Family and Significant Other Handbook file · Web viewWe realize that it’s likely been a “hard...

251 Main Street, Old Saybrook Ct. 860-388-9656

Welcome!

We realize that it’s likely been a “hard road” to get here and so, on behalf of all the staff here, we’d like to say welcome – we’re glad you’re here. Our ultimate goal is to help you and your loved one restore your relationships.

This handbook is long….and important. One of our staff members will walk you through this during your initial visit to Project Courage. However, there is a lot of information to cover and we don’t want to overwhelm you. So the purpose of this handbook is to orient you to Project Courage and to serve as an ongoing reminder of some of the more important points about the experience we provide to you and your loved one.

As we move forward together, please feel free to ask any questions regarding the services here, and let us know if there is a better way we can assist you.

Sincerely,

The Project Courage Team.

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251 Main Street Unit 101Old Saybrook, CT 06475

www.projectcourageworks.com

ContentsNavigating the Behavioral Health and Substance Use Treatment Industry....................................3WE NEED YOU!............................................................................................................................6Dealing with Resistance..................................................................................................................8Privacy and Confidentiality...........................................................................................................10About Project Courage..................................................................................................................15Program Rules...............................................................................................................................21Additional Program Policies..........................................................................................................23

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Navigating the Behavioral Health and Substance Use Treatment Industry

It may seem awkward to start with a section describing how the service delivery system of the behavioral health/substance use disorder treatment industry is structured. However, even if you only come to Project Courage for one appointment we hope the following information is helpful to you and your family and friends. Having a basic understanding of how the treatment industry is organized will empower you to make decisions about your care, or the care of those who are important to you.

The treatment industry for behavioral health and substance use treatment is tremendously hard to navigate even for those of us within it. So let’s start here: What services do you need? To answer this question it is helpful to explain a concept called the Continuum of Care. Most professionals in this industry rely on the Continuum of Care to help determine the right “kind” of care for their clients. An additional and important consideration will be the coverage your healthcare plan will provide (which we also cover further below).

Deciphering the Continuum of CareThe Continuum of Care is exactly that, a continuum with one end anchored by services that are the least intense, least restrictive, and at the other by those treatments that are the most intensive and most restrictive. One common version of the Continuum of Care is as follows:

Individual, Group, or Family TherapyTypically once per week for 1 hour.

Multiple Individual,

Group, or Family Therapy

Typically two to three times per week for 1 hour each session

Intensive Outpatient (IOP)

Typically 10-15 hours per week consisting of individual, group, & family therapy. Usually offered 3-5 days per week at 3-4 hours per day.

Partial Hospital (PHP)

Typically 20-30 hours per week consisting of individual, group, & family therapy. Usually offered 4-5 days per week at 3-6 hours per day.

ResidentialTypically 2-4 weeks of treatment at a facility where the client resides for the duration of the treatment.

Extended Care or Therapeutic

CommunitiesTypically 3 months to 1 year of treatment at a facility where the client resides for the duration of the treatment.

Outpatient Inpatient

Project Courage Services

A wild card not reflected in that above continuum is Detoxification or more commonly referred to as “detox.” Detox is a short term inpatient service lasting typically lasting 3-5 days. The goal of detoxification is to assist the client detoxing from substances they’ve been using which have created a physiological dependence. Typical substances that clients will receive detoxification services from include alcohol, opiates such as heroin or OxyContin, and sedatives such as

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http://www.projectcourageworks.com/start-here.html#insurance

http://www.projectcourageworks.com/start-here.html#insurance

benzodiazepines, like Xanax. In this regard, detox is truly a medical service and not treatment in a clinical or behavioral sense. Ultimately, detoxification services ensures the individual does not experience life-threatening withdrawal and/or provides stabilization so that the individual can enter treatment at one of the above points on the continuum of care.

Project Courage offers outpatient services that cover the first three points of this continuum, covering weekly therapy all the way to intensive outpatient.

To truly get a sense of what level of care a potential client needs it is ideal to have a thorough assessment completed by a professional who specializes in substance use disorders. However, we’ve often found that our clients and their loved ones have a deep sense of the level of care they need and typically they’re right. Unfortunately, insurances often require an assessment to be completed by a qualified professional before they will authorize payment for services. At Project Courage we are proud of the assessments we provide for our clients. We feel we've truly found a balance between conducting an assessment that provides sophisticated diagnostics while simultaneously honoring the human experience and not pathologizing the individual.

This leads us to the next important consideration when you’re looking for help: will my insurance cover the costs?

Making Sense of InsuranceFor most of us, a reliance on our health benefits to cover the costs for both physical health and mental health is an absolute necessity. Unfortunately, and despite significant legislative strides to effect change toward parity, there remains a significant disparity between the coverage insurances will provide for physical health and mental health. Thus, another possible roadblock on the road to getting help is assessing the benefits offered by your health insurance. To do this there are three essential pieces of information you need to know:

1) Is my health insurance plan an out-of-network plan or an in-network plan? In-network plans (often referred to as HMO’s) are plans that insurances offer which give their members a “network of providers,” (a list of doctors, dentists, psychiatrists, therapists, etc.). In-network plans mandate that their members must stay in this network of providers in order for the costs of such services to be covered by the insurance. Alternatively, out-of-network plans will supply their members with a similar “network of providers,” but they will also allow members to go outside of this network and still provide some coverage for the cost of associated services. Out-of-network plans provide their members with more discretion in who they access for services, and, as one might expect, typically the costs to obtain an out-of-network plan are higher.

2) If I have an out-of-network plan is there a deductible, and if so how much is it? One of the ways out-of-network insurance plans will try to encourage members to remain “in-network” is to establish a deductible; an amount of money that the insurance will need the member to pay

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out of pocket before they will begin to cover the costs for any out-of-network services. Deductibles can range from $300 dollars to $12,000, so this is an important piece of information to obtain before you go “out-of-network.”

3) If I have an out-of-network plan what is the “co-insurance?” In addition to deductibles, insurances will also attempt to encourage members to remain in-network through co-insurance. Co-insurance is the amount that a member will have to pay out-of-pocket for services from an out-of-network provider even after having satisfied a deductible. Typically co-insurances is reflected in a percentage of the cost that the insurance will cover versus what the member will cover and often ranges from 50%-80%. For example, if an individual as an out-of-network insurance plan with a $500 deductible and 80% co-insurance, and they were getting individual therapy that cost $150/session, then they would need to pay the first $500 to cover the costs for their therapy. After that the insurance would cover 80% of the $150/session costs, leaving the individual responsible for the remaining 20% or $30.

Obviously, this can be quite cumbersome to determine. So, when potential clients call Project Courage, we provide a service called a Verification of Benefits at no charge. This means that we will take on the burden of contacting your insurance and determining all of this information so that you can get the help you need with confidence.

Once the individual is armed with an understanding of the right level of care and the benefits they can expect from their health plan they’re in a much better place to get the help they need. At Project Courage we want to help you in both of these areas. We’re very sensitive to the fact that when people are calling us they need help, and the last thing they want is to feel overwhelmed by the daunting task of trying to navigate the maze of behavioral health and the addictions treatment industry as well as their insurance benefits. That’s why when potential clients call in we let them know we’re here to help whether that’s with services we can provide or getting them in touch with another provider. We stay involved until our clients are in good hands.

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WE NEED YOU!

We’ve struggled with how to convey this message to the significant others of our clients. In the end we decided that best approach is to be direct. Our cautionary sense about letting significant others know that we need them to be part of the treatment process stems from the fact that it is not uncommon for them to be experiencing varying degrees of exhaustion, fear, resentment, and an overall sense of being depleted. Through the years we’ve often heard “He’s the one with the problem, not me so he needs the treatment not me,” or we’ve encountered the general sense from family members that their involvement in their loved one’s treatment should begin and end with providing transportation to appointments.

We get it. We’re all so busy these days that for many of us, one more request to give up one more hour of the day is simply too much. When you add a substance use disorder to this already over taxed context, the challenge can become staggering.

We wish there was another way, and maybe someday there will be, however for now there’s no easy way around it…we need you to be involved in the treatment of your loved one. In fact the entire effectiveness of the treatment that your loved one receives here often rests on how involved you will be in their treatment.

There are, at a minimum, five opportunities you can be involved in your significant other’s care here at Project Courage.

1. During the intake and assessment process2. Through our psychoeducational group (Every Tuesday at 5:30 for six weeks)3. Through our parental/significant other coaching sessions4. Through our family support groups (Every other Monday at 5:30)5. Through family therapy

Intake & Assessment During the initial assessment process we would like to sit with our clients’ significant others so we can have their input on treatment needs and so we can orient them to treatment at Project Courage.

Coaching, Groups, and Family TherapyThrough many trials and challenges, we have developed a system for delivering services to our families and significant others that has proven effective. So often, our parents, spouses, partners, and significant others feel confused and frustrated about their role in their loved one’s life. For example, it’s not uncommon for the structure of an entire family to be flipped, where the adolescent is making important decisions and the parents feel as though they’re being held hostage. Other times, conflict dominates the relationship; it begins to feel that the relationship is based on a series of fights and arguments from one day to the next. And then,

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there is always the big “E-word” that gets thrown around by us professionals…enabling. Our significant others are bewildered by this concept; questions abound: “When am I enabling?” “Am I enabling now?” “How can punishment be enabling?”

To counter this, we typically deliver services to our significant others in a very specific way. First we use our psychoeducational group and coaching sessions to help significant others gain some clarity on their role in their loved one’s life. Key teaching points we’re trying to impart are a) The ability to set loving and clear expectations and consequences, b) The ability to care for oneself, and not to lose sight of this as your loved one struggles with a substance use disorder, and c) how structures in our brain that are meant to help keep us safe and alive can often have the unintended effect of interfering with our ability support our loved ones. In fact, these are the topics that structure our psychoeducational group. Over 6 weeks (1 group per week) we encourage you to attend this group while simultaneously attending 3 coaching session scheduled at your leisure, where you will take the material you’ve learned in group and individualize it to your situation.

From here many of our significant others have voiced a need for continued support. As a result we also offer our family support group. Where the psychoeducational group is structured, content driven, and time limited, the support group is open-ended, ongoing and relies more on the members than the facilitators.

In a perfect world what this allows is for you as the significant other to gain some clarity and direction, feel empowered, and be provided with a support system. In the meantime, your loved one is receiving treatment and also doing some hard work. With healing occurring for you and your loved one we can then bring the family together for family therapy.

In summary here’s what we’re asking: 2 hours per week for the first 3 weeks of treatment 1 hour per week thereafter with a good chance that this will reduce to 1 hour every

other week as treatment progresses for all involved parties.

You’re involvement in your loved one’s treatment significantly increase the odds of: He/she remaining in treatment (see next section) He/she opening up the communication lines (see section on Privacy and Confidentiality) He/she making lasting changes

Obviously we can’t make any one be involved in treatment. However, short of that we can STRONGLY urge you to be involved in your loved one’s treatment. It will very likely make a dramatic difference in the outcome and success of treatment. Additionally, while it may be difficult, we feel confident attesting to the fact that it will be no harder than the cumbersome and entangling communication patterns, arguments and interactions that you are likely experiencing—or beginning to experience now.

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Dealing with Resistance

One of the key reasons success rates for substance use disorder treatment have been so abysmal is the lack of treatment retention and adherence. While many clients enter treatment with a strong urge to change, there are also many clients who do not feel change is necessary and as such make efforts to avoid engaging in treatment. Directly relating to the previous section, this is where we rely heavily on our significant others.

A significant body of research exists that demonstrates change in human behavior is very complex. For example, one of these complexities plays out in the balance a person feels between being externally motivated and internally motivated to change. External motivation is often based on rewards or contingencies from the environment around us (physical environment, social environment, legal environment, work environment, etc.), whereas internal motivation is typically derived from our values of accomplishment, purpose, and desire for personal growth. An external motivator may be a probation officer that is mandating substance abuse treatment, an internal motivator may be self-talk that sounds like “I’m tired of living this way.”

It is very rare for individuals who are in the early phases of a substance use disorder to have a high level of internal motivation. Said differently, most individuals who are in treatment for the first time aren’t pumping their first in the air as they ooze with excitement and gratitude about being in treatment. When you’re talking about adolescents who are in the early phases of a substance use disorder this statement becomes profoundly true; simply put many of them just do NOT want to be there. We often hear parents say to us “I don’t want to make her go because then therapy will be like punishment.” While this sentiment makes sense on the surface, the inverse of this—seeing therapy or treatment as something desirable is highly unlikely. This becomes the highly painful conundrum that so many of us as professionals, family members and loved ones face; do we wait for the problem to get worse, until things get bad enough that they finally acknowledge they need help? Or do we try and create conditions that will externally motivate our loved ones to settle for treatment? There is no easy answer and no right answer.

At Project Courage we encourage the idea of setting clear expectations with a clear message of love. It is helpful to consider a continuum to illustrate this idea. On one end of the continuum is the relationship, and on the other end of the continuum is rules or expectations. If we stray too far towards the “rules” end of this continuum and there is no relationship or attachment bond, then a clear message is sent: The rules are more important than the relationship. This condition encourages indifference and rebellion. On the other hand if we drift to the relationship end, then boundaries begin to disappear, and though they will never admit it, the structure that adolescents crave is lost. This invites confusion, ambiguity, shame and loss of identity. For years now we have conducted assessments on our clients when they are entering

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treatment at Project Courage. Part of this assessment centers on how their significant others perform in the area of discipline. Over and over our adolescent and young adult clients rate their parents most poorly in the area of discipline. When asked why this is the case they consistently respond with something along the lines of “Because they always set rules but then they never stick to them. All I have to do is go to my dad and he’ll convince my mom to let me off the hook.”

One of the ways you will be challenged to maintain this balance between setting expectations and maintaining your relationship with your loved one, will be related to their starting treatment and/or continuing treatment. This is a critical juncture in the treatment process. If you are involved in your loved one’s treatment and working with Project Courage staff, then the likelihood of all parties navigating this crossroads successfully becomes much greater. Much of this underscores and reinforces the material we covered previously in the section titled We Need You.

In short the best way to manage your loved one’s reluctance to engage in treatment is to become involved in the treatment process yourself.

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Privacy and Confidentiality

Now we’re going to do our best to confuse you. After spending a lot of time stressing the importance of having you be involved in your loved one’s care, we’re going to discuss our clients’ privacy rights, and how these limit our ability to discuss your loved one’s treatment with you.

One important point to understand is that while we may provide services to you as a significant other, your loved one is the client. Thus, any services you receive at Project Courage are adjunctive to the primary services we provide your loved one. As such, your loved one is the client and is entitled to his or her rights of confidential treatment. This is true regardless of who pays for Project Courage services.

In the state of Connecticut and federally, a minor may receive treatment for substance use disorders without the consent of his/her parents, and in turn without his/her parents being informed or communicated with about the course of treatment. Connecticut and the federal government are very inclusive about their definition of a minor, being anyone under the age of 18. The two most relevant Connecticut statues supporting this are listed here:

Conn. Gen. Stat. 1-1d. "Minor", "infant", "infancy", "age of majority", defined. Except as otherwise provided by statute, on and after October 1, 1972, the terms "minor", "infant" and "infancy" shall be deemed to refer to a person under the age of eighteen years and any person eighteen years of age or over shall be an adult for all purposes whatsoever and have the same legal capacity, rights, powers, privileges, duties, liabilities and responsibilities as persons heretofore had at twenty-one years of age, and "age of majority" shall be deemed to be eighteen years.

Conn. Gen. Stat. 17-688(d) If the person seeking treatment or rehabilitation for alcohol dependence or drug dependence is a minor, the fact that the minor sought such treatment or rehabilitation or that the minor is receiving such treatment or rehabilitation, shall not be reported or disclosed to the parents or legal guardian of the minor without the minor's consent. The minor may give legal consent to receipt of such treatment and rehabilitation. A minor shall be personally liable for all costs and expenses for alcohol and drug dependency treatment afforded to the minor at the minor's request under section 17a-682.

For those of you who are a spouse, partner, relative, etc., the above statement and law becomes even more true. Access to your loved one’s treatment is very limited.

As difficult as this may be to accept, there are many reasons for this legislation that warrant its existence. So, the real question becomes, how are you supposed to be involved in your loved

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one’s treatment if there are significant limits on communication? Here’s what you need to know:

1. First and foremost the majority of our clients enter treatment at Project Courage and their significant others are already aware of this. Said differently, many of our clients are driven here by their parents, are accompanied to their initial sessions by their spouses, or are relying on a significant other to cover part or all of the costs involved in treatment. This means that the majority of the time our clients have already forfeited their right to not disclose whether they are in treatment or not.

2. Second, there are real exceptions to confidentiality. We’ve listed several of these below. The three most important to discuss here are as follows:

a) If our client presents as a harm to him/herself OR to othersb) If our client is a minor (under 18) and is being abused or neglectedc) If our client signs a Release of Information granting us permission to speak with

parties outside of the organization.As mentioned there are several other exceptions to confidentiality laws, many of which are explained in greater detail below. For our purposes these three are critical for your understanding.

As a significant other what you can take away from this is that if we have grave concerns about your loved one we can and will share this information with you. Second, that if your loved one signs a Release of Information, we can begin communicating with you. Two important caveats here: We often have family members and significant others ask “If he is using substances than isn’t he hurting himself? Wouldn’t this allow you to communicate with us?” The law is very clear about this that the harm to self or others needs to be imminent. For example, using substances does not warrant a violation of a client’s confidentiality, however if client made a statement about trying to kill themselves with a substance then this may cause us to notify you. Second, a release of information can be very specific or very inclusive. For example, when a Release of Information from is completed, a client can permit that we only share the results of his or her urine screens or that we can share about multiple facets of his/her treatment.

3. Third, at Project Courage we do our very best to respect our clients’ privacy while also acknowledging the important of having the family members and significant others of our clients be involved in treatment. As such, we provide the opportunity for our clients to sign a release to speak with significant others very early in the treatment. Thus, assuming you are aware that your loved one is seeking treatment at Project Courage, then you are able to get an early sense of whether or not a release has been signed by simply asking us. If we cannot share information because a release has not been signed we will inform you of this if you ask. If this is the case we can guide you on how to proceed.

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4. Going back to the notion that if it has already been established your loved one is in treatment, then there is no law that prohibits you as a significant other from sharing with us as much as you would like. For example, if your loved one has declined signing a release you can still call and let us know any information you feel is imperative for us to have.

5. Finally, simply because your loved one may refuse to sign a release does not mean we can’t proceed with providing you help. As we discussed in the section We Need You, there are multiple ways you can be involved in your loved one’s treatment where the focus is on you and how you manage your loved ones substance use disorder.

Also related to privacy and confidentiality, is the issue of our role to our clients and their significant others. Simply put, our role is to provide therapy. We are not forensic experts. By providing services to your loved one we are not agreeing to be an expert witness. Nor can we be expected to use the information that our clients and their significant others share with us against one another as this would be detrimental to the entire process of therapy.

All parties involved in the client’s treatment, including the client, agree that they shall not, for any reason, attempt to subpoena Project Courage staff for testimony or Project Courage records to be presented in a deposition or court hearing of any kind for any reason, such as a divorce case.

All parties acknowledge that the goal of psychotherapy, either individual, family, and/or marital or couples therapy, is for the sole purpose of the amelioration of psychological distress and that the process of psychotherapy depends on trust and openness during the therapy sessions.

Therefore, it is understood by all parties that by requesting Project Courage services, they are expected not to use information given to Project Courage staff against the other party in a judicial setting of any kind, be it civil, criminal, or circuit.

The signatures at the end of this document below reflect that the parties agree to the terms set forth above.

Some Exceptions to Client ConfidentialityDuty to warn and protectWhen a client discloses intentions or a plan to harm another person, the health care professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.

Abuse of children and vulnerable adultsIf a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the

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health care professional is required to report this information to the appropriate social service and/or legal authorities. Keep in mind that we need only have sufficient reason to suspect such abuse in order for a report to be necessary. Also, know that many times things occur that some individuals might not consider abusive or negligent. For example, prenatal exposure to controlled substances, driving an automobile while under the influence of a substance with a minor in the car, and repeatedly neglecting to take your child to appropriate medical care, would all be considered reportable offenses.

In the event of a client’s deathIn the event of a client’s death, the spouse or parents of a deceased client may have a right to access their child’s or spouse’s records.

Professional misconductProfessional misconduct by a health care professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns.

Court ordersHealth care professionals are required to release records of clients when a court order has been placed.

Minor (under age 18)In some case parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.

When insurance companies are paying the cost for servicesInsurance companies and other third-party payers are given information that they request regarding services to clients. Information which may be requested includes type of services, dates/times of services, diagnosis, treatment plan, description of impairment, progress of therapy, case notes, and summaries.

When booking appointments, arranging for payment or other administrative duties.Project Courage uses an office manager to perform many administrative duties including scheduling appointments, preparing monthly statements, data entry, etc. This individual understands that client records including, demographic, biographic, insurance, financial, and clinical information are confidential and are subject to requirements of PROJECT COURAGE’s privacy policies. This individual will only access that information which is needed to perform their work and/or related duties. Failure to maintain client confidentiality is considered reason for immediate termination.

Supervision and/or consultation with or from colleagues

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Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment. In such cases the name of the client, or any identifying information, is not disclosed. Clinical information about the client is discussed.

When attempting to secure paymentPayment is expected at the time of service. When fees for services are not paid in a timely manner, collection agencies may be utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, case notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies, and the client’s credit report may state the amount owed, time frame, and the name of the clinic.

Measures We Take to Protect Client ConfidentialityWe will take real and specific measures to protect the confidentiality of our clients including the following:

Though it may not be necessary, and when appropriate, we will seek to receive authorization from our clients prior to any disclosure.

Protecting written and electronic records by keeping them in a secure location. Maintaining your records after service provision has terminated in a secure location in

accordance with the time schedule set by the National Association of Social Workers. Discussing with our clients and other interested parties (i.e. parents, family) the

limitations to their rights of confidentiality. Limiting any disclosure we must make to that which is needed to achieve the desired

purpose. Informing our clients of, to the extent possible, any associated consequences of such

disclosures.

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About Project Courage

Project Courage is committed to providing professional mental health and substance abuse care to all of our clients.

Project Courage is licensed by the Connecticut State Department of Public Health to provide outpatient services for adolescents and adults struggling with substance use disorders.

Project Courage is licensed by the Connecticut State Department of Public Health to provide outpatient services for adults struggling with psychiatric disorders.

Project Courage is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) to provide outpatient treatment and intensive outpatient treatment for adolescents and young adults struggling with substance use disorders

Our Mission Statement:Project Courage provides specialized addiction treatment for adolescents and young adults that is client centered and addresses obstacles that have plagued the addiction treatment industry; We believe addiction is an opportunity for change.

Our StaffAndy Buccaro, LCSW, LADC. Andy is the Executive Director and founder of Project Courage. Before launching Project Courage, he was the Director of School-Based Programming for New Hope Manor Inc. In this role, Andy worked with public and private schools arranging contracts to allow schools to supplement their support staff with substance abuse counseling. Additionally, Andy worked as a clinician for Yale University’s Forensic Psychology Department in their research project comparing Cognitive Behavioral Therapy with Twelve Step Facilitation models for treating alcoholism and addiction. During this time, he also provided clinical services for Yale’s adolescent substance abuse prevention program for students re-entering New Haven Public Schools. Most recently he served as the Executive Director of Center for Change an intensive outpatient dual diagnosis clinic that delivered services to Turning Point a nationally recognized treatment program for young adult males. At Center for Change he developed, implemented, and produced clinical programming that received accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF). With credentials in both the mental health and substance abuse fields, combined with almost two decades of

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experience, Andy provides clinical services that include thoughtful, compassionate and confidential interventions. Andy’s specialties include substance abuse and anxiety disorders.

Ryan Hocking LCSW. Ryan earned his BA in Sociology from the University of New Hampshire and his Masters in Social Work from Southern Connecticut State University. Ryan started his career working at the Rushford Center, Inc. where he provided services to adolescents with mental health and addiction issues. His work there included biopsychosocial assessments, individual, family and group therapy. From Rushford, Ryan continued his social work career as a supervisor at the APT Foundation where he offered individual and group therapy to patients receiving opioid replacement treatment. Ryan most recently worked as the Assistant Executive Director at Center for Change, an intensive outpatient dual diagnosis clinic that delivered services to Turning Point a nationally recognized treatment program for young adult males. Ryan brings his dedicated work in the social work field to Project Courage and feels passionate about helping individuals and families achieve their treatment goals.

Greer Richardson, MD. PSYCHIATRIST Dr. Richardson graduated from Yale University, Department of Psychiatry in 2001 and began treating veterans with posttraumatic stress disorder and co-occurring illnesses such as substance use disorders, anxiety disorders, mood disorders and psychotic disorders. He has been in private practice since 2003 and treats a variety of illnesses, the majority of which have co-occurring substance use disorders. He is a national trainer for Cognitive Processing Therapy, a cognitive behavioral therapy for PTSD. He is a diplomat of the American Board of Psychiatry and Neurology and an Assistant Clinical Professor of Psychiatry at Yale University where he teaches Yale residents general psychiatry. He graduated from Baylor University with a BA in Philosophy and a minor in Physics and earned his MD from the University of Tennessee.

TIM HARMON – HEAD OF ADMISSIONSTim is currently attending Southern Connecticut State University where he plans to achieve his BA in social work and then work on earning his Masters. Tim takes on multiple roles at Project Courage. As the Care Coordinator, Tim is involved with much of the work behind the scenes with administering drug testing, as well as assisting around the office. As a Recovery Coach, Tim works with people to help remove obstacles in their life that could potentially be getting in the way of keeping them sober

Courtney Bushnell, LCSW- CLINICAL SUPERVISOR Courtney is a Licensed Clinical Social Worker. She received her Bachelor’s degree in social work from Providence College and then went on to receive a Master’s degree in social work from the University of Connecticut. Before joining Project Courage, Courtney was an Outpatient Coordinator at UCFS in Norwich, providing a range of clinical care including biopsychosocial assessments, individual, group and family therapy to people of all ages, focusing on substance use and mental health issues. Courtney is very passionate about creating a positive working therapeutic relationship and helping individuals and families work toward achieving their goals. “Nothing changes if nothing changes”

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Kerry Law MFT, LADC. FAMILY THERAPIST Kerry Law is a licensed drug and alcohol counselor and has a masters degree in marriage and family therapy. Kerry's practice focuses on working with individuals and families impacted by substance abuse and other mental health disorders. Kerry's experience includes 20 years in public service along with her work in an outpatient, residential and medicated assisted treatment programs

MICHELLE BAILEY – OPERATIONS MANAGERMichelle has a dual role at Project Courage, Office Manager and Fitness Coordinator. Michelle has her Bachelor of Science degree in Business Management with a concentration in health care and a Master’s degree In Business Administration from Quinnipiac University.Michelle is a certified personal trainer, group fitness instructor and yoga instructor with a passion for life that is unstoppable. Michelle believes how you work out, is how you live your life and motivates people to reach their fullest potential.

JOSEPH M. CRISCUOLO, CAC, CRPS, RSS – PRIMARY CLINICIAN & RECOVERY COACHJoe provides support to both clients and family members in his role at Project Courage. Before joining Project Courage, Joe provided Recovery Coach Support Services while employed at Aware Recovery Care. Joe has been involved in recovery for 22 years and is a member of the VIP Mentoring Program, performing volunteer service in the Bridgeport and Cheshire criminal justice system. Joe has facilitated 12 step meetings at Bridgeport Mental Health and the Prospect House. He is a Certified Addiction Counselor, (CAC), and is currently pursuing his Drug & Alcohol Recovery Counselor (DARC) at Gateway Community College. Joe also holds certifications as a Certified Recovery Peer Support (CRPS) and Recovery Coach Specialist (RSS).

TINA CAMPBELL – BILLING MANAGERTina brings her extensive experience in business administration and business management to Project Courages’ Billing Department. Tina has owned and managed her own business for over 10 years, has coached gymnastics for over 30 years, and believes that her compassion for others will be her greatest asset and help with her goal of making someone smile every day.

BEN BACKES – SCHOOL BASED COUNSELORBen is a school-based, substance use counselor at Project Courage, providing middle and high school students with individual substance use counseling within their learning environment. Ben brings experience with Medicated Assisted Treatment (MAT), individual, group, and family counseling. He has worked with a variety of individuals suffering from substance abuse and other mental health disorders. Ben received his Associates Degree and DARC Certificate from Gateway Community College in Drug and Alcohol Recovery Counseling, his Bachelors Degree in Social Work from Southern Connecticut State University, and is currently attending Fordham University where he will receive his Master’s Degree in Social Work this spring

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JEAN WATSON – PRIMARY CLINICIANJean earned her BA from Albertus Magnus College with a major in Psychology and a minor in Sociology. She earned her Master’s in Social Work from Southern Connecticut State University with a primary focus on Medical Social Work. Jean’s primary experience has been with the criminal justice system, specializing in sexual behaviors and compulsivity resulting in her CATSO (Connecticut Association for the Treatment of Sexual Offenders) certification. Additionally, Jean’s experience has focused on substance use and mental health disorders. Jean’s work includes individual treatment, family work, and group sessions. Jean is also a Register Yoga Teacher; her treatment work values and implements mindfulness and spirituality.

ROB DEFFENDALL -DIRECTOR OF RECOVERY SUPPORT SERVICESRob brings his 9 years of work in the recovery field and extensive involvement in the recovery community to Project Courage. Rob spent two years at Grant Street Partnership as a Residential Aide, five years at Turnbridge as a Case Manager and Support Staff Director while earning the title of 2014 Case Manager of the year, and previous to that, two years as Director of Residential Services at Westport House. Rob has over 10 years in sobriety, and is currently working on his CADC certification.

CHELSEA VERNI – RECOVERY COACHChelsea’s work is designed to support clients with their journey to recovery through goal setting, finding purpose, building community, and working on the client’s overall health. Chelsea utilizes her background as a certified yoga instructor by incorporating the philosophies she uses in her daily practice into her work here at Project Courage. She is currently working towards her BS in Psychology at Southern CT State University.

ANDREW LOCKE – RECOVERY COACHDrew initially went to college for business and finance. After two semesters he decided that staring at numbers all day was not for him. He switched to his other passion in life – psychology and helping others with their mental health. He graduated from the University of Connecticut with a BA in Human Development and Family Studies and began a career in different coaching and leadership positions. Most influential to Drew’s professional development was his time at Brian Gibbons Homeless Outreach in Waterbury, Connecticut which served as a raw introduction to substance use and specifically the opioid crisis. From there he moved on to a medical social work internship at Saint Raphael’s Hospital of the Yale New Haven Health network and once again was struck by the quantity of substance use cases he encountered. Drew is passionate about investigating the family dynamic in client’s lives as it plays a pivotal role in recovery. He takes pride in his assertive and honest leadership style, and knows that it takes observing the truth to effectively progress in life which he delivers to our clients and families

What Services does PROJECT COURAGE offer?Our goal is provide confidential, compassionate, and comprehensive services in one setting including but not limited to:

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Individual counseling Family counseling Group counseling Assessment Referral Support groups Advocacy Consultation Professional training

How does PROJECT COURAGE deliver its services?What follows is a description of how a typical progression in treatment might look. Extenuating circumstances may change this portrayal drastically, i.e. if an individual was in crisis, the clinical progression would look much different.

Outpatient Treatment (typically 1-3 hours per week):In the initial session at PROJECT COURAGE we will focus on completing an assessment. This can take anywhere from one to two hours. In addition to the initial assessment we will also have our clients meet with our consulting physician, so that he/she can also provide an additional screen for substance abuse and mental health. Upon completion of the assessment the professional at PROJECT COURAGE will compile an assessment summary and the client will be assigned a Primary Clinician. The Primary Clinician will arrange a time to meet with the client to review the assessment summary and other appropriate individuals (provided consent is given to do so). From here, additional appointments will be made and an action plan is developed in collaboration with the client, to address those issues that have brought the client to treatment. The action plan includes goals, objectives, and estimated timelines to achieve such goals. Additionally, the action plan may include frequency of appointments and the configuration of appointments (i.e. individual sessions, family sessions, group sessions, toxicology screens, or a combination of these). Outpatient sessions are typically forty-five minutes in length unless otherwise specified (family sessions at times will last 80 minutes, and some groups are longer as well). Finally, for clients who are receiving services at PROJECT COURAGE for reasons related to the use of substances, we require regular and random urine screens. Urine screening at PROJECT COURAGE is not meant to be, nor is used as a punitive measure, but rather as a means to provide a method of monitoring effectiveness of treatment and as a motivational tool for clients attempting to remain abstinent.

Intensive Outpatient Treatment (typically 15-17 hours per week):In many ways the initial intake process is similar for our intensive outpatient (IOP) clients. Once the assessment is completed our IOP clients are enrolled in our programming. They will attend groups for 9-15 hours per week, a one hour individual therapy session once per week, and if

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necessary receive medication management services. As with our outpatient services an action plan will be developed with the client, we will require our clients to meet with our consulting physician, and finally we will require random urine screens. Our IOP program typically lasts for 6-8 weeks, at which point many of our clients will enact a discharge plan that involves “stepping down” to outpatient level of care and remaining under the care of PROJECT COURAGE.

Recovery Support Services (community based treatment up to one year): Historically, treatment for substance Use Disorders (SUD) has been acute in nature resulting in short treatment duration with arbitrary timelines based on mandates by insurance reimbursement. More recently there has been a paradigm shift, and the behavioral health industry is coming around to acknowledging that SUDs are chronic in nature and like many chronic disorders (diabetes, hypertension, etc.) often require dramatic lifestyle changes. There are four domains that SAMHSA identifies as critical to develop for lasting recovery Health, Home, Purpose, and Community. To help our clients promote development in these 4 areas, Recovery Support Services at Project Courage offers up to a year of intensive case management. Clients in the Recovery Support Services program are assigned a Courage Wellness Team consisting of Recovery Coach, Registered Nurse, Therapist, and Psychiatrist. Our recovery coach and nurse will come to your home, to your community, to your coffee shop. We’ll use a variety of strategies to foster opportunities for recovery including urine screening, mobile application technology, transportation (limited to first month) and access to gym membership. Below is a breakdown of the minimum amount of hours spent in the community with the Recovery Coach and Registered Nurse.

Weeks 1 2-4 5-8 9-26 27-52R.C. 8-11 hrs Min of 4 hrs Min of 4 hrs Min of 2 hrs Min of 1 hrsNurse 2 hrs 1 hr 1x month 1 month 1x every 3

months

What theory base does PROJECT COURAGE employ?Developmental TheoryPROJECT COURAGE makes use of a developmental theory base. This means that we believe individuals develop emotionally, socially, physically, cognitively, morally, and spiritually over the course of their lives. Optimal development occurs when an individual’s genetic and biological make-up is well matched with his/her environment (i.e. family of origin, school, peer group, etc.). Certain variables in life—such as stress—can derail development and cause distress to the individual and those around him/her. For example, a boy who was repeatedly bullied throughout his elementary school years may not have developed socially and so as an adult struggles making connections with his co-workers. This understanding is paramount and guides PROJECT COURAGE in its considerations of causation, diagnosis, and treatment. In this sense we believe we’re offering “habilitation,” not rehabilitation by using evidence based treatment

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models forged for young people. Because we make use of a developmental model we believe in working the “whole” person rather than just pathologizing our clients.

Brain-In-Environment (BIE)With the onset of ever more sophisticated brain imaging technologies, the mental health field is viewing mental health and substance abuse disorders as physiologically based rather than psychologically based. PROJECT COURAGE engages with each client in regular practices to help optimize the functioning of their identified brain structures and specific brain pathways. Alcohol and drug abuse and dependence is viewed as a disease of the brain with behavioral consequences. Additionally, when possible all treatment is guided and informed by brain based research and findings.

Change TheoryChange theory assumes that all change in human behavior progresses through clear stages, and that it is significant to identify which stage of change an individual is in so that appropriate interventions can be selected. Different levels of change can be easily identified when working with individuals who are struggling with issues of substance abuse and/or mental health. For example, some clients feel their substance abuse, behavior, thinking, or emotion is not problematic, others feel it is problematic yet have no desire to change, and still others are ready to address their issue and begin the change process. Employing this model allows us to meet our clients at their level of change and avoid many of the pitfalls set up by other models that expect clients to fit into their concept of change.

Cognitive Behavioral TheoryCognitive behavioral theory (CBT), including rational emotive theory, has proven to be successful in the treatment of many mental health conditions. The assumption of CBT is that by identifying self-defeating behaviors and thoughts, one can then begin the process of replacing them with more productive thinking and acting. When used appropriately interventions from this theory base can empower clients by allowing them to take responsibility for their difficulties and effecting change in their own lives. A particular form of CBT that we employ at PROJECT COURAGE is Acceptance and Commitment Theory. This form of CBT shifts the focus away from controlling or avoiding problems and moves clients toward accepting that struggles are part of life. From here the client is aided in committing to living a valued life despite experiencing “life on life’s terms.” This paradigm shift dovetails nicely with the work our clients are engaged in not only with their mental health and substance abuse but also the Twelve Steps.

Systems TheoryPROJECT COURAGE also makes use of a systems theory base. Most of us interact with a family, work or school, a set of friends, etc. These constitute systems; thus, we have a family system, a school system, an occupational system, and so on. A systems model focuses more on the interactions between individuals and their correspondent systems. When we work with clients

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we’re often interested in how they interact with the systems in their lives, and what can be done to facilitate change via such interactions. So, if you are a parent of the individual receiving services do not be surprised if we would like to work with you in addition to your son or daughter.

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Program Rules

This is an excerpt from our client orientation handbook, which clients receive when they complete their initial assessment at Project Courage. We feel it is important that you are informed and made familiar with our program rules:

Learning to accept direction and individual responsibility are vital components of the recovery process. In this manner, we view the enforcement of our program rules as a therapeutic means rather than a punitive one. We will do our best to work with you and understand that the enforcement of disciplinary measures is stressful for both the client and staff. However, if your continued presence in the program will jeopardize the treatment of other patients or yourself, we will consider a noncompliant discharge.

As such, PROJECT COURAGE has the right to discharge a client who has become a behavioral problem, is noncompliant with facility rules, or violates specific rules related to possession or use of unauthorized substances, stealing, sexually acting out, violence or threats of such. The person responsible for bringing or referring you to PROJECT COURAGE will be notified of this action.

If you are discharged from our program because of noncompliance, than you may not continue to participate in group therapy, individual therapy, consultation or any other service provided by PROJECT COURAGE. Your therapist will offer a referral deemed appropriate by our staff and will assist you in following through on this.

Rules of conduct1. Do not have in your possession any mood altering chemicals and report any violations of

this rule to a staff member. The rules of the streets do not apply at PROJECT COURAGE; do not put yourself or others in harm’s way by withholding such information.

2. The following may be grounds for immediate noncompliant discharge: Possession or use of mood altering chemicals. Fighting. Sexual activity. Regularly engaging in: acts of intimidation, seductive behavior, destruction or

disrespect of property, abusive language and behavior toward peers or staff, or the ignoring of your treatment plan.

No sleeping during groups, individual sessions, psychoeducation sessions, etc. Do not work on school assignments in group, individual sessions, psychoeducation

sessions, etc. No electronics (cell phones, i-pods, etc.) in group therapy, individual sessions,

psychoeducation sessions, etc. No horseplay/roughhousing.

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No stealing. No gambling. No sexually explicit material (pornography). No cross talking or side conversations in groups. Do not leave group or individual sessions unless you absolutely have to (bathroom

breaks are available before, in-between, and after groups). No unauthorized absences from group or individual counseling. No selling, lending, or borrowing personal items to/from other clients. No drug or sex talk (war stories). No smoking outside designated areas. No chewing tobacco in groups. No cigarette butts outside of designated receptacles. Do not leave the premises without staff permission. No medications, aerosol cans, perfumes and colognes, mouthwash, hairspray, musical

instruments (unless previously authorized), razors, knives or any weapon of any sort. If you leave the program prematurely (against medical or clinical device) PROJECT

COURAGE has the right and obligation to inform your emergency contact of your decision and method of leaving.

Confidentiality of other clients must be upheld at all times. This means not releasing any information about another client without that client's permission. Violation of another person's rights or privacy can be grounds for discharge from the program.

In the event that the presence of substances or the use of substances is known or suspected to have occurred, PROJECT COURAGE reserves the right to search clients and their belongings at any time. All such searches will be conducted as deemed appropriate. Additionally, PROJECT COURAGE staff has a right to administer random toxicology screens to detect potential substance use. This includes random urine screens, hair follicle screens, saliva screens, and breathalyzer testing. By signing this agreement, you are authorizing PROJECT COURAGE to drug test you (the client) and to bill your insurance company if applicable.

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Additional Program Policies

Crisis ManagementFor the purposes of this policy, a crisis is defined as when an individual is seriously considering or has decided to hurt themselves or someone else.

In general staff are available during normal business hours. When the matter is urgent BUT NOT a crisis please call and if we are unavailable please leave a message. We check our messages throughout the day. For urgent matters we will make every effort to return your call within 24 hours from the time we receive your message, however no guarantees can be made. When you are meeting with your counselor please make arrangements with them regarding their phone availability. When your practitioner is away from the office for an extended period, such as at a training or on vacation, you may leave a voice-mail but please know the response time will be extended.

If you or the individual receiving services from PROJECT COURAGE is in a crisis, please make use of the following steps:

1. If the crisis is imminent you must call 911.2. If you believe there is enough time, you can call a mobile crisis unit:

You simply need to dial 211 to call the Connecticut Infoline. This service is available 24 hours a day, 7 days a week, 365 days a year. 211 is anonymous and will either refer you to an appropriate service or provide you with a crisis worker.

3. Call PROJECT COURAGE after you have employed step 1 or 2 above. If you get our voice mail leave a detailed message indicating what has happened and where we can reach you.

Goal SettingWhen individuals enter treatment they often desire certain results. There are often significant others who also are hopeful for certain goals to be accomplished. Finally, the practitioner may feel a particular outcome will be best suited for the individual receiving services. Usually, there is cohesion between each of these goal sets. Unfortunately at times there is not. We will work to achieve consensus regarding treatment goals. This may include the recommendation of a goal by the practitioner. However, when a triangulation of goals occurs please know that it is the individual receiving services whose goals need to be primary, except when to do so would result in injury to themselves or others.

Working with Primary Care Physician or PediatricianWhether an adult or a child/adolescent is receiving services we request that you inform your general practitioner about receiving services from PROJECT COURAGE. It is important that our

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clients meet with their doctor and have a blood screen administered to rule out the impact of any physiological conditions on their mental health. Additionally, a doctor may be able to provide needed insight and expertise, and make referrals for needed services such as a neurological exam.

For Divorced Parents of a Child Receiving ServicesIn order to best serve your child it is imperative that both biological parents are aware that your child is receiving counseling from PROJECT COURAGE. Thus, if you are bringing your son/daughter to PROJECT COURAGE please inform his/her other parent that you are doing so. In rare instances such as the threat of physical abuse and/or substance abuse issues from the other parent the enactment of this policy may be postponed.

Please have payment ready at the beginning of each session. If both you and the other parent are responsible for healthcare costs please determine who will be responsible for payment prior to engaging in treatment, and make arrangement to have the payment ready at the beginning of each session. Failure to do so will result in billing and collections procedures as detailed in the financial agreement.

Emphasis on CollaborationAs detailed previously, Project Courage makes use of systems theory. As such, it is essential that collaboration occur between the practitioner and the different systems in the client’s life. Please do not misunderstand, we will hold the protection of our clients’ privacy to the highest standards. However, we also want to provide the most efficient and effective service delivery. Please be willing to allow us to contact individuals who play a significant role in our clients’ lives. Examples might include, other providers (doctors, specialists, etc.), representatives from school systems, and representatives from the judicial system. Please know that ultimately this is our clients’ decision and in order to talk with any individuals a release of information form must be signed. Finally, when we speak with individuals pertinent in our client’s life please do not expect us to withhold any information or be dishonest with any of these individuals.

Use of SpiritualitySpirituality and spiritual concepts ought not be confused with religion. For our purposes we define spirituality as a way of finding meaning, hope, comfort, and inner peace. For some, these things are fulfilled through religion, however others may employ other avenues such as music, art, a connection with nature, or living by values. Some research suggests that the strength and comfort gained from prayer, meditation, and/or religion can contribute to healing. Historically in our culture the fields of mental health and spirituality have not intersected. Recently however, this seems to be changing. At PROJECT COURAGE we may employ spiritual principles or techniques to try and promote mental health. Please provide us with honest and accurate feedback so we can be respectful of your preferences regarding spirituality.

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Sign-off Sheet

All Inclusive: PROJECT COURAGEI (We) certify that I (we) have received a copy of, read, understand and agree to the conditions as described in the above document in its entirety.

Person(s) receiving services: Print

Significant Others: Print Sign Date

Print Sign Date



For Office Use Only

I attempted to obtain written acknowledgement of receipt of Family Member and Significant Other Handbook detailing agency policies. Acknowledgement could not be obtained because:

Individual refused to signCommunications barriers prohibited obtaining the acknowledgementAn emergency situation prevented us from obtaining acknowledgementOther (Please Specify):

______________________________________________________________________________

______________________________________________________________________________

Name and Title of Individual Completing:___________________________________________

Signature: ____________________________________________________________________



EMAIL AND TEXT POLICY

I, ________________________, (patient/guardian) hereby voluntarily provide my email and cell telephone number to Project Courage (hereinafter, “Practice”).

I agree to permit Practice and their Authorized Representatives to communicate with me by e-mail and text message with respect to the medical claims submitted to my health plan and with respect to any balances due to Practice after health plan and other payments received by Practice and for balances not covered by my health plan, coinsurance, deductibles or any other balance deemed client responsibility.

To be clear, I am consenting to communication by email as required by 15 U.S.C. §7001 and related state regulations and statutes. I understand that I have the option to receive any communication on paper or non-electronic form. In such case, I will notify Practice in writing of this request. I understand that my consent is continuous. However, I understand further that I may terminate my consent to e-mail communication in writing to Practice. There are no hardware or software requirements needed to receive e-mail communication from the Practice or their authorized representatives other than an active e-mail account obtained from a vendor that provides such e-mail accounts.

I understand Practice and their Authorized Representatives will not sell, share, or rent my e-mail address or any other personal information collected on this consent.

Date: _________________________________

Email address: ____________________________

Cell phone #: _____________________________

Patient/Guardian Signature: __________________________



Family and Significant Other Handbook file · Web viewWe realize that it’s likely been a “hard...

Documents

Transcript of Family and Significant Other Handbook file · Web viewWe realize that it’s likely been a “hard...