A New Approach: Intensive Short Term Residential Stabilization
At Grafton Integrated Health Network (GIHN), it is our goal to help vulnerable and high-risk populations lead better, more independent lives. Every day, we are increasing our ability to provide support to individuals across their lives, in whatever aspect of behavioral health care they may need. In the past year, we have placed a great deal of energy on our short term stabilization services. The program, based on the Leesburg campus, is a twenty-four hour trauma-informed program serving children and adolescents ages twelve to seventeen.

This short term psychiatric residential stabilization in combination with our community-based triage approach is a solution-focused, outcome-oriented, person and family-centered treatment regimen. This intensive intervention focuses on the entire circle of support - client, family, and community. Combining cognitive-behavioral, trauma-informed, systems theory and psychiatric approaches to “treatment that works” allows us to demonstrate real outcomes metrics with high empirical validity and reliability. In partnership with George Mason University, we are instituting a repeated measures outcomes database that focuses on and measures symptom acuity and functional autonomy. Once completed, other programs within GIHN’s continuum of care are also available as “step-down services” or for more acute treatment in the rare case it becomes necessary.

GIHN works with all involved to ensure the right system of care is developed for each individual. A client’s stay -- typically between 30 and 45 days -- provides an opportunity for the family and community to identify the naturalistic, community based support systems that can be engaged to continue the healing process when they return to their home environment. In many cases, this type of support can replace paid professional support systems.

“We were very intentional in our design of the program to integrate and partner with community resources and to limit length of stay as much as possible,” explains Scott Zeiter, executive vice president of strategic business development. “We have already established close connections to community-based resources such as Family Connections in Loudoun and are actively identifying similar opportunities with other organizations. We believe that these partnerships are truly helping to improve outcomes.”

Our team is constantly learning and adapting in order to best meet the community’s needs. For instance, we are looking forward to implementing a multi-family group program on Saturdays in the near future. Also in the works is a peer-to-peer program element, an idea that came to fruition through a friendship between “Kevin,” who you’ll read about later in this newsletter, and his Leesburg campus roommate. Peer-to-Peer programs are increasingly emerging as the bedrock of recovery- oriented best practices.

Less than a year after its launch, we are proud and excited about the progress of this program. And clients like Kevin are further proof that our goal – to help families and adolescents see possibilities where they thought there were none – is well within reach.
For more information about the continuum of services offered at GIHN, please contact the admissions office at admissions@grafton.org.

More than Just a Phase: A Teenager’s Journey Back to Health
According to his father, “Kevin,” a sixteen year old adolescent, has exhibited troubling behavioral issues since he was very young. Even at two years old, he was destructive and unable to follow rules.

“His day care wanted to have him evaluated,” explains Kevin’s dad. “Every single teacher, every single year wanted to have him evaluated. He never conformed to expectations or rules and was often argumentative and destructive at home.”

By 14, Kevin had already been arrested for breaking and entering, as he sought money to support his drug habit. He had also been at the Commonwealth Center five to six times. The same year, he was admitted to the Bon Air Juvenile Detention Center due to regressive and dangerous acting out behaviors including self injury, suicide attempts and smearing feces among others. Amid the unpredictable and sometimes volatile population, Kevin exhibited a great deal of anxiety and began a habit of cutting himself.

DIAGNOSIS:
Needing more intensive mental health and substance abuse services, Kevin was referred to Grafton Integrated Health Network’s (GIHN) short term stabilization program at the end of August 2011. In addition to his self-injurious behaviors, he was not eating, experiencing hallucinations and exhibiting unstable moods, depression, anger and impulsivity. His diagnoses at the time of admission included Mood Disorder, Conduct Disorder, Attention Deficit Hyperactivity Disorder and Poly-Substance Dependence.

ASSESSMENT:
When he first arrived at GIHN, Kevin presented a hopeless, defeatist attitude. Compounding this challenge, he experienced intense social anxiety that made him unable to participate in group substance abuse therapy. With an understanding that every plan of care must be as unique as the client it serves, Kevin’s substance abuse counselor, Sandra Dettra accommodated his feelings by providing individual substance abuse psychotherapy.

His therapist, Holly Ameen, had an open door policy. Her level of availability was extremely beneficial to Kevin. He responded very well, knowing that he could call upon his therapist at any time, as needed. He was also able to take breaks and self-initiated time outs when he felt overwhelmed within the classroom or the unit.

“Kevin never seemed big on therapy in the past, but he really opened up to it at GIHN,” says his dad. Kevin’s care included a team of individuals providing specialty therapies including: monitoring of psychotropic medication, individual therapy, family therapy, and dialectical therapy. In addition to his individual substance abuse counseling, Kevin also participated in group therapy once he felt comfortable doing so.

“As he began to trust us, Kevin’s demeanor changed entirely,” said Jenaea Ireland, his case manager. “He displayed a gentle, caring and even playful attitude. He even developed a strong connection with another client.”

This special bond – and its benefits on both clients’ journey back to health -- was the impetus behind a new GIHN peer support initiative. In fact, given his progress Kevin has been identified as a potential peer support volunteer in the hopes that his experience can help other teens and serve as a positive role model.

During his time in the short term stabilization program, Kevin’s team helped him to master important goals including:

Reducing the incidence of impulsive and disruptive behaviors. Kevin responded well to the structure and expectations provided to him. Initially, when he was given a consequence he did not like, he would make threats to harm himself. When staff responded with increased supervision and support, he responded positively. As a result, he did not engage in any self-injurious behaviors during his stay at GIHN.

No incidences of using illegal or non-prescribed substances. Kevin responded favorably to individual substance abuse therapy. He was tested when he returned from overnight passes and each result was reported negative for substance abuse.

Improve communication with parents. Kevin had a history of engaging in a negative thinking pattern and focusing on past failures. During his time at GIHN, his team, in coordination with his parents, worked with him to focus on the present moment and things he could look forward to.

PROGRESS:
Since leaving the short term stabilization program, Kevin has continued to make great progress. His GIHN team was very involved in helping to determine his after-care plan. Holly Ameen took Kevin to visit his new school while he was still at GIHN, helping to alleviate anxiety he felt about the impending transition and his return home.

Today, Kevin is living at home with his dad and younger brother. He attends the Leary School where he is working toward his GED, He also participates in vocational training. In addition to enjoying favorite pastimes including football and reading, he also spends time with his new girlfriend. “He attends school regularly, is focused on the future and is doing better than he ever has,” says his dad.

• GIHN is honored to be a finalist for the 2012 Negley Awards, an award we won in 2008 for our Minimization of Restraint initiative. Our current submission focused on what we call the “Safety 7,” a program designed to keep both clients and employees safe.
• The Negley Awards are a series of cash grants presented annually to provider organizations that demonstrate excellence in risk management practices. Grafton won the Negley Award in 2008 for its excellence in risk management.
• Shamsi Sadeghzadeh, director of outreach services presented “Early Detection, Evaluation and Treatment of Autism” to local pediatricians and Healthy Families in the Northern Shenandoah Valley.

• “Grafton: Moving from Control to Comfort” will be presented at the Fairview Development Center by GIHN executive vice president and chief outcomes officer, Kim Sanders in February. Kim will be serving as a consultant on behalf of the Substance Abuse and Mental Health Services Administration (SAMHSA) and National Association of State Mental Health Program Directors (NASMHPD).
• “Improving Goal Mastery through Data-Based Decision Making” will be presented at the 2012 Virginia Transition Forum by Lisa Marshall, director of clinical services, in Roanoke on March 12th through March 14th.
• Shweta Adyanthaya, director of communications and Kim Sanders will present “Promoting Trauma Informed Treatment Practices” at the American Association of Children’s Residential Centers (AACRC) 56th Annual Conference. In addition, “ABA in a Trauma Informed Program of Care” will be presented by assistant education administrator, Jason Craig and Shamsi Sadeghzadeh, director of outreach services. The conference will be in New Orleans on April 23rd through April 27th.