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Crossroads Agency Client Manual Updated Jan 2017

Client Manual

Developed By: Katie Viola Downey, LICSW

Program Director

Reviewed & Revised:May 2016, January 2017

CONFIDENTIALITYThis manual details policies and procedures relevant to Crossroads Agency. Unauthorized copying and distribution is prohibited.

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Section Page #Introduction and Welcome………………………………………………………………………………………………………………………… 3About Crossroads Agency…………………………………………………………………………………………………………………………… 3Our Program Philosophy………………………………………………………………………………………………………………………….… 3Goals and Objectives………………………………………………………………………………………………………………………………..… 3What is Confidentiality?……………………………………………………………………………………………………………………………… 4Limitations to Confidentiality……………………………………………………………………………………………………………………… 4What is a Qualified Service Organization Agreement?……………………………………………………………………………….. 5What type of treatment does Crossroads Agency provide?............................................................................ 5Family Support and Involvement……………………………………………………………………………………………………………..… 5What treatment approaches and modalities are used?……………………………………………………………………………… 5Crossroads Agency’s Stance on Medication Assisted Treatment………………………………………………………………… 6Overdose Prevention…………………………………………………………………………………………………………………………………. 7Nasal Narcan……………………………………………………………………………………………………………………………………………… 7Psychiatric Medication Evaluation and Treatment……………………………………………………………………………………… 8Qualifications of Service Delivery of Staff…………………………………………………………………………………………………… 8Special Accommodations for Equitable Access to Services…………………………………………………………….…………… 8Client Rights……………………………………………………………………………………………………………………………………………….. 8Client Responsibilities………………………………………………………………………………………………………………………………… 9Grievances…………………………………………………………………………………………………………………………………………………. 9Admission Eligibility Requirements……………………………………………………………………………………………………..……… 9Admission Process……………………………………………………………………………………………………………………………………… 10Readmission Process……………………………………………………………………………………………………………………………..…… 11Treatment Planning………………………………………………………………………………………………………………………………….… 11Discharge/Aftercare Planning…………………………………………………………………………………………………………………..… 11Program Rules/Guidelines………………………………………………………………………………………………………………………….. 12No Call No Show Policy/Attendance Policy…………………………………………………………………………………….…………… 12Discharge/Appeal Process……………………………………………………………………………………………………………………..…… 12Payment Policy…………………………………………………………………………………………………………………………………………… 13Child Safety………………………………………………………………………………………………………………………………………………… 13No Smoking Policy……………………………………………………………………………………………………………………………………… 13Client Advisory Board (CAB) ……………………………………………………………………………………………………………….……… 13Right for Self-Determination………………………………………………………………………………………………………………….…… 13Post-Discharge Follow-Up……………………………………………………………………………………………………..…………………… 13Clinic Hours………………………………………………………………………………………………………………………………………………… 13Client Resource List……………………………………………………………………………………………………………………………………. 14Receipt of Program Policies/Procedures…………………………………………………………………………………………………….. 16

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Introduction

Welcome to Crossroads Agency! We have developed this manual to make sure that you understand what will be expected of you while you are in treatment with us, as well as what will be required of us in order to meet your treatment needs.

Please take time to read this manual and ask your therapist for assistance in understanding it. While you are in treatment, review the policies, rules, and guidelines from time to time. We recommend that you act in accordance with all policies, rules, and guidelines described in this manual. If you do so, our staff will have the greatest opportunity to focus their energies on helping you meet your treatment goals.

Crossroads Agency is invested in performance and quality improvements, which means that we are continuously assessing our services and implementing changes that will improve the Agency. Your feedback is instrumental to helping us understand what areas are in need of change. Therefore, from time to time, we will be asking you to complete a survey. The survey is confidential, and if you choose, can be anonymous. Thank you in advance for helping us make this agency the best it can be.

About Crossroads AgencyCrossroads Agency is an outpatient mental health and substance use disorder counseling agency located in Springfield, Pittsfield and Worcester. The agency is dedicated to providing a wide range of services to individuals in need. Crossroads Agency was founded by George Collins in 2010 who was inspired to create the agency based on his personal experience, and his recognition and understanding of the benefits treatment can have on an individual, a family and/or their loved ones. George passed away suddenly in June 2015; however his legacy lives on through the clinicians that work tirelessly to follow the agency’s mission as well as in the clients that continue to seek services and not give up on themselves or their recovery.

Our Program PhilosophyCrossroads Agency serves to provide you with the highest quality mental health and substance use disorder treatment services, so that you may achieve your goals and improve your quality of life. Mental health and substance use diagnosis are complex brain disorders that impact biological, psychological and social areas of life. Our goal is to help you work through and resolve the deficits that have been created as a result of your diagnosis.

Our philosophy is based on the idea that in order to foster recovery, hope, self-determination and personal growth, we must create a safe and supportive atmosphere free from judgment. Our agency’s expertise is in working with clients that are on medication assisted treatment [MAT (Buprenorphine/Naloxone, Vivitrol and Methadone Maintenance)]; however, the majority of our clients present with underlying mental health conditions and/or compulsive behaviors. Therefore, the clinicians of Crossroads Agency are trained in the treatment of co-occurring disorders. Our target population is any individual that is seeking treatment for substance use/mental health issues. We employ Trauma Informed Care and practices, and given the ethnic and linguistic make up of the surrounding area, we have bilingual office and clinical staff.

Goals and ObjectivesThe goals and objectives of Crossroads Agency are based on the recognition that the presence of substance use or mental health disorders is not a personal failure, but a dynamic process that impacts people of all ages, economic background and cultural groups. It affects not only you, the client, but family members, friends, partners and others. The goals and objectives of Crossroads Agency are also to encourage a slow and steady course toward achieving optimal functioning. This requires a commitment to treatment and a persistent effort on your part. From the date of your initial appointment to the day in which you choose to discharge from our program; the agency will make sure that you are appropriately matched to a therapist that best meets your needs. During the first few weeks of your treatment, you will undergo assessment and evaluation. You and your therapist will develop a treatment plan that will reflect problems and/or needs identified during and preceding the intake assessment as well as any problem areas you determine to be significant to your recovery process. Treatment is individualized and based upon each client’s identified goals. Your success will be dependent on your determination and motivation.

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What is Confidentiality?Confidentiality is the cornerstone for providing a safe and healthy environment to our clients. The purpose of confidentiality is to protect a client’s right to privacy by making sure that information communicated between you and your clinician is not relayed or discussed to others without your written/signed consent. When you are first seen at Crossroads Agency, you will be provided with an explanation of our Privacy Practices Notice and right to confidentiality. The Privacy Notice describes how medical, substance use, mental health and other protected health information may be used and disclosed, and how you can gain access to this information. You will be asked to sign an acknowledgement that have you have seen and understand the notice. A copy can be given at any time.

Client confidentiality is protected by state and federal laws. These laws include HIPAA and 42 CFR Part 2 (see specific explanation below). Under these laws, Crossroads Agency cannot disclose any information to a source outside of Crossroads Agency that you attend the services within the agency. Furthermore, Crossroads cannot disclose any information identifying you as a substance use or mental health client, or disclose any other protected information except as permitted by state and federal law.

HIPAA – The Health Insurance Portability and Accountability Act: All personal health information including demographic data that is created by the agency and relates to your medical or mental health, the services you are provided, and payment for services falls under this federal law and may not be released without your written consent.

42 CFR Part 2: All information identifying you as an individual receiving treatment for a substance use disorder is confidential and may not be released without your written/signed consent. This federal regulation was created to decrease the stigma associated with substance use and to encourage increased access to treatment.

Limitations to Confidentiality Crossroads Agency must obtain your written consent before it can disclose protected health information about you. However, federal law permits Crossroads Agency to disclose information without your written permission in the following situations: Child Abuse or Neglect: Clinicians are required to file a report with DCF if you report that a child is being abused or neglected

(Once a report is filed, no other communication can be provided to DCF without written/signed consent by the client); Elder Abuse/Neglect: As mandated reporters, we may disclose your protected health information for the purpose of reporting

suspected elder abuse and/or neglect to the Department of Elder Affairs. The report is made immediately to the Elder Abuse Hotline, 800-922-2275.

Duty to Warn: a.) If you make an explicit threat to kill or inflict serious bodily injury on an identified victim(s) and the clinician believes that you have the intent and ability to carry out the threat, or b.) If you have a history of physical violence which is known to your clinician, and your clinician believes that there is a clear and present danger that you will attempt to kill or inflict serious bodily harm on an identified victim(s), your clinician must take reasonable precautions to warn or protect the intended victim(s) that you have identified;

Medical Emergencies: In the event that a major medical emergency takes place at the agency, information about you for the purpose of treating a condition that poses an immediate threat to your life and safety will be provided to ensure immediate medical intervention;

If a crime takes place on the program grounds or against a staff member of the program: The program may provide a limited amount of information to law enforcement. Only information related to the circumstances of the incident can be reported. Identifying you as a an individual with a substance use disorder is not permitted unless the crime is related directly to this;

If there is an agreement with a Qualified Service Organization Agreement (QSOA).Feel free to ask any of our clinicians or staff members if you would like more information or need further clarification on the topic of confidentiality.

What is a Qualified Service Organization Agreement (QSOA)?A QSOA is a two-way agreement signed between Crossroads Agency and an external service provider/agency/program providing services to Crossroads Agency clients on our behalf. The QSOA authorizes communication between the two parties under the same confidentiality guidelines described above. Under the guidelines of a QSOA, Crossroads Agency can provide the external entity with only enough information to allow the external entity to carry out its intended service. If additional information is necessary to carry out the service, you will be asked to sign a written consent specifically indicating what information you agree to release.

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What type of treatment does Crossroads Agency provide?Crossroads Agency provides counseling for mental health and substance use disorders. Our clinicians are also trained in treating other compulsive behaviors such as gambling, eating and sexual addiction(s). We provide individual and group therapy as well as Day Treatment services*. Individual Counseling: A therapeutic process through which clients work one-on-one with a trained therapist in a safe, caring

and confidential environment to explore feelings, beliefs, and behaviors that negatively influence their lives. The aim is to help facilitate change and improve quality of life.

Group Counseling: A therapeutic process in which clients meet in a confidential group setting with other clients experiencing similar stressors. Group members share personal information and provide feedback to others while the group leader facilitates productive communication. Topics may include exploring relationships, improving self-esteem, developing/enhancing coping skills, relapse prevention planning.

Day Treatment: Crossroads Agency’s Day Treatment Program consists of short-term, clinically intensive, structured day treatment. A client in the Day Treatment Program attends group therapy from 11:30am to 3pm. Day Treatment is attended five days a week or for a total of twenty sessions (Insurance may authorize a different number of sessions). Sessions are structured around specific topics related to substance use, mental health and co-occurring disorders. Completion of the Day Treatment Program includes attendance to all authorized sessions. *Currently provided at the Springfield site only.

Family Support and InvolvementCrossroads Agency believes in the benefit of incorporating family support into the counseling process. Your clinician will ask you about your interest in inviting your family members, partners, etc to be a part of your treatment. Clinician’s can assist these relationships by providing support and education to loved ones about mental health or substance use disorders. You must sign a written consent prior to engaging in a family counseling session.

*Family therapy and Couples counseling is offered by clinicians at Crossroads Agency on a limited basis; however, we are able to provide referrals to agencies within the community through the use of QSOA’s that can provide these services if we are unable to do so.

What treatment approaches and modalities are used?Crossroads Agency’s therapists use evidenced based treatment approaches. This means that the types of therapy provided have been studied and determined to be effective. These treatment approaches include Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Trauma Informed Therapy and Harm Reduction. CBT: This treatment approach focuses on exploring the relationship between a person’s thoughts, feelings and behaviors.

During CBT, a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs. The core principles of CBT are identifying negative or false beliefs and testing or restructuring them so that a new and healthier thought process can emerge.

MI: This is a treatment method that works on facilitating and engaging internal motivation within the client in order to change behavior. It is a goal-oriented, client centered counseling style for eliciting behavior change by helping clients to explore and resolve their ambivalence towards treatment or recovery.

Trauma Informed Therapy: This is an organizational structure and treatment framework that involves understanding, recognizing, being sensitive to and responding to the effects of all types of trauma that may have been experienced by the clients that we treat.

Harm Reduction: Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. For example, therapists educate their clients about safe disposal of needles to prevent the transmission of infectious diseases.

Psycho-education: Psycho-education refers to the education offered to clients with a mental health condition or substance use disorder to help empower them to deal with their condition in an optimal way. If a client is not educated about their condition or ways to decrease the symptoms associated with their condition, they may continue to be negatively impacted by them.

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Crossroads Agency’s Stance on Medication Assisted Treatment (MAT)Crossroads Agency believes in the use of MAT for clients with Opioid Dependence or Alcohol Dependence (Buprenorphine, Methadone, Vivitrol). Although our agency does not provide MAT, Crossroads collaborates with a number of local Suboxone/Vivitrol programs. We believe that in order for you to be successful in your recovery, we must work together with your other providers. We will ask you to sign a release of information if you identify being on MAT or if you request a referral to become established on MAT. Buprenorphine/Naloxone: This prescription medication commonly known as Suboxone, combines the medication

Buprenorphine and Naloxone to treat Opioid Dependence. It belongs to a class of drugs called opioid partial agonists. It does not cause euphoria, but does prevent symptoms of withdrawal and allows an individual to live a normal lifestyle. This medication is taken daily and works by sitting on the “opiate receptors” in the brain preventing other opiates from attaching and being able to take effect.

Vivitrol for Opioids Dependence: This prescription medication is a long-acting (approximately one month) form of Naltrexone, which is an opioid blocker. Vivitrol is injected on a monthly basis into the Gluteal muscle. Once injected, the medication travels to the brain and blocks the “opioid receptors.” This prevents an individual from feeling the effect of an opioid and minimizes cravings. In order to get onto Vivitrol, an individual must be free from any signs or symptoms of withdrawal for a specified period of time (approx 7-10 days).

Vivitrol for Alcohol Dependence: The exact same medication described above, can be used for the treatment of Alcohol Dependence. It works by reducing an individual’s desire to drink. It also decreases the feelings of well-being associated with alcohol consumption.

Buprenorphone/Naloxone and Vivitrol treatment can be obtained through Experience Wellness Centers, On Call Urgent Care, The Healthy Living Program, CleanSlate Centers, Holyoke Health Center and Brightwood Health Center. Methadone Maintenance: Methadone is a medication that can only be prescribed for the treatment of Opioid Dependence at a

Methadone Maintenance Treatment Program. Methadone is an opioid agonist, which means it has similar properties to other narcotic medication; however when taken on a daily basis, it eliminates physical withdrawal symptoms. At appropriate dose levels, it can reduce and/or eliminate cravings to use opioids, and if you do use opioids, it blocks the euphoric effects of the opioid.

Methadone Maintenance Treatment can be obtained at Community Substance Abuse Centers, Habit OPCO, and Providence Behavioral Health Hospital.

Benefits and Risks of Medication Assisted TreatmentScientific research has established that MAT increases the length of time that clients remain in treatment as well as decreases drug use, potential risk for overdose and death, the transmission of infectious disease such as HIV and Hepatitis C, as well as criminal activity. Often times, substance users enter the prison system as a result of being arrested while engaging in illegal behavior to have the financial means to use their substance of choice. MAT has also been proven to decrease the number of times a client goes to detox, number of emergency room visits and number of times a client is admitted to the hospital due to substance use. Over time, MAT can improve relationships, financial stability, employment opportunities and overall health and psychological well-being.

Like all medications, there are risks associated with being on Medication Assisted Treatment. Some of the risks are as follows: physical dependence, which results in withdrawal if stopped abruptly, respiratory depression when used with other substances (alcohol, benzodiazepines), experience of side effects, and pregnancy related issues (Methadone and Buprenorphine are both Category C medications. Vivitrol cannot be used during pregnancy).

Please note: Use of any of the medications explained above is not sufficient to treat a substance use disorder. Medication in conjunction with therapy and other support services such as AA/NA has been proven to improve an individual’s chance for sobriety and long-term recovery. The benefits and risks explained above should be discussed between you and your medical provider to determine if MAT is the best treatment option for you.

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Overdose PreventionIn March 2014, the Governor of Massachusetts declared a public health emergency due to the growing abuse of opioids including prescription synthetic opioids and Heroin. Since that time, the number of overdose deaths in the United States has surpassed the number of deaths caused by Motor Vehicle accidents. The Massachusetts Department of Public Health determined that there were 1256 overdose deaths in 2014, and 1526 overdose deaths in 2015. This number has increased in 2016 and will continue to increase without significant changes being made.

Individuals that are most susceptible to an overdose death include individuals that: Use an opioid with another respiratory depressant such as Benzodiazepines and/or Alcohol; Obtain the opioid from a new supplier; Use the same quantity of the drug after a sustained period of sobriety (Ie: Being released from jail, detox, treatment program); Use alone; Have someone else inject them; Have multiple years of experience using Opioids.

It is important for you to be aware of the signs of overdose. An overdose is a medical emergency that requires 911 interventions. Signs of an overdose include: Breathing that is slow, shallow or no breathing at all; Very sleepy and not responding to your voice or touch; Blue or grayish skin color, with dark lips and fingernails; Snoring or gurgling sounds.If you observe these signs, call 911 immediately, then: Tap, shake, and shout at the person to get a response; If there is still no response, rub knuckles on the breast bone (Sternum Rub); If you have access to Narcan, use it! If the individual is not breathing, begin rescue breathing. If the individual’s heart stops, begin CPR if you know it or yell for someone who does to assist you with it.

Nasal NarcanIn the event of an overdose, a medication called Narcan can be administered. Most medical personnel have Narcan on hand and are trained to use it. It is a nasal spray that reverses the effect of an overdose. Any individual can obtain Nasal Narcan at a local pharmacy. It can also be obtained for free by calling toll free (800)-383-2437. If a person overdosing is given Narcan, they must still be assessed by emergency medical personnel as it is still possible for them to overdose once the Narcan has worn off. Narcan only works on overdoses caused by the use of opiates, including: Heroin, OxyContin, Methadone, Morphine, Percocet, Fentanyl, Hydrocodone, Vicodin, etc.

Psychiatric Medication Services *Currently provided in Springfield, but clients from other sites may be referredCrossroads Agency has a qualified service provider on staff that is licensed and certified to provide medication management assessments and prescribe psychiatric medication. In order to be referred for psychiatric medication services, you must be an established client of the agency. Your therapist must refer you. Your therapist can only refer you after consistent attendance of at least three counseling appointments. Once you are referred, clinical staff will review your referral. If your referral shows evidence of a need for a medication assessment/psychiatric medication, you will be scheduled for your initial appointment. You will be required to sign an attendance contract, a controlled substances contract and agree to allow the qualified service provider to review your medications, both past and present, in the prescription monitoring program. If you have an extensive history of psychiatric care, you may be asked to sign a release of information so that the qualified service provider can have additional information when determining the best course of medication for your treatment. If you had been previously receiving medication from your primary care doctor or had recently been at an inpatient facility for the treatment of your mental health, you may also be asked to sign a release of information. We will make every effort to schedule your appointment as soon as possible. If it is determined that you are in need of a higher level of care, the qualified service provider as well as your clinician will assist you with a referral. Qualifications of Service Delivery of Staff

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Crossroads Agency’s staff meets the guidelines for DPH/BSAS personnel qualifications. The agency is staffed with highly qualified therapists that have advanced degrees, independent licensure and/or certification and have many years of experience in the field. In-service trainings are provided and attended on site as well as externally on a regular basis to ensure that all staff has up to date information on various topics related to the treatment of mental health and substance use disorders.

Special Accommodations for Equitable Access to ServicesCrossroads Agency is located on a ground floor office building that allows for easy access for individual’s that require ambulatory assistance (Ie: wheelchair, walkers, scooters). The agency complies with The Americans with Disabilities Act and provides trainings and education to the staff on an annual basis. Our Access Coordinator completes an assessment of needs and assists the agency in implementing new practices that ensure each individual obtains equal treatment. If a client of Crossroads Agency requires special accommodations, all reasonable efforts will be made to secure these accommodations. If you are disabled and do not feel that appropriate accommodations are being made, please inform your clinician. You may also file a grievance using our formal grievance process.

Client’s Rights and ResponsibilitiesIt is extremely important to us at Crossroads Agency that you maintain awareness of your legal rights and responsibilities as a client of our agency. According to Mass. General Laws Ch.111, s.70E & Chapter 91 of the Acts of 2005 and 164.09 CMR Licensure Regulations for Substance Abuse Treatment Programs by The Department of Public Health:

You have the right to: Considerate and respectful care, free from abuse, neglect or exploitation; Freedom from strip searches and body cavity searches; Control over your bodily appearance; however, on program premises, the licensee may prohibit attire and personal decoration

that may interfere with treatment; Treatment without regard to race, ethnicity, creed, national origin, religion, gender, gender identity, sexual orientation, age, or

disability; To challenge information in your client record by inserting a statement of clarification or letter of correction signed by both you

and yourt; Informed consent, including information about your condition and proposed treatment; Effective communication, involvement in the decision-making process, including the right to refuse treatment; Have your cultural, psychosocial, spiritual, personal beliefs or preferences respected; An environment that preserves dignity and contributes to a positive self image; Privacy during treatment/care; Obtain the name and specialty of the person responsible for your care; Prompt life-saving treatment in an emergency; Expect continuity of care; To terminate treatment at any time; Freedom from coercion; Confidentiality, privacy and security of medical records and communication (HIPPA, 42 CFR Part 2); Access to your record in the presence of the administrator or designee unless there is a determination that access to parts of

the record could cause you harm; Request a copy of your health record (upon the payment of a fee for copying, if applicable); Receive an itemized bill and information regarding financial aspects of your treatment.

You have the responsibility to: Provide information about past illnesses, hospitalizations, medications, and other matters relating to your health;

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Keep scheduled appointments and notify us when unable to do so; Be considerate of other clients in the waiting room; Respect agency property and use it responsibly; Provide financial and health insurance information necessary for the processing of your bill and be prompt in paying outstanding

charges; To grieve actions or decisions of the agency regarding your treatment; Freedom to practice your religious faith; To request a referral to a facility which provides treatment in a manner to which you do not object; To contact the Department of Public Health for any reason; Inform the agency administration immediately if you believe any of your rights have been, or may be violated.

GrievancesIf you have a complaint about your treatment at Crossroads Agency you have the right to file a grievance. We suggest that you file your grievance with your clinician, however if your grievance is with your clinician, you can file your grievance with your clinicians’ immediate supervisor, the Senior Clinician, or Program Director. We will attempt to resolve your grievance as soon as possible. Investigating the grievance may require us to interview you. If you are dissatisfied with the outcome of the grievance, you may appeal it. We will make every effort to resolve the issue in a timely manner. You will be provided with the outcome in writing. Regardless of the outcome you will suffer no reprisal, retaliation or punishment of any sort. You may also contact The Department of Public Health Bureau of Substance Abuse Services at (617) 624-5171. For more information about this process, please ask for a copy of our grievance policy

Admission Eligibility RequirementsThe following list includes the requirements necessary to be eligible for outpatient counseling services.1. Any individual(s) with concerns about a mental health or substance abuse problem, or a family member/significant other who

has concerns about someone else’s mental health or substance abuse problem;2. A desire to work on and improve overall understanding of mental health and substances use disorders to improve well-being;3. Therapist availability ;4. Active health insurance that is taken by the agency (If a client does not have health insurance, they may pay out of pocket for

services).

Admission Process1. An individual must contact Crossroads Agency via telephone, website or in person to complete a registration information form.

Your health insurance will be verified. You will be scheduled with the intake coordinator for the initial intake appointment if admission requirements are met.

2. The Intake Clinician will meet with you to determine if you meet the necessary criteria for an outpatient treatment level of care. If it is determined that you need a higher level of care, or do not present with a mental health or substance use disorder, the intake clinician will provide you with a referral(s) to ensure that you are able to access the appropriate level of care.

3. Once it has been determined that you meet the requirements for the level of care provided at Crossroads Agency, the Intake Clinician will begin the process of reviewing the consent packet with you. The consent packet includes the following documents, which you will be asked to sign:

a. Client demographic form;b. Consent for treatment;c. Consent for Crossroads to bill your health insurance;d. Copayment and attendance expectations;e. Notice of Privacy Practices, which includes an explanation of our privacy and confidentiality practices, uses and disclosures of your protected information with and without your authorization, your individual rights regarding access to your records, and how to file a grievance if you feel your rights have been violated;f. Requirements for court appearances and subpoenas;g. Explanation of No Call No Show Policyh. Individual Releases of Information

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You are encouraged to ask as many questions as necessary to make sure that you have a clear understanding of what you are signing.

4. You will also be provided with this Client Manual. The Client Manual is designed to provide you with answers to common questions that you may have about your treatment at Crossroads Agency. You will also be provided with an orientation resource folder that includes information and education related to a number of different topics that may impact you. You will then be asked to complete the intake assessment and evaluation.

5. Questions that you may be asked during the intake assessment and evaluation include but are not limited to the following:a. Reason for seeking treatment;b. Referral source;c. History of psychiatric issues (hospitalizations, medications, suicidal ideation/attempts);d. Family history (Psychiatric and Substance use);e. Legal Issues;f. Family/Financial/Employment Stressors;g. Medical History (treating physicians, medications, allergies);h. Substance use history (Type of substances use, age of first use, frequency of use, overdoses);i. Substance use treatment history;j. Current referral needs

6. You will also be asked to complete a number of assessments tools. Your response to these assessments tools will help you and your therapist to determine the best course of treatment and best treatment approaches for you. The following is a list of the assessment tools you will be asked to complete:

a. The Beck’s Depression Inventory: a 21 questions multiple choice self report inventory that measures the severity of depression;

b. The Burn’s Anxiety Inventory: a 33 question multiple choice self report tool that measures anxiety;c. The Drug Abuse Screening Test: a 20 question yes/no test that measures the presence of a substance use disorder; d. The HIV assessment: assesses for any high risk behaviors that you may be engaged in that require education to

decrease the possibility of transmission (Education will be provided to you during and upon completion of this assessment);

e. The Tobacco Assessment: a measurement of your readiness for quitting the use of nicotine products (If requested, Tobacco Cessation will be added to your treatment plan and information and education will be provided to you regarding ways to quit. Please inform your clinician if you would like us to send a referral request to your primary care physician for nicotine replacement therapy options);

f. The TB Assessment: determines if you have any past or present TB symptoms.7. The Intake Clinician will review all of your information and score your assessments once completed. The Intake Clinician will

then utilize the agency therapist matching system to determine who will be the best therapist for you. You will then receive your appointment for the second half of your intake, which will be with your assigned therapist.

8. Upon meeting with your primary assigned therapist, you and he/she will review your initial intake paperwork. You will begin to discuss goals for treatment and start the process of creating your treatment plan. You will also begin the process of discussing plans for discharge and aftercare planning.

9. You will be responsible for notifying the agency of any changes to your contact information (phone number, mailing address & email address) and health insurance coverage.

Readmission Process:If you present to the agency requesting readmission after being discharged due to attendance or behavioral issues, you will be asked to complete an appeal request. If there are no disciplinary reasons for your discharge, you will be scheduled for a readmission appointment. For all readmissions, we will do our best to see that you return to the clinician that you had prior to your discharge unless otherwise indicated by you. During the readmission appointment, you will be asked about any changes that have taken place since your absence from the agency. You will be required to review and sign the consent packet as well as complete the assessment tools. You will then begin creating your treatment plan with your clinician.

Treatment Planning

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A treatment plan serves as a basis of shared understanding between you and your clinician where information gathered is used to put treatment into practice. You and your clinician will create an initial treatment plan within the first two counseling visits. Based on the information you provide in your intake and assessment, you and your clinician will agree on primary problem areas to focus on as well as will establish agreed upon goals that you can meet during the therapeutic process. Your treatment plan will be reviewed with you every three months to determine if new problem areas are necessary, if goals have been met, if new goals need to be developed and if on-going treatment remains indicated.

Discharge/Aftercare Planning The Discharge and Aftercare planning process begins at the very beginning of your treatment. This is an important

component to the therapy process as it encourages you and your clinician to determine effective ways for you to remain stable once you have completed treatment at the agency. Some common characteristics of a discharge/aftercare plan include the following: activities to help you prevent lapse or relapse, development of a support system for you and your recovery, resources and referrals for school and/or work, and a list of referrals to contact if you are in need of specialized services or treatment. In the event that you choose to end your treatment against clinical advice, or without warning, you will have a plan in place to utilize if needed.

Program Rules and GuidelinesWe reserve the right to transfer a client to a different therapist for the following reasons: health insurance changes if present therapist does not accept the newly assigned health insurance, a conflict of interest arises, a client requests transfer for a sufficient reason. Other transfers may be approved at the discretion of the Clinical Director. Clients must abide by all of the program rules. The following rules are broad and general; therefore, they do not include every specific instance or behavior that may be construed as a violation. The program staff collectively determines when a violation occurs. Violation of program rules may lead to disciplinary action up to and including discharge from the agency. Crossroads Agency takes pride in providing a safe environment that provides quality treatment. We have high standards of behavior to ensure that all of our clients are able to receive optimal treatment in a safe and healthy way.

Clients must follow all of the program rules. We reserve the right to discharge clients due to conflicts that cause safety concerns among other clients and/or staff. Crossroads Agency has a zero tolerance for violence of any kind. The following is a general list of program rules:1. Clients must not attend therapy under the influence of alcohol and/or substances.2. Clients must not bring any weapons onto the agency grounds at any time.3. Clients must attend all scheduled counseling sessions. 4. Clients must call at least 24 hours in advance to cancel or reschedule a counseling appointment so as to avoid having a no call no

show.5. Clients will try to obtain supervision for their children while in therapy session. 6. Clients will maintain supervision of their children while at Crossroads Agency.7. Clients will refrain from using cell phones in waiting rooms and during counseling sessions.8. Clients are prohibited from smoking on agency grounds.9. Clients may not use a vaporizer with or without Nicotine by-product while on agency grounds.10. Clients will treat all staff with respect.11. Clients will respect the confidentiality of other clients seeking/receiving services from Crossroads Agency.12. Clients will be respectful of others in common/shared waiting areas.

No Call No Show Policy/Attendance PolicyClients are expected to attend all of their scheduled counseling appointments. Crossroads Agency understands that there may be emergency situations that result in an absence from a counseling visit. You will be informed about the attendance policy at admission and you will be asked to sign the “No Call No Show” policy. If you are absent a total of four times without calling in advance to cancel, you will be discharged from the agency. You have the right to appeal your discharge.

Discharge and Appeal Process

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Clients can be discharged from Crossroads Agency for the following reasons: Chronic No Call No Shows; Chronic cancellation or reschedules; Non-adherence to medication management requirements (selling, misuse, abuse of prescribed medications); Absence from the agency for 60 days without contact; Moving out of the area; Incarceration; Behavioral concerns that jeopardize agency safety; Administrative reasons; Self-discharge*

If you are discharged from the agency, you will receive a written notice in the mail. The notice will inform you as to why you were discharged and will include an appeal form and resources to assist you in finding other treatment options. All clients of Crossroads Agency have the right to appeal their discharge. Clients may also present to the agency in person to request an appeal form. Once the appeal form is completed and submitted, it will be reviewed by the agency staff. The staff will collectively make a decision about your appeal. If you are able to return, you will receive mailed written notification confirming approval of your appeal, which will include the therapist that you will be scheduled to see.

You may not be able to schedule with your previous therapist. It is your responsibility to contact the agency to schedule a return appointment. If you do not contact the agency within three weeks of receiving the approval letter, the agency will assume that you wish not to return. If you are not approved for return to the agency, you will receive written notification as well as a thorough explanation. You will also receive a list of agencies that you can contact for services.

Payment PolicyYou are expected to maintain active health insurance throughout your treatment. If you have co-pays or a deductible, you will be expected to make your payment at the time of service. Crossroads Agency accepts the following private health insurances: Aetna, BlueCross Blue Shield, Cigna (only one therapist accepts this insurance, therefore client’s with this health insurance are accepted based on therapist availability), Fallon, Harvard Pilgrim, Tufts, Health New England. We also accept Mass Health plans including the following: BMC Health Net, Health New England Be Healthy, MBHP, Network Health, and Neighborhood Health Plan. In terms of Medicare plans, we accept One Care. Due to therapist availability, we accept Medicare Part B on a limited basis. We accept out of pocket payment for services. Please ask about the rates. Lastly, we accept credit cards, check, money orders or cash for payment of services.

Child SafetyChildren that present to Crossroads Agency must be supervised by an adult at all times. Children may not use the bathroom facilities without adult supervision. If possible, the agency recommends that children are not present during individual therapy. Children are not permitted to attend group therapy or Day Treatment.

No Smoking PolicyThis is a non-smoking facility. Smoking in any form (including “Vaping”) by staff, clients and visitors is prohibited on the premises. Disciplinary action will be implemented for anyone who violates this policy.

Client Advisory Board (CAB)The Client Advisory Board is made up of 6-10 clients that meet quarterly to discuss various aspects of the program, provide recommendations for improvement and offer opinions that may improve the agency. All clients may apply to be on the board. Please speak with your therapist if you are interested.

Right for Self-Determination

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Crossroads Agency supports clients’ choice in seeking alternative therapies. Crossroads Agency will provide information, assistance and referral lists regarding alternative treatment for clients interested in accessing other treatment options.

Post-Discharge Follow-UpObtaining feedback from our current and former clients is extremely important to making positive changes that will influence how Crossroads Agency operates in the future. If you are open to being contacted after discharge to answer a brief survey, please provide us with a consent indicating such as well as how you would prefer to be contacted. We are able to send you mail, an email or contact you via telephone.

Agency HoursSpringfield: Pittsfield: Worcester:Monday through Friday: 8am to 6pmSaturday: 8am to 3pmSunday: Closed

Please note that later appointments may be available upon request.

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Client Resource ListOutpatient Based Opiate Treatment – Buprenorphine/Vivitrol: Substance Abuse Information and Education:

Experience Wellness Centers – Multiple Locations Ph: (413) 732-0040

Clean Slate Centers – Multiple LocationsPh: (413) 341-1787

Healthy Living Program-Indian Orchard, MAPh: (413) 301-7759

On-Call Urgent Care-Northampton, MAPh: (413) 584-7425Toll Free: (877) 489-0915

Holyoke Health Center-Holyoke, MATammi KozuchPh: (413) 420-2200

Brightwood Health Center-Springfield, MANorman DeschainePh: (413) 794-1705

Massachusetts Substance Abuse Information and Education Helpline:

Free and confidential information and referrals to public and private treatment programs

Health insurance may not be required Translation available in 140 languages Staffed 7 days per week

Toll Free: (800)-327-5050MassRelay: 711Website: www.helpline-online.com

Methadone Maintenance Treatment: Overdose Prevention/Narcan

Community Substance Abuse Centers (CSAC)Tanya LiquoriPh/TTY: (413) 746-0051-Locations in Chicopee, Northampton, Greenfield, Westfield

Providence Behavioral HealthHolyoke and Springfield SitesJanet StabilePh: (413) 539-2973TTY: (413) 536-6032

Habit OPCOMelinda MorenoPh: (413) 733-3488TTY: (413) 737-3681

Massachusetts Overdose Prevention Resource – Help available in over 140 languages

Free and confidential training on preventing, recognizing, and responding to overdose

Training on rescue breathing and how to use Naloxone (Narcan)

Nasal Naloxone (Narcan) available free of charge To find a Naloxone (Narcan) site near you call:

Toll Free: 1-800-327-5050 TTY: 1-800-439-4370Website: mass.gov/dph/overdose – For information about overdose resources

Detox: Family Support Services/Therapy:

Carlson Recovery Center – BHNKristin MorinPh: (413) 733-1423 (Intake: Mon-Fri 8am to 5pm)

Providence Behavioral Health HospitalLuz ThomasToll Free: (800) 274-7724TTY: (413) 536-6032

Center for Human DevelopmentPh/TTY: (413) 737-1426For Intakes: (800) 232-0510

Family Engagement Project – Home-based Lynne BlaisdellPh: (413) 313-4592

Providence Behavioral Health Mark Paglia For Admission: (800) 274-7724

Clinical Support Services – CSS: Transitional Support Services – TSS:

The Hope Center – BHNKimberly Lucas Ph: (413) 733-1423 – (Intake: Mon-Fri 8am-5pm)Ph: (413) 301-9500Ph: (413) 746-HOPE

Phoenix TSS (Post-detox)Daniel Pender Ph: (413) 538-8188 orPh: (413) 534-4005TTY: (413) 533-1790

Support Services for Women Support Services for Men

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Residential Recovery Residential RecoveryGandara for WomenMoana Rawlins Ph: (413) 540-9881TTY: (413) 540-9882

My Sister’s House for Women Catina KendrickPh/TTY: (413) 733-7891

Grace House for Women – CHDLisa Harvey Ph: (413) 586-8213For Referral: (617) 661-3991

Gandara for MenEstelle Santiago Ph: (413) 781-2234TTY: (413) 781-2234

Opportunity House for Men Joanne HilditchPh/TTY: (413) 739-4732

Hairston House for Men Daniel McCarthyPh/TTY: (413) 585-8390

Cole’s Place for MenTracy Mineo Ph: (413) 726-1030

Supportive Housing: Supportive Housing:

Serenity Program for Women Ph: (413) 536-0572

Miracle House for Men Emily English Ph: (413) 297-7436

Residential Recovery Programs-Men & Women:

Phoenix House -Robert Jaszek Ph/TTY: (413) 733-2178

Supportive Housing For Families:

Gandara Community Housing for FamiliesPh: (413) 536-0571 / For Referrals: (617) 661-3991

Homeless Shelters: Food Pantries:

Residential Resource Center – Families with childrenPh: (413) 301-7405

Samaritan Inn – 32 Men, 5 WomenPh: (413) 568-3122

Friends of the Homeless – Men and Women separatePh: (413) 732-3069

Springfield Rescue Mission – MenPh: (413) 732-0808

Open PantryPh: (413) 737-5353

Parish CupboardPh: (413) 734-7969

Martin Luther King Jr. Family ServicesPh: (413) 746-3655

Education/Employment: Other:

Mass Vocational RehabilitationPh/TTY: (413) 736-7296

Westover Job Corps CenterPh: (413) 593-4000

Career PointPh: (413) 532-4900

Department of Transitional AssistancePh: (413) 858-1000

Women, Infants and Children Nutrition ProgramPh: (413) 693-1029

US Social Security AdministrationPh: (866) 964-5061Ph: (866) 964-5058

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Receipt of Program Policies and Procedures

Client Name: ____________________________________ DOB: _____________________*If the information in this manual is changed or updated, Crossroads is required to provide you with a copy of the changes as well as obtain your signature upon your receipt of the updated changes.

I have received a copy and explanation of the Client Manual, which includes information about the agency and its services as well as its policies, procedures and practices. Specifically, the following information was explained to me:

Please check each item and sign below:

_______Confidentiality/Limitations to Confidentiality_______Types of Treatment provided by the Agency_______Explanation of Medication Assisted Treatment and how to access services_______Overdose Prevention/Nasal Narcan _______Psychiatric Medication Evaluation and Treatment_______Equitable Access to Services_______Client Rights and Responsibilities_______Grievance Policy_______Admission Eligibility Requirements/Process_______Readmission Process_______Treatment Planning_______Discharge/Aftercare Planning_______Program Rules/Guidelines_______No Call No Show Policy/Attendance Policy_______Discharge/Appeal Process_______Payment Policy_______Child Safety Policy_______No Smoking Policy_______Right for Self-Determination_______Post-Discharge Follow-up_______Client Resource List_______*By initialing here I consent to post discharge contact/survey. Please check your preferred method of contact and complete the field:

_____________________________________ ______________________________________ _____________________________________Email Address Telephone Number Address

____________________________________________ _____________________Client Signature Date

____________________________________________ _____________________Clinician Signature Date

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