Recovery Management: Recovery Management: Presentation Guidelines Presentation Guidelines

Bill WhiteBill White

bwhite@chestnut.orgbwhite@chestnut.org

www.williamwhitepapers.comwww.williamwhitepapers.com

Presentation GoalPresentation Goal

Enhance each participant’s abilities to Enhance each participant’s abilities to prepare and deliver presentations on prepare and deliver presentations on RM & ROSC via conference keynotes RM & ROSC via conference keynotes & workshops, inservice trainings, and & workshops, inservice trainings, and meeting presentations with key meeting presentations with key individuals and groups. individuals and groups.

Learning Objectives: Learning Objectives: Participants will be able to Participants will be able to

• Define & distinguish recovery Define & distinguish recovery management (RM) and recovery-management (RM) and recovery-oriented systems of care (ROSC)oriented systems of care (ROSC)

• Identify and discuss 8 areas of RM-Identify and discuss 8 areas of RM-related changes in service practicerelated changes in service practice

• Discuss tasks and tools for each of Discuss tasks and tools for each of the 3 stages of effective RM the 3 stages of effective RM presentations presentations

Personal PerspectivePersonal Perspective

• Work in addictions field since 1969Work in addictions field since 1969• 1998-2003: Behavioral Health 1998-2003: Behavioral Health

Recovery Management ProjectRecovery Management Project• 2002-2008: presentation & 2002-2008: presentation &

consultations on RM & P-BRSSconsultations on RM & P-BRSS• 2005-present ATTC/Philadelphia 2005-present ATTC/Philadelphia

DBH/MRS monograph series DBH/MRS monograph series • Gratitude to leadership team membersGratitude to leadership team members

Your Personal PerspectiveYour Personal Perspective

Each of you who present on this subject Each of you who present on this subject will need to build your own credentials will need to build your own credentials and reputations on this subject.and reputations on this subject.

• No substitute for preparation: You No substitute for preparation: You must become a serious student of this must become a serious student of this subject to avoid “flavor of the month” subject to avoid “flavor of the month” perception perception

• I will suggest resources as we proceed I will suggest resources as we proceed that will help with this process.that will help with this process.

Topical ResourcesTopical Resources

• RM/ROSC Monograph Series, particularly RM/ROSC Monograph Series, particularly the “science monograph” (2008) the “science monograph” (2008)

• RM/ROSC Papers at RM/ROSC Papers at www.williamwhitepapers.comwww.williamwhitepapers.com

• Book: Kelly, J. & White, W. (Late 2010) Book: Kelly, J. & White, W. (Late 2010) Addiction recovery management: Theory, Addiction recovery management: Theory, science and practicescience and practice. New York: Springer . New York: Springer Science. Science.

• Video of presentations from Philadelphia & Video of presentations from Philadelphia & Atlanta & PowerPoint SlidesAtlanta & PowerPoint Slides

Resources to Enhance Resources to Enhance Presentation Skills Presentation Skills

• Training of Trainer opportunitiesTraining of Trainer opportunities

• The Training LifeThe Training Life: Full text available : Full text available at at www.williamwhitepapers.comwww.williamwhitepapers.com

• Menu of presentation slidesMenu of presentation slides

• Availability of email/phone Availability of email/phone consultation with resource team, consultation with resource team, White, Achara, Laudet, etc. White, Achara, Laudet, etc.

Conceptual & Language Conceptual & Language Clarity Clarity ““Recovery management” (RM) is a Recovery management” (RM) is a

philosophical framework for organizing philosophical framework for organizing addiction treatment and recovery support addiction treatment and recovery support services across the stages of pre-recovery services across the stages of pre-recovery identification and engagement, recovery identification and engagement, recovery initiation and stabilization, long-term initiation and stabilization, long-term recovery maintenance, and quality of life recovery maintenance, and quality of life enhancement for individuals and families enhancement for individuals and families affected by severe substance use disorders. affected by severe substance use disorders.

Recovery Management & Recovery Management & Stages of RecoveryStages of Recovery

1.1. Pre-recovery identification and Pre-recovery identification and engagement (recovery priming)engagement (recovery priming)

2.2. Recovery initiation and stabilizationRecovery initiation and stabilization

3.3. Transition to successful recovery Transition to successful recovery maintenancemaintenance

4.4. Enhancement of quality of Enhancement of quality of personal/family life in long-term personal/family life in long-term recoveryrecovery

Conceptual & Language Conceptual & Language Clarity Clarity Recovery-oriented systems of care Recovery-oriented systems of care

(ROSC) are networks of formal and (ROSC) are networks of formal and informalinformal services developed and services developed and mobilized to sustain mobilized to sustain long-termlong-term recovery recovery for individuals and for individuals and familiesfamilies impacted impacted by severe substance use disorders. The by severe substance use disorders. The systemsystem in ROSC is not a treatment in ROSC is not a treatment agency but a macro level organization agency but a macro level organization of a community, a state or a nation. of a community, a state or a nation.

RM & ROSC Focus TodayRM & ROSC Focus Today

• My focus will be on how you as individuals My focus will be on how you as individuals and as teams can serve as and as teams can serve as presenterspresenters within within a variety of educational venues within your a variety of educational venues within your respective regions to introduce the concept respective regions to introduce the concept and practices of RM.and practices of RM.

• Dr. Achara will focus on how you can serve Dr. Achara will focus on how you can serve as as facilitatorsfacilitators and and resource brokersresource brokers for for groups interested or involved in ROSC-groups interested or involved in ROSC-related systems transformation processes. related systems transformation processes.

Stages of Effective RM/ROSC Stages of Effective RM/ROSC Presentations Are Like other Presentations Are Like other Effective Presentations Effective Presentations 1. Pre-presentation Planning (It’s all about 1. Pre-presentation Planning (It’s all about

the details—setting, audience, message the details—setting, audience, message refinement)refinement)

2. Clear Presentation Stages2. Clear Presentation Stages

--Opening--Opening

--Middle --Middle

--End--End

3. Post-presentation Follow-up (information & 3. Post-presentation Follow-up (information & TA)TA)

Stage One: OpeningStage One: Opening

• Spans 30-60 minutes prior to Spans 30-60 minutes prior to presentation through first 10% of presentation through first 10% of presentation timepresentation time

• Multiple tasks to be achieved in narrow Multiple tasks to be achieved in narrow window of timewindow of time

• RM/ROSC-related material can be RM/ROSC-related material can be threatening to multiple parties: Opening threatening to multiple parties: Opening tasks essential to enhance receptiveness tasks essential to enhance receptiveness

Tasks and Tools for Tasks and Tools for Presentation OpeningPresentation Opening

1. Resolve problems with presentation 1. Resolve problems with presentation environmentenvironment

2. Early audience contact, assessment & 2. Early audience contact, assessment & welcoming (refine message & diminish welcoming (refine message & diminish distance)distance)

3. Engage3. Engage * Initial presentation of self—warmth, * Initial presentation of self—warmth,

humility, respect, curiosity, confidencehumility, respect, curiosity, confidence * Speaker identification with audience * Speaker identification with audience

Tasks and Tools for Tasks and Tools for Presentation OpeningPresentation Opening

4. Equalize presenter-participant power4. Equalize presenter-participant power

--evaluate degree of power --evaluate degree of power discrepancy discrepancy

--increase or decrease your power--increase or decrease your power

--control the introduction--control the introduction

--gage formality based on --gage formality based on organizational/cultural contextorganizational/cultural context

--early participant involvement--early participant involvement

Tasks and Tools for Tasks and Tools for Presentation OpeningPresentation Opening5. Reduce resistance by acknowledging 5. Reduce resistance by acknowledging

achievements of modern addiction treatment achievements of modern addiction treatment (See forthcoming slides as sample)(See forthcoming slides as sample)--Given such achievements, why does --Given such achievements, why does treatment need to be “transformed”?treatment need to be “transformed”?

6. Create clear expectations via goals and 6. Create clear expectations via goals and learning objectives: Let audience know you learning objectives: Let audience know you will answer the why question using treatment will answer the why question using treatment systems performance data and their own systems performance data and their own experience (where time & format allows the experience (where time & format allows the latter)latter)

Tasks and Tools for Tasks and Tools for Presentation OpeningPresentation Opening

7. Honor the participants contributions 7. Honor the participants contributions and ideas via praise & gifts and ideas via praise & gifts (resources, e.g., handouts, (resources, e.g., handouts, monographs, links, etc.)monographs, links, etc.)

8. Create sense of historical & personal 8. Create sense of historical & personal urgency via your own commitment & urgency via your own commitment & energyenergy

Achievements of Modern Achievements of Modern Treatment Include Elimination Treatment Include Elimination of Belowof Below

Achievements of Modern Achievements of Modern Treatment Include (To name a Treatment Include (To name a few):few):• Replicable, community-based treatment Replicable, community-based treatment

modalitiesmodalities

• Federal, state, local, private partnership to Federal, state, local, private partnership to fund addiction treatment and ancillary fund addiction treatment and ancillary support industries, e.g., research, training, support industries, e.g., research, training, etc. etc.

• Accessibility: From less than 50 to more Accessibility: From less than 50 to more than 13,000 U.S. specialty treatment than 13,000 U.S. specialty treatment programsprograms

Achievements of Modern Achievements of Modern Treatment Include:Treatment Include:• Professionalization of addiction Professionalization of addiction

medicine & addiction counselingmedicine & addiction counseling• Systems of early intervention, EAP, SAP, Systems of early intervention, EAP, SAP,

SBIRTSBIRT• Screening/assessment/diagnostic tools Screening/assessment/diagnostic tools • Continuum of careContinuum of care• Millions of lives touched and Millions of lives touched and

transformedtransformedBackground Source: Background Source: Slaying the DragonSlaying the Dragon

Core Presentation TasksCore Presentation Tasks

Core of Presentation Must Answer 7 QuestionsCore of Presentation Must Answer 7 Questions

1.1. WhyWhy does addiction treatment need to be does addiction treatment need to be transformed? transformed?

2.2. WhatWhat changes in frontline service practices changes in frontline service practices occur in the shift to recovery management? occur in the shift to recovery management?

3.3. WhatWhat changes in administrative, regulatory, changes in administrative, regulatory, funding practices can be anticipated as part of funding practices can be anticipated as part of an RM/ROSC transformation process? an RM/ROSC transformation process?

Core Presentation Tasks Core Presentation Tasks

4. 4. HowHow will this process of systems will this process of systems transformation be achieved?transformation be achieved?

5. 5. WhoWho will be involved in systems will be involved in systems transformation (and how will it affect transformation (and how will it affect my role)?my role)?

6. 6. WhenWhen will this process begin and how will this process begin and how long will it take? long will it take?

7. 7. WhatWhat obstacles should we anticipate? obstacles should we anticipate?

Core Presentation: ToolsCore Presentation: Tools

Craft a presentation using a mix of the Craft a presentation using a mix of the following based on the audience following based on the audience characteristics and the time availablecharacteristics and the time available

• Findings from scientific researchFindings from scientific research• Treatment systems performance data Treatment systems performance data

(localize where possible)(localize where possible)• Video & Internet ResourcesVideo & Internet Resources• Self-disclosure / StoriesSelf-disclosure / Stories• Structured discussions and learning Structured discussions and learning

exercisesexercises

Critical Content Areas Critical Content Areas

I will focus in this first presentation on I will focus in this first presentation on how you can best answer:how you can best answer:

• WhyWhy does addiction treatment need does addiction treatment need to be transformed? to be transformed?

• WhatWhat changes in frontline service changes in frontline service practices occur in the shift to RM? practices occur in the shift to RM?

Impetus for Change Impetus for Change

1. Cultural and political awakening of 1. Cultural and political awakening of individuals/families in recovery individuals/families in recovery

* Growth/diversification of mutual aid * Growth/diversification of mutual aid

* New recovery advocacy movement* New recovery advocacy movement

* New recovery support institutions* New recovery support institutions

Tell this story in picturesTell this story in pictures

Resources: Resources: Let’s Go Make Some HistoryLet’s Go Make Some History

www:facesandvoicesofrecovery.orgwww:facesandvoicesofrecovery.org

Impetus for ChangeImpetus for Change

2. Frustration of frontline addiction 2. Frustration of frontline addiction professionalsprofessionals

3. Addiction science, particularly 3. Addiction science, particularly research on addiction/recovery research on addiction/recovery careers, treatment outcome studies careers, treatment outcome studies & treatment systems performance & treatment systems performance data data

Impetus for Change Impetus for Change

4. Addiction treatment payors4. Addiction treatment payors

5. Need to counter growing cultural 5. Need to counter growing cultural pessimism about treatment, e.g., pessimism about treatment, e.g., effects of celebrity rehab recycling effects of celebrity rehab recycling

RM & ROSC Part of Shift in RM & ROSC Part of Shift in Emphasis within 3 overlapping Emphasis within 3 overlapping Governing Constructs Governing Constructs • Pathology Paradigm: Knowledge drawn Pathology Paradigm: Knowledge drawn

from study of the etiology and from study of the etiology and epidemiology of substance use disordersepidemiology of substance use disorders

• Intervention Paradigm: Knowledge drawn Intervention Paradigm: Knowledge drawn from study of social and clinical from study of social and clinical interventions into severe AOD problemsinterventions into severe AOD problems

• Recovery Paradigm: Knowledge drawn Recovery Paradigm: Knowledge drawn from the study of lfrom the study of long-termong-term addiction addiction recovery recovery

Limitations of Acute Care Limitations of Acute Care Approach to Addiction Approach to Addiction TreatmentTreatment• Modern treatment has focused on an acute Modern treatment has focused on an acute

care model of addiction treatmentcare model of addiction treatment• Define AC Model Define AC Model • Extol what the AC Model can achieve: Extol what the AC Model can achieve:

biopsychosocial stabilization more biopsychosocial stabilization more effectively, more safely for more people effectively, more safely for more people than has ever been achieved in historythan has ever been achieved in history

• ““Treatment Works”, BUT Recovery initiation Treatment Works”, BUT Recovery initiation does not assure recovery maintenance for does not assure recovery maintenance for people with high problem severity / low people with high problem severity / low recovery capital—antibiotics analogyrecovery capital—antibiotics analogy

Limitations of Acute Care Limitations of Acute Care Approach to Addiction Approach to Addiction TreatmentTreatment• Discovery that addiction shares many Discovery that addiction shares many

characteristics with other chronic medical characteristics with other chronic medical disorders (McLellan, et al, 2000)disorders (McLellan, et al, 2000)

• Growing interest in: How would we treat Growing interest in: How would we treat addiction if we addiction if we reallyreally believed that believed that addiction was a chronic disorder?”, e.g., addiction was a chronic disorder?”, e.g., how models of “disease management” in how models of “disease management” in primary health care might be adapted to primary health care might be adapted to long-term management of addictionlong-term management of addiction

AC. RM & key recovery AC. RM & key recovery performance measuresperformance measures

Each of you will need to personalize Each of you will need to personalize and localize presentation of this and localize presentation of this material, but following 8 elements material, but following 8 elements are essentialare essential

• Review current AC model Review current AC model performance limitationsperformance limitations

• Outline current & future directions of Outline current & future directions of RM-models of careRM-models of care

8 Key Performance Arenas 8 Key Performance Arenas Linked to Long-term Recovery Linked to Long-term Recovery OutcomesOutcomes• Attraction, access & early Attraction, access & early

engagementengagement

• Screening, assessment & placementScreening, assessment & placement

• Composition of the service teamComposition of the service team

• Service relationshipService relationship

• Service dose, scope & qualityService dose, scope & quality

Key Performance Arenas Key Performance Arenas Linked to Long-term Recovery Linked to Long-term Recovery OutcomesOutcomes• Locus of service deliveryLocus of service delivery• Assertive linkage to communities of Assertive linkage to communities of

recoveryrecovery• Post-treatment monitoring, support Post-treatment monitoring, support

and early re-interventionand early re-intervention

NOTE: There are others but these 8 NOTE: There are others but these 8 are most criticalare most critical

1. Attraction, Access & Early 1. Attraction, Access & Early EngagementEngagement

AC Limitations AC Limitations • 10% & 25% data; late stage and under 10% & 25% data; late stage and under

coercion; waiting list drop-out data; attrition coercion; waiting list drop-out data; attrition data (more than 50% will not complete) data (more than 50% will not complete)

RM DirectionsRM Directions• Assertive community education & outreachAssertive community education & outreach• Assertive waiting list managementAssertive waiting list management• Lowered threshold of engagement; Lowered threshold of engagement;

rethinking motivation; institutional outreachrethinking motivation; institutional outreach• Changes in administrative discharge policiesChanges in administrative discharge policies

2. Screening, Assessment & 2. Screening, Assessment & PlacementPlacement

AC assessment is categorical, pathology-AC assessment is categorical, pathology-focused, professionally-driven, an intake focused, professionally-driven, an intake function & focused on individual; placement function & focused on individual; placement based on problem severity.based on problem severity.

RM assessment is global, strengths-based, RM assessment is global, strengths-based, client focused (rapid transition to recovery client focused (rapid transition to recovery plans), continual and encompasses the plans), continual and encompasses the individual, family and recovery environment; individual, family and recovery environment; recovery capital factored into placement recovery capital factored into placement decisions.decisions.

3. Composition of the Service 3. Composition of the Service TeamTeam

AC model uses disease rhetoric but few AC model uses disease rhetoric but few medical personnel; recovery rhetoric but medical personnel; recovery rhetoric but decreasing involvement of recovering decreasing involvement of recovering people.people.

RM expands role of medical (including primary RM expands role of medical (including primary care physicians) and other allied care physicians) and other allied professionals, recovering people (P-BRSS) professionals, recovering people (P-BRSS) and culturally indigenous healers. Also and culturally indigenous healers. Also emphasizes reinvestment in volunteer and emphasizes reinvestment in volunteer and alumni programs. alumni programs.

4. Service relationship4. Service relationship

Acute Care: Dominator model; emphasis on Acute Care: Dominator model; emphasis on professional authority; great power professional authority; great power discrepancy; role of client is one of discrepancy; role of client is one of compliance.compliance.

Recovery Management: Sustained recovery Recovery Management: Sustained recovery partnership (long-term consultation) model; partnership (long-term consultation) model; emphasis on prolonged continuity of contact; emphasis on prolonged continuity of contact; client as co-leader; philosophy of choice; client as co-leader; philosophy of choice; greater use of personal/professional self; greater use of personal/professional self; contrasting ethical guidelines. contrasting ethical guidelines.

5. Service Dose, Scope & 5. Service Dose, Scope & QualityQuality

AC model has become ever briefer, narrower AC model has become ever briefer, narrower via reimbursable services & continues to via reimbursable services & continues to incorporate methods lacking scientific incorporate methods lacking scientific support.support.

RM model emphasis on importance of dose RM model emphasis on importance of dose (NIDA principles—90 days), role of ancillary (NIDA principles—90 days), role of ancillary services and weeding out practices that services and weeding out practices that are not linked to recovery outcomes or that are not linked to recovery outcomes or that may produce inadvertent injury.may produce inadvertent injury.

6. Locus of Service Delivery6. Locus of Service Delivery

AC model locus is the institution: How do we AC model locus is the institution: How do we get the individual into treatment—get get the individual into treatment—get them from their world to our world? them from their world to our world?

* Problem of transfer of learning * Problem of transfer of learning RM model emphasizes the ecology of long-RM model emphasizes the ecology of long-

term recovery: “How do we nest recovery term recovery: “How do we nest recovery in the natural environment of this in the natural environment of this individual or create an alternative individual or create an alternative recovery-conducive environment?”recovery-conducive environment?”

* Healing forest metaphor (Coyhis)* Healing forest metaphor (Coyhis) * Concept of “community recovery”* Concept of “community recovery”

7. Assertive linkage to 7. Assertive linkage to communities of recoverycommunities of recovery

AC Model: Passive linkage, low affiliation and AC Model: Passive linkage, low affiliation and high early attrition, single pathway model of high early attrition, single pathway model of recoveryrecovery

RM model: Assertive linkage, multiple pathway RM model: Assertive linkage, multiple pathway model of recovery, linkage beyond recovery model of recovery, linkage beyond recovery mutual aid groups; active relationship with mutual aid groups; active relationship with local service committees, involved in local service committees, involved in recovery community resource developmentrecovery community resource development

8. Post-treatment Monitoring, 8. Post-treatment Monitoring, Support and, if needed, Early Support and, if needed, Early Re-interventionRe-intervention• 50-80-90 rule: More than 50% of clients 50-80-90 rule: More than 50% of clients

discharged from Tx will return to some use discharged from Tx will return to some use in the next year—80% of those will do so in in the next year—80% of those will do so in first 90 days after discharge.first 90 days after discharge.

• 15-25 rule: The stability point of recovery 15-25 rule: The stability point of recovery (risk of future lifetime relapse drops below (risk of future lifetime relapse drops below 15%) isn’t reached until 4-5 years for 15%) isn’t reached until 4-5 years for alcohol dependence; 25% of opioid alcohol dependence; 25% of opioid dependent persons who achieve five years dependent persons who achieve five years of abstinence will later resume narcotic of abstinence will later resume narcotic addiction. addiction.

8. Post-treatment Monitoring, 8. Post-treatment Monitoring, Support and, if needed, Early Support and, if needed, Early Re-interventionRe-intervention

25-35% of clients who complete addiction 25-35% of clients who complete addiction treatment will be re-admitted to treatment treatment will be re-admitted to treatment within one year, 50% within 2-5 years within one year, 50% within 2-5 years (Hubbard, et al, 1989; Simpson, et al, (Hubbard, et al, 1989; Simpson, et al, 2002). 2002).

An Acute Revolving Door: Of those admitted to the An Acute Revolving Door: Of those admitted to the U.S. public treatment system in 2003, 64% were U.S. public treatment system in 2003, 64% were re-entering treatment--23% accessing treatment re-entering treatment--23% accessing treatment the 2nd time, 22% for the 3the 2nd time, 22% for the 3rdrd or 4 or 4thth, and 19% for 5 , and 19% for 5 or more times (OAS/SAMHSA, 2005).or more times (OAS/SAMHSA, 2005).

8. AC Model: “Aftercare” as an 8. AC Model: “Aftercare” as an Afterthought Afterthought

Post-discharge continuing care can enhance Post-discharge continuing care can enhance recovery outcomes (Johnson & Herringer, recovery outcomes (Johnson & Herringer, 1993; Godley, et al, 2001; Dennis, et al, 1993; Godley, et al, 2001; Dennis, et al, 2003).2003).

But only 1 in 5 (McKay, 2001) to 1 in 10 But only 1 in 5 (McKay, 2001) to 1 in 10 (OAS, SAMHSA, 2005) adult clients receive (OAS, SAMHSA, 2005) adult clients receive such care (McKay, 2001) and only 36% of such care (McKay, 2001) and only 36% of adolescents receive adolescents receive anyany continuing care continuing care (Godley,et al, 2001) (Godley,et al, 2001)

8. RM Model: Assertive 8. RM Model: Assertive Approaches to Continuing CareApproaches to Continuing Care

• Post-treatment monitoring & support Post-treatment monitoring & support (recovery checkups)(recovery checkups)

• Stage-appropriate recovery education Stage-appropriate recovery education & coaching& coaching

• Assertive/continued linkage to Assertive/continued linkage to recovery resourcesrecovery resources

• Early re-intervention & re-linkage to Early re-intervention & re-linkage to Tx and recovery support resources Tx and recovery support resources

• Recovery community building Recovery community building

Closing of Presentation: Closing of Presentation: Summation Summation • Outlined 5 sources of impetus for shift to a Outlined 5 sources of impetus for shift to a

model of sustained recovery managementmodel of sustained recovery management• Outlined 8 areas of service practice that Outlined 8 areas of service practice that

significantly change in the transition from significantly change in the transition from AC to RM modelAC to RM model

• RM/ROSC do not eliminate AC model, but RM/ROSC do not eliminate AC model, but wrap the AC model in RM technologies for wrap the AC model in RM technologies for those with severe AOD problems and low those with severe AOD problems and low recovery capitalrecovery capital

• Add ROSC points from Dr. Achara’s Add ROSC points from Dr. Achara’s presentation on RM/ROSC transformation presentation on RM/ROSC transformation process.process.

Closing of Presentation: Closing of Presentation: Express a Sense of Historical Express a Sense of Historical Urgency Urgency It will take years to transform addiction It will take years to transform addiction

treatment from an exclusively AC treatment from an exclusively AC model of intervention to a RM model model of intervention to a RM model of sustained recovery support.of sustained recovery support.

The future of addiction treatment and The future of addiction treatment and recovery will hinge on well how we recovery will hinge on well how we are able to achieve this task. are able to achieve this task.

Closing of Presentation: Make Closing of Presentation: Make It Personal & Open It UpIt Personal & Open It Up

• The personal/professional destinies of some of The personal/professional destinies of some of you in this room are linked to leadership in this you in this room are linked to leadership in this emerging movement. For some of you, your emerging movement. For some of you, your whole lives have prepared your for this unique whole lives have prepared your for this unique moment in the field’s history. (Extend invitation moment in the field’s history. (Extend invitation for involvement.) for involvement.)

• Again expression your gratitude for the Again expression your gratitude for the invitation to present & open for further invitation to present & open for further questions, comments and personalization of questions, comments and personalization of materialmaterial

Concluding Note on Concluding Note on Preparation and Presentation Preparation and Presentation ProcessProcessParallel Process: What you want to Parallel Process: What you want to

convey to your audience is the very convey to your audience is the very essence of the transformation essence of the transformation experience, e.g., focus on engagement, experience, e.g., focus on engagement, tolerance, respect, personal and tolerance, respect, personal and system strengths, partnership, honesty system strengths, partnership, honesty (transparency), and commitment to (transparency), and commitment to continuity of support). continuity of support).