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Standards & Guidelines for Partial Hospitalization Programs and Intensive Outpatient Programs

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Standards & Guidelines for Partial Hospitalization Programs and Intensive Outpatient Programs 2021 Standards and Guidelines for Partial Hospitalization Programs & Intensive Outpatient Programs Editors: James Rosser, LCSW, CMT-P & Stephen Michael, DrPH Contributors: Catherine Eckl, LCSW Lawrence Haber, PhD Gretchen Johnson, DNP, MSN, RN-BC Jessica Lavender, LPC-MHSP Stephen Michael, DrPH James Rosser, LCSW, CMT-P Luana Shiba-Harris, MPA/HAS, OTR Sara Tucker, MA LLP Association for Ambulatory Behavioral Healthcare Table of Contents INTRODUCTION ............................................................................................................................................................ 2 DEFINITIONS ................................................................................................................................................................ 4 CONTINUUM OF CARE ................................................................................................................................................ 6 ROLE OF REGULATORY BODIES ............................................................................................................................. 10 ADMISSION PROFILES .............................................................................................................................................. 13 SPECIFIC ADMISSION CRITERIA ......................................................................................................................... 15 EXCLUSION CRITERIA .......................................................................................................................................... 17 CONTINUED STAY CRITERIA ............................................................................................................................... 18 PROGRAMMING ......................................................................................................................................................... 20 THERAPEUTIC MILIEU .......................................................................................................................................... 22 PROGRAM STAFF .................................................................................................................................................. 24 COORDINATION OF SERVICES: ........................................................................................................................... 26 LENGTH OF STAY: ................................................................................................................................................. 26 DOCUMENTATION ..................................................................................................................................................... 28 ASSESSMENT ........................................................................................................................................................ 28 PHYSICIAN ORDERS/SUPERVISION/CERTIFICATE OF NEED .......................................................................... 29 PSYCHIATRIC ASSESSMENT ............................................................................................................................... 29 TREATMENT PLAN ................................................................................................................................................ 30 TREATMENT REVIEWS ......................................................................................................................................... 30 MEDICATION MANAGEMENT ................................................................................................................................ 30 PROGRESS NOTES ............................................................................................................................................... 31 DISCHARGE SUMMARY ........................................................................................................................................ 31 ELECTRONIC MEDICAL RECORDS ...................................................................................................................... 32 LINKAGES ................................................................................................................................................................... 35 PERFORMANCE IMPROVEMENT/OUTCOME MEASUREMENT .............................................................................. 37 PERFORMANCE OUTCOMES ............................................................................................................................... 37 CLINICAL OUTCOMES ........................................................................................................................................... 40 BENCHMARKING METRICS .................................................................................................................................. 41 PROGRAM IMPROVEMENT................................................................................................................................... 41 TELEHEALTH .............................................................................................................................................................. 43 SUMMARY ................................................................................................................................................................... 47 APPENDIX A – EVOLUTION OF AABH STANDARDS AND GUIDELINES ................................................................ 48 REFERENCED DOCUMENTS .................................................................................................................................... 50 SPECIALTY POPULATION – CHILD & ADOLESCENT .............................................................................................. 53 SPECIALTY POPULATION – OLDER ADULTS .......................................................................................................... 55 SPECIALTY POPULATION – PERINATAL WOMEN .................................................................................................. 57 SPECIALTY POPULATION – EATING DISORDERS .................................................................................................. 59 SPECIALTY POPULATION – CHEMICAL DEPENDENCY ......................................................................................... 61 SPECIALTY POPULATION – CO-OCCURRING DISORDERS................................................................................... 63 FINAL COMMENTS ..................................................................................................................................................... 65 Standards and Guidelines for PHP & IOP Page | 1 Association for Ambulatory Behavioral Healthcare INTRODUCTION These Standards and Guidelines are presented from the perspective of the AABH national provider network. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. Important information about regulatory coordination and program structure will also be provided. This document has been designed to enable programs to: • achieve effectiveness and best practices in service delivery, • maintain regulatory compliance, and • provide safety through clinical guidelines, standards, and best practices. Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may differ from one region to another due to multiple factors such as specialized workforce availability, culture, resources, or health insurance coverage inconsistencies. These standards and guidelines focus on best practice for care in PHP and IOP settings; however, AABH acknowledges that some contracts with payers may override the standards in this document. It is therefore necessary for providers of PHP and IOP services to familiarize themselves with all current applicable requirements and interpretations for their local environment. PHPs and IOPs are designed to help individuals understand their illness, reduce the impact of functionally debilitating symptoms, and cope with challenging situational crises. People need to feel hope, find purpose, and care for others. Whenever possible, they want to keep their job and maintain their homes. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. The latest medication advances, therapeutic techniques, and peer connections meet individuals "where they are" in a positive milieu that fosters support and change. PHPs and IOPs should represent the core of psychosocial treatments. The final rules pertaining to the implementation of the parity legislation were presented in November of 2013. At the time, Pamela Hyde, JD, SAMHSA Director, announced that partial hospitalization and intensive outpatient treatment were specifically included as essential “intermediate behavioral healthcare” treatment options.1 This landmark decision validates over 40 years of effort by behavioral health professionals throughout the country to provide intensive ambulatory treatment and avert or reduce hospitalizations while creating an environment of personal recovery for countless Americans. The identification of target populations with criteria for admission to, continuation of, and exclusion from each level of care will be delineated. Specific aspects of program design will be discussed as they apply to specialized practice settings. A description of the essential treatment services such as group, occupational, and psycho-educational therapies will be provided. As providers have found
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