Clinical Approach
Our Clinical Model Genuine Recovery Windhorse
Program Scenarios
Windhorse Program Scenarios
Creative approaches to unique situations
The Windhorse Community Services (WCS) model is highly adaptable to
the unique circumstances faced by individuals with mental disorders
or injuries and their families. We always work with the whole person
in his or her natural environment, rather than narrowly focusing on
a diagnostic label and symptoms. This approach can make all the difference
in whether the client accepts and responds to treatment and whether
the treatment is successful. In all cases, WCS offers only the kind
and amount of contact necessary to make the treatment both effective
and affordable. We are committed to gradually reducing the amount of
care as recovery proceeds.
Schizophrenia and Related Psychoses: If possible, a client experiencing
psychosis will first meet with Windhorse Community Services staff
while still hospitalized. Inpatient treatment can be valuable in
providing a safe structure for a client in crisis, beginning a supervised
medication trial, helping a client make some sense of what has happened
to him or her, and creating a supportive aftercare plan. However,
once the client is able to make the transition from an in-client
to a private living situation, there is often a large gap between
the support of hospital care and traditional outpatient care. Partial-day
programs offered by many hospitals can be useful for people who need
the daily structure of groupwork and activities. But day hospital
remains a short-term solution. Some clients do not find partial hospital
appropriate or need additional care in order to feel safe and supported
at home. For these people, WCS provides a much-needed service.
If
the Windhorse approach seems right for the client, we propose
an optimal level of team support and structure for post-hospital care.
For clients with a diagnosis of schizophrenia or psychosis,
we propose
a full-team approach, including a team leader to coordinate
the team, counselors to provide contact through basic attendance, one
or two
housemates to live in the client's treatment household, and
an individual psychotherapist. A psychiatrist would be involved to
optimize the
medication regime in relation to the stages of recovery and
to monitor the client's general health. Before the client is discharged
from
the hospital, he or she and accompanying family members interview
the prospective WCS team to assess compatibility, and a team
schedule is created. Then WCS staff accompany the still hospitalized
client
on pass into the community to look for an apartment or simply acclimate
to the outside world.
Once the client is discharged, he or she will
most likely have a schedule of two, three-hour shifts of
basic attendance each day, frequent meals with housemates, and two
to three sessions
of individual psychotherapy per week. Basic attendance activities
include working with the client to accomplish household activities,
physical exercise, artistic or recreational activities, errands,
proper use of medications, and communication and relaxation
with staff members. All the team members, including the psychiatrist
when
possible, meet weekly to review treatment details and progress.
As soon as it is practical, the client is invited to join this team
meeting. There also is a weekly house meeting with the client,
housemate(s),
and team leader to focus on household issues.
Sometimes a client entering WCS care from the hospital needs
the support of a therapeutic household and a relationship with
a psychotherapist and/or psychiatrist, but not a full-team situation.
In this case, one or two WCS clinicians will do basic attendance
shifts with the client several times a week. Basic attendance
can
help with problems of isolation, coordinating medications,
helping to find work, keeping the household and finances organized,
and working
with a consistent schedule. Most often a Windhorse housemate
is not needed. This approach is useful for someone who does not need
substantial
support but is challenged with keeping life stable and organized
and with staying in relationship.
Duration of WCS care for clients with a diagnosis of psychosis
varies. WCS treatment for these disorders often begins in a
very structured manner, proceeds to a reduced schedule within six to
twelve
months, and then either ends or continues with occasional basic
attendance shifts as recovery continues. In some cases, the WCS team
continues
to provide consistent support for many years. One significant
advantage to this type of support is the prevention of relapse and
rehospitalization.
As well, client's families are relieved and encouraged with
the ongoing presence of a Windhorse team.
Affective Disorders: WCS
treatment has proved to be very helpful to people who are experiencing
the highs, lows, and uncertainties
of affective disorders (varieties of depression and bipolar
disorders). Highly structured teams are sometimes indicated for these
conditions.
Just as with clients diagnosed with schizophrenia, we commonly
help someone with an affective disorder transition out of the hospital.
Our approach can provide immediate and lasting benefit in terms
of
client stability. We encourage the client to take an active
role in working with his or her condition and help to bring stability
to a chaotic lifestyle. When safety is an issue due to suicidal
or
manic tendencies, we provide additional support so as to make
outpatient treatment more realistic.
Because affective disorders are
most often episodic, clients
with this diagnosis can go very quickly from needing significant
structure to needing very little. Flexibility is built into
our treatment design to accommodate this rapid shift, particularly
if someone is
changing medications and is experiencing mood instability
or acute depression, but will likely be stable once the new medication
takes
effect. In these cases, WCS treatment includes one or two
basic
attendance shifts per day in the client's home and community.
Treatment generally
lasts one to several months. A highly functioning person
may need help establishing and maintaining daily rhythms and activities
that
directly affect mood stability. We offer psycho-educational
support to help the client understand how food, alcohol, sleep,
cognitive activity, and the rhythms of daily living impact his
or
her
mood.
Frequently, we include a meeting between a WCS clinician
and the client once or twice a week. Even with minimal contact,
the
Windhorse principles can be very useful in creating an environment
that
addresses
core health needs.
Injury or Trauma: Paralysis or other disability due to injury
can dramatically interrupt and alter a person's life. Familiar modes
of being in the world may no longer work. In this case, WCS can help
the person regain the physical use of his or her home, arrange proper
transportation, make referrals to psychiatric and other necessary
services, provide grief therapy, encourage the person to make the
effort to return to an active life, and simply work side-by-side
on the ordinary challenges of daily living. Sometimes the most valuable
thing we can offer in this situation is to act as the client's trusted
ally and companion during times of bewilderment and shock. Typically
these treatment efforts are conducted by one or two clinicians. The
frequency of contact varies depending on the needs of the client.
Windhorse treatment can be very useful for people with mild closed-head
injuries. These injuries can result in the catastrophic disruption
of the client's internal rhythms and ability to function normally.
Difficulties with eating, sleeping, consistency of available
energy, concentration, mood stability, and sensory functions are common
problems
for people with these conditions. Sometimes the effects of
a head injury exist concurrently with other disorders or can trigger
the
onset of affective or thought disorders. As injured clients
recover from trauma, the steady presence of someone who understands
their
problems can be very useful. WCS staff help clients reestablish
and maintain a realistic schedule, wash clothes, do housework, and
organize
financial matters. We also provide companionship during times
of isolation or simply act as an ally in exploring confusing and complicated
life changes. Duration and frequency of this environmental
support
is dependent on need and available financial resources.
Eating Disorders and Substance Abuse: WCS tailors treatments
specifically for people with eating disorders or substance abuse
problems along with coexisting conditions. As in the treatment of
other disorders, we provide the amount of structure that best suits
the client's recovery and safety needs. Many of our staff have training
and experience in these areas. When necessary we incorporate expert
consultants and outside specialty programs for the client's specific
conditions in order to ensure that all treatment needs are addressed.
______________________________________________________
Windhorse Community Services makes an invaluable
contribution in our community providing environments for healing
and recovery
for people with
serious illnesses.
They are a group of very highly trained professionals able to
deal with difficult situations in a safe and compassionate manner.
As
an organization it has an excellent training program and ongoing
supervision for the staff. Communication with other agencies,
hospitals and individual practitioners is always ongoing and
prompt, creating
a unified approach to treatment.
— A local psychiatrist
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