Identifying, Intervening and Preventing Against Medical Advice (AMA) Discharges in the Treatment Setting

•             clients experiencing withdrawal symptoms and detoxification

•             clients with prior treatment failures

•             clients who are argumentative

•             clients who report little to no problems

•             clients with co-occurring disorders

•             clients who are male and ages 18 to 29

•             clients who isolate

•             clients who are externally motivated

•             clients with significant cultural differences

•             when clinicians do not engage the family in the treatment process

•             disorganization within the treatment environment

•             lack of attention to the clients

•             lack of orientation for clients

•             poor communication with the family, referral source, and between staff

•             emotional turmoil

•             negative influence from peers

Typically by the time the staff intervenes, a client is 90% out the door, so to keep them in treatment is nothing short of a miracle. Using early interventions and reachable goals is a necessity in reducing the possibility of a client leaving AMA and increasing the chances for long term recovery.

Intervention Strategies

Interventions are successful only when facilities and their staff know their population. This reality, coupled with an understanding of why people leave treatment AMA, enables us to implement strategies to reduce the likelihood of leaving AMA. The interventions used must make sense, be simple, and start before clients ever enter into the facility. Interventions used by Blue Ridge Mountain Recovery Center that have shown promise are as follows:

•             Create a culture of AMA identification

•             Admission process and orientation must be thorough

•             Obtain Consents to Release Information upon admissions

•             Review AMA information with family and the referral source

•             Assignment of counselor must make sense

•             Review of the AMA information by counselor with family and referral source

•             Room assignment must make sense

•             Assign an “accountabilibuddy”

•             Evening/Weekend Counselors must meet with all new admissions

•             Get the entire treatment team involved

•             Communicate

•             Create an environment of structure and fun activity

•             Be available and organized

•             Have a safe, secure place for meeting

•             Listen, listen, listen

•             Be empathetic

•             Ask clients what they need to support their stay in treatment

•             Negotiate an agreement that supports each client’s needs

•             Remain focused. Use clinical skills and client’s input to develop solutions

•             Seek a short-term solution for a long-term plan

•             Be consistent with the guidelines and hold “Guidelines Group” frequently

•             Plan for problems before they show up

•             Be fearless and honest

•             Discuss with clients what they may feel during the treatment process

•             Employ monthly trainings to discuss trends and strategies

•             Utilize staff meetings to discuss possible AMA risks

•             Have a complete program with individualized treatment planning

•             Pay attention to detoxification protocols

One of the most important factors in treatment outcomes is whether or not the clients believe they can succeed in changing. The quality of the facility staff-client relationship is key to client satisfaction and change. In the end, how staff feel about a client’s chances of success affect the client’s outcome. So the final question is, “Does the client believe there is hope?” For clients to feel hope, they must have movement, and to have movement, clients must have a plan. These plans must be individualized and reviewed with clients weekly in order to show them their progress or areas of concern.

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