Residential Treatment

Residential Treatment:

Rogers is a comprehensive psychiatric hospital, nationally recognized for specialty residential treatment programs for eating disorders, addiction, obsessive-compulsive disorder and anxiety disorders for children, teens and adults.

Life. Worth. Living.

June 24, 2014 - 3:25pm

Paddle Boarding to Recovery at Rogers Memorial HospitalAt Rogers Memorial Hospital, our treatment consists of many components. What makes our treatment approach unique is the multiple levels of therapy we provide including family, group, individual -- and experiential.

Often an overlooked piece, experiential therapy can be essential to a healthy recovery. This type of therapy involves a range of activities from art and music to recreation. With a ropes course, a climbing wall, access to multiple lakes and acres of trails through a beautifully wooded setting, Rogers is an ideal location to practice this form of treatment.



Something new: Paddle boarding

One of the most recent additions to the many experiential therapy activities offered at Rogers is paddle boarding. Paddle boarding utilizes a traditional surf board and a paddle, which is used to propel the boarder across the top of the water while standing on the board.

Paddle boarding offers many benefits, both physically and mentally. As in all experiential therapy activities, attempting and accomplishing a new task will build confidence. With an activity like paddle boarding, we remind our patients of their capabilities and strengths, while providing support as they challenge themselves to overcome fears and self-doubt. That’s empowering!

With increased exposure to the different activities offered, including paddle boarding, we often find this helps decrease the avoidance and anxiety surrounding experiential therapy for those who are hesitant to participate. Any physical activity can provide relief from anxiety and stress. While a patient is focusing on accomplishing the task at hand rather than on the therapy itself, he or she can let their guard down and feel free to be themselves.

With more confidence and a sense of relaxation, paddle boarding and experiential activities can invoke positive moods and give patients an uplifted outlook. And, by trying new and different leisure activities, patients find healthy interests to pursue in their free time.

Getting mentally and physically fit

In addition to the mental benefits of paddle boarding, this activity in particular also promotes a healthy lifestyle and physical fitness. Paddle boarding requires balance, coordination, strength and even patience. It can truly test an individual’s ability to persevere and once they have conquered the task, it will provide an undeniable sense of accomplishment.

Paddle boarding is rapidly increasing in popularity, and working its way up to one of the top water sports. Rogers Memorial Hospital is proud to be able to introduce this unique opportunity as both a form of therapy and an exciting new wilderness experience for our patients.

June 3, 2014 - 9:05am
Kristin Miles, PsyD

By Kristin Miles, PsyD


Kristin Miles, PsyD, is an attending psychologist at Rogers Memorial Hospital-West Allis’s Child and Adolescent Day Treatment program. Learn more at rogershospital.org.

Media in its multiple and ever-changing forms – TV, Internet, Facebook, Twitter, computer and video games – plays a prominent role in our lives. With this unprecedented 24/7 access, many children and teens have difficulty managing their media use. So what is the danger in multi-tasking multiple streams of entertainment and information?

Developmentally, the brains of pre-teen and younger teens have yet to develop self-regulation skills, and this impacts their ability to identify when it is too much. Research from the University of Bristol found that children and teens that spent more than two hours a day in front of a screen had a 60 percent higher risk of psychological problems. These findings are part of a growing body of evidence that indicates there is a connection between media use and children’s mental health.

How can media affect my child’s mental health?


Media can have both a positive and negative effect during the growth years, depending on how the medium is used. It can be a positive experience for shy children in helping them develop interpersonal skills, create a sense of community or, in others, teach empathy or tolerance.

However, research also shows that when media is overused it can become a significant distraction for children, which can impede learning or cause short-term memory problems, cause a decrease in attention span, disrupt sleeping patterns, or cause excessive moodiness or aggression and other behavioral issues. As children enter their teenage years, they find themselves more susceptible to peer influence which may make them more likely to engage in risky behaviors like skipping school, drinking or drugs.

What is an appropriate amount of time for my child to engage in media?

A study by the Kaiser Family Foundation stated that children as young as eight years old are spending nearly 7.5 hours a day consuming media. A 2013 policy statement from the American Academy of Pediatrics (AAP) offers guidelines which cover all media avenues including television, movies, video games and Internet or tablet applications. The AAP policy statement suggests screen time should be limited to less than one or two hours per day. Kids that had more than two hours per day were more likely to experience a drop in school performance, short attention spans and even increased belligerence.

Besides time limits, how can I help guide my child’s media experience?

Parents need to strike a balance in their children’s media experience that minimizes potential health risks and fosters appropriate and positive media use. If you are finding it difficult to enforce media limits for your children, consider the following suggestions:

  • Create “screen-free” zones at home
  • Make meal and family times technology free
  • Offer non-electronic activities like books, puzzles or board games
  • Develop a family media agreement where children and parents agree to communicate openly on media use

When my child is using media what can I do to ensure it’s safe and age appropriate?


The immediacy of media means your child or teen will probably be exposed, whether it’s with parental guidance or away at a friends or families. However, you can limit their exposure by:
  • Keep the computer in a public part of the house
  • Know and understand the media your children are using
  • Utilize a kid-safe browser and search site such as Zoodles, Kido’z, or KidZui
  • Create a code of conduct to follow (i.e. don’t share passwords or personal information, avoid strangers)
  • With older kids, discuss various media messages and advertising
Sources: Common Sense Media
May 28, 2014 - 9:58am

Sue McKenzieSue McKenzie, co-director of Rogers InHealth works to provide stories of hope and recovery to eliminate the stigma surrounding mental illness.

Stories change us. In my role at Rogers InHealth I have the joy of creating and participating in environments for people to encounter stories of hope, connection and recovery. Recently over 400 people who provide services to those facing mental health and addiction challenges gathered together at a Milwaukee college. The goal was to brainstorm about how to best address the complexities of trauma, poverty and depression. While participating as one of three panelists chosen to provide context and insight, I shared a brief story about a four-year-old boy.

I had the great pleasure of interviewing his mom and his special education teacher, Janice, for a program Rogers InHealth leads for school staff on engaging and motivating children with mental health challenges.

John’s* mom enrolled him in a local school district after he was expelled from a private preschool. Yes, a four-year-old expelled from preschool! Both adults expressed that John was a good kid with some tough challenges. This often led to others seeing him as a bad kid. Janice mentioned an example of a struggle his classroom teacher was having with John during naptime. After a few weeks of no nap, frustrations rose. Finally one morning, Janice took a walk with John and asked him about naptime. John readily offered that he hated the music the teacher put on. Now, I am not sure if the music was just irritating or if it somehow triggered something for John, but he was clear about his feelings. Janice went home that evening and thought about this dilemma. The next day she brought a pair of headphones to the teacher and suggested she offer them to John. John used the headphones that afternoon and rested with the other children.

Do you feel John’s relief? The teacher’s? Will you remember this story? That is why stories change us. When hearts and minds connect as they often do with a real story of real people, we discover insights that are relevant to our life.

What might you or another gain from a friendly walk or a simple solution? What happens when you ask another what they need and, if possible, provide it without judgment?

The combination of trauma, poverty and depression is very complex and daunting to address. John’s story reminds us that to effectively engage these tough issues we must engage with each unique person we encounter in our work and community life. In that engagement, we find our common humanity and possibly concrete ways to alleviate a bit of the suffering on the road to recovery-living.

To meet some of the awesome people I have interviewed in the past, go to rogersinhealth.org.

*Name changed to protect privacy

April 4, 2014 - 9:24am

DSM-5One of the primary changes in DSM-5 is that it now recognizes age-related aspects in each disorder and chronologically lists diagnoses that are most applicable to infancy and childhood first, followed by diagnoses that are more common to adolescence and early adulthood, and ending with those that are often diagnosed later in life. Within each disorder category, there are also modifications intended to help clinicians provide more accurate diagnoses that will lead to better treatment.

New Disorders

The fifth edition includes several new depressive disorders, including disruptive mood dysregulation disorder (DMDD) and premenstrual dysphoric disorder (PMDD).

The American Psychiatric Association, which publishes the guidebook, indicates DMDD has been included to address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children. DMDD provides a diagnosis for children up to age 18 years who exhibit persistent irritability and frequent uncontrollable behavior that may even be violent.

In addition, PMDD is now an official diagnosis that recognizes an extreme form of premenstrual syndrome characterized by strong emotional symptoms such as depression, anxiety, moodiness and irritability.

New Specifiers

While none of the core criteria for the symptoms of major depression have changed, the DSM-5 includes two new specifiers for depression. Now, the specifier “with mixed symptoms” allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the criteria for a manic episode. “With anxious distress” has also been added as a specifier because the presence of anxiety may impact treatment choices and the patient’s response.

Dr. Jerry Halverson, Rogers’ medical director of FOCUS and adult services, indicates the “with anxious distress” specifier may only be used with patients who exhibit at least two of the following symptoms during most of an episode:

  1. Feeling keyed up or tense
  2. Feeling unusually restless
  3. Difficulty concentrating due to worry
  4. Fear that something awful may happen
  5. Feeling loss of control of himself or herself

“The rationale for this is that the co-occurrence of anxiety with depression is one of the most commonly seen comorbidities in patients,” Dr. Halverson explained. “The addition of this specifier allows clinicians to indicate the presence of anxiety symptoms that are not reflected in the core criteria for depression or mania, but may be helpful when creating a treatment plan.”

He added that the specifier change from “post-partum” to “peri-partum” is also important. “This change in specifiers recognizes what clinicians and patients have known for a long time. Women can suffer from a major depressive order either before or after birth. Now, women who struggle with depression while pregnant can access the treatment they need.”

DSM-5 also includes guidance for the assessment of suicidal thinking, plans and risk factors, so that clinicians can address the prominent role of suicide prevention as part of a patient’s treatment.

Bereavement Exclusion Removed

In the past, any bereavement following the death of a loved one that lasted less than two months was not classified as a major depressive episode (MDE). The new edition, however, acknowledges that the grieving process may include an MDE that requires treatment just as with any other stressor. DSM-5 also removes the implication that grieving the death of a loved one may only last two months, which is important because most clinicians recognize that this grief usually lasts one to two years, and it offers guidelines to help clinicians distinguish between normal grief and an MDE.

“DSM-5 recommends that, even if it seems that depressive symptoms are an understandable reaction to a significant stressor such as the death of a loved one, the clinician should carefully consider the possibility of an MDE,” Dr. Halverson said. “DSM-5 also recognizes that the depressive symptoms related to bereavement-related depression respond to the same psychosocial and medication treatments as any other MDE. In fact, sometimes bereavement can precipitate an MDE and should be treated as promptly as possible. This exclusion enables clinicians to make a diagnosis of depression even during bereavement, with the hope that earlier treatment can be provided as needed.”

March 12, 2014 - 12:58pm

ADSM-5 OCD, PTSD, Anxiety few of the primary changes in DSM-5 include the reorganization of chapters for better groupings of disorders – including obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) – and the framework within those chapters that recognizes age-related aspects. This is important because it reflects the nature of some disorders within a patient’s lifespan. DSM-5 lists diagnoses that are most applicable to infancy and childhood first, followed by those that are more common to adolescence and early adulthood, ending with those that are often diagnosed later in life.

New Chapters for OCD and PTSD

“One of the most important changes regarding OCD and PTSD is that these two disorders have been removed from the anxiety disorder chapter where they were in the previous edition,” Bradley C. Riemann, PhD, clinical director of Rogers’ OCD Center and Cognitive Behavioral Therapy (CBT) Services, said. “Now, two new chapters surrounding OCD and PTSD (“Obsessive-Compulsive and Related Disorders” and “Trauma- and Stressor-Related Disorders”) have been created.” He says these changes were due to increased research and evidence demonstrating common threads running through a number of OCD-related disorders; for example, obsessive thoughts and/or repetitive behaviors.

Although Dr. Riemann says the change won’t really impact patients, the differences seem to reflect what clinicians have been seeing in their practices for quite some time. “These disorders can be related. That’s why DSM-5 places them sequentially in the guidebook to reflect their close relationship.” He added that what’s really important is that the DSM keeps evolving and getting more specific with each revision.

Obsessive-Compulsive and Related Disorders

Disorders in this chapter have features in common such as an obsessive preoccupation and repetitive behaviors. In addition, they reflect a relationship to one another in terms of overlapping symptoms and response to treatment. Hoarding and skin picking (newly recognized in DSM-5) fall within this category, along with hair pulling and body dysmorphic disorder (BDD), which is manifested by a negative preoccupation with body image that is focused on a minor or perceived flaw.

“This chapter provides more consistency among diagnoses, with fear, anxiety and avoidance being key,” Dr. Riemann said. “Now, the definition of obsession has also changed, with ‘urge’ replacing ‘impulse.’ Plus, new specifiers for tics and insight have been included. Patients no longer need to recognize that their obsessions or compulsions are excessive or unreasonable.”

Trauma- and Stressor-Related Disorders

PTSD is included in this new chapter, with criteria that differs significantly from those in the previous DSM. Now more explicit in regard to how an individual has experienced “traumatic” events, PTSD also includes a subtype for preschool children and four symptom clusters (re-experiencing the event, heightened arousal, avoidance, as well as negative thoughts and mood or feelings).

Anxiety Disorders

In addition to removing OCD and PTSD, DSM-5 now adds separation anxiety disorders and selective mutism to the chapter on anxiety disorders. (Selective mutism is a disorder in which a person normally capable of speech does not speak in specific situations or to certain people.) Previously, these diagnoses were provided primarily to infants, children and adolescents, but the fifth edition now recognizes their role even in adulthood. For example, children of adults with separation anxiety disorder and those with avoidance behaviors that occur in the workplace as well as at school are included in this chapter.

If you or someone you know is living with any of these disorders, call Rogers at 800-767-4411 for a free screening or request one online.

February 24, 2014 - 11:45am

DSM-5Commonly referred to as DSM-5 or “psychiatry’s bible,” the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (APA) provides revised criteria to be used by clinicians as they evaluate and diagnose different mental health conditions. Included in DSM-5 is a new chapter on “Substance-Related and Addictive Disorders.”

DSM-5 categorizes a variety of substance use disorders (SUDs) separately with criteria that provide a gradation of severity within each diagnostic category. Previous editions of the DSM identified two separate categories of substance use disorder, “substance abuse” and “substance dependence,” but the new diagnostic manual combines these disorders into one. The DSM-5 also makes a couple of changes to the diagnostic criteria for SUDs and adds a disorder not involving substance use to the chapter, Gambling Disorder. In so doing, the new edition has removed the terms “abuse” and “dependence” and has included the term “addiction” for the first time.

Why This Matters

The combination of the terms is important because “dependence” could be confusing to some clinicians and patients since the term is used medically to describe the body’s adaptation to a consumed substance. Thus, “physical dependence” and the DSM’s term “substance dependence” were often applied inappropriately. Also, many persons consider the term “abuse” to be stigmatizing and not appropriate to use in the description of a significant health problem.  While the term “substance abuse” still enjoys wide usage, it no longer is used to describe a specific condition within the DSM.

Dr. Michael Miller, medical director of Rogers’ Herrington Recovery Center, says these revisions are some of the most important changes to the guidebook. “This edition of the DSM moves away from a longstanding distinction between substance dependence and substance abuse, one considered a more severe condition and one a less severe one, with the two being rather mutually exclusive. SUDs are now referred to along a single continuum, and they are designated in the DSM-5 as mild, moderate or severe. Diagnostic criteria for former dependence and abuse have basically been combined. Now, two or more of 11 criteria need to be present for a diagnosis of SUD-Mild. For SUD-Moderate, it’s four or more, and for SUD-Severe, it’s six or more. In addition, the criterion of legal problems no longer appears and a new criterion in the diagnosis of SUD has been added to the DSM-5: craving.”

Some key criteria of SUD in the DSM-5 include:

  • Missing school, work or other responsibilities due to substance use
  • Building up a physiological tolerance to the effects of a substance
  • Craving the substance 
  • Failing to quit using despite multiple times of trying to do so

Dr. Miller explains that addiction is further defined by the American Society of Addiction Medicine (ASAM), and that ASAM published a major revision (also in 2013) to an important guidebook used by addiction clinicians. The ASAM Criteria is a revision of the utilization management and treatment planning guide first published by ASAM in 1991 as the Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders. 

“The new ASAM criteria really focus on the treatment aspect of addiction, rather than making a diagnosis and  trying to segment a diagnosis into a level of care. This newest ASAM Criteria includes updated criteria for ‘detoxification’ services, changing the title of those sections to ‘withdrawal management.” says Dr. Miller. The ASAM Criteria also includes chapters on the treatment of Gambling Disorder and Tobacco Use Disorder and sections on the treatment of special populations of patients, including pregnant women and persons in safety-sensitive occupations such as licensed health professionals. 

What is Addiction?

According to the ASAM, “Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

Furthermore, an addiction is defined as a “primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

Other Key Changes

DSM-5 also includes the addition of diagnostic criteria for conditions not previously included in the DSM, such as cannabis withdrawal and caffeine withdrawal. In addition, it removes the concept of “polysubstance dependence” as a separate disorder.  Including Gambling Disorder in the chapter on “Substance-Related and Addictive Disorders” is also a major change, in categorization of conditions and in the thinking about addiction. To this extent, the DSM and the new ASAM definition are aligned in viewing that addiction involving gambling is best understood not as an “impulse control” problem as the DSM had previously viewed it, but truly as a part of the spectrum of addictive disorders. This change within the DSM reflects increasing evidence that some behaviors – like gambling – can activate the brain reward system with effects that are similar to those of drug use. Other substances included in DSM-5 are alcohol, hallucinogens, opioids, sedatives/analgesics, stimulants and inhalants. Nicotine as a substance to which one can develop addiction is featured in the DSM-5, but the disorder associated with this drug has been renamed as Tobacco Use Disorder.  But, other than adding the new criterion of craving and removing the criterion of legal problems related to substance use, the wording for the other 10 diagnostic criteria for SUDs has not been revised from the previous edition of the DSM.

How to Get Help from Rogers 

If you or someone you love is struggling with addiction or any mental health condition, you can call Rogers Memorial Hospital at 800-767-4411 for a free screening, or you can request one online.

 

January 29, 2014 - 10:37am

Teen SuicideTeenagers are inundated with expectations in their homes, schools and social lives leading to an estimated half a million attempting suicide each year. It is not uncommon for teens to experience varying degrees of stress, self-doubt, pressure to succeed and worry about their future. Unlike adults, teens struggle with the ability to look at life’s stressful events as temporary. For some, a series of stressful events may lead to a belief that the unhappiness is an overwhelming burden that will go on for the rest of their life. As time goes on they may begin to feel depressed and anxious. At moments, suicide may feel as if it is the only viable solution to their problems and stress.

Common stressors teens experience can include: increasing demands at school, bullying by peers, managing romantic relationships, facing peer pressure to use drugs or alcohol, becoming increasingly independent from their parents and the pressures of finding a job or preparing for college.

Parents should be aware of some of the following signs of teen depression:

  • Significant changes in eating and/or sleeping habits
  • Withdrawal from friends, family and regular activities
  • Feelings of worthlessness, sadness or low self-esteem
  • Neglect of personal appearance or complaints about physical illness (headache, stomachache, etc.)
  • Persistent boredom, significant difficulty concentrating or a decline in the quality of school work
  • Loss of interest in pleasurable activities
  • Thoughts of death
  • Intentional self-harm

Signs you may see from a teenager who is planning to commit suicide (may include, though not limited to):

  • Talking about being a bad person or feeling empty inside
  • Giving verbal hints with statements such as: “Nothing ever works out for me. Everyone would be better off without me. I can’t take it anymore.”
  • Giving away possessions, cleaning his or her room, writing goodbye letters or posting farewells on social media
  • Becoming suddenly cheerful after a period of depression

In general, what should you do if you think that a teen close to you feels suicidal?

Ask them directly whether or not they have been thinking of killing themselves. People often feel uncomfortable talking about suicide, but doing so may save your loved one’s life. It is a myth that talking about suicide “puts the idea” into someone’s head. People who feel suicidal want to know that someone cares and will listen to their pain. Always take statements of wanting to die seriously. Do not leave your child alone.

Seek help immediately. If your teen states that they want to die or if they have thoughts about suicide, seek help from a qualified mental health therapist who can help identify and problem-solve your child’s needs.

With support from family and appropriate treatment, children and teenagers who are suicidal can go forward to feel hopeful and live productive and happy lives. If you feel a teenager you know is exhibiting some of these signs, Rogers Memorial Hospital can help. Our inpatient and day treatment programs provide a safe environment where teens can work on stabilizing their symptoms and identifying ways to manage their emotions when feelings of hopelessness arise.

To schedule a free screening call 800-767-4411 or request one online at rogershospital.org.

The following resources also provide information on teen depression and suicide:

January 16, 2014 - 12:14pm

Bradley C. RiemannBrad Riemann, PhD and clinical director of Rogers OCD Center and CBT services spoke with WUWM in Milwaukee on severe obsessive compulsive disorder. The good news, he shares, is that OCD is treatable even at its most severe level.

Last month Rogers opened an expanded our adult residential OCD Center which has the capacity to treat up to 16 percent more patients. The OCD Center is the anchor of Rogers full continuum of OCD services for children, adolescents and adults. In addition to residential OCD treatment, we offer partial hospitalization and intensive outpatient programs.

Hear Dr. Riemann’s full interview.

January 16, 2014 - 12:13pm

Jerry HalversonDepression and other mood disorders in young adults is the FOCUS of a new residential program at Rogers. With intensive psychiatric evaluations and medication management, the program builds on the strong foundation set by Rogers other residential treatment programs and strong evidence-based care.

Jerry Halverson, MD medical director of adult services at Rogers will lead the program.

Read what Dr. Halverson had to say to the Milwaukee Business Journal.

January 16, 2014 - 8:50am

New residential program FOCUS builds on clinical expertise

Losing interest in activities, withdrawal from family and friends, and sadness can be part of the daily struggle when fighting severe depression or other mood disorders. Behavioral activation – a major component of treatment in a new residential program at Rogers -- addresses these struggles.

Building on Rogers’s foundation of evidence-based care through cognitive behavioral therapy (CBT), on February 10, Rogers opens FOCUS, a residential program for young adults with depression and other mood disorders. For these patients experiencing a difficult transition to adulthood, behavioral activation is one key building block toward recovery.

But what exactly is behavioral activation?

As a treatment for depression and other mood disorders, behavioral activation is based on the theory that, as individuals become depressed, they tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms. The goal of treatment, therefore, is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood. Many times, this includes activities that they enjoyed before becoming depressed, activities related to their values or even everyday items that get pushed aside such as:

  • Exercising 
  • Going out to dinner 
  • Improving relationships with their family members 
  • Working toward specific work-related goals 
  • Learning new skills and activities 
  • Showering regularly 
  • Completing household chores

It is also important to examine sleep routines and eating habits and work toward normalizing these, as sleep and diet often change when individuals become depressed.

To assist with learning about how an individual’s activities affect his or her mood, with behavioral activation individuals are often asked to complete activity monitoring. This involves having the individual write down which activities he or she completes throughout the day (or week), with mood ratings for each activity. This allows the treatment provider to identify patterns in behavior, including avoidance, and to help increase engagement in behaviors that are related to improvements in mood. Often, additional strategies are needed to help individuals remember to complete assignments, gain the necessary skills to do various assignments and work toward their goals, while at the same time managing the uncomfortable emotions that may arise during different activities when one feels depressed.

Throughout treatment, increasingly challenging activities are assigned as the individual experiences improvements in mood and engagement in specific types of activities.

Watch for more information on the new FOCUS residential program. For a free screening for any of Rogers programs, call
1-800-767-4411.

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