One of the most difficult things prospective clients and family members and friends face when seeking residential treatment programs for substance abuse disorders is that there is no universal, nationwide standard for treatment center licensure and there are significant differences from state-to-state as to what qualifies as a counselor in treatment programs and who certifies them. If you want to know just how cobbled the road is in treatment center licensing, just check out the following report on State Regulations on Substance Use Disorder Programs and Counselors, a dry 41 page pdf that will make your head spin.
If you know someone that has ever been to a treatment facility, they’ve most likely heard both horror stories about other peoples experiences in treatment facilities and stories of positive outcomes and success. Since substance use disorder treatment has only started to lose its stigma in the United States, there’s quite a bit of understandable uncertainty that orbits the mind when you’re considering making what can be a life saving decision for yourself or for a loved one. So, in this article, we hope to give you 9 simple things to look for when considering residential treatment center options.
1. Check out the license status of the provider.
This might seem like a no-brainer, but it’s rare that people call their state licensing board to determine if the program their considering is presently licensed, if their are under a temporary suspension order or if they employ counselors with revoked or suspended licenses. In California, the licensing board is the California Department of Health Care Services and they are responsible for licensing treatment programs and disciplinary action. You might want to perform a simple google search and determine who licenses treatment programs in your state, call the agency and determine if the program you are considering is in good standing, if there have been any recent complaints or disciplinary actions.
2. Does the program meet third-party accreditation standards?
In the United States, there are 2 main third-party accreditation organizations, CARF International and the Joint Commission. CARF stands for the
Commission on Accreditation of Rehabilitation Facilities, and CARF focuses almost solely on substance abuse treatment facilities while the Joint Commission performs accreditation, certification and verification services for substance abuse treatment programs as well as hospitals and emergency service providers. The process of becoming accredited is involved and painstaking with either organization and there are a wide variety of policies, procedures, standards and policies accredited programs must prove they employ or adhere to such as program structure and staffing standards, screening and access to services standards, medication use policies, health and safety standards and many more. Determine if the program you’re thinking about is accredited by wither party and consider calling the accreditation body to determine if the program is in good standing.
3. How do they assess the needs of new clients?
You want a program that has clear policies and procedures that meet the highest standards on assessment and evaluation. Avoid any program that maintains a gung-ho “bring ’em on in” policy of admissions. A quality treatment program will have an initial assessment over the phone to determine a host of information by a licensed and/or certified behavioral health professional to determine variables such as substance of abuse, amount and frequency or use, other medical issues, mental health issues such as suicidal ideation or suicidal intent. Another round of assessments should be conducted upon admission to the facility and may also include a medical screening by a third-part medical provider to determine if the client is medically cleared for the level of treatment the facility provides.
4. Does the facility provide individualized care?
Whereas quality assessment is a strong indicator of a quality program, individualized care is equally important. The assessment will give the treatment team at the facility a baseline for individualized treatment. The client may benefit from a treatment plan that involves substance abuse treatment as well as treatment for a co-occurring mental health disorder. In clients that have both substance abuse disorders and mental health disorders, it’s vital to treat both simultaneously. Look for centers that offer a wide variety of treatment modalities, employ counselors, therapists and psychologists that can treat specific issues such as depression, PTSD or anxiety disorders if it applies to you or your loved one.
5. Does the program encourage family involvement?
It’s an understatement to say that family involvement is overcoming addiction is an important aspect of treatment. Before many people commit to treatment, their family members may be avoidant, ignore the problem, enabling, controlling or may themselves be addicted to drugs or alcohol. Family involvement increases the likelihood of long-term success and sobriety, increases the overall well-being of the family unit because family therapy decreases the uncertainty of family members and helps them understand how they can help support their loved one and also establish healthy boundaries.
6. Does the program offer medically assisted treatment and/or detox?
Most residential treatment programs will not admit a client that is actively high and for good reason. They could be medically and/or psychiatrically unstable and they may need to detox from their substance of abuse to reach a safe state so they are able to accept the benefits of treatment. Detox programs often employ the use of controlled prescription medication to help taper the client off of their drug of choice. Make sure the program only uses FDA approved medication during detox. If the program offers medically assisted treatment (MAT) after detox, make sure the medications are FDA approved as well. Some medications prescribed during the course of a MAT program include, but are not limited to naltrexone (oral or injectable), Campral, Suboxone or Sublocade.
7. Medical staff quality is important.
Any in-patient residential treatment center with a detox component and a dual-diagnosis program wherein controlled medications are prescribed such as taper medications and psychiatric medications should have a robust medical staff. This should include a Medical Director, typically a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.) that has a background in addiction medicine or psychiatry. They should also have LVN’s or LPN’s and Medical Assistants. They may also employ Nurse Practitioners and/or Physicians Assistants. Modern substance abuse treatment has evolved into a practice that combines both highly trained medical staff as well as highly qualified clinical staff.
8. Clinical staff quality is paramount.
Just as a quality residential treatment program should have a Medical Director, all treatment centers need a highly qualified Clinical Director. In California, for example, Clinical Directors should either be in process or in possession of licensure as a Clinical Social Worker, Marriage and Family Therapist or in process or possession of licensure as a Psychologist. In addition to having a Clinical Director in charge of the oversight and direction of all clinical staff, there should be a wide variety of others such as Associate Professional Counselors, Associate Marriage and Family Therapists and certified substance abuse counselors specializing in a wide variety of treatment modalities.
Staff to client ratio is an indicator of a good program. In California, the minimum staff to client ratio is one direct care staff member to three clients. This is the legal minimum and does not reflect the best practices that a highly qualified treatment center should maintain. A great question to ask an admission advisor or treatment program representative is, “What’s your staff to client ratio?”. If they stumble, can’t answer or admit they don’t know, you may want to move on.
9. Aftercare, engagement and sober living options.
High quality treatment programs don’t just offer residential treatment for 30, 60 or 90 days, they may also offer detox, intensive out-patient, outpatient treatment and maintain sober living options. Aftercare planning is important because treatment doesn’t and shouldn’t end after a 30 day stay in rehab. The treatment team at a high quality center should give you at least 3 referrals to other providers if you decide to leave, they should give you suggestions for continued treatment after successful completion of a treatment program as well. A good sign of a high-quality provider is that they have treatment programs at many different levels of care. In addition they will want to stay engaged with their clients after treatment in what many call “Alumni Programs” designed to keep their clients engaged in the recovery community. Sober living options are critical as well. Many people that go to residential treatment programs do so away from their homes and many of those people decide to stay where or nearby where they are treated and sober living homes help those who are recovering stay sober.
If you or a loved one is looking for a referral to a high-quality treatment program or if you have general questions about treatment you can call Sobriety Options 24 hours a day, 365 days a year at 1 (855) 485-0071.
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