Alaska Out-of-State Residental Program Treatment Facility Contact

Transcription

Qualis Health Alaska Mental Health
Out-of-State Residential Program Treatment Center Contact Information 2016
Facility/Provider Name
(Click on hyperlink to go to facility profile)
City
State
Contact Phone
Alt. Phone
Website
(Click on the hyperlink for more information)
www.acadiahealthcare.com
ACADIA MONTANA
BUTTE
MT
406-494-4183
BENCHMARK BEHAVIORAL HEALTH
CALO
(CHANGE ACADEMY AT LAKE OF THE OZARKS)
WOODS CROSS
UT
801-299-5319
LAKE OZARK
MO
573-7467362
CENTER FOR CHANGE
OREM
UT
888-224-8250
801-224-8255
www.centerforchange.com
DESERT HILLS
ALBUQUERQUE
NM
877-473-7194
505-352-3100
http://www.deserthills-nm.com
DEVEREUX CLEO WALLACE
WESTMINSTER
CO
800-456-2536
800-456-2536
www.cleowallace.org
DEVEREUX TEXAS TREATMENT NETWORK
LEAGUE CITY
TX
800-373-0011
281-335-1000
www.devereuxtx.org
JASPER MOUNTAIN
JASPER
OR
541-747-1235
http://www.jaspermountain.org/
LAKEMARY CENTER INC
PAOLA
KS
913-557-4000
http://www.lakemaryctr.org
MERIDELL ACHIEVEMENT CENTER (NEED UPDATE)
LIBERTY HILL
TX
800-366-8656
512-528-2100
www.meridell.com/
PROVO CANYON
PROVO
UT
800-848-9819
801-229-1032
www.provocanyon.com
SAN MARCOS TREATMENT CENTER (NEED UPDATE)
SAN MARCOS
TX
800-251-0059
512-557-0034
www.sanmarcostc.com
IDAHO FALLS
ID
800-209-8405
208-227-2159
http://tetonpeaks.com/
TEXAS NEUROREHAB CENTER
AUSTIN
TX
800-252-4835
512-444-4835
www.texasneurorehab.com
YELLOWSTONE BOYS&GIRLS RANCH
BILLINGS
MT
800-726-6755
406-655-2106
www.ybgr.org
TETON PEAKS
FORMERLY EASTERN IDAHO REGIONAL MEDICAL
801-299-5300
http://www.bbhsnet.com/
http://caloteens.com/
Acadia Montana February 22, 2016
Residential Treatment Services PRTF Information Inventory January 2016
This form was first introduced in 2013, and has been modified in this (2016) version. All Psychiatric Residential Treatment Facilities (PRTF) that contract with
Alaska Medicaid are required to complete this Section A. Facilities that indicate Autism Spectrum Disorder (ASD) as a specialty are also required to complete
Section B. The form will be posted on a website in order to be available to families, providers and guardians who are considering placement in a PRTF for a
child. If you facility has more than one Alaska Medicaid provider number, please complete one form for each. Use the tab key to move to each new section.
Please complete this form and return via email to: akbehavioralhealth@qualishealth.org
Section A
FACILITY INFORMATION
Name and title of person completing this form
Date completed
Contact number
Site/Cottage/Facility Name
Address
Mark Ryan, Clinical Director
February 22, 2016
800-477-1067, Ext. 6364
Acadia Montana
55 Basin Creek Road, Butte, MT 59701
GENERAL OVERVIEW
Accreditation Body
Joint Commission; Northwest Accreditation Commission, Licensed by MT Department of Public Health &
Human Services
Indicate which gender(s) you serve and the applicable age range and number of licensed beds below
Age Range
# of Licensed Beds
5-18
We maintain a 24 bed dual occupancy co-ed unit for
☒Males
children ages 5 to 12; a 14 bed co-ed single bedroom unit
for pre-adolescents 10 to 15 yearsold; a 52 bed boys’ dual
occupancy adolescent unit; and a separate 18 bed girls’
dual occupancy unit for a total of 105 beds.
Click here to type
5-18
☒Females
Click here to type
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☐Other
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Describe your client:staff ratio and how it is calculated for the following:
Nursing
Milieu
Comments
Click here to type
Day
One nurse on each unit
Adolescent Unit 1:5; Preadolescent Unit 1:4.5;
Children’s Unit 1:4.5
Click here to type
Evening One nurse on each unit
Adolescent Unit 1:5; Preadolescent Unit 1:4.5;
Children’s Unit 1:4.5
Click here to type
Night
There are 2-3 nurses for the Adolescent Unit 1:12; Prefacility based on census
adolescent Unit 1:12;
Children’s Unit 1:12
Does your facility have requirements regarding IQ?
If yes, please explain.
We generally require a full scale IQ of 60 – clients with an IQ between 50-60
☒ Yes ☐ No
may be deemed appropriate if cognitive capacity is documented and milieu
can address needs.
What is the average length of stay for
For AK Medicaid Recipients? Other State’s Medicaid
Tricare/Other Insured?
the facility overall?
Nine months
Recipients?
Tricare 100 days: other
commercial insuers 60-90
183.6 was ALS for 2015
Six months to a year
days.
Are you anticipating change to your program?
If yes, please describe.
We added 16 beds which serve our adolescent mal population
☐ Yes ☒ No
Is the facility locked or unlocked?
☒ Locked ☐ Unlocked
Is the facility secure?
☒ Yes ☐ No
Please describe your facility’s approach to identifying and
Acadia Montana has and will continue to work with referral
treating children and youth with FASD. What kind of training do
sources to identify specific needs and resources available to
your staff receive (include milieu as well as clinical staff).
meet those needs. We have worked with outside providers to
make genetic testing and QEEG reviews available to our clients
and internally we offer educational groups in substance abuse
issues offered through a licensed addition counselor.
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treating children and youth with extensive trauma histories.
What kind of training do your staff receive (include milieu as well
as clinical). Identify your trauma treatment approach and
describe the approach regarding staff training and Evidence
Based Practices.
All therapists have received on-line training and certification in
the use of Trauma Focused Cognitive Behavioral Therapy; the
majority have also attended a three day seminar on TFCBT use,
process and specific application. Mark Ryan, Clinical Director has
attended additional trauma training and has provided in-house
training to mental health staff, nurses, teachers and other staff.
Specific therapeutic approaches include: relaxation visualization,
mindfulness and components of art and play therapy as well as
cognitive approaches to treatment. These same approaches
would apply to Austism Spectrum Disorders and
Intellectual/Developmental Disability issues that arise with
residents. Acadia Montana also utilized the Child Behavior
Checklist (“CBCL”) on admission and again before discharge to
access the client’s competencies and behavioral/emotional
problems at admission and then at discharge.
Please describe your facility’s approach to secondary trauma in
Our program director attended training presented in Alaska and
staff (for example, stress resulting from helping or wanting to
on return implemented changes in lounge for staff, we train on
help a traumatized or suffering person).
trauma and trauma informed care, we review secondary trauma
signs in regular meetings with staff. Starting last year, we are
training our staff to be aware of their own ACES scores and how
that effects them.
Specialty Populations
Please check all specialty populations this
What training does staff receive for this population?
facility serves.
Medical Director has received advanced training in autism
☒ Autism Spectrum Disorders (High
disorders; experience includes serving for fifteen years as
Functioning and Asperger’s) NOTE: Facilities
medical director of a children’s hospital with a 20 bed
with this specialty must complete Section B
acute and 64 bed residential facility for children and
adolescents before becoming Medical Director at Acadia
Montana several years ago.
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☐ Autism Spectrum Disorders (severe/low
functioning) NOTE: Facilities with this specialty
must complete Section B
Sexualized behaviors:
☐ Sexually reactive (e.g. response to trauma)
☐ Sexually maladaptive (e.g. resulting from
cognitive or neuro-behavioral issues)
☐ Sexually offending: ☐ adjudicated/ ☐ nonadjudicated
Excluded Populations
Click here to type
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☐ Eating Disorder
Click here to type
☐ Other Click here to type
Click here to type
Please check all populations excluded from this facility.
☐ Sexually reactive (e.g. response ☐ Sexually maladaptive (e.g.
to trauma)
resulting from cognitive or neurobehavioral issues)
☒ Eating Disorder
☐ Autism Spectrum Disorders
(severe/low functioning)
☐ Suicidal ideation/attempts
☒ Other: Click here to type
☐ Psychosis
(high functioning/Asperger’s)
☐ Elopement Risk
☐ Other: Click here to type
Sexually offending:
☐ adjudicated/ ☐ nonadjudicated
☐ Physical Aggression
☐ Self-injurious behaviors
☐ Fire setting
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Comments: Acadia Montana does not maintain a treatment program for sexual offenders and will deny
admission for adjucated sexual offenders; we do work with children and adolescents who are sexually
reactive but would have to determine before admission that a referral would not be a danger to younger
peers. Additionally, we do not maintain a program for adolescents with a primary Conduct Disorder
diagnosis, although we do work with a number of clients that have displayed aggressive behaviors in
community settings. We do not admit cients with primary Eating Disorder.
Acadia Montana utilizes the Mandt System, which is a comprehensive, integrated approach to
What type of behavior management
preventing, de-escalating, and if necessary, interviening when the behavior of an individual
program do you use? Please name the
poses
a threat to harm to themselves and/or others. The focus of the Mandt System is on
program and describe the training.
building relationships between all the stakeholders in human service settings in order to
facilitate the development of an organizational culture that provides the emotional,
psychological, and physical safety needed in order to teach new behaviors to replace the
behaviors that are labeled challenging.
The Mandt System integrates knowledge about the neurobiological impact of childhood
trauma with the principles of positive behavior support and provides a framework that
empowers service providers to do their work in a way that minimizes the use of coercion in
behavior change methodologies.
All staff members go through an orientation training that includes a minimum of two days of
Mandt training; staff who work directly with the residents go through an additional day in
orientation with specific focus on use of physical holds. All staff are re-trained annually on the
Mandt System with one day training session. Any staff member may be required to re-take the
Mandt orientation training or specific training on physical holds if deemed necessary by
program management.
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Do you do functional behavior
assessments? If so, please describe your
approach. If not, how do you assess the
function of behaviors in your populations?
List types of safety monitoring used (e.g.,
staff observation, video cameras).
How does the facility assure access to
appropriate medical and dental care?
Does the facility use timeout?
☒ Yes ☐ No
Acadia Montana reviews clinical data submitted by referral sources in evaluating a specific
client's fit with the milieu that client would be admitted to. Historical information on
behaviors, response to treatment would be reviewed during this period with interviews with
family menbers/guardian or service providers to develop an initial plan of treatment. Shortly
after admission, the Child Behavior Checklist would be given with results utilized to define
behaviors and expand upon the treatment plan. During a child's stay with us, behaviors are
monitored daily by unit staff, nurses, teachers, and therapists to measure advancement or lack
of advancement in meeting treatment plan goals. Various evaluations may be ordered during a
client's stay with us to better define and perhaps explain behaviors. Acadia Montana would
work with a client's treatment team to approve those evaluations.
Staff observation and interaction is our primary safety monitoring technique. However, we do
also operate video cameras throughout the facility in common hallways, cafeteria, courtyards
and play areas.
Our medical staff is comprised of a Child & Adolescent Psychiatrist, who is also a Pediatrician,
two Psychiatric Nurse Practitioners, a contracted general practice physician who works with
non-psychiatric health issues of our residents, that physician comes to our facility as needed.
Twenty-four hour a day nursing care. Additionally, we contract with speech and physical
therapists to provide services within the facility and refer residents out to professionals in the
Butte community for dental, vision or other health needs.
If Yes, under what conditions?
We utilize exclusionary and inclusionary
timeouts, either resident or staff directed.
Escalating behaviors (verbal, physical, or
emotional) can drive a decision to seek a
timepout option.
If Yes, what follow up steps are taken?
Resident debriefing is completed at
conclusion of timeout with discussion of
events leading to timeout and how coping
skills might be used in the future. Notes are
taken by staff member on debriefing and
made available t primary therapist for
possible future work or in modification of
treatment plan.
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Does the facility use seclusion?
☒ Yes ☐ No
Does the facility use restraints?
☒ Yes ☐ No
Physical
Seclusion is utilized if a resident is displaying
extremely dangerous behaviors, either through
self-harm or potential harm to others. Forms
of de-escalation have been attempted with the
resident and have failed to reduce the risk of
potential harm.
Report of all seclusions are completed by
mental health associates and unit nurse those reports are forwarded for review by
treatment team daily. Debriefing of resident
and mental health staff is completed on
events leading to seclusion with a review of
possible triggers or issues discovered during
the process. Debriefings are forwarded to
treatment team for review.
Physical restraints are initiated when a
significant safety issue exists for a resident.
Restraints are ordered or confirmed by the
unit nurse with a full report of staff and
residents involved, cause, duration, timing,
outcome and any indication of triggers or
recommended coping skills that could be
utilized to prevent any other like event. All
reports are reviewed by the treatment team
and management team for possible
modification of treatment plan for the
individual resident or possible change in
procedures for the unit, program or facility.
A comlete debriefing of the resident
involved, staff members and other residents
is completed for review by treatment and
management teams.
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How are facility staff trained regarding
seclusion and the use of restraint? Please
describe initial staff training as well as the
follow up training process.
All staff that interact on a continual basis with residents receive an initial week long training
before they can work with residents; that training includes three days on physical holds and
techniques for use of de-escalation. That initial training is reviewed with all staff annually on
the use of the Mandt System; staff can be required to take additional training if techniques
utilized fall short of expectations.
How frequently are individual and facility
seclusion and restraint data reviewed, and
by whom?
Individual
Individual seclusions and restraints are
reviewed daily during the work week ;
weekend seclusions and restraints are
reviewed during Monday morning meeting
session. Attendees include: facility CEO,
Medical Director, Clinical Director, Nursing
Director, Program Director, Charge Nurse,
School Principal, all therapists and the
Director of Business Development.
Patterns of seclusions and restraints are
reviewed during daily morning meetings with
special staffings for residents with multiple
occurances over a specific time period.
Additionally, Program Improvement
Committee reviews individual, unit, shift and
overall program data on a monthly basis to
determine possible areas for improvement in
our treament procedures or process.
Under what conditions and for what kind
of events do you report “incidents” to
Alaska Behavioral Health?
Individual
Facility
Incident reports are reviewed daily during the
work week; weekend seclusions and restraints
are reviewed during Monday morning
meeting session. Attendees include: facility
CEO, Medical Director, Clinical Director,
Nursing Director, Program Director, Charge
Nurse, School Principal, all therapists and the
Director of Business Development.
Facility
Patterns of seclusions and restraints are
reviewed during daily morning meetings with
special staffings for residents with multiple
occurances over a specific time period.
Additionally, Program Improvement
Committee reviews individual, unit, shift and
overall program data on a monthly basis to
determine possible areas for improvement in
our treament procedures or process.
Does your program use aggregate progress If Yes, please describe.
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data for overall quality improvement?
☒ Yes ☐ No
STRUCTURE AND SUPERVISION
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Would you characterize the level of
structure and supervision provided by your
program as low, moderate or high?
High
Describe how the level or intensity of
supervision may vary across youth.
Is the level of supervision based on
individual risk and/or therapeutic need?
☒ Yes ☐ No
What are the characteristics that would
promote or prevent pairing of recipients as
roommates?
What is the safety monitoring
policy/procedure for determining the
assignment of roommates?
Please explain your rating.
As a psychiatric residential treatment facility we maintain a high level of structure in
programming with a daily schedule of meals, school, individual and group sessions,
recreational activities with limited free time for residents. During waking hours line of sight
supervision is maintained with specific exclusions for use of rest rooms, showering, or changing
clothes which may be overridden if a resident is placed under specific precautions where the
resident is a danger to self or others.
All residents are under the same general approach to the level of structure and supervision,
but as indicated that level of structure may be intensified due to individual behaviors that pose
a safety danger to a resident, peers or staff. In that event, specific orders establishing
precautions for defined periods of time will be put into practice by medical personnel acting in
the best interst of the resident. Residents may also earn the right through positive behaviors
to participate in all scheduled outings including educational, recreational and social events that
are scheduled throughout the week at Acadia.
Please explain.
A base level of supervision is consistent for all residents; hightened supervision can be
determined as necessary due to individual behaviors that are causing concerns for safety of the
reident, peers or staff. Through positive behaviors and participation in school, individual and
group sessions, recreational and social activities residents can achieve access to all planned
activities both in the facility and through area outings.
Safety of residents is the primary consideration for all roommate pairings. Age, sex, history of
behaviors, level of emotional maturity, development of coping skills and abiltiy to utilize those
skills in a social setting all impact roommate pairing considerations. Residents may also
indicate a preference for roommate assignment and that preference will be taken into
consideration by program and therapeutic staff, but again assuring advance in therapeutic
goals, attaining a high level of safety and comfort of residents will be the primary determinant
for assingments.
Review of clinical history by medical, clinical and program staff is undertaken before
assignment of roomates. New residents are told to report any issues related to their roomates
to staff. Those reports are forwarded to nursing and therapeutic staff to determine if an issue
requiring either re-assignment of roomates or a no roomate order is required.
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What happens when characteristics of
concern come to light, and how is a
roommate change made owing to these
characteristics?
What safety monitoring practices are
applicable during the day? At night?
Any concerns by staff with peer interaction is brought to the attention of the unit nurse
initially; he or she has the authority to take immediate action to insure resident safety if a
significant issue exists. Resident's primary therapist and medical staff are informed on all such
incidents with modification the primary treatment plan for that child if those concerns are
impacting on-going behaviors and treatment. More immediate action can be taken if a safety
risk is noted with program staff and primary therapists involved in discussing why actions were
taken by staff with the effected residents.
Staff ineract with residents on a continual basis throughout the day, maintaining line of sight
contact through most daily activities. Residents are expected to attend school during week
days and participate in group activities throughout the day with unit staff as well as therapists,
nurses, teachers and other staff interacting with the residents. Video camers run twenty-four
hours a day in common areas. During sleeping hours staff are assigned to specific units and are
required to walk hallways and view residents in their beds every fifteen minutes throughout
the night; notes are maintained on all such reviews with timing noted for all room passes.
EDUCATION SERVICES
Please indicate what types of educational
☒ On Site School ☐ Day Treatment ☐ Outpatient Services
services the facility provides.
☐ Other: Click here to type ☐ Other: Click here to type
Comments: Acadia Montana has a K - 12 school program that is accredited by the Northwest Accreditation Commission (NWAC), a Division of
AdvancED, monitored for Special Education compliance by the Montana Office of Public Instruction, and recognized by NASET (National
Association of Special Education Teachers) as a school of Excellence.
Acadia Montana requests school records upon admission and will work with the home school
Please describe how you communicate
as requested by parent/guardian and/or school district . Special Education records are renewed
with school districts. How do you ensure
communication with home-based schools? or up-dated as required by law and as requested by parent/guardian and/or school district. A
resident's school progress is evaluated and documented every 28 days and is reported as
requested by parent/guardian and/or school disticts.Thirty (30) days before dischage (if
known) the school district is notified and a transition meeting is scheduled as desired by the
receiving district. Home-based school are treated the same.
Educational Accreditation
Northwest Accreditation Commission (NWAC), a Division of AdvancED
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Does your program accept school credits
from other schools or programs?
TREATMENT PLANNING AND REVIEW
Who participates in regular treatment
team meetings? Please check each regular
(at least monthly) participant in treatment
review/planning.
☒ Yes ☐ No
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☒Other Medical (please list): Physician, Nurse Practitioner assigned, Unit Nurse may
participate
☐ Physical Therapist
☐ Speech Therapist
☐ Occupational Therapist
☐ Dietitian
☒ Psychologist
☒ LCSW
☐ Behavior Analyst
☒ Other Clinician (name, credentials): Masters level therapists which may include:
LCPC, Art Therapist, Recreational Therapist or others shown in previous column
including Speech Therapist, Physical Therapist or Occupational Therapist if assigned.
☒ School Representative (name, role): Resident’s teacher may attend, school principal
may attend to discuss various aspects of treatment or discharge plan
☒ Milieu (name, role): Program Director or unit staff member may attend to be
involved in discussion of specific topics related to that resident.
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How does your program involve the family
in treatment, keep them informed of their
child’s progress, and prepare them for
step-down as part of the discharge
process?
How does your program identify/assess
the function of challenging behaviors?
How does your program measure progress
on treatment plan goals and objectives
(e.g., subjective report, phase/level
progress/specific data points)?
Family involvement in the treatment of their child is critical. Family for many of our residents
may mean extended family and in a number of cases may involve adoptive families or foster
placements but in the vast majority of situations these "family members" are critical to making
treatment successful. Family therapy is scheduled weekly and for many of our residents that
means telephone or Skype sessions with direct face to face sessions as often as possible.
Family members are given an initial schedule of weekly therapy sessions and then asked to tell
us what works for them; our therapists work with primary family members on a schedule of
sessions that works for all participants. We encourage family members to participate in
monthly treatment team meetings where treatment goal attainment or issues in achieving
those goals are discussed. Specific behaviors that are positively or negatively impacting goal
attainment are reviewed with a review of how those behaviors will impact the resident in their
home community.
Most, if not all residents display some form of challenging behavior. Each resident's behaviors
and history of interaction with treatment professionals is fairly well documented in order for
that child to be approved for placement in a psychiatric residential treatment facility. Various
assessments and evaluations are ordered and completed by medical, therapeutic and
educational staff, tools such as the Child and Adolescent Needs and Strengths-Mental Health
(CANS-MH) and Child Behavior Checklist are completed to better define issues and suggest
possible approaches to treatment. A full evaluation of medication management is undertaken
to gain a greater understanding of the impact of previously prescribed medications and
determine if suggestions for modification will be made. An individual treatment plan is
designed with defined and measurable goals and treatment is initiated.
Treatment plans are designed to have measurable and observable goals which can be assessed
over a period of time to determine if objectives are being attained. Level system progress is
one area that can give immedicate feedback on progress in attaining goals; ability to maintain
a high level can reflect positively on the ability to manage achievement and carry that over to
the home and community environment. Other measurements of success in treatment plans
can include educational achievement, particularily through the Woodcock-McGraw-Werder
Mini-Battery of Achievement Scores and measured achievement in the Child Behavioral
Checklist (CBCL) which is given on admission and again before discharge.
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Does your facility employ a privilege/level
system?
☒ Yes ☐ No
TREATMENT
Below, please list (separately) your
facility’s Treatment Approaches/Evidence
Based Practices/Promising
Practices/treatment orientations (e.g.,
SPARCS, Resiliency Framework, Social
Stories, Nurtured Heart, Mentalization,
etc).
Art Therapy
If Yes, on what basis do recipients earn
privileges or improved level status?
Under what circumstances, if any, is the
level system modified?
Research Support For each approach listed
on the left, please identify the relevant
staff training/credentials or cite the
professional literature used to guide these
approaches.
Staff Training How are staff oriented to
the items listed? Describe if/how
administrative, clinical and milieu staff
receive orientation, training and ongoing
supervision.
Master’s Level Training
Master’s Level Training – post master’s
certification
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Acadia Montana has a four level system which
is monitored daily with points awarded for
positive progress in school, social, group and
individual treatment environs. Attainment of
higher levels within the system grants
residents the ability to participate in all
activities and can grant additional free time,
game time or phone and Skype priviliges
depending on a resident's treatment plan
guidelines. If a child struggles with a
particular aspect of our level system,
examples may include duration of school
classes or particular activities, modifications
will be made to allow that child to show
progress in goal attainment.
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TF-CBT/CBT
Mind over mood, feeling good book,
mood management, and other available
literature
Relational Emphasis: indicated by active
engagement, positive demeanor,
empathy, calmness, validation of position
goals and desires.
Miller, Hubble, Duncan (1996) – continued
demonstration by others in 2004, 2006 and
current. Demonstrates that relationship
produces 35% of the factors for change while
specific approach (cbt, etc. accounts for 15%.
PBIS (Positive Behavioral Intervention and
Support)
Program Director, Nursing Manager,
Assistant Program Lead, Principal,
Recreational Activities Staff attended
training in January 2016
Click here to type
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TF-CBT web based training/we use
monthly direct care staff trainings to
reinforce CBT concepts and have changed
ESI paperwork to reflect CBT approach.
Orientation training, yearly training,
ongoing training in monthly meetings.
MANDT recerts are required every year
and that program emphasizes
relationship.
Training/orientation began in February
2016 for staff to help them understand
and begin to build a concept of PBIS and
how it relates to our population.
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Does your facility employ or contract with Name and credential(s) of behavior specialist (if the individual does not have a BCBA,
a behavior specialist (behavioral
please provide a description of the person’s training in behavior analysis).
Click here to type
psychologist or BCBA) on the treatment
team or staff?
☐ Yes ☒ No
For each of the following professions/licenses, please answer the questions to the right.
How does your facility ensure
Is this professional a staff
If on contract, under what
that these professionals’
member? Full or part time?
circumstances is this
treatment recommendations
professional involved in
are implemented and
treatment and planning?
consistently followed?
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Dietitian
Click here to type
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Occupational Therapist
Click
here
to
type
Click
here
to
type
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Speech/Language Pathologist
Click here to type
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Other Medical (e.g., GI, Sleep)
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Dental
Other
Click here to type
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PSYCHOTHERAPY MODELS
Please identify the psychotherapeutic models (e.g., CBT, DBT) used at your facility, by population
Model
Population
Trauma Focused CBT
All Residents
CBT
All Residents
Click here to type
Click here to type
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Family Therapy What are your
expectations regarding family therapy?
Clinical Supervision Describe how a
professional provides clinical oversight to
the program. How many hours/week?
Click here to type
Click here to type
Click here to type
Acadia Montana bleieves that family therapy is critical in achieving a long term positive
treatment impact for individual residents. In some cases, family therapy is counter indicated
and in those cases Acadia will work with legal guardians and community resources to attain a
level of support within a resident's home community to assure that therapeutic achievments
are not lost upon discharge. We would expect that family sessions occure weekly and that
involvement continue through treatment planning sessions to define specific goals that the
resident, parent(s)/guardian, siblings and extended family can work through to maintain a
positive therapeutic environment upon return to family living.
Each primary therapist is supervised through weekly clinical meetings with the Clinical Director,
where individual cases and situations are discussed and options explored; additional weekly
sessions occur on individual units with the medical staff, Program Director, Director of Nursing
and teachers. Individual therapists may attend multiple unit meetings depending on the age
range and sex of residents they are assigned. Individual sessions with the Clinical Director are
scheduled for one hour per week, but can be extended given more intense cases; unit meetings
are scheduled for one hour for each unit. Additionally, as previously indicated each morning
during the work week, therapists, Medical Director and practitioners, Clinical Director, Director
of Nursing, School Principal, Recreational Director, and CEO meet to discuss any incidents from
the previous day, plans for resolution of multiple incidents and general meetings and events for
that day.
P a g e | 15
Crisis Supports How does the program
assure access to the appropriate care for
clients in crisis situation?
Acadia Montana is staffed with a full time Medical Director, two psychiatric nurse practitioners,
an on-call physician, a nursing staff that includes a nurse for each resident's unit for sixteen
hours per day; night staff has two nurses on duty each evening. Additionally, Acadia Montana
works with our local hospital (St. James Hospital) for emergency services that can not be
performed at our facility. If an acute setting is required for a child, we have worked with both
Shodair Children's Hospital and the Billings Clinic for acute placements.
Skill Development Please describe how
your facility helps recipients develop the
Methods/Interventions/Programs
following:
Interpersonal skills Individual treatment plans and groups supported or led by a resident's primary therapist would
normally deal with issues of interpersonal skill development, self-regulation and
communication. Groups led by other staff, including therapists, nurses, mental health workers
and medical staff may well work with residents on issues related to any of these areas.
Specialists for speech therapy may be brought in to work with specific issues and will become
part of the overall treatment team and process. Recreational therapy provided to all residents
may deal with issues of daily living like: cooking, laudry, cleaning, folding clothes, banking,
completing a resume or applying for a job.
Self-Regulation
Daily Living
Communication
Other
Please describe how your facility helps the
recipient generalize these skills to their
home environment.
See Above
See Above
See Above
See Above
Our overall job is to create a treatment plan that addresses issues recognized as having a
substantial impact on our residents and through the plan to development coping skills that will
allow that individual to cope in their natural environment. Kids come to use from a variety of
environments and we are concerned with giving that child the necessary skills to interact
constructively with family, peers and home community.
DAILY SCHEDULE
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Please describe the daily schedule.
How are transitions (to meals, school,
activities, etc.) managed?
How are meals managed (e.g.,
preparation, clean-up)?
Please describe the types of recreational
activities available to recipients.
Daily schedule is structured with specific time for getting up completing daily hygiene, going to
morning meal, attending school (five days per week) or planned activity, breaking during the
day for individual, group or family therapy sessions, attending recreational activities inlcuding
games and gym, reporting for lunch and dinner with team. Participation in outings for
educational and recreational purposes either on site or through trips throughout the region.
Specific free time is established for residents to interact, read, watch television or movies, do
art projects, call or Skype approved call list or receive calls from parents. Days are fairly highly
structured with defined times for getting up, meals, school, groups and recreational activities.
Mental health and other staff will transition groups of five kids from each unit to the cafeteria,
go through the café line with their choice of foods from designed meals and then eat meals in
the cafeteria with other members of their team and staff as they arrive. If for any reason a
child is not able to go to the cafeteria, a meal will be brought to the unit for that child.
Meals are designed by our dietician, prepared by a professional staff and presented to all
residents. Specific residents are on restricted diets due to allergies and will receive approved
meals. Residents are expected clean up their immediate area after meals, bring plates, trays,
etc. back to a kitchen window in the cafeteria and dispose of food remainants. Kitchen staff are
responsible for final clean-up of utensils and cafeteria.
On-Site Activities:
Acadia Montana has two in-side gyms, a
climbing wall, basketball and vollyball courts
in the gyms. We also have outside basketball,
vollyball, and playground equipment for
younger residents. Lounges maintain video
games, play areas, televisions for sporting
events and movies and some general
television shows.
Off-Site Activities:
Acadia Montana offers weekly outings, off-site
for all units. Both educational and
recreational outings are included with trips to
regional museums, theaters, swimming,
bowling, attending sporting events at a local
college, fishing in summer months, hicking,
skating and sleding. Our residents frequently
attend community events such as fairs,
sporting events, pow wows, carnivals, etc.
DISCHARGE PLANNING AND POST-TREATMENT
Click here to type
When does discharge planning begin?
P a g e | 17
Who is responsible for discharge planning
at your facility?
Acadia Montana offers weekly outings, off-site for all units. Both educational and recreational
outings are included with trips to regional museums, theaters, swimming, bowling, attending
sporting events at a local college, fishing in summer months, hicking, skating and sleding. Our
residents frequently attend community events such as fairs, sporting events, pow wows,
carnevals, etc.
What percentage of your recipients return
to:
Therapeutic Foster Care: 5%
Foster Care: 15%
Family: 50%
Group Home: 25%
Corrections: 1%
Independent Living: 4%
If Yes, please describe your findings.
Do you do any follow up to learn what
happens with your recipients after they
discharge from your facility?
☐ Yes ☒ No
Click here to type
Please use the space below for further comments regarding your facility.
Click here to type
Section B
AUTISM SPECTRUM DISORDERS QUESTIONNAIRE
P a g e | 18
Please provide additional information regarding the
We ask that all lower functioning residents andkids on the
characteristics of the recipients with ASD for whom you can
spectrum have language skills. We do accept residents below 70
provide specialized treatment (e.g., ASD with IQ under 70, ASD
IQ, down to 60 with consideration for low functioning kids.
with IQ over 70, Asperger’s disorder, etc.). Please be specific,
especially regarding developmental age and/or IQ requirements.
Please check each box that corresponds with aspects of treatment at your facility that are listed below. These elements, other than
CBT as discussed below, are described in “Practice Parameter for the Assessment of Children and Adolescents with Autism Spectrum
Disorder”, Journal of the American Academy of Child and Adolescent Psychiatry, Feb 2014.
Do you have screening
If Yes, please list the tools(s) by name and/or send copies.
mechanisms for ASD that
Our residents that are on the spectrum come to us clearly identified.
includes questions about ASD
and symptomatology?
☐ Yes ☒ No
What diagnostic
Psyciatric evaluation, psychological if needed, neuro psyc if determation is that there is a need.
evaluation/assessment
process do you use?
Please check all ☒ Family interviews
that are included: ☒ Review of past records
☒Consideration of DSM-V criteria
☒History, including educational and behavioral interventions
☒ Differential diagnosis
☒ Observation
☐ Specific Tools (please identify): Click here to type
For each of the following elements, please use the drop down menu to indicate whether it is included in your multidisciplinary
assessment of children with ASD. If you indicate “as needed,” please describe what would prompt an assessment.
Physical Exam Yes
On admit
Screening for Yes
On admit
Gastrointestinal Problems
Hearing Screen As Needed
Kid or history prompts
P a g e | 19
Examination for Signs As Needed
Team decision
of Tuberous Sclerosis
Genetic Testing As Needed
Team decision
Consideration of As Needed
Team decision
Unusual Features
Click here to type
Psychological Assessment As Needed
(cognitive and adaptive)
Communication As Needed
Team decision
Assessment
Occupational Therapy As Needed
Team decision
Assessment
Physical Therapy As Needed
Team/nursing decision
Assessment
Sleep Assessment As Needed
Doctor order/team decision
Please indicate which evidence-based and structured educational and behavioral interventions are in use at your facility by checking
the box in the left hand column as well as answering the additional questions in the right hand column, as applicable.
Is ABA used in school? ☐ Yes ☒ No
☐ Applied Behavior Analysis
(ABA)
Is ABA used in
☐ Yes ☒ No
residential?
Is ABA in treatment
☐ Yes ☒ No
plan?
What credentials does N/A
your ABA specialist
have?
Is this person on the
N/A
treatment team?
P a g e | 20
☒ Alternative Communication
Modalities
☐ Pragmatic Language skills
training
☒ Social Skills training
☒ Education
☐ Other
Is this person a
N/A
contractor or staff
member?
Please identify (e.g., Picture Exchange Communication System, sign language, assistive
technologies, visual schedules, etc.)
We do use PEC, sign and visual schedules
Please describe and/or identify the program or supporting literature.
Groups/Therapy
If structured educational models are used, please identify.
Most residents have IEP, aim to cover goals
Please describe.
Click here to type
Please answer the following questions.
Are there medications that you
If yes, please identify.
typically use with this population? Click here to type
☐ Yes ☐ No
Click here to type
Please describe your facility’s
approach to the use of medication
with children and youth with ASD.
Do you inquire about the use of
Please explain.
complementary/alternative
Look at Neurofeed back versus ABA
treatments?
☒ Yes ☐ No
What staff person/people are
Please identify by name, role and credentials.
familiar with the literature
Medical Director, Jim Killpack, MD
regarding best/evidence-based
practices for this population?
P a g e | 21
Under what circumstances, and/or
what are the characteristics of
recipients with ASD with whom
your facility uses Cognitive
Behavioral Therapy?
Who are the regular treatment
team members for the children
with ASD in your care?
CBT is part of our programming and therapy for all residents.
ASD kids are a regular part of our milieu and are on all halls and programs. All our therapists
and attendings have someone on the spectrum in their care.
For facilities that provide treatment for individuals with Asperger’s Disorder or individuals with ASD who do not experience
Intellectual Disabilities, please answer the following question:
Please describe your approach to
As above, all ASDkids are in all aspects of our program. Individual needs are addressed through
treatment and any interventions
the treatment plan to provide individualization.
that are employed specifically for
this population. Please also
provide information about the
research that supports this
approach with this population.
Please use the space below for additional comments.
Click here to type
P a g e | 22
Benchmark Behavioral Health, Inc
Section A
Date completed
Contact number
Address
Kelly Berg, Admissions Coordinator & Executive Assistant
February 19, 2016
(801)299-5319
592 West 1350 South, Woods Cross UT 84087
GENERAL OVERVIEW
Accreditation Body
Utah Department of Health and the Joint Commission
Age Range
# of Licensed Beds
13-20
84
☒Males
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here
to
type
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☐Females
Click here to type
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☐Other
Nursing
Milieu
Comments
Day
28:1 nurse
4:1 direct care staff
This does not include teachers, therapists, administrative
personnel
HOME
PRINT
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Evening
28:1 nurse
This does not include teachers, therapists, administrative
personnel
Click here to type
Night
28: 1 nurse
Our clients must have an IQ of 50 or higher
☒ Yes ☐ No
12 months
Recipients?
12 months
12 months
12 months
N/A
☐ Yes ☒ No
☐ Locked ☒ Unlocked
☒ Yes ☐ No
All employees are trained to recognize the signs/symptoms of
patients with FASD during their new hire training. They also
receive annual training on FASD and other disorders.
Every employee undergoes annual growth and developmental
training, which includes trauma informed cognitive behavioral
What kind of training do your staff receive (include milieu as well therapy.
Based Practices.
At Benchmark we collaborate constantly and whenever a staff feels
triggered in any way they can be "switched out" by another staff. We
also utilize an EAP program which all staff are aware of.
facility serves.
Page |2
☒ Autism Spectrum Disorders (severe/low
☒ Sexually reactive (e.g. response to trauma)
☒ Sexually maladaptive (e.g. resulting from
☒ Sexually offending: ☒ adjudicated/ ☒ nonadjudicated
New hire employees receive 40 hours of
orientation/training which includes population training. In
addition, staff members receive 40 hours of ongoing
training annually, which is population specific.
Same
Same
Click here to type
☐ Eating Disorder
Click here to type
Click here to type
to trauma)
☒ Eating Disorder
☒ Other: Diabetic
☐ Psychosis
☐ Elopement Risk
Sexually offending:
☐ Fire setting
Page |3
Comments: Click here to type
Benchmark utilizes and trains all staff in the Crisis Prevention Institute’s Non-Violent
Crisis Intervention program. This training promotes verbal de-escalation as the
principle intervention for acting out individuals, with physical restraints being used as a
last resort.
A monthly multi-disciplinary staffing meeting is held to discuss each patient. At this
time we review the patient’s behaviors, what they may mean, and discuss why he
might be exhibiting them. The patient’s therapist also meets with our Director of
function of behaviors in your populations? Clinical Services weekly to review their patient’s current level of behavioral functioning.
Additionally, when the need arises, we will conduct a “Special Staffing” meeting for a
patient who is struggling. At these sessions our therapists, unit managers, nurses,
teachers, and psychologist work together to gain a better understanding of that
patient’s behavioral presentation and discuss ideas for positive interventions.
Patients are always under staff observation with a staff to patient ration of 1:4. Video
cameras are in place for additional observation and are located in patient bedrooms,
classrooms, hallways, time out rooms, courtyards, gym and cafeteria. There are no
cameras located in patient bathrooms.
The facility has 18 nurses on staff with nurses always on site 24 hours a day. The facility
also employes two full time psychiatrists. Referrals are made to community services for
eye exams, dental, or orthopaedic care.
All patients have the resources available to When a patient is in time out they are
☒ Yes ☐ No
request a time out whenever needed.
monitered the entire time by staff
There are also staff initiated time outs that members. Staff will also provide
are utilized to allow for de-escelation and
feedback and support as needed. When
refocusing of behaviors.
the time out is over patients will verbally
process what led to the time out taking
place.
Page |4
☒ Yes ☐ No
☒ Yes ☐ No
by whom?
Seculsions are utilized as a last resort for
patients who are acting out at a level that
threatens the safety of themselves or
others.
If Yes, what follow up steps are taken? A
doctors order has to be obtained for a
patient to be placed in a seclusion.
During the seclusion the patient is under
constant monitering and supervision of
staff. Each seclusion is reviewed and
discussed by a multi-disciplinary
treatment team to determine whether
special interventions are needed for that
particular patient.
A physical hold will be used on a patient
Whenever a physical hold is used on a
only once all verbal means of managing the patient, the event is discussed and
situation have been exhausted and the
reviewed by the staff involved in the
patient has reached a point where he is a
physical hold and the patient. It is also
danger to himself or others.
discussed and reviewed by our multidisciplinary treatment team to
determine if there is a need for special
interventions for that patient.
Benchmark utilizes the Non-Violent Crisis Prevention program offered through the
Crisis Prevention Institute (CPI). New staff go through 40 hours of initial training, which
includes 16 hours of CPI training to become fully certified in the program. Staff receive
re-certification training in CPI every 6 months thereafter.
Individual
Facility
Every restraint & seclusion are discussed
Every month our Performance
and reviewed daily by a multi-disciplinary Improvement Committee holds a meeting
treatment team to determine if there is a to discuss the number of seculsions and
need for special interventions for a
restraints and develop strategies to
particular client.
reduce them in the coming month.
Page |5
Individual
Facility
We report to Alaska Behavioral Health
Every incident report is discussed and
each time an incident occurs that involves: reviewed daily by a multi-disciplinary
seclusion, restraint, AWOL, significant
treatment team to determine if there is a
injury, and sexually acting out. Additional need for special attentions, which would
incidents not on that list maybe be
include an incident report to Alaska
reported to Alaska Behavioral Health as
Behavioral Health.
well.
During Performance Improvement Committee meetings, data and outcome measures
are discussed and analyzed. This information then drives additional training and
☒ Yes ☐ No
development in areas that show a need for improvement.
structure and supervision provided by your High
Choose a level
☒ Yes ☐ No
There is always a direct care staff to patient ratio of 1:4. Additional staff in the form of
teachers, therapists, and administrative personnel may also be present. For instances
when a patient is placed on a precaution for self-harm or harm to others, a patient will
be under ‘Line of Site’ supervision until such time the doctor feels it is safe for the
patient to be taken off that precaution.
Please explain.
Increased supervision (supervision greater than the staff to patient 1:4 ratio) is based
on a patient’s special needs or high acuity/crisis needs. This includes the “Line of Site”
superivision discussed in the previous question.
Page |6
roommates?
characteristics?
A variety of factors will determine roommate placement. These include, but are not
limited to: age, abuse history, previous criminal offenses, psychiatric diagnoses, and
social skill deficits.
Roomates are determined based on the clinical profile and behaviors of each patient
on that specific unit.
Each situation is looked at on an individual basis. Unit managers will then make
suggestions for changes and get approval to follow through from the clinical team.
Patients are under constent supervision and monitoring by staff members, Q15’s are
done for each patient, and cameras are in place throughout the facility.
EDUCATION SERVICES
Comments: Benchmark has a fully accredited school on site with Special Education certified teachers.
As soon as we begin the admission process for a patient, we obtain their educational
transcirpts and then contact their local school district for student records. We make
communication with home-based schools? sure that we are following their IEP and that the patient’s home school district is
involved with the IEP process. We will do any testing and/or provide any educational
content that is required by that school district. When a patient is discharged, we
ensure that their local school district receives the appropriate educational records. We
are also available for participation in future IEP development or for clarification of
transcripts.
NWAC/AdvancED
☒ Yes ☐ No
Page |7
review/planning.
process?
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐Other Medical (please list): Click here to type
☐ Dietitian
☒ Psychologist
☒ LCSW
☒ Other Clinician (name, credentials): Recreation Therapist
☒ School Representative (name, role): Teacher
☒ Milieu (name, role): Unit Manager
Weekly family therapy sessions are conducted via telephone with the patient and their
therapist. The family/legal guardians are also invited to participate in the monthly
treatment team meeting, and updated monthly treatment plans are sent to family
members. The therapists provides additional contact with the family/legal guardians
throughout the month and assists with the discharge planning process as well.
Patients who fall into this category are identified in each month’s treatment team
meetings. To determine the best treatment strategies, a full review of their records is
completed, special staffing meetings are held, and/or testing is done by our facility’s
psychologist.
Page |8
system?
☒ Yes ☐ No
TREATMENT
etc).
Pathways Program for SO population
Measurable goals and objectives are placed on each patients individual treatment plan.
These plans are reviewed and adjusted on a monthly basis.
Click here to type
Patients are under a level system from 15. Patient receive greater privileges at
higher levels and they achieve these levels
by following program rules and
expectations and by actively engaging in
the treatment process.
approaches.
supervision.
Therapists are trained on site and through
masters level education courses.
Our Director of Clinical Services provides
supervision to clinical team and staff
members. Therapists are required to
complete ongoing CEU training.
Page |9
Trauma Focused Cognitive Behavioral
Therapy
Therapists are trained on site and through
masters level education. We are currently
in the process of having each therapist
become certified in this area through offsite and on-line trainings.
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Our Director of Clinical Services provides
supervision to our clinical team and staff
members. Therapists are required to
complete ongoing CEU training and then
conduct trainings to all staff on an annual
basis, especially regarding the behavioral
interventions that are used
Click here to type
Click here to type
Click here to type
David Gambles Ph.D.
team or staff?
☒ Yes ☐ No
are implemented and
Click here to type
Click here to type
Dietitian
Part time
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here
to
type
Click here to type
Click here to type
Click here to type
Part time
Click here to type
Click here to type
Click here to type
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Dental
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here
to
type
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Other
P a g e | 10
Model
Population
Cognitive Behavioral Therapy
All populations
Psychoeducational
Lower functioning populations
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
following:
Interpersonal skills
Self-Regulation
Daily Living
Communication
Other
Weekly family therapy is conducted via telephone as well as during on site visitations
when possible.
Our Director of Clinical Services and Assistant Director of Clinical Services work full time
and provide supervision and oversite to all clinical programs.
There is round the clock medical staff and direct care staff at the facility. Our
Administrative staff and therapists are also on call during non-business hours.
Therapeutic melieu, psychoeducational groups, recreational therapy, individual
therapy, unit and school outings.
P a g e | 11
home environment.
DAILY SCHEDULE
This is done through family therapy and regular contact with family members. Patients
also have opportunities to participate in staff supervised outings, including recreational
therapy outings. The therapists also works to help the patient generalize the skills they
are learning through the weekly family therapy sessions and off campus passes during
family visits.
School 8:00AM to 3:00PM, after 3:00PM milieu activites include outings, group therapy,
movie time, down time, etc… Specific schedules are available upon request.
Staff on different units communicate with each other through radio to ensure smooth
transitions.
Full time cafeteria staff members prepare all meals. Patients are responsible for
cleaning the dining area after their meals. Vocational opportunities are available for
patients to acquire culinary skills.
On-Site Activities:
Patients participate in Recreational
Through our Recreational Therapy
Therapy on a daily basis. These activites
department, patients may participate in
include, but are not limited to – baking,
outings such as movies, hiking, canoing,
gym time, on-site library visits, ping pong, ropes courses, snowboarding, museum
board games, and movies. Patients are
visits, and eating at restaraunts.
also allowed free time on the units where
they have access to video games, movies,
TV, board games and other recreational
items.
P a g e | 12
at your facility?
to:
☐ Yes ☒ No
Discharge planning begins on the day the patient is admitted when an estimated length
of stay is decided on. The patients discharge date is then discussed during the monthly
treatment team meetins and modified as needed based on the patient’s response to
treatment.
Each patient’s primary therapist works with the our treatment team, parents,
caseworkers, probation officers etc…, to develop a discharge plan.
Therapeutic Foster Care: Click here to type
Foster Care: Click here to type
Family: Click here to type
Group Home: Click here to type
Corrections: Click here to type
Independent Living: Click here to type
Click here to type
Click here to type
Section B
P a g e | 13
Click here to type
Click here to type
and symptomatology?
☐ Yes ☐ No
Click here to type
What diagnostic
process do you use?
Please check all ☐ Family interviews
that are included: ☐ Review of past records
☐Consideration of DSM-V criteria
☐History, including educational and behavioral interventions
☐ Differential diagnosis
☐ Observation
Click here to type
Physical Exam Choose an answer
Click here to type
Screening for Choose an answer
P a g e | 14
Click here to type
Hearing Screen Choose an answer
Click here to type
Examination for Signs Choose an answer
Click here to type
Genetic Testing Choose an answer
Choose
an
answer
Click here to type
Consideration of
Unusual Features
Click here to type
Psychological Assessment Choose an answer
Click here to type
Communication Choose an answer
Assessment
Click here to type
Occupational Therapy Choose an answer
Assessment
Click here to type
Physical Therapy Choose an answer
Assessment
Click here to type
Sleep Assessment No
Is ABA used in school? ☐ Yes ☐ No
(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
What credentials does Click here to type
your ABA specialist
have?
Click here to type
treatment team?
P a g e | 15
☐ Alternative Communication
Modalities
Click here to type
Is this person a
contractor or staff
member?
training
☐ Social Skills training
☐ Education
☐ Other
Please describe.
Click here to type
Click here to type
Click here to type
Click here to type
☐ Yes ☐ No
Click here to type
Please explain.
Click here to type
treatments?
☐ Yes ☐ No
Click here to type
P a g e | 16
Behavioral Therapy?
Click here to type
Dr. David Gambles, Dr. Jerome Vance, Dr. Bret Marshall, Nicole Abbott LCSW, Scott Roper
LMFT, Shanna Guzman CSW, Brian Anderson LCSW, Danielle Payne CSW, Mary Barker LCSW,
Chris Tippetts LCSW, Mindy Nance LCSW, Paul Okula LMFT
Click here to type
Click here to type
P a g e | 17
P a g e | 18
Calo (Change Academy at Lake of the Ozarks)
Section A
Name and title of person completing this
form
Date completed
Contact number
Address
Nicole Fuglsang, MA, LPC (Co-Founder, Vice President of Admissions Operations
May 1, 2016
573-746-7362
130 Calo Lane, Lake Ozark, Missouri 65049
GENERAL OVERVIEW
Accreditation Body
Joint Commission
Age Range
# of Licensed Beds
9-18
62 (22 preteen, 40 teen)
☒Males
9-18
62 (22 preteen, 40 teen)
☒Females
Click here to type
Click here to type
☐Other
Nursing
Milieu
Comments
Day
2.5 FTE’s on-site
4:1
Med Tech also onsite 8-2
HOME
PRINT
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Click here to type
Evening 1 FTE on-site
4:1
Click here to type
Night
1 FTE on-site
12:1
80 or above minimum, over 85 preferred.
☒ Yes ☐ No
Click
here
to
type
Click here to type
Recipients?
12-13 months
12-13 months
Click here to type
□ Yes ☒ No
□ Locked ☒ Unlocked
☒ Yes ☐ No
We do annual training with staff in regard to the impacts of
treating children and youth with FASD. What kind of training do FASD and students treatment and how to approach these
students withonteh contxt ofteh Calo CASA model.
All staff receive 40 hours of training annually, with at a
minimum of ten of those hours specifically trained on complex
What kind of training do your staff receive (include milieu as
and early childhood trauma. All staff are trained in our
well as clinical). Identify your trauma treatment approach and
developmental trama model CASA. Staff must pass a series of
written tests showing their competency in the CASA trauma
Based Practices.
model.
Please describe your facility’s approach to secondary trauma in Self Care, fatigue, burnout, and vicarious trauma are all trained
on during the orientation process, and ongoing yearly. All staff
take part in weekly 1:1’s with their direct supervisor to discuss
concerns as well.
Specialty Populations Please check all specialty populations this
facility serves.
Not our specialty, we only accept high functioning and
only if this diagnoses is in combination with the impacts
of developmental trauma/childhood stress.
Page | 2
□ Autism Spectrum Disorders (severe/low
functioning) NOTE: Facilities with this
specialty must complete Section B
□ Sexually maladaptive (e.g. resulting from
□ Sexually offending: ☐ adjudicated/ ☐
non-adjudicated
Click here to type
Click here to type
□ Eating Disorder
Click here to type
□ Other Click here to type
Click here to type
□ Other Click here to type
□ Sexually reactive (e.g.
☒ Sexually maladaptive (e.g.
response to trauma)
Sexually offending:
☒ adjudicated/ ☒ nonadjudicated
□ Eating Disorder
☒ Psychosis
□ Physical Aggression
☒ Autism Spectrum Disorders
□ Autism Spectrum Disorders
□ Self-injurious behaviors
□ Suicidal ideation/attempts
□ Elopement Risk
□ Fire setting
☒ Other: Valid Conduct Disorder ☒ Other: Pregnant Clients
☒ Other: Clients with parents
or Anti-Social Diagnosis
that are unwilling to participate.
Comments: Clients with primary diagnosis of substance abuse are also ruled out.
Page | 3
Individuals enrolled at CALO typically present with a significant history of acting out
behaviors that need to be addressed in treatment to ensure Individual safety, to
support the development of alternative coping skills, to reduce the lowered selfworth of Individuals that follows most acting out episodes and to allow increased
focus on treatment issues otherwise obscured by overt, problematic behaviors.
Guiding principles that govern CALO’s philosophy related to behavior management
include the following:•
Interventions are to be as least restrictive as possible•
Interventions are to foster adaptive and pro-social behavior, not exclusively
behavior control•
Interventions are to be confined to authorized techniques•
Interventions are to be created as a part of the Individual’s behavior support
plan and/or the Individual’s treatment plan•
Interventions are to only be
created by the Individual’s treating therapist•
Interventions are approved by the
governing bodyWhen it is decided by the Individual’s treating therapist that an
individualized behavior contingency is required, it is discussed with the Individual,
and if appropriate their parent in order to agree upon the type of intervention to use.
The parents of the Individual must be educated and agree upon the intervention
before it is implemented (this can be recorded in the Individual’s file in BestNotes).
Before implementation, the Individual must agree to the specific plan via digital
signature or verbal agreement in BestNotes, giving conformed consent to the
intervention. At a minimum, the interventions must be reviewed monthly for
antecedents to and consequences of the targeted behavior.
All interventions
should be created through the assessment of the Individual’s behaviors and the
creation of the Individual’s behavior support plan and/or the Individual’s treatment
plan so that interventions support the acquisition and reinforcement of
adaptive/replacement behaviors. Interventions are to be created by the Individual’s
treating therapist, and must only use interventions approved by both Missouri State
Department of Social Services and The Joint Commission. All staff must be trained in
individual interventions before implementing them, and the outcomes of the
interventions must be recorded in incident reports or other documentation in the
Page | 4
Individual’s file. The treating therapist must review these recorded outcomes no less
than once a month.
Calo does not do functional behavior assessments. As a residential treatment facility
and a special education school, we utilize our relational proprietary model, CASA, to
assess and direct treatment for our students.
List types of safety monitoring used (e.g., Staff observation, video cameras.
We have a full nursing team of registered nurses on-site that schedule all off campus
appointment for medical, vision and dental appointments. Our psychiatrist meets
with students on site. We also have a pediatrician and general practice physician (one
or the other) on-site weekly to meet medical needs our students without having to
take them off campus. Nursing staff orchestrates all ongoing care for clients. Students
receive a physician following enrollment and annually. They are also seen at least
annually by a dentist and optometrist. We have a full time rained staff that
transports students to and from all appointments.
Click here to type
Click here to type
□ Yes ☒ No
Click here to type
Click here to type
□ Yes ☒ No
Page | 5
☒ Yes ☐ No
The only physical holding of individuals
authorized at CALO are those that are
trained as appropriate by the governing
body and trained by their assigned
qualified trainers. CALO uses Safe Crisis
Management (SCM) as its only approved
system for holding individuals. The use of
non-physical, verbal and non-verbal deescalation techniques is always the
preferred method of managing negative,
aggressive, chaotic, or potentially
dangerous behaviors. CALO staff may hold
individuals only when absolutely necessary
to prevent students from harming
themselves, to prevent students from
harming others, and to prevent students
from creating a chaotic and potentially
dangerous environment where
nonphysical interventions are not being
effective. This might include some
instances of destruction of property. The
use of holding an individual occurs as a last
resort. Staff must exhaust de-escalation
methods proper to initiating a physical
hold unless an immediate response to an
out of control behavior requires
immediate action.
All staff at CALO trained to be involved
in physical interventions is trained to be
able to identify signs of physical,
emotional and verbal de-escalation. The
staff is trained to release the student
from the physical intervention at the
first moment safety is established. The
expectation is that the student be
physically held no longer than five
minutes. If the physical hold lasts longer
than five minutes, documentation
regarding the need of the physical hold
to continue is required. All physical
holds must be discontinued prior to
fifteen minutes.
After the discontinuation of a hold, the
staff’s shift supervisor should be
notified immediately, and an incident
report completed for use of the
administrator. The incident report must
include:
•
The name of the individual, the
date and time the child was physically
held
•
The circumstances that led to
the placement of the individual in a
physical hold and the de-escalation
Page | 6
attempts used to try to prevent the use
of the physical hold.
•
The name of the staff person
who initiated the physical hold, the staff
person(s) who assisted with the physical
hold, and any other staff and/or initials
of residents who witnessed the physical
hold.
•
The amount of time the
individual remained in the physical hold,
any changes in staff participation, and
the time of and reasons for release;
•
Documented behavioral
observations of the individual at each
five(5)-minute interval;
•
Specific notation of any
extension of any physical hold lasting
longer than five(5) minutes including
the reason for extension.
All physical interventions require
debriefing within twenty-four(24) hours
of the incident. It is preferred that all
staff and youth involved are present at
the time of debrief. If not all are able to
be present, each member, at minimum,
must be contacted and given the
opportunity to attend the debriefing.
Page | 7
The physical intervention program and
debrief form details the exact questions
and follow up necessary following a
physical intervention.
Incidents of a repetitive nature or those
where any party (involved or
witnessing) feels the physical
intervention was not performed
properly will be subject to a review by
administrators.
All students should be checked for
injuries by qualified staff after an
incident, as well as all orders authorized
by the individual’s treating therapist
during business hours, or the therapist
on call during non business hours.
Page | 8
All staff upon hire must complete a 32 hour course instructing them on the use of the
following:•
Safe Crisis Management.•
CPR/First Aid• Basic company
orientation• Basic company policy and procedure•
The specific population of
the facility and the causes of need for treatment• The specific verbal interventions
to implement with youth• The specific non-verbal interventions to implement with
youth• Peer/Team dynamic• Medical needs of the facilities population• Emotional
and physical needs of the facilities population•
Cultural, gender, and ethnic
sensitivity• Separating work life from personal lifeFollowing the initial 32 hour
training, each staff member is required to attend periodic trainings over the
aforementioned material by an approved trainer or supervisor each year not to total
less than of 42 hours annually, with ten of those hours dealing specifically with the
population cared for at CALO.CALO screens and assesses all students during the
application phase of enrollment for both risk of harm to self, and harm to others.
During this assessment, it is also taken into account the needs of staffing over regular
ratios and the needs for the use of physical interventions. A medical and
psychological history is collected on the individual to assess if there are dangers in
using physical holding, either psychologically or physically due to previous or current
medical conditions. These needs are reassessed during the monthly review of
treatment plans by the treating therapist, and any time needed, through the use of a
safety assessment administered by qualified CALO staff. Each staff member at
CALO with regular and direct interactions with the student is trained to identify
behaviors of concerns with regards to safety (physical, emotional, sexual, mental, and
psychological). Each staff member is trained to be able to intervene physically, or be
able to obtain help to intervene physically to provide the level of safety
necessary.Each staff member at CALO is trained and authorized to record the events
of a physical intervention in an incident report with the intent of clear and honest
communication about the incident.Each staff member at CALO is trained on
monitoring and identifying certain risk factors for the staff and the student during a
physical intervention to ensure that both youth and the staff are safe at all times.
Page | 9
seclusion and restraint data reviewed,
and by whom?
Does your program use aggregate
progress data for overall quality
improvement?
☒ Yes ☐ No
structure and supervision provided by
your program as low, moderate or high?
High
All staff at CALO is trained on the use and implementation of the CALO
treatment model for working with the youth of the facility. The treatment model
defines the correct time and ways in which a staff member may intervene.Each staff
member is trained to intervene in situations that do not risk safety by the use of the
following verbal and non-verbal communication and de-escalation tools:•
P.A.C.E.•
Attunement•
Mirroring and matching•
Presuppositions•
Safe touch•
Active listening•
Actions of considerationEach staff member is
trained to be able to identify a situation that risks a youth’s safety, and the proper
ways of providing safety via physical intervention, or obtaining a staff member that
can provide physical intervention.
Individual
Facility
Monthly
Monthly
Individual
Facility
Sentinel events, elopement, unsafe
Sentinel events
behaviors leading to the need for a
therapeutic hold, sexual acting out.
If Yes, please describe.
We have performance improvement goals in place, and review the progress monthly
for the following areas: Parent Engagement, Therapeutic Treatement Goals, Length of
Stay, Physical Restraints, Student Violence, Medication, Infection Control, and illness.
Moderate & high depending on needs of the child.
P a g e | 10
☒ Yes ☐ No
promote or prevent pairing of recipients
as roommates?
characteristics?
Calo
Please explain.
Our normal staffing ratios are low 1:4, however, at times studenst for safety reasons
will need even lower ratios say 1:2, 1:1 and we will facilatate that based on the needs
of the student.
Admissions staff, clinicial director and program director consult on all new
enrollments and make team home & therapist assignments based on psychosocial
assessment summary review which includes, historical records review, family
interviews, treating therapist interview, psychological evalution review, academic
record review, etc.
As part of this review history of unsafe behaviors or potential acting out behvaiors
are considered (history of sexual acting out, elopement, self-harming, etc.)
Our clinical team with consultation from our residential program supervisor leads the
charge in this regard and makes all rooming assignments. Students are assessed prior
to placement to determine the best fit. Prior acting out behaviors and such are taken
into consideration when making placements. If concerns arise following a rooming
assignment, the clinical team will re-assess and determine if a change or transition to
a different team needs to take place. Dorm room space is intentionally open to
increase visual supervision in that space. Students are supervised 24/7. Cameras are
also utilized within the dorm room space, obviously not in changing rooms, showers
or restrooms.
Awake staff in each team home at night, 15 minute bed checks, cameras in team
homes, supervisor viewing cameras views throughout the night, nursing staff onsite
awake at night as well.
EDUCATION SERVICES
P a g e | 11
Please indicate what types of educational ☒ On Site School ☐ Day Treatment ☐ Outpatient Services
□ Other: Click here to type ☐ Other: Click here to type
Comments: We have fully accredited intermediate school and high school on our campus, serving grades 2nd-12th. Accredited
through Advanced ed.
Calo has a fully functioning, accredited school on our campus and provide year round
school for all of our students. f a school district is supporting the academic funding
communication with home-based
for a student, we will keep in communication with the funding district for IEP
schools?
updates, etc. We stay in contstant communication with out families and update
schools upon their request. Upon transition from our program, we work with our
families and school districts to set up appropriate transition plans for a smooth
transition home.
Advanced EdCAS
☒ Yes ☐ No
P a g e | 12
review/planning.
How does your program involve the
family in treatment, keep them informed
of their child’s progress, and prepare
them for step-down as part of the
discharge process?
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
□ Physical Therapist
□ Speech Therapist
☒ Occupational Therapist
□ Dietitian
□ Psychologist
☒ LCSW
□ Behavior Analyst
☒ Other Clinician (name, credentials): Assigned Therapist & Clinical Director
☒ School Representative (name, role): Academic Director
☒ Milieu (name, role): Team Lead
Families participate in weekly family therapy (on-site or telehealth, depending on
their location) and weekly social calls. They receive monthly written treatment
summaries and are required to visit campus. We encourage parent visits every 4-8
weeks. We also facilitate two parent/students retreats per year and in addition have
3 parent training seminars.
We see behaviors as symptoms and seek to address the root cause of those
behaviors.
P a g e | 13
How does your program measure
progress on treatment plan goals and
objectives (e.g., subjective report,
phase/level progress/specific data
points)?
Calo is not a level, consequence or compliance based system. We address the root cause of
behaviors not just the behaviors themselves. Our CASA model walks families through the
phaseso treatment and what they should see/expect at each part of the treatment process.
Treatment Planning: Following admission, the focus of CALO is upon developing initial and
long term care plans for the treatment of each student. Based on the information gathered
during the Assessment Phase an Initial Treatment Plan (ITP) is developed for the early stages
of treatment. A more comprehensive Master Treatment Plan (MTP) is developed to address
each client’s assessed needs after the first four weeks of treatment. This MTP incorporates
data from prior assessments and history, as well as from observations and evidence of
present functioning. The MTP sets forth long term goals as well as short term objectives and
is reviewed and updated on a monthly basis. CALO emphasizes student and parent
participation in the MTP through periodic review of the MTP in individual therapy sessions,
telephonic sessions and written Monthly Summaries. Interdisciplinary information and peer
feedback is required in the development and update of the MTP.Treatment Plans will meet
timeline criteria.Criteria:1. Initial Treatment Plan - completed by treating therapist within 72
hours of admission.2. Master Treatment Plan - completed by treating therapist within 30 days
of admission.3. Treatment Team Summaries- completed by treating therapist and treatment
team every 30 days. Treatment Team Summaries include updates, progress and summaries
in the follow subjects/areas:1. Diagnostic Summary/Changes 2.
Goals, Objectives,
Progress3.
Self-Evaluation 4.
Family Involvement/Visits5.
Peer/Group6.
Significant Events7.
Milieu 8.
Academic/Education 9. Recreational
Therapy10.
Canine11.
Medication/Medical Review12. Plan for Aftercare13.
Need for RTC Treatment/Length of StayB. Master Treatment Plans and Monthly
Treatment Team Summaries will be reviewed by students and/or their families as
appropriate.Activities: The Clinical Director will initiate a quarterly clinical record audit January, April, July and October. Clinical Director reports deficiencies and coordinates
corrective actions through the Leadership Team.C. Treatment Team Summaries will meet
criteria for time lines.Activities: The Clinical Director monitors treatment team summaries on a
monthly basis. An annual summary is completed on time lines of reports as a part of the
annual report of Quality Improvement for presentation to the Leadership Team.D. Therapy
progress notes will reflect implementation of treatment plans.Criteria:1. Treatment Team
Summaries will reflect implementation of therapy objectives.2. School reports will reflect
progress toward educational objectives.3. Client Care Monitoring will reflect no problems in the
assessment or implementation of treatment planning.Activities: The Clinical Director will initiate
a quarterly clinical record audit-January, April, July and October. The Clinical Director reports
deficiencies and coordinates corrective actions through the Leadership Team.
P a g e | 14
system?
□ Yes ☒ No
TREATMENT
etc).
CASA proprietary model
Click here to type
Click here to type
Click here to type
Click here to type
Does your facility employ or contract with
team or staff?
□ Yes ☒ No
Research Support For each approach
listed on the left, please identify the
relevant staff training/credentials or cite
the professional literature used to guide
these approaches.
supervision.
All staff are trained initially and ongoing
throughout their employment at Calo in
regard to our CASA model. They must
complete competency evaluations in
written format and are observed and
corrected through ongoing staff
mentoring program as needed.
Initial new hire training, Initial 90 day
review, annual reviews, weekly 1;1
mentoring with supervisor, competency
assessments.
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Name and credential(s) of behavior specialist (if the individual does not have a BCBA,
Click here to type
P a g e | 15
are implemented and
Dietitian
On-site at least monthly to
Part-Time, contract employee
meet with students in need as
assessed by the health
services team. Able to be on
campus as frequently as
weekly if needed. Health
Services department facilitates
this process and incorporates
needs into Health Services
treatment planning,
Part of onsite treatment team. Full-time employee
Incorporated into academic
Contract employee
IEP and treatment planning.
On-site Health Services team
facilitates all outside provider
care.
Outside local medical
providers
Click here to type
Part of on-site treatment team
Based on IEP directive or
assessment of need by clinical
team. If clinical team assesses
a need Calo will work with
contractor to provide an
assessment and then ongoing
care as needed. Contractor
comes to campus to work with
students.
Click here to type
P a g e | 16
Dental
Other
On-site Health Services team
facilitates all outside provider
care.
Click here to type
Outside local dental provider
Click here to type
Nursing staff 24/7 onsite,
employed by Calo. Contract
pediatrician and/or general
practioner onsite, 3-4 times
per month.
Click here to type
Model
Population
Pretees, teens, & young adults
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
We expect our parents to participate in: family therapy weekly, on-site or through
technology, weekly planned social call with their child, visit campus at least every 4-8
weeks and participate in twice annual parent retreats onsite.
We have a clinical director over each program (boy’s teen, girl’s teen, preteen & young adult).
Clinical director completes file audits and 1:1 mentoring each week with each therapist in
their program. We provide onsite training by bringing professionals to campus for our annual
trauma conference, wellness workshops, lunch & learn events as well as specialized training
certification events (TCTSY, etc.). We also send all of our therapist annually to the ATTACh
conference for additional training.
P a g e | 17
following:
Self-Regulation
Daily Living
Communication
Other
Please describe how your facility helps
the recipient generalize these skills to
their home environment.
DAILY SCHEDULE
We have clinical, residential supervisors, nursing staff and leadership level staff on call
24/7 to support the residential team in regard to assessing the needs of our students.
When there is a concern regarding safety, clicnial staff assesses the student face to
face.
CASA proprietary model, neurofeedback, canine therapy, adventure programming
CASA proprietary model, canine therapy
CASA proprietary model, neurofeedback, canine therapy, adventure programming
We have a full aftercare prog
See attached Schedule
All daily schedule transitions are managed by our residential staff (Program Director,
team leads, and coaching staff) . All transitions are prepared for and/or processed
depending on what type of transition. For higher level transitions (a students
transitining home, etc.), therapist and/or leadership staff will facilitate transition.
We have a fully outfitted kitchen, dining hall, food storage (dry, cold & frozen
storage). We have a full kitchen staff that prepares all our meals and cares for the
kitchen and dining hall area. Kitchen staff are on-site 7 days a week.
P a g e | 18
On-Site Activities:
Full adventure/recreation programming
Biking, bouldering, climbing, social
included in our program to include: Cross- community outings, youth group, church.
training, biking, swimming, boating, water
sports, fishing, weight lifting, basketball,
volleyball, high ropes course, canine
walks, and fitness training.
Adventure/recreation occurs: 6 times per
week, 10 hours per week three weeks of
the month, 17 hours a week one week
per month as a full day trip is part of the
17 hour week.
At enrollment
Who is responsible for discharge planning Treatment Team, led by treating/assigned therapist.
at your facility?
What percentage of your recipients
return to:
Foster Care: 0%
Family: 100%
Group Home: 0%
Corrections: 0%
P a g e | 19
☒ Yes ☐ No
We are part of a national research study through the NATSAP organization. We also
follow-up with parent and student throughout their stay through internal surveys, at
the time of discharge through an exit interview of parents and student (separate
interviews), and ongoing post treatment surveys. For those that completed treatment
most recent success rate is 80.14%.
Calo is a specialized set of programs. We have four separate residential programs on our Lake Ozark, Missouri campus to include: male
preteen program, female preteen program (calopreteens.com), male teen program & female teen program (caloteens.com). We also have a
young adult program (caloyoungadult.com) located in Winchester, Virginia. At all our programs, we work with a very particular student focusing
specifically on early childhood stress/trauma and the emotions and behavior it produces. We heal trauma. We heal trauma in specific and
specialized ways. At Calo, relationships are the primary change agent. All treatment is connected to and motivated by relationships.
Relationships with family, Calo staff, Calo canines, and Calo peers are what drive change. Since family relationships are primary, we do not
accept students into our program—we accept families into our program. We want and encourage our families to be highly active in the Calo
program and the change process. Parents are an integral part of the treatment team and we require their intimate involvement.
Section B
P a g e | 20
ASD over 80 IQ, prefer over 85 IQ. Significant aggression with
80-85 IQ may be a rule-out, each case revieiwed individually.
Please check each box that corresponds with aspects of treatment at your facility that are listed below. These elements, other
than CBT as discussed below, are described in “Practice Parameter for the Assessment of Children and Adolescents with Autism
Spectrum Disorder”, Journal of the American Academy of Child and Adolescent Psychiatry, Feb 2014.
If we feel a child has undiagnosed ASD, we wil refer out for a full psychological evaluation.
and symptomatology?
□ Yes ☒ No
What diagnostic
Below tools are used to assess for a potential admission, if a child is in our care we would also
include observation as a tool.
process do you use?
□ Observation
□ Specific Tools (please identify): Click here to type
Physical Exam Yes
All students receive a physical exam post placement and at least
annually.
Click here to type
Screening for As Needed
P a g e | 21
Hearing Screen
Examination for Signs
Genetic Testing
Consideration of
Unusual Features
As Needed
Yes
Click here to type
As Needed
Yes
Psychiatric Services Director assess need.
All students assessed following enrollment
Click here to type
P a g e | 22
Psychological Assessment Yes
Psycho-Educational Testing- CALO requests a copy of a full battery of
psychological testing or current psychiatric evaluation is provided
before any Individual may enroll at CALO. If a current evaluation is
not available, a psychiatric evaluation will be completed within 7
days of an Individual’s enrollment at CALO. In addition, CALO's
Psychiatric Services Director(s) will complete an updated psychiatric
evaluation within 7 days of admission for all Individuals . The
psychological evaluation battery at a minimum should consist of the
following: A Diagnostic Interview, Intelligence Testing, Personality
Testing, and Achievement Testing. Histories and dispositions
towards substance abuse, violence, running away, sexually acting
out, homicidal/suicidal thoughts, and histories of confirmed
diagnosis are also preferred. All testing is conducted by a licensed
clinical psychologist, or by a doctoral level clinician who has the
results verified by a licensed clinical psychologist. The evaluation(s)
are a key factor in helping to determine an Individuals’
appropriateness for the CALO program. If an Individual does not
have a current battery of testing a current psychiatric evaluation
(within 1 calendar year) and records from continuous therapeutic
placement may substitute for a full psychological testing evaluation,
although each case will be reviewed individually. A Licensed
Psychiatrist must sign the Psychiatric Evaluation. Psychiatric ServicesAll treatment oversight, complete treatment oversight, is completed
by the Psychiatric Services Director(s) (PSD). CALO obtains a release
from the parent(s)/guardian(s) of all Individuals for our
psychiatrist(s) for the purpose of treatment oversight, medication
management, updates and consultations. When Individuals on
psychotropic medications enroll, these Individuals have their
psychiatric care transitioned to CALO’s PSD or another CALO
P a g e | 23
contracted psychiatrist for all medication management and
treatment purposes. CALO’s PSD works directly with CALO’s Clinical
Director and therapists to provide comprehensive oversight of all
psychological treatment. All Individuals will participate in an initial
psychiatric evaluation following admission and mediation
management appointments. With a frequency that is appropriate
for each Individual as determined by the PSD.
Assessment
Occupational Therapy Yes
Assessment
Click here to type
Full-time calo OT staff facilitates assessments with all preteens then
creates a OT/sensory diet, teens are assessed as determined by need
of treatment team.
Click here to type
Assessment
Click here to type
Please indicate which evidence-based and structured educational and behavioral interventions are in use at your facility by
checking the box in the left hand column as well as answering the additional questions in the right hand column, as applicable.
Is ABA used in school? □ Yes ☒ No
□ Applied Behavior Analysis
(ABA)
Is ABA used in
□ Yes ☒ No
residential?
Is ABA in treatment
□ Yes ☒ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
P a g e | 24
□ Alternative Communication
Modalities
Click here to type
Is this person a
contractor or staff
member?
□ Pragmatic Language skills
training
□ Social Skills training
□ Education
□ Other
Please describe.
Click here to type
Click here to type
Click here to type
Click here to type
□ Yes ☒ No
Psychiatric Services- All treatment oversight, complete treatment oversight, is completed by
approach to the use of
the Psychiatric Services Director(s) (PSD). CALO obtains a release from the
medication with children and
parent(s)/guardian(s) of all Individuals for our psychiatrist(s) for the purpose of treatment
youth with ASD.
oversight, medication management, updates and consultations. When Individuals on
psychotropic medications enroll, these Individuals have their psychiatric care transitioned to
CALO’s PSD or another CALO contracted psychiatrist for all medication management and
treatment purposes. CALO’s PSD works directly with CALO’s Clinical Director and therapists to
provide comprehensive oversight of all psychological treatment. All Individuals will participate
in an initial psychiatric evaluation following admission and mediation management
appointments. With a frequency that is appropriate for each Individual as determined by the
PSD.
P a g e | 25
treatments?
□ Yes ☒ No
Under what circumstances,
and/or what are the
characteristics of recipients with
ASD with whom your facility uses
Cognitive Behavioral Therapy?
Please explain.
Click here to type
Clinical team (Clincial Director, Therapists), all masters level clinicians or above.
We are not a CBT program.
Same treatment team as noted above.
Please describe your approach to Calo proprietary model
P a g e | 26
Click here to type
P a g e | 27
Center for Change
Section A
Date completed
Contact number
Address
Tamara Noyes, Director of Business Development
February 17, 2016
(888)224-8250, ext 267
Center for Change
1790 N. State Street, Orem, UT 84057
GENERAL OVERVIEW
Accreditation Body
The Joint Commissions, TRICARE certified for RTC
Age Range
# of Licensed Beds
Click
here
to
type
Click here to type
☐Males
13+
58
☒Females
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Click here to type
Day
1:16
1:4 Inpatient 1:6 RTC
Click here to type
Evening 1:16
HOME
PRINT
Page |1
Center for Change
Click here to type
Night
1:16
Minimum of 75 IQ
☒ Yes ☐ No
74 days for Inpatient and RTC Recipients?
74 days for Inpatient and
74 days for Inpatient and RTC combined combined
74 days for Inpatient and
RTC combined
RTC combined
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
Center for Change is an eating disorder program, so patients
must have a primary eating disorder diagnosis to be an
appropriate fit. If FASD is co-occurring the admissions
assessment would help to determine appropriateness for
treatment at CFC (cognitive functioning, ability to participate in
treatment, etc.). While we are a specialty eating disorder
program, we assess for all mental illness, including
developmental concerns to include FASD. Our initial clinical
assessment and our psychological evaluations screen for FASD
and when present, treating this condition is part of a patient’s
active and ongoing treatment plan. Clinical staff are masters
level or PhD level, and all staff participate in monthly in-service
training to address patient diagnoses and behaviors. Our staff
are trained in assessment and treatment of FASD.
Page |2
Center for Change
Based Practices.
Trauma can often be a contributing factor in the development of
an eating disorder, so the assessment and treatment of trauma
at Center for Change is of high priority. Patients are assessed for
trauma as part of the admissions process, and these issues are
addressed as part o the initial and ongoing treatment plan.
Because this is so often a part of eating disorder treatment,
clinical staff are well trained on assessing for and treating
trauma. Our staff are kind and sensitive in this delicate process.
All clinical, dietary, and milieu staff have ongoing training
through in-service meetings to stay current on the latest in
evidence based interventions, de-escalation and soothing
techniques, assessment tools and resources, etc.
We have policies and procedures for debriefing when our staff
have been involved in a traumatic or difficult situation with a
patient, so that an individual or small group of direct care staff
are given the support that they need. Additionally, our staff
have both instruction about and access to therapists,
supervisors, and clinical directors available to help them in time
of crisis, secondary traumatic symptoms, trauma exposure or
other emotional struggles. Throughout our ongoing staff
trainings for both clinical and direct care staff, we provide
training on self care - how to take good care of yourself as a staff
member working with patients with demanding symptoms and
tramatic backgrounds.
facility serves.
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☐ Autism Spectrum Disorders (High
Page |3
Center for Change
Click here to type
☒ Eating Disorder
Ongoing internal and external training for eating disorders
and co-occurring conditions.
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☐ Sexually reactive (e.g. response ☒ Sexually maladaptive (e.g.
to trauma)
☐ Eating Disorder
☐ Psychosis
☐ Elopement Risk
Sexually offending:
☒ Physical Aggression
☒ Fire setting
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Center for Change
☒ Yes ☐ No
☐ Yes ☒ No
Handle With Care. All staff who work directly with patients are trained/retrained
annually.
Yes. We understand that behavior including self-defeating behavior, is functional and
adaptive. We begin to assess the function of behaivor at the time of admittion as part
of our admission assessment -- not only the behvairo that need to be changed for the
patients benefits, but also the adaptive functio of behaviors. The ongoing treatment
planning process and continual therapeutic care is focused on helping patients
understand the function and reasons for behavior and to help them find new behaviors
and solutionas and ways of managing their difficulties in ways that are more healthy
and self-respectful.
Staff observation, video cameras, ongoing Q15 patient rounding at all levels of care
Center for Change is a Joint Commission Accredited specialty hospital with 24 hour
nursing. Medical issues that cannot be addressed at CFC, or dental issues, are referred
out locally with support (transporation, etc.) from CFC. Our facility is within 7 miles of
four medical/surgical hospitals with emergency departments and various specialty
medical care units.
Patient request or staff suggestion to move Time limited. If a secondary time out is
to a quiet area to regain emotional and/or
requested, a therapist is requested to be
behavioral control. This is always
involved to help assist the patient to
voluntary.
regain stability.
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Center for Change
☒ Yes ☐ No
by whom?
Physical restraints. No mechanical
restraints. Physical restraints are used in
emergency situations only and requires an
order from a physician/LIP.
Follow up includes nurse consultation
with physician and in-person evaluation
by the physician. For patients under 18,
notification of the parent, guardian,
family member, or conservator is
required.
All Center for Change staff who work directly with patients are trained in Handle With
Care. Direct care staff, including nurses, are trained/retrained on the Restraint Policy
and protocals annually. Handle With Care is a non-violent crisis intervetion that
includes orthepedically-sound brief physical hold techniques. The emphasis is on deescalation to reduce the need for any physical hold. Again, we do not use seclution at
Center for Change.
Individual
Facility
Risk Manager, per event
The Professional Executive Staff and
Patient Safety Committee monthly, and
the Governing Board quarterly.
Individual
Facility
Center for Change adheres to the Alaska
Center for Change adheres to the Alaska
Behavioral Health guidelines for reporting Behavioral Heatlh guidelines for reporting
in all areas including medical, AWOL,
in all areas including medical, AWOL,
sexual acting out, and physical aggression. sexual acting out, and physical aggression.
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Center for Change
We collect all incident report data, which would include restraint time, de-escalation
techniques, injury, falls, AWOL, medication errors, sexually acting out, physical
☒ Yes ☐ No
aggression, etc. We also collect and analyze data from patient satisfaction and family
satisfaction surveys, patient safety survey, pre and post psychological testing, longterm data and surveys including 3/6/9 months after discharge and annually thereafter
on clinical outcome. All of this data is used within the Performance Improvement
Committee and beyond to improve the treatment program at CFC.
High
We are a specialty program for eating disorders and related addictive disorders, that
includes supervised bathroom use, highly structured programmatic day, monitored and
supervised mealtimes, monitored Q15 checks on all patients from admission to
discharge.
The structure of the program decreases as patients progress from the inpatient to the
residential level of care. Treatment is individualized and structure is increased or
decreased as needed based on program advancement. The goal is to help the patient
gain more responsibility as they approach discharge, in preparation for aftercare.
Please explain.
Treatment is individualized.
☒ Yes ☐ No
Sexual acting out or physical aggression history, age
roommates?
Age, therapeutic and safety assessment
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Center for Change
characteristics?
Room assignment and roommate changes are all reviewed, discussed and approved
through the treatment team process, with final approval from our Director of Clinical
Services.
Q15 observation checks 24 hours/day, 7 days/week. Camera surveillance in general
patient care areas.
EDUCATION SERVICES
Comments: On site, Utah State Licensed Private High School, Cascade Mountain High School. Serivces grades 07 -12. We are
Northwest Accredited, have on site credentialed teachers, and a full service education program with faculty, adminstrator, and
education director. Our credit consequently, is accepted by every school to which our patients return. We are fully licnesed as a
private high school in the state of Utah, and have graduated students from high school, with diploma, from our school. Our students
have live, face to face instruction with a certified teacher, credentialed in the subject that they are teaching.
We readily and routinely work with the school districts and/or schools from which our
students come. We are able to accommodate some work from the school of origin,
communication with home-based schools? however, when schools find out about our program, they almost always opt to have
the student do schooling within our coursework, and then accept credits earned here
into their system.
AdvancED (NWAC)
☒ Yes ☐ No
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Center for Change
review/planning.
process?
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☒Other Medical (please list): APRN
☒ Dietitian
☒ Psychologist
☒ LCSW
☒ Other Clinician (name, credentials): LMFT’s, education director, physician, nurse
practitioner, utilization management specialist, clinical directors, CEO, recreation
therapists
☒ School Representative (name, role): Elayne McArthur, Academic Director
☒ Milieu (name, role): Kathy Spencer, Direct Care Manager
We require weekly family therapy for all adolescent patients with their primary
therapist or another family therapist. Where possible, those family sessions are live
face-to-face, or on a HIPAA compliant video conferencing system. When face-to-face is
not possible, we do full-length telephone therapy sessions. We also do family contact
and consultation as needed beyond therapy sessions. Monthly 5 day intensive family
therapy event where parents and other family members come for education, primary
family therapy, mulitifamily therapy groups, recreational therapueutic experiences,
training on dietrary issues and concerns, and discharge and aftercare preparation.
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Center for Change
We assess the function by a thorough review of clinical treatment, family history and
individual patient behavioral history. We review psychological evaluation and clinical
formulations. We review and assess behaviors in the moment on the units, in
activities, and in all aspects of treatment. We look for patterns and trends and
functions and adaptations that are related to a patients behavior. We give them good
intent for their behavior realizing they are trying to get their needs met. We help them
understand the function of their behavior and and we help them find new and better
ways of dealing with life and getting their needs met. We listen to our patients.
We use pretesting or initial admitting assessments as a baseline to look at progress
made and ongoing struggles so that we can update and attend to an everchanging and
current treatment plan. We also use subjective information and staff report from our
multidisciplinary team through the vehicles of verbal and written shift report, verbal
and written reports for Treatment Team meetings, phase advancement meetings with
patients and their own community of peers, phase advancement meetings with the
Treatment Team individually with the patient, and written and verbal reports from our
staff and family members on interactions in family therapy and other family
visits/phone calls. Reports from academic progress and social and academic behavior
in school in areas of learning and social interaction are gathered and discussed in
Treatment Team meeting.
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Center for Change
system?
☒ Yes ☐ No
TREATMENT
etc).
Trans-theoretical Model of Change
Basic adherence to program rules and
guidelines, effort made towards
overcoming difficulties and behavioral
problems, willingness to collaborate with
direct care and clinical staff in making
progress towards their treatment goals,
willingness to treat peers and staff with
respect, and a willingness and shown
ability to be part of a community which
provides a safe and respectful
environment for all to do their therapeutic
work.
The level system can be modified, if
needed, to address the specific needs of a
particular patient.
approaches.
supervision.
“Changing for Good (Prochaska, Norcross,
et al)
Staff are oriented to this model in New
Employee Orientation, as this is the
underlying model for our level system.
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Center for Change
Family Based Treatment (Maudsley
Method – FBT)
Click here to type
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Professional peer-reviewed journal articles Clincal staff are trained in this model in
(Chris Fairburn, et al)
their graduate mental health provider
training, and Center for Change continues
to support this model with ongoing
training including in-house clinical
trainings and supervision.
Multiple books and peer-reviewed articles Members of clinical staff have been
by James Locke and LaGrange
trained in this method through outside
certified programs, and have gone on to
train within our facility additional clinical
staff.
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team or staff?
☐ Yes ☒ No
are implemented and
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Dietitian
Because we are an eating
Full and part time
disorder treatment program,
dietitans are on staff and
participate fully as a treatment
team member.
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Center for Change
Dental
Other
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Model
Population
Trans-theoretical Model of Change
Adolescent and adult patients
CBT, DBT, ACT
Adolescent and adult patients
FBT
Adolescent patients with Anorexia & their families
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We expect families to participate regularly and consistently in weekly family therapy
sessions. We strongly urge participation in at least one of our 5-day monthly intensive
family therapy events.
We have two fulltime RN's (DON and Assistant DON) who provide supervision for our
24-hour/day nurses. We have six supervisors over our direct care staff who provide
supervision, training and oversite to our Care Tech's, who are also supervised by the RN
on every shift. We have six PhD or master's level clinical supervisors who oversee the
clinical work of our primary, individual, and family therapists who are all master's level
or PhD prepared.
We have one primary therapist and a clinical director and a physician/nurse
practitioner and the CEO and our DON who are all on call 24 hours/day, 7 days/week to
deal with any crisis situations.
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Center for Change
following:
Interpersonal skills We have skills classes, relapse prevention classes, and relationship classes/groups at
the Center.
Self-Regulation We have DBT groups and assignemtns which help our patients learn coping skills in
dealing with intense affect.
Daily Living Skills of daily living are covered in our skills groups. With the population we treat, 95%
of our patients are able to accomplish basic ADL’s on their own.
Communication Communication skills are taught in the skills groups/classes
Other Click here to type
Please describe how your facility helps the The general use of skills in the community, or peer milieu is one way in which they
implement and integrate skills into their life. They also utilize their skills in our in-house
home environment.
High School, Cascade Mountain High, in their classes and activities. When they have a
chance for passes with parents or family, they also have a chance to practice and
integrate skills into a regular life setting.
DAILY SCHEDULE
For adolescents, three meals per day, three snacks per day, three therapy groups or
classes per day, some free time per day, and school for 3.5 hours per day as well.
Transitions occur in the same facility, from unit to unit, and from school to treatment
living area. Patients are escorted by direct care staff to each activity which is next on
the treatment and daily schedule
All meals and snacks are prepared by our cooks in our in house kitchen. Food is served
in our dining room, which accommodates well our patients. Meals are under
supervision of direct care staff, and sometimes by dietitians, who can help those
patients who struggle with "food issues"
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Center for Change
On-Site Activities:
art, music, dance, exercise, yoga, outdoor
play, low ropes course, initiative games,
leisure activities
high ropes course, hiking, canoeing,
biking, walking, attending concerts or
other arts or cultural events
At admission
Who is responsible for discharge planning We have one staff who is assigned as our discharge planner. She works in concert with
at your facility?
the primary therapist to assure that the discharge plan and aftercare dispositon is well
planned, is carried out, and that appointments are made with aftercare providers prior
to discharge from the program.
What percentage of your recipients return Therapeutic Foster Care: 5%
to:
Foster Care: 5%
Family: 75%
Group Home: 5%
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Center for Change
☒ Yes ☐ No
We do 4 follow up support phone calls after discharge to lend support to patients and
families and encourage them as they get in the saddle with their aftercare provider
team. Then we do long term outcome surveys at 3,6,9 months and at 1,2,3,4,5 years
out, so that we know truly how our discharged patients are doing in the long term. Our
clinical outcome research shows that 1 year following discharge from our program, 50%
of our patients describe themselves as "recovered." Another 40% of our patients
describe themselves as "partially recovered" or "doing much better", and 10% report
that they are not doing well. These statistics are better than the average outcome from
those whose data is worthy to publish in peer reviewed professional journals. 90%
positive outcome is good stats on clinical and recovery outcome, not only at discharge,
but after the long haul.
At Center for Change we have programs for adults, and programs for adolescents. We specialize in treating serious eating disorders,
and all of those related illnesses that are commonly co-occuring with eating disorder illness such as: depression, anxiety, trauma,
abuse, PTSD, self harm, suicidal ideation,substance abuse, learning struggles, developmental struggles, social problems, relationship
problems, family difficulties, and other related medical and mental illness. We are licensed as a specialty psychiatric hospital in the
state of Utah, and can admit and treat medically and emotionally compromised patients. We offer all levels of care: inpatient,
Residential (RTC), PHP ( Day), IOP (intensive outpatient) and traditional outpatient services. We have great medical care, and clinical
and theapeutic care which is intensive, and high end in terms of quality.
P a g e | 16
Center for Change
Section B
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and symptomatology?
☐ Yes ☐ No
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What diagnostic
process do you use?
☐ Observation
P a g e | 17
Center for Change
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Choose
an
answer
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Consideration of Choose an answer
Unusual Features
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Assessment
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Assessment
Click here to type
Assessment
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Sleep Assessment Choose an answer
(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
P a g e | 18
Center for Change
Modalities
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
training
☐ Education
☐ Other
Please describe.
Click here to type
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Click here to type
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☐ Yes ☐ No
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Please explain.
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treatments?
☐ Yes ☐ No
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Center for Change
Behavioral Therapy?
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Center for Change
P a g e | 21
Desert Hills
Section A
Date completed
Contact number
Address
Michael Girlamo, Chief Operations Officer
February 17, 2016
505-480-6419
Desert Hills
5200-C Sequoia Ave NW, Albuquerque, NM 87120
GENERAL OVERVIEW
Accreditation Body
The Joint Commission
Age Range
# of Licensed Beds
5-18
64
☒Males
5-18
56
☐Females
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here
to
type
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☐Other
Nursing
Milieu
Comments
Day
1:30
1:2, 1:4, 1:5.
Milieu staff ratios are dictated by unit population and per
state licensing standards.
HOME
PRINT
Page |1
Desert Hills
Evening
1:30
1:2, 1:4, 1:5.
Night
1:60
1:5, 1:10
For the unit that addresses mild developmental delays, clients are required
☒ Yes ☐ No
to have an IQ between the ranges of 35 – 70. For all other units that do not
address mild development delays, clients are required to have an IQ greater
than 70.
3 months – 18 months,
Recipients?
Tricare: 4 months
3 months – 18 months, depending on
depending on population
3 months – 18 months,
population and client / family needs.
and client / family needs.
depending on population
and client / family needs.
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
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Page |2
Desert Hills
Based Practices.
Treating children and youth who have been exposed to trauma is
a large focus of the Desert Hills. The facility utilizes Dialectical
Behavioral Therapy (DBT), Nurtured Hearth Approach (NHA),
Building Bridges Initiative (BBI), and Eye Movement
Desensitization and Reprocessing (EMDR) as therapeutic
approaches to address clients and youth with extensive trauma
histories. Additionally, in the milieu, the staff have been trained
in NHA, as well as being trained in 2016 in DBT. Lastly, the facility
utilizes sensory items in the milieu in order to address
dysregulated clients.
The facility offers time away for staff and clinicians who suffer
from secondary trauma, as well as a staff lounge that has trauma
informed items (ie, sensory items) to help regulate. The facility
also offers Employee Assistance Program (EAP) for staff who may
benefit from therapy.
facility serves.
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Desert Hills
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☐ Eating Disorder
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to trauma)
Sexually offending:
☐ Eating Disorder
☐ Psychosis
☐ Elopement Risk
☐ Fire setting
Desert Hills subscribes to the Therapuetic Crisis Intervention (TCI) model offered by
Cornell University. Desert Hills has a “Train the Trainer” program in regards to TCI;
there are currently
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Desert Hills
☒ Yes ☐ No
☒ Yes ☐ No
☒ Yes ☐ No
Each client is assessed by a master’s level clinician prior to admission. This
comprehensive assessment addresses all biological, social, and psychological needs.
Additionally, upon an admission, an Individual Crisis Management Plan (ICMP) is
created which assesses triggers, identifies coping skills, develops safety plans and
trains all staff on the evaluation of the ICMP.
The facility does not utilize video cameras. All clients are monitored by staff in their
ratio as outlined per policy.
The facility has 24 hour nursing coverage, as well as 24 hour psychiatrist on-call. Both
of these elements assess for medical need and if a client requires additional medical
attention beyond the scope of Desert Hills, the client is referred out for medical and
dental care.
If the patient requests it.
1:1 with staff to process.
When the ICMP notes no restraint is
Nurse observes patient while in seclusion
allowed due to physical or emotional
and documents accordingly.
restriction.
If Yes, what follow up steps are taken? as
a last resort. verbal deescalation preferred.
If the client is exhibiting danger to self or
Life space interview after every intervention
others and all other verbal de-escalation
with patient as well as staff involved and
techniques have been exhausted.
ICMP is updated accordingly
Desert Hills uses TCI (Therapuetic Crisis Intervention). We do refreshers at 90 days for new
employees and then 6 months there after. We focus on verbal deescalation , we use restraint
and selcusion as a last resort, and only used if patient is in danger of hurting themselves or
others. Data collected monthly to review all restraint and seclusions for appropriateness
Page |5
Desert Hills
by whom?
Individual
Every weekday in the Clinical Flash
meeting.
Individual
Every IR (Indicent Report) is reviewed by the
risk manager and documented that is
reportable and what follow up is needed. The
QI (Quality Improvement) Staff then fax/email
reportable incidents
Facility
Every month by the Restraint and
Seclusion Performance Improvement
Team (which includes administration,
Program Directors, nurses and mental
health technicians).
Facility
The QI (Quality Improvement) reports
incidents including emergency room visits (i.e.
illnesses, or injuries) allegations of abuse,
neglect, or exploitation, death of patient,
sexual miscondut, medication errors or
significant adverse effects
Incident report data is aggregated on a monthly basis and trends are identified. These
trends then lend way to corrective actions when necessary. Incidents that are trended
☒ Yes ☐ No
included restraints, seclusions, assaults, elopements, medication variances, selfinflicted inuries, among others.
structure and supervision provided by your High - Intense, focused, structure and supervision - Keystone of what we do here at Desert Hills
Choose a level
All RTC patients are supervised very closely. Client to staff ratio can vary by unit, and clinical
need: we staff in relation to acuity, our ratios of staff to patient are hight than state mandate,
ratios are highest on the more acute units
Page |6
Desert Hills
☐ Yes ☐ No
roommates?
characteristics?
Please explain.
Both: All RTC patients are supervised very closely. Client to staff ratio can vary by unit, and
clinical need: we staff in relation to acuity, our ratios of staff to patient are hight than state
mandate, ratios are highest on the more acute units
This is evaluated by age, aggression, history of sexual acting out, and reassigning roommates is
regularly accomplished. Additionally, during treatment, if it is identified that two roommates
do not get along, we will take measures to reassign roommates.
Program Director's and Therapists evaluate regulary and evaluate upon intake. On some units,
reassigning roommates is regulary accomplished
If it is identified that two clients can no longer be roomates (whether that is a result
from an incident between the two, or a personality conflict), the Program Director will
re-assign roommates that same day.
Safety is of the utmost concern. Daily "Flash" meetings occur with Adminisstration, Program
Directors, and Staff to discuss the previous days incidents - identifying the triggers, R/S, acuity,
staff issues, and developing a corrective action plan accordingly.
EDUCATION SERVICES
☒ On Site School ☒ Day Treatment ☐ Outpatient Services
Comments: All residential treatment clients who are in grades 6 – 12 attend an on-site private or charter school. Elementary clients
who are special education attend the Albuquerque Public Schools Home School Program (APS teachers come to the facility to teach
the kids). Elementary clients who are regular education are bused to the elementary school in the community that is near the
facility.
The facility works closely with all school entities that we work with. The facility has an
Education Director who acts as the liaison between the facility and the private, charter,
communication with home-based schools? APS, and community schools.
The Desert Hills Private School is North Central Accredited.
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Desert Hills
review/planning.
process?
☒ Yes ☐ No
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☐ Psychologist
☒ LCSW
☐ Other Clinician (name, credentials): Click here to type
☒ School Representative (name, role): Laura Braun, Education Director (when needed)
☒ Milieu (name, role): the assigned Program Director will attend the Treatment Team
meeting. The PD represent the milieu staff.
Families are central to everything we do here at Desert Hills. They are invited in the
development of the treatment plan, weekly therapy sessions, monthly treatment team
meetings, regular contact with Program Directors; daily phone calls with their child.
Page |8
Desert Hills
system?
☒ Yes ☐ No
TREATMENT
etc).
Dialectical Behavioral Therapy
daily "flash”, Special Case reviews, treatment teams, specialized trainings, staff meetings,
groups with client(s). Objective is to never give up on a child
Monthly treatment team updates, phase system, evidenced based models on each unit with
workbooks, DBT, CBT
The sytem is set up as a “phase” system
and the client’s engagement is program is
what leads to positive reinforcement.
However, we have moved away from
consequences, thus it based on reward for
positive behavior and engagement in
treatment.
The phase system is constantly being
modified to be client specific.
approaches.
supervision.
All therapists are master’s level clinicians
trained in CBT as a part of their education.
Cedar Coons and Slyma Fine are trainers in
DBT.
The clinical directors supervise and train
the therapists weekly.
The therapists and Program Directors
receive DBT trainings every other week.
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Desert Hills
Certified Juvenile Sex Offender Therapist
Nurtured Heart Approach
Trauma Informed Care & Building Bridges
Gail Ryan, CJSOT
Therapists who work with the SMB
population are trained one time by Gail
Ryan in Colorado and given the
certification of CJSOT.
Local Nurtured Heart Trainers have
Internally, we train all staff on NHA at hire,
consulted with us and trained all staff.
and regular trainings on –going.
Building Bridges Program, Raul Alcazar
The Clinical Directors, therapists and
Program Directors have received Trauma
Informed Care Training. Also, Raul Alcazar
trained all staff facility wide in Trauma
Informed Care in 2015.
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team or staff?
☐ Yes ☒ No
are implemented and
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Desert Hills
Dietitian
The nursing staff note the
orders written by the Dietician
and carry them out. This is
monitored by daily peer review
chart checks completed by
nursing staff.
Part time / contract.
If a client is seen by an OT, the
Education Director will ensure
that all recommendations are
followed.
If a client is seen by a Speech ;
Language Pathologist, the
Education Director will ensure
that all recommendations are
followed.
Outsourced.
The Dietician is contacted at
time of admission if the client
has a history or present need
of dietary issues, or if the
client’s BMI is low or high.
Also, at any time during the
course of treatment, the
medical staff can contact the
dietician for an assessment and
recommendations.
N/A
Outsourced.
N/A
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Desert Hills
Dental
Other
If a client is seen by a speciailist Outsourced.
in the community, the nursing
staff is responsible for
reporting all findings the
client’s attending psychiatrist
at the facilty to obtain any new
orders and the nursing staff is
responsible to ensure the
follow through of these order.
Compliance is monitored by
daily peer review chart checks.
If a client is seen by a dentist in Outsourced.
the community, the nursing
staff is responsible for
reporting all findings the
client’s attending psychiatrist
at the facilty to obtain any new
orders and the nursing staff is
responsible to ensure the
follow through of these order.
Compliance is monitored by
daily peer review chart checks.
Click here to type
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N/A
N/A
Click here to type
Model
Population
All clients
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Desert Hills
Diabolical Behavioral Therapy
Pathways
Click here to type
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Male and female adolescents with emotion dysregulation
Sexually maladaptive clients
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Family therapy is to occur one time per week. If the family cannot make the therapy
session in person (which is the preferred method), then the session will take place via
telephone or teleconference.
Clinical Supervision occurs at a minimum of one time per week, one hour per
supervision, for each clinician. There can also be additional group supervisions as
deemed necessary.
All staff are trained in the Therapuetic Crisis Intervention (TCI) approach in order to
therapeutically intervene with clients in crisis.
following:
Interpersonal skills Interpersonal skills are taught in-vivo through mental health technician (MHT) interaction with
clients in the moment, through special topics groups (inlcuding, but not limited to, anger
management, social skills, conflict resolution, decision making skills,etc.), and through
interactions with peers on unit, in school, and in recreational groups.
Self-Regulation Self-regulation skills are taught through the use of sensory activities (struggle socks, weighted
animals, sensorio-motor activities) as well as through mindfulness skills and activities.
Daily Living Activities of daily living are taught through MHT hurdle help to complete activities (such as bed
making, laundry, and chores like sweeping and mopping of rooms, etc). Other daily living skills,
like schedule adherence, overcoming mood-dependent behavior, school attendance, nutrition
& table manners, etc are all taught and developed experientially and in-the-moment
interactions with peers, MHTs, school personnel and other facility staff.
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Desert Hills
Communication Communication skills are taught, developed, and reinforced throughout the RTC program.
Through groups (facilitated by MHTs, therapists, or Program Directors) specifically focused on
communication issues (peer conflict, grievances, conflict resolution, etc). Also, communication
skills are practiced in family therapy sessions.
Desert Hills utilizes the Nurtured Heart Approach as the general approach to engaging with
Other
residents and their families. This approach focuses on profound noticing and then verbalizing
resident behaviors seen through the lens of the resident's greatness.
Please describe how your facility helps the Therapists work with the residents and their family through family therapy sessions to teach,
practice, and refine communication skills, Nurtured Heart Approach techniques. During passes
with family or guardian, the resident is assigned homework to complete during pass. This work
home environment.
is specifically focused on generalizing skills within the home, or home community, of the client.
Upon return to the facility, the guardian fills out a form indicating the disposition of the pass,
and if homework was completed. Homework is reviewed in the next family therapy session,
with behavioral rehearsal to refine skill, and new assignment generated.
DAILY SCHEDULE
The day begins with Activities of Daily Living (hygiene, chores, breakfast, medications,
expectations groups, etc). School is from 9am-3pm Monday through Friday (with exceptions of
school holidays & vacation periods). After school, unit programming, including but not limited
to groups (as described above), recreational activities, therapy sessions (individual, group,
and/or family), snack & meal time, medications, etc, takes place. During the weekend, the
same activities take place (with the exception of school), with focus on unit outings in the
community, passes or visits with family/guardians, recreational activities, etc.
There are three main ways transitions are handled: 1. Through formalized expectations
groups where residents and MHTs discuss the expectations around certain activities (such as
outings, campus visitors, etc). 2. Through hurdle help of time reminders (such as "five minutes
left until it is time to clean up for lunch"). 3. Through line drills, i.e. a call & response repetition
of reminder phrases, when walking from one location to another.
Desert Hills has a fully equipped kitchen, menu's are developed weekly and approved by APS
schools dietician. Patients are served in a cafeteria and are responsible for scraping their plates
and wiping down the table
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Desert Hills
On-Site Activities:
Recreation times are allotted to all units on a
rotating schedule daily. The recreation
department facilitates organized recreation
periods throughout the day during school
hours; open and/or structured recreation is
part of the evening schedule. Special Events
are brought to the facility on occasion, such as
Exotics of the Rainforest, Black History Month
events, dancers or cultural events, etc.
Offsite activities usually occurs only on
weekends or holidays so as to not interrupt
the school day. Offsite activities include (but
are not limited to) the botanical gardens, zoo,
aquarium, museums & cultural event centers,
artistic & musical venues and events,
community service activities, equine assisted
therapy sessions, movies, restaurants, etc.
Discharge planning begins at admission. Therapists/Social Workers are responsible for ensuring
after care with input form the treatment team
at your facility?
to:
☐ Yes ☒ No
The treatment team, primarily the therapist, is responsible for ensuring appropriate
discharge planning.
Therapeutic Foster Care: 35
Foster Care: 0
Family: 50
Group Home: 10
Corrections: 2
Independent Living: 2
N/A
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Desert Hills
Click here to type
Section B
N/A
Click here to type
and symptomatology?
☐ Yes ☒ No
Click here to type
What diagnostic
process do you use?
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Desert Hills
☐ Observation
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Unusual Features
Click here to type
Click here to type
Assessment
Click here to type
Assessment
Click here to type
Assessment
Click here to type
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Desert Hills
(ABA)
Is ABA used in school?
☐ Yes ☐ No
Modalities
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
training
☐ Education
☐ Other
Please describe.
Click here to type
Click here to type
Click here to type
Click here to type
☐ Yes ☐ No
P a g e | 18
Desert Hills
treatments?
☐ Yes ☐ No
Behavioral Therapy?
Click here to type
Please explain.
Click here to type
Click here to type
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Desert Hills
Click here to type
Click here to type
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Devereux Cleo Wallace
Section A
Date completed
Contact number
Address
Andrea TeBeest, Intake Manager
February 8, 2016
303-438-2357
8405 Church Ranch Blvd. Westminster, CO 80021
GENERAL OVERVIEW
CO DHS, JCAHO
Accreditation Body
Age Range
# of Licensed Beds
12-21
61
☒Males
12-21
25
☒Females
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Click here to type
Day
Bambi
6:1
Click here to type
Evening Bambi
4:1
HOME
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Page |1
Click here to type
12:1 with 2 additional
support staff available for
acuity purposes
Minimum IQ of 70
☒ Yes ☐ No
9-12 months
Recipients?
30 Days
Click here to type
9-12 months
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
We have a licensed psychologist who completes a wide variety of
psychological evaluations as indicated by client behavior and history.
Staff are provided additional training from the clinical department
Night
Click here to type
Based Practices.
when a client's diagnosis or behaviors warrant it.
Our treatment process aims to integrate principles of a TraumaInformed Model of Care (i.e., neurodevelopmental effects of exposure
to adverse events during childhood) with an Applied Behavior Analytic
approach to improve individuals’ capacity for emotion regulation,
engage in relational interactions, and encourage positive social
behavior. This is achieved by creating an enriched treatment
environment and using positive reinforcement to support patterned,
repetitive experiences designed to target symptoms of developmental
trauma, and emotional and behavioral dysregulation. In this way,
Devereux Colorado - Cleo Wallace Center strives to create an
environment that is conducive to teaching new ways for clients to
respond to the demands of today’s world.
Page |2
We have staff available on-site, as well as, utilize an EAP service.
facility serves.
Through initial training and periodic training throughout the
year.
Click here to type
Initial training and periodic training throughout the year.
☒ Sexually reactive (e.g. response to trauma) Training is conducted by a SOMB therapist.
Click here to type
☐ Eating Disorder
Click here to type
Click here to type
to trauma)
Sexually offending:
☒ Eating Disorder
☐ Psychosis
Page |3
☐ Elopement Risk
☒ Fire setting
☒ Other: Pregnancy
We train our staff to establish and maintain a safe and warm therapeutic environment. We
utilize the New Directions Curriculum and an adaptation of the Crisis Prevention Intervention
(CPI) we call Safe and Positive Approaches that is standardized through the entire Devereux
Foundation. Our treatment process works to integrate principles of a Trauma-Informed Model
of Care (i.e., neurodevelopmental effects of exposure to adverse events during childhood) with
an Applied Behavior Analytic approach to improve individuals’ capacity for emotion regulation,
engage in relational interactions, and encourage positive social behavior. This is achieved by
creating an enriched treatment environment and using positive reinforcement to support
patterned, repetitive experiences designed to target symptoms of developmental trauma,
emotional, and behavioral dysregulation. In this way, Devereux Colorado - Cleo Wallace Center
strives to create an environment that is conducive to teaching new ways for clients to respond
to the demands of today’s world. Staff respond to challenging behavior by using positive
relational style to encourage de-escalation before giving feedback and predictable
consequences. When providing feedback, staff focuses on clearly identifying and describing
desired forms of behavior
During the first 30 days of placement, we conduct a variety of assessments based on problem
areas. If ASD is suspected by referring parties, or symptomatology observed post-admission,
and further assessment requested, our assessment process includes a minimum of a Functional
Behavior Assessment, and the Autism Spectrum Rating Scales.
Staff observation
24-hour nursing, on-call pediatrician, provide transportation to medical and dental
appointments. All clients receive a nursing assessment within 8 hours of admission, a physical
within 72 hours of admission, and a dental appointment within 6 weeks of admission.
Page |4
☒ Yes ☐ No
☐ Yes ☐ No
☒ Yes ☐ No
Quite room under constant visual
monitoring by staff
staff obtain a doctor's order and seclude the
client in a Quiet Room while maintaining
constant visual monitoring
staff process with client and come up with a
plan to return to the milieu
staff process with client and come up with a
plan to return to the milieu. A registered
nurse conducts a face-to-face evaluation
If Yes, what follow up steps are taken? A
registered nurse conducts a face-to-face
evaluation and the client processes with a
staff member to come up with a plan to
return to the unit.
Seclusion and Restraint are considered to be
the highest levels of behavioral interventions
and are only to be utilized in emergencies in
which there is an imminent risk of an individual
physically harming himself or herself or others,
including staff, and when all other, less
restrictive alternatives have been exhausted.
Clients may only be placed in seclusion and/or
restraint when their Individualized Emergency
Intervention Plan indicates its use as
appropriate and consistent with their
treatment plan or when they present an
imminent danger to themselves and/or others.
All staff receive an initial training regarding seclusion and restraint and receive a refresher
training every 6 months.
Page |5
by whom?
Individual
Facility
Individual
Facility
The multi-disciplinary team review any clients
who require 3 or more restraints/seclusions
in a week. Individual restraint/seclusion data
is reviewed monthly for each client's
Treatment Plan Review
death, suicide (including attempt or threat),
allegation of sexual abuse, harm to self, harm
to others, serious injury/illness requiring
attention by medical personnel, serious
injury/illness requiring attention by in-house
medical staff, use of seclusion or restraint,
unapproved absence over 10 hours,
medication error requiring medical attention,
law enforcement involvement, violation of
condition of probation, allegations of criminal
conduct, fire or other disaster,
Units and classrooms review their
restraint/seclusion data on a monthly basis
and compare the trends to previous months.
Multi-disciplinary teams also review any
restraint/seclusion incidents which may have
occurred a week at a time.
unplanned change in administrator,
knowledge or suspicion of abuse, neglect,
misappropriation of funds or property of
recipients of service, knowledge that any
employee, volunteer or household member
has been convicted or charged with an
offense under AS47.05
We review Key Performance Indicators monthly to determine trends.
☒ Yes ☐ No
structure and supervision provided by your Our level of structure and supervision is high. Staff provide consistent visual monitoring which
is documented every 11-15 minutes. Structure is developed by a multi-disclipinary team which
Choose a level
focuses to teaching pro-social behavior and rewards positive behaviors.
Page |6
Based on the individual's safety level, a client may be on routine monitoring (staff complete
visual check at least every 15 minutes), close observation (client remains within staff sight at all
times), monitored in the great room during sleeping hours, 4 minute checks. All of these levels
of supervision are determined by a clinician or nurse and are communicated to all members to
the treatment team
☒ Yes ☐ No
roommates?
characteristics?
Please explain.
EDUCATION SERVICES
Yes. The clinician or nurse determines the level of supervision.
age, prior victimization or offending behavior, risk to sexually offend, risk of being victimized,
threats of aggression
Roommate assignments are assessed weekly with the aid of a roommate assessment. All
members of the multi-disciplinary team share their input and determine roommate
assignments.
Staff members working during a shift where a concern may come to light will complete a new
roommate assessment and determine if changes are appropriate
Clients are monitored consistently during waking hours which is documented every 11-15
minutes. During sleeping hours, a bed and body check is completed every 11-15 minutes.
Additionally, all units are equipped with laser curtains which will sound an alarm in the vertical
plane of the bed is broken
☒ On Site School ☒ Day Treatment ☐ Outpatient Services
Page |7
communication with home-based schools?
review/planning.
If student has an IEP- the process brings the District and Devereux Cleo Wallace together
facilitating conversation. For a student without an IEP we would have an initial contact with
the former District if the plan is for the student to return to home school or to an alternative
school. If the plan is not to return to the home school, the development and realization of this
student's Educational Plan is driven by us toward earning credits for graduation or GED tracked
when the credit gap is likely difficult to overcome
Accredited by Colorado Deptment of Education for the State and Nationally through AdvancED
☒ Yes ☐ No
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☒Other Medical (please list): medication technician
☐ Dietitian
☐ Psychologist
☐ LCSW
☒ Other Clinician (name, credentials): Primary unit clinician
☐ School Representative (name, role): Click here to type
☒ Milieu (name, role): all staff assigned to work directly with the client; program
manager
Page |8
process?
Parents are involved in weekly family therapy, are invited to monthly treatment plan review
meetings and have immediate notification of any incidents.
system?
☒ Yes ☐ No
Motivational Assessment Scale
daily points which includes therapeutic goals are tracked a month at a time and compared to
previous month during monthly Treatment Plan Review. We utilize a computer program which
tracks restraints/seclusions, rates of aggression, rates of self-injury, and contraband use and
review that date from the date of admission to the current month during monthly Treatment
Plan Review
Clients admit on Orientation Level and
The level system is modified to meet the
progress over time to Level 1, Level 2, Level 3, needs of each individual and family. If the
and Graduation Level. Clients complete a level level system does not align with the
packet and therapeutic assignments to
client’s needs based on their goals and
advance levels. Additional privileges such as
length of stay, the treatment team can
later bed times are earned as the client
work with the client to insure that
progresses through the level system.
incentives are appropriately utilized.
TREATMENT
Page |9
etc).
Verbal praise (Positive relational
experiences
Making “time in” matter (Enriched
Environment)
approaches.
supervision.
It is crucial to notice and acknowledge when
children are doing well. Staff is trained to
acknowledge and provide positive feedback
when a child is successful. This motivates the
child to do well more often, in turn,
decreasing problematic behavior
It is very important to create an environment
where children are motivated and excited
about their treatment. This includes providing
activities that are fun and therapeutic,
encouragement to maintain appropriate and
meaningful relationships with others, and
feeling respected and liked by staff.
All staff receive an initial 2 week training
which orient them to our treatment strategie
and participate in refresher trainings on a
rotating schedule. Multi-disciplinary
treatment teams discuss clients and additional
trainings are offered when needed
trainings are offered when needed
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Earning points through the level system
(Differential Reinforcement)
New Directions
Click here to type
Sometimes it is necessary to mediate
motivation and bridge delays to
reinforcement by utilizing contingency
management and visual representation of
progress. By using Positive Behavior
Intervention and Support methods, the
frequency and consistency with which
patients engage in positive behaviors is
reinforced and patients are awarded for
participating in treatment. Additionally, for
specific diagnoses for which Response Cost is
indicated (in general the Disruptive Behavior
Disorders), staff may also utilize predictable
consequences to decrease the likelihood that
negative behaviors will be repeated. Forms of
negative feedback include: reduction in
privileges, restrictions from preferred
activities, drop in levels, and loss of points All
staff receive an initial 2 week training which
orient them to our treatment strategie and
participate in refresher trainings on a rotating
schedule. Multi-disciplinary treatment teams
discuss clients and additional trainings are
offered when needed.
Staff are trained on the use of the social
curriculum, New Directions. Implementation
of new directions in the classroom focuses on
using early interventions, making effective
requests, positive praise, setting clear
expectations and reinforcing positive
behaviors.
Click here to type
trainings are offered when needed.
trainings are offered when needed.
Click here to type
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Curt Mower, M.S., BCBA Megan Daveline, MA, BCBA
team or staff?
☒ Yes ☐ No
are implemented and
Dietitian
The dietitian performs a
Full time
nutrition assessment and
creates nutrition plan/goals
tailored to the individual client
needs. The dietitian nutritional
assessment and plan is
implemented into the
treatment plan. She reviews
and signs off on the plan.
On contract
Occupational therapist
consults with the treatment
professionals involved with the
client to insure that
interventions and skills are
practiced on a regular basis.
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On contract
Dental
Other
Click here to type
Click here to type
Click here to type
Speech/Language pathologist
consults with the treatment
professionals involved with the
client to insure that
interventions and skills are
practiced on a regular basis.
Click here to type
Click here to type
Click here to type
Model
Population
Dialectic Behavior Therapy
All clients
Applied Behavior Analysis
Aggression Replacement Therapy
Click here to type
Click here to type
Autism Spectrum Disorders, where clinically approriate
all clients
Click here to type
Click here to type
Family therapy aims to teach both the client and family skills to not only maintain gains made
during treatment, but to facilitate further improvement independent of therapy. A variety of
approaches may be used to accomplish these goals, most common being structural, systemic,
strategic, and behavioral parenting. By enhancing the family's capacity to function as a healthy
unit, it is hoped that further protective processes may be created
The clinical team is divided into two groups with each group meeting once per week. Each
clinician presents one client per month for review by the group. The supervision model we use
is a Competency-based Model based on a text published by Falender & Shafranske
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following:
Self-Regulation
Daily Living
Communication
Other
home environment.
DAILY SCHEDULE
Every student has a current IEP or Educational Plan in place, with appropriate modifications and
accommodations. In addition, each student has an ISTTP (Individualized Special Treatment
Procedure Plan) which is followed closely on the unit and in the classroom and includes deescalation strategies tailored to each individual
Daily therapeutic groups and individually tailored goals
Daily therapeutic groups and individually tailored goals
A structure created with the goal of teaching independent living skills and pro-social behavior
All clients particpate in daily groups which focus on sharing your opinion and listening to others
Click here to type
Critical attention and time is devoted to transferring programmatic successes to the home
environment. This may be accomplished through support giving, information exchange, parent
training, home passes with home work, and other similar wrap-around services.
Each unit is slightly different, however all clients attend school, participate in a daily
therapeutic group, attend dinner, are offered a structured recreation activity, allowed
structured leisure time, provided time for phone calls, and attend a medication administration
group.
Clients transition between activities in a single file line with no talking
We have an on-site dietician/kitchen manager who oversees the preparation of balanced,
healthy meals at our cafeteria
P a g e | 14
On-Site Activities:
We have a swimming pool, gym, weight room,
game room, outdoor basketball courts, 4
square courts, baseball diamond, volleyball
net in the summer. Every unit has a wide
variety of recreational toys, from footballs to
skateboards. A basketball team is offered for
boys and a volleyball team is offered for girls.
Our Physical Activites Coordinator provides
numerous off site activities. For example,
running, mountain biking, snowboarding, rock
climbing, rec center visits. In addition to these
activites, the clients are able to earn weekly
off grounds trips to places like the movies,
zoo, museum, dinner, shopping.
Tentative discharge plans are discussed with the guardian upon admission and the plan
is assessed at every monthly treatment plan review.
Who is responsible for discharge planning James McHenry, Jennifer McGee, Laura Stickney, Lynn Curtis, and Derick Burkhard
at your facility?
to:
Foster Care:
Family: 50%
Group Home: 25%
Click here to type
☐ Yes ☒ No
Approximately 80% of our clients step down to a lower level of care (i.e. group home, return to family, foster care, day treatment
P a g e | 15
Section B
We provide specialized care and treatment of individuals diagnosed
with ASD with IQs over 70 (although individuals with IQ scores
between 55 -70 are considered on a case by case basis). Our
treatment models are specifically chosen to provide the accommodate
individuals with a mismatch between developmental and chronological
age. During the first 30 days of placement, we conduct a variety of
assessments based on problem areas. If ASD is suspected by referring
parties, or symptomatology observed post-admission, and further
assessment requested, our assessment process includes a minimum of
a Functional Behavior Assessment, and the Autism Spectrum Rating
Scales.
Typically, individuals referred to our ASD program have previously been diagnosed with ASD
and symptomatology?
☒ Yes ☐ No
P a g e | 16
What diagnostic
process do you use?
During the first 30 days of placement, we conduct a variety of assessments based on problem areas. If ASD is
suspected by referring parties, or symptomatology observed post-admission, and further assessment
requested, our assessment process includes a minimum of a Functional Behavior Assessment, and the Autism
Spectrum Rating Scales.
☒ Observation
☒ Specific Tools (please identify): Autism Spectrum Rating Scales;Comprehensive Executive Functioning
Inventory;Motivation Assessment Scale, Functional Assessment Interview, Checklist of Adaptive Living Skills,
Adolescent Coping Inventory for Problem Experiences
Physical Exam Yes
The Nursing Assessment which is completed at admission,
Hearing Screen
Genetic Testing
Consideration of
Unusual Features
Psychological Assessment
screens all basic body systems including gastrointestinal and
neurological (including hearing).
Referral to a specialty clinic would occur if the pediatric
practitioner determined that there were one or more major
features present and two or more minor features present.
Yes
Yes
Click here to type
Click here to type
No
Yes
Click here to type
Click here to type
Yes
As requested by guardian or recommendation by the assigned clinician
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Communication
Assessment
Occupational Therapy
Assessment
Physical Therapy
Assessment
Sleep Assessment
Yes
Click here to type
As Needed
If requested by the guardian or indicated on the individual’s IEP.
Yes
Conducted upon request or if abnormalities are detected during initial
physical exam, with funding
Conducted upon detection of sleep problems (Albany Sleep Problems Scale &
Sleep Intervention Questionnaire
As Needed
Is ABA used in school? ☒ Yes ☐ No
☒ Applied Behavior Analysis
(ABA)
Is ABA used in
☒ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
What credentials does BCBA
your ABA specialist
have?
Yes
treatment team?
Is this person a
Staff Member
contractor or staff
member?
Modalities
Assistive technology primarily used for selectively mute individuals, Visual schedules commonly
utilized
training
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☒ Education
☒ Other
Multi-Modal Social Skills Intervention; ASSET; Problem Solving Social Skills
Several curriculm-based educational models focused on increasing functional academics directly related
to employment-related skill acquisition. Some example curricula include: Life-Centered Career
Education; School to Work Skills; Life School 2000; AGS Life Skills Curriculum; Consumer Math; and
English for the World of Work
Please describe.
Manualized protocols for Sensory Regulation, Dialectical Behavior Therapy, and the Neurosequetial
Model of Therapeutics when indicated
typically use with this population? *Completed by Dr. Michael Seller, PsychiatristOur psychiatrist prescribes medications that are FDA
approved for autism spectrum. This includes antipsychotics, which are basically approved to manage
☐ Yes ☐ No
anger. These have significant immediate and long term side effects, so our psychiatrist tends to use
them only when other options have failed. Our psychiatrists approach is to look for target symptoms
and comorbid conditions; ie, if the diagnosis is Autism spectrum and Depression, they would use
antidepressants, usually SSRIs. If Autism spectrum and Bipolar, they may prescribe mood stabilizers
or antipsychotics, such as Lithium, Depakote or Risperdal or Abilify. If there is coexisting ADHD they
may prescribe stimulants and/or alpha blockers such as Clonidine or Tenex. If there is not a coexisting
diagnosis sometimes medications may only be prescribed to address target symptoms. SSRIs work
well for cognitive inflexibility and obsessional thinking/ compulsive behavior, all of which are seen in
Autism spectrum. Clondiine and Tenex can help with emotional regulation, impulsive anger and
hyperactivity without the side effects of antipsychotics and stimulants, so they are often a first choice.
If someone comes in stabilized on medications, our psychiatrist will continue to prescribe what they
are taking rather than make changes, and for behavior or mood issues that arise, would adjust doses
rather than make complete changes to a different medication (unless it is clear that the medication is
worsening symptoms or not alleviating them at all).
Devereux Colorado does not use prns, as we want clients to learn to mangage moods and
behaviors with coping skills. We will treat coocurring psychiatric disorders, or symptoms of
emotional/ cognitive inflexibility or aggression, that don’t respond to psychotherapy.
P a g e | 19
treatments?
☐ Yes ☐ No
Behavioral Therapy?
Please explain.
Click here to type
Clinicians, psychiatrists, program managers.
All three of the social skills teaching protocols we employ include components of CBT. Please see #9
below for more details on individual characteristics.
Lisa Gauda, PhD (Clinical Psychologist); Michael Seller, M.D. (Psychiatrist); Chuck Green & Sean Daly
(SPED teachers); James McHenry (Case Coordinator); Todd Davis (Program Manager)
We specialize in providing treatment to individuals who do not experience intellectual disabilities,
and find that a majority of these individuals also experience significant co-occuring problems in
addition
to ASD. Specifically we have selected treatment modalities to treat Anxiety, Depression, and
Developmental Trauma-related Problems that occur co-morbidly with ASD.
P a g e | 20
Click here to type
P a g e | 21
Devereux Texas
Section A
Date completed
Contact number
Address
David Roberds-Roach, Director of Marketing
February 22, 2016
281-335-1000, ext. 2210
Devereux Texas
1150 Devereux Drive, League City, TX 77573
GENERAL OVERVIEW
Accreditation Body
The Joint Commission
Age Range
# of Licensed Beds
13-22 years
132
☒Males
13-22 years
132
☒Females
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Day
Nursing care is available at
1:4
Nursing care is available at all times. Nurses are assigned
all times.
to units based on applicable regulations.
HOME
PRINT
Page |1
Devereux Texas
Evening
1:4
all times.
Night
1:8
all times.
☒ Yes ☐ No
Devereux League City typically serves individuals with intellectual
functioning at or above the borderline range. However, every referral is
assessed individually to determine fit based on a holistic understanding of
the individual, including intellectual and adaptive functioning.
12-18 months
Recipients?
NA
12-18 months
12-18 months
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
Client's who are diagnosed with FASD are usually diagnosed with FASD
prior to entering our program. However, a comprehensive assessment
is completed upon admission. A medical and physical exam are
completed in addition to collecting family and developmental history.
If FASD is suspected, a neuropsychiatiric assessment is completed.
Individualized programming is developed for the diverse populations
that Devereux serves. The Master Treatment Plan for a client with
FASD is developed from a multi-disciplinary approach with the input of
the client and family. The Clinicians provide inservice to our Direct
Support Staff to educate, provide materials, and review treatment
approache
Page |2
Devereux Texas
Based Practices.
The Devereux Foundation has published Best Practice Guidelines on
Trauma Informed Care. Our clinicians are trained on Trauma Informed
Care (T.I.C.) and Trauma-Informed Cognitive Behavioral Therapy. All
staff members attend annual trainings on T.I.C. Thorough
Biopsychosocial information is gathered during client and family
interview and from previous placements or clinical professionals. The
Trauma Symptom Checklist for Children standardized assessment is
utilized to identify children and youth with extensive trauma histories.
To treat a child or youth identified with extensive trauma, traumafocused psychotherapies are used. Again, the Master Treatment Plan
and the Crisis Management plan is developed from a multi-disciplinary
approach and is individualized to address an identified trauma history.
Our Clinician's give regular inservices about Trauma Informed Care to
our direct care staff.
All staff complete Texas Department of Family and Protective
Services Trauma-Informed Care Training that addresses
secondary trauma in staff. Devereux encourages staff to
maintain a work/life balance by offering weeks of benefit time.
Devereux sends out Health and Wellness emails and designs staff
activities promoting eating healthy and being active. Employees
have access to Carebridge EAP as a stress management and
therapeutic resource.
facility serves.
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Devereux Texas
☐ Eating Disorder
☒ Other 18-22 year old men and women
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Staff members are trained on patient rights, informed consent,
focus on life skills and vocational skills training.
Click here to type
to trauma)
Sexually offending:
☐ Eating Disorder
☐ Psychosis
☐ Elopement Risk
☐ Fire setting
Comments: Devereux-League City carefully considers every referral sent to us. Clients who have been referred to
Devereux with a history of sexually acting out behaviors, eating disorders, fire setting behaviors and those on the
Autism Spectrum are closely reviewed for severity of behaviors and level of functioning.
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Devereux Texas
The concepts and structure of D-PBIS are integrated into the R.I.S.E. Program that: 1) Provides
clear, well-defined campus-wide values and expectations for all clients and staff; 2) Provides a
framework for teaching expectations to all clients and measuring their success; 3) Provides
specific lesson plans for all staff to assist in teaching behavioral expectations; 4) Provides
incentives and positive acknowledgement for all who live and work at Devereux; and 5) Allows
us to collect data and make data-driven decisions.
Deverux Functional Behavior Assessments are conducted by our Board-Certified
Behavior Analyst. The BCBA works with the treatment teams to integrate the results of
the FBA into the individualized treatment plans.
☒ Yes ☐ No
Clients are monitored by staff 24:7. Our clients are monitored by our staff according to the
client's level of supervision, ranging from face-to-face monitoring to periodic visual checks
dependent upon a client's safety needs. Staff monitor our clients during school hours, during
meal times, during acitivities (on and off campus) and during sleep hours. Level of supervision
is increased or decreased depending on the client's safety or therapeutic need.
Our clients are seen for a history and physical within 24 hours by a contracted physician. A
thorough nursing assessment is also completed at admission. A dental appointment is
required within 30 days of admission unless documentation is provided indicating a dental
appointment has occurred within the last 6 months.
If Yes, what follow up steps are taken? If
a client takes a time out, a staff member
A time out is always voluntary. A time out can
be taken independently or can be suggested by completes face-to-face monitoring of that
client. The client can voluntarily leave the
a staff member as a way to cope.
time out room at any time. Staff take actions
to assist the client to integrate back into
activities.
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Devereux Texas
☒ Yes ☐ No
☒ Yes ☐ No
The facility does use seclusion when all other
Safe and Positive Approaches (SPA) are not
successful and the client is a danger to
themselves or to someone else.
The facility does use physical restraint when all
other Safe and Positive Approaches (SPA) are
not successful and the client is a danger to
themselves or to someone else.
If a client is secluded, a staff member
completes face-to-face monitoring the entire
length of the seclusion. A face-to-face
evaluation by a psychiatrist or a trained
registered nurse is completed within one
hour of the initiation of the seclusion.
Reasonable measures are implemented by
staff to de-escalate and promote selfcontrol. Regularly scheduled meals and
bathroom breaks are provided. Once the
client has calmed and seclusion stopped, the
client is debriefed on the reason for
seclusion, a nursing assessment is complete
and the client can return to regular
programming. Notification to guardians and
funding agencies are made.
a client is restrained, only SPA approved
techniques are utillized. The client is
monitored by a nurse during the restraint for
proper positioning, breathing, and any other
medical concerns. Consideration for clients
who have extreme trauma histories is
exercised. A face-to-face evaluation by a
psychiatrist is completed within one hour of
the restraint. Following the restraint, a
client is debriefed on the reason for restraint
and a nursing assessment is completed.
Notification to guardians and funding
agencies are made.
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Devereux Texas
The direct care staff are initially trained during classroom orientation in Safe & Positive
Approaches and Emergency Behavior Interventions: Restraint & Seclusion Guidelines. Annual
training in Safe & Positive Approaches is completed during an eight-hour recertification course.
The EBI: Restraint & Seclusion Guidelines are also taught annually. Additional topics on EBIs
are trained to staff every six months per licensing requirements.
by whom?
Individual
Facility
Individual
Facility
Each Restraint and Seclusion is reviewed by
supervisory staff after each occurrence.
Clients who require the intervention with
increased frequency (by set criteria) are
reviewed in accordance with criteria for
"Trigger" reviews. Seclusion and restraint
data is reviewed by the Treatment Team and
by the Director of Nursing.
Our facility reports death, sucide, allegation of
sexual abuse, harm to self or others, serious
injury/illness, use of seclusion or restraint,
unapproved absence over 10 hours,
medication error requiring medical attention,
law enforcement involvement, violation of
condition of probation, allegation of criminal
conduct. Knowledge or suspicion of abuse,
neglect, misappropriation of funds or
property of recipients of services.
Seclusion and restraint data is reviewed
monthly by QM, Leadership and Operations
committees.
Fire or other disaster, unplanned change in
administration.
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☒ Yes ☐ No
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Devereux Texas
High
☒ Yes ☐ No
roommates?
characteristics?
Our program provides 24:7 staffing to support our clients. We have locked programs.
Structure is built into our program to help the clients regulate time, schooling, activities,
therapies, and sleep. Nurses charge each unit and provide medical support. Unit supervisors
oversee the milieu programming and clinicians offer therapeutic support in the form of
individual, family and group therapies.
As clients progress through their treatment programs, they may choose to opt out of some
programming. Also, our clients may participate in more activities on and off campus as they
increase in our phase and level system.
Please explain.
All clients are assessed at admission and on an ongoing basis, thereafter, for the presence of
risk factors that indicate a need for increased level of supervision and monitoring. The client
will be assigned to the level of supervision appropriate to the level of risk identified with
immediate implementation of additional precautionary measures as necessary to meet the
client’s safety needs. 2. Based on the safety needs assessed, each client is assigned to a level
of supervision (LOS) congruent with the level of risk identified. Each LOS is defined by an
intensity of observation and monitoring necessary to provide ongoing safety in daily activities
and during sleep hours.
The clinical team determines room assignment based on gender, age (the clients must be
within 2 years age range of each other unless the clients are over the age of 18), level of
functioning, level of supervision, and safety.
The staff monitoring procedure for determining the assignment of roommates is based on the
criteria listed above.
The clinical team considers the reason for change, client characteristics, and clinical
appropriateness when considering new roommates.
The clients are monitored according to their level of supervision with the exception of during
sleeping hours. All clients are monitored at 15 minute checks during sleeping hours.
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Devereux Texas
EDUCATION SERVICES
Comments: The Educational Services Program at Devereux League City includes both educational and pre-vocational programs. The program
includes grades 6-12, serving students who have been designated emotionally disturbed, learning disabled, or requiring special education
services. Curriculum is designed and based on current needs as indicated by strengths and deficits reported in multi disciplinary assessments.
An appropriate curriculum is determined for each student based upon the student’s IEP, a review of pre-admission school reports and
assessments, and the results of KTEA II (Kaufman Test of Educational Achievement). Children receive services in the least restrictive setting
necessary to meet the child’s needs and abilities.Clients attend school on campus with their assigned unit. Educational Services are
individualized to meet the client’s needs.
Communication with school districts occurs regularly. An Individualized Education Plan drives
the placement in the program in many situations. The Case Coordinators, members of the
communication with home-based schools? individuals Treatment Team, is the liason between Devereux and the school districts. School
districts are notified of progress in the treatment program and any incidents that occur with an
individual in the program. The school districts are invited to participate in monthly treatment
reviews and the districts receive updates on a client's progress via written quarterly reports.
AdvancED (formerly Southern Association of Colleges and Schools)
☒ Yes ☐ No
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Devereux Texas
review/planning.
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☐ Psychologist
☒ LCSW
☒ Behavior Analyst
☒ Other Clinician (name, credentials): Clinician’s credentials include LPC, LCSW,
LMSW, LMFT
☒ School Representative (name, role): Special education teacher
☒ Milieu (name, role): Unit Supervisor, Case Coordinator
process?
Our RISE program promotes movement toward less structure and more independence, thus
preparing clients for a lower level of care as they advance through the program. Our program
model supports family involvement via interaction during personal phone time and visitations
and in bimonthly family therapy sessions that focus on reunification. Case Coordinators are
instrumental members of the team who facilitate communication with family members.
Family members are viewed as part of the client team and families participate in Treatment
Team Meetings. Progress updates are communicated through phone calls, monthly team
reviews, and written quarterly progress reports. Guardians receive reports of incidents within
24 hours. Discharge planning begins at day one with the family and client participation in the
initial discharge planning process and planning continues until discharge. All members of the
team are involved in the discharge planning process.
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Devereux Texas
system?
☒ Yes ☐ No
The family and the client are involved in the development of the treatment plan, crisis
management plan, and biopsychosocial assessment. High risk behaviors are identified and
treatment goals and interventions are written to address the behaviors. The psychiatrist, along
with the team, continuously monitors the function of the challenging behaviors and assigns
precautions to monitor behaviors (i.e. assault precautions, self mutilation precautions, suicide
precautions, elopement precautions).
The Treatment Team reviews progress toward treatment goals every 30 days. Progress is
measured using our Phase/Level program and multi-disciplinary reports. The Treatment Team
may decide that a Functional Behavioral Analysis is appropriate for select clients. From
assessment nad FBAs, a behavior support plan is developed.
The R.I.S.E. Program is broken down into 4
phases: Commitment, Learning, Practice,
and Role Model. Privileges are earned as
clients learn new skills and progress
through the program phases. Staff
members assist clients with learning new
skills. Desired skills are customized to
different settings (e.g. school, afternoon
activities, dining hall) to mimic the
diversity of behavioral demands
experienced in natural environments.
The interdisciplinary treatment team may
individualize the client’s program to
optimize therapeutic gains and progress
toward meeting treatment goals.
TREATMENT
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facility’s Treatment
Approaches/Evidence Based
Practices/Promising
etc).
Research Support For each approach listed on the
left, please identify the relevant staff
training/credentials or cite the professional
literature used to guide these approaches.
Staff Training How are staff oriented
to the items listed? Describe if/how
receive orientation, training and
ongoing supervision.
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Guidelines for the Treatment of
Children and Adolescents with Major
Depression
*Devereux’s Best Practice Guidelliness and
recent revisions have been developed in concert
with the APA’s (2002a,b) criteria for developing
best practices and evaluating treatment
guidelines, as well as internal systems such as
standards of care, clinical training models,
supervision and consultation, and CQI.
In an effort to emphasize the
importance of training, supervision
and consultation in the support of
Best Practices, Devereux maintains
online clinical and direct care trainings
which are available to all Devereux
employees. Examples of clinical
training modules include “Writing
Strengths and Needs Statements”,
“Treatment Planning”, and
“Functional Behavioral Assessment”.
In addition, Devereux’s Office of
Clinical Affairs provides individual
case consultation as well as program
support for evaluation, program
development, and consumer outcome
studies. Ongoing supervision occurs
with Clinical and Medical Peer
Reviews. Clinical staff complete
inservices to educate Direct Care
Professionals about Best Practice
Guidelines.
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Devereux Texas
Guidelines for the Treatment of
Children and Adolescents with
Disruptive Behavior Disorders
*Devereux’s Core Values are reflected in the
BPGs: Encouragement of an interdisciplinary team
approach, support of innovative and effective
solutions, aspirations of enhanced personal and
professional staff development, and emphasis on
the value of family and community in service
delivery.
Treatment of Substance Use Disorders
Treatment for substance abuse disorders is
provided by a Licensed Chemical Dependency
Counselor.
Annual training hours must be in
areas appropriate to the client
population in our care. Topics
include, but are not limited to: nonviolent crisis intervention, restraint,
seclusion, admission authorization,
client intake & screening, physical and
emotional developmental stages,
effective communication, constructive
guidance and discipline, fostering selfesteem, positive interaction,
prevention and spread of
communicable disease, safety
practice, supervision and strategies
and techniques for working with our
population.
New hire orientation for direct care
providers complete instructor led
competency -based training for
Introduction to Substance Abuse
Disorders.
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Devereux Texas
Trauma Informed Care
http://mentalhealth.samhsa.gov/nctic/trauma.asp
DFPS Trauma Informed Care Training National
Child Traumatic Stress Network National Crime
Victims Research and Treatment Center
T.I.C. is embedded into the following
trainings: Orientation Introduction:
Initial discussion about the type of
individuals that we work with and
their resiliency. Ethics – Overview:
Explains abuse, neglect and
exploitation and how employees
should respond should they become
aware of these traumatic events on
campus or with our individuals.
Wellness and Benefits: Includes
instructions to access our EAP and
emphasizes the resources available to
them for assistance with dealing with
stressors to prevent greater issues
such as Compassion Fatigue.
Preventing Sexual Incidents: This
includes discussions of appropriate
interactions and behaviors of sexually
traumatized individuals.Age Specific
Growth and Development: Discusses
the reasons that individuals may not
be physically, emotionally, cognitively
on par with peers (trauma is one of
them).Safe & Positive Approaches:
Trauma reactions are discussed in
almost every aspect of the curriculum,
both the prevention piece and during
the physical portion.
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Devereux Texas
Click here to type
Click here to type
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Does your facility employ or contract
with a behavior specialist (behavioral
psychologist or BCBA) on the
Rose Filteau, BCBA
treatment team or staff?
☒ Yes ☐ No
How does your facility ensure that
these professionals’ treatment
recommendations are
implemented and consistently
followed?
Dietitian
The treating physician may order a Contract
As needed, as determined
dietary consult. In these cases, the
by the treating physician
dietitian collaborates with nursing
staff and dining hall staff to ensure
that the client’s dietary needs are
met.
For individuals receiving
Contract
occupational therapy, the OT
by the school and/or
collaborates with the treatment
physician
team and education staff to
implement recommendations.
Speech/Language Pathologist For individuals receiving
Contract
speech/language pathology, the
by the school and/or
SLP collaborates with the
physician
treatment team and education
staff to implement
recommendations.
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Devereux Texas
Other Medical (e.g., GI,
Sleep)
Dental
Click here to type
Click here to type
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Contract
As determined by the
physician
Other
Each client sees the dentist on a biannual basis. Nursing staff
implement recommendations as
necessary.
Click here to type
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Model
Population
Trauma-Focused Cognitive Behavioral Therapy
Adolescents
Adolescents
Interpersonal Therapy
Adolescents
Dialectical Behavior Therapy
Adolescents
Click here to type
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Devereux hopes that the client and family/guardian will enter into a partnership to
make a commitment to help empower the client to make changes in their life. Family
Therapy is typically held bi-monthly for 60 minute sessions.
Director of Clinical Services provides supervision of therapists employeed and
contracted by Devereux. Two clinicians are officed on each unit to provide oversight of
the milieu.
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Devereux Texas Treatment Network offers reasonable care in determining whether an
emergency exists, renders life-saving first aid, and makes appropriate referral to the
nearest facilities that are capable of providing emergency medical services. In addition,
it is the responsibility of the Facility to plan for client safety and management during a
crisis, notify all concerned parties, and plan for the short-term and long-term emotional
responses to a crisis situation. The Crisis Response Plan shall be reviewed and modified
annually and/or whenever there are significant program or staff changes.
following:
Interpersonal skills Clients are taught skills in many different ways, settings/environments, and through
servicesthat are provided at Devereux like school; individual, group and family therapy;
substanceuse counseling; recreation activities; nursing and psychiatric services;
community and staffled groups.
Self-Regulation Participation in The RISE program helps determine what responsibilities and privileges
a client will have in the program. As a client learns new skills and becomes more
responsible in making daily choices, a client will earn rewards and privileges. The staff
help the client to identifiy and utilize coping skills.
Daily Living The program is structured for clients to learn how to complete timely hygiene, attend
school/work, complete room care and laundry, learn meal preparation, learn money
management, and learn good sleep hygiene.
Communication Daily social and recreational activities are offered for learning appropriate peer
interaction. Staff work with the clients to help them talk about and better manage
their feelings.
Please describe how your facility helps the The clients practice skills with their family during family visitation, during family therapy
and during home visits. Clients are offered opportunities to volunteer in the
home environment.
community and attend social activities off campus to practice their learned skills in the
community.
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DAILY SCHEDULE
The clients rise between 7am and 8am and complete hygiene. Between 8am and 9am,
clients attend community group and eat breakfast. Clients attend school from 9am to
3:15pm with an hour lunch break. The clients return to the unit following school. From
3:15 to 3:45, clients relax after school and prepare for 3:45pm community group. From
4pm - 5pm clients participate in an activity (physical, church, leisure)as scheduled.
From 5pm - 6pm, clients eat dinner in the cafeteria. From 6pm - 7pm, clients
partiicpate in a scheduled activity (physical or leisure). From 7pm - 8pm, clients
participate in a leisure activity and eat snack. From 8pm - 9pm, clients complete
evening hygiene and prepare for bed. 9pm - 10pm - clients are in bed.
The staff report the schedule and expectations for the shift in community groups.
Clients are invited to participate in each activity. When clients line up, staff again let
the clients know what the activity is and what the expectations are.
Cycle menus for the cafeteria are planned by Dietitian, according to acceptable rules for
planning a balanced, appealing menu and are influenced by patient food preferences.
Meals are prepared by trained food and nutrition staff and served buffet-style in the
cafeteria or served by tray on the unit. Unit personnel will assist food service staff
unloading delivered meals. Food and Nutrition staff and employed clients clean
dishes, trays and tables following meals.
On-Site Activities:
Basketball, volleyball, soccer, biking,
Movies, shopping, out to eat, sports
canoeing, swimming, board games,
games, parades, beach, community
movies, holiday celebrations, cooking,
volunteering at resale shops and animal
exercise, football, softball, birthday
shelters, zoo, charity events
parties, etc.
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Devereux Texas
at your facility?
to:
☒ Yes ☐ No
The treatment team begins identifying discharge supports and services at the time of
admission.
The attending physician has the responsibility for ensuring the discharge planning
process in cooperation with other members directing the multidisciplinary treatment
team. Discharge planning begins upon admission for all patients. Family, legal
guardian or significant others shall be involved in the discharge planning process.
Therapeutic Foster Care: Click here to type
Foster Care: Click here to type
Family: Click here to type
Group Home: Click here to type
Past data has shown that 58 percent of clients remain in a traditional school setting and
that 23% quit school after discharge. 14% of those clients remaining in school are in
college programs. Rates of substance use remain very low with approximately 20% of
clients using drugs after discharge. Approximately half those report other social
problems related to their substance use. Approximately 50% of clients report being
engaged in leisure or recreational activities.
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Devereux Texas
Section B
Click here to type
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and symptomatology?
☐ Yes ☐ No
Click here to type
What diagnostic
process do you use?
☐ Observation
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Devereux Texas
Click here to type
Click here to type
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Choose
an
answer
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Click here to type
Unusual Features
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Click here to type
Assessment
Click here to type
Assessment
Click here to type
Assessment
Click here to type
(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
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Devereux Texas
Modalities
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
training
☐ Education
☐ Other
Please describe.
Click here to type
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Click here to type
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☐ Yes ☐ No
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Please explain.
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treatments?
☐ Yes ☐ No
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Behavioral Therapy?
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Jasper Mountain Center
Section A
Date completed
Contact number
Address
Julie Williamson, M.A., Residential Program manager
February 8, 2016
541-747-1235
37875 Jasper Lowell Rd., Jasper, OR 97426
GENERAL OVERVIEW
Accreditation Body
COA
Age Range
# of Licensed Beds
3-13
10 (Although not specifically licensed by gender, we
☒Males
attempt to keep the milieu balanced)
3-13
10 (Although not specifically licensed by gender, we
☒Females
attempt to keep the milieu balanced)
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Click here to type
Day
1:20
1:3
HOME
PRINT
Page |1
Evening
Night
1:20
1:20
1:3
1:10
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Awake staff while children are sleeping and 3 back-up
staff on property
We generally do not accept children with IQ’s lower than 70 unless it
☒ Yes ☐ No
appears that low IQ is the result of trama.
12-18 months
Recipients?
12-18 months
12-18 months
12-18 months
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
Children with elements of FASD/ARND are admitted if their
cognitive functioning is borderline or above. Identification is
often noticed before admission but if not we do a complete
psychiatric and psychological assessment with as much
information on early development as possible. Staff receive
training within and outside of the organization on adjustments to
children who are drug and alcohol affected. Most of the training
is child specific due to the many other comorbid issues that are
often linked to drug and alcohol impacts.
Most children referred are known to have had childhood trauma,
however, a fuller trauma history often comes out in our
What kind of training do your staff receive (include milieu as well programs. We do a complete trauma history, then use projective
techniques as well as individual and group trauma interventions
children both within the organizations and external training. Our
Based Practices.
expertise in trauma treatment goes back three decades and our
innovative approaches are included in several published books.
Page |2
We have a significant percentage of staff who have been through
trauma themselves. In our initial training, we encourage staff to
self monitor. Ongoing, we encourage them to take issues to their
supervisor. We have trainers that spot individuals that are
struggling with the contents. We have training that includes selfreflection. We have a mission statement where the health of our
staff is mentioned.
facility serves.
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Initial and on-going mental health training, as well as,
☒ Sexually reactive (e.g. response to trauma) specific NRT protocol training based on individual children
and behaviors.
☐ Eating Disorder
☒ Other Attachment Disorder
Click here to type
specific NRT protocol training based on individual children
and behaviors.
Page |3
specific NRT protocol training based on individual children
and behaviors.
Sexually offending:
to trauma)
resulting from cognitive or neuro- ☐ adjudicated/ ☐ nonbehavioral issues)
adjudicated
☒ Other Trauma/Abuse
☐ Eating Disorder
☒ Psychosis
☐ Elopement Risk
☐ Fire setting
Comments: Our program does not automatically screen out Intellectual/Development Disabilities, Autism
Spectrum Disorder, or Psychosis providing it is not the primary diagnosis.
Jasper Mountain uses the CPI (Crisis Prevention Institute) model of behavior
management. Agency trainers go through a three day course, and have to maintain 17
hours of training per year. All program staff receive the initial CPI training which
consists of 8 hour sfocused on crisis prevention, de-escalation, and management of
assaultive behaviors. The staff are required to attend a CPI refresher course annually.
We have 4 in-hourse certified CPI trainers.
Yes. We use pre- and post- instruments to assess level of functioning across
environments. In addition, we use a neuroreparative protocol to assess current
functioning and developing a plan for continued progress.
Page |4
☐ Yes ☒ No
☐ Yes ☒ No
☒ Yes ☐ No
The standard of supervision is within visual sight and audio monitoring at all times
unless asleep or in the restroom. At night we use laser beam monitoring with
computerized sensors and a voice activated system and automatic microphones so
staff are aware of all activity when the child is in bed. The level of supervision and
sophistication of our monitoring allows us to admit children with the most severe
aggressive and sexual risks.
We have on site nursing and nurse’s assistants who coordinate with both pediatricians
and dentists who serve our children. Routine screenings and appointments are
coordinated for both medical and dental needs. Complete medical evaluations are
done at intake, start of the school year and annual physicals. Dental exams are
provided twice a year with any needed follow-up dental work.
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When a child presents as a danger to
themselves or others.
We comply with CPI, SAMSHA, and
Oregon Administrative Rules on physical
restraints including licensed
authorization, well person checks,
debriefing and reporting.
Jasper Mountain does not use seclusion. Staff are trained in the use of restraint by the
CPI model of crisis prevention and intervention techniques described above and all
staff must be formally certified in physical interventions.
Page |5
by whom?
Individual
Facility
Individual restraint data is reviewed
Facility restraint data is reviewed monthly
monthly during the child’s Multiduring the monthly Quality Assurance
disciplinary Review Meeting and during
Meeting and every 90 days by the full
the monthly Quality Assurance Meeting.
Board of Directors.
Individual
Facility
All incidents including serious injury or
All incidents including serious injury or
illness, any sexual acting between clients, illness, any sexual acting between clients,
physical restraint and any unusual
physical restraint and any unusual
incidents are reported to Alaska
incidents are reported to Alaska
Behavioral Health.
Behavioral Health.
Annual pre and post data on seven assessment instruments. Children are tracked for
five years beyond discharge on 21 factors of success. Ongoing data is collected by the
☒ Yes ☐ No
Quality Assurance Committee for restraint useage, length of restraints, medication
delivery, improvement at discharge, injuries of any kind, complaints of any kind, and
consumer feedback.
High
Jasper Mountain provides 24 hour supervision. Children are not out of staff’s sight
except during showers/bathing, use of the restroom, and changing of clothes (alone in
the room). The milieu is structured, and there is a set routine from the moment the
children wake up to the moment they go to bed with technology monitoring in rooms
during sleep hours to help awake staff supervise all children as well as every child
visually checked every 15 minutes throughout the night.
Page |6
All children receive the same level of supervision, however the intensity of supervision
may increase if the child is having significant difficulty, presents as an added safety risk
such as a sexual risk, or is in need of additional support due to emotional/behavioral
dysregulation.
Please explain.
Both. Most of our children have demonstrated significant risk issues and therefore all
children are closely supervised at all times. Over and above the general standard of
☒ Yes ☐ No
supervision we have children due to therapeutic need who must have even more
intensive supervision, for example risk of self harm after a parent’s rights have been
terminated, risk to other children due to a reaction to a new medication, etc.
When pairing children as roommates, several factors are considered: age of the
promote or prevent pairing of recipients as children, history of sexualized behavior, personality (dominant vs. timid), and gender.
roommates?
Children with sexualized bheaviors are not paired with any children more than 2 years
younger/older. Children with a propensity for violence and/or bullying or intimidation
are not paired with children who are easily victimized or intimidated. Children are
separated by gender on different floors. Extra precautions are taken to insure that all
children are safe.
Children are not in their bedrooms except for changing/chores, morning routines, and
sleep. When more than one child is in their room, a staff member is also in the room.
Each bedroom is equipped with a laser alarm that is turned on at bedtime, and
monitors any movement that extends beyond the child’s bed. A speaker is activated
when the alarm goes off which allows staff to hear any movement or sound. While
children are asleep, night staff conduct room checks every 15 minutes to ensure that
every child is asleep in their bed. Additional precautions in room assignments are made
with the factors outlined in the previous question.
Page |7
characteristics?
EDUCATION SERVICES
communication with home-based schools?
Monitoring notes are made for every child during every shift. Any concerns are
immediately brought to the attention of program management staff. Room
adjustments are discussed in an ongoing dialog and changes are made when called for
to either provide maximum safety or therapeutic reason (pairing children as
roommates to work on developing friendship skills). When characteristics of concern
come to light, a roommate change is made immediately.
The standard supervision (visual and auditory) ensure full monitoring of every child at
all times. There is a combination of staff supervision and technology that monitors
children throughout the night. Our standard of supervision has prevented essentially all
safety and sexual risks among children, no elopements in memory, and a pattern of no
risks during nighttime hours.
☒ On Site School ☒ Day Treatment ☒ Outpatient Services
☒ Other: Speech, OT, remedial subjects, hearing accomodations, sensory services ☐
Other: Click here to type
We work closely with all school districts, local and out-of-state who cooperate in the
education of children from in-state and out-of-state. We share information and
reports, include the districts in discharge planning and invite them to review meetings
on progress.
Certified by the Oregon Department of Education, California Department of Education,
Illinois Department of Education
☒ Yes ☐ No
Page |8
review/planning.
process?
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☒ Psychologist
☐ LCSW
☒ Other Clinician (name, credentials): Therapists
☒ School Representative (name, role): Click here to type
☒ Milieu (name, role): Residential Program Manager
Parents assist in intake information and treatment planning and discharge criteria.
Parents are involved in weekly family therapy by phone or teleconference. Parents
participate in monthly full team meetings including school issues. Parents are invited to
have on-site visits on a monthly basis or what works with their schedule. Parents are
involved in determining length of stay. We have on-site accomodations for parents at
no cost during visits to the Center.
We track specific identified treatment issues that often include serious problem
behaviors. We track physical aggression, incidents of self-harm, sexual behaviors and
other issues, and depending on the treatment plan we may track disrespect, bullying,
non-compliance, tantrums, and elimination issues such as enuresis.
Page |9
system?
☒ Yes ☐ No
TREATMENT
etc).
We measure progress on multiple measures. We use daily progress on achieving
treatment objectives, we monitor serious behavior issues, we use standardized
measures to measure improvement in attachment, social skills, communication and
daily living skills, personal stability, and dozens of other measures are monitored. We
do extensive monitoring depending upon the primary issues of the child.
We have a system that is very different
The level system is based on each child’s
than most level systems. Children are
individual treatment plan and is modified
involved in developing individual
based on age, developmental level,
treatment objectives. They are rated
cognitive ability and needs.
multiple times per day on their own
unique issues. The children who are
struggling to meet their goals are on a
status focusing on improvement. This is
how we make sure that every child is
aware each day why they are in a
treatment program and what they need to
be working on.
approaches.
supervision.
P a g e | 10
CBT Anxiety; CBT Trauma Focused; CBT
Child Sexual Abuse
CBT in several forms have substantial
literature and are listed by SAMSA as
federally designated EBPs. Our licensed
therapists have traiing in these areas.
EMDR is a federally designated EBP. Our
licensed therapists have extensive training
in this approach.
Used in specific individual therapy by
licensed therapists. Information is
provided to other staff to assist with
overall integrated treatment.
EMDR Child
Only used in specific individual therapy by
Prolonged Exposure Therapy for PTSD
Designated EBP, Licensed therapists have
Specific individual and group therapy by
been trained in this approach.
licensed therapists. Information is shared
with other staff in treatment roles.
Solution Focused Brief Therapy
Designated EBP, Licensed therapists have
Used in specific individual therapy by
been trained in this approach.
Treatment Foster Care
Designated EBP Surgeon General’s Report This is a program within the agency with
on Mental Health, this is a program within trained program staff who receive internal
the organization and multiple staff have
and external training and in-house
extensive training.
supervision by staff with extensive training
and experience.
We employ a number of highly trained and experienced behavior specialists: Dave
team or staff?
Ziegler, PhD Licensed Psychologyist, international behavioral expert and author of eight
books, 44 years experience; Julie Williamson, MA Certified CPI behavioral trainer, 18
☒ Yes ☐ No
years behavior management experience; Three other CPI certified traind trainers or
behavior management.
P a g e | 11
Dietitian
are implemented and
Recommendations are carried out
by the agency nurse, nurse
assistant or staff designee.
Updates on progress are provided
in a monthly written report to
each child’s clinical team, with
health issues also reflected in the
monthly Individual Services &
Support Plan, compiled by the
child’s therapist/clinical case
manager.
PT. Staff
Click here to type
P a g e | 12
: If OT recommendations are
applicable to the school setting,
interventions are monitored by
the child’s teacher/special
education case manager. If OT
recommendations fall outside of
the school setting, the child’s
therapist/clinical case manager
ensures and monitors that these
interventions are followed. Both
educational and clinical domains
are reviewed monthly at the
child’s clinical team meeting, and
noted in the child’s Individual
Services & Support Plan (and in
the Individual Educational Plan as
applicable).
PT. Contract
the agency takes an
multidisciplinary approach to
treatment plan development,
integrating recommendations by
specialists providing input on each
child’s case. Monthly clinical
team meetings include
opportunities to review
recommendations of contracting
specialists. Specialists are also
welcome to attend meetings as
needed, if additional
communication is needed. The
child’s therapist/case manager
coordinates this input and
discussion.
P a g e | 13
Speech/Language interventions
are generally carried out in the
educational setting, with
monitoring and reporting by the
child’s teacher/educational case
manager. Significant
developments are also reflected
in the child’s Individual Services &
Support Plan, as well as noted in
monthly contributions by the
educational staff to the clinical
team meetings. IEP goal progress
is noted quarterly, and goals reassessed annually.
PT. Contract.
Recommendations are carried out
by the agency nurse, nurse
manager.
Outpatient Provider
the agency takes an
discussion.
: the agency takes an
discussion.
P a g e | 14
Dental
: Recommendations are carried
out by the agency nurse, nurse
manager.
Outpatient Provider
Other
Click here to type
Click here to type
: the agency takes an
discussion.
Click here to type
Model
Population
Holistic integrated treatment including mind, body and spirit.
All residents
Diet, activity, education, coordination and strength physical
development, learning how to work, getting along with others,
morality and values weekly groups all integrated within the
treatment for every child.
Relationship based treatment to improve bonding and
All residents where this is an issue.
attachment.
Intentive trauma treatment to address the impact of childhood
All residents with a trauma history (nearly all).
abuse.
P a g e | 15
Equestrian program to teach children respect and care of
All residents.
animals.
Ten federally designated evidence based practices integrated
Based upon the individual treatment needs of the children.
within the program.
We provide weekly family therapy as well as more extended on-site family therapy
when parents visit our program.
We have multiple clinical supervisors. A licensed psychologist oversees all treatment. A
licensed clinical social worker supervises therapists. Two licensed marriage and famly
therapists provide clinical supervision to other therapists. Clinical supervision is
individual for an hour a week and group supervision for two hours every other week.
We have a National model Crisis Response Program where trained crisis teams are
available 24/7 to respond to a child/family crisis and respond to the home and provide
a crisis respite stay if needed for htree days.
following:
Interpersonal skills Our program specializes in improving attachment through multiple methods including
assignment personal mentors.
Self-Regulation We focus all treatment plans on building the prefrontal cortex and executive functions
such as regulation.
Daily Living We optimize involvement in daily living including peer skills, chores, animal care, and
we monitor normal living skills.
Communication We do not have TV so children improve communiaion with contact with peers and
adults throughout their day with training to effectively communicate with others.
Outcome data reflects much improved communication.
Other We also work on neuro-integration, improve self perceptions, disconfirmation of past
negative roles, building neuro-pathways through mastery and practice enabling internal
change or ‘changing the child from within.’
P a g e | 16
home environment.
DAILY SCHEDULE
We have children increasingly get experience in the larger community to generalize
skills. One of the primary methods to do this is in the last phase of treatment where
children are placed in trained treatment foster homes to take skills learned in the
residence and apply theim in a family setting before returning home.
School days (year round school) up at 7:30 am for breakfast and morning routines, 8:15
school, lunch 12:30, afternoon transition 2:30, check in group and chores 2:45,
afternoon activity period to 5:30, dinner 5:30, after dinner activities to 7:45, evening
group 8:00, bedtimes depend age and on meeting individualized personal goals for the
day.
Transitions are important and we have a schedule, the children are given reminders of
the next step, staff oversee smooth movement to the next phase of the day. Many
children are working on improving the ability to transition.
Meals are planned by nutrition staff with our specialized diet of no artificial ingredients
or processed food, meals are prepared by support staff, children eat in family style with
treatment staff, individual children have chores to assist with set up and table cleaning.
Clean up is done by support staff.
On-Site Activities:
Riding and horsemanship in the on-site
Winter swimmning at a local aquatics
equestrian center. Running track fo rth
center, old-growth forest hiking,
erunning program, indoor courts for
community fun runs, camping at the coast
sports and games, swimming gon-site,
and Cascade mountains, field trips to
therapeutic recreation, hiking and daily
athletic events and concerts, trips to the
physical fun activities. Also arts and crafts coast, snow trips, movies, and much more.
for recreation.
P a g e | 17
Prior to intake.
Who is responsible for discharge planning The child care team is responsible for discharge with the case manager recommending
at your facility?
timeframes. Discharge planning begins at intake with goal setting and establishing
measurable criteria for step down care.
to:
Foster Care: 5%
Family: 45%
Group Home: 20%
Corrections: None
Independent Living: Too young
According to a recent national study we have the most extensive and longest followup
in the US. Results indicate children improved within the program but are much better
at 6 months than at discharge and improvements on 14 of 21 success factors are
☒ Yes ☐ No
strengths at 1 year, 3 years and 5 years after discharge. Only 2 of 21 xuccess factors are
a weakness overall at 5 years following discharge.
The program has 32 years of experience with the most challenging children in the United States, including many foreign born
adopted children. We do not screen out any child due to difficult behavior and we do not discharge children due to the severity of
behavior. Our pre and post outcome data on very difficult children indicates significant improvement overall and we follow up on all
children for 5 years after discharge an dtrack 21 areas of functioning. Our data on 550 children indicates significant improvement
overall and we follow up on all children for 5 years after discharge reflect very strong improvement in 16 of 21 success factors
overall. Jasper Mountain is the subject of a 2013 award winning documentary ‘Once Upon a Mountain,’ that shows the lasting
impact of the program’s Nerological Reparative Therapy approach on the children’s positive brain change. Jasper Mountain has a
proven track record of accepting the most challenging children and the children reflect remarkable progress as a group. The Program
is in a beautiful section of rural Oregon in the Cascade Mountains. The view from the Chiuldren’s residence spans over 50 miles of
P a g e | 18
mountains and the Willamette Valley below. Many parents wonder if the Program could be as good as it sounds and most parents
after treatment say it turned out even better than they hoped. Much more information and a virtual tour is available at
www.jaspermountain.org.
Section B
Click here to type
Click here to type
and symptomatology?
☐ Yes ☐ No
Click here to type
What diagnostic
process do you use?
P a g e | 19
☐ Observation
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Click here to type
Unusual Features
Click here to type
Click here to type
Assessment
Click here to type
Assessment
Click here to type
Assessment
Click here to type
P a g e | 20
(ABA)
Is ABA used in school?
☐ Yes ☐ No
Modalities
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
training
☐ Education
☐ Other
Please describe.
Click here to type
Click here to type
Click here to type
Click here to type
☐ Yes ☐ No
P a g e | 21
treatments?
☐ Yes ☐ No
Behavioral Therapy?
Click here to type
Please explain.
Click here to type
Click here to type
Click here to type
Click here to type
P a g e | 22
Click here to type
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P a g e | 23
Lakemary Center, Inc.
Section A
Date completed
Contact number
Address
Dr. Courtnie Cain, Clinical Program Administrator
February 19, 2016
913-557-4000 x 614
100 Lakemary Drive, Paola, KS 66071
GENERAL OVERVIEW
Accreditation Body
CARF
Age Range
# of Licensed Beds
6-21
65 total (not gender specific)
☒Males
6-21
65 total (not gender specific)
☒Females
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Day
One nurse on campus
1:4
One nurse is available on campus throughout waking
hours and on an on-call basis from 10:00 PM – 7:00 AM.
HOME
PRINT
Page |1
Evening One nurse on campus
1:4
Night
One nurse on call
1:10
☒ Yes ☐ No
Click here to type
Click here to type
We are a specialized facility providing treatment to children with intellectual
and/or developmental disabilities coupled with psychiatric diagnoses. Either
an intellectual or developmental disability needs to be present, and most
individuals in our program have an IQ of 70 or lower.
260.2 days
Recipients?
N/A
242 days
160.13 days
We are looking at changing our state license type from Psychiatric
☒ Yes ☐ No
Residential Treatment Facility (PRTF) to Secure Residential Treatment
Facility (SRTF). This will not change our programming aspects, but is in
response to changes within our state.
☒ Yes ☐ No
Although we don't provide specialized treatment for FASD, if a
child also has an I/DD, we can provide treatment at Lakemary. All
staff are specifically oriented to each child admitted to
Lakemary, prior to working with them.This orientation includes
individually specific information related to the child's strengths,
needs, preferences, support issues and individual goals and
objectives.
Page |2
Based Practices.
Most all children served at Lakemary have extensive trauma
histories. All staff have "Trauma Sensitive Care" training prior to
working with children. Trauma sensitivity remains a primary
focus in treatment planning and service delivery, both in the
milieu and clinical treatment. It is a foundational principle in all
service delivery at Lakemary.
We provide stress management and secondary traumatic
stress/compassion fatigue training to all new employees. We
also review in Annual Risk Awareness training, which is required
of every employee. We complete debriefings with staff after
every safety incident and have made therapists available for
processing with DSPs when necessary. All of our therapists
receive weekly individual and group clinical supervision.
facility serves.
All staff receive training training in basic diagnostic
overview, basic behavioral approaches, and positive
behavior interventions and supports.
functioning) NOTE: Facilities with this specialty overview, basic behavioral approaches, and positive
behavior interventions and supports.
Page |3
overview, basic behavioral approaches, trauma sensitive
care, and positive behavior interventions and supports.
Click here to type
☐ Eating Disorder
Click here to type
Click here to type
to trauma)
☒ Eating Disorder
☒ Other: Substance Abuse if a
current treatment concern – a
history of substance use/abuse is
not automatically excluded.
☐ Psychosis
☐ Elopement Risk
Sexually offending:
☐ Fire setting
Page |4
☐ Yes ☒ No
1) Positive Behavior Interventions and Support (PBIS): Incorporates evidencebased practices to look at the function of behaviors as well as environmental
factors impacting behaviors to help create individualized behavior support
plans. PBIS is a strengths-based model, which encourages looking at the whole
person through a person centered planning approach to enhance quality of life.
All staff receive initial training on PBIS and token economy implementation, as
well as PBIS refresher courses throughout the year. 2) Safe Crisis Management:
(SCM) Three day training covering both non-physical and physical intervention
techniques where all less restrictive interventions are tried prior to physical
interventions and physical interventions are only used when threat to safety is
immenent. All staff complete three refresher courses annually in addition to the
initial training and certification.
Lakemary includes an Intensive Behavior Supports Program (IBSP), facilitated by our
IBSP Clinical Coordinator, a Licensed Masters Level Psychologist who is an Autism
Specialist and completing his supervision hours to become a BCBA. Our IBSP Clinical
Coordinator also consults on cases to complete an FBA and develop a BIP when
appropriate.
Licensing regulation requires that we maintain children within staff sight or sound
observation at all times, alarms on doors and windows, partially gated community.
Some areas are equipped with video cameras.
We offer onsite medical and dental care, but Lakemary also works with several medical
providers in the are to ensure each child's medical and dental needs are met. We have
nursing transporters who ensure that each child attends appointments with the
information needed. All children, at minimum, receive annual physicals and dental
cleanings. All psychiatric appointments are handled on site with our
Psychiatrist/Medical director who meets with each child at a minimum of once every
30 days.
Click here to type
Click here to type
Page |5
☒ Yes ☐ No
☒ Yes ☐ No
by whom?
In School Only – N/A to residence
Physical restraint is implemented only
under significant safety concerns and if less
restrictive options were ineffective.
Click here to type
An observer to the physical restraint is
normally present. During the physical
restraint staff, must monitor the child for
certain needs every 5 minutes, and,
within 60 minutes of the initiation of the
restraint, the RN must complete a
physical and neurological assessment of
the child. Additionally, staff must debrief
with the child at the conclusion of the
restrainit and then staff debrief together
to determine what can be done
differently next time to further
therapeutic treatment. An order for the
physical restraint is provided and signed
off on by a master's-level LMHP.
All staff are trained and certified in Safe Crisis Management and attend a minimum of
three refresher courses per year.
Individual
Daily by residential, medical, and clinical
staff
Individual
Lakemary will forward individual incidents
(for Alaska children) to ABH in accordance
with their requirement.
Facility
Quarterly by Safety Committee
Facility
N/A
Page |6
We utilize the Ohio Scales to evaluate pre- and post-discharge symptom levels,
hopefulness, and adaptive functioning for parents and children. We also utilize
☐ Yes ☐ No
satisfaction surveys with parents and children to inform practices.
High
Licensing regulations require children are maintained in sight or sound observation
range at ALL times, even when asleep. Staff must be able to hear an "utterance" if the
child is not in eye sight, and sight must occur at least every 15 minutes. Each residence
has a house schedule dilineating the activities for the day, which are geared toward
active treatment throughout waking hours.
Lakemary provides a minimum of 1:4 staff:resident ratio. More intense supervision
may be implemented, with the most intense being 1:1 line of sight support. These
supports are time limited and based on safety needs of the resident. If a resident
requires this level of a support on a sustained basis, then we may consider more
restrictive treatment options.
Please explain.
Residents may have greater restrictions/higher levels of supervision due to precautions
for suicidal thoughts/behaviors, elopement risks, severe/targeted aggression, and/or
☒ Yes ☐ No
inappropriate sexual behaviors. Many of our residents also require increased
supervision on a regular basis with ADLs due to their level of functioning.
Gender, Age, Functioning Level, Risk Factors (including presence of inappropriate
promote or prevent pairing of recipients as sexual behaviors, poor physical boundaries, risk of self-harm, risk of aggression, risk of
roommates?
property destruction and/or stealing)
Feedback is solicited from treatment team members, including the resident, during
biweekly treatment team meetings which informs the continued appropriateness of a
roommate.
Page |7
characteristics?
If a safety concern arises, the Clinical Program Administrator makes a determination on
moves for one or both roommates. The therapist communicates with the family
regarding any moves and why they were made, as well as communicating any changes
in contact numbers.
At least 1:4 staff ratio during the day and at least 1:10 during sleeping hours. It is often
times more, depending on the environment. Plus, children must be kept within sight or
sound observation at all times. If severe risk is present, staff may be assigned to
monitor 1:1 with a child andmay be required to sit within arm's length at all times.
EDUCATION SERVICES
Comments: USD 368 partners with Lakemary and provides for an on-site school. Although employed by USD 368, school employees
function as a partner with Lakemary, both in the treatment planning process and in the provision of therapeutic treatment.
All children at Lakemary Center have an IEP for special education services, so it is
imperative the home district is involved with the child's education. The Admissions
communication with home-based schools? Liaison communicates with school districts prior to admissions, if necessary. The child's
therapist and school administrator communicate with the child's home school while
the child is at Lakemary, depending on the issue. Additionally, any IEP team member
may participate in this communication. The home district is always a part of the child's
annual IEP meeting. Prior to discharge, the child's therapist communicates as part of
the discharge planning process to share inforamtion regarding needed treatment
modalities and transition.
Lakemary School is a special purpose non-public school which is an extension of USD
368 in Kansas. The school is licensed and accredited by Kansas Department of
Education.
☒ Yes ☐ No
Page |8
review/planning.
process?
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☐ Psychologist
☒ LCSW
☒ Other Clinician (name, credentials): Child’s Assigned Therapist (Master’s-level
LMHP)
☒ School Representative (name, role): Garrett Strickler, School Behavior Specialist
☒ Milieu (name, role): Residential Team Lead and Milieu Therapists (master’s level
clinicians completing group therapies)
Lakemary requests that all families participate in weekly family therapy. We include
them via any method that allows participation. We generally have at least weekly
phone calls and/or emails. They participate bi-weekly in the child's treatment
planning. They contribute to the goals and objectives developed for their child. Since
discharge planning begins at admission, the family is involved in the discharge planning
process from the beginning, with objectives and support needs clearly defined.
Page |9
system?
☒ Yes ☐ No
Behavior function is discussed at each child's treatment planning process meeting. For
the more difficult behavior/function discovery, our IBSP Clinical Coordinator completes
a formal functional behavioral analysis (FBA) which goes back to the treatment team
for consideration and development of behavior intervention plans (BIP) designed to
teach alternate coping mechanisms or behavioral responses.
All treatment objectives are client-centered, observable, and measurable, making them
data-driven. We monitor data through looking at decreases in challenging behaviors
during two-week reporting periods, and increases in objective achievement (focused
on prosocial behavior and/or coping skills) in the same time period.
Residents earn points for demonstrating
The token economy may be modified for a
STARS behavior (Be Safe/Try Your
resident who needs more frequent
Best/Ask for Help/Be Responsible/Show
reinforcement or who does not respond
Respect). They are able to save/spend
to the token economy. Changes to a
their points 1-2 times weekly for tangible child’s individual system are discussed and
items and privileges. Residents do not lose made during th weekly Children’s Services
points they have already earned, but lose Team Meeting, including respresentatives
the opportunity to earn points if engaging from all areas of children’s programming.
in negative behaviors.
TREATMENT
P a g e | 10
etc).
Trauma Sensitive Care
Positive Behavior Supports
approaches.
supervision.
Kansas PRTF Annual Trainings
Initial training from LMHP prior to working
with children and regular booster trainings
available
Initial training from LMHP prior to working
with children and regular booster trainings
available
LMHP receives regular supervision with
LSCSW who is also Registered Play
Therapist. LMHPs also have opportunities
to attend Play Therapy CEU trainings
throughout the year with Lakemary
support.
Behavior Specialists are provided training
in ABA techniques and BIP
implementation from LMHP
Kansas Institute for Positive Behavior
Supports
Play Therapy
Master's level therapists only, supervised
by Registered Play Therapist
Intensive Behavioral Supports Program
ABA-based program
Click here to type
Click here to type
Click here to type
Dr. Courtnie Cain, Licensed Psychologist; Chris Delap, LMLP, Autism Specialist team or staff?
Completed BCBA requirements
☒ Yes ☐ No
P a g e | 11
Dietitian
Dental
Other
are implemented and
Recommendations are
communicated to medical,
clinical, and kitchen staff
directly
Implemented in IEP
Implemented in IEP
Routed through medical
department for
implementation
Provide onsite dental clinics on
a monthly basis
Consultant
Meets with clinical team during
biweekly visits to review
recommendations
Full-time
Full-time
Click here to type
Click here to type
Click here to type
Contract
Click here to type
Click here to type
Provides recommendations to
medical department for
implementation
Click here to type
Click here to type
Model
Population
Play Therapy & Theraplay
everyone/especially those children who are non-verbal
children who can engage in verbal processing
Family Therapy / Family Systems
all families
ABA/Applied Behavioral Analysis
children who are non-verbal or who have autism
Solution Focused Therapy / Trauma Systems
everyone / those with a history of trauma
P a g e | 12
weekly participation either in person or via electronic methods
Dr. Courtnie Cain provides clinical supervision to the program in her role as Clinical
Program Administrator. She provides weekly supervision to the Clinical Program
Coordinator who provides weekly supersision to all Therapists. Dr. Larry V. McDonald,
Medical Director, (psychiatrist & pediatrician) also proivdes oversite for all psychiatric
medication prescribing.
All staff are trained in crisis intervention and safe crisis management, including both
direct support professionals therapists, nursing, administrators other support staff. Any
of these individuals are available to assist in a crisis. We utilize a "Star" team which is
comprised of veteran staff specially skilled in de-escalating crisis situations. These
professionals are available on each shift.
following:
Interpersonal skills Treatment plan goals and objectives, milieu treatment/training, individual & group
therapy, IEP goals, life skills & vocational programming
Self-Regulation Treatment plan goals and objectives, milieu treatment/training, individual 7 group
therapy, IEP goals, life skills & vocational programming
Daily Living Treatment plan goals and objectives, milieu treatment/training, occupational therapy,
IEP goals, life skills & vocational programming
Communication Treatment plan goals and objectives, milieu treatment/training, speech therapy,
individual & group therapy, IEP goals, life skills & vocational programming
Please describe how your facility helps the Practice/practice/practice, positive praise/positive behavioral supports, weekly
individual therapy, group therapy, parent training/coaching, follow-up contact after the
home environment.
child discharges from Lakemary
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DAILY SCHEDULE
M-F, 7am Wake time; 7:15am to 3:08pm school; 3:08-3:15pm transition to residence;
3:15pm-5pm group therapy, recreation therapy,social skils, goals & objectives
treatment, dinner preparation; 5-6pm dinner and clean up; 6-7pm group therapy,
recreation therapy, social skills development, goals & objectives treatment, 7-8pm
hygiene/daily living tasks/skill development; 8-9pm varying bedtimes
Maintaining a routine schedule so children know what to expect on a regular basis.
Staff also announce transitions at various intervals, prior to the actual transition, so
children know what to expect and can ready themselves.
M-F, breakfast and lunch are prepared and served in the cafeteria in the administration
building. Supplies for other meals are sent up to each residence and are prepared by
staff and children. Meals are served in a family-style fashion.
On-Site Activities:
Recreation therapist on staff who
fishing, swimming, out to eat, go for
schedules a wide variety of activities,
walks, county fairs, shopping, hiking,
including, but not limited to: athletic
arboreitum, Deanna Rose Country Town
events, Bingo, special dinners, scavenger
and Park, Bass Pro Shop, bowling,
hunts, gym activities,fishing, swimming,
Christmas lights, Louisburg Cider Mill, Lake
special parties & events, birthday parties, Miola, local ball games, KC Royals games,
decorating cookies, baking, chili contests, the Plaza, parades, Shrine circus, Pumpkin
gingerbread house contests, pretzel
Patch, local parks, JoCo Fire Department
making, games, painting, crafts, listen to
activities, Malls, etc.
music, kareoke, etc.
Upon Admission
Who is responsible for discharge planning Primary Therapist
at your facility?
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to:
☐ Yes ☒ No
Foster Care: 14%
Family: 47%
Group Home: 26%
Corrections: 0%
Click here to type
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Section B
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The majority of our residents with ASD are functioning at a lower
cognitive level, typically IQ of 70 or below. However, we do
consider individuals who are higher functioning on the spectrum
if they demonstrate significant social skill deficits which would
make them appropriate within our treatment milieu. All
individuals would
We review previous diagnostic assessments prior to admission. If information is outdated, we refer
includes questions about ASD for psychological testing and assessment.
and symptomatology?
☒ Yes ☐ No
What diagnostic
We review incoming diagnostic evaluations from a licensed mental health professional and/or a
physician. Our contracted evaluators are doctoral-level psychologists and utilize standardized
process do you use?
objective and observational assessments.
☒ Observation
☒ Specific Tools (please identify): ADI-R, GADS, GARS, CARS, BASC, Conners CBRS, PDDBI, NEPSY,
etc.
Click here to type
Physical Exam Yes
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History of GI issues or presented GI concerns
Click here to type
Hearing Screen Yes
Click here to type
Examination for Signs Yes
Genetic Testing As Needed
Family or therapist request
Consideration of As Needed
Features are interfering with functioning or otherwise contributing to
Unusual Features
maladaptive behaviors
Psychological Assessment As Needed
Assessment outdated (older than three years) or significant change in
presentation
Per IEP guidelines
Assessment
Occupational Therapy As Needed
Per IEP guidelines
Assessment
Per IEP guidelines
Assessment
Per Medical Director or parent request
(ABA)
Is ABA used in
☒ Yes ☐ No
residential?
Is ABA in treatment
☒ Yes ☐ No
plan?
What credentials does Licensed Master’s Level Psychologist, Certified Autism Specialist
your ABA specialist
have?
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Modalities
Yes, as needed
treatment team?
Is this person a
Staff Member
contractor or staff
member?
PECs, visual schedules, assistive technology such as iPods or tablets, some basic sign language
(in conjuction with other methodologies)
training
We use multiple group and individual formats – social stories, structured and non-structured
play therapy, social skills for HFA, etc.
☒ Education
Entirely self-contained special education program utilizing Structured Teaching Model and
Applied Behavioral Analysis
Please describe.
☒ Other
Cognitive-Based Therapy as needed; Some structured Play Therapy techniques, Social Stories,
Positive Behavior Interventions and Supports; Trauma Systems Therapy; Medication
Management
typically use with this population? Evidence-based use of Abilify, Risperdal; Psychostimulants for focus and attention, sometimes
for explosive anger.
☒ Yes ☐ No
We strive for each resident to be on as few medications as possible to assist in managing
approach to the use of medication maladaptive behaviors in conjunction with behavioral programming.
P a g e | 18
treatments?
☒ Yes ☐ No
Behavioral Therapy?
Please explain.
We will incorporate dietary changes, herbal supplements, and/or sensory diets as indicated.
Dr. Courtnie Cain (Clinical Program Administrator); Chris Delap (Intensive Behavior Supports
Program Coordinator); Dr. Larry McDonald (Psychiatrist)
The child must have the following characteristics: able to express self verbally; demonstrate
adequate receptive language skills visually and verbally; able to demonstrate knowledge of
cause/effect; adequate short-term and long-term memory (for processing events).
Individual Therapist (master’s level LMHP); Dr. Larry McDonald (psychiatrist); Chris Delap
(Intensive Behavior Supports Program Coordinator) – as indicated
We only serve children with ASD without ID only if there are significant social or other adaptive
funcitoning deficits present. Our educational program is entirely self-contained special
education and our program is built around providing positive behavior intervention and
supports as well as skills training in emotional identification, emotional communication, and
emotional regulation; social skills training, etc.
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P a g e | 20
Provo Canyon School
Section A
Date completed
Contact number
Address
Tim Marshall, Director of Business Development and Contracts
February 16, 2016
801-420-6656
Provo Canyon School
4501 North University Avenue, Provo, Utah 84604
GENERAL OVERVIEW
Accreditation Body
Utah State Department of Human Services, Office of Licensing, Joint Commission
Age Range
# of Licensed Beds
8 - 17
194
☒Males
8 - 17
86
☒Females
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Click here to type
Day
1 - 25
1-5
Click here to type
Evening 1 - 25
1-5
HOME
PRINT
Page |1
Provo Canyon School
Click here to type
Night
1 - 45
1-8
IQ of 65 or higher
☒ Yes ☐ No
253 Days
Recipients?
93.2 Days
203.9 Days
256.2 Days
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
N/A – We do not treat FASD. When it is suspected or identified
we seek to transfer the client to specialized services.
CBT with enhanced elements of PBSI, trauma infomred care and DBT.
Acuity Based Care is incorporated with Rti for the higher acuity units.
What kind of training do your staff receive (include milieu as well Initial week-long training on hire, annual re-training and quarterly
themed trainings used to maintain program consistensy and integrity.
Based Practices.
Clinical consultation meetings and groups. Staff in-services
training and education.
facility serves.
Dr. Vjollca Martinson provides training to staff specific to the
generalized needs/strengths and cognitive processing styles as
a profile in general and more specifically regarding student in
program.
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Provo Canyon School
Click here to type
Included in our Trauma Focused CBT training.
Click here to type
☐ Eating Disorder
Click here to type
Click here to type
to trauma)
Sexually offending:
☒ adjudicated/ ☐ nonadjudicated
☒ Eating Disorder
☐ Psychosis
☐ Elopement Risk
☐ Fire setting
CBT, TFCBT with enhanced elements of PBSI, trauma infomred care and DBT. Acuity Based Care
is incorporated with Rti for the higher acuity units. Initial week-long training on hire, annual reprogram do you use? Please name the
training
and quarterly themed trainings used to maintain program consistensy and integrity.
Page |3
Provo Canyon School
☒ Yes ☐ No
☒ Yes ☐ No
☒ Yes ☐ No
by whom?
NO
Direct supervision 24-7
Local contracted providers
Self-directed or by staff promp
Immediate danger to self or others
Immediate danger to self or others
Debrief with the client
Debrief and review
Debrief and Review
Annual training and certification in HWC and program, state and federal policy.
Individual
Daily by the shift supervisor, risk manager
and executive director
Individual
Facility
Monthly by the leadership team
In accordance to Alaska Behavioral Health
Inpatient Psychiatric Alaska Medicaid Provide
Manual and Alaska Administrative Code: 7
AAC 50.140
In accordance to Alaska Behavioral Health
Inpatient Psychiatric Alaska Medicaid Provide
Manual and Alaska Administrative Code: 7
AAC 50.140
Facility
We track client satisfaction, reported concerns, accident and safety reports, ALOS,
ADC, seclusions, restraints, PRN’s and AMA reports monthly
☒ Yes ☐ No
Page |4
Provo Canyon School
High
☒ Yes ☐ No
roommates?
characteristics?
Q-15 minute checks and documented observations by direct care staff 24-hours per day/7-days
per week. School is provided five-days per week (Monday through Friday) from 8:30 AM until
3:30 PM. Weekdays the students schuele is to do personal hygene nad unit chores in the
morning, eat breakfast, attend school, participate in daily group after a short break from
school, then particpate in recreation activities, school homework, therapy assignments, and
prepare for bedtime. Weekends are much the same with an hour later wake-up expectation
and in place of school there may be outside activities, off-campus activities, gym time and/or
family visits.
Supervision is consistent across all youth. However, youth may earn the ability to participate in
supervised off-ground activities and be allowed more freedom within the facility in conjunction
with individualized treatment objectives and treatment success.
Please explain.
Supervision may be intensified to a level of individualized one on one staffing based on youth's
potential for harm as a precaution or as a resource to assist a youth in overcoming a difficult
task (such as acadmic assignments or specific treatment objectives)
Age, aggression, potential cultural concerns
Initially all student are assigned to an orientation unit prior to placment in a dorm in order to
evaluate which dorm may be the best resource for the youths success. History and clinical
needs are assessed and determined.
Depending on the nature and intensity of the concern, a change in roommate and/or bedroom
can be made immediately. If there is no immediate or appearent emotional or physical harm
and if there is a potential for theraputic benefit, addresssing the issue through open discussion,
setting goals, making personal commitments and demonstrating respect may be a better
alternative.
Continual staff monitoring with documented 15 minute checks on how the youth is doing
physically, socially and emotionally. Same pratice is conducted during the night shift with a
discription regarding sleeping pattern
Page |5
Provo Canyon School
EDUCATION SERVICES
Comments: Fully accreditied senior, jounior and elementry education is provided on-site 247 days per year (three full semesters). Education
includes full support for youth with active IEP needs. Our school functions as a traditional school system offering 6 hour course credits per
semester focused on accomplishing a hig school degree.
Fully accreditied senior, jounior and elementry education is provided on-site 247 days per year
(three full semesters). Education includes full support for youth with active IEP needs. Our
communication with home-based schools? school functions as a traditional school system offering 6 hour course credits per semester
focused on accomplishing a hig school degree
Northwest Acreditation Commission –AdvancedED
☒ Yes ☐ No
Page |6
Provo Canyon School
review/planning.
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☒ Psychologist
☒ LCSW
☒ Other Clinician (name, credentials): Primary Terapist if LFMT or LPC as well as
Recreation Therapist
☒ School Representative (name, role): Special Education Coordinator
☒ Milieu (name, role): Supervisor
process?
Weekly telephonic family therapy, participation in treatment planning and review, involved in
discharge planning, on-site therputic visits, theraputic home visits, etc.
Review of psychsocial history, previous levels of functioning, current behaviors, response to
prescribed or intiated interventions, tracking of progress, increased treatment intensity and
multidisciplinary reviews if needed to determine optional treatments or increased frequency of
clinical intervention when needed
Page |7
Provo Canyon School
Progress is identified through measurable, specific treatment goals monitored throughout the
each day of care. Identified needs and problems include specific, measurable objectives that
are weighted (based on precentage expectations) as to level of increase in
advancement/success or decrease in impeding thoughts, emotions or behaviors. Youth self
rate as well as all staff participate in rating observable elements
system?
☒ Yes ☐ No
Demonstrating achievement on individual
treatment goals and safety goals.
approaches.
supervision.
Oversight by clinical psychologist and use
of “Changing for Good”/Prochaska
New Hire training, 90-day provisional
supervision/shadow training, monthly
educational topics, on-going department
level training, and individual skill building
program.
TREATMENT
etc).
Stages of Change Model
Youth are able to advance in status (increased
privilage) as they demonstrate willingness to
engage and success in addressing individual
treatment objectives. Youth advancement is
based on multidisciplinary support upon
demonstrated increased treatment goal
success and personal safety. Youth who gain
advancement do not lose status once it has
been obtained.
Page |8
Provo Canyon School
Family-Driven Model
Youth-Guided Model
Trauma Informed Care
Culturally Competent Care
“Not by Chance”/Dr. Tim Thayne PHD,
“Residential Interventions for Children,
Adolescent, and Families: Best Practice
Guide”/Blau
program.
Guide”/Blau
program.
ARC Trained LFMT Trainer, “The Boy Who New Hire training, 90-day provisional
Was Raised as a Dog”/Perry, “Responding supervision/shadow training, monthly
to Childhood Trauma”/Hodas and others
program.
Guide”/Blau, Jones and Associated
Cultural Sensitivity Training
program.
Click here to type
team or staff?
☐ Yes ☒ No
Page |9
Provo Canyon School
Yes – Full Time
Click here to type
are implemented and
Documetation in Medical
Charts
Documentation in Charts
No - Contractual
No - Contractual
Click here to type
Dental
Yes – Full Time
No - Contractual
Click here to type
Other
Click here to type
Click here to type
Dietitian
Provides
report/recommendations
Provides
report/recommendations
Click here to type
Model
Population
Cognitive Behavioral Therapy/Trauma Informed Care
Male/Female age 8 - 17
Dialectic Behavioral Therapy
Systems/Family Theory
Group Psychotherapy
Recreation/Play Therapy
Patients and their families are expected to actively participate in family therapy 1x/week.
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Provo Canyon School
Each program is supervised by a clinical director. Oversight may consists of individual
supervision (when required for licensure), Case consultations, Peer Consultations, On-call
therapists, Weekly Clinical team supervision meetings, Consultations with Clinical Psychologist,
Treatment Team meetings and case reviews, etc. The Clinical Director does not carry a case
load, and therefore all his/her time is spent in clinical supervision. A therapist may, on average,
receive between 2-6 hours of clinical supervision per week.
24 hour on-site Nursing staff, On-call therapist, On-call Psychiatrist/L.I.P, Stablization and
Assessment Program/Unit (specifically for patients requiring crisis support), as needed
treatment team staffings, all staff trained in Verbal De-escalation and Handle with Care
methods.
following:
Interpersonal skills Individual/family/Group therapy, recreational therapy, community meetings/lessons,
Self-Regulation
Daily Living
Communication
Other
home environment.
Treatment team directives, individualized treatment goals/plans/interventions, staff trained to
process issues in the moment.
Individual/family/Group therapy, recreational therapy, community meetings/lessons,
Click here to type
Family environment at our facility, family therapy, family visits (on-site and off-site), and
discharge planning.
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Provo Canyon School
DAILY SCHEDULE
School is provided five-days per week (Monday through Friday) from 8:30 AM until 3:30 PM.
Weekdays the students schuele is to do personal hygene nad unit chores in the morning, eat
breakfast, attend school, participate in daily group after a short break from school, then
particpate in recreation activities, school homework, therapy assignments, and prepare for
bedtime. Weekends are much the same with an hour later wake-up expectation and in place of
school there may be outside activities, off-campus activities, gym time and/or family visits.
Youth are assigned to a definitive group for meals and various activities. Each group has a daily
schedule posted and specific times for each of their meal times and activities. Each group is
approxemently 12 to 18 youth and have assigned staff that monitor and manage all transitions
from the dorm units to the main building, to dinning, activities, school , etc.
All meals are prepared and served by employed, trained, adult kitchen staff who are also
responsible for clean-up and cleanlyness of the dining room and kitchen.
On-Site Activities:
PCS has a swimming pool, two gyms, large
outdoor sports fields that provide swimming,
basketball, flag football, softball, volleyball,
skate boarding, running, rock climbing, etc.
hiking, snowshoeing, canoeing, camping,
skiing, bowling, movies, lazer tag, etc.
Within 10-days of admission
Who is responsible for discharge planning The assigned primary therapist
at your facility?
to:
Foster Care: 12%
Family: 50%
Group Home: 15%
Corrections: 1%
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Provo Canyon School
☒ Yes ☐ No
Therapists contact the family or foster parent post discharge to offer support and assistance
Click here to type
Section B
High functioning ASD or Asperger clients with other mental
health disorders.
P a g e | 13
Provo Canyon School
and symptomatology?
☒ Yes ☐ No
What diagnostic
process do you use?
Please check all
that are included:
Self report by parent or legal guardian
We refer out to UNI or Wasatch Mental Health.
☐ Family interviews
☐ Review of past records
☐ Observation
Referred out
Referred out
Referred out
Referred out
Referred out
Choose
an
answer
Consideration of
Referred out
Unusual Features
Referred out
P a g e | 14
Provo Canyon School
Referred out
Assessment
Referred out
Assessment
Referred out
Assessment
Referred out
(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
Modalities
Click here to type
training
Click here to type
P a g e | 15
Provo Canyon School
☐ Education
☐ Other
Please describe.
Click here to type
Click here to type
☐ Yes ☐ No
Click here to type
Please explain.
Click here to type
treatments?
☐ Yes ☐ No
Click here to type
Under what circumstances, and/or Click here to type
Behavioral Therapy?
Click here to type
P a g e | 16
Provo Canyon School
If they are able to fully participate in our normal continuum of care and make progress we
continue to treat them, otherwise we seek a transfer of care to a more specific provider.
Click here to type
P a g e | 17
Eastern Idaho Regional Medical Center, Behavioral Health Center
Section A
Date completed
Contact number
Address
Brett Nelson, Coordinator, Residential Treatment BHC
February 19, 2016
(208) 227-2159
2280 East 25th Street Idaho Falls, ID 83404
GENERAL OVERVIEW
Accreditation Body
Department of Health and Welfare, State of Idaho
Age Range
# of Licensed Beds
12 through 18
22 Our beds are allocated according to need on a first
☒Males
come first serve basis
12 through 18
22 Our beds are allocated according to need on a first
☒Females
come first serve basis
Click
here
to
type
Click here to type
☐Other
Nursing
Milieu
Comments
Click here to type
Day
Teton 1:8
2 nurses, 2 techs
HOME
PRINT
Page |1
Click here to type
Evening Teton 1:8
2 nurses, 2 techs
Click here to type
Night
Teton 1:8
2 nurses, 2 techs
there is not a set number but the dr. reviews the information and if an IQ is
☒ Yes ☐ No
less that 85 that could be a rule out. the main concern is that the patient be
able to benefit from the cognitive program that we run.
Click here to type
6-8 months
Recipients?
4-5 months
4-5 months
Click here to type
☐ Yes ☒ No
☒ Yes ☐ No
Teton Peaks does not have a dedicated FASD program
component, however if a patient's IQ is a concern, screening
tools are used to determine deficits and the psychiatrist and
treatment team develop a treatment plan based upon
identifying and developing strengths and using positive rewards
to shape behavior. Staff receive trainings annually based upon
the specialty populations being served by Teton Peaks.
Psychiatrist and clinical Psychologist review admission
information to determine whether youth meets admission
What kind of training do your staff receive (include milieu as well criteria and can be treated effectively by our team and program.
If admitted to our program, youth is tested by our in-house
psychologist and tx team develops a comprehensive treatment
Based Practices.
plan. Licensed therapists then provide individual, family and
group therapy (substance abuse groups if needed). Milieu staff
are trained in basic behavioral techniques and behavior
management, annual trainings are provided related to trauma.
Page |2
Every staff have EAP services if needed for secondary trauma
that is experienced on the unit. After every traumatic event with
a patient there is a debriefing that happens for staff to help
determine what services or care, if any, for staff is needed. we
also have daily meetings to get an understanding of staff and
their concerns for the unit and we can then adjust staffing if
needed.
facility serves.
Annual trainings for specialty disorders such as Autism,
FASD The children we serve with Autism and FASD are
those who have a higher IQ, as they need to be able to
benefit from a cognitive, insight/DBT based program.
Click here to type
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Page |3
☒ Eating Disorder
☒ Other (Co-occuring medical problems)
As part of the Eastern Idaho Regional Medical Center,
Teton Peaks has access to the hospital's dietary
department. Dietary staff offer healthy eating groups and
consults with a dietitian. Teton has a therapist trained in
DBT skills who works with eating disordered patients to
teach DBT coping skills. Staff are trained and supported by
therapists and the psychiatrist to use 2 hr bathroom
restrictions after meals to address purging behaviors.
Therapist work with general eating disorder issues.
Our unit is staffed by a full time registered nurses, we
have a full time psychiatrist on staff and access to the full
staff of doctors employed by the hospital to assist with
complicated medical issues such as diebeties.
Click here to type
to trauma)
Sexually offending:
☐ Eating Disorder
☐ Psychosis
☒ Physical Aggression
☐ Elopement Risk
☒ Fire setting
☒ Other: (Primary Dx of Conduct ☒ Other: (Predatory behavior of
Disorder)
any kind)
Comments: Teton Peaks accepts youth with mild intellectual disabilities but not moderate to severe. Teton
Peaks does not accept youth who present with a primary diagnosis of Conduct Disorder or with primary
symptomology including: physical aggression or predatory behavior toward others, fire setting and/or
sexual acting out behaviors.
Page |4
☒ Yes ☐ No
Teton Peaks uses a tier system to manage behavior and encourage participation in
therapy and programing. The system includes assignments, infractions and specific
daily/weekly requirements to progress from tier to tier and earn progressive freedoms
and privileges. Staff are trained to understand and utilize the tier system as part of
their orientation and education to work on Teton Peaks.
we utilize Occupational therapy, Speech therapy testing and evaluation, psychiatric
evaluations and psychological testing to determine functioning and to assess behaviors
that need to be addressed in the program and therapy.
Patients are monitored on unit, off unit during activities, and in the classroom by
constant staff observation. The Teton Peaks unit, hallways, and classroom are
monitored by 24hr video surveilance. Any patients on precautions are monitored at 15
minute intervals to assure their safety.
Our case manager follows state regulations that require residents to receive medical
and dental follow up care within 90 days of admission or annually if the medical/dental
exam was as recent as nine months prior to admission.
Time outs are used to redirect resident's
Residents stay in time out only as long as
behavior when they become excessively
they are disruptive and unwilling to
disruptive to the milieu and refuse to
comply with program expectations. Time
comply without being separated from the
outs are logged, tracked and trended to
group.
determine if patterns arise and for
auditing by the administrative team
Page |5
☒ Yes ☐ No
☒ Yes ☐ No
by whom?
Seclusion is used if a resident has become
dangerous to themselves or others and
could benefit from being separated from
the milieu or will not calm down without
being separated.
Patients in seclusion are monitored 1:1
at 10-15 minute intervals and are
released as soon as they are calm and no
longer a danger to self or others.
Seclusions are logged, tracked and
trended to determine if patterns arise
and for weekly auditing by the
administrative team
Physical restraint is used for the purpose of Patients in a physical hold are held only
holding patients who are attempting to
long enough to escort them to the safe
harm themselves and others and to escort
area. Patients in restraints are monitored
them to a safe area away from the milieu
1:1 with constant monitoringand are
relaeased as soon as they are calm and
no longer a danger to self of others.
Holds and mechanical restraints are
logged, tracked and trended to
determine if patterns arise and for
weekly auditing by the administrative
team
Teton Peaks has certified trainers in Non-Violent Crisis Intervention (NVCI). All staff
working on Teton Peaks unit must be trained annually in NVCI and in the use of
mechanical restraints.
Individual
S&R data on individuals is reviewed the
day after the seclusion or restraint by the
treatment team
Facility
S&R data for the facility is reviewed
weekly by the administrative team
Page |6
Individual
Facility
Death, suicide, allegations of sexual
Death, suicide, allegations of sexual
abuse, harm to self, harm to others,
abuse, harm to self, harm to others,
serious injury/illness, seclusion/restraint,
serious injury/illness, seclusion/restraint,
elopment, significant medication error,
elopment, significant medication error,
involvement of law enforcement, violation involvement of law enforcement, violation
of probation, criminal conduct, fire or
of probation, criminal conduct, fire or
disaster, change in administrator,
disaster, change in administrator,
knowledge of abuse/neglect/employee
knowledge of abuse/neglect/employee
misconduct
misconduct
Teton Peaks uses the data we accumulate to discuss ways to improve our treatment,
we are currently striving not only to reduce seclusions/restraints, but to become a
☒ Yes ☐ No
restraint free facility.
structure and supervision provided by your High: completely locked and secure facility, patients are monitored 24/7 including 10program as low, moderate or high?
15 minute safety checks depending on the level of precautions of the resident. If a
Choose a level
resident becomes a danger to themselves or others, we have the option of putting
them on 1:1 supervision until such time as the psychiatrist determines that they are
safe to be released.
Level or intensity of supervision is determined on an individual basis by the treatment
team and psychiatrist. The team discusses factors related to risk of harm to self or
others, level of disruptiveness to other patients and the milieu, level of acting out
behaviors, etc…
Page |7
☐ Yes ☐ No
Please explain.
Both, the treatment team, each morning and more extensively on Monday evening,
discusses each individual resident to determine their therapeutic needs and their level
of risk. Based upon these factors, and any other relevant factors, the treatment team
determines individual levels of supervision
Any factors or characteristics that would put one of the residents in an unsafe, easily
promote or prevent pairing of recipients as manipulated, predator/victim situation, or any situation that would hinder or prevent
roommates?
therapeutic progress.
Roommates are initially assigned a room based upon the pre-admission assessment
(done by the psychiatrist and psychologist) and the on-site initial assessment findings.
The resident is then monitored closely and room changes are made based upon
therapist and/or psychiatrist recommendation.
At any time as concerns arise regarding roommates or room assignments, the Program
Leaders (head techs on the unit) can coordinate with the therapists and psychiatrist to
make an immediate change. If the situation is too urgent to afford time for the
characteristics?
coordination with the treatment team, the Program Leaders can make an immediate
room change (discussing it with the treatment team as they come available).
There is always a staff member on the unit, in the classroom, or at the resident's
activities (meals/recreation therapy/appointments). If the acuity raises on the unit
extra staff are placed on the unit as needed. If a patient's individual safety is in
question, increased safety checks (from 15 minutes to 10 minutes) are implemented. If
a resident's safety becomes critical a 1:1 staff to resident ratio can be established.
EDUCATION SERVICES
Page |8
Comments: Our Teton Peaks Academy is accredited through the local school district and employs one full-time certified teacher.
Because our academy maintains a contract with the local school district we have immediate access to the district's special education
coordinator and the teacher at BHC is a special education teacher who is certifed K-12.
Our teacher is an employee of the local school district and as such is in constant
communication with the school district. The RTC coordinator has access to the
communication with home-based schools? principal and the special education coordinator of the school district as needed.
Fully accredited on-line school through Bonneville School District.
☒ Yes ☐ No
review/planning.
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☐ Dietitian
☒ Psychologist
☒ LCSW
☒ Other Clinician (name, credentials): LCPC
☐ School Representative (name, role): Click here to type
☒ Milieu (name, role): Case manager
Page |9
process?
Therapists and Case Manager communicate weekly with the family; therapist for family
therapy (web-based video conferencing) and phone contact, Case Manager for
purposes of discharge planning and keeping parents current with treatment progress.
After admission our Clinical Psychologist administers a selection of testing determined
by he and the Psychiatrist. From the testing results the psychiatrist and treatment team
discuss behaviors and how they will manifest. Discussion concerning the function of
behaviors continues on a weekly basis in our staffing meetings.
Progress on treatment plan goals and objects are assessed by the primary therapist for
each resident. Each objective is considered and discussed with input from the
treatment team, as objectives or goals are completed new ones are established based
upon discussion from the treatment team. We also follow the stages of change for
each problem area idenitifed to monitor progress or lack thereof of residents. Some of
the information discussed to determine progress includes: staff notes regarding
behavior in the milieu, points sheets regarding participation in programming,
participation in therapy (individual, groups, family), completed therapy assignments,
demonstration of skills related to therapy goals.
P a g e | 10
system?
☒ Yes ☐ No
TREATMENT
etc).
Individual, Family and Group therapies
Residents earn levels based on
participation in program. Weekly each
resident obtains a staff signature
representing each aspect of treatment
(i.e. therapy, milieu programming, school,
recreation therapy). Signatures from each
area are required as well as a minimum
point range (points are given for
appropriate behavior in programming,
taken away for disruption of
programming). After having met these
criteria and having appropriately pasted a
minimum time period on the respective
tier, the treatment team discusses the
resident's progress or lack thereof and
votes regarding the next level/tier.
If there is some type of behavioral
intervention that is put in place by the
treatment team, consisting of the
psychiatrist, psychologist, therapist,
coordinator, nurse and case manager,
then the levels might be affected
depending on the intervention and its
purpose.
approaches.
supervision.
LCSW and LCPC on staff
20 Hours continuing education per year
P a g e | 11
DBT skills and groups
MRT substance abuse groups
Our LCSW is trained in DBT theory,and the
in-house psychologist has training in this
area
Our LCSW is a CADC and trained in MRT
Seeking Safety for Males and Females
Our therapists are all masters level
Click here to type
Click here to type
Psychologist offer staff training semiannually in DBT skills and theory
Our LCSW provides all MRT services and
needs 20 hours of training for licensure
per year.
20 hours training per year.
Click here to type
John Landers, Ph.D. Clinical Psychologist
team or staff?
☒ Yes ☐ No
are implemented and
Dietitian
By doctor order
Yes Full time
n/a
By doctor order
Yes Full time
n/a
By doctor order
Yes Full time
n/a
By doctor order
No on an as needed basis
n/a
Dental
By doctor order
No on an as needed basis
n/a
Click here to type
Click here to type
Click here to type
Other
P a g e | 12
Model
Cognitive Behavioral Therapy - with an emphasis on positive
reinforcement
Solution Focused, Systematic Desensitization, Mindfulness
DBT and Mindfulness training
Moral Reconation Therapy
Click here to type
Population
Depression, anxiety, substance abuse
Anxiety disorders
Trauma, abuse, borderline personality
Substance abuse
Click here to type
All residents receive at least one family session weekly, two when possible or needed.
Family therapy occurs by web conferencing and telephone. When families visit, the
primary therapists attempt to do family therapy daily. Family therapy is expected of
families regardless of their structure, often it involves foster parents, legal guardians
and each parent separately when separation/divorce divides a family.
Clinical supervision is provided by the clinical supervisor and happens in a variety of
ways. The clinical supervisor is involved individually with primary therapists regarding
therapy interventions, treatment planning, staffing clients, and discussion of tier
advancement (3-5hrs weekly). Supervision also takes place in treatment planning and
staffing meetings where treatment goals, therapy interventions, and therapeutic
progress are discussed related to each resident (5-8hrs weekly).
Teton peaks has multiple in-house crisis supports: Clinical Psychologist and therapists
trained in crisis deescalation and debriefing techniques, Non-Violent Crisis Intervention
trainers and team.
following:
Interpersonal skills Therapists, Occupational therapists, and psychiatric technicians work on these skills in
weekly groups and daily in the milieu
Self-Regulation Therapist address this in DBT groups and individual therapy. Our psychiatrist addresses
daily medication management.
P a g e | 13
Daily Living Therapists, psychiatric technicians, recreation therapists, occupational therapists
address these skills through weekly groups and daily activities that are part of
programming.
Communication Occupational therapists run a weekly communication group, individual therapy
addresses these skills individually.
Other Speech and language therapists and physical therapists are also available to address
needs.
Please describe how your facility helps the After residents have been in the Teton Peaks program for sufficient time to be
determined safe and to be taught the above mentioned skills the therapists begin to set
home environment.
up community and home passes such that the residents can practice their skills.
Resident begin on short visits and then are allowed overnight visits to face difficulties
and issues at home and in the community with their new skill sets. Family therapy is
also used to practice and generalize many skills.
DAILY SCHEDULE
Each day residents wake, shower, dress and have a room check prior to a morning goals
group. Following the group, breakfast and meds are passed (higher tiers go to breakfast
in the cafeteria). School takes place from 8:30 till noon when lunch and meds are again
provided. From 12:45 to 4:45 school is completed and groups (Recreational therapy,
psychotherapy, and MRT/ substance abuse)take place. 5:00 is physical exercize and
large muscle group activities. At 6:00 dinner begins, followed by skills groups, tier
groups and daily wrap-up groups that last until 8pm. From 8 to 9:30 is snack, calmdown activities and evening meds pass. Lights are out at 9:30 (10:00 on Saturday).
5-15 minute breaks are given throughout the day to help residents transition from
activity to activity and to get snacks or PRN meds as needed.
All meal planning, preparation and clean-up is handled by the hospital's dietary and
food services departments.
P a g e | 14
On-Site Activities:
Gym time (many large muscle group
activities), modified circuit training,
outside b-ball court and walking track
(when weather permits)
Our recreation therapists organize
numerous summer and winter activities
(from hiking and camping to cross-country
skiing and ice-skating, for those on higher
tiers)
Click here to type
Who is responsible for discharge planning Teton Peaks employs a full-time Case Manager who does all discharge planning.
at your facility?
Discharge planning begins as the resident arives and continues throughout their stay.
What percentage of your recipients return Therapeutic Foster Care: Aprox 5%
to:
Foster Care: Aprox 3%
Family: Aprox 90%
Group Home: Aprox 2%
Our Therapists make a call within 24 hrs to determine if the discharge was successful
and then the RTC coordinator makes calls at 1month and 3 months to find out
residents' progress and help parents with questions if they have any.
☒ Yes ☐ No
Click here to type
P a g e | 15
Section B
N/A
We screen for this when deciding on appropriateness for treatment by asking for information from
includes questions about ASD the referring facility
and symptomatology?
☐ Yes ☒ No
What diagnostic
If a patient is in our facility and is suspected that ASD was missed or is a possibility then our
psychologist will complete what tests he feels necessary to correctly dx issues.
process do you use?
P a g e | 16
☐ Observation
Click here to type
Physical Exam Yes
Click here to type
Screening for Yes
Click here to type
Hearing Screen Yes
Click here to type
Examination for Signs Yes
Click here to type
Genetic Testing No
Click here to type
Consideration of Yes
Unusual Features
Click here to type
Psychological Assessment Yes
Click here to type
Communication Yes
Assessment
Click here to type
Occupational Therapy Yes
Assessment
Click here to type
Physical Therapy Yes
Assessment
Reports from unit staff stating patient struggles to sleep through the
night.
P a g e | 17
(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
Modalities
Click here to type
☒ Pragmatic Language skills
training
☐ Education
Occupational and speech therapy
☐ Other
Please describe.
Click here to type
Click here to type
P a g e | 18
typically use with this population?
☐ Yes ☒ No
treatments?
☒ Yes ☐ No
Behavioral Therapy?
This per the evaluation from the psychiatrist
Please explain.
Registered nurses, therapists and techs
This is done on an as needed basis depending on what the therapist feels is appropriate for
patient.
Psychiatrist, psychologist, therapist, nurse, occupational and speech therapists.
P a g e | 19
We use a team approach utilizing the professionals that are employed, we use multi-team
meetings and approach to develop interventions specific to the patient that are evidence based
plans.
Click here to type
P a g e | 20
Texas NeuroRehab Center
Section A
Date completed
Contact number
Address
Cheryl Nickell, Program Director-Child and Adolescent Services
February 22, 2016
1-800-252-5151
1106 West Dittmar Road, Austin, Texas 78745
GENERAL OVERVIEW
Accreditation Body
Joint Commission
Age Range
# of Licensed Beds
8-17
3 coed treatment units, with 16 beds each
☒Males
3 coed treatment units, with 16 beds each plus 16 bed male
8-17
☒Females
RTC unit
Click here to type
Evaluated on indivual needs and mileu
☒Other
Nursing
Milieu
Comments
HOME
PRINT
Page |1
Day
1 nurse on each unit, around 1:3 subacute; 1:4 PRTF
none
the clock, regardless of
census
Evening 1 nurse on each unit, around 1:3 subacute; 1:4 PRTF
none
census
Night
1 nurse on each unit, around 1 rehab tech on each unit,
none
around the clock, regardless
census
of census
All of our patients have IQ’s that fall between 40-90.
☒ Yes ☐ No
9-12 months
Recipients?
9-12 months
9-12 months
9-12 months
n/a
☐ Yes ☒ No
☒ Yes ☐ No
FASD is identified through case history, neurological testing, initial
psychiatric evaluation and psychosocial assessment. We treat children
based on their behaviors and presenting problems and what prevents
them from living at a lesser level of care. We used FASD techniques
identfied by the CDC as the most appropriate. These include, but are
not limited to: parent training, friendship training, executive function
training, and parent-child interaction therapy and parent behavior
management training. The facility has over 30 years experience in
treating FASD and FASD associated behaviors. All therapists and case
managers have additional training on FASD - includes identification and
treatment methods for patients with FASD.
Page |2
Based Practices.
Trauma histories are identified through case history, initial psychiatric
evaluation, psychosocial assessment. When relevant, trauma histories
are also discussed weekly in patient staffings, weekly rounds, monthly
staffings and Clinical Case Review. Trauma informed care is part of
basic staff training and is the framework for the individual's treatment
plan. From there, the individual's therapy, group and family therapy
are designed and conducted by a licensed professional. All therapists
and case managers have additional required CEU traininging for TFCBT. Team meeting trainings related to Trauma Informed Care are
provided regularly on the unit for direct care staff.
Through team meetings and individual consultation, therapy staff
engage in discussions routinely with staff regarding issues that could
impact secondary trauma including methods to maintain safety on the
unit, promoting self-care among staff, and providing information on
community resources. Employees have access to EAP resources for
further assistance. All roles are recognized in problem solving
particular patients and given a voice to contribute to developing
solutions that can enhance the work environment and stress. Staff
appreciation events are on-going through the yee-haw recognition,
yearly awards, and staff appreciation day. Access to on campus health
screens are also available for employees. Ongoing education occurs
to alert staff about the concept of secondary trauma and the
importance of self-care. If there is a unique safety issue situation, the
Lead Clinical Therapist will provide additional support as appropriate
to debrief the incident.
facility serves.
Training upon hire related to child/adolescent development,
clinical inservices provided through team meetings that are
clinically / diagnosis specific. Trauma Informed Care training
annually. Access to outside training and recsources as needed.
Page |3
Training upon hire related to child/adolescent development,
clinical inservices provided through team meetings that are
clinically / diagnosis specific. Trauma Informed Care training
annually. Access to outside training and recsources as needed.
Sexually reactive and maladaptive behaviors are evaluated on
an individual basis to determine appropriate fit for the patient
and the mileu.
Click here to type
☐ Eating Disorder
Click here to type
☒ Other Intellectual Disabilities, Traumatic
Brain Injury, Seizure D/O, Genetic D/O
Click here to type
☐ Other
to trauma)
Sexually offending:
☒ adjudicated/ ☐ nonadjudicated
☒ Eating Disorder
☐ Psychosis
☐ Elopement Risk
☐ Fire setting
☒ Other: Conduct Disorder
Comments: Sexually reactive and maladaptive behaviors are evaluated on an individual basis to determine
appropriate fit for the patient and the mileu.
Page |4
SAMA The SAMA program focuses on preventing aggression from becoming physically
harmful. The emphasis of the course is on using the Assisting Process in all interactions.
Training occurs upon hire and retraining is conducted annually.
Function of behavior is actively assessed by many disciplines and discussed in rounds weekly,
patients individual staffing, team meeting and otherwise as indicated. Staff engage in
evaluation of data and monitoring for trends to establish an understanding of the antecedent
and the potential function of the behaviors exhibited, ie. avoid, escape, stimulation, etc. This
information is effectively communicated amongst the team members to assist with
interventions throughout the therapeutic environment. If behaviors impact school functioning,
the patient may also have an FBA specific to school.
Staff observation through Q15 minute checks.
All patients/guardians are required to complete Consent to Treatment. The facilty employs
Nurse Practitioners, has access to local medical facilities and is contracted with a dental
provider.
☒ Yes ☐ No
Only voluntary
☒ Yes ☐ No
Imminent risk
☒ Yes ☐ No
Physical holds only, imminent risk
The patient may request to take a voluntary
time out.
Face to face evaluation and debriefing occur
following the seclusion.
Face to face evaluation and debriefing occur
following the seclusion.
Page |5
Texas NeuroRehab Center operates under the philosophy that patient behavior must be
managed as to prevent or diffuse emergencies that might require intrusive interventions such
as restraint or seclusion. Staff are educated regarding the inherent risks of emergencies which
there is an imminent risk of harm to the patient or others. The use of non-physical
interventions are preferred methods for managing behavior. Staff are encouraged to use the
least restrictive intervention; for patient and staff safety. We prioritize the individual's dignity
and safety during the use of seclusion or restraint, through communication of clear
expectations, attempts to discontinue the use of restraint or seclusion as soon as possible , and
inclusion of the individual in the debriefing process.
by whom?
Individual
Facility
Individual
Facility
Seclusion and Restraint Data (STP) are
reviewed daily by the COO/Risk Manager,
Director of Nursing and relevant nurse
managers. Treatment team members review
individual STP data monthly, unless there is an
increase in utilization, where data is reviewed
immediately through Case Review.
Any incident which requires investigation by
the state of Texas investigating body will be
reported to the Division of Behavioral Health
within 72 hours. A summary of the the
internal investigation report will be sent.
Facility Leadership, Medical Executive
Committee, Behavioral Programming groups
all review STP data and trends monthly.
Any incident which requires investigation by
the state of Texas investigating body will be
reported to the Division of Behavioral Health
within 72 hours. A summary of the the
internal investigation report will be sent.
Data collection, review and analysis occurs for many elements of patient care. These elements
inlcude, but are not limited to: Use of Seclusion / Restraint, Patient Falls, Medication Variance,
☒ Yes ☐ No
Infection Control, Incident Reports, Patient Satisfaction, Patient Care/Concern & Grievances.
Data is aggregated and reviewed on a monthly basis, trends are reviewed and
recommendations for process improvement are made based on findings and discussions.
Page |6
structure and supervision provided by your Supervision of patients in our program would be considered moderate to high based on Q 15
minute checks, and the ability to adjust supervision based on risk factors and precautions
Choose a level
☐ Yes ☐ No
roommates?
characteristics?
EDUCATION SERVICES
identified for the patient. The milieu follows a daily schedule with structured activities.
If a patient has identified risk factors which would merit a precaution, the level of supervision
may be increased to meet the needs of the patient for safety.
Please explain.
Level of supervision is generally based on risk behaviors and milieu dynamics.
Age, developmental level, identified risk factors are just some of the characteristics that would
be considered when assigning patients as roommates
The facility does not mix genders in the assignment of roommates. The facility complies with
state licensing regulations in regards to age difference in roommates. The facility assigns
roommates based on considerations for developmental level, risk factors and other
therapeutic factors determined by the treatment team review.
The situation is assessed and modifications to room assignments are made.
15 minute observation checks daily, 24 hours a day.
Page |7
Comments: Students attend an on-site public school program offered through The University of Texas Charter School. The school provides
small classroom settings with a special education teacher, teacher's aide and direct care staff. They provide the maximum amount of individual
instruction at the student's pace. The school and pre-vocational program include a reading lab, computer lab, library, wood shop, pre-vocational
training area, kitchen and multiple classrooms equipped with the latest technology.
The school provides transcripts, individual education plans, report cards, diplomas and
graduation ceremonies. Teachers communicate with the student's home schools and credits
communication with home-based schools? are transferrable.
review/planning.
Texas Education Agency
☒ Yes ☐ No
☒ Psychiatrist
☐Pediatrician
☒Nurse
☐Pharmacist
☒ Physical Therapist
☒ Speech Therapist
☐ Dietitian
☐ Psychologist
☒ LCSW
☐ Milieu (name, role): Click here to type
Page |8
process?
system?
☒ Yes ☐ No
TREATMENT
etc).
Families are encouraged to participate in treatment team meetings, family therapy and
visit/off-campus passes.
Individual behavior plan, Case Review, Behavioral data collection, review and analysis.
Behavior program progress (Level system), data review (STPs, Patient Incidents, Behavioral
Intervention Data), and treatment team discussion.
In circumstances of challenging behaviors,
an individual behavior plan can be
developed and implemented to target
specific behaviros based on data
collection and analysis.
approaches.
supervision.
The level system is an ongoing system of
improving and recognizing behaviors.
Page |9
Milieu Management- the milieu utilizes
learning therapy concepts with a token
economy that measures frequency and
intensity of behaviors without a negative cost.
There is a high focus on consistency,
repetition, positive behavior, and predictable
response sets. They also incorporate goals
groups and a positive behavior sticker
program.
Aspects of DBT - Skills based groups
CBT
Satori
Long standing research and generally
accepted practice
All staff are required to participate in
orientation and annual retraining. They are
also staff programing guides on every unit and
regular staffing, behavior program meetings
and monthly team meetings to discuss
programming.
DBT studies based on working with
adolescents and families utilizing "The Middle
"path" in RTCs have been proven helpful even
when there are modifications to the full
program.
According to a book published in 2011 by
Judith Beck, more than 500 studies since 1977
support this therapy.
Staff training through team meetings
Local, state and nationally recognized tool for
behavior management.
Clinicans are expected to have a general
understanding as part of their school
curriculum prior to hire. We build on that and
incorporate training for our non-clinical staff
through orientation, team meetings and oneon-one experiences between the clinical and
non-clinical team. Satori
Direct care and clinical staff participate in an
initial 12 hour training program that utilizes
many teaching styles to ensure staff
competency. Every 6 months thereafter, a
basic review of skills provided.
P a g e | 10
School - utilizes the STAR (Strategies for
Teaching Based on Autism) and the Eden
Program (which provides both an assessment
tool and curriculum).
STAR - nationally recognized program
stemming from a research study in 2003.
All staff are required to participate in
orientation and annual retraining. We also
mandate additional training as it comes along.
For example, when we rolled out utilizing
EDEN all staff working with that curriculum
attended training both on working with
Autistic patients in general as well as EDEN
and task analysis. Ongoing training occurs
through monthly team meetings. Additionally
we offer extra trainings during Autism
awareness month. In reference to the STAR
program it is primarily used in the school, but
since our school is on campus the teacher is
part of our treatment team and staffing.
Behavioral psychologists - We have student psychologists who perform psychological testing.
Oversight is provided by PhD Psychologists. (Oversight – Walt Mercer, PhD., Ed Prettyman,
team or staff?
PsyD, Rachel Robillard, PhD)The University Charter School utilizes FBA's when appropriate.
☒ Yes ☐ No
are implemented and
Dietitian
Notes and Orders are written
Full time
n/a
to communicate
recommendations to be
followed;
P a g e | 11
to communicate
followed;
to communicate
followed;
to communicate
followed;
Full time
n/a
Full time
n/a
contract
Dental
to communicate
followed;
contract
Other
Click here to type
Click here to type
Consultation can occur to
ensure the information is
incorporated into treatment
planning beyond basic
standard.
Consultation can occur to
ensure the information is
incorporated into treatment
planning beyond basic
standard.
Click here to type
Model
Population
Behavioral therapy
CBT
Components of DBT
All Populations
Based on cognitive ability
Based on cognitive ability and presenting problems
P a g e | 12
Individual & Family Therapy
Social Skills Group Therapy
All - if contraindicated for Family Therapy, that time is utilized for
parent support, education and training. If contraindicated for
Individual Therapy, that time is vested in shadowing to identify ABC's
of behavior.
All patients have some form of social skills group lead by a masters
level clinician. Some patients, based on diagnosis and need may also
participate in skills group with Occupational or Speech therapy.
Expectations regarding family therapy include consistent participation by guardian/family
member on a weekly basis to discuss problem solving, enhance relationship, address familial
issues and discuss discharge planning. Therapists continue to be aware of specific cultural
considerations. Access to video conferenc is available if family can connect to facilitate face-toface interactions. On-site family therapy occurs when guardian is able to travel to facility.
Therapists are directly supervised by the Program Director/LCSW under Clinical Director.
Consultation occurs weekly with attending psychiatrist.
All therapy staff have been trained in crisis intervention and there is 24 hour nursing staff
available to address issues as they may arise. Nursing staff and rehab techs will address
immediate concerns, with follow up from therapy staff for additional support. The Beck
assessment tool is utilize to identify risk for suicidality and provides a framework to monitor for
safety.
following:
Interpersonal skills daily milieu focus, guidance, support, role modeling on unit, at school and within therapies;
additional assistance as required by OT, Speech, and IT/FT therapists for additional
interventions
Self-Regulation daily milieu focus, guidance, support, role modeling on unit, at school and within therapies;
additional assistance as required by OT, Speech, and IT/FT therapists for additional
interventions
Daily Living consistent routine/schedule, prompting as needed by staff; additional assistance as required by
OT, Speech, and IT/FT therapists for additional interventions
P a g e | 13
Communication prompting as needed by staff; Evaluation by speech and language pathologist for additional
interventions;
Please describe how your facility helps the TNC assists by providing learning opportunities at the facility to assist the patient to practice
and utilize these skills. Working with the family within family therapy to discuss and role play
potential situations. Information sharing with future providers via sending records and case
home environment.
conferences to further discuss areas of needed support upon return to the community.
DAILY SCHEDULE
Hygiene, school, therapies, leisure activities, meals, unit groups
Patients follow a daily schedule. Staff are present to facilitate transition between activities and
provide supervision. Transitions are managed by having posted schedules to help with
expectations. On the younger sub-acute unit we have a transition area and discuss the daily
schedule at goals group.
We have a full service kitchen and dining room on site. The kitchen is licensed by the
Department of Health Services. Dietary staff provide nutritional assessments when ordered.
Patients eat their meals in the cafeteria with staff supervision.
On-Site Activities:
play scape, gym hiking, swimming, games,
special events, pet therapy, Holiday events,
dances, family visits, recreational therapy lead
by a CTRS
Sea World, Austin Park and Pizza, Museum,
out to eat, movies, park, etc. Off-site activities
are based on safety and behavior.
Discharge planning begins at admission and progress is documented in the individual's plan of
care.
at your facility?
Case management staff as well as individual/family therapist
P a g e | 14
to:
☒ Yes ☐ No
Foster Care: 0
Family: 80%
Group Home: 10%
Corrections: 0
Independent Living: 0
We collect information regarding follow-up contact.
Texas NeuroRehab Center provides a highly structured and specialized residential and subacute residential programs for those facing a
combination of behavioral, medical, social and learning disabilities. Patients follow an individualized treatment plan developed by a physician
led treatment team which includes a comprehensive behavioral and neuropsychological assessment. The plan sets specific goals and
interventions and uses an array of services to assist the child/adolescent in meeting the goals and function at a lesser level of care. The
treatment milieu is supported by a astructured program providing 24 hour nursing care. These patients may present with an array of behavioral
issues such as severe impluse control, aggression, disruptive behaviros, learning and processing impairments, disturbance of social functioning as
well as medical complexities. Neuropsychological testing and recommendations are inclusive in the treatment program. Treatment includes
Individual and Family therapy, Family education, Social Skills groups,and Ancillary therapy (Physical, Speech, Recreational therapy and Sensory
Integration program) as clincially indicated.
Section B
P a g e | 15
_ Treatment is available for boys and girls ages 8-17, with IQ’s that fall
between 40-90. These children may have a variety of diagnosis
including the wide range of Autism Spectrum Disorders and are facing
a combination of medical, behavior, social and learning difficulties.
See next question
and symptomatology?
☒ Yes ☐ No
We screen for ASD by review of previous clinical and referral materials. We ask questions in both the
What diagnostic
Psychosocial Assessment and Initial Psychiatric Assessment to further identify ASD symptomatology, past
interventions, family history and psychosocial issues. Our Neuropsychological and Academic departments
process do you use?
utilize testing and/or adaptive functioning assessments including (ABAS), ADOS (Education), CARS, GADS, and
the Social Communication Questionnaire. These tools are copyrighted materials and we are unable to submit
a copy.
☒ Observation
☒ Specific Tools (please identify): Our Neuropsychological and Academic departments utilize testing
and/or adaptive functioning assessments including ABAS, ADOS (Education), CARS, GADS, and the Social
Communication Questionnaire.
P a g e | 16
Every patient receives an H&P
Physical Exam Yes
If there are indicators of gastrointestinal issues, further follow up may be
requested.
Part of Speech and Language evaluation if ordered by physician.
Hearing Screen As Needed
Every patient receives an H&P. If there are indicators of tuberous sclerosis
Examination for Signs As Needed
on the H&P as well as a physician recommendation this examination can be
ordered to further assist with diagnosis or the direction of treatment.
Genetic Testing No
Consideration of
Unusual Features
Psychological Assessment
Communication
Assessment
Occupational Therapy
Assessment
Physical Therapy
Assessment
As Needed
If needed to determine appropriate course of treatment, testing could
be explored.
As ordered by physician
As Needed
As ordered by physician; most often completed on patient if not done within
past year.
Speech and language evaluation as ordered by physician
As Needed
OT evaluation as ordered by physician
As Needed
A physical therapy assessment can be ordered by the physician, based on
medical necessity, if there is the presence of hemi paresis, spasticity and/or
gait dysfunction.
A sleep assessment can be ordered by the physician, based on medical
necessity, if the patient can tolerate the assessment with the presence of
suspected sleep apnea or intractable insomnia.
Yes
P a g e | 17
(ABA)
Modalities
Is ABA used in
☒ Yes ☐ No
residential?
Is ABA in treatment
☒ Yes ☐ No
plan?
What credentials does Behavioral Psychologists, PHD, PsyD
your ABA specialist
have?
yes
treatment team?
Is this person a
Staff member
contractor or staff
member?
☒ Pragmatic Language skills
training
☒ Education
TNC can utilize a variety of alternative communication modalities including the Picture Exchange
Communication System, sign language and visual schedules. Methods of assistive technologies utilized
can include Voice Output Devices, Alpha Smart, and various computer/IPAD applications.
The functional application of social skills is incorporated into a variety of modalities including social skills
groups, sensory motor groups, Occupational Therapy interventions, Speech/Language interventions,
education, and on the living units.
STAR (Strategies for Teaching based on Autism Research) Program
P a g e | 18
☐ Other
Please describe.
Components of ABA are incorporated into the school program and the milieu/treatment plan. In the
classroom, the STAR (Strategies for Teaching based on Autism Research) Program is implemented using
ABA instructional methods of discrete trials, pivotal response training and teaching functional routines.
On the living unit, the Eden Autism Services Curriculum can be utilized which are ground in the
principles of Applied Behavior Analysis (ABA) and address essential skill areas. Occupational Therapy
assists with classroom modification and unit education on sensory strategies to incorporate such as
weighted blankets/vests, therapy balls, and oral motor strategies. Several Therapeutic Listening
Integrated Listening Systems, Dream Pad, Sensory Motor Groups and the vocational program assists to
further facilitate application and use of communication tools.
typically use with this population? Medications are utilized to treat a specific patient’s symptoms. Our physicians utilize the AACAP
(American Academy of Child and Adolescent Psychiatry) guidelines to treat co-morbid diagnosis.
☒ Yes ☐ No
Parents/guardians are included in the discussion of this recommendation and consent is obtained to
pursue a medication course of treatment. Our physicians work to minimize the amount of medications
utilized by attempting trials of medications that can address multiple symptomatology the patient
exhibits. Areas addressed by medication can include agitation and maladaptive coping skills resulting in
aggression and self- harming behaviors. Medications that are FDA approved for use in children with
agitation include Risperdal and Abilify. Patients may exhibit ADHD symptoms including impulsivity,
hyperactivity, poor attention and distractibility which impede their functioning towards treatment goals
and within the community resulting in the possible use of typical medication for ADHD such as
stimulants or non-stimulants. Another area that may be addressed by medications can include explosive
outbursts resulting from a fluctuation of mood to which a mood stabilizer such as Depakote, Trileptal,
Risperdal, Abilify, or Zyprexa may be utilized. Anti-seizure medication would be utilized if warranted
due to a seizure disorder. Anti-depressants could be utilized to address depression symptomatology
resulting from potential low self-esteem due to ASD. General Anxiety or Social Anxiety symptoms
exhibited in higher functioning youth who are aware of their limitations may benefit from SSRI’s such as
Zoloft.
P a g e | 19
treatments?
☒ Yes ☐ No
Behavioral Therapy?
See above
Please explain.
The therapist will talk to the family about types of alternative treatments in the past. If the treatment
team believes that the treatment is relevant, the pros/risks would be discussed and implement as
treatment sees appropriate.
The interdisciplinary team utilizes best practices within their course of treatment for each child.
Monthly treatment team meetings provide training to staff on various practices as well as extra
trainings to provide further education specific to Autism Spectrum Disorder.
Cognitive behavioral therapy is used with some ASD patients to assist with emotional
regulation, anxiety, impulsive and intrusive thinking. Many of these patients struggle with
change, finding success and have negative thinking patterns which result in unsafe choices.
Patients are assisted to recognize their cognitive distortions to make changes in their behaviors.
The regular interdisciplinary treatment team members within TNC include the Physician, Registered
Nurses, Licensed Vocational Nurse, Licensed Clinical Social Workers, Licensed Professional Counselors,
Clinical Case Managers, Speech and Language Pathologists, Occupational Therapists, Vocational
therapists, Recreational therapists, and Teachers. Also included in the treatment team are the
parents/guardians, outside agencies (i.e. OCS, GAL, attorneys), potential discharge placements and any
other supportive services. The patient is included in the treatment planning process as appropriate for
their developmental level
P a g e | 20
All of our patients have IQ’s that fall between 40-90.
Texas NeuroRehab Center is a specialized residential treatment facility. Treatment is available for boys and girls ages 8-17, with IQ’s that fall as
low as 40. These children may be facing a combination of medical, behavior, social and learning difficulties. The cognitive behavioral approach
used by Texas NeuroRehab Center has been formed from over 40 years of experience working with the developmentally delayed population.
Best practices from all treatment modalities are combined to make up the individualized treatment plan for each patient. Routine,
predictability, and consistency create the groundwork for the improvement of coping skills, activities of daily living and tolerance of transition.
The primary goal of the program is to help the patient function more effectively in a variety of environments. The second goal is to master basic
functional routines that will lead to increased self-care an independent living. Specific areas on our Mesa living unit correspond with skill
acquisition: sensory activity room, functional routines area, round-up area, solo workstations and a gathering area. Color-coded walls and
furniture identify each area.
P a g e | 21
Yellowstone Boys and Girls Ranch
Section A
Date completed
Contact number
Address
Christi Beals, Chief Development Officer
March 9, 2016
406-655-2100
1732 South 72nd Street West Billings, MT 59106
GENERAL OVERVIEW
Accreditation Body
COA
Age Range
# of Licensed Beds
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10-18
☒Males
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12-18
☒Females
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117 total licensed beds
☐Other
Nursing
Milieu
Comments
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Day
1:30
1:5
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Evening 1:30
1:5
HOME
PRINT
Page |1
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Night
1:65
1:10
YBGR is not a good fit for youth with a full range IQ scale below 80
☒ Yes ☐ No
450 days
Recipients?
238 days
196 days
182
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☐ Yes ☒ No
☒ Yes ☐ No
YBGR currently utilizes Mentalization based treatments in
combination with social skills development. We provide staff
with reflective care training and clinical supervision is done
weekly with staff.
Trauma focused cognitive behavioral therapy and mentalization based
treatments. On-going training will be provided to all therapists during
What kind of training do your staff receive (include milieu as well weekly clinical staffings facilitated by our psychologist. The therapists
are Clinical Program Managers who are responsible for on-going
trainng with their teams based on the clinical needs of our youth. The
reflective care program through the Center for Reflective Parenting
Based Practices.
facility serves.
implemented at YBGR works seamlessly with MBT and all mental
health workers are trained at the time of hire with continued training
provided during team meetings.
Reflective care allows for discussion and acknowledgment of
secondary trauma in staff members. Supervisors provide follow-up
recommendations to on-site crisis-debriefing staff or off-site EAP
necessary.
Page |2
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☐ Eating Disorder
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to trauma)
☒ Eating Disorder
☐ Psychosis
☐ Elopement Risk
Sexually offending:
☒ Fire setting
Page |3
MABPRO: The main focus is always on preventing and de-escalating aggression and violence
before it becomes physical while at the same time, exploring the psychology of how and why
we respond the way we do. In turn, we can begin to change our own way of responding and
reacting to negative behaviors. The foundation of this training is to understand the idea of
emotional competence in the staff working with the youth. Staff are taught an awareness of
how their own personal goals, values, and beliefs affect their ability to respond effectively to
youth in crisis. Skills are taught for staff to craft a response to support young people in such a
way that the interaction leads to a “teachable moment” in which the youth is most receptive to
learning a new behavior in order to replace a more maladaptive one. Over time, the young
person needs fewer supports as they begin to hone their own self-regulation skills. Staff
working directly with the youth are required to complete 28 hours of training initially while
being required to complete a 4 hour recertification course in MABPRO ever six months.
YBGR does not use functional behavior assessments. The youth’s treatment team meets at
least weekly in order to discuss the youth, problem behaviors, progress, motivation, barriers to
treatment. This occurs during team meeting, clinical meeting, and monthly treatment plan
reviews.
Staff observation. YBGR takes special preventative precautions when a youth is determined to
be at increased risk of self harm or requires additional supervision. When an employee has
reason to believe that a youth is at an increased risk of self harm they immediately restrict the
youth to the unit, begin constant visual observation of the youth, and contact 24 hour nursing
staff. Nursing staff will perform a self-harm risk assessment and contact our 24 hour on-call
clinician to determine whether a youth be placed on suicide precautions (constant visual site of
staff) or close watch (10 minute checks). Constant observation precautions are utilized when
body boundaries of other youth are put at risk. For youth on this precaution, constant visual
observation of the youth is maintained when the youth is in proximity to others and
docuemtned in 10 minute intervals. Only the practitioners can remove a youth from
precautionsYBGR also utilizes individual and group safety plans that address an increased risk
of aggression and run risk behaviors. Youth placed on these precautions receive additional
monitoring and program structure as well as therapeutic journaling and processing. A program
manager or clinical program manager may approve the discontinuation of ISP's and GSP's
based on the youth's safety and compliance
Page |4
☒ Yes ☐ No
☒ Yes ☐ No
YBGR currently contracts with a midlevel provider two days a week. YBGR follows the
guidelines established in the EPSDT program. Youth that are identified to require vision and
dental needs are scheduled in Billings and transported and supervised by YBGR staff members.
If a youth requires specialized medical care as recommended by our midlevel provider, YBGR
utilizes either St. Vincent Healthcare or the Billings Clinic.
When verbal de-escalation is no longer
an open door time out exceeds 60 minutes a
effective and a youth's behavior becomes
face-to-face evaluation by a nurse or
disruptive to the milieu, staff may utilize
therapist must occur; staff stay within
proximity, specified area time out, or open
viewing distance with documented checks at
door time out
a minimum of every 10 minutes, termination
criteria is under emotional and instuctional
control, a debriefing is conducted within 24
hours of the procedure, a visual check of the
room occurs prior to the placement in an
open door time out.
If Yes, what follow up steps are taken? As
As outlined in the federal regulations seclusion outlined in the federal regulations the time
out room is visually checked prior to the
is only utilized to prevent imminent harm to
placement, all seclusions require a physician
others
order, a debriefing within 24 hours,
recommended changes to the
ICMP/treatment plan, face-to face nursing
assessment as soon as possible but no
longer than one hour with a follow up post
procedure, and notification of the parents
and guardians. A youth must be constantly
monitored as outlined in federal regulations
Page |5
☒ Yes ☐ No
If Yes, what follow up steps are taken? As
outlined in the federal regulations the time
out room is visually checked prior to the
placement, all seclusions require a
physicians order, a debriefing within 24
hours, recommended changes to the
ICMP/treatment plan, face-to face nursing
assessment as soon as possible but no
longer than one hour with a follow up post
procedure, and notification of the parents
and guardians. A youth must be constantly
monitored as outlined in federal regulations
MabPro training prepares staff for seclusions and restraints. Training includes competancy and
proficiency testing for certification.Federal Regulations mandating the use of seclusion and
restraint in a PRTF are reviewed with all direct care staff yearly during MabPro recertification
classes.
Page |6
by whom?
Individual
Facility
Individual
Facility
YBGR procedures require that whenever a
physical restraint has been used on a youth
more than four times within a seven-day
period, lead clinical staff members or
treatment team members will review the
youth's situation to determine the suitability
of the youth remaining in placement, whether
modification to the youth's plan is warranted,
or whether staff need additional training in
alternative therapeutic behavior management
techniques. Additionally physical restraints
and seclusions are reviewed daily through the
distribution of risk management reports that
are emailed nightly as well as through incident
reporting emails that are sent at the time they
occur.
Suicide, death, serious injury, physical abuse,
suicide attempt, allegations of sexual abuse,
injury requiring medical attention, assault
requiring medical attention
COA requires quarterly review of seclusion
and restraint data with a focus being on safety
and risk factors. This is done during our bimonthly risk management meeting. Any
injury to staff and youth (including self
injurious behaviors) is reviewed bi-monthly in
risk management as well. Policy review
regarding the use of physical restraints and
seclusion occurs at a minimum of one time
per year. Procedural changes identified occur
as needed
Suicide, death, serious injury, physical abuse,
suicide attempt, allegations of sexual abuse,
injury requiring medical attention, assault
requiring medical attention
YBGR uses several Performance and Quality Improvement standards to monitor quality and
make necessary improvements. Departments set and report on PQI monitors monthly.
☒ Yes ☐ No
Departments develop & carry out corrective action plans for areas identified over a period of
time as having below threshold results from their aggregate data collection.
Page |7
High
☒ Yes ☐ No
roommates?
characteristics?
High level of structure and supervision. Weekly scheduling occurs that provides structured and
therapeutic activities throughout the day. The expectation is that staff actively participate and
engage in these activities with youth in order to provide additional support and intervention
throughout the day. Additionally youth are not allowed to be in areas of the lodges
unsupervised which includes day rooms, kitchens, and recreational areas unless they have
earned a level that allows this. 24 hour awake staffing include bedchecks at a minimum of
every 30 minutes.
The level of supervision is expected to be consistent at all times, however there are times that
youth may need more than proximity due the the level of impulsiveness or lack of internal
controls to self manage behaviors.
Please explain.
The treatment team will determine the balance between individual risk and therapeutic need
with consultation with the external treatment team
Roommates are a team decision involving the Clinical Program Manager and the Progam
Manager of the unit based on the youth's history, clinical needs, and behavioral presentation.
Clinical Program Managers identify any youth who would pose a risk to have a roommate due
to sexualized behaviors at the time of admission and it is re-evaluated weekly.
If there is an immediate need to separate youth a telephone call to our on-call therapist and
program manager is made by our online staff. If a roommate expresses concern about their
safety other arrangements will be made immediately including but not limited to a change in
rooms, lodge, or sleeping arrangements
If a youth is not on suicide or close precautions it is the expectation that we know where the
youth are at all times and are supervising kids in close proximity and programming. Youth are
not expected or allowed to spend more than 15 minutes in their rooms at one time.
Programming is created to be an active and social opportunity. At night our staff are required
to document bed checks at a minimum of every 30 minutes between the hours of 8pm-7am
Page |8
EDUCATION SERVICES
Comments: Yellowstone Academy is the acrredited K-12 school on campus where residents reciee education. Operating on a trimester
academic calendar, YA has comprehensive services or both general and special education students. We have a superintendent, principal, school
psychologist, and school conselor on staff. Licensed teachers offer rotational classrooms, self-contained classrooms, and online learning
opportunities. Academic features include: individual education plan support, credit recovery options, state tsting administration, off-site ACT
testing, vocational and fina arts courses, and career exploration and development.
Our school staff contact the sending school district immediately upon placement of a youth. A
records request is faxed on the same day and a credit audit is performed by our school
communication with home-based schools? counselor. YA holds all required and requested IEPs and any other school related meetings. A
monthly summary is provided to the family, sending school, and any other approved agency.
Yellowstone Academy is accredited by Montana Office of Public Instruction (K-8) and by
AdvancedED (9-12).
☒ Yes ☐ No
Page |9
review/planning.
☒ Psychiatrist
☐Pediatrician
☐Nurse
☐Pharmacist
☐ Dietitian
☒ Psychologist
☒ LCSW
☒ Milieu (name, role): Program Manager
process?
YBGR lodge staff contact families on a weekly basis, we conduct weekly family therapy
sessions, contacts specific to incident reporting, federally mandated seclusion/restraint
notifications, monthly Master Treatment Plan Reviews (if not in attendance plans to share
after the meeting by the therapist), yearly IEP's, and customer service follow-up calls by
program managers. Additional communication as needed or requested by the
parent/guardians. Discharge planning begins at admission and is dicussed during family
therapy, individual calls between the therapist and parent as well as in the MTPR's to prepare
families for step down transiton. YBGR will work with families to schedule a trial discharge
homepass if appropriate with the expectation that the family and youth meet with future
outpatient providers.
P a g e | 10
system?
☒ Yes ☐ No
Upon admission an individual crisis management plan (ICMP) is created and assessed a
minimum of every 30 days. It is updated as needed and all members of the treatment team
are trained. An ICMP identifies behaviors of concern, safety concerns, triggers, and identified
intervention strategies. Additionally youth are staffed weekly during team meetings that occur
in the individual units. Clinical supervision occurs weekly with our psychologist and youth with
challenging behaviors are staffed clinically during that meeting.
Upon admission all youth have a psychiatric evaluation. Based on the diagnosis, problem areas
are identified. The problem areas are used to identify both long term goals and short term
objectives. These objectives are measurable and tracked either by the therapist or by the unit
staff and are reported every 30 days during the MTPR.
Yes - YBGR has a three tiered level system
with three sub-levels within the tiers. The
three levels are Bronze, Silver, and Gold. The
youth move up the sub-levels (eg. Bronze 1,
Bronze 2, and Bronze 3) fluidly as their
behaviors and stability warrants. The levels
are decided weekly during team meetings
with the final determination being made by
the Clinical Program Manager and Program
Manager.
The level system was created in order to
be modified to address each youth’s
treatment plan and progress in
placement.
TREATMENT
P a g e | 11
etc).
RTI
PBIS (MBI)
MabPro
Refelctive Care
Mentalization Based Therapy
approaches.
supervision.
Montana Office of Public Instruction
Weekly Trainings, Professional
Development Days (PIR Days)
Montana Office of Public Instruction
Professional Learning Communities
MabPro Trainer Certification
Annual and bi-annual training
Center for Reflective Parenting
Onboarding and ongoing during weekly
team meetings
Meninger Clinic
All therapists trained with ongoing training
during clinical supervision
Dwight Von Schriltz, School Psychologist; Chandra Perez, Clinical Psychologist
team or staff?
☒ Yes ☐ No
are implemented and
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Dietitian
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P a g e | 12
Dental
Other
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Model
Population
Mentalization Based Therapy and Reflective Care
All youth and guardians
Cognitive Behavior Therapy/Rationale Emotive Behavior Therapy Youth with diagnoses of behavior disorders, mood disorders, and
anxiety disorders.
Family Systems Therapy
Children and families
Click here to type
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Family therapy occurs weekly with the primary therapist for a minimum of 45 minutes and
normally includes the youth and guardians via phone. The expectation for family therapy is
that families are involved in planning and assessing treatment progress with regard to the
treatment goals. Guardians and parents are expected to participate in sessions, learn skills, and
support the youth through the treatment progress, and assist in determining appropriate
discharge dates and services.
The clinical director provides weekly group supervision to all therapists during the clinical
meeting. The clinical psychologist provides one hour of weekly clinical supervision to nonlicensed master's level therapists who are seeking LCPC. Therapists seeking LCSW are provided
one hour weekly supervision by an LCSW
YBGR has 11 staff members living on our campus who are responsible to respond to campus
crisis and support calls 24/7 through a structured on-call system. Additionally we have an
administrator on-call, clinician on-call, therapist on-call and a program manager on-call 24/7.
We work with local law enforcement, fire, and ambulance to ensure timely response and have
letters of agreement with both local hospitals: St. Vincent Healthcare and Billings Clinic.
P a g e | 13
following:
Interpersonal skills Individual, group, and family therapy; feedback from milieu and school staff; feedback from
Self-Regulation
Daily Living
Communication
Other
home environment.
DAILY SCHEDULE
peers; socail skills groups
Individual, group, and family therapy with a CBT focus; feedback from milieu and school staff;
feedback from peers
Individual, group, and family therapy; psychoeducation groups; charting (when applicable);
feedback from staff
Individual, group, and family therapy; feedback from milieu and school staff
YBGR employs a variety of experiential opportunities in order to enhance the skills-learning
process, including animal-assisted therapy, recreational activities, art and expression, and
spirituality. Additionally youth participate in off campus passes and community service in the
Billings and Laurel communities to practice skills learned in PRTF in a public setting.
Therapists and staff members provide in-the-moment feedback and direction that relates to
using learned skills in the home environment. Youth are encouraged to practice, gain mastery,
demonstrate, and describe the use of their skills during therapy sessions and in the milieu.
Youth may participate in imagery exercises in order to assist in generalizing the use of their
skills at home. Youth often participate in a home pass prior to discharge that offers the
opportunity to practice and demonstrate their skills in the home environment. Upon their
return to the facility from a home pass, the youth have an opportunity to continue working on
any areas of deficiency that may have arisen
The schedule is created weekly with the assistance of youth and posted in the milieu. During
times when youth aren't in school there is a balance between psychoeducational groups,
recreation, social skills development, lifeskills, and leisure.
P a g e | 14
The schedule allows kids to have predictability and motivation. Depending on the
developmental level of youth transitions can occur in several different ways. Some youth are
able to transition between activities with very little encouragement or prompting while other
youth require advance notice and a slower transition between activities. For some youth we sit
down and review expectations for the upcoming activity so they are prepared to move on.
Meals are provided by Sodexo. Youth gather in the dining hall or in their units for meals. YBGR
youth eat family style with the mental health workers and are encouraged to eat a nutritionally
balanced meal and exhibit socially appropriate behaviors
On-Site Activities:
Swimming, full-size gymnasium, two workout
areas with weights and cardio equipment,
bowling alley, game room with pool, air
hockey, XBox 360 Kinect, softball field, soccer
field, horseshoes, miniature golf course,
walking trails, bicycles, and a riding arena with
horses
Cross country skiing, hiking, camping, ice
skating, community service projects, attend
local rodeo, fishing, canoeing
Discharge planning begins upon admission.
Who is responsible for discharge planning At Yellowstone, the Clinical Program Managers, (Master's or PhD prepared therapists) provide
the discharge planning for youth assigned to their caseload.
at your facility?
What percentage of your recipients return Therapeutic Foster Care: < 15%
to:
Foster Care: < 10%
Family: 60%
Group Home: 15%
Corrections: <5%
Independent Living: 5-10%
P a g e | 15
☐ Yes ☒ No
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Section B
We are unable to accommodate youth with a full scale IQ (FSIQ)
below 80. We review packets when measures of IQ are between
70 and 80, but generally the FSIQ needs to be 80 or above
because out program requires verbal reasoning ability.
P a g e | 16
and symptomatology?
☐ Yes ☐ No
What diagnostic
process do you use?
Please check all
that are included:
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☐ Family interviews
☐ Review of past records
☐ Observation
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Unusual Features
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P a g e | 17
Click here to type
Assessment
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Assessment
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Assessment
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(ABA)
Is ABA used in
☐ Yes ☐ No
residential?
Is ABA in treatment
☐ Yes ☐ No
plan?
your ABA specialist
have?
Click here to type
treatment team?
Click here to type
Is this person a
contractor or staff
member?
Modalities
Click here to type
training
Click here to type
P a g e | 18
☐ Education
☐ Other
Please describe.
Click here to type
Click here to type
☐ Yes ☐ No
Click here to type
Please explain.
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treatments?
☐ Yes ☐ No
Click here to type
Under what circumstances, and/or Click here to type
Behavioral Therapy?
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P a g e | 19
Click here to type
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P a g e | 20

Alaska Out-of-State Residental Program Treatment Facility Contact

Transcription

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