Center City Patient Handbook 2023 - 61

Violence/Physical Aggression Risk:
Many individuals admitted to the facility have a history of physical
aggression or violence toward others. Many individuals have themselves
been subjected to violence in the home, school, correctional and community
environments or in prior facilities they have been placed in. They are also
likely to have impaired impulse control and lack other coping skills to
respond to a perceived threat or other negative emotions. All potential clients
are screened for a history of physical aggression or violence. When a history
is identified, additional review of the history and circumstances is done to
determine the individual's appropriateness for admission. If the individual
is determined not to be appropriate, referral to alternative resources is
offered and provided. If the individual is admitted, behavioral expectations
are reviewed with the client, and workforce are made aware of potential
concerns. Many of the same mitigation and response measures described for
physical abuse risk are utilized:
* Training of all workforce in verbal crisis intervention techniques.
* Communication of facility rules prohibiting physical aggression to include
violence, excessive horseplay and appropriate physical boundaries.
* Proactive treatment planning for patients with a known history of
aggression or violence to avert atypical discharge.
* Use of the therapeutic environment to model and coach healthy responses
to anger and aggression
* Use of swift and supportive intervention with clients who display
aggressive behavior
* Facilitation of positive concern resolution meetings when client to
workforce or client to client conflicts are identified.
When a client displays aggression in the facility, evaluation of
appropriateness for continued stay is completed by the multidisciplinary
team. If the client is discharged for safety reasons, appropriate referrals are
arranged. In extreme circumstances, law enforcement may be involved.
If the client is to remain in treatment, additional protective measures are
implemented as appropriate to the situation and as determined by the
treatment team.
Additional detail regarding screening, assessment, monitoring and response
measures applicable to violence risk are found in the site's Abuse Protection,
Reporting and Advocacy, Preventing Crises and Responding to Patient
Emergencies and Service Transitions procedures.
Self-Abuse Risk:
Many individuals admitted to the facility have some history of self-harm
behavior that has developed as a coping mechanism for difficult emotional
states. All prospective clients are screened for a history of self-harm. When
a history of self-harm is identified, additional review of the history and
circumstances is done to determine the individual's appropriateness for
admission. If the individual is determined not to be appropriate, referral to
alternative resources is offered and provided. If the individual is admitted,
behavioral expectations are reviewed with the client, and workforce are
made aware of potential concerns so that it can be incorporated into the
client's treatment services.
Suicide Risk:
Many individuals admitted to the facility have a history of or are otherwise
at heightened risk of suicide. Tools include the PHQ-9, GAIN-SS and the
Columbia Suicide Severity Rating Scale (CSSRS). The CSSRS is the clinical
tool utilized most frequently to assess for and monitor suicide risk of all
clients in all treatment programs. Detailed protocols guide the administration
and periodic re-administration of the tool. Additional preventive measures
include thought being given to the design of the facility and fixtures to
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reduce suicide risk, attendance tracking and periodic rounds to account for
the safety and whereabouts of at risk clients in the facility and training of
workforce in monitoring for signs and symptoms of suicidality as well as
emergency response procedures in the event of an actual attempt.
These detailed procedures and protocols are contained in the site's
Preventing Crises and Responding to Patient Emergencies and Patient Safety
procedures.
Financial Exploitation Risk:
The primary area of risk for financial exploitation exists between clients to
the extent that they may exert pressure on each other to borrow or be given
spending money and other personal property while in the facility. Clear
expectations are communicated regarding the prohibition on loaning of
money and exchanging of personal property between patients. Workforce
are also fully trained on the prohibition of financial exploitation of patients
and on the corporate policy regarding Professional Patient Boundaries. The
facility has clear guidelines prohibiting workforce from soliciting patients for
gifts, loans or any other personal resources.
Contraband:
If/When an individual is determined to have a history of bringing
contraband into a facility in previous treatment episodes, or is otherwise
assessed as at risk for contraband, measures will be taken to minimize the
risk such as concern resolutions and/or proactive treatment planning.
* All clients/patients entering the facility for programming will be asked to
submit to a search of their belongings. The program reserves the right to
search all personal belongings and vehicles on the property at any time
if deemed necessary. All patients sign a consent to search as part of the
Admission and Consent Agreement.
* Designated program workforce is trained on search procedures, what is
identified as contraband, and appropriate disposal of contraband items.
* Program rules and expectations regarding contraband will be explained
to each program participant. This will include a definition of what
contraband consists of, the rationale for why it is considered contraband,
and procedures used to ensure contraband does not come into the facility.
Instances of contraband on campus are addressed therapeutically.
Substance Use in Treatment:
All clients/patients entering Hazelden Betty Ford in Center City are oriented
to the policies and procedures regarding the implications should someone
use a mood altering substance while under Hazelden Betty Ford's care, or on
our premises. The following information will be reviewed with each patient/
client entering one of the treatment programs at the Center City location.
* No mood altering substances are allowed on these premises for any reason.
* If substances are discovered they will be appropriately disposed of.
* Rapid Urine Drug Screens and breathalyzers are administered periodically
to determine if someone has been using mood altering substances while in
care.
* Workforce are trained to observe patient/client behaviors to include sight
and sound indicators that may suggest someone is under the influence,
and appropriate steps to take should they have such a concern.
* A Risk Factors ad-hoc form is conducted on each client entering one
of our programs, to include histories that would inform us if there have
been past instances of using while in treatment. This tool is designed to
identify those who have a history of using while in a treatment center,
and the clinicians assigned to the care of such individuals will implement
treatment planning to avoid substance use and atypical discharge.
Center City Patient Handbook 2023

Table of Contents for the Digital Edition of Center City Patient Handbook 2023
