ColumbiaCare Services's treatment philosophy is guided by the research and insights of Abraham Maslow and Victor Frankl. Maslow (Motivation and Personality, 1954) described the hierarchy of needs that humans have, building from simply staying alive, to feeling safe, to being social, to contributing to society, to personal growth and fulfillment (self-actualization). Frankl (Man’s Search for Meaning, 1984) convincingly demonstrated that persons survive, and ultimately thrive, only when they have meaning in their lives.
ColumbiaCare Services looks at the person first, then how the mental illness affects the person. We seek to provide our residents a pathway to achieving the same things all humans need to not only feel safe and well, but to contribute and thrive.
Among the ‘side effects’ of serious and persistent mental illnesses are poverty, hunger, fear, and sometimes existence living on the street. When ColumbiaCare Services provides healthy and plentiful food, clean living space, and a home that is safe from assault and intimidation, we go a long way toward the recovery of our residents. As we create a low-stimulation environment, we allow our residents time to loosen themselves from alarming distractions, become aware of the effects of their mental illness, and to focus on their recovery. In time, the resident recognizes the importance of fully participating in their treatment and they are cordial and cooperative housemates, learning skills that make them feel part of the home.
As the resident feels comfortable in their new home, and we see sufficient focus and goal-directed behavior, we include the resident in increasing doses of social contact. We take special efforts to include family to the degree that we can, holding a strong bias that involved family is one of the best indicators of successful treatment and community integration. We encourage social contact within the home (to the degree that other residents feel comfortable) through house meetings, special outings, and informal relationship-building. Social contacts outside the home are also encouraged as they support the recovery of the resident. We assure that social opportunities are appropriately limited and strictly monitored but should and will be developed as possible.
We have witnessed that, as their basic needs and safety are assured, and the resident gets practice socializing both within and outside the home, the desire and the skills to contribute to society begin to emerge. This may take the form of taking an interest in the outside appearance of the home or the neighborhood; volunteering in church or community; completing GED or taking college coursework; or finding paid employment. When this happens, we see residents who are hopeful of recovery and living more fulfilled lives. This type of improvement leads directly to community living or step down to a less restrictive setting.
Procedures
Prior to admission, potential residents are screened for appropriateness by ColumbiaCare Services residential staff, the Extended Care Management Unit, and the local community mental health agency. All parties must agree that the proposed resident is likely to feel safe and hopeful about the placement, fits in with the other residents of the facility, and is likely to benefit from the therapeutic environment and services offered within the facility.
A Residential Services Plan is developed for each resident, meeting the standards of OAR 309-035-0159 and other rules. The Residential Services Plan describes what the resident needs to learn and to do in order to successfully live in the home, in a manner that is at once respectful and is a stretch for the resident. These Residential Service Plans describe the medication management, skills training, and other services needed to increase the resident’s living skills in the home and the skills necessary for living in a possibly less restrictive, more independent setting.
Each resident receives a Comprehensive Mental Health Assessment as per OAR 309-016-0005 (43). Taking into account what was learned in the Assessment about their strengths and challenges, each resident then engages in a process with facility staff that results in a Treatment Plan. The Treatment Plan describes one or two things that the resident will focus on for the next three to six months that will be seen as growthful and that taps into the meaning of the resident’s lives. At least one goal will target movement from the facility to a less restrictive, more community-like setting. These goals will be supported by medication, group and individual therapy, skills training, and consultation with family and community professionals. The Residential Services Plan will always be part of the Treatment Plan.
