Making Data-Driven Decisions
Featured Guest: Dr. Philip Hemphill
For this episode, I met with Dr. Philip Hemphill, the Chief Clinical Officer at Lakeview Health treatment center. He joined me for this interview at the Recovery Results conference in Dallas, where he spoke on transforming addiction treatment by implementing an integrative health model and using real-world data to inform decision-making.
David Condos: Hello and welcome to this episode of Recovery Unscripted. A podcast powered by Foundations Recovery Network. I’m David Condos, and today’s guest is Dr. Philip Hemphill, Chief Clinical Officer at Lakeview Health. He joined me at the Recovery Results conference where he spoke on transforming addiction treatment with real world data and an integrative heath model.
Also, be sure to stay until the end of the episode for our new trivia segment called This Week in Recovery History. Our first question is about the Washingtonian Society, an alcohol abstinence fellowship, that at its peak had over a half million members. And it was founded during this very week in which year — 1800, 1840 or 1880? Find out after the interview.
David: We’re here with Dr. Philip Hemphill. Welcome.
Dr. Philip: Thanks for having me.
David: I thought we’d start off by having you tell us a little bit about your personal story and how you got started in the world of addiction and behavioral health treatment.
Dr. Philip: Sure. Back in 1989, I graduated from college with the degree in psychology. I began working in a facility where we started treating people who had very severe trauma and addiction issues. Back then, there was not really very many programs that were addressing these issues. I had the opportunity to train under some really experts in the field and in the industry, and learn some treatment strategies that were really progressive for their time. That allowed me to begin to hone in my research and my clinical expertise related to dealing with addiction and co-morbid trauma issues.
That was my initial exposure and I stayed with that group for about 12 years. I was really embedded as a clinician, and eventually as a director, and a leader within that group. That was some wonderful experience as I got earlier on. I saw the significant amount of change that people could make in a very short amount of time. That was something that really kept me engaged in this industry despite the stressors and hardships that can come with working in mental health and addiction. The rewards just easily outweighed them.
David: Could you tell us a little bit more about your current role with Lakeview Health?
Dr. Philip: About two years ago, I decided to join Lakeview Health as their Chief Clinical Officer and from a management standpoint, I’m responsible for both the medical and clinical services that are delivered in the organization. Being a part of the leadership team that has an approach where everybody in the organization is a leader. Everyone in the organization has the potential to rise up within the organization and institution.
We actually promote more than 50% of the people within the organization. We believe in that. That’s my role today, is managing the clinical and the medical, and getting out and being the public face for our professional program that we are able to offer patients.
David: You touched a little bit about Lakeview’s philosophy. Could you tell us some more about their approach to treatment and some of the programs that are offered there?
Dr. Philip: Sure. Lakeview has been around for about 14 years and about three years ago, the group that acquired them decided to make a commitment in investment to continue the strong medical component of the treatment. With that as the backbone, we were able to offer an integrative approach to the treatment of substance use disorders. What that means is that, we have a number of master’s-level therapist and then we have about five or six masters level expressive therapist.
Art therapy, music therapy, vocational, recreational therapist, we have them. Then we have our wellness center which is staffed by master’s-level exercise physiologist, professional staff and then the commitment to their aftercare where we are following people for at least a year post-discharge. That’s a little bit about the integrative model.
David: You say you follow people for up to a year, is that following up with them or is there some aftercare involved?
Dr. Philip: Yes. That’s just part of their aftercare, the routine aftercare of being monitored and followed up. At least on a monthly basis including their family being contacted and we’re offering a number these alumni functions, continuing education, continuing recovery experiences. Because recovery is people change and developed over the course of time. Recovery has a developmental history just like a person does. That deserves a history being re-written and a person has a right to that history. To create new memories and new meaning, and feel a sense of I remember when. That’s all part of the healing process.
David: One thing I noticed about Lakeview is that you guys offer separate men’s and women’s programs, right?
Dr. Philip: Yes.
David: Could you tell us a little bit more about how you feel this gender responsive programs help your patients and why is it important to offer that option?
Dr. Philip: One of the things we do is to use data to inform our decision-making. We found that there was a lot of interference, a lot of static, a lot of background noise when we had the genders mixed. We made a commitment about a year ago that we needed to do something different. We started a building a women’s center, a women’s program called The Rose. It’s right next to the main campus. It’s just been phenomenal.
The engagement process has been significant for both genders. What we know specifically about women is that they usually take longer to enter treatment than males do. They have less access to treatment. This removes one of those access barriers. Also, once they get into treatment, their bodies are much more affected than men because of the composition of the body. Their absorption of drugs, their trajectory is a lot steeper. They get in trouble a lot quicker whereas males have a longer runway in their metabolism and their ability-
David: On a physical level-
Dr. Philip: On a cellular level, there are some differences there. It’s understanding that process first, educating people about their bodies and their minds. Then looking at some of the social oppression that takes place with women. Despite our ideas that there’s equality, we all know that there are some limitations to equality. For example, being able to speak openly and candidly about what were the barriers that led to them not coming forward earlier, let’s say. It could be child rearing, it could be financial, it could be tied into work. All of these things are variables that we can have people exhale and relax.
They’re much more likely to talk about abuse in their history and the details about abuse. They are much more likely to complete treatment in this setting. Males, on the other hand, are too much more likely to not have to have that guys. That sense of masculinity in a group where there is a need to challenge each other. That could be relax a little bit. They get in touch a little bit more with their empathy side. Instead of allowing for the stereotypical femininity to take over the role of being empathetic in a group. They have to step up and they have to practice their own empathy in the context of other men. We saw some really interesting dynamics going on, and the patients who are responding really well.
David: That’s relatively new thing for you guys, that’s six months ago?
Dr. Philip: Yes.
David: You’re already seeing great results from it?
Dr. Philip: Yes. We really are.
David: That’s awesome.
Dr. Philip: Yes. It’s been a real plus for the organization, and obviously for the patients and their family.
David: I know you mentioned some of the specialty holistic therapists you guys offer. I do want to touch on one real quick that I saw on your website: surf therapy. This is one I have not heard of before. Could you speak about this for a minute?
Dr. Philip: Absolutely. We’re dealing with a newer generation of people who are in need of recovery services. There has to be more engagement points in the context of healing. To sit in a circle for six hours a day, it’s not very appealing. You have to come up with alternative ways to keep people engaged in the process. If you really are looking at a holistic approach to where your whole body is in the process of healing. One of the ways to do that is to go out and be a beginner. We’re located exactly 10 miles from the Atlantic Ocean. We partnered with a local group who were very familiar with recovery and they’re called the Salt Water Cowgirls. They offer surfing lessons, and these are gender specific as well. We have a dozen surfboards; we have a dozen wet-suits it’s year-round. It’s an hour and a half surfing lesson and people are generally doing this towards the end of their stay. They’re not doing it in detox, they’re doing the last couple of weeks of their treatment here. The idea of what it’s like to be a beginner, what is it like to be in nature and be overwhelmed and have to get back up on that board?
What is it like to get that unexpected wave? What is it like to ask for help? What is it like to encourage another person? What is it really like to try again and again, and that’s something that is really a metaphor for recovery and healing. After we do the hour and a half lesson they come off the boards. Then we have a licensed clinician and a master’s level therapist who sits there and does an hour process group with them regarding what they just experienced.
It’s a very cathartic, a very powerful– I liken it to I had a professor at the university in the music department and we bought a dozen instruments. Then one day a week we would send all of these professionals over to the music department and they would learn how to play Mary had a little lamb on the xylophone. You’re talking about a very accomplished surgeon or radiologist or a nurse or lawyer. Here they are a beginner and that is like really what recovery is about, is about its okay to be a beginner. It’s okay to not know the answers.
David: I wanted to get into a little bit about what you’re speaking about here at the conference. One specific topic is integrative health as a model of care, could you tell us a little bit more about what goes into that process and why is that important for both treatment providers and patients that it helps?
Dr. Philip: Unfortunately, they have not done an adequate job of assessing mental health and substance use disorders in the medical industry. My goal and our goal here is why not on the back-end, why not have the people who are in behavioral health and substance use, why not have them do a robust medical intervention? That’s what we’ve committed to. We have 16 full time medical staff members who provide these services in excess of three to 400 appointments in a week.
People with substance use disorders don’t really take care of their bodies. This is an opportunity to have that be attended to, have things diagnosed that they’ve never really been treated for. It’s not only provided to the patients, but it’s also provided to the staff, so the staff gets to participate in the sense of wellness because we believe that if you take care of the staff members they will ultimately take care of the patients.
You have a reduction in AMA and you have more successful treatment completions the happier the stuff are. We have groups and individual training every morning Monday through Friday from 6 to 7 AM just for staff and also from 5 to 6 PM. Our professional trainers actually facilitate those meetings, those one hour sessions, training sessions for the staff. We have hundreds of continuing ed. opportunities that are on campus.
We have a conference center, so our employees don’t even have to leave the campus to get their continuing education. These are all parts of how we start the wellness out with the offerings to our employees and this is done from the leadership. That’s a part of what integrative health is really about, using the medical staff as a backbone providing this type of care that people have neglected for a major part of their life.
You realizing we have a 10,000 square foot gym two hours a day not only available to staff but the patients have access to the gym. Truly everything taking place, the food, the dietary needs, all of these things being on campus reaching out into the community going to 12 step meetings, bringing in some 12 step meetings on campus. That’s the integrative model that we’ve committed to and we feel very proud of that.
David: That’s great that you brought up the staff because that’s something I hadn’t really thought of before is taking the integrative model and not just using it to help your patients but making sure your staff are getting taken care of and growing through the resources that you have in that area.
Dr. Philip: Exactly.
David: One thing you brought up earlier was data. Could you tell us a little bit about how you’ve use data to shape the therapies that you are using?
Dr. Philip: Sure, first where we’ve used it is all of the services that we provide are evidence based services, whether we’ve done the research on them or not, that’s the very first way we’ve made a commitment to data. Every single group has a focus related to the objectives, the expectations, the descriptions. With that in mind the second part of the data comes from what we call fidelity measurements.
The leaders in the organization do intermittent checks on the different groups so not just go in and sit in a group. Are they using motivational interviewing techniques? Are they using integrative language? Are they using positive language, health language instead of pejorative negative language? How much participation do they have versus the patients? We are able to measure these. Are they using relapse prevention terminology? Are they challenging cognitive distortions?
We’re able to track people in their delivery of their service and if they’re not we’re able to make adjustments in real time, that’s one of the ways. On a monthly basis we do what’s called Senior Committee so all the leaders come together and talk about trends that are happening. Looking at trends related to people not completing treatment certain clinicians the types of patients they’re getting in. Are they having a more difficult time? Are they staying longer in treatment, are leaving earlier in treatment?
We want to use data on how we’re actually treating the patients. How many appointments is a person requesting? How many times are they interacting with their case managers? How many times is family seeing them? Does that affect their engagement? We use that type of data to help with interventions come up with strategies for bettering intervening these types of things. That’s how we use the data there.
Then we have formalized processes we have engage a group back in 2007 called TOPs, Treatment Outcome Package. This is an instrument that the patient fills out within the first 72 hours and then we have them fill it out within the last 48 hours of discharge. We have in the end of about 4,500 people that had filled this thing out since 2007. We using that data to inform our care, of late let’s say we’re seeing the mood disorders decreased a bit.
What that tells us is that through our professional care as well as our medical care people’s mood disorders are making some headway even in that short period of time. Then after that we’ve engaged a group on a monthly basis checking in with people up to a year out. We’re monitoring people on a monthly basis or we have contact with them directly and then we have contact with the family member directly. That’s the ways that we use data to inform our decision making and exercise adjustments along the way.
David: Right, I’m glad you brought up that you guys actually check to make sure that the program is teaching the things that you wanted to be teaching and using the language that you wanted to be using because I mean I imagine that there are some programs if they don’t do that then they can say they’re doing one thing but do they really know.
Dr. Philip: Yes, I mean it’s like any good psychological testing, you have reliability and validity. Validity is essentially, “Are you doing what you’re saying you’re doing and is the instrument valid is the treatment valid?”
David: Then yes to check up with them up to a year after they leave treatment, is that what you said?
Dr. Philip: Absolutely.
David: That’s awesome. We’ll just wrap up with one last question here. You’ve devoted a lot of your life to this field. Could you just tell us a little bit about how behavioral health is important to you?
Dr. Philip: It’s just a very rewarding feel personally, professionally, socially. It feels good waking up and going to work. It’s not like work it’s really fun. It’s really exciting to treat patients to train new professionals. There’s so many people that are of need out there. I mean we’re really only accessing a small portion of the people who really have desperate needs out there. The more that we can spread the information.
That’s why I’m so excited about the integrative model because of capturing more people. The accessibility points are going up and that’s really what’s needed in our country. Life is full of challenges, its full of changes and most people at some point in their lives are going to have a need. To be able to be a part of that need is just very fulfilling.
David: Yes, thank you Dr. Hemphill for being with us today. Thank you for your time.
Dr. Philip: Sure thing David, thanks.
David: Thanks again to Dr. Hemphill for joining us and thank you for sticking around to the end of this episode. As you heard in the intro I’m excited to introduce a new segment called This Week in Recovery History. Each time our highlighted different pivotal event from this week in history that help to shape today’s world of addiction and mental health recovery.
Our first trivia question featured the Washingtonian Society one of the earliest major alcohol abstinence fellowships in the US and it was founded at Chase’s Tavern in Baltimore, Maryland, on April 2nd of 1840. The society was the brainchild of six regular guys who wanted to create a sober community where they could share their alcoholic experiences openly and keep each other accountable toward their shared goal of total abstinence and the movement quickly spread.
At its peak the Washingtonians are believed to have had over a half million members, but by the end of the 19th century the society dissolved due fragmentation and in-fighting over political issues of the day such as prohibition and the abolition of slavery. And although it may be tempting to draw a comparisons between this fellowship and the Alcoholics Anonymous movement that followed, the Washingtonians were actually so non-spiritual that their critics accused them of placing themselves above the power of God.
That’s the Washingtonian society founded this week in the year 1840. Stay tuned for more recovery history in future episodes.
David: This is been the Recovery Unscripted podcast. Today we’ve heard from Dr. Philip Hemphill, Chief Clinical Officer at Lakeview Health. For more about their services, visit LakeviewHealth.com. And thank you for listening. If you’ve enjoyed this podcast please share it with someone else who might enjoy it as well and subscribe so you don’t miss any of our new episodes. See you next time.