Policy Manual

 
  3.MEP.53  

Authorized Clinical Services Procedure      

Type: Procedure                 Category: Service Delivery                 Level: Community Care 

Parties: Community Care employees and contractees

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Supporting References: G9.2.01/02/03/05/06/07/08

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  4-1-2004  Management Team    N/A
Related Document Code Related Document Name Type
4.ME.2 Use of Therapeutic Modalities and Behavior Modification Interventions Policy Policy

Procedure:  .

  1. Program Managers will ensure that all programs have a written philosophy that guides the implementation and development of the clinical services provided within the program(s). (A review of program philosophies will take place not less than annually within the CQI process.)
  2. Clinical Program Managers will ensure that all clinical approaches, modalities, and interventions are supported by evidence-based research and knowledge of best practice. A review of clinical approaches, modalities, and interventions will take place not less than annually at the program management level.
  3. Program Clinical Managers will ensure that all clinical approaches, modalities, and interventions are appropriately matched to the persons served within each of the organization's services. Clinical supervisory review and sign-off of service plans will suffice for this procedure.
  4. A list of authorized, clinical approaches, modalities, and interventions will be maintained by the Community Care Director of Treatment Services who will conduct a review of this list not less than annually.
  5. All clinical approaches, modalities, and interventions must be approved by the Community Care Director of Treatment Services.
  6. For the use of any unauthorized clinical modality or intervention at Community Care, the following procedure must be followed:
    1. A request must be submitted to the clinical program manager along with a written explanation, including a description of the modality or intervention and a written rationale for its use,
    2. The clinical program manager and the Director of Treatment Services of Community Care will approve authorized clinical services.
    3. Once approved, the benefits, risks, and alternatives must be explained to the person served and/or his/her legal guardian,
    4. A written informed consent of the person served and/or his/her guardian must be obtained prior to implementation,
    5. The personnel to employ the clinical modality or intervention, once it is approved, must be trained and/or certified to provide the clinical service prior to implementation,
    6. The client's individual service plan must include the stated use, the name of the service provider, and the timeframe of the service. The service plan must be signed by the treatment team, including the client and/or the legal guardian, prior to use.
  7. All clinical modalities, approaches, or interventions must have a supervisory review and all such reviews must be documented.
  8. Guidelines for approval of clinical approaches, interventions, and/or modalities include, but are not limited to:
    1. Least restrictive approaches,
    2. Normalized approaches,
    3. Positive/Strength-based approaches,
    4. Aimed at teaching pro-social adaptive behaviors,
    5. Aimed at modifying behaviors that are socially or personally maladaptive,
    6. Providing a therapeutic environment, and
    7. Applying behavioral interventions in a caring and humane manner.
  9. All uses of clinical interventions, modalities, and approaches must be documented in the client's case record. Documentation must include:
    1. The rationale for use,
    2. A schedule or timing of use,
    3. Outcome measures, and
    4. An assessment of the impact on the person served.
  10. The use of authorized clinical interventions must follow the Community Care Discipline Policy and the Restraint and Seclusion Policy. The following are not permitted:
    1. Corporal punishment;
    2. The use of aversive stimuli such as electric shock device;
    3. Withholding nutrition or hydration;
    4. Inflicting physical or psychological pain;
    5. Forced physical exercise to eliminate behaviors-Over correction;
    6. Punitive work assignments;
    7. Infliction of shame or humiliation
    8. Violation of Clients' Rights;
    9. Punishment by peers; and
    10. Group punishment or discipline for individual behaviors.
  11. Any intervention will be discontinued if it:
    1. Produces unacceptable effects;
    2. Is deemed unacceptable according to prevailing community standards; and/or Is ineffectual or detrimental to meeting service goals and objectives.