Episode 105

Adolescent Mental Health

with Scott Sowle

March 23, 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.


Every kid deserves high quality treatment. And so our motto, our tagline here, is ‘making exceptional care accessible.’



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

Scott Sowle: Hi Gary. Thanks for having me.

Dr. Gary Bisbee: We’re pleased to have you at this microphone. You’ve been working with teens and their families for multiple years. Where did your interest in that area come from, Scott?

Scott Sowle: So that dates back 36 years ago. I’ve been spending my entire professional career working with adolescents and families. When I was in my early twenties I went to go work for a organization called Hathaway Children’s Village in east Los Angeles that took care of kids that were from abused and neglected families, mostly alcoholic families. And I did that because I had to pay my way going with UCLA at the time. And also because I came from a family that had a genetic predisposition for alcoholism. So I had that interest. Started working with kids at Hathaway and for lack of a better term, found my calling.

Dr. Gary Bisbee: It’s been a terrific career. Much needed. I might add,

Scott Sowle: Thank.

Dr. Gary Bisbee: of course, you’re also an entrepreneur. So why don’t we turn to Muir Wood, which you founded now about 10 years ago. Can you please describe Muir Wood for us, Scott?

Scott Sowle: sure. Yeah I spent the first half of my career working in large acute care settings, nonprofit Catholic hospitals, running behavioral healthcare units. . And in in 1999 decided, to kind of branch out and start smaller residential, short-term residential treatment programs just because the quality of care could be much better. And I helped launch a program called Visions in 1999, helping the young investors at the time that did not have experience starting or running a. Get them off the ground. And then in 2008 I was the founder of Newport Academy in Orange County. Founded that with a another person, a partner of mine, and ran that for five years. And then seeing that there was a really underserved market here in Northern California at the time, there were only 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: So is there different programs? 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: 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 look. 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: So you’ve seen a marked increase in incidence of. Of of phenol use during the, over the last several years.

Scott Sowle: Yeah the Fentanyl use is probably the scariest thing that I’ve seen in my 36 years. The overdose deaths just in Marin and Sonoma County which are the two counties that that we’re in. So overdoses in Marin have doubled from 2018. And fentanyl overdoses are associated with roughly 50% of those overdoses every five days. Someone’s dying of a fe fentanyl overdose in in Marin and Marin’s, a small county of only 200 and, 50,000 people or so Sonoma where all of our residential campuses are even FARs. . So every two days someone’s dying of an overdose in Sonoma County. And we’re talking again about a county of 500,000 people. So relatively small. And deaths from Fentanyl have increased 2500%. From 2016 to 2021 fentanyl is hundred times more potent than morphine. And what’s the most scary thing about this is. Adolescents frontal lobes aren’t fully developed when they’re 16, 17 years old. That doesn’t happen until the early twenties. And so you have a lot of drug experimentation at that time. And so we’re not talking about addicts necessarily here. We’re talking about kids who may go up to a Saturday night party and someone has a line of cocaine and what they think is a line of cocaine one snort lights out, you’re.

Dr. Gary Bisbee: It’s horrible. There’s a state putting more resources into trying to work with this problem.

Scott Sowle: Yeah. You know what’s interesting is in even driving into work here in Sonoma County, there’s billboards right before you, when you go up to Santa Rosa, the capitol, or when you’re driving towards Marin, that basically one pill can kill. That’s the campaign here in, in Sonoma County. I dunno if, I don’t know if it’s statewide or if it’s, or if it’s national, but it’s one pill can kill. . Yeah, so they are actually putting a lot of work into that. I participate in on a board here in Marin where we’re looking at that going into schools. But it’s just it’s just really scary and more resources need to be put. It is something that unfortunately I believe we’re just on, on on the cusp of it. And and we’re lucky here. In Northern California one of the, probably the wealthiest parts of the country where we have resources. It just scares me to think about some of the flyover states where you don’t have the resources and you’re seeing probably rates of overdoses, rates of substance use disorder much higher than we see here. And and so yeah, it’s scary on many.

Dr. Gary Bisbee: I can’t imagine as a parent of course, speaking of families, how do you work with the families during the time that that your residents are with you?

Scott Sowle: So I get asked that question all the time. What is. 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. Having that adolescent evolve while they’re in treatment 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. And so what we do here is we do individual family therapy with with the boys and girls throughout the week. Our therapists carry a very low patient to staff ratio. So every therapist here carries a maximum caseload of six clients. So they’re getting a lot of attention, a lot of family therapy. We also have five touch points during the week online where parents can find support, find therapy. We used to have the parents come every other Friday. For some family therapy. And then that was book ended on Saturday by a on-campus family program day where we had a bunch of facilitators that would come in and do groups with the families and with the kids. But unfortunately with Covid we had to close off our campuses because we had kids coming to us and we were testing them. And when they’re obviously negative, they were admitted to our program. , but, being very protective of our campus that way. But if we would have f 40, 50, 60 parents come on campus every Friday, Saturday, we couldn’t control that. And then obviously when you. When you have an outbreak of Covid all your admissions, your basic, all your admissions are shut down. You you’ve gotta manage that covid out of out of the program. Our initial policies when Covid, first came into play was that we were gonna discharge the client back to their home environment. The Department of Public Health here in Sonoma County said, can’t do that. You gotta keep ’em, you gotta quarantine ’em, you gotta, cuz you can’t send someone positive back to their community. We just threw those policies out the window and we had to learn to contain Covid on our campus. We even went, as far as and we’re on, in Oma County, we’re on 50 acres here. So we got a lot of acres, a lot of campuses. But we even went as far as getting one of those fifth wheelers, those kind of trailers that you’d see on a movie set. So then when a kid was positive, we would put him in there with a therapist and contain him. Luckily it seems as though those days are. Knock on wood. But but it was a scary time and definitely something that impacted our our workplace.

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

Scott Sowle: Yeah, that’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 to 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 in both in meetings now. And being an in-network provider allows us that access to those clients. But because of our reputation and. 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 forced day of the hold they need to find some. 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 outta the hospital. We also see a lot of kids that are referred directly from therapists. 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: now, 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 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 payers. And I think the payers are of 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. And 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 time.

Dr. Gary Bisbee: Yeah, so you make the. 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. 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. And so that continuum of care is something that works best. In terms of what I found to be most impactful in a residential level of care and is having a gender separated residential level of care. So for example, , our campuses are either all boys or all girls. And those, the boys and girls never mix. They don’t mix, for any reason. They don’t have lunch together. They don’t go to groups together. They’re completely separated. They don’t even know that there’s other campuses. And that is primarily because we treat a lot of, as I mentioned, underlying issues like trauma. So when I speak with parents about what makes us different than say mixed gender programs, which I. I honestly can’t understand why. And I think if you were to interview a thousand therapists, they’d all tell you that gender separate is the only way to go. But when I talk to parents, I can go through all of the differentiators from Muir Wood but the one thing they really understand is, if you’ve got a, if you’ve got an adolescent daughter who has been, say sexually traumatized, let’s say she’s Unfortunately been sexually traumatized and you put her in treatment with an adolescent boy and she’s in group and she’s gonna, and she’s forced to talk about that. It’s not gonna happen. She’s not gonna open up. And so you put her in where with other girls where she can become vulnerable and really and that goes for the boys as well. I constantly see the boys come out of group in tears where they really have the ability to open up and become vulnerable and really get to the core issues of why they’re. And so in a mixed gender treatment environment, it just doesn’t work. And maybe it, it works financially because you can answer those admissions calls and get, if it’s a boy or a girl, you can bring ’em into treatment and fill those beds. And that sounds wrong and it is wrong. But I really believe in separating the genders in a residential level of care. And then, also low staff to client ratio, making sure that your staff are licensed master’s level licensed clinic. Having full-time psychiatry and then, creating really special as aesthetically special sites.

Dr. Gary Bisbee: I’m not sure if you can even answer this question, but how many patients or what percentage of patients would be readmitted.

Scott Sowle: I can, I can’t answer that. So a very low percentage I don’t have that exact number. We do have Rebecca Ashkenazi, which is one of our staff here that keeps all that data and But I would say less than 5%. Probably even, less than 3%. As I said we’ve got a, we’ve got a strong alumni program. The other thing that we do that no other program does, that I know of is we have a a six week parent coaching and support program. And that’s free for every family that goes through here, whether. You’re here for a day or you’re here for 90 days if you’ve been with us. And Rolin Glass, who’s one of our therapists here who gets the highest marks of parents RO Raleigh runs that. And it, what it is it’s it’s a it’s it’s a Skype session every week for an hour and a half with parents who are alumnis of our program to make sure they’re doing well. And that really the genesis of it was, , the parents were saying, you’ve got this alumni program for my son or daughter but you’ve got nothing in terms of aftercare for me and for us. And so we’ve, so when the kids leave here they leave with a home contract. They leave with. , what they should be doing when they go home. And so Raleigh kind of works with the parents on that to make sure that the kids are aligning with their home contract, that they’ve agreed to while they’re going through treatment with their therapist. And it seems to have really and so in terms of a, to get it back to your question, in terms of what level of readmission we have a pretty good idea because we’re keeping in contact with those parents.

Dr. Gary Bisbee: Good point.

Scott Sowle: And then one other thing I’d like to add is the insurance companies are really moving towards value-based treatment, and if you want higher rates from the insurance companies, they want you to prove that you’re offering a value.

Dr. Gary Bisbee: We talked about Covid Scott and COVID has been challenging for any organization, any health organization because of workforce issues. I’m sure that you’ve had some of that as well, but have you had challenges in terms of recruiting and retaining people?

Scott Sowle: Yeah, that’s unfortunately our A kill is heel in our business. It’s in a lot of businesses but the level of specialization in our field and, in order to be. We’re credentialed through the Joint Commission. We’re licensed and certified through Department of Healthcare Services and Department of Social Services. And as I mentioned, we’re in network with payers. And so with that comes you have to have master’s level therapists. You have to have a minimum level of credentialing for our staff. You have to have all of our staff need to have what they call live scan or fingerprinted and you can’t have any blemish at all. So it’s really specialized in terms of the staffing we have. So more than most businesses, yes. It we’ve definitely struggled there. One of the things I think that has helped us. Is and it hits the bottom line, of course, but we pay more than most. It’s a beautiful work setting. We really try to empower our staff. We have like I mentioned many times, low staff to client ratios. . And and then where we’re located, which was by design up here in Petaluma, just north of San Francisco. It’s far enough away from San Francisco, but it’s also located in an area where there’s a, there’s, Sonoma State, which is just miles away from here, has a master’s in counseling program. So we’re able to draw a lot of those folks out of there. And and then we’re not surrounded by other treatment programs, in our backyard here. People that tend to come here tend to.

Dr. Gary Bisbee: Scott, this has been a great interview. What advice do you. 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 of 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. 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. You can be 57 and have a life of meeting.

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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