Not Your Granddad’s Rehab

Sept. 16, 2016

Business is booming at Traverse City’s Addiction Treatment Services, which strives to be a rehabilitation center for the modern age.

When Addiction Treatment Services opened in 1974, it was housed in one building: Dakoske Hall on Eighth Street, where middle-aged alcoholic men fresh out of jail attended 12-step meetings and worked to stay sober.

In the years since, the spectrum of services offered by ATS has broadened as much as the variety of clients it serves. It’s spread across nine properties throughout Traverse City. And in recent years it’s attracted national attention as an innovative treatment provider.

CHALLENGES AND CHANGES

Most of the change at ATS has happened in the six years since Christopher Hindbaugh became executive director.

Hindbaugh said when he took over in October 2009, he found the nonprofit in dire shape.

“At that point, at the end of that fiscal year, we had lost $250,000,” he said.

Hindbaugh’s background was in behavioral health administration, but he’d most recently been leading community initiatives at the Kalamazoo Community Foundation.

“I was looking for a change, and I wanted to go back into behavioral health administration, so [ATS] hired me, thinking I would be able to raise money, thinking that I would be able to fundraise them out of this issue,” he said. “And when I landed here, I felt that doing just the opposite was our only way to be sustainable.”

His counterintuitive approach led to a period of painful transition that saw a lot of longstanding employees leave. The entire leadership team turned over in the first year. He said it was “gut-wrenching and really challenging … but it had to be done” to ensure ATC had a future.

“I didn’t know [coming in], because the board wasn’t fully aware of how bad things were,” he said. “I wanted to go back home. … But you know, I couldn’t do that.”

A DIFFERENT KIND OF CLIENT

Hindbaugh said ATS started out like most other substance abuse programs around the country.

“In the mid-’70s, there was lots of federal money that came to the states to create the halfway-house strategy — essentially homes focused on middle-aged white men, at the time, doing 12-step work,” Hindbaugh said.

“So that’s the lineage of most of the agencies like this.”

Addiction treatment facilities historically have worked hand-in-hand with the criminal justice system. ATS still does, but Hindbaugh said he’s worked to distinguish treatment from the court system in order to reach more people.

Traditionally, the middle class has been cut off from access to substance abuse treatment, he said.

“Part of that was because the only way you could get treatment in this country was through that system. You had to be indigent, essentially. Or you had to be of means to be able to go elsewhere — go to Malibu, go to Betty Ford — and pay out of pocket for that,” he said. “There was really nothing for folks in between.”

It turns out there are a lot of folks in between. Finding a way to provide services to average people has caused a rapid increase in the number of clients ATS serves.

“One of the consequences of our history was that we had created an organization that was ‘good enough’ for those folks, and so, six years ago, you’d very often hear, ‘Well, it’s better than where they came from.’ Or, ’At least they’re not on the streets or in jail.’ We really try to flip that around and say, ‘You know, until you’re comfortable referring a loved one to our agency, our work isn’t done here.”

MORE AND MORE SERVED

The number of clients served by ATS has increased rapidly in recent years. Since 2013, the number of people who have gone through its detox program has nearly doubled. The number of people seeking residential or outpatient rehab also has steadily grown (see graph).

That’s in part due to a spike in opiate addiction and in part due to ATS attracting people who were traditionally out of reach.

“We’re really convinced that there was always an unmet need here in our community, and so even as the opiate epidemic has come on the rise, it still hasn’t quite eclipsed alcohol abuse here,” he said.

Meanwhile, ATS has grown by other measures and can now take clients through detox, into a weeks-long rehabilitation program, and then to a long-term transition home. After that, the agency offers life management services to help clients get medical care, find housing and employment, and remain sober. Those with less severe addiction can attend outpatient therapy.

When Hindbaugh arrived, there were six properties in ATS’s portfolio. Today there are nine, and the organization is working on a plan to develop, in three to five years, a central campus that could house most of their services.

Eighteen months ago, the detox center took over what used to be the administration building at 940 E. Eighth St., and the administration has moved to offices on Cass. ATS also opened the PORCH community center at 747 E. Eighth St., where it offers outpatient services. Dakoske Hall, on Eighth Street between Union and Cass streets, now has 24 beds, up from the 12 available when Hindbaugh arrived. And Phoenix Hall on State Street has become a 12-bed women’s rehabilitation house.

In six years, ATS staff has increased from 49 to 82, and its annual budget has increased from $1.9 million in 2010 to over $4 million today.

MORE MASTERS DEGREES, LESS AA

Hindbaugh said in order to reach middle-class clients who need help, the vibe at ATS had to shift from “halfway house” to become more like a doctor’s office.

That’s what happened to ATS’s detox. The place looks more like a medical care facility, and Hindbaugh said that look isn’t superficial.

ATS has moved away from rounding up addicts and sending them to Alcoholics Anonymous meetings. Now it uses personal and group therapy that’s geared toward “evidence-based curriculum,” he said.

Hindbaugh has instituted requirements for staff that are not mandated by any regulator, but he said he believes they are necessary for ATS to attract a broader range of staff members and to get good results. For example, all counsellors at ATS today must have masters degrees. The agency also employs a full-time nurse practitioner and maintains 24-hour nursing at its detox. The food served meets federal dietary standards.

In addition, every employee at ATS, from maintenance to kitchen staff to the CEO, must be certified in addiction treatment, a Hindbaugh-instituted requirement that won ATS an award from the National Council on Behavioral Health — one of several national awards the agency has nabbed in recent years.

The requirement for addiction treatment certification among all ATS staffers is crucial, Hindbaugh said, because theirs is a 24- hour business. The people who sweep floors or serve food or drive people to appointments have a lot of contact with the clients, and their message has to be constant.

Hindbaugh said all of this comes at a cost because ATS doesn’t receive more Medicaid dollars for offering higher standards of care. But he said he believes it will result in better outcomes for clients, which will add to ATS’s appeal.

He admits the practices aren’t necessarily in the organization’s financial interest; by spending more money to make sure people in detox get better care, for example, the clients are less likely to come back. While that means a loss of income for the treatment center, it also means a better outcome for those substance abusers and, ultimately, society at large.

“If nothing else, we’re throwing everything that we have at the problem of addiction in our community,” Hindbaugh said.

LIGHTYEARS FROM FIVE YEARS AGO

Tom Gilbert, a former judge and founder of TC Retreat, a recovery house in Traverse City, said what Hindbaugh has accomplished is remarkable.

Gilbert, who served on the ATS board at the beginning of Hindbaugh’s tenure, said he thinks ATS has grown in important ways.

“They’ve expanded their programming, and they’re more inclusive,” Gilbert said. “We’re fortunate to have them in our community.”

Bob Peltz, recovery residences manager, is ATS’s longest-serving employee. Having been there 14 years, he knows the organization before and after Hindbaugh.

He said Hindbaugh is a visionary who has been able to reconsider every aspect of how an addiction treatment center is run and what services it can and should offer. He said the progress in care he’s seen is astonishing.

“We’re light-years from five years ago,” Peltz said. “The evolution’s been unreal.”

Peltz notes how Hindbaugh has been invited to the White House to be recognized for his work.

“I’m proud as hell about that, you know?” he said. “We’re a small organization. We’re not a Betty Ford or a Hazleden.”

Much of the change has come from that shift from 12-step-based counseling delivered by former addicts to a professional “results-based,” “best practices” approach — a an evolution that has caused some strain.

Tim Carlisle, who worked at Dakoske Hall prior to Hindbaugh’s tenure and recently returned, acknowledges that some clients take issue with the fact that fewer of the ATS counsellors are recovering addicts them selves.

Carlisle, who works as a driver for ATS and did a stint in rehab at Dakoske in 1989, said he explains to them that today the counsellors have masters degrees, that they spent a lot of time in school learning how to help people fight addiction.

“I think it’s been positive,” Carlisle said.

“Chris is always looking for new ways that they can help out in the community.”

A NONPROFIT WITHOUT A FUNDRAISER

Remarkably, ATS, a nonprofit 501(c)(3) organization, has propelled its growth surge without fundraising.

“The agency has been really resistant on tapping into philanthropy,” Hindbaugh said. “Except for one small grant in a partnership with Goodwill Industries, we’ve asked nothing from the philanthropic community, because we knew that if we run an efficient organization, that we can be profitable and not have to compete against basic needs like the Father Fred Foundation, the Women’s Resource Center. So we’ve been really intentional about that.”

Hindbaugh also doesn’t want to cause the organization to to become dependent on grants that might not be renewed in the next year.

In the future, Hindbaugh said that ATS likely will attempt to raise money in a capital campaign to build a new campus, but that will be a one-time deal — someone could get their name on a building for a million-dollar donation, for example.

But overall, the organization has been able to achieve its growth through service fees and Medicaid reimbursement.

Hindbaugh hopes in the coming years to attract venture capital investment to ATS, an objective that sounds at odds with the goals of a nonprofit, but Hindbaugh said it makes sense. Venture capital could enable ATS to achieve the scale necessary to provide a broad range of medical services to clients and to qualify the organization to receive re imbursement through insurance.

That would enable ATS to better compete with for-profit addiction recovery centers that are moving into the territory; one recently opened in Boyne City, and Traverse City phone books are filled with ads from rehab centers in Florida looking for mental health clients with insurance coverage mandated by the Affordable Care Act.

SITCOM STARS AND AWARDS

The first national award ATS won was from the Substance Abuse Mental Heath Services Association in 2013. ATS received the award for staging a City Opera House event that brought Third Rock From the Sun actress and recovering addict Kristen Johnston to speak in Traverse City. The agency had convinced Johnston to waive her $20,000 speaking fee by arranging to have a local filmmaker produce a short film about her visit; Johnston has been using that film to promote speaking events around the country ever since.

The Johnston event was part of a philosophy Hindbaugh brought to ATS: by bringing addiction into the open and keeping it in the public eye, he believes you can chip away at the stigma of addiction. He said ATS’s goal is to have people consider addiction a disease and to eliminate any shame associated with it.

To that end, ATS will remain a force in the region, keeping out of the shadows and resolutely in the public eye. And, as long as Hindbaugh is remains at the helm, it’s likely the group’s efforts — and outcomes — will continue to benefit its clients and the community.

Interested in learning more about addiction and supporting the work ATS does?

On Sept. 22, in celebration of National Recovery Month, ATS is sponsoring “SPEAK UP!” featuring Kinetic Affect, a nationally recognized duo of spoken word artists. The free event takes place at 7pm at the City Opera House.