Methodology

Rio Salado BHS will meet its stated goals and objectives by providing quality Outpatient Behavioral Health Treatment Services that include: Medication services, individual, group, family, crisis, and substance abuse and by complying with all requirements specified in A.A.C. Title 9 Chapter 20. : Outpatient Clinic R9-20-301. Employees must be at least 21 years of age, have the education and experience as the required of R9-20-204 as written in the agency job descriptions for Behavioral Health Para-professional, Behavioral Health Technician and Behavioral Health Professional. The Executive Director or his designee shall ensure that a behavioral health paraprofessional, behavioral health technician or behavioral health professional has the skills and knowledge necessary to perform the duties consistent with the job description.

The Agency is authorized to provide Outpatient Counseling and other services that include: Counseling, Screening, Assessment, DUI Screening, DUI Education, DUI Treatment, Medication Services, Misdemeanor Domestic Violence Offender Treatment services and observational assessments as indicated in the service plans. Clients that are not served immediately will be placed on a waiting list and called as soon as service openings are available, or they may be referred to another agency that has services available to meet their needs.

Psychotherapy and counseling services are provided for a range of behavioral health and substance abuse issues that include: DUI, individual, group, family, emergency and crisis counseling, medication services, as necessary. The counseling is provided once a week for 1 hour, but may be provided every 2 weeks as the clients progress in the treatment program. Groups are held 2 times a week or more often if demand requires it. 40 hours of drug, alcohol and mental health counseling are available per week as needed.

In order to ensure the provision of services to clients with special needs, the Rio outpatient program will serve adults, adolescents and children populations with age ranges from pre-school through elderly. Rio will specialize in individualized multi-modal treatment for individuals suffering from anxiety conditions, depression, rage/anger, grief/loss issues, low self- esteem, sexual/physical abuse, stress, trauma, CD and addictions.

During the course of on-going treatment, the treatment of each client will be re-assessed in order to modify treatment and/or to transfer the client to another agency based on the clients’ special needs. A 24 hour emergency phone service is available after business hours and on week-ends. Chemically dependent clients will be viewed against the background of family of origin and within the context of present family disturbances/dysfunction. SMI clients will be referred to other agencies that provide individual or group counseling to enhance living skills, build self esteem and increase self confidence. Clients will be encouraged to utilize support and relevant self help groups. Rio staff will work closely with referring case managers and referring staff to coordinate treatment plans and monitor client progress.

Home based counseling services will be provided if it is determined that the client requires intervention and there is a need for behavioral health treatment services which are more intensive than traditional outpatient services. Services will be provided, at any given time, based upon the acuity of the family system and condition.

10 hours alcohol, 10 hours drug, 10 hours mental health individual and 10 hours family counseling, at a minimum will be available and provided, as the need dictates, from: 8:00 a.m. to 5:00 p.m. M-F.
Weekend and evening services are by appointment. Length of sessions may vary from 1-2 hours each, depending on individual client needs.
Clients who need emergency crisis or special services for behavioral health issues outside of the normal working hours are referred to the appropriate 24 hour emergency crisis agency or 24 hour Information and referral service .
 
Program criteria for services that include; admitting/re-admitting placing clients on a waiting list, referrals to other agencies, client discharges, transfer and declining to provide behavioral health services or treatment to an individual are as follows:

Admission/Discharge/Readmission Criteria It is the policy of Rio to standardize admission procedures to the clients who are deemed appropriate for program design and service. It should be understood that the primary purpose of this service is outpatient counseling. Those client requiring extensive medical or hospitalization services are not appropriate for admission.

Although all services are available to the general population, the principle target population is one which presents with complicated substance abuse, psychiatric problems and personal emotional growth needs.

Intake procedures will be performed by Behavioral Health Professionals. Intake will be in compliance with the Arizona Department of Health Services rules R9-20-209. Procedure:

The outpatient counseling program shall utilize a standardized procedure in addressing: individual differences by a review of available information, comprehensive psychosocial history and a decision on appropriateness for in-house treatment or formal transfer to an appropriate treatment resource with follow-up. Admission will either be immediate, may be put on a waiting list or denied services with immediate transfer to a more appropriate agency system.
Clients on a waiting list will be served on a first come basis or may be referred to other agencies for services.

All outpatient evaluations shall encompass the following:

A. All evaluations shall be thorough, complete and comprehensively address the total physical, psychiatric and psychological needs of each patient Utilizing operational diagnostic criteria in the DSM-IV.
B. Each client shall be evaluated in a private room in an environment which is the least restrictive.
C. All subsequent interviews or consultations will also be conducted in a private room.
D. Records will be maintained in accordance with the assessment of compliance needs of the Department of Health Services/OBHL.
Readmission Procedure:

Clients who voluntarily withdraw from treatment or who are discharged for reasons such as loss of contact or need for other services may immediately reapply for admission at any time to the program. Clients who are terminated for lack of cooperation or inappropriate behaviors may reapply after a ninety (90) day period from the date of discharge. Clients manifesting abusive and/or violent behavior toward any center staff or clients may be banned from readmission for cause.
Discharge and Transfer Criteria:
It is the policy of Rio that all clients will be advised of the reason for termination of services and the opportunities, if any available for readmission.
Clients in the outpatient program may be discharged for any of the following reasons: 1. Client has resolved problems.
2. Service terminated for transfer to a different service because of new emerging needs.
3. Service continued but at another source within Rio. Client may also be transferred to another
agency for potential services which are beyond the range of services provided by Rio. Transfer necessity will be determined on the basis of each client's individual needs. AHCCCS clients will be transferred back to the case management source.
4. Service terminated by sending to a different service because of inability to utilize the service outlined in the treatment plan.
5. Lack of cooperation from client (unresponsive, consistent failure to keep appointment, continued failure to complete tasks outlined ill the treatment plan) .
6. Service terminated.
7. Loss of contact for thirty (30) consecutive days.
8. Client dissatisfaction -voluntary termination.
9. Client successfully completed treatment plan.
There shall be a discharge, termination or transfer summary included in all client records.
In the event of client dissatisfaction, complaints, refusal of admission and/or termination of
services against a client's wishes, the client will be advised of the grievance procedure. Client will be advised of the grievance procedure at the time of discharge. Clients shall also be informed that they may transfer to another agency of their choice. Transfer of clients will be coordinated through the appropriate behavioral health network.
Decision of discharge is based on the progress of the client toward the treatment plan and/or the determination to discontinue treatment for transfer to another provider.

State insurance and private insurance clients may be discharged based on the insurance companies' decision to terminate coverage at which time an appropriate sliding scale fee may be offered to the client, if appropriate. All discharges will be reviewed by the Administrator and/or his designee during monthly client staffing. Documentation will be maintained in client records.
All clients will be advised of discharge and informed of their client rights; grievance reviewed and appropriate transfer recommended. Clients will be advised of their fees due to Rio at the time of the intake session and requested to sign the client fee form indicating a full understanding of the fee structure payable or billed by Rio. Clients who choose not to continue receiving services or that will be transferred from Rio, and have paid any fees, will be entitled to a pro-rated refund.

Rio will not discharge or discriminate in any way against any patient by whom, or on whose behalf, a complaint has been submitted to the Arizona Department of Health Services/Office of Behavioral Health Licensure or who has participated in a complaint investigation process.
Agency facilities have Spanish speaking staff available for Spanish speaking clients. Persons that speak another language will be provided with an interpreter that speaks their specific language. The Rio Salado Behavioral Health Systems, Inc. facility located at 1308 W. Camelback Road in Phoenix, AZ, is handicap accessible. There is a wheelchair ramp for persons in a wheelchair or walker to enter the building. The hallways and office doors are wide enough to accommodate these persons. The bathroom is equipped with handicap grab bars to accommodate persons who are disabled. Individuals with a sensory impairment or other disability will be provided with a sign language interpreter or referred to an agency with staff qualified to provide specialized services. Skilled consultants may also be hired for clients with sensory impairments, if needed.
A client may be referred to another agency if it is determined that: the client needs a behavioral health and/or medical service need that the agency is not authorized to provide, agency staff are not qualified or trained to provide, the services needed are more intensive than the agency can provide, there is an agency closer to the clients home that can provide the services that the client needs, and if the client requests services from an agency that can meet their specific cultural needs.

A client may be denied outpatient services if the client is: under the influence of drugs or alcohol, withdrawing from drugs or alcohol, is in acute mental distress and needs an inpatient program. In these situations outpatient staff will contact appropriate agencies that can provide more intensive care and best meet the clients immediate and long term needs.

Rio  operates as an outpatient program and does not operate a residential or inpatient program where clients are more likely to have outbursts or become unmanageable. However, in situations where a client may become angry or unruly during counseling, attempts will be made to calm down the client by not re-acting in a defensive stance, ensuring the client that they are in a safe setting, offering them drink or food to calm them down, discuss the issue that has caused the situation with the supervisor and client. If it is determined that the client believes that the staff person 'working with him or her is causing the provocation, another staff person may be called to work with the client. Should all attempts fail and staff is not able to deescalate the situation, the Magellan/Southwest Network Rapid Response Team or 911 may be called for assistance. Agency staff are not trained or allowed to attempt client restraint.