Clinical Social Work at the Austen Riggs Center – Part 3: The Role of Discharge Planning
by Aaron Beatty
Although he has only been at Riggs for the past three years, clinical social worker David Rosenthal, LICSW, has a career in social work that spans three decades. “This field [social work] – you don’t choose it, it chooses you,” he says. Having worked in community mental health, hospitals, as a program director and as a college professor, Rosenthal brings a broad base of experience and unique perspective to his work.
Speaking specifically about discharge planning at Riggs, Rosenthal says “Discharge planning can seem simple and straightforward – and sometimes it is – but people come here with very complex developmental issues.” That fact, coupled with the “open setting” at Riggs and the value it places on patient authority, can make the process complicated, but at the same time more thoughtful and inclusive.
“Discharge planning starts when a patient is admitted, so the patient’s social worker is always thinking about that,” says Rosenthal. “We start talking about it in the beginning and always try to have it the background – sometimes it’s more in the forefront, depending on where a patient is in his/her treatment.” The goal of treatment at Riggs is to help patients become people taking charge of their lives, so having a framework that acknowledges, discusses and plans for what comes after treatment at Riggs is an important part of the treatment itself.
Whether a patient is becoming more involved in patient government, the work program, our Activities Program, or transitioning to one of our step-down programs, social workers “help patients look at Riggs as a microcosm for the rest of their lives; the things they are doing here, how they are interacting within our therapeutic community, the same things that happen here will happen on the outside,” says Rosenthal. Not only does this inform the discharge planning, but, remarks Rosenthal, “it gives social workers a way of talking about behavior that will likely be repeated on the outside and a way of working with patients while always having an eye on the outside life.”
The unique treatment structure at Riggs is centered around patient authority, examined living and a more open-ended length of stay (minimum six-week Initial Evaluation and Treatment /five month average length of stay). This means that the timing and development of a discharge plan is negotiated and co-created by the patient, his/her family, his/her social worker and other treatment team members to address the most critical needs of the patient in the most effective manner. As Rosenthal comments, “The sharing of ideas of when to discharge, what to do and where to go and what it will look like can often re-enact existing family dynamics.” While this can be a challenge, there is always an opportunity to closely examine everyone’s behavior in the process and uncover what is being communicated.
“Each family is different, each patient is different,” remarks Rosenthal. While the general criteria for discharge is that “patients can continue their work with an appropriate amount of support,” each discharge plan is as unique as the patients we treat.
Following up with patients, their families and subsequent treatment providers after discharge is a new element that will be added to the discharge process, which Rosenthal sees as “a big change that will make us better in terms of the coordination of patients’ care after they leave treatment at Riggs.” A successful transition from treatment at Riggs to an outpatient or other setting is an important part of the treatment process. Having social workers serve in a supportive role post-discharge will both benefit the patients who have recently discharged and hopefully inform and improve the discharge process overall.