The Charlotte Rescue Mission is a 90-day residential program that serves approximately 530 men and 365 women experiencing the disease of addiction annually. It has a long rich history and has been serving the Charlotte community for over 75 years for men and almost 25 years for women.
"The men's program provides a five-fold, client-centered treatment approach addressing spiritual, mental, physical, social, and vocational needs to battle addiction. The objective is to help individuals fighting addiction and homelessness to accomplish spiritual, mental, physical, social, and vocational goals and be free of addiction."
"Dove's Nest, Charlotte Rescue Mission's women's recovery program, opened its doors in 1992. The program provides a structured, yet loving and stable living environment, with a dedicated staff aimed at helping women understand and deal with the core issues of addiction as a disease" (Web site: http://charlotterescuemission.org/).
I had the privilege of interviewing Julie Viveros, RN, the Director of Nursing for the Rebound men's program about her unique role at the Rescue Mission.
Q: CAN YOU TELL US MORE ABOUT THE CHARLOTTE RESCUE MISSION, REBOUND MEN'S PROGRAM. WHO IS ELIGIBLE TO COME TO THE RESCUE MISSION?
A: It is a nonprofit faith-based Christian program that is offered free of charge to its residents. As long as individuals recognize their dependence on drugs and/or alcohol and decide that they need help to overcome their addiction, they are eligible to come to Rebound. Before admission, each individual must pass a drug screening test, and he or she must agree to be compliant with the program structure and policies of Rebound. Because we do not have any medical prescribers, we cannot serve clients who are acutely ill or unstable from a mental health standpoint in addition to their addictions. Because of the comprehensive nature of the program, they must be cognitively able to participate as well.
Most of our residents identify themselves as homeless upon admission. Because of generous support from individuals, foundations, churches, and businesses, we are enabled to offer our services free of charge to all of our residents. We do not rely on government or United Way funding, so the donations we receive from our regular supporters are imperative to our success as an organization. One of the unique aspects of the program is its length. It is a residential program that lasts 90 days at the men's Rebound campus and 120 days at the women's Dove's Nest campus.
The drugs of use that most of the men in Rebound report are primarily alcohol and crack cocaine. However, heroin use is increasing in our area. We are also seeing an increased use of other drugs such as Molly and other nontraditional substances. There is also the misuse of prescription drugs such as Oxycontin and benzodiazepines as well. You could say we pretty much see it all!
Q: HOW IS YOUR PROGRAM STRUCTURED, AND WHAT ROLE DOES SPIRITUALITY PLAY IN THE PROGRAM?
A: Clients advance through the program incrementally. Initially, they are in the preprogram where we evaluate if substance abuse (SA) is the primary diagnosis, and they essentially evaluate us and consider if they are committed to working through an intensive 90-day program. This lasts for about 3 days. For the first 30 days, clients cannot leave the campus except via the facility van and then only for necessary medical/mental health appointments or 12-step meetings. They are not allowed any contact with family or friends. From 30 to 60 days, they are required to procure a 12-step sponsor and are assigned a therapeutic job slot at our facility. They can initiate contact with family and friends, sign out for planners, and go to their own meetings. The 60- to 90-day period is spent working with a primary counselor on an aftercare plan. All throughout the program, they participate in 12-step meetings and group and individual counseling, attend chapel, attend classes offered by staff, and work on their general educational development (GED), leading to a certificate of high school equivalence if they have not graduated from high school. Classes include the adult/literacy or GED, addiction, anger management, relapse prevention, life skills, recreational activities, health-related topics, and others. The program is designed to heal individuals from the inside out by addressing their physical and spiritual needs.
Q: WHAT IS THE NURSING ROLE AT REBOUND?
A: The nursing role is truly unique. We do a lot with few resources available. We are staffed by four nurses including myself. All of the nurses are part time except for me. We have no MD or social worker on staff. A dedicated volunteer doctor comes once per month, and my dentist of many years volunteers to see several clients per month. When the physician identifies other medical or psychiatric care needs, referrals are made to the local emergency department or behavioral health. The primary medical problems of those we serve consist of diabetes, dermatologic problems, and undertreated hypertension, although clients can present with most any diagnosis. Continuity of care is an issue although there are some free clinics that are used as well. Many of our clients have mental health diagnoses although their symptoms cannot be too severe for our setting.
As the Director of Nursing at Rebound, I am responsible for ensuring that policies and procedures are followed by the staff and clients in the nursing office. I am the primary contact internally and externally, assuming final responsibility for all decisions regarding matter, policies, and/or procedures that affect nursing services.
Q: MENTAL HEALTH COMORBIDITY IS OFTEN AN ISSUE WITH CLIENTS WITH SUBSTANCE ABUSE. HOW DO YOU ADDRESS THESE ISSUES?
A: We send our clients to the emergency departments where providers will write a prescription and stabilize the person. They will then be seen in the Carolina Health Care System in the behavioral health clinic or will be referred to other clinics that will treat the indigent. Before clients are readmitted to our program, they must be screened by a nurse to assess where they are with their comorbid problems and to assure that they are stable on their medications. At any given time, roughly 90 of 132 clients are on medications for various conditions.
Q: WHAT IS A TYPICAL DAY FOR YOU?
A: My day consists of "chasing down" medications for the huge number of clients that are on them. The medications come from many different sources, and many difficulties arise in obtaining them. Most clients have no insurance, but for those who do, they often have no money for the copay. We are not funded well enough to pay their copays. We (the nurses) track all the appointments and meds with the help of our techs. We also oversee meds being given out to clients three times daily including "pack outs" to those who are legitimately out of the building looking for work, at school, or on a weekend planner. We provide client-specific education about their medications, diagnoses, and dietary issues. Upon admission, we assess each client and start a care plan. Before being admitted, clients are told to bring all their medications, but most often, they do not. We spend time making sure that clients get the appropriate referrals. This involves many telephone calls with outside clinics and also getting clients to social security, urban ministries, and other organizations to access services. We have interdisciplinary recovery team meetings 3 days per week and staff meetings once per month. The doctor's clinic requires coordination as well. We have an open door to the nurse for 1 hour a day to triage various complaints and assign over-the-counter meds, send them to the emergency room, or make other referrals.
Q: WHAT ARE THE CHALLENGES YOU FACE IN YOUR ROLE?
A: We are definitely understaffed. We do not have the support services that are always needed such as social workers or medical case managers, making it difficult to track and follow up on clients. In addition, the clients seem to be a lot sicker today in comparison with the past. The economy may play a role in that. There are housing issues, and continuity of care is always a problem.
Our goal is to empower the clients so that they can help themselves. This is evident in even promoting their ability to make a telephone call to request an appointment. Although they may have street smarts, social skills are often missing. Our dream is that the clients will stay on their psychiatric medications and other medications so that recovery is possible.
Q: HOW DO YOU DEFINE SUCCESS IN YOUR PROGRAM?
A: Our completion rate is very high. The factors that seem to influence this are the 12-step programs, the spiritual link, and the length of the program. We have so many success stories, which can be seen on our Web site, but it is also evident in the number of alumni involved with the program overall. We define success in our graduates by their ability to maintain gainful employment, stable housing, and long-term sobriety.
We keep track of the success of our graduates through follow-up telephone interviews that are conducted on a regular basis. Based on our Fiscal Year 2013 Program Report, the sobriety rate of residents reached beyond 6 months after graduation was 78%, whereas the national success rate is 14% (The Rotarian, February 2014).
We do have a Halfway House as well. After the completion of the 90-day program, there is a 45-day extension with the possibility of a longer extension, which allows clients to gain employment. Clients will continue to attend Alcoholics Anonymous or Narcotics Anonymous. After the extension, they can apply to move to the Halfway House or often move on to other similar area programs.
In addition to the Halfway House, we offer a program called Learning, Empowerment, Advancement Program, which provides extended housing for graduates as they apply and attend college or vocational/technical programs. Comparable transitional programs are in place at our Dove's Nest (women's program) campus as well that provide extended living accommodations for our graduates as they actively seek employment.
Q: HOW DID YOU GET INTO ADDICTIONS NURSING?
A: From a personal perspective, in 2005, I was not experiencing much fulfillment at my job and was considering taking a break from nursing altogether. I had recently experienced the grieving process firsthand upon the death of my brother and a close friend because of alcoholism. They died within a year of each other, leaving a gaping hole in my life. I realized that the medical establishment was oftentimes lacking in compassion and in knowledge with regards to SA issues. It also seemed to me that quite a few of the providers who I encountered seemed somewhat unwilling to adequately address SA issues and expressed the sentiment that "They bring it on themselves!" I felt very strongly that those caught in the grip of addiction deserved more. I saw a rather vague ad in the article for an SA RN, went to the series of three interviews, and have never looked back. It is been by far the most rewarding area of nursing I have experienced. Since I graduated from nursing school in 1995, my work history has included cardiac step-down units at hospitals and MD offices including internal medicine, cardiology, pulmonology, allergy and asthma, clinical research, hospice, and reproductive endocrinology.
Q: WHAT DO YOU FIND FULFILLING ABOUT THIS PARTICULAR POSITION?
A: This particular setting is so gratifying! I work with a wonderful interdisciplinary group of professionals who show compassion yet maintain boundaries and professionalism. We also are blessed to have many volunteers and a dedicated staff of paraprofessionals as well as those in development, administration, and so forth. It seems as though everyone is devoted to the work at a deeply personal level. It is extremely rewarding, and it allows a person to connect with clients from a spiritual perspective, not just strictly clinical. We see the transformation of lives, and whole family systems are changed. Many of our former clients come to work here, become volunteers, or attend the alumni events hosted by the Halfway House staff. Seeing a current or former client reunite with his or her family in a healthy relationship, complete a certificate or degree program, or maintain housing and employment-all of these are what makes it all worthwhile!