2022 - 2023:
Rite of Passage Treatment Cycle

  OPEN OCTOBER 1, 2023
Program Running: October 1, 2022 - July 31, 2023
Maryland Medicaid Clients: Contact Innovative Clinical Associates*
Private Pay Clients: Contact Keely 
*ICA also provides psychiatry.  Private Pay clients will need to partner independently with a psychiatrist for medication support during the therapy program.  Stay tuned in October and November for intakes for BlueCross BlueShield or Aetna.

Overview
Treatment Supported Rites of Passage (TSROP) is a 10-month outpatient psychotherapy treatment option brought to you through a partnership between Keely Owens, LCPC, Experience Learning, Inc., Innovative Clinical Associates, and others.
TSROP is a psychotherapy modality based on the research-supported Transtheoretical Model of Change, and incorporating nature-based mindfulness techniques as well as healing strategies of ecopsychology and transpersonal psychology.  The TTM incorporates all of the techniques that have proven effective in outpatient psychotherapy (including but not limited to Client-Centered, CBT, DBT, Gestalt, Jungian/Insight, Art and Play Therapy, Trauma-Informed Care, Neurophysiological support, and Mindfulness).  Furthermore, TSROP is an ecopsychology-informed outpatient program, which both utilizes nature-based mindfulness techniques throughout, and is centered around the structure of a Rite of Passage.  What this means is that at the centerpiece of outpatient treatment (and roughly halfway through its 10-month course), the client will choose or create an experiential activity in order to focus the change that they are striving to accomplish.  Therapy will be structured to help the client prepare for, undergo, and then stabilize a particular change or shift in their lives.  The Rite of Passage activity symbolizes the fulcrum of this shift.  Clients may choose between experiential retreats (several suggested by this program, but clients are also provided to find their own, in concert with their own cultural and/or spiritual preferences), or create a self-designed ceremony to serve as the Rite-Of-Passage centerpiece of treatment.  Through a charitable-donation partnership with Experience Learning, Inc., as well as generous crowdfunding, clients with financial need will receive support to be able to participate in experiential retreats that may otherwise be cost-prohibitive.  Following the rite of passage, outpatient therapy facilitates the experience in order to build the insights, cognitive patterns, habits, and environments necessary to support long-term change.  
Read more about the Transtheoretical Model of Change and the Ecopsychology Rite of Passage.  

Who Is It For?

TSROP is appropriate for anyone seeking mental health treatment or supportive counseling who meets the following criteria:
   - Outpatient level of care (clients who need Inpatient, IOP, PHP, or Rehabilitation will be provided referrals)
   - Desire to undergo change of some kind (clients who feel they do not need to change, that others are the ones who need to change, or who are looking for stabilization rather than change, are not appropriate for this therapy modality).  Not sure whether this is you?  At intake and during the first few months of therapy, we will work with the TTM to assess whether you want to change, what you want to change, and where you stand in the change process.  At any point, clients can transition treatment to stabilization and will receive referrals to appropriate clinicians for continuous outpatient treatment.
   - Relative stability (clients who are currently undergoing certain kinds of crisis are not appropriate for this therapy model).  Crisis, itself, is often a Rite of Passage: it forces change upon us.  Many crises are so unsettling that they call for what is known as "Psychological First Aid" - support that is focused on grounding, protecting the nervous system from trauma, and seeking a foundation for stability.  Many crises also require significant logistical attention.  During this kind of crisis, a person does not have the bandwidth to focus on the introspective activities required for the intentional change of TSROP, and it can exacerbate unsettling and trauma.  However, there are other forms of crisis that are an indication of an internal "call to change", and are a good match for this therapy modality.  Oftentimes, TSROP is also a good therapy modality to approach after the dust has settled on a crisis: things have stabilized, but your life has changed and you haven't yet changed to match it and learn how to thrive in your new status quo.  Not sure where you're at?  Contact Keely for an assessment.
   - Oriented (TSROP is not an appropriate modality for clients experiencing a significant episode of psychosis, delusion, disorientation, or neurophysiological disturbance, because it utilizes a number of techniques based on symbols and metaphors, which can further exacerbate psychosis.  Similarly, it is not appropriate for clients who are chronically under the influence of substances that alter orientation to reality.  A chronic disorder with intermittent psychotic episodes can work with this modality provided that there is an adequate plan in place for identifying and managing psychosis.
    - Adults and Young Adults (TSROP is not appropriate for children or early adolescents).

TSROP can and has helped people who have depression, dysphoria, anxiety, suicidality, trauma-related disorders (including PTSD), personality disorders, complex bereavement, adjustment disorders, identity challenges, OCD, ADD/ADHD, family, relationship, and marital challenges, multicultural issues, gender and sexual identity issues.  

TSROP is currently available to Medicaid clients and to Private-Pay clients.  The cost of therapeutic retreats is subsidized based on need, and can be entirely covered.  Money should not be an obstacle for any client who is willing to put in the work toward change. 

Curious whether TSROP is right for you? We are now accepting intakes for 2021-2022, and we are always accepting inquiries.  Contact Keely for more information. 

What Does Treatment Look Like?

TSROP involves several phases of treatment.  The exact length and timing of each phase will vary based on when you do your intake, what stage you are at in your change process, and what retreat or self-designed ceremony you choose to work with.  However, all treatment plans will conclude by August 1, 2022, and intakes/re-intakes for the next round of TSROP will not occur until October 1, 2022.  Clients who need continuous mental health support will be provided with referrals to outpatient care during that period of time.

​Phase 1: Intake
Phase 2: Contemplation
Phase 3: Preparation
Phase 4: Severance
Phase 5: Retreat (Threshold)
Phase 6: Reincorporation
Phase 7: Action
Phase 8: Graduation
Phase 9: Independence

Informed Consent

Please read the following, and ask questions as necessary.  You will be asked to sign a document indicating that you understand and agree to the information below upon beginning the TSROP program, given that Treatment Supported Rite of Passage is a specific modality of Outpatient Mental Health Treatment provided in the State of Maryland.

I understand that TSROP is an Outpatient-only, mental health counseling service provided directly by Keely Owens, LCPC.  I understand that Keely Owens, LCPC, is licensed to practice in the State of Maryland only, and that services must be provided within that state unless State or Federal exceptions are granted by law of practice.  I understand that Outpatient sessions will be conducted through a combination of Zoom telehealth and community settings, including outdoor settings. 

I understand that TSROP does not provide psychiatric services and is not suitable for all clients.  I understand that I will be assessed for my suitability for TSROP during my Intake.  TSROP will not discriminate based on race, culture, religion, gender, sexual orientation, or socioeconomic status.  My suitability for TSROP will be assessed based on clinical considerations including my developmental stage (TSROP is not suitable for children and early adolescents), my clinical diagnoses, and my level of crisis and support needs.  I understand that if I am not suitable for TSROP, appropriate referrals will be given to Outpatient or Inpatient services.  

I understand that if TSROP is not appropriate for me or is not meeting my needs, or if I am not able to complete the TSROP activities, my treatment under TSROP can be terminated at any time at either my or my counselor's discretion.  If I am enrolled in TSROP and counselor-discharged from TSROP prior to July 31, I will have the option to continue weekly, maintenance-focused Outpatient treatment with Keely Owens, LCPC until July 31, 2022, or to receive a referral to another outpatient provider.  After July 31, 2022, I will receive a referral to another outpatient provider.  If I require Inpatient care, I will receive a referral to an inpatient provider.  

I understand that billing for outpatient sessions will either be conducted through my insurance or through private pay.  The private pay rate is currently $45/session, including workshops.  I understand that, at this time, TSROP is only able to accept Medicaid-only insurance, through Innovative Clinical Associates.  I understand that as a Medicaid client I will also need to understand all of the rules and policies of Innovative Clinical Associates, which will be provided to me at Intake.  I understand that as a Medicaid client, if I lose my insurance coverage during the course of my treatment (including adding a new insurance, because ICA is only able to cover Medicaid-only clients), that I will have these options: I may choose to switch to Private Pay status at the above rate and continue my treatment (at a reduced frequency of sessions if need be), and I may apply for financial support if I have hardship, which I will receive if funds are available on a first-come first-serve basis; or I may choose to discharge to another provider, with a 2-month grace period where transitional Outpatient services will be received Pro Bono from Keely Owens, LCPC.  I will still have the option to complete my Retreat, and to have it covered through my existing scholarship, and to receive reincorporation sessions and participate in Graduation activities, if I choose to discharge.

I understand that Outpatient sessions cannot be billed unless I attend them, and that TSROP is providing significant financial support for its participants which relies on expected income.  I commit to providing one week of notice if I need to cancel an Outpatient session, whenever possible.  If I cancel Outpatient sessions with less than a week of notice, or fail to show up for them, I am responsible for rescheduling them within the same calendar month and within the availability provided by Keely Owens, LCPC.  If I am unable to attend the agreed-upon number of sessions in a given month, I have the option to pay a $45/session Missed Session fee.  This Missed Session fee is optional.  However, I understand that a maximum number of missed and unbilled sessions will be set at the outset of treatment, and if I exceed that maximum, I may be discharged from TSROP or from ICA at counselor's and agency's discretion.  In the event of discharge, I will be provided relevant referrals.

I understand that I will be discharged from TSROP, and from clinical care from Keely Owens, LCPC, regardless of my treatment status, at the end of the program on July 31, 2022.  My options for re-intake into TSROP at the beginning of the next cycle will be discussed with me at that time.  If I need ongoing Outpatient or Inpatient care upon discharge, I will be given relevant referrals beginning July 1, 2022, and all efforts will be made to secure my transition to another clinician.    

I understand that Keely Owens, LCPC, is a mandatory reporter in the State of Maryland, and that if I disclose actively occurring abuse of a minor child or vulnerable adult as defined by COMAR, the abuse will be reported to Child or Adult Protective Services, respectively.  I also understand that if I disclose an intent to harm myself or others, Keely Owens, LCPC, in cooperation with Innovative Clinical Associates, will conduct a lethality assessment and may, at clinical discretion, take action including reporting to the police for a protection recommendation or wellness check, notifying a designated person, or in extreme cases petitioning for involuntary inpatient care.  I will create a Crisis Plan at the outset of treatment, so that the specific actions will be known to me.  I understand that in some cases, if I cease contact with Keely Owens, LCPC or Innovative Clinical Associates without disclosing intent to discharge, the police will be requested to conduct a wellness check to ensure my wellbeing.   I understand that Keely Owens, LCPC, Innovative Clinical Associates, and Experience Learning do not provide real time crisis support in between sessions, and that a crisis hotline will be provided in the event of a psychiatric emergency that occurs between sessions. 

I understand that Keely Owens, LCPC, follows all of the legal and ethical mandates of the American Counseling Association and the State of Maryland.  Keely Owens, LCPC practices within her expertise and level of competence, discusses treatment options, does not engage in dual roles with clients, provides informed consent, follows ethical financial practices, keeps records accessible to me or those I designate at-will, and ensures confidentiality using the protocols established by HIPAA.  All of my Protected Health Information will be held confidential by Keely Owens, LCPC and Innovative Clinical Associates with the following exceptions:
- Mandatory Reporting as discussed above
- Subpoena from a court of law: Subpoenas will be responded to within legal limits and with every effort to protect client wellbeing
- Professional Consultation: If I am a Medicaid client, I understand that my clinical records are managed by Innovative Clinical Associates, and ICA personnel will view them, as appropriate, for billing and for clinical support.  If I am a Private Pay client, I understand that some of my information may be shared anonymously with an identified colleague (LCPC, LCSW, or Clinical Psychologist) for the purpose of clinical consultation to best provide me with services.

I understand that Keely Owens, LCPC, and Experience Learning, are collecting research on the efficacy of the TSROP program.  I understand that any assessments or clinical records that will be used for research will be anonymous, and that I will give specific consent for their inclusion.
Intake
Oct 1 - Oct 31*
* Intake dates for Medicaid and Private Pay.  BCBS and Aetna may be intaking later.
Contact Keely or Innovative Clinical Associates to see if a Treatment Supported Rite of Passage program is a good fit for you!  Assessments will be provided using the Transtheoretical Model of Change and General Intake.  Clients will be provided with Informed Consent, and offered referrals in the event that the program is not a good fit.  No cost for an Intake Assessment for private pay (Billable to Medicaid).
Autumn Earthwalk 2022: October 28

Contemplation
Oct 31 - Jan 31
During Contemplation phase, the goal is to explore who you are, what you want to change, what your obstacles and resources are, and where you are in the change process.  Therapeutic techniques during the Contemplation phase are insight-based, and include experiential exploration techniques such as sand tray, immersive therapeutic nature workshops (Earthwalks and Underground Circles), art therapy, and meditation.  During the Contemplation phase, you will also choose and commit to your Rite of Passage retreat or Self-Designed Ceremony. 
Contemplation Underground Circle 2023: January 28


Preparation
Feb 1 - March 1
What do you need to do in order to lay the groundwork for the change that you want?  During the Preparation phase, we look at your resources and obstacles, your attachments, your habits and environment, your self-talk and personal identity, and your physical and neurophysiological needs.  We take a holistic approach, utilizing multiple modes of mental health counseling (CBT, Solution-Focused, DBT), and trauma-informed care, to help you prepare for success in your change.  During this phase, we will also match you with a Rite of Passage activity.  There are several retreats offered by nonprofits that we partner with, and in the 2022-2023 Treatment Cycle we are hoping to offer an "in-house" retreat at Spruce Knob Mountain Center, in partnership with Experience Learning, Inc.  You will also have the opportunity to create a self-designed ceremony.
Winter Earthwalk 2023: Feb 24
  
Rite of Passage
March 1 - April 30
The Rite of Passage is the experiential centerpiece of this treatment modality.  The Rite of Passage consists of three stages: "Severance" (the immediate mental, emotional, and logistical preparation for the Rite of Passage); "Threshold" (the experiential activity itself); and "reincorporation" (the immediate debrief and anchoring of the experience).
2022-2023 ROP Dates (*-tentative):
Experience Learning In-House Retreat*: April 13-17
School of Lost Borders CA Spring Fast: April 3-15
Woman Within Eastern Spring Weekend: TBD
ManKind Project Spring NWTA: TBD
Self-Designed Ceremony: Within the March 1-April 30 Window

Severance
Your "severance" phase begins roughly two weeks before your Retreat (Threshold) Activity.
Every change we undertake can be likened to both a small death and a small birth: the person we used to be must die, and the person we are to become must be born.  Beginning about two weeks before your Rite of Passage retreat, you will be guided through a conscious preparation known as "Severance", involving both listening to and letting go of the things that no longer suit you, and "nesting" to prepare to welcome in the new.  Mindfulness techniques, Gestalt, and Self-Designed ceremony will be used to support Severance.
  
Retreat (Threshold)
During the Contemplation/Preparation phases, you will choose and commit to an immersive, experiential Retreat that takes you out of your daily "normal" and gives you a context in which to explore and challenge yourself, and claim the change that are seeking.  The Retreat will be chosen to be congruent with your personal beliefs and abilities: there are several different programs that TSROP will be partnering with, but you can also find a retreat offered by your own spiritual or cultural organization.  Retreats must meet certain criteria to ensure mental, physical, emotional, and spiritual safety, and to ensure that they are effective.
Retreats require that you leave your daily responsibilities for a period of 3-10 days (depending on the retreat), and they have an associated cost.  TSROP will have funds available to cover the cost, as well as support for opportunity cost, childcare, and pet care.  Our goal is that financial need should not be an obstacle to a person enrolled in this program.
In the event that group retreats are cancelled due to pandemic safety, or if no retreat can be found that matches your needs, self-designed ceremony will be used as the keystone experience for change.

Reincorporation
Immediately upon return from a transformative experience, the goal is to get grounded and oriented, and to capture the story of the experience.  The wisdom, insight, empowerment, and affirmation experienced in an extraordinary circumstance must then be brought into the daily grind of life in the form of positive change.  Reincorporation literally means "bringing it back into the body."  During the weeks following the return, the goal will be to tell your story and be witnessed, and validate and affirm the change that your story represents.  Techniques will include mirroring and storytelling, community welcome, mindfulness and self-care. 

Action
May 1 - June 30
* Your Action phase will start a week or two after returning from your Retreat, but not later than April 22.
Now it is time to do the hard work.  Having discovered the change that you need and gone on an adventure to claim it, you have to build that change into your cognitions, your behaviors, your relationships, and your environment.  The Action phase of change is about practice: learning how to walk through your days in your new identity.  CBT, DBT, and REBT techniques help you shape new, positive habits into your mind and brain, rewiring your neurons to support change.  Mindfulness techniques and biofeedback are also recommended.  The Action phase also involves environmental change, relationship building, and self-advocacy: making sure that the people around you, the responsibilities you take on, and your daily interactions with place and time are nurturing you.
  
Graduation (Maintenance and Closure)
June 30 - July 30
For the last month of treatment, the focus in on taking your path into your own hands.  You will take over the leading role in what the TTM calls the "Maintenance" phase of change: noticing when you are off-course and using the tools and relationships available to you to correct yourself.  The Graduation phase will also involve celebration of your hard work, through nature-based and group activities, as appropriate.

Independence
August 1
Discharge from TSROP and into a phase of Independence will occur on August 1 (or earlier, if you have reached a state of independence earlier).  To prepare for discharge, you will identify what support you need to continue your Action or Maintenance as a client-led, rather than a clinician-led, process.  Clients may opt to continue maintenance-focused outpatient care, and will be given referrals as appropriate.  Clients may also opt to receive support through natural support systems in their family, community, or relationships.  TSROP will accept new intakes beginning October 1, 2022; if a client is a candidates for re-intake into TSROP in October, the client must identify a support plan for the 2-month Independence period.