AllBetter

Navigating Mental Health and Substance Abuse: Family, Care, and Community Connections

• Joe Van Wie • Season 4 • Episode 82

Share episode

Discover the profound complexities of mental health and substance abuse treatment through our enlightening conversation with Shana Stefanik and Dylan Fredricey from STR Behavioral Health. Together, we explore their impactful journeys, the critical role of Cedar Crest—an essential residential facility—and the nuanced challenges of addressing substance use disorders. Dylan’s recent academic triumphs and the extraordinary potential of AI in modern care are also key highlights.

Join us as we navigate the intricate terrain of family boundaries in mental health treatment, especially for those struggling with both mental health and substance use disorders in Pennsylvania. We discuss the tough decisions families face when local options fall short and the importance of family involvement in recovery. Discover how facilities like Silver Pines and Cedar Creek provide a crucial continuum of care, ensuring integrated treatment solutions that truly address the multifaceted needs of patients.

Finally, we delve into managing high-acuity cases in smaller, focused environments such as Cedar Creek, emphasizing the importance of reducing stigma and ensuring frequent patient monitoring. Learn about the vital role of cultural competence in treating diverse populations, particularly the LGBTQ+ community, and the positive impacts of community engagement initiatives like the NEPA Pride Coalition. With exciting developments such as the upcoming outpatient facility in Lancaster, this episode underscores the pivotal importance of comprehensive, compassionate care in the mental health landscape.

For more Info on STR;
https://stepstorecovery.com/get-help/?gad_source=1

Give us a Review!

📢 **Announcement!** 📢. We want to introduce our new 24-hour, 7-days-a-week hotline for crisis or substance use treatment. Whether you are seeking help for the first time or are an alum in need of immediate assistance, our team is here for you around the clock. 📞 **Call 1-800-HELP-120 anytime, day or night.** #ScrantonRecovery #ScrantonRecovery #ScrantonRecovery Support the show


Stop by our Apple Podcast and drop a Review!

https://podcasts.apple.com/us/podcast/allbetter/id1592297425?see-all=reviews


Support The Show
https://www.patreon.com/allbetter

Speaker 1:

Hello and thanks again for listening to another episode of All Better. I'm your host, joe VanWee. Today's guest I have Shana Stefanik Technotronic. I don't know why I said that, but Shana is the Director of Business Development at STR Behavioral Health. She's also accompanied by Dylan Fredrisse. This is Dylan's second time on All Better.

Speaker 1:

Dylan is the Regional Director of Clinical Partnerships at STR Behavioral Health, which stands for Steps to Recovery. Shana is the Senior Regional Director of Clinical Partnerships and a woman in long-term recovery Working in the treatment field. She has allowed her to help those who battle with substance use disorder get their life back and enjoy living. She's a mom of two, with a 16-year-old son and a 15-year-old daughter. When she's not helping people get into treatment, she's either at the motocross track with her son or dance competition with her daughter. She always says her disease disorder has been her greatest gift. Now that she's recovering from it wants everyone to experience the same and if you remember Dylan, dylan was here about a year and a half ago two years ago and told his story.

Speaker 1:

Dylan was born in San Diego, california, where he spent the majority of his first 30 years Moving to NEPA region in about 2018. Years moving to NEPA region in about 2018. As a person in long-term recovery, dylan understands the importance of social connectedness and community. Beginning his journey in sobriety, dylan volunteered at an HIV AIDS service organization, aiding individuals and accessing life-sustaining medications and community support services. Inspired by this experience, he returned to school and, in 2018, graduated with two associate degrees in social work and social behavioral sciences. In 2020, dillon graduated from Penn State with his bachelor's degree in rehabilitation and human services Services, while maintaining a 4.0 GPA, earning the Luzerne County Council an Adult Higher Education's Outstanding Adult Learner of the Year Award. Dylan also, this spring, 2024, just graduated from Marywood University with a Master's in Social Work.

Speaker 1:

Since arriving in Pennsylvania, dylan has worked in a variety of positions in the drug and alcohol field, including three and a half years serving as a family counselor at a local detox and residential facility. In 2023, dylan transitioned into business development, serving as the director for a startup outpatient provider until March 2024. Driven by a passion for community service, dylan founded the NEPA Pride Coalition, a local nonprofit leveraging his lived experience to advocate for the LGBTQIA community through education, awareness and facilitating access to affirming services. He acknowledges in all his work the higher rates of substance use and mental health conditions among sexual and gender minorities and is dedicated to making a positive impact in this space, and he has tremendously has tremendously.

Speaker 1:

Today, both of them come here to speak on an opening of a mental health residential facility that was much needed in our area, cedar Crest. We get to talk about that. We talk about having substance use disorder as a primary or a secondary condition and what those distinctions are. We talk about staffing and clinical modalities and approaches when having substance use disorder and mental health being primary or secondary and how to separate those. We have a few other topics on hand, but I'm excited for you to meet Meet Shana and Dylan Guys. Thanks for coming in. The Silver Pines train is here. We have arrived. I'd like to welcome you guys. I just gave you a flattering intro that I didn't write yet it was beautiful.

Speaker 1:

Thank you Heartfelt. I'll lift it from Silver Pines. Is it SilverPinesTreatmentCenterscom? Silver Pines Recovery.

Speaker 2:

SilverPinesTreatmentC centerscom. Silver pines recovery Silver pines treatment centercom.

Speaker 1:

Yeah, so that's where I'm going to find your bios.

Speaker 2:

Oh God, mine's so outdated.

Speaker 1:

I have Dylan's. I'll add more to it, I'll make it. I'll make it sound great it already happened.

Speaker 3:

Dude, the bio is amazing.

Speaker 2:

My bio is terrible. Maybe I'll have you write mine Mine's really outdated, or you could just use AI.

Speaker 1:

Yeah, or we're just going to become AI by the end of this show. We'll wake up. We'll have a new awakening that we're really just artificial.

Speaker 2:

I'm afraid to start using AI because I will absolutely become dependent on it.

Speaker 1:

You already are. Yeah, I don't even realize it, just jump on the train.

Speaker 1:

Your voice will be. You go through an AI transcript program before this ends. It'll give you my title cards. It'll equalize the sound. It takes seconds. It's crazy. Listen to this. Tell me whose voice this is before we get started. I'm going to play this in the mic. This could blow your mind. Whose voice Taking over the world feels like a surge of raw, uncontainable energy coursing through your veins. It's yours. Symphony of triumph. You hear that and ambition. I played that for my kids. They're like daddy. Daddy, that is not me, that's my friend who took, who edits the podcast John Edwards. He took last night's show, he edited it and then he has an AI software. He just read into the mic click, match Joe's voice. That's John.

Speaker 2:

It sounds just like you.

Speaker 1:

It sounds just like you it sounds just like you Wow. Well, I'm glad we got. I'm glad we got to talk about this. Thanks for tuning in, Thanks for having us. Silver Pines recovery center. Well before we get started, I guess one one thing of order I wanted to do was congratulate Dylan. You had a great year. Um, you had a great achievement this year.

Speaker 3:

Lots of them. Yeah, it's been a wonderful year, yeah.

Speaker 1:

Um you finished graduate school, I did.

Speaker 3:

Yeah, congrats man. Yeah, thank you. Yeah, nine and a half years. You know, I was in school for nine and a half years.

Speaker 2:

But you did it, I did, you did it yeah.

Speaker 1:

It inspired me. I'm going for a master's in psych. We had this discussion. You've been a big inspiration and it seems subtle. It's not like I'm not. It's meeting guys like you, meeting other people in recovery, especially that end up in this field. There's something about education, when you want to go into behavioral health, that it's not laborious, it's it's enjoy. It's an enjoyable thing in itself, like before the, even the end arrives, and that's how you described it to me. Yeah, what did you?

Speaker 3:

graduate with. I graduated with a master's degree in social work, so an MSW yeah.

Speaker 1:

And now you're a license.

Speaker 3:

Well, because of my very colorful past, there's some explaining I need to do so. The license is coming, but I did just start the application, so I should be licensed by the fall.

Speaker 1:

Well, your personal goals and knowing you over the last three years have inspired me. It's influenced how I think about challenges. I wanted to note that before we got started.

Speaker 3:

Well, thank you, I appreciate that.

Speaker 1:

Yeah. So you guys came up today and you have a lot going on. I wanted to talk about some programs and I'll put it in this framework and I'll put it in this framework.

Speaker 1:

In Lackawanna County and Luzerne County, my friends, colleagues in behavioral health, drug and alcohol treatment and mental health crisis services have gotten used to this void. When it comes to crisis crisis being someone in a serious mental health breakdown that could be a harm to themselves or others the go-to is always CMC Geisinger Medical Center. This could involve a 302 observation for 48 hours. If they're deemed not a threat, which they could be stable, they're released and there's no follow-up. There's no other place to go and if there is, these appointments could be set. But the person really needs a caseworker and this isn't substance use disorder being the primary.

Speaker 1:

And there was a huge deficiency. We lost first hospital years ago. A lot of places that claim to be dual diagnosed. All three of us know that's just not true. That's just kind of a marketing, a dangerous way to market. Yep, it's a buzzword. Silver Pines has filled this void and I don't think the message is out there because it's I'm not saying because of marketing, but it's new. That's why, and this has been kind of your mandate in your outreach services, if that'd be correct to say yes. So I want to ask if I could just put that brief history out there and say, okay, there's a solution right now from this show that you can learn more about and, by the end of this, have information to reach out for mental health being the primary or comorbidity, or even psychosis or as a result of, say, methamphetamine use, long-term. Sure, there's a place now for real stabilization and psychiatric care that will run in tandem with substance use disorder. Yep, now describe that to me, because this, this is a couple, couple different places that are opening, sure, yep.

Speaker 2:

So I'll start with Silver Pines, who, you know, we've been around since 2017. It was drug and alcohol, you know, substance use disorder only. And then, as we grew over the years, realized that a lot of the clients that were dealing with substance use disorder had co-occurring mental health. I will speak for myself. When I went to treatment almost 10 years ago, it was I was not I, I, you know self-medicated with substances, but when I was in treatment, none of that was being addressed. It was like, ok, we'll just try this medication, go home do IOP. And I suffered for years until I was able to, you know, self-advocate. So what we saw at Silver Pines then was when we would get the substances out of the person, detox them, is that the mental health was then becoming primary and we didn't have the, we didn't have the resources to treat it and at the time there were maybe two or three places, maybe two in the state of Pennsylvania, for that middle, that middle of the road. So what we just started doing it was May of this year we got our mental health license.

Speaker 2:

We have the opportunity for that individual coming in who is? Maybe they, maybe they have a history of substance use disorder, but it's been, you know, in remission. They're in recovery, but their mental health, um, is primary. Now they can come to silver pines because they have a history of both. So they're going to come in, we're going to screen them, we're going to do that intake and it's like, okay, they have substances in their system. Now we're going to screen them, we're going to do that intake and it's like, okay, they have substances in their system. Now we're going to detox them safely. You know, seven to 10 days, reevaluate again, um, was it just the substances or is it mental health? It's mental health. They're going to go into our mental health track, okay.

Speaker 2:

We've had individuals in the mental that have come in for detox and then stayed with us 65 days for the mental health services, because you're not getting that anywhere else.

Speaker 1:

And how far of an area are you serving with this program?

Speaker 2:

So I mean we can at Silver Pines, we can go. I mean we're all over the state of Pennsylvania, but we could go outside, depending on you know, depending on their insurance and if they're willing to travel.

Speaker 1:

OK, so a lot of people this, like you said, it's common and sometimes it takes 30 days, even longer, depending on the drug of choice. Is this withdrawal? Is this pause? Is this long-term amphetamine use? Okay, this could present as mental health and sometimes you can't be too sure until you're stable and detoxed. Does it come back? And now it's intruding on the treatment. If SUD was primary, and that's what you're saying, you can make the distinction and you have the track there.

Speaker 2:

Yes.

Speaker 1:

Yes, wow, okay so go ahead, bill.

Speaker 3:

No, I was just going to say, you know, within we've been talking a lot about what you know, silver Pines, and that's the our closest facility to our region. But I think what is so exciting for me to be a part of this organization is there. You know, we're talking about the mental health, and so a gap that I have seen for those seeking primary mental health services, especially here in the state of Pennsylvania, is they go to seek a residential level of care and then they're kind of put in to these dual diagnosed programs where a lot of the of the programming not all, but a lot of it is overlapped. And so those people who they don't have a co-occurring disorder, who their primary psychiatric and they need that support. There's been no place for them to go, you know. And so it's really exciting that you know STR Behavioral Health recognized that and, you know, opened Cedar Creek and that's another program of ours that just opened.

Speaker 1:

So there's two programs Cedar Creek and Silver Pines. What's the title of the other one?

Speaker 2:

So Cedar Creek is our primary mental health, residential only. So if it's somebody who's co-occurring, duly diagnosed, they'll go to Silver Pines. Silver Pines, we only have eight mental health beds at Silver Pines. It's for the true dual client, for that individual who there is no substance use disorder, it's all mental health, who is maybe coming from first hospital or or an inpatient psych unit. Cedar Creek is now that middle piece.

Speaker 2:

So, now they're stepping down to a residential. We're not a locked unit. They can you know they don't. We can't hold them against their will. They want to be there. So then they come in and it's um, it's a completely different layout. It's a true mental health residential program. We are working with borderline uh, borderline personality disorder, um schizophrenia, um DID. I mean there's, there's, you know, a list of them and it's a higher acuity.

Speaker 1:

Yeah, and this is there was a great need At least I can speak for Lackawanna County for this that you can serve in this great resource for clinicians to know. Now, especially the primary and OneNote First Hospital has reopened under new leadership and ownership.

Speaker 2:

That's what we're hearing, yep.

Speaker 1:

So this is good news and I think what people tend to not understand families or friends or people that are in groups say you claim to be dual diagnosed and now you have a group setting which is traditional to substance use disorder and someone's still presenting, say, paranoia, having misperceptions in time space and maybe the early onset of what psychosis not a full break, but this would start to present in a group and what it does is re-stigmatizes the mental health, especially around people who just need SUD because of the paranoia. What feedback could be presented or felt like, or that they're not bonding.

Speaker 2:

Yeah, there's a different type of connection or loss of connection.

Speaker 1:

Yeah, yeah, and I I've seen it, I've seen it within groups and yeah, and I think you know, I don't want to say it's noble, but people were stuck because what are you going to do? Deny services, okay, let's get them to a better level of care, that's a great statement, but there's been no other level of care.

Speaker 2:

And the only other options for those levels of care were out of the state. There was nothing. In Pennsylvania, you were going to Florida, you were going, you know, to New England. You were going anywhere Florida, you were going, you know, to New England, you were going anywhere but close to home. So there was that level of separation even further from your family. Is that okay? You're going to get the help that you need your family's from Pennsylvania, but now they have to hop on a plane to come see you. People weren't willing to then get help because they were even farther removed.

Speaker 1:

And it's difficult because the family should be taking part in this therapy.

Speaker 2:

Yep, absolutely.

Speaker 1:

For a cohesive, long-term experience of stability right.

Speaker 2:

Well, and it's you know a lot of. There's this common misconception that, like mental health, is is one world and SUD is another world. Substance use disorder is a mental health disorder. It's the same, it's, they're the same illness. It's a disease of the brain. You just treat them a little bit differently. You know on the upfront. So where one person, a family with SUD, one person uses but the whole family suffers, it's the same thing. When somebody is diagnosed with borderline or bipolar, one person is suffering from that diagnosis but the whole family is suffering.

Speaker 1:

Yeah, there's great research I've seen in the last couple of years I don't know if you came across this, dylan, but it was research on schizophrenia or schizoaffective relationships within the family and even friends relationships within the family and even friends and how it was like a little sensational the way they position it. It's contagious and what they mean by that is when you learn to communicate within the, the boundaries and the reality of someone with schizophrenia that you love, you get used to that communication, which can't really work with anyone now at work. So you're speaking almost in a poetic shorthand and I've experienced this. In that poetic shorthand I would understand this person who would maybe go to a 12-step meeting for relief and support and be stigmatized as silly or weird because they would speak in a language that sounded like poetry.

Speaker 1:

Stigmatized as silly or weird because they would speak in a language that sounded like poetry and I, for example, I like I heard someone say at a meeting I had to detox the old fashioned way, like a kitty cat on a couch looking for a bowl of milk. I remember it exactly. The room laughed at him. I knew the guy, I knew what he was talking about. A guy dropped a cat off at his house while he was in early recovery and he ended up just keeping this cat because the guy moved out of town. He was talking about early sobriety. I didn't see it as crazy. So the point of the research was like I know what he's saying. I don't hear a dangerous or an incoherent person. I just heard his language and I'm like I know the facts of his life. That's how he communicates when it's starting to. You know, medication wasn't working.

Speaker 2:

Unraveling a little bit.

Speaker 1:

Yeah, so have you ever experienced that in in regard to you start to be in vibe with a loved one and you get stuck? You have to enter their world to communicate, Sure.

Speaker 2:

It's it's very difficult for them to cross over into your world of standard and you can't expect them to.

Speaker 2:

You know you can't expect them to, but that's I mean that ties into you know, the the family piece and again with with SUD it's like you know we push all this family programming and Al-Anon and family services for for the families of SUD.

Speaker 2:

The same applies for those with the mental health disorder, because there's still boundaries that need to be set by the family so that the individual if the individual is perhaps living with them, they need to be bed compliant, they need to understand what's going on. If you're going to live here, you have to take care of your mental health just as much as you would take care of your recovery, you know, if you've obtained sobriety. And it's hard because with with an individual with SUD, it's like it it, more times than not, as soon as the chemicals leave their body, they're starting to come back to earth a little bit and you could kind of sort of reason with them. You know, given the timeframe, somebody with a mental health disorder who's not taking their meds or undiagnosed, they're not. You know there's nothing in their system that we need to take out of it to get them to see clearly.

Speaker 1:

To have a baseline, to have a baseline.

Speaker 2:

This is their state, so it's okay. Well, we're going to send them over to this hospital. They're going to be there for three days. Their meds aren't even working. They probably have only seen a psychiatrist one time. You have no, you still don't have a baseline, and then they would go back to the street. Okay, well, we don't have, you're done here now, off you go. And then it was wash, rinse, repeat. The same cycle would repeat over and over. Go see your private therapist, which is very helpful, but that's like. That's your maintenance program for mental health your private, you know, your private therapist or your groups. What are you doing to get to the maintenance level? And that's where we brought in, you know, our mental health track at Silver Pines and then Cedar Creek in Bucks County.

Speaker 3:

We, we, we filled, we filled the void you touched and actually the whole continuum of care also. So as the Behavioral Health Network is now duly licensed, so detox, residential PHP IOP outpatient. We offer the whole gambit from.

Speaker 1:

And you described different from starting as a residential or detox component of stabilization. This could look like just a month of stepping down to almost a non-residential component. You're almost describing a year of solid, continual care.

Speaker 2:

Yes, With housing too.

Speaker 1:

With housing.

Speaker 2:

Yep. So as you get down to the lower levels, whether you're primary SUD or primary mental health, we have housing for both.

Speaker 1:

Describe the staffing there. Is there distinctions or differences between the SUD track versus the staffing needs or requirements of what you're doing for mental health?

Speaker 2:

So the ratios are going to be different for the mental health housing as opposed to the SUD. It's one. Instead of being called a tech or care coordinator, they're BHTs behavioral health techs. It's going to be one per six clients. They are only with the clients. A lot of like and I mean our PHP has been around since 2013. When you have a tech or care coordinator, a lot of responsibility falls on that tech. Where it's you're helping, you're helping them find housing for when they leave, or you're helping them get jobs and or you're running group and you're you're. You have your hands in so many different things we're at in the mental health capacity with the BHTs. The sole responsibility for that BHT is to be with those individuals. That's it. They're not doing laundry, they're not, you know, cleaning houses or running groups.

Speaker 2:

They're with that client because you have to be Just present supportive Just present supportive, meeting their needs, evaluating, assessing, because an individual could start to deteriorate at any given moment.

Speaker 1:

Yeah, text is the first response to observe and report these changes, the earlier the better.

Speaker 2:

Yep.

Speaker 1:

There was one thing you mentioned earlier. I just want to jump back on, because I really like to talk about it often that substance use disorder is in the same basket as mental health. It's not this thing you caught from drinking at the wrong bar. I mean I wish yeah, I don't know.

Speaker 2:

Goddamn alcoholism. I got a lot of your taps. Right, I'm going to sue them yeah.

Speaker 1:

But you. It is regional and it's really driven by I. You know I think all of us are from the same school of how strong environmental scenarios influence addiction. Becoming a solution to someone style something failed to form, a security that would give a person this search, that addiction almost feels like the security. Eventually, when you bond with whatever comfort you from the drug you want, becomes the solution Absolutely and it's a solution to pain.

Speaker 1:

I just think it's such a delicate line. The more time I spent with people I care about, I love or in the field that have mental health, what they're presenting is what I present internally and that's a I'm not. I don't want to overgeneralize, but I'm just saying this is one perspective you could look at so you could reduce stigma if you think something's different because you just have SUD. So you could reduce stigma if you think something's different because you just have SUD. Most people I've seen present psychosis or even just borderline personality like present or report.

Speaker 1:

Some of the ideas that are driving this division they have in all their relationships are things that happen to people with SUD internally and if they weren't, detox would be successful. You could leave detox. The brain would find this homeostasis. I'm going to find balance in my relationships. The drugs were the problem and you know, if I said out loud what I'm thinking all the time, I would be psychotic. That would be called psychosis. So I think the drugs for me were sedating. How loud my internal voices are and how I get treatment is to self-report it. Mental health it's presenting without the self-report. I started to look at it that way and it really dropped a barrier of like, oh we're all suffering from this, one just doesn't fit.

Speaker 1:

One can maintain it on the inside and the other one can't. Yeah, and that's hard to keep a job. Then it's I could, we can suffer through a job of FUD. Sud is your primary cause. You're going to at nine o'clock. You got a solution to that suffering.

Speaker 2:

Yeah, exactly. But it yeah, it's not the same way with with mental health.

Speaker 1:

Well, that's interesting. How long has this program been going?

Speaker 2:

So Cedar Creek just opened, june 10th. So, we're what is today, the 17th, the 18th I think and you're open one day a week. It feels like that it feels like that, um, because I want to be at full census.

Speaker 3:

We never close. Yeah, cause we yeah we never close.

Speaker 2:

Um, yeah, so it definitely, and let me say this too is another thing with Cedar Creek is that we're only 30 beds, right Like in in the SUD world. I come from the time where small facilities were the way to go. Huge facilities were the way to go. Now everybody's going back to small facilities. The only way to go for a primary mental health residential is to have that small cause. I mean the reality of it is can you have 30 schizophrenics walking around in an unlocked unit?

Speaker 1:

Put three border lines in the same process, right? You can't even handle that, right, and it's not I'm not like mocking.

Speaker 2:

The disorder I'm just saying is that it's unfair to that individual it's impossible so you know. So, third, very, very small, 30 beds um and the silver pines track. We we started doing dual, I think it was may. Yeah, it was roughly the we we did a month at silver pines before we opened cedar creek. Because again, we have that opportunity where if if silver pines isn't the right fit for that individual, we can laterally transfer them to cedar creek well, let me create a scenario and tell me how it would.

Speaker 1:

This would play out. Um, someone would scream they go to a PHP or just outpatient services. They're stepping down from a continuum of care. They feel stabilized. They were at a 30-day inpatient. This clinician knows something's presenting during groups. Life's going on a decline at work where they thought they would have been stable and there's an undiagnosed mental health issue. It gets identified there. When should silver pines or cedar crest be involved in that process? If a clinician was, what had a relationship with you guys?

Speaker 2:

you know immediately if, if, if you know which they are, the clinicians doing their job and they're recognizing that the individual is deteriorating, but not, you know, if they're suicidal they're trying to, you know, do something, harm themselves or harm someone, someone else they're going to go to an inpatient psych Right. Maybe their meds just aren't, you know, working effectively, but they're still showing up to work and being a productive member of society. They will step them up then to the residential level of care which would be at either Cedar Creek or Silver Pines. So then we have more eyes on them. We have. You know.

Speaker 2:

They're getting more individuals with their therapists. They're meeting with the psychiatrist, you know, two or three times a week instead of once a week to better gauge that. So we have this, we have this ability to, you know, serve the individual without just like dropping them off at a psych unit where again they're just going to get lost in the mix of things. Now, of course, you know, if it's super high acuity, we're going to want them to go there, um, but we have the ability to attempt to treat without having to go there.

Speaker 3:

I think too, it's like the intensive intensity of she was talking about having eyes on them, you know, and we were talking about, you know, like Q60s, for example, is like how, in SUD treatment, it's like every hour we have eyes on this person. We are note of noting where they're at any behaviors. Um, at Cedar Creek, we're like looking at Q fives and Q tens. Will you explain?

Speaker 3:

that what's a uh Q is is every five minutes or every 10 minutes or every 15 minutes. A staff member is noting where this person is. You know, if there's any behavior or projection that we're looking at, that we're seeing as alarming, those things are being checked and noted every 5, 10, and 15 minutes.

Speaker 1:

And this is usually by the tech on the floor. There's a cue 5, 10, 15 minutes, Like traditionally. Detox every 15 minutes and it'll scale down to a 30. Might get vitals. So in your mental health track that that's a great window, that's real care.

Speaker 2:

And the cap is 15 minutes. So, whether they've been with us for a week or or a month, every 15 minutes, no matter where you're at, you will still continue to be checked on. Even if you're making progress, you're doing well, we're seeing a change for the better, you are still being. That individual is still being checked on every 15 minutes.

Speaker 1:

And this go ahead. This for safety.

Speaker 3:

Yes, for safety to, you know, as part of the treatment planning. So we have a better idea of how we can help the person transition, you know, out of care. Because that's the goal, Right, we want to get people transitioned back into their normal lives. And so when you look at SUD, residential level of care, you get to a 60 minute queue. You know Q60. That doesn't happen at Cedar Creek. You get to to Q15. So that's the difference in, you know, the, the, the, I want to say the level of care. But that's the difference between SUD and mental health.

Speaker 1:

That's a clear distinction that makes sense to me and anybody who's never worked in treatment. That's like a almost like the floor room check eyes on present. This could be electronically on an iPad, this could be a written note, but you're you're checking off the boxes physically while they present what's the mood If there was speech, this kind of what you're recording every 15 minutes. That's a lot of data just for one patient. You got 30 beds so you keep it there. Obviously why you have to keep it small. Who digests that in a clinical meeting?

Speaker 2:

How does that? And then treats it effectively.

Speaker 1:

How does that roll out for a week? That's a lot of data collection. Clinically, if you're just checking off boxes for okay, stable, there's a mood change severe, mild. How do you digest all that weekly and it goes into a treatment plan because that's a lot of information? Yeah.

Speaker 2:

I mean, are you asking how we do it?

Speaker 1:

Yeah, I'm curious.

Speaker 2:

Absolutely so. It I mean for the for the treatment team primary therapist, executive director, clinical director, director of clinical services. They're meeting daily. It's you know, and luckily in the digital age everything's in there, so they're reviewing and getting caught up every single day. So nobody you know some maybe like an SUD facility and like we've done it, where they have their team meeting, but it's only, it's an extended one, but it's only once a week.

Speaker 1:

We have once a week.

Speaker 2:

Right. You can't do that in the mental health world. You have got to be connecting with your team every single day, including the PA or the psychiatrist. Hey, this is what's. This is what's going on, because there is no room for error.

Speaker 3:

All of that becomes part of the medical record. All of the cues, all of the engagement, that all becomes part of the medical record and part of the reason why the ratios have to be smaller. Residential SUD, you're 1 to 10, is usually the ratio um. For mental health it's it's much lower than that.

Speaker 2:

It doesn't have to be like I and I I do kind of want to speak on that. It doesn't have to be that ratio like six to one. That's our ratio. There are there are selfmade guidelines is that in order for us to effectively treat these individuals? We believe that it's six to a caseload for a primary therapist and six to a BHT. That is what we can effectively monitor, the right way.

Speaker 1:

That's nice monitor, you know the right way, that's nice For anyone if this sounds like inside baseball and you're just listening. Ratios mean, like she just explained, that's a caseload. So every counselor like an SUD. Depending on the higher level of the care is the less that could be on your caseload. Like she said, one counselor, six patients Below six patients support staff BH counselor six patients Below six patients support staff BHT is monitoring them, eyes on, observing, making these 15-minute check-ins. That's serious care and people who would have families waiting to see how treatment would resolve itself. Can a person enter back into a life that has meaningful connection outside of care or be partial care? That should give some really good security that you're you're in good hands and you guys are doing it right.

Speaker 2:

One thing I want to talk about too real quick is is it's cause, it's another disorder that's not discussed is our eating disorders. So you have primary mental health, you have primary SUD. Eating disorder itself is, you know, it's its own diagnoses, right, part of the same umbrella, but its own diagnoses. And you know. You have individuals again who are self-medicating, develop an addiction, but then their, so their, their SUD is primary, but then their eating disorder has been quiet, right. So what do we do? We take the chemicals out of their system they're not using anymore and then the eating disorder becomes primary.

Speaker 2:

So you have facilities that eating disorder facilities will not take the individual if they're using, if they're, if they have an SUD actively using, right. But then you have treatment facilities who won't detox the individual because they have an eating disorder. So there's another group of individuals who are just go figure it out, right, wow. So what you know this is a big deal is that what we can do at Silver Pines is we can detox that individual with the eating disorder, right. So they come in. We have the capabilities because we're duly licensed, we have registered dietitians on staff is that we can safely bring that individual in and detox and stabilize them from the chemicals and then transfer them to a primary eating disorder facility, wherever that may be. Yeah, and a lot of people, they're just not willing to take the risk on it, but it's, it's a group of people who are suffering from a whole nother diagnosis, that aren't getting treated because nobody, everybody's afraid, nobody wants to help them because, well, they're not eating or you know the chemicals.

Speaker 1:

Is that a liability thing? Absolutely, it's a liability? Absolutely yeah, so that's why we won't keep them Is there a high mortality rate to people that have severe eating disorders. If it was anorexia, yeah, there has to be. I'm not sure I'm just getting Um, yeah, there has to be.

Speaker 2:

I'm not sure, I'm just. You know my, my personal experience is, just as an individual in long-term recovery, Um, I've had, I have crossed paths with a lot of women with both SUD and eating disorder and, um, if it's not the drugs that kill them, um, it is the long-term effects to the body from the eating disorder that will then, you know, deteriorate and then decline.

Speaker 2:

So you're going, you have this individual who's really self-destructing in two separate ways and nobody wants to take the chance because hospitals will just discharge them. So where are they going? They continue to use or they continue to have disordered eating. So we filled that gap too. So we're able, you know, we'll bring them in, we'll detox them, stabilize them and then, you know, if we know, as long as we know that they have that, that eating disorder upon admission, we're already putting together the transition plan. Okay, we've got the since the chemicals out of your system. Now we're going to send you to ABC to work on your eating disorder.

Speaker 1:

And where is ABC?

Speaker 2:

Well, I mean our. So our umbrella company, our, our parent company. We have eating disorder facilities all over the country.

Speaker 3:

Oh, and that's we do, yeah, yeah, odyssey behavioral health, which is the parent company.

Speaker 2:

Magnolia Creek, Sela House. We have all over, but nothing local.

Speaker 1:

Yeah, it's another. Well, it's good to have that resource internally. So traditionally you have marketing. That is. You know, we're one of the last fields I hate using the word industry, but I think of widgets Last fields I hate using the word industry but I think of widgets but a field that does traditional marketing, relationship-based shaking hands and that's rapidly evolved over the last two decades to SEOs in this field that drive a brand or a number. But before we started the show we were talking about showing up shaking hands. We've had I'll be straight, we have no referrals but we talk often. I talk to Dylan all the time as colleagues. That's not really happening in other. That's not common in a lot of mental health or other fields that outreach coordinators meet weekly, monthly, cover some ground.

Speaker 3:

That's kind of the backbone of your, your marketing of Cedar Crest and Silver Pines right, cedar Creek, yes, so Cedar Creek and Silver Pines is, you know it's, it's relational, you know, and it's we're building those relationships with our community partners. And that's what you know, that's how we look at this thing. Is that you know, we, we can't do it all. We have to have community partners in order to have the most, the best impact that we can. And you know that's how we do it. We do it through relationships.

Speaker 2:

And I say this all the time like cause I started with Silver Pines, you know from the beginning is we are not. Silver Pines Treatment Center is not a destination facility. We don't have a swimming pool. You know we're not this. We are a blue collar working individual who needs to come and get better, have their paperwork filled out so they don't lose their job, and then get them prepped and prepared to go to return to work because they have a family to provide for a profession.

Speaker 2:

But what? What we are the best at is our culture and our clinical care. Like that's why our on boots, on the ground marketing strategy works, because we believe wholeheartedly in what we do. And so does everybody that works at Silver Pines, from from the the facilities manager to to the CEO. Um, everybody's approachable. And it's you experience that when you come down to Silver Pines, if you come down to do a tour or a presentation, we have guests, we have visitors. Every single time somebody leaves, they're like that is the best group of people that we've ever met. Oh, I could feel the energy because we genuinely care about what we're doing and who we're helping.

Speaker 1:

It's hard to stay in this field if you don't. Yeah, it's. We're not selling used cars.

Speaker 2:

I say that all the time we're convincing people where our job is to convince people that their life is worth living.

Speaker 1:

Yeah.

Speaker 2:

And we don't even know them. They're strangers to us.

Speaker 3:

Hmm, yeah, um, just for me. Yeah, the first conversation that we had together is how diverse populations experience unique and challenging barriers, you know, and STR steps to recovery. The outpatient program in Levittown was actually, I believe, the first outpatient provider to be recognized by the human rights campaign and accredited by the human rights campaign for delivering affirming and supportive services to the LGBTQ plus community. So for me, when this opportunity came up, it was like a no brainer.

Speaker 1:

And you were aware of this because you know our first podcast, you do a lot of trainings. It's not a nonprofit to train clinicians. There's distinct things that happen in LGBTQ populations that have to be recognized, especially on a clinical component, especially when it's entered in group. If it's the group understanding of this, does the clinician understand it? And you still do these trainings correct?

Speaker 3:

Oh, yeah, yeah. Yeah, I actually just did one in my role here at STR, cause we can do that.

Speaker 1:

That's part of the meeting people and having those conversations Break out the framework of it, what happens and is this a day long continue, kind of CE or like a training day for?

Speaker 3:

So are you talking about?

Speaker 1:

the work that I do. I couldn't make it to the last one we were planning on attending. I was out of town, but I will be attending one.

Speaker 3:

So there's many different topics, obviously, but, like the training that you missed a couple weeks ago, we just kind of looked at, you know, current trends within the LGBT community of substances that are being used, how many of the population is using the substance, and we look at the disparity. Lgbt people are disproportionately affected. So I usually like to look at that because that kind of like sets the tone for why this training is so important. And then we look at, you know, the last training we looked at like transference and counter-transference and how that works in a clinical relationship when you're dealing with the LGBT community.

Speaker 1:

How would you define those two terms, transference and counter-transence?

Speaker 3:

Transference is how? So as we navigate our way through life, this is just people. We carry our stuff with us.

Speaker 1:

Yeah, this is a good topic because I've been doing this now professionally from the start. It's for four years. We haven't been open that long, but it was planning and transference is real. I've gone home very distracted. I've lost sleep. I meet with other colleagues that aren't in our shop and we talk. I have to attend meetings. This is not my recovery, but, being that it's Scranton, there's a lot that could come home with me, and I have to sit and decompress before I go in my house.

Speaker 3:

So there's a lot that can come home with you, but also there's a lot that can be transferred to the clients that you're working with, that you're serving, and even from outside of our professional lives. But, like how we grew up, um, you know the values um that were instilled in us as we were growing up, in our experience and throughout our childhood and our adolescence, and all of that stuff like that, our journey, um, it shapes us and it shapes the way that we interact with our clients, um. So knowing those things and knowing our biases knowing um and not biases in, in like a derogatory term, because we all have our biases, whether they're um, subconscious or or not Um but recognizing those things um, and and, and the profound impact that it can have in the delivery of the treatment services that you're trying to provide, I work on it constantly.

Speaker 1:

It's not something you could stop working on. It gets easier. My language is very clean. My notes stay very clean. That's where I started to get that If you could write a good note, you could talk well in a clinical setting.

Speaker 3:

Well, and I'll just talk for me personally, what has been one of the biggest things that I have have had to, I wouldn't say, cope with, but as a person in long-term recovery, like I work, a 12 step program of recovery and the 12 step philosophy and the 12 step program of recovery should save my life, and so I am biased towards the 12 step program of recovery and like this abstinence based viewpoint and and that is what I do for myself and what has saved my life, but that's not necessarily going to work for everyone. Sure, and as a provider, we have to be able to meet the people where they're at, and you know that is connected with this transference, counter-transference, but also so is the way that we interact with other people.

Speaker 2:

That's easy for me, the 12-step not being for everyone, it's not, it's just metrical fact, or we'd all be in AA, right, it took me a long time to get to that point, though, because I was like narcotics, anonymous is the only way, and, um boy, was that, you know, until I started working in treatment says the four people right right, right right, especially in my area. Yeah, until this is it. We're all recovering, and then and then recover, damn it.

Speaker 1:

Yeah, there was, and nobody could say anyway say the prayers, yeah, say the right prayers, you're an an addict, not an alcoholic. We say the Lord's prayer don't mess up a word, or the spell won't work.

Speaker 2:

Don't say God, it was this whole thing. And then and then, when I started working in treatment, I was like, oh, there's other ways, you know. And it and that's another thing too is like when you come to Silver Pines, like, yes, we have Narcotics Anonymous meetings, come in, we have Alcoholics Anonymous meetings come in, but our holistic counselor, kate, who's been with us since the beginning, is also introducing smart recovery, dharma recovery. We, we have alumni who have completed the program, they've done well, they've, you know, they've continued, they've started and continued their journey of recovery, who have taken Dharma recovery that they were introduced to in Silver Pines back to their like home areas and started their own Dharma. And that's what it's about. Like, it's about the connection. And whether you do it through a 12 step or Dharma or Will Bridie, whatever it looks like, it doesn't matter. People are finding their purpose, you know, at Silver Pines and then taking that home with them.

Speaker 2:

Because we're not, it's not just you need to do right, you need to do a, b and C, and and that's it.

Speaker 1:

I'm biased to alcoholics and non-alcoholonymous in a really distinct way. I'm an atheist that got sober in AA. I don't speak of God in any terms that I know we're all winking in Lackawanna County.

Speaker 3:

You know the Eucharist that's where it's at Right.

Speaker 1:

Yeah. So, and I think a lot of people are like that. I'm just. I was more thorny about it because I didn't want to be conscripted into. Yeah, like, what do you think I'm saying? Like we're just willy nilly, just say the creator of the universe is the only thing that's going to solve my medical problems.

Speaker 1:

It's a strange idea to resist in the beginning. I don't have that bias here in the beginning. I don't have that bias here. But one bias that does like I have to stand guard on is how motivational like interviewing is. Just this. You know, this is a way it's an entry level modality, easy way to start with clinical interviewing, the sentiment behind what you're you're calling motivation. If you're putting inspiring cadence to your talks, I I'm very cautious with that because I don't know what someone else can achieve and how much time they have to achieve it. Life is very uncertain, so I could talk about these magnificent things that would sell hope and hope's cruelty to. If you're not clinically judging who's in front of you. It's not me, I'm not like, and that's why that training should be continuous for a guy like me and someone else, because trends and culture change. Mine might not, but I'm going to serve populations that have different cultures it's going going to keep changing.

Speaker 1:

Keep my eyes open, and that only happens by continuing to go to trainings, reading, talking to diverse clinicians within the field that we all have to stand guard against.

Speaker 2:

Yeah, and when Dylan was talking about the training and we've developed because we do a variety of trainings in, I guess it was a year or two ago Our executive director, matt Bardos, and myself developed a training for SHRM, for the Human Resources board group.

Speaker 2:

I can't think of what it stands for right now.

Speaker 2:

I'm drawing a blank for these individuals who are in the workforce, their human resource directors, their employee assistant programs, who have individuals who are, you know, using on the job or suffering from, from SUD, and instead of getting them help and connecting their employee to treatment, they were firing them and they couldn't understand why their turnover was so high.

Speaker 2:

And then their, your costs go up when you don't invest in your employee, if you would just make that connection. So we developed this training on the signs to look for what to do when you know when, when somebody gets caught or something happens, maybe they come to you and seek help, is being that person to just connect them with services, no judgment, no stigma, um, maybe hold their job for them as long as they, you know, um complete treatment successfully, and then you're investing in the client that or the employee. That employee is going to come back to work feeling better and get 10 times you're going to get 10 times more work out of that individual because you believed in them and and you know when we did that training it was it was. You would be shocked in this day and age the the ignorance and unknowing of what employers are not willing to do.

Speaker 1:

They just they are what an employee's rights are and what their rights are.

Speaker 2:

We just had you. It was right when you started, dylan, we were dealing with someone, we knew someone and the individual used. I don't even think they did anything stupid, they just got caught using immediately terminated Zero tolerance, zero tolerance policy which I understand it from a liability, especially if you're like a truck driver or something along those lines but offer them services to connect them, to care.

Speaker 1:

This work. It's tricky I mean, especially in Pennsylvania, you know work at will and alleviates any of the responsibilities that maybe labor unions have fought for. So you can't fire someone like that. You could terminate because there's the laws of have so many loopholes to protect the you know a staff the next year. What are you guys looking forward to?

Speaker 2:

Well, we're going to be opening. Do you mean professionally or personally?

Speaker 1:

You decide, okay, you're opening a McDonald's. We're going to open a McDonald's within Silver Pines and a Starbucks.

Speaker 3:

We're going to have a drive-thru.

Speaker 2:

Can we do the Starbucks first? I don't know, I might just decide.

Speaker 1:

We're just a blue-collar treatment center with a McDonald's. Wouldn't that be ideal? We'd have to do Dunkin', it'd be Dunkin' Donuts, it would be.

Speaker 2:

Dunkin'.

Speaker 3:

Let's get honest okay.

Speaker 2:

My husband's a union steel worker. It would have to be a Dunkin' All right local 81.

Speaker 2:

Yeah, so listen, but no, we're actually so. You know, we have Silver Pines, we have Cedar Creek, we we have steps to recovery bucks, we have steps to recovery Lehigh Valley, which is PHP and IOP, no housing. We're getting ready to open another outpatient in Lancaster, so the lease is signed Tentative. You know how construction and all that stuff goes Tentative. Open date will be January of 2025. Same thing mental health and SUD, PHP, IOP from the community, no housing attached.

Speaker 1:

Well, I wanted to get this out there and I'm glad you guys stopped by, because this is a much needed resource. It's nothing I wouldn't want to market anywhere and I'll keep sharing it as an extended outreach because it is needed.

Speaker 2:

Yeah, beds are needed.

Speaker 1:

Yes, Dylan for the next year. Will you be opening a franchise at McDonald's anywhere?

Speaker 2:

He's going to go with Starbucks, probably I would. You want to be competitors, don't you?

Speaker 1:

Jack in the Box Chick-fil-A.

Speaker 3:

I'm just I'm really excited to I'm newer to the STR network. I'm excited to be here, I'm excited to continue building up our relationships in the Northeast PA area and and you know, lower tier of upstate New York and you know, sharing the wonderful work that we're doing within our network with the community. So I'm looking forward to that and you know, in my personal life and the things that I do outside of work, I'm looking forward to continue being there for the people in my life that are in recovery and my sponsees and showing up and just doing the right thing. You know, the NEPA Pride Coalition has lots of really exciting things happening. We just were donated some space, so we're going to be moving into the Exceed Center in downtown Wilkes-Barre which we'll be able to kind of like do some engagement face to face with the community. So lots of really cool and exciting things happening. They're all gifts of getting sober, you know, and doing the deal as we say, absolutely.

Speaker 1:

Guys, I hope you come back soon.

Speaker 3:

Oh, I'll be here next week.

Speaker 1:

Yeah, don't you have a relationship here. Yeah, it's nepotism. My husband actually yes.

Speaker 2:

Oh yeah.

Speaker 3:

Yeah, I keep forgetting about that.

Speaker 2:

It's nepotism. My husband actually.

Speaker 1:

Oh yeah, I keep forgetting about that he's our A number one tech man. Nobody fucks with Gerard.

Speaker 2:

Nobody fucks with Dylan either.

Speaker 1:

He's so kind and approachable. There's a fierceness, gerard, with an arm cross and a look, he's awesome, he's the best. Love that guy he makes a real impact on our population and census. Look, he's awesome, he's the best. Love that guy. He makes a real impact on our population and census here. Thank you. This is my favorite thing about I came from a background of advertising and politics. There was no collaboration. This is all collaboration with one objective Reduce people's pain. I'll talk to you guys soon.

Speaker 3:

Thanks Joe, thanks Joe.

Speaker 1:

I'd like to thank you for listening to another episode of All Better. You can find us on allbetterfm or listen to us on Apple podcasts, Spotify, Google podcasts, Stitcher, I heart radio and Alexa. Special Thanks to our producer, John Edwards, and engineering company five, seven oh drone. Please like or subscribe to us on YouTube, Facebook, Instagram or Twitter and, if you're not, on social media, you're awesome. Looking forward to seeing you again. And remember, just because you're sober doesn't mean you're right.