SUBSTANCE USE AND CO-OCCURRING DISORDER DETOX & RESIDENTIAL TREATMENT PROGRAM
- Nov 14, 2019
SUBSTANCE USE AND CO-OCCURRING DISORDER
DETOX & RESIDENTIAL TREATMENT PROGRAM
CURRENT SUBSTANCE USE DISORDER PANDEMICS
It is commonly known that America is experiencing an opioid epidemic that has reached unprecedented proportions. September 1, 2019, the National Center for Health Statistics published data indicating that between 2018 and 2019, the number of people whom have died in reported opioid related death was 46,557. The number of unreported deaths is assumed to be an additional three to five thousand.
In California, the most recent data shows that there were 2,311 reported deaths due to use of opioids last year. The California State Departments (Department of Health Care Services, Department of Public Health and the Department of Social Services) are employing best efforts to address the problem. Luckily, Governor Newsom is pro-mental health care and has already positioned adept individuals as captains of these Department’s Substance Use Disorder and Mental Health campaigns. These include educational campaigns and promoting resources and evidence-based tools to providers and the public.
While the state is beginning to wage war against the opioid epidemic, it is inadequately armed. The Department of Health Care Services has made notable inroads, for example, by dispensing free Narcan and installing medication disposal sites in pharmacies across the state.
However, in 2018, California physicians issued 20 million prescriptions for opiates. Tackling the epidemic is an uphill battle. In addition to this grim situation, the state is also inadequately armed to fight the next epidemic…Fentanyl.
Along with what seems an uphill battle regarding opiates, another sinister epidemic has invaded the leagues of providers available to give services to those in need.
The field has become magnetic to some whom could be compared with “carpet-baggers” …corporations or greedy owners that take advantage of the substance use disorder population with unscrupulous piracy. What was once a field dedicated to ethical practices and supportive, nurturing respect for patients has become frail due to deceptive and profane corporate business practices. Commercialism has reduced the field to one where, in many instances, financial gain has replaced honest, principled health care.
The concept of assistance in a health care setting has, recently, been replaced with the application of business models unfit for healthcare and, marketing scams, insurance scams and patient brokering has left the field scarred. Providers, such as Hathaway Rehabilitation Center, have maintained ethical business practices and are built upon the essential nature of “caring.” We are left fighting for the integrity of the field as a whole.
HATHAWAY RECOVERY CENTER EQUALS INTEGRITY
Hathaway Rehabilitation Center stands up as an honest practitioner. We are a model of ethical practice in our networking, professional conduct and provision of services. The patient’s individual needs are the focal point of our services. And, we ensure financial practices that are dependable, prudent and upstanding.
It is Hathaway’s practice to never take advantage of substance use disorder patients nor use incentives to induce referrals. Hathaway staff was elated with the passing of SB1228 which now makes that practice illegal.
Hathaway Recovery Center, in keeping with our fundamentals of integrity, does not practice taking advantage of the insurance carriers whom pay for the patients’ services. We are an organization that is founded upon deeply held principles, beginning with honesty, and we are inflexible regarding our organization’s financial responsibility and obligation. With pride and self-confidence, Hathaway staff can assure any insurance company, referral source, funding source and network colleague that we reliably uphold respectable and responsible business practices.
HATHAWAY IS THE MODEL OF ETHICAL PRACTICES
Things Hathaway Recovery Center will not do:
Create incentives for patient admissions;
Pay a “marketer” for patient admissions;
Pay anybody “per head”;
Pay for any patient’s private insurance;
Inflate the patient’s disorders or disabilities;
Request paid days beyond what the patient requires;
Manufacture levels of care not required by the patient;
Continue to bill when the patient is no longer under our care;
HATHAWAY’S MISSION AND VISION
Our mission and vision describe our commitment to both the best evidence-based practices that we employ in caring for those in our charge as well as, our commitment to honesty, integrity and fairness. These qualities apply to each and every process and activity our staff engages in, whether large or small.
Hathaway Recovery Center’s mission:
“We are committed to providing the highest quality and compassionate health care and comfort to the whole person – mind, body and spirit. We strive for excellence in the delivery of high quality, effective recovery and health care to our community and all individuals we serve.”
“We treat all those we serve with compassion, kindness and respect and recognize and affirm the unique and intrinsic worth of each individual. We act with honesty, integrity and fairness. We pursue excellence in health care through continuing education, evaluation, quality assurance and appropriate staffing.”
HATHAWAY’S PHILOSOPHY, LICENSURE AND ACCREDITATION
Hathaway Recovery Center is a medical detox and residential treatment program for men and women, specializing in patients with co-occurring and biopsychosocial disorders. We offer a safe and nurturing environment where patients can begin their journey of recovery. As pioneers in the integrated residential treatment sector, we provide specialized treatment for a wide range of addiction and mental health conditions, always on a one-to-one basis.
Hathaway Recovery Center is compliance with the licensure of California Code of Regulations, Title 9, Chapter 5, and has earned, the esteemed, Joint Commission Accreditation. Hathaway offers sub-acute detoxification level of care and residential level of care as defined by the American Society of Addiction Medicine. Hathaway Recovery Center relies upon evidence-based practices to assist and support our patients.
Hathaway Recovery Center’s overall goal for each patient, is a foundation in lasting recovery, and the development and engagement in an independent and constructive lifestyle, without using substances. It is essential that patients are offered a therapeutic environment based upon our belief that all people with substance abuse and other addictive disorders should be treated with dignity and respect. Positive behavior and healthy decision-making are encouraged and modeled, further enhancing the therapeutic process and facilitating the desired outcome.
As a licensed facility, we adhere to the highest standards and comply with regular state inspections. Our professional staff has years of experience in the field of addiction and are up to date with current and trending clinical modalities and training. Hathaway Recovery Center’s facilities have developed a balanced therapeutic program utilizing traditional and holistic evidence-based treatments including strong rehabilitative components.
To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, culture and other demographic qualities.
In an effort to promote and maintain ongoing individualized treatment, the facility’s staff and patients work together to develop relevant treatment planning including realistic short- and long-term, time-bound goals. These plans are designed to maximize the opportunity to achieve specified goals and objectives that are realistic and achievable. This therapeutic approach, combined with individual and group therapies, is seen as an integral component of our effective treatment program.
In summary, Hathaway Recovery Center believes that embracing the values of teamwork, compassion, gratitude, joyful dedication, and integrity most effectively supports and encourages individuals to take responsibility for their own recovery and wellbeing. Our goal is to provide the highest quality detox and treatment in a setting that is safe and comfortable so that symptoms occurring in the brain and body after substance abuse can be addressed in a dignified manner.
HATHAWAY’S ACCESSIBILITY AND LOCAL NETWORKS
Hathaway Recovery Center offers services in a manner accessible and available to individuals in their community. Significant aspects of accessibility and availability include the need for access at times and places convenient for those served, prompt intake and engagement in services, access regardless of ability to pay and place of residence, access to adequate crisis services, and consumer choice in treatment planning and services. Because the emergency department (ED) is often a source of crisis care, Hathaway Recovery Center has clearly established relationships with local EDs to facilitate care coordination, discharge and follow-up, as well as relationships with other sources of crisis care. Use of peer, recovery, and clinical supports in the community and increased access through the use of telehealth/telemedicine supports also will further the statutory objective of availability and access to services
As described above, Hathaway Recovery Center works with local hospitals, emergency centers, health care facilities, psychiatrists, therapists and other professionals that cannot assist substance use disorder patients with detox or long-term sobriety and must refer to a program that can provide exceptional care. We accept those requiring co-occurring care and provide services with an expert team and in a setting that supports the cultivation of self-esteem, confidence and the resolution of shame and guilt. Locally, our program has an excellent reputation and hospitals and other medical and mental health care professionals are comfortable and grateful for the quality of care we provide.
We have been approached and built solidarity with referral sources including hospital discharge planners, judicial system professionals, social workers, community centers, religious organizations, substance use treatment facilities that cannot care for the co-occurring patient and other sources. The professionals at Hathaway have established strong bonds and interagency trust as Hathaway has proved its professionalism and effectiveness over the years.
INCIDENTAL MEDICAL SERVICES:
We are pleased to share that we have been approved by the Department of Health Care Services to provide “Incidental Medical Services” to our patients. The Department of Health Care Services and Governor Brown, in 2015, finally supported the issuance of medication assisted therapy including the use of Buprenorphine and other MAT medications. In 2016, AB848 took effect and programs that had previously been disallowed to hire physicians and other prescribing medical staff to prescribe (or order) medications that are essential to the success of patient detoxification and continued recovery were finally legal. In 2019, Although MAT has been in use, in particular Methadone (prior to Buprenorphine and other recent MAT medications) has been in use for many years, the philosophy that a MAT user was “not sober” (by some 12 step participant’s opinion, and, upon which many social model programs are based), is not only no longer tolerated, it is illegal.
The Medical/Clinical model of care has finally been acknowledged as the most effective modality when treating patients with co-occurring disorders. After many, many years of misunderstanding the disease of addiction, the Medical/Clinical model is laying the groundwork, as we go forward, in treating this formerly intangible and enigmatic disease.
The disease has finally been diagnosed as having neurological origins in tandem with attachment disorder, developmental trauma and physical and mental genealogical contributions. Healing begins with the provider understanding the complexity of the disease and employing evidence-based services that support repairing a “broken” endorphin system and pain relief (emotional or other) seeking behaviors. Any program “worth its’ salt” will utilize a biopsychosocial approach and the American Society of Addiction Medicine’s (ASAM) criterion to assess and determine appropriate care for each patient.
TREATMENT FOR CO-OCCURRING DISORDERS:
Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs—i.e., tobacco and alcohol. More than 50% of individuals who have severe mental health issues also have a substance use disorder. 37% of alcohol abusers and 50% of drug abusers suffer from AT LEAST one mental health disorder. For these individuals, one condition becomes more difficult to treat successfully as an additional condition is intertwined. Thus, people entering treatment either for a substance use disorder should be assessed for the co-occurrence of the other condition(s). Research indicates that treating both (or multiple) illnesses simultaneously in an integrated fashion is generally the best treatment approach for these patients.
Hathaway has been treating patients with co-occurring disorders since we opened in 2010. We are equipped to handle the unique needs of individuals struggling with substance use disorder and mental health diagnoses such as depression, anxiety, bi-polar disorder and other mental health illnesses.
In addition, our patients work with a Physician, Therapists and Certified Drug and Alcohol Counselor to establish a detox, residential and an exit/aftercare plan that will allow them to stay clean and sober after they leave our care. We encourage our alumni to engage in sharing their experiences with current patients so, current patients understand that others have walked in their shoes.
Our prescreening and admission screenings are all devised to determine any history or current co-occurring disorder(s). Our patients are also assessed again, after detoxification has taken place, since some substances can mask mental health disorders. If identified post-detox, these are of course, treated in tandem with substance use disorder. Should the patient’s secondary condition become the primary condition, the patient is referred to the appropriate level of care and once stabilized, has the opportunity to return to Hathaway to receive substance use disorder treatment.
Co-occurring issues that Hathaway is capable of treating in concurrence with substance use disorder include (In no particular order):
Increase Coping Skills
Obsessive Compulsive Disorder
Low Self Esteem
Sleep Disturbance & Insomnia
Elderly Persons’ Disorders
Impulse Control Disorders
Sexual Identity Crisis
SUBSTANCES HATHAWAY RECOVERY CENTER TREATS:
Hathaway Recovery Center treats the following substances of use:
Over the Counter Medications
Synthetic Cannabinoids (K2)
Synthetic Cathinones (Bath Salts)
HATHAWAY OVERCOMES LANGUAGE BARRIERS
Hathaway is capable of offering services to individuals and families that include substance users who do not speak English as their primary language. We help those whom have a limited ability to read, write, speak, or understand English or who may be eligible to receive language assistance with respect to the particular service, benefit, or encounter.
Hathaway Recovery Center has the ability to cross language barriers by providing counseling services to our patients in various languages. Not only does this help cross the lines of the language barrier, but we encompass cultural competency as a common thread within our case management and we build trust intrinsically, in this arena, where attachment disorder and distrust abound.
Hathaway Recovery Center help individuals who speak the following languages:
We are proud to extend our services to communities and individuals whom would otherwise have nowhere to turn and no one to understand, assist, communicate or help with treatment or resources.
COMMUNITIES WE SERVE:
Hathaway Recovery Center is pleased to serve sub-populations within our communities and those whom cannot receive care in the usual facilities (in no particular order):
Legal System Professionals
Vegetarian, Vegan, Mono-food Allied
Homeless and Indigent Persons
Homeless and Indigent Persons
Veterans, First Responders and Health Care Professionals
Racial Justice Allied
Sex Worker Allied
Lesbian, Gay, Transgender, Bi-sexual, Queer, Non-Binary
Hathaway Recovery Centers expert clinicians and physician ensure the effective and compassionate care for each and every patient. The following employees offer excellent
24-hour care for our patients. All patients are monitored throughout detox and residential care with scheduled and thorough observation and assessments by our knowledgeable and experienced staff. We are proud and grateful for our clinical staff that provides the exceptional services Hathaway claims.
HATHAWAY’S TREATMENT AND EXIT PLANNING:
From the beginning of admission, our patients are provided with excellent detox, residential and exit planning. From the initial days of treatment, the patient is assisted by our staff to work toward measured, achievable and time bound goals. The clinical staff works with the patient to identify common goals tailored to the patient’s needs on an individual basis. Goals must be reasonable and match with the patient’s level of motivation. Every treatment plan is shared during staff meetings to gather staff insight and information that may assist all clinicians and all staff in supporting the patient to meet their goals.
Hathaway Detox Treatment Planning:
Our Clinicians assist the patient to set the first goals of detox which may include successfully remaining sober to complete detox. A first step toward that goal may be to meet with the physician and to receive a physical examination. Another step may be taking medications as prescribed and to participate in random or scheduled drug testing. Any issues or barriers the patient may experience during detox may be identified and agreed to, with the patient’s input; the counselor and patient will work in tandem to determine what the patient will do should those problems arise. Detox treatment planning is conducted within 48 hours of admission.
Another detox goal might include identifying that the substance use has been problematic and what the consequences will be should the patient continue to use. The patient and counselor identify small steps toward the larger goals and determine deadlines. Should it be appropriate, the patient’s goals will lead toward continued engagement in the proper level of treatment after detoxification.
Hathaway Residential Treatment Planning:
Residential Treatment planning occurs within the first seven days of admission to this level of care. The plan is then reviewed and revised with the patient again within every seven days during individual sessions. The Clinical Director assesses each developed treatment plan and approves or requires adjustment. The Clinical Director may make suggestions to the patient’s clinician and work closely with the patient should the treatment plan need revisiting
During initial assessments, particularly during a biopsychosocial assessment and individual sessions, areas of the patient’s life affected by substance use are identified. These identified areas lay the foundation for the next level of care and engagement in treatment. The areas affected break down by ASAM’s six dimensions and are the foundation of a healthy treatment plan.
As the counselor and patient explore the areas of life that are affected by the disease, the severity of each dimension is also identified. This allows the patient and clinician to work out what goals to set first, second, and so forth and then break each one down into smaller, timebound steps. For example, should the patient have mental health issues, those would be one of the first goals to address so that the patient is stabilized, can participate fully and experience an expeditious and then, long-term improved quality of life. Steps might include being seen by a psychiatrist, obtaining prescribed medications and taking those medications as prescribed, engaging in therapy with a qualified therapist and participation in ongoing individual sessions and assessment.
For as long as Hathaway has the patient within our care, we continue treatment planning on a weekly basis with clinical review and staff input during staff meetings. Updates to the plan are made and the patient is always acknowledged for their progress or, supported in meeting whatever step may be causing a barrier to progress; potentially breaking steps down further or, walking closely with the patient through the step causing difficulty.
Hathaway Exit Planning:
As the patient has made progress throughout their treatment episode, Hathaway staff assist the patient with the expected end of residential care and ongoing engagement in both treatment and meeting the goals they have left to fulfill. Some goals may take longer than the patient has to participate in treatment at our residence. The exit plan clarifies what needs to be maintained and what steps need accomplishment to achieve the patient’s desired results. Hathaway relies upon the ASAM’s dimensions for clarity regarding the patient’s needs in exiting the program and in planning a smooth transition into the next level of care and greater independence.
Exit planning includes looking at obtaining a supportive living environment, dealing with family, longer term issues and any continued barriers or triggers that may flare up for the patient when not in the refuge of residential care. Exit planning identifies how the patient will maintain the support network built while in residential care and what further outside resources shall be “taped into.”.
Exit plan goals and smaller steps, originally set within residential care, are sometimes “maintenance goals…” potentially established in the prior level of care. For example, the goal of maintaining mental health engagement and the continuance of meeting ongoing expectations regarding self-care, including taking medications as prescribed, engaging in therapeutic sessions and activities, and maintaining a mental health support network, are clearly identified prior to exiting.
Hathaway’s exit planning always includes the engagement in the next level of care and for the patient to participate in treatment for as long is as possible. Statistic show that the longer a patient engages in treatment (at any level) they have the greater opportunity to stay sober for the rest of their lives!
We connect each transitioning patient with organizations that can assist for long-term treatment and resources. These include local partial hospitalization programs, intensive outpatient programs, mental health facilities, medical care facilities, community organizations (such as 12-step groups), spiritual or religious groups or mentors, legal professionals (attorneys, parole, probation officers), safe and supportive housing, safe and supportive recovery networks, (such as alumni) and other needed resources. Memorandums of understanding are used in each connection with outside resources.
Hathaway exit planning always includes the goal of participation in Hathaway Recovery Center’s Alumni meetings and ongoing activities. All Hathaway patients have the ongoing opportunity to seek assistance from Hathaway staff at any time, should they feel they are in danger of relapse or require a supportive network or environment. We encourage our patients to engage in the Alumni groups and to keep in touch with Hathaway staff and former patients (when former patients sign a release of information).
Hathaway’s Recovery Alumni:
Hathaway’s Alumni groups occur once a week and all current patients and engaged former patients come to participate. It is an opportunity for former patients to model ongoing recovery and provide support and hope for those in Hathaway detox and residential levels of care. Our Alumni also create a solid network of sober individuals that avail themselves to current and past patients of Hathaway, for support, help and reliably compassionate understanding.
Our Alumni can often be credited with the success of a discharged patient whom is in potential relapse and has “turned it around” due to Alumni’s system of support and outstanding willingness to show up and be available to those in trouble. We are proud to have built a “Recovery Family” that acts as a network, beyond our residential boundaries, who provide unparalleled support to newly discharged patients.
It is an honor to Hathaway’s Recovery Center that our Alumni continue to participate and can exhibit high standards and effective practices that assist any discharged patient interested and willing to continue to engage in the continued Hathaway journey. We are proud that our former patients come back to Hathaway to share their strength, hope, methods and practices of recovery to prove that sobriety can be maintained, and that recovery can be solid and continuous.
HATHAWAY’S CONTINUED COMMUNICATION
Hathaway is determined to ensure that our patients work on continued sobriety and to ensure Hathaway’s constant, growth and improvement, we methodically interact and systematically collect data regarding the ongoing success or relapse of our former patients.
We have an imperative to assess and improve our services. We determine patient success (ongoing sobriety) as validity of our approach. However, we do not dismiss the collection of data to follow a “bell curve” between full, ongoing sobriety and, the other end of the curve, full relapse. Although we know that relapse is sometimes a part of achieving sobriety and that many patients relapse (whether from Hathaway or other treatment programs), we consider relapse as an opportunity to consider where we might improve our approach. We use this information to gauge our efficacy and potentially augment our approach. We methodically utilize quantitative measurement of former patients and alumni to assess the success or weaknesses of Hathaway Recovery Center’s program – we assess our methods, modalities, clinical capability and overall efficacy.
Our measurement lies in contacting each and every former patient of Hathaway and surveying whether or not they have retained sobriety. We contact each discharged patient with a face-to-face interview, a telephonic contact or, an internet communication at the following timeframes: 1 week, 4 weeks (1 month), 8 weeks (2 months), 12 weeks (3 months), 16 weeks (4 months), 20 weeks (5 months), 28 weeks (7 months), 40 weeks(10 months), 52 weeks (1 year). However, sometimes, we cannot locate a former patient and we factor these un-reachable former patients into our data and tracking.
Any time we find that one of our patients has relapsed, we assist them with regaining sobriety, when possible. We offer assessment, consideration for admission and/or referral for those willing to return to treatment. Hathaway assists with planning, referrals, making strides toward overcoming barriers, and if necessary, readmitting the patient to Hathaway or another program when necessary.
HATHAWAY DATA COLLECTION AND QUALITY ASSURANCE
With every treatment episode we learn and improve the services we provide. We take every case and all information collected to use the information to quantify the clinical services that are working and those that need reassessment or improvement. We are always looking for new standards, methods, possibilities and evidence-based practices to include or improve our milieu.
Our data collection methods:
We conduct a qualitative collection of data as we feel this best suits our patients. We ask a series of standard questions; in a less-structured interview and we ask open-ended questions.
Interviews-Current Patient Information:
We conduct satisfaction surveys at the end of every patient’s treatment episode;
How many patients have admitted and remained in treatment until agreed upon discharge;
How many patients have relapsed while on-site or off-site and returning to Hathaway;
How many patients have admitted and remained sober in spite of leaving against medical advice;
How many patients have left against medical advice and relapsed;
Methods of Data Collection with Former Patients:
Hathaway Staff, having already established rapport during treatment, have the opportunity to conduct face -to-face interviews have a very high response rate.
Telephone Interviews take less time than face-to-face interviews. However, the response rate isn’t as high. Another problem is that survey bias may creep in. For example, people without phones can’t be surveyed and sometimes without face-to-face, patients may provide answers to questions they think Hathaway wants to hear, rather than what is truthful.
Computer Assisted Personal Interviewing (CAPI) is like a personal interview, but we use a laptop or tablet instead of paper questionnaires to enter the responses. CAPI has some of the same setbacks as the Telephone interviews.
It must be considered that a particular portion of patients will not be available, after discharge, to supply information on their quality of life, continued participation in treatment, and sobriety. We believe the percentage of those who we have “lost” in terms of communication or simple lack of ability to make contact, factors in at 19%. We include this consideration into our data, although we continue to make attempts to contact former patients, when they have been initially “off-line”.
HELP GROW HATHAWAY RECOVERY CENTER
We share the information above in order to generate interest with local and community organizations in joining with Hathaway Recovery Center to create deep and effective change in the lives of those with substance use disorder.
We seek partners to interact and connect with regarding the greatest success of our patients and to participate in inter-agency inspiration about how we will create change within our community, and across the world, as a whole.
The stigma of substance use disorder and, mental health disorders is a palpable and serious barrier to seeking or engaging in treatment. We are looking for informed and compassionate organizations who want to support our services and our long-term plans for each and every patient. We know that often, because a problem is looming and expansive, it is difficult to know where to start…
Hathaway Recovery Center offers an outstretched hand to any community organization, leader, private company, insurance network or, any other type of supportive individual or agency. We want to connect and create. We walk the path that assists those who are suffering from substance use disorder (and mental health disorders) and, we can lead anyone invested in support and enhancement of all patients’ success.
Thank you for your gracious consideration in collaboration with Hathaway Recovery Center. Please contact our Executive Director/Owner, Dina Rozenoyer, should you be interested in discussing the strategies we employ to save lives.
Dina Rozenoyer - Owner/Executive Director
Hathaway Recovery Center