Behavioral Health Facilities and Rehabilitation Facilities

Outpatient treatment Intensive Outpatient/Partial Hospitalization Inpatient Treatment Education programs Self-help Recovery Groups

Regularly scheduled outpatient substance abuse treatment Provided by: Mental Health Centers Hospital Outpatient Centers Freestanding Drug & Alcohol Centers e.g. Methadone Maintenance Clinics, Court-Ordered Programs and EAP

At least 9hrs per week in treatment do not stay overnight 9-20 Intensive Outpatient @ Everning Program Partial Hospitalization @ Day time

1. Medically MONITORED inpatient substance abuse treatment setting -non-medical residential setting. 2. Medically MANAGED inpatient substance abuse treatment setting -under direction of physician with all services of an Acute Care Hospital.

Prevention- individual & Families D.A.R.E

Support groups that assist in maintaining sobriety and drug free life AA Narcotics Anonymous 12 Step Programs Fetal Alcohol Syndrome Cocaine Addiction in NB

Adolescents Women Employee Assistant Programs (EAP) Dually Diagnosed Court Preferred

Fetal Alcohol Syndrome Cocaine Addiction in NB

Abuse problem in combination with mental illness

Assessment and/or Treatment -DWI -DUI -Other alcohol or drug related offenses

Physicians, nurses, nurse practitioners, physician assistants, -Counselors-may be social workers, psychologists, nurses -Case managers -can be counselors but their main function may be related to reimbursement and follow up. Recreation Therapist-for clients in Residential Programs

1. Inpatient Substance Abuse Facilities 2. Hospital- Based Ambulatory 3. Residential and Partial Hospitalization

Freestanding Community- based abuse programs

Commission on Accreditation of Rehabilitation Facilities

Individuals rights served by rehabilitation Facilities, CARF standards emphasize the clients participation in planning and choosing their own care

To detoxification units of hospitals, outpatients services (intensive outpatient patient, partial hospitalization and residential

Must apply the Medicare Conditions of Participation

it need to be "medically necessary" therefore there needs to be physician involvement and clear documentation of medical necessity of the Prescribed treatment.

1. Legal/Administrative Documentation 2. Clinical Documentation

Admission information Commitment papers financial insurance program rules consents client rights

Clinical Assessment Medical Assessment Individualized treatment Progress Note Discharge Summary Follow Up

Identifying information Presenting problem Health, medical and or developmental history Family & Social history History of Substance Abuse History of Psychological factors Education/Vocational history Clients abilities, strengths, needs & preferences Preliminary diagnosis Specific reasons why admission to program is denied (if applicable) Initial Problem list Assessment Summary

Identification Plan DSM IV Diagnosis Justification/reason for treatment Proposed treatment, including type and frequency Measurable goals & objectives with target dates Treatment plan

-Outpatient Mental Health Facility -Group Home -Personal Care Home -Psychiatric Crisis Facility -Inpatient Psychiatric Home

-Regularly scheduled Outpatient Mental Health - Hospital-Based, community Mental Health Care

-Residential, 24 supervision & daily skills treatments -Limited time basis to train client for less restrictive environment

Permanent Living Facility Some Supervision & meals No training Clients too severely impaired to live completely independently

Short Term Treatment of psychotic symptoms in a early stage.

Long-Term inpatient Not responsive to medication that allow them to live successfully in less restrictive environment

Community Mental Health Centers

The Community Mental Health Center led to the de-institutionalization of many psychiatric patients.

Was stablished for outpatient treatment, emergency service and short-Term Hospitalization.

The Federal Governments, State and County

1. TEMPORARY emotional crisis related to a traumatic event 2. CHRONIC long term mental illness

Includes disorders such as: Depression Suicidal tendencies due to traumatizing events e.i. death, divorce, bankruptcy or loss of employment -They respond well to counseling and medication

-Due to chemical changes in the brain not by traumatic events -bipolar disorder -schizophrenia -clinical depression

Aka maniac-depressive disorder. Changes from extreme euphoria into deep depression

Is a type of psychosis which is a state of extreme disorderly thinking. The patient is unable to distinguish reality from hallucinations (false sense of perceptions) & delusions(false ideas)

Is when the patient experiences deep feelings of melancholy and futility it can be stress induced.

1. Mental illness with Mental retardation 2. Mental illness with Chemical Addiction (MICA)

Diagnostic Evaluation & psychiatric Medication Mgmt Case Management Day Programming Residential Living Screening & Evaluating Services After Hrs crisis Services

Psychiatrists, nurses, or nurse practitioners

Helps clients by obtain other services outside of the health setting

Provides the clients to interact with peers & professionals e.g. Partia Hospitalization Programs

Group Homes Halfway Houses which averages from 6 month to 1 year

To determining the need of short term psychiatric or for recommending involuntary hospitalization

e.i Emergency services available 24 hrs

Early Identification & Intervention Diagnosis & Evaluation Outpatient Treatment Day Treatment Emergency Services Home Based Services Therapeutic Foster Care Therapeutic Group Home

Assess physical and health, intelligence,academic, potential social, & behavioral functions Family dynamics and environment

Regularly scheduled Individual, Group and Family

Integrates educational/mental health Services during school hours at special schools or mental health centers Partial Hospitalization Programs for Adolescents

Runaway Shelters

Family Centered care designated to preserve the Family unit

Designated for Troubled children within private homes or trained families

The State by the Department of Health or The Department of Mental Health

Voluntary

1. Joint Commission 2. CARF 3. NCQA -accredits Managed Behavioral Health Care Organizations or Behavioral Health Programs within MCO

Comprehensive Accreditation Manual for Hospitals of JC

Comprehensive Accreditation Manual for Behavioral Health Care

Assessment Treatment Plan Progress Note Special Treatment Procedures Discharge Summary and Plans for aftercare Inpatient Hospitalization

Within 60 hrs of admission

include intake (general assessment) demographic data, history, physical, emotional, behavioral, social, recreational, legal, vocational or nutritional assessments.

Assessment Treatment Plan Progress Notes Special Treatment Procedures Discharge Summary and Plans for aftercare Inpatient Hospitalization

It should include documentation related to treatment goals, and as per Federal regulations it should be written by physicians, nurses, social workers and others involve in the treatment

ECT, use of seclusion or restraints or psychosurgery.

most not to exceed 24 hours

Clinically privileged staff can order restraints for up to 1 hour, and physicians can order restrains for more that one hour.

At least every 15 minutes.

It should include history of findings and treatment provided Patient's legal status must be documented Most be a Provisional or Admitting Diagnosis at the time of admission Reason for admission stated by patient and others Most be Social Service Records e.g. interviews w/patient and family, home plans, family attitudes, community resource contacts and social history. A complete neurological exam must be documented.

Medicare and Medicaid and must comply with the appropriate COP

1.Be completed within 60 hours of admission 2.Include a medical history 3.Contain a record of mental status 4.Note the onset of illness and the circumstances leading to admission 5. Describe attitudes and behavior. 6. Estimate intellectual functioning, memory, and orientation. 7. Include an inventory of the patient's assets in descriptive, not interpretative fashion.

The written plan must include: A substantiated diagnosis Short-term and long range goals The specific treatment modalities utilized The responsibilities of each member of the treatment team Justify the diagnosis, treatment, and rehabilitation activities Include all active therapeutic efforts and treatment received

It must be recorded at least weekly for the first 2 months and at least once a month thereafter. Must be recorded by the doctor of medicine or osteopathy responsible, nurse, social worker, and other that are involve in active treatment modalities.

At every discharge it most contain a discharge summary that includes a recapitulation of the patient's hospitalization and recommendations concerning follow up or after care and a brief summary of the patients

Is to help the patient develop to the "fullest physical, psychological, social, vocational, avocational, and education potential possible with his/her physiological or anatomic impairment and environmental limitations".

Inpatient and Outpatient

Serve those with orthopedic, neurologic, and medical conditions. helping those with acute and chronic It serves both adults and pediatric patients.

Loss or abnormality of psychologic, physiologic or anatomic structure or function. It is a disease or diagnosis.

Any restriction or lack resulting from the impairment of the ability to perform an activity in a manner considered normal. It is how the disease affects the person.

Disadvantage resulting from impairment or disability that prevents fulfillment of a role that is normal. A handicap is an interaction between impairment and socioeconomic environment. It is the affect of the problem on the person's life (how it affect the person's life)

Durable Medical Equipment

are assistive devices or equipment that can withstand repeated use. e.g. orthotics (appliances to support, align, prevent or correct deformity), ambulation aids, prosthetics, wheel chairs, mobility devices and high technology assistive devices.

Joint Commission and CARF

Must have a full time medical director (MD 0r DO) has two year of training or experience or board certified in psychiatry, neurology, neurosurgery, orthopedic surgery, or rheumatology -the hospital should have preadmission screening procedures a multidisciplinary team and to held team conferences at least every two weeks to update the plan of care.

H&P MD documentation weekly team conferences Progress Notes by Medical Nursing and therapy staff Individual Program Plan Discharge Summary

Description of the patient's functional status prior onset of illness/injury ADLs, assistive devices reliance on caregivers, social history(describing caregivers and Home) a comprehensive neurological & musculoskeletal examination (ROM) Contractures, amputations DVT skin condition cognitive status (speech and language) psychiatric history

SNAP Strengths, Abilities, Needs and Preferences Desire Outcomes and expectation Anticipated Outcomes of interdisciplinary Team Assessment finding to direct development of Plan

It helps to establish goals and objectives for the admission

American Spinal Injury Association (ASIA) Traumatic Brain Injury Classification System( TBI) Functional Independence Measure Scores

Standardizes the neurological motor and sensory examination Diagnosis can be stated giving a sensory and motor neurological level and completeness of spinal cord injury

1. Glasgow Coma Scale 2. Rancho Los Amigos Scale

Used in ED after injury and in the first 2-7 days post injury scores measuring eye opening motor response and predictive of patient's outcome

Score ranging from 1-8 are used to communicate patient's level of recovery

used to assess patient functional status in terms of ADLs e.g. Katz index, Bartel Index, Functional Independent Measures (FIM)

Scores is incorporate into Medicare's new PPS System for impatient rehabilitation hospitals -documents severity of disabilities and outcome sin rehabilitation Commonly used measure of independence assesses improvement documents functional status and discharge planning needs justify treatment and costs, provide communication among professionals and standardizes nomeclature for functional outcome -score motor function in 13 areas -eating, grooming,bathing, dressing, toileting, sphincher control, mobility, location, comprehensive communication, comprehensive expression, social cognition- social interaction , problem solving, memory