Parent and Client Handbook

Parent and Client Handbook Community Based Acute Treatment (CBAT) 543 North Street New Bedford, MA 02740 Telephone Number (508) 984-4175 Fax Number (508) 984-3563 Available 24 hours/day Visiting Hours & Telephone Calls with clients are 11:00am to 7:00pm Calling ahead to schedule visits with clients is encouraged due to limited space Passes off the unit are allowed after 5 days but MUST be prearranged with your clinician

TABLE OF CONTENTS 1. CBAT Definition/Description/Eligibility Criteria pg. 3-4 2. Client Expectations pg.5 3. CBAT Chore List pg. 6 4. Visitation/ Mail/ Telephone Policies pg. 7 5. Food Policy pg. 8 6. CBAT Milieu Behavior Program pg. 9 7. Schedule & Point/Level Sheet pg. 10 8. Pointing Categories pg. 11 9. Level Infractions pg. 12 10. Level Consequences/ Privileges/ Bedtimes pg. 13 11. Time Out Policy pg. 14 12. Physical Restraint Policy pg. 15 13. Search Procedures pg. 16 14. Clothing and other Personal Items 16 15. Compliant/Grievance Procedure pg. 17 16. Client/Parent Grievance Policy pg. 18 Child and Family Services of New Bedford Community Based Acute Treatment 2

Community Based Acute Treatment Statement of Purpose 1. Definition The Community Based Acute Treatment provides children and adolescents a level of care to divert from admission to an inpatient psychiatric hospital. The CBAT is a voluntary treatment program to which a client cannot be placed on a section 12 or committed, as is the case with a psychiatric inpatient hospital. The CBAT provides a 24 hour therapeutic living environment with moderate levels of supervision, structure, restriction and intensity of service. The CBAT is for children and adolescents who need a protected and structured environment and who have sufficient intellectual capacity to respond to active treatment. The CBAT is less restrictive than inpatient treatment and more restrictive than partial hospitalization or outpatient treatment. The CBAT provides comprehensive treatment including a therapeutic milieu, multi-disciplinary services and multi-modal therapies. The CBAT is a community-based program that uses community resources for purposeful therapeutic and recreational activities, as well as the community resources for treatment and referral upon discharge. All clients admitted to the CBAT have an individualized treatment plan that clearly states the goals necessary for discharge and the necessary involvement of family/guardians, state agencies and provider agencies to accomplish the treatment goals. The average length of stay at the CBAT is 7-10 days, but a client can be discharged once the treatment plan goals are met. 2. Description The CBAT serves children and adolescents, ages 4-18. It has nine single bedrooms, three bathrooms, a kitchen, dining area, living room, and classroom/recreational room visiting/waiting room and two offices. The CBAT also has an outside recreational area and a program vehicle for recreational/educational activities in the community or to assist with a client appointment. The staff to client ratio during waking hours is 1/3 (three staff to nine clients), and during overnight hours (11 pm- 7am) there are two staff to nine clients. The CBAT has a structured treatment program that includes an educational curriculum, activity/recreational groups, clinical group therapy, sessions with child psychiatrist and clinician/social worker and family/provider meetings. 3. Eligibility Criteria Children and adolescents across the state of Massachusetts can be served by Child and Family Services of New Bedford, CBAT. Referrals to the CBAT come from an Emergency Services Program (ESP) of which there are 28 in Massachusetts. ESP s are open 24 hours/day, seven days a weeks and provide an emergency evaluation to a client by a masters level clinician to determine what level of care a client needs (inpatient, CBAT, partial hospitalization, outpatient services, etc.) Once a clinician justifies that a CBAT level of care is necessary; they attempt to get approval from the client s insurance company and then find the closest program in the area for the client. 3

Children and adolescents would meet admission criteria for the CBAT if all of the following were present: The client presents with symptomatology, consistent with formal mental health diagnosis (DSM-IV-TR) which requires and will respond to intensive, structured intervention. The client presents with significant impairment of social, interpersonal, and/or educational/vocational functioning requiring multi-disciplinary treatment interventions of moderate intensity in a structured 24 hour therapeutic environment. The client has sufficient intellectual capacity to respond to active psychological treatment The client is able to function with some independence and participate in community-based activities structured to develop skills for functioning outside of a controlled psychiatric environment. Children and adolescents would not meet admission criteria for the ARTP and require inpatient level of care if any of the following were present: Client has an intense psychiatric condition (acute psychosis) Client is actively suicidal and/or homicidal Client is medically unstable Client is chemically dependent on alcohol or substances and requires detoxification. Client has primary diagnosis of Mental Retardation or Autism 4

General Expectations Regarding Client Participation in Program 1. Attend all group therapy sessions 5x/week 2. Participate in the CBAT educational program 5x/week 3. Complete all daily chore assignments 4. Participate in all recreation and activity groups 5. Complete activities of daily living 6. Meet with social worker when requested 7. Speak politely and appropriately to all adult/peers 8. Try to eat all meals 9. Take all prescribed medications 5

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT CBAT CHORE LIST YOUNGER OLDER Load Dishwasher Unload Dishwasher Wipe Tables Breakfast Lunch Dinner Set Tables Breakfast Lunch Dinner Dry Dishes Put Away Dishes Sweep Floor Laundry Other Wash Large Dishes Put Away Dishes Sweep Floor Laundry Other 6

Visitation, Mail and Telephone Policies In Collaboration with the parent/guardian and or state agencies, a list of individuals approved for contact with the child will be identified. Visits with family and service representatives will be encouraged based on clinical appropriateness. Visiting hours will be from 10 am to 7 pm daily. Family and services representatives are encouraged to call ahead to schedule visits to prevent the client from having excessive interruptions in treatment. Visits will be an hour long unless approved by the clinical team. Visits will take place in the visitor s room, which will be monitored by staff via security cameras. As necessary staff will remain present for visits (i.e. court ordered). The clinical team will determine if any person(s) should be denied the opportunity to visit or have contact based on whether or not a safety risk to staff or clients is posed. Efforts to reintegrate the child with the family may include passes with family members as appropriate. These passes will be planned in advance with clear expectations of return time, responsible person and action to be taken if child fails to return. In the event that the client receives mail at the program it may be opened to determine if the sender is identified on the approved contact list or if there is concern of inappropriate person(s) contacting the resident. Inappropriate mail will be returned to the parent/guardians. Clients will be permitted to use the phone two times per day for 10-15 minutes each time. Staff will monitor phone calls and assist with dialing. The program will pay for long distance calls to parents or guardians. Receipt of incoming calls from parent or guardians will be permitted daily. Calling times are from 11:00 am to 1:00 pm and 4:00 pm to 7:00 pm daily. Phone contact outside of these hours will be permitted on an as needed basis. Parents or Guardians should be aware that the CBAT phones are programmed to ring into the program between the hours of 5 pm and 8 am. From 8 am to 5 pm, the phones are answered by a receptionist who is not on the unit. This being the case, if you call between the hours of 8 am and 5 pm, make sure you give the full name of the CBAT resident that you wish to speak to and let the receptionist know that you are trying to reach this individual in the CBAT. I would ask that parents or guardians be patient if they are calling and not getting a quick response. Outside activities are a large part of the daily schedule particularly during the summer months, and it is difficult for staff to hear the pages/phones ringing when the activity is boisterous. 7

Policy: Food on the unit Clients at the CBAT can not bring their own food onto the unit unless there is enough for all clients to have some. This is necessary to prevent disruptions to the milieu. Other clients sometimes get upset when they see other clients eating food which is not available to them to eat. If parents, guardians, or friends of client want to bring in food for client it must be eaten during the visit. The only exception is when there is enough food for all of the clients at the CBAT to have some. The CBAT goes food shopping on a biweekly basis and buys kid friendly food. Alternatives are offered at all meals to accommodate clients specific likes and dislikes. If any parents, guardians, or friends of CBAT clients have questions about this policy, please refer to the program coordinator with your questions and/ or comments. 8

CBAT Milieu Behavior Program Philosophy The CBAT Milieu behavior program is designed for children and adolescents from ages four through seventeen years. The principal goal of the program is twofold. First, the program provides a framework for a structured environment that allows children to practice developmentally appropriate and subsequent social skills with support from staff. Secondly, the program teaches children skills necessary to monitor and regulate individual behavior within a variety of settings. The model offers regular positive reinforcement for specific tasks, which parallel healthy child development. Each child is given feedback for participation in therapy groups, recreational activities, responsibility tasks, and hygiene. Each child is offered individualized treatment goals and instruction for skill development where significant deficiencies exist. The Point Sheet The point sheet serves as a record of the child s behavior and keeps track of the client s current level. The staff members complete the point sheet at an assigned pointing time. This serves as a rein forcer for the client s appropriate behavior, where the privileges are provided according to the client s points and level. 9

Child and Family Services of New Bedford Community Based Acute Treatment Weekly Point Chart Client Name: Client # Client Age: Week of: Clinician: POINT SCALE: 0 2 7:00 am-lunch MON TUES WEDS THURS FRI SAT SUN COMMENTS Adult Interactions Peer Interactions Response to Intervention Follow Routine Treatment Goals Point Total Level Achieved Staff Initials Lunch 3:00 MON TUES WEDS THURS FRI SAT SUN COMMENTS Adult Interactions Peer Interactions Response to Intervention Follow Routine Treatment Goals Point Total Level Achieved Staff Initials 3:00 - Dinner MON TUES WEDS THURS FRI SAT SUN COMMENTS Adult Interactions Peer Interactions Response to Intervention Follow Routine Treatment Goals Point Total Level Achieved Staff Initials Dinner Bedtime MON TUES WEDS THURS FRI SAT SUN COMMENTS Adult Interactions Peer Interactions Response to Intervention Follow Routine Treatment Goals Point Total Level Achieved Staff Initials Bedtime 7:00 am MON TUES WEDS THURS FRI SAT SUN COMMENTS Adult Interactions Peer Interactions Response to Intervention Follow Routine Treatment Goals Point Total Level Achieved Staff Initials Treatment Goals 1. 2. 3. 10

Child and Family Services of New Bedford Community Based Acute Treatment Pointing Categories Each pointing period has five categories of behavior to which behavioral counselors assign point (0, 1 or 2), depending on the amount of success a client has had with each category. These include: Adult Interactions, Peer Interactions, Response to Intervention, Follow Routine, and Treatment Goals. Adult Interactions: This refers to the client s general response to staff and adults in terms of demeanor, mood, and tone, level of cooperation with prompts or direction. Peer Interactions: This refers to the client s interactions with other client s on the unit. Ability to get along, engage in age appropriate activities, problem solve. Also included is the client s ability to avoid instigating others and not become involved in other s concerns. Response to Intervention: This refers to a client s willingness to participate in counseling (individual and group); his/her response to limits; willingness to process after time out or physical intervention; medication compliance. Follow Routine: This refers to a client s ability to follow the daily schedule and routine. The client is able to complete tasks in a timely manner with appropriate level of involvement from staff. The client is able to transition from activity to activity without significant difficulty. Treatment Goals: This refers to the work the client is doing in the milieu related to specific treatment goals. These might include anger management, appropriate peer interactions, verbal expression of emotion etc. 11

Child and Family Services of New Bedford Community Based Acute Treatment Level Infractions Level 2 Swearing Sexual comments/gestures Spitting in the environment Property destruction (minor) Horseplay Breaking another client s boundaries Escort (non-resisting) Out of location Splitting Staff Drug References Low Points (6 & under) Not doing homework Level 1 Restraint Resisting an escort Self-abusive behavior Urinating anywhere other than bathroom Assaultive behavior Property damage (major) In another client s room (especially bedtime) Spitting at staff or clients Spreading any biohazard Fire setting Refusing or horseplay with medications Runaway attempt Not informing staff when urinated the bed Refusing School Passing Personal Information Passing Notes Stealing Out of Location These infractions should be used as guidelines to determine what behavior problems warrant level 1 and which warrant level 2. Leads need to be notified of a level drop immediately. This list is not all-inclusive and issues may arise that are not stated above. Leads on shift should assist staff in making the determination about which level (1 or 2) would be assigned, depending on the severity of the behavior. Once a client is level dropped, he/she will remain on that level for a designated number of pointing periods. There are five pointing periods in a day (see Point Chart). The number of periods each client will be required to earn to attain a certain level will generally be based on age: Ages four to seven must earn one period to advance to the next; ages 8-12 must earn three periods; and ages 13-18 must earn five periods. Exceptions to these designations may occur if a client is considerably limited in his/her capacity to be successful at his/her age appropriate level. This can be determined at intake or may be adjusted at any point during his/her admission. Clients must earn a minimum of seven points to earn off level one and a minimum eight points to earn off level two. 12

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT Level Consequences/ Privileges Level 1 No electronics (television, video games, radio, etc.) Restricted from being in living room with the group Limited playtime outside with group Limited interactions with peers One hour early bed No field trips or off grounds activities Level 2 May watch television No video games Limited use of electronics Eligibility for off grounds determined by treatment team Half hour early bed Level 3 Achieve latest bedtime Use of all electronics May participate in any off grounds activities May be involved in all activities offered on the unit Bedtime Ages 4-6 Ages 7-9 Ages 1-12 Ages 13-17 Level 1 7:00 8:00 8:30 9:00 Level 2 7:30 8:30 9:00 9:30 Level 3 8:00 9:00 9:30 10:00 13

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT TIME OUT A time-out is time away for a brief period from the activity in order to regain control. Usually a time-out is necessary when there is too much stimulation and the client is having difficulty maintaining appropriate behavior (not respecting others, swearing, etc.). A regular time-out is from 2-10 minutes, usually away from the group in the same room or in the adjacent hallway or room. Sometimes the entire group of clients is taken out of the room so one client can remain and take a time-out. If difficulties maintaining appropriate behavior continue, there is an unlocked time-out room and then the situation would need to be discussed with a psychiatrist and clinician. A client can also choose to take a time-out on their own, especially if they are feeling that they might loose control of their behavior or if they feel uncomfortable or unsafe.. ASK STAFF AND THEY WILL ASSIST YOU!!!!! 14

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT PHYSICAL RESTRAINT The CBAT uses Crisis Prevention Institute (CPI) as a model for physical restraint. CPI is non-violent crisis intervention, which is a safe, non-harmful behavior management system, designed to help staff provide for the best possible care and welfare of assault, disruptive or out of control clients. If any client is presenting to be unsafe to themselves or others, they will be physically held by staff to keep client and others safe. A client will be physically held until they are calm and in control. Most physical holds last under 20 minutes. Physical holds beyond 20 minutes are rare and if this were to occur, the psychiatrist and clinician would be contacted for further recommendations/planning/orders. 15

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT Search Procedures Upon admission all residents possessions and pockets will be searched and inventoried by unit staff. The resident and/or parent/guardian will be present during the inventory of his/her belongings. Only when there is reasonable belief that dangerous/illegal items are present and when the administrator has been consulted will a resident be asked to disrobe. The resident will be asked to take off their own clothes, except for undergarments, in the presence of two same sex staff (at least one licensed and without staff touching the resident s body), in a private area. If a resident refuses to comply with the search, parents or police will be asked to assist with process to ensure safety of resident and unit. Clothing and Personal Belongings Due to recent reports warning of the close-to-epidemic status of several parasitic insects, especially in temporary residential settings, CBAT has increased its precautionary measures to insure the health, comfort, and safety of all clients and staff, and to protect all from exposure and spread of these insects, both to and from CBAT. Upon admission, your child s bags will be marked and placed in a secure area until the contents can be washed and/or disinfected. Any items that cannot be safely processed will remain in the secure area away from the CBAT unit until either the family can take it home or the child is discharged. Your child s clothing, including those clothes they wear to our unit, will be washed shortly after admission, then, every item will be inventoried. The children will be supplied with comforters, blankets, and pillows. We no longer allow those items to be brought from home. Stuffed animals, dolls, etc, will not be allowed unless than can be washed along with the child s clothing. Due to the limited storage available, only 3-5 days of clothing will be allowed. 16

CHILD AND FAMILY SERVICES OF NEW BEDFORD COMMUNITY BASED ACUTE TREATMENT Grievance Procedure There are no limits on the length of time, which can elapse after an incident or concern is noted and before the complaint is filed. A complaint can be made verbally to the worker and/or worker s supervisor with a request for a meeting to attempt to resolve the issue. If issue is unable to be resolved, a written complaint can be filed with the worker s supervisor assisting with the writing for clients/parents who have difficulty writing. The complaint would be submitted to the program or unit manager and copies will be forwarded to the site director. Within ten days of receipt of request, the unit manager will meet with grieving party and the supervisor and send a written evaluation of the grievance and its merit to the client/parent, the worker, his/her supervisor and the site director. The executive director will maintain records of complaints and decisions. 17

Client/Parent Grievance Procedure and Policy I. It is the policy of the Board of Directors of the Agency to provide a viable grievance policy available to the clients, and the parents of minor children, served by the Agency. The board feels that whether the Agency s services are voluntarily requested or involuntarily prescribed, the delivery of services should be humanistic, understanding and highly professional. II. Expectation of prior efforts to resolve issues between the client/parent and the worker. It is the expectation of the Board, and a requirement of access to the following grievance procedure, that if at al possible, serious efforts be made between the worker and the client/parent, perhaps with the presence of the worker s supervisor, to resolve the issues(s) at hand. At the first such meeting a copy of this Client/Parent/Parent Grievance Procedure Policy must be given to the grieving party. III. Initiation of the grievance procedure. 3.1 Within 10 working days of the failed effort to resolve the issue(s) pursuant to paragraph II above, the client/parent should submit, in writing, a request to meet with the program or unit manager, stating the essential facts and reason for the complaint or grievance. 3.2 Upon receipt of the request, the program or unit manager will forward a copy thereof to the Director of Professional Services, or Director of the Clinic. Within 10 working days from receipt of the request, the program or unit manager will meet with the grieving party and the supervisor of the individual involved, as well as any other relevant persons. 3.3 Within 10 working days of the meeting held pursuant to section 3.2 the manager will send a written evaluation of the grievance and its merit to the client/parent, the worker, his or her supervisor, and the Director of Professional Services or Clinic Director. 3.4 If the client/parent remains dissatisfied, he or she may request a meeting with the Director of Professional Services or director of the Clinic, by requesting, in writing, within 10 working days of receipt of the written evaluation pursuant to section 3.3 above. Such meetings will be scheduled within 10 working days of receipt of the request. 3.5 Within 10 working days of the meeting pursuant to section 3.4 hereof, the Director of Professional Services or Clinic Director shall send a written evaluation of the accuracy and adequacy of the previous evaluation by the program or unit manager to the grieving party, the worker, the supervisor and the Executive Director. 3.6 The decision of the Director of Professional Services is final. If the client/parent remains dissatisfied, he or she should be instructed to utilize the appropriate grievance procedure of the Department of Social Services and/or other appropriate standard setting or licensing agencies. 18