently, the most popular stage model in health psychology (Horwath, 1999) — has proven successful with a wide variety of simple and complex health behaviors, including smoking cessation, weight control, sunscreen use, reduction of dietary fat, exercise acquisition, quitting cocaine, mammography screening, and condom use (Prochaska, et al., 1994).