WHO IS ACCREDITED?

Private Organization Accreditation

Germaine Lawrence is a residential treatment center for girls ages 12-18 with complex behavioral, psychological and learning challenges.   Girls live at our programs while receiving special education, individual, family and group therapy; psychiatric and primary medical care; and a wide variety of therapeutic activities and interventions.
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ORGANIZATION TESTIMONIAL

The Village for Families & Children, Inc.

Galo A. Rodriguez, M.P.H., President & CEO

COA Peer Reviewers demonstrated their expertise through their knowledge of COA standards as well as experience in the behavioral health field. In addition, COA’s seminars and tools were very helpful in guiding us through the accreditation process.
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Purpose

Individuals who receive Services for Mental Health and/or Substance Use Disorders improve social, emotional, psychological, cognitive, and family functioning, and attain recovery and wellness.

CA-MHSU 8: Detoxification Treatment

Detoxification treatment is provided based on the needs of the service recipient.

Note: Organizations providing detoxification treatment will complete CA-MHSU 8 in addition to all other applicable core concepts. Detoxification can occur in variety of settings (e.g., ambulatory or residential) at varying levels of intensity.

Ambulatory Detoxification programs provide medication management and monitoring, clinical counseling, and other necessary support and referral services to help individuals safely withdraw from the substance(s) on which they are dependent. Services include but are not limited to: individual assessment and treatment planning, withdrawal management (medical and non-medical), counseling and education, and referrals for ongoing substance use treatment. Programs are available 24 hours a day, seven days per week and are staffed by an interdisciplinary team of qualified professionals. The intensity of the services are determined by the level of care provided (e.g. outpatient, intensive outpatient, and partial hospitalization) and whether or not extended onsite monitoring is performed. 

Residential Detoxification programs reviewed under this core concept can include programs that are: 

  • Clinically-Managed: Clinically-managed residential programs, also referred to as non-medical or social detox, emphasise peer and social support. Services are primarily provided by appropriately trained, non-medical personnel. 
  • Medically-Monitored: In medically-monitored residential/inpatient programs, 24-hour medically-supervised detoxification services are provided by an interdisciplinary staff under the direction of a licensed physician.
COA does not accredit medically-managed intensive inpatient detoxification programs. Medically-managed programs involve 24-hour medically-directed evaluation and withdrawal management and require an appropriately trained and licensed physician to provide and manage all diagnostic and treatment services. Programs are provided in acute inpatient care settings, such as hospitals, and are specifically designed for individuals with symptoms that require primary medical and nursing care services. 

Research Note: Detoxification is distinct from treatment for a substance use disorder, which involves a continuum of ongoing therapeutic services that promote recovery and prevent relapse. Detoxification is the process by which drugs or other harmful substances are removed from an individual’s body for a time period sufficient to restore adequate physiological and psychosocial functioning. Individuals that successfully complete detoxification continue to receive care in substance use treatment programs. Detoxification services are also referred to as withdrawal management. 

NA The organization does not provide detoxification treatment.

Rating Indicators
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • A number of client records are missing important information  or
  • Client participation is inconsistent; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • A description of the detoxification process
    • Procedures for providing detoxification services
    • A description of staff members and staff qualifications
    • Service recipient/personnel care and supervision ratios and scheduling criteria (residential detoxification programs only)
    • Privacy policy and procedures (residential detoxification programs only)
    • Service recipient/personnel care and supervision coverage schedules for the past year (residential detoxification programs only)
    • Interview:
      1. Clinical/Medical director
      2. Relevant personnel
    • Review case records
    • Observe facilities (residential detoxification programs only)

  • CA-MHSU 8.01

    Qualified personnel determine if detoxification treatment is appropriate for the individual using diagnostic criteria according to clinical decision support tools, such as clinical practice guidelines.


  • CA-MHSU 8.02

    Service recipients are placed in the appropriate level of care and have access to all components of the detoxification process, including: 

    1. evaluation; 
    2. stabilization; and  
    3. preparation for entry into substance use treatment. 

    Interpretation: Organizations should conduct a multidimensional assessment to determine the appropriate level of care. The multidimensional assessment is strengths-based and addresses the service recipient’s needs and challenges, as well as his or her strengths, assets, resources and supports.

    Research Note: A consensus panel of physicians, psychologists, counselors, nurses, and social workers established national guiding principles in detoxification and substance use treatment. According to the principles, the detoxification process must consist of three sequential and essential components: 1) evaluation, 2) stabilization, and 3) fostering patient readiness for and entry into treatment. Evaluation includes a comprehensive assessment and serves as the basis of the initial treatment plan. Stabilization is the process of helping individuals through acute intoxication and withdrawal to achieve a substance-free state. After the individual is stabilized, he or she should then be encouraged to enter into a substance use treatment program to promote a continuum of substance use treatment and care. 


  • FP
    CA-MHSU 8.03

    Detoxification treatment is provided by a qualified team of appropriately trained and licensed professionals. 

    Interpretation: Staffing will vary depending on the intensity of the services offered. For example, organizations providing medically-monitored detoxification will employ an interdisciplinary staff of nurses, counselors, social workers, addiction specialists and/or other health and technical personnel, whom all work under the supervision of a licensed physician.  

    Organizations should consult legislation, regulations, and/or contracts for licensing requirements in relation to detoxification programs to ensure that their program is appropriately staffed. 


  • FP
    CA-MHSU 8.04

    An initial medical screening is conducted by a qualified medical practitioner for all service recipients within 24 hours of admission to identify the need for immediate medical care and assess for communicable disease.

    Interpretation: Qualified medical practitioner refers to a licensed physician, registered nurse, nurse practitioner, physician’s assistant or other healthcare professional that is permitted by legislative, regulatory, and/or contractual requierments and the organization to provide medical care and services without direction or supervision. 

    Interpretation: Conditions that require immediate or prompt medical attention include, but are not limited to: acute illnesses, chronic health issues and/or diseases requiring therapy, signs of abuse or neglect, serious or accidental injury, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances. 

    NA The organization does not provide detoxification treatment in a residential setting. 


  • CA-MHSU 8.05

    The organization provides 24-hour-a-day supervision, observation, and care tailored to meet the service recipient’s assessed needs and goals. 

    Interpretation: Service recipients’ basic living requirements should be met in a culturally responsive manner. 

    Interpretation: Staffing requirements and care ratios can vary depending on the age, developmental level, and service needs of the population. 

    Note: Organizations must also meet state licensing requirements and provided scheduling criteria as justification for their service recipient/personnel care and supervision ratios. 

    NA The organization does not provide detoxification treatment in a residential setting. 


  • CA-MHSU 8.06

    Residential facilities contribute to a physically and psychologically safe, health, non-institutional environment by: 

    1. providing personal accomocations for service recipients that are age, developmentally, gender, and culturally appropriate; 
    2. providing private areas for bathing, toileting, and personal hygiene;
    3. allocating rooms for occasional on-site services, as needed;
    4. ensuring accommodations for informal gathering of service recipients, including during inclement weather; 
    5. having adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage; and
    6. being maintained in good, clean condition. 

    Interpretation: Bedroom space should, at a minimim, meet legislative, regulatory, and/or contractual requirements requirements and accommodate basic furnishings.

    Interpretation: Accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness. 

    NA The organization does not provide detoxification treatment in a residential setting. 


  • CA-MHSU 8.07

    The organizaion ensures service recipients’ comfort, dignity, privacy, and safety by: 

    1. establishing and implementing policies for searches of service recipients or their property consistent with applicable legislation, regulations, and/or contractual requirements;
    2. prohibiting the use of surveillance cameras or listening devices of persons in bedrooms, unless required by judicial order, law, regulations, and/or contracts;
    3. maintaining doors on sleeping areas and bathroom enclosures unless there is clear, clinical written justification for their removal; 
    4. providing one- or two-person rooms to service recipients who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
    5. requiring employees to knock before entering a service recipient’s room unless there is a safety or clinical concern.

    Interpretation: Service recipients should be apprised of the organization’s policy regarding room checks and personal searches.

    Interpretation: Regarding element (e), employees should knock before entering a service recipient’s room unless there is an immediate health or safety concern or a well-documented clinical concern. 

    Interpretation: When organizations are required by judicial order, law, regulations, and/or contracts, documentation must be provided to justify employing this practice which may include the judicial order, contract, or a copy of the state’s satefy plan involving the resident. Organizations will need to demonstrate in their privacy policy and procedures that they have taken measures to prevent and unintended violation of an individual’s rights and privacy. Service recipients must have access to private areas for self-care and teh changing of clothing. 

    Sensitivity is taken to ensure that all service recipients, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated. 


    Interpretation: The use of surveillance cameras or listening devices should not be used as a supplement to adequate staffing or supervision protocols. 

    NA The organization does not provide detoxification treatment in a residential setting. 

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