Attachment+A++Policy+and+Procedures.docx

ATTACHMENT A

Statewide Transitional Living Home

POLICY AND PROCEDURES

Contents

Overview Mission To provide compassionate and comprehensive transitional living (TL) support that empowers each resident with the necessary tools, skills, and resources to foster personal growth, independence, and meaningful reintegration into the community.

Purpose and Population The purpose of TL is to provide community-based residential services to residents with functional barriers related to their behavioral health. The focus is providing a longer term, safe, and stable living environment where residents can focus on building skills to enhance recovery from chronic behavioral health disorders.

The target population for TL is both male and female residents, ages 18+, who have a behavioral health disorder, and are enrolled in services at the local Human Service Center.

The timeframe for residents to reside in TL is flexible but the expected length of stay is between 6 and 18 months depending on individual stages of change, intensity and amount of services needed and residents’ responses to services.

Programming Treatment services are provided by integrated treatment teams at the TL Facility. Programs are evidence-based and individual treatment services are based on person-centered need.

Core Values

1. Person-centered care: The unique characteristics, preferences, and goals of each resident will be respected and at the center of all service planning and provision.

2. Recovery-oriented: Recovery from Mental Health and Substance Use Disorders is a process of change through which residents improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, 2011).

3. Trauma-informed: A trauma-informed system is one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including residents, caregivers, and service providers.

4. Integrated: It is recognized that quality care is integrative. Assessment and service planning include awareness of mental health, substance abuse, and physical health concerns. Necessary services are provided in a seamless and integrated manner.

5. Transparent: Team members will strive always to be open and honest in business practices and clinical work. Residents served are partners in service plans developed and services provided.

6. Accountability: It is critical to demonstrate that quality and effective services are provided to all served. Input will be sought from residents regarding their experience with services and adjustments will be made as necessary to meet identified needs.

7. Evidence-based practice: Team members shall provide high quality evidence-based practices across all areas of service provision.

8. Data-driven: Data regarding key outcome and access areas is collected and reviewed in real-time to inform practice decisions to individually improve/individualize care for each resident as well as inform agency level successes and quality improvement targets.

Settings of Care

Policy Resident choice and privacy are among the most crucial elements regarding this Settings of Care policy. Residents of TL have the right to reside in a home-like setting absent previously normalized institution-based thinking.

Procedure

1. The TL home-like setting must have the following qualities based on the needs of the resident as indicated in their person-centered plan:

· The setting is selected by the resident from among other differing setting options:

· Ensures a resident’s rights of privacy, dignity, and respect, and freedom from coercion and restraint.

· Optimizes, but does not regiment resident initiative, autonomy, and independence.

· Facilitates resident choice regarding services and supports, and who provides them.

· Freedom and support to control their own scheduled activities, within predetermined treatment program requirements that must be reviewed and agreed upon prior to treatment stay.

· If new treatment program requirements are developed during the residents stay, they must be a part of the creation and implementation of said requirement and must be notified of the change prior to the implementation.

· Have access to food at any time.

· Privacy in their sleeping or living unit.

· Unit Requirements:

· Residents have freedom to furnish or decorate their units/spaces.

2. Policy guidance and examples below provide examples of demonstrating and documenting resident choice and privacy.

· Food

· TL daily practices must demonstrate that residents can eat privately, do not have assigned seats, can eat when or where they choose. If there are set mealtimes, policies describe how residents may access snacks and other food when desired.

· Privacy

· TL daily practices must demonstrate that residents have access to private communications, assure personal and medical information is protected, and document that residents’ units have entrance doors that can be locked, and bathroom privacy is ensured.

· Choice

· TL daily practices must demonstrate that staff regularly ask the residents about their needs and preferences, residents are informed how and to whom to make a request for new team-based providers (case management, therapy, addiction/skills professional, psychiatry), residents are only made to adhere to a set schedule when the task required is in their person-centered treatment plan, residents have access to such things as a television, radio, and leisure activities that interest them and can schedule such activities at their convenience unless otherwise required by a court order or treatment-based agreement, visiting hours allow for flexibility.

3. The policy allows modifications of these requirements through the person-centered planning process.

a. Modifications must be supported by a specific assessed need and justified in the person-centered service plan. The following requirements must be documented:

· Identify a specific and individualized assessed need;

· Document the positive interventions and supports used prior to any modifications to the person-centered service plan;

· Document less intrusive methods of meeting the needs that have been tried but did not work;

· Include a clear description of the condition that is directly proportionate to the specific assessed need;

· Include regular collection and review of data to measure the ongoing effectiveness of the modification;

· Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;

· Include the informed consent of the resident; and

· Include an assurance that interventions and supports will cause no harm to the residents.

4. Modifications to any of what is documented within the resident choice and privacy criteria related to food, privacy, and choice, must cause no harm and must be highly individualized, based on a specific assessed need, documented in the person-centered plan, reviewed periodically, pursued only when less restrictive efforts have failed, and implemented in accordance with the regulations.

· Resident choice and privacy, along with related restrictions, must be documented in the person-centered plan.

· Restrictions cannot be used as “house rules” in any setting or for any population or for staff convenience.

· If all the residents receiving services in the setting agree to “house rules” as roommates and it is their choice to follow those rules, that is their choice. At no time can the provider or staff implement or enforce those rules.

· Examples of “House Rules” rights restrictions that Are NOT Permitted:

· Everyone is required to wake at the same time, eat at the same time, exercise at the same time, etc.

· Required checks in a residents’ private living space (e.g. nighttime checks at designated times, limited alone time in a resident’s room during the day)

· No one is allowed to have food or drinks in their rooms.

· Typically used household items such as cutlery, utensils, certain appliances, etc. are kept in a locked area away from everyone.

· The setting is fenced in or locked, and staff must let residents in and out of the setting.

· Rules that limit visiting hours for everyone

· Personal property, personal funds, or activities a resident has a right to engage in cannot be withheld to use them as reinforcement for desired behavior.

5. Money that already belongs to a resident cannot be used for reinforcement.

6. The following are examples of consequences implemented by the provider because of residents not meeting their goals or unwanted behavior and are not permitted:

· Video Games- Limiting or taking away a resident’s personal property such as their video game console and video games.

· Family Time/Visitors- Limiting or taking away visits with family or friends.

· Money- Limiting or taking away a resident’s money.

· Food- Limiting or taking away food.

Court-Ordered Residents

1. Residents can be placed in the TL program with a court order mandating treatment in place.

2. It is the responsibility of all staff to be aware of what resident is placed on a court order as well as what this court order mandates.

3. Court orders can be found within the myAvatar Electronic Health Record system.

4. If a resident violates any terms within their court order, the Behavioral Health Team, guardian and/or legal representative if applicable, must be notified immediately during business days and next business day should it occur outside of regular hours.

5. If a court-ordered resident leaves the residence without prior permission from their team, follow the Missing Resident section of this policy and procedure manual.

6. The behavioral health teams are to inform the Residential Director of any new or updated court orders.

7. Any modifications and communication with the court system will go through the Behavioral Health Team and/or guardian.

a. Modification to court order may require risk assessments to be completed.

Admission Overview TL provides services for adults, age eighteen and older, who have a severe and persistent behavioral health disorder, active involvement with a Human Service Center behavioral health team, and identified functional impairments documented with an independent living skills assessment approved by the Behavioral Health Clinic (BHC) leadership.

Policy TL Facility will serve residents placed in the program in accordance with the North Dakota Housing Discrimination Act (1999), the Federal Fair Housing Act and in alignment with SAMSHA recommendations for recovery housing programs.

Procedure

1. Applications are reviewed by the Statewide TL Admission group and emails are routed to the appropriate clinics for review.

2. If TL is a contract facility an Authorization to Disclose must be obtained prior to referral being shared.

3. The Clinical Review Team reviews applications weekly, year-round with exceptions for holidays and weather events that require the BHC to close.

a. Factors considered prior to admission include available beds, the individual's ability to live on their own within the next 18-24 months, their presenting diagnosis and active symptoms, the specifics within their court order (if applicable), any presenting sexualized behaviors, and how the referred individual may impact the current milieu.

If approved, the following must be completed/provided by the referral source. This information is provided to the Residential Director for state-owned facilities or BHC staff for contracted facilities. Information will be given to others as listed below:

· For individuals with court orders, the referring entity must work with the court to ensure that court orders are modified to allow placement at the TL, with specific provisions for what shall occur if the placement is disrupted. Copy needs to be given to HIS/Records Management who will ensure it is entered into the Clinical Pathway and imported into chart.

· Guardianship paperwork and/or fiduciary paperwork. Copy given to HIS/Records Management.

· If an individual needs to go through Open Access – need to ensure that guardian will be present that day or send needed consents for completion prior to date.

· Independent income (social security, employment, etc.) must be in place or have a plan for applying for benefits if currently in a placement that does not allow this to occur.

· Financial Redetermination completed within the last 6 months. Residential Administrator will then work with Support Services to determine rent based off sliding scale to ensure this information can be provided to the individual and/or guardian/payee. Contract TLs may require rent to be paid directly to the contracted provider; this rent is not based on sliding scale. Copy of Financial Redetermination given to Support Services.

· Active insurance (MA or BCBS Expansion) that will cover bundled billing at TL home or completed application in designated Human Service Zone. Copy of insurance given to Support Services.

· A Release of Information must be completed to allow BHC and TL Home to communicate with all appropriate professionals and natural supports involved.

· An updated Integrated Assessment (IA) and functional assessments may be required if not completed within the required timeframes (one year for IA, three months for functional assessments)

· Assignment to a behavioral health treatment team to ensure coordination of treatment services upon admission.

· Residential Administrator will ensure the individual is provided with the recommended item list for the TL Home.

BHC Registered Nurse (RN) at state-run facilities and TL RN for contract facilities will ensure the following and coordinate with referral source for needed information:

1. Follow-up psychiatric and medical appointments in the local community and/or BHC

2. Dates of last appointments and documentation of important medical information not already in myAvatar

3. For contract facilities, records will be faxed/emailed to the facility from the BHC and/or medical facility.

4. Prescription medications will be sent by the ordering physician/prescriber to a local pharmacy chosen by the resident and TL staff will coordinate obtaining filled medications. TL RN/LPN/MA II/MA I may contact the pharmacy and request medication refills when needed, TL RN/LPN/MA II/MA I will contact the BHC and/or medical facility to request medication refills if applicable.

5. All food allergies and/or specific dietary needs that are ordered by physician/prescriber will be communicated to the appropriate TL staff.

Day of Admission

· Support will open TL Residential Episode and ensure all needed information is present for accurate and timely billing.

· Resident will be provided with the resident handbook which will be reviewed with each person to ensure understanding and agreement.

· Following the review of the handbook the resident and admitting staff must review, complete (if applicable) and sign the following forms:

· Acknowledgment of Receipt of the Resident Handbook/Understanding of Rights/House Expectations form

· Tobacco Free Acknowledgment form

· Clothing & Personal Items Inventory form

· Personal Item Search form

· Off-site/Unsupervised Pass Process form Discharge Overview Discharge of residents from the TL program is considered when there is demonstrated improvement shown in weekly skills assessment. Current functional assessment scores, length of stay, and progress/engagement in treatment are utilized to make this determination.

Policy Individual transition planning and discharge will occur no later than 12-18 months of being in the program. Minimal exceptions are to be made to this timeframe and must be thoroughly reviewed by the Clinical Review Team if so made. Progress/regression in treatment as well as improvements in functioning will be measured by improvement in their independent living skills assessment.

Discharge planning is to begin upon admission and subsequently staffed clinically every two weeks by the Clinical Review Team.

Administrative Discharges “Unplanned Discharges”

1. Administrative discharges (or “unplanned” discharges) are completed by the Clinical Review Team under very rare circumstances. The behavioral health team must work with the resident to assist with additional treatment services in the event of substance abuse, increased unsafe/unmanageable mental health symptomology, or repetitive violations of program guidelines/requirements.

2. If the resident engages in behavior that places residents and staff in danger (physical/sexual aggression, ongoing substance use within the facility, for example) they may be asked to discharge from the program.

3. Should residents choose not to participate in recommended services or engage in behaviors listed above, clinical treatment team will meet with the resident and the following steps will be followed:

· Treatment team will give verbal warning about continued stay. Resident and clinical team will develop a plan for re-engagement in recommended treatment services and plan a follow-up meeting within 1 week.

· Should resident continue to not follow-through with recommended treatment a written warning will be given, detailing the expectations of continued stay at the TL home. Team will follow up on written warning after 1 week.

· If verbal and written warning are not successful, resident will be given a 30-day notice.

Planned Discharges

· A discharge date/timeframe is determined by the Clinical Review Team in conjunction with the behavioral health treatment team recommendations and the resident’s vocalization of their needs and wants.

· Once a discharge timeframe is identified, the behavioral health treatment team is to work with the resident to contact the housing to complete the appropriate paperwork to apply for the resident’s desired housing choice (project-based or portable voucher).

· The treatment team will assist the resident in identifying and viewing preferred discharge housing options and complete the subsequent application process.

· The residential team are to complete the Planned Discharge Form with the resident which includes all upcoming appointments, prescribed medications, and a list of recommended behavioral health services as provided by the behavioral health treatment team.

· Residential staff are to work with the resident to review the Clothing & Personal Item Inventory Form that was completed upon admission and obtain resident signature.

· TL staff will document discharge information into the client record.

· The note must contain the following information if available at time of discharge: discharge address, status of discharge, what medications were provided, a listing of upcoming appointments, and what follow-up services are recommended following discharge.

Continued Stay Criteria TL homes are designed to assist residents in building skills needed to live independently in the community. Skills are taught during group/resident therapy sessions, along with clinically driven programming at the TL home.

Residents at the TL home are expected to follow through with treatment recommendations and participate in services, this includes all clinical services and clinically driven programming at the TL.

Guidelines for Facilities with Accessible Beds Due to a TL home not being an acute facility, there is no legal reason to hold the accessible bed if someone can utilize that bed. However, due to it being an accessible bed the following guidelines are being put into place should the bed need to be utilized for accessibility purposes.

1. If the accessible bed is the only bed open, any admission (male or female) will be considered for this bed.

2. Should someone be considered for this bed there will need to be a thorough informed consent completed that if someone who needs an accessible bed request admission, the resident in the accessible bed would need to work with their treatment team to determine next steps to vacate the accessible bed within 30 days.

3. When a referral is received for a resident who needs an accessible bed, and the accessible bed is currently being utilized by another resident, the Residential Administrator and treatment teams will meet to discuss the following:

a. Is there anyone that is ready to transition out of the TL home within 30 days.

b. Evaluate progress in programming and determine if TL continues to be the most appropriate fit for everyone, continued stay criteria.

c. Who is on a court order that requires them to remain that the TL home for a certain amount of time.

d. If the above does not indicate another resident being ready for transition, the resident in that accessible bed will need to work with treatment team to find placement and transition out of the TL home within 30 days.

Resident Rights and Responsibilities

1. To be treated with dignity and respect.

2. To receive appropriate services based on individual needs using the least restrictive methods without discrimination based on physical or mental disability and no emotional or physical abuse.

3. To be treated without regard to race, age, religion, color, creed, national origin, sex or sexual orientation or preference.

4. To receive complete and current information concerning your diagnosis, treatment, alternatives, risks, and prognosis as required. This information shall be in terms and language that is understandable.

5. To be free to exercise religious faith of choice insofar as the practice does not interfere with the rights of other residents or the treatment program. As well as, have the right to be excused from any religious practice.

6. To reasonable access to care, development and implementation of their care plan, and refusal of treatment plan offered based on information provided.

7. To be free from unnecessary medication or treatment to the extent permitted by law.

8. To be free from unnecessary restraint and isolation.

9. To receive visitors and engage in private conversation, including telephone communications.

10. To send and receive sealed mail at own expense without interference.

11. To keep and use personal clothing and possessions.

12. To have opportunities for outdoor physical exercise.

13. Not to be subject to physical, emotional or sexual abuse or harassment by employees, another resident, visitors, etc. (ND Century Code 25-01.3-04)

14. To be free to exercise all civil, constitutional, and statutory rights including voting.

15. To have all personal and medical information handled confidentially in accord with applicable laws, regulations and standards based on federal confidentiality requirements.

16. To receive notice of federal confidentiality requirements.

17. To confidential treatment of their personal and medical records, and the right to approve or refuse the release of information to any individual outside the program or facility.

18. To respect individual privacy, individuality and cultural identity related to your social, religious, and psychological well-being.

19. To respect individual privacy as it relates to care and to conduct case discussion, consultation, and treatment discreetly.

20. To have access to nutritious food, properly prepared and served in adequate quantities. Provisions shall be made for special therapeutic diets.

21. To have adequate housing/shelter including equivalent, clearly defined and well-supervised sleeping quarters and bath accommodations for male and female residents.

22. To have services for males and females reflecting the special needs for each gender.

23. To voice a grievance and recommend changes and/or access to and complete a grievance procedure when necessary and to have prompt resolution.

24. To have an understanding of the clinical rationale for any restrictions placed on their rights.

25. To be cared for by staff who have been educated about resident rights and their role in supporting these rights.

26. To be informed of their rights in a language they understand.

27. Request and received an explanation of your bill.

Residents Have the Responsibility To

1. To be honest and direct.

2. Know and follow rules and regulations of the program.

3. Cooperate with staff and follow agreed-upon treatment plan.

4. Notify staff if they do not understand expected behaviors and treatment.

5. Ask questions if they don’t understand.

6. Provide accurate and complete information about symptoms, medications (prescribed, non- prescribed and herbal remedies), past illnesses, past hospitalization and concerns.

7. Provide the name or names of any contact person to whom information may be released.

8. Accept the consequences of not following the individual treatment plan or instructions.

9. Meet financial commitments related to my care.

TL Accountability Process Actions that will initiate this process include, but are not limited to:

· Substance use within facility – this does not include potential substance use in the community.

· Paraphernalia within facility

· Leaving without a pass or for a few days at a time

· Any illegal activity

· Hygiene that affects resident health and/or safety of other residents.

· Physical Assault of staff or other residents

· Inappropriate Sexual Behavior

· Verbal aggression towards staff or other residents at the TL home.

Violations that include illegal activity and result in law enforcement intervention may result in immediate discharge.

Warning Process

1. Verbal Warning- typically given by the residential staff to resident and will be documented and Residential Administrator will address with the resident. Residential team will inform the Team Clinical Lead. This verbal warning will be documented in Avatar.

2. Residential Administrator and Clinical Lead meet with resident to discuss what happened, plan, identify barriers, etc. This will be documented in Avatar.

3. Clinical Lead meets with resident; a letter is given to resident indicating a discharge date and teams will start to work on the discharge plan with resident.

Observation Protocol

1. Observation protocol is determined by the resident’s treatment team at the time of admission and periodically assessed based on high risk factors and improvements in functioning. All residents are assumed to be on Standard Observation protocol unless otherwise directed by their behavioral health treatment team.

2. Specific observation requirements provided by the behavioral health treatment team should be checked off/notated on the 30-minute check form daily.

3. “Awake Hours” are from 7 a.m. to 10 p.m.

4. “Sleep Hours” are from 10 p.m. to 7 a.m.

5. Standard Observation:

a. Residents are to be observed, physically, every 30 minutes during Awake Hours

b. Residents are to be observed every hour during Sleep Hours.

6. Increased Observation:

a. Residents are to be observed, physically, at a rate determined by the behavioral health team during Awake and Sleep Hours.

7. If at any time a resident is not able to be located at the time of the 30-minute check, please refer to the Missing Resident Policy and Court Ordered Resident Policy (if applicable) for direction.

8. The 30-minute checks will be documented in the shift note.

Missing Resident If a resident should leave the facility without prior approval of an off-site pass, staff will:

· Determine if the specific resident is placed at TL voluntarily or by court order.

· Determine if the specific resident has a guardian or legal representative.

· Determine if the resident is at imminent risk of harm to themselves or others.

Notification Steps

1. During business hours, notify the resident’s Behavioral Health Team via electronic communication and phone call.

2. Before/after business hours, notify 988 and consult with the on-call clinician.

3. If the resident has a guardian or legal representative, notify them of the situation.

4. Staff involved must submit an incident report online prior to the end of their shift. Incident reports are filled out when resident leave the facility for more than 2 hours with no contact.

5. Residential Administrator is accountable to ensure that the proper incident report process was followed by staff involved the next business day.

Programming All programming will be determined through utilization of assessments and in coordination with clinical treatment team. At state-run facilities, skills training will be provided by residential staff that are qualified to provide these services. At contract facilities, skills training will be provided by HHS staff. Skills integration will be provided by direct care staff at the residential facility. All programming will be guided and directed by the clinical treatment team.

Clinical Programming Clinical treatment programming (MH and SUD individual and group therapy) is person-centered and determined by clinical treatment team.

Individual Programming

1. Individual programming will be provided daily, for a minimum of one hour.

2. Individual programming is provided by utilizing specific independent living curriculum built off the resident’s independent living skills assessment.

3. Staff are to use the resident’s Individual Service Plan to determine what skills are to be integrated by utilizing the Individual Skills Curriculum binder.

4. Skills can be reviewed/re-learned multiple times during the residents’ treatment stay if needed.

5. Program progression is assessed based on the improvement of their KELS score.

6. If a resident chooses not to participate in individual programming, this information must be documented in the Electronic Health Record by the end of the workday.

7. Residents can be excused from individual programming if they have work (employment) responsibilities and/ or other appointments off-site that may supersede this requirement. If they are excused, staff must provide the missed lesson at a different time, within 24 hours before or after the missed lesson.

Group Programming (State-Run Facilities)

1. Group programming will be provided daily, for a minimum of one hour.

2. Group programming is provided by utilizing The Skills System programming. Staff are to use the Instructor Guide as created for them.

3. Residents are to be provided with a binder with the handouts and homework contained within. They will work through this binder as they complete the program.

4. The program can be repeated multiple times during their treatment stay if needed.

5. If a resident chooses not to participate in group programming, this information must be documented in the Electronic Health Record by the end of the workday.

6. Residents can be excused from group programming if they have work (employment) responsibilities and/or other appointments off-site that may supersede this requirement. If they are excused, staff must provide the missed group lesson one-on-one at a different time, within 24 hours before or after the missed lesson.

Independent Living Skills Coordination, Scheduling and Organizational Skills

1. Offer opportunities for residents to practice coordination and organizational skills in real-life situations, such as planning outings or group activities.

2. Coordinate with healthcare providers to schedule appointments that accommodate residents' needs

3. Assist residents in preparing for appointments by providing reminders, transportation assistance, and any necessary documentation.

4. Communicate relevant information to healthcare providers, such as changes in the resident's schedule or additional support needed during appointments.

5. Foster a supportive and encouraging environment where residents feel comfortable seeking assistance with coordination, scheduling, and organizational tasks.

Meal Planning, Preparation & Clean up

1. Each resident will be responsible for planning and preparing a minimum of one evening meal per week. Staff will assist with choosing a recipe, shopping for needed ingredients and preparing the meal as needed based on the functional needs of the resident.

2. The evening meal is a time for all residents and staff to sit at the table, use manners and have a pleasant conversation about the day’s events. This process assists the residents with learning healthy eating patterns and social interaction.

3. It is each resident’s responsibility to rinse their dishes and load them into the dishwasher.

4. It is strongly advised that food and drink (other than water) not be taken outside of the kitchen or dining area.

5. If a resident chooses to bring food/drink (other than water) into their bedroom, they are responsible for ensuring the dishes and/or trash are appropriately cleaned and/or disposed of before they go to bed each night.

6. If a resident chooses not to participate in meal planning and preparation (on their identified day), the evening meal, or cleanup of dishes/food trash in their room at the end of the evening, residential staff will work with them to find another meal to assist with during the week.

Housekeeping/Chores/Laundry

1. Staff will assist residents with assigned chores as needed until they are able to perform the chore independently.

2. Staff are to utilize the posted instructions on the walls throughout the TL home that guide residents to complete certain chores and tasks correctly.

3. Each resident is to be assigned a laundry day. Residents must wash bedding, clothing and linen weekly on their assigned day. Staff are to assist with modeling the appropriate process of washing/drying/folding/putting away of laundry within the same day to teach healthy habits.

4. Residents are to be reminded to use the laundry basket in their bedroom to assist with organization and cleanliness practices.

5. Staff are to document any positive or concerning observations regarding a residents’ ability to complete chores and other household tasks independently within the Electronic Health Record at the conclusion of their shift.

6. If a resident chooses not to complete chores, laundry or other household tasks after multiple prompting attempts, staff are to document this within the Electronic Health Record by the end of their workday.

Group Activities and Community Involvement

1. Activities can be at TL and/or out in the community. Residential staff are very diligent in finding different cultural activities, exercise and positive experiences for the residents.

2. Recovery Center – Residents will be asked to join and to participate in educational and recreational activities and supports at each week. The calendar of events will be posted monthly.

3. If a resident chooses not to participate in scheduled group and community activities, after multiple prompting attempts, staff are to document this within the Electronic Health Record by the end of their workday.

Weekly Resident Skills Assessment

1. Staff will record performance of residents as they perform the skills listed in the assessment (see “Weekly Resident Skills Assessment” form at the end of this document.

2. Staff must personally observe each skill, and each TL resident should have one skills assessment completed per week.

3. After the skills assessment form has been completed, TL staff will scan into the resident’s chart (state-owned TL facilities) or provide a copy to the local Behavioral Health Clinic.

Documentation and Electronic Communication

Policy The purpose of this policy is to ensure clear and concise daily shift notes and service notes are entered into the Electronic Health Record for every resident at the end of each shift. Additionally, it aims to keep residential and treatment team members informed of any important electronic communications, ensuring that all staff members are aware of relevant information.

Procedure

1. Adequate laptop and/or computer equipment must be made available to staff during their shift to ensure easy access to the Electronic Health Record and other required computer-based programs. All staff must be able to access and log on to the primary “stationary” laptop and the mobile DCA laptop during each assigned shift.

2. All staff members must check electronic communications (i.e. e-mail or Microsoft Teams if applicable) at least once during each assigned shift.

3. One shift note must be completed in the electronic health record for each resident at the conclusion of every shift.

4. If multiple staff members work the same shift, they may determine amongst themselves who will complete the note for which resident.

5. At minimum 1 skills integration note will be documented each shift for each resident.

6. Skills training (group and individual) and case management will be documented as services are provided by Residential Administrator or RN.

State-Operated Facilities Service Notes (Skills Training, Skills Integration and Case Management) Documented under outpatient episode.

Any billable service note will be documented following these guidelines: refer to Clinical Documentation Guidance located on SharePoint for detailed guidance.

1. Appointment is added to scheduling calendar.

2. Start note from the appointment created on calendar.

3. Ensure ISP intervention and Diagnosis are selected.

4. Use skills template in the text box.

Nursing Services Documentation Documented under the outpatient episode.

Services that may be documented include nursing assessments and skills training/integration notes.

Any billable service note will be documented following these guidelines: refer to Clinical Documentation Guidance located on SharePoint for detailed guidance.

1. Appointment is added to scheduling calendar.

2. Start note from the appointment created on calendar.

3. Ensure ISP intervention and Diagnosis are selected, when applicable.

4. Use skills template in the text box.

Weekly Clinical Review Team Meetings Behavioral Health Team representative, Residential Team representative, and Triad (as needed) will meet weekly to review the following:

· Upcoming community passes, overnight passes, and visitor requests.

· Weekly Resident Skill Assessment completed by Residential Administrator

· Pertinent updates on clinically driven residential programming

· Pertinent updates on clinical programming (skills guided and directed for integration)

· Discharge planning updates

· Employment updates

Residential Administrator will keep notes on weekly agenda for both clinical and residential topics covered. These weekly meeting notes will be saved in shared location approved by BHC leadership for both teams to access as needed.

Community Passes

1. Treatment team will determine readiness for community programming (off-site passes), ability to take overnight, and weekend passes with natural supports. This time frame should be no longer than 1-2 weeks following admission.

2. Residents must submit a “Pass Request Form” which is to be turned into the residential staff on shift at the time. Residential Administrator will provide a copy of this pass to the Behavioral Health Treatment team in a timely manner and both teams will approve/deny passes after collaborative review occurs.

3. 15-minute walks do not require an off-site pass. These can occur anytime throughout the day and are not limited by quantity.

4. If a resident leaves TL home property and/or leaves staff’s supervision while in a public location, staff are to follow the “Missing Resident” process.

5. Residential Director is accountable to for ensuring pass information is stored in an area of the staff office that is easily accessible to all staff.

Daytime Passes

1. Reoccurring daytime passes: “standing passes” are approved for tasks such as extended walks (more than 15 minutes), weekly scheduled support groups, community outings etc.

2. If a resident has a standing off-site pass for a designated amount of hours each day, they will communicate with residential staff when they will be taking their pass and plans for pass to ensure staff is able to locate them in the event of an emergency.

3. Residents will utilize sign-in/sign-out board.

4. When a resident returns from any approved pass, staff on shift are to verbally check-in with the resident regarding how their time was spent, if there were any concerns, etc. This information is to be documented in the Electronic Health Record by the end of the staff member’s shift.

5. One-time daytime passes: Residents must receive permission from their treatment team for off-site day passes at least 24-hours before the pass shall begin.

Overnight/Weekend Passes

1. Treatment team will determine readiness for community programming and ability to take overnight and weekend passes with natural supports. This time frame should be no longer than 1-2 weeks following admission.

2. Residents will fill out a pass request for all overnight/weekend passes at least 72 hours prior to the scheduled time to ensure it can be reviewed by the teams.

3. When a pass is approved, residents will:

· Work with the TL RN to ensure all medication that is needed is packaged.

· Work with residential and treatment team to develop safety and communication plan while on extended pass.

Visitors

1. Residents must receive permission from their Behavioral Health Team for on-site visitors. This is necessary to ensure the safety and confidentiality of others that live in the residence.

2. Residents must submit a “Visitor Request Form” which is to be turned into the residential staff on shift at the time. Residential staff must provide a copy of this pass to the Behavioral Health Treatment team in a timely manner to allow review.

3. When the visitor presents to the building for the first time, they must review and sign the "Visitor Acknowledgment Form." Refusal to sign this form will result in the visit not occurring.

4. Program Administrator is accountable to ensure staff have knowledge of when scheduled visits are to occur.

5. If a concern arises during the visit, residential staff must inform the appropriate behavioral health team in a timely manner and must document this in their shift notes.

Cell Phones Residents will be able to utilize their cellphones without restrictions on time. Cell phones will remain in the possession of the resident at all times.

1. Phone usage that could be considered disruptive to others such as listening to music or placing phone calls to others must occur in a private area or where others are not present.

2. Cell phones shall not be used during mealtimes to respect others in the TL home.

3. Residents are not allowed to audio record, video record or photograph at any point on owned or leased property.

4. If facility has a landline phone available, residents are expected to follow same etiquette outlined above for usage.

5. If residents demonstrate difficulty with sleep due to cell phone usage, teams will work with resident on healthy sleep habits.

Personal Vehicle Usage The purpose of this protocol is to support the TL residents who will be driving their personally owned vehicle while staying at the TL. The TL home is their home and therefore residents are authorized to operate a personally owed vehicle prior to meeting the following requirements.

Upon admission, teams will meet with resident and review this protocol. Team members will determine how familiar they are with the local community. If education is needed to ensure they are comfortable with getting to their destinations this will occur prior to them driving their own vehicle.

Residents may operate their own vehicle only if they have the following:

· a valid driver’s license, proof of insurance

· vehicle registration

· vehicle insurance

· visible means of financial support for payments and maintenance.

A copy of the resident driver’s license, vehicle registration and insurance will be made and kept in the resident’s personal folder.

Operating a vehicle while uninsured or unlicensed may lead to immediate termination from the program.

Residents are not permitted to allow other residents to drive their car due to insurance and liability issues. Residents are not allowed to store items in vehicle that you could otherwise not have in the TL home (e.g. including weapons, drug paraphernalia, alcohol, or illegal substances). Residents are not authorized to sit in the vehicle while on property for the purpose of using tobacco products. Residents are required to report all vehicle operating violations to the team.

Residents will be allowed to park operable (only) privately owned vehicle(s) on the premises. Residents will acknowledge that Department of Health and Human Services and/or any contracted provider is not responsible for any damages that may occur to their personally owned vehicle while on TL property.

Tobacco Policy TL is tobacco-free. This includes chewing tobacco and vaping. The use of any tobacco or nicotine products must be off property. Please be respectful and dispose of cigarette, chew, or litter in the garbage and not on the property.

Nicotine replacement therapy (patches, lozenges, gum, etc.) and counseling resources are available.

Contingency Management Contingency Management is a region-specific program and must be overseen by a Licensed Addiction Counselor. Please consult local BHC leadership regarding program.

Contingency management is an evidence-based program that uses psychosocial interventions to reinforce abstinence from substances, along with other activities that increase recovery capital. This behaviorally based clinical intervention uses tangible reinforcers as a way to incentivize positive recovery behaviors. Receiving incentives for reducing substance use or engaging in treatment can assist residents in becoming more aware and self-accountable regarding their substance use and enhancing their recovery capital and supports.

All residential and treatment staff will complete required Contingency Management training courses located on HeatheKnowledge.org. Residential Administrator and treatment team will monitor implementation of program to ensure evidence-based practices are being effectively delivered.

Contingency Management targeted behaviors and incentives are documented in daily shift notes. Each resident will have a targeted behavior sheet that allows for objective tracking of incentivized behaviors.

Residential staff will utilize a tracking system for targeted behaviors and any incentives received in a master excel sheet, this tracking system will only be used for operational purposes and does not include specific resident’s names or chart numbers.

Incentivized Behaviors:

· Involvement in Nicotine Replacement Treatment

· Following daily schedule independently

· Actively participate in clinically driven programming at TL home

· Actively participate in all treatment groups/resident sessions

· Adherence to medical services related to prevention and treatment of other conditions

· Independently take medications

· Random acts of kindness

Fishbowl Model: residents will have the ability to select from the fishbowl when they have shown the above behaviors.

The timing of reinforces impacts their effectiveness. Residents have the opportunity to receive up to 3 incentives per week for abstinence or when random acts of kindness are demonstrated. Residents have the opportunity to receive 1 incentive per week for treatment attendance.

Possible vouchers/prizes

· Achievement rewards

· Sleep in for an hour on the day of your choice

· Gift card to local business.

Medical Policies and Procedures Administrative Code and Medical Regulations Nurse Practices Act Administrative Code 43-12.1-02 Definitions

1. "Registered nurse" means an individual who holds a current license to practice in this state as a registered nurse and who practices nursing independently and interdependently…