(EDITOR'S NOTE: This is the third of three profiles of the recipients of Addiction Professional's 2016 Outstanding Clinical Care Awards. Our honorees will be recognized Aug. 20 at our National Conference on Addiction Disorders in Denver.)
Location: Loretto, Minn.
Target population: Individuals with a substance use disorder and brain injury/cognitive impairment
Quote: “We don't have, 'This is the Vinland way of doing groups,'” says clinical director Rick Krueger. “A pair of counselors does a group, and they figure out together how it will work.”
Vinland National Center remains one of the only treatment facilities nationally that is tailored to the cognitively impaired substance use treatment patient. Clinical director Rick Krueger says he freely shares information when organizations inquire about launching similar programs of their own, but most of the rumored efforts don't end up coming to fruition.
“It's hard to start this—it's a harder population,” Krueger says. “It takes a little more patience.” He adds with regard to the typical patient that impulsiveness and a tendency to get easily frustrated will often surface. “They're not feeling that they're grasping the material fast enough,” he says.
The motto among the clinical staff remains “safe and gentle and slow,” Krueger says. He tells patients, “Don't worry if you don't remember everything. Nobody in treatment remembers everything. If you grab one or two things, you've done well.”
Most of the patients at Vinland have a head injury history, usually incurred somewhere between five years and a decade prior to admission. Motor vehicle accidents constitute the most prevalent cause, says Krueger.
The typical age range at the facility is mid-20s to 50, and the center houses 41 beds for men and 12 for women. Lengths of stay average around 40 days, with some public funding of most clients' treatment.
Trauma-informed care stands as the foundation of Vinland's work, in that it remains critically important to convey a safe environment of care and not to retraumatize this population. “We work hard at having our clients feel safe. The clients are also assessing us as much as we are them,” Krueger says.
A battery of assessments, covering areas including physical health, neuropsychology and physical fitness, assist in mapping out treatment plans. Many of the patients have had previous treatment experiences, and since most are from the region in and around Minnesota, some familiarity with 12-Step traditions is likely. Vinland therefore does incorporate some 12-Step principles into its work, although it does not mandate meeting attendance.
“It doesn't do clients good not to include the language of AA, so that they know the difference between an open and a closed meeting and know something about the Big Book,” Krueger says.
The average clinician at Vinland maintains a caseload of around six, which might sound small until one thinks about the presenting issues of the target population. Vinland's 170-acre property offers an ideal backdrop for recreational pursuits that can translate to relatively affordable post-treatment activities, such as fishing.
“Almost 100% of our patients are in an exercise program,” Krueger says.
For this multi-need population, treatment completion rates serve as an important marker, and at Vinland they hover around 80% (compared with about 57% for substance use treatment programs in Minnesota, Krueger says). “We want to give them a chance to hit the ground running,” he says of patients.