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CHAPTER I: INTRODUCTIONThe Betty Ford Institute was created as the result of a planning process begun in 2005. Upon succeeding her mother in the Chair of the Betty Ford Center Board, one of Susan Ford Bales’ first actions was to appoint a Vision 2015 Task Force to consider the long term future development of the Center and its programs. This Task Force addressed the opportunities and challenges that might be expected for the Center. Its recommendations called for the creation of a new organization – the Betty Ford Institute – to be separately focused on broadly based programs of research, education and prevention related to addictive disease. The recommendations of the Vision 2015 Task Force were approved by the BFC Board in early 2006. An Institute Task Force, made up of invited national experts and BFC Board and management representatives, was appointed to oversee the early developmental planning of the new Institute. The Institute Task Force recognized the ultimate need for a Strategic Plan for the new Institute and that this Plan should be developed separately for the Institute. The Task Force also considered and recommended formal statements of Values, Vision and Mission for the Institute which were adopted by the BFC Board. These formal statements represent the foundation of this Strategic Plan and are included in Chapter II. In formulating these statements, the Institute Task Force considered various roles that the Institute might come to play and their deliberations were used as a valuable resource and input in developing the Strategic Plan. In early 2007, the BFC Board took a major step in actually creating the Institute by appointing an Executive Council to oversee the program development, management and operations of the Institute. This Executive Council held its first meeting in March, 2007, and met a total of three times during the year. One of its most important accomplishments is represented by this Strategic Plan. The Executive Council, having based its plan on the previously adopted statements of Values, Vision and Mission, formulated carefully delineated Goals, Objectives and Strategies for the Institute’s early growth and development over the next two to three years. These are the real "meat" of this Plan and can be found in Chapter III. The following persons contributed to the development of this plan:
CHAPTER II: VALUES, VISION AND MISSIONStatement of Values – "What are the "drivers" of the Betty Ford Institute?" What we care about, what really matters, what we truly believe – these are the values that provide the foundation on which our Center and our Institute are built. Values shape an organization’s vision and mission while prescribing acceptable behavior for everyone associated with the organization. The statement of Values of the Betty Ford Institute describes strongly held beliefs that guide all that we do. We believe...
The last several decades have witnessed unparalleled advancements in our scientific understanding of addiction, but social stigma and lack of public understanding remain rampant. The Institute strongly believes that one key to reversing social stigma lies in the successful translation and dissemination of research findings. Therefore, the Institute will commit resources to facilitate mechanisms for debate and discussions about some of the most significant issues facing the addiction treatment field today. Through these mechanisms, combined with actively communicating and disseminating the results of this work to wider audiences, it will be possible not only to promote a more informed public view of addiction, but also to foster and shape future research agendas. It is only through collaborative discussion and debate that we can fill critical knowledge gaps in our understanding of the complexity of addiction, its etiology, its course, and its consequences. Statement of Vision – "What might we look like in 2015?" The mental picture of an organization’s desired future is the guiding force of all its activity and the source of its energy. A Vision is a dream that beckons; an inspiration that motivates people to action. The Vision Statement for the Institute is intended to be compelling, so that it might inspire us to greatness. We envision that the Betty Ford Institute will always reflect the high ideals, standards, quality and reputation of the Betty Ford Center at Eisenhower. The Institute will be recognized as an innovative leader in all of its endeavors and will devote itself to the following initiatives:
Statement of Mission – "Why do we exist?" A formal mission statement is the platform for all organizational planning. An organizational mission statement asserts clearly and firmly why the organization exists and whom it serves. The Betty Ford Institute’s mission statement is:
CHAPTER III: GOALS, OBJECTIVES AND STRATEGIESPROGRAM FOCUS: PREVENTION Drug problems can develop in different individuals in different ways - sometimes obviously, but in many more cases, silently and insidiously. A great deal of scientific knowledge has accumulated to explain these complex pathways of alcohol and other drug addictions. We know, for instance, that early warning signs are apparent for some in early childhood and that adolescence carries with it new drug use opportunities and additional challenges. The Institute is committed to using this wealth of knowledge as a foundation to develop, design and test bold innovative strategies to prevent alcohol and other drug problems, and to intervene at the very earliest stages possible. The Institute is keenly aware of the multiple targets for drug prevention and has chosen to sharply focus its resources on improving the lives of families at high risk for addiction. We define a high-risk family as a family where at least one caregiver has an active alcohol or drug problem or is in recovery from addiction. Despite the well-known observation that children of alcoholic or other drug-dependent parents are at high risk for developing drug problems themselves, surprisingly little attention has focused on specific strategies to reduce risk for these children. It is conservatively estimated that, in any given year, more than 6 million (or almost one in ten children) live with at least one parent who meets DSM-IV-TR criteria for an active substance use disorder. Because the Betty Ford Center has decades of clinical experience with understanding the interpersonal dynamics of high-risk families and the special needs of children living in such families, the Institute is uniquely poised to contribute to the development of strategies to reduce a child’s risk of developing alcohol or other drug problems given that they have been exposed to this kind of family environment. Potential targets for intervention include (a), improving the parenting skills of parents in recovery; (b), increasing the family’s ability to recognize and assess early childhood problems in the areas of emotional and behavioral regulation; and (c), better understanding of environmental factors that interact with the family environment to produce adverse outcomes such as witnessing and experiencing domestic violence, and promoting particular resiliencies of children of parents in recovery. PREVENTION Goal I: To provide and disseminate practical, effective prevention solutions to families with children at high risk for alcohol and other drug problems, with a particular emphasis on children of parents in recovery. Objectives and Strategies
1.1.1. Conduct a systematic review of peer-reviewed articles. 1.1.2. Analyze new or existing data related to children growing up in families of substance users to improve our current knowledge reflected in the peer-reviewed literature. 1.1.3. Conduct research that focuses on how family history of substance use problems might contribute to high risk drinking and illicit drug use among college students and other young adults. 1.1.4. Hold structured discussions with clinicians involved in family-based treatment regarding their perspectives on addictive disease. 1.1.5. Hold focus groups with three groups of children and young adults (ages 7-12, 13-18, and 18-25, respectively) who have experience growing up in a family with an alcohol or other drug-dependent parent. 1.1.6. Develop a comprehensive communication and dissemination plan that at least involves writing two manuscripts for publication which consolidate the findings from our work. 1.1.7. Disseminate the knowledge to a variety of stakeholders by sponsoring a conference and using the Parents Resource Center of the Partnership for Drug Free America as another possible dissemination vehicle.
1.2.1. Assist BFC Children’s Program staff in developing a curriculum for the Training Academy. Create selection criteria for potential students of the Academy. 1.2.2. Begin to develop a list of potential candidate agencies to be included in the first group for training. Work in consultation with the Betty Ford Foundation to underwrite specific communities to be involved with the training. 1.3. To develop and test at least two practical prevention solutions targeted for high-risk families which build on the knowledge identified through the processes outlined in 1.1. 1.3.1. Convene a panel of experts to generate ideas regarding design elements and procedures for a prevention solution that seeks to reduce alcohol and other drug risk in children of parents in recovery. 1.3.2. Convene leaders of philanthropic organizations and other individuals interested in developing prevention solutions for children of parents in recovery as a way to increase awareness of BFI activities. 1.3.3. Commission a design team to develop prototypes for at least two prevention solutions. 1.3.4. Explore opportunities for funding a pilot study to validate, refine and test the effectiveness of at least one prevention program for parents in recovery, which could then be used to design a larger-sale initiative based on the pilot study results. PROGRAM FOCUS: MEDICAL EDUCATION Traditionally, there has never been an emphasis on teaching about addictive disease and its treatment in U.S. medical schools (nor in other health sciences schools such as dentistry, pharmacy, nursing or allied health). There is no standard or accepted curriculum for addiction topics in medicine. Although a few medical schools teach some addiction medicine information, these are often elective lectures – frequently limited to one hour – or perhaps covered in grand rounds. Likewise, there is no standardized approach for including information on addictive disease in training programs for residents or continuing education of practicing physicians in primary care specialties (family medicine, internal medicine, OB/GYN and pediatrics) The Betty Ford Institute plans to collaborate with other interested parties to design a model curriculum for medical schools to include teaching on addictive disease. The career teacher program that was established and funded by NIMH in medical schools in the late 1970’s is one example of a promising format. However, funding for this program evaporated and nothing has taken its place. The Betty Ford Institute will evaluate the success of current training programs for medical students, residents, and practicing physicians. The Institute’s exploration will include education programs conducted by the Betty Ford Center (e.g. the Summer Institute for Medical Students, the Medical Clerkship Program, and the Professionals-in-Residence Program) as well as the program developed by the Medical Education and Research Foundation - MERF (affiliated with the California Society of Addiction Medicine – CSAM). The initial exploratory meeting with MERF representatives and BFI staff and consultants was held on January 3 and 4, 2008, at Rancho Mirage. GOAL 2: To facilitate improvement in medical education regarding addictive disease in order to equip medical students, residents and practicing physicians with tools to diagnose and manage patients with addictive disease at all levels of practice. Objectives and Strategies 2.1. To develop a model addiction medicine curriculum for residents in internal medicine, pediatrics, OB/GYN, and family medicine specialties with specific training in addiction medicine. 2.1.1. Identify a minimum of 10 U.S. medical schools/teaching hospitals with current didactic training for residents in addictive disease, and obtain copies of their curricula. 2.1.2. Review the curricula to determine common topics and educational materials. 2.1.3. Add unique topics (e.g., 12-Step principles, neurobiology, DSM terminology) to be included in the "model curriculum" to target residents in internal medicine, pediatrics, OB/GYN, and family medicine students. 2.1.4. Determine a mechanism for writing the complete curriculum in different formats (e.g., slide format, 6-hour vs. 12-hour format, web-interactive). 2.1.5. Study progress of the American Society of Addiction Medicine in its efforts to gain recognition for Addiction Medicine as a specialty by the American Board of Medical Specialists (ABMS). 2.1.6. Identify the barriers to curriculum implementation in graduate medical education by medical schools/teaching hospitals. 2.1.7. Design the model curriculum in such a manner that it also serves as a template and basis for questions written and incorporated into physician Board and Specialty Qualification exams. 2.2. To explore the possibility of collaborating on the design of the "model" curriculum with the Medical Education and Research Foundation – MERF (sister organization to CSAM). 2.2.1. Analyze perceived deficiencies in current medical education curricula and benefits identified by physician graduates of MERF, BFC’s Summer Institute for Medical Students and Professionals in Residence programs; review with medical faculty and deans; summarize in a white paper. 2.2.2. Collaborate with MERF to seek additional funding to allow the program to expand. 2.2.3. Affiliate BFC’s Professionals-in-Residence Program opportunities with other MERF training. 2.2.4. Evaluate effectiveness of SIMS program. Seek ways to duplicate SIMS at other sites. 2.2.5. Study expansion of Medical Clerkship opportunities at BFC. 2.2.6. Explore collaboration with MERF around BFI-sponsored fellowships in addiction medicine and addiction psychiatry, and explore the concept of mentorship for students and residents. PROGRAM FOCUS: TRANSLATION OF RESEARCH FINDINGS The earliest thinking behind the development of a Betty Ford Institute reflected a need for it to "act as a convener, synthesizer, and facilitator to bring together the findings and expertise of others and to measure the value and interpret the important applications of these findings." The last several decades have witnessed unparalleled advancements in our scientific understanding of addiction, but social stigma and lack of public understanding remain rampant. The Institute strongly believes that one key to reversing social stigma lies in the successful translation and dissemination of research findings. Therefore, the Institute will commit resources to facilitate mechanisms for debate and discussions about some of the most significant issues facing the addiction treatment field today. Through these mechanisms, combined with actively communicating and disseminating the results of this work to wider audiences, it will be possible not only to promote a more informed public view of addiction, but also to foster and shape future research agendas. It is only through collaborative discussion and debate that we can fill critical knowledge gaps in our understanding of the complexity of addiction, its etiology, its course, and its consequences. GOAL 3: To translate and disseminate quality empirical research findings to targeted audiences. Objectives and Strategies 3.1. To identify, by June 2008, at least two key research topics in the addiction field for which the Institute could play a major role in advancing understanding by the scientific community and/or policy makers. 3.1.1. Review the existing literature on potential topics of interest to the Institute in an effort to identify significant gaps in existing knowledge. 3.1.2. Hold teleconferences between Institute staff and outside experts to decide on the specific topics, relevant audiences, presenters, and mechanisms of dissemination of information. 3.2. To discuss and disseminate information about at least one key topic in the addiction field by December 2008. 3.2.1. To invite key stakeholders with an interest and expertise in the topic to a conference at the Institute. 3.2.2. To have the invitees of the conference prepare manuscripts for subsequent peer review and publication in a scientific journal. 3.3. By June 2008, establish a mechanism for real-time dissemination of Institute-related documents and materials, including peer-reviewed scientific publications resulting from conferences. 3.3.1. To create an Institute website as a repository and dissemination vehicle for Institute-related materials. PROGRAM FOCUS: ETHNO-CULTURAL CONCOMITANTS OF ADDICTIVE DISEASE In the U.S., disadvantaged ethnic populations tend to suffer disproportionately with individual, family, and community complications of addictive disease. Most notably, these populations comprise Native North-Americans and African-Americans, both of whom share cultural histories of oppression, including genocidal colonization and slavery. The Betty Ford Institute will initiate programs of research, prevention and education designed to further understand the biological, psychological, social, spiritual and cultural factors by which severe and chronic addictive disease is transmitted down through many generations of Native-North American and other ethnic populations that have been victimized and stigmatized by neglect and discrimination for racial, political, or economic reasons. Implementation of this strategy will build on a variety of training and treatment activities initiated by BFC in 1999 with the Alkali Lake Band of Indians in British Columbia. In addition, relationships between BFC and the Morongo Band of Indians in the Coachella Valley have been on-going, and more recently, a training contract was signed with the St Francis Mission on the Rosebud Reservation in South Dakota (Lakota Band of Indians). It goes without saying that the BFI project will rely heavily on these relationships, as well as the pioneering work of Bill White and Don Coyhis in their recently published, and widely acclaimed, five-year study of how Native North American Nations resisted the efforts of three governments (British, French and United States) to supply them with weapons-grade alcohol for aggressive political, military and economic purposes over a span of several centuries. GOAL 4: To enhance and improve culturally sensitive approaches to prevention and treatment of addictive disease in disadvantaged populations. 4.1. To identify and articulate by June 2009 the origins and cultural manifestations of alcohol and other drug addictions that continue to ravage vulnerable ethnic communities. 4.1.1. Invite a small focus group of prominent and relevant representatives of ethnic groups meeting the above criteria to participate in a three-day retreat. 4.1.2. With consultation and advice from the retreat participants derived from their personal experience and first-hand knowledge of their particular ethnic and social circumstances, recommend culture-appropriate research, prevention, education, and treatment initiatives 4.1.3. Following the retreat, create an appropriately structured ethno-cultural Advisory Council to collaborate with BFI about how best to promote and implement these initiatives.
CHAPTER IV: GOVERNANCE AND MANAGEMENTExecutive Council The current members of the Institute Executive Council were appointed by Chairman Susan Ford Bales and the BFC Board in January 2007 to an 18 month term extending through the end of FY 2008 (June 2008). The Board will consider the continuing roles of the Executive Council and the reappointment of current members and/or the appointment of new members for future fiscal years. The Institute CEO will make his formal recommendations to the BFC Board in advance of the Board’s Spring Planning Retreat scheduled for May 2008. When the BFC Board approved the creation of the Institute, they reviewed four options for governance and organization. The Board selected an option which calls for a single governing Board (the existing BFC Board) for both the Center and the Institute. In order to promote the concept of "cooperative independence," this option called for the appointment of a subordinate body to oversee the operations of the Institute and to advise the governing Board in matters relating to the Institute. This body is composed of experts in addictive disease, the majority of whom will be from outside BFC. This subordinate body is called the BFI Executive Council. The Board also accepted the Task Force’s recommendation that the Chief Executive Officer of the Institute should report to John Schwarzlose, rather than to either the BFC Board or the BFI Executive Council.
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