(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.
(c) Transitional Residential Treatment Services. - (i) Description of Services. A transitional residential treatment service is a clinically managed, low intensity, peer-supported, therapeutic environment. The term "residential transition treatment service" does not include independent, self-operated facilities such as Oxford Houses. The service provides substance abuse treatment in the form of counseling for at least five (5) hours per week in-house or through a local certified program, with access to peer support through case management, which may include education and monitoring in the areas of personal health and hygiene, community socialization, job readiness, problem resolution counseling, housekeeping, and financial planning.
- (ii) Required Personnel.
- (A) A physician shall be available to provide medical consultation as either an employee of the service or under written contract with the service program.
- (B) The program shall have sufficient clinical staff and support staff to meet the needs of the client.
- (iii) ASAM Continued Stay, Transfer and Discharge Review. Reviews shall meet the standard set forth for Outpatient Services.
- (iv) Therapies and Interventions. Therapies and interventions shall meet the standard set forth for Outpatient Services.
- (v) Individualized Treatment Planning. Treatment planning shall meet the standard set forth for Outpatient Services.
(d) Therapeutic Community Model. - (i) Description of Services. Therapeutic community (TC) programs within the Wyoming Department of Corrections must be certified by the Division. Services must meet all applicable standards, including Chapter 1 and 2 Sections 1 - 9. and Section 14 of Chapter 4. The program must also meet the TC requirements of the National Standards for TC Communities. Where National Standards are stricter, National Standards would prevail. The Therapeutic Community approach places emphasis on individuals helping themselves and each other as opposed to a service model in which staff provides treatment to clients. The Therapeutic Community approach to substance abuse treatment is a psychosocial, experiential learning process. It utilizes the influence of positive peer pressure within a highly structured social environment. The primary therapeutic change agent is the community itself, including staff and program members together as members of a "family."
- (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 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) 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 him or 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 peer directed counseling under the direction of clinical staff utilizing 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 with peer input. 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 by level of service that are 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 issues, if identified as part of the assessment process or at any point during the continuum of treatment.
- (F) Treatment plan reviews shall be evaluated 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 as 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 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.
048-4 Wyo. Code R. § 4-16