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Lighthouse Residential Unit Program Description

Download Lighthouse Program Description.pdf

Lighthouse is a residential treatment program designed for adolescent girls ages 12 – 18 experiencing a severe emotional disorder. Lighthouse is a highly structured program providing person-centered individual, group and family-based treatment, behavior modification, education, and pro-social recreational opportunities to increase pro-social behavior, improve functioning and well-being, and facilitate a safe return to a stable living arrangement in the community.

Many of the girls participating in the Lighthouse program have participated in less restrictive services but have not been able to remain safe in their homes and/or communities.  Girls often discharge back to their homes with community-based supports in place to ensure continued success.  Sometimes girls who were previously hospitalized come to Lighthouse for continued intensive treatment prior to returning home.

The Lighthouse Program provides services 24 hrs. / 7 days a week. Staff is on site and available for support during day and night hours.

A Juneau School District Teacher and an aid provide educational services in an on-site classroom.

Appropriate Population/Length of Stay

Lighthouse is an intensive residential treatment program designed for girls needing therapeutic interventions and who cannot be treated effectively in their own family, a foster home, or in a less restrictive and less structured setting.  In some instances, girls may have multiple diagnoses due to placement in several facilities, or who may have been in such crisis that a true diagnostic picture was difficult to ascertain.  In these instances, the girls can continue treatment in Lighthouse once a clear diagnostic picture is obtained, however some may move to a different level of care if they are unable to stabilize.

In this highly structured setting, residential services are intended to serve girls who:

1. Exhibit destructive behaviors,
2. Have been identified as having intensive needs, and/or
3. Need a highly structured setting with psychiatric services available and/or to determine an accurate diagnosis.

The therapeutic behavioral health services provided to girls includes:

1. Determination of an accurate diagnosis
2. Behavioral stabilization and management
3. Comprehensive individual treatment planning focused on continued care and the young person’s long-term needs;
4. Planned individual and group therapeutic behavioral health services
5. Family engagement, education, skill development, referral, mediation, transition and after-care planning, consultation, and in-home services (as appropriate)
6. Crisis intervention and stabilization;
7. Maintenance and improvement of the young person’s educational progress and development of an individualized education program for each young person (coordinating with the school IEP team as needed);
8. Developing independent living skills;
9. Developing a plan for subsequent placement.

There is no minimum or maximum length of stay.  Typically girls participating in Lighthouse meet their treatment goals within six to twelve months.  

Admission Criteria

1. All of the following must be met to qualify for Lighthouse services:
   1. A behavioral health assessment indicating a diagnosis of a severe emotional disturbance, and recommending residential treatment. The assessment must be completed within the previous 90 days and conducted by one of the following:
      1. Psychiatric evaluation conducted by an MD or DO
      2. Psychological evaluation conducted by an Independently Licensed Psychologist
      3. Comprehensive Behavioral Health Assessment conducted by an independently licensed Social Worker (LCSW), Professional Counselor (LPC) or Marriage and Family Therapist (LMFT).
   2. The symptoms and impairments must be the result of a psychiatric or co-occurring substance abuse disorder.
   3. If admission is delayed due to being in a detention setting and waiting on a court hearing; an updated assessment must be completed which indicates the continued need for residential treatment.  
   4. If a young person’s symptoms are not precisely within the timeframes below, JYS may request that they be reviewed and determined by the Department of Behavioral Health on a case-by-case basis and a written decision will be provided to JYS.
   5. A discharge plan must begin at admission with a specific discharge date and specific providers identified to help facilitate the discharge in a timely manner.
2. At least two (2) of the following functional issues must be documented in the assessment to qualify for Lighthouse services:
   1. Aggressive/assaultive behavior to peers or adults within the last three to six months not accounted for by another diagnosis or due to the effects of a substance or medical condition.  (Examples: biting, kicking, pinching, bullying, cruelty to animals, destruction of property or threatening behavior, punching a wall, throwing or smashing items, frequent and/or uncontrollable tantrums of yelling and screaming, aggressive impulses that resulted in seriously assaultive acts) and/or threats to harm others with the means to do so;
   2. Property destruction in the home, school, or community within the last 6 months or substantial property destruction within the last three months grossly out of proportion to precipitating psychosocial stressors, not accounted for by another diagnosis or a substance or medical condition in the home, community, or school and/or charges were filed;
   3. Suicidal gestures or statements, without a plan or stated intent to follow through;
   4. Has been abusive to self within the previous one to two months as evidenced by cutting the skin, pulling out hair, picking, scratching, or rubbing the skin to create sores or scars or burning or branding the skin;
   5. Running behavior that puts the young person at substantial risk;
   6. Increased anxiety as evidenced by not being able to perform up to developmental expectations for the past two to three months (not due to developmental issues);
   7. Depressed, irritable or manic mood for at least two to six months, as evidenced by: changes in appetite or eating pattern, unexplained weight loss, anger outbursts with increased frequency or intensity, excessive guilt, excessive preoccupation with death, diminished ability to concentrate or make a decision, feelings of hopelessness, helplessness or worthlessness or no longer engages with friends; or family;
   8. Neglects to take responsibility for daily hygiene and needs direct assistance/direction to complete activities of daily living (not due to developmental issues);
   9. Not able to maintain appropriate sexual boundaries for the past four to twelve months (longer if youth has been in a restrictive setting).  As evidenced by: inappropriate sexual play with inanimate objects, sexual comments, sexual contact such as rubbing or touching others, inducing others to touch offenders private parts, penetration such as digital, penile or with an object, and/or adjudicated sexual offense.
   10. Criminal behaviors including the intolerance of adult authority or stealing from family, friends, and stores, which may or may not result in legal charges;
   11. Failure to abide by conditions of probation.
3. At least two (2) of the following environmental Issues in home, school, or community must be documented in the assessment to qualify for Lighthouse services:
   1. Serious stressors in the “family system” due to frequent moves, numerous disruptions, severe conflict, or issues of abuse;
   2. Inability to meet physical needs;
   3. Criminal behaviors by parents or family members occurring within the family or neighborhood;
   4. Exposure to alcohol abuse or use of illegal substances in “family setting” or “community network”;
   5. Exposure to domestic violence in “family setting”; 
   6. “Family system” is unable to participate in services or to provide a safe and therapeutic setting for the young person;
   7. Other family problems such as emotional instability, neglect, abuse , or absence;
4. Response to Services: the assessment must document at the least restrictive level of care in home, school or community, two (2) of the following: 
   1. Under stress, the young person has shown significant vulnerability to external stressors;
   2. The young person decompensates when under pressure due to family issues, turmoil in day-to-day living environment including educational setting;
   3. The young person is unable to maintain changes during transitions even with intensive supports.

Co-occurrence: Has a co-occurring condition, which does not allow maintenance in a less restrictive level of care (substance abuse disorder, medical condition, developmental disability, traumatic brain injury, FASD, etc.) does not rule a young person out from receiving services.

Continued Stay Criteria

Progress is reviewed every ninety days.  At that time, the youth and family team determine if a continued stay is necessary, or if the young person is ready to return to their home community, and if so what type of supports will be necessary for the transition.  Continued stay criteria is as follows:

1. The young person has exhibited behavior consistent with admission criteria within the past six weeks, or has exhibited new symptoms or behaviors that meet admission criteria and the treatment plan has been revised to incorporate new goals;
   1. History, clinical presentation and progress strongly suggest that discharge to lower level of care presents a high likelihood of deterioration, high risk behavior and the inability to make progress on goals;
   2. The treatment plan has objectives appropriate for residential care related to improving behavioral and social/emotional functioning;
   3. The young person is participating in the treatment process
   4. The family is participating in the treatment process;
   5. Vigorous efforts are being made to affect a timely discharge to another level of care; AND
   6. Continued placement is more likely to be beneficial to the young person than to be harmful;
   7. OR the young person does not meet the above criteria, but:
      1. Has clearly defined treatment goals necessary for discharge which can be completed in 30 days and no lower level of care can accomplish the goals OR
      2. Discharge to lower level of care available within 30 days and continued care will avoid an additional transition.

Program Philosophy

The program is strength based and uses the “Stages of Change” model. Girls admitted to Lighthouse, start their treatment on the Orientation Stage, with the goal of becoming familiar with program rules and expectations, their treatment team, staff and their roles and peers. After completing the Orientation Stage, youth progress through: “Contemplation”, “Preparation”, and “Action” and “Maintenance” stages. The process is guided by the youth’s clinician with input of staff and the youth’s treatment team. Every youth has an individualized treatment plan that identifies treatment goals, individualized interventions used to support youth in reaching these goals, as well as strengths and talents the youth possesses. 

Strong Family involvement is essential to the youth’s progress in the program.  Regular family visiting hours are part of the program schedule. Out of town families are invited to visit (Medicaid travel is arranged by the Case Manager every 90 days). Staff updates families and guardians weekly about the youth’s progress.

Staffing

The program operates at a staff client ratio of 1:4 during the day and 1:8 at night. Additional staff are present when needed. Each youth is assigned to a Case Manager and a Master’s Level Clinician. 

Staff Qualifications

All staff having contact with girls in Lighthouse are at least 21 years old and can be male or female. All Lighthouse staff have been provided with the following training:

• First aid & CPR
• Professional role of child care workers
• Child development
• Relationship building
• Communication skills
• Teaching discipline
• Clinical diagnoses
• De-escalation and crisis intervention including nationally recognized de-escalation techniques
• Clinical issues such as FASD, trauma, substance abuse, etc.
• Cultural competence
• Food handler certification

Staff are required to obtain a minimum of 15 hours of job-related training on an annual basis.

Services

Behavioral Health Associates ensure supervision during day and night hours. They provide skill building activities and behavioral management support for youths. The program uses a behavioral modification program referred to as a “Light System” (green, yellow, red). Youth earn points based on their participation and behavioral choices to earn privileges, such as participating in community activities. This system is used to motivate youth and to reward progress as well as positive choices.

All youth develop a safety plan upon admission to the program which is updated at least every 90 days.

Clinical services include a Comprehensive Behavioral Health Assessment, Individual Therapy, Group Therapy and Family Therapy, with and without the youth. 

Psychiatric Assessments and Medication Management are provided by a JYS-contracted Psychiatrist.

Professional Case Managers coordinate medical and educational services as well as aftercare planning. The Case Managers ensure that the youth’s treatment team is informed about the treatment progress. A Treatment Team Meeting is facilitated every 30-90 days to update the treatment plan. 

Funding

Lighthouse Services are funded by Medicaid, Private Insurance and generous grants from the State of Alaska.

FY 2021 Goals:

• 30-day treatment plan reviews
• Detailed procedure manual