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As Benjamin Franklin famously said, “Tell me and I forget, teach me and I may remember, involve me and I learn.” At Bridge House, training and hands-on learning is essential to ensure that staff and the professional team are equipped to support residents in the safest and most supportive ways possible. 

All Bridge House staff receive extensive training upon hire and are subsequently required to attend annual live trainings. Included are trainings required for compliance for State licensure such as suicide and self-harm prevention, therapeutic de-escalation techniques (AEGIS), Occupational Safety and Health Administration (OSHA) trainings, and CPR certification. In addition to what is required by the State, Bridge House includes a series of trainings that are specific to our facility and our population. These trainings include an overview of our philosophy and mission, strategies for milieu management, and basic counseling skills. 

New direct care staff complete at least 4 days of rigorous supervised hands-on training before working directly with residents. Our program staff are also taught monthly by Program Director, James Healey, who reviews concepts that are relevant to the current needs of our residents. Additional trainings are added as needed, particularly when we have a resident in need of more specialized care and attention (for example, someone with diabetes, a seizure disorder, cultural considerations such as Kosher diets/religious accommodations, etc.) Our leadership team is particularly adept at creating specific trainings to accommodate those needs in order to ensure that our staff are equipped to support that resident.

These trainings, along with the continual communication with all staff about current milieu needs, keep our residents safe and ensure our staff have the continued education needed to maintain a healthy therapeutic milieu. In essence, training never stops at Bridge House and we welcome opportunities to regularly educate our staff.

Philosophy and Statement: Description and orientation of the genesis of Bridge house. Where we fit in the continuum of care. The population we serve and the services we provide.

Disease Model: The disease model of mental illness and addiction and the implications for assessment, diagnosis and treatment of Bridge House residents.

Relationship Therapy: Basic introduction to helping professions and the healing factors of relationship therapy. What it looks like and what it means to be in a helping relationship.

Suicide and Self-Harm Prevention: Continual observation of residents for signs and symptoms of self-harm and suicide. Precautionary procedures.

Milieu Management: Basic components of milieu management and the strategic interventions that are utilized to maintain a safe and therapeutic environment.

Off-campus Activities: Procedures to follow to ensure the safety and therapeutic purpose of all off-campus activities.

Behavior Management: Introduction and implementation to AEGIS systems of behavior management including de-escalation techniques and restraints procedures. (2 days)

Basic Counseling Skills: The design and purpose of counseling skills.

Boundaries: Professional boundaries as a helping professional.

Group Therapy: Orientation to the basic concepts of small group dynamics and facilitation of group therapy.

Infection Control: Education about and procedures to follow to prevent and minimize the spread of infectious disease.

Blood-borne Pathogens: Education about and procedures to follow to prevent the exposure to blood-borne pathogens.

Medication Management: Policies and procedures associated with administering medication.

Urine Analysis: Orientation to the procedures associated with proper collection and testing of urine.

Blood Glucose Monitoring: Orientation to procedure for glucose monitoring in diabetic residents.

Safety: Fire plan, evacuation plan, earthquake safety and overall orientation to alarms, gas and water shutoffs.

Harassment Prevention: Preventing workplace harassment and discrimination

CPR Certification (required every 2 years)

 

 

An Interview with Carrie Thompson, Director of Admissions and Business Development
Q: Within the continuum of mental health care that is available today, what are my options?
A: When a person is experiencing a mental health crisis or struggling with chronic mental illness, they are often referred to some form of mental health treatment. While many types of mental health and behavioral health services provide “treatment” in the overarching sense that mental health concerns are being addressed, the distinctions between services provided along the continuum of care are helpful to understand.

We must first define and discuss some terms. In general, mental health care falls into three distinct categories: stabilization, assessment, and treatment. This can be confusing, because we often use the word “treatment” as an umbrella term to refer to all mental healthcare.

It’s helpful to clarify that stabilization services are usually accessed within medical model hospitals. Stabilization can include everything from addressing an acute mental health crisis in a psychiatric hospital, managing medication through the oversight and care of a psychiatrist, and/or detoxing someone from substance abuse. The primary goal of stabilization is to get someone from a more acute state to a space where they are able to engage in a therapeutic process. Stabilization is typically a short-term attempt to address a situation.

Assessment can oftentimes be coupled with stabilization, or can be found as a stand-alone service. The primary goal of mental health assessment is to clarify diagnostically what is occurring for an individual. An out-patient psychologist or a team at a psychiatric hospital can typically run test batteries and come up with a diagnostic conclusion. This approach, while appropriate for more simple cases, or high-functioning individuals, can often miss the secondary goal of truly understanding someone’s level of functioning beyond just a diagnosis, or outside the walls of a hospital.

Finally, “treatment,” is what people are typically referring to when they talk about longer-term care. Treatment, which is usually informed by some type of assessment, is accessed in a range of settings including residential treatment centers, intensive out-patient programs, transitional living programs and out-patient therapy. Individual therapy, group therapy and family therapy are implemented in these settings and typically follow a particular approach or modality. Treatment without a preceding thorough assessment to drive the treatment planning approach can at best be time consuming, and at worst be contra-indicated. 


Q: So in general, there’s stabilization, assessment, and treatment. What category is Bridge House in?
A: Bridge House holds an interesting spot on the continuum of mental health services, and is a unique hybrid of all three models. The Bridge House process incorporates a holistic approach to stabilization with the best elements of sophisticated comprehensive assessment, while integrating the cornerstones of compassionate, relationship based therapy and treatment. We have set out to re-vision the concept of assessment and diagnostic services available to clients around the country and the world. By slowing down the assessment process, a broad understanding is gained. Our professionals are able to observe not just how individuals operate and function in times of crisis or in restrictive settings, but are able to watch residents grow, evolve and heal, all guiding a better understanding of a person. 


Q: How do you incorporate all of these goals, and how do you prioritize each? 
A: Let’s first discuss stabilization. We know that we can not provide adequate care or accurate assessment if someone is in the throes of a crisis. When people arrive at Bridge House, we provide a safe, home-like, and welcoming environment, which is conducive to their stabilization process. This is especially helpful if they are experiencing an acute mental health crisis. We aim to connect and create trust and rapport with our residents from day-one, to help them understand that we are here to help them answer questions and create a road map for their future. We focus on empowerment and relationship building to guide this process. Stepping well beyond the goals of in-patient hospitalization, stabilization at Bridge House incorporates diet, nutrition, sleep, medication, exercise and mindfulness. Bridge House has a psychiatrist on-site who manages each resident’s medication regimen to aid with their stabilization process. Stabilization extends throughout someone’s time with us as we raise their baseline of functioning and engage in a healing process.
 
Then, in terms of assessment, we have taken the traditional approach to psychological assessment and evaluation, and expanded it to include observations of someone’s daily life and behavioral patterns as they live with us in a residential setting. We refer to this as the milieu assessment and the information learned through this process is far more valuable than any person’s response to a psychological battery. A resident’s capacity is assessed on both their good days and their bad days and cycles and patterns can be observed in real time, outside of the walls of an office or a hospital. Assessment and diagnostic services begin truly on day one as we learn about what it means to be human for each of our residents. Bridge House psychologists have the benefit of completing a wide array of formal assessments (personality, projective, social history, occupational therapy, IQ, achievement etc.), over the course of weeks, not days, as they are able to constantly adapt the measures used to answer the unique questions that exist for each and every one of our clients. By slowing down the assessment process, a holistic and broad understanding is gained.
 
In addition to stabilization and assessment, Bridge House also provides treatment for the challenges a resident may be experiencing. Over the course of care in a safe and supportive environment, Bridge House residents are exposed to a variety of treatment modalities in order to begin the healing process, and to determine the most appropriate individualized approach. While residents are learning about themselves through an integrated assessment process, they are simultaneously raising their baseline and level of functioning. At the end of their stay, residents leave Bridge House with a much better understanding of themselves and what kind of support they will continue to need in the future. Individual, group, family and experiential therapy is accessible to all residents throughout their entire stay at Bridge House, and the emphasis adapts and changes as we learn more about each individual. 

Q: I’ve heard of treatment programs that complete an assessment at the beginning of a client’s stay with them. How is that assessment different from what Bridge House is providing?
A: It’s true, there are some treatment programs that may integrate some cursory assessment at the outset of a client’s treatment experience, but it is typically not the most comprehensive assessment available. Everything at Bridge House that occurs, sits under the umbrella of assessment as we try to understand an individual, what their strengths and challenges might be, and how to best support them in redirecting the trajectory of their lives. Self-awareness and understanding goes hand-in-hand with emotional health, wellness, and healing.

Q: If Bridge House includes treatment, do residents need to continue therapy or treatment after they complete their time at Bridge House? 
A: The goal of someone’s time at Bridge House lies far beyond simply identifying an accurate diagnosis. We strive to help our residents truly integrate this new information into their daily life and subsequently improve their level of functioning. The outcome then allows residents to prepare for transition to the least restrictive level of care they are capable of managing since there has been opportunity for forward momentum alongside the assessment process.
 
While we don’t focus on long-term treatment, we have consistently seen that residents’ baselines have improved while they’re with us. Simply put, with structured support for healthy sleep hygiene, nutrition, regular exercise, community participation, and the development of self-awareness, people heal. We also recognize that mental health is a lifelong journey and that our people will likely need support well beyond Bridge House as they step into the next phases of their lives. Each individual will have unique and specific recommendations drawn up by their treatment team.
 
No one completes the Bridge House process without having had extensive communication with next-step providers and support systems prior to transition. We must ensure that residents are progressing to the appropriate level of care and bringing with them diagnoses and recommendations that have been accurate and applicable. This collaboration is essential in ensuring that the clarity provided in one setting is utilized in treatment and life planning in the weeks, months and years to come.

Because the primary focus of Bridge House is to help residents and family members better understand the underlying reasons for issues leading to impairment in day-to-day adaptation and functioning, we seek to understand these issues through the application of scientific, social, medical, and observational strategies. Bridge House is committed to leaving no stone unturned when it comes to the assessment of our residents’ mental health, and we understand that physical wellbeing is a significant component of mental health.

In addition to all of the psychological and observational evaluation that occurs throughout the Bridge House process, our holistic approach to assessment includes a series of medical tests, which we believe are a key part of the puzzle when helping residents who come to us seeking help. To inform their treatment and assessment, when each resident arrives we administer genetic testing (if not previously completed), blood work, and toxicology screenings.

Genetic Testing

Bridge House offers genetic testing to personalize medicine for each client. Our clinical team uses the specific information gathered from genetic testing to create a more personalized approach to treatment, as genetic testing allows clinicians to understand if a drug may work for someone before they even try it.

Genomind Professional PGx ExpressTM looks at 24 key genes that are associated with mental health. With this information, along with a resident’s medical history, our clinicians can make a more informed treatment decision. Genomind Professional PGx Express supports the genetic profile implications for the treatment of:

  • depression
  • anxiety
  • obsessive-compulsive disorder (OCD)
  • attention deficit hyperactivity disorder (ADHD)
  • bipolar disorder
  • post-traumatic stress disorder (PTSD)
  • autism spectrum disorder (ASD)
  • schizophrenia
  • chronic pain
Blood Work

Bridge House provides in-house blood work which reveals information about a resident’s physical health and gives insight into any physical concerns a resident might be experiencing The blood work completed will often reveal physical concerns related to many of the following:

  • anemia
  • thyroid issues/hormone imbalances
  • calcium and vitamin D
  • B12 and folate 
  • hemoglobin A1C
  • cholesterol levels
  • electrolyte imbalances
  • liver function
  • kidney function
Toxicology Screening

An initial toxicology screening (drug urinalysis) occurs upon admission and then each week throughout a resident’s stay. This screening process is particularly important for the assessment of a resident who has previously been using drugs, as it allows the treatment team to determine when a resident’s body is clear of substances and is closer to a baseline for more accurate assessment.

Additional Testing: As Indicated

If our treatment team determines that more information is needed, they will consider additional testing. Because this testing is administered “as indicated,” there is no definitive list of tests that our clinicians will consider. The following tests are additional tests we’ve used to better understand specific medical concerns presenting in a resident, but it is in no way a complete list of what can be explored as we engage in an individualized assessment for each person we work with. 

  • Hormone testing: If our initial in-house blood work reveals hormone imbalances or other related concerns, our treatment team may determine that further testing is needed. In this case, we will complete a comprehensive baseline test of hormone production which will help us pinpoint any imbalances and further inform treatment.
  • Micronutrient lab test: The Bridge House treatment team will consider a micronutrient lab test for residents to gain a better understanding of nutritional deficiencies in order to address any nutritional deficiencies or complications that may be the source of or contributing to any physical or psychological complaints/concerns. This test measures functional deficiencies at the cellular level and is “an assessment of how well the body utilizes 31 vitamins, minerals, amino/fatty acids, antioxidants, and metabolites, while conveying the body’s need for these micronutrients that enable the body to produce enzymes, hormones, and other substances essential for proper growth, development, and good health.” [Spectracell]
  • Food allergy/sensitivity testing: If there are concerns that food sensitivities or allergies may be playing a role in a resident’s health, an IgG (immunoglobulin G) test can aid in the structuring of elimination diets that may relieve symptoms of many chronic neurological, gastrointestinal, and movement disorders.
  • CT or MRI: If the treatment team has concerns about a resident’s neurocognitive function, a CT or MRI of the brain may be indicated to rule out serious illnesses such as brain tumor or possible traumatic brain injury.
  • Functional Magnetic Resonance Imaging (fMRI) or Functional Neurocognitive Imaging (fNCI): If a resident arrives with a history of traumatic brain injury (TBI) that has not been properly assessed, or if the resident is experiencing continuing issues despite previous TBI treatment, the Bridge House treatment team may determine that further assessment is needed.
  • Lyme Disease: An IGX immunoblot test will be administered if a resident’s history indicates that Lyme Disease may be a concern.
  • Sleep study: Throughout the assessment process it may be determined that a resident should participate in a sleep study in order to diagnose a potential sleep disorder. By recording brain waves, blood oxygen levels, and other vitals, a sleep study may help pinpoint potential concerns such as narcolepsy, sleep apnea, unexplained chronic insomnia, or other sleep-related disorders.
Integrating Medical Testing into Assessment and Treatment

The results of all of these tests are reviewed and integrated into a resident’s Bridge to Health Report and recommendations are formulated and discussed with the resident by their treatment team. Our Medical Director, Psychiatrist, Clinical Dietician, and team of nurses help integrate this information into a care plan that facilitates raising the baseline of physical health for each person receiving support at Bridge House.

Transgender Pride Flag

Being transgender is often a trauma in itself, and we like to have great empathy for individuals who are trans when welcoming them to Bridge House. It is important to fully understand what it means to be transgender before treating or supporting a person who identifies as such. To be transgender simply means that a person identifies as a different gender than their biological birth gender. Research has shown that people who identify as transgender often possess the brain of the gender with which they identify, and not their biological gender assigned at birth (Cleveland Clinic, 2019). 

Trans people are often victims of violence and discrimination. An open transgender status frequently finds individuals forced into unemployment, poverty, homelessness, and/or survival sex work. In 2019, at least 22 transgender and non-conforming individuals have been victims of fatal violence. This number also does not accurately depict the number of deaths because many police reports have misgendered these victims (Human Rights Campaign, 2019). Trans women of color face some of the highest levels of discrimination in any population nationwide (National LGTBQ Taskforce, 2019). Access to healthcare is very limited, as they are frequently turned away by doctors, therapists, and medical professionals due to personal beliefs, fear, or not specializing in transgender care. They also face daily persecution due to others not using their preferred pronouns, which results in daily revisiting of trauma and magnifying what the individual sees as “wrong” with them. 

Most people who are transgender learn from an early age to feel uncomfortable in their own bodies—they look in the mirror and see the parts that aren’t supposed to be theirs, they look at what’s wrong with them. There was an instagram post by @TBESTIG that circulated social media recently about what it was like to be trans. It shared about how people who don’t fully understand often say, “I identified as a dinosaur when I was six, kids that age are too young to know they’re trans.” The post then continues, “Nah, mate. You didn’t identify as a dinosaur. You didn’t cry yourself to sleep because you couldn’t figure out why you had no tail. You didn’t feel inexplicable sense of shame at your lack of claws. When you saw yourself in a mirror in a dinosaur costume, you weren’t upset about all the non-dinosaur bits you could still see. When others saw the costume, you weren’t brought to tears by them treating you like a child-wearing-a-costume instead of a real dinosaur” (@TBESTIG, 2019). 

Being transgender creates an identity crisis from an early age because your body—something that you should be able to rely on and trust—is telling you that you are not allowed to be yourself. This results in struggles with self-confidence, self-esteem, and difficulty finding a place in society because transgender individuals often feel like they don’t belong in social settings due to their foundational feeling of not belonging in their own body.   

When we approach treating people who identify as transgender, the most important thing we remember is: if someone says they are trans, we believe them. When this person shares their preferred pronouns and names, we use them. Not only does this validate who they identify as, but it validates them as a human in a world that often treats them less-than. A person who is trans has already decided their gender and their place, it is not anyone else’s place to decide that for them. We are not here to change their identity, but we are here to support them through the process of reinforcing who they are and who they want to be. 

People who identify as transgender are not seeking attention and are not “going through a phase.” Being transgender is a risk in today’s society—it is unsafe, it is a target for discrimination and violence. It is imperative to consider how important it is for someone to transition if they are willing to face the risks of transitioning (violence, discrimination, loss of relationships, loss of family, homelessness, poverty, etc.), versus living as the wrong gender. This isn’t a choice, but the individual’s biological makeup, as shown in the Cleveland Clinic research (link below).  

In understanding a person’s experience in being transgender, therapy can often lead into the exploration of the person’s relationship with gender throughout their life. Being trans inherently brings trauma, and it is important to explore this in therapy in a non-threatening approach that builds from a non-judgmental foundation of safety in the therapeutic relationship. People who have experienced trauma often will resort to behaviors of survival. 

Being trans isn’t bad, and it isn’t something to change. And when we step out of the individual’s way and don’t try and change who they identify themselves to be, we empower them to take control of the life they want and deserve. 

Resources

Cleveland Clinic (March 27, 2019). “Research on the Transgender Brain: What You Should Know.” https://health.clevelandclinic.org/research-on-the-transgender-brain-what-you-should-know/

National LGTBQ Taskforce (2019). Website: www.thetaskforce.org

Human Rights Campaign (2019). Website: www.hrc.org

Interview with Connie Anast-Inman (November, 2019), Executive Director for TEA (Transgender Education Advocates) of Utah from April 2011 to June 2015.

We are frequently asked by potential residents, their families, and members of the therapeutic community how we developed the ideas, assessment procedures, and therapeutic modalities utilized at Bridge House. This is a difficult question to answer because it was a plan developed over a period of nearly two decades. This plan began when Dr. Chris McRoberts created a psychological testing and evaluation firm with psychologists specializing in evaluating children, adolescents and young adults in schools, therapeutic programs, and private practice settings around the United States and even internationally. Over the years, it became clear to Dr. McRoberts that a majority of people with mental health, cognitive, learning, substance-abuse, and behavioral difficulties were not being adequately assessed or accurately diagnosed prior to beginning costly and time-consuming therapeutic regimens. Many people were being tested during times of crisis or while in a hospital when test results could be erroneous. Additionally, many people underwent psychological, educational or neuropsychological testing when they were experiencing the lasting effects of drugs or alcohol or immediately after significant medication changes which might impact their test results. Some were evaluated in the midst of a severe psychotic, manic, or depressive phase of their illness. Others had physical illnesses, chromosomal abnormalities, dietary problems, family situations, or histories of trauma that could cloud test results and lead to inaccurate diagnosis. It became clear that a slower, comprehensive, integrative, and community-based assessment strategy should be implemented.

RESEARCH EVIDENCE

In 2016 Dr. McRoberts partnered with Rod Andrus, a skilled clinician and manager with more than 20 years of experience creating and implementing therapeutic programming in residential settings. Together they developed a strategy for working with a diverse array of people experiencing mental health and adjustment problems with the goal of understanding the complex underlying reasons for the struggles people were experiencing. They utilized research evidence showing that people in acute and chronic distress must experience a caring and nurturing environment with their caregivers to feel safe and secure enough to make therapeutic gains. The assessment program they developed at Bridge House focuses on this type of environment while also providing structures to keep residents safe while they develop stability and with it the ability to heal. As this program is implemented, medications are adjusted and residents undergo medical, dietary, occupational therapy, DNA, and other comprehensive assessments before efforts are made to accurately diagnose and understand their problems.

DIAGNOSIS

Mr. Andrus and Dr. McRoberts also determined that a necessary component of the assessment process was to effectively communicate assessment results to each resident, to their families, and to future treatment providers so that a plan could be developed for lifelong health and healing. Because it often takes some time for people to understand the complexity of their issues, an integral part of the Bridge House process is helping each individual understand their diagnosis and the types of supports and therapeutic interventions they will need in order to function optimally in society. To this end, each individual at Bridge House participates in a wide variety of community activities in order for their ability to function outside of residential treatment to be evaluated and future plans can include interventions tailored to their reactions to real life experiences and challenges. 

HEALING

It was also clear that during the three month assessment process developed at Bridge House people could make significant change. This is accomplished through a wide variety of therapeutic interventions including eight hours a day of various forms of group therapy made available to residents, intensive individual therapy, and effective medication management. These interventions have consistently enabled Bridge House residents to make tremendous gains, which in turn, allow them to transition to the least restrictive level of care possible.

At Bridge House a fundamental tenet backed by many years of research is that caring relationships heal. Because of this, we hire the most kind, compassionate, and caring people we can find who are also able to set good limits and boundaries. This contributes tremendously to the healing process and creates an environment of peace, safety and security within which our residents feel secure enough to try new behaviors and to risk their deepest selves in order to make change.

Finally, the environment at Bridge House was chosen specifically for the peace and calm it engenders. Our beautiful home sits on five acres with a serene pond, outdoor living spaces, grassy areas, and beautiful trees away from the hubbub of city life. Our residents are free to move around the property, and, when they are safe to do so, can regularly go off the property to engage in service, athletic, and community activities.

We are trying something new at Bridge House, and it’s working to reduce the revolving door that so many people with mental health problems go through with multiple therapists, hospitalizations, medications, and other interventions that were ineffective due to an inaccurate diagnosis and a lack of understanding of each complex individual. We work hard at Bridge House to develop understanding, to create effective interventions, and to communicate our understanding of each resident and what will benefit them long-term.