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. Read on for an interview about this Hybrid Approach, 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.