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

Current through July 13, 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.