MODALITIES OF TREATMENT, THEIR FREQUENCY, AND LENGTH OF TIME

The following treatment modalities are utilized throughout the resident’s entire length of stay.  The treatment modalities are utilized to accomplish his/her individualized goals and objectives, and are meant to target specific risks and needs identified during assessment and during their stay at the Center.  Each resident has an individualized Master Treatment Plan with clear Goals and Measurable Objectives.   Residents attend Treatment Plan Update groups to help them gain the skills and attitude necessary to plan their movement from one phase to the next.  The interdisciplinary treatment team works with the residents to clarify goals, sharpen focus, and solidify plans before the final update is written.  When significant events occur, the interdisciplinary treatment team meets with the resident to update the treatment plan.

The table below shows how many hours per week are spent in each modality, and how many total hours of each modality are received in an average stay at the Center.  Residents participate in an average of 50 hours of structured activities per week.

·Individual Therapy as needed.  Though individual therapy is conducted, there is no specified weekly number of hours. It is believed that attending daily large group sessions, in addition to the other classes and group sessions held at the Center, provides sufficient opportunities for support, insight, and education.  Should a resident exhibit symptoms of depression, anxiety or other disorders, or confront a particularly difficult problem, individual work is scheduled to help them through the rough spots. Counselors, RCSOs, RS staff and administrators are available at anytime to counsel with residents about any subject. If all incidents of individual work were recorded, far more than 1 hour per week would be provided. RCSOs do schedule monthly one on one office visits.

·Primary Caseload Group meets one time per week for a total of 1.25 hours. This group provides residents an opportunity to keep their primary counselors and group members up-to-date on their treatment progress, what classes/groups they attended that week, etc. These small groups also provide a more intimate forum for discussion of personal and community issues. Issues brought up in Caseload are ideally taken to Large Group for discussion by the community.

·Thinking for a Change meets two times per week for 3.5 hours. This is where Thinking for a Change is taught and initially used. Residents, in groups of 8 or less, are usually put into TFC classes within 3 weeks of arriving at the Center. They attend all 22 sessions, and then attend a COGs lab three times a week to sharpen their cognitive skills.

·COGs Lab meets three times a week for 1.5 hours. This is a resident taught, counselor supervised group where residents have an opportunity to sharpen their cognitive skills by doing extra TFC homework assignments. Residents who receive thinking reports as a consequence for breaking rules or inappropriate behavior must process their reports in this group. This allows senior residents to help junior residents identify thinking errors and distortions, and find new thinking to replace old, dysfunctional thinking.

·Moral Reconation Training is taught by three Residential Supervisors. Residents attend one class per week for 1.5 hours. They are required to do workbook assignments which involve written work and oral presentations. MRT steps are repeated when Center rules are broken, thereby providing a built in consequence system. Senior residents help junior residents with assignments, and judging by the comments and attributions made in Large Group, MRT is a very meaningful part of the Center's treatment program.

·Stress Reduction Activities (walking, tai chi, yoga and chi kung) are offered each day of the work week. Residents are strongly encouraged to choose one or more of these activities and participate at least twice per week.

·Grief and Loss Group is prescribed for those residents dealing with significant grief and loss issues. Residents are referred to the group by the treatment team, and are interviewed by the facilitators before admission into the group. The group is 1.25 hours long and lasts for 12 sessions, and it delves into grief, loss, forgiveness, and resentments. It is taught by the Assistant Director and a spirituality consultant.

·Spirituality Group for two hours every other week with a spirituality consultant and Counselors. In this group, the resident's relationship to a higher power is explored and living spirituality in every day life is discussed. Residents are also introduced to guided imagery and mediation techniques. These most important relational aspects are explored throughout their entire stay.

·Treatment Plan Update Group is required for residents to move from Phase I to II and from Phase II to III. Residents are required to remain in the group until they formulate an acceptable treatment plan. Phase III residents also work on discharge plans. The groups meet for 1.25 hours per week, once a week. There are two groups, Phase I to II, and Phase II to III. Treatment planning is a dynamic activity and updates are worked on spontaneously when new problem behaviors emerge during treatment.

·Large Group Therapy for six and a quarter hours per week. This modality serves many important purposes.

The Large Group accomplishes the following:
*It provides an introduction of the resident to Community and the Community to the resident
*It provides a place and opportunities for Staff to model pro-social behaviors;
*It provides a forum where commonality issues are identified;
*It provides a forum where philosophy of treatment is discussed;
*It provides opportunities for our collaborative involvement to be modeled;
*It provides a forum where Community issues, relational problems, and behavioral problems are discussed and resolved;
*It provides a place and time for support to be modeled and given;
*It provides a forum where violations and consequences are discussed;
*It provides a forum where Announcements and Awarenesses can be shared;
*It provides a time and place where self-esteem can be bolstered;
*It promotes important community communications;
*It enables residents to explore their relationship to community

· Multi-Family Therapy is scheduled for caseload groups every six weeks on Saturday for three hours. Significant people in the resident's life attend and Chemical Dependency and cognitive techniques are explored. In these groups, problem identification occurs, problem resolution begins, and may be carried into individual chemical dependency family counseling as indicated. Residents and family members share insight into cognitive processes at work in their relationships, and deeper communications are encouraged.

· Family Therapy as indicated per the treatment plan to deal with significant family problems caused by chemical dependency and criminality. These sessions are usually every other week for l.5 hours for 4-6 sessions.

· Process Group takes place once a week for 1.25 hours. This group is intended to explore more thoroughly the feeling dimension of the cognitive-behavioral process. The most appropriate residents for this group are the highly motivated and psychologically minded persons, all of whom must be referred by their primary counselors, in conference with their RCSOs, and other treatment team members.

· Specialized Support Group takes place every day for an hour, for residents who have been placed on a special support status. Three phases of support have been put into place: cafeteria, house, and house and grounds. Residents are assigned to support when they break rules or exhibit inappropriate behaviors. Support is viewed, not as punishment, but as a means of supporting the resident through rough times. A counselor and volunteer residents meet with residents who have been placed on support. During these sessions, written work is assigned and reviewed, thinking and feelings are explored, and support and guidance is given.

· Relapse Prevention Education takes place once a week for 1.25 hours and lasts for 9 sessions. In this class, residents explore refusal skills and relapse triggers encountered in major life areas, i.e. family, recreation, drug offers at work, etc.

· Chemical Dependency Education lectures for 1.25 hours each week for 6 weeks. Major theme topics include: · Chemical dependency and the disease model ·AA and the 12 Steps ·Sponsorship with support systems ·Relapse prevention triggers ·Cognitive Therapy · Spirituality · The need for healthy rituals and consistency in living

Experiential Challenge Program (Challenge Based Activities) This is a challenge-based program where all elements of the treatment program come together in a new environment and laboratory. Sessions are 2.5 hours long, every three weeks. Every resident experiences 12.5 hours minimum of experiential activities. These activities are sequenced on the challenge course for team problem solving, trust development, pro-social behaviors, gender issue discussions, manifestations of competition and anger, individual learning styles identification, asking and giving support, commitment and defeat/loss. This experience also incorporates the benefits of physical fitness, use of recreational activities and leisure time, and learning about the spirituality of connecting a greater awareness of the cosmos. Activities may include orienteering, special activities for resource development, such as going to the library and eating out. All these activities would involve group problem solving, planning, developing consensus, and processing the consequences of behaviors. This treatment generalizes to chemical dependency treatment issues and continued problem solving after discharge. The curriculum is developed by the Experiential Challenge Program.

Other Program Components

1. Education Program:* Adult basic education is offered by instructors located in the facility. The program is administered by the Williamson County Literacy Council. There is a full-time instructor at the center and the educational assessments are done by a person that comes in every two weeks for these assessments. Every resident that enters the center is administered an education assessment. The tool used to assess individuals is the T.A.B.E. (Test of Adult Basic Education). The Instructional models provide opportunities for adult learners in self-directed programs using high-interest materials. 

2. Life Skills Program:* Life skills training, consisting of 15 hours of classroom instruction, develops skills and knowledge in money management, parenting, job placement, health and nutrition, and stress management. Classes are taught through a collaboration with the Agricultural Extension Agency of Williamson County.

3. CSR/Work Detail Program:* Residents are required to complete 200 hours of community service restitution for every 90 days they are in the program. A minimum of 15 hours a week are required until residents are in phase III of treatment at which time they only require seven hours per week. Residents are assigned to CSR projects by a Residential Supervisor. Residents perform CSR in-house (floors, kitchen, yard, landscaping, gardening) and for many agencies in the community. General house keeping does not constitute CSR.

Off Campus Activities OCAPs, formerly known as furloughs, allow residents to leave the facility for an extended period of time (for the day or overnight), up to 72 hours. Eligibility is determined by the treatment team. OCAPs status is usually assigned late in phase II, after the resident has fostered a trusting relationship with the treatment team, and continues until the resident leaves the Center. OCAPs are graduated, beginning with 4 hours and extending, usually, to 24 hours. OCAPs over 24 hours are only given in cases where a resident lives a long distance from the Center, or when exceptional circumstances make a longer OCAP advisable.

Special Post Release Supervision on the Substance Abuse Caseload Residents that graduate from CTTC and remain in the Williamson County area are placed in the Substance Abuse Caseload. They receive intensive supervision and are required to report to their CSO once a week. As part of their participation in this program, residents are required to continue their recovery program through participation at AA/NA and aftercare. Residents submit to urinalysis testing each time they report. Residents are supervised by the Specialized CSO that is funded by the Substance Abuse Caseload Program grant. Information on this program is tracked through that program. The average caseload size is 70. Residents remain in this specialized caseload for a period of one year. They may be required to report less often, as they progress in their program.

Aftercare Program Aftercare is an essential part of the treatment program, and it runs for one year following discharge. Residents are prepared for aftercare before they leave the Center. Residents from Williamson County attend weekly aftercare meetings at the Center. Residents from Travis County attend weekly aftercare meetings in Austin. Those from other counties are required to secure aftercare while on their last couple of OCAPs. Many counties do not have the resources available in Williamson and Travis Counties, but probation and substance abuse resources are activated, as much as possible, in order to provide this essential service. Former residents pay $5 per aftercare meeting.

Follow Up surveys are administered at 6 months, one year and two years following discharge from the Center. The following information is collected:

To be answered by the former resident. - Have you been rearrested in the past 6 months? - How many days in the past 6 months have you: Been employed Experienced family problems Experienced financial problems Been abstinent from using alcoholic beverages Been abstinent from using drugs Been abstinent from using your primary drug of choice Attended 12 step meetings Attended school - Are you currently attending aftercare? - If you have completed aftercare, what date did you complete it on?

To be answered by the former resident's community supervision officer: - What program did the resident enter after leaving the treatment center? - Have you terminated supervision on this defendent? - If so, what date was supervision terminated on? - What type termination did the defendent receive? - Was the termination alcohol or drug related? - Did the defendant commit a subsequent offense? - If yes, what was the offense? - During supervision, following treatment, did the defendant test positive for drug or alcohol use? - If yes, please specify the number of positive UAs.

This activity began in September of 2000. The instrument was initially designed to correspond with TCADA follow up data, however, in January 2001, the instrument was revised to show rearrests, alcohol and drug use, and probation violations within the past 6 months versus in the past 30 days.

Urinalysis Urinalysis drug testing is conducted at the CTTC Laboratory using the Cobas Mira Plus System. This machine is used to test for alcohol, cocaine, tetrahydrocannabinol (THC), barbiturates, amphetamines, and opiates. Residents are tested upon their arrival and after furloughs.

Top of Page