Every engagement at Avina, from a five-day detox to a five-year retainer, runs the same architecture. The intake. The approval. The bench. The day. The discharge. The arc.
Phase 01
An enquiry is submitted, by a principal, a parent, an attorney, a trustee, or a clinician. The note is read by Kelly or her senior operator. Reply within forty-eight hours, by phone or by email, never automated.
A one-hour call. No clinician on the line. No notes shared. The conversation establishes whether Avina is the right firm for the case. We do not enrol every case that calls. We do not enrol cases we cannot serve well. If we are not the firm, we name the firm that is, and that referral is not transactional.
An engagement letter is issued. It names the Chief of Staff for the case, the practices commissioned, the engagement state, the rhythm of family briefing, and the boundary of confidentiality between principal and family. One contract, one office, one accountable operator.
If detox is part of the engagement, the Medical Director reviews the case, approves the protocol, names the physician of record, and signs off on the residence as the site of care. No detox begins without this.
The Director of Nursing schedules the rotating shift. Pharmacy is briefed. The companion is paired by personality and lifestyle, not just skill. The household is briefed by the Chief of Staff so that the principal’s ordinary life proceeds without disturbance.
A five-day detox is a full clinical engagement. It is not a hotel stay with vitamins. The protocol is hospital-grade. The setting is the principal’s home.
The five-day standard
Avina’s standard alcohol-detox protocol runs over five days, with seven- and ten-day variants depending on indication. Opioid detox runs over eight days under a Subutex taper. Benzodiazepine detox is longer, with extended monitoring. Polysubstance is sequenced. The Medical Director selects the protocol; the Director of Nursing schedules the team; the principal is held in their own bed.
The arriving nurse takes consents. Drugs and alcohol in the residence are disposed of appropriately. Baseline vitals: blood pressure, heart rate, temperature, respiration, oxygen saturation. Withdrawal scoring begins (CIWA for alcohol, COWS for opioid). The first nursing report goes to the physician-attended group thread.
Medications are dispensed under physician order, documented on the paper MAR and in the electronic record. Comfort medications run alongside: clonidine for anxiety and blood pressure, gabapentin for anxiety and relaxation, ondansetron for nausea, trazodone for sleep, multivitamin and folic acid and thiamine for repletion. Vitals taken at every administration. Withdrawal score taken hourly during peak.
Nursing handover at every shift, with a written report to the group thread. The physician of record is reachable by text and by phone. Any change in condition is escalated within minutes. If a patient declines vitals, the refusal is documented. If there is an emergency, the protocol is to call 9-1-1 and then notify the physician.
The taper closes. Withdrawal scoring tapers with it. The principal eats, sleeps, talks. The companion arc begins or continues. Telehealth is scheduled. The Chief of Staff briefs the family on the next state.
A note on safety
The protocol library is governed by the Medical Director. It is reviewed quarterly and audited annually. We do not improvise. We do not vary. We do not deliver detox without a physician of record on the case.
If a principal is not a candidate for in-residence detox, on clinical grounds, we will say so before any contract is signed. We will help the family find the right facility, even if it is not us. The standard is the standard.
Phase 03
Detox is the door. The work that lasts begins on the other side of it. The Avina engagement model holds the principal across four states; the practices flex within those states; the contract does not change.
Chief of Staff embeds. Bench is named: physician, nursing, companion, therapist, household, counsel. Companion daily. Plan authored. Family briefed weekly. If detox is part of the case, it begins here.
Companion daily. Chief of Staff weekly. Coordinated clinicians. The principal is held while the work is done. IV protocols where indicated. Telehealth weekly. Family briefed on the rhythm we agreed.
Case manager and Chief of Staff fortnightly. Telehealth weekly. Companion as needed. The principal carries more weight. The bench remains in place. The brief continues.
Chief of Staff monthly. Quarterly bench reviews. The principal calls when they need to. The firm holds the file.
There is no booking page. No open diary. No intake funnel. A single enquiry form is read by the principal or her senior operator, and replied to within forty-eight hours.