Episode 63

Adolescent Mental Health

with Scott Sowle
Episode hosted by: Gary Bisbee, Ph.D.

April 4, 2023

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Scott Sowle
Founder & CEO, Muir Wood Adolescent & Family Services

Scott Sowle launched Muir Wood Adolescent and Family Services in 2013. Muir Wood is the culmination of his personal and professional experiences and has become recognized nationally as a gold standard in adolescent behavioral health care.



If you follow your passion, whatever that may be, you can do well. And you have a life of meaning.



Dr. Gary Bisbee: Good afternoon, Scott, and welcome.

Scott Sowle: Hi Gary. Thanks for having me.

Dr. Gary Bisbee: You’ve been working with teens and their families for multiple years, so why don’t we turn to mu wood, which you founded now about 10 years ago. Can you please describe mu wood for us, Scott?

Scott Sowle: sure. Seeing that there was a really underserved market here in Northern California. At the time, there were only two. Programs treating two residential treatment programs, treating adolescents. One was the Camp Recovery Center, which had been around for 40 or 50 years. And the second was a a program that was part of a large hospital that treated primarily kids coming outta the criminal justice system. So there was really nothing up here. So came up here. One because, Northern California is where I’ve always wanted to live. My family’s up. And also seeing an underserved meetup here. So started Muir Wood, you’re right about 10 years ago. January was our 10th year anniversary. We started off just with six beds all boys program all private pay at the time. And then we’ve grown to 64 beds both treating adolescent girls, adolescent. We have both campus. We have three separate programs. A 28 bed campus for dual diagnosis adolescent boys, a 18 bed campus for dual diagnosis adolescent girls, and then most recently an 18 bed campus for primary mental health girls. And then we’re soon to add another 18 beds to compliment that adolescent girls program, which will be another adolescent Residential primary mental health program for boys.

Dr. Gary Bisbee: What are the common disorders that you would treat? You reviewed them generally with your four different units, but what are the common conditions that you’d be treating?

Scott Sowle: So in my 35, 36 years working in this field, Gary the last say three or four years, the psychiatric acuity of the clients retreat has just, Gone up exp exponentially. It’s just it’s crazy what we’re seeing. The level of anxiety, the level of depression, le level of trauma the level of attachment disorder and then confounded with substance use disorder. And so a lot of the kids that come into treatment, they come in. With the primary reason of substance use disorder, but that’s just masking an underlying condition like depression or anxiety or attachment or, attention deficit disorder, whatever it may be. And so that’s really at the core of what we treat here. And I’m happy to say that Muir Wood is one of the only programs of our. That has a full-time psychiatric component. So we have full-time psychiatrists on staff. A lot of programs don’t do that. I don’t understand how they do that with the level of psychiatric com complex clients that we’re seeing. But I’m very proud to say that we do have full-time psychiatry.

Dr. Gary Bisbee: So is there different programs, Scott, for the separate conditions what kind of range of services, for example, would be available? You mentioned that you have full-time psychiatric services, but what other services would be available?

Scott Sowle: Because we’re an adolescent program, Gary, we also have an academic component. I should add that.

Dr. Gary Bisbee: I

Scott Sowle: Unlike, unlike a an adult where obviously you don’t have an academic. Component. We have state of California credential teachers, full-time on staff, and our academic program is also WASP accredited, which is the Western Association of Schools and Colleges. Again, many programs don’t have that. We do, and we have that because if kids are in treatment with us for 45 or 90 days and they’re keeping current in their academics. It’s one less trigger when they return home. And I really wanted to establish a strong academic program with Muir Wood because of that trigger. I didn’t want kids to build a foundation of recovery while they’re in treatment with us. Only to return to their homeschool. Have the teachers or administrators say, you need to repeat the 11th grade or whatever it may be. And that’s just a huge recipe for relapse. And so the academic component here also plays quite an instrumental part in our program. But yes, we have three different programs. As I mentioned the two campuses for dually diagnosed adolescents, and then the one that’s more primary mental health. And we really. Even with the primary mental health, some of the kids in there have experimented with substances, maybe cannabis, some cannabis use. But really what we’re seeing here at our substance use disorder programs. Is higher use of cannabis use disorder. Higher use of alcoholism or stimulants. And then obviously the most scary thing for us these days isn’t just the opioids, but the fentanyl that we’re seeing was in itself really in the last year.

Dr. Gary Bisbee: How do you work with the families during the time that that your residents are with?

Scott Sowle: So I get asked that question all the time. What is the most. Probably important component of of treatment and what’s probably the biggest component to a successful treatment outcome. And there’s really two things. One is length of treatment. And there’s a myriad of things, but length of treatment and then most importantly parental involvement. And really what we work on here is the family system because having an adolescent come to treatment having that adolescent evolve while they’re in. Having them work on some of those underlying issues we just talked about. If you don’t have the parents working in alignment with their son or daughter, it doesn’t work. In other words, you can’t send your son or daughter to treatment. Have them go through treatment, have them evolved, come back to a dysfunctional family system. It’s just a recipe again for relapse.

Dr. Gary Bisbee: So do you ha, do you gain referrals from agencies or hospitals or is it word of mouth? How do you, how do the patients find you?

Scott Sowle: Yeah, it’s a great question Gary. So about, we were one of the f mi Muir Wood was one of the first to do this for about six or seven years ago. We pivoted from being a private pay facility or an out of network facility to an in-network facility. And I really did that because I had worked at a and founded a treatment center prior that really catered more towards an affluent client base. And I, when I came up here to Northern California, I really wanted. I believed every kid deserved high quality treatment. And so our motto, our tagline here is Making exceptional care accessible. That’s on, on, on all our literature, and that’s what all of our staff walk around discussing and both in meetings now. And being an in-network provider allows us that access to those clients. But because of our reputation Because we practice value-based care, we get a lot of referrals, not only from the insurers, from the payers, but also from hospitals, from inpatient programs where those discharge planners at those hospitals want to get those kids. Out of an acute care setting where they’re typically put on a 72 hour hold. And that fourth day of the hold, they need to find someplace for that adolescent to go. And really what hospitals do is mostly stabilization and triage. We do treatment and so we see a lot of those kids coming out of the hospital. We also see a lot of kids that are referred directly from the. From educational consultants from families of alumni they refer their families to us now, family members to us. And just through word of mouth. And so we currently sit at 64 beds. We pretty much at all times run with a wait list, and that’s why we’re expanding our. And because one, I think it’s cuz of the quality of care that we provide, but also I just think it’s a sign of the times. There’s a growing need for what we do in the community.

Dr. Gary Bisbee: What about insurance coverage? To some degree insurance coverage almost dictates the amount of time they can be with you in a residential facility. Is that true?

Scott Sowle: It is. And so we’re lucky in some respects. We have a in-house utilization review department. Having full-time psychiatrist is great because, when it gets to be peer to peer with the docs at the insurance company, we have We have docs that can do that and that are really good at it. And and then, we work with we work with insurers that we have great relationships with. They understand that the value that we’re providing. And so our average length of stay hovers right around 45 days, and that’s including the payer. And I think the pairs are coming around to the understanding that, again, I mentioned this earlier in the interview, that one of the most significant factors in a successful treatment outcome is length of stay. And you know it where it used to be, get ’em in, get ’em out in less than 30 days, and then you just rinse and repeat. And that keeps happening over and over again. And not only is that traumatic for the child, it’s traumatic for the family that, let’s get it right the first.

Dr. Gary Bisbee: Yep.

Scott Sowle: Let’s get it right the first time other. Otherwise what happens is you get this kind of cyclical, kids are in and out of treatment and then what happens when they’re young adults, they’re in and out of treatment. And hopefully I think the insurers are starting to come around a little bit. I know they are with us and I appreciate that. But hopefully that’s a sign of the times as.

Dr. Gary Bisbee: Yeah, so you make the point that time in residence is really an important. Requirement, if you will, for treating these adolescents. What other several things have you found to be necessary when you’re treating adolescents?

Scott Sowle: Yeah. So again, time and treatment and being in residence, but also that kind of continuum of care is really important, so stepping them down to the appropriate level of care. know, What we do here is with short-term residential is really acute stabilization and treatment. And then and then those skills, those sets of tools that that the kids and the families learn while they’re with us, they can use those when they go onto their, the next level of care, which would be partial hospitalization or intensive outpatient. Also a low staff to client ratio, making sure that your staff are licensed master’s level licensed clinicians having full-time psychiatry. And then, creating really special as aesthetically special sites. If you were to look at. The campuses at Muir Wood they are beautiful campuses and it, and for a lot of people they don’t understand that. But when you’ve got an adolescent coming to treatment, and it might be their first treatment episode or it might even be their first time away from home and they, driving up with their parents, they have no idea. They’re scared to death. They don’t know where they’re going. If it’s one flu over the Cuckoo’s Nest, if they’re going to a psych, And then they come here and they’re on six acres of rolling hills and beautiful houses and staff that can relate to them. And you just see the walls drop down and they can actually start treatment right away rather than, taking weeks for them to begin treatment.

Dr. Gary Bisbee: Scott, this whole program just makes so much sense. Now, will you accept patients from outside Northern California?

Scott Sowle: Yeah, we’ve treated patients from the East coast. We’ve even treated patients from Australia from London but the, from all over the world. But, but the vast majority of clients are local to Northern California, and the reason for that is that, We are in network with as I said, Kaiser, Anthem, Aetna, Cigna, m h n. You go down the line. Typically payers want clients treated within a certain geography of where they live, especially with adolescents, because having the parents involved in treatment is paramount. And so luckily we see a lot of referrals from our payer. And a lot of those kids obviously are from Northern California so their parents can really participate in treatment now being moving, a lot of our family therapy online has allowed us to see clients from Southern California and from other western states. But again, most of our clients are from Northern California.

Dr. Gary Bisbee: You made a passing reference to this earlier, but let me ask the question directly, which is, what are your expansion plans?

Scott Sowle: Yeah. We have operated independently for the past 10 years and then this the beginning of this year, we had a capital investment from a wonderful set of folks at AVEs e. And so they see our platform and our brand as something that can be used to expand this service both throughout California and then perhaps into other MSAs in other states. I think what we’re looking at doing in the near term meaning this year is expanding our services into other underserved markets in California. With Muir Wood, my it is the same thing I did when I opened Newport Academy. At that time in Orange County, there wasn’t really any treatment programs for adolescents. Now there’s one on every corner. And then when I came up here to Northern California, again, as I mentioned earlier, there was nothing up here. So my my focus has always been going into underserved markets, and so that’s what we’re looking at doing right now in, in in other areas of California. Believe it or not, there are some areas. Some counties where substance use disorder is off the charts, but there’s absolutely no beds for kids. And it’s because those those aren’t the sexy MSAs that people want to be in, Malibu, Beverly Hills, Newport Beach but their MSAs where kids are really struggling and they deserve the same help. Kids and the more affluent and sexy, sexy MSAs are. And so that’s really where we’re focused And again, we plan on doubling our at least doubling our current size. Just this year.

Dr. Gary Bisbee: Let’s turn from your wood, which is just a terrific story. Scott, congratulations. Let’s turn from your wood to you as a founder. You’ve founded at least two companies in Meer Wood. One other. Do you view yourself as a purposeful or an accidental entrepreneur?

Scott Sowle: Maybe a mixture of both. I was I was pre-med at ucla. That was my as a child that was my direction. As I said earlier I I came from Family of Scottish and Irish alcoholics. It was very disruptive in my family. My grandmother who I’d only met once was actually institutionalized for many years cuz that’s what they did back then. And so I saw how destructive substance use disorder could be in families. And Again, I was heading down a path to be a physician and because I wanted to look at my own, my own family issues started working with families and kids with those issues and just basically found my calling. I’m, I couldn’t be more happy with what I’ve been able to do with my life. I look at. Some of the same folks I went to UCLA with that I’m still very close to. And they’re very successful in their fields. Attorneys, wall Street folks. And, but, Every time I talk to them, they wanna talk to me about what I do. I’m the hit at the dinner party, so to speak, and I I love what I do. I has, it’s a life of meaning which is so important to me. And I’ve literally, even though as a founder you’re working seven days a week I never think of Mira where his.

Dr. Gary Bisbee: I was going to ask what’s the most rewarding and then what’s the most challenging aspect of being a entrepreneur or a founder? And you pretty much answered the fir the most rewarding part. What challenges have you encountered that as you’ve been a founder and started and grown your company?

Scott Sowle: Yeah. Probably the most challenging thing is currently at staffing we talked about that. Cuz the demand is there. But it’s just the things you can’t control the support that you get from state and federal entities. The the fentanyl epidemic, who saw this coming? The the things really that are out of my control. Th those are the things that, that really are the most frustrating. I I’m not a founder who is not on campus. I I believe in being on site every day. I’m a founder who oftentimes is a janitor sometimes a. I, I really, and when I worked one of the things that goes a long way with some of my staff we call our line staff the mental health technicians here the folks that are just starting out in their career, we call ’em care coordinators here. For the first three and a half years of my career at Hathaway Children’s Village, I worked as an overnight care coordinator. In those days, you’d go to work at Monday at three, and you’d come home Thursday at four and you had to sleep there without getting paid. I’m sure labor laws are a little different back then. And so I tell the staff that work here, look, I’ve been in your shoes. I’ve done your job. And it goes a long way. But. But yeah, the only thing really that’s challenging are things out of my control.

Dr. Gary Bisbee: I definitely see that. Scott, this has been a great interview. I’ve got two kind of wrap up questions. One of which is what advice do you give young people who come to you and say, Hey, Scott, I’m thinking about. A career in mental health, or I’m thinking about a career working with adolescents. What kind of advice do you give them?

Scott Sowle: Our teacher one of our teachers here on campus tends to bring up cuz my office is right above his school and he tends to bring up the boys on the day of their graduation to meet with me. And so I get a real opportunity. When I first started the program, I was in every graduation and I got to know the families and the kids really well. And unfortunately, that’s one of the most frustrating things is getting to be at a size where you just don’t have that same kind of you. Level of insight. But, the kids come up to me and for a lot of them they have had an epiphany in treatment. They’re like many kids struggling with anxiety or what they’re gonna do for the rest of their lives. And they come here, they get clean. They start to do some real work on themselves and they start to feel good. Ab self-esteem is probably the biggest thing we treat here, right? If you wanna put it. And so they start to have some self-esteem and and some of those kids have come back to work for me. In fact, I’ve got a lot of staff that are now, either in master’s level programs or came back to work as care coordinators. And so my advice to them, Carrie, is Follow your passion, right? If you know the you can do well by doing good. And if if your motivation is just the bottom line you’re gonna be 57 and not find a li that your life’s been meaningful. But if you follow your passion, whatever that may be if you want to enter this field you can do. And you can be 57 and have a life immediate.

Dr. Gary Bisbee: Final question along the same lines, but in this case, what do you say to someone that comes and says, Scott, I really think I’d like to found my own company. What advice do you give them?

Scott Sowle: I get that a lot. So I, one of the things I’ve also helped a lot of young entrepreneurs start their business and That brings me a lot of joy. Pay it for it. I had some mentors in my life that, and that, that’s one thing in the mental health field. You get a lot of people that really wanna help you. And when I was young I had some just amazing mentors. And so I try to do that myself whenever I can. And I’m, and I share as much of myself as I can because it brings me a lot of joy. That everyone can have a great idea. You’ve got to find the funding to do that, and that could be a big obstacle. And typically people wa you know people with the funding have heard mentalities, so they want, someone who’s already done it successfully. So it’s really tough if you’re just someone who’s got a passion. But my advice is following my own lead. Start from the bottom. Work your way up. Work your butt off. Get notice. Put yourself in the right position so that someone that has access to capital, let’s say can fund your dreams. And and then timing. Timing is everything in life too, and then hopefully be mission driven and have a good plan.

Dr. Gary Bisbee: Scott, thanks for your time today. All the best of luck as you continue to grow Muir Wood. It’s just a fantastic program, so well done.

Scott Sowle: Gary, thank you so much for having me. I really appreciate it.

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