Annette Escalante, MSW, MLADC Vice President

2. Annette Escalante, MSW, MLADC Vice President

3. 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.

4. 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.

5. Southern NH HIV/AIDS Task Force • Milford Regional Counseling Services • Welcoming Light • Harbor Homes • Healthy at Home • Keystone Hall

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

7. Outpatient Services • Substance use disorder/dual diagnosis assessments & evaluations • Adolescent Outpatient Program • Gender specific intensive outpatient program • Individual and group counseling • Impaired driver intervention and aftercare • Prevention services • Recovery maintenance and aftercare • All services available in Spanish • No appointments needed

8. Programs Offered in Residential • Detoxification • Transitional Housing • Cynthia Day Family Center • 90 Treatment for Co-Occurring • 28 Day Treatment Program for Co-Occurring • All clients in the residential communities receive mental health counseling as part of their treatment.

9. Detoxification • 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.

10. Residential Services Client Detox 28 day 90 day TLC CDFC

11. Harbor Care Wellness Center • Psychiatry • Primary and preventive health care to anyone over 15 years old • Low Income • No Income • No Insurance • With private insurance – Harvard and Anthem Blue Cross • Insured by Medicaid/Medicare • Homeless or at Risk of Homelessness

12. Why are we here?

13. 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

15. Appropriate treatment? • Assessment/evaluation for both substance abuse and mental health • Severity of detoxification • Severity of mental health disorder • Medication compliance • Medication assisted treatment • On going psychiatric care • Criminal record • Family system

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

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

20. 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 glance down at the sidewalk and there, in the hardened cement, was scrawled the message: “Expect a miracle!”

21. 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

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

23. Services provided at CDFC • Substance Abuse • Psychiatry • Parenting • Medical • Trauma • Domestic violence • Life skills • Housing • Educational/Vocational • Financial • Legal

24. Challenges • 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.

25. Adverse Outcomes • Numerous health and social problemsrequiring costly care• Risk for homelessness and incarceration• Women are at risk of being victims ofsexual abuse and domestic violence• Parents with co-occurring problems riskencounters with child welfare

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

27. Integrated Treatment Essential for consumers who are significantly impaired by both kinds of disorderEssential for consumers whose mental disorder interferes with treatment of their substance use disorderEssential for consumers whose substance use disorderinterferes with treatment of their mental disorder

29. Common Factors of MentalIllness and Substance Abuse • Brain disorders • Lack of insight • Chronic • Impacts family • Shame and guilt • Require treatment

30. 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

31. Integrated Dual Diagnosis Treatment (IDDT) Jaime Gormley LICSW, MLADC Lindsay Herdman, MSW

32. Integrated Dual Diagnosis Treatment (IDDT) Assist persons with both a severe mental illness and a serious substance abuse problem.

33. Integrated Dual Diagnosis Treatment (IDDT) • Multidisciplinary Team • Integrated Substance Abuse Specialist • Stage-Wise Interventions • Access for IDDT Clients to Comprehensive DD Services • Time-Unlimited Services • Outreach • Motivational Interventions • Substance Abuse Counseling

34. Integrated Dual Diagnosis Treatment (IDDT) • Group DD Treatment • Family Education and Support on DD • Participation in Alcohol & Drug Self-Help Groups • Pharmacological Treatment • Interventions to Promote Health • Secondary Interventions for Substance Abuse Treatment Non-Responders • High intensity services

35. Client stories

36. Questions

38. PRIZES