Crossroads AgencyClient ManualUpdated Jan 2017

Client Manual

Developed By:

Katie Viola Downey, LICSW

Program Director

Reviewed & Revised:

May 2016, January 2017

CONFIDENTIALITY

This manual details policies and procedures relevant to Crossroads Agency. Unauthorized copying and distribution is prohibited.

Section / Page #
Introduction and Welcome………………………………………………………………………………………………………………………… / 3
About Crossroads Agency…………………………………………………………………………………………………………………………… / 3
Our Program Philosophy………………………………………………………………………………………………………………………….… / 3
Goals and Objectives………………………………………………………………………………………………………………………………..… / 3
What is Confidentiality?……………………………………………………………………………………………………………………………… / 4
Limitations to Confidentiality……………………………………………………………………………………………………………………… / 4
What is a Qualified Service Organization Agreement?……………………………………………………………………………….. / 5
What type of treatment does Crossroads Agency provide?...... / 5
Family Support and Involvement……………………………………………………………………………………………………………..… / 5
What treatment approaches and modalities are used?……………………………………………………………………………… / 5
Crossroads Agency’s Stance on Medication Assisted Treatment………………………………………………………………… / 6
Overdose Prevention…………………………………………………………………………………………………………………………………. / 7
Nasal Narcan……………………………………………………………………………………………………………………………………………… / 7
Psychiatric Medication Evaluation and Treatment……………………………………………………………………………………… / 8
Qualifications of Service Delivery of Staff…………………………………………………………………………………………………… / 8
Special Accommodations for Equitable Access to Services…………………………………………………………….…………… / 8
Client Rights……………………………………………………………………………………………………………………………………………….. / 8
Client Responsibilities………………………………………………………………………………………………………………………………… / 9
Grievances…………………………………………………………………………………………………………………………………………………. / 9
Admission Eligibility Requirements……………………………………………………………………………………………………..……… / 9
Admission Process……………………………………………………………………………………………………………………………………… / 10
Readmission Process……………………………………………………………………………………………………………………………..…… / 11
Treatment Planning………………………………………………………………………………………………………………………………….… / 11
Discharge/Aftercare Planning…………………………………………………………………………………………………………………..… / 11
Program Rules/Guidelines………………………………………………………………………………………………………………………….. / 12
No Call No Show Policy/Attendance Policy…………………………………………………………………………………….…………… / 12
Discharge/Appeal Process……………………………………………………………………………………………………………………..…… / 12
Payment Policy…………………………………………………………………………………………………………………………………………… / 13
Child Safety………………………………………………………………………………………………………………………………………………… / 13
No Smoking Policy……………………………………………………………………………………………………………………………………… / 13
Client Advisory Board (CAB) ……………………………………………………………………………………………………………….……… / 13
Right for Self-Determination………………………………………………………………………………………………………………….…… / 13
Post-Discharge Follow-Up……………………………………………………………………………………………………..…………………… / 13
Clinic Hours………………………………………………………………………………………………………………………………………………… / 13
Client Resource List……………………………………………………………………………………………………………………………………. / 14
Receipt of Program Policies/Procedures…………………………………………………………………………………………………….. / 16

Introduction

Welcome to Crossroads Agency!

We have developed this manual to make sure that you understand what will be expected of you while you are in treatment with us, as well as what will be required of us in order to meet your treatment needs.

Please take time to read this manual and ask your therapist for assistance in understanding it. While you are in treatment, review the policies, rules, and guidelines from time to time.We recommend that you act in accordance with all policies, rules, and guidelines described in this manual. If you do so, our staff will have the greatest opportunity to focus their energies on helping you meet your treatment goals.

Crossroads Agency is invested in performance and quality improvements, which means that we are continuously assessing our services and implementing changes that will improve the Agency. Your feedback is instrumental to helping us understand what areas are in need of change. Therefore, from time to time, we will be asking you to complete a survey. The survey is confidential, and if you choose, can be anonymous. Thank you in advance for helping us make this agency the best it can be.

About Crossroads Agency

Crossroads Agency is an outpatient mental health and substance use disorder counseling agency located in Springfield, Pittsfield and Worcester. The agency is dedicated to providing a wide range of services to individuals in need.Crossroads Agency was founded by George Collins in 2010 who was inspired to create the agency based on his personal experience, and his recognition and understanding of the benefits treatment can have on an individual, a family and/or their loved ones. George passed away suddenly in June 2015; however his legacy lives on through the clinicians that work tirelessly to follow the agency’s mission as well as in the clients that continue to seek services and not give up on themselves or their recovery.

Our Program Philosophy

Crossroads Agency serves to provide you with the highest quality mental health and substance use disorder treatment services, so that you may achieve your goals and improve your quality of life. Mental health and substance use diagnosis are complex brain disorders that impact biological, psychological and social areas of life. Our goal is to help you work through and resolve the deficits that have been created as a result of your diagnosis.

Our philosophy is based on the idea that in order to foster recovery, hope, self-determination and personal growth, we must create a safe and supportive atmosphere free from judgment. Our agency’s expertise is in working with clients that are on medication assisted treatment [MAT (Buprenorphine/Naloxone, Vivitrol and Methadone Maintenance)]; however, the majority of our clients present with underlying mental health conditions and/or compulsive behaviors. Therefore, the clinicians of Crossroads Agency are trained in the treatment of co-occurring disorders. Our target population is any individual that is seeking treatment for substance use/mental health issues. We employ Trauma Informed Care and practices, and given the ethnic and linguistic make up of the surrounding area, we have bilingual office and clinical staff.

Goals and Objectives

The goals and objectives of Crossroads Agency are based on the recognition that the presence of substance use or mental healthdisordersis not a personal failure, but a dynamic process that impacts people of all ages, economic background and cultural groups. It affects not only you, the client, but family members, friends, partners and others.The goals and objectives of Crossroads Agency are also to encourage a slow and steady course toward achieving optimal functioning. This requires a commitment to treatment and a persistent effort on your part. From the date of your initial appointment to the day in which you choose to discharge from our program; the agency will make sure that you are appropriately matched to a therapist that best meets your needs. During the first few weeks of your treatment, you will undergo assessment and evaluation. You and your therapist will develop a treatment plan that will reflect problems and/or needs identified during and preceding the intake assessment as well as any problem areas you determine to be significant to your recovery process. Treatment is individualized and based upon each client’s identified goals. Your success will be dependent on your determination and motivation.

What is Confidentiality?

Confidentiality is the cornerstone for providing a safe and healthy environment to our clients. The purpose of confidentiality is to protect a client’s right to privacy by making sure that information communicated between you and your clinician is not relayed or discussed to others without yourwritten/signed consent. When you are first seen at Crossroads Agency, you will be provided with an explanation of our Privacy Practices Notice and right to confidentiality. The Privacy Notice describes how medical, substance use, mental health and other protected health information may be used and disclosed, and how you can gain access to this information. You will be asked to sign an acknowledgement that have you have seen and understand the notice. A copy can be given at any time.

Client confidentiality is protected by state and federal laws. These laws include HIPAA and 42 CFR Part 2 (see specific explanation below). Under these laws, Crossroads Agency cannot disclose any information to a source outside of Crossroads Agency that you attend the services within the agency. Furthermore, Crossroads cannot disclose any information identifying you as a substance use or mental health client, or disclose any other protected information except as permitted by state and federal law.

HIPAA– The Health Insurance Portability and Accountability Act: All personal health information including demographic data that is created by the agency and relates to your medical or mental health, the services you are provided, and payment for services falls under this federal law and may not be released without yourwritten consent.

42 CFR Part 2: All information identifying you as an individual receiving treatment for a substance use disorder is confidential and may not be released withoutyour written/signed consent.This federal regulation was created to decrease the stigma associated with substance use and to encourage increased access to treatment.

Limitations to Confidentiality

Crossroads Agency must obtain your written consent before it can disclose protected health information about you. However, federal law permits Crossroads Agency to disclose information without your written permission in the following situations:

  • Child Abuse or Neglect: Clinicians are required to file a report with DCF if you report that a child is being abused or neglected (Once a report is filed, no other communication can be provided to DCF without written/signed consent by the client);
  • Elder Abuse/Neglect: As mandated reporters, we may disclose your protected health information for the purpose of reporting suspected elder abuse and/or neglect to the Department of Elder Affairs. The report is made immediately to the Elder Abuse Hotline, 800-922-2275.
  • Duty to Warn: a.) If you make an explicit threat to kill or inflict serious bodily injury on an identified victim(s) and the clinician believes that you have the intent and ability to carry out the threat, or b.) If you have a history of physical violence which is known to your clinician, and your clinician believes that there is a clear and present danger that you will attempt to kill or inflict serious bodily harm on an identified victim(s), your clinician must take reasonable precautions to warn or protect the intended victim(s)that you have identified;
  • Medical Emergencies: In the event that a major medical emergency takes place at the agency, information about you for the purpose of treating a condition that poses an immediate threat to your life and safety will be provided to ensure immediate medical intervention;
  • If a crime takes place on the program grounds or against a staff member of the program: The program may provide a limited amount of information to law enforcement. Only information related to the circumstances of the incident can be reported. Identifying you as a an individual with a substance use disorder is not permitted unless the crime is related directly to this;
  • If there is an agreement with a Qualified Service Organization Agreement (QSOA).

Feel free to ask any of our clinicians or staff members if you would like more information or need further clarification on the topic of confidentiality.

What is a Qualified Service Organization Agreement (QSOA)?

A QSOA is a two-way agreement signed between Crossroads Agency and an external service provider/agency/program providing services to Crossroads Agency clients on our behalf. The QSOA authorizes communication between the two parties under the same confidentiality guidelines described above. Under the guidelines of a QSOA, Crossroads Agency can provide the external entity with only enough information to allow the external entity to carry out its intended service. If additional information is necessary to carry out the service, you will be asked to sign a written consent specifically indicating what information you agree to release.

What type of treatment does Crossroads Agency provide?

Crossroads Agency provides counseling for mental health and substance use disorders. Our clinicians are also trained in treating other compulsive behaviors such as gambling, eating and sexual addiction(s). We provide individual and group therapy as well as Day Treatment services*.

  • Individual Counseling: A therapeutic process through which clients work one-on-one with a trained therapist in a safe, caring and confidential environment to explore feelings, beliefs, and behaviorsthat negatively influence their lives. The aim is to help facilitate change and improve quality of life.
  • Group Counseling: A therapeutic process in which clients meet in a confidential group setting with other clients experiencing similar stressors. Group members share personal information and provide feedback to others while the group leader facilitates productive communication. Topics may include exploring relationships, improving self-esteem, developing/enhancing coping skills, relapse prevention planning.
  • Day Treatment: Crossroads Agency’s Day Treatment Program consists of short-term, clinically intensive, structured day treatment. A client in the Day Treatment Program attends group therapy from 11:30am to 3pm. Day Treatment is attended five days a week or for a total of twenty sessions (Insurance may authorize a different number of sessions). Sessions are structured around specific topics related to substance use, mental health and co-occurring disorders. Completion of the Day Treatment Program includes attendance to all authorized sessions. *Currently provided at the Springfield site only.

Family Support and Involvement

Crossroads Agency believes in the benefit of incorporating family support into the counseling process. Your clinician will ask you about your interest in inviting your family members, partners, etc to be a part of your treatment. Clinician’s can assist these relationships by providing support and education to loved ones about mental health or substance use disorders. You must sign a written consent prior to engaging in a family counseling session.

*Family therapy and Couples counseling is offered by clinicians at Crossroads Agency on a limited basis; however, we are able to provide referrals to agencies within the community through the use of QSOA’s that can provide these services if we are unable to do so.

What treatment approaches and modalities are used?

Crossroads Agency’stherapists use evidenced based treatment approaches. This means that the types of therapy provided have been studied and determined to be effective.These treatment approaches include Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Trauma Informed Therapy and Harm Reduction.

  • CBT: This treatment approach focuses on exploring the relationship between a person’s thoughts, feelings and behaviors. During CBT, a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs. The core principles of CBT are identifying negative or false beliefs and testing or restructuring them so that a new and healthier thought process can emerge.
  • MI: This is a treatment method that works on facilitating and engaging internal motivation within the client in order to change behavior. It is a goal-oriented, client centered counseling style for eliciting behavior change by helping clients to explore and resolve their ambivalence towards treatment or recovery.
  • Trauma Informed Therapy: This is an organizational structure and treatment framework that involves understanding, recognizing, being sensitive to and responding to the effects of all types of trauma that may have been experienced by the clients that we treat.
  • Harm Reduction: Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. For example, therapists educate their clients about safe disposal of needles to prevent the transmission of infectious diseases.
  • Psycho-education:Psycho-education refers to the education offered to clients with a mental health condition or substance use disorder to help empower them to deal with their condition in an optimal way. If a client is not educated about their condition or ways to decrease the symptoms associated with their condition, they may continue to be negatively impacted by them.

CrossroadsAgency’s Stance on Medication Assisted Treatment (MAT)

Crossroads Agency believes in the use of MAT for clients with Opioid Dependence or Alcohol Dependence (Buprenorphine, Methadone, Vivitrol). Although our agency does not provide MAT, Crossroads collaborates with a number of local Suboxone/Vivitrol programs. We believe that in order for you to be successful in your recovery, we must work together with your other providers. We will ask you to sign a release of information if you identify being on MAT or if you request a referral to become established on MAT.

  • Buprenorphine/Naloxone:This prescription medication commonly known as Suboxone, combines the medication Buprenorphine and Naloxone to treat Opioid Dependence. It belongs to a class of drugs called opioid partial agonists. It does not cause euphoria, but does prevent symptoms of withdrawal and allows an individual to live a normal lifestyle. This medication is taken daily and works by sitting on the “opiate receptors” in the brain preventing other opiates from attaching and being able to take effect.
  • Vivitrol for Opioids Dependence:This prescription medication is a long-acting (approximately one month) form of Naltrexone, which is an opioid blocker. Vivitrol is injected on a monthly basisinto the Gluteal muscle. Once injected, the medication travels to the brain and blocks the “opioid receptors.” This prevents an individual from feeling the effect of an opioid and minimizes cravings. In order to get onto Vivitrol, an individual must be free from any signs or symptoms of withdrawal for a specified period of time (approx 7-10 days).
  • Vivitrol for Alcohol Dependence: The exact same medication described above, can be used for the treatment of Alcohol Dependence. It works by reducing an individual’s desire to drink. It also decreases the feelings of well-being associated with alcohol consumption.

Buprenorphone/Naloxone and Vivitrol treatment can be obtained through Experience Wellness Centers, On Call Urgent Care, The Healthy Living Program, CleanSlate Centers, Holyoke Health Center and Brightwood Health Center.

  • Methadone Maintenance: Methadone is a medication that can only be prescribed for the treatment of Opioid Dependence at a Methadone Maintenance Treatment Program. Methadone is an opioid agonist, which means it has similar properties to other narcotic medication; however when taken on a daily basis, it eliminates physical withdrawal symptoms. At appropriate dose levels, it can reduce and/or eliminate cravings to use opioids, and if you do use opioids, it blocks the euphoric effects of the opioid.

Methadone Maintenance Treatment can be obtained at Community Substance Abuse Centers, Habit OPCO, and Providence Behavioral Health Hospital.

Benefits and Risks of Medication Assisted Treatment

Scientific research has established that MAT increases the length of time that clients remain in treatment as well as decreases drug use,potential risk for overdose and death, the transmission of infectious disease such as HIV and Hepatitis C, as well as criminal activity. Often times, substance users enter the prison system as a result of being arrested while engaging in illegal behavior to have the financial means to use their substance of choice. MAT has also been proven to decrease the number of times a client goes to detox, number of emergency room visits and number of times a client is admitted to the hospital due to substance use. Over time, MAT can improve relationships, financial stability, employment opportunities and overall health and psychological well-being.