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A new beginning for new beginnings recovery center: new generation of leadership revives, refocuses, revitalizes mission of teen-focused treatment center.

Begun as a 34-bed facility by three recovering physicians some 25 years ago, New Beginnings Recovery Center (NBRC) of Opelousas, La. has always offered its clients an atmosphere that blended Cajun hospitality and family-focused concern. However, by the time that its last surviving founder, Dr. Trahan, was in his latter years, the center had endured several years of serious financial struggle: its patient population had dwindled, its commercial insurance reimbursements had faltered, its clinical staff had shrunk dramatically. Incoming patients expected big discounts, while NBRC's vendors expected cash-only. After Dr. Trahan's death in late 2010, his family concluded that NBRC must be sold or closed.

But then came another family, Judy and Franklin Roemer of Shreveport, La., who recognized both the community's need for NBRC and its potential to become a respected specialty treatment center once again. Before finalizing their purchase of the 21-acre NBRC campus, the couple formed an experienced governance group. They asked a well-known and experienced healthcare and substance abuse treatment professional, Johnny Patout, LCSW, to provide them a detailed needs assessment and strategic planning recommendations--and then to lead the team that would operate the "new" New Beginnings.

"What impressed me about the Roemers' desire to acquire the facility were two things: a belief that the service [teen-focused care] was needed and that this care must be of the highest quality," said Patout. Their commitment made a deep impression on him and on the New Beginnings governance board: "Not one time," he added emphatically, "did they ever mention a desire to make money."

After a two-week review of personnel, facilities, resources, and treatment needs, Patout submitted a strategic improvement plan that pulled no punches: It would require a year of intensive effort, significant and ongoing facility and system investments, a redefined mission that focused on teens, and a major recruitment and re-staffing effort (see Figure 1). It also meant that the organization's fixed operating costs would increase substantially for six months to a year before the impact of staffing, care, quality, and facility improvements might be matched by any substantial improvement in NBRC's reputation, or reflected in a rising rate of patient referrals and admissions.

Figure 1: Strategic planning issues and results

Issue           Before                 After

Patient focus   Patients aged 13-30    Teens only, ages 13-19

Staffing        1 licensed counselor   1 Physician (ASAM
                2 counselors in        Certified
                training               Addictionologist)
                1 part-time nurse      1 Psychiatrist
                Administrator          5 Masters' level
                Other sup port staff   therapists
                Total: 15              24/7 nursing
                                       1 Recreational
                                       1 Registered Dietitian
                                       Other support staff
                                       Total: 40

Treatment       State residential      State inpatient treatment
capabilities    treatment license for  license for SUD and
                SUD treatment          co-occurring disorders;
                                       Detoxifcation services;
                                       Intensive family program

Accreditation   None                   "Positive" CARF survey
                                       completed in June; NBRC
                                       awaiting official CARF
                                       survey results.

Admissions      5 patients per month   18-20 patients per month

Insurances      2 networks             12 networks, including
                                       Blue Cross/Blue Shield in
                                       La., Ga., Miss., Tenn, and

Administration  Inadequate billing     New billing system

Reputation and  'Pretty bad'           75% of current patients
referrals       reputation, few        gained via regional
                referrals              referrals from

Physical plant                         $500,000 in improvements,

Profitability   Break-even             $700,000 in 2012

Associations,   None                   NAATP and NAADAC
Conferences                            membership; attendance at
                                       five industry conferences

Marketing       None                   Two outreach coordinators
                                       New website
                                       New blog, article
                                       Conference speaking

The board's response, received in July 2011, was simple, Patout recalled. "Let's go forward." The purchase of NBRC was finalized and the plan took hold.

Quality begins with staffing

"The driving force behind the strategic plan was to recruit a high quality clinical team," said Patout. But at the time of the NBRC purchase, July 2011, the clinical team consisted of just four people: a medical director, two addiction counselors, and an LPN. So, he had a lot of work to do. Starting there, and for much of the next year, he focused on recruitment, adding an ASAM-certified physician, a psychiatrist skilled in treatment of co-occurring mental health issues, five Masters' level therapists, and 24/7 nursing coverage.

Among the new hires was clinical supervisor Charlotte Bienvenu, LCSW, who knew more than most about NBRC's history. As the daughter of one of its founding physicians, she admitted that "New Beginnings always had a special place in my heart." The facility's "pretty bad reputation" in recent years had been a source of heartache because, she explained, "I know what my dad intended." When she learned of plans to revitalize the center--specifically the involvement of the Roemer family and a trusted former colleague, Johnny Patout--she sought to get involved. Cindy Lieux, RN, did the same thing and soon became NBRC's director of nursing.

During the same period, NBRC achieved another strategic plan objective, gaining an in-patient care license from the state that reflected its new capabilities to detox and treat SUDs as well as co-occurring disorders. In the past, the facility had only a residential care license.

And, reflecting its new focus on teens, NBRC also took on a full-time recreational coordinator and a Registered Dietitian. New appointments also strengthened NBRC's management, quality assurance, administrative, care, and support capabilities while rounding out a staff of 40--not quite triple the staff of 15 that existed just a year before.

"Once we got the new staff in place, things began to come to fruition," Patout said, noting that by spring of 2012, signs of NBRC's revitalization were everywhere: a pickup in reimbursements, improved daily revenues, increasing numbers inquiries, and a rise in admissions. The positive shift in culture and patient milieu was also complemented by ongoing improvements that gave NBRC's young patients access to a wider range of recreational activities and resources on the 21-acre NBRC campus.

Sustaining a quality culture

"When you're working with teenagers, there are many ways to gauge treatment quality," says Patout. "For me, it is very telling to just walk on campus and observe the kids actively participating in treatment. We urge professionals who are interested in referrals to do that--just come and take a look." He asserts that where a "positive environment" of treatment exists, "people say they can feel it."

But concern for quality goes considerably beyond "feelings" at NBRC. The approach is comprehensive, Patout explained, since "teenagers are complex, treating substance use disorders is even more complex, and treating co-occurring disorders is even more so." Effective treatment demands not only a highly skilled staff and a range of therapeutic approaches-12-Steps, rational emotive therapy, cognitive behavioral therapy, and EMDR--but "even more a group of folks who can really bond with the kids and get them engaged." He said that kids often come in "expecting to be treated in a harsh manner" based on the recent troubles in their lives, but find that "we do things very differently here."

A typical stay for NBRC's 13-19 year-old patients ranges from 60-90 days. In addition to a range of substance abuse problems, patients suffer from a range of co-occurring conditions--depression, anxiety, personality disorders, trauma, ADHD, bipolar disorder, and psychosis. The 34-bed facility still has some room to grow, since patient census typically ranges between 25 and 30.

According to Patout, NBRC "turned the corner" toward sustained success in March and April of 2012 when its still-forming staff implemented systematic improvements to meet an unacceptably high level of "acting out" among its young patients. Lengths-of- stay rose as these improvements took hold, resulting in dramatically improved patient engagement that reduced a once-significant elopement rate to near-zero. Staff saw and appreciated the impact of this concerted effort, then came together around this symbol of NBRC's revitalization. New patients found a more positive treatment milieu as well.

The culture of improvement remains essential. "We measure a variety of things in our quality improvement effort, and what I look at are trends over time." Hecites "trends in admissions, lengths-of-stay, ASAs (patient departures 'against staff advice'), patient satisfaction, and family satisfaction." While the expects that most trends will point in a positive direction, "we're always looking to improve something, regardless of improvements already made."

NBRC also has been aggressive in tracking outcomes, starting at discharge, when staff work with parents to develop next steps for each teen's after care. NBRC conducts follow-up calls at 30 days, 60 days, 90 days, 180 days, and 360 days, Patout said. "We're asking, 'How are they doing? How is their attitude, their schoolwork, their participation in the 12-Steps?'" To date, he says that outcomes have been "better than expected."

Recent 180-day results, for example, showed that 60% of parents say that their teen is "doing well."

Established in 2001, the James W. West, MD, Quality Improvement Awards recognize NAATP-member addiction treatment organizations that improve the quality and effectiveness of their services and document their results along the way.

The award is named in honor of James W. West, a longtime quality improvement advocate and medical director emeritus at the Betty Ford Center. Award recipients are honored at the National Association of Addiction Treatment Providers' annual conference.

This, the 13th annual award, recognizes the team at New Beginnings Recovery Center, Opelousas, La., whose efforts demonstrate a comprehensive approach to effective, continuous quality improvement.

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Title Annotation:NAATP
Author:Grantham, Dennis
Publication:Behavioral Healthcare
Date:Jul 1, 2013
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