Visitors frequently ask how Pomegranate’s programs and services differ from other providers of adolescent treatment. The short answer is the intensive nature of care, multi-disciplinary staffing and availability of Psychiatrist, CNP, nursing and psychiatric care staff, on-site 7 days a week.
For Pomegranate Health System’s acute hospital, that is defined as “a treatment approach that provides active but short term treatment for a patient who is presenting with moderate to severe symptoms and functional impairments.” (All-Staff 1/14 presentation) Acute patients come from emergency departments that are both local and throughout the state and region, as well as crisis intervention service providers (such as Netcare Access). The length of stay is 3-10 days with a purpose of stabilization. Standards of care are determined by licensing agencies. The Joint Commission on Hospital Accreditation -Hospital Standards, and Ohio MHAS (Mental Health and Addiction Services) In-Patient Standards accredit the acute hospital.
Pomegranate’s acute treatment employs evidence-based practice for medical services. Sometimes, in a limited number of cases, teens will need further psychiatric care and residential treatment is advised; typically teens return home with community care, or to a less intense step down level of care.
The acute hospital follows a medical model. “The medical model of care focuses on [that which is dysfunctional] within the patient, using a problem solving approach. The medical history, physical examination, and diagnostic tests provide the basis for the identification and treatment of a specific illness. The medical model is thus focused on the physical and biologic aspects of specific diseases and conditions. Nursing care is formulated on the basis of a holistic nursing assessment of all dimensions of the person (physical, emotional, mental, and spiritual) that assumes multiple causes for the problems experienced by the patient. Nursing care then focuses on all dimensions, not just physical.” (Mosby’s Medical Dictionary, 8th edition) In addition to nursing care, acute patients receive psychiatric evaluation/monitoring daily, as well as individual, group and art therapy from licensed clinicians.
For Pomegranate Health System’s residential treatment, the treatment approach follows a clinical model. “The clinical model of care is an approach that recognizes the presence of traumatic symptoms and acknowledges the role that trauma played in the lives of clients. Traumatic experiences can be dehumanizing, shocking, or terrifying, singular or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety. Trauma includes physical, sexual, institutional abuse, neglect, intergenerational trauma, and disasters that induce powerlessness, fear, recurrent hopelessness, and a constant state of alert. Trauma impacts one’s spirituality and relationships with self, others, communities, and environment, often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.” (Mosby) Healing is possible! The aim is restoration and permanency.
The residential treatment facility follows The Joint Commission for Behavioral Health Care Standards and Ohio MHAS (Mental Health and Addiction Services) Residential Service standards. Pomegranate’s residential treatment employs evidence-based practice for clinical services. Because of our multi-disciplinary approach, teens also participate in the grant funded PREP program (personal responsibility education), nursing group, receive medical, dental and eye care visits and evaluations in addition to individual and group therapy under the care and direction of a psychiatrist. Psychological evaluation, educational testing or other requirements might be added to the mix as necessary. Pomegranate’s mental and behavioral health programming includes both residential treatment (with a diagnostic component), and emergency shelter care.
In addition to the therapeutic care which is provided by licensed professional counselors, social work professionals and therapists, Pomegranate has different educational opportunities including a school on site, with classrooms on each campus. Teens in residential care are assigned a CPST- psychiatric case worker, in addition to a therapist upon admission. The ratio of youth to youth leader is 1:5 (max size); each ‘campus’ has several trained staff present at any given time.
Residential criteria include “age 12-17, adolescents who show persistent unsafe behavior while in a lower level of care environment, who either disrupt their home life or bring about constant opposition. The majority of referrals come from Franklin County Children Service (or other county children service agencies), while a few are transferred from the acute unit for additional therapy. The length of stay in residential is 30+ days (longer term) with an average of 4-6 months,” explained acute nurse, Amanda and residential unit clerk, Alicia, in their January All-Staff meeting presentations.
“It’s comprehensive programming with a structured schedule,” said Angela Nickell, CEO, “and an intensive level of care. We are providing a home away from home, schooling, various types of therapy, recreation, meals under Dietary Solutions, nursing care and nursing group, medication management, monitoring & supervision, as well as the complete medical component under psychiatrists on-site in an accredited hospital/treatment facility setting. We take our slogan, ‘healing, hope and resilience’ very seriously.”
[photo credit: Andreas Meyer-Lindenberg, M.D., PhD, NIMH Clinical Brain Disorders Branch. Illustration of schizophrenia’s effect on the brain; from- http://www.nih.gov/news/pr/jan2002/nimh-28.htm Image from NIH, United States Department of Health and Human Services, public domain. While patients performed a working memory task, the less the prefrontal cortex (red) activated, the more dopamine increased in the stratum (green).]