Module 1: Welcome to Aspire Wellness Group

Welcome to the team! This training is a collegiate-level, self-paced course designed to equip you with the core competencies required for your role. This is not a simple review; it is a comprehensive training on clinical models, documentation standards, and state regulations.

Your Role & Scope (QMHPC/E)

As a QMHP or Clinical Intern (QMHPE/Trainee), you are the primary deliverer of our skilled interventions. Your core responsibilities include:

Collaborating on assessments and treatment plans (ISPs).
Delivering structured, skill-based interventions to clients and families.
Coordinating care with schools, doctors, and other supports.
Monitoring for safety and implementing crisis prevention plans.
Completing accurate, high-quality, and timely documentation (within 24 hours).

Prohibited Activities (Per DBHDS & Agency Policy):

Provide services independently without supervisor approval (Interns).
Make a formal diagnosis (this is done by an LMHP or PhD).
Transport clients, handle client funds, or administer medication.
Finalize documentation without supervisor review (as required by policy).

Module 2: The IIH Service Model & Clinical Approach

Intensive In-Home (IIH) is a specialized, high-fidelity service. Understanding its regulatory purpose and our specific clinical model is essential for compliance and good outcomes.

DMAS Service Definition (The "Why")

Per DMAS (Virginia Medicaid), IIH is not just "therapy in the home." It is a time-limited, intensive service designed for a specific purpose:

Population: Youth (under 21) at high risk of out-of-home placement (e.g., residential treatment, foster care, or hospitalization).
Goal: To stabilize the client's crisis, improve family functioning, and build sustainable skills to prevent placement.
Requirements: The service must involve crisis response, intensive care coordination, and direct skills training with both the youth and their caregivers.

Our Clinical Approach: "No One Size Fits All"

We are a trauma-informed agency that blends evidence-based practices (EBPs) to meet the unique needs of each client.

1. Trauma-Informed Care (The Lens)

We operate from a "What happened to you?" perspective, not "What's wrong with you?" This means creating safety, trustworthiness, choice, and collaboration.

2. Trauma-Focused CBT (TF-CBT) (The Model)

For clients with clear trauma histories, TF-CBT is a primary model.

P.R.A.C.T.I.C.E. Components: Psychoeducation, Relaxation, Affective Modulation, Cognitive Coping, Trauma Narrative, In-Vivo Exposure, Conjoint Sessions, Enhancing Safety.

3. Dialectical Behavior Therapy (DBT) Skills (The Toolbox)

For clients with high emotional dysregulation, impulsivity, or self-harm (NSSI).

Distress Tolerance: T.I.P.P. skills for crisis survival.
Emotion Regulation: Understanding emotions and checking the facts.

Module 3: Clinical Documentation & Compliance

Clinical documentation is the most important administrative part of your job. It is not optional. All documentation must be completed within 24 hours.

The Golden Thread: How Our Forms Connect

The Foundation: Comprehensive Needs Assessment (CCA)
Identifies the needs. Every goal must link back to a need here.
The Roadmap: Comprehensive Treatment Plan (ISP)
Creates SMART goals based on the CCA. Every session must work toward one of these goals.
The Proof: Clinical SOAP Note
The daily note. The "A" (Assessment) section must state progress toward the specific ISP goal.

Best Practices: Writing a Strong Intervention (The "A" in SOAP)

Avoid passive language. You must describe your active skill.

Weak / Non-Billable:

"Client was angry today. Worker observed client's behavior. Client eventually calmed down."

Strong / Billable:

"Client presented as angry (clenched fists). Worker utilized de-escalation skills and validated frustration. Worker then used a CBT worksheet to help client link thoughts to feelings. Client identified 2 alternative thoughts."

Module 4: Rights, Safety, & Crisis Intervention

Client Rights (DMAS/DBHDS 12VAC35-115)

Dignity & Respect: Fundamental right.
Least Restrictive Setting: We are the alternative to hospitalization.
Grievance: Clients can file a complaint without retaliation.
Confidentiality (HIPAA & 42 CFR Part 2): Extra protection for substance use records.

Crisis Intervention: A 3-Phase Approach

Phase 1: Assess (Triage)

Assess Ideation, Plan, Intent, and Means.

Phase 2: Verbally De-escalate

Stay calm. Validate feelings ("I see you are angry"). Set clear, non-threatening limits.

Phase 3: Act & Escalate

IMMEDIATELY CALL YOUR SUPERVISOR.
Review the Safety Plan.
Contact Guardian.
Contact Crisis Services (988) or 911 if imminent risk.

Module 5: Competency Test

Please answer the following questions. You must score at least 80% (12/15) to proceed.

1. Per DMAS, the primary goal of IIH is to:

Provide 24/7 supervision in a locked facility. Stabilize youth at risk of out-of-home placement and build family skills. Only provide talk therapy once a month.

2. What is the "Golden Thread" of documentation?

A billing software. The concept that all documentation (CCA, ISP, SOAP) is linked. A policy that notes must be in gold ink.

3. You suspect neglect. What must you do?

Wait for proof. Ask the client to report it. Call CPS immediately as a mandated reporter.

4. Which is a "Prohibited Activity" for a QMHP?

Transporting a client in personal car. Teaching a coping skill. Writing a SOAP note.

5. A client's rights can be restricted:

Never. If they are rude. Only if behavior poses danger, with a formal plan.

6. A school counselor calls for an update. You need:

A signed Release of Information (ROI). Verbal permission. Supervisor permission only.

7. Law protecting substance use records?

HIPAA 42 CFR Part 2 Mandated Reporter Act

8. A client wants to file a grievance. You:

Discourage them. Provide the form and assist them without retaliation. Ignore it.

9. Most important part of the "A" in SOAP?

Client's outfit. Your opinion of the parent. Assessing progress toward the ISP goal.

10. Client reports active SI with plan. First call?

911 always. Supervisor to co-develop response. School.

11. Example of a "Passive" note?

"Worker utilized CBT worksheet." "Worker observed client watching TV." "Worker modeled 'I feel' statements."

12. DBT "T.I.P.P." skill is for:

Problem solving. Interpersonal requests. Crisis survival / Distress Tolerance.

13. "Trauma Narrative" belongs to:

TF-CBT DBT IFS

14. First step in de-escalation?

Telling client to calm down. Calling 911. Managing your own emotional state.

15. Arrive at home, hear yelling/throwing. You:

Go inside to help. Enter to find client. Do not enter. Return to car, call supervisor. Call 911 immediately.

Module 6: Training Attestation

You have completed the core training modules. The final step is to review and sign the Orientation Acknowledgment.

Orientation Acknowledgment: I certify that I completed Aspire Wellness Group’s Online Orientation and understand agency policies, my scope of practice, supervision requirements, safety procedures, documentation standards, and the grievance/human rights processes. I understand that failure to follow policy may result in corrective action up to and including termination of placement/employment.

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