IOP PHP Policies and Procedures pdf doc download

About the Author

Dr. Bruce Bassi is a board-certified psychiatrist who has run his own practice for over 5 years. He is is a renowned expert in the field of mental health facilities and clinical care, having started and/or grown multiple facilities. As the founder and CEO of a successful treatment center, he has dedicated his career to improving the lives of individuals through compassionate and evidence-based practices. Dr. Bassi’s expertise lies in developing innovative strategies, implementing robust policies, and fostering a culture of excellence, resulting in exceptional outcomes for patients under his care.

Download Instructions

Upon purchase you will have access to the link to a Google Document. Within the Google Document, you may download it as a PDF or a word document (.doc or .docx).

You will also receive a list of words and phrases you must change to make it customized to your practice. It is recommended that you use the “Find and Replace” feature within Microsoft Word to replace them, as there may be numerous instances of those words.

Document Content

The document consists of over 250 pages of a IOP/PHP policies and procedures pdf designed for CARF accreditation in the State of Florida for mood disorder and substance abuse treatment program.

Section 1: Clinical Policies 11

Admission Criteria 12
Appropriateness for Partial Hospitalization Programming 14
Appropriateness for Intensive Outpatient Programming 16
Exclusion Criteria for Admission 18
Level of Care Evaluation with ASAM Criteria 19
Patient Assessments 21
Identification of Needs 21
Continued Stay Criteria 24
Physician Orders, Supervision, Certificate of Need 25
Psychiatric Assessment 25
Intake Procedure 26
Medication Management Policy 28
Holds/Restraints Policy 33
Program Schedule 35
Weekly Schedule 35
Rotating Lesson Plans 35
Individual Counseling 36
Discharge Planning 37
Referral Policy 38
Case Management Referral 40
Service Descriptions and Plans 42
Accessibility of Services 43
Availability of Services 45
Acceptability of Services 46
Appropriateness of Services 47
Components of Client Records 49
Maintaining of Client Records 51
Retention of Client Records 53
Documentation in Client Records 54
Supervisory Forms 55
Consent for Treatment 56
Diagnostic Assessment 57
Progress Notes 58
Communication with Other Treating Providers 60
Interpreter and Communication Assistance Services 61
Client Transfers 63
Missed Appointments 64
Cancellation Policy 65
Termination of Client Services 66
Involuntary Termination and Clients Terminating Against Advice 68
Client Rights 70
Client Grievances 73
Client Orientation 75
Client Health Education 76
On Call Procedure 77

Section 2: Safety Policies 78

Safety of Patients 79
Personnel Safety 82
Facility Safety 83
Fire Safety 84
Bomb Threat 86
Natural Disasters and Inclement Weather 87
Health and Safety Hazards 88
Equipment and Safety 89
Disruptive Clients or Visitors 90
Dangerous or Unauthorized Items on Premises 92
Illness or Injury 93
Incident and Reportable Incidents (Major Unusual Incident) 94
Medication Handling 102
Medication Storage 104
Allegations of Staff Neglect and Abuse of Clients 105
Infection Control 106
Utility Failure 107
Evacuation Plan – San Jose Blvd 108
Transportation of Clients 110

Section 3: Privacy Policies 111

Technology and System Privacy 112
Confidentiality General Rules 114
Technology and System Plan 116
Sanctions for Violation of the Privacy Practices 118
Privacy Officer 119
Monitoring Compliance with Privacy Regulations 120
Consent for Use and Disclosure of Protected Health Information 121
Notice of Privacy Practices 123
Authorizations for Release of Information 125
Client Rights and Grievances Regarding Privacy Regulations 129
Tracking Disclosures of Protected Health Information 130
Confidentiality Rules for Third Parties 131
Minimum Necessary Disclosure of Protected Health Information 132
Client Access to Client Records 133
Amendment of Records 134
Employee Computer Policy 135

Section 4: Personnel Policies 136

Equal Employment Opportunity and Affirmative Action 137
Personnel Privacy and Fair Employment Practices 139
Employment Classifications 140
Payment Practices 141
Vacation and Sick Days 142
Holidays 143
Bereavement Leave 144
Maternity and Paternity Leave 145
Medical Leave 146
Health Insurance 147
Sexual Harassment Policy 148
Recruitment of Employees 149
Position Descriptions 150
Professional Development 151
Cultural Competence and Diversity 152
Supervision 153
Work Performance Reviews 154
Employment Violations 155
Corrective Counseling 156
Personnel Grievance Procedure 157
Drug Theft in Work Place 158
Employment Terminations 159
Resignation Notice 160
Layoffs 161
Personnel Records 162
Office Hours 163
Staff Training Requirements 164
Professionalism and Etiquette 165
Drug Free Workplace 167
Part B: Tobacco Products 167
Liability Insurance 168
Personal Telephone or Computer Use 169
Staff Updates 170
Conflict of Interest 171
Ethical Standards 172
Social Media Policy 173
News Media 174

Section 5: Administrative Policies 175

Policies and Procedure Manual 176
Confidentiality of Company Information 178
General Office Procedures 179
Management of Incoming Cash Flow 180
Management of Outgoing Cash Flow 181
Billing for Letters 182
Risk Management 183
Inspection, Licenses, and Permits 184
Legal Requests and Investigations 185
Corporate Compliance 186
Succession Planning 187
Continuity of Operations Plan 188

Section 6: Quality Assurance Policies 189

Quality Improvement Program 190
Measurement of individual characteristics 190
Measurement of access issues 191
Measurement of staff function and efficiency 191
Measurement of workflow 191
Measurement of programming 192
Measurement of health and safety 192
Measurement of patient feedback 192

Frequently Asked Questions (FAQs)

Are there any additional bonus materials included in the IOP policies and procedures document?

Answer: Yes, there are additional materials included: General Clinic Consent and Consent for Treatment, Stimulant Consent, Benzodiazepine Consent, Sleep medication Consent, Buprenorphine Consent, Release of Information, Initial Screening Form, Intake Form, Patient’s Bill of Rights Sign (in waiting room).

I live in another state, other than Florida. Would you customize this document for my state?

Answer: Please reach out to obtain pricing for how much it would cost to customize the document for another state. In the past, we have made different versions of the document for other states for an additional charge.

Are the policies applicable for an eating disorder program?

Answer: This IOP / PHP document is designed for a substance treatment facility. Therefore there are 5-10 sections that are specific to substance treatment. You may delete these sections and add in pertinent sections to an eating disorder program.

Are the policies applicable for a mental health treatment program?

Answer: Yes, these policies are applicable for a mental health treatment program.

Are the policies written for accreditation to any specific program?

Answer: Yes, the policies are written for CARF accreditation with applicable references to CARF sections.

What is the purpose of developing policies and procedures for a mental health treatment program?

Answer: Policies and procedures are a requirement for state licensure, accreditation (CARF, Joint Commission) and insurance contracts (Aetna, Cigna, Optum, Humana, Blue Cross). The purpose of developing policies and procedures for a mental health treatment program is to establish clear guidelines and protocols for delivering consistent, high-quality care to individuals seeking mental health services. It helps ensure that all staff members are on the same page regarding best practices, safety measures, ethical considerations, and legal requirements.

Are there any quality measures incorporated into the policies and procedures?

Answer: The policies and procedures were developed with HEDIS quality measures in mind. Additional HEDIS quality measures can be reviewed under “Behavioral Health” subsection.

Who should be involved in the development of the policies and procedures document?

Answer: The development of policies and procedures should involve a multidisciplinary team consisting of mental health professionals, administrators, legal experts, and other relevant stakeholders. This ensures a comprehensive approach that takes into account various perspectives and expertise. Involving staff members who will be directly implementing the policies and procedures is also essential to gather their insights and ensure practicality.

How can we ensure that the policies and procedures are aligned with legal and ethical guidelines?

Answer: To ensure that the policies and procedures are aligned with legal and ethical guidelines, it is crucial to conduct a thorough review of relevant laws, regulations, and professional standards. This may involve consulting legal counsel, staying up to date with industry guidelines, and referencing ethical codes of conduct. Additionally, seeking input from professional associations or accrediting bodies can provide valuable guidance.

How often should the policies and procedures document be reviewed and updated?

Answer: The policies and procedures document should be reviewed and updated on a regular basis to ensure its continued relevance and effectiveness. The frequency of reviews may vary depending on changes in laws, regulations, best practices, or internal processes. Typically, an annual review is recommended, but significant changes or emerging issues may require more frequent updates.

How can we ensure that staff members are aware of and adhere to the policies and procedures?

Answer: To ensure staff members are aware of and adhere to the policies and procedures, effective communication and training are essential. This can involve conducting comprehensive training sessions during onboarding and providing regular refresher courses. Additionally, creating easily accessible and user-friendly documentation, such as handbooks or online resources, can help reinforce the policies and procedures and serve as a reference for staff members.

What steps should be taken to address any non-compliance with the policies and procedures?

Answer: Addressing non-compliance with policies and procedures requires a proactive and supportive approach. It is crucial to establish a reporting system that encourages staff members to raise concerns or violations without fear of retaliation. When non-compliance occurs, it should be thoroughly investigated, and appropriate disciplinary actions, such as retraining or progressive discipline, should be implemented. The goal should be to correct behaviors and ensure compliance while maintaining a culture of continuous improvement.

How can the policies and procedures document promote a safe and therapeutic environment for patients?

Answer: The policies and procedures document should aim to create a safe and therapeutic environment for patients by addressing factors such as privacy and confidentiality, patient rights, informed consent, crisis management, risk assessment, and emergency procedures. It should outline protocols for maintaining confidentiality, handling sensitive information, ensuring patient dignity, and promoting a supportive and respectful atmosphere.

What measures can be implemented to continuously improve the policies and procedures document over time?

Answer: Continuous improvement of the policies and procedures document can be achieved through a feedback-driven approach. Encouraging staff members, patients, and other stakeholders to provide feedback and suggestions can help identify areas for enhancement. Regularly reviewing and evaluating the effectiveness of the policies and procedures, considering new research and advancements in the field, and conducting periodic audits or assessments can all contribute to ongoing improvement efforts.

Do the policies and procedures assist with feasibility and market analysis?

Answer: No, the policies do not assist with feasibility and market analysis. However, we offer a course that would be appropriate for individuals who are starting to build their practice. This course also gives examples of: consent forms, articles of incorporation, meeting minutes, patient bill of rights (Florida), supervisory agreement, independent contractor agreement.