Current through September 21, 2024
(a) Day 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.
(b) Description
of Services. Day treatment clinical services provide twelve (12) or more hours
of clinically intensive services a week per Wyoming service definition, with no
more than three (3) days between clinical services, excluding holidays. If the
program does not have availability, pre-engagement services shall be provided.
Per ASAM description, services provided include direct access to psychiatric,
medical and laboratory services, and thus are better able than intensive
outpatient services to meet the needs identified in Dimensions 1, 2, and 3,
which warrant daily monitoring or management, but which can be appropriately
addressed in a structured outpatient setting. Services include, but are not
limited to: individual, group, and family therapy, as indicated by client
needs, medication education and management, educational groups, occupational
groups and recreational therapy.
(c) Required Personnel.
(i) Day treatment clinical services are
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.
(ii) 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.
(iii) Staff is capable of monitoring
stabilized mental health problems and recognizing any instability of clients
with co-occurring mental health problems.
(d) 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 every two (2) weeks. Severity shall be rated for each dimension with
sufficient documentation showing justification for level of care
recommendations.
(e) Therapies and
Interventions.
(i) Services include, but are
not limited to, individual and group
counseling, as indicated by client needs, medication
management, educational groups, occupational and recreational therapy, and
other therapies, as indicated.
(ii) 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.
(iii) 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.
(iv) Motivational enhancement and engagement
strategies shall be used in preference to confrontational approaches.
(f) 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.
(vi) 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 plans 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.
