The Turning Point, Inc.
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THE TURNING POINT INC. MISSION STATEMENT The mission of The Turning Point, Inc. (TPI) is to provide accessible and effective client-centered outpatient substance abuse and dependency treatment with an emphasis on the family unit. Accessibility and responsiveness to our clients is imperative. To accomplish this, we have individual office locations and shared locations throughout Harris and immediately surrounding counties, including Galveston, Fort Bend and Montgomery. In addition, TPI provides services two full days a week to the underserved communities in Liberty and Chambers Counties, where there are no substance abuse. In Harris County, TPI provides an excellent access point for adolescents in need of substance abuse treatment as it is co-located with the Houston Council on Alcoholism and Drug Abuse at three juvenile detention centers in Katy, Seabrook, and Houston, Texas. PROGRAM SUMMARY INFORMATION The Turning Point, Inc. provides client-centered outpatient substance abuse and dependency treatment which recognizes that clients have individual needs, differing levels of motivation, and unique family and environmental influences and which understands that the sobriety process is ongoing, necessitating that the client is armed with a set of workable recovery tools and has access to the positive reinforcers (job, family, friends) that will support his/her recovery. Through an intense (Three Phase program), client centered approach (utilizing Motivational Enhancement Therapy), the client is encouraged to “try out treatment,” is taught useful and immediately reinforcing problem solving skills, and is encouraged to build a treatment alliance with peers and staff. Our treatment philosophy is based on social learning theory, which assumes that the client’s using behavior (even with a genetic contribution) has been learned over time and is continued and maintained through a reinforcement schedule that is unique to the client. Within a caring but, accountable group process, the client examines the faulty thinking, poor emotional coping strategies, and limited behavioral skills repertoire that imprisons him/her in their using. Through peer understanding, support, and feedback; counselor didactic and experiential exercises; and client role play, problem solving tasks, and homework assignments; the client learns to examine, understand, and ultimately confront his/her thinking, emotions, and behavior, ultimately realizing the intricate and individual relationship these have with his/her using. Our treatment approach is cognitive-behavioral. Through cognitive restructuring, utilizing the “thinking report” (based on the “Thinking For a Change” curriculum), clients learn to identify the destructive beliefs, attitudes, and ways of thinking that result in negative, debilitating emotions, and the self-destructive behaviors that have been associated with these emotions (i.e., using). Through experiential behavioral skills training, clients systematically acquire the interpersonal and intrapersonal skills necessary to sobriety, i.e. problem solving, assertiveness skills, drug refusal skills, anger control, interpersonal communication, etc. Finally, utilizing the CENAPS Model of Relapse Prevention Therapy (CMRPT), sober clients learn the techniques necessary to maintaining his/her sobriety. STRUCTURE The structure of TPI is based on the concept that treatment must be accessible and responsive to the client. TPI provides services at 13 licensed locations in six counties of the most highly populated area of Southeast Texas. Most are located on or near bus lines. To assure that offices provide services individualized to his/her particular client populations, emphasis is placed on pushing the decision-making process down the chain of command, enabling increased individual counselor decision-making responsibility. However, counselors only individualize his/her treatment within the confines of agency approved curriculums and his/her decisions are regularly monitored/reviewed through initial and discharge client meetings and regular weekly meetings (including rigorous audits of client files) conducted by clinic office supervisors. Administrative personnel also participate in monthly random treatment plan, client records, and billing audits of all staff and supervisors. Through the use of regularly scheduled client satisfaction surveys, clients are able (through an anonymous process) to express his/her satisfaction or dissatisfaction with all aspects of the delivery of services (treatment access, program materials, counselor skills, facility needs, etc.). In addition to maintaining consistently quality treatment, these audits and reviews serve to provide valuable information about what is working in the program and, more importantly, what may not be working. We realize the huge responsibility of providing what may be the only treatment experience a client may ever have. In addition to providing state of the art, evidenced-based, and effective treatment through a loving, caring, and educated staff, we work to make the treatment experience as warm, encouraging, and safe as possible. Over the last five years, we have upgraded and enlarged all of our office locations. All office locations are ADA approved. Each and every staff member (including treatment, clerical, and administrative staff) understands that clients are to be treated with respect and dignity at all times. More than that, however, we make every effort to make the treatment experience as accepting, encouraging, and memorable as possible. This encouragement includes consistent positive peer interactions, positive and encouraging counselor feedback, and a fun and lively treatment environment (socials, Phase transition awards) that clearly demonstrates to our clients that a life without drugs and alcohol is not only possible but ultimately preferable. WORK PLAN AND PROGRAM STRUCTURE The goal of treatment is to provide the client with the self-management skills necessary to remaining sober and living life happily.
Clients will best be able to achieve change when motivation comes from within themselves, rather than being imposed by others. Motivation Enhancement Therapy (MET) is a client-centered approach which places responsibility for change on the client and not on the counselor. MET understands and respects that most clients are ambivalent about change, even when they are able to see the benefits of changing their behavior, and it assumes that ambivalence is normal and expected. Through reflective listening and open ended questions, the counselor works to (1) express empathy, (2) develop discrepancy, (3) avoid argumentation, (4) roll with resistance, and (5) support self-efficacy. MET encourages clients to proceed through the change process such that they make an independent, committed decision to pursue abstinence. 2. COGNITIVE RESTRUCTURING: Thinking Report Turning Point’s treatment program is based on the social learning theory concept that a client’s behavior and substance abuse have been learned over time as a response to faulty beliefs (schemas) about themselves and the world around them and the inappropriate or irrational thinking patterns that accompany those beliefs. These faulty beliefs and irrational thinking frequently result in disturbed mood or emotions and maladaptive or self-destructive behaviors. Intervention involves teaching the client to systematically and objectively review his/her thinking processes, to recognize faulty thinking that leads to negative emotions, and to replace inappropriate and self-destructive behavior with pro-social, non-using behavior. This intervention process is called cognitive restructuring. The key to understanding the relationship of faulty thinking to negative emotions and unhealthy behavior is the Thinking Report (Functional Analysis). The ability to successfully complete a “Thinking Report” is essential to self-management of behavior and emotions outside of the treatment setting and to increasing the likelihood that the client will successfully deal with life problems and crises without relapsing to substance abuse. 3. BEHAVIORAL SKILLS TRAINING As the client learns to critically evaluate his perceptions and to challenge his faulty thinking, he usually discovers that he often does not have the pro-social behavioral skills and emotional management strategies to replace the negative ones that he now recognizes as unhealthy but upon which he has traditionally relied. Behavioral skills training provides a sequential, client-centered, experiential way of developing the intrapersonal skills (particularly emotional control techniques) and the interpersonal skills (to deal with people, places, and situations) essential to helping the client apply his new thinking skills. Behavioral skills’ training provides the client with new ways of handling life’s problems without drugs or alcohol. Perhaps most importantly, however, it enables the client to discover that sober behavior is more rewarding and, ultimately, more fulfilling than is using behavior. The first few sessions are generally focused on skills related to initial control of drug use (e.g., identification of high-risk situations, coping with thoughts about drug use). Once these basic skills are mastered, training is broadened to include a range of other problems with which the individual may have difficulty coping (e.g., social isolation, unemployment). Clients are taught the skills as both specific strategies (applicable in the here and now to control drug use) and general strategies that can be applied to a variety of other problems. Thus, behavioral skills are not only geared to helping each client reduce and eliminate substance use while in treatment, but also to imparting skills that can benefit the client long after treatment. 4. RELAPSE PREVENTION AND INTERVENTION The CENAPS Model of Relapse Prevention Therapy (CMRPT®) is a comprehensive method for preventing chemically dependent clients from returning to alcohol and other drug use after initial treatment and for early intervention should chemical use occur. The five primary goals of the CMRPT are to:
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LENGTH OF STAY (Treatment Phases)
The Turning Point Outpatient Treatment Program is completed in three phases. The five Stages of Change (TIPS #35) and TDI guideline placement criteria are used in determining initial placement in treatment and individualized phase change decisions. TPI outpatient treatment program is a minimum of 12 weeks and a maximum of 24 weeks. All phase changes are staffed with the treatment team. A decision for change in phase or continuation in the client’s current phase is made on a case-by-case, individualized basis. For many clients, however, a longer stay in any phase may be necessary to produce stabilization or lasting improvement. Assessment of a client’s needs is ongoing throughout the treatment. All Phase changes are formal and viewed as a reward. Staffing shall include the referral source, the client, at least one of the client’s family members, and the primary counselor. PHASE I PRE-CONTEMPLATION/CONTEMPLATION Four – Six weeks This phase is intended to produce initial abstinence and stabilization. Clients are expected to recognize that they are experiencing alcohol- and other drug-related problems and need to pursue abstinence as a lifestyle goal so they can resolve these problems. Some clients require stabilization from acute and post acute withdrawal and/or psychosocial life crises.
Identifying situations, affects, and cognitions that remain problematic for clients in their efforts to maintain abstinence or which emerge after cessation or reduction of drug use. Maintaining gains through solidifying the more effective coping skills and strategies the subject has implemented. Encouraging client involvement in activities, and relationships; that are incompatible with drug use. Rather than introducing new material or skills, the maintenance version of cognitive behavioral therapy focuses on broadening and mastering the skills to which the client was exposed during the initial phase of treatment. Phase II is Early Recovery, where clients identify and learn how to replace addictive thoughts, feelings, and behaviors with sobriety-centered thoughts, feelings, and behaviors, where clients repair the lifestyle damage caused by the addiction and develop a balanced and healthy lifestyle.
Phase III is often considered to be “Late Recovery”, in which clients resolve family-of-origin issues that impair the quality of recovery and act as long-term relapse triggers. It also consists of maintenance activities in which clients continue a program of growth and development and maintain an active recovery program to ensure that they do not slip back into old addictive patterns.
Peer facilitated aftercare group will meet 2.0 hours for one year or longer if desired. Weekly after care is available to all client who graduated successfully for the TPI out patient treatment program. Aftercare is available for adult and adolescents. INDIVIDUAL COUNSELING Individual counseling allows for better tailoring of treatment to meet the needs of specific clients. Clients receive more attention and are generally more involved in treatment when they have the opportunity to work with and build a relationship with a single therapist over time. Sessions normally last 50 minuets (with the exception of the initial interview/assessment which normally is two hours in length and longer if necessary. GROUP COUNSELING Clinicians have emphasized the unique benefits of delivering treatment to substance users in the group format (e.g., you are not alone, others similarities shared, peer support and positive peer pressure). This generally requires the group sessions to be 2.0 hours to allow all group members to have an opportunity to comment on their personal experiences in trying out skills, give examples, and participate in role-playing. Treatment is more structured in a group format because of the need to present the key ideas and skills in a 50/50/50 RULE A great deal of work is done during each session, including reviewing practice exercises, debriefing problems that may have occurred since the last session, skills training, feedback on skills training, in-session practice, and planning for the next week. This active stance must be balanced with adequate time for understanding and engaging with the patient. To achieve a good integration of manual-driven and client-driven material in each session, we utilize the "50/50/50 Rule" for the flow of a typical 60-minute CBT session. During the first 50 minutes, therapists focus on getting a clear understanding of clients' current concerns, level of general functioning, and substance use and craving during the past week, as well as their experiences with the practice exercise. This part of the session tends to be characterized by clients doing most of the talking, although therapists guide with questions and reflection as they get a sense of the clients' current status. The second 50 minutes is devoted to introduction and discussion of a particular skill or completion of thinking reports. Therapists typically talk more than clients during this part of the session, although it is critical that therapists personalize the didactic material and check back with clients frequently for examples and understanding. The final 50 minutes reverts to being more client dominated, as clients and therapists agree on a practice exercise for the next week and anticipate and plan for any difficulties the clients might encounter before the next session. Ending with, a 10 minute wrap up. |
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