Outpatient treatment services must meet all applicable standards, Chapters 1 and 2, and Sections 1 through 9 of Chapter 4, of these standards, including the following service level requirements.
(a) Description of Services. Outpatient services per ASAM description encompasses services which may be delivered in a wide variety of settings. Outpatient programs provide regularly scheduled sessions of usually fewer than nine (9) contact hours for adults and fewer than six ( 6 ) contact hours for adolescents a week. The services follow a defined set of policies and procedures or clinical protocols.
(b) Required Personnel. - (i) Outpatient clinical services are appropriately staffed by Qualified Clinical Staff person(s) who are credentialed through the Wyoming Mental Health Professions Licensing Board established under the provisions of W.S. § 33-38-101, et seq., a psychologist who is licensed to practice psychology pursuant to W.S. § 33-27-113(a)(v), a Licensed Physician by the Wyoming State Board of Medicine, as defined in Chapter 1, Section 4, of the Definitions of these standards, and a Wyoming Advanced Psychiatric Nurse.
- (ii) Staff is capable of obtaining and interpreting information regarding the client's bio-psychosocial spiritual needs, and is knowledgeable about the dimensions of alcohol and other drug disorders, including assessment of the client's readiness to change.
- (iii) Staff is capable of monitoring stabilized mental health problems and recognizing any instability of clients with co-occurring mental health problems.
(c) ASAM Continued Stay, Transfer and Discharge Review. ASAM dimensional criteria shall be reviewed by the clinical staff person responsible for treatment whenever the condition changes significantly per Chapter 4, Section 6, of these standards.
(d) Therapies and Interventions. - (i) Intervention services per ASAM description involve skilled treatment services, which include, but are not limited to, individual and group counseling, as indicated by client need, family therapy, educational groups, occupational and recreational therapy, psychotherapy or other therapies, as indicated by client need.
- (ii) Such services are provided in an amount, frequency and intensity appropriate to the client's individualized treatment plan.
- (iii) Motivational enhancement and engagement strategies are used in preference to confrontational approaches.
- (iv) For clients with mental health problems, the issues of psychotropic medication, mental health treatment and their relationship to substance abuse disorders are addressed, as the need arises. Programs that provide co-occurring treatment offer therapies to actively address, monitor, and manage psychotropic medication, mental health treatment and the interaction with substance-related disorders. There may be close coordination with intensive case management and assertive community treatment for clients who have serious and persistent mental illness.
(e) Individualized Treatment Planning. - (i) Treatment plans shall be completed in conjunction with the initiation of treatment.
- (ii) Initial treatment plans shall be developed with the client. The client and clinical staff responsible for the course of treatment will sign this initial individualized treatment plan, if possible.
- (iii) Treatment plans shall be developed utilizing the assessment information, including ASAM dimensional criteria and the DSM diagnoses.
- (iv) Treatment plans shall document outcome driven goals that are measurable. The plan shall specify the changes in the client's symptoms and behaviors that are expected during the course of treatment for the current level of service the client is in and shall be expressed in measurable and understandable terms. The goals shall describe improved functioning level of the client utilizing ASAM dimensional criteria.
- (v) Treatment plans shall integrate mental health issues, if identified as part of the assessment process, or at any point during the continuum of treatment.
- (vi) Treatment plan reviews shall be evaluated throughout the course of treatment based on client progress or lack of progress toward goals per ASAM continued stay, transfer and discharge criteria. Modifications shall be made as clinically indicated. This review shall include a written description within the client record of degree of progress or lack of progress for each stated goal and can be completed within the progress notes or as part of an ASAM dimensional criteria review form.
- (vii) Treatment plans shall list action statements that describe the steps the client will take to meet each stated goal.
- (viii) The provider shall endeavor to develop a single, individualized work plan when the client is receiving services from other human services agencies, including, but not limited to, the Department of Education, Department of Family Services, Department of Workforce Services, or Department of Corrections. The treatment plan shall be comprehensive and include goals and services developed in collaboration with the client, the client's family, where feasible, and other human service agencies serving the client's overall functioning level.
048-4 Wyo. Code R. § 4-11