Annette Escalante, MSW, MLADC Vice President

Annette Escalante, MSW, MLADC Vice President Annette Escalante, MSW, MLADC Vice President - Start

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Annette Escalante, MSW, MLADC Vice President

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Annette Escalante, MSW, MLADC Vice President


Keystone Hall is a non-profit organization that provides comprehensive residential and outpatient substance use disorder treatment, prevention, and recovery supports to New Hampshire community members, including men, women, adolescents and families.


Keystone Hall is a member of the Partnership for Successful Living. A collaboration of six affiliated not-for-profit organizations providing southern New Hampshire’s most vulnerable community members with access to housing, health care, employment and supportive services.


Southern NH HIV/AIDS Task Force Milford Regional Counseling Services Welcoming LightHarbor Homes Healthy at HomeKeystone Hall


All programs at Keystone Hall are evidence-based, gender-specific, culturally competent and follow a recovery oriented systems of care model.



Substance use disorder/dual diagnosis assessments & evaluationsAdolescent Outpatient Program Gender specific intensive outpatient program Individual and group counselingImpaired driver intervention and aftercarePrevention servicesRecovery maintenance and aftercareAll services available in SpanishNo appointments needed

Outpatient Services


DetoxificationTransitional HousingCynthia Day Family Center90 Treatment for Co-Occurring28 Day Treatment Program for Co-OccurringAll clients in the residential communities receive mental health counseling as part of their treatment.

Programs Offered in Residential


Clients stay between 3-5 days Clients come in detoxing from all substances to include alcohol, opiates, cocaine, marijuana, prescription medication, etc.Awaiting license for medical detox unit.



Residential Services


28 day




90 day


PsychiatryPrimary and preventive health care to anyone over 15 years oldLow IncomeNo IncomeNo InsuranceWith private insurance – Harvard and Anthem Blue CrossInsured by Medicaid/MedicareHomeless or at Risk of Homelessness

Harbor Care Wellness Center


Why are we here?


Substance Abuse Costs Our Nation More than $484 Billion per Year

The Costs of Drug Abuse are as Substantial as that of other Chronic Conditions:

Diabetes costs society $131.7 billion annually

Cancer costs society $171.6 billion annually



Assessment/evaluation for both substance abuse and mental health Severity of detoxificationSeverity of mental health disorderMedication compliance Medication assisted treatmentOn going psychiatric careCriminal recordFamily system

Appropriate treatment?




The Cynthia Day Family Center is funded by the NH DHHS/Division of Community Based Care Services, Bureau of Drug and Alcohol Services.



Pregnant Post Partum Woman & Infants and Parenting Women with ChildrenThe Center is designed to provide a holistic, family centered approach to the treatment of women while allowing them to care for their young children.

Cynthia Day Family Center


For the past 25 years, Cynthia Locke Day has been known as

the lady who wears sparkles in her hair.” Once the Vice

President of IDAK Corp, and a supervisor of 27 medical

facilities, Cynthia’s life became consumed by alcoholism and her marriage ended in divorce. Within two years, Cynthia was unemployable. Down to her last $10, she happened to glancedown at the sidewalk and there, in the hardened cement, was scrawled the message: “Expect a miracle!”


Our dual program offers a unique and comprehensive approach in the treatment of chemical dependency and psychiatric disorders.recognizes that many of our patients suffer from a variety of psychiatric and psychological problems


Must be over 18 years old.Primary diagnosis must be substance abuse.Family reunification.NH resident.Pregnant woman get priority.

Overview of CDFC


Substance AbusePsychiatryParentingMedicalTraumaDomestic violenceLife skillsHousingEducational/VocationalFinancialLegal

Services provided at CDFC


Mental health issues surface after client has been abstinent.Mental health diagnosis is inaccurate. (Bath slats, meth).Medical issues during pregnancy.Primary caregiver of children.Children’s issues.



Adverse Outcomes

Numerous health and social problems

requiring costly care

• Risk for homelessness and incarceration

• Women are at risk of being victims of

sexual abuse and domestic violence

• Parents with co-occurring problems risk

encounters with child welfare


Studies in substance abuse settings have found that from 50% to 75% of consumers had some type of mental disorderStudies in mental health settings have found that between 20% 50% of their consumers had a co- occurring substance use disorderExperts in this field assert that co-occurring disorders should be the expectation, not the exception in any behavioral health care setting

Prevalence of CODs in treatment



Integrated Treatment

Essential for consumers who are significantly impaired by both kinds of disorder

Essential for consumers whose mental disorder interferes with treatment of their substance use disorder

Essential for consumers whose substance use disorder

interferes with treatment of their mental disorder



Brain disordersLack of insightChronicImpacts familyShame and guiltRequire treatment

Common Factors of Mental

Illness and Substance Abuse


Why focus on dual disorders?

• Substance use disorders are common in

people with severe mental illness

• Mental illness is common in people with

substance use disorders

• Dual disorders lead to worse outcomes and

higher costs than single disorders


Jaime Gormley LICSW, MLADCLindsay Herdman, MSW

Integrated Dual Diagnosis Treatment (IDDT)


Assist persons with both a severe mental illness and a serious substance abuse problem.

Integrated Dual Diagnosis Treatment (IDDT)


Integrated Dual Diagnosis Treatment (IDDT)

Multidisciplinary Team

Integrated Substance Abuse Specialist

Stage-Wise InterventionsAccess for IDDT Clients to Comprehensive DD Services

Time-Unlimited Services


Motivational Interventions

Substance Abuse Counseling


Integrated Dual Diagnosis Treatment (IDDT)

Group DD Treatment

Family Education and Support on DD

Participation in Alcohol & Drug Self-Help GroupsPharmacological Treatment

Interventions to Promote Health

Secondary Interventions for Substance Abuse Treatment Non-Responders

High intensity services


Client stories








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