Intensive 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. Intensive outpatient treatment programs per ASAM description provide at least nine (9) hours for adults and six ( 6 ) hours for adolescents of structured programming per week, consisting primarily of counseling and education about substance-related and mental health problems. Program services must, at a minimum, meet three (3) times a week with no more than three (3) days between clinical services, excluding holidays. Programming must be at least eight (8) weeks due to the severity level required for this level of care. Services for this level of care must be available within two (2) weeks of the assessment, if the program has open availability and the client is readily able to start. If the program does not have availability, pre-engagement services shall be provided. The client's needs for psychiatric and medical services are addressed through consultation and referral arrangements, if the client is stable and requires only maintenance monitoring.
(b) Required Personnel. Intensive 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. - (i) Staff is capable of obtaining and interpreting information regarding the client's bio-psychosocial spiritual needs, and is knowledgeable about the bio-psychosocial spiritual dimensions of alcohol and other drug disorders, including assessment of the client's stage to change.
- (ii) Staff is capable of monitoring stabilized mental health problems and recognizing any instability of clients with co-occurring mental health issues.
(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. At a minimum, dimensional criteria must be reviewed with support documentation at least one (1) time monthly. Severity shall be rated for each dimension with sufficient documentation showing justification for level of care recommendations.
(d) Therapies and Interventions. - (i) Services include, but are not limited, to individual and group counseling, as indicated by client needs, medication management, family therapy, educational groups, occupational and recreational therapy, and other therapies, as indicated.
- (ii) Services are provided in amounts, frequencies and intensities appropriate to the objectives of the individualized treatment plan.
- (iii) Family therapy shall be utilized when indicated by client needs, involving family members, guardians and/or significant other(s) in the assessment, treatment and continuing care of the client.
- (iv) A planned format of therapies shall be delivered on an individual and group basis and adapted to the client's developmental stage and comprehension level.
- (v) Motivational enhancement and engagement strategies shall be used in preference to confrontational approaches.
- (vi) For clients with mental health problems, the issues of psychotropic medication, mental health treatment and their relationship to substance abuse disorders shall be addressed as the need arises. Programs that provide co-occurring treatment shall 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 severe 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 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 continuum of care 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 goals.
- (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. § 4-12