Program Requirement and Expectation

Program Requirement and Expectation

Scope

The following policy applies to all staff, contractors, and clients.

Policy Values

  • Integrity
  • Stability
  • Transparency
  • Autonomy

Policy Purpose

The creation of this policy is to identify standard entry criteria, transition, and exit criteria that suit the persons served in each level of care.

Policy Rules

  • Persons served will complete verification of benefits prior to admitting to establish financial requirements or exclusionary criteria.
  • Persons served will complete a pre-screen assessment to support understanding initial admit exclusionary or inclusionary criteria.
  • Persons served will be evaluated using the ASAM or LOCUS assessment by a licensed clinician to establish appropriate level of care or need for referral to appropriate facility.
  • Persons served will be given a clear expectation and outline of requirements for transition per level of care at admit or step down.
  • Persons served will be given a clear outline of requirements for successful discharge at admit.
  • Persons served will be supported in transition and/or exit to assure they are receiving appropriate planning to participate in ongoing services.
  • All requirements will be identified by the clinician and medical provider for all levels of care provided by this facility.

Procedure

  • Clients must have a verification of benefits completed prior to admit to establish insurance or cash pay rate.
  • Financial obligations must be clearly communicated and clients must acknowledge understanding about their financial responsibility upon admit.
  • Clients requesting admission to Residential or Outpatient services, who are in active use of a substance that has the potential for severe withdrawal symptoms, will be referred to a detox center prior to cleared admit.
  • Clients requesting admission to Social Detox will be evaluated for safety and appropriate level of care by the detox medical provider, using information obtained during the prescreen assessment prior to intake, and a history and physical within 24 hours after intake.
  • Prescreen assessments must establish appropriate mental health entry criteria (current symptoms) and/or substance abuse use history.
  • Clinicians will assess the client using a BPS/CDA following a qualifying prescreen.
  • Clinicians will assess clients based on the ASAM for substance use disorder primary or LOCUS for mental health disorder primary.
    • ASAM score requirements per LOC are as follows:
      • Detox: 3.7
      • RTC: 3.5-3.1
      • PHP: 2.5-2.1
      • IOP: 2-1.5
  • LOCUS requirements for mental health admit are scored and divided by the requirements on the assessment which dictates and demonstrates appropriate level of care.
  • Potential clients for residential and outpatient services will not be admitted with the current need of controlled prescriptions including THC Medical Cards.
  • THC medical use will not be allowed in any levels of care.
  • Detox Clients will be evaluated daily by the Detox medical provider until they can be stabilized and transitioned to a lower level of care, or until it is determined that a higher level of care is needed via Utah Rule: DHHS R501-11-6(1).
  • Once accepted to the appropriate level of care, clients will be expected to attend groups regularly and complete their handbook for the attended level of care prior to transition and/or exit.
  • Clients must attend a minimum of 30 days residential treatment, regularly attend groups, complete their handbook, and be cleared by both primary clinician and medical provider to qualify for successful step down or discharge.
  • Clients must attend a minimum of 6 weeks of partial hospitalization treatment, regularly attend groups, complete their handbook, and be cleared by both primary clinician and medical provider to qualify for successful step down or discharge.
  • If a client in either level of care is deemed not stable at the standard treatment time frame (6-weeks PHP, 30-day RTC) a discussion will occur to support continued treatment or change to their level of care.
  • Individual client stabilization is prioritized and treatment length may be adjusted when deemed appropriate by clinic and/or medical staff.
  • ASAM or LOCUS scoring will be completed continuously throughout care to support appropriate transitions in level of care.
  • Spanish speaking clients will be referred out to an appropriate facility that can meet their needs. This facility does not have the ability to support persons served who are non English speaking.

Terms and Definitions

ASAM

The American Society of Addiction Medicine, founded in 1954, is a professional medical society representing over 7,000 physicians, clinicians and associated professionals in the field of addiction medicine.

Level Of Care

The “level of care” is the setting in which an individual needs medical or long-term care services. In most states, applicants who require a nursing home “level of care” have medical conditions or functional limitations that result in being a danger to oneself.

LOCUS

The Level of Care Utilization System (LOCUS) was created by the American Association of Community Psychiatrists to provide Mental Health and co-occurring Substance Abuse Providers with a standardized tool to ensure scarce healthcare resources are consistently utilized in the most effective and efficient manner possible.

Prescreen

A pre-screen, also known as a brief screen, is defined by SAMHSA as “a rapid, proactive procedure to identify individuals who may have a condition or be at risk for a condition before obvious manifestations occur.”

CDA/BPS

The purpose of the BioPsychosocial (BPS) Assessment and Comprehensive Diagnostic Assessment (CDA) is to provide a comprehensive clinical assessment geared to identifying both strengths and needs.

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