TIP 46 Administrative Issues In Intensive Outpatient

Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC

Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

 Strategic planning
Conducting a community needs assessment

Identifying program strengths

Clarifying program mission

Developing and evaluating goals

Identifying strategies to attain goals

 Communities that Care Planning System
https://preventionplatform.samhsa.gov/


People who have knowledge of or experience

with SA
 Representatives from the:
local community

 client population
 program’s referral sources
Gender, racial, cultural diversity

 People with expertise in:
state and local politics

insurance & managed care

financial management

legal matters

nonprofits and foundations



 Program mission statement and philosophy
 Client care (screening, assessment, and
treatment and discharge planning)
 Recordkeeping (security of clients’ records)
 Organizational structure (governance
committees and staff positions)
 Personnel (procedures for
hiring, evaluating, and termination)
 Program structure and staffing
 Clients’ rights and the program’s grievance
process


 Comprehensive Accreditation Manual for
Behavioral Health Care (CAMBHC)
 Section 1: Client-Focused Functions
Ethics, Rights, and Responsibilities (RI)

Provision of Care, Treatment, and Services (PC)

Medication Management (MM)

Surveillance, Prevention, and Control of Infection (IC)



 Section 2: Organization Functions
Improving Organization Performance (PI)

Leadership (LD)

Management of the Environment of Care (EC)

Life Safety (LS)

Management of Human Resources (HR)

Management of Information (IM)

Opioid Treatment Programs (OTP)

Foster Care (FC)

Performance Measurement and the ORYX

Initiative


Core values and mission

 Input from the persons served and other
stakeholders
 Individual-centered planning, design and delivery
of services
 Organizational leadership
 Information management and performance
management
 Fiscal management (including risk management)
 Human resources
 Communication
 Accessibility
 Health, safety and transportation


Information analysis and outcomes management

 Rights of the persons served
 Program structure and staffing
 Screening and access to services
 Transition/recovery support services
 Pharmacotherapy (if applicable)
 Seclusion and restraint (if applicable)
 Records of the persons served
 Quality Improvement


 FloridaRules Common Licensing Standards
 Standards for IOP
Core services provided at least each 9

hours/week
Individual, group and family counseling


Psychiatric services


Substance abuse education


Relapse prevention skills


Life skills


Vocational Rehabilitation


Referral to wrap-around services


No more than 50 clients



 Managed care companies
 Vocational Rehabilitation & Employers
 Mental health treatment providers
 Employee assistance programs (EAPs)
 Schools
 Hospitals
 Welfare agencies
 Criminal justice agencies
 Religious leaders


 Food banks
 Recreational facilities and programs
 Credit Counseling
 Adult education
 Parent training
 Housing resources
 Childcare providers
 Self-help groups
 Legal assistance
 Transportation


 Eliminate non-core services that are non-
self-supporting after 6 months
 Evaluate staffing and consolidate positions
 Reduce paperwork
 Implement time-saving EMR
 Automate repetitive activities (record and
rebroadcast orientation)
 Team with other agencies to increase buying
power


 Recruitinterns and volunteers
 Write AmeriCorps and other grants
 Work with programs that refurbish computers


 Cultivate relationships with the money
people
 Invite officials and funders to program
functions (i.e. graduations) with appropriate
releases
 Humanize the client population to funders
and the community at large
 Keep website updated about program
achievements


 Lack of experienced staff
 High demand for counselors
 Low pay, long hours
 Stressful job
 Administrative demands
 Limited community resources


 Does the clinician have experience
In the programs modality

With the client population

 Does the clinician understand co-occurring
disorders
 Do skills suggest ability to perform all
functions effectively
Assessment

Integrated summary

Treatment planning

Referral



 Program staff interview candidates before
the clinical director
 Candidates role-play a counseling session
with staff
 Clinical director interviews candidates
recommended by staff


 New staff should sign a statement that they
will support the concepts that:
Addiction is a biopsychosocial and spiritual

disorder best treated by multidisciplinary
approaches which may include medication
Recovery is possible

Recovery support groups play a vital role in

treatment and recovery


Familiarity with professional standards and

reporting requirements
 Willingness to use supervision and peer
assessments to gain insights into deficiencies
 Awareness of current addiction research and
trends
 Involvement in professional organizations
 Respect for clients from diverse backgrounds
 Recognition of the effect that personal bias
toward other cultures and lifestyles can have on
treatment
 Understanding of personal recovery and its
effect on the provision of treatment

 Capacity to conduct self-evaluation
 Participation in regular continuing education
 Emotional maturity
 Adaptability
 Creativity
 Ability to relate effectively with others
 Capacity to confront and resolve internal
personal difficulties
 Willingness to learn about and understand
people with different backgrounds


Use of current screening and assessment

instruments
 Effect of cultural diversity on information
gathering and client assessment
 Symptoms of intoxication, withdrawal and
toxicity for psychoactive substances
 Physical, pharmacological and psychological
implications of substance abuse
 Mental status assessment criteria
 Treatment matching and placement criteria
 Confidentiality requirements
 Theories about how behavior changes
 Assessing clients’ readiness for changes

 Communicate with clients and their significant
others
 Work with clients to define and prioritize needs
 Understand available treatment modalities and
community resources
 Develop individualized treatment plans with
clients
 Establish a SPOC
 Marshall community resources
 Advocate for the client


 Engage clients and establish rapport
 Recognize intervention effectiveness
 Integrate therapy with real-time events
 Recognize when to seek consultation or refer
 Educate clients and their families about
addiction and recovery
 Help clients build and practice recovery skills
 Encourage clients to develop a strong sober
support system


 Conflicts of interest
 Staff-client relationships
 Grievance procedures


 Core clinical staff
 Clinical management (case managers and
clinical supervisors)
 Specialized services
 Administrative and support staff


 Medical services
 Counseling
 Case management
 Family services
 Social services
 Psychological services
 Psychiatric services
 Liaison with criminal justice, child welfare
and other agencies


 Vocational rehabilitation
 Recreational therapy
 Art, music and dance therapy
 Nutrition counseling
 HIV/AIDS counseling
 Spiritual counseling
 Literacy instruction
 General equivalency diploma preparation


 Policy on how long a client needs to be in
recovery
 Written job requirement specifying staff
abstinence
 ADA protects against discrimination in
employment
 Staff Relapse
Legal vs. illegal drugs

Incentives for relapsing employees to seek treatment

(job modifications, temporary transfers etc.)
Duration of abstinence before returning to work

and/or client services


 Staffto client ratio 1:8-1:15
 Considerations
State regulations

Funder regulations

Types of care provided

Linkages to wrap-around services

Realistic workload



 General staff meetings
Weekly

Address staff concerns

Provide training

Allow for case reviews

 Crisis meetings
Sentinel events

Client crisis



 Program performance/Utilization review
 Policymaking
 Competitive status
 Finances


 IOP is an essential step-down component.
 IOP management involves
outreach, advocacy, planning and
supervision.
 Through community partnerships, IOP
programs can receive referrals and distribute
workload.
 IOP administrators can motivate and engage
their staff through bottom-up management.
 IOP programs should regularly be assessed for
their cost-effectiveness and improved to
meet patient needs.

TIP 46 Administrative Issues In Intensive Outpatient

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TIP 46 Administrative Issues In Intensive Outpatient