Raising children. Earning a living. Cooking, cleaning and paying the utility bills. Life's everyday stresses and responsibilities don't magically disappear when patients begin an addiction treatment program. Yet, effective addiction treatment requires all-out commitment, focused attention and new ways of living that take patience and practice. That's the challenge and beauty of outpatient addiction treatment says Al Updike, outpatient program manager at Hazelden's centers in Chaska and Maple Grove, Minnesota. "Outpatient care allows people to have one foot in the real world and one foot in treatment," Updike explains. Patients live at home, go to work or school, and care for their families. That means cravings and relapse triggers happen under real-world conditions—while socializing with friends, after a rough day at the office, or while driving by the liquor store. "Outpatient programs help people navigate those white-knuckle situations in early recovery, offering support, accountability, and the tools to work things through with a counselor and treatment peers," adds John Engebreth, director of clinical operations at Hazelden in St. Paul. The one-counselor model To best meet the emerging and increasingly diverse needs of treatment patients, Hazelden's outpatient leadership team in Minnesota has been working to refine and adjust programming. At the top of the patients' needs list: flexible scheduling and targeted care for women, men, emerging adults, individuals recovering from opioid addiction and other special-focus groups. The team conducted an eight-month pilot program at Hazelden in St. Paul built on the "one-counselor model." Patients stay with the same counselor throughout all phases of treatment rather than changing counselors at different stages of care. As patients progress through care, treatment becomes less frequent, eventually decreasing to one session per week. "From a clinical standpoint, our team focused on increasing the counselor-patient therapeutic alliance, supporting the patient's transition from clinical management to self-management, and fostering the patient's confidence in his or her recovery journey," Engebreth reports. In addition to providing continuity of care, the one-counselor model offers a high degree of patient involvement in determining the appropriate level of care, says Terri Hayden, executive director of Hazelden in St. Paul. "This approach meets the individual patient's needs so well," Hayden explains. "If a patient has progressed to the point of attending treatment one day per week but runs into some struggles or tough times, we can quickly adjust her treatment to three or four sessions a week—still with her same counselor—to accommodate her situation. The patient doesn't need to be discharged from one program and readmitted to another. She doesn't need to tell her story to a whole new group of people or worry about insurance coverage or figure out a new financial plan. We're there for her, with the level of care she needs, when she needs it." More growth and change ahead "Demand for outpatient treatment has increased dramatically," continued Hayden. "As health care reform unfolds, more people have access to insurance coverage for addiction treatment. The changes we're making to outpatient care allow us to double the number of patients we serve while adjusting the level and frequency of treatment over time to ensure each patient's successful, gradual transition from clinical care to self-care." From an operational standpoint, Hazelden's outpatient pilot program was designed to increase the number of patients served while further improving treatment outcomes and reducing overall program costs. Completed in August 2015, the pilot was successful on all counts, Hayden reports. As a result, all Hazelden Betty Ford Foundation outpatient programs in Minnesota are transitioning to the one-counselor model of care, including the adolescent and young adult program at Chaska. Expanding outpatient capacity remains a strategic priority across the entire Hazelden Betty Ford Foundation, said President and CEO Mark Mishek. In February, the Foundation opened the Betty Ford Center's first outpatient facility in Los Angeles. In June, a major expansion was completed at Hazelden's Maple Grove, Minnesota, outpatient center, and the soon-to-be-completed expansion and renovation of Hazelden's St. Paul campus includes new space for outpatient programming. While the Foundation looks closely at potential new outpatient sites on the West Coast and in the Midwest, the one-counselor model of care allows for increased treatment capacity at current sites without adding bricks and mortar. "By finding more ways to deliver the highest standard of outpatient treatment, we can provide help and healing for many more people still struggling with addiction," said Mishek.