Interview with David Kerr, founder of Integrity House
Integrity House, founded in 1968, is New Jersey’s largest nonprofit provider of substance abuse treatment. Inspira spoke with Mr. Kerr on November 1, 2016. Below is a lightly edited transcription.
Inspira: What first interested you in the field of substance abuse treatment?
David Kerr: I got in the field in 1965 as a state parole officer in Newark. It was just a job, but then I got interested in the men and women who were my parolees. That led me to found Integrity House in October of 1968 with 8 addicts who were former parolees of mine. Gradually the program built from 8 to 500 and now we see more than 2,000 people a year.
How fee-for-service is hurting addiction treatment
Inspira: What is your biggest concern for the drug and alcohol treatment industry in the next year?
David Kerr: One of the biggest problems is fee-for-service billing. That doesn’t work at all for drug treatment. It’s a mess.
Inspira: Why is fee-for-service the wrong way of billing for addiction?
David Kerr: The billing mechanism is about to kill the industry. We’re trying to help people, but it seems like all we do is fill out forms. Every time someone comes in to be counseled, whether for 5 minutes or an hour, you have to sit down and write it up. If you have 100 clients in a residential facility, you’re not going to sit down and write 100 clients up.
My belief is there is a way to have accountability, but the fee-for-service mechanism hurts the nature of our field.
Paperwork has increased recently
Inspira: Has this changed recently?
David Kerr: Over the last 2 years, paperwork has increased. People think that’s the way it should be. For those of us who have seen both sides of this, it feels like you’re not in the business of helping people — you’re in the business of writing up papers every day. To me, it’s a system that is going to drive our quality down.
Inspira: Can you give an example of how the quality could go down?
David Kerr: It will assure people are there for a short period of time. These short-term programs provide a service to a client. They last 3-4 weeks, maybe 6 weeks. Then the person can’t get any more funding. So the drug addict goes and does dope right after their 4 week session.
Alternative billing solutions
Inspira: What would you suggest as an alternative?
David Kerr: You can tell I’m not in favor of the present system. There’s a better way that could really work. Fee-for-service is the worst way.
The best way is a per diem rate where [treatment] programs would provide a bill once a month. That way they could do their work with addicts and the billing part doesn’t consume every minute of their time. Programs would still have accountability — like who’s there and not — but it would be basically once per month based on capacity.
Simplify documentation to improve client progress
Inspira: How would you like to change the system?
David Kerr: Here’s the issue. The program managers and directors have to follow the money. If you don’t follow the money, you don’t get paid. But we should be following the client, helping people. Instead, we get bogged down in the mechanism and the process, and we forget about the client.
If every time you talk to a patient you have to document it, counselors will be in their offices locked up just writing. If you don’t do that, you don’t get paid and you can’t help anyone.
It would be better if the counselor doesn’t have to do any writing. They could just check off what services were done, then bill for them. They could put a paragraph in every month on the client’s progress and the client could input how he or she sees progress.
It can be done more simply by putting in measures of progress. Is the guy working yet? How are the reports from his family? Is he reintegrating with them? Is he showing progress with anger management? Keep it simple and check off as much as possible, but ensure he is making the progress the counselor says he is. The system is skewed to accountability for serving a client, but there is no accountability for the progress.
Advice for starting a substance abuse treatment facility
Inspira: What advice would you give to someone just about to start a drug abuse or alcohol treatment facility today?
David Kerr: New guys coming in like to see themselves sitting behind a desk counseling a client. That’s unfortunate. People don’t get well that way. You have to work with that individual and encourage them to see themselves in a better light. There is no quick fix. You just have to work on their self-esteem.
In drug addiction, you have to help the client get their self-respect back. It’s not a disease-based model. The goal is helping someone regain their self-esteem. The funder wants you to get your client from sick to well, but addicts aren’t sick — they’re getting high. You’re not helping sickness, you’re trying to get someone’s lifestyle to change.
Clients aren’t diseased, they need a coach
Inspira: What is wrong with treating addiction like a disease?
David Kerr: We’ve started in the wrong direction with the disease model. It’s a brain disease, no one will deny that, but you don’t treat it with a medical model. You coach people to get better. The client is a person that has veered into a lifestyle that is destroying him.
When you see thousands of people like I have, you don’t see them as sick. They’re capable people who have taken a wrong turn.
You have to support the client’s own self-improvement. That’s what actually works. Then the person gets his own self-respect and is able to move himself into a new way of living. That’s what works. It’s not a cure to a brain disease.