Industry Insider - October 2015

Sept/Oct 2015

Vol. 1 No. 1

UNITE: Rally for the Ages pg. 2 Recovery Housing— End of the Gold Rush pg. 12 Pioneering Canadian Initiative Recognized pg. 14 CARON Focus on Elderly pg. 19 A Technological Pathway to Support Recovery pg. 20

Claudia Black Young Adult Center Opens LEADERSHIP Lessons to Live by

Industry Insider

Sept/Oct 2015

Table of Contents UNITE to Face Addiction: A Recovery Rally for the Ages.......................................................... 2 AA Celebrates Eighty Years.................................................................................................................... 2 Claudia Black Young Adult Center Opens at The Meadows....................................................... 3 The Good, the Bad, and the Ugly.......................................................................................................... 6 Harvard Medical School Recognizes Dr. John Kelly as Inaugural Incumbent.................... 7 Around the States ...................................................................................................................................... 8 AAC Rapidly Grows Treatment Network Amid Industry Attention........................................ 9 Sunspire Acquires Caron (Texas)......................................................................................................... 9 Evolving Health Care: Surviving and Thriving in the New Behavioral Health Paradigm.............................................................................................. 10 Benefits and Challenges of Recovery Housing.............................................................................. 12 Pioneering EASI Tool from Canada Recognized in States for using ASAM Placement Criteria in Fight against Addiction ............................... 14 The Legal Beat: Patient Brokering..................................................................................................... 15 The Kennedy Forum Review............................................................................................................... 16 YPR Continues Rapid National Growth, Announces EPIC New Partnership with Life of Purpose.......................................................................................................................................... 17 New Leadership Takes Helm at Crossroads Centre, Wins Jasper G. Chen See, MD, Voluntary Leadership Award at NAATP Conference.................................................................. 18 Caron’s Strategic Blueprint Includes Major Expansion of Treatment for Seniorst........................................................................................................................... 19 Launching the First LGBTQ Substance Addiction Program in Florida............................... 19 A Technological Pathway to Support Recovery........................................................................... 20 Ask The Expert: “The Doctor’s Gap”.................................................................................................23

Sept/Oct 2015

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Letter from the President Dear Reader, This is an exciting time for the treatment industry in the United States and beyond. Real growth brings with it real responsibilities and I am therefore proud to welcome you to this special first edition of Counselor’s Treatment and Recovery Industry Insider.

In the midst of fast-moving changes in the nation’s health care agenda, and with so much tumult in the business machinations of the SUD (substance use disorder) industry, I trust that this regular publication, also available on our website, will be an invaluable guide to a world where long-term, sustainable recovery is supported by quality services and ethical providers.

At Counselor magazine, we know the value of advancing that conversation with accurate reportage, having provided a hub for organizational networking, information exchange, and innovative advances in addiction treatment to health care organizations nationwide for over thirty-five years.

The dialogue from the Insider will be carried on at our U.S. Journal Training conferences where, in addition to Counselor and Renew magazines, my team is passionate about identifying the best available substance abuse treatment services in communities throughout the country.

We at Counselor are proud to commend those who are involved in the art of making a difference and continue our tradition of applying platforms of media resources to distinguish with accuracy between positive recovery stories and stories that exacerbate addiction and substance abuse.

This publication is the latest offering in that tradition. Now even more counselors will have access to initiatives by the more reputable providers in addition to the latest news and research in addition to the most valuable discussions provided by U.S. Journal Training conferences.

In this issue we present the first edition of Counselor’s Treatment and Recovery Industry Insider.

Sincerely, Peter Vegso

President/Publisher.

Health Communications, Inc.

Letter from the Editor As Editor Gary Seidler writes in Counselor magazine, our company hatched The US Journal of Drug and Alcohol Dependence the very first “trade” periodical that reported on research, findings, new treatment modalities, and educational advances in the then fledgling alcoholism and drug abuse field.

That began a tradition of our focus on our future and and almost forty years of fulfilling our promise to deliver valuable content intended to inspire, empower, and facilitate the “good guys” who enter this space while reporting on others whose machinations threaten it. As is true of most human services industries, ours has its fair share of scam artists and predators who seek to line their pockets with tainted gold mined by a vulnerable population.

The time is certainly right, as new federal and state laws are improving addicts’ treatment options. The final rules were passed governing the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) requiring health plans to provide the same dollar limits for mental health benefits as for medical and surgical benefits; our coming publications will undoubtedly feature the most significant government action yet to enforce the provisions of federal and state insurance parity law.

It will add to what promises to be an exciting, purpose-driven period in keeping mental health professionals informed and will continue to be a national voice for the cause of addiction treatment, in addition to strengthening our place in the broad national coalition supporting parity.

While we’ll explore the implications of laws such as these, we’ll remember that substance use, prevention, treatment, recovery, and mental health not only affect the person involved, but have a profound impact on others around them. The Insider will report with journalistic integrity on important developments and progressive initiatives throughout this fascinating North American—and indeed international—arena.

Sincerely,

Stephen Cooke Director of Editorial Communications and Marketing

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Sept/Oct 2015

UNITE to Face Addiction: A Recovery Rally for the Ages

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ddiction to alcohol and other drugs continues to be an insidious public health crisis impacting more than 85 million Americans. On October 4, 2015 an original and galvanizing event will take place in Washington, DC with the intention of building on the emerging national grassroots movement to solve the addiction crisis.

The event in the nation’s capital offers the opportunity to participate in the largest rally ever held in the United States to unite to face addiction and stand up for recovery. The intention of organizers of UNITE to Face Addiction is to host a conspicuous national rally that will transform the conversation from problems to solutions for one of the most pressing issues of our time.

“Too many of those affected have been incarcerated, and for decades they and others have been afraid to speak up about the failed policies and poor care due to long-standing stigma and discriminatory public policies,” says Greg Williams, the campaign director of UNITE to Face Addiction and director of The Anonymous People. “For too long, a great majority of people connected to addiction have remained silent.”

UNITE to Face Addiction is being organized by an independent coalition of national, state, and local nonprofit organizations to produce a collaborative and unifying event to collectively raise awareness and reduce the human and social costs of addiction.

Why now?

Long-term recovery from addiction is a reality for over 23 million Americans, one of our nation’s best-kept secrets. Regardless of the paths people have chosen to achieve recovery, their lives and the lives of their families, friends, neighbors, coworkers, and communities are vastly improved as a result. They are the living proof that there are real solutions

to the devastation of addiction.

While recovery from addiction is a reality, more than 350 Americans die from alcohol or other drugs on average each day—some 135,000 people each year— more than who die from either homicides or motor vehicle accidents. Another 22 million Americans are still suffering from addiction and the majority never receive any help.

The goal of the rally is to let the nation know that addiction is preventable and treatable, that far too many of those have been incarcerated, and that recovery works—Americans do recover and get well.

The rally will be held from 4–8 pm on the Capitol Mall, and Williams and his Outreach Committee are inviting all who care about this issue: providers, policy makers, family members, concerned citizens, and particularly those for whom recovery has had a transformative impact.

“We know that addiction is preventable, treatable, and people can and do get well,” continued Williams. “Where is the national outrage about this needless loss of life, the costs to families and the economy, and more importantly, the demand for solutions?” ■

AA Celebrates Eighty Years

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ighty years ago this June, an alcoholic who couldn’t cease drinking was visited by an alcoholic who believed he’d found an answer. Since then, the fellowship of Alcoholics Anonymous (AA)—that celebrated society of alcoholics helping alcoholics—has grown to approximately 2 million members worldwide.

Every five years, thousands of AA members are joined by a variety of professionals,

supportive community members, and friends from around the globe to celebrate sobriety and fellowship, and to rededicate themselves to carrying the message of hope and recovery back home.

Over 57,000 from over ninety countries assembled in Atlanta, GA from July 1–5 for The International Convention of Alcoholics Anonymous, along with an additional estimated 8,000

family and friends who travelled with them, for an overall estimated economic impact of $66,550,000.

With a flag ceremony featuring those nations and meetings in The Georgia Dome, the area around The Georgia World Congress Center was the focal point for international recovery on America’s holiday weekend. Literature displays and archival exhibits illustrated the rich history and international heritage of a fellowship whose literature spans ninety languages and over 170 countries.

The international convention was first held in Cleveland, OH in 1950, and has continued every five years since. Practically every AA member has experienced firsthand a similar conversation in which a sober alcoholic offered his or her experience, strength, and hope at no cost and with no obligation. Upcoming conventions will take place in Detroit, MI in 2020, and Vancouver, Canada, in 2025. ■

Sept/Oct 2015

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Claudia Black Young Adult Center Opens at The Meadows Interview by Robert J. Ackerman, PhD Transcribed & edited by Leah Honarbakhsh

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uthor, speaker, and trainer Claudia Black, PhD, is a well-known member of the addiction and behavioral health field. She presents her work on family systems, mental health, correctional services, and addictive disorders through workshops and seminars around the world. Dr. Black received her doctorate degree in social psychology from Columbia Pacific University and her master’s degree in social work and bachelor’s degree in social welfare from the University of Washington.

Earlier this year, The Meadows treatment center in Arizona launched the Claudia Black Young Adult Center for patients ages eighteen to twenty-six who are suffering from addictions, emotional trauma, and co-occurring disorders. Author and Counselor magazine Advisory Board Chairman Robert J. Ackerman, PhD, spoke with Claudia about her work with young adults and the opening of the this new program.

Dr. Ackerman: Thank you for taking the time to do this interview; I’m glad for the opportunity to talk to the Claudia Black. So most recently The Meadows named their young adult program after you, and it is now called the Claudia Black Young Adult Center. How did you feel about that?

Dr. Black: When they first came to me they actually asked if I would be more involved in their young adult program, and that was very exciting for me. Then when they said they wanted my name associated with the program, I think that was something else entirely. There’s definitely a shy part of me, and I was much more interested in the hands-on aspect of being involved in their program. However, so many people are familiar with my work that I think what it says very quickly is that if I’m involved in it, it’s a program with a lot of integrity and depth. Despite my shyness about it, there’s a part of me that realizes it’s a positive association, so I understand. It’s a real honor.

Dr. Ackerman: It’s an honor that you deserve, no doubt. How long have you been affiliated with The Meadows?

Dr. Black: I’ve been affiliated with them since 1998. Since that time I’ve been there on a monthly basis, spending four or five days clinically inside the treatment center. One of the gifts of being involved is that it has allowed me to have clinical oversight on what they’re doing. Again, that’s where my heart really lies.

Dr. Ackerman: When you started, what was it that led you and/ or The Meadows into thinking about creating a young adult program?

Dr. Black: One of the things was that they started to have a higher percentage of young adults coming into the treatment program. As the numbers increased, I think it became evident how easily someone between eighteen and twenty-five or twenty-six years of age can get lost and can facilitate their own getting lost. One of the challenges in this program has been that young adults aren’t as motivated as perhaps their parents are for them to be in treatment. I also think that developmentally these young adults require a different style of counseling—what we’ve learned in the last few years due to neuroscience has really told us that. So the combination of what we’ve learned about how they can create change in their lives and the fact that the number of young adults coming into treatment was rising, made it a very obvious decision that

a specific program was warranted. From the moment they separated young adults out, it’s been nothing but validated.

Dr. Ackerman: Well, it took a while before people finally started paying attention to adolescents, that particularly trying time in life, and chemical dependency. However, there’s a lot to be said for the idea that one of the most difficult periods in life may not be adolescence, but may instead be the transition to adulthood. What do you think about that?

Dr. Black: I think that this young adult age group, especially today, has an extremely difficult passage to navigate. I don’t want to negate how difficult adolescence is, but I think historically there have been more rites of passage for adolescents. I know we’re thinking back about twenty-five or thirty years, but I don’t think that families had as much of an influence as they wanted to have, and now culturally there’s so many more outside influences.

We actually thought that as you work with young adults you’re working with people who have a lot of trouble relaunching and finding individuation and emancipation. What we’re seeing in the young adult program is that the inability to succeed is totally affected by serious depression, serious anxiety, and multiple addictive disorders. It isn’t simply that they didn’t learn some of the basic life skills; it’s much more complex than that. These young people are so lacking in any kind of direction.

As a family and as a culture part of what we do is help adolescents by giving them a strong foundation and roots so that ultimately they can grow wings to be able to move on. However, what I’ve seen a lot of in these young adults are clipped wings. They don’t have a strong foundation or a strong sense of self. They’re lacking meaning and purpose in life—issues that are all complicated by these co-occurring dynamics.

Dr. Ackerman: You mentioned “relaunching,” which brought to mind that “failure to launch” concept. How does that apply to your ideas about young adults?

Dr. Black: I think that for many people “failure to launch” means that these young people are still living at home, they aren’t taking responsibility for structure in their daily lives, and they aren’t accountable for supporting themselves financially. I definitely see these things in the young adult population. I think that in many ways people don’t see the complexity of young adult life as a problem that is contributing to failure to launch. One of the surprises that I’ve seen in this population is how much self-loathing occurs. We see a lot of depression and the depth of that depression has surprised me. It’s not as much about the depth of the sorrow as it is about the depth of the self-hate and

Dr. Claudia Black, center, with family counselors Ashley Chesky and Patricia Plum at the Center in Wickenberg, AZ.

self-loathing. Families wonder, “Where does this come from?” because they’ve all tried to just provide for their children. I think the intent is there, but what has occurred is something different.

Dr. Ackerman: Do you think the parents are doing too much?

Dr. Black: In some cases, yes. In the young adult population that we work with we see significant acrimonious divorce. We see a lot of substance abuse and other addictions on the part of the parents. We see a lot of parents with their own depression, many times untreated.

And then you get young adults who don’t appear to have the kinds of dysfunction I just mentioned, but these kids are the ones who feel that they will never measure up to expectations or be good enough. So I do think for some of our young people that can be very significant. We also see a lot of suicidal ideation in these young people. That also surprised me. A lot of that suicidal ideation is related to the ideas of “I’ll never be good enough.”

Dr. Ackerman: In relation to what you were talking about when you mentioned self-loathing and failure to launch, do you see any differences in failure to launch as it might apply to young women versus young men?

Dr. Black: Yes. Failure to launch in young women might be related more to depression—that is, depression that is getting in the way of their ability to move forward in their lives. In young men we tend to see more substance abuse, and in many cases it’s about medicating emotional pain for them. That’s where you see that kind of gender difference, in how they deal with their emotional pain. The young women tend to succumb more to the emotional pain, and with the young men there’s a bit more of that fight aspect.

With young women I also see a lot of attachment to men. I don’t see it as a rescue; I don’t see them thinking that this person is going to come and take them out of a bad situation. It’s more of a value concept, where they feel they have more value because they are in a relationship with someone.

Dr. Ackerman: Right. There’s research out there that talks about what you’re alluding to, and it’s called the “partner effect.” It’s about how oftentimes one gender is more affected by the behavior of their partner, or that they take more of an identity from their partner than

they do from themselves. I think that might be close to what you’re talking about when you’re talking about young women and attachment. In fact, the research says that young women are more affected by their partners than young men are.

So when young people are working with you in the program, how long do they stay on average?

Dr. Black: They stay in our program for forty-five days. One of the things the research is also saying is that we have an extremely high percentage of our young adults who are going into highly structured aftercare programs—they’re going into either IOP or sober living environments. This is good because we’re well aware that forty-five days for this particular age group is just not enough by itself.

Dr. Ackerman: Of course. Obviously the young people you are working with are experiencing multiple types of problems, so perhaps we could talk about some of those. What are some of the substance abuse issues you are seeing when they come in?

Dr. Black: They’re bringing in everything, really. It’s interesting because I expected it to be predominately opiate addiction, as many other adolescent and young adult programs are seeing a lot of that. We still see that, but we’re also seeing everything else. For example, alcohol addiction is extremely prevalent in this population, but we also see heroin addiction, bath salts, opiates, crystal meth, and all the new designer drugs. Alcohol and opiates are probably the ones we see the most.

Dr. Ackerman: Did you discover some unique challenges in working with this age group?

Dr. Black: One of the biggest challenges is that while these patients recognize and acknowledge their substance abuse, they are unwilling to give up alcohol use because they don’t see it as that much of a problem. They are very resistant to giving that up. Part of that is that they just can’t imagine life without some kind of so-called “party.”

They think that they can just give up the other drugs and that they will still be able to drink and it will be fun for them. It’s important for us to do a lot of social activities so they can meet people who haven’t been drinking or using in the past few years.

The other challenge is that it’s not usually their idea to come into treatment. It’s usually someone else’s, and most often it’s the par-

Sept/Oct 2015 ents who want them there. Sometimes these young adults have to get through a fair amount of treatment before their motivation changes.

We have to do a lot of motivational interviewing and use what leverage we can. Usually within ten to twelve days we have been able to take these very resistant clients and transform their willingness to get treatment. The fact that we have such a high percentage of this population going into highly structured aftercare tells you that they’ve really turned around their motivation.

Dr. Ackerman: I know you have a vast amount of clinical experience with many different populations, but within the young adult population did you run into anything that surprised you clinically?

Dr. Black: I think the social phobia, which is extremely prevalent, has surprised me. A lot of times when I run groups and I ask why these young people are in treatment, I don’t have to ask about the anxiety; they bring the anxiety up. In some cases these are college students who are achieving and doing okay academically, but not emotionally and socially. I think that’s what has surprised me the most.

Another thing is that, at The Meadows specifically, about 70 percent of the young people who come in have various addictions and co-occurring dynamics, but 30 percent do not have any addictions, so they’re coming in with only psychiatric diagnoses. More often than not what we’re working with are trauma responses, depression, and anxiety.

A lot of this is related to the extent of bullying in this age group. I was very surprised at how widespread that was, and not just significant for young people in, say, second grade. If I took ten of the young adults in the program, six of them would say that their experiences with bullying were very significant.

Dr. Ackerman: That’s interesting. So, if we can think back a little bit to when we were young adults, do you see many differences in the generations between young adults then and young adults now?

Dr. Black: Our culture was different then, and I think it was easier to find ourselves and to find a path. Today there are so many choices and our young adult population hasn’t learned how to earn their way in. Additionally, they want things to occur for them at a faster pace. I feel like they’ve been given more without having to earn it, so they don’t derive as much pleasure from the process of really working for something.

Dr. Ackerman: Do you think that applies to recovery? That they expect it to come quicker and easier than previous generations?

Dr. Black: I don’t know about that. I think that’s always been a problem, and one that’s not limited to young adults in this generation. That’s part of the immaturity that comes with addictive thinking.

Dr. Ackerman: That is true, yes. Another thing I wonder is about one of the trends in the field over the past ten years: medication-assisted treatment. Is that something that’s showing up more and more in working with young adults?

I think medication-assisted treatment is expanding as we expand our knowledge of co-occurring disorders as well. It definitely seems as though it’s here to stay, but that doesn’t mean that it’s being completely accepted by the field. I was just curious as to your opinion on that.

Dr. Black: I can say that we get a lot of serious depression, a lot of bipolar disorder, and we’re very good at differential diagnosis. There are a lot of times where medication is going to be very appropriate. However, I think that in any good psychiatric system you spend just as much time looking at what medications these patients have already been on.

For example, I get twenty-two-year-olds who got put on medication at fourteen years of age and nothing has been reexamined or changed.

Then you take a look at how dramatically their lives have changed, how they have physically changed, and the level of maturity and psychological change, and obviously the medication needs to be assessed. A lot of times there’s also better medication available today with fewer side

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effects. So we do a lot of medication history with people to discover to what degree medication is necessary and/or helpful.

Dr. Ackerman: So Claudia, in addition to your program and the fact that they have you, what do you see as the strengths of the young adult program at the Meadows?

Dr. Black: We have a very high staff to patient ratio. I think higher than normal, and not just in relation to primary staff but to our behavioral staff as well. We do that because we believe in what we call being “eye-to-eye,” meaning knowing exactly where our patients are at.

Another one of the strengths is that our trauma services are integrated into the program. What I mean by that is that we don’t have a separate trauma track; we have individual trauma services involving extensive neurofeedback sessions and sometimes EMDR, but we also do breath work, sensory-motor psychotherapy work, and other experientially based therapies. Obviously when it comes to trauma histories we incorporate mindfulness into everything.

I know probably a lot of other treatment centers say this as well, but we also have a particularly strong—and I think different—family program.

It begins with web-based information; all our families are having private, web-based conversations with our family therapists prior to them ever coming into the family program at the center. Then when they finally come into the family program, they have a totally experientially based program, just like the patient. A few times during the week they are in the program they are also involved in the whole family program community.

Dr. Ackerman: As we wind down here, I’d like to get to some more personal questions. In relation to your program and its success, what do you get out of this?

Dr. Black: On a personal level, it truly makes my heart sing. This program allows me to use all my years of experience. I come in feeling calm in a wise kind of way, which I think you need when you’re working with the young adult population. Things aren’t as surprising and you aren’t as reactive as you might be without all those years of experience.

For me it’s an opportunity to work with people who’ve had a lot of pain in their lives—and I’ve devoted my whole career to working with these people—but to work with them at an age when they truly don’t have to live that pain out as they move into creating their own families and careers. It gives me a sense of pride that I can be involved in something as important and significant as that.

Dr. Ackerman: Good! I mean, we’ve talked about all these things that you’re giving to the program, so I really wanted to ask what you get out of this experience. It sounds like you’re getting some good stuff.

So for therapists and perhaps even young adults who are reading this interview, are there any words or ideas you’d like to leave them with?

Dr. Black: Well, I would definitely like to see more therapists working with this age group. Additionally I would also like to see more male therapists working with this population. I work with a great group of people, but I’ve become very aware as I work with these young men that we need more role models for them in the field.

To therapists I would say don’t be afraid of young adults. It’s tough, but they are really so vulnerable and they truly want to live their lives differently. They’re confused, but I find them to be motivated. We need to get through any resistance and we need to love them for who they are.

As for young adults, I would just really like to be there for them. ■ Robert J. Ackerman, PhD, is chairman of Counselor’s advisory board.

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Industry Trends The Good, the Bad, and the Ugly Michael Walsh, MS, CAP, BRI-I

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hile thinking about the options for this article, I began looking at “hot button topics” such as ethics and the influx of new players and programs emerging in the industry. I spoke to friends and colleagues before settling on what I believe will be the first in a series of groundbreaking legislative initiatives which have the potential to both strengthen and yet polarize our industry.

I’ve recently revisited the topic of commitment laws, which intrigued me while working on my master’s in substance abuse counseling a few years ago. At that time there were very few states in which families, loved ones or friends could engage in a process to mandate treatment for mental health or substance abuse issues. Many states have some version of a law to involuntarily commit someone for up to seventy-two hours if they are a danger to themselves or someone else. Florida’s Marchman Act and Kentucky’s “222” allow for a longer commitment (up to six months) under certain circumstances. Each of these has its limitations, including the time, resources, and knowledge needed to investigate and carry out the process and also the lack of treatment resources in many cases. These laws are being debated in many states and have been extremely useful in engaging people in treatment and recovery who otherwise may have continued to suffer.

There are other proposed laws in Florida and elsewhere that would allow for mandatory treatment and also to provide services once someone is committed to treatment, such as the Jennifer Act (“What is,” 2015).

PATIENT RIGHTS

Other legal aspects of the treatment industry concern patient rights and provider responsibilities, such as what happens when the police show up looking for a client. How many staff have an understanding of what questions to ask, what to say, and what not to say? In some instances an “I cannot confirm or deny if that person is in treatment” is sufficient, but the police may show up with a “pick-up warrant”; do all staff know the policies, procedures, responsibilities, and law regarding this procedure? Is it different in various states? Somehow I doubt that we have prepared staff and

clients to properly assess and deal with all the legal and ethical possibilities which may unfold during and after treatment.

Right now I’d like to discuss another aspect of how the law affects or can influence treatment services, perception, and opportunities to change. There are many different levels of care and treatment modalities or combinations of modalities that have emerged over the last fifty to seventy-five years, depending on who you ask, and I’m sure there are more to come.

If you read the history of treatment and recovery in the US, you will learn, as I have, a lot about what it was like, what happened, and what it’s like now in the treatment continuum.

In William White’s Slaying the Dragon (1998), he outlines the history of addiction treatment and recovery in America, which basically spans America’s entire history. In the second edition, Mr. White continues to detail the evolution of this movement. I highly recommend these books to anyone interested in treatment or recovery.

What has emerged is a complex often misunderstood quagmire of options with very little organization, little practical oversight, and an ever-growing and changing “playing field” which can leave consumers vulnerable, payers skeptical, and providers perplexed, not to mention polarized.

The natural progression, if you will, of services expanding from medical detox to primary treatment, extended care, PHP, IOP, sober living, recovery communities, ancillary supports, drug testing, monitoring, coaching, and the list goes on, has exploded into a gold rush mentality. I keep thinking of the title “the Good, the Bad, and the Ugly” as I survey the current landscape.

It is often difficult to tell who is who and why!

Perhaps a bit naive at times, I was mentored in this industry by extremely intelligent and dedicated professionals who lived by certain codes borrowed from various places: •First, • do no harm.

•Do • the next right thing.

• •You can’t operate sober the way you did when you were drinking.

I didn’t know what I didn’t know and I was encouraged to always remain teachable.

In today’s marketplace of treatment I see more examples of “the blind leading the blind” and “ignorance is bliss” than anything else.

Although there are plenty of dedicated, hardworking, and ethical programs and professionals, it is becoming more and more difficult for them to succeed, as they must compete for business with others who don’t know what they don’t know, or worse, don’t care. It is also increasingly difficult for consumers and allied health professionals to keep pace with this playing field.

TIME IN RECOVERY

Enough from the soapbox; let’s talk about the changing landscape and the positive influences striving to encourage others to seek a better way. My philosophy when treating addiction is that time is a client’s best friend. We know from physician’s health programs (PHPs) that longer stays and the use of monitoring can produce exceptional recovery outcome stats.

We are embracing a system which often starts with medical stabilization and proceeds through various levels of comprehensive clinical programming and eventually leads into supportive environments designed to lengthen the treatment continuum. The twenty-eight-day “silver bullet” has been shown to be a myth; according to NIDA, anything less than ninety days is ineffective (2012).

Time in recovery can be elusive; getting someone through enough of the stages of change to be willing to stay in a community and then finding the resources to support that time has been extremely difficult. Peer support comes in many forms and is not a new concept.

However, the structural make-up and clinical evolution of peer support recovery services has been documented to show success. No matter what levels of care or routes to recovery people take at some point in their recovery, they will hopefully be surrounded by a village of people who can become their allie in the fight against this disease.

William White states that There is a long history of peer-based recovery support services within the alcohol and other drug problems arena, and the opening of the

Sept/Oct 2015 twenty-first century is witnessing a rebirth of such services. These services are imbedded in new social institutions such as recovery advocacy organizations and recovery support centers and in new paid and volunteer service roles. These peer-based recovery support roles go by various titles: recovery coaches, recovery mentors, personal recovery assistants, recovery support specialists, and peer specialists. Complex ethical and legal issues are arising within the performance of these roles for which little guidance can be found within the existing literature (White et al., 2007).

When he wrote those words, I don’t believe William White could have foreseen the explosion of services and businesses which have emerged over the last three to five years. Although needed on many levels, the net result of much of this growth has not benefitted the consumer, the payers or our industry. Once opportunists realized they could benefit financially in a big way from “helping people,” oftentimes through dubious business practices, the need for regulation became quite apparent. Some unintended side effects have been drug testing abuses, patient brokering, and other negative

business practices.

Few states have seen the growth Florida has and consequently few states needed regulation and oversight as desperately. Not usually a fan of big government, I have been involved with some extremely motivated individuals who have championed the cause here and on June 10, 2015, the Florida Sober Home Bill (HB 21) crossed the last hurdle by achieving Governor Scott’s signature on its way to become state law, effective July 1, 2015. John Lehman, president of FARR, was instrumental in its passing and is continuing to be a voice for reform which I believe is long overdue in Florida and elsewhere.

This law is a good start, but it is not going to address all the current issues. Much as Iowa is an important state in national elections, so is Florida when it comes to addiction treatment.

Like Minnesota, Pennsylvania, Arizona, and California, Florida has a lot invested in treatment and recovery. This law is a first step; it needs funding help and will not rid our industry of all its flaws. ■

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Michael Walsh, MS, CAP, BRI-I, is currently executive director and COO at HARP Treatment Center on Singer Island, FL. Former president/ CEO of The National Association of Addiction Treatment Providers (NAATP), he holds a master’s degree in substance abuse counseling and is a certified intervention professional. As a certified addiction professional, he has extensive knowledge, experience, and understanding of the treatment industry from preadmission through the intervention, admissions process, case management, referent relations, client services, and aftercare coordination for patients

References National Institute on Drug Abuse (NIDA). (2012).

Principles of drug addiction treatment: A researchbased guide (3rd ed.). Retrieved from https://www. drugabuse.gov/sites/default/files/podat_1.pdf “What is the Jennifer Act?” (2015). Retrieved from http://thejenniferact.com/about_the_jennifer_ act_file_a_marchman_act/the-jennifer-act/ White, W. L., Baker, H., Benham, B. W., McDonald, B., McQuarrie, A., Carroll, S., . . . Rasheed, H. A. (2007). Ethical guidelines for the delivery of peer-based recovery support services.

Retrieved from https://vtrecoverynetwork.org/data/Recovery_ Symposium/EthicalGuide4DeliveryofPeerServices2007.pdf White, W. L. (2008). Slaying the dragon: The history of addiction treatment and recovery in America.

Bloomington, IL: Chestnut Health Systems.

Harvard Medical School Recognizes Dr. John Kelly as Inaugural Incumbent

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arvard Medical School has recognized Dr. John Kelly as the inaugural incumbent of the Elizabeth R. Spallin Professorship in Psychiatry in the Field of Addiction Medicine in a ceremony at HMS’s Gordon Hall of Medicine.

“John, you are an outstanding member of our faculty, an exceptional researcher, a skilled clinician, and a very deserving inaugural incumbent for this great honor,” said Harvard Medical School Dean Jeffrey S. Flier.

Dr. Kelly is the founder and director of the Recovery Research Institute, the program director of the Addiction Recovery Management Service, and associate director of the Center for Addiction Medicine at Massachusetts General Hospital.

His clinical work and research has focused on addiction treatment and the recovery process. He will be a regular contributor to our publication, beginning with “Scientifically Informed Recovery: What’s New?” in the next issue.

The professorship was established by anonymous donors and named for Dr. Kelly’s mother, who was a registered nurse.

“The quiet philanthropists we thank today are demonstrating great confidence that Mass General, HMS, Dr. Kelly, and all future incumbents of this professorship will continue to advance the field of addiction medicine while maintaining the high standard of care that patients have come to expect from Mass General’s addiction programs,” said Flier.

Upon Dr. Kelly’s retirement, the professorship will be renamed the John F. Kelly Professorship in Psychiatry in the Field of Addiction Medicine. ■

Jeffrey S. Flier (right), Dean of the Faculty of Medicine at Harvard University, presents a citation to Dr. John Kelly, the inaugural Elizabeth R. Spallin Professor of Psychiatry in the Field of Addiction Medicine. Image: Suzanne Camarata Photography.

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Sept/Oct 2015

AROUND THE STATES

MAINE: McLean Borden Cottage has opened in Camden, ME, and is the hospital’s new residential treatment program for drug and alcohol addiction and the first McLean program to open outside of Massachusetts.

Set on nearly fourteen acres of lawns and gardens and overlooking Penobscot Bay, Borden Cottage is modeled clinically after McLean’s other off-campus programs and will be “fully integrated into the McLean alcohol and drug abuse treatment program and an integral part of the hospital,” said Philip Levendusky, PhD, ABPP, senior vice president for Business Development and Communications, director of the Psychology Department, and codirector of Psychology Training at McLean Hospital.

As with all of McLean’s programs, Borden Cottage provides evidence-based treatment modalities for alcohol and drug addiction. Led by clinicians who are experts in the use of pioneering medications and behavioral treatments, the goal is for patients to achieve and maintain abstinence and learn how to manage the stresses of an active life without returning to alcohol or drugs. The seven-day-a-week program focuses on recovery and relapse prevention, and a thirty-day minimum stay assures full benefit from the program. Also provided is hands-on support and education for family members and significant others about drug and alcohol addiction and close collaboration with referrers and community providers.

FLORIDA: Police are finding more of the new designer drug “flakka” in Broward County, FL than anywhere else in the nation. Crime labs analyzed 477 cases of flakka confiscated in Broward in 2014, according to August statistics from the US Drug Enforcement Agency (DEA).

No other county came close, with Chicago’s Cook County clocking in next with 212 cases.

When adjusted for population, Broward’s

rate of flakka cases outpaced all major US urban counties. With a population of 1.8 million, Broward had a rate of twenty-seven cases per 100,000 residents, with the prevalent theory advanced by local experts is that the crackdown on pill mills left a vacuum to be filled by the next drug trend.

From about 2007 through 2010, Broward County was the nation’s capital in oxycodone sales. Unscrupulous doctors wrote prescriptions from storefront clinics, dispensing more than 9 million tablets in one six-month period alone, according to the DEA, but the problem was somewhat thwarted by Florida legislation cracking down on the prescription pill trade and a flurry of raids on pain clinics.

In the three years prior to 2014 combined, the Sunshine State had only 149 flakka cases: one in 2011, ninety-four in 2012, and fifty-four in 2013. The next Industry Insider will report in greater depth on this growing issue in South Florida and beyond.

TENNESSEE: The Ranch treatment center, set in the beautiful rolling hills of Nunnelly, TN, is introducing Deep Transcranial Magnetic Stimulation and ketamine treatment for severe, treatment-resistant depression.

In recent months, the center’s medical and clinical teams noted an increase in symptom severity among clients seeking treatment for depression, and began exploring treatments to alleviate and arrest this disorder. Their search led them to Deep Transcranial Magnetic Stimulation and ketamine treatment.

Deep Transcranial Magnetic Stimulation (dTMS) is a noninvasive procedure that uses wave technology to reach the area of the brain that modulates mood. The treatment has been shown to be effective in the treatment of a number of disorders, including depression. It takes place in an office and is administered under the direction of a physician. No medication is needed for treatment, and patients usually feel relief from symptoms of depression within a few weeks.

Ketamine is a Schedule III narcotic primarily used in anesthesia, but there is strong clinical evidence that ketamine is effective in quickly reducing the effects of depression. The clinical team at

The Ranch treatment center consulted with Dr. Steven Levine, a board-certified psychiatrist and nationally recognized expert in the use of ketamine for depression, to develop a stateof-the-art protocol for its clients. The drug is administered under the direction of the center’s medical director, Dr. Michael Baron, MD, MHP, FASAM, who is a licensed physician board certified in psychiatry and anesthesiology. The results have been encouraging. “We’re seeing an almost immediate reduction in suicidal thoughts and improved quality of life,” says Dr. Baron.

ONSITE APPOINTMENT Rondal Richardson, a twenty-five-year veteran of the entertainment industry and nationally known expert in entertainment philanthropy, has joined Onsite as COO. Onsite has carved out a much-needed niche in customized therapeutic and educational workshops with a wide variety of programming surrounding personal growth, emotional wellness, and mental health.

Miles Adcox, CEO for Onsite, said, “Rondal has been a dear friend to all of us at Onsite for many years, and under his leadership as president of the Possibilities board and producer of Inspire Nashville, we have seen a dramatic increase in the size and impact of the organization. I know Rondal walked away from several great opportunities in order to join us, and I am honored by his belief in what we are continuing to create here at Onsite. Rondal could not be a better fit to lead us into the next chapter.

Beyond what Rondal has accomplished professionally, we are most excited about who he is and how he shows up for people in need. He leads with heart and is a gift to the culture we have worked hard to create.”

Rondal Richardson said, “Onsite is the perfect resource to help fulfill my lifelong passion of helping others reach their full potential. This is the right time to join this incredible team, and I believe whole-heartedly in what I have personally experienced at Onsite. Helping to lead the trajectory of this vibrant organization’s legacy as the worldwide leader in personal growth workshops is a dream come true.

Miles’s vision and compassionate leadership in the resounding way he is transforming lives at Onsite sets the gold standard.” ■

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Mergers & Acquisitions AAC Rapidly Grows Treatment Network Amid Industry Attention

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s this first edition of the Industry Insider went to press, American Addiction Centers (AAC) faced a media blitz and intense industry scrutiny with the resignation of an executive in response to a California Department of Justice investigation. A grand jury indictment brought charges involving a 2010 incident in which a patient died at Forterus—purchased by AAC in 2011—the morning after he checked in to the Southern California facility.

The case was settled in civil court previously and AAC affirmed in a statement that it will “vigorously defend the company and each individual charged in court” and believes that the California Department of Justice’s case is without merit. Chairman and Chief Executive Officer of AAC Holdings Michael Cartwright affirmed in the company’s second-quarter earnings call in August the company’s belief that the California Department of Justice’s case is without merit. “The company believes the criminal charges are legally and factually unfounded and intends to contest them vigorously in court’” AAC said in a statement, adding that “..the company is not currently aware of any evidence that the company or any of the individuals charged were responsible for the resident’s death.”

AAC is currently the fastest growing provider of inpatient substance abuse treatment services, operating twelve substance abuse treatment facilities and one mental health facility specializing in eating disorders, with revenues in its second quarter earnings report rising 85 percent to $53.8 million.

The case and its implications have not slowed AAC’s rapid growth, with two more digital marketing companies acquired recently in addition to Cartwright’s projection of 480 more beds being added to reach a projected 1,200 beds by the end of 2016. AAC Holdings has purchased Referral Solutions Group, LLC and Taj Media, LLC for a total of $60 million through its operating subsidiary, American Addiction Centers, Inc., “We are more than doubling our bed capacity in the near term. As a result, we want to significantly increase our inbound demand from consumers seeking treatment. Acquiring Referral Solutions Group and Taj Media accomplishes this objective immediately and provides a platform that reaches millions,” Cartwright added.

August also saw the company complete the acquisition of The Oxford Centre, the operator of a seventy-six-bed residential treatment facility on 110 acres in Etta, MS, and three outpatient centers in Oxford, Tupelo, and Olive Branch, MS. “With the addition of twenty-four new beds earlier this year at Chairman and CEO of AAC Holdings, Michael Cartwright.

Oxford’s residential campus and the three outpatient centers expanding our outpatient platform into a new state, we expect this added capacity and treatment options to help us meet the growing demand for care,” added Cartwright. “We are excited to have Billy Young, Dr. Tom Fowlkes, and all the good people at Oxford join our team. We have now increased our national footprint from 487 beds at the end of the third quarter of 2014 to 663 active beds today and over 500 beds in our pipeline, and are committed to clinical excellence that includes effective programming, experienced and caring staff, premium facilities, and exceptional service and outcome studies,” Cartwright stated. ■

Sunspire Acquires Caron (Texas)

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unspire Health acquired Caron Treatment Center’s forty-bed residential treatment operations in Princeton (outside Dallas), TX. “Building upon Caron’s reputation and proven track record, we look forward to continuing to address the treatment needs in the state of Texas, an underserved market with the lowest addiction treatment capacity in the nation,” said A. J. Schreiber, CEO of Sunspire Health.

“Sunspire Health’s clinical and personalized approach has helped thousands of people achieve lasting sobriety and we are eager to bring our proven model of treatment to the region,” stated Schreiber.

Doug Tieman, president and CEO of Caron, heralded the strategic move (see related article pg. 19). “While this means we will no longer have a presence in Texas, we are thrilled to be handing over the reigns

to a quality operator like Sunspire Health whose mission and vision are in alignment with Caron’s. We look forward to working with Sunspire Health on a seamless transition for our patients and employees,” stated Tieman.

Similar to Caron, Sunspire Health offers abstinence and evidenceand experientially based treatment for those suffering with substance abuse disorders, co-occurring mental health disorders, eating disorders, problem gambling, and sex addiction.

Sunspire Health is headquartered in Lyndhurst, NJ, and currently includes licensed residential treatment facilities in California, Florida, Massachusetts, and Oregon, with new facilities scheduled to open later this year on Hilton Head Island, SC, Gilman, IL, and Key Largo, FL. ■

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Evolving Health Care: Surviving and Thriving in the New Behavioral Health Paradigm Ali Bagheri with MAP Health Management, LLC

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n our ever-evolving system of working to streamline the delivery of health care, the nation is moving toward precision quality care. The new model of patient-powered research will provide opportunities to better measure chronic disease and tailor treatment to the individual. The new regulatory and reimbursement framework built upon accountable care, technology, and data collection necessitates private and public reporting of outcome measures in order for providers to survive and thrive. Measurement is impossible without data, and with addiction services in particular, outcomes data has been sparse and unreliable.

Accountable care principles of patient-centered care and the medical home are driving the integration of primary care and addiction treatment. Simultaneously, there is an increasing role for behavioral health centers of excellence to partner with medical homes and provide specialty care. This evolution will emphasize primary care referrals to specialty behavioral health providers, including addiction treatment centers that meet and exceed standards. With the advent of value-based reimbursement, referring providers will be increasingly interested in having the ability to discern quality specialty providers by using standardized performance measures. These measures will ensure a com-

petent care coordination network is in place, resulting in better quality care for patients.

Behavioral health organizations motivated to become centers of excellence should focus on quality, cost, and outcomes. Quality of care requires a strategic focus on evidence-based practices, appropriate levels of care, and detailed documentation of encounters. This model of excellence includes setting and tracking organizational goals, staff engagement, and a feedback loop to transform workflows and processes. It also requires adoption of health technologies that enable detailed documentation, an EHR system that can facilitate information exchange, and electronic streamlining of paperwork and processes to reduce operational waste.

With the ICD-10 deadline approaching in October 2015, many providers and some health technology vendors are hoping for a delay.

However, ICD-10 is an opportunity for better data collection, analytics, and improved reimbursements. Consider the ICD-9 Code 30550, which codes “Opioid abuse, unspecified.” There are several corresponding ICD-10 codes that provide for a more detailed set of descriptors, allowing providers to code not only for a broad “what,” but also a more descriptive “why.”

With cost being a major factor in the new

health care landscape, many new regulations are geared toward driving costs down. Providers sometimes see cost optimization as cost cutting, which is in direct opposition to quality care. In practice, a value-driven paradigm allows for improved quality and cost savings.

The responsibility lies with providers to continuously improve organizational processes and care plans to optimize efficiencies and patient outcomes, especially in light of new reimbursement models. More and more we will see measures and reimbursements pegged to efficiencies and waste.

As we have experienced in other areas of health care, the move away from the fee-forservice, volume-based model to a value-based, global payments model will be realized in the near future in the field of chemical dependency treatment. Several states have tested the waters in recent years, and more will follow.

Payers are also moving toward case rates or bundled payments. For a patient entering inpatient substance abuse treatment, a single case rate could encompass many of the services traditionally billed as fee-for-service. The onus will be on the provider to determine individual care plans for patients under this payment structure. These newer reimbursement models will include detailed recording of patient encounters, performance measures, and subsequent reporting outcomes in order to evaluate the effectiveness of treatment. They are not meant as a “one size fits all” method of payment, but rather as an average payment, which the provider can use to tailor individual care plans to patients.

The availability of exchangebased health plans allow for broader access to addiction services in the wider population.

The ACA bars the denial of coverage for preexisting conditions, including substance abuse, and it expands rules set forth in the

Sept/Oct 2015

Mental Health Parity and Addiction Equity Act, requiring mental and behavioral coverage at equal levels to other medical care for all private or public policies. However, these newer plans, though more widely available, may not provide the level of reimbursement for behavioral health and addiction treatment that have been seen in the past. This could present challenges to both providers who are navigating these exchange plans and patients who are seeking treatment with the expectation that services they receive will be covered.

Moving beyond a focus on cost to the need for further research of substance abuse performance measures, Garnick and colleagues (2012) identified the following broad categories: • •Inclusion of medications to treat addictive disorders on a health plan’s formulary • •Rate of collecting and reporting data on clients’ perceptions of care using standardized instruments (e.g., the ECHO or Modular survey). Surveying clients is consistent with the national priority for patient-centered care.

• •Measures of management practices. This may include whether treatment organizations have business practices in place that are associated with better treatment processes, such as management practices that have been found to be associated with shorter wait times from first contact to treatment admission.

• •M easures of connections between organizational providers across the continuum of treatment services. This includes a range of efforts that support care coordination including communication, networks or

contract elements between providers of residential and follow-up outpatient services.

These recommendations speak clearly to the evolving model of patient-centered care and the operational, technological, and clinical performance standards. Although many of the specific measures within these categories have been under development in recent years, Garnick et al. (2012) identifies the following gaps: • •Maintenance of treatment effects. These include recovery support and retention, going beyond counting units and timing of services to also focus on treatment intensity and quality of engagement, and the therapeutic relationship.

• •M easures tailored for specific groups of clients. Based on results of research showing which treatment approaches are most effective for specific groups, measures might be tailored specifically for women, individuals released from incarceration or adolescents.

Focusing on these gaps and the chronic disease model of addiction, community-based approaches such as peer recovery support are experiencing an increased role in the posttreatment environment. Beyond the therapeutic and care coordination benefits, recovery support can be an effective avenue for posttreatment data collection of patient-reported outcomes. Peer supported programs result in higher long-term engagement, offering the provider the opportunity for consistent and frequent data collection, measurement, and risk assessment.

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The analysis of a critical mass of substance abuse patient data will transition from measurement and comparison into the next level of value: predictive analytics, with the goal of reduced readmission and increased remission rates, which are likely to be addiction treatment quality metrics in the future. Predictive analytics is a lofty but attainable goal, and it will take time to accomplish.

Meeting the needs of patients and payers takes more than analytics. It takes cultural, organizational, clinical, and operational adoption of the performance-based paradigm. There must be a willingness to be measured. There must be a philosophy of openness and transparency and the understanding that in this new paradigm, the only place to hide is in excellence. ■ Ali Bagheri is vice president of MAP Health Management’s Live Data. He oversees the data science, architecture and analytics, digital content and application development, infrastructure, compliance, and overall information strategy for MAP Health Management, LLC. For information visit www.ThisIsMAP.com; www.

RelapsePrevention.org.

References Garnick, D. W., Horgan, C. M., Acevedo, A. McCorry, F., & Weisner, C. (2012). Performance measures for substance use disorders-what research is needed?

Addiction Science & Clinical Practice, 7(1), 18.

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Benefits and Challenges of Recovery Housing Johh Lehman

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or some time now those of us at the center of the standardsbased recovery housing movement have witnessed a migration away from true transitional support. Traditionally recovery-oriented housing has offered safe, alcohol and drug-free, peer-supportive environments at affordable weekly rents for persons in early recovery. When being discharged from detox or residential treatment, it is common to register low on the Recovery Capital Measurement Scale. High problem severity/complexity coupled with low Recovery Capital often translates into a recipe for relapse. Even as highly motivated persons leave the security of a protective environment, their will to embrace change, including the commitment to sustain abstinence, is battered by the incoming realities of living life on life’s terms.

Operators of transitional recovery housing are often persons in longterm recovery themselves who seek to support kindred souls. Many agree to enroll those who arrive penniless, unemployed, and disengaged from family support. My experience over thirty-five years confirms that this group is universally motivated by love and gratitude. In every respect, they are missionaries offering hope and practical support to a marginalized population adrift in the turbulent sea of homelessness as a direct result of addiction. Many owners of these “halfways” hold down full-time jobs to support themselves and their families. Though they often share tales about misuse of their kindness, they also universally celebrate their gratitude for having secured a front row seat to witness spectacular transformations. This “in the trenches” role isn’t for everyone, however; for those it attracts, their selfless service is an awesome spectacle to behold in its own right.

However, over the last decade another transformation has gained momentum. More and more substance use disorder treatment providers, particularly those offering intensive outpatient program (IOP) level care, have embraced a practice of absorbing the recovery housing expense for clients who remain enrolled in their clinical program.

Nowhere in our nation is this practice more widely evidenced than in the Southeast Florida corridor. The IOP enrolls a “resident” in a nearby recovery residence. The resident is not held accountable to pay rent and

board independently. Instead, the IOP arranges to pay a “weekly case management fee” to the recovery residence for so long as the resident remains an IOP “client.” Depending on competitive factors, case management fees generally range from $200 to $500 weekly. This fee offsets the cost to the residence operator of providing housing, a weekly grocery card, and a local gym membership. Real-world application of this collaboration between outpatient treatment and recovery housing providers does have the potential to remedy one of the single most significant challenges to the delivery of quality, long-term treatment and recovery support. Properly applied, consumers, their families, third-party payers, and communities are all beneficiaries. However, abuses to this funding platform that originate from its use as a marketing tactic undermines its value.

At the intensive outpatient level, could utilization management be used as a tool for payers and providers to collaborate in assessing a client’s problem severity/complexity as measured in the context of Recovery Capital? What if eligibility for the resident/client’s continuing financial support was determined by an evidence-based assessment?

High problem severity/complexity coupled with low Recovery Capital might alleviate client accountability for room and board while the resident is enrolled in a phased structure. As future assessments reveal decreased severity/complexity coupled with enhanced measurements of Recovery Capital, the client then transitions into a second phase which might include life skill trainings focused on employment and money management. Phase three might engage recovery coaches and peer specialists to guide resident participation in executing a self-directed recovery plan. This structure offers a transitional support approach that meets individuals where they’re at and then empowers them to take ownership of recovery management at a pace appropriate to their individual circumstance.

This is not an original idea. William White, MA, has written prolifically on the subjects of recovery management, Recovery Oriented Systems of Care (ROSC), and Recovery Capital. Teodora Groshkova, Dr. David Best, and William White pioneered development and research regarding the Assessment of Recovery Capital (ARC) scale. Doug Polcin, EdD, MFT, conducted outcome studies based on a similar phasing structure. Dr. Ijeoma Achara currently consults state agencies regarding the practical implementation of ROSC. Positive results are in evidence across the nation. However, as is true with other promising practices, there exists an inherent opportunity for unscrupulous providers to abuse systems for short-term gain, undermining broader adoption and pitting payers and providers in conflict with one another.

THE END OF THE GOLD RUSH

It’s important to understand that insurers do not pay for room and board at any level of behavioral health care; not detox, residential, partial hospitalization, intensive outpatient or recovery housing. Insurers reimburse for clinical services deemed to meet “medical necessity.” At higher levels of care, there is a presumption that clients reside “on campus” or in “community-based housing” while receiving clinical services. State oversight agencies generally provision licensure criteria specific for behavioral health care levels. As payers and providers collaborate to effectuate a continuum of care, any number of financial drivers may creep in from either side to impair care decisions. As

Sept/Oct 2015 previously referenced, some substance use disorder treatment and recovery housing systems rely on urinalysis revenues to offset the costs associated with providing longer-term systems of care. Though viable in theory, this practice has proven to be a Pandora’s box.

Unethical providers have developed a complex system of abuse that utilizes urinalysis screenings, ordered by medical directors at a frequency of three, four, and five times per week. Tests sent for confirmation to independent use laboratories, partly or wholly owned by the same provider, are billed to insurers at rates as high as $3,000 per test.

While a decade ago urinalysis testing was considered by back-office number crunchers solely as a “cost center,” it is now often perceived as the primary revenue center. Do the math: three weekly confirmation tests billed at $3,000 each multiplied over a twelve-week IOP enrollment translates to $108,000 per client. An IOP program with a revolving roll-call of thirty-five clients, and acting in collusion with the medical director and confirmatory laboratory, bills $3,780,000 quarterly or over $15 million annually for urinalysis screenings alone.

Client and referral inducements of free rent and board in nearby sober homes have become the norm along the southeast Florida corridor. No case management assessment is conducted to determine if free room and board is in the client’s best interest. Instead, clients are taught to think of their insurance card as an American Express Black card. When housing is utilized by the behavioral health care provider to induce enrollment, this practice breeds entitlement in consumers. This complex marketing and revenue generation platform has now infiltrated other regions of the country, including New York, Pennsylvania, Colorado, Arizona, and Texas. Ethical operators, who seek to support the resident’s transition towards accountability for self-directed recovery, find it increasingly difficult to compete in this environment. This particular misuse of an opportunity that might otherwise have been considered the Holy Grail, providing funding for long-term treatment and transitional support, is about to end.

Centers for Medicare and Medicaid Services (CMS) is set to change the dynamic with upcoming rule and billing code revisions. The Gold Rush is over. Commercial insurers will follow suit and will also likely seek claw-back. The day of reckoning for those who abuse the system has arrived. Due to push back from ethical operators in Florida, a state and federal investigation into insurance fraud and patient brokering was launched by Florida CFO Jeff Atwater’s office several years ago.

Last year, Florida witnessed two FBI raids of DCF-licensed PHP/IOP programs who allegedly used free rent in their affiliated sober home to induce “residents” to enroll as “clients” of their clinical services platforms. Sources now indicate that ten separate Federal RICO indictments totaling in excess of $1 billion will be announced shortly. Additional indictments are expected to follow given the fact that the investigation has opened 100 files in Palm Beach County over the previous two years.

These RICO indictments drive stakes in the hearts of coconspirators who have sucked their last ounce of blood from this vulnerable population. While we applaud this law enforcement victory, we are mindful to temper our celebration with acknowledgement that curtailing abuse does not effectively address the original funding problem.

INDEPENDENT CASE MANAGEMENT

How might state licensure agencies improve licensure criteria and regulatory practices to promote consumer-centric care and provide adequate resources to effectively address the transitional needs of this disabled population? Rhode Island recently implemented a Home Health Model for case management of adolescent mental health benefit recipients. This model might be expanded to include substance use disorders for adult populations:

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The state has characterized the health homes model as an opportunity to improve an existing system of care, develop new payment methodologies to accommodate activities such as communitybased care coordination, and provide a consistent system of care for children with special health care needs as they transition to adulthood. An important aspect of Rhode Island’s reform is the five-year Global Consumer Choice Compact Waiver approved by the Centers for Medicare and Medicaid Services (CMS) in early 2009, under which Rhode Island operates its entire Medicaid program.

Among other things, the waiver has allowed the state to mandate enrollment in either capitated or fee-for-service (FFS) managed care.

The state also is participating in the Multipayer Advanced Primary Care Practice Demonstration, through which CMS provides a monthly care management fee for Medicare enrollees in advanced primary care practices. In addition, the state recently has received a Money Follows the Person grant to support efforts to help institutional residents return to health and supportive care in community settings and is working with CMS to implement models for integrating Medicare and Medicaid services and financing for persons dually eligible for the two programs in capitated or FFS managed care. As part of the integration plan, the state is considering creating a Community Health Care Team to focus on long-term services and supports for FFS participants and incorporating managed long-term services and supports into the service package for managed care participants (Spillman, Ormond, & Richardson, 2012).

Whether by this approach or some other, independent case management services contracted for by payers makes common sense.

An intermediary is necessary to assess individual consumer severity/ complexity and Recovery Capital. This practice should determine what resources are allocated to treatment and transitional support. Consumers would then be provided an opportunity to choose services from accredited providers. These allocated resources follow the client: simple, direct, and consumer-centric. The year ahead is shaping up to be one of positive change in behavioral health care and recovery support systems. Consumers, their families, communities, and American taxpayers are the primary beneficiaries. As a nation, we must invest heavily to remedy the current addiction health care crisis. Let’s do so wisely and make every dollar count. ■ John Lehman currently serves as president of the Florida Association of Recovery Residences (FARR) and on the NARR Standards Committee. He has helped to develop the FARR organizational infrastructure and continues to support initiatives that advocate for residents’ rights. In long-term recovery himself, John was fortunate to reside in peer supportive housing and has managed several recovery residences over the years.

References Spillman, B. C., Ormond, B. A., & Richardson, E. (2012).

Medicaid health homes in Rhode Island; Review of preexisting initatives and state plan ammendment(s) for the state’s first health homes under section 2703 of the affordable care act. Retrieved from http://aspe.hhs.gov/daltcp/reports/2014/hhopinion2-ri.pdf

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Pioneering EASI Tool from Canada Recognized in States for using ASAM Placement Criteria in Fight against Addiction I

n the North American treatment industry landscape, Canadians are not expected to be at the table with their American counterparts, eh? But please don’t tell that to those who work for the Edgewood Health Network.

The Edgewood Health Network (EHN)—with its family of addiction treatment centers and clinics offering desperate families hope for more than thirty years—has rolled out a new way of helping health professionals, families, employers, and most importantly those afflicted with substance use issues to find the appropriate level of care needed to live a healthy life.

In a major first for companies north of the border, the EHN became the first Canadian firm to receive the James W. West, MD, Quality Improvement Award presented by the National Association of Addiction Treatment Providers at that organization’s annual conference held May 16–18 in Carlsbad, CA. Acting on a vision to bring together two of Canada’s leading adult addiction and mental health treatment providers, the EHN is a concept created last year to provide a network of consistent, quality addiction treatment across the country. Edgewood and its galvanizing CEO Lorne Hildebrand were recognized for their pioneering work in expanding and delivering comprehensive addiction care on a national scale in Canada, not only for broadening its reach in 2014, growing to 178 beds and seven outpatient locations, but for its utilization of the newly developed EASI and its intensive outpatient programs.

The EHN offers a full continuum of care for anyone struggling with addiction issues across its wide network. It has two residential, fully staffed and medically supervised treatment centers in Nanaimo, BC (Edgewood Treatment Centre), and Toronto, Ont. (Bellwood Health Services).

These centers are fully accredited and staffed with doctors, psychiatrists, psychologists, addiction counselors, and nurses ensuring twenty-four-hour a day support for clients. They are treated for substance addictions from alcohol to cocaine and heroin. Clients with gambling,

Edgewood CEO Lorne Hildebrand receives the James W. West, MD, Quality Improvement Award from incoming NAATP Board Chair Carl Kester of Lakeside-Milam (left) and new NAATP President Marvin Ventrell at the North American association’s annual conference.

sex addiction, eating disorders, and other process addictions are also treated at the EHN facilities in Nanaimo and Toronto.

The award also recognizes the work the EHN is doing to standardize the successful treatment of the illness. Over the last year the EHN has created and begun implementing a new assessment tool called the Edgewood Assessment Supplemental Inventory (EASI) which qualified clinicians are beginning to use to help find the right treatment options for those seeking help.

Using American Society of Addiction Medicine (ASAM) Placement Criteria, as well guidance from the DSM-5, the universally accepted tool of the American Psychiatric Association, EASI combines the criteria offered by these two authorities, along with the rich experience of EHN psychiatrists, physicians, and clinicians, to help clients see where they are at and what their options are when it comes to problems with addiction.

While we are deluged with daily images

of the suffering addict, not everyone battling substance issues needs a lengthy and costly stay at a treatment center—if they can find a center to admit them. Some people can face their dilemma with one-on-one counseling.

Some people would fare better in a group setting. Some need structure, assignments, and goals. Of course, others will need medically supervised detoxification and structured inpatient residential treatment.

But wherever one resides, the question remains as to who needs to be where. Michael Hathaway, the EHN’s national director of continuing care, was one of the senior consultants on the EASI development team. He says EASI takes a lot of the guesswork out of a complicated assessment.

“So many changes have taken place over the years in how the experts are looking at substance use disorder. Rather than ‘old school’ where you kind of trust your intuition and everybody does their own kind of assessment,

Sept/Oct 2015 we really wanted to standardize it and make sure it was thorough enough, and caught or included all the key components of making an accurate assessment,” said Hathaway. Essentially, EASI is a thirty-six-page document of revealing questions which are posed to clients by trained and qualified clinicians.

In a nonjudgmental, collaborative manner the EASI uses the voices of ASAM, the DSM-5, and the experienced clinician to score the assessment and help clients determine what the best course of action is depending on their situation. Following ASAM’s Patient Placement Criteria, which contains six dimensions in the treatment realm, EASI looks at withdrawal potential; medical conditions and complications; cognitive, emotional, and behavioral aspects; a client’s desire to change; relapse potential; and overall environment for recovery in a client’s life.

Each dimension is assessed independently, and studied or scored based on a scale running from minimal to severe. With many of the questions probing the potential strengths of a client as well as the trouble spots, the EASI tool makes sure clients get a voice in their treatment assessment too.

“One of the clients’ fears is that the therapist is just going to assume they’ve got a problem,” says Hathaway. “The EASI takes away some of that fear. We don’t just look at all the things that have gone wrong, we also include what has worked for them in the past.

It’s much more collaborative and exploratory instead of ‘you just need treatment!’” he said.

“It is more like ‘This is how you’ve scored. This is what we think. How comfortable are you with our recommendations? What do you think?’”

Showcased by its honors at the NAATP Convention, it is now the first Canadian center to be honored in NAATP’s forty-year history, and NAATP Executive Director Marvin Ventrell said that the association was particularly pleased to present the award to EHN as the first Canadian center to be so recognized.

“The disease of addiction knows no political or geographic boundaries and we are grateful for EHN’s example of outstanding service outside the US border,” said Ventrell.

Representing some 600 not-for-profit and for-profit free-standing and hospital-based programs, the James W. West, MD, Award continues to salute addiction treatment programs whose efforts demonstrate comprehensive approaches to effective, continuous quality improvement, and will turn more US attention to implementation of these standards north of the border. ■

Industry Insider 15

The Legal Beat: Patient Brokering Jeffrey Lynne

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s a for-profit industry, substance abuse treatment providers spend an inordinate amount of time and energy trying to weed out patient brokers and other lead generators.

However, what is repeatedly lost in the modern debate over business ethics is the need to focus instead upon ensuring that any given patient is given the tools they need to succeed, notwithstanding how they end up on one’s doorstep.

The purpose of the Stark Law and other similar federal and state mandates which prohibit the payment to one party for the referral of a “qualified” patient is to ensure that the patient is the one making the ultimate health care decision for themselves, and to remove the pecuniary incentive that a health care provider may have in the referral, or in ordering tests or other procedures. However, in modern health care generally, and in behavioral health care and substance abuse treatment in particular, there are few if any patients/clients who actually make the decision to receive treatment themselves. Entry into the system most frequently begins either by some form of intense third-party intervention or other legal entanglements forcing the client’s hand (“hitting bottom,” as they say).

As such, the proliferation of “lead generators” and other “marketers” only becomes distasteful when they prey upon the most vulnerable and least informed patient and the patient’s next of kin. Left unregulated, “patient brokers” seem to know no bounds. Stories of persons trolling AA meetings to find the newly initiated in order to get them high and then drop them off at a detoxification facility for a kickback is more than anecdote. Other stories about “sober homes” that allow their residents to actively use drugs so long as they patronize a specific treatment center (which center, in turn, provides a kickback to the home operator posing as a “marketer” for the patient referral) is more than euphemism. It is real, it occurs daily, and stronger consumer protection laws must be passed at the state level to stop this scourge from overtaking residential neighborhoods under the guise of “recovery residences.”

But with that said, the seemingly symbiotic relationship between treatment providers and marketers is not inherently evil, for how a provider obtains a client does not directly correlate with the competency and level of success of any particular program. Stated otherwise, a specific treatment program can participate in all forms of otherwise distasteful practices in obtaining clients, but have high client success stories with low relapse rates.

On the other hand, the most ethical treatment programs which refuse to participate in any form of payment of lead generation may be populated by terrible clinicians. The two are not mutually exclusive.

To be clear, there is no defense to be made of patient brokering and the untoward underground black market economy which has grown around it. But without some form of acceptable and regulated patient referral service, the industry will find itself controlled by larger, consolidated networks of health care providers rather than the community-based care which the Americans with Disabilities Act was, in part, founded upon.

The modern health care paradigm of economically sustainable substance abuse treatment is nothing short of a minefield. But rather than debating the ethical dilemma relating to lead generators and marketing companies, perhaps it is time for the industry and lawmakers to come together and embrace patient referral sources as the necessary “missing link” to connecting clients in need of services with providers who have the capacity to provide clinical care. ■ Jeffrey C. Lynne opened his own Delray Beach, FL law firm in 2010 and merged it with fellow land use attorney Michael S. Weiner and commercial litigator Laurie A. Thompson to form Weiner, Lynne, and Thompson, PA. As a result of his work with substance use disorder (SUD) treatment and housing providers, Mr. Lynne has forged a reputation as a leader in defining the role played by SUD treatment within our communities; he has led discourse about the need and right to provide safe, affordable housing for those in treatment in addition to those established in recovery.

16 Industry Insider

Sept/Oct 2015

The Kennedy Forum Review

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he Kennedy Forum was held in Boston on June 9, 2015 as the latest endeavor by the two-year-old organization’s ambitious agenda to transform the way mental health and addiction are viewed and treated in the United States. Patrick Kennedy’s team continues to pursue change through payer accountability, provider accountability, integration and coordination, technology, and brain fitness and health.

The Mental Health Parity and Addiction Equity Act has given society a tool for achieving Kennedy’s promise of a day when a person’s mental disorder would no longer result in separate but unequal treatment. Multiple panels and presentations explored how that promise is playing out in the workplace, in our justice system, and among veterans returning from our nation’s recent conflicts.

Its first-ever State of the Union in Mental Health and Addiction was held in February 2015, and more details will be forthcoming in the next Insider on the 2016 summit. In partnership with the Scattergood Foundation and the Treatment Research Institute, The Kennedy Forum has launched a first-of-its-kind tool, ParityTrack, that will aggregate and promote parity implementation activities, legislation, and regulation on the state level.

“Together, we will highlight, expand, and promote best practices in mental health and addiction treatment and policy at the federal, state, and local level,” said Kennedy. “With the Parity Implementation Coalition, we are updating a resource guide for consumers and advocates to help them understand the Parity law and to give them the tools they need to protect their rights and get the care they need. Over the last twelve months, the Forum has convened dozens of experts from across sectors to discuss the greatest challenges and the most promising solutions in behavioral health practice, service delivery, and policy. From these valuable dialogues, we are issuing a series of white papers and issue briefs beginning this summer.” ■

Patrick Kennedy welcomed guests to his presentation in Boston on How to Make Mental Health America’s Business: How Care for the Whole Person Can Improve Lives, Reduce Societal Costs, and Bring Greater Productivity.

The Closing Plenary of The Kennedy Forum featured Mental Health on the Global Stage: Now is the Time to Act, with (l-r) Tom Insel, MD, Director, National Institute of Mental Health; Kathy Pike, PhD, Executive Director and Scientific Codirector, Global Mental Health Program, Columbia University; David Satcher, Director, Satcher Health Leadership Institute, Morehouse School of Medicine; 16th US Surgeon General Jody Silver, Executive Director, Collaborative Support Programs of New Jersey; and Gary Gottlieb, MD, MBA, CEO, Partners In Health.

Industry Insider 17

Sept/Oct 2015

YPR Continues Rapid National Growth, Announces EPIC New Partnership with Life of Purpose

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oung People in Recovery (YPR)—the national grassroots advocacy organization focused on creating recoveryready communities throughout the nation for young people in or seeking recovery—has broadened its recovery-oriented programming, “My Recovery is EPIC” (EPIC), with South Florida behavioral health conglomerate, Life of Purpose.

“The EPIC program is designed to provide recovery life skills and training around YPR’s four main pillars: education, housing, employment, and recovery messaging,” said Robert Ashford, YPR program director. “This program allows people in or seeking recovery to have access to recovery support services before they have left the treatment center. Expanding the program through Life of Purpose treatment centers is a major step in bridging the gap between treatment and continued recovery.”

Standing for Evidence-Based, Peer-Delivered, Individually Developed, and Community-Focused, EPIC empowers and educates individuals receiving care sooner in the intervention and stabilization process, allowing them to find their voice, invest in the recovery process, and become a collaborator in the decision-making process while still in drug treatment.

Robert Ashford is a certified peer recovery support specialist and an advocate for all individuals seeking long-term recovery.

Robert currently serves as the national program director for YPR, as well as the program director and founder of the University of North Texas Collegiate Recovery Program.

“We are expanding our South Florida chapter contingency to include Delray, Miami, Port Saint Lucie, Boca Raton, and Boynton Beach in the next ninety days,” continued Ashford. “South Florida

has more young adults emerging in recovery than anywhere in the country, and we want to ensure they are supported to have the best chances for success and high quality of life.”

EPIC provides a continuum of care specifically designed to nurture the participant’s recovery. The program provides training and life skills for the person in recovery and their family, so the entire family can be actively involved in and supportive of recovery process.

The program is currently offered by Starlite Recovery Center, an Acadia behavioral health organization in Kerrville, TX. Starting immediately with the Life of Purpose Boca Raton facility, YPR will implement EPIC at every Life of Purpose facility around the country, including facilities in Texas, Ohio, Tennessee, and Arizona in the near future. Life of Purpose, with an already innovative and patented academically focused substance use disorder treatment model, is a natural partner for YPR and the EPIC programs.

“Life of Purpose was created as part of the implementation of a macro-level social work intervention to address the systemic needs of young people receiving treatment for substance use disorders (SUD) in a modern environment.

By providing a research-driven solution through integration with higher education, we are implementing alternative solutions and goals in the field of alcohol and/ or other drug (AOD) treatment.

Drawing from social work theory and lived experience, the Life of Purpose model treats young adults with substance use disorders from a problem-solving approach. The EPIC programs complement our innovative treatment model of empowerment,” says Andrew Burki, MSW, Life of Purpose CEO.

Robert is currently pursuing a double bachelor’s of social work and psychology with a minor in addiction studies at the University of North Texas. Robert has been the recipient of many prestigious awards, most notably NADAAC’s Young Emerging Leader Award (2014), Young People in Recovery’s Advocate of the Year (2014), and the University of North Texas Soaring Eagle Award (2014). Robert also serves on multiple nonprofit organizations’ board of directors, the Council for Advising and Planning for the Texas Department of State Health Services, and is a current national planning partner

with SAMHSA. Life of Purpose is the only residential substance use disorder treatment center located on a college campus in the United States.

Their Boca Raton location, which resides on the campus of Florida Atlantic University, is the first of many planned locations nationwide.

Life of Purpose is dedicated to providing the educational resources and clinical services necessary to promote success and empower young adults; this is achieved through multimodality clinical care, and a proprietary academically focused case managers and aftercare program. ■

Life of Purpose CEO Andrew Burki (left) seals the new partnership with YPR CEO Justin Luke Riley at the company’s headquarters in Boca Raton, FL.

18 Industry Insider

Sept/Oct 2015

New Leadership Takes Helm at Crossroads Centre, Wins Jasper G. Chen See, MD, Voluntary Leadership Award at NAATP Conference

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time of transition for a leading international detox and residential treatment facility also yielded significant success over the last few months as its new leadership won major awards and received its CARF accreditation. Caron’s Jasper G. Chen See, MD, Volunteer Leadership Award recognizes individuals who have provided exceptional volunteer leadership in the area of addiction treatment through board membership and philanthropy. This award is presented annually at the NAATP board reception held as part of the NAATP Annual Leadership Conference, with the reception sponsored

by Caron Treatment Centers and NSM Insurance.

Founder and board chair of Crossroads Centre, Eric Clapton, was nominated by Denise Bertin Epp, CEO of the Crossroads Centre.

Mr. Clapton was unable to attend due to a concert conflict, but sent an audio acceptance video honoring the legacy of Dr. Chen See and the Caron Centers; he also captured for the NAATP assembly, live from The Royal Albert Hall in London, his vision for Crossroads Centre with the inspiration of its new leadership, and recovery in general.

Denise Bertin Epp recently took the helm as the new CEO for Crossroads, bringing her high standards of excellence in the field of care delivery, as well as her proven experience of building a strong clinical team, to both Crossroads in Antigua and at The Sanctuary in Delray Beach, FL. “The possibility to lead an organization that has such a rich history, presence in the community, and a very bright future was very attractive to me,” said Ms. Bertin Epp. “The abundance of serenity offered purely from the Caribbean environment makes it

Sanctuary CEO Nancy Steiner, RN (Top).

Denise Bertin Epp, CEO Crossroads Antigua (Right).

a preferred place to recover. Emphasizing our continuum of care between Crossroads Centre Antigua and the Sanctuary in Delray Beach under the stewardship of CEO Nancy Steiner, RN (pictured collecting the award on Mr. Clapton’s behalf) offers greater opportunities to connect and coordinate the behavioral health care services for our clients and families that we serve.”

In an active first six months at the helm, Denise shepherded Crossroads to its July accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF International) in the wake of a comprehensive, two-day, onsite evaluation by the CARF Surveyors.

“One of our goals as a Board has been CARF accreditation for Crossroads, and that this has already been achieved by our staff under Denise’s stewardship is a

testament to the excellence of teamwork at the centre,” said board representative Charles Montague.

“We are confident that Denise’s loving guidance will continue to enhance our mission to provide world class abstinence-based treatment in the years to come. Crossroads was awarded a three-year accreditation, the highest level of accreditation available to a residential addiction treatment program. Crossroads Centre, Board members, leadership team, and staff continue to work together

to develop and implement approaches and strategies that have the potential to improve care in keeping with our mission, vision and values.”

Ms. Bertin-Epp had recently been CEO of two long-standing Twelve Step missions in the field, Brighton Hospital in Brighton, MI, and Guest House, an international treatment center providing addiction treatment to Catholic clergy and religious since 1956, where she completed a three-year term, and was ready and willing to fulfill this position in Antigua. After relocating from Michigan recently, she replaces Leo Hageman, who retired from his executive role as managing director earlier in 2015, who led the Crossroads team for the last fourteen years.

“Leo stepped in and took his place in the frontline at Crossroads at a time of great need . . . He saved our bacon, and then continued to work tirelessly to secure the future of the centre,” said Founder, Eric Clapton. “His pragmatism, combined with his hard-earned experience of Antiguan culture and protocol, provided an immediate lifeline at a time when we could have sunk, literally, into the mangroves . . .

He is a man of high principle and boundless energy, combined with tenacity and great humor, and we will always be deeply grateful for his inestimable contribution to the cause.” During his tenure, Mr. Hageman had many outstanding accomplishments; he is attributed with the expanded growth of Crossroads to include the acquisition of the Sanctuary in Delray Beach, FL, the construction of Bevon House, the transitional living house in Antigua, and the reputation and presence of Crossroads in both the local and international communities. ■

Sept/Oct 2015

Industry Insider 19

Caron’s Strategic Blueprint Includes Major Expansion of Treatment for Seniors

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ith recent transactions, Caron Treatment Centers has continued the precise focus of what President/CEO Doug Tieman calls its “strategic blueprint” to advance the Centers’ next generation of lifesaving addiction and behavioral health care treatment.

Caron’s forty-bed residential treatment operations in Texas were purchased in July by Sunspire Health, to the satisfaction of Tieman, who sees its mission as closely aligned with Caron.

Caron President/CEO, Doug Tieman.

“Our new strategic plan, which our board identifies as a ‘blueprint,’ has clearly-defined goals of where we’re going,” said Tieman as he prepared for the launch of his new book Flying over the Pigpen. “Our focus is on expanding our Pennsylvania and Florida facilities with a company-wide commitment to innovation, leading medical and technological tools, proven patient outcomes, and personalized behavioral health care solutions.”

The pivotal part of that expansion in Pennsylvania will be Caron’s $10 million Carole and Ray Neag Medical Center, which broke ground at the Caron Alumni Reunion in June and will be poised for use in the spring of 2016.

The state-of-the-art center will support the expansion of treatment for seniors and addiction, chronic pain, and brain health initiatives as well as overarching medical care.

“The Neag Center will enhance the front door of our PA headquarters, a new admissions entrypoint that takes advantage of the aesthetic

mountain location. The newly designed building means that every client will have a view of the valley, and our Neurorehab Center is charting a future course in state of the art brain imaging.”

With plans for a similar facility at Caron Renaissance in Florida, its established communities in the northeast and southeast regions will allow for increased accessibility to life-changing treatment services.

It all fits his leadership lessons from the new book, for which multiple events are planned for the rest of 2015 hosted by donors to the nonprofit.

“Caron has taken leadership roles in treating addiction in young adults and adolescents, sponsoring research, and the expansion of treatment for seniors endorses vision allied with a strategic blueprint— it’s about having the vision and taking the appropriate steps to implement that,” Tieman states.

Since Mr. Tieman joined Caron, its revenue has grown more than tenfold, making it one of the largest nonprofit residential addiction treatment centers in the nation.

Mr. Tieman has spent thirty years in the addiction treatment field in treatment center and industry leadership positions. ■ Flying Over the Pigpen

Leadership Lessons from Growing Up on a Farm Doug Tieman Foreword by Christopher Kennedy Lawford ISBN: 9780757318603 • Item: 8606 5½ x 8½, 288 pages, trade paper • $14.95 US • $20.95 CDN

Launching the First LGBTQ Substance Addiction Program in Florida

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pen Out Recovery is being launched as the first stand-alone LGBTQ program in Florida to assist individuals in recovery for substance addiction.

Open Out National Outreach Coordinator Joyce Matera is excited about the launch of the program. Previously, Joyce spearheaded the creation of LAMBDA North, a community center and cultural hub in Lake Worth, FL. As a board member, Joyce (pictured) saw the clubhouse overflowing for its lesbian, gay, bisexual, transgender, and questioning community seeking recovery by providing a safe and comfortable place to gather. “Moving to South Florida after thirty-two years in recovery, I felt the need for LGBTQ voices to be heard,” said Joyce at the recent opening. “With so many different traumas and stresses involved, programs that are LGBTQ-dedicated are proven to be more effective than those in the treatment landscape that simply ‘integrate’ LGBTQ services.”

Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that approximately 20–30 percent of those who identify as members of the LGBTQ community have issues with substance abuse in comparison to 9 percent of the general population.

“Successful recovery requires clients to feel comfortable expressing themselves,” said Dr. Liza Weiss, clinical director of Open Out Recovery. “Open Out creates an environment where clients can talk freely without fear of judgment from others.”

Open Out’s program utilizes evidence-based practices to facilitate a holistic approach to healing that includes focusing on the physical, neurological, mental, social, emotional, and spiritual aspects that must be addressed.

The treatment approach includes emphasis on sexual and gender identity, as well as programming focused on trauma therapy.

Open Out is the latest initiative from Aion

Recovery, a health care organization that builds treatment programs centered on peer-supportive communities.

Peer-supportive treatment allows the therapists and therapy topics to be specialized to the clients, providing an individ- Joyce Matera, national ualized approach to outreach coordinator for Open Out Recovery. group therapy.

For more information, please visit www.openoutrecovery.com, or e-mail contact@openoutrecovery.com ■

20 Industry Insider

Sept/Oct 2015

A Technological Pathway to Support Recovery Richard D. Froilán-Dávila, PhD, and William B. Secor, PhD outcome studies conducted over two years of a device which can possibly influence these physiological reactions. They are not intended to replace a Twelve Step program or other pathways to recovery, but rather possibly enhance and augment them.

TECHNIQUES

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here is considerable innovative research on substance abuse and its causes, preventions, and treatments. Much of this research is focusing on possible genetic, neuropsychological, and physiological components of abuse. New studies use the latest in neuroscience and fMRI. Hundreds of new devices and treatments are touted to be advantageous for the treatment of a variety of conditions, including abuse. Often they are based on pseudoscience, are expensive, and the “benefits” they provide are placebos and regarded as quackery. This study uses a meta-analysis, incorporating multiple quantitative studies and the author’s (Froilán-Dávila’s) qualitative research conducted with three treatment centers.

Many individuals recovering from substance use disorders (SUDs) continue to experience depression, anxiety, and stress, which often results in relapse.

These symptoms are of a physiological nature. The following are

The Biosound Therapy System (BTS) uses biofeedback, music therapy, meditation, and massage; techniques used in the relief of stress, anxiety, high blood pressure, guilt, fear, depression, and trauma. Biofeedback consciously controls the autonomic nervous system by slowing down heart rate, increasing body temperature, and decreasing oxygen consumption. Progressive relaxation techniques and biofeedback are self-regulatory techniques used in cognitive behavioral therapy and research that affect clients’ cognitive and physiological systems (Jacobson, 2011).

Music, meditation, and massage have extensive histories in the treatment fields (AMTA, 2015; Eisler, n.d.; “History of,” 2015). The BTS device is a possible addition to the treatment armamentarium incorporating these methods. The device could possibly affect a wide range of physiological reactions including emotional, cognitive, and psychological components of substance abuse which the person is still experiencing, even though in recovery.

RESEARCH DESIGN

Fear, stress, and anxiety are physiological states. This research

monitored clients’ physiological states—heart rate, pulse, blood pressure—in treatment programs using the BTS with a pretest and posttest questionnaire to monitor their personal assessments of fear, anxiety, racing thoughts, depression, and physiological and cognitive emotional states. Each of the clients was assessed prior to using the BTS and after its use. At the conclusion of the research a statistical analysis was performed of the possible success of the BTS for its effectiveness in reducing the variables mentioned.

The Research Populations Research populations were participants in the Women in New Recovery program in Mesa, AZ, and studies from southern Florida by the author (Froilán-Dávila) through personal interviews at three treatment centers. The Arizona study was almost two years in duration (seventeen months), and included approximately three-month separate uses of the BTS, from November 12, 2012 to March 15, 2014.

The Test Instrument A Likert scale is a psychometric scale that employs questionnaires (Likert, 1932). It is a widely used for scaling responses in survey research. When responding to a Likert questionnaire item, respondents specify their degree of agreement or disagreement on a scale for a series of statements. Thus, the range captures the intensity of their feelings for a given item.

Modern test theory treats the difficulty of each item (the ICCs) as information to be incorporated in scaling items.

Interpretation of the responses were interpreted in the following ways:

• •T he pretest measured the respondent’s feeling prior to the use of the BTS. Possible responses about their physical and emotional states might be in the negative range (e.g., from a 5 (neutral) down), while the posttest might measure positive, especially the “feel good” variables.

• •Because the posttest measured respondent’s feelings after the use of the BTS, those responses, if the experiences were positive, might be above 5.

The BTS The BTS combines biofeedback, music therapy, meditation, and guided imagery, all modalities frequently used in cognitive behavioral therapies. The BTS integrates biofeedback through a program based on research on the psychophysiology of stress, anxiety, and depression and interactions between the heart and brain. Sound frequency healing, music therapy, and guided imagery include audio and video sessions with positive affirmations and messaging. Coherence is also measured.

Coherence is how physiological patterns change with the experience of different emotions. The term “coherence” has several definitions, applicable to the study of human function. Merriam-Webster defines the word as the “integration of diverse elements, relationships or values” (2015). Thoughts and emotional states can be considered “coherent” or “incoherent.” Positive emotions such as love or appreciation are coherent states, whereas negative feelings such as anger, anxiety or frustration are incoherent states. These associations are not merely metaphorical; research

Industry Insider 21

Sept/Oct 2015 6.75 6.75

The effectiveness of Biosound Therapy in reducing the physiological/emotional indices of frustration etc. stress, anxiety, and frustration.

4.5 4.5

Anxious 2.25 2.25

Fearful Frustrated

00

Overwhelmed -2.25 -2.25

Stressed -4.5 -4.5 Intensity Intensity

Tired Pre Pre

WOMEN IN NEW RECOVERY (MESA, AZ) Demographics (N=217) •Age • Range: 18–70 •Average • Age: 27 •Males: • 0 •Females: • 217 verage Percent Increase/Decrease A for Beginning and Ending Dates •Anxiety: • 53 percent decrease •Fearfulness: • 50 percent decrease •Frustration: • 41 percent decrease •Feeling • Overwhelmed: 44 percent decrease •Stressed: • 52 percent decrease •Tired: • 35 percent decrease •Positive: • 16 percent increase •Peaceful: • 45 percent increase •Happy: • 22 percent increase •Excited: • 21 percent increase Physical Pain •Back • Pain: 47 percent decrease •Neck • Pain: 26 percent decrease •Headache: • 27 percent decrease Coherence Average •70.28 • percent after five minutes •49.36 • percent after eighteen minutes

Post Post

Difference Difference

studies indicate evidence that different emotions lead to measurably different degrees of coherence in the oscillatory rhythms generated by the body’s systems.

The BTS uses a vibrational platform of memory foam integrated with an audio/visual system synchronized with low frequency sine tones and binaural beats with a monitor at the end of the bed and a finger pulse senor that measures heart rate variability (HRV). Clients practice deep breathing, imagine positive emotional thoughts, and are encouraged through entertaining games and visualizations to generate improved heart rhythm patterns. The combination of music, vibrations, and binaural beats is purported to bring clients from a beta to a theta state in many people in about fifteen minutes. When generating a coherent heart rhythm, the activity of the two branches of the autonomic nervous system (ANS) is synchronized and the body’s systems react with increased balance and harmony.

The Research Hypothesis The null hypothesis was as follows: “The BTS demonstrates no significant statistical evidence of improvement in the physiological, emotional, cognitive or psychological improvement for those in recovery as measured by heart

rate, pulse, blood pressure, anxiety, fear, calm (racing thoughts), suicidal ideations, and depression, as measured by a Likert type pretest and posttest.”

STATISTICAL ANALYSIS

Southern Florida Study The southern Florida study was in three phases: clients, directors of programs, and staff. There was a pretest and a posttest to access the clients’ feelings and sensitivity to the BTS. The second phase conducted by the author (Froilán-Dávila), who visited three South Florida programs— North Palm Beach, Delray Beach, and Pompano Beach—where he interviewed clients, staff, and directors of programs.

The researcher presented his own questionnaire to each person interviewed. The questionnaire was based on a scale of 1–10 with 1 being the least and 10 being the greatest. The question was: “What would you assign to your experience of the BTS?” The third phase was the author’s own experience with the BTS. The first visit was to The Recovery Team. Program Director Terry Marvin said their program used holistic treatment in the recovery process, so the BTS fit into their treatment approach. He experi-

22 Industry Insider

Sept/Oct 2015

Effectiveness of Biosound Therapy in enhancing the “feel better” references: positive, peaceful, happy, excited.

9

3 2.25

6.75

1.5 4.5

0.75 0

2.25

-0.75 -1.5

0 Intensity Positive Happy

PreP

ost

Difference

Intensity

PreP

Peaceful

Backpain

Headache

Excited

Neckpain

Excited

enced a meditative state using the BTS. Using the researcher’s question, he rated his personal use as a 9 and his recipients rated it a 7.5.

He said the recipients could experience a slowing of racing thought patterns, specifically, “The treatment forces you to focus on the need to concentrate and leaves you with the experience to calm the mind.” The recipients of services stated, • •“Before I used the BTS I was having racing thoughts and was unable to quiet my mind.

After the treatment I felt more at peace and calmer.”

• •“ The vibration and music combine to take me out of where I was feeling a body, mind, and spiritual experience.”

• •“ I felt at times like I was floating.”

•“I • would love to take one home.”

The second program was at the Transformation Treatment Center, where the author met with James Wainwright, assigned full-time in administering treatment. He stated that everyone admitted goes through at least three half-hour sessions on the BTS. He believed it contributes to reducing anxiety and racing thoughts.

On a scale of 1–10 he gave it an average of 7.0 for his recipients

of services. He felt that through guided imagery, “the device brings the mind into the present, helping focus.” He uses it himself for short periods, but doesn’t have time to go through a full treatment, which resulted in his personal rating of a 5. He discussed how positive the application is on the brain/mind through the guided imagery process. He collected over 2,000 one sheet self-evaluations completed by each recipient.

The responses on the Likert Scale were mostly in the realm of “Received some or a lot of benefit from the treatment.” There were only two negatives, one of which included the following comment: “Videos that switch scenes every five seconds are actually aggravating for me.” Additional comments in the positive range included: • •“This thing is amazing, I feel so much better.”

• •“ Phenomenal videos and audio!”

•“Excellent.”

• • •“I wished I had asked more questions before doing this.”

• •“Great session, very good for mind and body.”

• •“My favorite was the health video because it gave me something to focus on.”

•“Relaxing, • very good.”

• •“ Love the feeling when the

vibration slows down, feeling the stress just falling off the body.”

•“It • was stress relieving, relaxing, and let me decompress and focus on my state of being and mindbody connection. Very productive for anxiety.”

There were several other similar positive outcome statements. The estimated percentages of positive versus negative outcomes were 87 percent positive, 13 percent negative.

The third program was Recovery Forever. The author met Dr. Joseph Millitz, who stated that the massage and guided music was a good temporary effect for calming clients emotionally and physically.

It calmed the racing mind effect, which is especially advantageous for anxiety. New recipients of service are encouraged to use the BTS at least twice. Dr. Millitz stated that on a scale of 1–10 he would rate it an 8 for the recipients of services and an 8 for his own experience.

He stated that programs included in the BTS helped him get rid of guilt and shame while lowering his blood pressure, anxiety, and pulse.

According to him, the BTS is used regularly. Another therapist at this program described it as “Reducing anxiety and actually feeling the emotions rising and melting

ost

Difference

away.” She had worked in hospice for twenty years previous to coming to work there and stated this would be a great addition to that work. At one time she had a diagnosis of cancer and the BTS treatment reduced her headaches.

She stated that on a scale of 1–10 she would rate it a 7 for the recipients of services and a 10 for her own experience using it.

The author interviewed another recipient of service who had high anxiety and didn’t think this would work. She stated, “I was very surprised, it greatly reduced my anxiety.” She said she learned to meditate on her own. When asked if she thought it was a body, mind, and spirit experience she stated, “After a couple of minutes on it I feel I am in a safe place.” On a 1–10 scale she rated her experience between an 8 and 9. She also stated that she would like to have one at home.

SUMMARY AND CONCLUSIONS

The hypothesis about the BTS was rejected. Two outcome studies from three sources and different programs seem to provide consistent results and some indication of the physiological, emotional, and psychological relief by using the BTS. However, this research does not involve an assessment of the

Sept/Oct 2015 treatment centers or the counseling techniques per se. As research seems to indicate, the treatment of SUDs is a complex undertaking and requires a multimodal, holistic approach including social support groups such as Twelve Step, multiple pathways to recovery programs, individual and group therapy, medical intervention if necessary, and techniques which directly affect the physiological consequences of abuse for those in recovery. In part, the BTS seems to address this need, but additional studies are needed. ■ Dr. Froilan-Dávila has been in the field of substance abuse since 1966 and has been working professionally in the field since 1970.

He has served on special assignments for NIAA, NIDA, and SAMHSA. He was appointed in the early eighties to the Birch and Davis committee by NIAA to develop national standards for Alcohol and Drug Abuse Counselors. He later started the Connecticut Alcohol and Drug Certification Board and served the first two terms as president. He is a tenured full professor and coordinator of the Addictions Track at the School of Human Services, Springfield College.

William B. Secor’s background is in health and neuropsychology. He has taught human biology, A&P, research design, statistics, and mathematics on the university level. He is a member of the AAAS, the American College of Epidemiology, the Public Health organizations of Connecticut and New Hampshire, and Psi Chi the Honor Society in Psychology. At present he is conducting research in obesity and working with the Hillsborough Education Foundation, Tampa, FL, and in private practice.

References American Music Therapy Association (AMTA). (2015). What is music therapy?

Retrieved from http://www.musictherapy. org/about/musictherapy/ Eisler, M. (n.d.). The history of meditation.

Retrieved from http://www.chopra. com/ccl/the-history-of-meditation “History of massage therapy.” Retrieved from http://www.naturalhealers. com/massage-therapy/history/ Jacobson, E. (2011). Tension control for businessmen. Eastford, CT: Martino Fine Books.

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 55.

Merriam-Webster. (2015). Coherence.

Retrieved from http://www.merriamwebster.com/dictionary/coherence

Industry Insider 23

Ask The Expert: “The Doctor’s Gap” Lee M. Goldberg, MBA, CIC

Q

Will the General and Professional Liability insurance policy I have cover my facility and my doctors?

T

he answer is yes and no. The traditional (unendorsed) General and Professional Liability insurance policy that is commonly available to addiction treatment facility operators is not designed to cover medically licensed staff. The facility’s liability policy is intended to cover the facility for General Liability (bodily injury or property damage) and Professional Liability (wrongful acts).

This policy will generally cover the facility only on behalf of the actions of medical directors, doctors, psychiatrists, and nurse practitioners on a vicarious basis as long as all subjectivities are met. These subjectivities and failure to comply with them are what create the “Doctor’s Gap.” The policies generally read that in order for the facility’s policy to defend and indemnify the facility (not the MDs/NPs) from a covered loss there must be a contract between the MD/NP and the facility specifically outlining the scope of work to be performed, the MD/NP must be scheduled as a subcontractor, the MD/NP must carry their own Medical Malpractice policy with limits equal to that carried by the facility, and the MD/NP policy must name the facility as an additional insured.

Failure to comply with these subjectivities or any other outlined in the policy documents will waive the vicarious coverage and an otherwise covered loss will be denied.

The Limit of Insurance subjectivity is perhaps the most common issue we encounter. Chances are a facility that has been around for more than a few years will have the majority of the contracts and wording in place. However, individual states have become involved with Medical Malpractice insurance and while a doctor may be complying with the rules and regulations on a statewide level, the facility still needs to comply with the wording and restrictions on their policy in order for coverage to be awarded. It is up to the facility and the insurance agent of the facility to ensure that the limitations of the policy are met by proper external risk management efforts and strategies.

The way to avoid un- or under-covered losses is to ensure the contracted individuals are carrying the limits required by the facility’s policy and that the facility has all of the proper contracts and documentation in place. There are some facility policies that allow, for a fee, to schedule the medical staff on the facility’s policy.

Although this seems at first to be the most cost-effective method, it is important to understand that in this scenario the licensed medical staff and the facility will now be sharing the liability limits of a single policy. Alternatively, there are very affordable stand-alone Medical Malpractice policies that provide coverage for a single facility that a medical director can purchase when required by the facility for which they are subcontracted.

The insurance options exist and are available to almost any facility structure. The first step is understanding how your facility is organized and how the policies you select are designed to respond. Ask your insurance representative the difficult questions and be comfortable with the strategy you have chosen. ■

Disclaimer: The explanation provided is a general outline based on the experience of one insurance agent and should not be treated as a description of coverage, an indication to bind coverage or an amendment to an insurance policy. Insurance policies differ greatly and should be interpreted by those licensed to do so.

Lee M. Goldberg, MBA, CIC is a licensed insurance agent with years of experience analyzing and offering alternative insurance options for addiction treatment facility operators, medical staff, and supporting medical services.

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