CORNERSTONE BEHAVIORAL HEALTH

Transcription

1 CORNERSTONE BEHAVIORAL HEALTH Policy & Procedure Manual

2 CORNERSTONE Behavioral Health -A Division of Mountain Regional Services, Inc Feather Way, Suite 1 * P.O. Box 6005 Evanston, WY Policy & Procedure Manual Copyright 2000 by Mountain Regional Services, Inc. All Rights are Reserved No part of this manual may be duplicated in any form without prior written consent of Mountain Regional Services, Inc. Written 1994 Revised: 1997 Revised: 2000 Revised: 2003 Revised: 2006 Revised: 2009 Revised:

3 TABLE OF CONTENTS - POLICY AND/OR PROCEDURE: SECTION I: PROGRAM QUALITY Service Delivery Plan Consent for Services 18 Client Refusal to Sign Paperwork 18 Criteria for Admission/Re-Admission Accessibility of Treatment 19 Developing a Waiting List 20 Order of Selection for Admission of Persons Awaiting Services Ineligible for Services 21 Psychological Screening Substance Abuse Evaluations 22 Client Rights Confidentiality Financial Agreement - Fee for Services Sliding Fee Scale Substance Abuse Quality of Life (QOL) Client Orientation to Cornerstone Behavioral Health 29 Coordinating Client Services 29 Filing Grievance Initial and On-Going Assessment Client Duplicate Charts 32 Client Treatment Records Time Frames for Making Entries Into Client Charts and Completing Reports Direct Involvement of the Client in the Decision Making Process 34 Individual Plan for Client Client Follow-Up 37 Transition/Discharge Planning 38 Transition/Discharge Summary Plan Referrals of Needed Client Services Release of Information 43 Obtaining Previous Diagnostic Medical & Other Reports 43 Coordination of Prevention, Treatment and Transition/Discharge Planning Medication Use and Storage of Pharmaceutical Samples 45 Psychiatric Advance Directives Special Needs Use of Special Treatment Intervention 49 Crisis Intervention Quality Assurance Records Review 51 Medicaid Quality Assurance Plan Weapons and Violence 54 Nonviolent Practices 54 Smoking & Smokeless Tobacco Use 55 Abstinence

4 Alcohol and/or Other Drugs and Psychiatric Disabilities 56 Controlled Substances at Cornerstone 56 Child/Adolescent Being Suspended from School While in Treatment 57 Recruitment and Retention Plan for Psychologists Staff Training Supervision of Direct Service Personnel SECTION II: MRSI-NOTICE OF PRIVACY PRACTICES SECTION III: THE INTERNSHIP PROGRAM The Internship Program Goals Expectations for Interns Supervision Didactics Observational Learning/Technology-Assisted Consulting Administration of the Internship Evaluations Additional Educational Opportunities Vacation/Professional Leave What if Problems Arise? Frequently Asked Questions Evanston/Rocky Mountains Cornerstone s Staff Internship - POLICIES AND PROCEDURES Intern Recruitment/Public Disclosure Intern Selection Administrative and Financial Assistance Intern Rights and Responsibilities Intern Performance Evaluations Due Process and Grievance Procedure for Interns and Training Staff Outline of Internship Program Goals, Objectives, Competencies, and Activities Allocation of Intern Hours -4-

5 SECTION I PROGRAM QUALITY -5-

6 195 Feather Way Post Office Box 6005 Evanston, WY Telephone (307) Fax (307) I. NEEDS FOR SERVICE AREA SERVICE DELIVERY PLAN Cornerstone Behavioral Health (hereinafter Cornerstone ) is active in assessing the needs of the community by collecting and analyzing data from available resources. Examples include: Hearing Our Consumer Voice: The 2011 Consumer Survey; The 2010 Wyoming Prevention Needs Assessment: State of Wyoming Profile Report (WYSAC); and Wyoming s 2011 Youth Risk Behavior Survey. Our assessment of community needs is an ongoing process. Cornerstone collaborates with a wide variety of social service agencies by participating in regularly scheduled meetings, which keeps Cornerstone in touch with the needs of the community. In addition to conducting ongoing needs assessment with other agencies and referral sources, we regularly survey our clientele, which provides another way to assess community needs, to which we respond in a constructive fashion. For example, we survey our clientele during treatment, as part of the required attendance of Family Week activities, State mandated surveys, after discharge, in our follow-up surveys, client satisfaction surveys, and a suggestion box located in the lobby. Consequently, our needs assessment, which focuses on both prevention and treatment, is a continual process that spans agencies, including social service agencies and State agencies, referral sources, the legal system, and our clientele. This information is continually analyzed, and the analysis is integrated into the business practices of the organization. The input is used to help determine if the organization is: Meeting the current needs of the persons served and other stakeholders; offering services that are relevant to the persons served and other stakeholders; and identifying potential new opportunities for the growth and development of programs and services. For example, the need for adolescent substance abuse treatment has again been identified by the community. As a result, Cornerstone has implemented a full array of treatment programs specifically designed for adolescents to include the following: Minor in Possession School (MIP) - Early Intervention, ASAM 0.5 Level of Care; Adolescent Outpatient Treatment Program (AOP) - ASAM I Level of Care; Adolescent Intensive Outpatient Treatment (AIOP): Phase I (ASAM II Level of Care) and Phase II (Aftercare; ASAM I Level of Care). The services outlined below reflect the ongoing needs assessment and are updated as the needs of the community change. -6-

7 II. ABOUT CORNERSTONE BEHAVIORAL HEALTH Cornerstone Behavioral Health (hereinafter Cornerstone ) Wyoming's premier provider of nationally accredited outpatient mental health services and substance abuse treatment programs. Established in 1988, Cornerstone provides area residents with comprehensive, professional services in the comfort and privacy of a state of the art clinic located next to Evanston Regional Hospital. The professional staff at Cornerstone consists of a broad range of mental health providers, licensed psychologists, psychological interns, and board certified psychiatrists (via telehealth through Cheyenne Regional Medical Center). Cornerstone s outpatient treatment programs refer to a variety of services in the areas of mental health and substance abuse, which are designed to address the needs of the clients. Cornerstone offers a wide range of mental health services, including: Psychological testing and assessments, family and couples therapy, child and adolescent therapy, computerized testing for attention deficit hyperactivity disorder (ADHD), individual and group therapy, and telehealth psychiatry through Cheyenne Regional Medical Center. In the area of substance abuse services, Cornerstone offers substance abuse treatment programs that allow clients to remain with their families and at their jobs or school while receiving treatment. Substance abuse services include: Substance abuse evaluations, Cornerstone s long-standing and successful Intensive Outpatient Treatment Program (IOP-Phase I, IOP-Phase II), Outpatient Treatment Program (OP), DUI School, individual, couples and family therapy, drug testing, breathalysers, and prevention education; and Cornerstone s more recent Adolescent Programs that include Adolescent Intensive Outpatient Treatment Program (AIOP-Phase I, AIOP-Phase II), Adolescent Outpatient Treatment Program (AOP), and Minor in Possession School (MIP). Cornerstone accepts most insurance plans, including Medicare and Medicaid. All fiscal operations are in accordance with generally accepted accounting principles. As part of the Wyoming Department of Health, Behavioral Health Division Contract, Cornerstone will charge clients, who are served under the contact, according to the sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Division Sliding Fee Scale Guidance for Treatment Providers as set forth in The sliding fee scale shall be posted in the lobby and made available to persons seeking services provided by the contract. III. GOALS FOR CORNERSTONE BEHAVIORAL HEALTH Cornerstone Behavioral Health is committed to developing and implementing services for each client to meet the following goals: 1. Support the recovery, health and well-being of the persons or families served; 2. Enhance the quality of life of the persons served; 3. Reduce symptoms or needs and build resilience; 4. Restore and/or improve functioning; and, 5. Support the integration of the persons served into the community. -7-

8 IV GENERAL ADMISSION CRITERIA Cornerstone strives to provide the highest quality behavioral health and substance abuse services. The organization uses treatment interventions that are based on accepted practices in the field and incorporate current research and evidence-based practices. Unless otherwise stated, Cornerstone will accept individuals who: Are medically stable enough to be in an ambulatory setting versus an inpatient facility; Are financially able to accept and pay for services as billed with or without the assistance of medical insurance. However, as part of the Wyoming Department of Health, Behavioral Health Division - Block Grant, Cornerstone Behavioral Health will charge clients who are served under the contract, on a sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Division Sliding Fee Scale Guidance for Treatment Providers as set forth in Cornerstone may not refuse services to clients who are served under the contract due to the client s inability to pay. V SERVICE DELIVERY RANGE OF SERVICES Psychological Screening A psychological screening/assessment is the initial contact/interview with client. Information collected during this interview includes: Demographics, mental health history, medical history, social history, substance abuse history, legal history, occupational history, mental status, etc. The assessment results in the preparation of an interpretive summary that is: Based on the assessment data; used to formulate treatment needs and development of the individual plan; identify any co-occurring disabilities and/or disorders and how they will be addressed in the development of the individual plan; assess whether the individual has other needs that might be better met by alternative treatment or providers. Individual/Family/Couples Therapy Individual/Family/Couples Therapy is for those individuals who demonstrate a need for psychotherapy during the psychological screening. The therapist, with client input, will determine the form of psychotherapy that would best serve the client s needs. The client is seen individually if problems are primarily associated with his/her functioning or if family/significant others are unwilling to attend therapy. If problems are embedded within the couple s dyad or family system, those therapies are provided. Psychological Evaluation When a psychological screening does not provide conclusive information about an individual s problems, psychological testing is recommended to get a more complete understanding of the individual in order to facilitate treatment planning. -8-

9 Substance Abuse Evaluation and Intake Substance abuse services, including appropriate placement of clients and their continued stay, transfer, and discharge recommendations, are determined to the extent reasonably possible, through application of the current American Society of Addiction Medicine Patient Placement Criteria-Second Edition-Revised (ASAM PPC-2R; please see ASAM PPC-2R for additional information on ASAM criteria). A. Substance Abuse Evaluations (clinical interview plus testing, including ASI) are designated for new clients or clients without a current evaluation. A current evaluation may be one that has been completed within the past six months to one year, as long as the evaluation is a valid indicator of the client s current level of functioning. This evaluation is the initial contact/interview with the client. Information collected during this interview includes: Demographics, mental health history, medical history, social history, substance abuse history, legal history, occupational history, mental status, risk assessment, etc. The assessment results in the preparation of an interpretive summary that is: Based on the assessment data; used to formulate treatment needs and development of the individual plan; identify any co-occurring disabilities and/or disorders and how they will be addressed in the development of the individual plan; assess whether the individual has other needs that might be better met by alternative treatment or providers. If an urgent need for treatment is apparent, a client may be admitted to the treatment program until such time as a substance abuse evaluation can be conducted. A clinical interview/brief intake will be conducted to determine the need for detoxification and appropriate medical referral prior to admission. As the schedule permits, a substance abuse evaluation will be conducted with testing, including ASI, with appropriate referrals if needed. The substance abuse evaluations are designed to evaluate if the client has a substance abuse problem and to indicate which treatment modality, if one is needed, best serves his/her needs. In addition to the ASAM placement criteria and the ASI, the following testing instruments and protocols may be used in the evaluation/intake process, as indicated: AUP; SASSI-3; JASAE; PEI; SALCE; CIWA-AR; and, NEEDS Assessment Survey. In the case of the diagnoses of Substance Dependence or Abuse, per DSM-IV, treatment options include: Detoxification, residential/inpatient, intensive outpatient, outpatient or transitional services. When the evaluation indicates a sub-critical substance use problem that would be better served with a preventative treatment focus, modalities such as MIP or DUI School may be recommended. While Cornerstone does not provide services for all levels of care, clients are informed of treatment recommendations and of services available both at our agency and other agencies. -9-

10 B. Substance Abuse Intakes (Clinical Interview) are designed for individuals who have recently completed a treatment program, moved from another geographic area where they were receiving services, or had evaluations completed by another agency within the last six months. VI CORNERSTONE S SUBSTANCE ABUSE PROGRAMS General Information ASAM Criteria. Substance abuse services, including appropriate placement of clients, their continued stay, transfer, and discharge recommendations are determined, to the extent reasonably possible, by applying the American Society of Addiction Medicine Patient Placement Criteria-Second Edition-Revised (ASAM PPC-2R). The ASAM PPC- 2R is a guiding tool for determining placement, continued stay, and discharge of a client, spanning a broad range of intensity of care, from Early Intervention (Level 0.5, least intense level of care) to Medically Monitored/Managed Intensive Inpatient Treatment (Level III.7/IV, most intense level of care). Cornerstone provides adolescent and adult outpatient care that spans ASAM Levels of Care 0.5, I and II, with groups as the primary method and modality of care. Our MIP and DUI schools are Early Intervention, ASAM 0.5 Level of Care; our Outpatient Programs provide services at the ASAM I Level of Care; our Outpatient Aftercare Programs, which are Phase II of our Intensive Outpatient Program, provide ASAM I Level of Care; and, Phase I of our Intensive Outpatient Programs provide ASAM II Level of Care. Special Populations for Substance Abuse Services: Criminal Justice Clients: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to criminal offenders. For those clients that are involved in the criminal justice system, Cornerstone specifically addresses the person s criminal behavior(s) and thinking. Cornerstone shall comply with all court orders and cooperate with probation and parole agents in sharing information reasonably necessary for both to fulfill their obligations. Drug and alcohol testing will be conducted with offenders in coordination with the legal system overseeing the client. Where possible, Cornerstone shall use restorative justice principles in the individualized treatment plans of offenders. Clients are required to provide written consent in compliance with the 42CFR, Part 2 and 45CFR, Part 160 and 164, for the exchange of information between Cornerstone and the corrections system. This release per 42 CFR, Part 2, does not require an expiration of the release due to criminal justice status. If a client refuses to sign the release, Cornerstone may deny services. -10-

11 The clinical staff providing treatment to criminal justice offenders shall demonstrate training, education, and knowledge in the treatment of the criminal population. If the client fails to attend required treatment without permission as prescribed by the court, Cornerstone must notify the court or its representative within three (3) days of the client not showing. Cornerstone shall develop in collaboration with the court or its representative a case plan that identifies the roles and responsibilities of the client, program and court. In addition, a liaison from Cornerstone shall attend Uinta County Adolescent and/or Adult Drug Court staffing weekly. Cornerstone shall utilize referral sources in the areas of: housing, employment, mental health, education, and other services, as needed. Adolescent Treatment Services: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to adolescents. Adolescent services are provided for clients age 13 through 17. If the individual started the program prior to turning age 18, they may complete the program after they turn age 18. At a minimum, services shall include: Behavioral health services designed specifically to address the multifaceted needs of this population; in addition to general treatment requirements, Cornerstone shall tailor services to the particular safety, developmental, educational, healthcare, family needs, and preferences of children and adolescents. A discharge/transition plan shall be developed prior to the client being discharged and should include information addressing educational needs of the client and the transition of the client back into school, if applicable. Cornerstone shall comply with the program descriptions set forth in the ASAM Patient Placement Criteria Manual specifically relating to adolescent treatment services. Co-Occurring Treatment Services: Cornerstone Behavioral Health will maintain certification from the Wyoming Department of Health, Behavioral Health Division to provide treatment to co-occurring clients. At a minimum services shall: Address a high level of relapse potential with more intense levels of service; adapt program material and methods of counseling to individuals with mental disorders; provide and utilize skill building groups, as appropriate; provide case management, as necessary; emphasize motivation enhancement, including outreach for -11-

12 clients with active substance abuse disorders and severe mental disorders who are disengaged. SAMHSA TIP (Treatment Improvement Protocol) and Tap (Technical Assistance Publications Series): The manuals in the Treatment Improvement Protocol (TIP) and Technical Assistance Publication (TAP) series are best-practice guidelines for substance abuse treatment. The Division of Services Improvement at SAMHSA s Center for Substance Abuse Treatment (CSAT) draws on the experience and knowledge of clinical, research, and administrative experts to produce the manuals, which are distributed to facilities and individuals across the country. Cornerstone s treatment services are based in part on the SAMHSA s TIP/TAP series (i.e., the treatment services for the criminal justice population are based in part on the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Improvement Protocol 44 (TIP) Series publication, Treatment of the Criminal Justice Client ; adolescent treatment services are based in part on the SAMHSA Treatment Protocol 32 (TIP) Series publication, Treatment of Adolescents with Substance Abuse Disorders ; and substance abuse services for individuals with co-occurring disorders are based in part on the SAMSHA Treatment Protocol 42 (TIP) Series publication, Substance Abuse Treatment with Co- Occurring Disorders. Signing Documents, Discharge, Grievance. To participate in treatment, clients must sign all required documentation, including but not limited to: Consent for Services, Financial Agreement, Group Rules, Policy on Abstinence, Group Therapy, Agreement to Attend, Disease (TB, STD, AIDS) Reporting Requirements, etc. Basis for discharge include, but are not limited to: Refusal to sign all required documents, violations that endanger self or others, violations that interfere with treatment, or for lack of progress. Discharge may result in referral to a more structured program. If a client is dissatisfied with one or more aspects of services/treatment received, the client may file a grievance as outlined in the Policy/Procedure Manual (Filing Grievance). Individual Psychotherapy: Treatment/Counseling/Consultation. Individual Psychotherapy Treatment, which is part of the Outpatient and Intensive Outpatient Treatment Programs, is tailored to the unique needs of the client, such as, but not limited to: Co-occurring diagnoses, grief and loss issues, crisis management, lack of satisfactory progress in completing program requirements, etc. The length and frequency of this intervention are determined on a case by case basis. DUI School (Early Intervention, ASAM 0.5 Level of Care) Program Description. Cornerstone s DUI School utilizes Hazelden s Who s Driving DUI Curriculum. In addition, the provider of these services has demonstrated the ability, through education and training, to provide the services required according to Rules and Regulations for Substance Abuse Standards Chapter 4, Section 10. Cornerstone s staff has completed the education curriculum developed by the Division. The DUI School is -12-

13 an eight hour program that Cornerstone offers six (6) times per year. DUI School educates the individual about the seriousness of driving under the influence. The School also provides a basic education of alcohol and drugs, related abuse issues and high risk behaviors connected with acquiring HIV and STD s. To complete the school successfully, clients must satisfy requirements, including but not limited to: Complete a post test with a score of 70% or above as a measure of acquired knowledge; and, develop a satisfactory personal action plan setting forth actions he/she will take to avoid violations in the future. The provider will determine if all requirements have been met. Who We Serve. DUI School is for adults, who are seeking education as a result of a court order and/or as required by the Department of Transportation. If a client has legal charges and/or is court ordered to attend a DUI School, an evaluation/assessment is required. The evaluation/assessment should include documentation of review of the record of blood alcohol level and driving record of the client. If Cornerstone did not complete the evaluation/assessment, a copy of the report including recommendations is required. If the evaluator recommends an educational modality, with the intention of preventing a more serious substance abuse problem, the client may attend the DUI School. If there are no legal charges and/or DUI school is not court ordered, an evaluation is not required to attend the DUI School. Any participant in the DUI School must be able to make use of this process, be motivated, not be a danger to self or others, and not interfere with delivery of the DUI School. MIP School (Early Intervention, ASAM 0.5 Level of Care) Program Description. Cornerstone s MIP School utilizes Prime for Life (PRI), which is a research-based curriculum addressing alcohol and other drugs. Cornerstone s staff has completed the training for the Prime For Life education curriculum. The MIP School is an eight hour program that Cornerstone offers up to six (6) times per year. The curriculum can also be lengthened, depending on the needs of those being served. The MIP School educates the individual about the seriousness of high risk behavior and substance use to help people reduce their risk for alcohol and drug problems throughout their lives. The curriculum's nonjudgmental approach tends to decrease resistance to the life-saving information presented in the program and to increase the students' openness to change. To complete the school successfully, clients must satisfy requirements, including but not limited to: Attendance for the duration of the School, satisfactorily completing a post test as a measure of acquired knowledge, and develop a satisfactory personal action plan setting forth actions he/she will take to avoid violations in the future. The provider will determine if all requirements have been met. Who We Serve. Our MIP School is for individuals who have not reached majority and are seeking education as a result of a court order and/or as required by the Department of -13-

14 Transportation. If a client has legal charges and/or is court ordered to attend a MIP School, an evaluation/assessment may be required as per Wyoming Law , Driving or having control of vehicle while under influence of intoxicating liquor or controlled substances. If an evaluation is required, the evaluation/assessment should include documentation of review of the record of blood alcohol level and driving record of the client. If Cornerstone did not complete the evaluation/assessment, a copy of the report including recommendations is required. If the evaluator recommends an educational modality, with the intention of preventing a more serious substance abuse problem, the client may attend the MIP School. If there are no legal charges and/or MIP school is not court ordered, an evaluation is not required to attend the MIP School. Any participant in the MIP School client must be able to make use of this process, be motivated, not be a danger to self or others, and not interfere with delivery of the MIP School. Outpatient Treatment Program-Adolescent (AOP) and Adult (OP) (ASAM I Level of Care): Program Description. AOP/OP consists of one two-hour group session a week, for a total of twelve (12) sessions, and various treatment program requirements. Group members must arrive 15 minutes before group begins to take care of finances and testing (urinalysis or breathalyzer). Prime Solutions is an evidence-based interactive treatment program that includes standardized treatment measures based on The Transtheoretical Model of Change. The outpatient treatment programs will focus on the Stages of Change, incorporating in-class activities as well as take-away experiential exercises to be completed at home. Who We Serve. AOP/OP is designed for adolescents and adults who meet criteria for ASAM I Level of Care and typically, have a substance abuse diagnosis, with no withdrawal, who are stable and able to make use of the group process, and whose needs are manageable in this program. OP Alumni (Optional): Upon successfully completing the program, clients are considered lifetime alumni and are welcome to participate in AOP/OP sessions, at no charge and as needed, as long as this continues to be the appropriate level of care and the therapist and group members consent. Intensive Outpatient Treatment-Adolescent (AIOP) and Adult (IOP): Phase I (ASAM II Level of Care): Adolescent Intensive Outpatient Treatment (AIOP) and Adult Intensive Outpatient Treatment (IOP). Our Intensive Outpatient Treatment Programs (AIOP/IOP) consists of two phases, Phase I and Phase II, both of which a client must complete successfully to graduate from Cornerstone s Intensive Outpatient Treatment Program (AIOP/IOP). -14-

15 AIOP/IOP-Phase I Program Description. Phase I consists of nine (9) hours of intensive group treatment per week for a minimum of 12 weeks for a total of 108 hours); a Family Week experience, and various treatment program requirements, including but not limited to completing the Prime Solutions treatment manual, regularly attending AA, NA or other support groups and regular sponsor contact, all of which must be satisfied to complete Phase I. The program must meet a minimum of three times per week with no more than three days between clinical services, excluding holidays. Upon completion of AIOP/ IOP-Phase I, the client graduates to Phase II, the Aftercare Program. Family Week consists of three nights, three hours per session, with various treatment program requirements. Family Week is for clients in the Intensive Outpatient Treatment Programs and their family members, significant others, and friends. Typically, the client completes Family Week during Phase I of the client s treatment program. Who We Serve. IOP-Phase I is designed for adults and AIOP-Phase I for adolescents who meet criteria for ASAM II.1 Level of Care, who typically have a diagnosis of substance abuse and/or dependence, who are able to make use of the group process, and whose needs are manageable in this program setting, e.g., not a danger to self or others, not a firmly entrenched antisocial personality disorder, not with mental health problems or other problems that would undermine or inhibit group process or the integrity of the treatment program. Intensive Outpatient Treatment-Adolescent (AIOP) and Adult (IOP): Phase II (Aftercare - ASAM I Level of Care): AIOP/IOP-Phase II (Aftercare). Phase II Aftercare for adults (IOP) consists of one twohour group session a week, for a minimum of 52 sessions; Phase II Aftercare for adolescent (AIOP) consists of one two-hour group session a week for a minimum of 26 sessions. In order to satisfactorily graduate from Phase II Aftercare, the client must complete various treatment program requirements, including but not limited to: Regularly attending AA, NA or other support groups and regular sponsor contact, and a required minimum of six months of continuous abstinence. Alumni (Optional) - AIOP/IOP-Phase III: Upon successful completion of AIOP/IOP- Phase II (Aftercare), clients are considered lifetime alumni and are welcome to participate in Aftercare sessions, designated Phase III, at no charge and as needed, as long as this continues to be the appropriate level of care and the therapist and group members consent. Who We Serve. AIOP/IOP-Phase II are for individuals who meet criteria for ASAM I Level of Care, who typically have a diagnosis of substance abuse and/or dependence, who are able to make use of the group process, and whose needs are manageable in this program setting, e.g., not a danger to self or others, not a firmly entrenched antisocial personality disorder or conduct disorder, not with mental health problems or other -15-

16 problems that would undermine or inhibit group process or the integrity of the treatment program. Clients attending the intensive outpatient treatment program Phase I, who successfully completed all the requirements of Phase I, may graduate to Phase II, the Aftercare Program. Furthermore, individuals who have successfully completed either an inpatient treatment program or intensive outpatient therapy for substance dependence or abuse elsewhere, and have maintained an appropriate period of sobriety following treatment may be considered for Phase II. Charges & Readmission for AIOP/IOP-Phase II: As part of the Wyoming Department of Health, Behavioral Health Division - Block Grant, Cornerstone Behavioral Health will charge clients who are served under the contract, on a sliding fee scale adopted from the Wyoming Department of Health, Behavioral Health Services Division Sliding Fee Scale Guidance for Treatment Providers as set forth in The sliding fee scale shall be posted in the lobby and made available to persons seeking substance abuse services. For clients served under this contract, Cornerstone may not refuse to offer or provide services due to the client s inability to pay. A client shall not be denied access to services for nonpayment without it being addressed as part of the treatment plan with a reasonable timeframe for resolution of the issue. However, services may be denied to clients who fail to address financial responsibilities as indicated in the treatment plan and refuse or are unwilling to pay their agreed upon fee. The following policy/procedure applies to only those individuals who completed Cornerstone s Intensive Outpatient Treatment Program-Phase I (AIOP/IOP). If a client relapses during AIOP/IOP-Phase II (Aftercare) and the Treatment Team determines the appropriate level of care is readmission to AIOP/IOP-Phase I, the following criteria are applied regarding cost: A. If the client is in good standing and has not received new legal charges, the client may return to AIOP/IOP-Phase I without new/additional charges for Phase I. When graduating to Phase II Aftercare, charges will resume. B. However, if the client receives new legal charges and is required and/or recommended to return to AIOP/IOP-Phase I, the new financial charges will be determined using a sliding fee scale based on household income and household size A Closer Look: Further Criteria for Admission and Participation in Treatment Programs In addition to criteria for program placement described earlier in this document, the following criteria and guidelines are used for placement, admission and participation in our treatment programs. -16-

17 Outpatient Treatment Program (AOP/OP) and Intensive Outpatient Treatment Program (AIOP/IOP) The client must: a. Be eighteen (18) years or older in the case of IOP or OP; b. Be thirteen (13) through seventeen (17) years of age in the case of AIOP of AOP. If the individual started the program prior to turning age 18, they may complete the program after they turn age 18. All possible admissions outside that age range will be assessed individually for appropriateness to the program; c. Not need detox services. Clients on methadone maintenance must be detoxed from methadone before admission; d. Agree to complete all treatment program requirements and to attend all sessions and appointments. Note: In the case of AIOP/AOP, Parents/Guardians/ Significant others will be asked to commit to being involved in the client s recovery process through Family Week, and possible conjoint therapy/ consultation and/or parenting classes. In the case of IOP, clients will be encouraged to involve their families, significant others and friends in the Family Week Experience; e. Agree to remain free from any mood altering substances, such as alcohol and illicit drugs. Addictive prescription medication will be reviewed; f. Agree, after signing releases, to obtain a letter from his/her physician if the client is on psycho-tropic medication and the therapist requests such a letter. The letter will state the appropriateness of the client for the program; g. Sign all appropriate documentation (described earlier in this document). A client may be deemed inappropriate for admission if a client: a. Failed two previous treatment experiences (inpatient, outpatient, or a combination of both); b. Demonstrates an inability or lack of desire to remain clean and sober; c. Has a current living situation that is considered too dysfunctional for the client to succeed in treatment; d. Is deemed by staff or medical personnel to be in need of ongoing medical attention during the treatment process; or, e. Is deemed inappropriate for group work. -17-

18 Consent for Services Whenever a client comes into Cornerstone, a completed and appropriately signed Consent for Services form will be maintained in the client file. No services will be performed without this Consent for Services form being completed and signed by the appropriate parties. Client Refusal to Sign Paperwork Whenever a client comes into Cornerstone, required documents must completed and appropriately signed (e.g., financial agreement, acknowledgment of privacy practices, consent for services, emergency treatment release, client rights, confidentiality, group rules, TB test agreement, etc.). No services will be performed without these documents being completed and signed by the appropriate parties. These documents will be maintained in the client file. Criteria for Admission/Re-Admission Cornerstone maximizes opportunities for the persons served to gain access to the organization s programs and services. Efforts are made to ensure that individuals who have the potential to benefit from services will be served. Need for behavioral health services will be determined through the screening/evaluation/intake procedure, with admission for treatment based on the client being diagnosed per the requirements of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) at admission with a disorder or with significant behavioral issues which are in need of treatment. The diagnosis will be determined by a clinician legally qualified to do so in accordance with all applicable laws and regulations. Clients who present with behavioral or substance abuse issues that do not fully meet the criteria necessary for a specific diagnosis, but which nevertheless results in significant impairment in functioning, are also considered candidates for treatment. Screenings/evaluations/intakes will be completed in a timely fashion. Information will be obtained from the client, family members/legal guardian (when applicable and permitted); and other appropriate and permitted collateral sources. This collateral information is obtained with the permission (signed release of information form) of the client unless a legal relationship indicated contact without permission. Individual and family services are based on the strengths, needs, abilities, preferences, desired outcomes, expectations, and cultural background of the person or family served. The intake process takes into account the individual s age, development, and education. Substance abuse services including appropriate placement of clients, and their continued stay, transfer, and discharge recommendations are determined to the extent reasonably possible, through application of the current ASAM client placement criteria. The ASAM PPC is a guiding tool for determining placement, continued stay, and discharge of a client. Refer to the ASAM PPC-2R for additional information. -18-

19 Re-admissions are considered on a case by case basis following the admission criteria. If a mental health client returns prior to six months post discharge, a new assessment is not required. Any significant changes in the client, or his/her status, major life issues, accomplishment of significant goals, hospitalizations, etc. will be documented in the re-admission progress note. However, if the absence has been longer than six months, a new screening and supporting documentation will be required. If a substance abuse client returns after being officially discharged, the re-admission will be considered on a case by case basis. However, if new legal charges are present, a new evaluation/assessment is required. Accessibility of Treatment If a person seeking substance abuse services is not able to be seen within 24 hours of the person s initial contact with the program (excluding weekends and holidays) the following options will be discussed with the individual: 1. Waiting list (if applicable). 2. Schedule appointment in first available time slot. 3. Referral to outside agency. 4. Schedule of Twelve (12) Step meetings in the community (if applicable) will be provided. 5. Individuals that are court ordered to receive substance abuse assessments/evaluations are scheduled on a first come/first serve basis. However, individuals who are requesting substance abuse services and are NOT involved with the legal system are scheduled to meet with a substance abuse counselor immediately to determine level of care needed. If an individual is deemed to be appropriate for either Outpatient Group or Intensive Outpatient Treatment, the individual will be admitted into the appropriate program immediately and scheduled for an assessment/evaluation as soon as possible. 6. If the client cannot be seen for an assessment and/or treatment within seventy-two (72) hours of the initial contact, the client will immediately be referred to an outside agency. 7. If an alternative provider is not available, Cornerstone will then engage the client in an appropriate level of care (group and/or individual) and/or will provide information relating to Twelve (12) Step Meetings in the community until such time treatment services are available. -19-

20 Developing a Waiting List Cornerstone s outpatient programs offer a variety of service modalities that are designed to assist individuals from the community to enhance their quality of life. Each clinician has a designated number of individual therapy hours available to provide services. If/when there are no available hours remaining, individuals who call will be informed that a waiting list has been implemented. Individuals are then taken/scheduled from the waiting list on a first come first served basis. For the substance abuse programs, priority is given to pregnant women and IV drug users. However, if the individual does not wish to be placed on the waiting list, the individual is informed of the other agencies in the area that provide like-services. If the individual caller indicates immediate services are needed/required, the individual is directed to call 911, go to the Evanston Regional Hospital Emergency Room, and/or call High Country Behavioral Health (the community mental health center responsible for crisis situations). Once a waiting list is implemented all contacts made to Cornerstone regarding screenings/intakes will be documented on the waiting list. 1. In the event a clinician whose areas of expertise are congruent with the needs of the client is unavailable, the person seeking services will be offered the option of placement on a waiting list. 2. The waiting list will indicate the name of the person seeking services, date o f placement on the list, symptom severity, age, preferences, identified need, or special needs and contact information. The administrative director will maintain the waiting list through ongoing review and updating of the list with regular input from the clinical director. 3. Documentation of any and all contacts with the person on the waiting list is maintained. 4. The waiting list information is obtained, analyzed and used in program planning, performance improvement activities, strategic or community based planning, organizational advocacy efforts, financial planning, and resource planning. 5. Individuals placed on the substance abuse waiting list are encouraged to attend A.A., N.A., etc. and are asked to check in with Cornerstone frequently. Order of Selection for Admission of Persons Awaiting Services Policy: Once a person is placed on a waiting list, services will be provided in a timely manner to persons who have the potential to benefit from the services. Procedure: 1. The waiting list will be reviewed and updated in the weekly Cornerstone staff meeting. -20-