Hope Adult Program

Program life
The Menninger Clinic strives to offer a treatment experience that differs from a traditional hospital and helps the patient take full advantage of treatment.

Where patients reside
The Hope Adult Program is contained in a large one-story building—one of seven buildings on the 14-acre campus shaded by tall pines. The patient living buildings are much like a university residence hall with patient rooms up and down the hallway. Spacious common areas with sofas and tables, both large and small, anchor the halls. Rooms where groups meet, nursing stations with an open doorway, TV/game areas, a kitchen-snack room and laundry room round out the Program’s space.

On the campus, lawn chairs, gazebos, a pool, gymnasium, exercise center, tennis courts, walking trail along with the sounds and sights of a backyard await patients during their unscheduled time.



Atmosphere on the unit
Staff dress in business and business casual attire. Patients are encouraged to dress comfortably. Appropriate attire is required on the unit at all times.

Most of the treatment team offices are located in the building with the unit. As a result, members of the entire treatment team interact with patients both formally in treatment and informally throughout the day. Staff are available on the unit around the clock when patients have questions or need support.

The patients and staff function together as a community. The patient community plays a vital part in the milieu. Patients meet weekly in a community meeting. This meeting provides a forum to welcome new patients and staff, say goodbye to those leaving and to discuss issues of interest to the patients. Patients and staff meet to plan the activities for evenings and for trips into the community.

The unit is locked to provide a safe environment of care for the patient community.

For meals, patients are encouraged to eat together in the dining room with supervision of staff. Meals are served 8 am, noon and 5 pm. At the cafeteria, patients and staff throughout Menninger share the same main dining room.



Unstructured time
Unscheduled time in the evenings and weekends is considered essential in the rehabilitation model. Our patients often have great difficulty structuring their time and this leads to symptom exacerbation. Thus in having unstructured time, we are attempting to duplicate real life. In all aspects of treatment, we encourage the patient adopt his or her own agency.



First days in the program

• With an Admissions coordinator, the patient and family complete the admissions paperwork.
• Members of the treatment team greet the patient and family on the unit.
• The staff inventories and checks the patient’s personal belongings.
• The patient moves into his/her room. Rooms are set up for double occupancy. Each offers an in-room bathroom with tub/shower, individual desks, a closet and a window. A handicapped accessible room is also available. This is a co-ed program. Roommates are the same gender. Patients socialize in the common areas and not in one another’s rooms.
• A staff psychiatrist and an internal medicine physician see the patient within 24 hours of admission.
• Staff introduce the patient to other staff and patients, and orient them to the unit.
• The treatment team and patient work together to stabilize symptoms and begin assessments that help the team better understand the patient and his/her needs. During these days, the patient may participate in a shortened version of the core programming. The treatment team and patient collaborate on goals for treatment, and a treatment plan is set.

Daily schedule
The Hope Adult Treatment Program integrates evidence-based therapies into an individualized treatment plan. A blend of treatment approaches is designed to stabilize symptoms, teach and coach the use of adaptive skills and foster a successful transition to a patient’s home community and a rewarding lifestyle.

The clinical program schedule accommodates additional therapies prescribed by the treatment team, such as individual psychotherapy, family therapy, 12-step programs and medication management. The treatment team will vary the schedule to meet the patient's clinical needs and update it during the patient's treatment.

Assessment
A diagnostic assessment is completed within two weeks of admission by the clinical team. The team also considers patient and family history, psychological testing, past treatment records and observations in formulating the diagnostic assessment. Team members share assessment findings during a diagnostic conference in which the patient's diagnoses and clinical understanding are communicated along with an estimated length of stay, which correlates with the treatment goals. These findings are then shared with the patient.

The staff continues to assess the patient throughout the stay. Progress is reviewed on a weekly basis by the team with the patient and the parents.



Core treatment program
All patients participate in the following treatment modalities.

• Individual & group therapy
  These therapies are central aspects of treatment and are provided by program staff. In order to facilitate an integrated treatment program, the patient's team leader serves as his/her treatment coordinator.
  
  Individual therapy provides the opportunity for in-depth understanding of a patient's problems and attention to problem solving through the developing relationship between the therapist and patient. It is sometimes the development of this basic trust that allows the patient to address deeper and more difficult issues. The style and focus of individual therapy is directly related to the prioritized goals of treatment. For example, the focus of therapy for a patient with psychotic symptoms may be to decrease anxiety related to being in treatment with reality checks coming from the outside regarding distortions. As the patient progresses, the focus of therapy will shift to skill-building and adaptive functioning to manage symptoms. In contrast, a patient with social anxiety, depression, family conflict and role diffusion may work in individual therapy to define a sense of self and family and be encouraged to have authentic experiences and communication.
  
  Group therapy provides an opportunity for patients to share their problems and receive support while providing the same to peers. Every patient's problems are unique, but also overlap with problems of others. Group therapy helps patients people achieve a sense of commonality of problems and experiences, and provides the opportunity to help, as well as be helped.

• Milieu therapy

The milieu is the supportive, therapeutic environment in which the staff work with patients on repairing difficulties in the interpersonal or family relationship that can be applied during treatment and at home. The milieu provides structure, education and support. A consistent routine is maintained, which fosters predictability and trust. Milieu structure assists patients in containing negative behavior and provides opportunities to remediate the behavior through staff and peer feedback and modeling.

A milieu is considered therapeutic when there is a community that provides a sense of membership and belonging and plays a central role in the individual patient's life. In the therapeutic community, staff and patients reflect a sense of responsibility for the welfare of other patients in the community and the community as a whole. The therapeutic community has a set of values and norms for behavior with an expectation that community members will participate in activities, value one another as individuals and learn to care about and trust one another.

The objective of the therapeutic community is to provide a safe, nurturing environment in which patients can develop a sense of trust in staff and other patients in order to share and scrutinize their problems, feelings and beliefs.

Additional objectives are to provide a means for a patient to integrate new and positive experiences; then use these experiences to increase self-esteem and opportunities to practice new, adaptive living skills, social skills and empowerment for experiencing success. Activities that foster these objectives include a weekly community meeting, consisting of all team members and patients, and a nightly agenda meeting for individual and community issues that is attended by patients and nursing staff.

Staff members interact with patients to foster relationships based on mutual trust and respect. All staff serve as role models to assist patients with learning improved social skills, problem solving and relationship skills. Patients are expected to complete assigned talks with nursing staff that are focused on core treatment issues.

• Specialized skill-building groups: These groups are part of the core program and focus on issues such as treatment review, social skills and relationships, cooking and gender issues.
  
  Therapeutic activities and recreation: Patients meet with the activity therapist upon admission to begin an activities assessment. The activity therapist coordinates an active program of recreation and skill-building activities.
  
  Programs focusing on cultural and spiritual values: Cultural and spiritual needs are assessed at the time of admission. The clinical team uses Menninger and community resources to address these needs. Patients may attend chapel services on the grounds. The hospital chaplain is available for individual consultation as requested by the treatment team.

• Individualized treatment
  In addition to the core program, patients are prescribed individualized adjunctive programming by their treatment team based on their clinical needs. Most of these adjunctive modalities are provided within the program. Some interventions are accessed through cooperation with other specialized programs at Menninger.

Specialized programming is available for:

Patients with substance abuse issues

• Substance abuse evaluation
• Individual substance abuse counseling
• Substance abuse educational groups
• 12-step group treatment
• Off campus AA and NA groups

Patients with impulsive, anger management & suicidal/self-harm issues

• Anger management group
• Dialectic behavior therapy (DBT) group
• Individualized milieu structure to accommodate behavioral difficulties
• Social skills building through milieu therapy groups

Patients with eating problems or history of trauma

• Body image group
• Eating disorder consultations and nutritional counseling
• Self-harm group, when appropriate and requested by the treatment team

Patients with anxiety disorders or obsessive-compulsive problems

• Cognitive behavioral therapy (individual and group therapy)
• Obsessive-compulsive disorder consultations
• Response prevention (individual and group therapy)

In an effort to help patients master basic social and adaptational skills and to support their return to the community, the Hope Adult Program utilizes community resources when clinically appropriate. These resources include:

• Community Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings
  
• Community recreational programs

Discharge planning
Discharge planning is an ongoing process that begins at the time of admission. An initial discharge plan and estimated length of stay is established at the diagnostic conference early in the patient’s stay. This plan is reviewed and revised in weekly team meetings.

Unscheduled time may be used to do therapy homework, “practice” socializing with others, relax with a hobby or activity, exercise, read or participate with other patients and staff in planned recreational activities. With approval from staff, group activities—on the unit, on the campus or in the community—may include events, games and movies.

Supervision by staff
The patient’s treatment team determines the level of supervision the patient needs. Supervision levels change throughout a patient’s stay based on the team’s assessment of the patient’s clinical needs.

The supervision levels and the activities prescribed by the treatment team aim to help the patient accomplish treatment goals and provide for the patient’s safety. As the patient attains their goals, they typically earn privileges to participate in individual and group activities on and off the campus.

Menninger is a leading psychiatric hospital dedicated to
treating individuals with mood, personality, anxiety and
addictive disorders, teaching mental health professionals
and advancing mental healthcare through research.

The Menninger Clinic | 800-351-9058 | 713-275-5000 | Houston, Texas
Affiliated with Baylor College of Medicine and
The Methodist Hospital in the Texas Medical Center
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