Addiction Industry Gets Exposed…Finally.

For years I’ve been talking about the unethical and illegal means by which mental health and substance abuse treatment centers advertise to and treat clients. And now, finally, in one of the most accurate portrals of the industry, The Verge published a fantastic piece on the aweful practices large addiction treatment centers. From the manipulative call centers to terrible and dangerous clinical work, Cat Ferguson (freelance reporter based in California) exposed the seedy underbelly of this mostly hidden industry, predominantly in Florida. She focuses on Aid in Recovery, a sketchy hotline with a bazillion different phone numbers and websites (all of which are owned by a parent company Treatment Management Company) that funnel prospective clients (with good insurance!) to one of their affiliated treatment centers around the country. AIR is not unique. Hundreds of huge companies fight, cheat and steel every day for referrals. My one critique is that Cat didn’t pull in examples from the mental health treatment centers which are as aggressive and sketchy. Same bad actors engaging in greedy behavior to get clients.

The article reaffirms why it’s so important to work with a therapeutic placement consultant or educational consultant who knows what to avoid and how to find the most effective treatment. Not a sales pitch – just a fact that a good consultant can sniff out the industry bullshit from a mile away.

Odyssey Behavioral Healthcare Buys Pasadena Villa and Lifeskills

Odyssey Behavioral Healthcare, a partnership between Nautic Partners, LLC and CEO Scott Kardenetz, announced it completed the acquisition of residential/outpatient mental health and addictions treatment providers Pasadena Villa (TN, FL) and Lifeskills South Florida (FL). Screen Shot 2015-08-22 at 9.23.56 AM

Odyssey, headquartered in Brentwood, TN, was formed to build a diverse platform of behavioral healthcare facilities across the treatment spectrum in psychiatric and addiction care.  Scott Kardenetz is a 25-year veteran with former leadership positions at Ardent Health Services, Psychiatric Solutions and Universal Health Services. Nautic and Odyssey plan to invest $50 million of equity capital to support its strategy of growth.

Behavioral Health mergers and acquisitions experts expect this trend to continue, with a growing emphasis on the development of a full continuum of services and settings which promises to be an even bigger market than the strictly luxury-leaning residential programs that historically been the focus of consolidation. 

About Odyssey Behavioral Healthcare

Odyssey Behavioral Healthcare was formed in 2015 as a partnership between Nautic Partners and Scott Kardenetz. Odyssey’s treatment centers include Pasadena Villa and Lifeskills, which provide adult residential treatment care in three primary facilities and outpatient care in Tennessee and Florida. Odyssey will seek to expand the platform through new development and acquisition. In developing its platform, Odyssey seeks to acquire and develop treatment facility leaders in their therapeutic niche and that can benefit from senior management leadership and support.

Muir Wood Expands… Reaching for Alta Mira Recovery

Scott Sowle, the founder and executive director of Muir Wood Adolescent & Family Services (Sonoma County, CA) teamed up with private investors to acquire the residential and outpatient addiction and co-occurring disorders treatment organization from Constellation Behavioral Health. Constellation Behavioral Health operates Alta Mira Recovery Programs in California.

Muir Wood will operate as a stand-alone program focused on youth treatment, run by founder and executive director Scott Sowle. They will be expanding their residential treatment capacity by adding a residential campus for adolescent girls program. Constellation Behavioral Health operates Alta Mira Recovery Programs in California. Muir Wood will expand its residential treatment capacity for young males from its present 6 beds to 10. The adolescent male program, housed on a six-acre campus, includes weekly family programming, experiential therapies, and an accredited academic program.

Program Review: The Renfrew Center

Renfrew PicMany years ago I had the pleasure of visiting The Renfrew Center just outside of Philadelphia, PA. At first, I wasn’t sure if this was a gigantic private residence with it’s ancient stone farm house, stables, and quintessential barn. Definitely one of the more beautiful suburban locations for a treatment center I’ve seen. I had my tour of the grounds which look more like an upscale farm (in a good way), talked with the Executive Director about mental health under a giant oak tree, and got to know the program schedule as young women shuffled in and out of the various buildings. Below are more details on Renfrew with my Final Thoughts at the end. 

Background

The Renfrew Center is headquartered in has been serving women with eating disorders and behavioral health issues since 1985. As one of the nation’s first residential eating disorder facility, with 16 locations throughout the country, Renfrew claims to have worked with more than 65,000 women since their founding. The Renfrew Center has experienced it’s most significant growth in the last decade and a half have with the additional of programs across the country. 

Services

The Renfrew Center offers a full continuum of care that supports patients well beyond a residential stay. This comprehensive range of services available at most of their locations, includes day treatment, intensive outpatient and outpatient programs. The services are tailored for each patient and with her referring therapist to develop treatment plans and goals based on her unique needs.

Renfrew maintains continuity in philosophy and approach throughout the individual’s treatment, while facilitating timely transitions from one level of care to another in order to maximize treatment and insurance benefits. 

Residential services are only offered in their Philadelphia, Pa and Coconut Creek, Fl locations. 

Clients

Renfrew works with women over the age of 14 suffering from anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified (EDNOS) and related mental health problems.

Locations

Cost
Residential – $8050 per week
They work with most insurers so a significant portion of services may be covered. 

Reviews
Employees on multiple sites give Renfrew some terrible grades for working conditions, diversity of the work force, and work-life balance. Most notably were many comments on Renfew’s seeming focus on profit and not much focus on treatment. They also described poor, untrained supervisors that did little to organize chaotic situations. 

Clients on the other hand often report having a positive experience and feeling somewhat nurtured. There were dozens of reports from clients going back to Renfrew multiple times for support. This could be viewed as good or bad. 
The New York location stood out with many, many negative reviews which highlights an ongoing theme among larger providers like Renfrew – when it comes down to actual effectiveness of a program, everything has to do with the clinicians at specific locations and very little to do with the corporate handlers up above. 

Contact

Here is a link to their online contact form which is probably the best way to get ahold of them. 

Final Thoughts
Oh how I wish programs like Renfrew could just slow down and focus more on quality. I’ve known too many therapists over the years who think poorly of Renfrew’s clinical integrity to feel comfortable referring clients that come to Fonthill. That said, it doesn’t mean women struggling with an ED should avoid Renfrew. I think programs like this have a place in the menu of options, especially if you want treatment close to a major metro area like Philadelphia. Just make sure to make a decision on more than what the admissions folks at Renfrew tell you. Look up reviews, talk with outpatient eating disorder specialists (like Dr. Joanna Marino in Washington, DC) or placement specialists (…like Fonthill ) and do your homework. It’s expensive and takes a huge amount of time to go to Renfrew so don’t rush in. 

Getting Insurance to Pay for Residential Treatment

imagesSince paying for therapeutic treatments like residential treatment, intensive outpatient program and therapeutic boarding school with insurance is a big topic we’ve broken this into a few different posts. Today, we’re starting with the basics of the health care act that tightens up the requirements for insurers. Historically, insurance paid for outpatient services and residential treatment was only for more affluent families. But thanks to the mental health parity act, insurers are not more responsible than ever for paying for higher levels of care. 

What’s the Mental Health Parity Act?

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurance plans that cover mental health or substance use disorders to pay for coverage for those services that are no more restrictive than the coverage for medical/surgical conditions. Basically, if they pay for medical stuff, they have to pay for mental health and substance abuse stuff – that’s the ‘parity’ part. 

What Does it Cover?

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits covered
  • Coverage for out-of-network providers
  • Criteria for medical necessity determinations

MHPAEA does not require insurance plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental illness and substance use disorders. However, coverage that insurance plans do offer for mental and substance use disorders must be provided at parity (the same) with coverage for medical/surgical health conditions.

The original MHPAEA was enacted in October of 2008. The main purpose of MHPAEA was to fill the loopholes left by the previous Mental Health Parity Act was legislation signed into law on September 26, 1996 that requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical benefits offered by a group health plan.

What if My Plan is Not in Compliance?

Before escalating things and contacting state or federal officials, contact Fonthill to see how to ‘encourage’ the insurers to provide appropriate coverage (look for future blog posts on how to communicate and educate your insurers for coverage). If you still have concerns about your plan’s compliance with MHPAEA, you can contact the Feds or your State Department of Insurance. You can contact the Department of Labor at 1-866-444-3272 or http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html. You can also contact the Department of HHS at 1-877-267-2323 ext 61565 or at phig@cms.hhs.gov or your State Department of Insurance at http://naic.org/.

Check back next time when we explore some tricks to getting insurance to pay for treatment – it’s what the insurance companies don’t want you to know. 

 

 

The Menninger Clinic Video

 

Here is a short promo video from the Menninger Clinic in Texas. They are an inpatient psychiatric hospital that specializes in treating individuals with complex mental illness, including severe mood, personality, anxiety and addictive disorders. Learn more at http://www.menningerclinic.com/

Program Review: Veritas Collaborative

In April 2014, Dr. Marino and I visited Veritas Collaborative in Durham, NC, a 2 year old for profit eating disorder treatment program specializing in children and adolescents. Don’t let the age of this program fool you – they clearly know what they’re doing and have some clinical and business heavy-weights in their corner.VC dining pic

 

Below is a write-up of our experiences, thoughts and additional info we gathered together just for you. As always, our perspective as clinicians may be uniquely different from those of perspective clients or their parents. We highly encourage you to do your own research before committing to any program.  

What They Do

Veritas provides Inpatient, Residential Treatment and Partial Hospitalization for adolescents and children with eating disorders. What is key in our description is what is not listed. This means, during a time when other programs do everything for anyone, Veritas has committed to specializing. They have 26 inpatient/acute residential beds and 12 partial hospitalization beds. Below is a description of the three different levels of care (directly from the Veritas Collaborative site).

Inpatient hospitalization is the most intensive level of treatment available. Inpatient treatment is necessary for those who need frequent nursing care or are medically unstable (as determined by vital signs, lab abnormalities, or general physical and psychological condition). Patients who are severely entrenched in their disorders are depressed, suicidal, or are a danger to themselves or others, are also appropriate for this level of care. These patients see a medical doctor daily.

Acute Residential Treatment is a 24-hour monitored, structured treatment program for medically stable patients who still need constant supervision. Nursing care is still provided around the clock, but patients see doctors less frequently. Some individuals are admitted directly to residential treatment while others first go through inpatient treatment and them move to the residential program.VC bdrm pic

The Partial Hospitalization level of care is appropriate for patients who need structured programming but do not need 24-hour supervision. Patients participate in individual and group therapy, structured activities, and programming around meals similar to what is offered in the inpatient and residential programs. Some patients admit directly to this level of care, but many “step down” from the residential or inpatient levels, as partial programming still provides a high amount of structure and support. These patients are medically stable, and can move more readily while maintaining appropriate, non-disordered behaviors without direct supervision.

Another key feature to the Veritas program is the pervasive use of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), both of which are evidence-based treatments for eating disorders and co-occurring mental health issues.

Who They Serve

Veritas serves children and adolescents (both male/female) 10-19 years old from around the country experiencing eating disorders. It’s rare for an eating disorder program to serve younger adolescents and children which is a huge plus. It’s also less common for a program to work with male clients. VC pic

Location

Veritas is located at 615 Douglas St #500, Durham, NC 27705. They sit right next to Duke University. They are 20 minutes from the Raleigh-Durham International Airport (super, super easy airport to travel through) and 2 hours from the Charlotte airport. The parking deck is easily accessed from the road. The building is nondescript but that’s works nicely for those seeking a more discrete treatment experience. 

Fees + Insurance + Financing 

Yes, they accept insurance and will work with you to figure out what is covered.

As with most treatment centers, there are many outside financing agencies that specifically work with mental, behavioral and substance abuse programs.

A quick word about their fees – they wouldn’t say. Not a peep about daily or monthly rates which, in our humble opinion is no bueno. See below in the Reviews section for commentary on this. It’s not unusual for programs to defer questions about cost but they eventually give us an idea (normally as a monthly rate). But not Veritas. 

Reviews

It’s really disappointing and feels a bit awkward when we have a hard time finding negative reviews of a program. Either they’ve done a good job of scrubbing the internet of nasty feedback or…. they actually provide great service. From all around the intertubes we scoured parent blogs, professional review sites as well as the more general review sites. So what’s out there? What’s the overall judgement of this fledgling treatment center? Mostly just really nice praise for the staff, treatment and program as a whole. The thing that kept on coming up over and over was Veritas’s involvement of the whole family – which happens to be another key feature they told us about on our tour. Family work is at the core of how they impact the client’s treatment. 

One negative in our view is discussion of cost. We really, really like programs to be up front about what the estimated costs for service will be. It’s not that we expect a solid dollar amount since we know as well as the next professional that expenses can go up or down depending on loads of variables. But what we do want to see is an effort towards transparency, especially with pricing. When asked for pricing we were told ‘it depends‘ but would not commit to a daily or monthly rate and nothing is listed on their site. 

Other than the cost issue we experienced, there’s not much else for us to complain about. We’ll definitely continue looking for bad reviews and update this post. 

Contact Information

Reach out to Kelly Robinson at krobinson@veritascollaborative.com or 919.698.8574 to learn more or take a tour. You can also schedule a tour directly from their site here: Schedule a Tour.

Final Thoughts

Overall, we encourage perspective clients to take a tour and consider the program. It’s best to higher an educational consultant or case manager to go with you. They will ask detailed questions you may not think to ask or just feel way too uncomfortable to ask. This is a decision you should not make alone. 

Program Review: Timberline Knolls Residential Treatment Center

You may have recently heard of Timberline Knolls for the high-profile admission of Ke$ha on Friday, January 3, 2014. Or maybe you heard of Timberline Knolls when Demi Lovato was raving about it to MTV when she was discharged several years earlier. Both of these and many other celebs are drawn to Timberline Knolls for their quiet, discrete environment with a good reputation for getting young women healthy.  imgres

Reviews

We take reviews from the internet lightly since they could have been written by competitors (yes, that really happens), written by staff posing as program alums or written by actual alums. Unfortunately – there’s just no way to know for sure so be cautious when considering the reviews. Most of the negative reviews for Timberline Knolls across these sites indicates pretty good clinical program, really nice setting, but super high pricing which may not be very transparent (not currently listed on their site) and significant problems with the Timberline Knolls administration for various issues. 

Google Reviews: 2.8/10 (10 Reviews)
Yelp Reviews: 5/5 (2 Reviews)
EdTreatmentReviews.com: Mixed
BBB.com: 8 Complaints
ComplaintsBoard.com: 6 Complaints 

Who They Serve

They admit women ages 12 – 60’s to extremely discrete care (lots of celebrities). Timberline Knolls recognizes that recovery from eating disorders, addiction and the other conditions is a lifelong process for women. Women require different tools as they move through different phases of life. Their customized program addresses the unique treatment needs of women at various stages of life. 

Many adult women come to Timberline Knolls after having been in recovery for many years. They offer programming tailored to the specific needs of mature women, including those of mothers with children at home. Many clients come to them having been triggered by complicated life events like a death in the family, divorce or significant career challenges.

Residents live in separate lodge settings based upon their age. Adolescent girls attend school at the state-approved Timberline Knolls Academy. They benefit from the tight integration between the classroom and a therapeutic living environment that supports their social, developmental and clinical needs. Check out their video here

Location

timberline-knolls-campusTimberline Knolls (40 Timberline Drive Lemont, Illinois 60439) is located on 43 wooded acres just a few miles southwest of Chicago, less than a half-hour’s drive from either O’Hare or Midway Airport. An interesting side-note: The campus received recognition for its beauty from the American Institute of Landscape Architects. The tranquil grounds contain a lake and reflecting ponds, an historic art studio, comfortable contemporary residential facilities, and outdoor activity fields.

Residents are housed in one of four residential lodges, (Oak, Maple, Pine and Willow), which are staffed 24 hours a day with nursing and clinical support staff. Timberline Knolls also employs on-campus security staff 24 hours a day to protect the safety and privacy of both residents and staff.


Fees, Insurance and Financing 

$875 per day. The daily rate is inclusive for all clinical, educational, psychiatric, behavioral/milieu, nursing, and expressive therapeutic services on a 24 hour, 7 days a week basis. Individual, family, and group therapies are included. It also includes all meals and lodging. The daily rate is based on a tuition model of monthly billing. Non-included services are off-site medical services such as pediatrics, gynecology, dentistry, dermatology, hospitalization, urgent care, emergency care, urine/blood/lab work, etc., and medications. If any of these services are required, the specific provider of those services will directly invoice the parent(s)/guardian(s) or their insurance. 

If applicable Timberline Knolls works with a client’s insurance company (some in-network, some out-of-network) to get as much of the fees covered. Admissions counselors will help clients investigate their benefits.

If insurance is not an option and out-of-pocket is out-of-reach, contact Timberline Knolls and ask about financing.

Final Thoughts

Timberline Knolls had a bumpy start when they started in 2005. The original founders were two pretty shady characters who have since been replaced by reputable investors that seem to be focused on providing a good quality program to upper and middle class women. Most of the feedback we gathered from online and colleagues was that they do a descent job working with the clinical issues but could be a lot more upfront about expenses. They also received several negative marks for having difficult admin staff. These issues could be more about personality (clients as well as the staff) and less about policies that impact every client.

Overall, we encourage perspective clients to take a tour and consider the program. It’s best to higher an educational consultant or case manager to go with you. They will ask detailed questions you may not think to ask or just feel way too uncomfortable to ask. This is a decision you should not make alone. 

Virginia Senator Deeds Stabbed by Son (…And How it Could Have Been Avoided)

Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds  who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate.  Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.

Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:

1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family. 

2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster. 

3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.

4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right. 

5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him. 

If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare.