PSYCHIATRIC RESIDENTIAL TREATMENT PROGRAM

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1 PSYCHIATRIC RESIDENTIAL TREATMENT PROGRAM MISSION STATEMENT Carson Valley Children s Aid is dedicated to the delivery of services to children, youth and families that ensure their safety, build on their strengths, honor their differences and empower them to achieve their goals for success in life. VISION For children, youth and families to realize their potential and thrive. PHILOSOPHY OF CARE The Psychiatric Residential Treatment Facility at Carson Valley Children s Aid (PRTF) provides structured care for children and adolescents who have a demonstrated history of serious mental illness and behavioral problems. The PRTF assists our children in improving their level of functioning while developing skills to move towards positive membership in society. The primary objective of Carson Valley Children s Aid s PRTF is the successful reintegration of the child into their family and/or community. This is best accomplished by drawing on the strengths and resources of each child, in partnership with their family, and developing a vision of reality-based outcomes with reasonable and achievable goals. CVCA s PRTF provides an integrated multi-disciplinary, team-based approach to treatment utilizing a trauma-informed resiliency model as the foundation for evidencebased service delivery. Treatment Team members include representatives from CVCA s clinical, psychiatric, educational, residential and nursing departments as well as family members and the child him/ herself. Approaching behavioral problems through an injury model (as opposed to a sickness model), we promote healing and recovery through a strength-based approach. This approach allows a child to take an active role in creating their goals and treatment plan, and is supported by the fundamental belief that children and families have the ability to overcome adversity and succeed in their goals. Page 1 of 8 Updated

2 CVCA Treatment is designed to fit the needs of each individual child. An individual Treatment Plan is created with the child and family upon admission to the program. Working with the Treatment Team, each child and family also creates a Life Plan that identifies specific goals for each aspect of the program (residential, clinical, education, case management, nursing, and psychiatric). Diverse theoretical orientations guide individual and group therapy sessions. CVCA is committed to implementing evidence based approaches including Dialectical Behavioral Therapy and Trauma Focused Cognitive Behavioral Therapy. CVCA recognizes the importance of family and community support in creating a successful outcome for each child. Active family involvement, including child visitation and family participation in treatment is strongly supported and encouraged. CVCA maintains the philosophy that family visitation is the heart of permanency planning. Discharge planning is an integral part of the child s Treatment and Life Plans. The discharge planning process begins upon admission in order to facilitate a successful return to home and/ or community. WHO IS SERVED CVCA's PRTF serves up to 35 children, ages The PRTF includes two residential cottages: Lower Beech Cottage is a co-educational residence for 22 children, 9 boys and 13 girls; Thistle Cottage is an all female residence for 13 girls. PRTF care is appropriate when prior interventions have been unsuccessful in keeping a child functioning safely in the community, yet higher levels of care are unnecessary. All children served by the PRTF meet medical necessity for PRTF services and have a DSM IV primary diagnosis on Axis I. CVCA's PRTF offers services to children and families without regard to race, religion, gender, sexual orientation, or national origin. REFERRALS AND ADMISSIONS CVCA collaborates with a variety of mental healthcare and child welfare providers who refer children to our care. PRTF services are authorized through Community Behavioral Health. Upon referral, a child's behavioral and psychiatric information is assessed by the Treatment Team, which in turn recommends a pre-admission interview with the Clinical and Admissions Directors. ASSESSMENT AND SERVICE PLANNING Each child, in collaboration with family and the PRTF Team, creates an individualized Life Plan with clear treatment goals. Treatment goals are designed to be specific and attainable, targeting behavioral problems as well as any traumatic or emotional roots of those problems. Treatment objectives are identified within each goal in order to

3 structure short-term success, thus building self-worth and competence as the child learns, heals, and grows. Comprehensive bio-psychosocial evaluations are provided quarterly for each child, with recommendations supported by ongoing assessment of the treatment plan goals. Each child meets monthly with the Team psychiatrist to review medications and assessing goals as appropriate. Monthly Life Plan meetings bring the entire Treatment Team together with the child to review the Life / Treatment Plan, measure a child s progress on behavioral goals, and discuss discharge planning. The full interdisciplinary team participates in the monthly meeting, including: the Clinical Director, Residential Coordinator, Clinical Therapist, Nurse, Psychiatrist, school representative, parent(s)/ guardian, county behavioral health providers, DHS representative(s), other related service provider(s) as able, and the child. The Individual Service Plan is a formal meeting that occurs within 30 days of admission and at least every 6 months thereafter. The Individual Service Plan reports progress on measurable and individualized goals and incorporates time sensitive objectives as they relate to the reunification process. The initial family assessments and Life Plans outline the child s visitation plan. CVCA structures visits as to best insure the safety of the child. Siblings, extended family members, and other significant persons involved in the child s life are also encouraged to maintain contact and involvement with the child in PRTF care. Educational assessments are available as appropriate within the CVCA on-grounds educational program. SERVICES PROVIDED Services to Children The PRTF provides children with a structured and supportive residential environment. Daily routine and behavioral expectations are clearly organized and consistent. Team members work to maintain a climate of respect and positive regard for all children in the program. There is close supervision and support for each child at all times and all services and supervision are geared to the developmental needs of the children served. Each PRTF cottage is part of the residential community where Team members and children learn, heal, and grow together. There is a cooperative atmosphere for the benefit of all. In this "family-like" atmosphere, adults and children form positive, caring relationships which serve as a basis of positive change. Team members teach and model positive discipline and problem solving. Enjoyable and meaningful activities and

4 instruction are provided to improve self-esteem and lead to reachable goals for the group and the individual child. CVCA's on-grounds Educational Program provides small class sizes and a well structured environment in alignment with the treatment philosophy of the PRTF. Psychiatric services include: Initial psychiatric assessment and evaluation, monthly medication checks, quarterly psychiatric re-evaluations, Treatment Team participation, and safety assessment. Clinical therapeutic services include individual therapy, provided by a Masters level Clinical Therapist utilizing evidence-based practices (either Dialectical Behavior Therapy or Trauma-Focused Cognitive Behavior Therapy, as appropriate). Children also receive crisis counseling on an as needed basis by Clinical Team Members. Topicspecific psycho-educational groups also occur daily (e.g. anger management, trauma, life skills, self-esteem, etc.) with children participating as recommended in the Life Plan. Therapy Type and Minimum Frequencies: Individual, evidence-based therapy: 2 sessions per week (or as indicated by treatment plan) Group therapy: 2-3 psycho-educational and adaptive skill building sessions weekly (as indicated by treatment plan) Family therapy: 1 session bi-weekly or as appropriate to family situation (as indicated by treatment plan) Therapeutic Milieus: Daily Transition/Independent Living/Life Skills: Daily Therapeutic Educational Program: Appropriate to educational needs. The structured residential living environment includes the essentials of family living such as food, clothing, recreation and group activities, provided for the child under the guidance and supervision of the Cottage Coordinator and residential youth care workers. The program is highly structured and supervised, utilizing an eclectic array of interventions in developing positive personal and interpersonal skills and behaviors. Life skills training is completed within the natural routine and setting of the cottage. These skills include personal hygiene and self-care, room and clothing care and maintenance, budgeting and banking, work skills and other areas of self and social competency. Clinical and residential Team members work together to plan gender specific, co-ed, and age-related small group, individual and unit activities. Multimodal therapies are provided according to and based on clinical appropriateness. Residential nurses monitor and implement the personal health care needs of each child. Program nurses provide direct nursing care and act as liaison with psychiatry, the general practitioner, local hospital care, and other healthcare providers. Nurses routinely administer medications or provide oversight to Team members certified in

5 medication administration. The residential nurse interacts with the Treatment Team in integrating medical care with overall treatment. Healthcare services are also provided by on-grounds, contracted, nurse practitioners and dentists. Liaison relationships with other adjunct healthcare providers are maintained to provide a comprehensive array of necessary medical and substance abuse services as appropriate. Local providers, hospitals, pharmacies, laboratories and others offer services in conjunction with individual consumer needs and insurances. Case Management Services include the coordination of services and communication with children, family members, and outside agencies. Education services are provided through CVCA's on-grounds education program,. Under a Private Residential Rehabilitation Institute (PRRI) license, children enrolled in 6 th through 12 th grade may continue to receive individualized education while residing at CVCA. Both regular and special education services are available. Remedial tutoring and academic enrichment are also provided. Children are registered in school following the day of admission. Extensive support around attendance and academic performance is provided as an integrated part of the residential program. Psychiatric and psychological assessment is available, as recommended by the child's treatment team and approved by family and referral source. Evaluations are performed by a Licensed Psychiatrist or Licensed Clinical Psychologist. Comprehensive Biopsychosocial Evaluations include strengths-based, culturally sensitive approach and include family and treatment team input. Structured therapeutic recreation and scheduled activities are an important part of the program. Team members work together to execute small group, individual and unit activities in conjunction with the Youth Development Coordinator. These activities are designed to build a sense of group and community, teach appropriate social skills, build self-esteem and provide structured after-school time. They include on-campus sports activities, ropes course and climbing wall, arts and crafts, and therapeutic games, as well as outings to community YMCA, local and state parks, sporting events and adventure based activities. Services to Families As noted above, family involvement is an integral part of the child's treatment program. CVCA recognizes that children are not independent persons and that it is essential to work with them in the context of a family plan. Families are expected to work closely with the treatment team to enhance their child s success in the program. CVCA is committed to providing outreach to the child s family and to assist in the family in whatever way possible to function as active members of the child s treatment team. Family therapy is provided by a Masters level Clinical Therapist. Members of the immediate family are encouraged to participate. Assistance with transportation is available. Case Managers coordinate services and communication between children,

6 family members, and outside agencies. Milieu Team Members provide transportation for children to participate in therapeutic leaves (visitation) with family. Case Managers collaborate with families to ensure appropriate after-care services. STRUCTURED RESIDENTIAL MILIEU The structured residential living environment includes the essential of family living such as food, clothing, recreation and group activities, provided for the child under the guidance and supervision of the cottage coordinator and residential youth care workers. The program is highly structured and supervised, utilizing an array of interventions to develop positive personal and interpersonal skills and behaviors. Children and teams take an active role in securing the safety of the Cottages. Fire Drills are conducted on a monthly basis. Children and team members are expected to participate and learn evacuation routes from all egress points and remain within the expected evacuation times. A waiver has been applied for Thistle Cottage s second floor window that supports the safety of this point of egress. This waiver was requested after a thorough review by Township experts who deemed the point of egress as safe and appropriate. TRANSITION PLANNING Planning for a child's return to the community begins when a child enters the program. All treatment and Life Planning/ Case Management is geared to the goal of the child reunifying with their family or stepping down to a less-structured level of care, as appropriate. Life Plan services include the identification and implementation of after care and educational services. AFTERCARE SERVICES Before a child leaves PRTF care, they are connected with individual and family services as appropriate. Potential aftercare services include: individual and family therapy, inhome therapeutic teams to support the transition back to the community and family, inhome crisis support, psychiatric services, and educational services. SERVICE MONITORING AND REPORTING All services to children in the PRTF are directed by a child s Life Plan. The Life Plan includes the Treatment Plan, which is created at admission and includes goals for the Residential and Clinical aspects of the Program. The Life Plan also includes goals for Case Management, Education, and Nursing. Each child s progress in treatment is measured during their monthly Life Plan/ Treatment Team meeting. During this meeting, all members of the Team (Clinical,

7 Residential, Case Management, Education, Nursing, Psychiatry) submit a written report indicating progress and challenges in treatment. At this time, the Team identifies any changes appropriate for the Life or Treatment Plan. Team meetings and accompanying reports occur within the first 30 days of a child s stay in the RTF and every 30 days thereafter. Individual Service Plans are sent within thirty days of the DHS Accept for Service Anniversary Date. ISP/Life Plans are completed at intake and at the sixth (6 th ) and twelfth (12 th ) month of the DHS accept for service date. Quarterly Progress Reports are forwarded to DHS thirty days prior each three month DHS accept for service anniversary date. Critical Incident Reports are sent within five days of the incident. DHS Workers and CBH are notified by phone within twenty- four (24) hours of the incident. Structured Case Notes for all youths are forwarded by the 10 th of each month. Clinical and Case Management notes document all service delivery. Permanency Planning Review Document forwarded to DHS and CBH quarterly. Discharge Summaries are forwarded to DHS and CBH within ten (10) days of the discharge. Case reviews are completed a quarterly basis; however if a youth is struggling with managing his or her behavior, the case review will be conducted on a monthly basis. PROGRAM TEAMS PRTF Program Teams include: the Clinical Director, Masters level Therapists, Life Plan Managers, Cottage Coordinator, Nurses, Youth Care Workers, Behavioral Support Staff in the Education Program, Education Program Leaders, and a licensed Psychiatrist. The agency employs youth care workers whose personal characteristics and educational backgrounds are consistent with the requirements of the position. Youth care personnel are on-duty at a 6:1 ratio at all times in order to assure the safety and therapeutic support of all children in the program. All Team Members receive 40 hours of training (exceeding the state requirements), within 15 days of hire. Regularly scheduled trainings are mandated as defined in CBH credentialing requirements. Ongoing trainings in trauma-informed practice occur routinely. Team Members are expected to demonstrate sensitivity toward cultural issues as well as openness, tolerance, understanding, and affirmation regarding individual differences.

8 Team Members are called to develop a genuine interest and appreciation toward learning the ways of others and celebrating those differences. All supervisors meet with each of their team members on a weekly or bi-weekly basis as regulated. During supervision, supervisors train in the areas of basic job responsibilities (i.e., documentation standards, strategies to support children and their Life Plans, inter-personal communication, etc.) as well as provide support and guidance in working with behaviorally challenging youth. Supervisors are also available to their Team as needed, on an individual basis. Licensing supervision may be provided in addition to basic supervision.

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