Since 2008, Direction has provided mental health care to adolescents in the Greater Nashua Area. As the only program of its kind in the region, we offer a much-needed “intermediate” level of care for adolescents who have needs that are too complex to be effectively managed in an office outpatient setting, but do not reach the threshold warranting inpatient hospitalization. We offer an alternative for outpatient providers, emergency rooms, school guidance counselors, primary care physicians, parents, and other local agencies seeking mental health care for their patients, students, clients, and children. To date we have treated over 2,000 adolescents.
For some adolescents, Direction serves as the point of entry to psychiatric care. For others who already are engaged in treatment, it provides crisis stabilization when outpatient treatment alone is insufficient or ineffective. For those adolescents who do require inpatient level of care, it serves as a step-down program to provide smoother transition back into the community. It appeals to parents, patients, and other providers because of its ability to provide a wide array of services in a relatively short period of time. It appeals to insurance companies for the same reasons, and because it accomplishes its goals in a more cost-effective way.
Our programs take place at a newly-renovated 3500-square-foot suite, located in converted mill space in Downtown Nashua. This site has a reception area, several large group spaces, several offices, two bathrooms, and a kitchenette.
The Treatment Team
The Treatment Team consists of a multidisciplinary group of clinicians who have been hand-selected because they share certain key characteristics. In particular, as individuals they have acquired extensive clinical experience working both directly with adolescents and with the Nashua-area agencies that serve them; they have demonstrated significant creativity, passion for their work, and an ability to form relationships with even the most “difficult” adolescents; and they have demonstrated an ability to maintain their perspective and their sense of humor – absolutely critical abilities in dealing with adolescents — even during the most challenging of times.
The Medical Director is a Child and Adolescent Psychiatrist, Board-Certified in Child and Adolescent Psychiatry as well as General Psychiatry. Unlike many other similar programs, he is on-site in Nashua during program hours 5 days per week and actively involved in our clients’ care.
Admission to Direction
Referrals to Direction come from a variety of sources. For adolescents not already in treatment, sources include parents, schools, primary care physicians, and local emergency rooms. For those adolescents already in treatment but in need of crisis stabilization, referrals may come from other outpatient treatment providers. Inpatient units, including those at New Hampshire Hospital, Cheshire Medical Center, Hampstead Hospital, and Southern New Hampshire Medical Center, refer patients to Direction for step-down treatment, ensuring a smooth transition back to the community after inpatient treatment.
The program is paid for by the vast majority of insurances.
As part of the admission process, every client receives an immediate comprehensive psychiatric evaluation by Direction’s Child and Adolescent Psychiatrist. This evaluation is reviewed and discussed within the multidisciplinary treatment team, which then formulates the master treatment plan.
Levels of Care
Direction offers two different levels of care:
The Partial Hospitalization Program (PHP) operates 6 hours per day, from 12 PM to 6 PM, with lunch at about noon each day. Adolescents begin with the PHP and transition after a few days to a couple weeks to the IOP.
The Intensive Outpatient Program (IOP) operates 3 hours per day, between 3 PM and 6 PM. Clients typically “step down” from the PHP to the IOP during their time at Direction.
Group therapy forms the core component of treatment in Direction’s IOP and PHP. It is led by the Program Director, a licensed mental health clinician with years of experience working as a therapist at a Nashua residential program. Over the years, he has developed a model of group therapy called Wholeistic Education® (WED) that has proven extremely effective in engaging and treating even the most challenging children and adolescents. All groups are led by either the Program Director or by another staff clinician. Other staff members, including Masters- and Bachelors-level clinicians, assist the group leader.
Family therapy is an integral part of Direction’s treatment program, and is provided by staff health clinicians at appropriate intervals.
The Site Psychiatrist (the Medical Director) oversees all aspects of treatment and provides medication management to those adolescents for whom it is appropriate. One advantage of his strong presence at the program is that it allows him to closely monitor medication effects and respond quickly with changes when indicated. Essentially, it allows him to manage medications in a manner more similar to an inpatient psychiatrist, and to provide more intensive psychiatric services than many other programs provide.
Program length of stay is variable, and dependent on each client’s own particular clinical needs. The average is between 15 and 18 program days. Clients generally attend the program 5 days per week, though frequency of attendance may be reduced as clinically appropriate.
Discharge planning begins upon admission to ensure suitable aftercare arrangements are made prior to completion of the program.
Direction usually has between 10 and 20 adolescents attending each day.
Transportation is provided for clients in the surrounding areas to both the IOP and PHP, again minimizing interference in parents’ own schedules. Parents are expected to provide transportation home from the program.