Current through December 21, 2024
Intensive outpatient treatment services must meet all
applicable standards, Chapters 1 and 2, and Sections 1 through 9 of Chapter 4,
of these standards, including the following service level requirements.
(a) Description of Services. Intensive
outpatient treatment programs per ASAM description provide at least nine (9)
hours for adults and six ( 6) hours for adolescents of structured programming
per week, consisting primarily of counseling and education about
substance-related and mental health problems. Program services must, at a
minimum, meet three (3) times a week with no more than three (3) days between
clinical services, excluding holidays. Programming must be at least eight (8)
weeks due to the severity level required for this level of care. Services for
this level of care must be available within two (2) weeks of the assessment, if
the program has open availability and the client is readily able to start. If
the program does not have availability, pre-engagement services shall be
provided. The client's needs for psychiatric and medical services are addressed
through consultation and referral arrangements, if the client is stable and
requires only maintenance monitoring.
(b) Required Personnel. Intensive outpatient
clinical services are appropriately staffed by Qualified Clinical Staff
person(s) who are credentialed through the Wyoming Mental Health Professions
Licensing Board established under the provisions of W.S. §
33-38-101, et seq., a
psychologist who is licensed to practice psychology, pursuant to W.S. §
33-27-113(a)(v), a Licensed
Physician by the Wyoming State Board of Medicine, as defined in Chapter 1,
Section 4, of the Definitions of these standards, and a Wyoming Advanced
Psychiatric Nurse.
(i) Staff is capable of
obtaining and interpreting information regarding the client's bio-psychosocial
spiritual needs, and is knowledgeable about the bio-psychosocial spiritual
dimensions of alcohol and other drug disorders, including assessment of the
client's stage to change.
(ii)
Staff is capable of monitoring stabilized mental health problems and
recognizing any instability of clients with co-occurring mental health
issues.
(c) ASAM
Continued Stay, Transfer and Discharge Review ASAM dimensional criteria shall
be reviewed by the clinical staff person responsible for treatment whenever the
condition changes significantly per Chapter 4, Section 6, of these standards.
At a minimum, dimensional criteria must be reviewed with support documentation
at least one (1) time monthly. Severity shall be rated for each dimension with
sufficient documentation showing justification for level of care
recommendations.
(d) Therapies and
Interventions.
(i) Services include, but are
not limited, to individual and group counseling, as indicated by client needs,
medication management, family therapy, educational groups, occupational and
recreational therapy, and other therapies, as indicated.
(ii) Services are provided in amounts,
frequencies and intensities appropriate to the objectives of the individualized
treatment plan.
(iii) Family
therapy shall be utilized when indicated by client needs, involving family
members, guardians and/or significant other(s) in the assessment, treatment and
continuing care of the client.
(iv)
A planned format of therapies shall be delivered on an individual and group
basis and adapted to the client's developmental stage and comprehension
level.
(v) Motivational enhancement
and engagement strategies shall be used in preference to confrontational
approaches.
(vi) For clients with
mental health problems, the issues of psychotropic medication, mental health
treatment and their relationship to substance abuse disorders shall be
addressed as the need arises. Programs that provide co-occurring treatment
shall offer therapies to actively address, monitor, and manage psychotropic
medication, mental health treatment and the interaction with substance-related
disorders. There may be close coordination with intensive case management and
assertive community treatment for clients who have severe and persistent mental
illness.
(e)
Individualized Treatment Planning.
(i)
Treatment plans shall be completed in conjunction with the initiation of
treatment.
(ii) Initial treatment
plans shall be developed with the client. The client and clinical staff
responsible for the course of treatment will sign this initial treatment plan,
if possible.
(iii) Treatment plans
shall be developed utilizing the assessment information, including ASAM
dimensional criteria and the DSM diagnoses.
(iv) Treatment plans shall document outcome
driven goals that are measurable. The plan shall specify the changes in the
client's symptoms, and behaviors that are expected during the course of
treatment for the current level of service the client is in and shall be
expressed in measurable and understandable terms. The goals shall describe
improved functioning level of the client utilizing ASAM dimensional
criteria.
(v) Treatment plans shall
integrate mental health issues, if identified as part of the assessment process
or at any point during the continuum of treatment.
(vi) Treatment plan reviews shall be
evaluated throughout the continuum of care based on client progress or lack of
progress toward goals per ASAM continued stay, transfer and discharge criteria.
Modifications shall be made as clinically indicated. This review shall include
a written description within the client record of degree of progress or lack of
progress for each stated goal and can be completed within the progress notes or
as part of an ASAM dimensional criteria review form.
(vii) Treatment plans shall list action
statements that describe the steps the client will take to meet each stated
goals.
(viii) The provider shall
endeavor to develop a single, individualized work plan when the client is
receiving services from other human services agencies, including, but not
limited to, the Department of Education, Department of Family Services,
Department of Workforce Services or Department of Corrections. The treatment
plan shall be comprehensive and include goals and services developed in
collaboration with the client, the client's family, where feasible and other
human service agencies serving the client's overall functioning
level.
