San Marcos has been a leader in psychiatric residential treatment for years. Founded in 1940, San Marcos has undergone multiple changes and adjustments related to the treatment of adolescents in this country. While this report will address aspects of programming at San Marcos, the real story is about the staff who weathered the changes with courage, tenacity and an obvious commitment to their patients. While many of the residential treatment programs in the nation eventually went out of business or fell into mediocrity, San Marcos continued to prevail in the tough market place of the past 20 years. This could not have been accomplished without the long-standing and dedicated staff.
Dr. Cassie Schmidt, CEO, has been at the helm throughout the past 16 years. Like many of the employees at San Marcos, she was there when it was one of the preeminent treatment facilities in the country and primarily funded by third-party payments. In the early days, insurance payments were ample and the program had their pick of patients.
After the idyllic treatment conditions in the early days, San Marcos endured extreme change, which included taking the more difficult patients from across the country, adjusting to new owners and the reduction in per diems. At this time, it was difficult for San Marcos to "pick and choose" their patients, which resulted in making treatment adjustments and learning to work with a new complex population that included many who were not eager to be in treatment. At the same time, San Marcos faced more budget cutbacks and drastic reductions in patient benefits. Cassie and her staff again stepped up to the plate and persevered in keeping their treatment team in place by working through the changes.
Cassie was the last member of the San Marcos staff that I met with and because I had to catch a plane, I did not get to spend enough time with this determined leader. I had met Cassie once before and had some familiarity of her, but after meeting with her staff all day, I was even more fully aware of the respect she had earned from them. My first comment to her was, "You must be one tough and courageous lady!" She did not crack a smile, but responded by simply saying, "I am." When I asked how she and her staff were able to achieve this level of success through all of the changes they had endured, she said, "We kept our eye on the kids and the important work we were doing. That is all that is necessary; we can't do anything about something that is out of our control."
Many times throughout the day, the staff made several positive comments about Cassie. They discussed her hands on approach, said she works too hard and described her as the "energizer bunny." In a meeting with the recreational specialist, clinical services coordinator and chemical dependency counselor, we discussed how the different departments work together. After a discussion of the clinical integration of their extensive ropes course, Recreation Therapist, Kristy Pounds, told me that Cassie somehow gets the staff anything they need for the patients. Another staff person told me that Cassie receives two reports daily and that "because Cassie pretty much knows everything that is going on around here, everyone tries harder."
I also met with the director of specialized therapeutic services, Gilbert Sanchez, a 27-year veteran of San Marcos and the supervisor of the managers of the dorms. With over 170 patients, Gilbert explained how important this aspect of supervision is and how San Marcos has refined its detailed and extensive behavioral system over the past 10 years. Throughout the day, patients carry a card with them and receive verbal feedback in specific areas of behavior and participation. This behavioral feedback system begins with new patients. The frequency is reduced as the patients demonstrate responsible behavior. Gilbert pointed out that their system utilizes physical restraints only as a last resort and there is no locked seclusion. The program trains and closely supervises the staff in de-escalation approaches. San Marcos emphasizes clear boundaries, expectations and structure to enable the patients to learn appropriate coping and life skills. The overall individual and group therapeutic approach is also cognitive-behavioral in nature.
I met with Webster Averyt, COO, and Zack Franks, Patient Rights Coordinator, who discussed their roles of paying close attention to the rights of all patients and how this is accomplished. San Marcos is perhaps the only program in the country that employs a full-time employee dedicated solely to patent rights. Zach has developed a system of feedback that allows patients a confidential filing of complaints that he personally handles. With some of the current issues in the "Parent-Choice" industry related to licensing and developing patient rights standards, I felt that San Marcos was on the right track.
Dr. John Rust has become an icon at San Marcos and perhaps the most visible psychiatrist in the field. He is a thoughtful and gentle man who is known for his ability to pull together all available information on a patient, identify other needed assessments and provide the medical leadership needed to refine a patient's treatment plan. I used my time with John to discuss several complex boys and girls I am currently working with and his input was valuable. It added much to my understanding of these young people. John works closely with the admissions team and others to identify appropriate patients and serves as the executive medical director.
There are several examples of how San Marcos can fill some placement needs. First, the Prescription Plan can provide a short-term treatment/ diagnostic experience for complex patients that may assist professionals in better choosing a future placement. This 30 to 90 day intervention is in a very small unit. The second option would be to continue a long-term treatment for a patient after the Prescription Plan. Consultants who work with students on military insurance should also know that San Marcos works extensively with Tricare. San Marcos is also an approved provider for Denali Kid Care of Alaska.
The San Marcos Charter School is operated through the University of Texas in Austin, Charter School System. Principals, Dr. Donnie Wilson and Louis Hubbard, reported that the school's connection to the University has enabled San Marcos to expand its services, expertise and personnel. The University in turn, improves San Marcos' ability to train staff and teachers to work within a wide variety of complex educational problems. San Marcos provides an academic curriculum and tutoring for fifth through the twelfth grades, which includes special education classes. Each classroom consists of a teacher, teacher's aide and a mental health associate.
San Marcos maintains its standard of being a quality residential treatment program. The most visible advancement is the extensive ropes course developed two years ago. It is apparent that San Marcos places a high importance on using experiential activities across all disciplines. This serves as a natural vehicle for all staff and patients to work together by improving their teamwork and finding new ways to communicate with the patients.