Behavioral Health Facilities and Rehabilitation Facilities
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What are the Substance Abuse Settings
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Outpatient treatment Intensive Outpatient/Partial Hospitalization Inpatient Treatment Education programs Self-help Recovery Groups
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Describe the Outpatient Treatment for Substance Abuse Settings
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Regularly scheduled outpatient substance abuse treatment Provided by: Mental Health Centers Hospital Outpatient Centers Freestanding Drug & Alcohol Centers e.g. Methadone Maintenance Clinics, Court-Ordered Programs and EAP
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Explain Intensive Outpatient/Partial Hospitalization for Substance Abuse Settings
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At least 9hrs per week in treatment do not stay overnight 9-20 Intensive Outpatient @ Everning Program Partial Hospitalization @ Day time
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What are the two types of Inpatient treatment settings
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1. Medically MONITORED inpatient substance abuse treatment setting -non-medical residential setting. 2. Medically MANAGED inpatient substance abuse treatment setting -under direction of physician with all services of an Acute Care Hospital.
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Give some examples for Educational Programs
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Prevention- individual & Families D.A.R.E
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Give some examples for Self-help Recovery Groups
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Support groups that assist in maintaining sobriety and drug free life AA Narcotics Anonymous 12 Step Programs Fetal Alcohol Syndrome Cocaine Addiction in NB
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Who are the clients for Substance Abuse treatments
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Adolescents Women Employee Assistant Programs (EAP) Dually Diagnosed Court Preferred
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What are some examples for women usage of substance abuse treatments
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Fetal Alcohol Syndrome Cocaine Addiction in NB
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Explain Dually Diagnosed for Substance Abuse Care
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Abuse problem in combination with mental illness
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Give some examples for Court Referred
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Assessment and/or Treatment -DWI -DUI -Other alcohol or drug related offenses
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Who are the caregivers in Substance Abuse Treatment Settings
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Physicians, nurses, nurse practitioners, physician assistants, -Counselors-may be social workers, psychologists, nurses -Case managers -can be counselors but their main function may be related to reimbursement and follow up. Recreation Therapist-for clients in Residential Programs
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What Substance Abuse Settings are surveyed against the standards published in the JC Comprehensive Accreditation Manual for HOSPITALS
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1. Inpatient Substance Abuse Facilities 2. Hospital- Based Ambulatory 3. Residential and Partial Hospitalization
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What Substance Abuse Settings are surveyed against the standards published in the JC Comprehensive Accreditation Manual for BEHAVIORAL Health Care
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Freestanding Community- based abuse programs
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CARF
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Commission on Accreditation of Rehabilitation Facilities
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Who and how serves CARF
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Individuals rights served by rehabilitation Facilities, CARF standards emphasize the clients participation in planning and choosing their own care
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Who does Commission on Accreditation of Rehabilitation Facilities (CARF) apply
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To detoxification units of hospitals, outpatients services (intensive outpatient patient, partial hospitalization and residential
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What are the requirements for Medicare reimbursement for Substance Abuse Facilities
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Must apply the Medicare Conditions of Participation
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What are the requirements for Medicaid coverage for Substance Abuse Facilities
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it need to be "medically necessary" therefore there needs to be physician involvement and clear documentation of medical necessity of the Prescribed treatment.
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What are the two key documentation for Substance Abuse record
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1. Legal/Administrative Documentation 2. Clinical Documentation
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What are the key elements included in the Legal/Administrative Documentation for Substance Abuse
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Admission information Commitment papers financial insurance program rules consents client rights
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What are the key elements included in the Clinical Documentation for Substance Abuse
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Clinical Assessment Medical Assessment Individualized treatment Progress Note Discharge Summary Follow Up
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What are the key elements found in the Clinical Assessment for Substance Abuse Documentarion
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Identifying information Presenting problem Health, medical and or developmental history Family & Social history History of Substance Abuse History of Psychological factors Education/Vocational history Clients abilities, strengths, needs & preferences Preliminary diagnosis Specific reasons why admission to program is denied (if applicable) Initial Problem list Assessment Summary
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What are the key elements found in the Individualized Treatment Plan
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Identification Plan DSM IV Diagnosis Justification/reason for treatment Proposed treatment, including type and frequency Measurable goals & objectives with target dates Treatment plan
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What are the settings for Mental Health Care?
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-Outpatient Mental Health Facility -Group Home -Personal Care Home -Psychiatric Crisis Facility -Inpatient Psychiatric Home
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Describe the outpatient Metal Health Facility Settings
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-Regularly scheduled Outpatient Mental Health - Hospital-Based, community Mental Health Care
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Describe Group Home in Mental Health Settings
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-Residential, 24 supervision & daily skills treatments -Limited time basis to train client for less restrictive environment
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What are the settings for Personal Care Home in Mental Health Care
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Permanent Living Facility Some Supervision & meals No training Clients too severely impaired to live completely independently
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Describe Psychiatric Crisis Facility Settings
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Short Term Treatment of psychotic symptoms in a early stage.
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Describe Inpatient Psychiatric Hospital Setting
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Long-Term inpatient Not responsive to medication that allow them to live successfully in less restrictive environment
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What do CMHC stands for?
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Community Mental Health Centers
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What does CMHS led to?
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The Community Mental Health Center led to the de-institutionalization of many psychiatric patients.
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Who are part of the Community Mental Health Center CMHS
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Was stablished for outpatient treatment, emergency service and short-Term Hospitalization.
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Who provide fundings for CMHC
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The Federal Governments, State and County
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What are the two main categories of Mental Health Disorders of Adults
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1. TEMPORARY emotional crisis related to a traumatic event 2. CHRONIC long term mental illness
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Describe Temporary Emotional Crisis related to a traumatic event
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Includes disorders such as: Depression Suicidal tendencies due to traumatizing events e.i. death, divorce, bankruptcy or loss of employment -They respond well to counseling and medication
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Describe Chronic Long Term mental illness and give some examples
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-Due to chemical changes in the brain not by traumatic events -bipolar disorder -schizophrenia -clinical depression
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Define Bipolar Disorders
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Aka maniac-depressive disorder. Changes from extreme euphoria into deep depression
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Define Schizophrenia
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Is a type of psychosis which is a state of extreme disorderly thinking. The patient is unable to distinguish reality from hallucinations (false sense of perceptions) & delusions(false ideas)
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Define Clinical Depression
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Is when the patient experiences deep feelings of melancholy and futility it can be stress induced.
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Who are Dually Diagnoses Patients
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1. Mental illness with Mental retardation 2. Mental illness with Chemical Addiction (MICA)
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Give some examples of Core Services for Adults
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Diagnostic Evaluation & psychiatric Medication Mgmt Case Management Day Programming Residential Living Screening & Evaluating Services After Hrs crisis Services
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Who performed Diagnostic Evaluation & psychiatric Medication Management
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Psychiatrists, nurses, or nurse practitioners
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How does Case Management help Mental Health patients
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Helps clients by obtain other services outside of the health setting
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Describe Day Programming for Adults
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Provides the clients to interact with peers & professionals e.g. Partia Hospitalization Programs
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Who is part of Residential Living
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Group Homes Halfway Houses which averages from 6 month to 1 year
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Why is important Screening & Evaluation Services
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To determining the need of short term psychiatric or for recommending involuntary hospitalization
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What differentiate After Hours Crisis Services
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e.i Emergency services available 24 hrs
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What are some examples of Core Services for Adolescents
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Early Identification & Intervention Diagnosis & Evaluation Outpatient Treatment Day Treatment Emergency Services Home Based Services Therapeutic Foster Care Therapeutic Group Home
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What Kind of services does Diagnosis and Evaluation give For?
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Assess physical and health, intelligence,academic, potential social, & behavioral functions Family dynamics and environment
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What kind of Core Services Outpatient Treatment have for Adolescents
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Regularly scheduled Individual, Group and Family
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What kind of Core Services Day Treatment have for Adolescents
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Integrates educational/mental health Services during school hours at special schools or mental health centers Partial Hospitalization Programs for Adolescents
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What are Emergency Services for Adolescents as adults
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Runaway Shelters
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What is the purpose for Home Based Core services for Adolescents
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Family Centered care designated to preserve the Family unit
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What kind of Core services do Therapeutic Foster Care give to Adolescents
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Designated for Troubled children within private homes or trained families
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Who licenses Mental Health Facilities
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The State by the Department of Health or The Department of Mental Health
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Accreditation is
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Voluntary
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What are the Three accrediting bodies for Mental Health Facilities?
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1. Joint Commission 2. CARF 3. NCQA -accredits Managed Behavioral Health Care Organizations or Behavioral Health Programs within MCO
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Explain Standards for accreditation for Inpatient and Hospital-based Outpatient facilities providing Mental Health Services?
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Comprehensive Accreditation Manual for Hospitals of JC
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Under what standards are accredited the settings such as Group Homes and Freestanding facilities/
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Comprehensive Accreditation Manual for Behavioral Health Care
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What are some key elements for Mental Health Documentation
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Assessment Treatment Plan Progress Note Special Treatment Procedures Discharge Summary and Plans for aftercare Inpatient Hospitalization
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What are the COP requirements for inpatient psychiatric patients' psychiatric evaluations be performed?
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Within 60 hrs of admission
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What are the key components for Assessment for Behavioral Health Facilities and Rehabilitation Facilities?
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include intake (general assessment) demographic data, history, physical, emotional, behavioral, social, recreational, legal, vocational or nutritional assessments.
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What is the documentation for Mental Health Facilities?
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Assessment Treatment Plan Progress Notes Special Treatment Procedures Discharge Summary and Plans for aftercare Inpatient Hospitalization
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What should be included in the Progress Notes for Mental Health Facilities ?
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It should include documentation related to treatment goals, and as per Federal regulations it should be written by physicians, nurses, social workers and others involve in the treatment
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Give some examples for Special Treatment Procedures
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ECT, use of seclusion or restraints or psychosurgery.
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What is the time frame for restraints/seclusion to be used?
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most not to exceed 24 hours
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Who can order restrains in an emergency and for how long?
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Clinically privileged staff can order restraints for up to 1 hour, and physicians can order restrains for more that one hour.
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When a patient is restrained the patient must be monitored every?
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At least every 15 minutes.
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Explain the Standards for Psychiatric Hospitals Development of Assessment/Diagnostic data.
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It should include history of findings and treatment provided Patient's legal status must be documented Most be a Provisional or Admitting Diagnosis at the time of admission Reason for admission stated by patient and others Most be Social Service Records e.g. interviews w/patient and family, home plans, family attitudes, community resource contacts and social history. A complete neurological exam must be documented.
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Federal Facilities received reimbursement from:
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Medicare and Medicaid and must comply with the appropriate COP
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Explain the Standards for Psychiatric Hospitals Evaluation.
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1.Be completed within 60 hours of admission 2.Include a medical history 3.Contain a record of mental status 4.Note the onset of illness and the circumstances leading to admission 5. Describe attitudes and behavior. 6. Estimate intellectual functioning, memory, and orientation. 7. Include an inventory of the patient's assets in descriptive, not interpretative fashion.
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Explain the Standards for Psychiatric Hospitals Treatment Plan
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The written plan must include: A substantiated diagnosis Short-term and long range goals The specific treatment modalities utilized The responsibilities of each member of the treatment team Justify the diagnosis, treatment, and rehabilitation activities Include all active therapeutic efforts and treatment received
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Explain the Standards for Psychiatric Hospital Recording Progress.
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It must be recorded at least weekly for the first 2 months and at least once a month thereafter. Must be recorded by the doctor of medicine or osteopathy responsible, nurse, social worker, and other that are involve in active treatment modalities.
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Explain the Standards for Psychiatric Hospital Discharge Planning and Discharge Summary
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At every discharge it most contain a discharge summary that includes a recapitulation of the patient's hospitalization and recommendations concerning follow up or after care and a brief summary of the patients
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What is the goal of all Rehabilitation Settings
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Is to help the patient develop to the "fullest physical, psychological, social, vocational, avocational, and education potential possible with his/her physiological or anatomic impairment and environmental limitations".
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What are the two type of settings for Rehabilitation Setttins
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Inpatient and Outpatient
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What type of patients are serve by Rehabilitation Settings
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Serve those with orthopedic, neurologic, and medical conditions. helping those with acute and chronic It serves both adults and pediatric patients.
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Define Impairment
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Loss or abnormality of psychologic, physiologic or anatomic structure or function. It is a disease or diagnosis.
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Define Disability
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Any restriction or lack resulting from the impairment of the ability to perform an activity in a manner considered normal. It is how the disease affects the person.
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Define Handicap
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Disadvantage resulting from impairment or disability that prevents fulfillment of a role that is normal. A handicap is an interaction between impairment and socioeconomic environment. It is the affect of the problem on the person's life (how it affect the person's life)
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DME
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Durable Medical Equipment
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Define Durable Medical Equipment and give some e.g
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are assistive devices or equipment that can withstand repeated use. e.g. orthotics (appliances to support, align, prevent or correct deformity), ambulation aids, prosthetics, wheel chairs, mobility devices and high technology assistive devices.
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What are the two accreditors for Rehabilitation Facilities
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Joint Commission and CARF
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What are the Medicare Requirements for reimbursement for Rehabilitation Facilities?
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Must have a full time medical director (MD 0r DO) has two year of training or experience or board certified in psychiatry, neurology, neurosurgery, orthopedic surgery, or rheumatology -the hospital should have preadmission screening procedures a multidisciplinary team and to held team conferences at least every two weeks to update the plan of care.
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Key elements for rehabilitation Facilities
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H&P MD documentation weekly team conferences Progress Notes by Medical Nursing and therapy staff Individual Program Plan Discharge Summary
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What should be included in H&P
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Description of the patient's functional status prior onset of illness/injury ADLs, assistive devices reliance on caregivers, social history(describing caregivers and Home) a comprehensive neurological ; musculoskeletal examination (ROM) Contractures, amputations DVT skin condition cognitive status (speech and language) psychiatric history
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What should be documented in the MD assessment for Rehabilitation Facilities
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SNAP Strengths, Abilities, Needs and Preferences Desire Outcomes and expectation Anticipated Outcomes of interdisciplinary Team Assessment finding to direct development of Plan
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Why is important the Individualized Program Plan
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It helps to establish goals and objectives for the admission
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What are some of the Classification Systems
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American Spinal Injury Association (ASIA) Traumatic Brain Injury Classification System( TBI) Functional Independence Measure Scores
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Explain ASIA American Spinal Injury Association
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Standardizes the neurological motor and sensory examination Diagnosis can be stated giving a sensory and motor neurological level and completeness of spinal cord injury
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Give two examples of Traumatic Brain Injury Classification System
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1. Glasgow Coma Scale 2. Rancho Los Amigos Scale
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Explain Glasgow Coma Scale
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Used in ED after injury and in the first 2-7 days post injury scores measuring eye opening motor response and predictive of patient's outcome
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Explain Rancho Los Amigos Scale
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Score ranging from 1-8 are used to communicate patient's level of recovery
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Explain Self-Care scales
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used to assess patient functional status in terms of ADLs e.g. Katz index, Bartel Index, Functional Independent Measures (FIM)
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Explain FIM
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Scores is incorporate into Medicare's new PPS System for impatient rehabilitation hospitals -documents severity of disabilities and outcome sin rehabilitation Commonly used measure of independence assesses improvement documents functional status and discharge planning needs justify treatment and costs, provide communication among professionals and standardizes nomeclature for functional outcome -score motor function in 13 areas -eating, grooming,bathing, dressing, toileting, sphincher control, mobility, location, comprehensive communication, comprehensive expression, social cognition- social interaction , problem solving, memory
