1. Recovery Support Plan Interventions: The Evolved Action Plan
PRESENTED BY: Action Plan Revision Committee
Dean Porterfield, David carrillo, travis Hupp, kyle cruze, Melissa hudgens

2. Purpose:
The Action Plan Revision Committee was charged with the task of developing a process in which we could better support Cumberland Heights patients when they were struggling with their adjustment to treatment as well as providing patients with on going behavioral infractions clear expectations specific to the behaviors of concern.
Why the Change?: Though not all programs use the same procedure to address distracting or disruptive behaviors, there was a tendency to have a “one intervention plan” fits all approach, and we know each patient brings a variety of understanding and ability to grasp the established programming.

3. The Goal
The goal established by the committee was to develop a tiered process that addressed the varying levels of needed support.
Create a document that could be put immediately in place by CA’s/RA’s until the presenting issues could be addressed by the treatment team. This allows the patient to get the needed support or redirection more immediately with the hope of curving the behavior when it first appears. It also allows the front line staff to create an intervention to aid in managing the milieu.
Assure that staff played a role in the established plan and not let all the responsibility ride on the patient.
Assure the intervention is time oriented and not open-ended.
Aid in reducing AMA’s, the additional support or direction is intended to help the patient modify or learn a new behavior, thus making the transition into treatment easier.
Develop a way to capture and get credit for our patient specific interventions as it will be a treatment plan addendum.

4. The Process Reviewed plans currently being used in each department.
Sent our a survey via Survey Monkey to all staff, including IOP. Assessed common infractions, interventions that are working, identifying when a patient should be discharged and gauged participants level of tolerance/appropriate expectations for individuals at various points in their treatment stay.
Using the survey, breaking down the behaviors and other factors down into a three tiered intervention.
Developing three separate user friendly plans that represented increase in expectation and potential consequence.
Do a test run of using the plans within the Youth and YMP.
Making plans on a shared folder, assessable by all.

5. Recovery Support Plan: 1st Tier
Purpose: is intended to provide the patient with a better understanding of CH treatment expectations. The focus will be on acceptance, compliance, use of recovery skills and self-regulation skills in order to have a more effective treatment experience.
When to Use: this plan is not meant to be punitive, but to aid in the patient acclimating and having specific goals to guide them in the treatment process. Could be used for someone struggling while on detox, someone who does not manifest the needed skills or behavior in their current skill set. Can be implemented by CA/RA and does not need approval from tx team.

6. Recovery Support Plan Instructions:
Enter patient name and date the plan, the review should take place within 3 days of implementation.
Identify the “Areas of Needed Support”, use drop down box, if the concern is not listed, use “other” and type it in.
Get feedback directly from the patient to see what type of support/intervention would help them be successful and type that into the “Patient Assessment” box. Use this information to formulate goals.
Establish a minimum of 3 goals in the “Goals” section, use drop down box for suggestions.
Identify what staff will do to support the patient in the “Staff Responsibilities” section.
Gain patient and staff signatures.
Provide patient with a hard copy, bring a hard copy to morning staffing and out a copy of the plan to your treatment team.

7. Recovery Support Plan Instructions:
Staff review document with patient, discuss progress. Decide if plan has been met, the plan needs to be extended or the plan needs to be modified.
Make a note in the patients chart that a plan was started, also document when the plan was completed or amended.
Have the original plan with signatures sent to scanning for the chart.

8. Re-evaluation is a critical step in executing successful plans
Re-evaluation is a critical step in executing successful plans. 3 to 5 day follow up periods is advised.
This section is a drop down list of issues / infractions that are prompting the plan. If items isn’t listed, add to “Other” section
This section is for Patients to give their feedback around what they feel like would help them in this process – the idea is to make this plan collaborative and not punitive.
This section specifically tracks what the goals of the plan are and requires staff to recognize completion of goal.
This section requires that staff state what they are going to do in order to support the growth and development of patient. This identifies the active role(s) that staff are taking to help support patient.
This section must be completed by staff as a way of outlining what the “plan” is moving forward and upon completion of the plan.

9. Recovery Behavioral Modification Plan
When to Use: to address continued infractions of guidelines and to correct pronounced behaviors that impede patients treatment progress and/or treatment progress of other community members.
This plan will be put into place by the patients counselor or clinical coordinator/director.
This type of plan can be extended, or re-instituted with new goals. A patient could be on such a plan a few times before it reaches the level of looking at a transition to a more appropriate placement.

10. Recovery Behavioral Modification Plan Instructions:
Refer back to the instructions for the Recovery Support plan.
Primary Difference: This plan is to be developed by Counselor or Clinical Coordinator/Director.

11. Re-evaluation is a critical step in executing successful plans
Re-evaluation is a critical step in executing successful plans. 3 to 5 day follow up periods is advised.
This section is a drop down list of “Behavioral Concerns” that are prompting the plan. If items isn’t listed, add to “Other” section
This section is for Patients to give their feedback around what they feel like would help them in this process – the idea is to make this plan collaborative and not punitive.
This section specifically tracks what the goals of the plan are and requires staff to recognize completion of goal.
This section aligns with the stated goals, giving more specific details to the ways in which the stated goals are going to be completed.
This section requires that staff state what they are going to do in order to support the growth and development of patient. This identifies the active role(s) that staff are taking to help support patient.

12. Transitional Support and Level of Care Assessment
Purpose: Used to formally address ongoing concerns as it relates to the treatment process at CH. Expected to demonstrate compliance on all the previously addressed in Recovery Behavior Modification Plans. This includes following all guidelines established by CH and actively participating in the milieu. Noncompliance with this contract will likely result in discharge from the program.
When to Use: If a patient has made it to this plan, the treatment team is feeling as if they have done all they can do and discharge is imminent, if not already decided on. If decided on, the plan may help keep the patient invested long enough to secure a next placement or some other Continued Care Plan.

13. Transitional Support and Level of Care Assessment Instructions:
The decision to use this plan requires permission from the program director or designee.
The counselor/case manager will expedite identifying a program to transition to and a solid Continued Care Plan.
The goals are already stated on this contract, but others can be added.
If appropriate, have the patient give input or assess self-awareness about the circumstances in which they find themselves. Do they believe another level of care needed?
Inform and get feedback from attending physician and psychiatrist as appropriate.

14. Drop down options are not used in the document due to the individualized circumstances of each patient once they reach this point in their care with us. Specific expectations should be outlined for the patient in this section.
It is still important that Patient Feedback is sought and support given to the best of our ability.

15. Please Note:
Look to your program Director for specifics about how to implement your plan.
Remember to reward close approximations to the desired behavior.
Keep in mind that each patients skill set is different. We may expect a young man/woman to know how to make his/her bed/do his laundry, but in all reality, he/she may never had to do this task prior to coming here.
As staff, we may need to teach them identified skill or pair them with a peer who can teach them.

16. Feedback?
Please feel free to offer feedback as you start implementing the new plans into your program. You can do so through any committee member listed on the first slide.