Philosophy

SCPS has adopted the “no wrong door” philosophy in providing behavioral health services. This model mandates a welcoming approach to all clients, eliminates arbitrary barriers to initial engagement in services, and specifies mechanisms for helping each client (regardless of presentation and motivation) to connect to a suitable program as quickly as possible whether within the agency or through the referral process. SCPS continually strives to better serve our community as evidenced by increased collaboration with other agencies in the form of shared resources, contractual relationships, and integration of service delivery models.

Sitka Counseling & Prevention Services utilizes the Bio-Psycho-Social-Spiritual model in developing and providing behavioral health treatment services. This theoretical model conceptualizes mental illness and substance misuse to be a result of complex interactions among biological, psychological, social, and spiritual factors.

The Biological component includes genetic factors that may predispose an individual toward mental illness/chemical dependency; brain chemistry imbalances; physical changes or damage as a result of injury or substance misuse; and/or biological risks due to substance use such as HIV/AIDS, sexually transmitted diseases, tuberculosis, and/or Fetal Alcohol Spectrum Disorder. The Psychological component includes the cognitive, behavioral, and emotional aspects of behavioral health including co-occurring mental health/substance use disorders. The Social component refers to relationships with significant others, social support systems, communication skills, and sense of belonging in the social environment. The Spiritual aspects includes a sense of purpose and meaning in life; a sense of the transcendent; that there is "something" greater than ourselves; self-exploration; and/or self-realization.

This theoretical framework encompasses the wide range of mental, emotional, physical, and spiritual issues related to mental illness/ substance use disorders and allows for a holistic assessment and treatment of individual needs. Since this model recognizes that behavioral health issues affect individuals in diverse ways, a comprehensive assessment is necessary to determine individual needs and a continuum of care is essential to provide appropriate treatment services to meet individual needs. This model allows for treatment services to be increased or decreased according to individual progress and is client driven versus program driven.

However, this approach also necessitates that integrated and coordinated services are offered within a continuum of care. SCPS offers a continuum of care that includes prevention, early intervention, crisis emergency services, outreach, outpatient treatment, in-home therapy, residential treatment, rehabilitative services, and corresponding referrals to other community services such as job training, community based support groups, child protection, housing, domestic violence advocacy, medical/dental care, spiritual support, housing services, and legal services per individual needs.

In addition, SCPS supports the utilization of harm reduction strategies designed to lessen possible adverse health, societal, and economic consequences of untreated behavioral health issues. Success is no longer defined only by complete, sustained absence of symptoms or abstinence, but also as progress toward other measurable outcomes such as improved social functioning, improved job/school performance, decreased criminal justice involvement, improved relationships with significant others, improved emotional self-regulation, and increased sense of purpose/meaning in life.

Core Values

•  Consumer-centered services: Behavioral health consumers have a primary role in defining their individualized needs and have choices among services that address those needs.

•  Consumer rights : Respect for consumer dignity and rights, including confidentiality and the unique cultural framework for each consumer, underlies all services.

•  Consumer-directed policy development : Consumers are actively involved in shaping policies and laws affecting persons experiencing mental illnesses and substance use disorders.

•  Comprehensive system : Services that address fundamental life needs--such as housing, employment, education, health care, and transportation--are included in addition to the comprehensive behavioral health services.

•  Integrative/collaborative system : Consumers, family members, advocates, providers, and government agencies work in partnership to integrate diverse services and minimize service barriers.

•  Strength based : Services incorporate and build upon the strengths of consumers, family members, friends, and natural community supports.

•  Home and community focus : Services are provided as close to the consumer's home and community as possible, and local communities take active ownership in providing needed and least restrictive services.

•  Preventive services : An emphasis on prevention and early intervention helps reduce the need for more intensive, crisis-oriented services.

•  Outcome-based system : Consumer satisfaction and other measurable outcomes help define "success" and promote accountability for service providers.

•  Cost effectiveness : Services are effectively managed to maximize resources, promote efficiency.

Integrated Guiding Principles

SCPS has adapted the eight research/consensus-derived principles to guide the delivery of its comprehensive, continuous, integrated system of care (Minkoff, 1998, 2000)

•  Dual diagnosis is an expectation, not an exception.

•  All individuals with co-occurring psychiatric and substance use disorders (ICOPSD) are not the same - the national consensus four quadrant model for categorizing co-occurring disorders (NASMHPD, 1998) shall be used as a guide in service planning.   In this model, ICOPSD can be divided according to high and low severity for each disorder, into high-high (Quadrant IV), low MH - high CD (Quadrant III), high MH - low CD (Quadrant II), and low-low (Quadrant I).

•  Empathic, hopeful, integrated treatment relationships are one of the most important contributors to treatment success in any setting ; provision of continuous integrated treatment relationships is an evidence based best practice for individuals with the most severe combinations of psychiatric and substance difficulties.

•  Case management and care must be balanced with empathic detachment, expectation, contracting, consequences, and contingent learning for each client, and in each service setting .   Each individual client may require a different balance (based on level of functioning, available supports, external contingencies, etc.); and in a comprehensive service system, different programs are designed to provide this balance in different ways.

•  When psychiatric and substance disorders coexist, both disorders should be considered primary - integrated dual (or multiple) primary diagnosis-specific treatment is recommended.

•  Both mental illness and addiction can be treated within the philosophical framework of a "disease and recovery model" (Minkoff, 1989) with parallel phases of recovery (acute stabilization, motivational enhancement, active treatment, relapse prevention, and rehabilitation/recovery), in which interventions are not only diagnosis-specific, but also specific to phase of recovery and stage of change.

•  There is no single correct intervention for ICOPSD - each intervention must be individualized according to quadrant, diagnoses, level of functioning, external constraints or supports, phase of recovery/stage of change, and multidimensional assessment of level of care requirements.   Programs must also be sensitive to age, culture and gender specific needs of its clients/patients.

Clinical outcomes for ICOPSD must be individualized - based on similar parameters for individualizing treatment interventions.   Abstinence and full recovery are usually long term goals, but short term clinical outcomes must be individualized, and may include reduction in symptoms or use of substances, increases in level of functioning, increases in disease management skills, movement through stages of change, reduction in "harm", reduction in service utilization, or movement to a lower level of care.