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Posted: Oct 27, 2009 11:07


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Boulder, CO
Brooks Witter, MA
Clinical Intake Director

Visit by Loi Eberle, March 31, 2009

Living Well Transitions [LWT] in Boulder, CO, describes itself as an "assertive community treatment program customized to meet individual needs." Their goal is to support young adults transitioning out of destructive and/or disruptive behavior patterns by helping them "re-enter a more balanced life pattern". I remember when the late Bill Sell created this program in 2004 and have heard of its positive outcomes, yet this was my first visit.

I met with most of LWT's eleven program staff at their downtown office in Boulder and found their unified view of a sane society to be refreshing. I also spoke with a program resident and parents of former residents, noticing how LWT staff uses a variety of modalities, skills, and techniques to constantly remind their clients/residents of the possibility of a sane, open and clear mind. The resident I interviewed described her previous inability to achieve sobriety for any length of time, despite her history of drug and alcohol rehabilitation programs. She chose LWT as a last resort and was grateful that they taught her to advocate for her needs by emphasizing internal work rather than external benchmarks. They motivated her to create a resumé that led to a job she loved, enabling her to pay many living expenses. Her mother glowingly described this program's impact on her daughter, also discussing the challenges that led her to develop intrinsic motivation to follow her dream.

LWT residents live independently in single apartments and are responsible for manifesting what they say they want. LWT Life Skills Counselors contact residents daily, focusing on building relationships, speaking about sanity and encouraging personal accountability for making good choices. Through Motivational Interviewing, Life Skills Counselors encourage residents to define their core values and reflect upon whether each decision they make moves them toward, or away from, their "wholesome" vision of themselves.

This program differs from most others in that LWT directs clients to "focus on individual goals and not be distracted by the needs of a group dynamic." Though lacking a strong peer milieu, residents are taught to develop healthy friendships. On most days, groups are taught specific skills at the LWT office, with a skills counselor available for group study halls. Recently they began the 10 week Path of Freedom curriculum developed by Fleet Maull.

When parents and consultants express concern about negative behavioral influences in Boulder, LWT highlights its many opportunities for learning to choose between life-promoting and life-destroying activity. In addition to Boulder's outdoor recreation, sports, healthy living options and many academic institutions, LWT staff teaches self-regulation skills. They meditate for their own self-care, refraining from imposing their belief systems on others. A few are Buddhists and teach at the Naropa University; the others are not.

LWT understands its residents might experience set-backs and bad choices: evidence that they are not yet ready to live completely on their own. LWT assumes a harm reduction approach, also supporting residents' participation in Alcoholics Anonymous and Narcotics Anonymous by getting them to daily meetings to meet their "30 in 30" or "60 in 60" goals. All clients have random UAs. If there is use of pot, it will be repeatedly brought up to the resident, asking for reflection on the impact that substance is having, asking: "Is it helping or hindering your ability to move toward your goals"? Issues are handled on a case by case basis. Those with a history of devastating relapses are monitored very closely. Relapse is understood to be part of recovery; learning how to pick oneself back up and find the resources to carry on can become a life skill of lasting importance. In cases of experimentation, when staff is not seeing drastic problems, the focus becomes helping the resident understand its impact and reflect on more effective ways of meeting those needs.

Obviously Living Well Transitions is positioned on the end of the spectrum that represents more freedoms. To determine suitability, Brooks Witter, Clinical Intake Director, carefully assesses applicants to determine whether they are ready to act responsibly and can take care of themselves. He conducts written and on-site interviews with the applicant, the parents and prior program clinicians to determine whether applicants have an adequate insight into their need for, and commitment to, positive change. Obvious rule outs are people still caught in addiction and those who are super avoidant of staff interaction.

Residents are expected to maintain an appropriate level of behavior, even on weekends, when there is less staff contact. While this creates the possibility of incidents, it also forces the residents to begin advocating for themselves, asking for help when they feel the need. There are no curfews at Living Well. Staff sees their role as supporting residents in making lifestyle choices that are seen as intrinsically sustaining to them in the long run. When poor choices occur, staff reflects back to residents that they are not "showing up with integrity."

Residents must learn to handle this level of freedom effectively. This involves skills in many areas, including: recognizing and overcoming triggers, learning to self-soothe and self-regulate, obtaining employment or attending classes, managing finances, relationships and discovering areas of interest. LWT uses a "robust" team approach in supporting residents' acquisition of these skills. When there are concerns, the Program Manager alerts the Life Skills counselor internally. They have on-call staff available 24 hrs a day. If a resident can't maintain appropriate behavior over a period of time, it becomes necessary to discuss with the resident the need to arrange for a higher level of support than LWT can offer.

Living Well Transitions emphasizes the importance of good admission decisions, recognizing that while some young adults need a lot of structure to contain them, others no longer learn within that level of structure. Indeed, not every young adult who has struggled is ready for the level of freedom that LWT represents. For appropriate candidates, Living Well Transitions offers tremendous opportunities to develop insight and acquire the skills needed to guide their path.

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