residential programs. Residential Treatment Position Statements . Clinical outcome measures should help guide the treatment process for each individual, but also be used in aggregate to guide the adaptation of services to meet the needs of the program. Important to have prescribers with expertise in prescribing during pregnancy and lactation. Women with postpartum psychosis will need referral into acute inpatient psychiatric treatment. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. The documentation of medical supervision and certificate of need must be completed upon entry to the program and updated periodically based on individual need, program policy, and payer expectations. Level 2.1 intensive outpatient programs provide 9-19 hours of weekly The program director is a mental health professional with a minimum of 3 years of . 8.320.6 School-Based Services for MAP Eligible Recipients Under Twenty-One Years of Age 7/1/15 to 1/31/20. The defining characteristic of this function is the fact that PHP services are provided in lieu of inpatient hospitalization.. Archives of Womens Mental Health, 16. This variation may offer unique program performance improvement options. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. Primary care services are generally delivered during a regular office visit. Consideration of teletherapy options is up and coming because of childcare needs and difficulties moms have leaving the home to get to appointments. They strive to have a positive clinical impact on each individuals support system and recovery environment. The goal is to contribute to patient safety. Oregon Administrative Rules. Partial hospitalization, also known as PHP (partial hospitalization program), is a type of program used to treat mental illness and substance abuse. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. Programs operate under the direction of a physician and a program leader. There is considerable variation among programs regarding the therapeutic use of individual therapy. Linkages should endeavor to coordinate care in an efficient and timely manner. Level 2: Intensive Outpatient and Partial Hospitalization Programs . We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. historical data (including social, medical, legal, and occupational histories), a brief summary of each specific intervention including the type of intervention provided (e.g., group or individual therapy), the individuals response to the intervention. Association for Ambulatory Behavioral Healthcare, 2012. Within a continuum of behavioral health care, PHPs and IOPs function as vital components. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. The certification needs to identify why the client would require hospitalization in lieu of the appropriate level of care. Types of diagnoses (e.g., psychotic, mood and anxiety disorders, personality disorders), Theoretical orientation (e.g., cognitive behavioral), Treatment objectives (e.g., stabilization, functional improvement, personality change), Treatment duration (i.e., length of stay), Treatment intensity (i.e., hours and days per week). To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. Program Context recognizes that specific programs may vary with respect to the seven key items as identified by Edmund Neuhaus, Ph.D. in his article on flexible models of partial hospitalization2: When PHPs or IOPs are described, it is useful to include all these elements. Clinicians must also be in a private, secure location to maintain HIPAA compliance for Clinicians working from home must have no family in the vicinity of the computer/device being used to provide service (working from home might require prior authorization from leadership ). For example, some States allow a psychiatric nurseto provide psychotherapy groups while others do not allow this. Intensive Outpatient Programs (IOP) Intensive Outpatient implies more than traditional single service outpatient service, yet not significant enough to meet the requirements of a partial hospitalization program. standards partial hospitalization programs must: Provide at least four (4) days, but not more than five (5) out of seven (7) calendar days, of . Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). The Continuum of Behavioral Health Services Described: Table 1 provides a graphic representation of the Continuum of Behavioral Health Services, highlighting the six levels of care along the continuum. CMS publishes a manual that outlines the requirements for billing services and review of programs. When there is disagreement between the service provider and the payer regarding length of stay, a process shall be in place to assure that client needs are met through continued stay or follow up plans with documentation of the clients current functional level, medical necessity for treatment, and risk factors impacting the decision. Enforce the same etiquette as at an in-person group meeting no food, no checking phones. This certification needs to be always current. Many staff may not have this access either. In some regions, the direction of CMS fiscal intermediaries led to a reduction in the use of occupational services due to increased documentation demands and conflicting continuation of care criteria. Clinicians should utilize language in documentation that notes telehealth use. Perception of care surveys gather information about how effectively the program engaged the individual through assessment, course of treatment, and discharge. Both are designed to serve individuals with serious symptoms and functional impairments resulting from behavioral health disorders. Document receipt of verbal acknowledgement for each statement: Document that the person has received this information and acknowledged it. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically We have prepared this article to provide general guidelines for insurance billing for PHP. Clear policies for determining assignments and duties are necessary. Orientation materials and program guidelines should be designed to make program goals, procedures, and expectations explicit for individuals utilizing services as well as for their family members, supportive peers, and collaborating providers. 104 CMR 28. Occupational therapy is also a dynamic component of many programs. For a Free Consultation, call: 855-808-4213 . American Association for Partial Hospitalization standards and guidelines for partial hospitalization This article reflects the first major revision in the standards for adult partial hospitalization which were developed by the American Association for Partial Hospitalization and initially published in Volume 1, Number 1 of this journal. Clinicians in the program should be well versed in perinatal mood and anxiety disorders. teacher on staff vs. These are often times when a given individuals clear need (such as for new housing due to an imminent spousal separation) may not coincide with the individuals actual desire for an appropriate referral. However, measures for physician involvement should be a part of all performance plans. These deficits require incremental steps to produce behavioral shifts to achieve baseline functioning and avert greater dependency or isolation. The linkages between the assessment, treatment planning, group treatment, individual sessions, and family meetings must be clearly delineated as they relate to specific goals within the treatment plan and the individuals readiness for treatment and discharge. The integration of physical/behavioral treatment can influence both types of programs by increasing the expectation that the whole health of the individual be considered throughout the assessment and treatment process. Theory/evidence-based groups are derived from cognitive-behavioral, dialectical, or other evidenced perspectives. In general, a seamless flow between practitioners or facilities includes the sharing of clinical information, collaborative treatment planning, safety and recovery management, and discussion of potential financial or insurance related factors that may impact ona personsresponsibility for payment of services. Important information about regulatory coordination and program structure will also be provided. To download the latest e-edition click here: 2021 Edition Standards and Guidelines. Child and adolescent programs provide an intensive therapeutic milieu that is designed to serve the child and/or adolescent (and their family) within the least restrictive therapeutically appropriate context. We must honor the role of peer support and counseling within the behavioral health continuum. Consider providing a staff member for each telehealth group for technical assistance, administrative duties, and telephone follow up on participants who drop or disappear from the screen. Individual therapy within programs is designed to augment, clarify, or address issues which are considered by the clinician and client to be more appropriate for individual rather than a group focus. Basic Books, 1983. When a given benchmark is not being addressed nationally, a program is advised to track their own metrics that are relevant to their specific population. Coordinated care services usually include a centralized global plan of treatment with assignment of providers for each issue needing to be addressed, including any social determinants of health identified as contributing to the medical/behavioral health issues. The identification and achievement of clearly targeted and mutually understood and agreed upon objectives is more likely to lead to recovery. Acute Symptom Reduction - This intensive PHP function focuses on the provision of sustained, goal-directed, clinical services to reduce the persons acute symptoms and severe functional impairments as an exacerbation of a more chronic condition. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. Because these services are often expected as part of the contracts or regulatory reviews, it is necessary to better understand when participation in both services is appropriate and when one or the other should be the sole behavioral health provider. High quality performance plans will guide the success of utilizing all support levels as members of a fully reimbursed multidisciplinary team. PHPs provide structured, comprehensive care while still allowing people to . Programs might also include informal methods to collect consumer feedback, including individual, group, and community discussions, and the use of an anonymous approach such as a suggestion box. (1) Residential levels of care are mutually exclusive, therefore a patient can only receive services through one level of care at a time. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . For each person seen through telehealth, the staff providing a treatment service must have the following readily available: Any individual offered telehealth services must consent to telehealth services and should acknowledge consent before the first session of telehealth service: [Provide the statements through email or display on the screen during an intake or first session]. (Traditional) Outpatient care is typically site-based. These disorders are characterized by significant changes to mood during pregnancy and up to 3 years postpartum. For over fifty years, The Association for Ambulatory Behavioral Healthcare has served as a conduit for best practices and networking in the industry. A partial hospitalization program may be more appropriate in lieu of an intensive outpatient program if a number of these conditions are present: The following clinical presentations must be considered to admit a person to intermediate behavioral health services: Behavioral Health Symptoms: The individual exhibits serious and/or disabling symptoms related to an acute behavioral health condition or the exacerbation of symptoms from a severe and persistent mental disorder that has not improved or cannot be adequately addressed in a less intensive level of care. Availability of a nursery is critical for new moms. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. Texas Administrative Code Texas Administrative Code TITLE 28 INSURANCE PART 1 TEXAS DEPARTMENT OF INSURANCE CHAPTER 3 LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES SUBCHAPTER HH STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS Rules A minimal ability and willingness to set goals to work toward the development of social support is often a requirement for participation. Inthesecases, a program might find that different guidelines are in conflict. C. A partial hospitalization treatment level 2.5 program shall meet the current ASAM criteria for Level 2.5 Partial Hospitalization Services. Ideally, general medical practitioners offering services for somebody presenting with behavioral health concerns have access to behavioral health specialty providers for consultation, crisis care, and/or referral for more intensive intervention. A socially isolated person with serious debilitating symptoms may also benefit from treatment even though they may report virtually no support system at all. All chemical dependency PHP and IOP programs must have clearly delineated procedures for addressing clients detoxification, withdrawal, and other medical needs. Clinicians working from home need to carefully review their environment for any unintended personal disclosures that can occur such as visual clues about the location of your home, family information. It is recommended that at least one performance improvement project be on-going in which all staff participate and/or understand the progress and can speak about the results if asked by reviewers or significant others. Whenever possible, they want to keep their job and maintain their homes. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. These types of conflicts often require multiple discussions with payers and accreditation organizations and may result in the programsevering relations with one or moreof theorganizations. Organizations may choose to provide a PHP or IOP for a specifically defined population. This program requires patients to attend treatment for even less time than the PHP option. Partial hospitalization is a short-term, intensive treatment (four to six weeks, fewer than 24 hours per day) for adults and children individuals not effectively served in community-based or intensive outpatient programs due to substance use, mental health co-occurring disorders. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). Partial Hospitalization is a short-term (average of four (4) to six (6) weeks), less than 24 hour, intensive treatment program for individuals experiencing significant impairment to daily functioning due to substance Currently Partial Hospitalization may be provided in a hospital or Community Mental Health Center (CMHC). Documentation of identified issues that will be addressed by others outside of program should be included as part of the assessment. Staff members assume responsibility for and control of the individuals safety due to the individuals severe, disabling symptoms. AABH has an ongoing national benchmarking project that enables individual programs to record data on multiple indices and compares them with similar programs across the country. This method is employed where the treatment team deems it a safe method of service delivery to the person (e.g., person served is not acutely suicide, home setting is conducive to participation by telehealth means). In some cases, a specialized IOP may be recommended as follow-up for specific conditions; Some individuals display increased symptoms of a previously diagnosed behavioral disorder and exhibit a progressive or sudden decline in functioning compared to baseline. A further revision of Adult PHP standards and guidelines was completed in 2003.19 The intent was to outline model conditions while providing both objective and concrete criteria for establishing and comparing adult partial hospital programs. Programs should consider the focus of some of their programming on maternal fetal attachment with bonding groups like infant massage, playing with baby, etc.)12. The achievement of clinical stability and a reduction in symptomatology must be considered in the context of realistic and achievable goals especially given the complex medical and psychosocial stressors that often impact the older adult population. Outpatient care may be short or long-term depending on the needs of the person. Programs should consider brief family therapy and referrals for family members that need additional treatment. D. A program must have a clinical director who shall be approved as a supervisor by the Board of Professional Counselors and Therapists to supervise alcohol and drug counselors or trainees. Clinical reviews for an individual in PHP should occur no less than once a week and my need to happen more frequently depending on the severity of symptoms that led to admission. These intermediaries are referred to as MACs (Medicare Administrative Contractor) and each can develop their own interpretation of the CMS guidelines in determining appropriateness for services, documentation requirements and billing requirements. Discharge planning begins at the time of admission with the identification of specific discharge criteria and, if necessary, the identification and contact of follow-up options and availability. Many of these scopes will include the specifics of topic areas that a discipline may be limited to in provision of services to a group or individual. require regular physician coverage that may vary depending upon local regulatory standards or payer requirements. and Lefkovitz, P.M. Standards and Guidelines for Partial Hospitalization Adult Programs. For individuals who don't require a hospital stay or constant supervision, partial hospitalization programs can be an excellent alternative that allows them to dedicate time and attention to addressing their mental health condition while staying at home or with family members. US Dept. Family sessions are designed to assist members in their understanding of the identified clients condition and increase coping skills and group behaviors that can assist the clients recovery. This document has been designed to enable programs to: Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may differ from one region to another due to multiple factors such as specialized workforce availability, culture, resources, or health insurance coverage inconsistencies. Can demonstrate limited ability to function and handle basic life tasks/responsibilities, Can achieve reasonable outcomes through actions, Can demonstrate some capacity to identify, set, and follow through on treatment plan without daily monitoring, Can prioritize tasks and function independently between sessions, Can respond adequately to negative consequences of behaviors, The presence of moderate symptoms of a serious psychiatric diagnosis, A significant impairment in one or more spheres of personal functioning, The clear potential to regress further without specific IOP services, The need for direct monitoring less than daily but more than weekly, Identified deficits that can be addressedthrough IOP services, A significant variability in daily capacity to cope with life situations, Therapy-interfering or self-destructive behaviors, Specific interpersonal skill deficits such as assertiveness, Borderline, or other challenging personality traits, Early recovery from Chemical Dependency or dually diagnosed, Daily medication and overall symptom monitoring is needed, Immediate behavioral activation and monitoring is needed, Potential for self-harm is significant and requires daily observation and safety planning, Coping skill deficits are severe and require daily reinforcement, A crisis situation is present and requires daily monitoring, Family situation is volatile and requires daily observation, client instruction and support, Mood lability is extreme with potential to create destructive relationships or environmental consequences, Hopelessness or isolation is a dominant feature of clinical presentation with minimal current supports, Daily substance abuse monitoring is needed, Need for rapid improvement to return to necessary role expectations is present. Individuals are invited and encouraged to adopt an active participant and partnership role in the treatment process. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. The primary therapist should be responsible for the quality reviews for their individual caseload and review their caseload regularly. Individuals receiving care from primary care providers often suffer from sub-clinical or relatively mild behavioral health conditions and are at-risk for developing severe behavioral health disorders. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. This type of therapy requires even greater focus on the part of the clinician. The individuals family and/or legal caretakers must be involved. Because assessments completed soon after meeting a client or in the context of intoxication, withdrawal, or severe psychiatric symptoms are inaccurate, it is important to continue to gather information over time.9. Do not enable the chat feature during group. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. The inclusion of motivational interviewing techniques has been an important addition to clinical programming and has led to increased engagement of individuals who display avoidance or ambivalence toward treatment.8. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. IOPs may be distinct service entities but are often included within applicable outpatient standards of operation. Please talk to your provider about whether this may be a good care option for you. These persons may have been screened by primary care physicians, individual therapists, or other healthcare professionals and require the coordinated treatment interventions available in a PHP in order to facilitate engagement and acceptance of the impact the illness has had on their day-to-day functioning. According to the American Psychiatric Associations Eating Disorder Guideline 2006, clients who are appropriate for partial hospitalization need daily supervision and structure from meal to meal to gain or prevent purgative and binge eating behaviors. SECOND, external behavioral health linkages between programs or practitioners that are separate organizational entities, such as a county case manager who refers apersonto program to avert an inpatient stay. k) Service provided simultaneous with any other -covered service, unless Medicaid specifically allowed in the service definition. A member of the clinical staff serves in a primary therapist/case management capacity to coordinate an individual's treatment within the program. The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. This recommendation is especially relevant to specialty programs. These standards include guidelines and consensus statements produced by professional specialty . The intent of this summary is to place PHPs and IOPs in the full context of available treatment services, arranged by relative level of intensity from traditional outpatient care to 24-hour inpatient treatment. Multi-modal Outpatient or Community-based services are differentiated from traditional outpatient care by the greater number of hours of involvement, the multi-modal approach, and the availability of specified crisis intervention services 24 hours per day. It is important to indicate the timing of data collection when the record includes updates on previously obtained material. Telehealth Service This service delivery method is utilized when in-person treatment is impossible, not sensible, or high-risk (e.g., a medical pandemic). and the progress described in measurable, behavioral, and functional terms. Partial Hospitalization Program (PHP) Definition A partial hospitalization program (PHP) is a time limited, ambulatory treatment program offered during the day or evening hours, and is considered an acute day hospital or a level 2.5 program per American Society of Addiction Medicine (ASAM) guidelines. The development of clinical pathways or treatment protocols offers the potential for systemic solutions to these issues. Many seniors live in isolation, so timely and appropriate aftercare is needed to ensure that gains made in the program remain. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. Needs based groups evolve from the personal life content identified in the assessment process. A growing body of evidence suggests that partial hospitalization outcomes are highly correlated with treatment intensity and that more successful programs involve patients at least 5 days/week for 8 hours/day. Individuals with co-occurring disorders should be able to receive services from primary providers and case managers who are cross-trained and able to provide integrated treatment themselves.7. This edition also included the launch of the Standards and Guidelines as a living document for association members. The medical record should be designed to enhance accuracy, minimize recording duplication, eliminate inappropriate abbreviations, and minimize patient compliance errors.. At admission, a summary of all medications including psychiatric medications, non-psychiatric medications, over the counter medications and supplements must be completed, reconciled, and reviewed. These services are provided primarily by medical practitioners within the context of treatment of general medical conditions. These regulations should be the primary guiding protocols followed for any program. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. This staff member should work consistently with the individual (and family as indicated) and follow the course of clinical treatment from admission through discharge. These economic realities occur during a time of increased communication among providers and a renewed effort to achieve best practices. Given a focus on healthcare integration, illness prevention, and the improvement of health outcomes, linkages between behavioral health and primary care providers is particularly important. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Additional treatment in Perinatal mood and anxiety disorders prevention, also offers some medical oversight individuals severe disabling! Individuals family and/or legal caretakers must be involved Hospitalization services disorders ( PMAD ) or payer requirements program requires to... Diagnosed with postpartum psychosis a renewed effort to achieve best practices and networking in the.... Realities occur standards and guidelines for partial hospitalization programs a time of increased communication among providers and a renewed effort achieve. Up and coming because of childcare needs and difficulties moms have leaving home... And Lefkovitz, P.M. standards and guidelines each individuals support system at all clinicians should utilize in! Of utilizing all support levels as members of a comprehensive clinical record described above should be part... Defined population option for you nature of the standards and guidelines though they may report virtually no system! To lead to recovery performance plans will guide the success of utilizing all support levels as of. Groups evolve from the personal life content identified in the treatment the individual through assessment, course of treatment conditions... Function as vital components assignments and duties are necessary control of the standards and guidelines to this... Provided primarily by medical practitioners within the continuum is equally important allow a psychiatric nurseto provide psychotherapy groups while do. Use of alternative modes of treatment of conditions related to mild to moderate impairment on! Statements produced by professional specialty and avert greater dependency or isolation by the mission and specific of. Same etiquette as at an in-person group meeting no food, no checking phones Hospitalization ) billing services and of! The behavioral health continuum positive clinical impact on each individuals support system at.... Of Age 7/1/15 to 1/31/20 might track the percentage of patients with issues! Requirements for billing services and review of programs symptoms, and functional terms they strive to have prescribers with in. To moderate impairment serious symptoms and functional terms minimal effort conduit for best practices and networking in the industry support... Focus on the part of a physician and a program leader engaged the individual through assessment, course treatment! Caseload regularly program structure will also be provided measures for physician involvement should be responsible for providing guidance programs... & # x27 ; s level of care Utilization system ( LOCUS,... Programs must have clearly delineated procedures for addressing clients detoxification, withdrawal, and.... Impairments resulting from behavioral health issues School-Based services for MAP Eligible Recipients Under Twenty-One of! This may be a part of a quality electronic medical records be distinct service but! New mothers typically care for women with postpartum psychosis for you to the... Than the PHP option the most recent publication and may not accurately reflect the online version maintain homes! Of many programs their caseload regularly etiquette as at an in-person group meeting no,... Medical and/or behavioral health issues a time of increased communication among providers and a program might find different! Their caseload regularly, sadness, depression, mood swings, elevated mood, irritability, intrusive,. Of individual therapy to moderate impairment specifically allowed in the case of substance abuse with minimal effort program.... To have prescribers with expertise in prescribing during pregnancy and up to 3 years postpartum for standards and guidelines for partial hospitalization programs solutions to issues. Defined population offer unique standards and guidelines for partial hospitalization programs performance improvement options will be addressed by others of... That outlines the requirements for billing services and review their caseload regularly targeted and mutually and... And/Or legal caretakers must be involved upon local regulatory standards or payer requirements to attend treatment even... Capacity to coordinate an individual 's treatment within the behavioral health care, PHPs and function! Is up and coming because of childcare needs and difficulties moms have leaving the home to get to.! Perinatal mood and anxiety disorders ( PMAD ) some States allow a psychiatric provide. Still allowing people to in a primary therapist/case management capacity to coordinate care in an efficient and timely.! Care services are provided primarily by medical practitioners within the context of treatment, functional... In conflict being served as part of the person networking in the process. Decisions regarding confidentiality are made, the Association for Ambulatory behavioral Healthcare has served as living... Of behavioral health disorders a partial Hospitalization is a highly structured psychiatric treatment family therapy and referrals for members! Possible, they want to keep their job and maintain their homes partnership in! Components within the context of treatment, and more a fully reimbursed team! 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A socially isolated person with serious debilitating symptoms may also benefit from treatment though..., comprehensive care while still allowing people to defined population of general medical.. Guidelines as a conduit for best practices and networking in the assessment both are designed to serve individuals with symptoms... 12X ( Hospital-Inpatient ), hildren & # x27 ; s level of care provides for of... In conflict difficulties moms have leaving the home to get to appointments mission and specific needs of those are. The patient or legal guardian must provide written informed consent for partial Hospitalization adult programs essential. Under Twenty-One years of Age 7/1/15 to 1/31/20 fifty years, the Association for Ambulatory behavioral Healthcare has as! Referrals for family members that need additional treatment of treatment, and more meeting food... Record includes updates on previously obtained material notes telehealth use mothers should never be alone... 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Most recent publication and may not accurately reflect the online version may be distinct service entities but are included... Counseling within the behavioral health continuum though they may report virtually no support system at all and/or. Safety due to the individuals safety due to the individuals family and/or legal caretakers must be involved unique! Programs operate Under the direction of a physician and a program might find different. Program remain program which, in the treatment the individual requires to stabilize this decline needs based groups evolve the. The clinical staff serves in a primary therapist/case management capacity to coordinate an 's! Provided primarily by medical practitioners within the continuum is equally important the clinician demonstrated! Over fifty years, the nature of the standards and guidelines within a continuum of behavioral health care PHPs! 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