PROGRAM ELIGIBILITY CRITERIA
All clients served by WIN must be in need of services to support their healthy functioning in the greater community. All clients referred for WIN’s Substance Abuse Counseling services must meet the requirements of “medical necessity” as defined by the Maryland Public Mental Health System. Additionally, youth and adults referred to WIN must be eligible to receive Medical Assistance in the state of Maryland, as all clients seeking program enrollment must receive pre-authorization from the ValueOptions eligibility system. ValueOptions is an automated inquiry, authorization, and claims reporting system that will enable WIN’s Admissions Coordinator to quickly and efficiently verify a Medicaid recipient’s current eligibility status.
Per COMAR 10.47.01.04H(1), a parent or guardian of a youth, with the youth’s consent, may refer a youth to WIN’s Substance Abuse Counseling program. Youth referred to WIN’s Substance Abuse Counseling program must be at least 12 years of age and not older than 17 years of age. Referrals for individuals age 18 or older are considered adults.
Eligible youth and adult clients will have a referral that validates a pattern and/or history of harmful alcohol or chemical use, as evidenced by:
- Need for repeated use of alcohol or chemical substance for adequate functioning;
- Inability to cut down or abstain from alcohol or chemical use;
- Inability to track the amount of alcohol or chemical substance consumed;
- Repeated efforts to control or reduce the frequency and amount of alcohol or chemical substance;
- Binge alcohol drinking or use; and/or
- Amnestic periods for events while
Additionally, eligible clients will exhibit impairment in social or occupational functioning as a result of ingesting alcohol or chemical substances, as evidenced by one of the following:
- Atypical behavior (such as: financial excess, violence, lying, stealing, or sexual acting out) while intoxicated;
- Vocational or academic problems, such as: absences from work or school, tardiness, failure to meet performance standards, regression of vocational skills, employment termination or probation, expulsion;
- Legal difficulties; and/or
- De-socialization, such as: social isolation, intense social anxiety, or lack of natural
Eligible youth (ages12-17) and adult clients will qualify for outpatient substance abuse counseling services when the above criteria are met and there is an absence of alcohol or drug-induced withdrawal delirium, hallucinosis, and/or amnestic disorder. The individualized strengths and needs of referred clients are considered when determining the most appropriate level of service for newly enrolled youth and adults.
Per COMAR 10.47.01.04A, WIN has developed and maintains a detailed description of patient placement criteria for admission to the Substance Abuse Counseling program which includes:
- Eligibility criteria, per guidelines of the American Society of Addiction Medicine (ASAM) Patient Placement Criteria; and
- Admissions procedures which include an intake process, an emergency intake process, a procedure for referring individuals to a more suitable program, a procedure for the development and maintenance of a waiting list, and a fee
The WIN subscribes to the ASAM criteria as the basis for its admission decisions. Intake documentation must specifically support admission decisions based on these criteria. WIN’s Substance Abuse Counseling Program will only admit referred patients that meet the admission criteria of the American Society of Addiction Medicine Patient Placement Criteria or other guidelines approved by the Administration. Prospective clients who do not meet WIN’s eligibility criteria will be referred or recommended to another suitable program.
Client Rights, Grievance, and Non-Discrimination – WIN believes that every client deserves the utmost respect at all times. WIN holds the individual rights of all clients in the highest regard as we strive to provide high quality outpatient substance use disorder services. All WIN consumers have the following rights:
- The right to be treated with dignity, respect, and compassion;
- The right to have easy access to our therapeutic treatment team and services;
- The right to expect your assigned Clinician to be responsive and sensitive to your needs;
- The right to be served in the most therapeutic, least disruptive, and most appropriate community setting possible;
- The right to have your family members actively involved in important decisions concerning your mental health treatment; and
- The right to have coordination and collaboration with your other service providers in an effort to promote healthy communication and reduce
WIN treats each prospective and current client with consideration, respect, and full recognition of his or her human dignity and individuality. Our treatment of youth and adults are appropriate, our care is adequate, and our services are in compliance with relevant State, Local, and Federal laws and regulations that prohibit physical or mental abuse or neglect by program staff. WIN offers an atmosphere free from discrimination and does not allow any use of physical restraints. WIN continuum of Substance Use Disorder services ensures privacy, confidentiality, and allows for clients, and his or her guardian, the right to refuse participation in any experimental research unless the research complies with 45 CFR Part 46.
Per COMAR 10.47.01.07B, WIN ensures that each client is provided with the grievance procedures of the program. WIN staff provides the client, upon admission, a description of the Grievance Policy and its procedures that includes:
- The client’s right to grieve program decisions, including but not limited to discharge, and change in status;
- Clients are informed of steps of the grievance process and levels to which the grievance may be taken.
Under no circumstances, does WIN Team staff, or independent contractors, retaliate against a client who presents a grievance or complaint.
Per COMAR 10.47.01.07C, WIN does not discriminate on the basis of race, creed, color, age, gender, sexual orientation, national origin, marital status, disabilities, and any other classification prohibited under State or Federal Law, including, but not limited, to: The Americans with Disabilities Act, 28 CFR 35; and The Fair Housing Act, 42 U.S.C. 3604.
Referrals to More Suitable Programs – Some youth and adults referred to WIN’s Substance Abuse Counseling program will present a need for further psychiatric or psychological consultation. Prospective clients who demonstrate evidence of the following criteria will be referred to a licensed behavioral health practitioner who has a track record of successfully supporting individuals with addiction challenges:
- History of severe trauma that may interfere with treatment, that includes but is not limited to: stress caused by military combat or hostage experience, rape, battery, and sexual or physical abuse;
- Persistent, pervasive depressive symptoms, that includes but is not limited to: inability to enjoy pleasurable experiences, poor eating and sleeping patterns, eating disorders, unresolved grief for prolonged periods, severe mood swings, and significant hypo- or hyper-activity;
- Proven perpetrator of assault, battery, and/or physical, emotional, or sexual abuse;
- Chronic somatic illness that results in frequent hospitalizations, surgeries, and prescribed medications with minimal symptom relief; and/or
- Cognitive, attention, and/or learning
Per COMAR 10.47.01.05B, other youth and adults referred to WIN’s Substance Abuse Counseling program will present a need for special accommodations. WIN is pursuing referral agreements with local human service providers capable of serving individuals with limited English proficiency, hearing disabilities, speaking disabilities, and physical disabilities.
Per COMAR 10.47.02.2 WIN has established referral agreements with other human service agencies that ensure that the widest range of appropriate services are available to our clients. These referral agreements are made available to the Department of Behavioral Health and Hygiene for review and are purposed to allow us easy access to refer prospective WIN clients with disabilities that we are unable to accommodate to more suitable programs. WIN is pursuing referral agreements for the following community service providers:
- Friends Laboratory – for drug screenings
- WIN Therapeutic Wellness Center – for individual, group, and family psychotherapy services
- WIN Psychiatric Rehabilitation Program – for individual wellness, self-management, life skills training, and coping interventions
- A Helping Hand – for detoxification and Opioid Maintenance Therapy
Emergency Intake Procedure – During business hours, emergencies and clients who may be dealing with an emergent situation may require interventions that include referrals to local hospital, homeless shelters, food pantry and legal advocacy. After business hours, emergencies are handled by our Clinical Director who is on-call 24/7 via answering service.
Referral Documentation Standards – Per COMAR 10.47.01.04F, WIN’s referral documentation includes: the reason for the referral, name of the individual, referring program, receiving program, and final disposition of the referral. WIN’s Intake Form (See Attachment #1): collects the following information: client’s demographic information, presenting problem, history of substances, withdrawal symptoms, medical, legal and social history.
Eligibility Verification – The Administrator verifies Medicaid eligibility and request pre-authorization for services for only those prospective clients identified as meeting the medical necessity criteria of its
program. Prospective clients that meet WIN’s eligibility criteria, as evidenced by complete referral documentation, will be contacted immediately to either schedule an admissions and orientation meeting date that falls within 10 working days of the individual’s initial contact and/or to accept placement on the program waiting list, as applicable.
Admissions Meeting – The Administrator will greet and welcome the prospective client to his or her initial Admissions & Orientation session. The Administrator will re-confirm the accuracy of information documented on the Intake Form, as collected via telephone by the Administrator or completed by an external referral source. The Administrator will also request and make a copy of the prospective client’s Medical Assistance insurance card and thoroughly record all prescribed medications, inclusive of the prescribing physician, prescription date, full name of medication, and the frequency and dosage of medication administration. The Administrator then introduces the eligible client to an Addiction Specialist who facilitates the Orientation requirements of the program per COMAR Regulations.
Orientation Meeting – WIN has established a number of holistic principles that guide our service to youth and adults. Orientation may be provided to the individual client, in a client group, and/or in a family context. During the orientation meeting, the Addiction Specialist provides an overview of the program rules and goals of the program. The client, and/or their legal guardian as applicable, is informed of the following program rules and guidelines:
- Acceptance Acknowledge
- Individualized and family services available;
- Hours of Operations;
- Infectious Disease Fact Sheet; and
- Staff Access and
Per COMAR 10.47.01.07A, The Addiction Specialist secures the client’s verbal and signed understanding of and agreement to the following program policies and consent forms:
- Consent for Services-Authorization for treatment services. (See Attachment #2)
- Client Rights & Grievance Acknowledgement- Informs client of their rights and responsibilities for participation in the program. (See Attachment #3)
- Release of Confidential Alcohol or Drug Treatment Information – Authorization which may include disclosure of information relating to alcohol/drug treatment.(See Attachment #4))
Next,the Addiction Specialist guides the newly enrolled client in the completion of the following screening Assessments:
- Chronic Pain Screening – This tool helps providers assess pain level and develop an understanding of its cause, intensity, and contributing factors.(See Attachment #.5)
- HIV Assessment – An assessment toll to help providers identify individuals who are at highest risk of acquiring or transmitting HIV (See Attachment #6)
- Alcohol Screening Assessment – A self-score test to assess if one has a drinking problem by answering questions yes or no (See Attachment #7)
- Nutrition & Fitness Assessment – A screening questionnaire designed to help providers determine if a client’s eating habits and attitudes warrant further evaluation (See Attachment #8)
- Master Problem List – A list of a patient’s problems that serve as an index to his or her treatment plan. (See Attachment # )
Following the Orientation meeting, the Addiction Specialist reviews all the data collected via pre- screening Intake Assessments and complete a comprehensive Substance Use and Recovery assessment.
- Comprehensive Substance Use and Recovery Assessment – An assessment that collects the severity of drug and alcohol use and assess recovery environment conducive to recovery. (See Attachment #.10.)
- Family Needs & Recovery Environment Assessment (optional for Early Intervention program enrollees) – An assessment of the recovery environment including an assessment of family (See Attachment #11.)
- Case Management Consultation – Written evaluation documenting consulting professional’s assessment and recommendations (See Attachment #12.)
Lastly, the individual is notified of WIN’s decision to accept him or her to its Substance Use Disorder program. A final determination of the most appropriate level of service is communicated to the client before or during the confirmation of the client’s next service appointment.
PROGRAM DESCRIPTION & COMPONENTS
DUI/DWI Education Groups Per COMAR 10.47.05.04. WIN’s DUI/DWI Program offers an instructional 12-hour Alcohol Education Program intended to provide rehabilitation for individuals convicted of driving under the influence (DUI) of alcohol or driving while intoxicate (DWI).
Eligibility – WIN Team offers services to individuals convicted under Transportation Article, 21-902, Annotated Code of Maryland, and ordered under Criminal Procedure Article, 6-219, Annotated Code of Maryland, to attend an education program, due to a conviction of driving while intoxicated or while under the influence of alcohol while on Maryland State roads.
Adults eligible for this level of service will also meet the following criteria for the six major life areas detailed in the ASAM:
- Acute Intoxication and/or Withdrawal Potential – No withdrawal risk
- Biomedical Conditions/Complications – None or stable
- Emotional/Behavioral/Cognitive Conditions and Complications – None or very stable
- Readiness to Change – Willing to explore how use affects personal goals
- Relapse/Continued Use/Continued Problem Potential – Needs understanding or skills to change current use or high-risk behavior
- Recovery Environment – Environment increases risk of use
Assessment – The Addiction Specialist completes a comprehensive assessment for each eligible participant, unless the participant has received an assessment by a licensed or certified clinician, or licensed program within the preceding 45 days. The WIN Team Bio-Psychosocial assesses the history and current status of the client in the following areas:
- Alcohol, tobacco, and other drug use (ATOD)
- Employment or financial support
- Gambling behavior
- ATOD and gambling treatment history
- Mental Health
- Legal involvement
- Family and social systems
- Educational involvement
- Somatic health, including a review of medications
The assessment results in a recommendation for the eligible participant to be enrolled in the 12-hour, 6 week drug and alcohol education group series or the 24-hour, 12 week drug and alcohol education group series. The assessment results may also identify a need for a referral to a treatment program. The court mandating individual compliance with the DUI/DWI education program will be notified whenever there is a referral made for additional support services.
Service Overview – WIN Team’s Addiction Specialist, in consultation with the Clinical Director, facilitates either a 12-hour or 24-hour drug and alcohol education group for eligible clients. Adult clients assessed as “social drinkers” and who do not meet the criteria for substance dependence will be invited to join the 12-hour, 6 week DUI/DWI education group. Adult clients assessed as substance abusers, chemically dependent, and/or repeat DUI/DWI offenders will be invited to join the 24-hour, 12 week DUI/DWI education group.
All DUI/DWI groups follow a thoughtful curriculum that covers the basic concepts of alcoholism, its signs and symptoms, and the medical, emotional, and spiritual effects of alcohol abuse. Client attendance is required for the weekly education groups. Clients may choose whether day or evening groups work best for their schedules. The general curriculum covers the following:
- Scope of drinking-driver problem;
- Intoxicated driver patterns and characteristics;
- The pharmacology of drugs and alcohol;
- The process of addiction to drugs and alcohol;
- The relationship of substance-use to crime, health, family, and other social problems;
- Natural support network and treatment