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NAMI California Conference 2009

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Psynergy presentation about Full Service Recovery in Therapuetic Communities. Overview and reccomendations for evidence-based services in residential mental health settings are illustrated.

Psynergy presentation about Full Service Recovery in Therapuetic Communities. Overview and reccomendations for evidence-based services in residential mental health settings are illustrated.


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  • 1. NAMI CALIFORNIA Annual Conference 2009 Full Service Recovery in Therapeutic Communities Presented by Psynergy Programs
  • 2. Today’ Panel
    • Christopher Zubiate, MSW
    • Chief Executive Officer
    • Arturo Uribe, LCSW
    • Chief Operations Officer
    • Darlene Prettyman & Barbara Pitcock
    • Family Liaisons.
    • Carlos Leglu, LMFT
    • Director of Clinical Services
    • Adam Dick, BS
    • Assistant Administrator..
  • 3. Today’s Learning Objectives
    • To provide insight into Evidence-Based practices that can serve consumers and their families in REAL community settings as opposed to warehoused locked facilities.
    • To explore the benefits of client-centered care for clients, families, providers and the general community.
    • To share the challenges of locating, developing and operating Modified Therapeutic Communities to serve individuals experiencing chronic or persistent mental distress.
  • 4. Our Philosophy
    • Psynergy Programs, Inc. was founded on the philosophy that individuals experiencing mental distress have the potential to do better when everyone works together.
  • 5. What We Expect
    • Our vision of a future filled with personal and community transformation is one we strive to share with our clients and their families.
    • Clients at our facilities experience an atmosphere that celebrates hope, promotes personal growth, builds social networks, and helps individuals realize their full potential.
  • 6. The Tradition of a Treatment Community
    • Therapeutic community is a term applied to a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach is usually residential with the clients and therapists living together, is based on milieu therapy principles and includes group psychotherapy as well as practical activities.
    • Therapeutic communities have and gained some reputation for success in rehabilitation and patient satisfaction in Britain and abroad… The evolution of therapeutic communities in the United States has followed a different path with hierarchically arranged communities (or concept houses) specializing in the treatment of drug and alcohol dependence.
    • The term was coined by Tom Main in his 1946 paper, "The hospital as a therapeutic institution",[1] and subsequently developed by others including Maxwell Jones, R. D. Laing at the Philadelphia Association, David Cooper at Villa 21, and Joshua Bierer.
    http://en.wikipedia.org/wiki/Therapeutic_community
  • 7. Therapeutic Community
    • Essential Elements
      • Behavioral Limits, Sanctions and Rewards
      • Role Modeling
      • Self-Help and Mutual Support
      • Peer Pressure
      • Counseling
      • Education
      • Personal and Community Responsibility
      • Job Functions and Vocational Training
      • Re-entry into larger community
  • 8. Modified Therapeutic Community (NREPP)
    • The MTC model retains most of the key components, structure, and processes of the traditional Therapeutic Community but makes three key adaptations for individuals with co-occurring disorders:
    • It is more flexible, less intense, and more personalized.
    • MTC reduces the time spent in each activity, deemphasizes confrontation, emphasizes orientation and instruction, uses fewer sanctions, is more explicit in acknowledging achievements, and accommodates special developmental needs.
    • SAMHSA - Date of Review: March 2008
  • 9. Vision for the Future
    • We are committed to creating innovative options for individuals to move out of locked settings and into successful community living.
  • 10. Context for Change
    • De-institutionalization in the 1960s
    • Negative impression of board & care homes
    • Stigma associated with the “mentally ill”
    • Temporary solution to community housing
    • Shortage of mental health professionals
    • Warehousing and trauma
    • Limited state oversight and accountability
    • NIMBY: Not-in-my-back-yard
    • Institutions for Mentally Diseased (IMD)
    • No evidence base for existing models
    • Mental Health Services Act
  • 11. CA Network of Mental Health Clients Board & Care Project
    • Is Anybody Home?
    • … what seems to be rare is the care home which truly provides care in a way which encourages growth and dignity.
    • Dave Hosseini
        • CNMHC
  • 12. CA Network of Mental Health Clients Board & Care Project
    • Is Anybody Home?
    • By Dave Hosseini
        • Voices From the Board and Cares
        • Issues and Recommendations
        • Conclusion
  • 13. CA Network of Mental Health Clients Board & Care Project
    • Voices From the Board and Cares
    • Mike, 48 – “What I remember most is spaghetti, spaghetti, spaghetti…”
    • Betty, 52 – “It makes me fell like a nobody to not be able to buy a hamburger or a coke…”
    • John, 45 – “ They (B&C operators) started up with the ‘fines’ again and told us ‘anyone who complains will be out’…”
    • Sandy, 44 – “One person who works there calls me ‘stupid’ all day long because I am slow with things… I feel like I get hit in the stomach and head when I am around her – she doesn’t hit me though – it’s her words…”
    • Charles, 54 – “I was given a ‘choice’ between a board and care or a long-term locked facility, so I ‘chose’ the board and care…I believe that people should be given the supports they need to live in the community…”
    • Elaine, 47 – “they always bought the cheapest of everything and for a while we even had to buy our own toilet from the operator…”
  • 14. CA Network of Mental Health Clients Board & Care Project
    • Issues and Recommendations
        • Training of Operators and Staff
        • Client Service Plans
        • Medication and Related Medical Issues
        • Nutrition Issues
        • Reports/Deficiencies by Licensing
        • Fine/Penalty Procedures
        • Language, Literacy, and Cultural Competency
  • 15. CA Network of Mental Health Clients Board & Care Project
    • Issues and Recommendations
        • Transportation Issues and Obligations
        • Admission Agreements
        • Frequency/Quality of Oversight
        • Payee Issues
        • Resident’s Rights
        • Evictions
        • Access/Reasonable Accommodations
  • 16. CA Network of Mental Health Clients Board & Care Project
    • Recommendations / Conclusion
    • Immediate:
    • A system be setup in which individual homes are randomly selected for further scrutiny of nutritional issues. Currently CCL has the ability to demand documentation of food purchases when a home is under investigation – expand this authority; require all homes to submit such documentation and randomly examine a small number.
    • Increase the fine structure, eliminating loopholes and grace periods.
  • 17. CA Network of Mental Health Clients Board & Care Project
    • Recommendations / Conclusion
    • CCL be required to track and list violations on a statewide and regional basis rather that the current system of leaving them in each individual file. Also, information on violations should be readily available to the public.
    • An innovative program be established in which consumers and family members accompany CCL on inspections and participate in giving feedback to facilities.
    • Ongoing:
    • A statewide conversation among stakeholders recognizing the problem and advancing possible solutions to improve the lives of those in licensed care homes.
  • 18. A New Vision of Community Life
    • Nueva Vista
    • - Opened 2005
    • Cielo Vista
    • - Opened 2008
    • Psynergy.org
  • 19. Components of Success
    • Clinical Case Management
    • Residential Supports
    • Medication Services
  • 20. Evidence Base for Change
    • Modified Therapeutic Community (NREPP – 2008)
    • Illness Management and Recovery (SAMHSA)
    • Integrated Dual-Diagnosis Treatment (SAMHSA)
      • Dialectical Behavioral Therapy
      • Motivational Interviewing
      • Harm Reduction
      • Stage Change Approach
      • Family Psychoeducation
  • 21. Program Agreements
    • In addition to adhering to certain standards of conduct, residents entering the program also must maintain a consistent level of participation and put forth a considerable degree of effort to meet program expectations.
    • It is expected that each member will progress toward achieving their treatment and recovery goals and become eligible for graduation within a period of six to twelve months.
  • 22. Program Agreements
    • Trust and Safety
    • Respect and Cooperation
  • 23. Program Agreements
    • Trust and Safety
    • Members will not harm, or threaten to harm, themselves or others.
    • Members will not possess or conceal any weapons or dangerous objects.
    • Members will not use alcohol or illegal drugs or abuse prescribed medication.
    • Members will not lie, cheat, steal or intentionally deceive others.
    • Members will not bully, intimidate, coerce or harass others.  
  • 24. Program Agreements
    • Respect and Cooperation
    • Members will not use offensive words or vulgar language toward others.
    • Members will not spread demeaning stories, gossip or rumors about others.
    • Members will not disregard the needs and feelings of others.  
    • Members will not engage in aggressive or hostile acts toward others.
    • Members will not disturb the peace or violate the privacy of others.
  • 25. Clinical Services
    • Clinical Director
    • Psychologists
    • Staff Psychotherapists
    • Occupational Therapists
    • Chemical Dependency Specialists
    • Rehabilitation Specialists
    • Animal Assisted Therapist
    • Clinical Interns
    • Integrated Assessment
    • Client-Centered Treatment Planning
    • Individual and Group Therapy
    • Family Therapy
    • Family Education and Support
    • Canine and Equine Assisted Therapy
    • Individual and Group Rehabilitation
    • Community Integration Services
    • Case Management
  • 26. Typical Day at Psynergy
    • Psynergy’s offers a series of rehabilitation groups and structured activities designed to enhance each resident’s ability to cope effectively with life challenges and to attain greater autonomy in community living.
    • Graduates Psynergy’s “empowerment training” develop a greater sense of trust, self-confidence and self-control and growing ability to create a healthy lifestyle.   Group trainers and Residential Counselors provide coaching, guidance and assistance to participants on a daily basis.
    • Participants are expected to meet with their counselor each week to discuss their progress.
  • 27. Residential Supports
    • The Residential Program is designed to help clients improve mental health and functioning and features activities and workshops.
    • The activities focus on the development of Activities of Daily Living, social skills, coping strategies, accessing community resources, health education, multi-cultural awareness, money management, and recreational activities.
    • In addition, the Psynergy therapeutic communities offer three “core groups” and five “elective groups” on a regular basis throughout the year.
  • 28. Life Skills Academy
    • Core Group Training: 1) Health, Hygiene and Nutrition. 2) Keys to Success: Motivation, Planning and Problem Solving. 3) Making Connections: Active Listening and Constructive Communication. Elective Group Training : 4) Feeling Good with Physical Fitness. 5) Money Management: Keys to Financial Freedom. 6) Everything You Need to Know about Medications. 7) Relaxation and Recreation: Ways to Manage Stress. 8) Household Management: Keys to Independent Living.
  • 29. Medication Services
    • Medical Director
    • Staff Psychiatrists
    • Licensed Psychiatric Technicians
    • Dental Hygienist
    • Specialized Medication Room Staff
    • Transportation
    • Integrated Psychiatric Assessment
    • Medication Management
    • Medication Education
    • Specialty Medical Care
    • Vision and Dental
    • Innovative Medication Packaging
    • Family Education and Support
  • 30. Psychiatric Assessment
    • Comprehensive screening by one of our Senior Clinical Staff.
    • Within 24 hours of admission, a complete evaluation of the client’s psychiatric, clinical and medical needs is initiated. 
    • A client will meet with one of our staff psychiatrists usually the very next day who will recommend a course of treatment.
    • Psynergy values the importance of family involvement throughout the assessment process and strives to incorporate every aspect of the individual into our assessment so that we are prepared to meet the client’s needs. 
    • The assessment process is consumer-driven and person-centered to discover an individual’s strengths and goals.    
  • 31. Psychiatric Assessment
    • Once the initial assessment is complete, additional outside appointments are scheduled to meet the client’s primary and specialty care needs.
    • To facilitate recovery and reduce symptoms, a client may be seen more frequently, but typically in the first 30 days, a client can expect to see one of our psychiatrists and clinicians weekly. 
    • Overall, the assessment is ongoing. Weekly reviews of a client’s progress helps facilitate recovery and prevent relapse.
  • 32. Medication Management
    • We don’t want to leave anything out of the potential equation that can be used to find the best regimen to allow each client to achieve personal success. Our team observes clients daily in a residential setting, assessing how they interact with staff and other residents. 
    • Side effects of medication, often a problem elsewhere, are minimized at Psynergy because clients are monitored every day. 
    • A major part of our success in dialing in the best medications for each client is the ongoing education that our professionals receive.
    • They stay current on the newest psychiatric medications to arrive at the most successful dosing and drug combination strategies available.
  • 33. Psynergy Fusion
    • Psynergy Programs recognizes that clients understand and appreciate high standards of cuisine and care.  This does not change simply because they are going through a crisis. 
    • Salads where carrots are shredded just moments before they are served, organic produce hand-selected at local markets, freshly baked bread, and delicious, low-fat entrees help clients achieve and maintain a healthy weight and lifestyle.
    • When clients experience cooking and accommodation comparable to what they would receive in a home setting, it is easier to visualize themselves going home.
  • 34. Psynergy Fusion
    • Psynergy’s Executive Chef is a graduate of a prestigious culinary training program in Alsace, France.
    • Chef Lionel Haberle previously worked at resort hotels in the French Caribbean and world-class restaurants in the Carmel Valley.
    • A passion for freshness and preserving the nutrients in food is an integral part of our whole- person approach to mental health and wellness. 
    But what we do here is more than just cooking quality food. With our highly varied, international cuisine, we also think about transporting clients to places they’ve never been before– from North American comfort food to European, Asian and Caribbean specialties. There’s nothing institutional about our menu. It’s more like the melting pot of a world-class bistro, with a weekly outdoor barbecue and some very special surprises served at each holiday. -—Lionel Haeberle
  • 35. Questions & Dialogue
    • What ways can families advocate for innovative alternatives to locked settings?
    • How can the Therapeutic Community better involve and include family members?
    • What additional stories need to be collected to create support for more housing with dignity?
  • 36. Thank You !
    • We believe that it's the little things that come together to make a genuine difference-our clients, our families, our residences, our staff, our leadership each contribute to the atmosphere and amazement every day!