SSTAR’s Enhanced Partial Hospital Program - PowerPoint Presentation

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SSTAR’s Enhanced Partial Hospital Program

Julie Sanders, LICSWjsanders@sstar.org508-235-7082

GOALS FOR TREATMENT

SCREENING TOOLS WE ADMINISTER GAD 7 Measures Anxiety levels PHQ 9 Measures Depression levels PCL 5 Measures Post Traumatic Stress symptoms – used at the VA

Divert individuals from higher cost and less effective care in emergency departments and inpatient psychiatric hospitalizations

Improve functioning – measured at admission, discharge and 30 days post discharge with standardized screening tools.

Improved long term recovery, with less use of inpatient or Emergency Departments for crisi

s or relapse.

WHAT MAKES US ENHANCED? Access to 24/7 DBT phone coach

to ensure diversion from ED or higher level of care if possible Acupuncture – NADA auricular protocol offered as well as very popular acupressure groups to teach clients how to self-regulate Lab work available on site- performed as needed before prescribing medication- with full access to our Community Health Center Primary Care Physicians. The only PHP in Massachusetts that offers on site Medication Assisted Treatment (MAT) including

Sublocade

and Vivitrol injections as well as Buprenorphine prescription.

Inclusion Criteria - Patients must be at least 18 years of age

- Patients must have a mental health diagnosis and may also

have a substance use disorder diagnosis; patient cannot only

have SUD

- Patients must be in some level of acute stage of illness that cannot

be managed in a traditional outpatient setting. We are a

diversionary level of care- designed to keep clients out of ER’s and inpatient level of care.

- Patients should be able to maintain safety in the community

- Patients with non-suicidal self injury (NSSI) are welcome

- Patients

must not meet Section 12 criteria (no imminent risk to self or others)

- Patients must not have withdrawal symptoms that require medical management (ex: seizures)

- Patients must not require Eating Disorder-Specific treatment

- Patients with acute psychosis or mania will be determined on a case-by-case basis prior to admission

Exclusion Criteria

EPHP Schedules Telehealth Home Schedule

9:00 am-2:30

9-10am

Daily Check-in and Mindfulness

10-10:45am

Acupressure Group

11-11:45am

DBT Expressive Therapy Group

12-12:45pm

Recovery Group

12:45-1:45pm

Lunch

1:1 F

ollow up with Psych (2x weekly) Therapy (1x weekly)/Case Management as needed  1:45-2:30pmWrap up Group/ Building Positive Experiences

Day 1 In Person Schedule 8:45am-2:30pm

8:45-10am

COVID-19 Rapid Test,

EPHP Intake

10-10:45am

Acupressure Group

11-11:45am

Psychiatric Intake

12-12:30pm

MAT Evaluation

(as needed)

12:30-1pm

Lunch

1-1:45pm

Private Acupuncture/

Acupressure

2-2:30pm

Orientation to DBT and ZOOM

Dialectial Behavioral Therapy (DBT)

Effectiveness of dialectic behavioral therapy in routine ...

www.ncbi.nlm.nih.gov

 › 

pmc

› articles › PMC4579507

by C

Stiglmayr

 · 2014 · Cited by 31 — 

DBT

 has proven especially effective in reducing self-

injuriousbehavior

, suicide attempts and inpatient treatment days. It should also be noted that treatment with DBT showed a marked reduction of disorder-related direct and indirect monetary costs [14–17]. 

Dialectical Behavioral Therapy (DBT)

WHY DBTThe premise of DBT is that when we know how to do things better (more skillfully) we will. DBT is a skills- based therapy focused on the client becoming their own behaviorist – tracking their moods and urges and learning and practicing skills to manage these urges.

Well researched as effective for many mental health disorders as well as addictions.

SSTAR now has a comprehensive DBT program to refer clients upon discharge. We have 2 active 2 hour-weekly DBT skills groups and 1:1 DBT clinicians for clients with high-risk behaviors. We have a DBT consultation team that meets weekly to ensure compliance and prevent burn out for clinicians.

HOW WE IMPLEMENT

DBT diary cards given at day 1 of intake. Clients complete each day and share intense emotions or urges from the night before during morning check in group.

Diary cards are reviewed in 1:1 therapy and are reviewed by prescriber to inform prescribing practice.

Daily DBT groups focused on Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness, and Skills when the Crisis is Addiction (rotating daily).

Access to 24/7 DBT phone coaching by one of our trained DBT clinicians. Designed to divert from ED, or ESP provider.

SSTAR’s EPHP

DEA Controlled Substances Policy

“The EPHP is committed to utilizing evidenced based therapies to treat those with co-occurring mental health and substance use disorders. As subscribers to the dialectical behavior therapy framework, we teach individuals to tolerate distressing emotions with specific skills and practices that work, over time, to reduce suffering and increase confidence.

SSTAR is currently working to address issues with prescription of controlled substances. In general, this effort focuses on

dealing with the long-term use of medicines with habit forming potential, the use of high dosages of medications, and the use of medications outside of their FDA approved conditions or recommendations

.  Examples of these medicines include: 

Benzodiazepines

: Used for anxiety disorders and insomnia. Examples are 

Alprazolam, clonazepam, lorazepam, diazepam, flurazepam, temazepam

, and others. 

Insomnia medicines

: Examples are zolpidem, eszopiclone, zaleplon and others.  Stimulant medicines: Used for Attention Deficit/Hyperactivity Disorder. Examples are Dextroamphetamine/amphetamine, methylphenidate, lisdexamfetamine and others.  Gabapentin: Used (off label) for anxiety disorders.  Prescribers at the EPHP aim to minimize the use of the above medications, favoring the use of medications and coping skills that address long-term symptom control.

Gabapentin will not be started for psychiatric purposes at the EPHP. If your non-SSTAR prescriber treats you with these medications, we will continue them at their current doses, while teaching you techniques that will help you use these medications less in the future.

If you continue your treatment in the SSTAR Ambulatory Behavioral Health department, the above medications will likely be tapered gradually on an individual basis.

Please be prepared to discuss these issues with your EPHP care team. We have your health, safety and best interests in mind and seek to make an individualized plan.” 

Covid-19 Safety Guidelines

SSTAR and EPHP are committed to the highest standards to maintain health and safety during the pandemicPatients will complete a rapid COVID test onsite on the first day of treatment prior to intake and groups

Only 1 client per day will be onsite at EPHP to ensure maximum physical distancing

100% of EPHP staff has been vaccinated against Covid-19 and are tested frequently

Facemasks must be worn at all times by staff and patients unless eating or drinking

High level HEPA air filtration units are running 24/7 in every room of EPHP

Surface cleaning is performed regularly with p

articular attention paid to cleaning high touch surfaces frequently

Disinfectant wipes and hand sanitizer are stationed in every room and hand washing sinks are available in 2 areas of EPHP to encourage hand hygiene

CCBHC

*Start-up funding for this program was provided through our SAMHSA CCBHC grant.

* The CCBHC grant has enabled SSTAR to meet the standards required to become a Certified Community Behavioral Health Clinic and the innovative new EPHP is one of the ways we are

achieving the access and integration standards associated with the CCBHC initiative.

*We are in the final year of this grant and

will need state public and private insurance reimbursement either through traditional contracts, or as an innovative demonstration project to document improved outcomes with this integrated model.

*There is federal legislation pending to support a national CCBHC initiative. A

dditional federal funding and state action to adopt CCBHCs in Medicaid would be needed to permanently sustain the CCBHC model.

Referrals

To make a referral, please use our online referral form at SSTAR.org under outpatient services

Julie Sanders will follow up on all referrals within 24 business hours with client and or referral source

Referral Questions to

jsanders@sstar.org

or call (508) 235-7082

Additional Questions?

EPHP STAFF

Julie Sanders, LICSW, Program Director EPHPDr. Michael Halassa, Psychiatrist, Medical Director EPHP Katherine Serra, PMHNP, Psychiatric Nurse PractitionerKimberly Johnson, LMHC, MT-BC (Music Therapy Board Certified)Doreen Cunha, LADC IIMary Spencer, M.Ac.O.M., Licensed Acupuncturist (Lic.Ac.)

Robin Maccini, Administrative Assistant