Association for Ambulatory Behavioral Healthcare, 2007. Outcomes have become increasingly more important not only internally, but to external agencies, including regulatory agencies, insurance providers and consumers. Example metrics include, but are not limited to: An ongoing periodic analysis of job duties and workflow processes is recommended to assure that job-related functions are not outdated and are being performed in the most efficient and effective manner. Portsmouth, Virginia. Child and adolescent programs provide an intensive therapeutic milieu that is designed to serve the child and/or adolescent (and their family) within the least restrictive therapeutically appropriate context. Whenever possible, maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a program with new peers and new staff. These meetings are critical to achieve continuity of client care, address the identified needs of the therapeutic community, assure appropriate utilization of services, and maintain necessary operational efficiencies. Medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement. require regular physician coverage that may vary depending upon local regulatory standards or payer requirements. Adult Residential Care Provider (ARCP) Ambulatory Surgical Center (ASC) Behavioral Health Services Provider. Inthesecases, a program might find that different guidelines are in conflict. Monitored study time vs. A solid aftercare plan is crucial for success with this population. Medicare regulations solidified the role of group therapy in PHP treatment when it was defined as one of the essential service units required each day. When using comparisons to review programs, administrators should not penalize individual programs that have developed a plan to improve the program. The EMR further facilitates this opportunity for improved integration and information sharing. If possible, consider a nursery onsite. Partial hospitalization programs (PHPs) differ from inpatient hospitalization in the lack of 24-hour observation, and outpatient management in day programs in 1) the intensity of the treatment programs and frequency . Groups that are structured to be repetitive, slower, and engage patients at multiple sensory levels are very important and can reduce the impact of physical and cognitive limitations on treatment. Clinicians should utilize language in documentation that notes telehealth use. When selecting outcome measures for the program, carefully consider the following: Programs should take caution that using a single outcome measure with all participants in a program could create problems unless that tool has established itself to be broadly applicable to multiple diagnostic groups. Institutional Habilitation Facilities 0940-05-24 Minimum Program Requirements for Mental Retardation Residential Habilitation Facilities 0940-05-25 Minimum Program Requirements for Mental Retardation Boarding Home Facilities 0940-05-26 Minimum Program Requirements for Mental Retardation Placement Services Facilities The interactive telecommunication technology included audio and video. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. An internal safety reporting mechanism is also advised to assure that types of problems such as medication errors, falls, injuries, or other critical data can be recorded and monitored. Service Planning These individuals are at high risk for hospitalization or re-hospitalization, and a less intensive level of care has been unable to achieve clinical stability. Finally, a new section of was added to address the role of regulatory bodies on programming and documentation. Be diligent in having copies of the scopes of work for each or the disciplinesaprogram is using to stafftheprogram. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. 45/123 Regular staff meetings should occur to address clinical needs, milieu issues, changing programming features, and relevant administrative issues. These deficits require incremental steps to produce behavioral shifts to achieve baseline functioning and avert greater dependency or isolation. Partial Hospitalization Programs (PHP) - Partial hospital implies a daily psychosocial milieu treatment of generally four or more hours duration a day with group therapy, psycho-educational training, and other types of appropriate therapy as the primary treatment modalities. -. The quality of the treatment we deliver is the value we offer to patients. Payer of services (e.g., managed care, government-supported national health care, such as national health insurance systems in Canada and Europe, and Medicare in the United States). Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. Women in the program should have the option to bring babies to group or leave in nursery. Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit. Retrieved July 20, 2018, from http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cooccurring/. Recovery-based education builds upon steps designed to create self-monitoring and individual recovery. 70.3 - Partial Hospitalization Services (Rev. This would also include ongoing communication between program staff and apersonsresidential program coordinator or community care manager while that personis in treatment. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. Each State should have an office that manages Medicaid. Services may include group, individual, couples, family therapy and medication management for symptom management. Additionally, systems may have ancillary features that will benefit an individual in treatment, such as mechanism to disallow inappropriate abbreviations in both medications and other information is also recommended. Residential services are provided to individuals who require greater support, monitoring, and intensity of services than can be offered in acute ambulatory settings. All co-occurring programs must have clearly delineated procedures and linkages for addressing clients detoxification, withdrawal, and other medical needs. This provider is often determined by the complexity of the illness, medications, and overall medical or case management needs; Some individuals display a relatively high baseline functioning prior to the onset of a behavioral health condition yet require treatment in a partial hospitalization program to provide medication stabilization, insight, and self-management skills to reduce symptoms and risk to self-harm. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. If screenings find significant concerns in any of these areas, program staff should include appropriate action items to address the concerns. We must honor the role of peer support and counseling within the behavioral health continuum. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. For a Free Consultation, call: 855-808-4213 . Second Edition. These metrics not only impact the financial outcomes of the program but can also be reflective of the overall impact the program is having for those who participate in programming. Positive psychology focused topics address strength building themes in groups that maximizes individual potential. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. We meet five days a week from 9 a.m. to 3 p.m. A. 4-4-103, -5-4202, -5-4204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, . All monitoring of suicidal ideation, such as daily screens, must continue. The identification of target populations with criteria for admission to, continuation of, and exclusion from each level of care will be delineated. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. Policy and Standards: Partial Hospitalization Documentation . Efforts to achieve best practices require analyses of critical data points, clinical outcomes, and treatment processes. We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. Family work is crucial and should be a part of every clients treatment plan. The quality of therapeutic presence is even more important in telehealth than it is in Holding the space is much more challenging. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. Programs are encouraged to be ready for medical emergencies related to substance abuse such as narcotic withdrawalcrises 9 some programs keep medications onsite for emergency use and have staff competent inadmistration. Service utilization during each acute episode of care will become the focus of overall continuum management. Often the program is the first treatment setting for persons experiencing an acute exacerbation of symptoms. Personalized Recovery Oriented Services (PROS) - A comprehensive recovery oriented program for individuals with severe and persistent mental illness. Access, treatment, and discharge data are key areas for tracking. Programs can usually expect to conduct program improvement planning following a review to address the issues discovered and highlighted as needing improvement. As with individual treatment, time is limited, and staff needs to maximize the experience often leaving some issues for more extensive family treatment following discharge. Fourth Edition. However, this range may extend to 21 years of age dependent upon the individuals developmental level and the goals and objectives and licensing requirements of any program. Occupational therapy is also a dynamic component of many programs. Because these services are often expected as part of the contracts or regulatory reviews, it is necessary to better understand when participation in both services is appropriate and when one or the other should be the sole behavioral health provider. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. High quality performance plans will guide the success of utilizing all support levels as members of a fully reimbursed multidisciplinary team. Example metrics include, but are not limited to: All programs are evaluated on issues related to the health and safety of those people being served in a program. In some cases, removal from a given residence or placement in a residence or residential treatment setting may be a precondition for treatment. This process usually has two steps: Programs should create a documentation system that allows for thorough but efficient review of a case at each step. The structure is needed to monitor before, during and after eating meals and snacks. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. If suicide risk is present in the participant, take action immediately, including staying online with them until help and safety has been secured. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. With recent changes to regulatory requirements in onsite visits, this document provides guidance in preparation for regulatory reviews. 104 CMR 30. Additional factors such as the presence of centralized intake, clinical complexity, medication challenges, family issues, insurance authorization procedures, and documentation needs, all impact staff-to-client ratio. Can J Psychiat, 49, 726-735, 2004. We encourage a shift in the oversight focus from document analysis to a concern for outcomes and the overall client experience. This staff member should work consistently with the individual (and family as indicated) and follow the course of clinical treatment from admission through discharge. Movement needs to be monitored hourly, determining how much movement or exercise is medically safe for each clients stability. The individual is not judged to be in imminent danger of withdrawal or has recently undergone medical detoxification. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. Partial Hospitalization - A program for adults or adolescents which provides active treatment designed to stabilize or ameliorate acute symptoms in a person who would otherwise need hospitalization. Fatigue, sensory impairment, decreased concentration ability, and discomfort with transitions or changes in programmatic structure are challenging factors to address in program development. As an example, an outpatient staff psychiatrist may need to coordinate a referral with the program staff to avert a hospitalization in the same organization. State laws may apply. A member of the clinical staff serves in a primary therapist/case management capacity to coordinate an individual's treatment within the program. Structure of the Accreditation Requirements Standards & Guidelines - AABH Standards & Guidelines These Standards and Guidelines are presented from the perspective of the AABH national provider network. Because assessments completed soon after meeting a client or in the context of intoxication, withdrawal, or severe psychiatric symptoms are inaccurate, it is important to continue to gather information over time.9. Basic Books, 1983. It is important for programs to provide lactation consultation in the program as working through difficulties with breastfeeding is a common treatment goal with this population. It may also incorporate access to care, length of stay, medical necessity criteria, or demographic data to evaluate treatment practices, treatment environment, the distribution of staff assignments, or the potential need for new services. The actual format and content in often determined by diagnostic profile, target group, or theoretical orientation. The processes and results of access, engagement, treatment, and discharge should be considered. Recently in behavioral health, a few payers are developing protocols that are not in line with Medicare guidelines, which again can create challenges in programming and billing. Each record section should conform to regulatory documentation requirements to assure that the notes meet billing requirements as well as clinical requirements. The following core areas are examples of data elements that can be reviewed regularly as part of a performance review plan: The tracking of specific diagnostic or other characteristics can be essential to program design or psycho-educational content. Family sessions are designed to assist members in their understanding of the identified clients condition and increase coping skills and group behaviors that can assist the clients recovery. We hope this document will be used in concert with active dialogue on a local, regional and national level to improve care and individual recovery. Evaluation for medication assisted treatment (MAT) services may also be indicated. As programs choose to include telehealth service delivery methods to provide the best care possible to all participants during normal or challenging times, programs need to move thoughtfully into each modality used considering confidentiality, best care practices, the severity of our patients issues, and the risk for them and for us caused by changes in treatment methods. American Association for Partial Hospitalization standards and guidelines for partial hospitalization This article reflects the first major revision in the standards for adult partial hospitalization which were developed by the American Association for Partial Hospitalization and initially published in Volume 1, Number 1 of this journal. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. However, we recognize that many states have established state-specific standards and expectations for care, and have codified these into state laws, regulations and licensing rules. AABH maintains a table of clinical outcome measures that have been used in PHPs and IOPs and can be accessed HERE for members. The Indiana Health Coverage Programs (IHCP) provides coverage for inpatient and outpatient behavioral health services - including mental health and addiction treatment services - in accordance with the coverage, prior authorization (PA), billing and reimbursement guidelines presented in this document. The degree to which an individuals medications are managed and the extent to which they must be reconciled, tracked, or summarized may vary according to program mission, regulation, or defined clinical responsibility within the continuum. Standards and Guidelines for Partial Hospitalization Programs. Each program is challenged to provide effective care within increasing time constraints and with limited resources. Individuals receiving care from primary care providers often suffer from sub-clinical or relatively mild behavioral health conditions and are at-risk for developing severe behavioral health disorders. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. PHPs and IOPs may be free-standing programs, part of a distinct behavioral health organization, or a department within a general medical health care system. Of equal importance is the capacity of the EMR to allow tracking within the report writing function that enables program staff to access and consider data that is related to program function and performance improvement. Partial hospitalization is a short-term, intensive treatment (four to six weeks, fewer than 24 hours per day) for adults and children individuals not effectively served in community-based or intensive outpatient programs due to substance use, mental health co-occurring disorders. In a perinatal program it is important to understand that the baby in utero also needs consideration from the program and moms that breastfeed who are using substances are also putting their babies at risk. A clinical record must document what information is gathered, considered, or developed throughout treatment for each individual admitted. Programs can provide daily symptom management, while at the same time, necessary case management services are engaged to foster the highest level of functioning possible. Study with Quizlet and memorize flashcards containing terms like Developed by the substance abuse client's treatment team, this document is used to identify the typeand frequency of services needed by the client. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. They strive to have a positive clinical impact on each individuals support system and recovery environment. and the progress described in measurable, behavioral, and functional terms. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. Telepsychiatry Guidelines . Key definitions related to partial hospitalization and intensive outpatient programming will be presented. Again, consider having another staff member, such as a behavioral health tech, present to handle these technical issues to reduce the impact on the group process. Moda Health Medical Necessity Criteria Mental Health Partial Hospitalization and Intensive Outpatient Treatment Page 1/5 . Orientation materials and program guidelines should be designed to make program goals, procedures, and expectations explicit for individuals utilizing services as well as for their family members, supportive peers, and collaborating providers. Given these factors, staff-to-client ratios tend to vary and are addressed by each program according to need and staffing requirements. Portsmouth, Virginia. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. With regard to treatment within one organizational continuum, programs should also maintain liaisons with specific providers including psychiatrists and other physicians, psychologists, social workers, psychiatric nurses, occupational therapists, case managers, rehabilitation practitioners, educators, and substance abuse counselors. Some individuals are at risk for inpatient hospitalization and require the intensive services of partial hospitalization treatment due to acute debilitating symptoms and/or some risk of harm to self or others. Children's Partial: 9. Therefore, it is important to collect a thorough substance abuse history. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. The identification and achievement of clearly targeted and mutually understood and agreed upon objectives is more likely to lead to recovery. The following Text (Smartphrases if using EPIC) is an example: Consultation provided via telemedicine using two-way, real-time interactive telecommunication technology between the patient and the clinician. Important information about regulatory coordination and program structure will also be provided. Our eating disorder partial hospitalization program in Dallas Texas addresses the physical, emotional, and spiritual aspects of our client's well-being. Third Edition. The presence of significant denial or unwillingness to address change may often be inevitable due to the acute circumstances surrounding an admission especially from an emergency department or crisis worker. Initially, the individual may only be able to agree to begin treatment and form a basic treatment plan, and may require close monitoring, support, and encouragement to achieve and sustain active and ongoing participation. These persons may have been screened by primary care physicians, individual therapists, or other healthcare professionals and require the coordinated treatment interventions available in a PHP in order to facilitate engagement and acceptance of the impact the illness has had on their day-to-day functioning. Many of these scopes will include the specifics of topic areas that a discipline may be limited to in provision of services to a group or individual. Include programs such as Depressed Anonymous, Emotions Anonymous, and the National Alliance on Mental Illness (NAMI). Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. Medical Assistance (where applicable) reimburses for hours of service in a given day, payment is on a per session basis for most insurance companies or specific individualized service for Medicare or Medical Assistance, Severity of dysfunction or behavioral symptoms, criteria for admission require more acute individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, criteria for admission require moderate individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, Hours and variety of intensive services per week, services offered at least 5 days per week with an average of 6 hours of treatment per day, people usually attend between 6 and 12 hours of treatment per week, specific State, Joint Commission, and other regulations, regulations are generally included within outpatient regulations, except for Medicare, staffing requirements are more specific regarding staff-client ratio with most clinical staff ratios are less than 1:12, Less regulation regarding size of caseload but caseloads tend to be larger than PHP, tend to provide more sessions over a longer period of time, Intensity of physician and supervisory oversight, require a higher demand of physician oversight that often includes coverage and/or supervision for all hours when clients are present. Acute Symptom Reduction - This intensive PHP function focuses on the provision of sustained, goal-directed, clinical services to reduce the persons acute symptoms and severe functional impairments as an exacerbation of a more chronic condition. Outcome measures should document progress towards meeting goals for discharge. American Society of Addiction Medicine (ASAM) (April 2001). Clinicians must also be in a private, secure location to maintain HIPAA compliance for Clinicians working from home must have no family in the vicinity of the computer/device being used to provide service (working from home might require prior authorization from leadership ). Mol, J.M. These tools provide further input regarding the programs effectiveness in facilitating recovery steps and enhancing peer support for participating consumers. Portsmouth, Virginia. The defining characteristic of this function is the fact that PHP services are provided in lieu of inpatient hospitalization.. The multidisciplinary team is central to the philosophy of staffing within a partial hospitalization or intensive outpatient setting. PHPs work best as part of a community continuum of mental health services which range from the most restrictive inpatient hospital setting to less restrictive outpatient care and support. Regulatory agencies will often assess the use of outcome measures as a core part of a quality improvement plan for programming. Association for Ambulatory Behavioral Healthcare, 2008. Coordinated care services usually include a centralized global plan of treatment with assignment of providers for each issue needing to be addressed, including any social determinants of health identified as contributing to the medical/behavioral health issues. Individual therapy within programs is designed to augment, clarify, or address issues which are considered by the clinician and client to be more appropriate for individual rather than a group focus. 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