Approaching Outpatient Care

Recovery Unscripted banner image for episode 49

Episode #49 | January 24, 2018

Featured Guest: Alex Dorsey and Ashley Buchanan

For today’s show, I welcome two guests who can give us an inside look at the role outpatient treatment plays in the overall recovery journey. Alex Dorsey leads the admissions team for Foundations’ 13 outpatient facilities nationwide and Ashley Buchanan serves as a patient care coordinator for Georgia treatment program Black Bear Lodge. They joined me to share how they approach helping people safely and effectively step down from residential treatment to outpatient to aftercare to a sustainable life in recovery.

Podcast Transcript

David Condos: Hey guys, welcome to this episode of Recovery Unscripted. I’m David Condos, and this podcast is powered by Foundations Recovery Network. For today’s show, I welcome two guests who can give us an inside look at the role outpatient treatment plays in the overall recovery journey. Alex Dorsey leads the admissions team for Foundations’ 13 outpatient facilities nationwide and Ashley Buchanan serves as a patient care coordinator for Georgia treatment program, Black Bear Lodge.

They joined me to share how they approach helping people safely and effectively step down from residential treatment to outpatient to a sustainable life in recovery.

Now, here’s Ashley and Alex.

I’m here with Ashley Buchanan and Alex Dorsey. Thank you guys so much for being with us.

Ashley: Yes, absolutely, thank you for having us. So excited to be here, thank you.

David: To start off, could you tell us a little bit more about your own personal stories and the paths that you’ve taken to do what you’re doing today, let’s start with you Ashley.

Ashley: So I have been working in the social work field for several years. A large part of that time was spent working with children and families. While working that position for Family and Children Services, I heard about this company that was starting in the mountains of Northeast Georgia called Black Bear. I went and felt really excited about the work that Black Bear was doing. As a part of Foundations, what Foundations was doing. There is so much work that Foundations in Black Bear do to help break the stigma and just make it something that is a normal part of conversation and that wasn’t what I experience at my previous jobs. I just really wanted to be a part of what they were doing, so that’s how I ended up here.

David: And Alex?

Alex: I personally have been affected by addiction and mental health in my family. Growing up, didn’t really realize how much until I got into college. I took my first psychology course and really started to be intrigued with the mind and how really the invisible disease started to affect and then that led into learning about addiction and substance abuse and tying into what I realized my family had been affected by growing up. During my last year of undergrad I did an internship at Youth Villages here in Nashville, Tennessee, and was really able to see how families were affected through a disease of addiction and mental health with the children and how they were affected by being taken into foster care and how the social work Dynamic all played together.

I went on to get my masters in mental health counseling, along the way found out about Foundations and started off about four and a half years ago. Now, I run the outpatient admissions team for incoming and admissions as well as step down from our residential facilities.

David: Nice. Like you said you both working with Foundations now. Could you tell us each a little bit more about kind of your current roles and the teams that you’re apart of?

Ashley: Sure. I personally work with Black Bear Lodge, one of our inpatient residential programs in Georgia. My role there is a patient care coordinator. Basically, what the gist of that is, is meeting with the patient individually that I’m assigned to help develop any sort of aftercare planning that works for them. That’s clinically recommended for them. Finding out what’s important to them, where they want to go, what responsibilities that they have and just really trying to remove as many barriers as possible, so that they can participate in the best treatment that’s available for them.

Alex: I run or manage an admissions team here at the Nashville corporate office for Foundations Recovery Network doing incoming admissions over the phone for those calling in seeking treatment for outpatient specifically to our 13 different facilities across the country. What I love about Foundations Recovery Network is we really aim to meet the patient where they are, whether it’s starting off at the residential level and in transitioning down the stairway essentially to outpatient or the other way around if they’re starting off at outpatient, really our mission is let’s meet them where they are and use some of the best treatment approaches in the industry to really help them get healthy.

David: Like you said, outpatient is the world that we’re diving into here, so for people who don’t maybe know all of what that involves, what is outpatient treatment mean, just in a general sense?

Alex: Outpatient treatment encompasses a couple different levels of care. At the end of the day it means they’re coming to treatment and then returning home or to a sober living at night. They’re not staying overnight or over the weekends at a facility. What it provides is support in their communities, support in their environment, support with their families. If they’re shoveling at work with stressors and they’re coming to group that evening for treatment, then they really get to deal with what happened that day. We’re helping to develop those coping skills and really use them in real-time situations.

David: Yes. What might a typical day look like for somebody who’s in one of these outpatient programs?

Alex: It can vary anywhere from as little as three hours a day of the combined group therapy and individual therapy, all the way up to about six and a half hours a day. We offer a lot of different levels of care depending on really where the patient’s at and what the most clinically appropriate treatment plan is for them.

David: I guess while they’re there in those three to six hours it’s a lot of the groups and the things that they’re receiving from the program is a lot of it, similar to what the inpatient programs are having during the day and the difference is just that they go home?

Alex: A lot of it is similar in theory. We get asked that question all the time for patients it’s like “Oh, I’m down to my 30 days stay, I have to go do this all over again on an outpatient level.” That’s really not where it’s at. The way I put it, the patient is residential allows them to fill their toolbox full of tools. Now, what outpatient does is allow them and help them pull those tools out and actually use them on a day-to-day basis. While the overall theory of what they’re learning like Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, that overall is the same. The skill sets that they’re actually using and learning are different. Each therapist and each group has a different perspective.

New group dynamic can completely change what the patient learns, the therapist can change what they learn, where the patient’s at can change what they’re able to learn. While in theory what their learning is the same, the ability to use it in their life is not.

David: Could you say just a little bit about why outpatient is such an important part of an overall recovery plan and when is that the right choice for someone?

Ashley: Well I think to piggyback on what Alex said, the 30 days really gives a patient a lot of tools. Going to an outpatient program really just helps to continue that and that’s what we try to offer and discuss with patients when we meet with them is how important it is to continue that. You’ve been in somewhat of a bubble for 30-45 days, so going home or going to sober living, this extra support and extra clinical care is so vital to continuing recovery.

Alex: I always explain too that it’s a step-down process for a reason. A lot of patients didn’t get to the point where they need to go to residential treatment overnight and it’s not going to be fixed overnight or within 30 days. It’s a gradual step down process, removing them from that treatment bubble, that safety, that support, that care and then taking them home to absolutely nothing sometimes can be really more detrimental than anything. Intensive outpatient care is really there to help them when they have a strong Foundation. Now, we have to help keep them standing and that’s really what outpatient treatment is there to do.

David: Like you said earlier, some of the people are coming in and kind of going straight to outpatient if that’s what right for them but then a lot of people are stepping down like you mentioned kind of a stairway, so could you describe that step-down process and how that works.

Alex: Foundations really differentiates itself from a lot of treatment centers because like Ashley said earlier, we really want to start focusing on their aftercare plan. As soon as it makes sense too. That’s right around day 10 and sometimes the aftercare plan is more difficult than just a single meeting. Ashley, correct me if I’m wrong but it’s typically about four to five meetings over the 20 days span.

Ashley: Yes anywhere from three to five is generally the average.

Alex: We really want to set them up for success. The first conversation usually is, let’s talk about what your life was like before, is it smart to return home? Do we need to go to sober living? Do you have a home? Because a lot of patients come to us maybe in situations that they can’t return home. It’s not an overnight decision about where they’re going to go. The step down starts about day 10 and then from there they’ll reach out to myself. We handle a lot of the internal processes. We check the insurance with the respective facility that they want to look at. We check for sober-living availability. We get back to the patient care coordinator and give them the options and saying, “Hey, Foundations San Diego or Foundations Nashville has availability the insurance works great, clinically it’s a great fit. Here’s some sober living options that we use in the area. Let’s see if we can get the patient set up with one of those”

Then they take it from there with talking to the patient.

Ashley: They review the information we involve families at how the patients want to have them involved or their support systems and just go from there to see what is the best fit. Even sometimes we have to consider legal issues, if they’re on some sort of probation or can’t leave the state those can really be big factors as well.

Just really working together as a team and the patient being a huge part of that team and their support system and finding out what is going to work best for them. One of the really awesome things about our Foundations outpatients is that they’re dual diagnosis. We partner with a lot of different IOPs across the country, but not all of them are dual diagnosis and can offer that holistic aspect. That is one thing that a patient is going to experience at a Foundations place that they might not at other ones.

That’s another thing that we really encourage because the level of care that they can get is so strong. It’s evidence-based treatment as well. We have so much support in saying this is why this would work for you.

David: Yes, I know like we’ve had Siobhan Morse on the podcast before so it’s awesome to see like Foundations is getting a lot of that research from the actual patients who are going through the actual programs. I’m so sure that’s helpful to be able to tell the patients like, “Hey this is real, this is people like you who are going through what you’re going through.”

Alex: Yes.

David: I know like Black Bear doesn’t have an on-site outpatient. How does that process work where you’re helping them find whether it’s a Foundations one … I know there are outpatients in Georgia through Foundations or through another program, what goes into that decision process, could you tell us about that?

Speaker4: At that 10th day, that’s really us meeting the patient and just getting to know them. What’s important to them. As I said a few minutes ago, what are the barriers to them experiencing the best level of care that they can. We take into account whether or not they have job responsibilities that they have to get back to. Financials are a huge part, family dynamics such as if they have children that they have to return to because someone else is caring for them. It’s just all those factors you weigh them and talk with the patient and then after hearing what’s important to them and what matters to them, then we see what’s going to be the best fit.

Whether that be going to one of our outpatient programs because maybe they are near there, which is a great option or is getting them set up with sober living or if they have to return home and it’s to an area where we don’t have a Foundations program just really utilizing our internal resources and finding the best fit for them. Yes, it’s a process of getting to know the patient and also involving their clinical team and the medical team and their support system and really finding what is going to be the best fit for them.


David: With some of these patients when you start talking to them like you said it’s only day 10 of treatment so that still like pretty early in the process do you have patients who are resistant of the idea of, “Why do I need more treatment when I’m done here.” What are some of the challenges I guess that you face with that ?

Alex: Sure we do have those challenges. Usually entails for me personally is just really getting to know the patient in finding out why they feel that way and really being able to explain well this is why that’s important. Also a large part of that is involving their whole treatment team because it’s not just me or not just the patient there’s so many aspects involved that are providing the best care for the patient.

If they’re not on board with aftercare, because sometimes we do have patients that are not. It’s just really involving the team to help them to understand not in any sort of way forcing them but just to show them why this is so important. It’s not just 30 days because as we’ve talked about it’s really just continuing that care and treatment to really learn some more skills and be able to put those skills in place.

Then sometimes if they’re resistant to going the sober-living or leaving the state or anything like that, we just really work with them where they’re at and try to find the best fit possible. In North Carolina for instance, we don’t have a Foundations facility but we do have some great IOPs that we have worked with and partner with. Utilizing those resources as places that we trust, places that our business development representatives have gone out and visited, because we do know it’s not a possibility for everybody to go to our foundation’s facilities but when possible absolutely we try to work it out.

David: Yes. I guess we’ve talked about IOP, outpatient stuff, sober living are there some other aspects of aftercare or the post residential treatment transition that you found to be helpful like are there other pieces that we haven’t covered yet that are that plan?

Ashley: Typically, after they complete an IOP program they would be set up for individual therapy, psychiatry, extra support groups and all of our Foundations facilities offer aftercare, which is a great way to stay connected and that you can go to for as long as you want. IOP is just however long two months three months. It’s really just getting them connected and the IOP has a large part in doing that like finding the individual providers for them.

Alex: Yes that’s really– it is a step down process from– you’ve got around-the-clock support to a couple hours a day support and then you go on to more the long-term maintenance care of an individual therapist to work on issues long-term. A psychiatrist like Ashley said the support groups and getting them tied into our life challenge groups that we have in our alumni groups that we have at each facility.

That’s the biggest thing because then they’re going to be in a safe place and they know the faces they’re going to see every day. We really want to get them tied into that because most of the facilities have free for life alumni meetings. It’s a very– I don’t say gradual but a step-down process. You’re going down the staircase.

David: Yes. It doesn’t eventually steps down to nothing it just steps it just steps down to something that is helping you maintain for the long-term and becoming part of your life.

Ashley: Yes you’re not ever stepping down to nothing because recovery is a lifetime process. Whether it’s from substance abuse or mental health. For most people they’re always going to need some type of something in their life. Whether it’s 12-Step meetings, whether it’s smart recovery, refuge recovery. Having those different options for the patient really helps to pull from different avenues that they can integrate into their recovery.

David: I’ll wrap up with this last question. Everyone who serves in this field or most of their time to this mission has their own reasons for wanting to do further this cause of recovery. Could we end by having each of you sum up why being involved in this process of helping people progress into their long-term life of recovery is so important to you.

Ashley: For me I think it goes back to why I started in this field. Really just so much comes with the stigma of mental health and addiction dual diagnosis that I want to be a part of breaking that stigma. Just making it everyday conversation, we treat cancer and so many other diseases as that It’s so hard for others to see addiction and mental health as a disease. Just wanting to continue that and really just make it a part where people feel comfortable and being able to seek treatment and get help for what they need it for without having to be embarrassed or feel scared because of the stigma that comes with it.

Alex: For me, being a part of Foundations Recovery Network, I truly believe in what we do. I truly believe in the care that we provide all the way from residential down to our alumni groups. Seeing so many people struggle with addiction and so many people struggle with mental illness like Ashley said, there’s a stigma that is still out there. Even though the Surgeon General has recommended or acknowledged not recommended but acknowledged that it is a medical condition and it truly is a disease just like diabetes and just like heart disease, it’s still not recognized like that in society.

It’s a shame unfortunately, that it can’t be a part of everyday conversation and there’s so many people that struggle behind closed doors that nobody knows. I think that’s the saddest part of thinking of those individuals feeling alone and feeling like they have nowhere to turn. Doing this work and helping the people that we help gives them hope and gives them opportunity. Hopefully they won’t be able to provide that to someone down the road who might be struggling. Seeing my family go through it over the years, I know that there’s another side. I know that recover is possible and so giving that to just one person gives neither the hope to continue on.

David: All right. Ashley, Alex, thank you for your time today.

Alex: Thank you.

Ashley: Thank you.

David: Thanks again to Alex and Ashley for joining us. Now we get to welcoming back Stephanie Spann, national race director for the 6K run walk series put on by Heroes in Recovery. Welcome, Stephanie.

Stephanie: Thank you David.

David: How are you doing today?

Stephanie: I’m good, how are you doing?

David: Doing well, doing well. To start off could you give us a quick summary of kind of the Heroes’ mission and why you are out there doing those 6Ks?

Stephanie: We hold these 6K races all across the country both in person and virtually. What we want to do is we want to seek to inspire a sense of community whenever we can. Our main event obviously the hero 6k is to create awareness of the need for treatment and we also like to support those that are in recovery currently.

David: All right perfect. I know I’ve been to one and there it is a great, great experience. I’m excited about that and excited about this new year. I know you guys have a lot of cool stuff planned. Could you tell us about just a quick overview of the races and the virtual races, I know you mentioned for 2018.

Stephanie: We are already open registration for six of our races. One being this weekend in Palm Springs, California. April, we will move into San Diego on April the 7th, then into Orange County on April 21st. We will be in Memphis on May the 19th and in Atlanta on June the 30th, and we are in the final planning stages for hometown in Leiper’s Fork, Tennessee, which will be early September. Details on that will definitely be coming out very soon.

David: I know this is early, so you can’t give all the details but just so people know what to imagine when you say virtual runner. That means that anyone like you don’t have to be in one of those cities you can still participate. How is that going to work?

Stephanie: The way our virtual series works is participants can register to participate, they can select what city they like to support or what charity they like support and no matter where you are in the country you can support the Heroes in recovery movement and you still get some really awesome swags and awesome goodies mount to you. We’d like to broaden our horizon a little bit and allow people nationwide to be able to be behind the movements to support the Heroes in recovery 6K.

David: Awesome, I’m excited about that. As you mentioned a big race coming up this weekend out in California, could you tell us a little bit more about what that one is going to look like and who at sports.

Stephanie: Very exciting, this is our seventh year going out to Palm Springs, California. The race is presented by Michael’s House in the corridor. If anybody is looking for a family friendly, dog friendly event, come on out to the corridor on Sunday morning the race starts at eight o’clock. The charity beneficiary for Palm Springs’ race is Safe House of the Desert. We will be excited to be out there raising awareness for everything they do for the area out there. I had the pleasure of running the course a little bit last year and checking it out and the views are absolutely breathtaking. You can see the mountains in the background where the snow on the top. It will be a good time.

David: That sounds really good, really good. Where can people go to find more information about the all races and also everything else you are doing like the virtual running?

Stephanie: If you go to, you can see all of our races are open for registration right now and the entire schedule and all those details are online.

David: Thank you, Stephanie.

Stephanie: Thank you, David.

David: This has been the Recovery Unscripted podcast. Today we have heard from Alex Dorsey and Ashley Buchanan of Foundations Recovery Network and Black Bear Lodge. If you like to talk with someone like them to discuss the best treatment options for yourself or loved one, please call any time at 855-823-2141. See you next time.

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