Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0054 - Substance Abuse
Chapter 4 - DESCRIPTION OF SERVICES AND REQUIREMENTS FOR SUBSTANCE ABUSE SERVICES
Section 4-16 - Residential Treatment Services
Universal Citation: WY Code of Rules 4-16
Current through September 21, 2024
(a) Residential treatment services must meet all applicable standards, Chapters 1 and 2, and Sections 1 through 9, and Section 14 of Chapter 4, of these standards, including the following service level requirements.
(b) Residential Treatment Services.
(i) Description of Services. Clinical
services can be provided in a low, medium or high intensity level of service
based on client needs utilizing the ASAM dimensional criteria to determine at
what level the client should participate. Services include at least thirty (30)
hours of structured services that are designed to treat persons who have
significant social and psychological problems. If the program does not have
availability, pre-engagement services shall be provided by the referring agency
or the accepting agency. Service hours can be reduced based on client progress
and outside activities, such as employment. When the client has reached a
sustained level of functioning based on ASAM dimensional criteria, the client
must be transferred to a less intensive level of care. Services include, but
are not limited to, individual, group, and family, as indicated by client
needs, medication education and management, educational groups, and
occupational groups and recreational therapy. Such programs are characterized
by their reliance on the treatment community as a therapeutic agent. The goals
of treatment are to promote abstinence from substance use, to promote healthier
behavior patterns, and to affect a global change in participants' lifestyles,
attitudes and values. The approach views substance-related problems as
disorders that must be treated holistically.
(ii) Required Personnel.
(A) Service shall have sufficient clinical
staff and support staff to meet the needs of the client.
(B) Clinical services are staffed by
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.
(C) A physician
and/or nursing staff is available to provide consultation as either an employee
of the program or through written agreement.
(D) All staff persons who assess and treat
clients must be capable of obtaining and interpreting information regarding the
needs of clients, and must be knowledgeable about the bio-psychosocial
dimensions of alcohol and other drug dependence.
(E) A staff person with the responsibility of
assuring case management services is provided.
(F) A mental health professional is available
either as an employee of the service or through written agreement to provide
joint and concurrent services for the treatment of clients diagnosed, unless
the clinical staff person is cross-trained in mental health.
(iii) 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.
(iv) Therapies and
Interventions.
(A) Physician shall review and
document the medical status of a client within forty-eight (48) hours after
admission.
(B) Clinical and wrap
around services shall be provided to improve the resident's ability to
structure and organize the tasks of daily living and recovery.
(C) Planned clinical program activities shall
be provided to stabilize and maintain stabilization of the resident's substance
dependence symptoms and to help her develop and apply recovery
skills.
(D) Activities include
relapse prevention, interpersonal choices and development of social network
supportive of recovery.
(E)
Counseling and clinical monitoring shall be provided to promote successful
initial involvement or re-involvement in regular, productive daily activity,
such as indicated, successful reintegration into family living.
(F) Random drug testing shall be administered
when indicated.
(G) Services
include, but are not limited to, a range of cognitive, behavioral and other
therapies based on client needs.
(H) For clients with mental health problems,
the issues of psychotropic medication, mental health treatment and their
relationship to substance abuse disorders are addressed, as the need arises.
Programs that provide co-occurring treatment 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.
(v) Individualized Treatment Planning.
(A) An initial treatment plan shall be
completed within one (1) week of the initial assessment focusing on
stabilization of the client. Treatment plan goals must be more individualized
and measurable as the client stabilizes.
(B) 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.
(C) Treatment plans shall be developed
utilizing the assessment Information, including ASAM dimensional criteria and
the DSM diagnosis.
(D) 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.
(E) Treatment
plans shall integrate mental health issue if identified as part of the
assessment process, or at any point during the continuum of
treatment.
(F) Treatment plan
reviews shall be completed throughout the course of treatment 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 part of an ASAM dimensional criteria review
form.
(G) Treatment plans shall
list action statements that describe the steps the client will take to meet
each stated goal.
(H) The treatment
plan shall be comprehensive and include goals regarding services provided by
other agencies that are relevant to the client's overall functioning
level.
(I) 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.
(c) Transitional Residential Treatment Services.
(i) Description of Services. A transitional
residential treatment service is a clinically managed, low intensity,
peer-supported, therapeutic environment. The term "residential transition
treatment service" does not include independent, self-operated facilities such
as Oxford Houses. The service provides substance abuse treatment in the form of
counseling for at least five (5) hours per week in-house or through a local
certified program, with access to peer support through case management, which
may include education and monitoring in the areas of personal health and
hygiene, community socialization, job readiness, problem resolution counseling,
housekeeping, and financial planning.
(ii) Required Personnel.
(A) A physician shall be available to provide
medical consultation as either an employee of the service or under written
contract with the service program.
(B) The program shall have sufficient
clinical staff and support staff to meet the needs of the client.
(iii) ASAM Continued Stay,
Transfer and Discharge Review. Reviews shall meet the standard set forth for
Outpatient Services.
(iv) Therapies
and Interventions. Therapies and interventions shall meet the standard set
forth for Outpatient Services.
(v)
Individualized Treatment Planning. Treatment planning shall meet the standard
set forth for Outpatient Services.
(d) Therapeutic Community Model.
(i) Description of Services. Therapeutic
community (TC) programs within the Wyoming Department of Corrections must be
certified by the Division. Services must meet all applicable standards,
including Chapter 1 and 2 Sections 1 - 9. and Section 14 of Chapter 4. The
program must also meet the TC requirements of the National Standards for TC
Communities. Where National Standards are stricter, National Standards would
prevail. The Therapeutic Community approach places emphasis on individuals
helping themselves and each other as opposed to a service model in which staff
provides treatment to clients. The Therapeutic Community approach to substance
abuse treatment is a psychosocial, experiential learning process. It utilizes
the influence of positive peer pressure within a highly structured social
environment. The primary therapeutic change agent is the community itself,
including staff and program members together as members of a
"family."
(ii) Required Personnel.
(A) Service shall have sufficient clinical
staff and support staff to meet the needs of the client.
(B) Clinical services are staffed by
appropriately 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.
(C) A physician
and/or nursing staff is available to provide consultation as either an employee
of the program or through written agreement.
(D) All staff persons who assess and treat
clients must be capable of obtaining and interpreting information regarding the
needs of clients, and must be knowledgeable about the bio-psychosocial
dimensions of alcohol and other drug dependence.
(E) A staff person with the responsibility of
assuring case management services is provided.
(F) A mental health professional is available
either as an employee of the service or through written agreement to provide
joint and concurrent services for the treatment of clients diagnosed, unless
the clinical staff person is cross-trained in mental health.
(iii) 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.
(iv) Therapies and
Interventions.
(A) A physician shall review
and document the medical status of a client within forty-eight (48) hours after
admission.
(B) Clinical and wrap
around services shall be provided to improve the resident's ability to
structure and organize the tasks of daily living and recovery.
(C) Planned clinical program activities shall
be provided to stabilize and maintain stabilization of the resident's substance
dependence symptoms and to help him or her develop and apply recovery
skills.
(D) Activities include
relapse prevention, interpersonal choices and development of social network
supportive of recovery.
(E)
Counseling and clinical monitoring shall be provided to promote successful
initial involvement or re-involvement in regular, productive daily activity,
such as indicated, successful reintegration into family living.
(F) Random drug testing shall be administered
when indicated.
(G) Services
include peer directed counseling under the direction of clinical staff
utilizing a range of cognitive, behavioral and other therapies based on client
needs.
(H) For clients with mental
health problems, the issues of psychotropic medication, mental health treatment
and their relationship to substance abuse disorders are addressed, as the need
arises. Programs that provide co-occurring treatment 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.
(v) Individualized Treatment
Planning.
(A) An initial treatment plan shall
be completed within one (1) week of the initial assessment focusing on
stabilization of the client. Treatment plan goals must be more individualized
and measurable as the client stabilizes.
(B) Initial treatment plans shall be
developed with the client with peer input. The client and clinical staff
responsible for the course of treatment will sign this initial treatment
plan.
(C) Treatment plans shall be
developed utilizing the assessment information, including ASAM dimensional
criteria and the DSM diagnosis.
(D)
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 by level of service that are expressed
in measurable and understandable terms. The goals shall describe improved
functioning level of the client utilizing ASAM dimensional criteria.
(E) Treatment plans shall integrate mental
health issues, if identified as part of the assessment process or at any point
during the continuum of treatment.
(F) Treatment plan reviews shall be evaluated
throughout the course of treatment 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.
(G) Treatment plans shall list action
statements that describe the steps the client will take to meet each stated
goal.
(H) 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.
Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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