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31

January

 The Kiloby Center for Recovery sends the following letter to your insurance company upon admission into our program.  The letter outlines the Center’s unique approach and requests your insurance company to adequately cover your treatment.  The letter also outlines the need for all clients to participate fully in the Center’s aftercare program. 

 

Dear Insurer:

In 2017, the Kiloby Center for Recovery performed an audit through a random cross-section of all client files for those clients in the last two years who participated in our partial hospitalization and intensive outpatient drug and alcohol program. The results, as shown below, reveal the effectiveness of our program.

The Kiloby Center focuses primarily on mindfulness therapy, relapse prevention, drug and alcohol addiction education and trauma resolution.  The Center’s counselors and therapists are required to complete and become certified in an eight month to one year mindfulness certification program in addition to their state-mandated professional credentialing as licensed therapists or certified alcohol and drug counselors.  In order to provide more comprehensive therapy and counseling, the Center provides three individual sessions for each client per week, whereas most treatment centers provide only one individual session per week.

The Center’s mindfulness approach is a hybrid of the evidence-based practices of Acceptance and Commitment Therapy (where the focus is on recognizing self as awareness rather than self as thoughts, emotions and sensations) and DBT (where the focus is on being present to and dissolving negative emotional states). As with DBT, there is a strong mindfulness skills training component in the Center’s program, where clients are expected to master certain mindfulness skills and graduate through various phases of mindfulness skills training before the Center may recommend their discharge from the program.  In addition, the Center has an extensive aftercare program involving the necessity for the client to continue deepening in their recovery after discharge through continued mindfulness self-practice, meetings (NA, AA, Rational Recovery and/or mindfulness recovery support groups), case management, sponsor-/mentorship and participation in and ongoing monitoring of results through our unique bi-weekly alumni video conference program, which provides the Center with the opportunity to directly monitor clients’ progress or lack thereof post-discharge.

The Center’s approach helps clients manage and dissolve the underlying causes of their addiction, usually trauma-related.  The Center focuses on trauma as a result of recent studies showing that chronic relapsing is often the result of unresolved trauma and pursuant to SAMHSA’s recommendation to treatment providers to screen for and treat trauma for all substance abuse clients for which trauma or PTSD is indicated.  The Center also addresses any and all co-occurring conditions such as stress, anxiety and/or depression, in addition to working with cravings for alcohol and/or drugs.  Medication is prescribed where necessary.

Clients are assessed at admission, midway through treatment and at discharge on cravings, anxiety, depression, PTSD/trauma and suicidal tendencies.  The Center uses Beck’s standardized testing for depression and anxiety.  Our trauma assessments include the CDC’s ACE assessment as well as the U.S. Department of Veteran’s Affair’s recommended “Brief Trauma Questionnaire,” which we have expanded to better assess the prevalence of PTSD symptoms during and after treatment and adjust treatment plans accordingly.

Our random cross-section audit of client files in 2017 for clients who have participated in our program in the last two years shows that, for those clients who completed our recommended length of treatment period, levels of cravings, depression, trauma and anxiety decreased from 8 or 9 on a 10 point scale at admission, to 0 – 2 at discharge, and suicidal thoughts became non-existent.  The “recommended length of treatment period” is determined by the client’s case manager based on initial assessments and history of use and co-occurring disorders and may be adjusted during treatment based on midway assessments and overall progress during treatment, which are all documented in the treatment plan.  Our clinical supervisor is a licensed marriage and family therapist with 20 years experience in addiction treatment and oversees all treatment plans and case managers.  There is a weekly staff meeting between all clinical staff to discuss progress or lack thereof and adjustments to treatment plans.

When we reduce the level of care from PHP to IOP, the program remains virtually the same, except that the client is reduced to three hours per day for several days per week.  For clients who receive IOP authorization for at least five days a week, those clients continue to receive three individual sessions per week.  The client continues to address any outstanding cravings, anxiety, depression and trauma and becomes more educated about addiction and mindfulness. At the IOP level, clients are encouraged to begin living life outside of our Center, where they face real-life environmental cues and emotional triggers, while learning to practice our tools in the face of those cues and triggers.  This better prepares them for life after discharge.

For those clients whose insurance plan covers PHP, followed by IOP, followed by OP and who participate fully in our recommended aftercare program, between 70% to 80% of such clients report being clean and sober at the one and two year mark after discharge.  In cases where these clients do relapse, the relapses are usually minor, not resulting in re-admission into an addiction treatment program.  Returning to the aftercare program usually gets these clients back on track.  For those clients who receive the Naltrexone Implant during treatment, who have adequate coverage for all levels of care and who follow the recommendations of our aftercare program, the success rate increases to well above 90%. Each of these categories of client success are far above the national average success rate of 5% to 15%.  In 2017, the Center is implementing an independent outcomes measurements system, mostly likely through TRI (Treatment Research Institute).

Difficulties arise when insurance plans do not support all levels of care, when their insurance plans do not cover the Naltrexone Implant or when clients do not follow up with all aspects of our aftercare program.  These factors reduce the success rate to about 50%, which is still well above the national average.  We encourage all insurance companies to support the Center in its efforts to provide long term successful recovery by providing coverage for PHP, followed by IOP, followed by OP as well as ongoing drug testing and sober living where appropriate and coverage for the Naltrexone Implant where clinically appropriate for opiate and alcohol addicted clients.  This raises the success rate and provides a cost savings to insurers in the long run, as clients reduce the need for future multiple admissions into treatment centers for severe relapse.