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Woodstone Residence

Kim Williams, BSc, MA, RD

Aman Dhaliwal, BScN, RN

The Woodstone Residence

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The Woodstone Residence

• Residential treatment for medically stable 17 to 24 year olds with a diagnosis of anorexia nervosa (AN) and bulimia nervosa (BN)

• 14 beds

• The usual length of stay is three months, max. 4 months

Collaboration

• The Woodstone Residence, operated by the PHSA as part of BC Mental Health and Substance Use Services in collaboration with the Looking Glass Foundation

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Looking Glass Foundation

– Fund-raise to enhance the programming and profile of the Looking Glass Residence.

– augment clinical practice, teaching, and research within the Looking Glass Residence

– Advocate for youth and young adults with eating disorders

BCMHSUS (a division of PHSA)

– maintain overall responsibility: • Delivery of care and

operations

• Quality and safety, ensuring standards and protocols are met

• Evaluation and reporting

• Budget planning and management

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Looking Glass Residence

Residential Treatment

• For individuals that require more intensive services than are available in their local communities.

• The Woodstone’s multidisciplinary program provides a combination of therapy, meal support and education and psychiatric, medical care in a 24/7 homelike residential environment.

• provides a safe and supportive environment in which to challenge the power of an eating disorder; and learn how to resist using destructive behaviours to cope with daily life.

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Philosophy

• Recovery focused

• Strengths based

• Tailored to individual’s needs at the same time builds a supportive community

Provincial Access Committee

• The access interface between the Woodstone and referring regions.

• Meet monthly - Representatives from Health Authorities, MCFD and Woodstone.

• Ensuring that access decisions are transparent, directed to the most appropriate candidates, and aligned with the mandates of provincial services in general and Woodstone’s program in particular.

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Provincial Access Committee

• The 14 residential beds are divided and allocated to each of the health authorities:

FHA 5.2

VIHA 2.2

VCH 3.5

NHA 1.0

IHA 2.2

Referrals

• Referrals are faxed to individual’s regional representative

• Regional representative determines the region’s priorities and forwards referrals as appropriate to Woodstone’s intake coordinator.

• Intake coordinator processes each referral and contacts the individual, regional representative and community partners with an admission date.

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Per Diem

• Daily user fee for all patients ages 19 and over of $30.90 per day.

• No per diem payment required for those patients under 19.

Inclusion Criteria

• Primary diagnosis of AN or BN as per DSM V

• Between the ages of 17 and 24

• Connected to, and has exhausted, the local secondary level public services available in her/his community

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Exclusion Criteria

• Any urgent medical/psychiatric condition requiring an acute evaluation with 2 weeks prior to admission

• Acute risks of suicide or self-injurious behaviour • Loss of more than four kg body weight during the

previous two months • Tube feeding required • Less than 80 per cent standard body weight for age, sex and height. BMI less than 16 • Temperature lower than 36° Celsius • Blood pressure lower than 80/50 • Postural decrease in blood pressure of >10 mmHg

Exclusion Criteria

• Heart rate <50 (for ages 16-17) • For adults greater than 18 years of age a postural

increase in heart rate of greater than 30 beat per minute on standing with associated dizziness

• Any ECG abnormalities, and specifically a QTc interval of >450 ms

• Serum phosphate, potassium, magnesium, glucose, creatinine not within normal range within 2 weeks prior to admission

• Loss of consciousness or seizure within the last 6 months that has not been evaluated by a neurologist

• Concurrent substance abuse that may predispose the patient to acute risk of withdrawal

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Staff

• Medical Director • Operations Manager • Nursing Supervisor • Psychiatrists • GP/NP • Nurses • Mental Health Workers • Therapists • Dietitians • Intake Coordinator • Night Care Aids • Cooks • Administrative Assistant

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Stages of Care

• Assessment Stage: During the first seven days we assess residents for health status, begin treatment, and ensure safety.

• Recovering Wellness Stage: Designed to help residents recover their physical health.

• Enduring Health Stage: Teach residents the thoughts and behaviours that will make their mental and physical wellness last.

• Continuing Journey Stage: Planning for transition home and preparing for the next steps in their healing journey.

* Movement through these stages is timed to best support the individual. It is based on review and consultation by the Woodstone

team and in consultation with the resident.*

House Expectations

• To help maintain a safe, healthy, respectful, and orderly environment that is conducive to healing.

– Attend and be on time for all program activities

– To be an active participant in the treatment plan

– Bedrooms are locked 15 minutes prior to breakfast and access after this is limited.

– Appropriate dress/attire (may no borrow or lend clothes with other residents)

– Post meal support: 30 minutes after snacks and 1 hour after meals

– 100% completion of all meals and snacks, or you will be provided with and appropriate meal replacement.

– Use of cell phones and handheld devices are limited.

– Computer time is 7:30pm - 8:00pm. A no social media guideline applies.

– Refraining from discussing information about other residents at Woodstone.

– Lights out at 10:00pm Sunday through Thursday, 11:00pm Friday and Saturday

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House Expectations (cont’d)

Residents are expected to refrain from the following: • Inappropriate language (e.g., disrespect, name-calling, ect.) • Physical aggression toward staff or other residents • Self abusive/harm behaviours • Destruction of property • Possession of unsafe items • Theft of property, whether it belongs to Woodstone or

other residents • Runaway attempts • Use of mood or mind altering substances (e.g., alcohol,

street drugs) on site or off site which interferes with your therapeutic process.

Program Schedule

Jan 19th – Jan 25th

2015

Monday Tuesday Wednesday

Thursday

Friday

Saturday Sunday

6:45

7:00-7:45

7:45

Wake & Dress

Be Downstairs

Lock Rooms

Wake & Dress

Be Downstairs

Lock Rooms

Wake & Dress

Be Downstairs

Lock Rooms

Wake & Dress

Be Downstairs

Lock Rooms

Wake & Dress

Be Downstairs

Lock Rooms

8:00 Breakfast

(RN/MH)

Breakfast

(RN or MH/MW)

Breakfast

(ET/QH)

Breakfast

(RN/MH)

Breakfast

(RN/MH) 8:00 Wake & Dress Wake & Dress

8:30

Check In

And

Gratitude

Check In

And

Gratitude

Check In

And

Gratitude

Check In

And

Gratitude

Check In

And

Gratitude

8:45 Be Downstairs

Lock Rooms

Be Downstairs

Lock Rooms

9:00

8:45

DBT

(MW)

Emotion Focused

Therapy

(NF)

CBT

(LB)

Nutrition Group

(RD)

The Daring

Way

(LB)

9:00 Breakfast

(RN/MH)

Breakfast

(RN/MH)

10:30 Snack

(RN/MH)

Snack

(RN/MH)

Snack

(RN/MH)

Snack

(RN/MH)

Snack

(RN/MH) 9:30

Therapy

Homework

Check In

And

Gratitude Circle

10:45

Weekly Goal

Setting

(MH/RN)

Exploring my ED/My

Wellbeing

(MW)

Medical Group (Dr.

Pederson)

Community Group

(Team)

Media Lit

(QH) 11:00

Snack

(RN/MH)

Snack

(RN/MH)

11:50

Medical Check Ins

(Nurse

Practitioner)

And Vitals (RN)

Nursing Group

(RN)

Interpersonal

Effectiveness

(NF)

Group Therapy

(LB/QH)

F.O.N.F.F.

(RD) 11:30 Leisure Education

1130-1250

Group Outing

(MH/RN)

12:45 Meds Meds Meds Meds Meds 12:50 Meds Meds

1:00

Lunch

(NF/DV/AD)

Lunch

(MH/DV)

Lunch

(MH/RN)

Lunch

(AD/QH)

Lunch

(MH/LB) 1:00

Lunch

(RN/MH)

Lunch

(RN/MH)

1:50 Expressive Art

(Cat/MH/RN)

Group Therapy

(QH/LB)

City Explorations

(RN/MH)

Recovery Skills

(LH)

Weekly Goal Setting

(MH/RN) 1:45

Saturday Outing

(MH/RN)

2:00

Ruby’s Bakery

3:00

P.E.T./Rest

Group Walk

(MH/RN)

P.E.T./Rest/

GRADS

Group Walk

(MH/RN)

City Explorations

(RN/MH)

R P.E.T./Rest/

GRADS

Group Walk

(MH/RN)

P.E.T./Rest

Group Walk

(MH/RN)

Saturday Outing

(MH/MH) Ruby’s Bakery

4:00 Snack Snack Snack Snack Snack

4:00 Snack Snack

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Family and Friend Visits

• The Woodstone Residence welcomes the participation of friends and family members, as part of the care team as they are integral to the residents life and provide support, comfort, and important information during the residents stay.

• Due to program structure, visits need to be planned and pre-arranged with the resident and the Woodstone team.

• The best time for family/friend visits are during the following times: – Monday to Friday 7:00pm – 8:30pm – Saturday, Sunday and holidays throughout the day

Therapeutic Passes

• Passes home can begin in Stage 3 (Enduring Health Stage) of recovery or when residents have been at Woodstone for over a month.

- At this time residents will have learned some new skills and will have a chance to experiment in their normal environment. • Passes need to be discussed with therapists and need to have

therapeutic goals associated with them. • Pass Request Forms are filled in by residents, which outlines the

above and are reviewed and approved by the treatment team in rounds.

• Residents complete a Pass Return Form post pass in order to identify successes and challenges they may consider when identifying their goals for their next therapeutic pass.

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Reasons for Early Discharge

The Woodstone treatment program is voluntary. In some cases, in order to keep residents safe and supported, early discharge may occur under the following circumstances (but not limited to the list). Early discharge is considered on a case-by-case basis as a result of:

• Medical instability • Psychiatric instability • Inability/unwillingness to participate in the treatment

program • Pattern of non-compliance with House Expectations,

deemed to be interfering with their own or others’ treatment

Contact Information Kim.williams@cw.bc.ca adhaliwal-02@cw.bc.ca