They turned a blackboard into a giant welcome sign with flowers, curly cues and positive messages.
The employees at Rimrock Trails in Prineville also prepared welcome baskets with art supplies, food and an MP3 player. When the first teenager arrived, the aides and counselors were ready and eager.
The day of celebration in mid-April marked the return to business of a clinic that had been closed for eight months. Rimrock is one of the few residential centers in left Oregon that treats adolescents with addiction problems. Two similar facilities closed last year.
At any one time, only a few dozen teens can be treated in Oregon for addiction and mental health problems because of the lack of space.
The profession has struggled with staff shortages and seen a sharp cut in capacity at a time when overdoses are skyrocketing and the state is awash in potentially deadly opioid pills and methamphetamine.
The reopening of Rimrock was extraordinary: Its 24 treatment slots nearly doubled overnight the capacity for adolescents in Oregon, said Erica Fuller, Rimrock’s longtime director.
“This is a crucial resource that has nearly collapsed completely,” Fuller said.
The reopening was not a given.
The center closed because it couldn’t hire enough staff. It had no option but to shut, Fuller said.
“We were losing staff so quickly that it was impossible to recruit and hire,” Fuller said. “We had to find all of the remaining kids in our program an alternative placement and arrange that transfer of care.”
That left the administration a hard choice: close for good or try to reopen. The nonprofit was founded in 1990 and has long been an anchor for children’s addiction services in eastern Oregon.
Services across the state have been cut in recent years. In 2018, Oregon had six government-funded facilities to treat in a residential setting children with addictions.
Three no longer operate.
The Oregon Health Authority is distributing millions of dollars in new funding for addiction providers, but it’s unclear whether that will be enough to secure the sector’s future.
It remains fragile, according to Heather Jefferis, executive director of the Oregon Council for Behavioral Health, which represents providers.
“Youth and family (addiction) services have been one of the least sustainable and systemwide underfunded services for decades,” Jefferis said. “The current outcomes show this has not changed.”
A lot was at stake for Rimrock. Within days of closing, the board and management met and started discussing their options. They made a decision within two weeks.
“We have board members who have been here from the beginning of this organization, and nobody wanted to see it fall,” Fuller said. “So we made the decision that we were going to do everything that we could to try and reopen our program.”
‘Over 150 applicants’
Rimrock serves children 12 to 17 from around Oregon. Some have foster parents, and some have been homeless. Most have tangled with the law and are referred to the center by a justice official.
Fuller said she has received about 100 requests for admission this year while they were preparing to reopen. Potential patients and their families are screened by staff before admission. The teens need to commit to go through the program, which lasts 60 to 90 days.
After Rimrock closed in August, the leaders did some soul searching. To succeed, they figured they needed change.
“They really took a step back and tried to identify what they could do differently to really enhance the services that they provide to at-risk adolescents,” said Mel Rose, Rimrock’s director of residential services.
They took a different approach to hiring. They only brought on counselors and support staff who had personally grappled with addiction or mental health problems. When Rimrock closed, it hadn’t been able to attract new staff for months.
Many aides and counselors want to work in urban centers – not Prineville – and they often prefer to work in clinics or hospitals which pay more. The facility had a massive response when it asked for applicants with prior addiction or mental health experience.
“In two months, we had over 150 applicants,” Fuller said. “That was really successful.”
The facility hired 30. Their personal experience gives them an edge with Rimrock’s youth, Rose said. Staff can relate to the teenagers. They know what their struggle is like. They also know what it takes to recover.
“That lived experience provides a bit of an inroad to building connections with the clients that we serve,” Rose said. “The people who are assisting the residents are people who have walked in their shoes in one way or another.”
Staff started training in December.
New approach to treatment
The center is located in a commercial/residential area at the edge of Prineville on just over 2 acres near the base of Ochoco Wayside State Park, which overlooks the town.
The two commercial buildings, with classrooms, living quarters, counseling offices and a gym, have been decorated to feel more like home than an institution. It has colorful bean bag chairs, landscape murals and tasteful bedding. Each teen has their own bed and wardrobe, with four beds in a room. Boys and girls are separated.
Their days are regimented.
When they arrive, the teens are briefed about the facility so that they know what to expect. They’re assigned a treatment aide who remains their support person during their stay. The aide gives them a welcome basket and together the two go over the handbook and schedule and sort through the resident’s belongings. Inappropriate items are stored until their departure.
The facility will not let residents have sharp objects or opened toiletries, which can contain intoxicants. It doesn’t allow skimpy or skin-tight clothing and gang colors and insignias are banned.
The day starts at 7 a.m. After hygiene and breakfast, the teens attend their first group session to set goals for the day. The rest of the day is divided between classes and therapy sessions, which include an individual session once a week. Residents have daily personal time and access to a gym, basketball court and climbing wall.
Once a week, the facility hosts activities such as hikes, visits to museums and equine therapy. Employees also bring in craftspeople and others who teach career skills or art, with classes in jewelry making or knitting, for example.
“We try to give them exposure to a lot of fun activities,” Fuller said.
After dinner, lights are out at 9:30 p.m.
“Their day is very structured,” Rose said. “They are literally moving from one pre-planned activity to the next.”
But Rimrock’s approach differs from a traditional behavioral modification system, she said. Rimrock stresses collaboration, not reward.
For years, treatment centers have used “point and level” systems to modify behavior. They reward desired behavior by awarding points. When someone earns a certain amount, they advance to the next level which might bring an added privilege like a later bedtime. Consistently noncompliant behavior costs points.
That system is based on a belief that kids would do well if they had the motivation. At Rimrock, staff think that youth excel when they know how.
“The bulk of the work that we’re doing with the kids is embedded in developing relationships and working with the kids collaboratively to help them develop the skills that they are missing,” Rose said. “Those lagging skills show up in a behavioral form, at home and at school, because kids are being asked to do things that are really beyond them. So it’s really a very different way of understanding kids.”
Staff try to identify a teen’s concern and then work with them to find a solution.
“That whole process is what really helps these kids develop the skills that they’re lacking,” Rose said. “It takes time.”
Kids go home
The first week back in business, Rimrock welcomed six teenagers. It was soon up to 10 but now has six. Four were expelled because they were too disruptive. Running away from the program, going into town, aggressiveness and acquiring alcohol can get someone expelled, Rose said.
“We tried a lot of different interventions with the hope of being able to point and shoot these kids in a different, more productive direction,” Rose said. “But sometimes, no matter what you do, it’s just not the right time for that child to be in a particular treatment program.”
The referrals to Rimrock have severe addiction and mental health problems. Many need psychotropic drugs, Rose said. Studies show that the longer the treatment, the greater the chance of success. Addiction can alter the brain, and it’s a chronic disease that needs lifelong management, experts say.
“I’ve been doing this for decades. Treatment works,” Fuller said. “When you’ve seen someone who has lost all hope and is living with a severe addiction who gets clean and sober, their soul comes back to life. The twinkle in their eye returns. They’re excited about their future.”
But residential treatment is not enough. Fuller said. She said the teens need outpatient care for at least 90 days to be successful. That requires support from families, teachers and others, Fuller said.
Even then some teens relapse and need to return to residential treatment.
Two facilities close
About a year ago, Yes House, an addiction and behavioral health facility in Corvallis, was barely hanging on. It could care for 30 children but wasn’t getting enough referrals as the pandemic took hold. It struggled to retain staff.
Milestones Family Recovery, which ran Yes House, also treats addicted adults. That side of the business was doing better. Adults are easier to treat and require fewer staff members.
The company’s leaders decided to close Yes House to children and convert it into an addiction residential center for men.
“When the kids moved out, the men moved in,” said Tanya Pritt, women’s residential and outpatient program manager for Milestones.
The company has not looked back, and it’s not alone.
Last December, the largest addiction and mental health residential program for children in the state closed temporarily. Fora Health, located in Portland, had room for 40 children. It had run a children’s addiction program for nearly 40 years. In 2014 when the current executive director, Maree Wacker, was hired, up to 30 beds were always taken. But in recent years the facility was lucky to have 12 residents.
“One of the things that dramatically changed not only for us, but for all the providers in the state who provide youth care, was when the marijuana bill was passed,” Wacker said.
The 2016 legalization of recreational marijuana – for those 21 and older – changed society’s view of the drug, she said. A gateway to harder substances for some young people, marijuana use became more accepted, even for youth.
“It’s a societal norm that just became more acceptable.” Wacker said.
The decriminalization of drugs with the passage of Measure 110 in November 2020 further increased society’s tolerance for drug use, providers said.
Fora Health also had trouble recruiting staff, even though it’s located in Portland. Wacker said Medicaid payments were too low.
“We couldn’t offer a wage that would be competitive,” Wacker said.
By the end of last year, Fora had five adolescents in its residential program. One planned to leave and three were graduating. The administration found a place for the remaining teen and suspended operations.
“The plan was to reopen again in January,” Wacker said.
Personal interest in treatment
Wacker had a personal reason for the services to continue. She took the job at Fora because she believed in the “power of treatment,” she said
“I have both a husband and a son who are in recovery,” Wacker said. “I felt like it was important to support an organization that makes those services available to anyone, regardless of their ability to pay, which is what Fora does.”
Her son was 15 when he needed residential treatment. He’d been an athlete in an upper middle-class neighborhood. Three or four universities were interested in recruiting him for their Lacrosse teams. But through friends, he got into drugs. One swiped prescription OxyContin from his grandfather, and another shared liquid morphine prescribed for a cancer patient.
“They were into some pretty heavy stuff,” Wacker said.
He spent about 30 days in residential treatment, and graduated a year late from high school. He got off opioids and has shunned them ever since. Wacker said he recently refused to take painkillers after a surgery.
“He has a lifetime of saying ‘no,’” Wacker said. But he’s married and has two children and is doing fine.”
She hoped Fora’s program would reopen. So did board members. They met early in the year for three hours to discuss the situation. They reviewed the center’s history, its dwindling census and its finances. It was obvious it needed to close.
“By the time we got to the end of it, it was pretty clear what our decision needed to be,” Wacker said.
The program’s end contrasts with the facility’s successes. During the pandemic, Fora Health raised $28 million and moved from a building in downtown Portland to a campus in southeast Portland covering nearly 3.5 acres. It includes 1 acre of therapeutic green space, with places to meditate and garden, and a sports facility.
The company continues to treat adults 70 in residential addiction treatment and 24 for detox. It also offers outpatient services.
“We’re just starting to get patients back in because of the pandemic,” Wacker said. “We have enough space to support 1,000 outpatient patients once we’re fully staffed.”
Hiring remains a problem for providers of behavioral health and addiction treatment, provider say. The Oregon Health Authority has $132 million for grants to behavioral health and addiction providers to shore up their workforces.
Rimrock Trails got about $582,000. The agency also raised reimbursement rates to give providers more financial stability.
Fuller of Rimrock welcomes the increases but said they do not secure Rimrock’s future.
“The rates that we understand that are being proposed are still not enough to sustain operations,” Fuller said.
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