standards and guidelines for partial hospitalization programs

The original Standards and Guidelines for Partial Hospitalization established by the American Association for Partial Hospitalization was a landmark document in recognizing the modality of treatment known as partial hospitalization.13 It established parameters for defining partial hospitalization, was far reaching in its attempt to guide the establishment of quality treatment programs and, hopefully, to encourage increased development and funding of the modality. In 1991, the standards were revised to address the need for clarification of the definition of PHPs, and to further delineate the boundaries and unique characteristics of the treatment modality.14, The AAPH position paper, The Continuum of Ambulatory Mental Health Services (1993), proposed three distinct levels of ambulatory care, with partial hospitalization as a primary example of the most intensive of the three.15 The continuum model recognizes the importance of a broad range of non-residential services that augment partial hospitalization in meeting the needs of clients requiring greater intensity than traditional outpatient treatment. AABH published the fourth edition of the Partial Hospitalization Program Standards and Guidelines in 2008.23 For the first time this document included summarized information regarding the evolution of partial hospitalization program standards and guidelines, the continuum of behavioral health services, standards and guidelines regarding partial hospitalization programs which target specific populations (child/adolescent, geriatric, co-occurring, and chemical dependency), as well as a summary of standards and guidelines concerning intensive outpatient programs. At the time, Pamela Hyde, JD, SAMHSA Director, announced that partial hospitalization and intensive outpatient treatment were specifically included as essential intermediate behavioral healthcare treatment options.1 This landmark decision validates over 40 years of effort by behavioral health professionals throughout the country to provide intensive ambulatory treatment and avert or reduce hospitalizations while creating an environment of personal recovery for countless Americans. Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. Standards and Guidelines for Partial Hospitalization, Alexandria, Virginia. That edition included a discussion of the impact of electronic medical record, a focus on the recovery movement, and guidelines for eating disorder programs among other additions.24 The update in 2015 updated relevant information about PHPs and specialty group guidelines.25. Staff members must be trained and experienced in child and adolescent behavioral health, family therapy, milieu therapy, and therapeutic crisis intervention. DESCRIPTION A psychiatric partial hospitalization program is a treatment setting capable of providing Casarino, J., Wilner, M., and Maxey, J. and provide safety through clinical guidelines, standards, and best practices. Number of hours of structured treatment provided per day, Individual assessment/therapy/intervention time needed, Management of potential for self-harm or other emergencies, Need for specialized nursing or case management services. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. In some States, treatment planning may be supervised by a Physician Assistant or Nurse Practitioner with psychiatric licensing approved by the State. Licensing and Operational Standards for Mental Health Facilities. For individual admitted to an IOP, recurring reviews should happen no less than once every 30 days, and again, may need to occure more frequently based on the symptoms present at the time of admission. There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. IOPs may see staff-to-client ratios from 1:12 to 1:20 depending on the focus of the program or the acuity level of individuals in the program. Each record section should conform to regulatory documentation requirements to assure that the notes meet billing requirements as well as clinical requirements. For example, this level of care may include traditional outpatient counseling by one provider, medication management by another provider, and crisis and support services by a community agency (all three provider entities in separate settings serving as distinct stand-alone providers). 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. It should provide the capacity for narrative description to reflect unique client dynamics or circumstances. -. Staff members assume responsibility for and control of the individuals safety due to the individuals severe, disabling symptoms. 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. In some regions, the direction of CMS fiscal intermediaries led to a reduction in the use of occupational services due to increased documentation demands and conflicting continuation of care criteria. % of individuals within a diagnostic category, % of individuals with secondary substance abuse issues, % of individuals with first episode of care, Amount of time spent in specific functions, Insurance certification/communication time, Individual therapy time (based on program goals), Shifting functions from one type of staff to another, Increase or decrease the overall availability or amount of given services, Shift the % of a given service within a specific day, Increase in engagement with program participants, Client satisfaction with specific groups or program elements, Development of clinical pathways related to specific diagnostic groups, Increased follow-up with outpatient services following discharge, # of medication changes during episode of care, Specific disease monitoring such as Tuberculosis or Asthma, Provision of written medication education. Multi-modal Outpatient or Community-based services are differentiated from traditional outpatient care by the greater number of hours of involvement, the multi-modal approach, and the availability of specified crisis intervention services 24 hours per day. We meet five days a week from 9 a.m. to 3 p.m. An external audit should not be the impetus for utilization reviews. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. The seventh edition (2018) guidelines provided a significant change in the guidelines. These disorders are characterized by significant changes to mood during pregnancy and up to 3 years postpartum. Whenever possible, theperson receiving servicesshould be included in this process. Consider a preparatory contact over the platform prior to the first meeting, especially for groups. The tool should be tested, standardized, and validated; The tool should be appropriate for the individual being treated; The tool should be able to be used for repeated measures to document change; The tool should be consumer friendly and easy for the individual to understand. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. In general, the Centers for Medicare and Medicaid Services (CMS) sets the standard for payer requirements, and most payers start with the Medicare guidelines when developing their own requirements. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. The medical care home model, with its focus on integrating medical and behavioral health treatment, provides hope and promise of greater early identification, primary prevention, improved treatment outcomes, and decreased healthcare costs. Association for Ambulatory Behavioral Healthcare, 2015. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. Individuals with co-occurring disorders should be able to receive services from primary providers and case managers who are cross-trained and able to provide integrated treatment themselves.7. Programs should monitor regular program related performance outcomes that focus on the overall health of the program. A number of clinical factors may impact staff-to-client ratios in programs: For example, the direct treatment staff-to-client ratio in some acute PHPs may need to be 1:3, while in other less intensive programs, a ratio of 1:12 may be appropriate. The individual may exhibit some identifiable risk for harm to self or others and may or may not admit to passive or active thoughts or inclinations toward harm to self or others yet is willing to work in program. Institute of Medicine of the National Academies. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. A built-in method of updating treatment plans and clinical information (using a read and accept format) without deleting everything prior to completing an intake is also a useful time-saver and increases accuracy. Postpartum Psychosis is a true psychiatric emergency. C. A partial hospitalization treatment level 2.5 program shall meet the current ASAM criteria for Level 2.5 Partial Hospitalization Services. The best way to find out about Medicaid guidelines is the first contact the State office responsible for guidelines and ask for guidance. Partial hospitalization is a time- limited, structured program of multiple and intensive psychotherapy and other therapeutic services provided by a multidisciplinary team, as defined by Medicare, and provided in an outpatient hospital setting outpatient department facility or a Medicare-certified community mental health center (CMHC) that meets Some flexibility in programming should always be considered given individual circumstances, Is uninterested or unable due to their illness to engage in identifying goals for treatment and/or declines participation as mutually agreed upon in the treatment plan, Is imminently at risk of suicide or homicide and lacks sufficient impulse/behavioral control and/or minimum necessary social support to maintain safety that requires hospitalization, Has cognitive dysfunction that precludes integration of newly learned material, skill enhancement, or behavioral change, Has a condition such as social phobia, severe mania, anxiety, or paranoid states in which the individual may become more symptomatic in a predominantly group treatment setting, Has primarily social, custodial, recreational, or respite needs. If medications are dispensed on-site, appropriate staff must document medications that are administered on site. Second Edition. Whenever possible, maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a program with new peers and new staff. Payers may require different processes or timelines. . D. A program must have a clinical director who shall be approved as a supervisor by the Board of Professional Counselors and Therapists to supervise alcohol and drug counselors or trainees. If medications are changed during treatment, the types and dosages, clinician responsibility, and timing should be clearly documented with the rationale for the medication changes. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. Responsibility for and control of the individuals severe, disabling symptoms to partial hospitalization and outpatient! 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