The following was written by Continuum Behavioral Health’s Emilie Rebelo whose current role is as IOP Coordinator at Continuum at Meadow’s Edge.
As a recent graduate from Johnson and Wales University with a Bachelor’s degree in counseling in 2014, I began my job search. I had interned at The Providence Center for my internship and knew I wanted to pursue a role as a case manager. I was soon hired at Continuum Behavioral Health, working at the HealthPath program for two years while I was working towards my Master’s Degree in Counseling. HealthPath provided me with direct experience with patients as well as learning the in’s and out’s of agency setting counseling. When finishing my Master’s Program I began looking for a more clinical role. Continuum offered me a position at Meadow’s Edge Recovery Center as the IOP Coordinator. Continuum Behavioral Health has given me the opportunity to grow within the same organization, beginning from a Bachelor’s level degree to a Master’s level within a short span of time.
About the Program/IOP
Continuum Behavioral Health now offers Substance Use Intensive Outpatient Programs (IOP) at both our Providence and North Kingstown locations. Continuum’s Intensive Outpatient Program (IOP) provides treatment to individuals struggling with co-occurring and substance use issues. The program offers initial and ongoing assessment, group therapy, medication evaluation and medication management, individual sessions focused on treatment and aftercare planning, urine toxicology monitoring, and family involvement. The program is designed to provide a supportive and solution-oriented intervention tailored to the individual. Treatment intensity, focus and length will be proportionate to the individual’s need.
The overall goal of the program is to provide a safe therapeutic environment that encourages and promotes health recovery. The program is abstinence-based and appropriate for individuals transitioning from a higher level of care (ie: hospital, residential and PHP) or for individuals needing more structured support than outpatient services.
Each session is three (3) hours per day, four (4) days per week. Daytime and evening programs are available and the average length of the program is approximately 3-4 weeks, depending on the individual need, and clinical necessity.
Research substantiates the benefit of the group process-
* Increase sense of support and connectedness
* Decrease in self-criticism and negativity
* Greater ease in identifying feelings and self-disclosure
* Increased confidence in trying out possible solutions.
The theoretical approach to the groups are a combination of Cognitive Behavior Therapy, Dialectical Behavioral Therapy, and Motivational Enhancement. Topics include Relapse Prevention, Family Systems, Neurobiology of Addiction, Introduction to support groups including AA.
How to Begin the Referral Process
Continuum’s IOP is has two locations:
Continuum at Butler Campus
200 Butler Drive, Providence
(4th speed bump on the left)
Hours: Tuesday-Friday from 4p-7p
Continuum at Meadows Edge
Ten Rod Rd, North Kingston
Tues, Thurs, Fri Sat from 9-12pm
Please call the above number to schedule an intake appointment. Additionally, providers can fax the patient’s demographic/insurance info, initial assessment, most recent MD note, lab results and medication list to the corresponding location.
Continuum Behavioral Health is contracted with most of the major providers- BCBS, Optum, UBH, Beacon/NHP; Tufts, HPHC, Cigna, Aetna, Magellan, in addition to Self Pay
Patients will need to provide their insurance card to their appointment so verification of benefits for levels of care can occur.
Why Choose Continuum?
Continuum is passionate about your health, well-being, and recovery. Our diverse staff is dedicated to helping you achieve the goals you set for yourself. Continuum services are also convenient, accessible, affordable and effective in order to make your time with us as accommodating and useful as possible. We want to help you help yourself, and Continuum’s IOP is an excellent place to start.
Jessica Markowitz is a clinical therapist at Continuum Behavioral Health, based out of Women and Infants Hospital, and specializes in treating pregnant and postpartum women. Markowitz is passionate about normalizing mental health and teaching patients to not be ashamed about what they’re experiencing. As a perinatal mental health specialist, she does all she can to support pregnant women and prepare them for parenting.
Always interested in how the mind works and how our experiences shape us, Markowitz pursued a Bachelor’s degree in psychology at Wesleyan University in Connecticut. Knowing she wanted to become a clinical therapist, she went on to receive a Masters in Social Work from Smith College in Massachusetts.
Markowitz first entered the behavioral health field as an intern at Bradley Hospital in East Providence. It was not until sometime later while looking for fulltime work that she happened upon her first job in perinatal mental health at a midwife clinic in Denver, Colorado. Although she had no prior experience working with pregnant women, she “just fell in love with it, and thought this is the work I’m meant to do,” said Markowitz.
She has worked with Continuum since February as an outpatient therapist located at Rhode Island Hospital. As the only Continuum employee working at the hospital, Markowitz says, “I have this whole support of this team here so I can do a lot of collaboration with the day hospital therapists and I can connect Continuum patients here with our psychiatrists for med management.”
Working everyday with patients suffering from postpartum depression, anxiety, and PTSD, Markowitz has a unique and highly personal approach to treatment. “I am always interested in learning about peoples’ childhoods and past experiences and the way that influences the way they make sense of the world.” She takes the time to hear each and every patient’s story, because she cares to listen.
1 in 7 women face postpartum depression during pregnancy or within the first year, and Markowitz wants her patients to know that it is okay to not be okay. “I love being able to work with people and remove the shame around postpartum depression and anxiety. You’re not born knowing how to parent, you are thrown into this transition, she said.
Markowitz also has plans for the future; she is in the beginning stages of starting a Continuum group therapy program at the hospital, for patients struggling with similar problems. She goes above and beyond to deliver the highest level of care and comfort to her patients; its’ safe to say they’re in good hands.
Gretchen Anderson is the clinical director of Continuum at Meadows Edge, and is passionate about finding new ways of reaching those who need care.
Gretchen’s first experience in healthcare was volunteer work in her home state of Minnesota. After doing her undergrad studies at the University of New Mexico, she worked in a residential facility for adolescents and debated between going into either nursing or social work.
She chose the latter, and obtained a Masters of Social Work from Highlands University in New Mexico. “I’ve always had a kind of nurturing sensibility and I like to problem solve, so this field was a natural fit for me.”
After relocating to Rhode Island, Gretchen worked at Butler Hospital for 11 years as a social services clinician, a position that provided important training for her current role. “My experiences at Butler made me a better clinician, but it also helped me to understand healthcare structures and the importance of making sure other clinicians have the support they need.”
She started at Meadows Edge in October 2016. As clinical director, she is responsible for ensuring that the Center is following state regulations and policies, improving care in current programs and looking at implementation of new programs, among many other things.
But unlike most clinical directors, Gretchen also keeps up with an assigned caseload of patients in addition to her administrative duties. “It keeps me grounded and focused on a day-to-day basis, and it helps me to think creatively about the different systems we need to develop to offer better services.” When seeing patients, she is very holistic in her approach to care, and tries to meet people where they are at, whether involvement with legal issues, family issues or personal issues.
The variety is an aspect of the position Gretchen greatly enjoys. “My duties can range from going outside and sweeping the front porch to triaging an acute patient situation.”
What does Gretchen feel sets Continuum at Meadows Edge apart? “The talented staff and the accessibility of appointments. We have doctors and a nurse prescriber that are available to meet with our patients, and we’re usually able to give someone an intake in the first 24 hours, which is not typically the case everywhere.”
Looking to the future of Meadows Edge, Gretchen is exploring the possibility expanding intensive outpatient hours to Saturdays and extending their successful pain program. “We have a long history of solid clinical expertise; my job is to look at better ways of delivering care and reducing the stigma surrounding substance use treatment.”
Outside of work, Gretchen likes outdoor activities and spending time with family.
Continuum’s HealthPath program is mentioned quite frequently on our website as well as all of our social media platforms—but what is it, really? We will begin breaking down the program to help you understand exactly what the program entails.
What is HealthPath?
HealthPath is an innovative team-based program designed to serve adults who have received psychiatric services or substance-use treatment more intensive than outpatient services (this can include inpatient, intensive outpatient, crisis stabilization, partial hospitalization, crisis intervention, or residential levels of care). Individuals interested in the program must have Blue Cross Blue Shield of Rhode Island as their primary insurance. Healthpath offers community-based, wrap-around services, care, and support to all clients enrolled in the program.
What services does Healthpath offer?
Clients who are enrolled in HealthPath will have unlimited access to a range of services including:
- Psychiatry/Medication management
- Vocational support
- Peer support
- Case management
- Care coordination
- Nursing staff
- Transportation to and from medical appointments, if necessary
- Group Therapy (DBT, Life Skills, Family Support, Women’s group, Early Recovery)
- Internet-based access to team (telemedicine)
- Specialized care in case of an emergency after hours or on weekends and holidays
How much does HealthPath cost?
Health Path services are covered by your benefit plan and are only available to adult members of Blue Cross & Blue Shield of Rhode Island who choose to enroll in the program.
HealthPath clients are responsible for one monthly co-payment while receiving services. This copay is maxed out at $40 per month. If the client’s plan has a deductible, the monthly co-payment will apply after they have met their deductible.
What will happen at the first appointment?
The initial intake will be with a HealthPath clinician who will gather past medical, family, and psychiatric information as well as speak with the client about why they are seeking help. After the intake, clients will be set up with a team of professionals, which includes a medication prescriber, case manager, therapist, and nurse.
How long does this program last?
The HealthPath program typically lasts between 6 months to 1 year, depending on the clients individual needs.
How can I find out more information?
For more information on becoming a HealthPath member, call us at 401-415-8868.
This article, written by Catherine Degood, DO, was originally posted in the Rhode Island Family Medicine Spring 2016 issue.
As primary care physicians when we encounter a patient requesting opioids for pain we ask ourselves, is this patient really benefiting from the medication or is there a larger problem? My goal is to help providers better understand the complex biopsychosocial nature of chronic pain.
Many of us will experience some degree of chronic pain as defined as pain lasting longer than 12 weeks by the NIH. It is not entirely known how acute pain develops into a more complex chronic pain syndrome. With acute pain there is an initial pain signal- whether visceral, somatic, or neuropathic- consistent with tissue damage. The central nervous system then interprets the pain signal to elicit a protective response. With repetition the pain signal can either be increased (sensitized) or be decreased (desensitized) by the individual’s central nervous system. The increasing or decreasing of pain signals has a both an intrinsic component (think naturally occurring endorphins) and a behavioral component which can be learned (think Lamaze/hypnobirthing).
When working with chronic pain it is important to understand the interconnection of behaviors, emotions, medications and changes in activity level that patients experience as a reaction to their pain. These factors can all contribute to the sensitizing effect on the central nervous system and therefore the worsening of pain. We call this the chronic pain cycle:
Why does an individual’s pain system become sensitized or desensitized? While there are still many unknowns there are common psychosocial factors often associated with chronic pain: personality disorders, depression, anxiety disorders, somatoform disorders, substance use disorders and a history of growing up in family with substance, physical, emotional or sexual abuse. Other contributors can be chemical (for example opioid hyperalgesia), behavioral (belief systems or expectations about managing pain and stress), physical (deconditioning) and social (loss of income and resultant financial stress) which can all play a role in developing a chronic pain syndrome.
Maladaptive and illness-focused expectations frequently seen in patients with chronic pain include
- Believing that medication is the only thing one can do for pain
- Not recognizing the connection between emotion and pain
- Feeling one has no control over their pain
- Undergoing multiple procedures and tests looking for a cause and a “cure”
- Feeling trapped in a sick role/seeing oneself as totally disabled because of pain
- Feeling others are responsible for one’s pain and suffering
- Fear that any movement will worsen pain
We may promote these unhelpful expectations in our primary care offices. Many of us feel inadequately trained and lack sufficient resources to manage chronic pain patients. The medical system has moved from the collaborative multidisciplinary pain clinics of the 1980s to the primary care physician directing the pharmaceutical and procedural treatments of today. But focusing only on biomedical and pharmacological management of pain disempowers patients and frequently worsens their chronic pain. This may be why they rarely seem to get better in our offices! In addition to medication and procedural interventions, many patients require targeted behavioral interventions and a structured physical rehabilitation plan.
At Continuum Behavioral Health the most common pain scenario we see is an individual physically dependent on opioids who is significantly deconditioned and with a strong belief that opioid medications are the only thing they can do to improve their pain. We integrate a combination of Cognitive Behavioral Therapy, buprenorphine if needed, and encourage starting a gentle exercise program to develop pain management skills. Buprenorphine is a partial agonist at the opioid receptor with a favorable safety and side effect profile to the traditional full opioid agonists. The goals of treatment are improved physical and emotional functioning, increased effective strategies for managing pain, and reduced pain intensity.
If a patient has red flags for developing a more complex chronic pain issue consider referral to a behavioral based pain program. Even for the patient that refuses a referral there are many useful books, websites, physical therapists and individual counselors that can help people develop skills to manage their pain. For patients that you do prescribe narcotics utilize a pain contract that includes, as criteria for being prescribed medication, the patient’s involvement in efforts to manage their pain.
For more information or to refer a patient to Continuum for chronic pain feel free to call (401) 294-6170.