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CASE STUDY

How the Safe and Sound Protocol (SSP) Became Key to Capstone’s Residential Treatment Plans for Young Men

Founded in 2001, Capstone Treatment Center has supported thousands of young men and boys aged 14-26 with a broad range of mental health challenges through its comprehensive curriculum. Striving for excellence to help individuals and their families, Capstone sought out the Safe and Sound Protocol (SSP) in 2022. The treatment center aims to build trusted relationships between clients and therapists to further realize its vision of fostering psychological and physiological safety, thereby expediting clients’ healing journeys.

Since 2022, Capstone has made the SSP a core element of its residential therapy curriculum. This integration has led to significant improvements in client regulation, shutdown behaviors, panic attacks, family relationship dynamics and overall treatment progress. Clients have also shown an improved connection with Capstone’s therapists and positive changes in how they present and interact with others. Further, the Capstone team has developed a shared language around Polyvagal Theory and nervous system regulation that has provided additional methods for assisting clients with escalating behaviors.

Recognizing this success, Capstone is now exploring the expansion of SSP delivery to both its outpatient and new women’s residential programs.

Jeremy Carter of Capstone

“SSP is now a standard part of what we do with every client. … We always want to be the best at what we do, and if we find something that can make us better, we’re going to jump all in on it.”

— Jeremy Carter, LMFT, LPC, Clinical Director at Capstone Treatment Center, on the residential treatment center’s SSP journey

Highlights of Capstone’s SSP Integration

Challenges

CHALLENGE:

Building Trust Between Therapists and Clients with Complex Needs

Clients often arrive with multiple mental health struggles and problematic coping behaviors, with over half of clients struggling with addiction. This high level of complexity can create challenges in establishing trust and engaging in therapy.

One key goal for the SSP is to help clients transition into the therapeutic process with greater safety, accelerating their readiness for the intensive therapeutic curriculum.

Furthermore, some clients arrive with extensive treatment histories, with their families viewing Capstone as an “ultimate” option. This creates a strong sense of urgency for therapists.

CHALLENGE:

Integration of the SSP into an Intensive, Established Curriculum 

Capstone has a well-established intensive curriculum including a variety of required activities that must be completed within a fixed time span of 90-96 days. The smooth integration of the SSP without disrupting existing services was essential. 

To ensure attentive care for each client, Capstone maintains a low therapist-to-client ratio of 1:2 and all therapists undergo training in advanced modalities, such as EMDR and Brainspotting. With a dense treatment process already in place, incorporating SSP required evaluating the best resource implementation to continue the flow of therapeutic delivery. Designing the delivery model and implementation plan, including the selection of ideal SSP providers and the timing of training and delivery, required careful consideration. 

Highlights of Capstone’s SSP Integration

Solutions: Customized Delivery Model + Mentorship + Measurement of Outcomes

Customized Delivery Model Design

Unyte assisted the Capstone team in implementing a treatment model that starts all clients with the SSP at the time of intake. All clients now start the SSP before fully engaging in other therapeutic activities, taking into account their established curriculum, therapists’ capacity and client needs.

Whole-organization Implementation and Training

Unyte assisted Capstone in onboarding 35 staff members, including leadership and therapists, so that everyone was prepared to deliver the SSP from the beginning of the implementation process and on the same timeline. This organization-wide training helped drive a collective shift toward a Polyvagal-informed approach at Capstone.

Dedicated “SSP Champion”

Capstone created a dedicated SSP Coordinator role responsible for starting the SSP with each client and managing delivery schedules thereafter. Identifying and empowering an SSP champion has been an important element in Capstone’s successful integration, and demonstrates Capstone’s strong commitment to and belief in the SSP. Other therapists eagerly took on the SSP delivery role when the SSP Coordinator was unavailable.

Clinical Support and Mentorship

Unyte provided customized 1:1 and group clinical support for the SSP Coordinator and therapists. In monthly mentorship sessions led by an advanced expert mentor, Unyte and Capstone jointly reviewed SSP delivery methods used in complex client cases and explored the application of the main principles of Polyvagal Theory at Capstone.

Regular Business Meetings with Leadership

Unyte met regularly with Capstone’s leadership team to ensure alignment with goals while optimizing the SSP model and mentorship process to achieve these goals.

The Unyte and Capstone teams. Left to right: Becca Lill (Key Account Manager, Unyte); Kayla Ann Wilson (SSP Coordinator and Intake Specialist, Capstone); Jeremy Carter (Clinical Director, Capstone); Marcelo Sena (Head of Business Development, Unyte)

Highlights of Capstone’s SSP Integration

Results

Clients have become more regulated and open to engagement with therapists after the SSP.

Polyvagal Theory has become a shared language among all staff and therapists. It has effectively enhanced their engagement with clients and provided their clinicians with another tool to aid in the treatment process.

Capstone continued training new therapists as they joined the organization. In under two years, the number of staff trained in the SSP increased from 19 to 35, demonstrating continued trust in the SSP.

The improvements demonstrated in client engagement have given Capstone the confidence to explore expanding the SSP to its outpatient and residential women’s programs.

CASE STORY:

Overcoming Shutdown Behaviors

Adam, 14, exhibited shutdown behaviors, making it challenging for his therapist to engage in conversation. After starting the SSP and canine companion therapy, there was a noticeable shift. Over subsequent sessions, Adam gradually opened up, displaying more of his personality, making jokes and feeling a sense of relief from the weight he carried.

CASE STORY:

Reduction of Panic Attacks

Caleb, 15, experienced frequent panic attacks that disrupted his daily life, often occurring without known triggers. Initially suffering three to four attacks per week, this occurrence fell to once per week after the SSP. With his enhanced physical condition, he became a leader in his group at Capstone, actively engaging in therapy and showcasing remarkable progress.

CASE STORY:

Freeing from Memory Struggles and Self-doubt

Ben, 20, suffered from lingering COVID symptoms, such as brain fog and mood swings, which hindered his academic pursuits and left him doubting his abilities. After undergoing the SSP, he found himself opening up emotionally, and his memory function and energy improved. Now, he is excelling academically with confidence.

Note: All names used in these case studies are pseudonyms.

“I’ve noticed a lot of guys who come in and they’re shut down. They don’t want to connect. They don’t want to pursue relationships because they have a history of relationships hurting them. … Bringing SSP onto the team was super important, and has fostered that connection and that regulation for our [clients].”

— Kayla Ann Wilson, LMSW, SSP Coordinator and Intake Specialist at Capstone Treatment Center

Deep Dive into Capstone’s SSP Integration

About Capstone

Capstone is located in Judsonia, Arkansas, and offers residential therapy programs for young men aged 18-26 and teenage boys aged 14-17 with a wide range of mental health struggles. Capstone is a highly specialized Christian treatment center that treats trauma, substance abuse, sexual compulsivity, family issues, addictions, behavioral problems and co-occurring disorders. Capstone offers a range of therapeutic modalities including EMDR, Capstone NeuroCoach, canine companion therapy and the SSP.

 

Why Unyte?

Capstone places great importance on fostering safety and building trust with clients throughout their programs. Their approach focuses on addressing problematic behaviors stemming from feelings of threat, such as isolation, disconnection, loneliness and hurt. The Capstone Model, developed by its founder Adrian Hickmon, Ph.D., aligns with Unyte’s values, the principles of Polyvagal Theory and the aim of the SSP: to restore the ability to detect and respond to cues of safety, thus creating more flexibility in the nervous system.

 

How Unyte Supported Capstone

Customizing SSP Integration for Capstone: “SSP First”

As part of its Organizational Solutions plan, Unyte analyzed Capstone client demographics and reviewed its established curriculum, therapists’ specialties and average caseload. Unyte and Capstone collaborated closely to customize mentorship content, onboard new providers and modify the delivery model as needed. 

After careful planning, Unyte assisted Capstone in implementing an “SSP first” model, meaning all clients start the SSP before participating in any other therapeutic activities. This way, clients engage in later treatments in a more regulated state. It also increases and accelerates the potential benefit of other interventions as clients progress through the curriculum.

Dedicated Support for Capstone’s SSP Champion: The SSP Coordinator

Many organizations appoint an SSP champion, resulting in effective delivery and integration. Uniquely, Capstone created the new role of SSP Coordinator to serve as the dedicated program champion. This role is responsible for initiating the SSP and managing the SSP delivery schedule while communicating progress and collaborating with other SSP providers and case-carrying therapists. The SSP Coordinator has directly influenced the success they have seen with the listening therapy.

Unyte’s team provided dedicated support to the SSP Coordinator through 1:1 mentorship and ongoing asynchronous support between regular group mentorship sessions. This targeted support aimed to enhance the SSP Coordinator’s knowledge, build their confidence and ensure the smooth delivery of the SSP in synergy with the established curriculum.

Expanding Polyvagal Knowledge to Leadership and Therapists to Create a Culture Shift

It was important to Capstone that all therapists understood effective and safe practices for SSP delivery. Recognizing the importance of safety-building within Polyvagal Theory and the SSP, Capstone engaged Unyte to organize SSP and Polyvagal Theory training for their team, including leadership and therapists.

Bringing all case-carrying therapists together as SSP providers accelerated the adoption of Polyvagal Theory as a shared language amongst their team and positively contributed to covering the therapeutic ground with their clients.

Ongoing Mentorship and Clinical Support

Addressing the needs of clients with complex conditions can present unforeseen challenges. Even with a well-equipped team dedicated to SSP integration, Unyte and Capstone conduct monthly virtual mentorship sessions to review SSP best delivery methods in complex client cases and explore the main principles of Polyvagal Theory. 

Additionally, Unyte implemented 1:1 calls with selected SSP providers to better understand their experience and refine the mentorship process accordingly.

One year after the start of delivery, Unyte modified the mentorship model to provide smaller group learning sessions as the team’s needs changed and confidence increased. As Capstone continues to grow, the Unyte team adjusts training support to best suit their evolving needs, ultimately helping them provide the best support to their clients.

Measuring and Ensuring Aligned Business Goals

Unyte supports Capstone’s development by meeting regularly with the Clinical Director to discuss organizational goals, ensure alignment between both parties, celebrate successes and identify areas for improvement. This ongoing collaboration optimizes the model to achieve long-term business objectives.

Results

74

 clients completed the SSP

35

staff have been trained as SSP providers

Improved Client Regulation and Increased Engagement with Therapists in the Curriculum

With the SSP in place, clients become regulated more quickly and open to engagement with Capstone’s therapists. Many young men, previously often stuck in a dorsal vagal “shutdown” state or sympathetic “fight-or-flight” state, are now opening up emotionally and engaging more readily in therapy. Those grappling with negative emotions are gaining confidence. Additionally, some continue with the SSP beyond the initial period.

Capstone is one of more than 4,000 clinical practices that have successfully integrated the SSP into its treatment plans. Approaching its third year of implementing the SSP, Capstone will benchmark clinical outcomes against real-world evidence collected from the Unyte community. The aggregated evidence is as follows:


Anxiety

Depression

Trauma-related symptoms
61%
of clients moved from clinical to
non-clinical level
63%
of clients moved from clinical to
non-clinical level
47%
of clients moved from impaired to
not-impaired level
5.6-point
improvement in symptoms of anxiety
Measured by GAD-7
5.4-point
improvement in symptoms of depression
Measured by PHQ-9
17.5-point
improvement in trauma-related symptoms
Measured by PCL-5

Enhanced Therapist Knowledge, Well-being and Collaboration

Fully integrating the SSP into the male residential treatment program and bringing all 35 staff together for training has provided a collaborative environment for their team to have shared training on the benefits provided by the SSP approach. 

After completing the on-demand Foundational SSP Training and engaging with mentorship, therapists have gained new insights that enable them to approach clients differently. With Polyvagal Theory now serving as a shared language among all therapists, their team can evaluate the impact of SSP on their clients and better tailor their treatment plans as a result. 

 

Extending SSP Integration as Capstone Expands

Building on its success, Capstone is now exploring the expansion of SSP delivery to both its outpatient and new women’s residential programs. Unyte is looking forward to supporting Capstone as more team members get involved with the SSP project and the positive reach of the SSP grows.

“The SSP is a practical, hands-on, therapeutic aid that is doing more than delivering its own effects to individual nervous systems. It is creating a deep reframing educational space for reworking how we respond to clients and approach our work in general. I see this shift happening at Capstone.”

— Laurie Belanger, LCSW-R, EMDRIA Approved Consultant, SSP provider. As an external Unyte Clinical Mentor, Laurie collaborated with Unyte in mentoring Capstone through SSP integration.

Are you interested in using the SSP within a treatment center or healthcare organization?

Ideal for organizations with 4+ providers, Unyte’s Organizational Solution features a 360-degree approach that includes bespoke program design, professional clinical mentorship and data-driven outcome measurement.

What you can expect:

  • Full access to the Safe and Sound Protocol (SSP)
  • Customized SSP delivery plan with implementation execution
  • Professional mentorship within reach
  • Regular progress reviews for success
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