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Improving Quality of Care via On-Site Utilization Review

By: Philip Hensarling, Director of Utilization Review on Quality of Care

Renewal Lodge by Burning Tree

Renewal Lodge by Burning Tree is a substance abuse treatment center located in Elgin, Texas. Treatment at Renewal Lodge includes a 12-step approach, dual diagnosis, medication management, psychotherapy, and comprehensive discharge planning. Our facility accepts private insurance to supplement the cost of treatment. Renewal Lodge by Burning Tree is also JCAHO accredited and is licensed by the state of Texas for residential substance abuse treatment. Since December 2017, I took on the role of Director of Utilization Review at Renewal Lodge after serving as an Admissions Specialist. As an alumnus of Burning Tree, I’ve developed a passion for helping families and their loved ones in the recovery process. As Director of Utilization Review and with the help of the Burning Tree leadership team, we have been able to make significant progress in improving the quality of care. By moving from outsourced utilization review to in-house utilization review, Renewal Lodge has increased authorized days for a residential level of care by 25% from 2017 to 2018.

Quality of Care Review Process

The utilization review (UR) process begins with a UR representative making a pre-certification call within 24 hours of admission, once the verification of benefits (VOB) has been reviewed. The insurance company is provided with patient and administrative information such as client name, DOB, ID number, facility name, tax ID and address. Clinical information is then relayed from three assessments: pre-clinical, intake and nursing. Insurance companies will review from either the national criteria, American Society of Addiction Medicine (ASAM)[i], or state criteria, Texas Administrative Code (TAC)[ii]. Insurance companies can also go a step further and establish their own medical necessity criteria, such as 24/7 on-site nursing. After the pre-certification call, the insurance company will authorize or deny an initial number of authorized days, which are offered in portions of approximately 4-14 days. Per TAC standards, the average length of stay for 24-hour residential treatment is between 14-35 days. Length of stay is determined by applicable criteria or standards met for continued stay3. The responsibility of the UR representative is to convey, with the help of clinicians and doctors, how the information presented in the client’s chart meets the appropriate criteria or standards. Clinical reviews are typically requested on the last authorized day of each portion of authorized days. A licensed therapist or nurse from the insurance company evaluates the information presented then provides a decision to authorize, step down to a lower level of care or discharge a client. If authorized, the insurance company will issue an authorization number which enables the facility to bill appropriately. If denied, a peer review will be scheduled with a medical doctor. An appeal may be requested thereafter by an independent 3rd party if authorization still isn’t granted.

Common Practice

Substance abuse treatment facilities often have UR representatives either working off-site or out of sight, which potentially allows for a higher caseload. This may even make a great deal of sense as far as the bottom line is concerned. On the flip side, contact with co-workers by phone or email only can limit their ability to communicate and problem solve effectively. When working in a high-stress environment, delays in communicating critical information can lead to team members feeling helpless awaiting a response. Negligence is more likely to occur in a bottleneck of communication within an organization. Pressure also creates a potential to manufacture dishonesty which leads to more mistakes. Finally, something is bound to slip through the cracks, i.e. lack of medical follow-ups, missed appointments, missing pertinent past diagnoses and/or medical history, incorrect or incomplete treatment plans and/or therapeutic interventions, missed collateral contacts, issues with discharge planning, etc. This ultimately impacts the quality of care.

Innovative Practice

In order to manage the flow of information between operations, clinical and medical, it is essential to establish a role dedicated to utilization review within the leadership team that operates on-site. Direct contact mitigates problems, insulates clients from negligence and creates an environment for meaningful relationships to culminate, which everyone can agree is the foundation of both good business practice and long-term sobriety.

  • Democratic Approach: Burning Tree maintains a democratic approach to the treatment of substance abuse clients in residential treatment. Collectively, our professional clinical staff weigh in and vote on therapeutic interventions, treatment plans and individualized discharge plans. A democratic approach addresses two main problems that are often a pitfall in counseling: counter-transference (the emotional reaction of the counselor to the client’s contribution) and lack of communication. This approach provides oversight and limits the risk of errors due to work overload by maintaining a level of accountability in a system of checks and balances called “Master Treatment Planning,” which is a weekly meeting attended by clinical, operations and medical staff. By working directly with operations, adjustments to scheduling can be arranged to coincide with scheduled reviews for UR. Questions asked by care managers can be answered by operations, clinical or medical in minutes rather than hours. If your life were at stake wouldn’t you rather have a team of professionals making decisions on your life rather than just one professional?
  • Increased Accountability and Protection Against Negligence: Paired with a treatment team the utilization review department is an asset rather than an adversary to clinical, medical and operations. My experience of most UR relationships is one department is always “doing it wrong” and playing the blame game. When UR specialists are either off-site or tucked away in a separate building, they do not have direct communication which influences the quality of care. Establishing the UR department in an on-site leadership role creates a layer of accountability that protects counselors from “dropping the ball” which inevitably trickles down to the client. After all, it’s easy to overlook emails and miss phone calls from the UR department regarding specific information. Medical appointments and follow-ups must be scheduled timely. Clinical problems must be identified, and treatment plans or therapeutic interventions followed up on. Direct flow of communication creates a symbiotic relationship between medical, clinical and operations. It would be illogical to assume that having the one department that relies on operations, clinical and medical not be on-site to coordinate the flow of vital information which must be relayed accurately to insurance providers. The right hand must talk to the left in order to be effective in any treatment-based platform. An on-site UR department is the glue. An on-site Director of UR has direct contact with medical and clinical daily which allows problems to be identified quickly, solutions implemented and progress to be measured then relayed to providers. An added benefit is having answers to the care manager’s questions before they’re asked.
  • Non-Clinical Relationship: The UR representative’s role within the organization should also include a non-clinical relationship with every client. Burning Tree offers a daily “Community Group” which focuses on accountability through a 12-step lens. Pertinent information can be charted then presented to the treatment team by the UR representative. From the insurance company’s perspective, a chart on a screen suddenly becomes more like a real human being suffering from a chronic disease, with the help of an established non-clinical relationship. For example, if you’re in the market for a used car, would you rather buy a car from someone who knows the car inside and out or buy sight unseen from someone states away?

An on-site Director of UR, with proper processes and procedures implemented, helps create a client-focused continuum from admission to discharge. A client-focused approach is the way out of the dark shadow unethical treatment centers have created for the industry. My personal belief is authorizations and dollars will flow provided we act with integrity in our business of serving others first and providing the high level of quality of care. When non-clinical, clinical, operations and medical work together the client wins.

References

[i] ASAM Criteria

https://www.asam.org/resources/the-asam-criteria/about

[ii] Texas Administrative Code – Admission Criteria for 24-hour Residential.

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=28&pt=1&ch=3&rl=8011

[iii] Texas Administrative Code – Continued Stay Criteria for 24-hour Residential

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=28&pt=1&ch=3&rl=8012

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Dear Renewal Lodge Visitors,

My name is John Bruna, co-founder of the Mindfulness in Recovery® Institute, and more importantly, a grateful member of the recovery community. I am incredibly fortunate to have found my recovery in 1984. Of course, I did not achieve continuous recovery through willpower or my own efforts, but through the guidance and caring support of countless others that selflessly taught me how to live through the 12 Steps.

My journey of recovery brought this once homeless, shame-based, traumatized, insecure young man to a life far beyond anything I could have ever imagined. I discovered self-worth, the joy of helping others, the gifts of parenting and grandparenting, and most importantly the ability to live a meaningful and purposeful life with integrity.

One of the greatest gifts of recovery is that I have the opportunity to give back and help others discover their self-worth, dignity, and the skills to fully live lives that they find truly meaningful. This is the inspiration for developing the skills of Mindfulness in Recovery® (MIR) to meet the needs of new generations struggling with alcohol and other substance use disorders. MIR is a set of evidence-based skills designed to help people fully integrate their tools of recovery in ways that are personalized, practical, and in alignment with their deepest values.

While we train counselors and therapists throughout the United States and abroad, I personally have chosen to work directly with the amazing team and clients at Renewal Lodge to develop the model MIR 12-step program for the nation. I choose Renewal Lodge because of the vision of its mission and the dedication of its team. Renewal Lodge is an extremely rare environment in which the staff embodies the very mindfulness and 12-step practices and skills they offer their clients. The results have been beyond my expectations. It is an honor to be here and I treasure my personal time with every client I meet.

With Gratitude,

John Bruna
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John Bruna
Director of Mindfulness
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Patty Raymer
Patty Raymer
Sr. Biz. Dev. Representative
Patty Raymer serves as Sr. National Business Development Representative for Burning Tree Programs. Active in the national recovery community since 1992, Patty has enjoyed over 30 years of sobriety, service, and excellence in her personal triumph over addiction. Today she helps guide families and clients in their own quest for meaningful, individualized treatment solutions. As one of the most recognizable names in our industry, Patty believes that enrolling in one’s own personal work is the best way for the family to heal from the wounds of addiction. Subscribed to the mantra of “Trust God, Clean House, Help Others,” Patty and her husband reside in the beautiful Texas Hill Country.
Russell Angell, BS, LCDC
Russell Angell, BS, LCDC
Primary Counselor
Russell Angell serves as a Primary Counselor for Renewal Lodge. He graduated from Texas Tech University with a Bachelor of Sciences in Human Sciences, is a Licensed Chemical Dependency Counselor Intern, and a Certified Mindfulness In Recovery Facilitator. He utilizes the therapeutic modalities of ACT, Motivational Interviewing and mindfulness practice. Russell hopes to use his own life experiences as a person in recovery to help his clients connect with themselves and find a more meaningful, purpose-driven life, and to share his passion for the intersection between spirituality and mental health. Russell is happily married with one son and lives in Elgin, Texas.
Craig Powell
Craig Powell
Financial Assistant
Craig Powell serves as a Finance Assistant at Renewal Lodge. He has grown within the organization since starting out as a Recovery Mentor and has maintained sobriety since 2019. Craig is responsible for assisting the Comptroller in collecting payments, sending and receiving invoices and ancillary transactions. In his spare time he enjoys gaming and spending time with his step daughter and significant other.
Cody Odom, MS
Cody Odom, MS
Controller
Cody Odom serves as the Controller for Burning Tree Programs. Responsible for managing the accounting and finance departments, Cody’s overarching mission is to ensure that all of our families and clients continue to receive ethical, affordable treatment. Holding a Bachelor of Business Administration from Texas State University, Cody will be completing his Masters in Accounting during the summer of 2022. A Texas native, Cody is a sober softball enthusiast, the parent of two adorable cats, and is recently married in May 2022 . He became sober in 2015.
Evan Varty
Evan Varty
Director of Utilization Review
Evan Varty serves as the Director of Utilization Review at Renewal Lodge. His experience as a client with The Lodge back in 2018 is what launched his passion for helping others. Now as a part of the team at Renewal Lodge he is furthering his education and studying to become a LCDC. In his role as Director of UR Evan manages the utilization review department, insurance contracting, credentialing, and continuing care.
Rico Hernandez
Rico Hernandez
Maintenance
Rico Hernandez serves as the Director of Maintenance for Renewal Lodge. Responsible for managing and maintaining the Grounds, Facilities, and Fleet of the eleven acre property of Renewal Lodge. Rico employs a broad range of professional skills in commercial and residential construction. Earning employee of the year twice since 2009. Rico, his son and three dogs Puggles, Franklin (Pugs) and Ace (Husky) reside in his home town of Elgin Tx. Rico exhibits Renewal Lodge passion for “Creating a life of excellence beyond sobriety”.
Jessica Peralez, BS
Jessica Peralez, BS
Director of Operations
Jessica Peralez serves in the combined role of Operation Director and Human Resources Administrator. She has a passion for helping others where she gravitated towards the field of substance abuse. As a daughter of a recovered alcoholic, she wanted to continue to be of service for clients and employees alike. She has been with Burning Tree since 2018 and resides in the nearby town of Bastrop, Texas with her two dogs and fiancé. She is engaged to be married in February of 2023. She intends to pursue obtaining her PHR certification to assist in the development and future growth of Burning Tree.
Lauren Juvers
Lauren Juvers
Nat’l Biz. Dev. Representative
Lauren Juvers serves as National Business Development Representative for Burning Tree Programs. Responsible for acting as an ambassador of the program, Lauren’s duties consist of sharing her personal story of recovery, working with professionals who specialize in treating addiction, and giving hope to families who are desperate to help their loved ones. As an Alumnae of Burning Tree Ranch, she describes the program as a “nationally known, long-term residential treatment center for the chronic relapser and treatment resistant individual.” An avid animal lover and PADI-certified scuba diver, Lauren has been sober since 2011. She resides in Dallas, TX.
William Zaney, LCDCI
William Zaney, LCDCI
Biz. Dev. Representative
William Zaney, LCDCi has over 3 years of experience working in behavioral health and is currently a Business Development representative for Renewal Lodge. William is a licensed therapist and is pursuing a Master of Science in Healthcare Administration at Texas Tech School of Health Professions. His previous roles within the organization include Admissions Specialist, Counselor, Director of Utilization Review and Discharge Coordinator. William is happily engaged to fiance, Erin. He enjoys spending time on his farm and going to the movies whenever possible.
Julian Duran
Julian Duran
Nat’l Biz. Dev. Representative
Julian Duran serves as National Business Development Representative for Burning Tree Programs. By educating families and providers on the unique program offered at Burning Tree Ranch, Julian seeks to create as many opportunities as possible for the chronic relapser. Prioritizing open-mindedness, teachability, and faith as the foundational principles of his own recovery, Julian helps our network of community partners continue to grow on a daily basis. Counted amongst his favorite hobbies are weightlifting, reading, dancing and service work. Sober since 2012, Julian resides in beautiful Arizona.
Eric Button, PRSS
Eric Button, PRSS
Sr. Biz. Dev. Representative
Eric Button serves as Family Liaison & Sr. Business Development Representative for Burning Tree Programs. A customer service expert, Eric unites our families with the clinical process at Burning Tree Ranch, introducing each family to the support, education, and resources available throughout their loved one’s treatment process. As an alumnus, he shares his personal recovery story throughout the United States, helping connect as many families as possible to the wide network of professionals who, like Eric, are dedicated to improving the lives of others. An avid aircraft enthusiast and aviator, Eric has been sober since 2005. He and his fiancé reside in Austin, TX.
Sally Lebeau
Sally Lebeau
Admissions Specialist
Sally serves as a dedicated Admissions Specialist for Burning Tree Programs. An alumna of Burning Tree Ranch, Sally believes that “by aiding our clients and families in the process of finding a program that best fits their needs, I get to play a small part in helping them accomplish a life beyond their wildest dreams.” Sober since 2005, Sally has over 5 years experience working as a professional in the treatment industry. She believes in the virtues of honesty, integrity, and compassion. Happily married, Sally enjoys the beach, reading, and eating her favorite icecream with her husband, Matt.
Alexis Thomas
Alexis Thomas
Admissions Specialist
Alexis “Lexi” Thomas serves as Admission Specialist for Burning Tree Programs. Holding a Bachelor’s degree in Public Health from the University of Arizona, Lexi lends passion, knowledge, and insight to the admissions process. Treating every inquiry with a sense of tenderness and empathy, Lexi knows first-hand what the family member’s experience of addiction feels like. After losing her own family member to addiction, Lexi dedicated her life to helping others find the freedom they deserve. A native of Tucson, AZ., Lexi is happily married and mother to her newborn, Otto. She also counts one dog and a cat amongst her growing family.
Sarah Adams
Sarah Adams
Admissions Specialist
Sarah serves as a dedicated Admissions Specialist for Burning Tree Programs. Known for her compassionate and insightful nature, Sarah is often one of the first friendly voices a client or family member will engage. “I like to meet people where they are at, listen and learn. It is always an inspiration to get to be the outstretched hand that someone is reaching for in need.” With a degree in biology from Stephen F. State Austin University, Sarah is constantly seeking to expand her education. Most recently, she has begun pursuing her counselor’s license. In her free time, Sarah enjoys reading, traveling, exercising and exploring the great outdoors.
Erik Jokinen
Erik Jokinen
Admissions Specialist
Erik serves as a dedicated Admissions Specialist at Burning Tree Programs. Being in long-term recovery himself, Erik enjoys helping families and individuals find the same freedom that he and his loved one’s discovered on their shared journey to wellness. With over 8 years of professional treatment experience, Erik’s favorite part of his career is getting to support those in need as they engage in the inspirational process of asking for help. Erik has a 4-year old daughter, one dog and two cats. When not working, he enjoys spending time with his family and attempting to be decent at golf.
Olivia Wilder
Olivia Wilder
Director of Admissions
Olivia Wilder serves as Director of Admissions for Burning Tree Programs. Responsible for helping execute the organization’s vision of excellence, Olivia leads a talented team of admissions specialists dedicated to Burning Tree’s philosophy of “creating a life of excellence beyond sobriety.” Trained in multiple intervention disciplines, Olivia utilizes mindfulness, DBT skills, and a solutions-focused approach to help achieve dynamic results on behalf of the loved one in need. Sober since 2014, Olivia is a proud alumna of Burning Tree Ranch. She counts her two children and loving husband amongst her greatest blessings. Her intervention training includes a specialization on Drug and Alcohol and Applied Suicide.
John Bruna
John Bruna
Director of Mindfulness
John Bruna serves as the Chief Clinical Consultant for Renewal Lodge. He is a counselor, educator, former Tibetan Buddhist monk and current mindfulness teacher. Raised in a low-income environment where he was surrounded by drugs, alcohol, and violence, John was able to find recovery and change the course of his life at the early age of 22. John is the creator of the Mindfulness in Recovery (MIR) Program and co-founder of the Mindful Life Program.
David Elliot
David Elliott
Founder & President
David Elliott serves as the Founder and President of Burning Tree Programs. Responsible for architecting the vision of the organization, David’s chief mission is to promote lasting change in the lives of those suffering from chronic relapse. With a hands-on approach, involved presence, and unyielding commitment to excellence, David serves as the heartbeat of our organization’s steadfast commitment to long-term, progress-based treatment. “My favorite part of what we do is to witness the evolution that individuals undergo during the course of treatment at Burning Tree.” An avid dog lover, Mr. Elliott resides in Dallas, TX. He has been sober since 1992.
Brook McKenzie, LCDCi
Brook McKenzie, LCDCI
Chief Operations Officer
Brook McKenzie serves as Chief Operating Officer for Burning Tree Programs. Based at the Ranch facility in Kaufman, TX, Brook plays an everyday part in the lives of our clients and families. His leadership style is informed by his own experience as a Burning Tree Ranch alumnus. With compassion, understanding, and a deep insight into the mind of the chronic relapser, Brook gets to engage in the healing experience of every family that Burning Tree serves. Happily married with two young boys, Brook enjoys fatherhood, sobriety, and all the wonders of living a full life in recovery.
Tharin Smith
Tharin Smith
Dir. of Aftercare Services
Tharin Smith serves as the Director of Alumni Services at Renewal Lodge. He is responsible for engaging our alumni and facilitating Big Book group daily. He is a product of long-term treatment himself for 14 months. Tharin has maintained his sobriety since 2005 and remains active in the 12-Step community. From embracing and working this “new design for living,” he has committed to helping others and entered the treatment field in 2012. He continues to carry his enthusiasm for recovery in an effort to give hope to all clients at Renewal Lodge. In his spare time, Tharin enjoys family time with siblings, nieces, nephews and great nieces and nephews. His hobbies include growing datil peppers and making datil pepper jelly, along with a quest to find the world’s best barbeque.
Chance Lippert, LCDCI
Chance Lippert, LCDCI
Dir. of Recovery Services
Chance Lippert serves as the Director of Recovery Services at Renewal Lodge. He is a Licensed Chemical Dependency Counselor Intern and Certified Mindfulness In Recovery Facilitator. William incorporates his knowledge of 12 step recovery and mindfulness practices to help clients establish recovery by helping them stay engaged in a new way of life. Chance is also responsible for organizing alumni sweat lodge events. William has been sober since November 2018 and found his way into the addictions treatment field shortly after. Chance is happily married with two daughters with whom he lives in Austin, Texas.
Kristi Miles, CCMI
Kristi Miles, CCMI
Medical Assistant
Kristi Miles serves as a Medical Assistant for Renewal Lodge. She has been a Certified Clinical Medical Assistant for 9 years and has worked in various specialties during that time. Some of these include pediatrics, internal medicine, psychiatry, and rheumatology. She has worked in the substance abuse treatment field for almost 6 years. Kristi is currently working towards her Bachelor of Science in Nursing degree and hopes to finish by 2024.
Cynthia Singer, MS, LCDC
Cynthia E. Singer, MS, LMFT-A, LCDC
Primary Counselor
Cynthia Singer serves as a Primary Counselor for Renewal Lodge. She has a Master’s of Science degree in Marriage and Family Therapy from Nova Southeastern University and a Bachelor of Sciences in Family Studies and Human Services from Kansas State University. Cynthia is a Licensed Chemical Dependency Counselor and is EMDR trained. Cynthia utilizes the therapeutic modalities of CBT, Motivational Interviewing, EMDR, and Solution Focused Therapy. Her passion is being a catalyst for change within her clients as they pursue their recovery and other therapeutic endeavors.
Auryana Malek, FNP
Family Nurse Practitioner
Auryana Malek serves as a Family Nurse Practitioner for Renewal Lodge. She has an extensive healthcare background and a passion for providing compassionate care to patients of all ages. Skilled in Advanced Cardiac Life Support (ACLS), primary care, psychiatry, addictions, and MAT. Strong healthcare services professional with a Master’s degree focused in Family Nurse Practitioner from The George Washington University. Auryana maintains passion for providing holistic quality healthcare to all populations, especially those struggling with addiction.
Doug Wade, LMFT
Doug Wade, LMFT
Family Program Director
Doug Wade, LMFT serves as the Director of Family Programs for Renewal Lodge and Burning Tree West. Clinically trained in Marriage and Family Therapy, his commitment to helping individuals and their families is evident as he works to nurture families in their burgeoning recovery. Using a strengths-based approach to the Family System, Doug engages each member with the intention of creating a safe place for relationships to heal. His unique approach to each family has been regarded as a highlight of their recovery. Doug holds a B.S. in Family Studies and Gerontology and a Master’s Degree in Marriage and Family Therapy.
Aaron Ball, RN
Aaron Ball, RN
Director of Nursing
Aaron Ball serves as the Director of Nursing for Renewal Lodge. He has been an Registered Nurse for 12 years and has worked in many different specialties. He has spent the last 5 years working across the entire spectrum of the substance abuse treatment field and has found a passion for working with those that struggle with addiction and alcoholism. His own personal experience with recovery has granted him a unique and valuable perspective that allows him to serve this patient population most effectively.
Mark Muecke
Mark Muecke, LMSW, LCDCI
Primary Counselor
Mark Muecke serves as a Primary Counselor for Renewal Lodge. He received his Master of Social Work degree from the University of Houston in 2019. Mark also received advanced training graduate of the Dallas Psychoanalytic Institute-Academic Track. He also holds a BS in Mathematics, BA in History and a Master’s degree in Journalism and Public Affairs. Mark is also a Licensed Chemical Dependency Counselor Intern. Mark utilizes the therapeutic modalities of Psychodynamic Therapy, Motivational Interviewing and CBT. He has a passion for utilizing empathy and respect to help clients gain insight to support long term recovery.
Melissa Rivera, MSN, RN, PMHNP-BC
Psychiatric Nurse Prac.
Melissa Rivera serves as a Psychiatric-Mental Health Nurse Practitioner for Renewal Lodge. She is a board-certified Psychiatric-Mental Health Nurse Practitioner, licensed and trained to treat behavioral health concerns across the lifespan. Melissa graduated with her Master’s in Nursing from The University of Texas at Austin where she completed a scholars program in Integrative Behavioral Health. Melissa is trained in multiple therapeutic modalities including: psychodynamic psychotherapy, cognitive behavioral therapy, dialectical behavioral therapy, play therapy, and motivational interviewing. Before her entry into nursing she received her Masters in Counseling and worked as a Licensed Professional Counselor in the Austin Area. Her experience as a LPC spanned from working with severe mental illness through the local mental health authority doing community-based outreach, working with adolescents in the juvenile probation system, as well as working with families and children who were victims of abuse through the Child Advocacy Center in Travis County. Melissa’s approach to treatment is to work collaboratively with her patients to support their treatment goals with evidenced-based practice, while fostering an empathetic and non-judgmental environment.
Brent Thach
Brent Thach, BA, LCDC
Clinical Director
Brent Thach serves as the Clinical Director for Renewal Lodge. He has a Bachelor of Arts degree in Political Science from West Texas A&M University, is a Licensed Chemical Dependency Counselor, and a Certified Mindfulness In Recovery Facilitator. Brent’s utilizes the therapeutic modalities of REBT, ACT, and mindfulness practice. Brent’s area of expertise is teaching our clients how mindfulness and the 12 steps complement one another in recovery. His leadership style encourages clients to learn how to live mindfully and a life of purpose guided by their values. Brent also has 11 years of sobriety and resides in Elgin, Texas.
Philip Hensarling, LCDCi
Philip Hensarling, LCDCI
Executive Director

Philip Hensarling serves as the Executive Director of Renewal Lodge. Philip has served Burning Tree Programs for over 6 years which roles include Admissions and Corporate Director of Utilization Management. Philip is also a Licensed Chemical Dependency Counselor Intern (LCDCI) and alumni of Burning Tree Ranch. He is also pursuing his Bachelors of Healthcare Administration from Southern New Hampshire University. Philip specializes in insurance contracting and negotiations. His goal is to make quality treatment more accessible to those suffering from the disease of addiction. He has a passion for running and loves his lab mix Murray.

Carlos Tirado, MD, MPH
Carlos Tirado, MD, MPH
Medical Director

Dr. Carlos Tirado serves as the Medical Director for Renewal Lodge. He is board certified in general and addiction psychiatry by the American Board of Psychiatry and Neurology and addiction medicine by the American Board of Addiction Medicine. Dr. Tirado attended medical school at The University of Texas Houston Health Science Center and completed his residency in general psychiatry at The University of Texas Southwestern Medical Center in Dallas. Dr. Tirado received specialty training in addiction psychiatry and research at the internationally prestigious Center for Studies on Addiction at the University of Pennsylvania. Dr. Tirado is trained in Cognitive Behavioral Therapy and Motivational Interviewing.

Peter Piraino, LMSW, LCDC, LISAC
Peter Piraino, LMSW, LCDC, LISAC
Executive Clinical Director, CEO

Peter Piraino, LMSW, LCDC, LISAC, serves as Executive Clinical Director for Renewal Lodge and CEO of Burning Tree Programs. Responsible for executing the vision of Burning Tree’s philosophy of excellence, Peter’s primary goal is to help as many clients as possible gain access to the treatment they need. A clinician by training, Peter incorporates sound, ethical business practices to help inform the organization of its duties to the greater community. By placing the needs of his staff and company ahead of his own, Peter leads with a team approach that continues to inspire the mission of Burning Tree Programs. A proud father, Peter and his wife count six dogs amongst their family members.

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