Choosing an Inpatient Addiction Treatment Center
Written in: May 2017
In response to numerous questions and emails from individuals and families regarding inpatient treatment centers out of state and in New York, LIRA has created this objective resource guide as a community service. We do not endorse any particular inpatient center although we have received feedback on many. Our intention is for you to be well informed when you and your family make this important decision.
Is it best to choose a New York program or an out of state facility, I hear conflicting information?
The need to seek treatment outside New York escalated in response to insurance company denials or limitations on inpatient length of stays and discriminatory practices. With legislative changes in recent years due to our collective advocacy efforts individuals are now permitted 14 days of inpatient treatment before insurers can conduct a utilization review. As an ideal advocates support a minimum of 30 days for those in need of inpatient care.
There are other factors to consider. Why are you considering out of state treatment? Often we hear my husband, son, daughter needs to be as far away from here as possible. Sometimes being near home is the best or perhaps the only option, to be near supportive family etc. (or if there are probation or other legal restrictions). In other instances, a complete change of scenery is preferable or indicated. There are many quality programs located in New York and if you need assistance we can provide you with a host of options to choose from should you or your loved one opt to stay local and near home.
There are also many out of state providers that offer quality services. A number of out of state facilities have been adequately vetted and once again if you need direction we can provide you with a list of reputable programs to review if you decide to go that route. When making your decision we strongly suggest speaking to other individuals and families who have lived experience with in-state and out of state programs for a first-hand account. Be aware of freelance, “interventionist” type individuals soliciting business. Many families have experienced emotional turmoil and financial hardships due to unscrupulous and deceptive practices.
Is the facility licensed or possess an operating certificate in New York or the state of operation?
Most all reputable programs are licensed by the state or certified by the Single State Authority (SSA) in which they reside. In New York that agency is the New York State Office of Alcoholism and Substance Abuse Services (OASAS). Being licensed or certified does not mean the program is well regarded it does indicate that a minimum level of standard has been met which is a good baseline starting point. www.oasas.ny.gov.
Is the program/facility accredited?
By either the Joint Commission (TJC) www.jointcommission.org or the Council on Accreditation of Rehabilitation Facilities (CARF) www.carf.org the two most widely recognized and reputable organizations with this review expertise.
Why is accreditation important?
Having this accreditation means the facility or program has undergone a rigorous, in depth examination of the quality of care and safety of the treatment and services and exceeds the minimal level of acceptable industry standards. There are no guarantees that this equates to a good experience but it does provide reasonable assurance and confirmation that a certain level of standards have been met.
How long is the particular program in existence? Who are the key personnel (medical and clinical professionals) are they certified or licensed?
While longevity can be a favorable indicator it is not a definitive predictor of quality treatment services rather another check off on a list of criteria that may help with making a final decision. Masters level clinicians with addiction specialization (CASAC, CAP, LADC) have become the standard indicating a superior level of expertise and related skill set. Check the facility web sites and look at the staff bios and background for a more in-depth look. There are also many fine counselors without an advanced degree.
What type of programming is offered? Ask to see a daily schedule of activities.
A full day of activities including morning reflection, breakfast and chores are designed to help the individual begin to rebuild the structure of daily living (and prepare for a return to the workforce) which is often lost in an active addiction lifestyle. Ideally there will be a blend of educational classes, clinical groups, individual sessions and leisure activities in addition to access to mutual aid support meetings.
What type of insurances does the facility work with? Do they accept government insurance i.e. Medicaid or the state equivalent?
In New York, most programs accept both private insurance and Medicaid. Out of state facilities are often “out of network” and may accept those benefits if applicable. They will not accept New York Medicaid although recently there are one or two programs who indiate they are now accepting NY Medicaid.
Who has Medicare coverage and does the program accept Medicare?
Medicare health insurance coverage is typically associated with older individuals yet is also common for those with physical disabilities as well. Medicare generally covers only those addiction treatment services provided by a hospital based program and not free standing addiction treatment centers.
If self-paying will the facility work with the family on a sliding scale based on their ability to pay?
Most every program will accept self-paying clients and reputable facilities are usually willing to negotiate a reduced rate if warranted. Be sure to inquire if you’re interested and in need of a reduced fee option.
What if the family does not have insurance or the ability to pay, where can they go?
On Long Island, Charles K Post Addiction Treatment Center (ATC) in West Brentwood is a New York State OASAS operated program. The ability to pay is not a determining factor for admission. If you or your loved one is a NY State resident you are eligible provided there are no additional medical, psychiatric or clinical factors that would preclude admission. Should the need arise OASAS operates eleven additional ATC’s across New York State.
Are the treatment plans individualized? How does the facility ensure that this process happens?
Some facilities have been known to use a cookie cutter format for all and will cut and paste one distinct goal and objectives for different clients on a treatment plan with 3 or 4 common ones to have it appear to be individualized. The client should always be involved in a participatory treatment planning process and able to input specifically on areas of need he/she think are relevant and would like to work on.
Does the facility use evidenced based practices as part of the overall clinical approach?
Evidenced based practices are desirable, and grounded in research which indicates they are effective in achieving the desired outcome. These best practices should be incorporated into clinical programming.
Is there a specialized relapse prevention tract to assist those with a multiple treatment history?
Often there are unaddressed “wounds” or trauma, sometimes from childhood, unconsciously contributing to the relapse pattern. Frequently there is a direct correlation between the age at time of trauma and the beginning or escalation of substance use. A skilled clinician should be able to uncover these issues and make the connection. Trauma informed care is essential in effective treatment.
Does the facility utilize a trauma informed care approach?
Some reports indicate more than one third of men and two thirds of women with substance use disorders have significant trauma in their backgrounds. There is a usually a connection between unresolved trauma and the inability to maintain abstinence or sustain recovery. Trained masters level clinicians will have effective methods in their skill sets including: Eye Movement Desensitization and Reprocessing (EMDR), Thought Field Therapy (TFT) and Havening. All can help heal/resolve trauma.
Is there women’s specific programming?
Women present with unique, gender specific needs including: motherhood and being frequent victims of domestic violence and other trauma. These clinical concerns may be addressed more appropriately and thoroughly supported in a women’s only therapeutic milieu.
Does the facility demonstrate the capacity to effectively treat young adults (20-29) what specific programs or approaches are utilized?
The presence of this cohort in treatment centers has grown dramatically in recent years and clinical approaches should be inclusive and customized to meet this increased demand.
Does the facility provide family services and/or engage the family as part of the treatment process?
Research shows involvement of the family may be a crucial component in a successful outcome. In person family sessions or phone conferences are helpful to keep the family updated and part of the process. Family members should also be encouraged to have their own recovery action plan as well.
Who participates in the continuing care planning and discharge sessions?
Counselors, clients, case managers, family members, Employee Assistance Professional’s, union representatives, probation, child protective services and others may all be part of the process depending on the individual circumstances. Building in sufficient recovery supports for the post treatment period will help maximize the client’s chances for effecting positive change and sustaining recovery.
If there is an unauthorized use of prohibited substances (relapse with alcohol/drugs) what is the facility policy? Automatic discharge? Is there a referral to another program or indicated level of care?
Most programs will discharge the client administratively. While requiring the client to leave may be the prerogative, failure to provide an adequate referral is not good practice. Will the facility commit to notifying a family member (if legally permitted) should this situation arise?
Other questions you may want to ask (if applicable).
Is there evidence of cultural competency among staff?
Specialized tracts, bi-lingual and culturally diverse staff are desirable to ensure the needs of all clients can be adequately met. If applicable ask if staff are trained and well versed in culturally specific issues.
Are there any out of pocket expenses for the client or family?
Knowing this in advance can provide clarity in case the purchase of certain items is required or permitted and may help you during your facility selection process.
Does the facility permit the regular use of personal electronics?
These items are usually prohibited to allow the individual to focus exclusively on treatment.
What are the telephone use guidelines?
Consensus is that limited phone access works best to minimize outside distractions.
Does the facility have visiting days or hours?
Visiting can be therapeutic. Counselors and staff should review and approve visitor requests to screen out those who may have a detrimental effect on the clients’ treatment efforts. Visiting is typically limited to family members although exceptions are made, (sponsor, supportive boss, close friend etc.)
How long is the length of stay in an inpatient treatment program?
Treatment stays can vary widely and are typically subject to utilization review by the insurance company or managed care entity. In New York, a minimum of 14 days is now the law. (Subject to retrospective review to ensure medical necessity) Out of state stays can be longer with less insurance company involvement and may or may not be actual one facility inpatient treatment rather an apartment or house-style common living arrangement with transportation provided to the clinical programming.
Does the program have an alumni organization, have reunions or hold annual events or gatherings?
Having others stay connected to the program upon discharge indicates a certain level of satisfaction with the facility and helps to promote a sense of pride and comradery amongst clients/alumni.
How does the facility follow-up with clients post discharge?
Regular follow-up contact is being embraced by more providers these days. These outreach efforts help individuals stay connected to recovery and are supportive. This type contact can assist individual alumni and reinforce recovery support whle this tracking can help programs monitor success rates which have become a focal point in a data driven outcome climate.
Is smoking permitted?
All NY State OASAS certified programs are non-smoking facilities. Programs may have the ability to assist with smoking cessation efforts. Check directly with any out of state program for their smoking policies.
Are there housing options available post discharge, are site visits allowed, who provides oversight?
Safe, supportive housing is a crucial need for many and an important consideration in the recovery process. When preparing for this transition phase, having as much information as possible is advisable.
Does the facility embrace and provide Medication Assisted Treatment (MAT) Including Methadone?
Medication Assisted Treatment (Buprenorphine, Naltrexone etc.,) has become a leading evidenced based treatment option and a viable recovery pathway of choice for many with an opiate use history.
Are there accommodations for religious devotion?
Some have abandoned their religious affiliation and commitments due to addiction. Reconnecting can be a source of healing, comfort and connectedness. Faith based recovery is another viable pathway.
Are there reviews of the program available, testimonials?
Hearing what others have to say may provide insight that can be helpful when making a selection.
We hope you find this infograph helpful. Choosing a treatment center can be confusing and intimidating, it does not have to be.
Additional questions? Contact Us.