Specialized forces: Launching treatment tracks for special populations

A police officer in treatment struggling to find peer support because he fears being paired with someone he once arrested. A woman who feels she might be bisexual being alienated by heteronormative new patient forms when she enters inpatient treatment to try to get sober.

Unique life circumstances and experiences for certain groups can make it difficult to receive treatment in programs for the general population. As their name implies, specialized treatment tracks are a way for facilities to accommodate special populations, such as airline pilots, members of the clergy, or the aforementioned police and LGBT community.

Princeton House Behavioral Health in Princeton, N.J., and BLVD Treatment Centers in Los Angeles each have launched specialized treatment tracks in recent years.

Princeton House’s specialized offerings include a track for first responders, launched in 2013. BLVD, meanwhile, features a pair of specialized intensive outpatient tracks—an LGBTQ-affirmative track that has had an average enrollment of nine patients since its launch two years ago, and a “primetime” track for clients over the age of 35.

Neal B. Schofield, MD, chairman of the department of psychiatry at Princeton House, and Lauren Costine, PhD, chief clinical officer at BLVD, each played a role in the development of the specialized tracks at their respective facilities.

The two shared with Addiction Professional some of their insights on successfully launching specialized treatment tracks.

A specialized track means special training. For marketing purposes, it can be tempting for facilities to say they treat special populations. But offering truly specialized treatment tracks requires a deeper level of investment.

“I get very concerned when I know folks are out there treating people they are not trained to treat,” Costine says. “They’re treating people outside their scope of practice, but they’re doing it anyway. That actually happens all the time in the healing world, the psychotherapy world and the addiction world. People want clients, right?”

The example of using heteronormative documents is one case where even well-intentioned facilities can stumble with special populations if their personnel do not have specialized training, Costine says.

“The reality is there are some programs that are mindful of this or interested in offering some kind of LGBT programming, but a lot of folks don’t even know they are creating an atmosphere for a questioning person to walk in the door,” she says. “Are they going to come out in that program? Are they going to use that opportunity to start exploring what’s going on inside of themselves while they’re trying to get sober? How much is that going to affect their ability to stay sober? It’s a very big problem.”

Finding the right personnel. Costine and Schofield agreed that for a facility looking to launch a specialized treatment track, both retraining current personnel and hiring new team members can work as long as their knowledge base is solid.

“The key thing is not so much where they come from in terms of whether we train them on the job or they come in trained from the outside, it’s that we’re very selective about the people we pick to do the treatment,” Schofield says. “They need to have an empathy for the populations they serve.”

Costine, meanwhile, is helping to train clinicians looking to work with the LGBT population. In addition to her work at BLVD, Costine is an adjunct faculty member at Antioch University in Los Angeles, where she has worked on the development and management of the LGBT specialization in clinical psychology, a two-year program launched in 2006.

“You see budding therapists’ worlds are opened up,” she says. “They start seeing things more clearly and how the dominant culture is very blind to what it’s like to be a sexual or gender minority. That’s not the dominant culture’s fault, either. This is thousands of years of really bad programming and conditioning that need to be undone.”

Be accommodating on an individual level. Beyond adequate training for personnel, Schofield says a critical part of getting buy-in from patients in specialized treatment tracks is having an ability to shape programs to their needs on a case-by-case basis if necessary.

“You don’t want to have the person fit the program, you want the program to fit the person,” he says. “Otherwise, it’s almost as if they don’t fit, then they are a failure. I try to avoid anything that connotes in any way to a patient that they’ve failed. I tell them I don’t want anything but good for them, which is the truth. We try very hard to address that.”

Tom Valentino is Senior Editor for Addiction Professional.