Working with residential program

[smalltownpsych]

I wasn’t sure exactly how to word this title. I have a PMH-NP that works for me in an outpatient private practice and a local long-term transitional program for young adults has been referring patients to her. For a number of reasons, I don’t think this is a good idea. The main reason is that the patients are in a structured treatment program that farms out it’s treatment both with meds and therapy and then says they aren’t a treatment. Heck, I don’t even know who handles the meds although I was planning to find that out in a meeting later today. We initially got involved because the clients were in a phase out portion of the program which the patients were led to believe that they were independent and had completed the program, but they aren’t and releases and communication with program are expected and program has keys to their apartments. Long story short, can I and should I tell them we won’t accept their patients?

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[Bartelby]

You are right to look closely before you get involved. Residential treatment should involve patients who have pretty intense treatment needs. If your practice works with them, you are really partnering with that program and you will start to take a share of responsibility for the outcomes achieved there. I would want to know who is there at the program working with the patients. Do they have regular safety checks, reasonable facilities, coverage for after-hours emergencies, etc. etc.? Also, do they effectively manage milieu issues (which tend to eat up a disproportionate amount of time in a setting like that)? Even though that is not really your responsibility, obviously if someone completes suicide or has another bad outcome related to deficiencies of the program you are likely to end up named in any suit.

I think partnering with a very high-quality program where roles and responsibilities are clearly defined upfront could be a good setup, but anything short of that I would not be interested in taking on.

 

[smalltownpsych]

You are right to look closely before you get involved. Residential treatment should involve patients who have pretty intense treatment needs. If your practice works with them, you are really partnering with that program and you will start to take a share of responsibility for the outcomes achieved there. I would want to know who is there at the program working with the patients. Do they have regular safety checks, reasonable facilities, coverage for after-hours emergencies, etc. etc.? Also, do they effectively manage milieu issues (which tend to eat up a disproportionate amount of time in a setting like that)? Even though that is not really your responsibility, obviously if someone completes suicide or has another bad outcome related to deficiencies of the program you are likely to end up named in any suit.

I think partnering with a very high-quality program where roles and responsibilities are clearly defined upfront could be a good setup, but anything short of that I would not be interested in taking on.

Thank you for your response. That is in line with my own thoughts and very consistent with my own experience in a couple of programs. Spot on about the milieu stuff and how that can suck you right in. My meeting with the clinical advisor of their program went well and we are not going to work with the patients in this program. As far as partnering with a very-high quality program, my real goal is to build that program so I'll keep heading in that direction.