COMMUNITY INTEGRATION HOME (CIH)
OVERVIEW
PROGRAM DESCRIPTION
1. PURPOSE: To provide community based residential and treatment services to
Forensic Consumers with addictive diseases and mental illness transitioning from
state hospitals to the community.
2. POPULATION: Adult Consumers who are served by hospital forensic services
and whose legal status is either Not Guilty By Reason Of Insanity (NGRI), Civilly
Committed Incompetent to Stand Trial (IST) or those who have been determined
by the Forensic Team in conjunction with the criminal court to be in need of these
services.
3. TREATMENT SERVICES:
Mental Health Services such as medication
management, day treatment, counseling and case management will be obtained
through service providers in the community, generally Community Service
Boards and other private providers. Substance Abuse services will be provided
through contracted services in the community and will be tailored to meet each
individual consumer’s needs. These services may be provided at the group home
or at other locations. Twelve Step meetings in the community will be utilized.
Residential rehabilitation and skill development training will occur at the group
homes and at selected sites in the community, depending on the type of skill
training. Residential Rehab services include budgeting, nutrition and food
preparation, navigating in the community, health awareness (physical, dental
health, sexually transmitted diseases etc.), interpersonal and communication
skills training, medication training and support, symptom management,
supportive counseling, and development of skills to access community-based
services, both social and recreational. All services are individualized to the
consumer’s needs.
4. LEVEL OF SUPERVISION: This program is designed to provide supervision by
dedicated Resident Care Provider 24 hours per day, seven days per week when
consumers are present in the group home. The level of planned skill
development training or other activities at the home or in the community, such as
planned outings, will determine the number of necessary staff in the group home
at any given time. Consumers will not be permitted in the group home without
staff supervision. A houseparent will provide coverage for those residents who
are ill and are unable to attend their day program or other daytime activities.
5. TREATMENT OBJECTIVES:
Overall treatment objectives and expected
outcomes for the consumers are as follows: Skill development and restoration in
functional areas which have previously interfered with ability to live in the
community; ability to participate in educational, recreational, and social activities;
employment (competitive or sheltered); ability to develop and maintain
appropriate social relationships; and independent or semi-independent living.
The Community Integration Home (CIH) is a residential program providing
a safe structured residential environment for clients leaving Regional
Hospital’s Forensic Units to transition to the community.
The CIH is located in the general community (in a residential area) and
serves a maximum of six clients. The program provides 7 days per
week/24-hour supervision. The professional and para-professional staff
provide therapeutic and supportive interventions designed to teach
independent living skills in the least restrictive setting appropriate for these
clients. The Team Leader works to link the client to support services in his
community, as well.
All clients are engaged in paid employment, work training, educational or
day treatment activities during the daytime, as appropriate to their
individual strengths and needs.
The length of stay is variable, depending on the needs of the individual
client and their response to transition to the community. As clients adjust
to community living, they may participate in increasingly independent
activities and privileges. These privileges afford them a residential setting
that offers the greatest freedom possible, given their individual
circumstances, and may permit them to transition into even less restrictive
settings in the future such as Personal Care homes and Supervised
apartments.
DEFINITIONS
NGRI – Not Guilty by Reason of Insanity.
IST – Incompetent to Stand Trial
Civilly-committed IST – An individual who has been found incompetent
for trial, whose competence is not likely to be restored, and whom the
court has committed.
Transition – Movement from inpatient status to community residence with
the permission of the court for trial visits. This step is often an intermediate
step between inpatient status and either Conditional Release or
Community Release.
Conditional release – Release of an NGRI patient from inpatient status to
full-time community residence with the express permission of the court for
such release. These patients continue to be monitored by the REGIONAL
HOSPITAL Conditional release team or designee or designee. Conditions
of the release are spelled out on the Conditional Release Plan.
Community release - Release of civilly- committed IST patient from
inpatient status to full-time community residence with the express
permission of the court for such release. Conditions of the release are
spelled out on the Community Release Plan. (Generally a Bond with
conditions that is monitored by a court official.)
ADMISSION CRITERIA
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Only male clients 18 years old or older are eligible to reside at the CIH.
The client will have successfully completed a course of treatment at a
DHR forensic inpatient facility in the state of Georgia, and will have
been deemed by the treatment team of that facility to be appropriate
for transition to a less restrictive environment.
The client will have a valid court order that permits overnight stays in a
community residence of up to one week, or a valid conditional
release/community release order that permits residence in the CIH.
The client must not be actively suicidal or homicidal.
The client must not meet criteria, in the view of his treatment team, for
transition to a less restrictive setting than the CIH (i.e., he must not be
considered appropriate for a personal care home, supervised
apartment, independent living, or family residence at the time of
discharge from a REGIONAL HOSPITAL).
REFERRAL PROCESS
Referrals are made by a Regional Hospital’s Forensic Services
Department. Referrals are made via one of the following avenues, and
always in the setting of a valid court order permitting such a transition:
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By the treatment team of a REGIONAL HOSPITAL’S Secure Units,
when a client is deemed ready to begin transition to the community.
By the treatment team of another Regional Hospital’s Forensic
Services Department, when a client there has been deemed ready to
begin transition to the community, and in the event that the client’s
home community is located within the referred REGIONAL HOSPITAL
catchments area. In this case, the referral will mandate a staffing
between the two facilities regarding such a transition, and will not
proceed unless all parties agree such a step is appropriate.
By the conditional release team or designee of a REGIONAL
HOSPITAL’S Forensics Service, in the event that a client has not
successfully transitioned elsewhere and appears to require more
residential support and structure.
A member of the REGIONAL HOSPITAL treatment team will schedule a
pre-transition meeting with the referred REGIONAL HOSPITAL treatment
team, the Conditional Release Coordinator or designee, the CIH Team
Leader and other appropriate persons to discuss the referral. In the event
that a conditional release/community release patient is being referred from
another placement to the CIH, REGIONAL HOSPITAL treatment team
members will not attend, but the REGIONAL HOSPITAL Conditional
Release Coordinator or designee will attend.
If the client is assesses to meet CIH admission criteria, and is assessed to
be ready to begin transition or full-time residence, and there is a vacancy
at the CIH, an admission date is scheduled. The client may have a preplacement visit to the CIH prior to the admission date.
ADMISSION PROCESS
Once a resident is assessed to be appropriate for the CIH, a transition
period generally begins during which he will receive a series of trial visits
over an agreed-upon time period. Visits will become gradually longer until
the client is ready to begin full-time residence. In some cases, (such as
movement of an existing conditional release patient, or placement of a
client for whom transition is thought to be clinically contraindicated) there
will be no transition period, or a highly truncated transition period.
Once an admission date is set, the client will be asked to sign paperwork
for the group home, and assist in developing his treatment plan there.
The resident will be required to have a physical examination within six
months prior to admission to the CIH, as well as placement of a PPD or, in
the event of a previously positive PPD, documentation of the most recent
negative chest x-ray. The REGIONAL HOSPITAL Forensic Services staff
will be responsible for providing these materials to the staff of the CIH.
Residents may bring their own comforter, pillow, hygiene supplies, radios
and other personal belongings to make their rooms more comfortable,
although many of these are provided by the CIH. All belongings brought to
the CIH by the resident must conform to the CIH guidelines.
VISITING, HOME PASSES AND PHONE CONTACT
Visiting
Family members, attorneys, clergy and other community support
individuals are encouraged to visit during routine visiting hours, as follows:
Sunday and Major Holidays, 12:00 noon to 4:00 P.M. Visiting during
program activities is not permitted. Attorneys may visit at any time, but are
encouraged to arrange for visits by calling program staff before arrival.
Special visiting hours may be arranged outside regular visiting hours. Most
visits should be no longer than one hour.
Passes
Residents may earn the privilege of individual passes once they have
successfully completed the CIH orientation phases, and provided that their
court order/conditional release/community release plan permits this.
Passes are contingent on the resident having shown a level of
responsibility and an ability to safely handle such independence. Passes
may be independent or with family / significant other.
Phone calls
Residents are allowed to make and receive telephone calls during
unstructured time until 10 p.m. Sunday thru Thursday and until 11 p.m. on
Friday and Saturday. Calls should be limited to 15 minutes as a courtesy
to peers, who share this phone line. Family and referring agencies may
call the group home at any time (24 hours a day) to speak with staff.
TREATMENT SERVICES
While at the CIH the resident can expect to receive these services:
Orientation Level:
An Orientation Level is established to allow residents the opportunity to
earn freedom as they achieve goals related to independent living skills
and show responsible, safe behavior.
Psychiatric Services:
Psychiatric services will be provided through the provider / community
service board that services the CIH catchments area and Mental Health
Center. Medications will be prescribed and monitored through this clinic.
Case Management:
Case management will be provided through the community service board
serving the individual or through other community-based agencies.
Additional support will be provided by the REGIONAL HOSPITAL
Conditional Release Coordinator or designee.
Recreational/Leisure Skill Development
Recreational activities will be provided daily at the CIH, including games,
reading materials, and hobby supplies. Residents are encouraged to
pursue their own interests during their free time. Residents are required to
assist in planning monthly activities with an emphasis on budgeting,
accessing community resources and developing healthy leisure skills.
Physical fitness is also encouraged as a part of the recreational program.
A House Council comprising of the residents and Resident Care Provider
will meet weekly to develop the scheduled activities upon consensus of
the Council.
As residents achieve higher privilege levels, they may be permitted to go
on independent outings that they plan themselves.
Basic Living Skills
Residents will be given assistance in learning to sew, cook, launder
clothes, clean house, iron, answer the telephone, use the phone book,
and perform other essential skills needed on a daily basis.
Independent Living Skills
Residents are required to take care of their own clothes and to prepare
their meals (under staff supervision). Groups will be conducted, teaching
residents on such topics as budgeting, balancing a checkbook, grocery
shopping, accessing health care, etc. When appropriate, residents will be
assisted in acquiring higher skills such as learning to apply and interview
for a job or to negotiate the public transportation system.
Specialty groups
Special groups will be conducted to provide information such as
assertiveness training, anger management, relationship building, stress
management, communication skills, manners, sex education, substance
abuse issues, conflict resolution, cultural awareness, nutrition and
grooming.
Substance abuse services
These services will be provided through contracted services in the
community and will be tailored to meet individual residents’ needs. A
contracted provider will provide group therapy in the home 3 times per
week. Residents will also receive individual therapy 3-4 times per month if
needed.
Community meetings
Community meetings are held weekly to teach problem solving skills and
to help residents learn to resolve conflicts with one another. Residents
learn to negotiate chores, schedules, rules and other issues related to
living in a community.
Schedule
The weekday and weekend schedules at CIH will be appended to this
document and posted at the facility. This schedule changes to meet the
needs of the residents served.
Transportation
Each CIH will have a vehicle on site to attend specific events in the
community and to go shopping. Resident Care Provider will transport
residents to and from their daytime activities as needed. Some residents
will access transportation through a medical reimbursed transportation
services or public transportation such as Marta.
DISCIPLINE AND GRIEVANCE POLICY
Rules and consequences are described specifically in the program manual. The
following is a list of principles and guidelines the Community Integration Home adheres
to:
1. The client’s intelligence, clinical condition and individual rights shall be
considered in determining consequences for inappropriate behavior.
2. The use of consistent praise to reinforce appropriate behavior and
encouragement of strengths will be routine.
3. Logical consequences will be imposed, related to inappropriate behavior, and will
be carried out in a calm manner.
4. Rules will be clear, definable, and enforceable. Each resident will receive a Rule
Book on admission.
5. Physical restraint will be used only when critically necessary in an emergency
situation to protect a resident from imminent physical injury to himself or others.
6. Seclusion or placement of a resident in a locked room will not be used.
7. Meals and water will not be denied.
8. Denial of sleep is prohibited.
9. Denial of shelter, clothing or essential personal needs is prohibited.
10. Denial of essential program services is prohibited.
11. Verbal abuse or eliciting fear is prohibited.
12. Physical and corporate punishment is not permitted.
13. Assignment of excessive or unreasonable work tasks that are unrelated to the
resident’s inappropriate behavior is prohibited.
14. Denial of communication and/or visits is prohibited.
15. Chemical or mechanical restraints are prohibited
16. Resident shall not be permitted to discipline other residents except as part of an
organized therapeutic self-governing program that is conducted in accordance
with written policy and supervised directly by designated staff.
If a resident feels that he has been mistreated or his rights have been
violated, he may make a verbal complaint to the CIH Team Leader or the
REGIONAL HOSPITAL Patient Rights office.
Health Services
A. Medical treatment
Residents are required to have a physical examination prior to admission
and annually while at the CIH. Those providers who followed the client
prior to discharge from REGIONAL HOSPITAL, such as Grady Hospital,
public or private medical facility or residents’ personal, credited, medical
care provider will provide routine medical care.
B. Dental treatment
Dental treatment will be provided as needed by providers in the
community. Semi-annual check-ups and cleaning are recommended for
all residents.
C. Medical emergencies
In the event of a medical emergency the resident will be transported to the
appropriate Emergency Room. When possible, staff will transport the
patient; however, if necessary 911 will be called and transportation will be
conducted via ambulance.
D. Psychiatric treatment
Residents will be treated by psychiatrist and facilities as designated in
their conditional / community release plan.
Schedule of Fees
A. Monthly room and board
Clients will be assessed monthly room and board. Monthly room and
board may be assessed on a sliding scale, so that clients who earn less
may pay somewhat less.
B. Therapeutic services
Clients may be responsible for a co-payment in securing medical and
psychiatric services from the county in which they reside. Some clients
may be eligible for payment of medical services through Medicare or
Medicaid.
Discharge Planning
In many cases, the Community Integration Home will act as a “stepping
stone” toward a less restrictive and more autonomous living arrangement.
Decisions regarding discharge will be made jointly between the CIH
treatment team and the REGIONAL HOSPITAL Conditional release team
or designee. Such moves always must be effected in the context of a
valid court order supporting the move. If the CIH team feels that a client is
nearing readiness for transition to a less restrictive placement, a
representative of this team will notify the Conditional Release Coordinator
or designee in order for a dialogue to begin between the hospital and the
group home regarding alternate living situations. Working together, and
with the client in question, these teams will determine what future
placement appears most beneficial for the resident. If necessary, the
hospital’s conditional release team or designee will approach the court for
a new order approving the placement.
Attachments: Weekday and Weekend schedules