This program has a great deal of potential but with some bugs to work out of the system.  We respect the psychiatrist who owns the program, Dr. George Ullrich.  We like the concept. We especially like the relatively seamless continuum of services.  We would like to see the supervision tightened, both clinically and administratively.  An Educational Consultant colleague recently said to us, “[Dr.] George Ullrich is a very good man and a very good psychiatrist.  Unfortunately his program is not as good as he is.”  

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We at FamilyLight ^sm have referred to Innercept and may do so again. But we would like to see improvements first.  For the immediate future any referrals we might make to Innercept will be with a cautionary note to the family involved so that they understand what we understand as its shortcomings and can determine whether its advantages outweigh those shortcomings.  For the moment we place a strong caution on enrollment at Innercept any person who has traits that suggest Aspergers Disorder or features of the PDD/ Autism spectrum.  We see somewhat more potential for success with people who present complex psychiatric disorders but are over-all compliant, with no signs of an oppositional presentation.  Even in those cases, we would want the potential resident, their family, and the referral source to be cognizant of the concerns we raise in what follows. 

Briefly, Innercept is a cluster of clinically intense and transitional programs for adolescents and young adults, with headquarters in Coeur D'Alene, Idaho.  The programming involves a well conceived continuum of care with age specific (under 18 separate from young adult) and gender specific program locations primarily in rural areas near Coeur D'Alene.  Each of the four intensive locations involves family style living in a rural setting that feels anything but restrictive. It is managed, by Dr. George Ullrich, a very competent psychiatrist known to FamilyLight ^sm long before there was a place called Innercept. 

Remember that the phrase "residential treatment center" means different things in different jurisdictions.  It is not clear to us that the phrase is officially in use at Innercept at all. However clinical services in the "Intensive" and "Assessment/Stabilization" programs match the intensity of service of the more intensive "RTC" and "RTF" programs in states using that terminology.  In fact the stabilization location is specifically designed as an alternative to hospitalization, which is about as intensive as clinical programs get, short of being hospitals. 

Innercept's therapeutic program is supplemented by accredited (grades 7-12) education through Innercept Academy,  support for collegeHYPERLINK "http://www.innercept.net/college.htm" HYPERLINK "http://www.innercept.net/college.htm"work with three local colleges, online courses, learning support and tutoring from Innercept staff, and possible dual enrollment for both high school and college credit.

One unique strength of Innercept is the very creative continuum of services without loss of continuity of care, which ranges from full hospitalization (not at Innercept but at a hospital where Dr. Ullrich can admit and attend patients) through various stages of gender specific residential care to relatively unstructured transitional programming.  We know of no other program that rivals this offering.

We leave additional details of Innercept’s programming to Innercept's own web site, which we believe is a fair and accurate representation of the structure and layout of the program.  We also have confidence in Innercept's admission staff representing those aspects of program fairly and accurately. Our only significant concern about the admission staff is frequent difficulty with reaching a person as opposed to a voice mail and getting a timely call back from the voice mail message.  We believe timeliness in the admission function warrants some attention.

In preparation for this revision of our earlier review, we have obtained input not only from our observation of and experience with the program and input from our own clients who have been at Innercept, but also from parents who were not our clients whose sons/daughters have been residents at Innercept, former residents who were not our clients, and educational consultants who have referred to Innercept in the past but have become – at best – more cautious in doing so, along with a parent of one current resident who is reported to be doing well in the program.  Not all of their concerns will be repeated here because we cannot substantiate all of them.  But where appropriate, we have considered those concerns in formulating our recommendations for improvement. 

Consistently, when we speak with former patients/ residents at Innercept, including those who report a generally positive experience and those who were clearly successful at and after discharge, they express feeling stifled or excessively restricted while in the program.  Many of these felt that as they made progress, the “goal line” was being moved as they believed they were making adequate progress. Others felt they were simply excessively restricted.  Still others spoke about activities theoretically available being made unavailable for lack of transportation or other reasons.  One had a general concern about inadequate programming to fill a day.  We have heard concerns that we will not repeat here for lack verification, in some cases, and to avoid invading privacy in others.  However our recommendations that follow have been influenced by some of those reports.  In those cases, we could not objectively confirm the validity of the concerns, but we believe that if the recommendations we offer would be adopted, the concerns, if valid, would be resolved. 

One of our primary concerns is that we provided Dr. Ullrich at Innercept with an earlier draft of this review, soliciting a response with a promise to (1) correct any errors of fact that he pointed out to us, (2) consider any differing opinions he offered and consider revising accordingly, and (3) publish any statement provided by Innercept along with the review.  The only reply from Innercept has not been from Dr. Ullrich, but directly addressed the concerns of the family of one of our clients and is specific to their situation and does not appear to be intended for publication.  The absence of dialog regarding our concerns and recommendations suggests resistance to appropriate accountability.

We have recommendations for improvement. While we like the intended model of the program, we believe that there is a general looseness in the operation that calls for greater accountability and systemization.  We also have clinical concerns.   Additional concerns might fall into both areas. 

•  Accountability and systemization: 

▪  We  would like to see internal communication improved, so that when there is a statement to a client and family as to how things will be done, all staff will function consistently with that.  This also needs to extend to consistency on staff expression of program recommendations to residents and families and between staff members.  If there is an agreement on specifics of how a family and the program will relate to each other, Innercept must take responsibility for adhering to the agreement rigorously just as they rightfully expect the family to do.

▪  We would like to see more timely and appropriate responses to communications from parents and referral sources.  We appreciate Dr. Ullrich’s skill in handling such communications when he does the job personally.  We do not believe his staff is trained adequately on this issue and it should not be necessary in a facility of this type to call on Dr. Ullrich personally for all such communications.  

▪  We are aware of a resident of Innercept who was dismissed on January 18, 2010.  At the time, his family had paid for services through January 31, 2010, subject to a small amount of the billing for that period being held back.  However, the amount actually paid was in excess of the amount appropriate to the first eighteen days of January. As of February 15, neither refund nor explanation for the absence of a refund had been offered.  Following our inquiry, the matter appeared to be clarified satisfactorily.  However, in early March, we learned the family still had heard nothing from Innercept. We received a second assurance then that the matter would be resolved appropriately.   The absence of a clear and timely explanation offered at Innercept’s initiative is representative of the communication gaps at Innercept that would not occur in a program more attuned to customer service. 

▪  We would like to see admission calls generally answered in person by a competent admission counselor on business days. (We do not suggest lack of competence on the part of those currently handling admission calls at Innercept; we only question accessibility and response time)   When calls cannot be answered in person, there needs to be a customary response time within a few hours – usually within an hour or so and never more than 24 hours.  We would like to see Innercept and all other comparable programs have an on-call admission person available 365 days per year and at all hours except late night and overnight, although we hasten to add that this standard is not generally kept by other programs. We encourage this as a standard, but actually Innercept may be better than others on this point as regular referral sources are likely to know how to reach someone in authority at Innercept outside regular business hours. 

▪  In the event of the need for a resident to be dismissed from the program, time should be allowed for a parent or other appropriate person to travel to Innercept to accompany that person leaving. We also recommend that Innercept consider adopting a procedure similar to the procedure at Benchmark Transitions where a resident who is not functioning appropriately will be maintained off property until they can earn their way back.  At Benchmark Transitions that procedure has seriously reduced premature discharges. 

•  Clinical:

▪  We would like to see treatment planning and execution handled strictly in accordance with our guidelines.  This requires that there would be a treatment plan for every resident is updated on a regular basis, not less frequently than quarterly.  Because of concerns from former clients about the “goal line” being moved, we especially want to see consistent use of behavioral objectives clearly defining what is expected of each resident (1) within the time frame leading to the next comprehensive review, (2) in order to gain more privileges or other rewards from success in the program (such as a move to a different level or setting), and (3) in order to be ready to return home or move to a less restrictive setting.  A temporary plan guiding treatment needs to be in place within 24 hours of admission, and a comprehensive plan consistent with these guidelines should normally be in place within thirty days of admission – always within six weeks of admission.  Residents, parents, referral sources, and Innercept staff members impacting the experiences of residents/ patients all should possess an updated written version of the plan, and Innercept staff members and clinicians should be guided by the plan in all interactions with the resident/ patient.  In a treatment center in this price range, we see no excuse for not maintaining this standard.  Parents, usually students/ residents, and referral sources should be participants in person or by conference phone when comprehensive reviews occur.

We have discussed with Dr. Ullrich the issue of the “goal line” moving.  He reports difficulty in doing as we suggest (perhaps in part) because parents sometimes want to make changes after a person is in treatment. We do not believe that is a sound response.  The better residential treatment centers assess their clients/ residents/ patients very early in the process and define the behavioral goals for discharge.  These may be considered discharge criteria.  When a program has levels of care, as Innercept has, what is required for each transition at each level of care needs to be defined at that time as well.   We’ll call that transition criteria. 

Parents (of residents who are minors) and young adults themselves always can opt for an early discharge.  However, we do not think it is appropriate for any treatment center to retain a client when issues identified on the treatment center’s assessment have been resolved even if the parents or the resident request that. We acknowledge that additional issues can arise unexpectedly while a resident is in treatment that affect discharge criteria legitimately.  However  barring the most extreme kind of unexpected negative change in condition (Example:  the client experiences a major traumatic event while in treatment that triggers PTSD for the first time) these changes should only arise early in treatment and must never be imposed while the resident is mentally preparing for a discharge in the near future. 

When we have inquired about treatment plans of our clients at Innercept, they have not been written with the quality we believe is appropriate, we have not seen evidence of regular updates, and we have not seen indications that what is written in the treatment plans actually guides what is happening. Our sense is that treatment at Innercept tends to be reactive to events to a greater degree than appropriate as opposed to being based upon an orderly treatment planning process that strategizes moving toward goals that everyone involved understands.  In one case, we were getting directly contradicting reports about the appropriateness of discharging one of our clients when speaking with the client’s therapist as opposed to one of the members of the administrative team.  Dr. Ullrich phoned us and successfully clarified the situation, and in so doing, communicated the specifics of how the communication problem arose.  What prompted the confusion would have been prevented in its entirety by employing the treatment planning process we are suggesting, and we see in place in the better clinical facilities.

▪  We want to see greater emphasis on family therapy and family involvement.  We applaud Innercept for offering family therapy and special on-site programming for parents.  However it has not been our experience that Innercept clinicians are sufficiently assertive with parents regarding the integral role parents have in the recovery process of their sons and daughters. 

▪  We want to see greater thoroughness in psychological evaluations provided by Innercept.  We very recently had opportunity to review an evaluation done on a young adult under Innercept’s auspices.  That evaluation avoided addressing the possibility of a personality disorder, entering “Deferred” on Axis II of the diagnostic profile.   While we know of no official determination that this is inappropriate, the deferral of diagnosis on Axis II (i.e. deferral of addressing the question of whether or not there is a personality disorder) lowers the usefulness and therefore the value of the evaluation.  When an adult patient/ resident person is displaying symptoms typical of personality disorders it is at best puzzling why a licensed psychologist would defer diagnosis on Axis II.  When we see those kinds of symptoms, diagnosis on Axis II is one of the most important things for a psychological evaluation to address. In general, other service providers deliver more informative evaluations and we would not ever knowingly select or recommend a provider of this type of service who would do what was done on this evaluation.

▪  We seek clarification of the amount of planned, constructive, activity in the main program residences as opposed to downtime and we seek similar clarification as to what at “Stabilization” is therapeutic as opposed to punitive.

▪  We want to see greater awareness by clinicians regarding case management responsibilities of some referral sources and better coordination in those areas. 

▪  We want to see a part time psychiatrist on staff and able to cover for Dr. Ullrich and attend patients both at Innercept and at the local psychiatric hospital when Dr. Ullrich is not available.  We hear that there is now a “Dr. Stoddard,” a psychiatrist, attending patients at Innercept, but we have not had confirmation from Innercept management.  We do not know whether he is full time or part time or whether or not he can maintain continuity in the event of a hospitalization at the local psychiatric hospital.  We mention the local psychiatric hospital because one important offering of Innercept that sets it apart has been potential for continuity of care if a resident needs hospitalization.  However that continuity has been subject to disruption when Dr. Ullrich is out of town and/or on vacation or simply wanting/ needing downtime.  All people including Dr. Ullrich deserve down time. In this line of work, downtime is essential to ability to exercise continued good judgment.

▪  We want to see more sophistication and training for non-credentialed staff who supervise residents. We want to see enhanced training for all staff, including licensed therapists, in serving the needs of residents with PDD/ autistic spectrum disorders including Aspergers Disorder.  A focal point of such training would be skills to de-escalate a resident in crisis and avoiding interventions likely to make matters worse. 

▪  We want to see more sophistication and training for credentialed staff in strategizing with residents and their families to maintain a team effort between Innercept staff, parents, referral sources and the resident, utilizing constructive input from others that stretches usual patterns of thinking at Innercept as well as setting appropriate limits where necessary.

•  Additional concerns affecting both areas:

▪  When it becomes necessary to establish special rules and procedures for interaction between a resident/ patient,  people interested  that  resident/ patient (family members, referring professionals, etc.), and Innercept staff, those rules and procedures are equally binding on Innercept staff as they are on the resident/ patient and the family and other outside interested parties.  In any case, communication between Innercept and outside professionals, conducted in accord with law and accepted standards of confidentiality, should not be abridged. 

▪  We are quite concerned about countertransference.  We are in possession of a copy of an email from staff at Innercept bringing to the attention of a parent certain limits that Innercept felt a need to impose regarding interaction between a parent and son at Christmas, where the son was a young adult resident at Innercept.  While we have some subjective discomfort with the limits themselves, we will not engage in discussion of the limits themselves in this venue.  A fair and balanced discussion of the limits themselves would take more space and more time to describe than we believe is warranted, and would also invade the privacy of the client and his family.  However, we believe the manner of communicating the limits demonstrated a level of anger that is simply not appropriate coming from clinicians.  We emphasize that our greatest concern lies in the manner of communicating those limits, as opposed to the limits themselves. This communication and additional comments in communications with Dr. Ullrich in which he suggested his choices in addressing the needs of a client were to some degree circumscribed by potential staff reaction added to our concern about countertransference.  Clinical facilities are not operated for the comfort and convenience of staff.

▪  We would like to see greater openness to feedback and emphasis on self evaluation and quality improvement as major emphasis of the program, in the style that is required for Joint Commission accreditation. For further information on what we mean, we suggest consultation with Joint Commission Standards for Quality Improvement.

We have one recommendation for families placing a son or daughter at Innercept, other than what is implied by our descriptions and recommendations to Innercept:  Ask Innercept’s admission people to describe precisely the activity level that will be available to the family member becoming a resident, and require that the response to that question be made part of your contract with Innercept, binding upon them as the service they are obligated to perform in exchanged for your fees.

In looking at listings for Innercept that come up on Google, we noticed one that described Innercept pejoratively as being "in the Cedu model."  For better or for worse, Innercept is radically different from the former Cedu organizations and web postings claiming Innercept is “in the Cedu model” are impeaching their own credibility.   It is true that Dr. Ullrich did at one time consult with a school in the Cedu organization.  That school was a softer version of the Cedu model.  In any case, Dr. Ullrich had no part in the program design and management of that Cedu school. The original Cedu model was openly hostile to psychiatry.  The Cedu Schools (prior to purchase by Brown Schools) allowed their students to have access to psychiatric services only reluctantly and only due to marketing pressure.  For a school or program to be operated by a psychiatrist and every resident to be under care of a licensed therapist is a direct repudiation of the original Cedu model.   In addition, other hallmarks of the Cedu model like intensive sleep deprived seminars (Cedu called them “propheets”) do not occur at Innercept. The usually harsh peer to peer intervention characteristic of Cedu does not occur at Innercept, at least on a staff sanctioned basis  (we don’t think it occurs at all), and group therapy at Innercept bears little resemblance to Cedu “raps.” We can neither confirm nor rule out an unduly punitive approach to behaviors that call for correction; if this is an issue that may be one potential derivative of the Cedu history that has been incorporated at Innercept. It appears that someone who is unfamiliar with either Innercept or Cedu or both, knew about Dr. Ullrich’s former work at a Cedu school and jumped to a false conclusion.

When we see a web posting of this kind, it appears to us that the person posting simply does not know what Cedu was and is simply throwing in a word likely to generate a negative reaction, not knowing what they are describing.

Innercept is a treatment venue with great potential.   We are certainly not suggesting that the concept that Dr. Ulrich describes and has attempted to implement is bad. On the contrary, we like that. However when we examine the Innercept  organization chart in light of experience with this program and others, it is clear where the problem lies.  There is no one in management or in clinical supervision who has in-depth experience with managing a complex facility serving a private clientele that expects serious customer service. Most of the clinicians working at Innercept, with whom we have had direct communication, have had prior experience only in the public sector or private practice.  Dr. Ullrich has serious clinical background for his position, but he appears to have been new to his current kind of responsibility when he founded Innercept. However, when you examine the organization chart (as of February 13, 2010), you will see that there is a broad range of roles and functions reporting to him.  We believe Dr. Ullrich is attempting to do too many things himself and more than any one person can do well, while the facility needs attention in areas in which we believe no one at Innercept, including Dr. Ullrich, has significant experience. 

We strongly recommend to Innercept that it employ a person who has major experience both as a clinical supervisor and as senior manager in a comparable treatment program serving private clients.  This person should be placed essentially in an executive director position, ensuring that the program is pulling together and ensuring that all staff both receive proper support and are subject to proper accountability for delivering appropriate services.  Dr. Ullrich should remain in three functions:   (1) Medical Director and attending psychiatrist for some or all residents and supervising the care rendered by any other psychiatrist on staff, (2) a function that resembles “Chairman of the Board,” and (3) a clinical supervision/teaching function for the entire staff. 

As “Chairman of the Board,” Dr. Ullrich would not just be chairing board meetings of a board.   Dr. Ullrich should continue to define treatment philosophy, determine the overall character of the facility, and hold all others accountable for supporting his vision. In a very limited range of circumstances he should be the contact person for the facility although other staff should be trained to lift much of that burden from Dr Ullrich and to discharge that duty at the level of competence that is customary in facilities serving private pay clients. We suggest that this communication responsibility be shifted from Dr. Ullrich, not because he does not do it well, but because he could not possibly maintain the frequency of contact that is needed with all families and referral sources and other staff should be trained to handle such communication with excellence.  While we want Dr. Ullrich to have an active role in clinical supervision, we do not think he should be the sole source of clinical supervision.  The person in the new position and those reporting to him/her need to take responsibility for making certain Dr. Ullrich’s treatment philosophy and other wishes are carried out, in the context of proper clinical behavior and adjusting to the context of expectations of privately funded psychiatric facilities.   We are not optimistic that what we see as shortcomings at Innercept can be corrected without the addition of a person of very great experience and capability being hired and given the authority and backing to make the corrections that are essential if Innercept is ever to reach its potential. While we usually encourage promotions from within, for the position we envision here, we do not believe that anyone currently at Innercept has the background and skill to do this job effectively.

We leave additional details of programming to Innercept's own website, which we believe is a fair and accurate representation of the programming at Innercept.  We also have confidence in Innercept's admission staff representing the program fairly and accurately once you reach them. 

Innercept falls within our acceptable range, but we would welcome some improvements.  When we suggest consideration of Innercept to a client, we will call attention to the issues we raise here.  We welcome comments on this review, especially from Innercept.  

Please note that Dr. Ullrich was provided with an advance copy of this review, which differs from the final version as posted.  His comments were solicited for posting with the review, but we have received no response.  When we sent that to Dr. Ullrich, we stated that we would (1) correct any errors of fact that he pointed out to us, (2) consider any differing opinions he offered and consider revising accordingly, and (3) publish any statement provided by Innercept along with the review.  The only reply from Innercept has been directly addressing the concerns of the family of the young man dismissed from the program in January and is specific to their situation and does not appear to be intended for publication.  If they do not agree with our criticisms, we would welcome an opportunity to present their side of those issues.

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Feedback is invited. We will publish any feedback in good taste. Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated  3-24-10