8 West Inpatient Detoxification Service
The Opioid Treatment Program is one component of the 8-West Acute Behavioral Inpatient Unit’s detoxification service. The 8-West Unit is part of Saint Francis Hospital and Medical Center’s Behavioral Health service. Saint Francis provides acute, inpatient child, adolescent and adult psychiatric and substance abuse treatment on four specialty care units.
8-West is a 24-bed in-patient psychiatric unit for adult patients 18 years of age or older with substance use disorders, and co-occurring psychiatric and substance use disorders. Three distinct treatment services are provided: 1) medically managed inpatient detoxification; 2) medical and acute psychiatric stabilization for patients with co-occurring psychiatric and substance use disorders; and 3) chemical dependency rehabilitation services to provide recovery maintenance skills training, and individualized relapse prevention planning for patients requiring this level of ongoing post stabilization structure, and medical supervision to achieve and sustain recovery goals.
Individuals receive 24-hour acute inpatient medically managed level of care in a safe, secure, and supportive environment. This enables individuals with substantial loss of control over substances to concentrate their energies on recovery away from problems that can impair their progress. The program at the 8-West Unit is designed to incorporate treatment interventions that effectively address needs that persons with substance use disorders have in common, as well as to respond to each client’s specific challenges to attain long term recovery goals.
Referrals can be made from community agencies, outpatient providers, families, and managed care companies. Prompt, confidential assessments are completed by a licensed behavioral health professional to determine the severity of the crisis. Following the initial assessment, clients are triaged into the level of care and service, which is most appropriate to address their individual treatment needs. Saint Francis Behavioral Health follows InterQual utilization review criteria as guidelines for admission and continued stay decisions. (InterQual is consistent with revised ASAM criteria regarding the need for medically managed detoxification.)
Opioid Treatment Program
Patients who are evaluated by our physician as appropriate for methadone detoxification protocol (opioid dependent with current use pattern, and withdrawal history that indicates the need for pharmacological intervention to alleviate withdrawal discomfort) are admitted to the Opioid Treatment Program. Exclusionary criteria for methadone detoxification includes pregnant women (see protocol), patients under 18 years of age, and patients who have been detoxed using methadone two times within the past 12 months (unless the patient meets the CSAT criteria for waiver and waiver application is filed by the physician).
Professional Staff: The Opioid Treatment Program team is headed by a Board Certified Internal Medicine physician with over 11 years in the practice of Addiction Medicine who maintains ASAM (American Society of Addiction Medicine) CME training annually, and a Board Certified Psychiatrist (American Society of Psychiatric Medicine) with over 5 years experience with the treatment of co-occurring psychiatric and substance use disorders. Other members include: Advanced Practice Nurse Clinician; Registered Nurses; Licensed Pharmacist; Licensed Clinical Psychologist; Licensed Clinical Social Worker; Licensed Alcohol and Drug Counselor, Licensed Professional Counselor; Licensed Marriage and Family Therapist; Master’s level Clinician; Creative Therapist; Dietitian; Pastoral Counselor; and Mental Health Workers. All of these staff are supervised by Behavioral Health Leadership Team which is headed by the Chairman and Director of Behavioral Health Services and Medical Director of the Opioid Treatment Program, who is Board certified in General Psychiatry and Addiction Psychiatry.
Plan for Professional Services
Our staff recognizes that detoxification is often the first stage of treatment for the chemically dependent person. The goal of detoxification is to wean the dependent person from their substance with a minimum of suffering and thereby encourage the addict to continue with other stages of treatment and recovery. Assessment begins with the identification of observable withdrawal symptoms, toxicology results, patient presentation and reported history of response during withdrawal.
Our system is committed to continuously pursue the advancement of treatment interventions, which have a demonstrated effectiveness for improving the probability that our patients will be successful in sustaining positive treatment outcomes. Effective assessment and treatment must address associated medical, psychological, developmental, family, social, vocational, and legal problems. We rely on the diagnostic skill of our multidisciplinary treatment team, who collaborate in the formulation of a comprehensive and individualized treatment plan.
Gender specific, culturally sensitive, developmentally appropriate, and diagnostically related services are available to meet the specialized needs of women, and dually diagnosed patients. HIV/AIDS patients are maintained on all treatment regimens and care is coordinated with their infectious disease specialist or clinic, when needed. All patients are assessed for acute or chronic pain problems at the time of admission. Treatment interventions and continuing care services are implemented to effectively address co-occurring pain disorders.
The components offered for our client’s treatment include:
- Medical evaluation and determination of appropriate detoxification protocol
- Ongoing monitoring of medical stability in response to clinical interventions
- Nursing assessment for symptom and pain management
- Health education
- Psychopharmacological evaluation and treatment as indicated
- Ongoing psychiatric supervision by a staff psychiatrist
- Goals Group – The group focuses on the process of individual goal setting is tied to the initial treatment plan that each client creates for him/herself.
- Education Group – This group is led by the nursing staff which relates to clients’ improved self-care and recovery goals
- Recovery Group – This group focuses on use of daily recovery skills that maintain recovery and prevent relapse.
- Clinical Psychotherapy – This group discusses the main issues that were identified by the client and the treatment team which affect the client’s social, emotional and behavioral health. This group is run by a master’s level therapist.
- Sobriety Enrichment – This group reviews the principles of 12-step recovery program and application of the steps in everyday living.
- Medication Group – This group is to educate clients about their medication, how to use medication safely, and the beneficial and appropriate use of medication in recovery.
- Nutrition Group – Led by a registered dietician, this group reviews the relationship between good nutrition and physical/emotional health, and teaches clients how to develop a healthy diet.
- Creative Therapy – These groups incorporate art, movement, fitness and games to help clients identify and manage feelings, improve interpersonal relationships, learn new daily skills for self-sufficiency, and to orient clients toward gaining a sense of mastery, problem solving, competence and interest development.
We recognize the importance of the patient’s perception that each episode of treatment is successful, and that he/she is moving toward the achievement of his/her long-term care goals. Continuing care planning and aftercare services is an important part of each treatment episode, providing direction and structure to assist patients in maintaining treatment benefits. Specific continuing care plans are designed to address the individual patient’s needs. These include gender or culturally specific services, psychiatric and specialized medical follow up, a full range of recovery supportive continuing care options, and specialized services for HIV/AIDS.
Patients are provided an opportunity to express concerns or complaints through a confidential Complaint Form that provides direct access to all levels of Administration. All concerns and complaints are addressed and responded to within 24 hours (see Patient Complaint Policy). This procedure is also utilized in the event that a patient is in disagreement with the staff decision to initiate discharge. In addition to the steps outlined in the Patient Complaint Procedure, patients may request an administrative hearing in the presence of an outside advocate. This meeting is not a formal legal procedure, but its sole purpose is to resolve all areas of continued disagreement or conflict with the patient, and to ensure that the patient’s needs for continuing care are fully addressed.
We have in place an effective monitoring system for the detoxification services and rehabilitation interventions. The monitoring enables us to evaluate and compare the outcomes established for the detoxification and rehabilitation interventions. The goal is to assess and improve treatment compliance and retention; increase the percentage of positive discharges completing treatment with benefit. Goals/objectives achieved 2002 to 2005 include:
- Maintain a restraint free therapeutic environment
- Maintain a high patient satisfaction rating
- Demonstrate quality treatment outcome (ORYX Data)
- Effective assessment and problem identification
- Effective engagement and retention of patients
- Improved discharge planning services
- Maintain safe medication administration