Member Profiles

Recovery Centers of America Addresses Relapse in New Treatment Program

The risk of relapse is the nemesis of anyone in recovery from drugs and alcohol. Unfortunately, around half of those who receive treatment will use drugs and alcohol again. The National Institute on Drug Abuse (NIH) states that relapse rates for drug use are similar to rates for other chronic medical illnesses. However, relapse IS dangerous because it carries a higher-than-average risk of overdose and the potential to go back to regular usage of drugs or alcohol.

To address the problem of multiple relapses for patients seeking treatment for addiction, Recovery Centers of America (RCA) has created a specialized program at its Devon, Pennsylvania facility called PRISE, Promoting Recovery through Intensive Support and Education.

“Relapse is a common occurrence in addiction recovery and it’s important for individuals – and their families – to not give up hope if it does happen,” said Scott Weisenberger, LPC, Vice President of Clinical Services for Recovery Centers of America. “Understanding that doesn’t mean that we encourage relapse but that we can learn the skills to move on from it and try again.”

Patients are saying it’s unlike any other program – singling out separate, smaller groups, more activities, and therapy concentrating on life outside the treatment center. Programs for patients who have relapsed have been added to all the inpatient treatment facilities in the RCA healthcare network.

PRISE uses a three-pronged therapeutic, evidence-based approach to treat these patients for whom recovery has been elusive:

• Acceptance Commitment Therapy: PRISE patients reconnect with earlier values and aspirations, learn to let negative emotions and behavior “pass through” and take a stand for themselves by staking their own claim on recovery.
• Narrative Therapy: Staff work with patients by making problems concrete and thus easier to solve. By identifying addiction – and not the person – as the problem, patients can apply solutions more easily.
• Positive Psychology: Through community activities, work therapy, and doing for others, patients learn true gratitude – which energizes them to move forward. The simple act of helping another person struggling with addiction, science has proven, can trigger happiness neural pathways in the brain.

The curriculum contains individual and group therapy and seminars designed to reunite patients with their former values and actively address individual crises and trigger points that can set off a relapse.

PRISE also partners with the RCA Chester County Alumni Chapter to match patients with alumni mentors for face-to-face guidance on moving from addiction into the world of recovery. Additionally, patients will engage in live volunteer experiences in the community, such as working at a food bank. Finally, patients learn practical life skills to assist them in life on the outside.

The 3-4 week program starts right after a period of detoxification with the creation of the addiction story. That story becomes the blueprint for creating a new life of recovery and reuniting each patient with who they were and who they were meant to be. The recovery story will be presented to the entire community prior to each patient’s discharge. The symbolism is clear: By writing their addiction story, they are leaving that behind at RCA and by writing their recovery story, they are stepping into their future.

Medication-assisted-treatment is also offered in the PRISE program in both the inpatient and outpatient program using Suboxone and Vivitrol.

Recovery Centers of America (1-800 Recovery) provides evidence-based comprehensive addiction treatment at six inpatient residential facilities in Devon, Pennsylvania; Mays Landing, NJ; Westminster and Danvers, Massachusetts; and Earleville and Waldorf, Maryland. A full spectrum of Outpatient treatment is also provided at many of these facilities and in Vorhees, NJ. RCA also provides Medication-Assisted Treatment (MAT) at its facility in Trenton, NJ and an additional MAT facility is planned in Delaware County, PA.

Contact: Terri C. Malenfant
Director of Public Relations
Recovery Centers of America
tmalenfant@recoverycoa.com
(610) 715-2144

Breaking Down Barriers to Patient Flow Across a Growing Psychiatric
Service Line

The NewYork-Presbyterian psychiatric service line is one of the largest inpatient psychiatric providers in the United States, with more than 550 beds spanning 6 locations.

Historically, access to beds had not been optimized or coordinated. Staff in the emergency departments and medical floors were spending exorbitant amounts of time locating beds for individuals who needed psychiatric treatment. The goal of this initiative was to find a single solution that could be implemented across the entire enterprise.

NewYork-Presbyterian launched a Psychiatry Inpatient Access Center in early 2018, creating an efficient and centralized process for bed placement horizontally across the region. Here are its features:

Opportunity for Improvement:

• Identify and breakdown barriers to admission flow across the service line
• Maximize throughput and capacity
• Utilize technology
• Increase cross campus collaboration
• Decrease Lengths of Stay (LOS) in emergency departments and medical units once medically stabilized

Objectives:

• Reduce the bottle-neck effect in emergency departments and inherent delays in locating psychiatric beds
• Design and implement a new enterprise wide approach toward admissions related to individuals requiring inpatient psychiatric hospitalization
• Creation of a bed flow management system, which will result in increased throughput, shared acuity, and positive patient experience

To address these issues, a central Psychiatry Inpatient Access Center was created to manage all psychiatric beds in the system and create a single point of contact for those in need of an admission.

• Timeline – brought 550 beds across 6 hospitals online over 12 month period
• Functionalities –
  • Patient placement through use of a multifaceted assessment process
  • Streamline patient flow
  • Streamline patient financial clearance
  • Oversight of internal and external admission into inpatient psychiatry beds
  • Improve the patient experience by significantly reducing LOS in Emergency Departments

Psychiatric Access Center: Triage and Placement Process

The following criteria are taken into account when identifying the right bed for each patient:

• Specialty needs – i.e., Eating Disorders, Geriatric, addiction recovery, etc.
• Med/Psych needs
• Acuity
• Geography
• Patient/Family preference
• Bed availability
• Patient insurance
• Urgency for hospital Emergency Departments, CPEPs, and LOS on medical floors

Health System Outcomes

• Increased patient throughput in emergency departments, with decreased LOS
• Decreased open beds
• Increased transparency
• Stabilized acuity across a larger pool of beds
• Improved financial outcomes
• Leveraged Information Technology solution and data to drive quality, throughput, and financial performance

Results:  Optimization of access for NYP consumers

• Decreased LOS in CPEPs
• Transfers to Gracie Square Hospital (part of the NYP Psych Service Line) increased from 65% to 84%.
• Transfers to NYP Brooklyn Methodist Hospital increased from 2% to 31%.
• Patients are placed in beds that meet their needs and preferences (whenever possible).
• Staff in both the Emergency Departments and medical floors have a single number to call to place an individual in need of psychiatric inpatient treatment, resulting in increased patient and staff satisfaction.

For more information, please visit www.nyp.org/psychiatry.

American Addiction Centers’ vision to revolutionize addiction treatment features Addiction Labs, a premium clinical and toxicology lab that is one of the few labs nationwide dedicated solely to addiction treatment.

Addiction Labs’ personalized approach ensures patients receive the right medication and dosage, which leads to fewer side effects, faster results, improved compliance, reduced prescription costs, and, ultimately, better outcomes.

Addiction Labs’ approach includes three main areas: pharmacogenetics, toxicology, and medical screenings:

Pharmacogenetics

Pharmacogenetic testing is the combined study of medications and inherited genetic traits. By conducting genetic testing, physicians can work to develop personalized treatment protocols to enhance therapeutic initiatives and ensure that patients are receiving the proper medication at the earliest point in treatment.

Toxicology

Addiction Labs has one of the most robust and comprehensive addiction treatment-focused testing menus in the nation and can test for more than 29 drug classes and 190 metabolites. The testing menu includes:

• More than 40 fentanyl analogs
  • Tests for fentanyl analogs often identify unexpected fentanyl derivatives laced in abused substances such as heroin and opioids. The lab is one of only a few in the country that can also test for carfentanil, a fentanyl analog 10,000 times more potent than morphine. By closely monitoring the Drug Enforcement Administration’s (DEA) seizures list, the lab can create tests for various drugs, allowing treatment centers nationwide the ability to apply these tests to their patients.
• Designer stimulants
  • Bath salts carry a high risk for fatal overdose and psychotic behavior. Up to 40 percent of emergent treatment for bath salt abuse suffered psychotic symptoms including harm to themselves or others.
• Kratom
  • Kratom is a botanical product with psychotropic, opioid-like effects that is currently a legal substance. Due to health risks, the U.S. Food and Drug Administration (FDA) banned kratom imports in August 2016 and the DEA has listed kratom as one of its newest Drugs and Chemicals of Concern.
• Synthetic cannabinoids
  • K2 / Spice is the second most popular illegal drug among American teenagers with rising prevalence of 3.7 percent of 12th graders in 2017. Addiction Labs offers tests for more than 50 of the most popular synthetic cannabinoid derivatives.

Medical Screening

Patients with addiction problems typically have co-occurring health issues—many of which are serious— that must be assessed. Co-morbid medical conditions can hinder the recovery process and increase the risk of relapse or even death. To understand the whole patient, the lab also offers testing in hematology, chemistry, infectious disease and hormone levels, among others. This philosophy of treating the whole person enables medical professionals to accurately monitor the effectiveness of the patient’s treatment regimen, giving them their best chance at achieving long-term sobriety.

A nationally known toxicologist and a team of geneticists oversee Addiction Labs’ research about the role of genetics in addiction. This work continues to advance pharmacokinetics, how patients process medication; and pharmacodynamics, how medication affects the patient. Researchers also continue to identify additional traits that can contribute to addiction vulnerability; suggest better treatment guidelines; and aid providers in achieving better patient outcomes.

Rogers Behavioral Health launched a system-wide safety program called Go Pro for Safety with a focus to encourage all employees to be proactive in protecting patients and the Rogers team. The vision is to inspire a culture of safety leading to the safest environment for patients and employees by using an interdisciplinary team approach to deliver evidence-based, highly reliable care.

Initiatives

Go Safe focuses on the safety and security of our grounds and other environmental factors. Safe stands for Security Awareness Facility Environment.

• Environment of Care rounds: efforts to reduce potential for patients harming themselves. Improvements include weighted or secured furniture, magnetic bathroom door installation, and removal of ligature points.
• Can the Can: Aluminum cans create the risk of self- harm for patients and environmental hazards can increase the opportunity for injury.
• See Something, Say Something: aimed at increasing staff awareness and reporting, this initiative focuses attention on surroundings.
• Injury Prevention: activities related to preventing staff injuries due to hazards, improper techniques, and increasing staff knowledge on post-injury protocols.

Go Zero aims to eliminate patient and employee harm caused by use of restraints and seclusion, medication errors, and falls.

• Nonviolent Crisis Intervention (NCI)- As part of the Go Zero initiative, NCI is being relaunched within Rogers with goals to promote the best possible care, welfare, safety, and security for staff and patients involved in a crisis situation and ultimately to have zero restraints and seclusions.
• Medication safety: On any day, patients at Rogers Behavioral Health receive medications as a part of their treatment. When given correctly, medications are a beneficial part of bringing patients back to health. Applying the Go Zero initiative to medication safety means we aim to reach zero medication errors. To help nurses in achieving this goal, nurses now have the structure and equipment to conduct private, safe, and timely medication passes.
• Fall Prevention: the Go Zero fall reduction program is being developed to include clinical operating procedures to address falls holistically in the adult addiction and eating disorder inpatient setting.

The Clinical Effectiveness and Quality Department reviewed aggregate data to better establish system Safety and Quality priorities. The analysis determined:

• 74% of incidents occurred in patient rooms
• Improvement in incident documentation can aid in better insights.
• Data collected in the electronic health record can lead to further insights into adverse events.
• More cycles through clinical protocols lead to better outcomes and fewer readmissions.

Priorities:

• Safety Rounding – multidisciplinary team from multiple campuses to analyze and improve the existing process.
• Suicide Risk Prediction – Utilizing advanced computer science techniques will provide us the ability to better predict suicidal behavior.
• Clinical pathway recommendations – Utilizing evidence-based outcomes and protocol templates to direct patient care through various levels of service in order to decrease recidivism and increase clinical effectiveness.

For more than 110 years, Rogers Behavioral Health has been a leading not-for-profit, private provider of specialized mental health and addiction services for adults, teens, children and families. Rogers provides treatment in Wisconsin and six other states, making it one of the largest providers of specialty behavioral healthcare. Learn more about services for depression and mood disorders, eating disorders, addiction, obsessive-compulsive and anxiety disorders, and posttraumatic stress disorder at www.rogershospital.org.