Overview

Peaceful Minds Recovery Services (PMRS) Level 2.1 intensive outpatient program (IOP) serves the needs of residents in the greater Pahrump, Nevada area. PMRS accepts Medicaid, private insurance and cash-pay reimbursement for services.

PMRS’ agency philosophy is to empower clients and transform lives by restoring individuals, families, and communities by creating a safe, structured, and nurturing environment in which to provide therapeutic services. Our professional team is devoted to healing the entire person’s mind, body, and spirit in a holistic approach to therapy. 

The intensive outpatient programming meets or exceeds standards of care outlined by Nevada’s Substance Abuse and Treatment Prevention Agency (SAPTA), the American Society of Addiction Medicine (ASAM), the Substance Abuse and Mental Health Services Administration (SAMHSA), and Medicaid. Educational and treatment strategies are based upon evidence-based, cognitive behavioral theory. Primary clinicians are licensed or certified to practice by the state of Nevada.

Potential clients are assessed to determine diagnosis and appropriateness for a 2.1 level of care. Non-appropriate clients will be referred to agencies and programs providing a higher (or lower) level of care. All other clients are evaluated for biopsychosocial problems and receive individualized treatment planning and programming designed to meet their most urgent recovery, health and case management needs.

Programming standards include psychoeducational and process groups three hours per day, three days per week. Additionally, clients are encouraged to participate in weekly one-on-one and/or family (one clinical hour) sessions with their primary clinician.

The duration of treatment is contingent upon client progress toward mutually-directed goals and milestones set with his/her primary clinician in a master treatment plan. Generally speaking, the Level 2.1 treatment episode is one of between 24 and 36 sessions, or approximately 60 to 90 days.

Goals of treatment include maintaining extended abstinence, sustaining behavior changes, improving resilience to relapse, addressing ASAM multidimensional problem areas and developing sober social support constructs. Clients should be able to demonstrate improved personal responsibility and self-efficacy upon the completion of treatment.


Attendance

 

 

Regular attendance is MANDATORY. Absences must be excused and every effort must be made to contact the primary clinician or PMRS prior to the group session that will be missed. A doctor’s note may be requested at the clinician’s discretion, and is required for two consecutive medical-related absences. More than three absences may result in referral to a higher level of care or alternative provider.


Schedule

 

 

 

 

 

 

 

 

Monday:          9:00 a.m. to 12:00 p.m.

Wednesday:     9:00 a.m. to 12:00 p.m.

Thursday:        9:00 a.m. to 12:00 p.m.

Groups start and end on time.

Group members will be given a 10-minute break at 9:50 a.m. and again at 10:50 a.m. Clients are expected to be back in their seats at 10:00 a.m. and 11:00 a.m., respectively. These 10-minute breaks may be altered by the clinician to support activities or processes within a particular group session. Clients are expected to be seated and ready for group per the clinician’s instruction.

Observed Federal holidays include: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Day.


Tardiness

Clients are expected to be seated at least five minutes prior to group start time. Clients will not be admitted to group later than 9:10 a.m. unless pre-arranged with their clinician. Clients later than 30 minutes will not receive credit for having attended that day’s session. Multiple incidences of tardiness will be addressed with a behavioral contract, and, if appropriate, referred to a more structured (higher) level of care. Tardiness applies both to start times and to returns from break.


Group Rules

1.     Groups start and end on time.

2.     Clients are required to return to their seats from break on time.

3.     Please smoke and use the restroom on breaks. That is what the break is for.

4.     No eating in group. Eat before, after, or on break.

5.     Ask permission prior to leaving group for emergency restroom needs. Return within five                     minutes.

6.     No hats, hoodies or other clothing articles obstructing any part of the face.

7.     No sunglasses in group (documented medical exceptions allowed).

8.     Do not tip back in your chair, and/or prop chair against the wall.

9.     No sitting or lying on the floor.

10.  No profanity.

11.  No racial, sexual, gender or other personal attacks. Group needs to be a safe place for everyone.

12.  Take turns speaking. Avoid interrupting. Raise your hand.

13.  Standing or unobtrusively pacing proximally to group is allowed to help combat sleepiness or              discomfort sitting. Falling asleep or having eyes closed during group is not appropriate behavior.

14.  Group attendance can only be verified and counted if you sign in (each session).

15.  The clinician and/or staff is the ultimate authority in the group.

16.  Service animals must be kept on a leash/restrained at all times. During group, the service animal          may not be petted, held or otherwise interacted with by group members other than the animal’s          handler.

17.  Treat the group like the critical, life-saving business it is.


Client Expectations

 

 

 

 

 

 

 

 

 

 

 

 

 

Clients are expected to maintain appropriate behavior, and to follow group and agency rules at all times. Clients are expected to comply with any and all legal obligations they may have. If a client has an outstanding warrant, he/she is expected to address this matter while in treatment.

Clients are expected to complete clinician-provided “homework” on-time, and to make every effort to comply with the clinical recommendations of his/her primary, and other, agency staff and case management personnel.

While individual and/or family sessions may be optional (depending upon the client’s fee-for- service provider requirements), PMRS requires a minimum of one monthly individual session and one monthly family session (assuming the willingness of family or significant others). The agency strongly encourages weekly individual sessions and semi-monthly family sessions.

A client who relapses while in treatment should report this fact immediately to his/her clinician and arrange for an “as soon as possible” individual session. Clients should NOT attempt to attend group while under-the-influence. Depending upon the circumstances of the relapse, the client may be allowed to continue IOP under a behavior contract, or may be referred to a higher level of care.

Clients are expected to engage in sober social support while in treatment. Self-help meetings include 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. Other sober social support groups include Celebrate Recovery, SMART Recovery, Rational Recovery and Women for Sobriety.

Safe Environment

 

 

 

Group needs to be a safe place physically, emotionally, cognitively and spiritually. Toward that end, clients understand that what is shared in group stays in group. Clients are expected to adhere to protecting the confidentiality of their peers, in both name and circumstance.

Any concerns regarding the safety of the treatment milieu should be directed privately to the primary clinician, senior staff and/or officers of the agency.


Random Drug Testing

 

Clients agree to random drug testing, and testing upon suspicion of use. Samples may be requested to be provided under both unobserved and observed conditions.


Education Topics and Schedule

 

 

 

 

 

 

Clients will be provided psychoeducational presentations, process group discussion and related “homework” under the following mastheads:

·       Disease of Addiction

·       Tools and Self-Awareness

·       Family and Relationships

·       Continuing Care

·       Life Skills

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Sample Calendar

Subject to Change and Substitution

 

Bootstrap Example
Week# Session 1 Session 2 Session 3
Week 1 Disease Model Triggers/Coping Sober Social Support
Week 2 Brain Body Impact Post-Acute W/D Process of Relapse
Week 3 Stress ID and Mgt Enabling / Codepen. Spirituality / Forgive
Week 4 Defense Mechs Family Roles Relapse Prev Plan
Week 5 Motiv, Impulse, Goal Consequences of Addic Cross and Process Addic
Week 6 Restruct Think / REBT Exercise - Recovery Sex, STDs, Health
Week 7 Life After Treatment Hi-Risk / Anger Mgt Stages of Change
Week 8 Nutrition - Recovery Pharmacology Manage Budget Money
Week 9 Rx vs. Non-Rx drugs Healthy Meals / Budget Recovery Lifestyle
Week 10 Vocational Tips Home Economics Boundaries & Comm

Clinical Considerations

Admission

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Direct admission to PMRS’ IOP Level 2.1 is generally recommended for a client with a primary active diagnosis of a substance use disorder and who meets the criteria below. A co-occurring disorder(s) may also be present, but the severity of such disorder(s) must also meet a 2.1 level threshold.

 

Acceptable levels for IOP admission.

Dimension 1 – Acute Intoxication                                                      Level 0, 1

Dimension 2 – Medical                                                                      Level 0, 1, 2

Dimension 3 – Emotional, Behavioral or Cognitive                           Level 0, 1, 2

Dimension 4 – Readiness to Change                                                  Level 0, 1, 2, 3, 4

Dimension 5 – Potential for Relapse                                                  Level 1, 2, 3, 4

Dimension 6 – Recovery Environment                                              Level 0, 1, 2, 3, 4

For transfers in, or “step-downs” from higher levels of care, the client should have successfully completed that level of care, but still demonstrate difficulty in at least one or more of the dimensions noted above.

IOP admissions would typically demonstrate “0” or “1” in dimensions 1 and 2; “1” or “2” in dimension 3; and “2”, “3” or “4” in dimensions 4, 5, and 6. If initial admission-appropriateness is not clear, cases will be staffed with the clinical director and senior clinicians.

Appropriate admission example: John Doe demonstrates zero or little risk of acute withdrawal. John may have medical conditions or complications, but not of enough severity to prevent him from regular treatment attendance or to cause significant distraction from completing treatment obligations. John has emotional, cognitive or behavioral challenges that need monitoring and that may be a distraction in treatment. However, these symptoms are not severe and do not impact the safety of himself/others, or independent functioning. Although John Doe may express or demonstrate a readiness to change, he may not self-diagnose as addicted, may demonstrate ambivalence, lack of understanding of the disease of addiction, and lack of commitment to following directions. John has a history of multiple failed attempts to remain abstinent, and/or has other emotional, cognitive, behavioral or medical problems which require structure and supervision in order to support ongoing abstinence. John’s recovery environment may be supportive, but problems in the other dimensions are a challenge. Or, John’s recovery environment may not be supportive, but can be improved with structure, education and case management support.


Group Size

 

 

The IOP group is considered an “open” group. Operation is continuous, with participants joining and completing, or abandoning, group on an ongoing basis. Per NAC 458.262, group size will be limited maximally to 15 clients. However, it is agency policy that every effort will be made to maintain a maximum standard group size of 12.


Treatment Engagement

 

 

 

 

 

 

 

At this initial stage, clients are made to feel welcome and instructed that the best results derive from a partnership with their clinician. The clinician will further assess and prioritize client-reported needs. The master treatment plan will be created and reviewed. An ASAM assessment is also conducted. The clinician will explain the process of treatment and the expectations of client during this period.

Client appointments for medical, dental, vision, legal and other will be addressed as needed. Clients will be encouraged to start attending sober social support immediately, and will be asked to identify current relationships which are supportive of client’s recovery. Requests for Releases of Information (ROI) should procured at this time, if they have not been already.

Clients will be provided additional treatment plans and “homework” based upon mutually determined client priority and need.


Continued Stay

 

 

 

 

 

 

Clinicians will complete a new ASAM assessment of each client monthly, or more frequently if circumstances dictate. Clients will be determined to remain clinically-appropriate for level 2.1 care when (one or more of the following)

·       Client is making progress, but not meeting treatment plan goals. Client needs additional time to         achieve articulated milestones and objectives.

·       Client is not making progress, and continues to struggle with overcoming challenges. Client               presents as willing and has the capacity to work toward attaining treatment goals.

·       New problems have been identified in the course of treatment. This level of care remains                     appropriate for addressing these new problems.


Discharge Criteria

 

 

 

 

 

 

 

 

 

 

 

 

Clients may be discharged in the following circumstances:

·       Client meets his/her treatment goals. Continuing at this level of care is no longer justified.

·       Client completes the program, meeting treatment goals and/or completing the maximum                   number of sessions approved by provider’s utilization review department.

·       Client presents with new problems or increased severity of previously-known problems and                 requires transfer to a higher level of care.

·       Client demonstrates failure to address and/or lacks the capacity to address his/her problems and           would benefit from transfer to a different level of care.

·       Client fails to comply with behavioral requirements, and fails to comply with remedial                         interventions such as behavioral contracts, and requires an administrative discharge to a                       different provider or level of care.

·       Client decides to leave against clinical advice despite interventions by his/her primary clinician           and other agency clinicians/staff.

·       For any discharges other than those considered “completion”, the client will be provided referrals         and all efforts will be made to effect a “bed to bed” transfer.


Completion Criteria

 

 

 

 

 

 

Client is determined to have successfully completed PMRS in either of the following circumstances:

·       Client has met the maximum number of sessions approved by provider’s utilization review                   department.

·       Client has sustained abstinence while attending the clinically recommended number of                       treatment sessions. During this time, the client has complied with clinical requests and has                   completed treatment plan milestones and goals. The client has developed a relapse prevention             plan and a continuing care plan. The client has regularly attended sober social support and can           identify at least five sober individuals with whom he/she stays in regular contact. ASAM                     dimension 1 is “0”. ASAM dimensions 2, 3, 4, 5, 6 are assessed as “0” or “1”.


Case Management and Referrals

 

Clinician and agency staff will work with client to address ongoing needs in ASAM dimensions 2, 3 and 6. The client will be encouraged to attend weekly continuing care meetings at the agency. The objective, post-IOP, is to encourage independence from the treatment program and develop self-efficacy in a self-directed, community-supported continuing care model.


Special Accommodations

 

PMRS will make reasonable accommodations for clients in compliance with the Americans with Disabilities Act of 1990.


Service Animals

 

 

 

The only questions allowed (by law) to ask of a person who reports needing a service animal:

1.     Is the animal a service animal and required because of a disability?

2.     What work or task has the animal been trained to perform?

Clients with service animals will be accepted provided that the client adheres to the rules outlining handling of the service animal notated in the “Group Rules” section of this document.


Additional Information


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