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: It is often the case that 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.