rebuilding a life despite or within the limitations imposed by
One way the state put that philosophy into practice was to
create a program in hospital emergency rooms that deployed
peer advocates to crisis intervention units to offer support and
practical assistance to others with mental health or substance use
At a broader level, the state shifted from an acute care
model within the arena of substance use disorders to a
longitudinal recovery management model. That paradigm shift
represented a movement from models of care that have focused
primarily on brief, episodic treatment modalities that help
people to achieve abstinence or get “clean” to services that go
far beyond stabilization.
With mental health conditions, a recovery-oriented approach to treatment similarly expanded the focus beyond symptom reduction. Providers now work collaboratively with people
to assist them in learning how to manage their conditions and
how to draw on support beyond the formal health-care system
to establish the quality of life they desire in their communities.
Now Evans is taking the same approach to “re-engineer”
Philadelphia’s service system.
Take the day programs where many city residents with
serious mental illness spent their time in the past, for example.
One of the first things Evans and his colleagues did was to
help people in those programs become more engaged in
their communities. “We want to help people be a part of the
community versus just being in the community,” he says. As
a result, those programs’ focus now is to help people live full
lives just like everyone else, not simply to occupy people’s time
during the day, he says.
One easy but effective change has been to teach participants
In addition, Philadelphia now has what Evans says is one
how to use public transportation rather than relying on
Medicaid-funded vans to get to the programs. “It opens up a
whole new world beyond treatment,” says Evans. “People can
In addition to re-orienting the system toward recovery,
Evans takes seriously his commitment as a psychologist to
“ground what we’re doing in what science tells us works.”
That means providers now receive training not just in the
recovery orientation but in such under-used but evidence-
based techniques as cognitive therapy and trauma-informed
care. Over the last six years or so, for example, the system has
trained hundreds of providers to use cognitive therapy and its
principles in inpatient and outpatient settings, with children
and adults and for mental health and substance use conditions.
of the nation’s largest initiatives related to peer specialists,
people who have firsthand experience with mental health and
substance use conditions.
“Peers with lived experience are very effective at engaging
people, keeping them connected to services and helping them
maneuver their own personal recoveries,” says Evans.
Allowing peers to work alongside professionals aligns with
Evans’s philosophy of engaging the people he serves in the
decision-making that affects them. In fact, his department never
makes a major policy or funding decision without involving
people with lived experience.
Although Evans says the transformation of the city’s
behavioral health system is still a work in progress, he’s
getting results. The re-orientation of the day program from
maintenance to recovery, for instance, has resulted in fewer
visits to crisis centers, fewer inpatient admissions and cost
savings that the city can then re-invest in other community-based services, Evans reports.
But persuading the city’s more traditional mental health
professionals to embrace the recovery orientation hasn’t always
been easy, says Evans.
“It challenges fundamentally the way clinicians view
themselves, their role and people with behavioral health
conditions and their potential,” he says.
Because a recovery orientation encourages individuals to
drive the process of their own recovery, it can be threatening
to professionals accustomed to being in charge, he says. People
may resist certain treatments or reject professionals’ advice
about their relationships — forms of pushback that are good
for individuals but may trouble providers.
“What we tell providers is that their professional role is
enhanced in a recovery-oriented system because they have to
have a much broader set of skills and much broader way of
working with people,” says Evans. “It’s relatively easy to help
people manage symptoms; it’s much more complex to help
people figure out a pathway in life.”
Now the wider world is paying attention. Earlier this year,
Evans won the American Medical Association’s Dr. Nathan
Davis Award for Outstanding Government Service, the
association’s top government service award in health care.
The award honored Evans for his leadership in transforming
Philadelphia’s behavioral health system and strengthening its
ability to take a public health approach.
Evans also received an America Honors Recovery Award in
2013. Sponsored by Faces & Voices of Recovery with the Caron
Treatment Centers, the award recognized Evans’s leadership
and its role in inspiring others to value change, listen and learn
from people in recovery and work toward recovery-oriented
institutions and communities.
... and beyond
Evans isn’t the only one emphasizing a recovery orientation.
This way of working is the wave of the future as health-care
reform continues, according to Evans. “If you look at health-care reform, what does it emphasize? Outcomes.” Reform is
also encouraging person-driven care that focuses on treating
the whole person rather than just his or her symptoms and
on integrating physical and behavioral health care — all
emphasized in Philadelphia’s transforming system as well.