The development of a treatment plan, discussion of barriers to engagement, and intimate emotional issues are examples of the kinds of topics often reserved for individual time. In a recent NABH Annual Survey, more than half (56.8%) of all NABH members responding offered psychiatric partial hospitalization services for their communities, and more than a third (35%) offered partial hospital addiction services.Throughout the years, these NABH members have been a stable group of providers . As with individual treatment, time is limited, and staff needs to maximize the experience often leaving some issues for more extensive family treatment following discharge. Outcomes have become increasingly more important not only internally, but to external agencies, including regulatory agencies, insurance providers and consumers. Additional elements include opinions related to the programs use of effective treatment methods, relevance of therapeutic subject matter, cultural sensitivity, teamwork, and the overall quality of care. First Edition. This program requires patients to attend treatment for even less time than the PHP option. Confidentiality guidelines pertaining to individuals in chemical dependency treatment tend to be more restrictive than for those individuals in mental health treatment. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. For each person seen through telehealth, the staff providing a treatment service must have the following readily available: Any individual offered telehealth services must consent to telehealth services and should acknowledge consent before the first session of telehealth service: [Provide the statements through email or display on the screen during an intake or first session]. https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html?redirect=/home/regsguidance.asp, https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html. The record must provide the capacity to individualize goals to specific needs, emphasizing recovery principles and reflecting a language easily understandable to the individual. These metrics not only impact the financial outcomes of the program but can also be reflective of the overall impact the program is having for those who participate in programming. The plan may address patient safety concerns, primary symptoms, self-esteem issues, coping skill deficits, priority decision points, level of motivation, recovery issues, barriers to treatment, and factors which impact readiness for discharge. The defining characteristic of this function is the fact that PHP services are provided in lieu of inpatient hospitalization.. In some cases, it may not be clear from diagnostic criteria alone which level of care is appropriate. Utilizing a Motivational Interviewing approach to assessment (as well as ongoing treatment) with individuals with chemical dependency is considered to be a best practice. Policy and Standards: Partial Hospitalization Documentation . The individual exhibits acute symptoms or loss of function that necessitates an intermediate level of care or has relapsed and failed to make significant clinical gains in a less intensive level of care yet does not need 24-hour containment. PHPs and IOPs can be distinguished by their primary program function or treatment objective. The program can last for a week or up to six months. Association for Ambulatory Behavioral Healthcare, 2015. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. Examples may include childcare demands, appointments for services such as housing, or employment interviews. Marketplace forces and cost containment efforts have often resulted in a decrease in service availability, more restrictive eligibility (medical necessity) requirements, and reduced lengths of stay. A recovery model that focuses on increased quality of life is essential to give the older adult investment and purpose in treatment. Benchmarking, whether internal or compared to peers, provides an overview of how elements of a program are performing. A focus on medication adherence, therapeutic impact, and relationship between psychiatric and physical medications should also be considered. Follow-up may be provided by outpatient psychiatrists or the individual may be referred back to primary or physical/behavioral integrated outpatient care. Consider providing a staff member for each telehealth group for technical assistance, administrative duties, and telephone follow up on participants who drop or disappear from the screen. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. PHPs work best as part of a community continuum of mental health services which range from the most restrictive inpatient hospital setting to less restrictive outpatient care and support. Peer support is encouraged in programs where applicable regulations allow the use of peers who have been trained to support the clinical efforts of the program. The American Society of Addiction Medicines (ASAM) Patient Placement Criteria (ASAM PPC-2R) (previously mentioned) is considered a best practice for assessing and determining level of care placement for individuals with substance use disorders.6, Psychoactive substance history & detoxification status, Emotional/behavioral/cognitive functioning. We must honor the role of peer support and counseling within the behavioral health continuum. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. Scheifler, P.L. Casarino, J., Wilner, M., and Maxey, J. This document has been designed to enable programs to: Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may differ from one region to another due to multiple factors such as specialized workforce availability, culture, resources, or health insurance coverage inconsistencies. Because these services are often expected as part of the contracts or regulatory reviews, it is necessary to better understand when participation in both services is appropriate and when one or the other should be the sole behavioral health provider. Symptoms continue to impair multiple areas of daily functioning and medications are being adjusted, Impaired insight and skill deficits place one at a significant risk for further functional deterioration, Individual displays willingness yet difficulty understanding or coping with significant crises or stressors, There is a continued significant risk for harm to self or others. Study with Quizlet and memorize flashcards containing terms like Developed by the substance abuse client's treatment team, this document is used to identify the typeand frequency of services needed by the client. Services may be provided during the day, evening, and/or on the weekend. Standards for Intensive Outpatient Treatment: 22258025: Effective: 08/29/2019 Change 65D-30.002 Definitions, Certifications and Recognitions Required by Statute, Display of Licenses, License Types, Change in Status of License, Required Fees, Licensure Application and Renewal, Department Licensing .. 22030172: 6/25/2019 Vol. Many seniors live in isolation, so timely and appropriate aftercare is needed to ensure that gains made in the program remain. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. These Standards and Guidelines are presented from the perspective of the AABH national provider network. In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. This table is available to members HERE. Linkages related to successful treatment will be considered. Core clinical staff members come from diverse disciplines, such as psychiatry, psychology, social work, counseling, addictions, medicine, and nursing. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. In the current healthcare environment, this level is also referred to as Primary Integrated Care and supported by the Center for Medicare and Medicaid Services (CMS) Integrated Health Model. On the other hand, integrated occupational therapy programs complement other services and teach valuable skills within an evidence -based model that contributes significantly to positive clinical outcomes. Compiles and analyzes data and prepares case records, reports, and documents that comply with state and federal standards in providing case notes, treatment plans, and evaluations. Linkages should endeavor to coordinate care in an efficient and timely manner. It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. The individuals progress or lack thereof toward identified goals is to be clearly documented in the record. Any additional laboratory testing, as determined by the organization and in accordance with the level of care provided. Older Adult programs are an important means of delivering behavioral health treatment to adults age 55 and older. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. These are often times when a given individuals clear need (such as for new housing due to an imminent spousal separation) may not coincide with the individuals actual desire for an appropriate referral. For those with AN, weight restoration may need daily monitoring to prevent re-feeding syndrome. Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. Because of the complexity of this issue, additional collaboration among residential and acute ambulatory providers, regulatory groups, and insurers is recommended to clarify when a combination of services is appropriate and to develop joint strategies to decrease redundancies and cost while providing excellent care to each person. Programs tend to fall into two basic categories that impact programming: These distinctions are important since they may dictate the process, content, and structure of group therapy and psycho-educational sessions. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. Additional benefits should include enhanced tracking and report writing functions that improves decision-making through the collection of timely, accurate information. A clinical record must document what information is gathered, considered, or developed throughout treatment for each individual admitted. Successful engagement in the clinical process and willingness to address issues at whatever stage of treatment, Capacity to gain insight and respond successfully to therapeutic interventions, Continued need for medication monitoring and intervention, Capacity to make progress in the development of coping skills to meet baseline functional needs, Need for support and guidance in handling a major life crisis, Continued need for managing risk accompanied by capacity to follow a safety plan, Commitment to developing and following through on a recovery-oriented discharge plan. Initially, the individual may only be able to agree to begin treatment and form a basic treatment plan, and may require close monitoring, support, and encouragement to achieve and sustain active and ongoing participation. Upon discharge, a list of medications that have been discontinued is to be available along with a list of all current medications and appropriate contraindications for the patients benefit. These are important things to address during the course of treatment in these programs. Partial Hospitalization Programs (PHP) - Partial hospital implies a daily psychosocial milieu treatment of generally four or more hours duration a day with group therapy, psycho-educational training, and other types of appropriate therapy as the primary treatment modalities. The psychiatric assessment is the guiding document in creation of a treatment plan for each person in treatment. Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. Due to the nature of individual need and program design, it is expected that all needs which are addressed during treatment will not show up on all treatment plans. Also, the program expectations should be flexible in order to accommodate a decrease in the number of hours per day or days per week of individual participation over time as a person moves toward discharge. Cognitive and physical impairments may make day-long treatment services demanding for some individuals. We encourage an appreciation for the complexity of creating and sustaining a milieu that engages and appreciateseach individualin their personal stage of change. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Can J Psychiat, 49, 726-735, 2004. However, we recognize that many states have established state-specific standards and expectations for care, and have codified these into state laws, regulations and licensing rules. These screenings also include risk for harm to self or others, pain, abuse, substance abuse, nutrition, vocational/financial need, legal concerns, housing, family issues, preferred learning style/methods, and any other ongoing unique individual concerns which may require consideration. -. They should provide face-to-face services with each client upon admission for an evaluation and thereafter as clinically indicated. Clients with eating disorders may enter PHP level of care with a body mass index (BMI) which measures the relationship between height and weight, of 17.5 (adults) or less with a diagnosis of anorexia nervosa or may be of normal weight with a bulimia nervosa diagnosis, while they may be obese with a BMI of 30 or more or morbidly obese with a BMI or 40 or more. A number of clinical factors may impact staff-to-client ratios in programs: For example, the direct treatment staff-to-client ratio in some acute PHPs may need to be 1:3, while in other less intensive programs, a ratio of 1:12 may be appropriate. The change in symptoms requires the intensity and structure of PHP to avert further deterioration. There are no guidelines for how a State should license behavioral health facilities, which may lead to a need to search carefully for the licensing requirements. II. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. Inthesecases, a program might find that different guidelines are in conflict. Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. Partial Hospitalization These programs are defined as structured and medically supervised day, evening and/or . The Indiana Health Coverage Programs (IHCP) provides coverage for inpatient and outpatient behavioral health services - including mental health and addiction treatment services - in accordance with the coverage, prior authorization (PA), billing and reimbursement guidelines presented in this document. Example metrics include, but are not limited to: Staff are not only the largest cost to programs, but also have the biggest impact on programming and quality in a program. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. Often the program is the first treatment setting for persons experiencing an acute exacerbation of symptoms. New York: Guilford, 2002. 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