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Discharge Categories
Discharge Categories
In 2011, Dawn Farm changed its discharge categories.
We believe our previous discharge categories (completion, left against staff advice, discharged for noncompliance) were problematic for at least three reasons.
- First, they suggest that addiction is an acute problem rather than a chronic problem--that a single, time-limited course of treatment is an appropriate response to a chronic condition.
- Second, they emphasize individual programs rather than continuity of care.
- Third, they emphasize client compliance rather than engagement or progress, which can easily result in harm to our relationships with clients.
One important consideration is that there will be two kinds of admissions and discharges—episode and program admissions and discharges. Episodes will typically consist of more than one program admissions and discharges. During one episode a client may be admitted and discharged from Spera, Residential, Outpatient, Transitional Housing and Recovery Support Services. A client may have more than one admission to a single program during one episode. (For example, someone may be admitted to residential, leave residential, and come back to residential all in one episode.)
(a) Discharge - indicates the end of a treatment episode because there is mutual agreement that treatment and recovery goals have been accomplished and no further treatment is needed.
EXAMPLE - Discharged from all Dawn Farm programs, and not referred to another agency. The expectation is that this client can sustain recovery without further professional intervention.
EXAMPLE- Client completes four levels of Outpatient groups and is discharged from all services with Dawn Farm.
(b) Chooses no further treatment - indicates that the client has made the decision to end the treatment episode—they are leaving Dawn Farm services and is not interested in seeking treatment elsewhere. Staff believe that there are treatment and recovery goals that still need to be accomplished.
EXAMPLE - This client is choosing to leave Dawn Farm services, and is not interested in a referral to another agency at this time. However, the client is having a conversation with us about leaving, and developing a recovery plan to help sustain recovery in the community.
EXAMPLE- Client is recommended to the next level of group at Outpatient and chooses to not continue with services.
(c) Dropped out and unable to contact - indicates that the client has stopped attending services and has not discussed the matter with Dawn Farm staff.
EXAMPLE - This client leaves without notifying us and without having a conversation about leaving.
EXAMPLE- The client leaves residential while at a 12 step meeting and staff is unable to contact within 72 hours.
EXAMPLE- The client no call no shows to Outpatient for several sessions and staff is unable to contact them.
(d) Referral to another agency - indicates that the client’s current treatment episode will continue with another service provider.
EXAMPLE - Discharged from all Dawn Farm programs, but referred for additional services from another service provider.
EXAMPLE- Discharged from residential and the client finds a different aftercare program to attend (one closer to home).
EXAMPLE- Discharged from Outpatient and referred to individual services.
(e) Transferred within Dawn Farm's continuum of care - indicates that the current treatment episode will continue in another Dawn Farm program.
EXAMPLE - Transferred from one Dawn Farm program to another, like from Detox to the Farm, or from the Farm to Transitional Housing.
Any of these discharge categories may apply to a program discharge, but (e) could never apply to a episode discharge.
To capture more better information for QA, we have added the following specifiers for :
- mutual decision / client decision / staff decision
- referral completed at discharge / referral in process at discharge
- planned transfer / early transfer
Rationale:
Rationale:
- Gets away from discharge categories that function as a reward (completion) or punishment (non-compliance, maximum benefit)
- Emphasizes client choice rather than compliance and our power and authority
- The emphasis on client choice puts the pressure on us to attract the client into recovery rather than relying on external coercion
- Emphasizes our continuum and movement between levels of care rather than completing individual programs
- Because of all of the above, they lay foundation for better long term engagement
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