Scope of Services and Levels of Care

INTRODUCTION
The Department of Psychiatry, Chemical Dependency Program at Saint Joseph Hospital is committed to providing adult patients with quality care for chemical dependency treatment. The treatment provided is consistent with the mission and values of Resurrection Health Care. The goal of treatment is to help the chemically dependent patient reach his/her maximum level of functioning, achieve abstinence and re-integrate into the community. Patients receive individualized care based on the reason for their admission.

PATIENT POPULATION/ SCOPE AND COMPLEXITY

The Chemical Dependency Program provides inpatient and outpatient treatment to persons 18 years of age or older who are diagnosed with substance abuse/addiction illnesses. Our program is designed for those individuals who can make a long-term commitment to treatment and recovery, including the willingness to appropriately participate in all of the programs therapy and treatment modalities. Patients admitted to the program must have the physical, occupational, cognitive, and social resources and capabilities to make significant life changes required for long -erm recovery. Detoxification services are available for those who need to be medically stabilized prior to beginning long-term treatment. The Chemical Dependency program consists of a 15-bed inpatient unit, which provides care twenty-four hours per day. The primary diagnoses treated on the unit are addiction; however, patients may have additional medical and psychiatric co-morbidities. The majority of patients treated will be admitted from independent living environments. The Clinical Nurse Manager provides clinical and operational leadership to the department. The Department Chairperson provides overall medical direction to the Department of Psychiatry. The Medical Director provides medical direction and clinical oversight of programming and patient care for Harborview Recovery Center. Clinical Supervisors, a Program Development Coordinator and a Clinical Nurse Specialist provide direct clinical supervision to the department as well.

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PATIENT CARE NEEDS

A multidisciplinary team utilizing the medical model provides for the full continuum of patient care and patients are assessed at key points throughout their inpatient stay. Reassessment is ongoing throughout the hospitalization to help determine whether the plan of care is appropriate or needs revision based on change(s) in the patients condition. A physician certified in addiction medicine diagnoses the chemically dependent patient and in conjunction with specially trained nurses and certified addictions counselors formulate the multidisciplinary treatment plan. The care includes: A. Assessment of medical, biopsychosocial and spiritual needs. B. Identification of treatment goals and development of a plan of care. The multidisciplinary treatment team meets regularly to review the course of treatment and modifies the plan of care as needed. C. Treatment Modalities: 1. Medical management 2. Individual, group, milieu and family therapy 3. Education and Lectures (e.g. their disease process, medications, relapse prevention, coping skills, self help groups, nutrition) 4. Family support and/or treatment 5. Discharge and aftercare planning The care and services are evaluated for their effectiveness through the department Quality Assessment and Improvement Committee and medical leadership.

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LEVELS OF CARE
The multidisciplinary staff provides comprehensive treatment to patients, families and significant others. When a patient presents for treatment, the appropriate level of care is assessed. The primary diagnosis must be chemical dependence based on Diagnostic and Statistical Manual IV-TR (DSM-IV-TR) criteria. The biopsychosocial assessment is performed by the Registered Nurse and Certified Addiction counselor and reviewed with the Addictionologist to formulate the Treatment Plan. Reassessment is ongoing throughout the program and based on changes in patients condition (relapse) and goal attainment. The multidisciplinary team meets regularly with the Medical Director to review the course of treatment. Family/significant other counseling is provided as appropriate. Patient care is initially assessed by each discipline and the newly admitted patient receives: History and Physical examination Initial psychosocial assessment Nursing assessment Multidisciplinary Treatment Plan

Medical Stabilization (Detoxification)

Medical Stabilization/Detox is a 3 to 5 day medically supervised program with 24- hour nursing care. During the medical stabilization (detoxification) process, a physician certified in addiction medicine performs the initial patient evaluation and assessment of physical findings, which leads to the formulation of an initial treatment plan. During the medical stabilization process, the patient may participate in the daily programming as clinically and medically tolerated.

Inpatient Rehabilitation Services

Inpatient Rehab is a long-term 21-28 day structured clinical program that consists of individual, group, milieu and family therapy, as well as education regarding the disease concept, relapse, development of sober coping skills and a sober social support network in the community. The patient is in need of and provided with a safe and stable living environment to develop sufficient recovery skills. The program is medically monitored with 24-hour medical services and 24-hour onsite nursing services to monitor any co-morbid medical conditions and ancillary detoxification needs.

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Inpatient Residential
Inpatient Residential is a long-term 21-28 day structured clinical program that consists of individual, group, milieu, and family therapy, as well as education regarding the disease concept, relapse, development of sober coping skills and a sober social support network in the community. The patient is in need of and provided with a safe and stable 24-hour living environment to develop sufficient recovery skills. The patient is considered to be of low to minimal risk for withdrawal. The patients level of functioning may range from diminished biomedical conditions to receiving concurrent medical monitoring. The emotional/behavioral conditions may vary from minimal to an inability to control impulses and may lack the relapse prevention awareness and skills.

Partial Hospitalization (Day Treatment Program)

Partial Hospitalization provides 20 or more hours of clinically intensive programming per week based on individual treatment plans. Treatment provided consists of group, individual, family counseling, education regarding the disease concept of addiction, relapse, development of sober coping skills and a sober support system in the community through the attendance of 12 step meetings. Hours of programming are: 9a.m.-3 p.m., Monday through Friday. The Partial Hospitalization Program is available for those patients who require a structured day program with nursing and medical supervision, intervention and/or treatment. There is the availability of medical and/or nursing services to manage this patients ancillary detoxification needs. The patient requires more intensive multidisciplinary evaluation, treatment and support than can be provided in a traditional outpatient visit setting or an intensive outpatient program. The program has ready access to psychiatric, medical and laboratory services. Family/significant other counseling is provided as appropriate.

Intensive Outpatient Program (IOP)

The Intensive Outpatient Program generally provides 9 or more hours of structured programming per week. The program meets three times weekly for three-hour sessions. Treatment primarily consists of group, individual and family counseling, education regarding alcohol and other drug problems as well as relapse prevention. The patients needs for psychiatric, medical and/or ancillary detoxification needs are addressed through consultation or referral arrangements. IOP differs from partial hospitalization in the intensity of clinical services that are directly available. The IOP has less capacity to effectively treat individuals who have substantial medical and psychiatric problems or a history of chronic relapse or multiple treatment attempts in intensive

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outpatient or partial hospitalization programs. Family/significant other counseling are provided as appropriate.

Continuing Care
Continuing Care is a group counseling session that is offered after a patient has completed primary treatment (Inpatient or Outpatient). The group meets one hour per week, for a twelve-week commitment. Facilitated by a Certified Addictions Counselor, issues relating to integration back into their lives and community, as well as other issues that arise associated with early recovery are addressed. At the conclusion of twelve weeks, the patient is re-evaluated and may be discharged from Continuing Care or continue on a month-to-month basis.

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STAFF SERVICES
The multidisciplinary team in the Harborview Recovery Center provides comprehensive treatment to patients, families and significant others. Emergency services are accessible and available twenty-four hours per day. The clinical staff includes: Physicians Certified in Addiction Medicine (Addictionologist) Certified Addictions Counselors Registered Nurses Chemical Dependency Technicians Licensed Clinical Social Worker/Case Manager Activity Therapy services- Recreational Therapist Exercise Therapy instructors Spiritual Counselors Nutritional Services/Registered Dietician Clinical Nurse Specialist Psychiatrist Intake Coordinator services Occupational and Physical Therapy services Pharmacist Volunteers from the 12-step communities

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QUALITY ASSURANCE AND IMPROVEMENT

The care and services of the program are evaluated and monitored on an ongoing basis through the unit based Chemical Dependence Quality Assessment and Improvement Committee. Important indicators of patient care and/or service are reviewed quarterly and analyzed to identify improvement opportunities. This committee reports to the hospital based Quality Assessment and Improvement Committee.

PRACTICE STANDARDS AND CONFIDENTIALITY GUIDELINES

The Chemical Dependency Unit complies with the hospital and department policies and procedures, nursing standards of care and practice. The Department follows the guidelines of Centers for Medicare and Medicaid Services (CMS), the Illinois Mental Health Code, Illinois Department of Public Health, Healthcare Facilities Accreditation Program, (HFAP), Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT). In addition, the hospitals services are regulated by HIPAA, which outlines legally mandated requirements to insure privacy and rights. Adherence to the Federal Regulation (42 CFR Part 2), which outlines patient confidentiality requirements, is enforced by the hospitals compliance program.

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