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.” He cites “trends in admissions, lengths-of-stay, ASAs (patient departures ‘against staff advice’), patient satisfaction, and family satisfaction.” While he 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 aftercare. 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.”