NEWS

Exciting Developments in Detox and Co-Occurring Disorders Treatment at Fairfax

Treatment has intensified and the number of beds has expanded at Fairfax for patients admitted for detox and co-occurring disorders (psychiatric and substance use disorders). The three primary psychiatrists treating these patients are certified in addiction medicine or addiction psychiatry. The Program Manager and the Clinical Therapists on the unit are Master’s level mental health professionals with extensive training and experience in COD and chemical dependency treatment. Several of the staff are CDPs or CDPTs. The nursing staff receives ongoing training in working with patients with mental health and chemical dependency issues.

All this translates to more effective treatment. Patients attend several primary treatment groups each day. In addition, there is a Goals Group each morning, 7 days a week, led by the Clinical Therapist, and a wrap-up group in the evenings led by nursing staff. In these two groups, patients are assisted in developing goals related to their treatment plan and then reviewing progress toward these goals.

A theme gives focus to each day for patients and staff. These include Understanding Your Diagnosis, DSA (the Developmental and Systems Approach created by Fairfax MD Charles Wang), Grief and Loss, DBT (Dialectical Behavioral Therapy), Interpersonal Relationships (Self and Others), Self Care, and Aftercare. Treatment groups incorporate this theme of the day in establishing their recovery plan.

In the psycho-educational groups, the Clinical Therapist will educate group members on drugs and alcohol and how these substances interact with mental illness and with medications. As needed, there will also be education on mental disorders, such as anxiety disorder, frequently present in chemically dependent individuals.

The Skills Group led by the Clinical Therapist teaches individuals the skills needed to help them cope with uncomfortable emotions without the use of drugs and alcohol. The Process Group, facilitated by the Clinical Therapist or Program Manager, gives members the opportunity to discuss what they are experiencing.

Detox at Fairfax can be for alcohol or drug dependency. The primary medication utilized to help the patient during the alcohol detoxification process is Serax (Oxazepam), rather than Librium and Valium, due to liver metabolism issues that can arise from these two drugs. For opiate detoxification, a combination of Clonidine, Baclofen and Bentyl is used to mitigate withdrawal symptoms. Suboxone is frequently used to modify withdrawal symptoms or to start on maintenance when indicated and adequate follow-up can be put into place.

Fairfax Hospital's inpatient programs for substance abuse are focused on short-term detoxification and stabilization for individuals with chemical dependency and those who suffer from co-occurring disorders. We then refer patients to many of the Intensive Outpatient Programs in our community for further treatment to assist them in their recovery process. Discharge planning may also include mental health outpatient treatment — a psychiatrist or psychiatric nurse practitioner for management of psychiatric medications and a therapist to help the individual with mental health issues.

Enhanced Weekend Programming Getting High Marks

Fairfax Hospital has restructured the Social Services Department, implementing a number of programmatic and staffing changes which are designed to provide patients with the best possible treatment experience. Fairfax is committed to patient-centered care, and has enhanced its seven-day-a-week programming. The program schedule on weekends will more closely resemble the schedule on weekdays, with the core, structured groups and staff-supervised activities. These typically include a community meeting, goals group, psycho-educational group, skills development, and a process group. To achieve this more therapeutic treatment model, the staffing pattern has been modified to have Clinical Therapists working on weekends. With acute psychiatric hospitalization being a relatively short length of stay, it was important to achieve a more consistent, 7-day/week program. A patient admitted on a Thursday or Friday can now expect to receive the same quality treatment experience as the patient admitted on a Monday. Within the first 24 hours in the hospital, the patient will be engaged in treatment by a Psychiatrist and by a Clinical Therapist.

The role of Clinical Therapist is new at Fairfax, transforming the previous position of Case Manager by adding more group facilitator responsibilities. The Clinical Therapist plays a key role in the interdisciplinary treatment team model, and is involved in initial assessment, treatment and discharge planning, family contact, and coordination with the patient’s providers in the community. It is a role most often associated with Social Workers in the hospital multidisciplinary approach. To achieve this expanded clinical function of group facilitation, Fairfax has created the complementary position of Discharge Planner to assist the Clinical Therapists in linking the patient with community resources.

Fairfax established its clinical reputation in the community in large part through its emphasis on grouporiented treatment as a major element in the treatment process. Group facilitators include Nurses, Program Specialists, Occupational Therapists, and Chemical Dependency Professionals, in addition to the Clinical Therapists. Though the more primary function of inpatient treatment is symptom stabilization, patients often comment on the new skills they learned in groups at Fairfax, when describing their experience to their outpatient Psychiatrists and therapists.

The initial reaction of family members to the new program model and staffing pattern has been very positive. Being able to communicate so quickly and easily with a Clinical Therapist, and getting the needed information about treatment, has reduced the family’s anxiety and apprehension. Families who have had prior experience with a weekend admission, at Fairfax or another hospital, are noticing the difference and expressing their appreciation. These changes represent an example of Fairfax Hospital’s commitment to improving customer satisfaction and achieving excellence in behavioral healthcare.

Fairfax Reconfigures in Response to Changing Needs

Over the past year, Fairfax has seen significant changes in demand for service in each of the programs: Adult, Youth & Adolescent and Chemical Dependency. Throughout 2008, demand for adult beds far surpassed availability. During the summer months, nearly as many patients could not be admitted due to lack of available beds as were admitted – particularly for adults, notably for the most acute adults. At the same time beds in the Youth and Adolescent Unit went unused.

In an effort to better meet demand for services, the hospital embarked on an ambitious remodel and reconfiguration project during the summer of 2008. This enabled Fairfax to provide greater flexibility in unit configurations as demand changed.

Fairfax remains the largest private provider of Inpatient Psychiatric services in the State of Washington, with a total of 101 beds for Adults, Adolescents and Youth. The layout of the hospital provides space for separate inpatient programs within the hospital for Adult, Youth & Adolescent Services and Chemical Dependency.

Currently, Adult Services is divided into two separate units: Adult General and Adult Acute Care. Separation of these two milieus provides a better treatment environment and ensures that treatment programs are geared to the needs of the patients. At Fairfax, the distinction between the two programs is based on the patient’s ability and readiness to engage and take responsibility for their own recovery.

Chemical Dependency Services including both Medical Detox and Co-occurring Mental Health and Substance Abuse have also expanded into a separate program unit. As with other programs, the separation ensures that we are able to meet the needs of this unique patient population.

While demand for Youth and Adolescent Services has declined in past months, Fairfax continues to offer programming for this population, with the ability to increase bed numbers if necessary. In the coming months, as additional remodeling projects are completed, Fairfax will be better able to remain responsive to the needs of our community and support the programming needs of our patient population.

Family Involvement Encouraged during Fairfax Hospitalization

Family involvement in treatment during hospitalization at Fairfax is an important experience for the family members as well as the patient. In some instances, this begins during the admission process when family is directly involved in the referral and brings the patient to the hospital. In most instances, patients will be asked to include family members on a Release of Information form. This enables staff to communicate with the patient’s family, and involve them as indicated in treatment and discharge planning. It also ensures that family members receive information regarding available family educational programs.

The Support and Education Group for families is a one-hour weekly meeting available on a drop-in basis for family members of a patient currently hospitalized at Fairfax. The main purpose of the group is to create a supportive environment where families can gain knowledge about mental illness and treatment. Families often benefit from the opportunity to meet others who are experiencing similar issues, such as feelings of isolation, and stigma. The group is facilitated by a Case Manager who will provide an overview of the goals of hospitalization, the various levels of care at Fairfax (e.g. Partial Hospitalization, Chemical Dependency Intensive Outpatient), and education on the treatment process at Fairfax. The facilitator can also recommend community resources, such as National Alliance on Mental Health (NAMI), for additional or ongoing support to the family. Specific questions regarding their hospitalized patient will be re-directed to that individual’s Case Manager and/or Psychiatrist.

This group, now available to all families with a patient hospitalized at Fairfax, evolved from the previous Support Group for families of patients in our Youth and Adolescent Program. The change was initiated by Ron Escarda, CEO, with our new Case Management Director, Shahzina Karim, as it was apparent that the families of adult patients also needed support and education. Family members sometimes have the expectation that family therapy will be offered at the hospital, but in the short stay of acute hospitalization this would not be appropriate.

Psycho-education can be most beneficial for the family, just as psycho-education is a major treatment approach with our patients, who learn skills to better manage symptoms and crises. When family therapy is desired and indicated, this will be part of the discharge plan, with recommendations and referrals to therapists in the community.

The Support and Education Group meets every Wednesday at 4:00 PM at Fairfax. For information, contact Shahzina Karim at (425) 821-2000, x6086. For other family members, or friends, in need of similar help, NAMI Eastside has a Family Support Group which meets at Fairfax Hospital on the first Tuesday of each month at 7:00 PM.