Youth Substance Use Disorder Treatment and HUB Program

By: Granite Pathways

New Hampshire has a powerful new weapon in the battle against opioid addiction with the opening of the state’s first-ever residential treatment center for young people by Granite Pathways, an agency that supports individuals with mental illness and substance use disorders, disabilities and other barriers to long term economic well-being. This critically important work will be done as a continuum of care in partnership with community providers throughout the state.  

At the ribbon-cutting festivities on October 30th New Hampshire Governor Christopher T. Sununu, New Hampshire Department of Health and Human Services (DHHS) Commissioner Jeffrey A. Meyers, and officials from Granite Pathways acknowledged the creation of a 36-bed youth treatment center on the grounds of the Sununu Center in Manchester that will be operated by Granite Pathways.

The fight to end the crisis of opioid addiction in New Hampshire can only be won when the entire community of providers and families work together,” said Craig Stenning, Senior Vice President of Granite Pathways “We are grateful to Governor Sununu and DHHS Commissioner Meyers for leading this effort to ensure that every state resident struggling with addictions has the resources they need for recovery and seamless transition back to the community.” 

The new Youth Residential Treatment Program is the first of its kind in New Hampshire. “For so long we’ve been a state without an adolescent treatment facility,” Governor Sununu said at the ribbon cutting . “Today’s ceremony marks a major milestone for our state, offering comprehensive treatment services to help youth suffering with substance misuse begin the road to recovery and self-sufficiency.”

The program will serve youth ages 12-18 using a range of evidence-based clinical and support interventions. Established partnerships with statewide providers ensure that when young people leave the facility they will have access to a comprehensive array of community-based services as they continue their process of recovery.

A guiding strategy of Granite Pathways is skill-building to promote an internal belief in self-competence—personal branding, values clarification, decision making, exploring interests and developing personal attributes and strengths. The program will provide youth with the tools they need to negotiate barriers to recovery and identify new sources of engagement and interest to ensure a happy and productive future. 

Hallmarks of Granite Pathways treatment and care include --

  • Trauma Informed--Because young people seeking treatment are likely to have experienced trauma, Granite Pathways creates an environment where participants feel safe and staff believe in resilience and the ability of individuals to heal.
  • Family and Youth Driven--Consistent with its system of care values and principles, Granite Pathways engages young people and their families in guiding their own service planning and encourages them to make decisions about their own lives.  
  • Strength Focused--Clinicians and staff work with each youth to identify strengths, skills, interests and individual needs that will be incorporated into each individual treatment plan.
  • Aspirational--Motivational therapies encourage youth to envision and aspire to a future in which dreams and goals are realized.

The Granite Pathways program model incorporates the four major dimensions identified by SAMHSA (Substance Abuse and Mental Health Services Administration) as key to recovery support. These include (1) Health, defined as learning to overcome, manage or successfully live with symptoms and making healthy life choices that support physical and emotional well-being; (2) Home, defined as a stable and safe place to live; (3) Purpose, defined as meaningful daily activities, such as job, school, volunteer work or creative endeavors and increased abilities to lead a self-directed life of meaningful engagement with society; and (4) Community, defined as relationships and social networks that provide support, friendship, love and hope. 

The Youth Treatment Program multi-disciplinary recovery team includes registered nurses, licensed social workers, clinical case managers, and psychiatric caregivers who can initiate medication-assisted treatment (MAT) when indicated. Certified recovery support workers, many of whom are in recovery, serve as peer counselors and are uniquely suited to serve as mentors.

Granite Pathways clinical staff understand the complexities of addiction and its co-occurring factors and provide appropriate care. Among adolescents nationally, 62 percent of males and 82 percent of females entering substance use treatment have a co-occurring psychiatric disorder. According to NAMI New Hampshire—"Without appropriate, integrated treatment for mental health and substance use disorders delivered simultaneously by one provider or team, adolescents and young adults with co-occurring disorders are more likely to have negative outcomes.” 

The residential component of the program allows families to participate more fully in the recovery process. Intake coordinators meet with youth and their families upon admission to discuss proposed role, which will change as appropriate based on individual needs and wishes. Parents are the primary decision-makers in their children’s lives, and even when legally limited, strong family engagement promotes optimal youth engagement. The program features a robust family engagement, treatment and support plan that includes removal of barriers to participation such as transportation and child care. All family members, including children, are invited to take part in family-based activities.

Residency allows for youth to communicate with peers who are also struggling with addiction. “What has always been lacking for adolescents has been exposure to other kids of the same age who are struggling with the same things,” said Kiersten Clark, a Granite Pathways program consultant. “When you are 16 you think you are invincible. Youth have to hear from other young people about the dangers of overdose, and the impact of addiction on them and their families.”

As school connectedness is central to prevention and recovery, the program incorporates contact with school personnel to plan for school work while the student is in treatment. Clinical case managers work with young people and their families to identify school-based support—a teacher, guidance counselor, or peer support person—with whom the resident can maintain contact during treatment. Students can be tutored on premises. Outdoor physical activities, yoga and meditation are scheduled throughout the day.

Youth recovery is enhanced by online learning tools and resources for individualized and group support. These include:

  • GetReady!™ and PrepNOW™--Interactive, Web-based curricula that provide work-readiness training and preparation for continuing education and employment.  
  •  --Weekly call and online video conferencing for peer support
  •  --This popular site includes features such as an online forum where residents and family members can discuss relevant topics and get access to resources that address a broad range of potential questions or needs.
  •  --This online recovery program allows individuals to participate in 12-step meetings online.

The program will offer opportunities for youth to participate in a variety of educational and workforce development programs. Module-based programs for soft skills development, work readiness and college readiness will be available. Residents will have the opportunity to augment functional learning with aspirational experiences designed to invigorate and expand their sense of what is possible.  

We give youth the tools they need to be proud of their recovery,” said Donna Keefe, Director of New Initiatives at Granite Pathways.

In October Granite Pathways was named one of nine hubs in the state’s new “hub-and-spoke” system of care. Hospitals and community provider “hubs” serve as entry points into an integrated system of care that includes “spokes” including rehabilitation facilities, doctors, hospitals, mental health providers and housing agencies. The regional hubs provide screening, assessment for medical and social service needs and referral to area spokes. They are supported by a 24/7 emergency hotline and located within an hour’s drive of any state resident who seeks services.

The streamlined network of care is funded by a Federal State Opioid Response (SOR) grant of $45.8 million over a two-year award period. Under the plan, the state will expand medication-assisted treatment (MAT), recovery supports services, access to recovery housing, evidence-based prevention programs, workforce opportunities, and training and education for providers and people in recovery.

The hub-and-spoke system of care has shown great promise. A study by the Vermont Department of Health of the state’s hub-and-spoke system found that participants in treatment reported a 96 percent decrease in opioid use and a 100 percent drop in overdose incidences. None of the participants overdosed in the 90 days leading up to the study, compared to 25 percent who had overdosed in the 90 days before entering treatment. Participants reported an 89 percent decrease in emergency department visits and a decrease in family conflict and feelings of depression, anxiety and anger. Mark Levine, MD, Vermont’s health commissioner, has credited the hub-and-spoke system with saving hundreds of lives.

 “We are glad to be working with the Governor and the state along with the other hubs in crafting this new program for a robust and responsive mechanism to ensure that those in need of treatment for addiction are able to access the care that they need in a clinically appropriate setting,” said Stenning. “I commend the Governor and Commissioner Myers for their perseverance to make this new network come to fruition.” 

The hubs are Granite Pathways in Manchester and Nashua; Cheshire Medical Center in Keene; Lakes Regional General Hospital in Laconia; Littleton Regional Health Care; Concord Hospital; Androscoggin Valley Hospital in Berlin; Wentworth-Douglass Hospital in Dover; and Dartmouth-Hitchcock in Hanover and Keene. 

Granite Pathways is honored to work side by side with an outstanding community of individuals, advocates, government funders and providers who share a deep and abiding commitment to combatting the opioid crisis that is ravaging our state.