Rehoboth McKinley Christian Health Care Services Alcohol and Substance Abuse Treatment Program
- Need: Treatment and rehabilitation for those with alcohol and substance use disorder in a rural area of New Mexico that has high rates of alcohol-related deaths.
- Intervention: A health center reestablished a 90-day inpatient Alcohol and Substance Abuse Treatment Program that offers career readiness and work placement for clients.
- Results: The program has grown from 3 to 69 clients enrolled in inpatient treatment and 32 in the work rehabilitation program. Many of the clients are now employed by local businesses.
Alcohol and substance misuse in New Mexico's McKinley County has been steadily rising the past few decades. From 2013-2017, it had the highest number of alcohol-related deaths in the state. The town of Gallup has been ranked one of the highest in the nation for alcohol-related deaths in the past. Treatment and rehabilitation was needed, not only for the health of individuals, but also for the town's welfare.
David Conejo is the current CEO of the Rehoboth McKinley Christian Health Care Services (RMCHCS), a rural nonprofit hospital which serves New Mexico's McKinley and Cibola Counties and the Navajo Nation Zuni Indian Reservation. Sixty percent of the population served by RMCHCS services are Native American. To address substance and alcohol misuse in the community, Conejo reestablished a substance abuse treatment program in 2015. A similar program once operated out of RMCHCS, but on a smaller scale. The new program includes several unique features:
- Clients are enrolled for a 90-day period of detoxification, treatment, and workplace preparation instead of the traditional 30- or 60-day period. The extension allows for more time to establish sobriety and has seen lower relapse rates than other programs.
- A heavy focus on career readiness and work placement. Clients are taught new skills and are able to hone their occupational expertise through supervised work placements and course work.
RMCHCS built a treatment center 7 miles from their facility for New Mexico residents who qualify for the program. The center is furnished with 69 beds and was designed with features to cultivate healing, like a kitchen for culinary arts, a gym for physical activity, a separate house for counseling sessions, and a Native American sweat lodge. Plans are underway to build a greenhouse.
RMCHCS partnered with many organizations and groups for education, staffing, referrals, and other aspects to make a successful program:
- Navajo Technical University
- The University of New Mexico
- Behavioral Health Collaborative
- New Mexico Rural Health Network
- New Mexico Department of Veterans Services
- New Mexico Courts
- Pueblo of Zuni
- McKinley and Cibola Counties' law enforcement offices
- McKinley and Cibola Counties' first responders
- Local businesses, contractors, and organizations for the work rehabilitation program
To make the RMCHCS Alcohol and Substance Abuse Treatment Program free for clients, money was raised from the local community, totaling $450,000. The hospital also received funding from the State of New Mexico, the Substance Abuse and Mental Health Services Administration (SAMHSA), and local behavioral health agencies.
As a result of New Mexico's graduate medical training initiatives, RMCHCS is the recipient of a May 2020 grant award from the New Mexico Human Services Department. The grant supports the facility as a training site for psychiatric residents in their final two years. RMCHCS is also the site of a new family medicine program, with first residents to start in 2021. Involvement in these programs also allows RMCHCS to participate in medical student education. RMCHCS believes its leadership in these graduate-level education initiatives contributes to improving primary and behavioral health care for New Mexico's rural and Native American communities.
Throughout the entire 90-day inpatient stay, clients participate in group and individual counseling sessions. Clients also go through an extensive assessment and are medically screened at the beginning, throughout, and at the end of the 90-day treatment period. The purpose of the screenings are to evaluate the client's condition, progress, and their susceptibility to cravings (for example, low levels of iron can induce more cravings, and low Vitamin D levels can trigger seasonal affective disorder).
The program is broken into three 30-day stages:
Treatment Phase 1 – Known as the "dark days" phase, clients are limited to activities only on the grounds of the treatment center and are not allowed contact with outside influences. The purpose of the strict policy is to help the client develop an awareness of the severity of their disorder and commit to the detox process. A care team made up of a counselor, a case manager, a training manager, and a nurse is established in this stage.
Treatment Phase 2 – The next 30 days are focused on prevention and reentry, how to stay away from the influences that would have previously drawn them into their drug or alcohol misuse.
Treatment Phase 3 – This period is focused on occupational readiness and training. Clients can take classes to pursue a GED or college credit. Other sessions include:
- Relapse prevention
- Anger management
- Educational opportunities and certifications through university classes
- Financial management
- Parenting classes
- Healthy living
- Cooking and nutrition
AfterCare Phase – If the client decides to continue with the program, he or she enters into an aftercare program, a supervised 120-day work rehab program. Staff help the client find work the client can do once they graduate from the program. The 20/20 program includes 20 hours of work and 20 hours of counseling every week. Work sites include the RMCHCS facility and local businesses and service agencies. Clients are connected with jobs that best fit their skills. This phase starts with community service work or "ungratifying work" (like gardening, cleaning trash, or painting) which is used for therapy as well as motivation to move toward "gratifying work" where the clients' skills are better utilized. Money the client earns during the work rehabilitation program is placed in a discretionary fund the client can use toward housing or transportation. At the end of this phase, there is a graduation ceremony for the clients who complete treatment. Transitional housing of up to four months is provided to graduates.
Behavioral Health Service Phone App
Medical and behavioral health providers track each client's progress through a behavioral health service app, a platform that enables providers to treat addiction in new ways. The app, created for RMCHCS by a behavioral health software vendor, securely monitors the health of the client based on criteria set by their providers. The app is linked to RMCHCS's electronic medical record system and is used by providers to identify patients and manage their health data. The app has the capability to produce reports based on patient data that can quickly be compiled and used to develop successful treatment plans. Providers can customize reports to identify at-risk patients, diagnose their symptoms, and monitor their treatment success in real time. Reports are focused on the following:
- Care report planning
- Evidence-based reporting
- Resource utilization
- Healthcare benefits
- Patient care progress
The app also reminds clients of their probation appointments through a calendar and keeps track of attendance by allowing the client to check in through a selfie sign-in (photo feature that relies on facial recognition to open) that is time-stamped and geotagged. A provider database allows RMCHCS counselors and providers to check the client's progress. The app also helps streamline follow-up care and can help measure the effectiveness of the program and recidivism rate. It measures client compliance rates through the attendance of judicial meetings, 12-step group meetings, counseling sessions, testing, and medical appointments. The use of the app is completely free to the client. This method has not only helped clients maintain their physical health and sobriety, but it also leaves a positive impression on judges during appearances in court.
Since the Alcohol and Substance Abuse Treatment Program relaunched in 2015, enrollment has grown from 3 to 69 clients in inpatient treatment and 32 in the work rehabilitation program. Residents have noticed a change in Gallup and surrounding areas compared to 20 years ago. Some graduates have been hired by the employers they worked for during the work placement program. Others have gone on to become independent artists. Judges have offered positive remarks on the program.
- Relapse rates have decreased
- 40% decrease for the 90-day program
- 74% decrease for the 120-day program
- CEO of Rehoboth McKinley Christian Health Care Services, David Conejo, was named one of 60 rural hospital and health system CEOs to know in 2019 by Becker's Hospital Review.
- A Conversation with Dave Conejo, Rural Health Leadership Radio, 2018
- In McKinley County, NM's Battle Against Addiction Progresses, NMPolitics.net, 2018
Several decades ago, RMCHCS had an involuntary detox program. Judges mandated those convicted of a crime related to alcohol or substance misuse to enroll in the program, but the public raised concern that this was violation of rights. Because of that, RMCHCS offers the program to clients on a voluntary basis only. Most are willing to enroll in a 90-day program instead of serving jail time.
The Alcohol and Substance Abuse Treatment Program uses a 12-step philosophy similar to Alcoholics Anonymous's 12-step model.
RMCHCS recommends taking the following steps when setting up a similar program:
- It is common for the general public to focus on the problems that accompany alcohol or substance use disorder. Helping them understand the barriers that stand in the way of someone seeking treatment, the complexity of addiction, and ways to help is important for building community support.
- Building trust with clients is of high importance. If you expect honesty, prove that you are a safe person. If you expect hard work, give them encouragement to do so.
- The behavioral health service phone app software documents and enforces Commission on Accreditation for Rehabilitation Facilities (CARF) requirements and could be useful for facilities looking for a technological service that meets CARF standards.
American Indians, Alaska Natives, and Native Hawaiians
Behavioral health workforce
Criminal justice system
May 28, 2019
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