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AOD Services

ALCOHOL AND OTHER DRUG TREATMENT (AOD) TREATMENT

Purpose

To codify the Mid-Ohio Psychological Services, Inc. policies concerning the delivery of alcohol and other drug  (AOD) treatment services and establish the responsibilities of both clinical staff and support staff for the delivery of this service.

Policy

It is the policy of Mid-Ohio Psychological Services, Inc. to provide the highest quality, abstinence-based, most cost effective treatment to persons dealing with alcohol and other drug addiction/abuse.  These services are provided by qualified mental health/chemical dependency practitioners and supported by competent clerical staff, all of whom are sensitive to the needs of the consumer.  The AOD Program will establish a Planning Policy which clarifies the mission, goals, and objectives for delivery of AOD services and which includes a budget for these services.

It is the responsibility of the Alcohol and Other Drug Treatment Program Director (AOD Program Director), in direct consultation with the Executive Director and Administrative Coordinator, to oversee the delivery of AOD treatment services.  The AOD Program Director is responsible for codifying the procedures for this service and for ensuring compliance by all staff with the established procedures, reporting any discrepancies to the appropriate staff personnel and the Executive Director.

The AOD Program Director shall conduct regularly scheduled individual and or group supervision sessions.  Supervision sessions will be used to develop written goals and methods of supervision that are agreed upon with the supervisee. Documentation of what occurred during supervision and progress toward supervision goals will be kept.

It is the responsibility of all clinical staff and support staff to provide immediate feedback to the AOD Program Director when any problems arise in the delivery of this service or when any areas for improvement are identified.

It is the responsibility of the Quality Assurance Committee to review the provision of this service through established procedures to ensure the thoroughness, appropriateness, and effectiveness of service delivery .The review will include ensuring that AOD clients admission, continued stay and discharge are appropriate based on the ODADAS protocols for level of care (youth and adult) for publicly funded clients including a minimum of methodology, frequency, and content of activities.

Procedures

Admission

All admissions to the Mid-Ohio Psychological Services, Inc. must first enter through the intake, Mental Health Assessment/ AOD Assessment, and staffing phases before actually being admitted for outpatient counseling.  The time period involved in these phases may vary, depending on the nature of the problem, scheduling limits, hours of operation, and client attendance, but normally entail at least two evaluation/assessment sessions, or two separate appointments, usually five to ten days apart.

Financial EligibilityClients must have Medicaid or agency based payment for the cost of services in order to be eligible for the AOD program.

Intake

Intake usually begins when a client calls with a presenting problem.  Support staff are to complete an Initial Telephone Contact Form or a referral source must complete a Referral to MOPS Form.  The Initial Telephone Contact Form and/or Referral to MOPS Form will be reviewed by the Site Supervisor or their designee and the case will be assigned to a clinician for assessment according to established guidelines provided by the AOD Treatment Program Director.  During the initial phone intake, every effort will be made to determine the existence of any special needs including assistance with language, physical challenges or the potential impediments to the provision of treatment and every effort will be made to address these concerns at no cost to the client.

The receptionist will make arrangements for the individual to be seen by a counselor for their Mental Health Assessment/AOD Assessment session, setting the appointment with appropriate consideration to the person’s work schedule, place of residence, availability of transportation, and other valid circumstances; however, it is requested that, when possible, the assessment be conducted within seven working days of the initial contact.  At this point, the client will be informed of relevant fees for service.  The client is given/mailed an appointment card indicating the time, date, and day of the session, as well as the name of the counselor the client is scheduled to see.  The Receptionist notes the client’s name in the computer scheduler for the time, date, and type of session (Mental Health Assessment/AOD Assessment).  If the client is in acute distress and in need of emergency services, the client will be referred to the community Emergency Services program as established by the Mental Health Board.

When the client initially comes into the agency, they are asked to complete the Physical Health Assessment (self report) form, Psycho-Social History (self report) form, appropriate Outcomes Form, and Billing Authorization Form and to review the Client Guidelines and Client Rights Statement.  The client must complete these forms and sign the Authorization for Services portion of the Client Guidelines form prior to receiving any services.  These materials may be mailed to the client prior to the client first arriving to the office, when time permits.  The client must sign a statement indicating that they have received and reviewed the Client Guidelines and Client Rights Statement.  If a client is a minor or is under legal guardianship, the parent/legal guardian must sign the Client Guidelines, Client Rights Statement, and Authorization for Billing forms to provide authorization for services.  Upon completion of these forms, the person is then registered with the agency and the case is entered into the Master Log where an individualized client number is assigned to the case.

Client case numbers are based on the current year, month, date, and numerical sequence (Example:  For a person who registered on April 6, 1991 and is the third client to register that day, their individualized client I.D.  number will be 91-04-06-03).  The Master Log will then serve as a tracking device that follows the client’s involvement in the agency through termination of service(s).  The billing clerk then enters the client information into the practice management software.  An Individualized Client Record (ICR)  is then organized, into which all of that client’s records are placed and maintained.  At this time, the ICR will have at least the Phone Intake (or Referral to MOPS Form), Physical Health Assessment (self report) form, Psycho-Social History (self report) form, and Authorization for Billing and the signed portion of the Client Guidelines (Authorization for Services) and Client Rights Statement.   The Records Clerk will then organize the file, arranging to established procedures.  The file will then be affixed an identification label with the client’s last name, first name, and middle initial, as well as his/her individualized case number.  The file is to be stamped with “CONFIDENTIAL” on its front cover.

Individual Client Records (ICR) for AOD ClientsAll Individual Client Records (ICR) for all program areas of MOPS including AOD will include the following documents:

Initial Telephone Contact Form

Physical Health Assessment-Self Report

Psychosocial History-Self Report

Psychosocial History (which includes Mental Status Examination and AOD Assessment)

A statement clarifying payment issues.

A signed acknowledgment of Client Rights and Agency Policy and Procedure (which includes authorization for services).

A signed education acknowledgement of AOD clients form

A signed acknowledgement of receipt of the client grievance procedures for AOD clients form.

Notes reflecting each client contact or contact with other persons concerning a client (with a signed release of information as appropriate)

Each of these components will be in the ICR by the end of the first session unless otherwise noted.  The education and client grievance acknowledgement will be completed when a client is admitted to AOD services. Case notes will be dictated within one day of the session and will be in the chart within 14 days of the session.  The ISP will be completed within seven days of the completion of the assessment or the first scheduled session afterwards; the ISP will then be updated every 90 days. Within 30 days appropriate statistical reporting forms (MACSIS, etc) will be completed.  Upon termination from treatment, the ICR must also contain a Treatment Termination form and the appropriate statistical reporting forms.

Mental Health Assessment/ AOD AssessmentAll clients must receive a Mental Health Assessment/AOD Assessment prior to receiving AOD services.  The Mental Health Assessment/AOD Assessment is either conducted according to the policies and procedures of this agency or is obtained from another agency through the transfer of an Integrated Client Record.  After the first session, a Plan of Action must be completed.  The Mental Health Assessment/AOD Assessment is complete when an Individual Service Plan (ISP) has been established or when it has been determined that mental health services are not necessary at this time.  The ISP must be signed by the client, the participating clinicians, and the clinical supervisor.  Mental Health Assessment/AOD Assessments should be completed by the second session but must be completed within the first four sessions or 30 days, whichever comes first.

During the Mental Health Assessment/AOD Assessment, all the materials in the ICR are to be reviewed, appropriate collateral material obtained (with signed release of information forms), appropriate testing conducted, a complete psycho-social history gathered, and a mental status examination administered.  The clinician must also complete the MACSIS Intake Form and the appropriate Outcome Measure (as appropriate).

Case note for Mental Health Assessment/ AOD Assessment sessions must include a section addressing clinical formulation.  This clinical formulation section to the case note must include supporting data, evidence of sign and symptoms, and reasoning for the diagnosis that is being provided.

Assessments By Other Agencies

An Assessment will accepted from another certified program if it meets the following criteria:

  1.  It was conducted within 1 year of the clients admission to the program
  2.  It has been reviewed AOD Program Director for compliance with the agency’s standard assessment.

If any of the criteria are not met then a Mental Health Assessment/ AOD Assessment will need to be conducted by this agency before the client can be admitted into the program. If the assessment is accepted it must be signed and dated by the AOD Program Director and the copy must be filed in the clients file.

Youth Mental Health Assessment/ AOD Assessment

Youth evaluations are conducted by a qualified counselor (as determined by the agency’s Professional Staff Organization) with training and/or experience in assessing/counseling adolescents.  The purpose of the evaluation is to determine the nature of the chemical use problems (if any exists).  The evaluation attempts to gather together as much information as is available to the counselor, utilizing self-reports, school behavioral checklists (when available), parental observations and concerns, and reports from the referring agency (if applicable).  It is the policy of Mid-Ohio Psychological Services, Inc.  that all youth evaluations must be conducted with the consent and involvement of the parent(s) or legal guardian of the adolescent.  If the youth is hearing impaired or is in need of other special evaluation services that are beyond the scope of this agency, every reasonable effort will be made to refer the client to an appropriate agency.

Note:  In addition to the intake procedures already outlined, the following forms must also be completed with regard to adolescents:

  1. Consent for Treatment of a Minor form to be signed by the parent or legal guardian.  Parent or guardian is informed of relevant fees.
  1. Release of Information (consent form) to be signed by both the adolescent and parent/legal guardian.
  1. Client Rights to be reviewed and signed by both adolescent and parent/legal guardian.

The following procedure is suggested to conduct the Youth Evaluation.  It is not meant to be rigidly followed, but to be utilized as a general guide for counselors conducting the evaluation, allowing flexibility of personal counseling style, and flexibility in addressing the particular problem(s) presented.

A.     The counselor sees both the adolescent and parent(s) for about 10 minutes to explain what is taking place and to initiate the therapeutic relationship.

B.     The counselor, with the parents, fills out the appropriate sections of the Adolescent Psycho-Social Summary in an interview style.

C.     The parent(s) are asked to return to the Waiting Area.  The adolescent is seen alone to complete the Adolescent Psycho-Social Summary in an interview style.

D.     Where there are serious discrepancies in responses between what the parent(s) report and adolescent reports, they are brought together again to resolve the problem.

Clinical StaffingWhen outpatient counseling is recommended, the AOD Treatment Program Director assigns an appropriate counselor for that particular client. Assignments are generally based on client caseload and counselor’s strengths, specializations, and experience that are appropriate to the identified needs of the client.  This may be accomplished through written “standing order” procedures.

Admission into outpatient treatment requires that the individual’s problems are related to substance use issues.  To be admitted to outpatient treatment, the client must present with a diagnosable substance use condition as defined by the Diagnostic and Statistical Manual IV.  Clients are admitted for treatment based on the guidelines set forth in the community service plan.  Clients will not be will not be denied admission to the program due to their use of prescribed psychotropic medication.

If a client is deemed inappropriate for treatment following the mental health assessment/ assessment and clinical staffing, a letter will be forwarded to the client and referral source (as appropriate and with written authorization of the client) indicating that the client is not appropriate and suggesting alternative treatment options as appropriate.  A client may be deemed inappropriate because they require a higher level of service intensity than is available at this agency, they do not meet the diagnostic classification as noted above, or they are deemed not amenable to treatment.  A client may also be referred to other treatment providers and rejected from treatment at this agency due to payment issues, conflict of interest issues, or agency capacity issues.  If a client is deemed inappropriate for treatment at this agency, the case will be closed unless the clinician conducting the mental health assessment/ assessment determines that a higher level of care is needed and it appears that the client will return to this agency for follow-up care from that higher level treatment (this case may remain open for up to six months and will be “suspended” during this period of time).

Outpatient TreatmentOutpatient treatment begins when an ISP has been developed that addresses problems and level of care identified in the clients assessment  and the client has been assigned a counselor.  Outpatient treatment is designed to address the issues identified on the ISP through face-to-face interaction with the counselor and client. The ISP will be reviewed and updated every 90-days to take into account the clients changing clinical needs and response to treatment.

Clients receiving AOD treatment will receive education concerning the impact of substance usage on all areas of the client’s life.  Additionally, clients will receive education on HIV infection, AIDS related complex (ARC), and AIDS, Tuberculosis, Hepatitis B and C.

In the event of a client-counselor conflict, and the client has difficulty with the initially assigned counselor, the client may request re-assignment to another counselor.  The client is required to inform his/her initial counselor of the problem and request a different counselor.  If the counselor cannot resolve the conflict, he/she will present the client’s request to the clinical staff in the clinical staffing.  The clinical staff will determine the appropriateness of the client’s request and if it is approved, will re-assign the case.  In the case of a re-assignment, a Case Transfer form must be completed.  When the request is denied, the counselor will inform the client at their next scheduled session.  If the client still is not satisfied, the counselor will make arrangements for the client to be seen by Client’s Rights Officer, AOD Treatment Program Director or Executive Director along with the counselor to attempt to resolve the conflict.

Case notesCase notes must include the client name, I.D. number, date and time of the session, type of session, and the time spent in the session.  Case notes for the initial two sessions should begin with a summary of why the client is being seen and a brief mental status examination.  All subsequent case notes should begin by addressing any discrepancies in the client’s presentation.  As a general rule, case notes should include a description of client progress since last session in relation to treatment goals and objectives, and any changes in a client’s cognitive, affective, or behavioral functioning.  They should include a brief summary on the purpose of the session, what occurred in the session, and what is planned for the next session. The signature and credentials of the person making the entry should follow each Case note entry.   All activities concerning a client should be documented by a case note.  Case notes are preferably dictated but may be typed by the clinician.  If dictated, case notes must be turned in at the end of the business day for transcription.

Termination

While the client remains active in treatment/assessment, it is the responsibility of the assigned counselor to ensure the maintenance of the file and to report on the client’s involvement to the referral source (when appropriate).  If a client fails to appear for a session or fails to reschedule an appointment, it is the responsibility of the support staff to initiate the following procedures:

  1. Notify the clinician of the situation.
  1. Attempt to contact the client to clarify their intentions and document said attempt.  This attempt should include at least one attempt to phone and one attempt to send a Missed Appointment Notification form.
  1. Initiate a Termination Summary form, filling in the appropriate sections including # of sessions, name, attempts to reinitiate, etc.
  1. Have the counselor complete the Termination Summary form, MACSIS-Case Closure Form and have the clinical supervisor sign off.
  1. Place the ICR in the temporary inactive file.
  1. After a reasonable amount of time, place the ICR in the file archive.

Specialized ServicesThe Mid-Ohio Psychological Services, Inc. will make every reasonable effort to have available interpreters for those with severe hearing impairments, as well as individuals who cannot understand or speak the English language.  The interpreter shall be familiar with the Federal Regulations regarding confidentiality of Client Records for Mid-Ohio Psychological Service and are individually liable for abide by them.

When an individual appears at the agency and is hearing impaired but understands sign language, an effort is made to arrange an appointment convenient to both the client and the interpreter for an initial screening/evaluation session.  If treatment is needed, Mid-Ohio Psychological Service, Inc. will make an effort to link the client with a treatment resource that has specialized services for the hearing impaired, like that available at Netcare in Columbus, Ohio, which has outpatient services.  In the event that outpatient services are seen as a viable option of treatment for the identified problem and the client prefers to receive these services through the Mid-Ohio Psychological Services, Inc.  arrangements would need to be made with the Interpreter to schedule sessions with the assigned counselor and client at the agency.

The Administrative Coordinator will maintain a list of interpreters for those clients who do not speak English or who require the assistance of an interpreter.  This service will be provided at no charge to the client.

Re-AdmissionAny client who has not been in counseling contact with the program without prior notification for over six months will be required to be re-evaluated.  The counselor conducting the initial interview will determine the type of re-evaluation.  It may involve re-administering an evaluation device or may simply be a screening session.  The client will not pick up where he/she left off in treatment as had been outlined on the Individual Service Plan or Plan of Action.  Consequently, the client’s case will be re-staffed by the counselor conducting the re-evaluation, and the appropriate recommendations will be made by the clinical staff relative to the results of the evaluation.  It is also possible that the initial diagnostic impression may be upgraded as a result of new or additional information.

In the event of a client applying for readmission after his/her case had been terminated, the client will need to go through the intake process as outlined above. The new ICR must indicate that the client was previously seen at this agency and must reference the previous client ID number.

Client TransferWhen a client is transferred from one staff member or service area to another within the agency, the following information is to be recorded on the Referral/Transfer Form:  the dated signature of the staff member transferring the person, the name of the staff to which the person is being transferred, and the effective date of the transfer.  The case notes shall reflect that the reason(s) have been explained to the person served, and, if appropriate, parent or guardian that the person being transferred participated in the transfer decision.  The person’s response to the transfer decision shall be documents in the case note.

Interagency ReferralWhen a client is transferred to or from another agency, the following information shall be documented in the Individual Client Record:  the name and dated signature of the staff member making the interagency referral, the name of the individual or agency to whom the interagency referral is being made, the effective date of the interagency referral, the authorization for release of information according to division F of section 5122.31 of the Ohio Revised Code, and progress and/or consultation reports requested from the agency to which the person is referred.  The Client Record will reflect the reason(s) for the referral, including documentation that the reason(s) have been explained to the person being referred, and if appropriate, parent or guardian, and that the person being transferred participated in the referral decision.  The person’s response to the referral shall be documented in the client record as well.  When a person is referred to a psychiatric hospital, a copy of the Individual Service Plan shall be provided to the hospital treatment team with consent of the person served, or the person’s parent or guardian, when appropriate.

The Mid-Ohio Psychological Services, Inc.  maintains a close working relationship with other human service providers in and around Fairfield County area.  Mid-Ohio Psychological Services, Inc. takes a holistic approach to the treatment of mental and substance use disorders, looking at the needs of the whole person, and not just one or two aspects of its clientele.  To better meet these varied needs, Mid-Ohio Psychological Services, Inc.  has linked its services with the services of other resources in the area, and have implemented procedures of referral to these service providers.

  1. Mid-Ohio Psychological Services, Inc.  does encourage its clients involved in outpatient treatment to either see a personal physician or to find a personal physician for at least a general examination.
  1. Mid-Ohio Psychological Services, Inc will encourage and assist pregnant clients in contacting local obstetricians for prenatal care by utilizing case management services and document the referral in the clients record.  If a client refuses referral assistance, it will be documented in the client’s record.
  1. In the event of an immediate emergency medical need, the Mid-Ohio Psychological Services, Inc.  has linked with Emergency Services as contracted by the Fairfield County Mental Health and Recovery Services Board.
  1. In the event of any client needing inpatient psychiatric/substance use care, the Mid-Ohio Psychological Services can make the necessary arrangements to have the person admitted.
  1. Medical Emergencies are to be referred to the Fairfield Medical Center for further assessment and stabilization.  In life threatening medical emergencies, staff will call 911.
  1. Any other referrals for services are made by the Mid-Ohio Psychological Service, Inc. whose responsibility it is to link the client up with the agency or agencies that can best provide the needed service(s).  The referrals can be made via direct phone contact and an appointment made for the client, or the client can be given the name and address of the service provider to contact.

rev 01/2012

ALCOHOL AND OTHER DRUG PLANNING POLICY

PurposeTo ensure that Mid-Ohio Psychological Services, Inc. is offering appropriate and effective alcohol and other drug (AOD) treatment services that will meet the needs of the residents of Fairfield and surrounding communities.

MissionThe Mid-Ohio Psychological Services, Inc. AOD Treatment Program’s mission is to reduce the negative impact of alcohol and other drug addictions on the citizens of Fairfield County and surrounding communities.

GoalsTo promote healthy attitudes and behavior regarding alcohol and other drugs.

To promote/facilitate recovery from chemical/alcohol abuse/dependency.

To address the need for culturally specific and relevant programming for ethnic minorities, deaf or hearing impaired and others through the agency’s cultural competency plan.

ObjectivesIncreased healthy attitudes and behaviors regarding alcohol and other drugs.

Successful termination from treatment of 50% of clients receiving AOD services.

Treatment Services to be ProvidedThe Mid-Ohio Psychological Services, Inc. AOD Treatment Program will provide an array of outpatient services including: AOD Assessment, AOD Individual Counseling, AOD Group Counseling, AOD Medical/Somatic Services, AOD Case Management, and AOD Crisis Intervention.  Each of these services will be provided according to the Mid-Ohio Psychological Services’ established policies for each of these services with specific emphasis/attention to AOD treatment issues.

Mental Health Assessment/AOD Assessment services are designed, through face-to-face contact, to determine the functional level, psychological state, and contributing medical conditions, and to formulate a diagnostic impression through the use of psychological testing and clinical interviewing for the purpose of establishing the nature and extent of treatment, which is indicated for a particular individual.

Behavioral Health Counseling Therapy Service/AOD Individual Counseling is face-to-face verbal interaction is designed to help reduce the impact of the individual’s mental illness or emotional disturbance on their day-to-day life.  Through counseling, individuals are aided in maximizing the quality of their life through utilization of traditional therapeutic techniques, which aid the individual in interfacing with their environments.Pharmacological Management Service/AOD Medical/Somatic Service (psychiatric) services are designed as medical interventions, including physical examination, prescription or supervision of medication, and medical interventions to address the physical health needs of the person served.  These services are provided in a face-to-face fashion by a physician who is qualified to provide psychiatric services. Community Psychiatric Supportive Treatment Service/AOD Case Management provides an array of services delivered by a community based, mobile, multidisciplinary team of professionals and paraprofessional.  Services are directed towards adults, children and adolescents and will vary with respect to hours, type and intensity of services, depending on the changing needs of each individual.  These services are expected to complement other services already in place for the individual.    The purpose of services is to encourage the individual’s multi-system involvement as appropriate and to ensure continuity and effectiveness of delivery of services and/or systems to the individual.

AOD staff will provide AOD crisis intervention treatment services to clients who present with crisis issues.  Staff will work to stabilize the client through counseling to assist the client in understanding the events that caused the crisis and will utilize therapeutic tools to aid in deescalating the crisis.  Clinicians will help clients achieve stabilization by helping the client with problems solving, developing strategies to address problems, and assist in implementing these strategies to return the client to their normal status.  Stabilization may include the use of case management services.  If a client is deemed by AOD staff to be at an eminent risk of hurting themselves or others then they will be referred to Emergency Services for consideration for psychiatric hospitalization.  If they are deemed to be at eminent risk for relapse, an attempt will be made to address the relapse factors and an attempt will be made to facilitate a sober support system.

Hours of Operation

The hours of operation of the MOPS AOD Treatment Program is 9:00 a.m. to 7:00 p.m. Monday through Thursday, 9:00 a.m. to 5:00 p.m. Friday.

Revenues and CostsThe estimated revenues by source, and the cost for providing each AOD treatment service will be found in the annual MOPS budget that will be approved annually by the MOPS Board of Directors.

Target PopulationAll services provided by the MOPS AOD Treatment Program will target individuals who experience AOD issues in conjunction with other mental health issues.

Planning ProcessThe agency Executive Director, Clinical Director, and AOD program Director will annually review and revise as necessary with the MOPS Board of Directors AOD Program policy and procedures to be presented annually to the MOPS Board of Directors. MOPS Board minutes will reflect that the review has taken place.

Program EvaluationAs part of the planning process, the program will be evaluated by the QA committee regarding the following issues:

  1. Accessibility to services
    1. Participants will initiate treatment within 14   days of phone intake
  2. Quality of services
    1. Participants will rate the quality of treatment that they received at a three or higher on a five point scale.
  3. Effectiveness of services
  4. At least 50% of clients successfully will terminate, having established sobriety.

This program evaluation will utilize both client satisfaction survey data as well as a review of Quality Assurance data.  The client satisfaction survey will be provided to all clients who receive AOD services at the time of case closure and/or at a designated time of the year.  Quality Assurance data that will be reviewed to evaluate the above identified goals include: length of time from phone intake until initially seen, % of clients who complete treatment while maintaining sobriety, and average length of treatment (number of sessions prior to termination).

This program evaluation will be conducted as part of the agency’s global agency evaluation process and will be reported to the board of directors according to the QA Annual Calendar.