Anorexia Nervosa Binge Eating Disorder Specializing In Treating: Blimia Nervosa Eating Disorder NOS ADOLESCENT PROGRAM AGES 11-17 ADULT PROGRAM AGES 18 AND UP (435) 938-6060 www.avalonhills.org Logan, Utah
FOUNDERS MESSAGE Avalon Hills Eating Disorder Programs have helped hndreds of clients recover. We assist in bilding strong personal fondations for a healthy ftre. We nderstand the process, the emotion and the angish that can afflict individals and families managing an eating disorder. Avalon Hills is a privately-held, residential treatment program and we, as owners and fonders, are personally invested in the ftre of each client. We have committed or professional lives to bilding the best, most effective program we can offer. We are singly focsed on one thing Treat to Otcome. We invite yo to review or Treat to Otcome information and learn more abot the 'why' behind what we do. We know that selecting a treatment program is a difficlt task. Websites and brochres can be a good resorce for gathering information, bt they often miss the mark in giving yo a sense of the tre natre of a program and its philosophy. We have created a short video to help show the Avalon Hills process, which we feel distingishes s from other programs. Please visit or website at avalonhills.org to see, first-hand, what or program has to offer. As yo proceed throgh yor decision-making process, yo will likely have many qestions. Please reach ot to or compassionate admissions team, as they nderstand the emotions and isses that individals and families face along this difficlt jorney. Be well, Benita Qakenbsh-Roberts, Ph.D. Fonder, Owner, CEO, Avalon Hills Eating Disorder Programs Gary Lee Roberts Fonder, Owner, Director of Specialty Projects, Avalon Hills Eating Disorder Programs Committed Avalon Hills Board Members, Exective Team, Directors, Treatment Team, and Treat to Otcome Staff 2 www.avalonhills.org
ABOUT US Benita Qakenbsh-Roberts, Ph.D. Fonder, Owner, CEO In 2003, Avalon Hills Eating Disorder Programs was co-fonded by Dr. Qakenbsh-Roberts, and her hsband, Gary Roberts. Benita is a licensed psychologist with over twenty years of clinical experience. She has worked with children, adolescents and adlts, with a wide range of mental health disorders in inpatient, residential and ot-patient settings. The core philosophy nderlying the Avalon Hills treatment approach originated from her thesis and doctoral research (Qakenbsh, Stein & Doty, 1996; 1998). This research explored change in females who overcame eating disorders and the reported factors that facilitated their recovery. She completed her Ph.D. in the combined Clinical, Conseling and School Psychology Program at Utah State University in 1998. Initially, Dr. Qakenbsh-Roberts was responsible for program development, implementation and spervision of therapetic interventions and coordination of bsiness and clinical operations at Avalon Hills; with company growth, her dties now inclde leading an indstry initiative as an advocate for patients and seeking consistent parity for mental health treatment with insrance companies and the federal government. Since the opening of Avalon Hills in March 2003, Dr. Qakenbsh-Roberts has been committed to continally improving the treatment programs of Avalon Hills, while simltaneosly growing the organization into a thriving, dynamic and internationally-known organization. Benita is a member of the American Psychological Association, Utah Psychological Association, Academy of Eating Disorders, International Association of Eating Disorder Professionals and the Eating Disorder Coalition. Dr. Qakenbsh- Roberts is a co-fonder of the Residential Eating Disorders Consortim which was formed in December, 2011; this is the only trade organization committed to serving the niqe needs, challenges and goals of residential care for the eating disorder commnity. www.avalonhills.org 3
ABOUT US Gary L. Roberts Fonder, Owner, Director of Special Projects Mr. Roberts is one of the fonders of Avalon Hills. With a specialized backgrond in therapetic experiential grops and activities, his expertise in wilderness conseling and risk management natrally compliments the clinically and skills-based programming at Avalon Hills. Mr. Roberts has oversight of physical planning and manages special projects related to expansion. In addition to being a member of the Exective Team, Mr. Roberts participates in many of the day-to-day operations across the organization and works with the Management and Qality Improvement Staff to improve patient services and bsiness operations. As an owner and fonder, he takes pride in remaining personally involved in the implementation of programming, particlarly those of an experiential natre. Mr. Roberts is heavily involved in assessing activities that improve the qality of the services delivered at Avalon Hills. His expertise with Eqestrian-Assisted Psychotherapy (EAP) and therapetic initiatives has been the cornerstone for experiential programming at Avalon Hills. Gary s down-to-earth personality, in conjnction with his commitment to excellence and pride in offering qality care, facilitates openness within the client poplation. 4 www.avalonhills.org
MISSION: TREAT TO OUTCOME Avalon Hills has a dynamic cltre and a Treat to Otcome philosophy at its heart. One of the most common qestions asked of s is, What is Treat to Otcome? Treat to Otcome, officially defined, is a commitment to keep clients in treatment ntil they are able to sstain treatment gains at a lower level of care, in their home commnities. This commitment to sstainable recovery is Treating to Otcome. For Avalon Hills, treating to otcome trly encompasses who we are, what we believe, how we offer treatment to patients and it embodies or advocacy efforts on a local and national level. Treat to Otcome allows or treatment team to conceptalize and follow a treatment plan, based on what is in the best interest of the client. In hiring professional staff, we seek like-minded individals who also desire to practice according to this philosophy treating to otcome is an organization-wide effort. From the exective team, to the treatment team, to the bsiness and billing office and throghot the entire of the organization, we make every effort to ensre positive otcomes for or clients. Treat to Otcome is what makes s trly niqe and gides or treatment program. PHILOSOPHY OF THE PROGRAM At its core, the Avalon Hills team believes in the hman capacity to grow and change. We nderstand the complex and individalized natre of eating disorders which nderscores the need for thorogh assessments and flexibility in treatment www.avalonhills.org 5
approaches. Frther, we know that change occrs one step at a time. Ths, or treatment follows a stage-based readiness model of change. Restoration to and maintenance of a healthy body is crcial in overcoming an eating disorder. The brain is fnctionally affected by the conseqences of disordered eating. Residents will learn to manage their eating in a non-complsive, normalized way and will develop a healthy, positive relationship to food and physical activity. In addition to maintaining good physical health, clients learn to manage emotions and self-destrctive rges. They gain insight, awareness and skills for coping effectively with stress and begin to develop an approach for identifying how to live according to their vales. Or approach to recovery is niqe among treatment programs. Or se of expressive therapies, a variety of therapetic animals and animal activities, combined with a therapetic se of otdoor experiences provides significant opportnities for discovery and growth, not otherwise offered in hospital-based facilities. OVERVIEW OF THE PROGRAM Avalon Hills offers a comprehensive, evidence-based and holistic approach to the treatment of eating disorders. It incldes a wide range of therapetic modalities and activities. There are a nmber of facets that may impact treatment otcome. Client factors (e.g., natre and corse of the illness, readiness for change), therapetic factors (e.g., qality of the therapetic alliances), program factors (e.g., tilization of evidence-based treatments, goodness of fit with client) all play a role in the effectiveness of any treatment endeavor. NEW INFORMATION, NEW INSIGHTS AND NEW EXPERIENCES Avalon Hills approaches treatment from the fondational belief that sccessfl recovery incldes New Information, New Insights and New Experiences. In a strctred, spportive, family-style environment, we employ evidence-based strategies that help facilitate lasting change. Or developmentally-sensitive model fosters growth in each client s evolving self. Thoghts and feelings that initiated and help sstain disordered eating, body distortions, and ineffective coping styles are identified. Clients are challenged to move in the direction of their identified vales, as they bild larger patterns of committed action that will help sstain long-term recovery. 6 www.avalonhills.org
We believe that new experiences bind new ideas and behaviors to create endring change. Avalon Hills tilizes psychotherapetic practices, therapetic milie, expressive therapies, behavioral exposre, mltiple animal-assisted and servicebased therapetic activities as part of treatment. We also provide otdoor experiences and challenges in order to provide significant and varied opportnities for learning and growth. NEW INFORMATION We help clients explore ambivalence abot recovery. Clients begin to practice skills for effective living as they identify ways in which the eating disorder interferes with living a vales-driven life. This reslts in finding healthy alternatives to disordered eating and increases motivation for recovery. NEW INSIGHTS New information is not enogh. Clients are gided to integrate the new information, nderstand body image distrbance, identify, express and manage emotion and work throgh painfl experiences. They begin to bild a more secre sense of self to replace the disordered identity. NEW EXPERIENCES As clients develop more flexibility in thinking, they begin to integrate new information and insights, resolve conflicts, accept choices and conseqences, face their fears, rehearse incremental steps toward recovery and prepare for post-treatment challenges. www.avalonhills.org 7
THERAPEUTIC STAFF CORE TREATMENT STAFF Psychologists Licensed Clinical Social Workers Marriage & Family Therapists Psychiatric Providers Physicians Nrse Practitioners Registered Nrses Licensed Practical Nrses Utilization Review Team Registered Dieticians Direct Care Liaisons Direct Care Associates Body Image Therapist Exercise Specialists Clinary Manager SUPPORT STAFF Edcation Specialists Art Therapist & Art Specialists Eqine Specialists Clinary Associates BUSINESS STAFF Chief Exective Officer Director of Special Projects Director of Specialty Services Director of Hman Resorces Director of Qality Assrance Director of Admissions Controller Otreach Manager Admissions Coordinator Office Managers Billing Manager & Billing Staff 8 www.avalonhills.org
COMMUNITY The Avalon Hills facilities rest in scenic Cache Valley, Utah. Cache Valley is home to breathtaking scenery, world-renowned companies and Utah State University. The famos fr trapper, Jim Bridger, prononced the valley to be the most beatifl valley in the Rocky Montains. Cache Valley offers for distinct seasons and an endless list of recreational opportnities. Residents and torists enjoy rock climbing, snowmobiling, montain biking, horseback riding, downhill and cross contry skiing, snowboarding, fishing, hiking and more. Located eighty miles north of Salt Lake City, at the center of Cache Valley, Logan proffers the cltral benefits of a mch larger city, inclding art msems, festivals and theatres that host Broadway msicals, opera and comedies. Logan was recently ranked as The Safest Commnity in the United States in which to Raise a Family and is home to more than two dozen city parks, riverside natre trails, indoor and otdoor swimming pools, golf corses, movie theatres, a pblic zoo, health and fitness clbs, a variety of shops and restarants, as well as, the main camps of Utah State University. ASSESSMENT HEALTH ASSESSMENT De to the effects of eating disordered behavior on physical health, the program reqires a health clearance prior to admission, in an effort to establish medical stability. Upon arrival, the client will be assessed by or primary care provider to ensre adeqate on-site health stats. www.avalonhills.org 9
NUTRITION ASSESSMENT Dietary restraint, excessive exercise, bingeing and prging all lead to ntritional imbalances. A thorogh ntritional assessment will be condcted by a registered dietitian. The dietitian and primary therapist will develop an individalized meal program with each client. CLINICAL INTAKE ASSESSMENT A clinical interview will be condcted by a mental health therapist as part of the mlti-disciplinary intake procedre. Prior to admission, a therapist will also conslt with a member of the otpatient team. All data is then tilized to formlate a comprehensive mltidisciplinary treatment plan. PHYSICAL ACTIVITY ASSESSMENT A physical activity assessment is completed by or exercise specialist to determine a client s history of activity in an effort to recommend levels of physical activity while in residence. Activity level is assessed each week by medical personnel as well by the exercise specialist. PSYCHIATRIC EVALUATION Mood disorders, anxiety, sbstance se and other psychiatric conditions often accompany eating disorders. Upon admission, a thorogh psychiatric evalation will be condcted by a board-certified psychiatric provider. The prescriber will work closely with the primary care provider and other members of the interdisciplinary treatment team, to ensre the physical and mental health needs of each client are incorporated into a comprehensive treatment plan. OUTCOME ASSESSMENT Standardized psychological qestionnaires are administered at admission, discharge, 6 months after discharge and 12 months after discharge. Client participation in or otcomes assessment process enables Avalon Hills to evalate the effectiveness of or treatment and make improvements, as needed. This data is sed to monitor the qality of or program and to contribte to the nderstanding of eating disorder treatment via conference presentations and scholarly pblications. Or goal is to continally improve the qality of or program, the lives of or clients and help advance the field of eating disorders treatment. 10 www.avalonhills.org
EDUCATION ADOLESCENT Althogh therapetic goals will always be the primary focs at Avalon Hills, each client, with the help of or Edcation Coordinator, will create an individalized edcation plan to follow, while in treatment. Edcation plans are tailored to fit the niqe needs of each resident and may inclde the following: Initial contact with the home school s gidance conselor to determine a baseline of the stdent s academic standing. We will also assess the individal needs of the stdent, relative to the reqirements of the school to which she will retrn pon discharge. 2-hor blocks (five to six days per week) of schedled edcation time; clients will have access to qalified ttors who can assist with academic goals. The Edcation Coordinator s corresponding with each client s school and parents to review completed assignments, academic progress and any edcational concerns. ADULT Althogh therapetic goals will always be or main focs, each client will also be encoraged to acqire and develop skills that will enable them to sccessflly integrate back into their home commnities. In some cases, a client may be involved with online class work or she may be enrolled in a corse throgh the local niversities. All will be exposed to and expected to develop life skills, essential for contined and independent recovery. Examples inclde: Essential living skills: grocery shopping, meal planning, food preparation, pkeep of a home environment, bdgeting and managing finances. Academic planning: examination of home and local opportnities inclding commnity colleges, bsiness colleges and niversities. Employment planning: the program will assist clients with completion of resmes and job applications. We will assist with the process of job selection and practice interviewing. Rotine health appointments (schedling and follow throgh). Spport and gidance will be provided to help each client choose options that are consistent with her interests and vales. www.avalonhills.org 11
TREATMENT COMPONENT: NEW INFORMATION When a client is ready to discharge from Avalon Hills, maintaining treatment gains at a lower level of care is paramont. Each client will take part in didactics covering five major phases of recovery maintenance: Stabilization with an early intervention plan Assessment of the client s commitment to a valed direction in her life Identification of warning signs of relapse Management of warning signs of relapse Planning for recovery in ways that meet the client s needs LIVING WITH VALUES Vales gide and define a life. Vales mst be a free choice, by the individal. While at Avalon Hills, we try to help clients clarify and decide directions for themselves that will lead to a life well lived. NUTRITIONAL EDUCATION Weekly ntritional didactics focs on teaching clients intitive eating skills, debnking myths abot food and facilitating a healthy approach to achieving balanced eating. SPIRITUALITY GROUP An evolving sense of spiritality (niversality, connection and faith in something greater than oneself) is an important dimension of a balanced, healthy life. Clients are not taght any specific or sectarian principles; rather we embrace the vale of all faiths and philosophies as expressions of the desire of spirital connectedness. Each individal is encoraged to develop a worldview that works for her as evidenced by a positive lifestyle. HEALTH EDUCATION Rotine edcation is provided by the medical department to increase awareness of the medical and physical complications related to eating disorders, as well as general health isses. 12 www.avalonhills.org
SKILLS GROUP Weekly skills grops are designed to teach and strengthen skills necessary for recovery. Each client has the opportnity to practice these skills tilizing principles of mindflness, interpersonal effectiveness, emotional awareness, distress tolerance and general decision making skills, related to improving the qality of life. DIDACTICS Weekly didactic grops edcate patients and explore topics of emotional avoidance, conflict resoltion, thoght acceptance, assertiveness, commnication skills, loss and grief, gratitde, forgiveness and appropriate emotional expression. Additionally, grops are condcted with a focs on healthy relationships, managing exercise and learning to live with simplicity. TREATMENT COMPONENT: NEW INSIGHTS INDIVIDUAL PSYCHOTHERAPY Each client is assigned to a primary therapist who meets with the client two times per week. The primary therapist coordinates client care across disciplines, participating in daily morning ronds to review client stats and weekly treatment team meetings. We tilize Acceptance & Commitment Therapy (ACT), in combination with other cognitive therapies sch as Dialectical Behavioral Therapy (DBT) and Mindflness-based Cognitive Behavioral Therapy (MBCT), to help clients gain necessary skill that promote lasting recovery. FAMILY THERAPY Each client will be involved in a family session one time per week, as is clinically appropriate. Healthy family relationships often help sstain recovery. Learning and sing skills that enhance open and honest discssion promotes improved commnication. Family therapy is also a time when edcation abot the natre of eating disorders can occr. The family sessions typically happen by phone and dring on-site visits. www.avalonhills.org 13
PROCESS GROUP Grop therapy occrs for times per week and is the primary vehicle for openly exploring individal isses with peers. The willingness to express thoghts and emotions provides a means of approaching (rather than avoiding) isses that nderlie eating disordered behaviors. Additionally, this process enables the client to find ways to meet the fndamental hman need for belonging. BODY IMAGE GROUP Body image grops are held weekly. This grop spports and challenges clients as they identify and practice small, incremental steps toward body acceptance. Over the corse of treatment, patients learn to recognize and accept thoghts and sensations related to their bodies. As they do so, the relationship with their body begins to normalize. Becase poor body image if often the last symptom to remit, Avalon Hills places strong emphasis on this aspect of treatment and provides weekly individal sessions with the body image therapist to agment the patient s work in body image grop. ANIMAL ASSISTED THERAPY Animal Assisted Therapy (AAT) is the se of animals to facilitate positive changes in a therapetic setting. AAT promotes physical, emotional, cognitive and social improvement. Avalon Hills ses three forms of AAT: Animals in the residential setting Pet resce and rehabilitation Eqine therapy activities and Eqine-assisted psychotherapy (EAP) 14 www.avalonhills.org
ART AND EXPRESSIVE THERAPIES Art and expressive therapies sch as msic, pottery and dance provide opportnities for insight into emotions sch as anger, shame and pain insight that may not be achieved throgh verbally-oriented therapies. Beyond this, these therapies allow one to explore vales and express niqeness. TREATMENT COMPONENT: NEW EXPERIENCES COOKING CLASS Developing a healthy relationship with food is fndamental to recovery. To that end, clients are involved in weekly cooking classes where they are taght simple food preparation and presentation skills. OUTDOOR EXPERIENCES The primary prpose of recreational services is to improve health and well-being. Avalon Hills offers opportnities for otdoor experiences and challenges sch as hiking, canoeing, rafting, and skiing all with a goal of enhancing recovery. Weekend leisre activities provide opportnities for behavioral challenges leading to individal expression, self-awareness and competence in social environments. www.avalonhills.org 15
EAT-OUT CHALLENGE Clients who are not otherwise restricted will be involved in eat-ot challenges. Dietitians select a variety of venes (restarants in the area) and clients are exposed to foods and sitations they might otherwise avoid. The prpose of each challenge is to increase both cognitive and palate flexibility, which lead to improved recovery. SHOPPING CHALLENGE Clients with eating disorders often experience restriction in fnctioning. For example, they may develop fear of normal activities sch as grocery shopping, going to a mall, trying on clothes, wearing form-fitting clothing or looking at oneself in a mirror. Shopping challenges provide clients with an incremental way to approach these fears. Approaching, rather than avoiding fears, leads to improved fnctioning and a sense of confidence that can generalize to many areas of the client s life. FITNESS Excessive focs on weight and body size often accompanies an eating disorder. Over the corse of the illness, fitness for fn can morph into complsive, extreme and rigid exercise rotines. Engaging in healthy and enjoyable fitness rotines helps to break these nhelpfl practices. Examples of weekly fitness opportnities offered are: yoga, low-impact and time-limited aerobics, strength training, martial arts and tai chi. THERAPEUTIC LEAVE OF ABSENCE As a client s recovery progresses, she is offered opportnities for local and home passes, based on her individal treatment plan. While on a therapetic leave of absence, there are opportnities to assess her progress in the recovery process. Obstacles to recovery are identified and discssed in individal, family and grop therapy sessions. Upon approval of the treatment team, each client is offered extended time at home to practice her recovery. While on her home pass, and as a fnction of recovery maintenance, the client is expected to attend sessions with her otpatient team in preparation for her retrn to her home area. 16 www.avalonhills.org
TREATMENT COMPONENTS IN-DEPTH DAY OF ADMISSION Physical examination Meet with interdisciplinary treatment team for diagnostic interview Initiate treatment plan Initial meal plan prepared by registered dietician Contact aftercare team 9 online self-report assessment measres (completed within first five days, at discharge, post discharge - six months, and one year) ~ Eating Disorder Inventory (EDI-3) ~ Eating Disorder Diagnostic Scale (EDDS) ~ Beliefs Abot Appearance Scale (BAAS) ~ Mltidimensional Body-Self Relations Qestionnaire (MBSRQ) ~ Beck Depression Inventory (BDI-II) ~ Beck Anxiety Inventory (BAI) ~ Short Form 36-version (SF36-v2) ~ Eating Disorder Qality of Life Instrment (EDQOL) ~ Intitive Eating Scale (IES) www.avalonhills.org 17
EXPERIENTIALS Eat ot challenge Therapetic leave of absence Art grop Cooking class becoming comfortable with food preparation Monitored exercise at Sports Academy Dance grop, yoga or other body movement Weekend experiential Horsemanship: Eqine Assisted Psychotherapy (EAP) WEEKLY SCHEDULE Daily health check by nrsing Meeting with primary care provider 2-3 times per week Individal therapy twice per week (45-60 min.) Family therapy once a week (reqired for adolescents, encoraged bt optional for adlts) Grop therapy for times per week (90 min.) Grop therapy (Body Image Focs) weekly (90 min.) Body image individal conslts and challenges as needed Individal Ntritional conslts twice per week Psychological didactics five times per week (45 min.) Mindflness grop, weekly Spiritality grop, weekly 18 www.avalonhills.org
Ntritional grop didactic, weekly Fitness grop didactic, weekly Exercise individal conslts, as needed Art experiential, weekly Cooking class, weekly Edcation coordination and ttoring (ongoing) Animal assisted therapy/animal care, daily Eqine Assisted Psychotherapy (EAP) Variations may occr de to individalized treatment plan and seasonal program changes www.avalonhills.org 19
(435) 938-6060 www.avalonhills.org Logan, Utah We believe in change