8.301 Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent)

Transcription

1 8.30 RESIDENTIAL TREATMENT CENTER SERVICES Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent) Description of Services: Residential Treatment Services are provided to individuals with eating disorders who require 24-hour treatment and supervision in a safe therapeutic environment to avoid eating disordered behaviors such as food restricting, purging, over-exercising, use of laxatives/diet pills/diuretics. RTS is a 24 hour a day/7 day a week facility-based level of care. RTS provides individuals with eating disorders therapeutic intervention and specialized programming in a controlled environment that is specifically tailored to the treatment of eating disorders. This can be accomplished on a specialized residential unit or a unit with a specific, specialized tract/program that relies on evidencebased approaches to treat these complex disorders. RTS addresses the identified eating disorders through a wide range of diagnostic and treatment services. Nutritional counseling is required in these residential settings. The services are provided in the context of a comprehensive, multidisciplinary and individualized treatment plan that is frequently reviewed and updated based on the individual s clinical status and response to treatment. This level of care requires at least weekly physician visits. This treatment primarily provides social, psychosocial rehabilitative training and a focus on family or caregiver support. Active family/significant involvement through family therapy is a key element of treatment and is strongly encouraged unless contraindicated. Discharge planning is documented and must begin at admission, including plans for reintegration into the home and community. If discharge to a home/family is not an option, alternative placement must be rapidly identified and there must be regular documentation of active efforts to secure such placement. Licensure and credentialing requirements specific to facilities and individual practitioners do apply and are found in our provider manual/credentialing information. Important: While level of care determinations are considered in the context of an individual's treatment history; Beacon Health Options never requires the attempt of a less intensive treatment as a criterion to authorize any service. Criteria Admission Criteria All of the following criteria are necessary for admission: 1. The individual demonstrates symptomatology consistent with an Eating Disorder diagnosis as listed in the most recent version of the DSM which requires and, can reasonably be expected to respond to, therapeutic intervention at the residential level of care. 2. Facility demonstrates ability to safely treat Eating Disorder individuals with specific, individualized, evidence-based care. The residential facility must be in Beacon Health Options network or be accredited by one of the organizations listed in Beacon Health Options policy N206 Credentialing Criteria for Facility/Organizational Providers. 3. The individual is experiencing eating disordered behaviors in the home, community and/or outpatient treatment setting and is not sufficiently stable, either physically, emotionally or behaviorally, to be treated outside Reviewed: 7/15/13, 11/18/13, 11/17/14, 2/5/15 Page 1 of 5

2 of a highly structured 24-hour therapeutic environment. 4. The individual demonstrates a capacity to respond favorably to rehabilitative counseling and training in areas such as problem solving, life skills development, medication compliance training and independent or semi independent living as appropriate. 5. The individual has a history of multiple hospitalizations or other treatment episodes at other levels of care and/or a recent inpatient stay with a history of poor treatment adherence or outcome. 6. The individual lacks community/primary supports sufficient to maintain him/her in the community with treatment at a lower level, and the individual requires 24 hour structured monitoring, including monitoring during and after all meals to avoid behaviors such as restricting, over exercising/purging, and/or use of laxatives/diuretics/diet pills. 7. Although weight alone should not be the sole criterion for admission or discharge at this residential level of care, the individually calculated ideal body weight is generally <85% (or BMI of 15 or less) at this level, combined with other objective evidence of complications that require 24 hour residential care 8. The multi-disciplinary discharge planning process starts from the assessment and tentative plan upon admission, and includes the patient and family/significant other as appropriate, unless contraindicated secondary to risk of harm to patient or family/support. A bio-psychosocial outpatient team should be collaborated with or created if not in already in place (including physical health practitioner, behavioral health therapist, psychiatrist, nutritional expert). Firm aftercare appointments should be in place upon discharge. Psychosocial, Occupational, and Cultural and Linguistic Factors Exclusion Criteria These factors, as detailed in the Introduction, may change the risk assessment and should be considered when making level of care decisions. Any of the following criteria is sufficient for exclusion from this level of care: 1. The individual exhibits severe suicidal, homicidal, acute mood symptoms/thought disorder,, or threatening physical symptoms and objective signs of medical instability which may require a more intensive level of care such as the following: a. Pulse < 40 bpm b. Blood Pressure < 90/60 mmhg or significant orthostatic changes > 20 mmhg c. Blood glucose < 60mg/dL Reviewed: 7/15/13, 11/18/13, 11/17/14, 2/5/15 Page 2 of 5

3 Continued Stay Criteria d. Potassium < 3 meq/l or other electrolyte imbalance (magnesium, phosphate, sodium) e. Temperature < 97.0 degrees F f. Severe dehydration g. Renal, cardiovascular or other organ damage or failure h. Poorly controlled Diabetes Mellitus i. Weight < 75% of IBW or rapid, significant weight loss jeopardizing the immediate health of the individual (i.e. Greater than 15% total body weight loss the last 30 days) j. Requires enteral tube feeding or parenteral feeding in a structured inpatient acute setting and is unable to utilize these mechanisms safely at a less restrictive level of care k. pregnancy with potential risk to mother s or fetus health l. refeeding syndrome 2. The individual does not voluntarily consent to admission or treatment. 3. The individual can be safely maintained and effectively treated at a less intensive level of care. 4. The individual has medical conditions or impairments that would prevent beneficial utilization of services, or is not stabilized on medications. 5. The primary problem is social, legal, economic (i.e. housing, family, conflict, etc.), or one of physical health without a concurrent major psychiatric episode meeting criteria for this level of care, or admission is being used as an alternative to incarceration All of the following criteria are necessary for continuing treatment at this level of care: 1. The individual s condition continues to meet admission criteria at this level of care. 2. The individual s treatment does not require a more intensive level of care and no less intensive level of care would be appropriate. 3. Treatment planning is documented and individualized and appropriate to the individual s changing condition with realistic and specific goals and objectives stated. Treatment plan should be structured to gain weight at a reasonable rate. This also includes appropriate lab work. Follow up tests should be ordered as needed. Education on healthy skills should be included in the treatment plan (e.g. CBT or DBT skills, healthy exercise protocols, healthy meal selection etc.). Treatment planning should include active family or other support systems involvement, unless contraindicated. The expected benefits from all relevant treatment modalities are documented. 4. All services and treatment are carefully structured to achieve optimum results in the most time efficient manner possible consistent with sound Reviewed: 7/15/13, 11/18/13, 11/17/14, 2/5/15 Page 3 of 5

4 clinical practice for eating disorders. 5. If treatment progress is not evident, then there is documentation of treatment plan adjustments to address such lack of progress. Progress in relation to specific symptoms or impairments is clearly evident and can be described in objective terms, but goals of treatment have not yet been achieved or adjustments in the treatment plan to address lack of progress are evident and there is fair likelihood that the individual will show progress with these changes. 6. Care is rendered in a clinically appropriate manner and focused on individual s physical, behavioral, and functional outcomes. 7. Individual is actively participating in treatment to the extent possible consistent with his/her condition, or there are active efforts being made that can reasonably be expected to lead to the individual s engagement in treatment. 8. Unless contraindicated, family, guardian, and/or custodian is actively involved in the treatment as required by the treatment plan, or there are active efforts being made and documented to involve them. 9. When medically necessary, appropriate psychopharmacological intervention has been prescribed and/or evaluated. 10. An individualized discharge plan has been documented and developed which includes specific realistic, objective and measurable discharge criteria and plans for appropriate follow-up care. A timeline for expected implementation and completion is in place but discharge criteria have not yet been met. 11. There is a documented active attempt at coordination of care with relevant outpatient providers and community supports when appropriate, including a multi-disciplinary bio-psycho-social outpatient team including a physical health practitioner, a behavioral health therapist, a psychiatrist, and a nutritional expert. Firm aftercare appointments should be in place prior to discharge. Reviewed: 7/15/13, 11/18/13, 11/17/14, 2/5/15 Page 4 of 5

5 Discharge Criteria Criteria 1, 2, 3, 4 or 5, in addition to 6 and 7 are sufficient for discharge from this level of care: 1. The individual s documented treatment plan goals and objectives have been substantially met and/or a safe, continuing care program can be arranged and deployed at an alternate level of care. 2. The individual no longer meets admission criteria, or meets criteria for a less or more intensive level of care. 3. The individual, family, guardian and/or custodian are competent but non-participatory in treatment or in following the program rules and regulations. There is non-participation of such a degree that treatment at this level of care is rendered ineffective or unsafe, despite multiple, documented attempts to address non-participation issues. 4. The individual is not making progress toward treatment goals despite persistent efforts to engage him/her, and there is no reasonable expectation of progress at this level of care, nor is treatment at this level of care required to maintain the current level of functioning. 5. Consent for treatment is withdrawn, and it is determined that the individual has the capacity to make an informed decision and does not meet criteria for an inpatient level of care. Support systems, which allow the individual to be maintained in a less restrictive treatment environment, have been thoroughly explored and/or secured. 6. The individual can be safely treated at an alternative level of care. 7. An individualized discharge plan is documented with appropriate, realistic and timely follow-up care is in place. Reviewed: 7/15/13, 11/18/13, 11/17/14, 2/5/15 Page 5 of 5