MAPLE MANOR HANDBOOK

Residential Rehabilitation Treatment Center MAPLE MANOR RESIDENTIAL REHABILITATION PHILOSOPHY & GOALS Alcohol and Drug Abuse Services, Inc.’s Maple Manor is a 16 bed non-hospital inpatient rehabilitation facility offering drug and alcohol treatment services to men and women over 18 years of age.

Our goal is to provide services to chemically dependent adults helping them to achieve and maintain abstinence and, subsequently, improve family, vocational, and social functioning, as well as physical and emotional health.

The Maple Manor program bases its treatment approach on the belief that chemical dependency is a primary, chronic, progressive, and relapsing disease, and when left untreated, can be fatal. The treatment approach is primarily based on the 12 Step Program of Alcoholic Anonymous and Narcotics Anonymous. However, other approaches the methodologies are utilized. Treatment is provided by experienced professionals who are aware of and adaptable to the unique needs of each individual. Therapist work with each client to develop an individual treatment plan that is based on abstinence from chemicals. We provide a caring and complete treatment experience to anyone affected by alcohol and other drugs under the supervision of the Medical Director, utilizing our Case Management Department for meeting special needs, the Outpatient Department for follow-up outpatient therapy, and the Prevention Department to provide education.

ADMISSION CRITERIA Alcohol & Drug Abuse Services shall comply with the civil rights of each client. The Maple Manor program shall not discriminate or deny services to any individual on the basis of age, sex, race, creed, ethnicity, color, national origin, marital status, sexual orientation, disability or religious affiliation.

The following criteria will be used to establish eligibility to receive treatment services at Maple Manor: 1. Male or female, 18 years of age or older. 2. Must be in need of inpatient treatment for chemical dependency as determined through an evaluation performed by an appropriate referral source. 3. Must be chemically free (except for life-sustaining medication) for at least 72 hours prior to admission. 4. Must be capable of mentally and physically participating in the full range of program activities. 5. Must demonstrate a willingness to participate in the program by signing a treatment plan and resident contract at the time of admission. 6. Must not be actively psychotic, suicidal, acting out, or in need of 24 hour psychiatric or medical attention. Maple Manor is able to provide services to individuals with physical limitations/disabilities.

CONFIDENTIALITY The Agency maintains strict confidentiality requirements as mandated by state and federal regulations. Information, written or verbal, can only be released with written consent of the client.

COST Fees are based on a liability scale taking into consideration a person’s income and dependents. Insurance, Medicare, and Medicaid are accepted. No one is denied treatment because of inability to pay. TREATMENT METHODOLOGIES

The Maple Manor program is highly structured, using the following methods to provide treatment to clientele:

Reflection Group: Time spent each morning by clients reading daily meditations/affirmations and reflecting on the meaning in their lives. It is also a time for clients to focus on what goal they hope to accomplish that day.

Group Therapy: Therapeutic Group process enabling clients to thoroughly explore their past substance use, issues related to substance use, and issues relating to a lifestyle of recovery. It is a time to receive feedback from peers and staff to begin to make behavioral/lifestyle changes paramount to recovery.

Step Study: Information session to target further exploration into the 12 step philosophy of AA/NA.

Guided Imagery: Led by therapists who will educate clients in benefits and techniques of utilizing relaxation in recovery.

Individual Therapy: Therapeutic hourly one-on-one sessions addressing issues such as relationships, stress, feelings, and other emotional health concerns in conjunction with issues related to chemical dependency.

Spirituality Group: Intent of this group is to expand upon the concept of a “Higher Power” and to familiarize clients with the importance of a spiritual approach.

Fitness: Each client is encouraged to participate in the fitness program offered three times a week. The program is led by physical fitness technicians who will assist clients in developing a personal fitness program using various weights and other exercise machines.

Assignments: Client will be given assignments to complete to help them explore their substance using behavior and the consequences and effects of their personal use.

Reading Group: Time spent by clients reading specific program material (i.e.: AA/NA Big Book, etc.) and reflecting on its use in their personal program of recovery.

AA/NA Attendance: A self-help program based on the 12 step process. Clients will attend meetings each day.

Family Group: Therapeutic process for family members to participate in, allowing them the opportunity to learn about the chemical dependency disease and to help begin the process of rebuilding family relationships.

Living Skills Therapy: Each client is responsible for the condition of their living space while in treatment to encourage them to take responsibility for themselves. Clients will be assigned light chores to be accomplished daily. Free Time: client will be provided with some opportunity for free time where they will be able to address personal needs, read, and talk with other residents.

A schedule of activities is listed in the middle of this handbook. All residents are expected to follow this daily schedule.

It is the philosophy of Maple Manor that the key to addiction and the recovery process is communication. Residents are required to participate in groups and interact at AA/NA meetings. Residents are to carry themselves in a “spirit of cooperation” with other residents and staff.

SOME GROUND RULES OF GROUP MEETINGS

Members are encouraged to tell or show feelings to any degree short of physically harming other people, or property, in the room. We encourage people to be responsible for their own feelings, so don’t hold back an opinion or an outburst because you think it may “hurt” someone else’s feelings. It may, for a few minutes, before they remember it doesn’t have to …let us bring that into the group’s concerns, when it happens.

However, one’s privacy ought to be respected so, if you feel you’re being pressured, you have the right to say so, but be as honest and accurate as you can.

On the other hand, remember that anything worth doing is worth doing poorly, if that is the only way you can do it under the circumstances. If you don’t know how to say or express what you think or feel, do it in a clumsy, bumbling way. No one should be expected to express themselves just right. If you are inclined to do so, ask some of the group members to reflect how you are coming across, to check out whether you are making your point or expressing your feelings the way you intend.

Interrupting is OK. Perhaps you could preface you main interruption with a preliminary one, like saying “Excuse me, May I interrupt?” But perhaps you won’t feel quite as calm, and will just butt in.

Flow of topics is pretty much up to the group. The main job of the staff member is to help others keep to the ground rules. If they want the staff member to participate, they can invite him or her to do so.

Other ground rules can be developed by negotiating between members and staff.

The main aim of the group experience is to become more honest, articulate, communicative, and assertive, (as opposed to manipulative or aggressive), and another aim is to become better able to get others to help you find solutions to your problems, and to help them to do so. Probably you will end up knowing yourself and the others better. You may like each other better, but that is not an aim of the group experience. CLIENT RIGHTS

Each client shall receive a copy of the policies and documents insuring him/her of his/her civil rights. This project shall not deny anyone services on the basis of age, sex, race, creed, ethnicity, color, national origin, marital status, sexual orientation, or religious preference.

A. Physical Restrictions Under no circumstances will physical restraints be use. If, in case it appears that physical restraints are necessary, the person will be transferred for treatment to a hospital having psychiatric care facilities. The staff will utilize restraint mechanisms when absolutely necessary prior to the person’s admission into the hospital.

B. Personal Effect Each client shall have separate storage area for all personal effect. Valuables may be kept in a locked area, and the client will have access to these articles at any time. This program will not be held responsible for articles stolen or damaged if they are not placed in a secured area.

C. Privacy Staff reserves the right to observe the client unpacking or packing when they enter or leave the Manor and to inspect bedrooms at any time. Each individual shall be allowed the right to privacy during non- scheduled program hours upon request to office staff.

D. Peonage Clients will not be expected to work while they are in treatment in this facility. However, clients are expected to maintain their living quarters in a desirable fashion. Clients are encouraged to aid in the maintenance of the facility and be conscious and aware of the personal living arrangements. If in fact a situation should arise that a client or resident would be asked to work, other than the maintenance of his own living area, just compensation would be made.

E. Travel The program’s vehicle will be utilized in attending all regularly scheduled activities outside the facility.

F. Access of Legal Counsel Each resident is permitted access to legal counsel. If residents do not have funds to pay for an attorney, an appointment may be made for them with the Legal Aid Services.

G. Client’s Right to Inspect Records Each client has the right to inspect his/her records (files with a counselor present). Following this review each client has the right to request correction of information. Each client also has the right to enter rebuttal information into the file. File material cannot be removed or given to the client, except a client may have a copy of anything he/she signs. THE LANGUAGE

The key to recovery from addictive disease is communication. It is necessary for anyone who is involved with addition, whether he is addicted, a family member, employer, employee, friend, counselor, etc., to be able to “speak the same language”. It is for this reason that we offer several terms and their definitions. They are not in alphabetical order; the order is determined by the relationship of one word to another.

SUBSTANCE/CHEMICAL For the purpose of this pamphlet, we are using these two terms interchangeably. The chemical of choice, whether alcohol, nicotine, etc. is a matter of personal choice, dependent of age, peer group, and availability. The chemical or substance itself is not the problem; what it does to the person using or abusing it, is where the problem lies.

PSYCHOACTIVE – A term used for all mood-altering chemicals, including nicotine, marijuana, alcohol, sugar, etc.

ALCOHOLISM/ADDICTION—There are many definitions of alcoholism, but a very broad one found on pg. 3 of the Manual on Alcoholism written by the American Medical Association is: “Alcoholism is an illness characterized by preoccupation with alcohol (or substance, ed.) and loss of control over its consumption such as to lead usually to intoxication if drinking (or using, ed.) is begun; by chronicity; by progression, and tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational and/or social adjustments as a direct consequence of persistent and excessive use of alcohol (or substance, ed.)” One aspect of addition is that it is a progressive illness which continues regardless of whether or not the substance is used. In other words, after a period of abstinence, if use is resumed, the addiction will pick up where it would have been had the person not been abstinent.

CO-ALCOHOLIC (CO-ADDIT)—A term used to describe anyone who is involved with an addicted person. Addiction is a disease of paradoxes – on one hand it is a disease of loneliness – the addict is lonely beyond all scope; on the other hand, addiction is a compelling disease – everyone regardless of how remotely is involved. The Co-Alcoholic may be a friend, family member, neighbor, employer, employee, minister, counselor, etc. Co-Alcoholics generally are in pain because they try unsuccessfully to care for and/or change the alcoholic.

AA (ALCOHOLIC ANONYMOUS)—A self-help group of people addicted to alcohol and other substances. It began in 1936 by two recovering alcoholics, Bill W. and Dr. Bob. AA is the oldest and best known treatment. AA is based on attraction – our program is based on promotion. We are not affiliated, but cooperate with each other.

NA (NARCOTICS ANONYMOUS) – A self-help group of people addicted to substances. Formed in 1953 in California, it is based on principles adapted from AA.

AL-ANON—A self-help group for family or friends (co-alcoholics) for alcoholics. This group helps folks involved with addicts to sort out their own feelings, and to detach from, while still caring about, the alcoholics. ENABLER—A person who (without intending to) makes it easier for an addict to practice their addiction, like a husband covering for his wife’s alcoholic forgetting and passing bad checks, or a wife pretending to her friends that her alcoholic husband drinks normally.

ACOA—Adult Children of Alcoholic. A self-help group helping members cope with ongoing problems in an alcoholic family or how to develop a lifestyle different from what one learns by growing up in an alcoholic household.

ALATEEN—A self-help group for children of alcoholics. Alateen helps children sort out and deal with life problems in addiction by providing an opportunity for sharing feelings about addiction with others who have similar concerns.

SPONSOR—A sponsor is a person who is actively involved with a self-help groups and helps newer members with both specific problems and general orientation about the program.

THE BIG BOOK—The “Big Book” is really Alcoholics Anonymous, which contains the philosophy of AA and several recovery stories. This book is utilized by most self-help groups.

SELF-HELP GROUPS—A series of groups comprised of helping each other to recover from a specific problem (Family Anonymous, Alcoholics Anonymous, Gamblers Anonymous, Recovery Anonymous, Narcotics Anonymous, Al-Anon, Overeaters Anonymous, Parents Anonymous, Parents Without Partners). Fortunately, many of these groups are located within driving distance. Call either Maple Manor or the Drug & Alcohol Center for meeting times and places.

RECOVERY –A term used by anyone who is changing his life or lifestyle by going beyond the state of being “dry” or substance free to a state of sobriety – living a productive, happy life without the need for mood-altering chemicals.

RECOVERED OR RECOVERING—The 64 million dollar question. Some folks use the term “recovering” to denote the nature of the disease – that is cannot be cured, but can be controlled. A relapse is inevitable if the person returns to his chemical use. Other folks feel they have recovered for the chronic or active stage of the disease, and now have a “thinking” problem that they must change their lifestyle to adapt to living without chemicals.

SOBER/DRY—Dry is the term used to denote the state of being free of the chemical, or detoxified. Sober is used as an all-encompassing term meaning living without the chemical in a happy, healthy way; a change in lifestyle has taken place and the person is continually working on “sobriety”.

RELAPSE—“To fall or slip back into a former state, especially into illness after a partial recovery”. (The Random House Dictionary). Because alcoholism or addiction is a chronic illness, relapse or return to use of a substance can occur. In this case, a person should be treated in the same manner as we would treat someone who had a relapse of any other illness. RELAPSE-cont’d. Although a relapse in addiction is frightening, family members and friends find the thought that the person might resume drinking or using again is terrifying. In some cases, they almost wish that resumption would occur just to end the feeling of terror. This feeling, of course, brings guilt feeling because you wanted the loved one to get sober and would have done anything to bring this about. This kind of confusion is part of the illness of addiction and the reason that co-addicts or co-alcoholics need to seek treatment either in a self-help group like Al-anon or a treatment center. Addiction is “cunning, baffling, and powerful”.

TOUGH LOVE—A term used to describe the philosophy of forcing the addict not to be responsible for his disease but to be responsible for anything that happens as a result of his intoxication.

MEETINGS—“Going to meetings” or “need a meeting” – terms used to describe self-help group meetings – you often hear someone saying “I need a meetings”, or “You need a meeting”, a term used to describe a need for the support and nurture inherent in the self-help group philosophy. The person making this kind of statement is concerned about a return of the “old attitude” present during the time of substance use.

HALT—An acronym for hungry, angry, lonely, tired – all warning signals for return to old attitudes which can precede a relapse. MAPLE MANOR: A FIVE PHASE TREATMENT PROGRAM The therapy program at Maple Manor is divided into five phases. In order to attain comfortable sobriety, a resident should complete all five phases, a regimen that takes approximately 30-45 days. Maple Manor remains small in order to allow maximum individual growth. It is important for family and friends to understand this Five Phase system not only so that they will be an aid to treatment, but also because they will find themselves going through a similar process. Growth is painful and it is possible for family, friends and resident to “just put in their time, hoping that if the resident just stops using chemicals that everything will change”. However, as AA says, “alcoholism is cunning, baffling, and powerful”. It is a disease that affects individuals in almost indeterminable ways and, although it’s painful, everyone involved should be part of treatment.

DETOXIFICATION

Prior to admission to Maple Manor, the resident must have been alcohol and/or chemically free (except for life-sustaining medications) for 72 hours. This detox process generally takes place in a hospital setting, but may be handled at home under the supervision of a physician. Detoxification can result in a medical emergency.

PHASE I

This phase generally lasts three to five days. The new resident in confused, hurt, angry, lonely, full of remorse, and self-pity. In many cases, the family feels the same way. The “bottom” that AA talks about can occur during this phase. It’s important that the person face his addiction squarely, but with the help and support available from staff, current residents, and recovering folks.

PHASE II

Every resident is immersed in the program from the beginning of his stay. As his confusion clears and he begins to be more aware of his addiction, he moves into Phase II of the program. At this point, he is reading the literature about addiction and beginning to understand the information sessions. By the second phase, which is usually about the second to third week of the program, he has been to several AA meetings and is beginning to at least feel that some changes can be occurring. He begins to feel there is some hope.

PHASE III

Phase III is the critical stage of the program. It usually occurs between 10 and 20 days of the residents stay at Maple Manor. It is at this time that “the decision” is made. A phenomenon that occurs in many cases if called “withdrawal anxiety”. It is during this phase that the resident realized, either consciously or subconsciously, that sobriety means more than not using a chemical – that it requires a change in lifestyle. It is a prospect which is frightening to say the least. In many cases, it is during this time that someone chooses to leave the program; he has made the decision that it’s too painful to face life without his chemical of choice.

As stated previously, the number of days is not important, the importance lies in the progression of the person through the phases. Someone who leaves the program during this period of time has acquired the facts that he needs to make decision about sobriety. He has chosen against sobriety at this time, however, addiction does not blame him for his disease, but allows the responsibility for his actions while intoxicated to rest squarely on his shoulders. Therefore, if he should lose his job, bounce a check, have a car accident, for example, by not calling the boss, not covering checks, and not lying to the police.

PHASE III cont’d. Called “tough love” or emotional detachment, it’s the only way to ever get him to decide that it is more painful to drink than to get sober. It also helps to preserve the co-addict’s sanity.

It is during this phase that co-addicts make their decision about sobriety also. They may choose to take their person home and to go on protecting him or they may decide to continue with counseling. Al- Anon, and to absolve themselves from total responsibility for the disease. By this time, the family realizes that they never made the person drink or use chemicals and they will never be able to make him stop.

PHASE IV During this phase, the resident has decided that he/she must make a change in lifestyle, has been reading literature, listening to information, is better able to concentrate, has been participating in groups and discussion, is better physically, and is beginning to think about his/her job, family, and social life. The person is ready to “make up for lost time”, so to speak. One of two things may happen. One, the resident may want to leave treatment in a flurry of excitement to resume his/her life, or may sink in a depression to have “separation anxiety” similar to that experienced by someone leaving a summer camp or hospital. Both states are merely opposite sides of the same coin. At this point, the resident’s counselors may discourage the person from leaving on schedule and offer an extension of residence; either to work through the anxiety or, perceiving the person to “be on a roll” or to have developed momentum, to use some additional residence time to accumulate some additional valuable treatment experience.

PHASE V This is the time for the person to put some of their new-found skills and attitudes into action. Realistic commitments are discussed, regarding family, job, personal relationships, and so on. For family, the adjustments are many. There, as in Maple Manor, communication is the key. The ability to talk about the insecurities, misunderstandings, hurts, self-pity, and so on, is what makes the adjustment easier. Alcoholism and addiction are devastating and awareness of just how the illness has affected one’s relationships and priorities.

FOLLOW-UP Following completion of treatment, clients are encouraged to attend and participate in self-help groups. Clients are also scheduled for follow-up care in their community for outpatient treatment services.

RELAPSE PREVENTION TRACK It is the belief, of the staff at Maple Manor, that relapse can be a very real part of addiction. Relapse is a process that results in a return to old behaviors including using. Maple Manor offers a 14 day program to help individuals deal with a relapse. Individuals participating in the relapse program follow the daily program established for all program participants; however, all individual sessions and homework assignments are geared at exploring and dealing with relapse issues. JOURNAL WRITING A person’s ability to concentrate and remember is usually poor in early recovery. Keeping a journal is a powerful way to help you remember, sort things out, and see yourself more clearly, while your brain is healing. Guidelines for journal writing include: How did my day go? 1. Did I accomplish my goals that I set for the day? 2. Can I recognize any relapse warning signs in myself today? 3. How do I feel physically, emotionally, spiritually? 4. What did I do today that will support on-going recovery? 5. What are my goals for tomorrow? 6. What changes do I still need to make in my attitudes and behaviors to support on going recovery? In addition, at the end of each lecture, group, AA/NA meeting, movie, or any time when relevant or helpful, take 5 or 10 minutes to jot down: 1. Anything you find interesting, or worth thinking about more. 2. Any topic or idea that relates to you and why. 3. Anything you learned you want to remember. 4. Any feelings you are having…positive and negative. 5. Any tool that can help you now and possibly in the future.

Include in your journal any ideas of your treatment plan you worked on that day and how you and others see you progressing in treatment.

You are expected to begin journal writing on the very first day of treatment. The journal is not intended to be perfect. No one besides you and your counselor will read it so do not worry about sloppy writing or spelling. If it is honest, it will probably be fairly messy and have contradictory thought and feelings in it. MAPLE MANOR HOUSE PROCEDURES The purpose of the following rules and procedures is not to cause stress to our clients or to punish them. Rather, their purpose is to create a living environment that is structured, consistent, fair, and respectful of each client’s rights- a comfortable secure environment in which every client can feel safe and secure as they begin their journey to sobriety. GENERAL RULES AND PROCEDURES BUILDING/GROUDS 1. The front door is locked at all times for client confidentiality and safety. Clients are only permitted to open the front door for other current clients of Maple Manor and for known staff members. 2. Clients are encouraged to not bring valuables to Maple Manor. If they do bring them, we suggest that they give them to a staff member on duty who will put them in a safe place. Please note there is only access to the safe from 8AM to 4PM, Monday through Friday. 3. Clients are not permitted to enter the kitchen or be in staff offices by themselves. 4. Clients are asked to refrain from actions that damage our living environment. For example, do not put feet on the furniture, tip back on the chairs, take the cushions out of the group groom chairs, write on the walls, or twist the curtains or blinds. 5. Clients may not leave Maple Manor grounds without being accompanied by a staff member. Program grounds include Maple Manor, Maple Manor’s parking lot, AA/NA meetings and the doctor offices and fitness center during scheduled times. 6. When outside, clients should remain in the area between our building and the outpatient facility directly across the parking area. Clients are not permitted near the stairs/picnic area of the physician offices beyond the dumpster. Clients are also not permit near the library, near the storage units, or behind the facility in the area of the Wellness Center parking lot. Clients are only permitted to be in the pavilion/sidewalk area after dark. Clients are not permitted to be in the parking lot or on the grass after dark.

SAFETY 1. Clients are reminded to use universal safety precautions when dealing with blood or other potentially infectious body fluids or materials. These precautions are posted in every bathroom and throughout the building. 2. The use of profanity or obscenities will not be tolerated and may result in disciplinary action. 3. Intimidation against staff or other clients is not permitted. In addition, harassment or derogatory comments regarding race/color/ethnic background, national origin, sex, religion, disability, sexual orientation, marital status, physical appearance, or pregnancy is not tolerated. Psychological harassment, including humiliation, ridicule, and embarrassment of another client of a staff member is not permitted. Maple Manor wants a safe, non-judgmental environment for all clients. 4. All mail must be inspected for contraband, Staff will not read your mail but mail must be opened in front of staff. Due to safety concerns, clients may not keep the envelope but may make note of return address if needed. 5. If staff becomes aware that other clients know of a safety issue (i.e. client injury or serious medical concern, doing self-injurious behaviors, planning to harm themselves or others, or drinking or using substances) and have not told a staff member about the safety issue, then staff will evaluate the situation and if necessary, consult with the supervisor. After consulting with the supervisor and depending on the severity of the safety concern, a strike may be given or staff may immediately discharge any client who does not report a safety issue. Client safety is a primary concern of Maple Manor and we encourage and expect social responsibility in a recovery environment

SMOKING 1. Smoking is only permitted from 6AM to 11PM during free time when groups, meals, or other scheduled activities are not taking place. 2. Smoking, including electronic cigarettes, and tobacco chewing are permitted outside only and never in the van. The designated area for tobacco use is in the pavilion area where the picnic tables are located. Clients are not permitted to stand or sit on the porch or steps to use tobacco products. 3. Cigarette butts should be placed in the containers that are provided instead of being thrown on the ground. Please do not leave half-smoked cigarettes in the ash trays. Please do not spit in the pavilion or on the sidewalk but instead use a spit cup.

DAILY SCHEDULE/PROGRAMMING 1. All clients will be on “blackout” for the first seven days of treatment. Blackout starts and will be counted form the day of admission which means that phone and mail privileges will begin on the eighth day. On the day of admission the client will be permitted to make necessary phone calls such as asking a family member to bring personal belongings to the Manor or to inform immediate family they are in the Manor. 2. Clients are expected to be on time for group and individual therapy sessions, fitness, outside meetings, and medications. The daily schedule is in the client handbook and is posted throughout the facility. Please be responsible and be on time! 3. Bedtime from Sunday through Friday is 11PM, after which clients are to be in their rooms with lights out immediately thereafter. Bedtime on Saturday is 1AM with lights out immediately thereafter. 4. Clients will be awakened at 7AM except on Sunday when they may sleep until 9AM. Clients are expected to get up as soon as they are called. 5. With the exception of Sunday, breakfast is served at 7:15AM. On Sunday, breakfast is served at 9:15AM. A continental breakfast is served daily.

TELEPHONE 1. Generally, they may make or receive phone calls from 5:00 – 10:00 p.m. Monday through Friday, 2:00 p.m. – 11:00 p.m. on Saturday, and from 9:00 a.m. to 10:00 p.m. on Sunday. However, even during those hours clients may sometimes be out of the building for special events, to attend mandatory AA/NA meetings, or to attend optional church services. 2. There is a seven minute time limit on phone calls in order to assure that all clients have the opportunity to use the phone. The following are additional rules regarding phone use: a. The number of phone calls allowed per day will vary depending client privilege level. b. Clients may lose phone privileges for any of the following: calling for other clients who are on blackout; foul language while on the phone; yelling or shouting while on the phone; talking for more than the allowed 7 minute time limit; or any other phone offenses as perceived by the staff member on duty. c. If a client does one of the above behaviors, he or she will lose phone privileges for one week after the incident for the first offense. After phone privileges are reinstated and if the client again does one of the above behaviors, phone privileges will be lost for the remainder of the treatment stay. 3. Clients may use office phones only for urgent reasons and with staff approval. The use of office computers is prohibited unless there is approval from the treatment staff to use the computer briefly (i.e. to check a bank balance or use the Medical Assistance COMPASS website). If approved, then the computer may only be used with direct monitoring of the computer usage by a staff member.

TELEVISION/RECREATION 1. Please see the posted television hours in the group room for the television schedule. 2. Watching the music channels on television is prohibited. 3. Maple Manor has a small library of movies with a recovery theme. Our general rule is that they may be viewed only after 5:00 p.m. unless an exception is made by the counselor on duty. On Saturday evening, other entertainment type movies are available in the counselors’ office. 4. The use of all radios, musical instruments, CD players, Walkmans, iPods, MP3 players, etc. and non-recovery related reading material is prohibited. Clients are not permitted to bring in their personal movies/DVD/VHS tapes, etc. while in treatment. 5. Material such as art supplies, crossword puzzle books, word finds, games, cards, etc. will be taken at Intake and put in the storage room. The client will be permitted to use them on the weekend but must return them to a staff member on Sunday evening. It is the client’s responsibility, not the staff member’s responsibility, to remember to do this. 6. Sports equipment is made available for use at certain times during the day. It only may be used outside. Please exercise caution when playing near the buildings or near vehicles. Please return all sports equipment to the building after each use.

DRESS CODE 1. Clients must be fully and modestly clothed at all times, including wearing socks and shoes/slippers. Clients must be fully dressed in street clothes by 8:30 a.m. and until bedtime. 2. Residents are required to bathe daily. Toiletries are not permitted to be kept in the showers. Carry bins are provided for your use to transport your toiletries to and from the showers. Please limit showers to 10 minutes. 3. Staff members have the right to determine what is appropriate at the time of admission. Any items considered not appropriate will be taken at admission or when the clothing is brought to the facility and will be placed in storage. Please ask for these items to be returned at discharge. 4. Clothing, hats, or jewelry that promote the use or sale of alcohol, drugs, or tobacco or is suggestive of the drug sub-culture, such as tie-dye, show profanity, encourage violence, or are sexually suggestive are not permitted. 5. Clothing that bears the name of any musical group or that advertises concerts are not permitted. 6. Examples of inappropriate clothing include, but are not limited to: a. Unbuttoned blouses and shirts b. Ripped clothing that has any rip or hole that exposes the torso, shows undergarments, or shows any part of the leg above the knee. c. Immodest or provocative clothing, including low-cut shirts or tight shirts, shorts, or jeans d. See-through clothing e. Pants worn below waist level that expose undergarments f. Tank tops, halter-tops, muscle shirts g. Skirts shorter than fingertip length h. Hemp necklaces 7. Clients must wear proper sleepwear such as modest pajamas, full-length nightgowns, shirts and shorts, sweatpants, etc. 8. Hats are not permitted in the building. If a hat is worn outside, it must be worn in a forward- facing manner. Hats that are worn backwards or off to the side are not permitted. Bandanas are not permitted to be worn at any time. The hood of a hooded sweatshirt (hoodie) is only permitted to be worn outdoors. 9. Tattooing and body piercing is not permitted. Shaving of the head, any cutting of the hair, and perming or dying of hair is not permitted. 10. Body piercings are restricted to the ears and one additional piercing. Spike piercings are prohibited. 11. Due to allergies, the use of cologne and perfume is not permitted. 12. Painting of the nails and attaching acrylic fingernails is not permitted while in treatment.

RULES CONCERNING BEDROOMS 1. Bedrooms are off-limits for everyone except staff, the client and his or her roommate. This includes standing in the doorway of another client’s room. Exceptions must be cleared with the counselor on duty. For instance, during visiting hours an infant may be placed on a bed to rest or a large family with little children may be allowed to gather in the bedroom. 2. Clients are only permitted to use the bed assigned. Staff must approve any bed or room changes. 3. Beds are to be made neatly by 8:00 a.m. Extra blankets should be placed at the foot of the bed rather than be used as a bedspread. Clients are expected to clean their bedrooms and bathrooms daily and help maintain cleanliness and order throughout the building. 4. Sheets are to be washed once a week. 5. Room inspections will be conducted on a weekly basis. Staff reserves the right to inspect a room at any time. 6. With the exception of wrapped candy, food may not be stored in the client’s bedroom. 7. During the day or evening, clients are not to be in their bedroom for more than ten minutes at a time. However, with permission, they may be in their room for brief periods to study, read, or do assignments. 8. Clients are not permitted to lie down or take naps anytime during the day or evening. In case of illness the client must secure permission from a staff member before lying down. 9. Except at night or when the client is changing clothes, bedroom doors are to be left open.

PROPER BEHAVIOR ON THE VAN 1. Female clients must sit in the front passenger seat or in the first bench seat. 2. While on the van clients are to refrain from inappropriate behaviors such as yelling or singing loudly, harassing others, using profanity, engaging in sexual talk, or glamorizing drinking or drug use. 3. Eating, drinking, and the use of tobacco in the van is prohibited.

OUTSIDE EVENTS/MEETINGS 1. All house procedures listed apply to whenever Maple Manor goes, for example at AA/NA meetings or other AA/NA social functions. 2. Clients who are on Level 2 or higher on the Privilege System are taken to town every Thursday at noon. Clients are encouraged to get what they need for the week. Other clients who are at Privilege Level 0 or 1 may give staff of list of necessary items to purchase such as toiletries or cigarettes. Stopping at the store at any other time is prohibited. Clients are limited to buying two items of candy per week and are not permitted to purchase any beverages while shopping. To encourage financial responsibility, clients are asked to buy their own toiletries and regularly used over the counter medications. Any items purchased and the receipts for the items purchased are to be given directly to staff upon return from town for inspection. 3. Purses are not allowed to be brought to outside meetings, social functions, etc. 4. Clients are not permitted to arrange meetings with family and/or friends at AA/NA meetings or anywhere else. If an accidental meeting should occur, the client will not be permitted to sit with the friend or family member. Also, clients are not permitted to arrange for family, friends, or AA/NA members to bring items to them at meetings or elsewhere without prior approval. When prior approval is granted, items are to be given directly to the staff member on duty for inspection prior to the client receiving them. 5. Only decaffeinated soda is permitted at Maple Manor but caffeinated soda may be drank outside of Maple Manor at AA/NA meetings/picnics. 6. Please close all windows and turn off all electrical equipment before leaving the building.

VISITATION 1. Visitation is a privilege, not a right. Visitors are limited to immediate family members- parents, grandparents, spouse, significant other, children, brothers, sisters, and, with permission, friends in the client’s recovery network. 2. All visitors must be approved by staff on the weekly visitation list before 3:00PM each Friday. If your visitor is not on your visitation list by that time, he or she will not be allowed to visit that weekend. The visitation list will be reviewed every week by a counselor and visitors may be denied attendance due to various reasons, including if the potential visitor is using substances or poses an unhealthy risk to the client’s recovery. 3. Family visitation is limited to two adults per client, any exceptions are to be approved prior to visitation. There are no limits to children. Due to space concerns, staff do reserve the right to limit the number of visitors per client on any particular weekend. 4. The visitation schedule is Saturday 1:00 pm –5:00 pm. In order to visit a client on Saturday, a family member MUST attend the Family Session from 1:00 pm – 2:00 pm on Saturday. Any exception must be cleared with staff. Visitors must attend the Family Session EVERY Saturday in order to visit the remainder of the visitation times that weekend. 5. All clients must attend the family session, whether or not they have visitors, in order to help them learn to adjust to family life after discharge from the Manor. 6. Visitors are not permitted to bring in any food for the clients. 7. Clients are not permitted to sit in cars or to significantly separate themselves from the group during visiting hours. Visitors are to remain in the same boundary areas between surrounding our building and surrounding buildings as clients. 8. On some occasions family visiting hours may be cancelled or modified in order to permit clients to participate in a special recovery event such as an AA/NA sponsored breakfast, an AA/NA picnic, AA/NA Day of Sharing, Maple Manor Alumni event, or other recreational activity, etc. 9. Any visitors must report to a staff member immediately upon arrival to the facility. Clients are not permitted to engage in any visitation during non-visiting hours unless it has been approved by a staff member. This includes when family members/friends drop off any items requested by the client. Any items brought by visitors for clients must be given to a staff member for inspection BEFORE the items are given to the client. Clients are not allowed to touch the items until they are inspected by a staff member. It is the client’s responsibility to inform your visitor of these rules. WORK THERAPY (CHORES) 1. Clients should check the bulletin board every day to see what chore they have been assigned. 2. Chores are to be done daily. 3. After completion of the task clients are to write his/her initials and the date in the space provided on a daily basis. 4. Clients are not permitted to switch chores without permission of staff. If you have a physical limitation that may interfere with doing a particular chore, please inform staff.

GUIDELINES FOR GROUP SESSIONS 1. Specific rules for group sessions are posted in the group room. They will periodically be reviewed by the counselors.

2. Without special permission clients may not lie on the floor during scheduled group activities. 3. Clients are not permitted to wrap up in blankets during group sessions or bring pillows or stuffed animals to group. 4. Clients are not permitted to eat during group. 5. Clients are not permitted to leave group once group has started unless it is an emergency. Please use the restroom before the start of group to avoid disruptions. 6. The Group Room and Creative Room doors must remain open and lights on when group is not in session.

ADDITIONAL RULES/PROCEDURES 1. Gambling is prohibited. 2. Volunteer staff members have the same authority as employees. 3. Random drug and alcohol screens may be conducted at any time. Refusal to submit an alcohol or drug screen will be viewed as non-compliance and will be grounds for immediate dismissal. 4. Caffeinated coffee is not permitted to be in the tumblers (tall glasses) and is only permitted to be in coffee cups. 5. Energy drinks are not permitted at any time. 6. Maple Manor is not responsible for purchasing client prescriptions or over-the-counter medications; however some over-the-counter medications are available for client use with approval. 7. Powdered and liquid supplements are prohibited unless prescribed by a doctor. Other vitamin supplements will be examined for content and may or may not be prohibited according to content. 7. If a romantic relationship begins to develop between two clients, the two involved clients may be sent to separate rehabilitation facilities upon the review of the treatment team for the sake of each person’s recovery. We encourage clients to be supportive of each other but to not associate exclusively with one particular client.

DISCIPLINE PROCEDURES In order to help clients accept responsibility for their behaviors, Maple Manor has a Strike system. Strikes are given when a client deliberately or consistently breaks a house rule. Depending on the circumstance the client may be given a warning before a strike is given; however, in the case of a serious offense the strike will be given immediately or could result in immediate discharge. In addition to receiving a strike, clients may be moved down a level or levels in the Privilege System. If a client accumulates two strikes, he/she will be discharged from Maple Manor for Non-Compliance with Facility Rules.

There are seven instances when a client is immediately discharged from Maple Manor. For Instances #1 through #4, clients will not be allowed to return Maple Manor for at least one year after discharge. For Instances #5 through #7, clients will not be allowed to return to Maple Manor for 60 days after discharge.

1) If he or she engages in sexual activity, or sexual conduct, sexual gestures, sexual comments or those made in a sexually deviant manner, including kissing, inappropriate touching, or anything else that staff determines to be sexual conduct. 2) If he or she uses alcohol and/or any drugs without a doctor’s permission. 3) If he or she threatens or engages in violence against any person in Maple Manor or against the property of Maple Manor. Any type of abusive behavior towards staff or other clients will not be tolerated. 4) If he or she is in possession of any prescribed or over-the-counter medication without a staff member’s permission or in possession of alcohol, illicit drugs or paraphernalia. 5) If he or she is in possession of a cell phone while in Maple Manor or uses a cell phone or other phone outside of Maple Manor, for example at AA/NA meetings, or any other electronic devices such as iPods, MP3 players, or Blackberries. 6) If he or she leaves program grounds (program grounds includes Maple Manor, Maple Manor’s parking lot, AA/NA meetings and the doctor offices and fitness center during scheduled times) without a staff member’s permission. 7) If a client engages in any unauthorized visitation on Maple Manor grounds or arranges for visitation without staff approval.

DISCHARGE INFORMATION 1. Upon successful completion of treatment, the client may choose one of the following books: The AA Big Book, the NA Basic Text, the AA Twelve Steps Twelve Traditions, the NA How and Why book, the NA Just for Today mediation book, the AA Daily Reflections meditation book, or the Hazelden Twenty-Four Hours a Day mediation book. 2. Clients who complete treatment will also receive a Maple Manor Medallion presented in memory of our dear friend, Edward T. Fuller. 3. Prior to discharge, clients are to wash their sheets, blanket and bedspread, make up the bed for the next client, and thoroughly clean and vacuum the bedroom and bathroom. 4. Following discharge, clients are welcome to keep in contact with staff through phone calls, letters, or brief visits at convenient times. However, former clients are not permitted to visit friends who are still in the Manor. Instead, they are asked to restrict their contact with these friends to phone calls, letters, and AA and NA meetings. Clients must wait 60 days before returning to Maple Manor to visit another client. If an exception may be needed, the request will be reviewed by the Inpatient Supervisor. 5. Clients are invited to join the Maple Manor Alumni Association by signing their name and address in the Alumni Book in the office. Please update Maple Manor of any address changes if you wish to stay involved in the Association. Maple Manor Alumni Association announcements are also made at some local AA and NA meetings. 6. Any personal items left 30 days after discharge will be given away, thrown away, or destroyed. Please claim these items before then. 7. Maple Manor requests that a former client may not return to lead the in-house meeting until the former client has 6 months or more of sobriety time.

VIDEO SURVEILLANCE

1. I understand these premises are under video surveillance. Video cameras are located both inside and outside the facility. 2. Any tampering with the cameras may result in discharge.

R11/12

MAPLE MANOR RESIDENT CONTRACT I, ______, hereby agree to be admitted to Maple Manor for the treatment of my alcohol/drug addiction. I understand that Maple Manor is a 12-bed residential treatment facility.

I agree to stay the amount of time designated by my individual treatment contract.

I understand that the consumption or possession of alcoholic beverages and/or other drugs not prescribed by a physician, or patronization of a place that sells same, will result in my immediate dismissal. I further understand that all medications; prescription and non-prescription must be turned over to the staff member on duty. This includes nail polish removers, shaving lotions, perfumes, hair sprays, and razors.

I understand that, upon any early discharges, re-admission shall be based upon the following:

1. Reason client has requested re-admission and apparent motivation. 2. Prior case history progress. 3. Reason for prior discharge. 4. Effect re-admission might serve.

Clients who are discharged from Maple Manor must wait at least 60 days before they become eligible for re-admission. The exception to this is if a client is discharged from Maple Manor due to drug and/or alcohol use, threats or acts of violence against staff or other clients, or sexual misconduct then they must wait 1 year before they become eligible for re-admission to Maple Manor.

I understand that State Fire Laws prohibit smoking in the facility and to do so will result in my immediate disciplinary action.

I understand that, upon my early discharge, the agency is not responsible for my transportation.

I understand that I have a financial obligation to this agency and I must make arrangements to meet this financial obligation.

I understand there is a blackout period upon my entering Maple Manor. During this time, I shall not receive nor send any communications. Emergencies will be taken care of with assistance of the Maple Manor staff.

I shall comply with the rules, as detailed in the Maple Manor Handbook and posted on the Manor bulletin board and by the Manor Nurses Station.

I understand that a Maple Manor resident shall not leave Maple Manor without being accompanied by a staff member/volunteer.

______/___/______/___/___ Client Signature Date Witness Date

ALCOHOL & DRUG ABUSE SERVICES, INC. CLIENT CONSENT FORM I, give my consent to to disclose information from my patient record to for the sole purpose of: (a) obtaining benefits due me as a result of my drug/alcohol abuse or dependence (specify the benefits by name):

(b) treatment of my chemical abuse or dependence (i.e. drug and/or alcohol) treatment of my co-dependence or ACOA/COA issues. (c) Monitoring Progress

(d) determining evidence of or extent of an addiction problem through evaluation (e) coordination of services (f) Other: (Specify)

I understand that information will be disclosed only for the purpose(s) noted above, and that the information released will be limited to the following items: (1) Date(s) of evaluation and cooperation with Level of Care recommendations (2) Recommendation for Level of Care/Diagnosis (3) Adherence with recommendation including date(s) and attendance at sessions and brief progress reports including knowledge of relapse (4) Termination date of treatment and reason for termination/prognosis (5) Other: (Specify)

I understand that my alcohol and/or drug treatment records are protected under the Federal regulations governing Confidentiality of Alcohol & Drug Abuse Patient Records, 42 C.F.R., Part 2, and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). 45 C.F.R. Pts. 160 & 164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent verbally or in writing at any time except to the extent that action has been taken in reliance on it. I further understand that if my treatment is a condition of a court order, I may not revoke my consent until I have completed court requirements pursuant to Federal Confidentiality law 42 C.F.R. part 2 subpart C subsection 2.35 (a), (b) and (c). This consent expires automatically as follows:

(Specification of the date, event, or condition upon which this consent expires)

I understand that generally Alcohol & Drug Abuse Services, Inc. may not condition my treatment on whether I sign a consent form, but that in certain limited circumstances I may be denied treatment if I do not sign a consent form.

I have read this form, had its contents explained to me and I understand its contents, and have been offered a copy of this document which I have: ACCEPTED DECLINED

CLIENT DATE WITNESS DATE CONSENT TO USE AND DISCLOSE YOUR HEALTH INFORMATION This form is an agreement between you and Alcohol & Drug Abuse Services, Inc.

When we examine, diagnose, treat or refer you we will be collecting what the law calls Protected Health Information (PHI) about you. We need to use this information here to decide on what treatment is best for you and to provide treatment to you. We may also share this information with others who provide treatment to you or need it to arrange payment for you treatment or for other business or government functions. (Federal and Pennsylvania Drug and Alcohol Laws require that we obtain a release for you to be able to share most information and we are limited in the information that we share. Because these laws are more stringent than the Federal HIPAA law we will follow the Drug and Alcohol laws.)

By signing this form you are agreeing to let us use your information here and send to others. (Federal and Pennsylvania Drug and Alcohol Laws require that we obtain a release for you to be able to share most information and we are limited in the information that we share. Because these laws are more stringent than the Federal HIPAA law we will follow the Drug and Alcohol laws.)

The Notice of Privacy Practices explains in more detail your rights, how we can use and share you information. Please read this before you sign this Consent form. If you do not sign this consent form agreeing to what is in our Notice of Privacy Practices we cannot treat you.

In the future we may change how we use and share your information and so may change our Notice of Privacy Practices. If we do change it, you can get a copy from our privacy officer.

If you are concerned about some of your information, you have the right to ask us to not use or share some of you information for treatment, payment or administrative purposes. You will have to tell us what you want in writing. Although we will try to respect your wishes, we are not required to agree to these limitations. However, if we do agree, we promise to comply with your wishes. (Federal and Pennsylvania Drug and Alcohol Laws require that we obtain a release for you to be able to share most information and we are limited in the information that we share. Because these laws are more stringent than the Federal HIPAA law we will follow the Drug and Alcohol laws.)

After you have signed this consent, you have the right to revoke it (by writing a letter telling us you no longer consent) and we will comply with your wishes about using or sharing your information from that time on but we may already have used or shared some of your information and cannot change that.

My signature indicates I have read and understood the above statement and that I have been given a copy of the Notice of Privacy Practices.

Signature of Client Date CLIENT’S RIGHTS

Each person requesting service from Alcohol & Drug Abuse Centers shall be made aware of his rights in receiving such services. These rights include the following:

1. To receive a copy of any document the client may sign. This shall include general consents, contract/treatment plans, Aftercare plans, or the like. 2. All clients shall have the right to inspect their own records subject to the following limitations (I) The project director may temporarily remove portions of the records prior to the inspection by the client if he/she determines that the information may be detrimental if presented to the client. Reasons for removing sections shall be documented and kept on file. (II) The client shall have the right to appeal a decision limiting access to his records to the project director. (III) The client shall have the right to request the correction of Inaccurate, Irrelevant, Outdated or incomplete information from his/her records. (IV) The client shall have the right to submit rebuttal data or memoranda to his own record. 3. To be oriented to the project and its services at the time of admission. This shall include services offered, hours of operations and current fee schedules. 4. To have an individual Contract/Treatment Plan prepared which will outline the goals of treatment as well as the objectives of such goals and the projected time of expected completion. 5. To terminate treatment prior to completion should such be required. 6. Clients terminating early, before completing their program and against facility advice, or for lack of contact, may request re-evaluation and re-admission into the program, Clients terminating early from the Residential Program may request re-admission following a 60 day interval from date of termination. Re-admission depends on the new evaluation. 7. A person receiving care of treatment under the provisions of, or subject to the provisions of Section 7 of the Pennsylvania Drug and Alcohol Abuse Control Act (71 P.S. 1690.107), shall retain all civil rights and liberties except as provided by law. No client shall be deprived of any civil right solely by reason of treatment. Some examples of civil rights are: the right to receive and send uncensored mail, the right to vote, the right to an attorney, and the right to make outside telephone calls (for Maple Manor clients this is following the blackout period during scheduled hours). 8. To be made aware of the criteria for admission, treatment, completion and discharge. 9. To file a grievance about decisions made by agency personnel concerning my treatment. The procedure is as follows:  A grievance is defined as a written/verbal complaint by an individual regarding a decision made by ADAS outpatient or inpatient.

Every individual has the right to express a grievance for the reasons specified below:

1. Termination of services 2. Disagreement with a level of care recommendation 3. A specific concern regarding their outpatient counseling The appeal procedure should be as followed; 1. The individual is to initially attempt to resolve the issue with their specific counselor 2. In the event it cannot be resolved, the individual will be instructed to call the department supervisor at (814) 642-9541 (outpatient) or (814) 642-9522 (inpatient) to discuss the concern in order to resolve it quickly and amicably. This may include a meeting with all parties involved. The individual client has the right to involve an advocate of their choosing. 3. In the event the concern is still not resolved to the individual satisfaction, they are to send a written grievance explaining the concern to the Executive Director (120 Chestnut Street, Port Allegany, PA 16743). Please include your full name and contact information for follow up. All written grievances will be responded to in writing within 5 working days from the date it is received. The Executive Director’s decision is considered final.

Each client shall receive a copy of the policies and documents insuring them of their civil rights. This project shall not deny anyone services on the basis of age, sex, race, creed, ethnicity, color, national origin, marital status, sexual orientation, physical handicap or religious preference. This project is prohibited from using physical abuse (including sexual abuse and physical punishment) and psychological abuse (including humiliating, threatening or exploiting actions).

I, , have read this document, had it explained to me, had my questions answered to my satisfaction, and had the current fee scheduled explained to me, based on my present liability.

CLIENT: DATE:

STAFF: DATE:

Provided copy of this document and treatment handbook YES NO

09/2014 jlr ALCOHOL & DRUG ABUSE SERVICES, INC. CONFIDENTIALITY AND THE CLIENT

The release of client information if governed by Federal and State Law. In order to release any information, the program must have the client’s signed consent. This consent must have specific information such as: - To who it is to be released - For what specific purpose - When the Consent Form expires - The Consent Form must be dated - Who witnessed the client’s signature

When a consent is given and information released, the information is confidential and not to be shared with anyone. Client identifying information can be given to others in the following situations without a consent. - Mandated reporting of child abuse/neglect- information regarding the incidents only may be released. - Should a client commit a crime or threaten to do so on the program premises or against program personnel- law enforcement will be notified of action or intent, demographics and status as patient. - Where a client’s life is in immediate jeopardy, information records can be released to qualified medical personnel. - Following the death of client, programs are allowed to reveal information related to the cause of death to the coroner and abiding by Federal Law 2.15b 1&2. - In the case of a suicide threat by a client, the appropriate Mental Health professionals may be notified.

“This notice accompanies a disclosure of information made to you with consent of such client. This information has been disclosed to you from records protected by federal confidentiality rules (42 C.F.F. Part 2). The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R. Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.” Clients may see the full Confidentiality regulations upon request.

I have received a copy of this written summary of the Confidentiality Laws and Regulations.

CLIENT: ______DATE: ______STAFF: ______DATE:______

ALCOHOL & DRUG ABUSE SERVICES, INC. CODE OF ETHICS

1. I will dedicate myself to the best interest of the clients. 2. I will be willing, when I recognize that it is in the best interest of the client, to release or refer the client to another program or individual. a. Referral of our clients to treatment shall be made to the most appropriate available. i.e., if a client is not appropriate for Maple Manor, a referral will be made to another inpatient facility. b. The length of treatment for inpatient or outpatient shall be based on need, compliance and progress towards accomplishment of treatment goals. c. It is not ethical to continue to foster a therapeutic relationship with a client who completes inpatient treatment and moves on to outpatient. It is understood that a bond will exist between the client and first counselor, but it is important that the inpatient therapist encourages the client to have the same trust with the outpatient counselor. 3. I will protect the privacy of the clients and will adhere to all state and federal laws of confidentiality. 4. I will not discriminate against any person or organization. 5. I will respect the rights, integrity, and welfare of clients, agencies or other professionals. 6. I will maintain respect for organization policies and management functions within agencies and organizations, but will take initiative toward improving such policies if doing so will best serve the interest of the clients. 7. I will maintain at all times an objective, non-possessive, professional relationship with all clients. a. A staff member will not act as a sponsor to any agency client or ex-client. If asked to be a sponsor, staff must explain the reason that it is not allowed; it crosses therapeutic boundaries in the relationship if sponsoree becomes a client of this agency. b. A staff member who attends AA meetings while acting as an employee of ADAS will not discuss their own recovery issues. c. A staff member will not serve as a sponsor for another employee of ADAS. d. Socializing with known client and ex-clients is not permitted. If a friend becomes a client, the previous relationship should not change. However, while in treatment, the staff person will not be privileged to staffing, discussions, etc. about the client. 8. I have a commitment to assess my own personal strengths, limitations, biases, and effectiveness on a continuing basis; and I have a personal responsibility for professional growth through further education. 9. I will be responsible for my personal and professional conduct with particular attention to the use of alcohol and other mood changing drugs and issues of emotional, physical, and sexual abuse. 10. I, as an individual, have a responsibility to myself, my clients, and other associates to maintain my physical, emotional and mental well-being. 11. I will be responsible for maintaining my own safety CLIENT FEE SCHEDULE

SERVICES CHARGE CO-PAYMENT (MEDICAL ASSISTANCE)

Individual Outpatient Counseling $ 89.00 per hour $3.00 per appt. (Minimum charge) Urinalysis 25.00 Family Counseling 90.00 per hour Intervention (first visit) free (second +) 89.00 per hour Maple Manor 170.00 per day $10.00 per day (Minimum charge) Intensive Outpatient Program 132.00 per day Recovery Support 70.00 per hour Case Management 91.00 per hour Consultation/Education 75.00 per hour Group Counseling 44.00 per hour Evaluation requiring written report 75.00 Evaluation with a Urine requiring written report 100.00 SAP Technical Assistance 200-400.00 per day Youthful Offenders Group 75.00 1st Time Offenders Group 100.00 Tobacco Youthful Offenders Group 40.00

A LIABILITY ASSESSMENT WILL BE COMPLETED ON EACH CLIENT TO DETERMINE THE MAXIMUM FEE TO BE CHARGED MONTHLY.

SERVICES AVAILABLE

DIAGNOSIS AND ASSESSMENT OUTPATIENT COUNSELING FAMILY COUNSELING GROUP COUNSELING RESIDENTIAL TREATMENT PREVENTION/EDUCATION Revised 3/14 cr ALCO H OL & DRUG ABUSE SERVICES, INC. OUTPATIENT COUNSELING SEVICES (844) 621-4080

BRADFORD 2 MAIN STREET, 6TH FLOOR BRADFORD, PA 16701 (814)362-6517 FAX: 814-362-3202 HOURS: MONDAY THOUGH FRIDAY 8:00AM TO 4:00PM TUESDAY 8:00AM TO 8:00PM

KANE 19 FIELD STREET KANE, PA 16735 (814) 837-7691 FAX: 814-837-6983 HOURS: MONDAY THROUGH FRIDAY 8:00AM TO 4:00PM WEDNESDAY 12:00PM TO 8:00PM

PORT ALLEGANY 12 Church Street Suite 100 PORT ALLEGANY, PA 16743 (814) 642-9541 FAX: 814-642-0725 HOURS: MONDAY THROUGH FRIDAY 8:00AM TO 4:00PM WEDNESDAY 8:00AM TO 8:00PM

COUDERSPORT 279 RT. 6 WEST ROOM #3 COUDERSPORT, PA 16915 (814) 274-9745 FAX: 814-274-8763 HOURS: MONDAY THOUGH FRIDAY 8:00AM-4:00PM MONDAY NOON TO 8:00PM

ST. MARYS 1305 BUCKTAIL ROAD ST. MARY, PA 15857 (814) 781-1700 FAX: (814) 781-6134 HOURS: MONDAY THOUGH FRIDAY 8:00AM-4:00OM MONDAY 8:00AM TO 8:00PM

**EMPORIUM 305 CHESTNUT STREET EMPORIUM, PA 15834 (814) 486-0653 FAX: (814) 601-0875 HOURS BY APPOINTMENT

RIDGWAY 225 South Street Suite 1 Ridgway, PA 15853-2029 (814) 788-2080 FAX: (814) 788-2088 HOURS: MONDAY 8:00AM-8:00PM TUESDAY THROUGH FRIDAY 8:00AM-4:00PM

REFERALS- Are accepted from sources throughout the service area. These sources shall include, but not be limited to the following: Employee Assistance Programs, legal systems, and clergy, as well as self-referrals. AFTER HOURS- Referral sources may call any of the above numbers as calls are automatically forwarded to the Residential Treatment Center, (814) 642-9522.