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More than just a helping hand by Heather Murphy Public Relations Twenty men and women in neon orange vests move down Rutledge Avenue. They giggle and joke as they pick up cigarette butts and the remnants of someone’s soda cup.  Hard to believe that at one time, these individuals wouldn’t even leave the house. The men and women participating in the Adopt-a-Highway program have all been diagnosed with severe, chronic mental illnesses like schizophrenia and bipolar disorder. All 60 of the MUSC Community Care Team’s (CCT) clients have a history of hospitalizations and medication noncompliance. But for many of these clients, the story’s different now, thanks to CCT. The staff recited numerous success stories, like a man who wouldn’t leave his neighborhood or home for the past six years. He went to a KFC restaurant last week. Or another man who was nonverbal and sure that someone was trying to kill him, and now actively participates in planned social functions for the group. “Before, I felt like I had no one. I was quite a recluse, but this has changed my whole life,” said Wendy*. “I don’t feel alone anymore and I see how important it is to take my medication. I understand the seriousness of my illness; coming here and to group therapy has been a very educational experience.” Wendy’s favorite thing about CCT is group therapy and her goal is to continue to stay active and enjoy her reconnection with her family and friends. One major goal of the team is to keep its 60 clients out of hospitals, not uncommon for this type of community program. What’s different about this group is what the staff is willing to do to ensure this goal. The staff of nine agrees that flexibility and the ability to “think outside the box” is what sets them apart. By participating in activities, like ensuring safe housing, special outings, ensuring medication compliance (for some clients, this means a visit from a staff member two or three times a day when meds are taken), and financial guidance for clients, the staff promotes stable recovery for those in its care. An added bonus to this type of care is that for many clients, many of the special outings are a “first.”  “We use community outings to the beach, movies, picnics, the library, sporting events, and the fair as a means to build appropriate social skills in real life settings,” said Cheryl Grant, clinical counselor. “A lot of the everyday things that we see or get to do and then take for granted are big events for our clients. We recently adopted a portion of Rutledge Avenue and the clients have enjoyed the volunteer work because it makes them feel good to contribute to society.” Many of the clients have never enjoyed these activities due to lack of transportation, no one to accompany them, or no way to afford them. “I like coming here because it occupies my time, I like the trips and playing basketball, and I like not feeling alone anymore,” said Davis*. “I’m staying on my medication and I really enjoy our group discussions, because it feels good to relate to other people.” Davis can’t help a large smile when he says life’s a lot easier now. The clients describe the staff not as nurses, physicians, or therapists, rather, they say they are more like friends. “On top of all our duties as counselors, we’re also like social workers because we often help with the Social Security office, food stamps, physically moving them, and repairing things in their homes,” said Sandra Tolen, clinical counselor. “These people need help learning basic life skills like organizing and cleaning a home, how to budget money, and even how to buy clothes that fit properly. Sometimes we’re surrogate family members, too.” “In addition, because we want to keep our clients out of the hospital, we follow the PACT (Psychiatric Assertive Community Treatment) model,” said Virginia Rueger, clinical nurse specialist. “Sometimes clients have a difficult time explaining to other health care professionals, etc. what is wrong when they go to appointments, so we go with them as advocates.” Some of the groups the team offers include men and women’s exercise groups, group therapy, nutrition group, and a medication compliance group. The group, according to Linda Lewis, clinical director, takes a team approach and combines it with interdisciplinary services and coordination with other agencies, and the result is a highly successful program.  “Our main client population consists of people with schizophrenia and those with bipolar disorder,” Lewis said. “This population accounts for the highest number of inpatient admissions to the medical center in 2002, and is the most expensive level of health care. When we help a client avoid hospitalization, we significantly reduce the client’s health care cost over time and since clients view hospitalization as failure in many instances, we make a positive impact on their lives at the same time.” And keeping clients out of the hospital is not always an easy task. “We do everything that we can to help our clients,” said Diana Laikam, advanced practice nurse. “We have someone on call 24 hours a day, seven days a week, we deliver medications to ensure compliance, we work with them on nutrition, and finances. “When we receive new clients, they are extremely reluctant to leave their homes and often have difficulty communicating. Usually, we are the only people that a client will allow in the home. One of our goals is to help with social interaction so that our clients can function as normally as possible in society,” Laikam said. Because the majority of the group’s clients are on SSI because of their disability, the staff faces constant dilemmas concerning a patient’s $500 monthly income for living expenses and medications. While the team will admit that their job is highly rewarding, this team of qualified individuals (everyone has at least 10 years experience), will also admit that they couldn’t help their clients without a strong communicative base. Lewis describes each team member as having an incredible level of personal and professional commitment.  “Not only do we have a team that can handle any emergency, we also have Paul Robbins, M.D., on call 24/7. I imagine he’s one of the few doctors left who makes house calls anymore,” Lewis said. “I really enjoy the Monday, Wednesday, Friday rounds because we do so much brainstorming and planning,” said Ronald Clark, clinical counselor. “We have a wonderful way of bouncing ideas off each other that helps to better serve the clients.” “Cynthia Salvo, administrative support, is a vital part of this program,” said Brad Moultrie, clinical counselor. “She gets information to us very quickly and when we really need it. This support allows us to be much more available to our patients.” Because of the growing popularity of the program and its group initiatives, Lewis said the group is often strapped for transportation. “We have two state vehicles, and everyone else uses their private vehicles to transport clients. We often run into a problem with having enough space for everyone. We’d love a van, but the expense is too much for the program right now.”  To learn more about the Community Care Team, call 534-0773 or to make a donation towards a new van, contact the Health Sciences Foundation at 792-2677 and specify where you would like your donation to go. *Names have been changed to protect individual privacy.     Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.