I am here with April Wilson, Vice President of Mother
and Child Residential Services for Prototypes a behavioral
healthcare systems offering assistance for men
women and children with special programs for women
with children. Good morning April, how are you?

April: I'm good, how are you?

Ted: I'm doing well. Thank you very much for giving us
the time this morning, I appreciate it.

A: No problem.

T: What I'm going to do is, obviously I want to know
about Prototypes, but I would like to start out with
maybe a little bit of your background and how you got
into the addiction recovery field.

A: Okay, I'm actually a woman in recovery myself. I
entered treatment in 1988. Actually entered Prototypes
as a client myself. At that time Prototypes was the only
organization, I was pregnant with my daughter and
back in 88 it was even more difficult then to find a program
for mothers with children. For one because I was
pregnant and also because I was a high risk pregnancy,
due to my drug use, particularly IV drug use.It was very
difficult to find a program. I spent approximately three
months making calls, I had my attorney helping me
and we were really trying to find a place where I could
go for treatment. I finally ended up getting in touch
with someone who was a part of Prototypes. Not only
did they say they could take me but they were also
excited about they all the risk categories I had. Actually
that was their specialty. They were giving priority to
women who were pregnant and IV drug users. Where
every other call I had made that was what closed the

T: Sure, absolutely.

A: So, I did my own treatment. I never really thought at
that point that this was what I want my career to be.

T: Does anybody really?

A: Yeah, I don't think so. What had happened was I got
a job. I was a single mom. i had had my child. Everything
was going well with that. I got a job that I was
working twelve hour shifts. My former counselor in the
outpatient program for Prototypes said ,"That's a lot
of hours to be working with a small baby, we have an
overnight position open in our residential program. It's
an entry level position, why don't you apply for that?"
So I did, thinking that this will be something just temporary,
an overnight shift while my daughters little. I've
been there for twenty-two years.

T: Wow.

A: I quickly realized once I started doing the work that
my passion was there and I definitely wanted to give
back what was given to me. They will probably have to
push me out of there in my wheelchair.

T: Hopefully that won't be anytime soon.

A: Yeah, hopefully, I'm talking years from now. That's
how I got into the field. I started in an entry level
position and gradually over the last twenty-two years
worked in many capacities throughout the organization.
Doing direct service, then in various management
positions. I've been in this current role overseeing all
the residential services for Prototypes for almost two
years. It's difficult work but, at this point, I wouldn't ever
want to do anything else.

T: I'm sure it is tremendously rewarding.

A: That's how I got started in the field.

T: Could you give me a little, maybe a brief history of

A: Sure, as I mentioned with being the only program
that would take me, that was our founders dream. To
really have an organization that reduced those barriers
for women in particular. Mothers, as you know,
experience many barriers in trying to access treatment.
Our founders were community mental health workers,
they saw such a fragmented system, where if you had
a mental health disorder and a co-occurring substance
abuse you couldn't be treated for your mental health
disorder. Then if you were referred to substance abuse
disorder treatment they weren't addressing your
mental health issues. I think, back then, they really
saw a need to have an integrated program. One that
wouldn't turn clients away that had multiple vulnerabilities
that they are trying to address. Other treatment
programs you had to go strictly for your mental health,
or for your substance abuse and then go somewhere
else for your parenting skills. A parenting mother might
have to go to six different places to address the needs
she was experiencing as a woman in recovery. Many
people need to know that women will put time with
their children first, so if there are that many barriers
they won't seek treatment.

T: Right

A: Our founders had a vision that they wanted to have
a place where women and clients could go where you
have that holistic approach. Where we are looking at
the whole person and what do we need to do in order
for this person to recover. That's really the concept that
our agency was founded upon. I think that's the reason
why I have been here for twenty-two years. I've been
in the field long enough to know now that what we
do is truly unique. It's a wonderful thing for a client to
come to one place and get all of their needs addressed.
We take clients into our program that no one else will
take. Still today, even though it is a little different than
it was twenty-seven years ago where you will find more
providers that are integrated it is still a very fragmented
system. Even today we take clients turned away by others,
for say either their mental health issues, or because
of issues with the justice system. We like to consider
ourselves the last house on the block.

T: Your founders, that was Vivian Brown and Miriam

A: That's correct, yes.

T: You were one of the first women's residential programs
as well.

A: Correct.

T: You mentioned you were in treatment there, did you
go to Pomona?

A: No, when I was in treatment they were still in the
process of getting the Pomona property. I about two
months into my treatment they acquired the property.
During the day we would go over to that facility and
at night we were in another facility in West Covina. A
smaller facility. When I was in treatment it was fully
operational as a residential treatment until after I had
already graduated.

T: Oh, alright. Being the V.P. of the Mother and Child
and the Residential Services, you mentioned that you
take clients that other s won't take, what are your criteria
for accepting clients?

A: We do assessment on the front end we do severity
index and asam assessments pre-admission. Any assessments
that we do in terms of assessing the criteria
is really just to gain the information that we need in
order to provide a comprehensive treatment plan. Our
goal os not to use screening criteria or instruments
not to screen people out but really to gather as much
information as we can to insure that we are able to
provide a quality treatment experience for the client.
For the most part we do assessments on the front end
but unless there is a very compelling reason as to why
they wouldn't be successful in our program, either they
need a higher level of care than we are able to provide
that's the only reason we would screen somebody out.
It's just that they need a higher level of care.

T: What about funding, I know that a lot of people that
come to you maybe don't have funds themselves, so
how do you deal with that?

A: Right, we do try to find any resource possible in
order to fund the client in treatment. We do have some
contracts that are funded through county and state
programs that are available for indigent clients. We are
also able to provide treatment to people with private
insurance. We have contracts with several managed
care companies. We are also able to take clients on a
private pay basis at a much lower cost than traditional
treatment. It may cost $10,000 a month we are able to
provide it at less than half that cost. in every aspect we
try to provide services to as many clients as possible.
Of course, are county and state programs the funds
are limited, so in many cases if we are not able to serve
the client we do have wait lists. We do provide them
with referrals to other services and continue to check in
with them on a regular basis. We try to do everything
we can to provide services to who ever calls us. We try
to work with them in every way. If they don't have any
funds at all then we look for alternative sources. We
have had instances where even if we don't have specific
contracts with an insurance provider we are able to
have single case agreements.

T: Tell me about what kind of facilities you have. I know
that you've got more than one location and I know
that you've expanded over the course of the last twenty-
two years, I know that you've grown much larger.

A: We do thirteen different locations. For our residential
programs we have one in Ventura County, which is a
smaller facility, 56 beds. we have another residential
program that focuses specifically on women that are
survivors of domestic violence with a co-occurring
substance abuse disorder. We started that program
back in the nineties because, once again, our founders
were seeing that women were experiencing the same
dilemma. If they had suffered violence they were being
turned away from help if they had a substance abuse
or mental health disorder. We saw that as a need so
we have a program that deals with women who are
survivors of domestic violence but also have a co-occurring
substance abuse disorder. That's a thirty-two
bed facility that's in the L.A. area. We have a program
in Orange County that's a residential program. It can
serve up to fifteen families. They are funded through
Orange County Social Services, which is the county's
department of children and family services. Are you
from California Ted?

T: Recently came back to California, I had been in Georgia
for twenty years.

A: That program is specifically for families who have
lost custody of their children but it is part of their
reunification plan. They are assigned to our program
to work on parenting and recovery support while they
maintain custody of their children. All the participants
in that program are referrals form Orange County
Social Services. Our largest campus in Pomona is a
large residential facility that is licensed for a 160 adults
and 90 children. It's a seven acre campus. It's our most
comprehensive campus where we are able to provide
everything on site. That is medical, psychiatric, mental
health services for both adults and children. Because
of the size of the program we are able to allocate more
resources to provide those services on site. We are partnering
with a federally qualified health clinic to provide
more comprehensive medical care on site, but we currently
have our own medical nurses. They provide triage
and are able to monitor all medications. Thar's our
biggest residential program. All of our programs have
the same model, so the same services are provided at
every site either through referral or direct services.

T: As far as the actual substance abuse treatment what
kind of treatments do you offer. How do you approach
it? Do you use twelve-step or C.B.T. are you using combinations
of different things?

A: Yes, it's a combination of different things. We definitely
are string proponents of the twelve-step programs.
We encourage all of our clients to become
actively engaged with a twelve-step program. The
treatment program isn't solely based on twelve-steps.
We do C.B.T. , our individual services are based on
C.B.T.. We also provide several evidence based practices
in terms of addressing trauma. So we do seeking
safety other various evidence based practices related
to specific issues that our clients are facing. We also
use motivational interviewing. All of our treatment is
individualized. Evidence based practices is part of our
treatment model but it's really based on the individual
client's needs as to what groups they would be assigned
to which evidence based practice we would be

T: I know you offer life classes and that sort of thing,
do you do vocational training, job placement services
anything like that?

A: Yes, all of our residential campuses have a component
as a part of their treatment. Our treatment is
based on a modified therapeutic community. As part of
their residential community, meaning that everything
the client does is part of their treatment. It's part of
the basic life skills from the moment they get up in the
morning until when they go to bed at night. Everything
they do is really part of their therapeutic treatment process.
In that sense it's a therapeutic community model.
We call it a modified therapeutic community. This was
something put together by our founders years ago.
There is actually a white paper on it that you can look
up.The concept is by all intents and purposes a therapeutic
community but we don't subscribe to the old
school in your face, wearing signs, tearing you down
kind of thing. The traditional therapeutic community
idea is that you have to tear someone down in order to
build them up. That's definitely not our philosophy, we
think our clients have been torn down enough. It's our
job from the very start to build them up.

T: You think?

A: So we're based on therapeutic community but it's

T: You kind of get away fro the military idea.

A: Exactly. We find that works best for our population.
As you may or may not know, 95% of our client, particularly
the female clients, are coming to us with long
histories of trauma. Over the last twenty-two years it's
really sad we are seeing clients a lot younger. The histories
of trauma I have seen over the last I would say 10
years have just been horrific. It's unbearable when you
hear some of the things our clients have been through.
I think over the years the drugs that they are making
are a lot more harsh than 25 years ago. I see clients that
have really hit rock bottom a lot sooner than they did
back when I was in treatment. We want to make sure
that trauma is a part of their treatment because that is
imperative for their recovery.

T: Pretty much led into where we were going. You
mentioned you have seen younger people that have
experienced much more trauma than in the past. Are
you primarily seeing that with street drugs? I know that
what has become very prevalent is prescription drugs
what have you seen a lot of as far as that?

A: The last couple of years we are seeing more prescription
drugs. I would say that would be the last five years.
I think the big one is meth. We have seen a lot of devastation
with meth-amphetamines among the younger
population. We have recently been seeing more clients
who have used designer kinds of drugs like bath salts
and spice and all of those things. That's been more recently
though. Crack has also been a devastating drug
that we have seen bring our clients to their knees a lot
faster. Of course this just my explanation, because I've
been clean for twenty-five years now, the things they
are cutting the drugs with and putting in the drugs are
causing clients more severe issues in physical health
and mental health and it is bringing them to treatment
faster. It's destroying their physical health and mental
health a lot quicker.

T: I've talked to a few cooks some of things they put in
it's like "You do What?!!!"

A: It's unbelievable. Its poison. Hydrochloric acid, use
pore that stuff on the ground and it will burn a hole.

T: Yeah it's pretty insane.

A: That's not scientific it's just my own opinion. I think
whatever they are putting in the drugs these days is
bringing clients to their knees much faster. They are
coming through our doors in poor
physical health. More severe mental health issues, I
think often times they are drug induced. We are definitely
seeing more severe issues at a much younger
age than we have in the past.

T: For instance meth, there is often times a sexual component,
so there tend be S.T.D.'s that tend to show up.

A: Exactly. Our founders were giving priority to IV drug
users for that reason, to really screen them for HIV and
all the things that are so compromising for this population.
Nowadays we are seeing more instances of hepatitis
C and a lot less HIV but back twenty years ago we
saw much higher incidents of clients with HIV.

T: As far as treatment goes, do you have any thoughts
on where it might be going in the future?

A: I think with the future what's good is the Affordable
Care Act is going to be pushing everybody to catch up
to where Prototypes has been for the past twenty-seven
years. Really looking at providing that holistic care in
terms of mental health, substance abuse disorder and
your medical. I think that's where our field is going. To
a more comprehensive approach that will be covered
under each client's insurance. No longer, number one,
will they not have ability to access treatment, because
now they will have insurance. I think that comes with a
new level of accountability for providers making sure
that they are providing the services that we have talked
about today, really looking at the whole person rather
than this fragmented system of care. That's a positive
thing. The concerning thing is will that lead to not being
able to write enough treatment for as long as a person
needs it for a client to be successful. That' my main
concern. I think the positive things of where the field
is going are wonderful. Now all providers are going to
have to think in the way that we have always thought.
On the flip side we know that dealing with this population
you need to keep them in treatment long enough
to deal with these multiple issues that coming in with.
Are we going to be able to provide the services at that
level. How will Prototypes be able to make sure we are
able to do that. Whether it be through alternative funding
sources or looking for other ways to enhance what
we are able to provide under their insurance benefits.

T: The people I have been talking to are wondering
what are insurance companies going to actually let
them do.

A: Right.

T: Being able to work out what they will be able to provide
as treatment.

A: It is a whole other level of talking about the client
differently and looking at them differently and trying to
keep them in treatment and convincing the insurance
that they need to stay in treatment. That's a skill that a
lot of agencies are going to have to catch up and learn
how to do. Historically the substance abuse field does
not have to do that. Now, it is kind of learning how to
navigate within those systems in order to provide the
services for your client. It is going to be the challenge
for the future. I think Prototypes is positioned very well
to do that, more concern is for the little providers who
aren't preparing themselves for that. What's going to
happen to them and the clients that they serve?

T: One of those things we need to advocate for.

A: Absolutely.

T: There are groups that are trying to make legislative
bodies more aware of what's going on. I think we just
need to be as loud as we can.

A:I think that is the way to go. There has been movement
in that regard but we still have a long way to go.

T: What do you see the future holding for Prototypes?

A: As I just mentioned, I think Prototypes is in a really
good position of being prepared for the ACA and the
changes it will bring to our field. We have been preparing
for a long time and I think we are well positioned
to deal with that. The way we have always looked at
things is being able to provide the services we provide
no matter what comes. We are looking at every which
way we can serve our clients, whether through insurance
or private pay methods. Providing a more affordable
program for clients. We really just continuing to
look at how we can provide the services we have over
the last twenty-seven years within whatever system it
ends up being. However all this plays out we still want
to be the same provider we have always been and not
let that disrupt what we do for our clients. Our leadership
is always looking forward making sure we are
able to do that and not let it cause a disruption for our
clients. So, whatever is in the future, we are prepared
for that.

Interviewed by Ted Dunn

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