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Episode 23: Tim Cesario with TJC Consulting, LLC
39 Plays4 days ago
Tim Cesario has worked in the field of substance use counseling since 1990 as a counselor, clinical supervisor, team leader and program director. He currently serves as the Director of Recovery Services for Cumberland River Behavioral Health, Inc. During his time as director, Tim developed programs to meet the needs of people with substance use disorder in underserved areas of southeastern Kentucky. In 2012, he founded TJC Consulting, LLC, and provides consultation to organizations seeking to develop treatment programs, assist with grant writing and provides trainings throughout Kentucky and several other states.
Tim is the former Chair of IC&RC's Board of Directors, a position he held from May of 2021 until October of 2023. Tim was a member of the Kentucky Board of Alcohol and Drug Counselors from August 2014 to January of 2024 and served as board chair from November of 2018 until leaving the board. He currently serves as chair of the Kentucky Agency for Substance Abuse Policy, a role he has held since August of 2020.
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Transcript
Introduction to 'Destination Change'
00:00:11
Speaker
Welcome to Destination Change, a podcast where we talk recovery, treatment, and more.
Meet the Hosts and Guest
00:00:16
Speaker
I'm your host, Angie Fiedler-Sutton, with the National Behavioral Health Association Providers, and I use she-her pronouns. Our guest today is Tim Cesario.
Tim Cesario's Career Overview
00:00:24
Speaker
Tim has worked in the field of substance use counseling since 1990 as a counselor, clinical supervisor, team leader, and program director. He currently serves as the Director of Recovery Services for Cumberland River Behavioral Health, Incorporated.
00:00:36
Speaker
During his time as director, Tim developed programs to meet the needs of people with substance use disorder in underserved areas of southeastern Kentucky. In 2012, he founded TJC Consulting and provides consultation to organizations seeking to develop treatment programs, assist with grant writing, and provides training throughout Kentucky and several other states. Tim is also the former chair of ICNRC's board of directors, a position he held from May of 2021 until October of 2023.
00:01:01
Speaker
Tim was a member of the Kentucky Board of Alcohol and Drug Counselors from August 2014 to January of 2024 and served as a board chair from November of 2018 until leaving the board. He currently serves as a chair of the Kentucky Agency for Substance Abuse Policy, a role he has held since August of 2020.
Tim's Journey into Recovery Field
00:01:16
Speaker
Thank you for joining us today, Tim. Oh, no problem. I'm happy to be here. Now, I always like to hear origin stories. So what got you into the recovery space versus all of the other job options that are out there?
00:01:30
Speaker
You know, I, it's hard to explain. It was just a calling, you know, I was an athlete in college and I didn't go to college and know where I lived. And yeah I saw a lot and I did what I could to to help people out during that time. And I probably did my own fair share of damage during those years too.
00:01:50
Speaker
Once I got out of college, I started working with kids and a lot of them had and some substance use issues. that They were the ones that I gravitated to. It just seemed to be a calling. but you know i' I've been working with people in with substance use disorders ever since. Why helping help help people with scovria? I know that sounds like an obvious question, but what about it draws you?
Rewards of Recovery Work
00:02:11
Speaker
Well, ah you know, it's just, I love to see the growth. I love to see the growth that people go through. I've worked in some long-term programs where you meet someone and they're at their rock bottom. they're They're in a place where nobody wants to be.
00:02:25
Speaker
and often hopeless and helpless and just to see the the flashes whenever they start to see that they can they can get help they can live that life that other people criticize them for not living you know for me The most important part is seeing people reach their potential, which you know even this day, I'm an administrator. I have been for the last 12 years and I still make it a point to do groups weekly in our one of our residential facilities.
00:02:58
Speaker
You know, I have a caseload of people that I see individually, just because I like that hands-on part of it, you know, having the conversations, talking to people about, you know, what they need. And, you know, a lot of times it's like putting a puzzle together, helping them find it. Because, you know, we know that the people that we work with, the majority don't have simple solutions available to them, especially in southeastern Kentucky, where the resources are limited. that I enjoy that, and I enjoy seeing people move forward in their life.
00:03:28
Speaker
Well, that's actually a great way to kind of segue into
Challenges in Recovery Services
00:03:31
Speaker
my next question. I grew up in, I'm based in Los Angeles, but I grew up in Missouri and I grew up in ah a fairly small town of about 5,000 people. So I understand underserved areas of the Midwest, but can you talk a little bit more about ah you know that ah working with that audience? Sure. You know, one of the yeah the biggest obstacles people have in this area, mean transportation. We don't have public transportation here. Usually transportation comes through either a social service organization or it's somebody that's charging the outrageous amounts to transport somebody. I mean, just a few years ago, we have a ah facility that's three miles away from a hospital. We had to take a client to the hospital, but
00:04:13
Speaker
There was no nobody could transport him. So we had to call this organization. It cost us $100 to drive someone across town. I'm thankful that there's a resource. I just wish it was a little bit cheaper. But that's that's one of the big obstacles. The other is, ah you know, it's so rural. There's employment opportunities here, obviously, but there's not a lot of them. It seems like educational barriers are one of the things that we have to help people with a lot of people.
00:04:39
Speaker
and And I don't want to sound pejorative or anything, but we work with a lot of people that didn't finish high school. So one of the things we try to do, especially in our residential, and we have two recovery Kentucky centers, we get them involved with like GED classes or something to to help at least get that obstacle out of the way. And, you know, i've I've seen people that got their GED or now in college, I think one that actually works under my programs right now.
00:05:09
Speaker
Got his GED did print while he was doing prison time. kate Got out of prison. Went through a drug court program. Got his bachelor's degree and he's currently about halfway through his master's degree. So, you know, that's somebody that I like to believe that we helped. Have you always lived in Kentucky or have you moved around a little bit?
00:05:29
Speaker
No, I moved to Kentucky in 2001. I was born and raised right outside of Pittsburgh, a small town called Mount Pleasant, Pennsylvania. What drew you to Kentucky? Oh hell, a lot of personal stuff. One of the things, you know, just going through a divorce and just kind of needing to reset.
00:05:47
Speaker
Now, you're the former chair of ICNRC's board of director and it looks like, you know, it's been fair less than a year since you've left or a little over a year, I guess. Tell me about your work
Involvement with ICNRC and Bylaws
00:05:56
Speaker
with them. We've we've also interviewed Mark Adanasi, who's obviously the current ah president of the board or chair. ah But kind of, you know, how did you get involved with them and what did you do while working with them? So with ICNRC, that all started back in 2019. They were trying to rewrite their bylaws and I guess there had been several attempts at it and they weren't successful. So the person that was the acting executive director at the time, she sent out a letter just asking for volunteers for people to be on a committee that wrote new bylaws. And I had only been to one IC&RC meeting before that, but I thought, you know, that's something I'd be interested in doing. So I i set that up to go to, I think it was in Orlando that we did that.
00:06:45
Speaker
And I was sitting in a room full of people, you know, I walked in, I didn't know anybody and they started talking and I thought to myself, what have you, you know, what are you doing here? You're not one of these people, you know, you're not one of the ones that knows how this is supposed to work and everything. I just sat there and I was quiet and we got a discussion going and we were probably about an hour into it. And I think the issue was they wanted to have a ah board of directors of,
00:07:13
Speaker
like nine to 11 people. And it had to do with insurance coverage and that sort of thing. And everybody had the mindset that you have to have, I think it was 76 member boards at the time. All the boards need to be represented. So I sat there and I'm thinking and the wheels are turning. And finally I said, guys, there's a way to do this. And there were some skeptics in the crowd, but they said, go ahead, tell us.
00:07:36
Speaker
And you know my mind went to like Congress and representatives and that kind of thing. And we got to talking about it. And that is how the idea of having the ah caucuses throughout IC&RC that had chairs that would represent that caucus on the board of directors. And once that happened, I was nominated. When the those bylaws were approved, I was nominated to be the representative of caucus three.
00:08:05
Speaker
And the board of directors was formed in, I believe it was September or October of 2020. The original board was seated and I got nominated for vice chair. And eventually, I guess it was in May of the following year, the the chair at the time resigned.
00:08:25
Speaker
and Of course, I went into that seat. It was interesting. That's how I got started. well Speaking of ICNRC, your longer bio talks about you have a passion for the professional and working in the field and continues to lobby for advancement of professional credentials for those working with people living with substance use disorder in Kentucky. Why is credentialing so important?
Importance of Credentialing
00:08:47
Speaker
Well, there's two things with it, and and I'll speak just from my experience in Kentucky. One is that there's an applicable code of ethics for everybody that's a credential holder. And the second thing is that that makes you accountable to a professional board, which means that we need to follow our code of ethics or you know things can go off the rails and you know just signing a code of ethics or having a code of ethics doesn't keep from having problems or or you know, people misbehaving, I guess, in their role. But I think there's accountability, which means boards and commissions and and those sort of things are there for public protection. And I think the more people you encourage to become credentialed, the safer the people receiving services are.
00:09:31
Speaker
Great now i'm also in your bio we talk about you have assisted with grant writing. Let's talk a little bit about that work. I'm sure we've got people in our audience that write grants themselves. What are some of the suggestions, you know, things you've come across or suggestions that you would have in terms of helping with grant writing? but With grant writing, there's an exercise in patients in my experience.
00:09:51
Speaker
it It takes time to gather information and gather statistics. And, you know, I found, you know, the first time I wrote a grant, I just sat down and started writing. And that's, you know, you can do that. I didn't get that grant, but you can do it. What I kind of discovered is that before I started writing, I need to outline and I need to structure exactly what it is that I want to show and what statistics that I can find to back up what I'm trying to show.
00:10:17
Speaker
and then putting a i guess a coherent argument in there for why the things that I want to do are going to benefit the communities that I live in. Awesome. Now, um you also have promoted peer support as an option for people in early recovery. We have a peer support level ourselves. That's out been getting a lot of traction too. kind of Talk a little bit about why that's becoming, I get popular is the wrong word, but you know what I mean.
Role of Peer Support
00:10:44
Speaker
I think popular is a good word because I think whenever somebody gets that first year under their belt and they're really wanting to give back that gives them an avenue to do it. So I think it is becoming popular because of that. But, you know, you just look back with the experience I've had as a counselor, just in my personal life, people that helped me the most were the the people that had been through it. and It's one of those things where you know you're going to face a lot of challenges whenever you're early in recovery. Having somebody there that navigated those challenges already that can give you suggestions, they can maybe eliminate two or three missed opportunities. The person that's early in recovery hasn't identified yet. you know I think mentoring is a big part of it, leading people in the right direction, but having those people that are willing to lead in that that direction is so important.
00:11:35
Speaker
Now, one of the things we like to talk about on destination change is the fact that that recovery and treatment is a journey. It's not a destination that there are issues that cause you to go off the track, et cetera, and
Recovery as a Journey
00:11:47
Speaker
stuff like that. Talk a little bit about kind of what it means to go through treatment or recovery.
00:11:51
Speaker
ah To me, it just means bettering your life. I'm also certified in harm reduction and I do some harm reduction trainings for ICNRC and the Missouri Certification Board. and I think that that's a big change from whenever I first got into the field. you know When I first got into the field, it was abstinence or bust. and Of course, we know, especially
Harm Reduction Strategies
00:12:11
Speaker
on the first try, most people bust. One of the things I've embraced over time is you know when you started to become popular yeah i was old school and i didn't believe in doing that but you know i think the the responsible thing to do is whenever you're saying something that's out there so much educate yourself find out what the benefits are does the benefits outweigh the the negatives and you know that's something that.
00:12:37
Speaker
Over time, I came to embrace. i think it's I think it's one of the most useful tools we have. The other part of it is Kentucky's had a big push for needle exchanges and that kind of thing. and The the over overriding message of all this is, we do this to to limit disease. okay Needle exchanges, my first experience with those was in the prevention of HIV and hepatitis, and that was back in the 90s. But you know the the message that started coming clear to me is that People are dying from these diseases. Well, if they die, we can't help them anymore. And I think doing things like Narcan distribution, being open to different paths for recovery gives us an opportunity to continue to work with people, even if they're not abstinent. And, you know, I think that's empowering for our client to
00:13:25
Speaker
or or or someone that's seeking services to come to us to know that I don't have to be perfect. I just have to keep trying, right? ah that's That's an important message. That's what keeps people interested in and improving their life is knowing that somebody cares enough to like accept. yeah And this isn't a good word to use, but whenever you love somebody, do you love somebody for their perfection or do you love them for their flaws? And and that's kind of the mentality that I try to have with it now is You know, yeah, you use this weekend. Okay. You know, I can work with you on that. How much did you use? What did you use? Were you in a safe environment? Okay. First thing, if you weren't in a safe environment, let's make sure you always have a safe environment to go to. All right. You know, if you use, if you drank a six pack, what can we do to help you cut that down to four or three or four? You know, having that mentality that it's about progress, not perfection.
00:14:18
Speaker
Exactly. Well, you've mentioned a few already, but you know what are some of the biggest barriers do you feel for people to move forward in treatment? You've talked about cost, we've talked about you know ah harm reduction. but Honestly, I think stigma is still huge.
00:14:32
Speaker
I do a training on stigma, and one of the things that I talk about in that training, this is probably back in 2004, 2005. I had a ah client shop for his appointment 15 minutes late. And where i where my office was, it was on the opposite side of the intake office. And the intake office was where the staff congregated between clients. Well, one of the other counselors in the office came back into my office and says, hey, Tim, your junkie's here. Yikes.
00:15:01
Speaker
yeah Yeah and i mean i was furious when i heard that and i saw i saw the guy and the unfortunate part is that he heard it he was standing in the window and he heard it and he came into my office and the just the pain that you could see in his eyes that left an impression you know i helped him out that day he was okay whenever he left my office but I educated the counselor that, uh, that came to my office and announced his presence because yeah not nobody, I don't know. And we see clients that are mental health and substance use and nobody deserves to hear that kind of judgment in a place where they're supposed to be receiving help. And, you know, that's one thing I insist on now, uh, with the people that I supervise. We don't treat addicts. We treat people with addictions focused on people, right? Cause you know, it could be anybody's relative, you know, another thing. And, uh,
00:15:52
Speaker
the name of the author escapes me, but yeah just reading articles where you read about you know somebody that's got an abscess that needs treated or they're gonna die and they won't go to the emergency room because how they get treated when they go to the emergency room. And I think we need to be open-minded to the fact that whether we like what somebody's doing or not, if they're seeking help and we're able to provide it, we need to do that. That's the big thing. That's exactly the kind of thing I was looking for. now you know You kind of hinted when you talked about harm reduction being a new thing. You've been with the industry since 1990, which unfortunately, as I like to joke, the 90s were not last decade. ah What would you say are some of the biggest changes in the industry since you started, some of the you know both positive and negative?
Evolution of Treatment Options
00:16:39
Speaker
Well, on the positive front, I think we're there's more treatment options available to people. Now I got into the field and I was living in Pennsylvania outside of Pittsburgh and there were some, there were probably three or four residential programs right around us. And if you know anything about Pennsylvania, it's Pittsburgh on one end, Philadelphia on the other, and farm country in the middle.
00:17:01
Speaker
Okay, it' so it's it's it's very rural and access for treatment for people there, it was pretty limited just like it is here in Kentucky. Actually, right now, one of the improvements over the years is that the Commonwealth of Kentucky has more treatment beds available per capita than any state in the country, which is awesome. And that was a statement that Governor Beshear made earlier this year. And that's what I'm going by. But that's that's one thing is I think there's there's more people that are willing to offer treatment now.
00:17:31
Speaker
One of the other things that, and i I've really tried to be conscious of this during my time as an administrator, when I came into the position, i and now we have two residential treatment centers, a recovery Kentucky center and outpatient offices. And since then, just with grant opportunities, we've been able to add a crisis stabilization unit for people with substance use disorder.
00:17:53
Speaker
We've added a quick response team. We recently opened a recovery community center that is, it' it's just a hangout for people in recovery. You know, they have meetings there. They can just sit and hang out, watch. They do activities there, sober activities like Superbowl, Final Four, that kind of stuff. Someplace safe to watch it. We recently added a new recovery center. It's called the Cumberland River Roar Center, which is the first one of its kind, at least that I'm aware of in Kentucky. And from what I understand, you know we we did that with the with the Fletcher group. And from what I understand, there's a lot of people in other states that are interested in that model. So I think the ability to be innovative is is a good thing. If I were to pick something bad, and I don't think there's a whole lot that's happened that's bad and the in the time that I've worked in this field. But if I were to pick something bad, I would say that that
00:18:46
Speaker
you know, there's more for-profit organizations ah popping up that, you know, providing services. that I question their commitment to helping people. I'll just leave it at that. Yeah. No, that makes sense.
Future of Recovery Services
00:19:00
Speaker
Well, with your experience in the industry, where do you see kind of it going in the next five to 10 years? where What do you see happening? So the role model that I just described, I think is going to be a big thing. I know that there's already There's a second one in the works in ah Kentucky. We hosted a group from Virginia, from the Tidewater area, that's very interested in duplicating what we did. And what it is is, you know, just after a meeting one day, ah Governor Fletcher just said, well, if you were going to build your here phil your dream program, what would it look like?
00:19:35
Speaker
And I thought to him, I can't tell you that right now. He says, well, give me a call in a week or two and we'll talk about it. I sat down and I thought of every barrier that we, that I could think of. There were two things that really motivated me in this. The barriers, like I said, education, housing, recovery housing, stable housing for people in recovery, transportation, and access to treatment, and those types of things. In my mind, I built a little campus that had a recovery center on one part of the campus.
00:20:05
Speaker
family reunification units in another part of the campus community center just for people to go and hang out. That would be a safe environment on another part of the campus and then outpatient office within within walking distance of everything else. And I wrote that all up, submitted it to the governor, explained to and And Governor Fletcher, as a former governor, explained how I thought we could have multiple entry points for people to jump in and out at at various points once they've received the services and they liked it. And there was some tweaking done to it, but the Fletcher group did the bulk of the tweaking. I mean, like they really took the idea and ran with it.
00:20:44
Speaker
I think that's a ah model that's going to be duplicated quite a bit. Great. Now, our audience is a wide range of of people from counselors to CEOs. So I always like to ask, you know what kind of advice would you give to other people in the industry or people who might want to, who are still just starting kind of thing? What what kind of things have you learned over the years? I'm glad you didn't ask me what all I forgot.
00:21:09
Speaker
What I've learned, again, patience, there's a couple of things where that comes into play. People don't change at our pace. Okay. And there's a process to becoming good at what you do, which involves education, whether it's formal or lived, but it involves taking the things that you've learned and learning how to use them correctly.
00:21:27
Speaker
I really think that just the growth that I've seen in this field over the last 10 years has been amazing. But yeah I've also met people that want to go from first day on the job to running the business in the first week that they're there. And that's not the way it works. I mean, I've done this for thirty but almost 35 years.
00:21:47
Speaker
And I learned a little bit along the way and I continue to learn. And I think that that's the most important thing is keeping an open mind to new ideas. That's the one recommendation I would give them. And then similar, if you could go back in time and talk to yourself when you were first starting out, what would be the one piece of advice you'd give yourself? You know, I was talking to somebody about that recently, and I honestly believe that if I had me from 25, from 35 years ago,
00:22:15
Speaker
as an employee now, I'd probably tell them to seek a different line of work because I wasn't good at it. But I think, you know, the one thing i I've always had really good bosses, you know, and if I can, I'll just mention Deanna Sherbondi whenever I worked in Pennsylvania.
00:22:30
Speaker
Mike Soule, who hired me at this agency, Danny Jones, that was my executive director up until about five years ago, and Melanie Yeager, who's my executive director. Now, every one of them has has expressed confidence in my ability to so to do what I do, but there's also been open-minded to new ideas, okay?
00:22:51
Speaker
And I probably talked my way into forgetting what the question. but advice yourself Yeah. Listen to the people that are supervisor or boss at the time, because the more you listen to them, the more open minded they are to you. If that makes any sense. I think having a good working relationship with the people that supervise you can be beneficial. You know, I mentioned Deanna Schirvandi first and She was my clinical supervisor 30 years ago. that so thirty And I still talk to her. I was going to say, good bosses are are hard to come by. And when you got you, you keep in touch with them. Definitely. As the bio mentioned, you're currently serving as the director of recovery services. I'm sure you don't have an average day or week. I'm sure it varies, but kind of give me an idea of what, what that does. What, and what, what is a director of recovery services and what do you do?
00:23:41
Speaker
So I oversee all the programs that treat substance use disorder in our region of Kentucky. We cover eight counties. So the programs that I oversee are, we have a Recovery Kentucky Center. We have the Rohwer Center that's based on the Recovery Kentucky model with all the other additions that I'd mentioned earlier. We've got a residential center for men. We've got a residential treatment center for pregnant and parenting women. We've got 11 outpatient offices. We've got a recovery community center. We've got a quick response team and on top of that I am also over our regional prevention center and I'm very very certain that I've forgotten at least one program but there's a lot that we cover and there's a lot of I've had a lot of opportunities to write grants. I've had bosses that were open-minded to new suggestions and we've added a lot of services over the years so we have a lot of opportunities to meet people where they are
00:24:41
Speaker
And I'm just very thankful that but I've had the opportunity to to be part of this. Now, I also like to ask my guests, what kind of resources do you use on a regular basis in the industry? what you know Are there books that you go to on a regular basis or magazines or even other podcasts?
Need for Professional Development
00:24:59
Speaker
Well, believe it or not, I've actually watched this podcast once.
00:25:03
Speaker
and then And it was the episode that you had Pete Nielsen on. oh yeah yeah So honestly, I research a lot. um I'm somebody that can sit down and start looking into, let's say, xylazine and end up learning to about a bunch of other different drugs. I'm the type of person um that I like to hear it and see it. So I try to get to as many trainings as I can and be involved as the with the development of as many trainings as I can. Over the years, the things that I remember most are the things that I sat there and listened to firsthand. that And I don't know if I answered your question whenever I said that, but i that's my style of learning. that's are there Are there newsletters or or magazines that you would recommend to other people? And a counselor magazine, of course, I've i've read that one.
00:25:51
Speaker
The newsletters that our state sends out are are usually very helpful. And that's one thing that, you know, I don't work for the state government, but just working for a community mental health center, I get a lot of information from the state level that filters down to me.
Resources for Professionals
00:26:08
Speaker
And a lot of it is research-based. The fact that I'm over a regional prevention center helps because the director there will say, Hey, Tim, you got to read this. But my curiosity, I'm going to go back to trainings and I know that that's, that's not really the area you wanted to go to. No training. Well, it's one of those things where I hear something in a training and I'll start researching it. And, you know, what would I like to know more about this particular training? I've actually developed trainings based on those trainings. So that's, you know, that's something that I enjoy doing.
00:26:43
Speaker
Well, and a reminder to our audience that NBHAP does have regular webinars that are free to attend live. Many of them have CEs that you can get free if you attend live, and then our NBHAP members get them free regardless of whether they attend. So just a hint there. Now I could probably talk to you for another couple hours. It feels like we've barely even touched on your bio, but unfortunately we are getting close to the end of time. So was there something that you wanted to talk about that we haven't or that you thought I was going to ask, but we didn't?
00:27:08
Speaker
Honestly, I can't think of anything that I wanted to add. i do Well, the one thing I would say is the harm reduction credential. I think that's a really important one to get. It's an excellent training. And I think that that's the direction this field is moving in. And I think a lot of people are opening in their eyes to the fact that we've got to keep people alive in order to help them long term. So that's one that I would recommend for people. Exactly.
00:27:35
Speaker
Now, if people want to hear, get in touch with you or want to learn more about you, where would they
Contact Information and Conclusion
00:27:40
Speaker
go? They would go to my website, TJCConsulting.org. And on there, I have a lot of trainings listed, my contact information. I mean, you can email me from the website and my email address is TJCC at TJCConsulting.org. so but Very easy to remember. Yeah. When somebody asked me about the name of the the business one time and that it's actually named after my dad's initials. So that's something I wanted for out there, right? I talked about my bosses, but he and my mom were the biggest influences on my life. So i want to give them a shout out to while I'm on here. Definitely. That is a great idea. So you've been listening to Destination Change. Our guest today was Tim Cesario. Thanks for being here. Our theme song was Sudden Nation by Kitsa and used via Creative Commons license by the Free Music Archive. Please consider rating and reviewing the podcast on Apple Podcasts so we can get more listeners. In the meantime, you can always see more about the podcast, including show notes and where else to listen on our website, www.NBHAP.org.
00:28:43
Speaker
If you have any questions for the podcast, please email us at info at NVHAP.org. Thanks for listening.