I was just recently at LHI. Most of the staff was very kind and considerate. However, some of the staff, and I won’t name names, were passive/aggressive and took out their anger on the “clients”,- “patients” in underhanded ways. It seemed like the weaker you were, the more you cried and were in need the more you were liked and coddled by the staff and the other clients (patients) for that matter. As I got healthier and stronger, and voiced my opinion about agreeing and/or disagreeing with things, such as my own treatment plan, or the level of censorship we had to deal with, the more “business” I got from staff. If you’re looking just for “refeeding” it’s the place to go. They will fatten you up for sure, at a much quicker rate than they discuss with you in the beginning, you have NO SAY in how fast you will be gaining weight, and it hurts, it hurts a lot. I was constantly trying to work with the nutritionist to slow down the process so I could feel more comfortable, I just couldn’t take the pain and I was there 5 weeks before being discharged, that’s a long time! The nutritionist knows a lot about nutrition but she’s not a great “listener” and had many of her facts about me wrong from the get go, just from one short conversation with me on my first or second day. Once she got an idea in her head, there was no going back……….you have NO SAY in your goal weight, you have NO VOICE on the team, be advised, you are not part of the team, you are just the patient. Do as they say, say what they want, and you will be fine there. Don’t be yourself, don’t have an opinion, or god forbid voice one. DO NOT use any ED language or words such as EXERCISE, or you will be booted out, if you’re frustrated, learn to journal NEVER express yourself out loud, no good will come of it, you will be re-directed, and left to feel even more frustrated. Just learn to behave as they want you to and your time will go slow and steady. Also, beware the therapist, who is very good, and you will like to share with…………she also shares the hat of administrator and if you get into any trouble there she is the one who will sit you down and threaten to kick you out…….so much for patient/therapist trust?! Personally, I’m still pulling knives out of my back………..and having a lot of trouble trusting any new therapists I’ve met.
At LHI I never actually acted on any SI urges so I’m not sure if/how you would be “punished”. I have a feeling if someone did self injure, they would probably require the patient to make up a safety contract with their case manager and if they weren’t able to follow it, I’m pretty sure they’d be asked to leave. I don’t have any evidence that this is exactly how it would go, I’m just making an assumption. It would also probably depend on the situation – how serious was the injury, was it an attempt at anything worse, what triggered the patient to self injure, do they feel safe at the program, are they working closely with their OP therapist on this issue, etc.
Here’s my review, I hope it’s helpful!!
When were you there:
April – June ’11
Describe the average day:
Arrived at house at 8am, filled out mood monitors, weights on Mondays and Thursdays I think, 8:30am started to portion meals, 8:45am breakfast, group, 10 minute break, 10:45am snack, group, short break, 12:45pm lunch, group, leave house around 2:15-2:30pm
What were meals like?
One staff sat with us at every meal and snack but did NOT eat. This felt weird at first but you get used to it. For challenge meals (I think every Tuesday and Thursday.. I don’t totally remember) staff actually did eat with us so it made it a little easier to see that they had to eat it too!
What sorts of food were available or served?
I think they were pretty good at working with food allergies and vegetarianism but I can’t say for sure because I didn’t have to deal with that. Breakfast was generally yogurt, granola, cereal, fruit, bagels, toast, english muffins, cream cheese, peanut butter, butter, 1% milk, coffee, juice, etc. Snacks were fruit, string cheese, cottage cheese, Goldfish, Fig Newtons, etc. Lunches were generally sandwiches/wraps and/or soups and veggies. Obviously all depending on your meal plan.
Did they supplement? How did that system work?
Yes. If you can’t finish your meal/snack in the time allotted, you were given a certain amount of Ensure and staff would sit with you. Obviously, you could refuse, but if it became a problem, you would probably be stepped up to a higher level of care.
What privelages are allowed?
It’s PHP so obviously there’s a lot of time not spent at program. While you were at program, you could use your cell phone at breaks. There were two smoke breaks. Idk, I can’t really think of any other privileges you’d have at a PHP…
Does it work on a level system?
Nope.
What sort of groups do they have?
Yoga (more like relaxation), Mindfulness, Art Therapy, DBT, CBT, lots of process groups, Nutrition, umm I can’t remember the rest. But they were pretty good.
What was your favorite group?
Art Therapy
What did you like the most?
The people. Specifically my case manager, Liz.
What did you like the least?
Sometimes I felt like it was unrealistic to completely avoid any food, diet, weight-related talk at the table. I understand a little bit is necessary but sometimes it felt a little ridiculous.
Would you recommend this program?
YES.
What level of activity or exercise was allowed?
It was pretty individual. The general recommendation was no more than 40 minutes of exercise a day (and they were saying exercise = walking, not like elliptical or running or anything) and that’s with NO exercise restriction. I like to do yoga and one class is 90 minutes so obviously that went over but in general they asked you to keep it at 40 min.
What did people do on weekends?
Whatever you want. You are FREE!
Do you get to know your weight?
Case by case. Weights were done blind but some nutritionists would tell you if you wanted to know (and they felt it was appropriate).
How fast is the weight gain process?
I dunno :/ sorry
What was the average length of stay?
I think around 6 weeks.
What was the average age range?
18+. When I was there, most of the group was around 18-25ish but there were a few older.
What kind of aftercare do they provide? Do they help you set up an OP treatment team?
Yes. Most people already have an OP treatment team when they come in, I think, but definitely if you didn’t have one, they would help you out. They had good referrals and I found a good OP nutritionist through them.
How many patients in PHP or IOP?
I think the most they could have was 9 or 10..
“Laurel Hill Inn usually will accept 17 year olds if they seem mature enough to come and there is space. The exercise for people who are normal weight or close enough to it is 20 minute walks, twice a day. Keep in mind though that if it’s too hot, too told, looks like it will rain, and so on there won’t be a walk, so it’s generally more like once a day or never during the summer. There’s yoga too, which is more relaxation-based than exercise.
For your passes, they know and expect that you’ll be getting more than the weekday amount of exercise just from walking around the city a bit or whatever you decide to do, and that’s fine. As long as it’s like, natural walking around and not a pass to work out at the gym it should be okay. Of course the whole point is being responsible for yourself when they send you off on your own, so you can really do whatever but then have to deal with it if you’ve lost weight Monday or aren’t improving mentally.
Also, they can drop people off and pick them up from the T station for weekend passes, which means you can take the subway into Harvard Square or Boston, but the drop-off and pick-up times generally mean shorter passes than for people with independent transportation. So horseback riding would probably be okay with the staff people but I don’t know that you could realistically get to a horse farm, do your riding, and get back all in one afternoon. When you’re on “Level 3″ you can leave for full days though.
It’s not great…I mean the reality is that you’re mostly confined to a center and answering to counselors all the time and stuff…but I would say don’t focus too much on making it perfect, with horseback therapy and great passes and the optimal amount of exercise, because in the scheme of things it’s just for a month or two and you have the rest of your life to be independent afterwards. So yeah…try to focus mostly on the major reasons that you came in the first place. And I’m saying this because I didn’t do that at all, and looking back I wish I had.”
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I can answer some of these-
LHI does try to indivdualize as much as possible for health/dental issues as much as they can but sometimes they cannot bend the rules- I am sure if you talk with them they will try their best.
I am not sure about the gatorade thing. But here is the thing- IF you are ortho- and ONLY if, you will be given 8 ounces to drink after vitals. You may be able to drink water if you explain your dental issues.
Gatorade is not a daily part of the menu and it is only once a day if you are ortho.
You can work with the dietician regarding crunchy foods- She can most likely help you pick out things that are soft foods that will offer you the same nutritionally. But realizing this is a residential and you won’t always be able to avoid eating everything that is harder as you do go out to dinner once a week and no one can predict what the menu will be.
As far as refusing food, I wouldn’t recommend it- try to go in with the mindset that you are not going to do this as much as possible. They have little tolerance to be honest. They understand we struggle but don’t tolerate it much and will ask you to leave. They do expect that you will reach out and ask for help when you feel like restricting instead of acting on it.
You aren’t allowed in rooms much at all. Basically only in mornings when getting ready and at night, before bed. There are day rooms and tv rooms during down times and laptops are allowed in those areas but when I was there, they only got internet in the kitchen/art room.
They do search your rooms and it is only randomly and to keep you safe- they only did it once when I was there, it wasn’t bad at all.
The goal weights are individual and you’ll work one on one with Carole. She is very reasonable but will not let your ED decide.
She wants you healthy.
Hope this helps you.
I was just recently at LHI. Most of the staff was very kind and considerate. However, some of the staff, and I won’t name names, were passive/aggressive and took out their anger on the “clients”,- “patients” in underhanded ways. It seemed like the weaker you were, the more you cried and were in need the more you were liked and coddled by the staff and the other clients (patients) for that matter. As I got healthier and stronger, and voiced my opinion about agreeing and/or disagreeing with things, such as my own treatment plan, or the level of censorship we had to deal with, the more “business” I got from staff. If you’re looking just for “refeeding” it’s the place to go. They will fatten you up for sure, at a much quicker rate than they discuss with you in the beginning, you have NO SAY in how fast you will be gaining weight, and it hurts, it hurts a lot. I was constantly trying to work with the nutritionist to slow down the process so I could feel more comfortable, I just couldn’t take the pain and I was there 5 weeks before being discharged, that’s a long time! The nutritionist knows a lot about nutrition but she’s not a great “listener” and had many of her facts about me wrong from the get go, just from one short conversation with me on my first or second day. Once she got an idea in her head, there was no going back……….you have NO SAY in your goal weight, you have NO VOICE on the team, be advised, you are not part of the team, you are just the patient. Do as they say, say what they want, and you will be fine there. Don’t be yourself, don’t have an opinion, or god forbid voice one. DO NOT use any ED language or words such as EXERCISE, or you will be booted out, if you’re frustrated, learn to journal NEVER express yourself out loud, no good will come of it, you will be re-directed, and left to feel even more frustrated. Just learn to behave as they want you to and your time will go slow and steady. Also, beware the therapist, who is very good, and you will like to share with…………she also shares the hat of administrator and if you get into any trouble there she is the one who will sit you down and threaten to kick you out…….so much for patient/therapist trust?! Personally, I’m still pulling knives out of my back………..and having a lot of trouble trusting any new therapists I’ve met.
What happens first?
Once you inquire about treatment, you will talk to the admission director. He will determine what level of care based on a phone intake with some questions, would be best suited for you. Then they go through insurance and such, and request clinical information from your doctor and team if you have one (this consists of blood work and to make sure your medically stable) Then you will do a more formal interview, for people that live close you actually go to LHI and do an assessment with there clinical director (whom is amazing and nice!!!), and that gives them a more accurate picture on treatment plan for you.
Resi tx:
The house:
LHI is a small facility, and they only take 9, 10 at the most for treatment. I liked this a lot, because tx was indiv and you didn’t feel like a number. Everything is done within the house, which is really homey and comfortable. Most rooms are doubles, but there is one single room. There are a few rooms that have bathrooms within there rooms, but no more then two people share a bathroom- so there’s many bathrooms in the house
Groups:
There are groups every day, generally they keep you pretty busy, however there is some down time within the evenings. Groups there consist of DBT, CBT, Relapse Prevention, Interpersonal Effectiveness, Positive Psych, Risk Taking, here and now, process groups, yoga, art therapy, body image, nutrition, and Team building.
Your team:
Your team consists of a therapist, case manager (which is a licensed social worker), a nutritionist, & psychiatrist. You meet with the therapist (everyone has the same one and I can’t talk more highly of her!) 2x a week, your case manager 3-5x a week (depends on family therapy or indiv cases), nutrition (1-2x a week) and psychiatrist (1x a week or as needed). Staff are so nice that you can generally ask to see your case manager or nutritionist for a brief question or check in if things come up. There are also about 20+ counselors that are around both day and evening, that offer check in’s, hang out, some run groups, etc. There is one overnight person- there AMAZING!!! Truly I don’t know how they did it- but the staff consists of 30+ of the most supportive, caring people I have ever met! They were always there when I needed them, or even when I thought I didn’t!! I truly can say each one of them impacted my life and I think of them all the time!
Meals:
Meals are done on a exchange system at LHI. So you work with your nutritionist to determine what meal plan you need. Some are on maintenance plans, some are on weight rehab plans- it is truly indiv. Based on your meal plan, you make a menu the week before (there is a group for this) and you work off of your exchanges and the foods they offer. They have a wide array of foods to pick from and can accommodate a vegetarian diet.
Breakfast items included (bagels, toast, many kinds of cereal, muffins, juice, fruits fresh and dried, milks (all various), nuts, oatmeal’s, cottage cheese, eggs, quick breads, etc.) Lunch items (usually sandwich items so all deli meats they even had veggie slices, cheeses, breads, wraps, tuna, fruit, salads, veggies, cottage cheese, milks (all various), etc.) Dinners were catered- so you could plain jane and order fish, tofu, chicken, or beef with a grain and veggie or you could choose the restaurants options (there was like 10 various meals). Grains offered for dinner included rice, barley, pasta, quinoa, squash, breads, etc. Veggies- anything and Proteins-as I mentioned above including beans.
Snacks- anything from crackers of various, cheese and crackers, pb and crackers/fruit, fruit, cottage cheese, chips, etc.
Meals are at 8:00, 12:00, 5:00, snacks were at 10, 2, 7. Meals and snacks are served at a formal dinner table and 2 staff members would sit with us. Meals are timed at 30 minutes, and snacks at 15 minutes- staff lets you know when you have 5 minutes left. On Monday nights, there is group cook- where everyone participates in cooking dinner-there is always a vegetarian option to the meal. On tues is the restaurant outing (you have to be approved via level though), which is chosen by staff and sometimes clients (if they are dcing soon). The outing can be difficult for many people at first, but in time becomes easier- and you have staff to support you and make it so much more at ease! The staff that go are funny and fun to be around!
Dessert-yes there are desserts offered- typically for those on weight rehab plans. Everyone does do a dessert on Tues pm in place of PM snack, so you do have exposure to it.
Gatorade-all this Gatorade talk on these postings haha. You do have to have Gatorade in the AM before breakfast its 4 ounces. IF you are orthostatic after breakfast (they do vitals every morning) then they have you drink 4 ounces again. If you continue to be ortho throughout the day they don’t make you drink it.
Caffeine- that’s a no go. Be ready to be on Excedrin with caffeine if you are addicted to caffeine!
Meal replacements- if you don’t finish your meal staff will offer a replacement. LHI rule is 100% compliance, so they do expect you to take the replacement for what you didn’t consume, however they are people and do understand things come up. If it is a pattern I have seen people be put on contracts or told they would dc if they continued to have meal incidents. At first I thought this was harsh, but really if you want to get better you got to do the work and its also really hard for other clients to witness you restricting meals when they are trying hard.
In addition to exposure dinner outings- you have opportunities to go to Whole foods at the salad bar with the nutritionist and cook dinner as well. Every week you gain more experience with portioning your own meals, from gradually decreasing measuring to eye balling.
Bathrooms-
Bathrooms are locked and are opened by staff. If you have to use the bathroom after a meal or snack within a certain time period you have to count- you master this quickly Staff opens your personal bathrooms in the AM and PM for morning and bedtime routine. If you have purging concerns, staff is always there for check ins or such.
Medical:
When you get to LHI you will be assessed by the MD and most likely get blood work. She is off site, so LHI staff drives us- most of the time there is always someone going on the trip. You will see her until it is no longer necessary, deemed by your team and doctor.
Outings:
LHI does a great job of offering exposure/experiential work to their clients from dinner outings to weekend outings. Each weekend you elect as a community were/what you would like to do- Fridays were usually pottery painting and sat/sun was barnes and noble, arts/crafts store, movies, bowling, build a bear, etc. The weekends are more low key, with the exception of morning process groups, and group outings- they were free. So you have a lot of down time. There are visiting hours, but most people go out on passes. You have to request passes (both with people and solo) and they get approved by the team. It’s Boston, so there is a lot to do and public transportation is really easy. They do have drop off/pick up’s at the subway on the weekends for clients that choose to travel via that.
Levels:
LHI does work off a level system. There are three levels. Everyone starts on level 1, and it typically lasts a minimal of a week. On level 1 you have to be in eye sight of a counselor. After a week or if you are medically at risk it may be longer, you get moved up to level 2. On level 2 you can attend dinner outings, go to your room on specific hours, not have to be in eye sight, begin to portion some of your snacks/meals, just more freedom in general. Clients can request level three.
Exercise:
Exercise is limited at LHI to everyone. We do yoga 3x a week and the instructor is amazing. If granted we have walks 2x a day, which we take as a group and counselor, and they are either 30 or 15 minutes depending on the weather. In the winter you can choose to do yoga or other tapes for this time. You must be granted walks, which is usually depending on your nutritionist and your weight stabilization/rehab.
Weight gain:
Those on weight rehab usually get put on a gradual weight rehab program. LHI rec 1-2 pounds a week for weight gain and above the 95% according to research and such.
Family Therapy:
You and your case manager determines what you want family therapy to look like. Some opt out, some participate occasionally, some do it weekly. Family therapy can be done over the phone or in person.
What can you have there?
You are allowed I-pods, phones, laptops, sharps (there locked up though). Laptop and phone use during the week is limited to before breakfast and after dinner for laptop and before breakfast and after 3 for cell phone and you can’t use them in groups. Your truly busy during the day with groups and appointments anyways, that you can’t use them. There is one community computer and it does have a printer. There is a phone you can use at LHI as well. Mail is received daily. Your screens must be faced out with laptops, to insure that you are being safe. Sharps are locked (tweezers, hair strengtheners, razors, etc for obv reason and you just request them in the morning).
Medication-
LHI uses CVS for there main pharmacy. You are responsible for all medication, they lock them in the med closet and during med times you go and request them and take them indiv but in view of the counselor. It is JACHO accredited so there really strict about signing out meds and such- and if you refuse meds u have to sign.
Average length of stay-
Well I was there a long time, prob longer then the average, but the min is 30 days. I would say most girls stayed 6 weeks on average to 8.
Can you know your weight?
I know this is always the million dollar question. It truly is dependent on you and your team/nutritionist. I knew my weight, but towards then end I didn’t- it was probably best. You get weighed 3x a week M, W, F in the morning.
Transition care:
LHI does offer a day program and and IOP program. I actually attended the day program as well, for 2 weeks, but then needed different care- so I can speak for it.
Day program-
Held in a different house, it too only houses 10 people. It does not accommodate living, so you need to find your own residence or commute from home. The house, like resi, is very homey and nice! Its held from 8-2 pm M-F. A lot of the girls from resi transition to day, however there are individuals that come just for day program that never went to resi.
Team- your team consists of a case manager (which you see 1-2x a week), nutritionist (which you see 1x a week). They are big on corresponding with your outpatient team and many people often or sometimes leave during the day to see there outpatient team if there local.
Meals:
It is still based on exchange system, which is according to your team. The major difference is at day there are limited options, and you don’t pre plan your menu- well only your protein and bread option for lunch. They usually put out 3-4 options of each exchange at meals and snacks. Meals take place at a dining table, there more informal then resi. You can see the clock, but the counselor still calls 5 minutes. You are allowed caffeinated beverage in the morning, then decaf tea in the day.
Groups:
Groups consist of many process groups, DBT, CBT, body movement, body image, yoga, art therapy.
You are a lot more open in day, with naming specific behaviors or difficulties with the group; as it is encouraged.
Weights:
You get weighed 2x a week in day program in the morning. Same applies its up to you and your team if you can know your weight or not.
Bathrooms:
Are not locked. But if you do have to go to the bathroom after meals and snacks, you do count.
Parking:
Those that commute there is off street parking.
IOP-
I can’t really speak specially for IOP because I never attended; however I did have many friends attend. SO I do know that its from 3-7 ish. They do have similar groups offered and people bring there own meals, sometimes go out, etc for dinner. It’s held at the house that day is. There is fewer staff members, and you still have a case manager and nutritionist whom work alongside your outpatient team.
I hope that helps. I am willing to answer any other questions people have! Again I can’t talk more highly of this place. I know everyone has there own opinions, and there was defiantly some bumps along the road and some people that are harder personality wise to click with, however LHI is just surrounded by people who genuinely care about their clients well being!