Date: Thursday, July 9, 2026
Hello, I am James-Angelo Suarez. I am in my first year with a Florida county human services department, where I oversee a hospital-based peer recovery program that embeds Recovery Peer Specialists (trained individuals with lived experience of substance use and recovery) in emergency department settings to connect patients with treatment services. As part of my role, I participated in my first annual on-site monitoring visit for the program and came away with a few unexpected lessons.
Monitoring visits are often viewed primarily as compliance exercises. You arrive with a checklist, score what you observe, and submit a report. The challenge is that a completed rubric tells you what happened but rarely explains why, or what should happen next.
Because I was new to the program, I found myself documenting details that might have seemed routine to more experienced staff. Rather than relying solely on scores, I recorded narrative observations about workflow, staff interactions, and contextual factors. That additional layer transformed the monitoring report from a scorecard into a more useful management tool, one that supervisors could use to support staff development and strengthen operations. Monitoring and evaluation do not need to exist in separate silos. Even small additions to routine monitoring processes can generate information that supports learning and improvement.
One monitoring criterion involved assessing whether peer specialists were applying motivational interviewing (MI) principles during patient encounters. The emergency department environment made this difficult. I could observe rapport-building, pacing, and whether the peer specialist was following the patient’s lead. However, I could not reliably assess whether specific MI techniques, such as reflective listening or open-ended questioning, were being used consistently.
This highlighted an important distinction between observing practice and assessing fidelity. As a result, I recommended exploring more structured methods, such as the Motivational Interviewing Treatment Integrity (MITI) coding system, as a complement to routine observation. Observational monitoring is best viewed as a starting point for assessing fidelity, not the final word.
Some of the most informative findings came not from what I observed, but from what I did not observe. One required procedural step was consistently absent across multiple visits and had also been flagged during the prior year’s monitoring cycle. That pattern across two monitoring cycles revealed that this was not an individual lapse but a workflow problem requiring a systemic solution.
Isolated observations, therefore, provide snapshots. Patterns across monitoring cycles tell a story. Longitudinal monitoring data can surface persistent barriers and implementation challenges that a single site visit would miss entirely.
Before your next visit, ask yourself: will someone reading these notes two years from now understand what happened, why it mattered, and what was done about it? Writing with both your immediate and future audience in mind encourages richer documentation without substantially more effort.
Monitoring does not have to choose between accountability and learning. With intentional documentation, it can accomplish both.
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