We get a lot of patients from recovery clinics where they have been receiving treatment for an SMI determinant, from the hospital from probation, and from outpatient behavioral health clinics. If individuals have both a mental health issue as well as substance use – we offer the highest level of care without being inpatient. They may not need – or want – to be inpatient, but still need a high level of care. They can get that with ATDT. Our patients are still often actively using, although not permitted to on premises. We do not perform drug testing, although some individuals may be involved with other programs where it is required. For some, ATDT is the best of several other hard choices – inpatient, imprisonment, even death – or ATDT. Individuals may have experienced an overdose or suicide attempt and were hospitalized ATDT can help and some prefer this as an option to inpatient.

We provide a very structured day as part of the approach. They start with breakfast and an activity, then split up into small groups with assigned clinicians for their “check in” group. This is group therapy with an individual focus. They then go to a symptom management group which deals with subjects related to for their mental health diagnosis; this could be anything from talking about specific diagnosis to setting boundaries to communication skill-building. It is then time for lunch and a lunch activity – this might be outdoors or arts/crafts or a game – a time focused on fun & relaxing. It is then time for recovery group focused on substance use. This is followed by a period of time where they again break up into small group with clinicians for Check Out group – here they rate their symptoms, and answer questions to help process the day. There are therapeutic breaks after every group session. Finally, it is wrap up group time and candy is passed out.

We simulate a social environment and schedule that is therapeutic in its structure. Activities may be considered non-therapeutic but still offer a space for making improvements. One example of a specific evidence-based treatment is a Cognitive Behavior Therapy (CBT) called “Roadmap to Peace of Mind.” It is designed to address thoughts and how they contribute to feelings and behaviors – focusing on changing thoughts to change the way you feel to change your actions, change negative core beliefs.

We really work to meet the patients where they are at. ATDT is a four-month program because the first month is really dedicated to building rapport and habit; we understand it is an adjustment period. A lot of times people will come in very resistant, especially to group therapy and after a week or two, they start to really like it. Sometimes people start and do not come back – or they come back months or years later. A lot of individuals do not want to leave – it becomes a safe space for our patients. Success is an individual thing and may emerge in different areas of the day and schedule. Patients that have left might call us again, sometimes with their success update, sometimes because they need to come back. This is a safe space and we understand that recovery is a journey. A unique aspect of ATDT at Terros Health is that because we are part of a whole health, whole person care model, we work with every single program across Terros Health. For our patients who may have been struggling in the system – health care or justice or maybe both – when they come to ATDT, they feel more supported and that they are part of their own care team. We help create a safe space for them so that they can focus on their care and treatment and get better.

We have remained open during the pandemic. And it was difficult at the beginning. We have implemented safety protocols: face masks, gloves, temperature screening before entry, plexi-glass in kitchens, groups rooms are spaced out for social distancing. There is a rigorous cleaning schedule: environmental services cleans twice daily and at night; staff cleans consistently throughout day; we are using hand sanitizer, CDC-recommended solutions; and we offer face shields and bandanas as alternatives. There is often anxiety and stress because of COVID-19; we do a lot of calming around it. We have learned a lot and we can share that knowledge with our patients. A recent graduate shared that they were so grateful to have a safe place to come for treatment during COVID-19. We offer a WebEx engagement group for those with health issues if clinically indicated, or for those who are quarantining. We have found the Terros Health nurse line, operated by three staff nurses, helps because if a patient has symptoms, they can access a medical professional for guidance.