Opioid Treatment DEFINITION - PDF

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DEFINITION Opioid Treatment Programs (OTPs) provide opioid treatment and comprehensive medical, psychosocial, and addiction treatment for narcotic-dependent individuals in a therapeutic environment. Note:
DEFINITION Opioid Treatment Programs (OTPs) provide opioid treatment and comprehensive medical, psychosocial, and addiction treatment for narcotic-dependent individuals in a therapeutic environment. Note: Please see OTP Reference List for a list of resources that informed the development of these standards. Table of Evidence Self-Study Evidence - Provide an overview of the different programs being accredited under this section. The overview should describe: a. the program's service philosophy and approach to delivering services; b. eligibility criteria; c. any unique or special services provided to specific populations; and d. major funding streams. - If elements of the service (e.g., assessments) are provided by contract with outside programs or through participation in a formal, coordinated service delivery system, provide a list that identifies the providers and the service components for which they are responsible. Do not include services provided by referral. - Provide any other information you would like the peer review team to know about these programs. - A demographic profile of persons and families served by the programs being reviewed under this service section with percentages representing the following: a. racial and ethnic characteristics; b. gender; c. age; d. major religious groups; and e. major language groups - As applicable, a list of groups or classes including, for each group or class: a. the type of activity/group; b. whether the activity/group is short-term or ongoing; c. how often the activity/group is offered; d. the average number of participants per session of the activity/group, in the last month; and e. the total number of participants in the activity/group, in the last Page 1 month - A list of any programs that were opened, merged with other programs or services, or closed - A list or description of program outcomes and outputs being measured On-Site Evidence No On-Site Evidence On-Site Activities No On-Site Activities Page 2 OTP 1: Access to Service Individuals are promptly admitted for services. Table of Evidence Self-Study Evidence - Access procedures On-Site Evidence - Blank consent form On-Site Activities - Interview: a. Clinical or program director b. Relevant personnel c. Persons served - Review case records - Observe facilities OTP 1.01 Services are provided in a welcoming environment that is conducive to rehabilitation, and operating hours are based on the needs of the service population. (FP) OTP 1.02 Pregnant women and individuals with urgent needs and emergency medical or psychiatric situations receive priority admission. (FP) OTP 1.03 Prior to admission each service recipient, or a parent or legal guardian, completes and signs a consent form. OTP 1.04 Page 3 Individuals under 18 years of age are eligible for treatment only if they have experienced two documented, unsuccessful attempts at short-term detoxification or drug-free treatment. OTP 1.05 Service recipients have emergency access to staff 24 hours a day, seven days a week. OTP 1.06 The organization does not serve individuals receiving services from other OTPs, except in extenuating circumstances, and the case record contains: a. results of a review to determine if the person is enrolled in another OTP; and b. justification of extenuating circumstances as determined by the medical director or physician, when they exist. Page 4 OTP 2: Screening and Intake The organization's screening and intake practices ensure that applicants receive prompt and responsive access to appropriate services. Table of Evidence Self-Study Evidence - Screening and intake procedures On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Clinical or program director b. Relevant personnel c. Persons served - Review case records OTP 2.01 Individuals are screened and informed about: a. how well the individual's request matches the organization's services; and b. what services will be available and when. Research Note: Literature suggests that patient matching is a critical strategy in helping to maintain individuals in treatment. Matching an individual's needs with appropriate services should involve (1) assessment; (2) selection of appropriate services and location of services; (3) identifying other support services; and (4) reevaluating the match regularly. NA Another organization is responsible for screening, as defined in a contract. OTP 2.02 The organization provides or recommends the most appropriate and least restrictive or intrusive service alternative for the applicant. Page 5 (FP) OTP 2.03 Prompt, responsive intake practices ensure equitable treatment and support timely initiation of services. OTP 2.04 Individuals who cannot be served, or cannot be served promptly, are referred or connected to appropriate services. Related: OTP 13 NA The organization accepts all clients. Page 6 OTP 3: Assessment Service recipients participate in an individualized, strengths-based, culturally responsive, comprehensive psychosocial and medical assessment. Note: Refer to the Assessment Matrix - Private, Public, Canadian, Network for additional assessment criteria. The elements of the matrix can be tailored according to the needs of specific individuals or service design. Individuals readmitted within 30 days are not required to undergo a formal re-assessment. Table of Evidence Self-Study Evidence - Assessment procedures - Assessment tool and/or criteria included in assessment On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Medical personnel b. Clinical personnel c. Persons served - Review case records OTP 3.01 At admission, a physician, or another qualified medical practitioner, documents that opioid treatment is medically necessary based on a determination that the individual: a. has been dependent on opiates for at least one year before admission, except in extenuating circumstances set forth in federal, state, and local law or regulation; and/or b. is physically dependent upon a narcotic drug, using accepted medical criteria, such as those listed in the Diagnostic and Statistical Manual for Mental Disorders. Interpretation: Extenuating circumstances may include release from penal institutions, pregnancy, and prior treatment history. Page 7 OTP 3.02 Personnel who conduct assessments are qualified by training, skill, and experience and can recognize individuals with special needs. OTP 3.03 The information gathered for assessments is strengths-based, comprehensive, directed at concerns identified in the initial screening, and limited to material for meeting service requests and objectives. OTP 3.04 A physician assesses each service recipient to ensure that he or she has voluntarily chosen opioid treatment and understands all relevant facts concerning the use of opioid treatment medication. (FP) OTP 3.05 Each person admitted to the program receives a medical evaluation by a physician, or a qualified medical practitioner under the supervision of the medical director, within 14 days of admission that includes, but is not limited to, the following baseline information: a. medical history, including history of narcotic dependence; b. evidence of current physical dependence; c. laboratory examinations, including a serological test for syphilis, a tuberculin skin test, and a toxicology test to analyze drug dependence; d. determination of the presence of infectious diseases or organ abnormalities; e. determination of vital signs, general appearance, and condition; and f. family, economic, occupational, and housing needs. Interpretation: Individuals identified as having mental health needs receive integrated treatment directly or through referral to a cooperating service provider. (FP) OTP 3.06 All individuals are screened for: Page 8 a. high-risk behaviors related to HIV/AIDS, sexually transmitted diseases, multi drug-resistant tuberculosis, and other infectious diseases; b. patterns of other drug use; c. presence of co-occurring health and mental health conditions; and d. issues related to criminal activities. Interpretation: Individuals identified as having mental health needs receive integrated treatment directly or through referral to a cooperating service provider. OTP 3.07 Assessments are conducted in a culturally responsive manner to identify resources that can increase service participation and support the achievement of agreed upon goals. Interpretation: Culturally responsive assessments can include attention to geographic location, language of choice, and the individual's religious, racial, ethnic, and cultural background. Other important factors that contribute to a responsive assessment include attention to age, sexual orientation, and developmental level. Page 9 OTP 4: Service Planning and Monitoring Every person participates in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support. Table of Evidence Self-Study Evidence - Service planning and monitoring procedures On-Site Evidence - Documentation of case review On-Site Activities - Interview: a. Clinical personnel b. Medical personnel c. Persons served - Review case records OTP 4.01 A service plan is developed in a timely manner with the full participation of the service recipient, and expedited service-planning is available when crisis or urgent need is identified. Interpretation: Service planning is conducted so that the service recipient retains as much personal responsibility and self-determination as possible and desired. Individuals with limited ability in making independent choices receive help with making or learning to make decisions. OTP 4.02 A family-centered service plan is developed with the participation of the individual's family and/or significant others when agreed to by the person. OTP 4.03 Page 10 The service plan is based on the assessment, and includes: a. agreed upon goals, including education, vocational, and employment goals, desired outcomes, and timeframes for achieving them; b. recommendations for medical, psychosocial, economic, legal, or other support services and by whom they will be provided; and c. the service recipient's signature. OTP 4.04 During the service planning process the organization explains: a. available options; b. how the organization can support the achievement of desired outcomes; and c. the benefits, alternatives, and risks or consequences of planned services. OTP 4.05 The service plan addresses, as appropriate: a. unmet service and support needs; b. possibilities for maintaining and strengthening family relationships; and c. the need for support of the individual's informal social network. OTP 4.06 The worker and a supervisor, or a clinical, service, or peer team, review the case quarterly to assess: a. service plan implementation; b. progress toward achieving goals and desired outcomes; and c. the continuing appropriateness of the service goals. Interpretation: Experienced workers may conduct reviews of their own cases. In such cases, the worker's supervisor reviews a sample of the worker's evaluations as per the requirements of the standard. Timeframes for review should be adjusted depending upon: issues and needs of persons receiving services and frequency and intensity of services provided. Page 11 OTP 4.07 The worker and service recipient or legal guardian regularly review progress toward achievement of agreed upon goals and sign revisions to service goals and plans. OTP 4.08 Family members and significant others, as appropriate and with the consent of the individual, may be invited to participate in case conferences and may be advised of ongoing progress. Interpretation: The organization facilitates the participation of family and significant others by, for example, helping arrange transportation or including them in scheduling decisions. Page 12 OTP 5: Service Philosophy The service philosophy: a. sets forth a logical approach for how program activities and interventions will meet the needs of service recipients; b. guides the development and implementation of program activities and services based on program goals and the best available evidence of service effectiveness; and c. outlines the service modalities and interventions that personnel may employ. Interpretation: A program model or logic model can be a useful tool to help staff think systematically about how the program can make a measureable difference by drawing a clear connection between the service population's needs, available resources, program activities and interventions, program outputs, and desired outcomes. Table of Evidence Self-Study Evidence - Include service philosophy in the Narrative On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Clinical or program director b. Relevant personnel c. Persons served Page 13 OTP 6: Community Services The organization informs the community about its services, remains informed about community needs and resources, and identifies the mutual benefits of supporting individuals in their recovery. Table of Evidence Self-Study Evidence No Self-Study Evidence On-Site Evidence - Description of the public education and community relations program On-Site Activities - Interview: a. Personnel involved with the public education and community relations program OTP 6.01 A public education and community relations service component: a. educates the public about the value of opioid treatment; b. builds community support; and c. provides information about the organization. OTP 6.02 A public education and community relations service component also: a. serves as a community resource for substance use and related health, mental health, and social issues; b. establishes mechanisms to hear community views and issues about opioid treatment and the organization's presence in the community; and c. aims to address and resolve community concerns. Page 14 OTP 7: Service Elements Services are responsive to individual strengths, needs, and goals. Table of Evidence Self-Study Evidence - A description of services On-Site Evidence - Referral procedures - Service agreements and formal referral arrangements On-Site Activities - Interview: a. Clinical or program director b. Relevant personnel c. Persons served - Review case records OTP 7.01 The organization provides, directly or by formal arrangement: a. substance use counseling that is coordinated with other counseling and services; b. access to physicians with knowledge of appropriate prescribing practices for an addicted population; c. activities that address the importance of drug and alcohol-free lifestyles and de-emphasize the role of intoxicants; and d. activities that address issues of particular concern to women, including intimacy, prevention of exposure to and transmission of HIV/AIDS and other STDs, child care, pregnancy, and family planning. Interpretation: The organization should establish and maintain relationships with other providers in the community. Formal arrangements include service agreements and formal referral arrangements. OTP 7.02 Service recipients, and adults with whom they live, are oriented and Page 15 educated about: a. program guidelines, rules, and regulations; b. the nature of addictive disorders; c. signs and symptoms of overdose and when to seek emergency assistance; d. the dangers of cross-tolerance; e. dependency substitution and self-medication; f. therapeutic effects of opioid treatment medication; g. common myths about opioid treatment medication; h. the benefits of treatment and the recovery process; i. dispensing medication; and j. toxicology testing procedures. OTP 7.03 Individuals receive: a. infectious disease prevention and risk reduction information and education; b. counseling on HIV infection and other infectious diseases and referral for testing; c. intensive clinical support for continued active use of alcohol and other drugs; d. supplemental psychotherapy services or referrals for co-occurring mental health disorders; e. support, information, and referral when seeking alternative therapies; f. access to vocational rehabilitation, evaluation, education, and training services; and parenting workshops; g. access to support and specialized recovery groups if the person and his/her family is affected by HIV/AIDS; and h. noncompliance and discharge procedures. Interpretation: Counseling addresses the importance of treatment adherence and honesty and communication with the provider. Research Note: Research suggests that individuals in opioid treatment programs who receive a combination of counseling, medical, psychiatric, employment, and family services remain in treatment longer than those that receive minimal counseling only. OTP 7.04 Page 16 Multiple models of care are used during different phases of the treatment process to meet the individual needs of service recipients, families, and significant others. Interpretation: The organization may organize treatment in a group format based on the characteristics of a particular population, for example, by gender, age, sexual orientation, and racial, ethnic, and cultural background. OTP 7.05 The organization links individuals to peer support and self-help services when available. Interpretation: It is critical for providers to have an understanding of both the substance use and co-occurring disorder. If that level of expertise is unavailable, the organization should arrange for appropriate care elsewhere and facilitate the coordination of treatment and any other medications prescribed. OTP 7.06 Individuals diagnosed as having co-occurring health, mental health, and substance use conditions receive integrated treatment directly or through active involvement with a cooperating service provider. Interpretation: Sometimes self-help services, such as 12-Step programs are unfamiliar with opioid addiction treatment. The organization can establish their own program or make efforts to identify groups that are familiar with and accepting of individuals receiving opioid treatment. Research Note: The presence of a substance use and a mental health condition can make diagnosis and treatment significantly more difficult, resulting in poorer treatment outcomes. Research has demonstrated that integrated treatment is most effective for this service population. Treatment should be motivational, individualized, and comprehensive to accommodate the wide range of treatment needs. Note: Organizations that treat substance use conditions are expected to have core capability to address co-occurring mental health conditions. An organization that has a specialized outpatient co-occurring disorder treatment program must also complete Outpatient Mental Health Services, recognizing that the mental health standards may need to be adapted for specialized core services provided within the context of services for Page 17 substance use conditions. OTP 7.07 The organization coordinates with the criminal justice system to advocate for continuous treatment for individuals who are incarcerated, or on probation or parole. NA The organization does not serve any individual involved in the criminal justice system. OTP 7.08 The organization provides, or makes referrals for, relapse prevention services including counseling, support, and education for individuals who want to discontinue opioid treatment. Page 18 OTP 8: Medical Services Medical services are provided, directly or by referral, according to individual needs. Table of Evidence Self-Study Evidence - A description of services - Procedures for obtaining medication blood levels - Procedures for making referrals to medical, psychiatric, or pain management services - Procedures for evaluating the benefits derived from treatment - Table of contents of training curricula On-Site Evidence No On-Site Evidence On-Site Activities - Interview: a. Medical director b. Relevant personnel c. Persons served - Review case records OTP 8.01 The organization provides or makes referrals to medical and psychiatric se
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