Per COMAR 10.47.02.05, WIN’s Intensive (Level II) Substance Use Disorder Outpatient services is an outpatient evaluation and treatment service for youth and adults. The Intensive Outpatient Substance Use Disorder program is designed to stabilize, educate, and support individuals with achieving and maintaining abstinence through a continuum of intensive individual and group counseling sessions aimed to increase coping and relapse prevention strategies. The service includes the provision of essential educational and treatment components while allowing individuals to apply their newly acquired skills within their own environments, with natural support networks, and without an inpatient residential stay.
The anticipated outcome of the program is to empower individuals to achieve permanent changes in their alcohol and drug-using behavior by intensely addressing major lifestyle, attitudinal, and behavioral issues that have the potential to undermine the goals of treatment or inhibit the individual’s ability to cope with major life tasks without the non-medical use of alcohol or other drugs.
The frequency and intensity of treatment at this level depends on the individualized needs of the client, but consists of a planned regimen of scheduled sessions, such as: a minimum of 6 hours per week and a maximum of 20 hours per week for youth; a minimum of 9 hours per week and a maximum of 20 hours per week for adults.
Eligibility – Youth and adult clients appropriate for this level of treatment shall meet the current edition of the ASAM Placement Criteria for Level 1, or its equivalent, as approved by the Administration. Per COMAR 10.47.01.04H(1-4), WIN provides Level 2 Intensive Substance Use Disorder Outpatient services to youth via treatment protocols that provide for the needs of children and adolescents and incorporates the use of promising family intervention practices. The documented consent of a parent or guardian is secured for all children and adolescents interested in admission to the program.
The Addiction Specialist, in collaboration with the Clinical Director, will ensure that the appropriate level of services and individualized interventions are documented in the treatment plan for the youth client. The WIN Team will not admit children and adolescents into the Intensive Substance Use Disorder Outpatient program when elements of the program make treatment, care, and rehabilitation for youth contraindicated. The educational needs of youth admitted to the program will be met in compliance with local, State, and Federal laws and regulations by competent staff who meet relevant background screening requirements.
Youth eligible for this level of service will meet the following criteria for the six major life areas detailed in the ASAM: 36
- Acute Intoxication and/or Withdrawal Potential – Minimal withdrawal or at risk of withdrawal
- Biomedical Conditions/Complications – None or stable, not distracting
- Emotional/Behavioral/Cognitive Conditions and Complications – Low risk of harm, safe between sessions
- Readiness to Change – Needs close monitoring and support several times a week
- Relapse/Continued Use/Continued Problem Potential – High risk of relapse, needs close monitoring and support
- Recovery Environment – Needs close monitoring and support
Adults eligible for this level of service will meet the following criteria for the six major life areas detailed in the ASAM:
- Acute Intoxication and/or Withdrawal Potential – Minimal risk of severe withdrawal
- Biomedical Conditions/Complications – None or not distracting
Emotional/Behavioral/Cognitive Conditions and Complications – Mild severity
- Readiness to Change – Variable treatment engagement, requires structured program
- Relapse/Continued Use/Continued Problem Potential – High likelihood of relapse without close monitoring and support
- Recovery Environment – Unsupportive environment, individual has coping skills
Screening and Assessment – The ASAM Addiction Severity Index is used as the standardized screening assessment for newly enrolled clients. A problem-oriented screening instrument is used to further assess the treatment needs of youth clients. WIN Addiction Specialist, in collaboration with the prospective client and/or guardian as applicable, completes a comprehensive assessment for each eligible participant within 1 week of program admission that addresses the following areas:
- Physical Health
- Employment and Financial Support
- Drug and Alcohol Abuse
- Treatment History
- Legal History
- Family and Social Dynamics
- Academic Needs
- Mental Health
The assessment results in a recommendation for the eligible participant to be enrolled in the Level 2 Intensive Substance Use Disorder Outpatient program and may also identify a need for a referral to ancillary services.
Treatment Planning – The initial comprehensive assessment informs the content of the treatment plan that is developed within 5 working days in collaboration with the enrolled client, his or her parent or guardian as applicable, and the Addiction Specialist. The treatment plan reflects the individualized needs of the client, inclusive of: socialization, alcohol and drug abuse or dependence, psychological, vocational, educational, physical health, legal interventions, and family dynamics. The individualized interventions noted in the treatment plan reflect the following:
- Long-range and short-range treatment plan goals and objectives
- Strategy for implementation of treatment goals and objectives
- Target completion date for treatment goals and objectives
- A schedule of individual, group, and if appropriate family counseling services
- Criteria for successful completion of treatment
- Referrals to ancillary services and/or self-help groups, as needed
In the rare instance that the Addiction Specialist is unable to develop a treatment plan within 5 working days of the completed comprehensive assessment, the Clinical Director will determine and document the reason for the delay in the client’s medical record, and assign another Addiction Specialist to develop the treatment plan within 5 working days of the Clinical Director’s documentation of the delay. Concurrent treatment plans are reviewed and updated every 30 days.
Individualized Service Interventions – The treatment services and interventions available to youth and adult clients admitted to the Intensive Level 2 Substance Use Disorder Outpatient program will include: case management services; alcohol and drug education; individual, family, and/or group counseling; family intervention support; and referral services.
- Case Management Services – Youth and adult clients enrolled in the Intensive Level 2 Substance Use Disorder Outpatient program may identify a need for case management services that will help him or her handle aspect of their lives that are not directly related to substance use but that might impact whether the individual remains in treatment and has successful treatment outcomes. Case management services reflect the individualized needs of the client, as identified in the screening and assessment process and reflected in treatment plan goals. These services are intended to improve the social determinants of holistic health that impact the enrolled client and his or her family. Individualized case management services may include, but are not limited, to: assistance with health needs, assistance with transportation, assistance with child care, and assistance with family situations, living conditions, school or work
- Alcohol, drug, and infectious disease education – Within the first 30 days of treatment, the Addiction Specialist will provide and document in the client’s medical record evidence that the client has completed training in infectious disease education. The infectious disease education includes information dissemination regarding human immunodeficiency virus, hepatitis, sexually transmitted diseases, and tuberculosis. Ongoing alcohol and drug education is available to clients via scheduled individual or group counseling sessions. The alcohol, drug, and infectious disease education series culminates with a client risk assessment, identification of risk reduction interventions, and, if appropriate, referral for counseling and
- Individual and group counseling – Individual counseling is an integral part of the Intensive Level 2 Substance Use Disorder Outpatient program. Sessions are initially devoted to the review of treatment plan goals and expectations, scheduled with clients at least twice weekly, and available upon request and/or a clinical determination. The following are WIN individual and group counseling topics:
- Stages and Symptoms of Addiction
- What is Recovery?
- Denial As a Barrier to Recovery
- Using 12 Step Groups in Recovery
- Depression and Recovery
- Dealing with Anger and Resentment
- Alcohol and Physiology
- Heroin and Physiology
- Cocaine and Physiology
- Prescription Drugs and Recovery
- Spirituality in Recovery
- High Risk Situations
- Loneliness and Isolation
- Intimacy and Sexuality
- HIV, TB, and STI’s
- Relapse Prevention
A 24-hour group counseling service is available to all youth and adult clients enrolled in the Intensive Level 2 Substance Use Disorder Outpatient service. Group counseling is recovery-focused, educational, not limited in size, and follows a best practice curriculum that covers the basic concepts of alcoholism and substance use addiction, signs and symptoms of dependency, and the medical, emotional, and spiritual effects of alcohol and/or substance abuse. Enrolled clients attend group counseling sessions weekly and may choose to attend a day or evening group session. Addiction Specialists record in the client’s medical record an individualized progress note after each individual and group counseling session. The note is available to the client, parent or guardian as applicable, and any other service provider the client has consented to having access to his or her program attendance and treatment progress records.
- Family Counseling – WIN offers monthly family counseling, education, and support services when deemed a clinically appropriate intervention for enrolled clients. A comprehensive Family Needs and Recovery Environment assessment of the treatment needs of the family members of an enrolled client is completed prior to assigning an Addiction Specialist to the family and determining a family counseling session schedule. Outcomes of the assessment are noted in the client’s treatment plan with specific indication of family member involvement in the client’s recovery process. Family counseling sessions are purposed to educate family members on thebasic concepts of alcoholism and drug abuse; its signs and symptoms; its medical, emotional, and spiritual effects; and effective relapse prevention and coping strategies. When appropriate, family members are also referred to other human service providers that address intense family counseling and/or case management needs. The family members of all enrolled clients, whether or not the family counseling service is utilized, receive verbal and written information about free and low- cost self-help family groups and supported activities located within their community.
- Referral Services – WIN maintains a listing of agency referral agreements and local providers that offer medical examinations, services through the Division of Rehabilitation Services, vocational assistance, mental health services, social services, legal assistance, and substance abuse treatment services. We have established informal partnerships with physical health and mental health providers able to schedule examinations and/or consultations within 24 hours of the request for service made by telephone and within 72 hours of the request for service made in-person. The WIN Team’s continuum of mental and social services are available to enrolled clients and their family members, provided the appropriate eligibility requirements are
Service Continuity, Change, and/or Discharge – The enrolled client’s level of addiction severity and response to substance abuse treatment determines his or her length of stay in the Intensive Level 2 Substance Use Disorder program. Treatment plan goals are collaboratively developed with the client and are primarily used to determine the length of treatment, as opposed to a preset structure for the individual. Generally, services are continued for enrolled clients when it is evident that he or she is making progress toward goal achievement and it is reasonable to expect continued progress with the existing treatment or recommendation for a lower level of care.
There are many reasons an Addiction Specialist, in consultation with a Clinical Director, may recommend that a client be transferred to a different type of services. The two most common reasons are: 1.) The client is not able to achieve the current goals of their treatment but could achieve similar goals with a different treatment modality; 2.) The client has achieved his or her original treatment goals but has since developed new treatment challenges that are best addressed in a different treatment setting. When a youth or adult client is identified for a service change or transfer, the client’s discharging Addiction Specialist, in consultation with the Clinical Director, shall complete a written transfer summary at the time of the service transfer that includes: the reason for admission and discharge, the client’s address and contact phone number, current medications (if applicable), and the diagnosis and prognosis of the client at the time of service transfer.
Substance Use Disorder (Level 2) Outpatient service recipients will be discharged from services when there is no court-ordered mandate that prevents compliance with a discharge request, the client has asked to be discharged, and/or the client has fulfilled the goals of the treatment plan and no other service is needed to maintain sobriety and/or abstinence. When a youth or adult client is identified for discharge, the Addiction Specialist, in consultation with the Clinical Director, shall complete a written discharge summary within 30 days of the client’s discharge from the program that includes: the reason for admission and discharge; the client’s address and contact phone number; current medications (if applicable); the diagnosis and prognosis of the client at the time of service discharge; a summary of the services delivered to the client inclusive of the frequency, duration, and impact of services rendered; continuing service recommendations; summary of the transition progress; and the extent of the client’s involvement in the discharge plan.