RIVERBEND PROGRAM UPDATES FOR 2022 PSYCHIATRIC EMERGENCY SERVICES

HEATHER GAYLORD, DIRECTOR

In September of 2015, Riverbend launched New Hampshire’s first mobile crisis team, and since then this team has served the people of Central New Hampshire. It has since been joined by emerging mobile crisis counterparts that served the southern part of the state in Nashua and Manchester. On January 1st, 2022, as part of the effort to serve all State residents equitably, a new system of care was initiated, and all of the remaining community mental health centers needed to launch their own mobile crisis services. New Hampshire’s mobile crisis service capacity grew with the addition of seven new teams. This expanded system of care is managed by Beacon Health Options. It’s accessed via the New Hampshire Rapid Response Access Point (NHRRAP). NHRRAP now serves as the central call center for all the state’s behavioral health crisis calls and for mobile crisis team deployments.

Working collectively, all ten mental health centers now respond to requests for mobile crisis response. Teams are deployed based on availability without reference to caller location or ‘catchment area.’ This enhances rapid access and timely response for people in crisis. The NH Rapid Response system serves people of all ages who are dealing with behavioral, mental, and substancerelated crises in real time, 24 hours a day, 365 days a year. In 2022, NHRRAP:

• Answered more than 25,000 calls,

• Engaged in more than 600 text and chat conversations,

• Fulfilled more than 5,000 same or next day crisis stabilization appointments, and

• Deployed mobile crisis teams more than 6,250 times, throughout New Hampshire.

As we enter our second year of statewide mobile response utilizing the NHRRAP system of care, we look forward to ongoing system refinement, improved communication, and the development and utilization of additional integrated tools for referral and follow-up.

CAROLYN WELCH, DIRECTOR

As we enter the New Year, I am pleased to highlight 2022’s many positive developments in Riverbend’s Residential Programs, beginning with grant funding secured by our Development Office which made it possible to renovate all of our residential sites. Twitchell House’s windows were replaced with new, energey efficient windows and additionally received fresh coats of paint. Our Fayette Street and Mill House residences also received paint, in addition to new flooring and kitchen and bathroom upgrades. Finally, Mill House also received a generous grant for all new furniture!

New vans were secured in 2022, allowing residential staff members to take residents on trips ranging from breakfasts together at area restaurants, drives to see holiday lighting displays, and time at the Deerfield Fair as well as the ocean. We also brought clients to a variety of concert events and helped with access to recreational bowling.

We look forward to the great things that 2023 will bring to Riverbend as a whole. And here in Residential Services, we anticipate many more outings for our residents, fully staffed programs, and fewer COVID worries and restrictions.

Franklin Location

SUSAN LUNT, DIRECTOR

The Franklin Adult Team is currently fully staffed and has enjoyed so much success with its ongoing Dialectic Behavior Therapy (DBT) group that we have initiated a second one. And the new DBT group is enjoying consistently strong attendance. Both groups are scheduled to continue through the winter of 2023 and, in all likelihood, well beyond.

We are also looking forward to expanding other group therapy offerings. Currently, they include an Illness Management and Recovery (IMR)-based group, a “Beating the Winter Blues” group, and a “Tools for the Emotions” group.

The Franklin Children’s team continues to be busy, and looks forward to further serving the Franklin community.

CHILDREN’S INTERVENTION PROGRAM

MELISSA

COLBY, DIRECTOR

I am so proud of all that the Children’s Program accomplished in 2022. In the COVID era of staffing shortages and increasing need for services, our dedicated, talented staff keeps thriving, overseeing an expanding program supporting young people and families with grace. We are committed to our mission and to collaborating with all child-serving agencies to respond to the needs of our community.

In 2022, we expanded services for adolescents struggling with substance use. Our staff members have been trained in the tools and methods of the Seven Challenges, an evidence-based practice designed to evaluate the risks and consequences of adolescent substance use, recognize the needs that are being met, and then identify what is needed to bring about a positive change.

Our Autism Team has been so versatile throughout the pandemic, restructuring to meet all challenges. In 2022 we launched a clinic-based Applied Behavior Analysis (ABA) program. We have an energetic, talented, fully staffed team working to teach functional communication skills to children with autism.

I am beyond excited to continue the expansion of these initiatives in the upcoming year! It continues to be an honor to lead this amazing program and be a part of all the great work being done here.

Choices And The Doorway

SHANNA LARGE-REUSCH, DIRECTOR

In 2022, our Choices and Doorway teams worked together to develop an expansion of our Medication Assisted Treatment (MAT) model. This harm reduction program went live in early April. It is based on the Medication First Principles as listed below:

• Clients receive pharmacotherapy as quickly as possible

• Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits;

• Individualized psychosocial services are offered as a condition of pharmacotherapy;

• Pharmacotherapy is discontinued only if it appears to be worsening the client’s condition to have one of these boxes, and The Doorway Team is developing an operation plan to maintain the supply of the boxes, provide training for partner businesses, and register the boxes’ locations on Google Maps.

At Choices, this translates to clients entering the program, completing an assessment, and being able to see a Medication Provider quickly, sometimes on the same day. Before each follow-up appointment, clients meet with a Recovery Support Worker who evaluates their recovery and assists with any needs they might have. This expansion has grown steadily since April and is now 42 clients strong, making up about half of the MAT program. It is genuinely meeting the needs of clients in the community.

Based on its success, this project may expand to include other concerned communities. The goal is to enable individuals to access naloxone anonymously and easily throughout the area without barriers.

Community Support Program

SHEILA MULLEN, DIRECTOR

At Riverbend’s Community Support Program (CSP) we continued to offer one of our core services: Dialectical Behavioral Therapy (DBT), a comprehensive, evidencebased treatment modality for individuals diagnosed with Borderline Personality Disorder. The weekly combination of structured individual therapy and skills group meetings provides a strong educational component to this treatment. CSP offers many DBT groups to help meet clients’ needs and recovery goals in a variety of ways.

Entering 2023, The Doorway Team is collaborating with our Public Health Network to obtain approval for the distribution of naloxboxes in the downtown Main Street area. Individuals from the NH Harm Reduction Coalition are creating a list of partner businesses who would like

Pre-DBT is the first phase of DBT. We offer two PreDBT groups which run for 12 weeks each, offering an introduction to DBT skills and the structure of group treatment. One does not need to be connected to an individual therapist to join these groups. The next phase is a 48-week DBT group which meets weekly for 2 hours. During this phase, participants have an additional hour of individual DBT therapy each week. These groups teach core skills in the areas of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. To join full DBT, clients must work with an individual therapist supporting the client by reviewing orientation materials and giving informed consent. Once full DBT has been successfully completed, participants can elect to further their DBT skills in a Graduate DBT group -- meeting weekly for 1 hour – which allows participants to maintain their skills while also sharing support with their peers . Grad DBT refreshes DBT skills for clients who have graduated from the full program.

Our newest DBT offerings expand the client population for whom DBT skills are effective. We offer a pre Radically-Open DBT (RO) designed to bring DBT skills to clients considered “over-controlled” and includes diagnoses like Anorexia Nervosa and Obsessive Compulsive Disorder. This group is a precursor to a planned full RO DBT group which will run for 30 weeks, targeting mindfulness, interpersonal integrity, and social connectedness skills. The group teaches clients how to turn off “threat system” physiology to improve selfexpression through communication and facial and body signaling. Clients in DBT Prolonged Exposure (PE) attend a full 48-week group and additional individual sessions weekly to use exposure techniques targeting symptoms of PTSD. Individual PE sessions use in-vivo experience tasks, imaginal exposure, and processing to target traumatic memories and the associated symptoms that cause distress in daily life. These are used in conjunction with DBT skills to effectively treat PTSD.

We are so proud of the robust DBT program that our talented clinicians have worked diligently to create. We look forward to having a positive impact on our clients and their recovery goals.