Level of Care

R.E.A.C.H. Mobile Health Services provides treatment services in an ASAM Level 1A Outpatient Services – Adult MAT level of care, and patients are admitted according to the Patient Placement Criteria. Psychosocial support services are delivered at a fixed site treatment center while the pharmacotherapy services are provided at the mobile medical unit. The nature, frequency, and intensity of clinical services are determined by the level of patient need, eligibility for pharmacotherapy, and the appropriate level of care to address those needs. Referral to other levels of care may occur during a patient’s treatment episode.

Assessment and Treatment Planning

All appropriate applicants receive a comprehensive biopsychosocial assessment, an Addiction Severity Index (ASI) interview, and a mental status examination. With emphasis on the patient’s strengths and self-generated solutions, and in collaboration with the patient, an initial individualized treatment plan is developed based on the identified needs. This treatment plan is reviewed at specific intervals with each patient and revised as needed.

The Symptom Screening Form, a mental health-screening tool, has been provided by the Baltimore Substance Abuse Systems, Inc. and Baltimore Mental Health Systems, Inc. to assess all applicants for issues of dual diagnosis. The Beck Depression Inventory is administered as indicated.

Counseling Services

Modalities: Group, individual and family-counseling services are available. Each patient, based on the individualized assessment of needs, is assigned to the most appropriate modality. Upon evidence of need or on request, a patient may be assigned to multiple modalities. Demonstrated need or request determines the frequency of sessions.

Groups are facilitated using behavioral/educational, support-oriented, and self-help models. Program orientation, education, and task groups augment on-going therapy groups. Specialized groups for women, patients with HIV/AIDS, chronic cocaine abusers, acupuncture, job readiness, and relapse prevention are offered. Every effort is made to keep group size to ten (10) patients.

Focus: Counseling sessions are focused on the needs of the individual patient, including but not limited to medical stabilization; development of behavioral-cognitive strategies for relapse prevention and other coping skills; development of insight and promotion of personal growth; provision of support; improvement of overall level of functioning; and substance abuse, health, and nutritional education.

Most addiction counselors have received 24 hours of training in Motivational Enhancement Therapy. As a result of the training and adequate supervision, the counselors are integrating the techniques they learned into groups and individual sessions in an effort to increase the motivation of the patients they serve.

Medical Services

Methadone maintenance is the primary medication protocol utilized for the patients treated at the core program. Antabuse therapy and naltrexone aftercare protocols are available to patients as needed or requested. A medical history assessment, physical examination, serological work-up, and tuberculin skin testing are routinely performed on all admissions. Medical and psychiatric consultations are available as indicated. Substance use detection is currently available through oral fluid, urinalysis, and blood alcohol screening/testing. All tests are administered and based on demonstrated need and in accordance with Federal Regulations governing the use of an approved narcotic drug in substance abuse treatment. HIV and hepatitis C testing is offered on request and provided on site.

Special Populations

Protocols have been designed to address the unique needs of the following patient populations.

Pregnant Addicts – Uncomplicated pregnancies can be treated effectively in a non-hospital based treatment program with methadone and the provision of on-site counseling that focuses on parenting skills, proper nutrition, and basic pre-natal and post-partum instruction on maternal, physical, and infant care. These cases are considered a high priority and are admitted to treatment on an emergency basis as quickly as possible. They receive on-going case management to assure proper coordination with high-risk obstetrical care for the term of the pregnancy as well as the standard care provided to all patients.

Females of Child-bearing Potential – Patients who are or who become pregnant will not be started or continued on medications other than methadone. A pregnancy test will be performed for female patients of childbearing potential periodically or as indicated, or when such a patient is recommended for taper from methadone, either voluntarily or administratively.

HIV Infected Addicts – Individual and group counseling and case management services have been designed to address the needs of the infected patient and his/her significant others. Patients living with HIV require specialized case management that focuses on medical and psychosocial needs. Education, counseling support, on-site medical triage services, and appropriate linkages for off-site medical care are among the services available.

Dually Diagnosed – A full psychiatric/psychological evaluation is available to those patients identified with co-morbidity by the staff during the intake/assessment process and at any time throughout the treatment process. The psychiatric/psychological evaluator will determine the appropriateness of the treatment settings with referral to appropriate providers within the community for those cases requiring more intensive psychiatric supervision than can be provided on-site.

Poly Substance Abuse – Treatment protocols have been developed to address concomitant problems of the patient dependent on multiple substances including alcohol, cocaine, and benzodiazapines.

Case Management Services

Patients are provided with case management to access additional treatment and other vital services not available on site. In addition to assessment and treatment planning, other case management activities will include referrals, linkages, monitoring, and advocacy for the patient to facilitate accessing support services and to coordinate the various serviced patients require.

Referral Services

Referrals are made when needed services are not available on site. Such services may include financial and housing services, medical and dental care, employment, vocational and educational counseling, self-help groups, etc. The program maintains a computerized community resource database that contains hundreds of community resources in the areas most frequently needed by our patient population. This database is readily available to all clinicians and kept current and user-friendly. One of the CARF Accreditation survey reports commended R.E.A.C.H. MHS for the development and regular use of the community resource database.

AIDS Education, Prevention, and Treatment

All patients admitted to the program are instructed about reducing high risk behaviors. HIV testing, with appropriate pre-and post-test counseling, and referral for medical care and for other community-based services are also available. Most R.E.A.C.H. MHS addiction counselors have completed the Maryland AIDS Administration training for HIV pre-and post-test counseling certification. In addition to offering referral for testing and counseling at intake and throughout treatment, all counselors are trained to integrate STI prevention strategies into their routine counseling sessions.

As part of the R.E.A.C.H. MHS four part orientation series, each patient completes a 1-hour educational session on HIV/AIDS. This orientation covers the definitions of HIV and AIDS, the routes of transmission, and prevention methods, including abstinence from intravenous drug use and safer sex. Proper condom use is also demonstrated. The purpose of HIV testing is discussed, and patients are provided a list of testing sites.

Prevention Activities

R.E.A.C.H. MHS is funded to provide treatment services to over five hundred (500) opioid dependent persons as its primary function. However, in the course of normal activities, staff is called upon to speak about substance abuse in the community, to provide training to other disciplines, and to work with patients in treatment to better educate their own children about the perils of substance abuse and peer pressure. During the past fiscal year, two staff attended Goodwill’s annual Thanksgiving event to talk with participants about the availability of drug treatment at R.E.A.C.H. MHS and to educate participants about medication-assisted treatment in general. As part of our mission as healthcare providers, several staff members and our mobile medication unit also attended the Edmonson Village Health Fair this summer to provide information about drug treatment to fair participants.

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