Maple Grove/Chaska Patient Handbook 2023 - 56

Through Hazelden Betty Ford Foundation's own in-service training and
outside trainings, as well as through education requirements of professional
certification, workforce maintains an awareness of the needs of people
served in the treatment programs. These include patients' rights and ethics,
confidentiality, grievance mechanisms, and other pertinent subjects, all
of which comply with accreditation and State licensing requirements.
Workforce members are orientated to mandated reporting procedures for
abuse.
Virtual Services Considerations
Population: There are no changes related to the patient population. As part of
the screening and placement process, workforce will determine an applicant's
appropriateness for virtual non-residential services based upon several
factors, including but not limited to significant transportation barriers, travel
distance, legal barriers, medical, mental health, childcare or other clinical
considerations that contraindicate in-person services.
Physical Plant: The physical plant for virtual services is limited to the
area where the clinician is providing services from and where patients are
receiving services. Clinicians may facilitate programming from the licensed
location or from a home office provided the necessary equipment and
supervisor approval is in place. Patients may participate in programming from
their home or other appropriate private location. In both scenarios, spaces
occupied by the patient and the clinician must meet both minimum privacy
standards (consistent with patient-clinician interaction) and confidentiality.
At the beginning of each session, the clinician confirms the physical address
of each participant. The clinician may also ask the patient to " scan " the room
using their webcam, phone, tablet, laptop, etc. to ensure no one else is in the
room from which the patient will join non-residential services. The clinician
is able to contact individual group members via secure private chat message
during the group if the clinician has a specific concern during the group. If the
patient were to experience a crisis or an emergency during a virtual session,
the clinician would follow the Virtual Emergency/Crisis Response procedure.
Environment: The location of the program is via a virtual telemedicine
platform. This platform is both HIPAA and 42 CFR Part 2 compliant. The
platform vendor also has signed a BA/QSOA agreement with Hazelden Betty
Ford. Confidentiality requirements applicable to written medical records shall
apply to telehealth services including the actual transmission of the service
and any other electronic records. As mentioned above, at the beginning
of each session, the clinician will confirm the physical address of each
participant and may ask the patient to " scan " the room using their webcam,
phone, tablet, laptop, etc. to ensure no one else is in the room from which the
patient will join the for services.
Virtual non-residential services will utilize the same curriculum and structure
as Hazelden Betty Ford in-person services. This includes educational lectures
and process groups (group therapy), assessments, and individual counseling
services. The topics, format, and length of each component will remain the
same. Just as with in-person patients, those participating in virtual services
will have procedures in place for completion of laboratory testing for the
detection of alcohol or drugs (i.e., urine drug screen testing, etc.). The program
will be facilitated by an appropriately credentialed clinician who has received
training on use of the virtual telemedicine platform as well as overview of
program Policies/procedures.
Vulnerability Mitigation Measures
The following section describes strategies employed by the program to
address the most common vulnerabilities encountered with the client
population served by the program.
Intoxication Risk:
Individuals with a history of substance use disorders are susceptible to
continued use and, while using substances, may experience diminished
ability to exercise caution in relations with others and to act responsibly
in their own interest. Withdrawal concerns may increase fall risk and/or
exacerbate existing physical, emotional and mental distress. Clients may also
have greater vulnerability due to clinical factors such as history of abuse,
cognitive limitations, poor personal boundaries, impulsivity, difficulties with
assertiveness, etc. The workforce recognizes these factors in the prevention
of abuse. A multidimensional assessment of each client is made to determine
the extent to which they may be susceptible to abuse for the current course
of care as well as for continuing care. Thereupon, appropriate measures,
including referrals, are incorporated into the client's treatment plan. Any
time a client is intoxicated, they are placed in a safe location in the facility for
observation and consideration of appropriate next steps. Alcohol and drug
testing may be administered to verify substances used, level of intoxication
and potential safety concerns. Appropriate workforce are consulted and
a safe plan is agreed upon with the client and other stakeholders. Further
steps may include referral to a medical setting, arranging transportation to
a safe location or involvement of emergency resources as appropriate to the
circumstances. Concerned persons are contacted and requested to provide
safe transportation home or to a medical facility as deemed appropriate.
After the immediate safety concerns are addressed, the use is then taken
into account by the treatment team as part of an updated evaluation of
appropriate treatment options which may include continued participation in
the program or referral to another level of care.
Additional detail regarding response to an intoxicated client is found in the
site's Impairment - Under the Influence procedure.
Sexual Abuse Risk:
Many individuals admitted to the facility have a history of sexual abuse
or exploitation and therefore have enhanced vulnerability. Some clients
have limited understanding of sexuality, have emerging sexuality issues, a
history of sexual trauma and other intraspecific factors that may make them
more likely to seek or cooperate in inappropriate sexual activity. The risk of
inappropriate or abusive sexual incidents in the facility is minimized through
the following measures:
* Clear communication that romantic relationships and sexual activity
between patients is discouraged and if it occurs, will be dealt with as a
clinical concern.
* Screening for sexual trauma history as well as further assessment, therapy
and coping skill development when indicated
* Increased monitoring when a risk is identified.
In regard to the potential risk of sexual exploitation of patients by workforce
members, the following preventive measures are in place:
* All workforce members are trained at hire and annually thereafter
regarding the vulnerable adult and maltreatment of minors laws.
* All workforce members are trained at hire and annually on the corporate
Professional-Patient Boundaries policy.
* In some cases, intentional clinician assignment may be done based on
specific identified vulnerabilities. If such a specific assignment cannot be
accommodated, a collaborative process is conducted to identify whether
a referral would or would not be in the best interest of the client under the
circumstances.
Additional detail regarding measures applicable to this area of risk is found
in the site's Abuse Protection, Reporting and Advocacy procedure.
Physical Abuse/Violence Risk:
Many individuals admitted to the facility have a history of physical abuse
and therefore have enhanced vulnerability to physical abuse as well as
an increased likelihood of perceiving a threat in social and therapeutic
interactions with others. Patient conflict with workforce and peers may
occur creating increased risk of physical altercations. 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 patients are screened and
assessed for a history of physical abuse, including gathering of collateral
information from family and others. When a risk has been identified, the
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Maple Grove/Chaska Patient Handbook 2023

Table of Contents for the Digital Edition of Maple Grove/Chaska Patient Handbook 2023
