Mental Healthcare Act 2017 mandates that proper discharge planning should be done and documented before any discharge is done from MHEs. Discharge planning should be based on a thorough assessment of the needs of the patient. Family should be actively involved in the planning process.
Full Answer
When is adequate planning for discharge from mental health treatment not possible?
For a few cases such as immediate voluntary discharge, disagreement of the treatment plan, an absence of capacity to consent for psychiatric illness, discharge against medical advice or other emergency condition, adequate planning may not be possible.
How do you get patients to follow discharge instructions?
Arm your patients with tools for success. Literacy, cognition, education level, socioeconomic status, and level of social support all contribute to a patient's adherence to discharge instructions. Careful attention to providing an individualized care plan sets patients up for success.
What happens after the decision is made to discharge a patient?
Once the decision to discharge has been made the counseling team finds other options for their patient. The best option may be another treatment center. Although you can’t make them go, the treatment team does everything in their power to facilitate a safe exist plan.
What should be included in a discharge plan?
The discharge plan should be a comprehensive tool and should be based on: where and how a patient will get care after discharge; what the patient and his or her support groups (family, friends, hired help) can do to facilitate recovery; particular healthcare problems that might occur in the new care setting;
Why is it important to consider the first session the beginning of discharge planning in counseling?
Patients are asked to play an important role in the partnership between patient and staff by reviewing these options and scheduling follow-up or first time appointments with the information provided to them by staff. This is integral to ensuring a strong discharge plan and helps to reduce the risk of relapse.
What is a treatment plan for substance abuse?
A substance abuse treatment plan is an individualized, written document that details a client's goals and objectives, the steps need to achieve those, and a timeline for treatment. These plans are mutually agreed upon with the client and the clinician.
What is the most effective intervention for substance abuse?
CBT is often rated as the most effective approach to treatment with a drug and alcohol population.
What is phases of treatment?
Various models exist describing the overall phases of treatment, but most have elements in common. The National Institute on Drug Abuse (NIDA) describes four stages of treatment: initiation, early abstinence, maintenance of abstinence, and advanced recovery.
What are the four steps of treatment planning?
First, the clinician behaviorally defines the counseling problems to be addressed. Second, achievable goals are selected. Third, the modes of treatment and methods of interven- tion are determined. Fourth, the counselor explains how change will be measured and how outcomes will be demonstrated.
What are treatment plan interventions?
Interventions are what you do to help the patient complete the objective. Interventions also are measurable and objective. There should be at least one intervention for every objective. If the patient does not complete the objective, then new interventions should be added to the plan.
What are the priority nursing interventions for substance abuse?
Nursing interventions for a client with substance abuse include:Providing health teaching for client and family. Clients and family members need facts about the substance, its effects, and recovery.Addressing family issues. ... Promoting coping skills.
What are the most successful methods for intervention?
To help run a successful intervention:Don't hold an intervention on the spur of the moment. ... Plan the time of the intervention. ... Do your homework. ... Appoint a single person to act as a liaison. ... Share information. ... Stage a rehearsal intervention. ... Anticipate your loved one's objections. ... Avoid confrontation.More items...
How do you facilitate an intervention?
Steps Involved in an InterventionStep 1: Get help. This may involve contacting a professional interventionist, social worker, or doctor. ... Step 2: Form the intervention team. ... Step 3: Make a plan. ... Step 4: Gather information. ... Step 5: Write impact statements. ... Step 6: Offer help. ... Step 7: Set boundaries. ... Step 8: Rehearse.More items...•
What are the 6 stages of recovery?
According to The Developmental Model of Recovery (DMR) developed by Terence Gorski, there are six stages people go through during recovery: transition, stabilization, early recovery, middle recovery, late recovery, and maintenance.
What is the process of recovery?
Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. Even people with severe and chronic substance use disorders can, with help, overcome their illness and regain health and social function. This is called remission.
What is the second phase of psychotherapy?
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions.
Why is it important to keep the rulebreaker in treatment?
Continuing to keep the rule-breaker in treatment only enables their unhealthy behavior. It also comprises the quality of treatment for other patients. By the time a discharge is decided upon every other option has been tried.
What happens when addicted people break rules?
When they break rules and are discharged for it, they learn responsibility and that rules do apply to them. When they get a free pass, they learn nothing.
Why do addicts act like they are rewarded?
Although their bodies continues to age, they lack the ability to function as mature adults. They lash out at those closest to them and may have temper tantrums and display violent and threatening behaviors. They behave like this because it works. In other words, addicted individuals are rewarded for acting badly.
Why do addicts behave like this?
They behave like this because it works. In other words, addicted individuals are rewarded for acting badly. When a patient enters a treatment center they’re given a set of rules to follow. Addiction thrives in chaos. Without rules and structure, rehab facilities will become just another place to get high.
Do treatment teams expect patients to follow rules?
No treatment team expects their patients to follow rules perfectly. Some rules will be broken. This can be used as a teaching opportunity. Chances are given, commitments are made and change occurs. But not every patient is willing to make these commitments. Some have become masters at manipulating their family.
What is administrative discharge?
Administrative discharge (AD)—also referred to as “disciplinary discharge,” “discharge for cause,” or “discharge upon staff request”—is the adversarial termination of services due to a client’s failure to comply with program rules and expectations. The reasons for AD vary by modality but generally include: 1 Failing to participate in service activities, e.g., missing counseling sessions 2 Threatening, or appearing to threaten, the physical or psychological safety of others 3 Breaking rules regarding relationship boundaries, e.g., having phone or face-to-face contact with family members or friends during a “blackout” period, verbal abuse (profanity, racial slurs), or 4 Refusing to live within rules established for communal living (e.g., hygiene, assigned chores, disruptiveness, quiet hours, and punctuality for treatment activities) 5 Failing to pay service fees 6 Possessing contraband in the treatment facility (e.g., illicit drugs, cigarettes, prohibited food items) 7 Using alcohol or unprescribed drugs, or 8 Failing to secure medication for a psychiatric condition.
What is countertransference in therapy?
Countertransference is the “total emotional reaction of the therapist to the patient” —a reaction that involves the therapist’s beliefs about the client, his or her feelings for the client, and his or her overall attitude toward the client (Imhof, 1991).
What is therapeutic milieu?
Many readers would concur that therapeutic milieu is a crucial but fragile dimension of addiction treatment that can be compromised or lost. The AD stands as the ultimate instrument for preserving that milieu, even if applied in an inconsistent manner.
When terminating a client because you believe they are a danger to you or someone else?
When terminating because you believe they are a danger to you or someone else, and you are therefore unwilling to meet with them in person. When terminating with a client who has a history of threatening to file licensing board complaints. When terminating with a client who has difficulty processing rejection.
When a therapist and client agree that it's time to move on, both may have mixed feelings.?
When a therapist and client agree that it’s time to move on, both may have mixed feelings. The client has formed a trusting and close relationship with the therapist and may have even come to see the therapist as a friend. So it’s important to be warm and supportive, but also to set clear boundaries.
What happens if a client is unhappy with the therapist?
When a client is unhappy with the therapist’s services, objects to the therapist’s philosophy, or accuses the therapist of wrongdoing, the client may terminate the relationship. If the client does not, the therapist must assess whether the relationship can continue.
What are the general guidelines for therapy termination?
Therapy Termination Activities: General Guidelines for Therapy Termination. Therapy termination can make both the therapist and client feel insecure. Therapists may wonder if they did enough to serve the client and may feel defensive if the client is unsatisfied. Clients may worry that termination is their fault or may fear leaving therapy means ...
Why is it important to know when to terminate therapy?
For therapists, knowing when to terminate therapy is an important skill that can protect both the client and the therapist. The following strategies can help you manage your therapy termination session no matter why therapy has ended.
Why is it important to discuss termination with a child?
It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible.
When is the end of therapy important?
When a therapist and client have a long and trusting relationship, the end of therapy is a major milestone. But when a therapist is not a good fit for a client or there is an issue in the relationship—such as repeated no-shows or dissatisfaction with therapy—handling termination is even more important. Clients can terminate therapy ...
Why is discharge planning important?
This is particularly important when the beneficiary (or client)_feels that the discharge is inappropriate for any reason. Similarly, good discharge planning for patients, their families, and their healthcare providers, paves the way to successful transitions from one care setting to another.
Who should contact if a Medicare discharge is too soon?
Medicare beneficiaries and their advocates who question the appropriateness of a proposed discharge from a Medicare hospital, whether the discharge is too soon or whether necessary post-hospital services have been arranged, should contact the local Quality Improvement Organization ( QIO) and file a complaint.
How long is an outpatient observation in Medicare?
Medicare beneficiaries throughout the country are experiencing the phenomenon of being in a bed in a Medicare-participating hospital for multiple days, sometimes over 14 days, only to find out that their stay has been classified by the hospital as outpatient observation. In some instances, the beneficiaries’ physicians order their admission, but the hospital retroactively reverses the decision. As a consequence of the classification of a hospital stay as outpatient observation (or of the reclassification of a hospital stay from inpatient care, covered by Medicare Part A, to outpatient care, covered by Medicare Part B), beneficiaries are charged for various services they received in the acute care hospital, including their prescription medications. They are also charged for their entire subsequent SNF stay, having never satisfied the statutory three-day inpatient hospital stay requirement, as the entire hospital stay is considered outpatient observation. The observation status issue has been challenged in Bagnall v. Sebelius (No. 3:11-cv-01703, D. Conn), filed on November 3, 2011. Litigation is ongoing. For updates, see https://www.medicareadvocacy.org/bagnall-v-sebelius-no-11-1703-d-conn-filed-november-3-2011/ (site visited May 27, 2015).
When a hospital determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an
When a hospital (with physician concurrence) determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an expedited QIO review. The CMS guidelines provide that the appeal for expedited review must be made before the beneficiary leaves the hospital.
What is discharge notice?
A notice is any written or oral discussion of one’s rights and protections, particularly with respect to costs and services available in a proposed care setting. It is therefore important that notice is:
What information is useful for Medicare beneficiaries and their advocates?
The following information for Medicare beneficiaries and their advocates is useful in challenging a discharge or reduction in services in the hospital, skilled nursing, home health, or hospice care setting: Carefully read all documents that purport to explain Medicare rights.
What is discharge documentation?
A discharge summary is completed detailing the progress on treatment plan goals and reason for discharge. Health, behavioral, and medication changes during the period of case management services are also documented in the discharge summary.
Why is discharge important?
The discharge process is critical to ensuring that your clients have a smooth transition from one service to another. There are other situations when the client is not compliant with services and chooses to leave on their own. This is sometimes referred as a discharge against medical advice or “AMA” discharge.
What does a case manager do during discharge?
This often includes providing the client and/or the family with a provider list so that they can make informed choices. The linking process may also include educating families about available resources without influencing their choices. Case managers may also provide assistance with setting up and attending tours with families.
What is discharge planning?
Last Updated on December 29, 2019. Discharge planning is yet another essential function of case managers, support coordinators and social workers. The discharge process is often met with mixed emotions from case managers. The brief sense of relief of having one less case is usually followed by anxiety knowing at some point you’re going ...
What does it mean to be discharged?
In most cases, discharge means that the client has achieved his or her goals and is no longer in need of services.
What are the factors that contribute to adherence to discharge instructions?
Literacy, cognition, education level, socioeconomic status, and level of social support all contribute to a patient's adherence to discharge instructions. Careful attention to providing an individualized care plan sets patients up for success.
What should discharge plans include?
In an effort to improve self-management of diabetes care, discharge plans should include at minimum: medication reconciliation. To ensure continuity of the medication regimen, the patient's medications must be verified to be sure no essential medications were discontinued and to ensure the safety of new prescriptions.
How long does it take to rehospitalize a patient with COPD?
One of the most common diseases that require rehospitalization within 30 days of discharge is COPD. Patient teaching during stable periods is recommended to educate patients about self-care. Many patients with COPD rely on self-taught self-management strategies during exacerbations that they may not report. This suggests that clinicians should give more comprehensive education; for example, teaching patients about triggers to avoid, signs and symptoms of exacerbations, strategies to manage exacerbations, and information about medications. When nurses simplify treatment regimens and verify patient knowledge and skill with new inhalers, patients are better able to self-manage their treatment and prevent exacerbations.
What are the factors that affect readmission?
Risk factors for readmission include clinical issues, such as advanced chronic obstructive pulmonary disease (COPD), heart failure, stroke, diabetes, significant unintended weight loss, depression, cancer, and palliative care. Use of high-risk medications, such as antibiotics, glucocorticoids, anticoagulants, opioids, antiepileptic drugs, antipsychotics, antidepressants, and hypoglycemic agents, may also increase the likelihood of readmission. Other factors raising the risk include polypharmacy, previous hospitalization (unscheduled hospitalizations within the last 6 to 12 months), low health literacy level, black race, and lack of social support with inadequate or no family or friend contact by phone or in person. 4
What is critical patient history?
A critical patient history element is documentation of the patient's baseline knowledge and skills. Patient educational assessments should include health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” 7 A good way to evaluate health literacy is to ask patients to read their prescription containers and explain how they should take their medication.
What should be documented in an electronic health record?
Accurate and timely documentation in the electronic health record should reflect evaluation of knowledge and skills taught and learned, and demonstrated by the patient in return. Documentation should include the patient's preferred learning style; barriers identified, such as low literacy skills or limited financial support; preparedness to learn; and relevant clinical information, such as a new diagnosis or poorly managed pain. Resources and support available at home should be recorded with perceived barriers, interventions to overcome barriers, and outcome achieved.
What can be used to help educate patients with low literacy skills?
Patient education websites, printouts, animations, and more can be used at the bedside to help educate patients with low literacy skills. Printed materials should be prepared at the appropriate literacy level and visual aids tailored to the patient's medical condition and needs.
How do treatment plans help guide therapy?
Treatment plans help guide therapy by outlining the client’s goals and objectives. Without such goals, therapy can become aimless as new problems arise each week, causing therapy to continue indefinitely. Goals create a clear “finish line” for therapy and give each session direction.
Why is it important to have a plan for dealing with a recurrence of a presenting
Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. Because of this, it is important that clients have a plan for dealing with a recurrence of their presenting problem. Depending on the issue, this might mean returning to therapy.
What is termination in therapy?
Termination is a time to review the client’s achievements and reinforce plans for maintaining good mental health. The information below will help you facilitate a smooth and successful termination process.
What does it mean to part with a client?
When it’s time to part with the client, the process may be straightforward and professional, or it may be more emotional. The client may experience a wide range of emotions, from sadness and a sense of loss, to pride, satisfaction, and a sense of independence. Allow the client to express their emotions, and validate their experience.
Why is it important to have a mental health maintenance plan?
Depending on the issue, this might mean returning to therapy. A mental health maintenance plan helps clients recognize ongoing mental health needs by summarizing their triggers and warning signs.
When is therapy completed?
Generally, therapy is completed when a client has achieved the goals outlined in their treatment plan. However, this decision is a matter of professional judgment. When therapeutic goals are nearing completion, discuss the client’s readiness to terminate and their feelings--whether positive, negative, or ambivalent--related to ending therapy.
Can positive changes go unnoticed?
Sometimes the positive changes that are fostered during therapy happen so gradually that they go unnoticed. Reviewing a client’s progress throughout treatment--and particularly at termination--will highlight these positive changes. As a therapist, you might see positive changes in the client that they have yet to notice.