Program 2 - Outpatient Services

Policies and procedures for Bonita House outpatient treatment services.

Program Overview

The Outpatient Services Program provides flexible, community-based treatment for clients who do not require residential care but benefit from structured therapeutic support. Services are designed to promote recovery while allowing clients to maintain their community connections.

Service Components

Individual Therapy

Frequency: Weekly or bi-weekly sessions Duration: 50-minute sessions Focus Areas:

• Trauma-informed care
• Cognitive behavioral therapy
• Motivational interviewing
• Solution-focused therapy
• Skills development

Group Therapy

Available groups include:

• Process groups (8-10 participants)
• Psychoeducational groups (up to 15 participants)
• Skills training groups
• Peer support groups
• Family therapy groups

Psychiatric Services

• Initial psychiatric evaluation
• Medication management
• Quarterly reviews minimum
• Crisis consultation available
• Coordination with primary care

Intake and Assessment

Initial Contact

1. Screening Call - Determine appropriateness for services
2. Intake Appointment - Schedule within 5 business days
3. Clinical Assessment - Comprehensive biopsychosocial evaluation
4. Treatment Planning - Develop initial treatment plan
5. Service Authorization - Verify insurance/funding

Assessment Tools

Standard assessments administered:

• PHQ-9 (Depression screening)
• GAD-7 (Anxiety screening)
• AUDIT (Substance use screening)
• Columbia Suicide Severity Rating Scale
• Functional assessment

Treatment Planning

Plan Development

Treatment plans must include:

Problem Identification

• Primary diagnosis
• Contributing factors
• Functional impairments
• Client strengths

Goals and Objectives

• Measurable goals
• Specific objectives
• Target dates
• Intervention strategies

Service Schedule

• Frequency of services
• Duration of treatment
• Provider assignments
• Review dates

Plan Reviews

• Initial plan within 7 days of intake
• 30-day review for new clients
• Quarterly reviews thereafter
• Modifications as clinically indicated
• Client participation required

Service Delivery Standards

Appointment Scheduling

Standard Hours

• Monday-Friday: 8:00 AM - 6:00 PM
• Saturday: 9:00 AM - 1:00 PM (groups only)
• Evening appointments available upon request

Scheduling Protocol

• Advance scheduling encouraged
• Same-day crisis appointments available
• Reminder calls 24 hours prior
• Rescheduling with 24-hour notice

Attendance Policy

Client Responsibilities

• Arrive on time for appointments
• Provide 24-hour cancellation notice
• Maintain regular attendance
• Participate actively in treatment

No-Show Protocol

1. First no-show: Phone outreach same day
2. Second no-show: Letter sent, case review
3. Third no-show: Administrative discharge review

Clinical Documentation

Session Notes

Required elements:

• Date, time, duration
• Service type and location
• Presenting issues
• Interventions provided
• Client response
• Plan for next session
• Risk assessment if indicated

Progress Notes Format

Use SOAP format:

• Subjective: Client’s reported experience
• Objective: Observable data
• Assessment: Clinical interpretation
• Plan: Next steps and follow-up

Crisis Management

Crisis Response Protocol

During Business Hours

1. Immediate clinical assessment
2. Safety planning
3. Higher level of care if needed
4. Family notification (with consent)
5. Follow-up within 24 hours

After Hours

• Warm handoff to crisis hotline
• Mobile crisis team activation
• Emergency department referral if needed
• Next business day follow-up

Safety Planning

All high-risk clients must have:

• Written safety plan
• Crisis hotline numbers
• Emergency contacts
• Coping strategies list
• Means restriction plan

Medication Management

Prescribing Guidelines

• Evidence-based prescribing practices
• Start low, go slow approach
• Regular monitoring of effects
• Laboratory monitoring as indicated
• Medication education provided

Medication Monitoring

Required Elements:

• Effectiveness assessment
• Side effect review
• Adherence evaluation
• Drug interaction screening
• Refill management

Discharge Planning

Discharge Criteria

Appropriate discharge when:

• Treatment goals achieved
• Client requests discharge
• Non-compliance with treatment
• Need for different level of care
• Insurance/funding ends

Discharge Process

1. Review Progress - Evaluate goal achievement
2. Transition Planning - Identify ongoing needs
3. Referrals - Connect to appropriate resources
4. Documentation - Complete discharge summary
5. Follow-up - 30-day post-discharge contact

Quality Measures

Outcome Tracking

Monitor and report:

• Symptom reduction scores
• Functional improvement
• Client satisfaction
• Treatment retention rates
• Readmission rates

Performance Standards

• 90% client satisfaction rate
• 80% treatment plan completion
• 85% appointment attendance rate
• 100% crisis response within 1 hour
• 95% documentation compliance

Telehealth Services

Platform Requirements

• HIPAA-compliant video platform
• Secure internet connection
• Private location for sessions
• Audio/video quality verification
• Backup communication plan

Telehealth Protocols

• Verify client location
• Confirm emergency contacts
• Assess appropriateness for telehealth
• Document platform used
• Address technical issues promptly

Staff Training

Required Competencies

All outpatient staff must demonstrate:

• Clinical assessment skills
• Evidence-based practice knowledge
• Crisis intervention capability
• Cultural competence
• Documentation proficiency

Continuing Education

• 20 hours annually minimum
• Trauma-informed care training
• Suicide prevention training
• Ethics training every 2 years
• Supervision requirements per licensure