Rogers Memorial Hospital

The Obsessive-Compulsive Disorder Center is one of a handful of residential treatment centers in the United States providing intensive and structured treatment for adults with severe or complex cases of obsessive-compulsive disorder (OCD).

Other behavioral health concerns effectively treated at the center include:

• Obsessive-compulsive (OC) spectrum disorders (trichotillomania, body dysmorphic disorder, hypochondriasis)
• Generalized anxiety disorder
• Panic disorder and agoraphobia
• Post-traumatic stress disorder
• Social anxiety disorder
• Comorbid depression

The length of stay at The Obsessive-Compulsive Disorder Center is open-ended; the average length is 60-90 days. Our overall goal is for patients to complete at least 75% of their hierarchy during their treatment stay.

Why Treatment Is Effective

• Cognitive-behavioral therapy services directed by a nationally recognized expert in anxiety disorders treatment
• Experienced multidisciplinary treatment team using evidence-based treatment
• Comprehensive assessment and personalized treatment plan
• Individualized length of stay
• Emphasis on patient and family education
• Comprehensive case management/coordination of continuing care
• Access to onsite experts for additional clinical consultations

Admissions and Insurance Coverage

The Obsessive-Compulsive Disorder Center can effectively treat adults age 18 years of age and older who meet the following criteria:

• Have a primary diagnosis of OCD, OC-spectrum disorders or another anxiety disorder
• Demonstrate a willingness to receive treatment and a desire to recover
• Have a level of cognitive and psychological functioning that allows him or her to benefit from residential treatment
• Be declared medically stable by a licensed physician
• Meet the admitting criteria for residential treatment

An initial screening with the prospective patient starts the admission process. Based on a review of this screening, the clinical director will recommend an appropriate level of care. After the review, admissions staff will contact the patient and share the clinical director’s recommendation.

As a courtesy to prospective patients, admissions staff will contact the individual’s insurance carrier to obtain a quote of insurance benefits. Benefit availability, service providers, and medical necessity criteria vary with each insurance plan. We recommend that potential patients check with their medical insurance carrier to determine what is covered and if there are any exclusions. After admission, patient care specialists can provide assistance with remaining questions or concerns.

Treatment Team

The Obsessive-Compulsive Disorder Center provides comprehensive, multi-modal treatment with 24-hour a day supervision under the direction of licensed clinical psychologist who specializes in the treatment of OCD and anxiety disorders.

Other members of the treatment team may include:

• Internal medicine physician
• Board-certified psychiatrist
• Licensed clinical psychologist
• Behavioral specialists
• Master’s-level therapist
• Registered nurse
• Experiential therapists
• Registered dietitian
• Residential counselors

On admission, each patient meets with members of the multidisciplinary treatment team for a comprehensive evaluation. This detailed assessment also includes administration of Y-BOCS, generation of exposure exercises and creation of a graduated exposure hierarchy. This information forms the basis of a personalized plan of care.

Treatment Components

The treatment team uses a number of treatment components to help each patient deal with the psychological issues that underlie and brought them to our program. All treatment plans are based on a comprehensive, graduated exposure hierarchy and a strict cognitive-behavioral therapy approach. According to the goals and objectives of their individualized treatment plan, patients may participate in the following components:

Behavior Therapy

Our program uses a highly structured program of exposure and, for OCD, ritual prevention. Exposure is the graduated, repeated confrontation of feared situations, objects or ideas. Ritual prevention is blocking the typical response before, during, and after exposure so habituation can take place. Based on the principle of habituation, our program seeks to prolong the exposure until the fear reduces on its own accord with the passage of time.

To maximize its effectiveness, this process must be:

• Prolonged enough to lead to within trial habituation (at least 50% reduction in anxiety)
• Repetitive enough to lead to between trial habituation (until it causes minimal to no anxiety)
• Graduated enough to increase compliance

Cognitive Restructuring

Patients learn how to identify and correct errors in thinking that generate anxiety and depression. This is accomplished through a series of steps including the use of individual therapy, group therapy and specialized exercises to provide the structure necessary.

Community Outings and Therapeutic Passes

With physician approval, patients have opportunities to practice newly acquired strategies in “real life” settings through supervised outings and therapeutic passes with clinical staff or family members. These experiences are useful for patients in reducing anxiety and easing their transition and integration back into his or her home community.

Daily Living Skills Training

This realistic aspect of living is a crucial component to overcoming OCD and help to create a sense of belonging to the residential community. Patients practice independent living skills by having the responsibility of maintaining their bedrooms, washing their personal laundry and linens, and jointly being responsible for care of their living areas. If a patient is unable to do a certain task because of his or her OCD, assistance will be given until he or she is able to accomplish the task.

Experiential Therapy

Each patient may participate in a range of experiential therapy groups during the week. Experiential therapy may include art, music and recreation components that assist in exploring communication, cooperation and problem solving skills in a variety of settings. These therapies provide opportunities for patients to develop self-awareness, critical decision making skills and increase personal responsibility.

Family Education and Therapy

Family is a vital part of the patient’s treatment. The active involvement of family members helps ensure a successful transition back home. Family members become involved by learning about the illness, its consequences and how to support their loved one during the ongoing recovery process. Families participate in weekly therapy. During these sessions the patient’s illness is considered within the context of the family’s communication patterns, value and belief system, rules, roles and expectations.

Group Therapy

Patients participate in group psychotherapy to review assignments daily. A process group is held twice weekly to help patients focus on conflict resolution, effective coping strategies, relapse prevention and discharge planning/continuing care.

Individual Therapy

Each patient is assigned to a core clinical team consisting of psychiatry, nursing and behavioral specialist staff that develop the treatment goals and exposure hierarchy, then facilitate and monitor the patient’s progress. Patients meet with a member of their team at least twice each week to address treatment issues, refine their exposure hierarchy and discuss the course of treatment.

Pharmacotherapy

The psychiatrist will meet with the patient to complete a comprehensive psychiatric evaluation, which includes history, diagnosis and treatment recommendations. Subsequently, the psychiatrist will meet once or twice per week with the patient to monitor medications and review medical status. During these sessions, the psychiatrist also discusses treatment progress, obstacles, and provides guidance and support.

Typical Daily Schedule

The Obsessive-Compulsive Disorder Center provides structured therapeutic programming seven days per week. A typical weekday schedule is shown:

Morning

• Vitals/Weights; Medications
• Breakfast
• Exposure and Ritual Prevention

Afternoon

• Lunch
• Cognitive Restructuring
• Experiential Therapy
• Supervised Assignment Work

Evening

• Dinner
• Goal Review Group
• Supervised Assignment Work
• Daily Living Responsibilities or Community Integration Activity

In addition to the individual sessions with the psychiatrist and other treatment team members scheduled throughout the day and week, residential counselors are available 24 hours a day on each unit. The residential counselors provide assistance and one-to-one support to patients on treatment compliance, setting daily goals, problem solving, feelings identification and other issues that are part of each patient’s treatment plan.

Continuing Care and Discharge Planning

Rogers Memorial Hospital is committed to providing smooth transitions for patients so they may continue their recovery after discharge from The Obsessive-Compulsive Disorder Center. Plans for continuing care begin shortly after the patient’s arrival.

With proper consents the treatment team works closely with the referring professionals to communicate treatment progress and assist in making discharge plans. If necessary, staff will assist with locating resources needed to provide continuing care.

The treatment team monitors each patient’s progress and level of participation. If, based on the patient’s behavior, the center is no longer a helpful or appropriate form of treatment, or if the patient needs a different level of care, the treatment team will explore options with the patient and his/her family.

Should they become necessary, Rogers Memorial Hospital provides short-term acute stabilization of psychiatric symptoms on its inpatient units. Oconomowoc Memorial Hospital, located approximately two miles away, provides pharmacy and laboratory testing services, as well as emergency medical care.