success stories

Working with a young adult client and their family, who had one instance of psychosis and was overusing prescription medication and recreational substances I experienced the importance of individualizing treatment structures within a program. This client had been placed in an inpatient psychiatric hospital program for months and was then transferred to a psychosocial rehabilitation program and was living in supportive housing. However, it soon became clear that the client was no longer symptomatic nor had any safety concerns and was mostly in need of support in reestablishing their life, as they had previously been fully independent before hospitalization. As a result, this client was struggling in these more restrictive settings and was placed in such more to meet the needs of worried parents. In these situations, parents understandably are usually drawn to these restrictive settings in the name of safety, but they don’t have a full conceptualization of how an improper level of care can harm their child and limit their growth. Soon, this client was responding poorly to working with a multidisciplinary team of up to seven clinicians, was missing appointments and avoiding engaging with the program. In this situation I collaborated with the client, their parents and the treatment team to advocate for what was clinically appropriate. This resulted in the client remaining in the program, but moving to a fully independent living situation with a reduced treatment team that included three members:  a primary clinician/case manager, a substance use counselor and a psychiatrist. Within this structure this individual was able to flourish. They established and maintained independence, connected with the local substance use recovery community, got involved in a vocation of great interest to them and engaged with the local creative community. In a relatively short amount of time, around 10 months, they were able to fully discharge from the program and continued only with meeting with a weekly outpatient therapist and a psychiatrist monthly.  

Many times I have worked with individuals who have cycled through various programs and treatment centers, and such was the case with a young adult client and their family whom I collaborated with. Prior to meeting this individual, they had been through multiple programs over the past five years, including wilderness, specialised educational programs and supportive housing. This client, a “failure to launch” individual who also had significant mood issues, was originally placed in intensive supportive housing. Working with his treatment team and his parents, we were able to determine that having the supportive housing aspects, where all meals were provided, cleaning was done by the facility and his days were highly structured, was restricting his growth. Together, we determined that they were more appropriate for a semi-independent apartment, where they would be roommates with another person in a similar situation and where a team of multidisciplinary clinicians would have 24/7 access to the apartment, but that the individual was responsible for his activities of daily living, their daily structure and maintaining the apartment. This setting motivated the individual to secure meaningful employment and through exposure to the community, was able to eventually identify, engage with and flourish in a vocational passion that helped them establish full independence over the course of the next two years. I continued to collaborate with the client, their parents, and the treatment team to determine when it was clinically appropriate to drop the client to a lower level of care within the program and then eventually to discharge them to a small private team of outpatient clinicians  involving a handful of appointments per month.

Often it is clinically appropriate to advocate for a higher level of care, as was the case with a young adult client I worked with who was placed in a psychosocial rehabilitation program at his parents’ request. I was soon able to determine that being in a program that involved independent living and engaging with the community and others was not the right fit due to the individual being acutely symptomatic, as well as having significant substance abuse and behavioral issues. The combination of the client’s struggles and the clinical setting were resulting in a deterioration of their condition. Collaborating with the client and his family, we were able to identify a more appropriate program for them that was significantly more structured and where they would get the specialized therapy they needed on an intensive basis. As this program was on the other side of the country from the program that they were originally in and were not able to travel on their own, I assisted them in physically getting there. I stayed in touch with the client and their treatment team at the new program, and worked with the team to identify when the client was ultimately able to transition first to a semi-independent living space, and then eventually to a fully independent living situation, both of which they did. Also, I was able to work with the individual’s parent to help them see how their own mental health needs and codependency were affecting their treatment decisions for their child, and guided them to getting the support they needed. 

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