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.

Our mission is to provide high-quality, person-centered behavioral health services that empower youth and families. We do this through a trauma-informed, evidence-based, and culturally responsive lens.

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.

This "at-risk" definition is the root of our medical necessity. We are here to prevent a more restrictive level of care.

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, as identified in their psychological evaluation and CCA.

1. Trauma-Informed Care (The Lens)

This is our foundation. We operate from a "What happened to you?" perspective, not "What's wrong with you?" This means creating safety, trustworthiness, choice, and collaboration. Many challenging behaviors are adaptations to trauma.

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

For clients with clear trauma histories, TF-CBT is a primary model. It's a structured, components-based approach that helps clients and caregivers process trauma.

P.R.A.C.T.I.C.E. Components: Psychoeducation, Relaxation, Affective Modulation, Cognitive Coping, Trauma Narrative, In-Vivo Exposure, Conjoint Sessions, Enhancing Safety.
Your Role: You will be teaching these skills (Relaxation, Affective Modulation, Cognitive Coping) to help a client prepare for processing their trauma with a licensed therapist.

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

For clients with high emotional dysregulation, impulsivity, or self-harm (NSSI), we teach DBT skills. These are concrete tools for managing intense emotions.

Mindfulness: "What" and "How" skills. Being present.
Distress Tolerance: Crisis survival skills (e.g., T.I.P.P., A.C.C.E.P.T.S., Self-Soothing).
Emotion Regulation: Understanding emotions, checking the facts, problem-solving.
Interpersonal Effectiveness: G.I.V.E., D.E.A.R. M.A.N. skills for getting needs met.

4. Internal Family Systems (IFS) (The Concept)

IFS is a non-pathologizing way to understand a client's internal world. It views the mind as having different "parts" (e.g., an "angry part," a "scared part," a "protective part").

Your Role: You can use this concept to help clients build self-compassion. Instead of "I am angry," it's "A *part* of me is angry." This helps the client get curious about that part's job (e.g., "It's angry because it's trying to protect me from feeling hurt").

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 (or by the next business day).**

Our documentation follows a "Golden Thread" — a concept meaning that every document is linked to the one before it.

The Golden Thread: How Our Forms Connect

The Foundation: Comprehensive Needs Assessment (CCA)
This is the "WHY." It's the full assessment (CANS, DLA-20) that identifies the client's needs, strengths, and risks. Every goal in the treatment plan must link back to a need identified in this document.
The Roadmap: Comprehensive Treatment Plan (ISP)
This is the "WHAT." Based on the CCA, you, the client, and your supervisor create SMART goals. Every single session you have must work toward one of these goals.
The Proof: Clinical SOAP Note
This is the "HOW." It's your daily note that proves you provided the service. The Golden Thread is critical here: The "A" (Assessment) section *must* state how the client progressed toward their ISP goal.

Medicaid & Audit Compliance (The "So What?")

Why are we so strict about documentation? Because every service is subject to audit by DMAS (Medicaid). If our notes are not compliant, the state can "claw back" (take back) the money paid for the service.

An auditor is looking for:

Medical Necessity: Does this client still meet criteria for this high level of care?
The Golden Thread: Does the SOAP note intervention match an objective on the ISP? Does that objective match a need from the CCA?
Active Intervention: Did the QMHP actively *do* something (teach, model, coach) or just "observe"? Passive services are not billable.

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

The Assessment section is your clinical synthesis. The intervention is *what you did*. Avoid passive language.

Weak / Passive / Non-Billable Note:

"Client was angry today. Client talked about a fight at school. Worker observed client's behavior. Client eventually calmed down."

This note shows no skill. It's passive ("observed," "talked") and not billable.

Strong / Active / Billable Note:

"Client presented as angry (clenched fists, loud voice) related to a peer conflict. Worker utilized de-escalation skills and validated client's frustration. Worker then used a CBT worksheet (cognitive triangle) to help client link their thoughts ('He disrespected me') to their feelings (anger) and behaviors (yelling). Client was able to identify 2 alternative thoughts. Client's progress toward ISP goal 1.a (anger management) was good, as they successfully used a cognitive skill in session."

This note shows *your* skill, links to the ISP goal, and proves an active intervention occurred.

Module 4: Rights, Safety, & Crisis Intervention

As a provider in Virginia, you are legally and ethically bound to protect your clients' rights and safety. This module covers your core responsibilities.

Client Rights (DMAS/DBHDS 12VAC35-115)

All clients have fundamental rights. You are responsible for protecting them.

Dignity & Respect: You must treat all clients and families with respect.
Least Restrictive Setting: Our entire service is based on this—we are the alternative to a more restrictive hospital or facility.
Informed Consent: Clients must participate in their own treatment planning.
Grievance: Clients can file a complaint (grievance) at any time, for any reason, without fear of retaliation. You must assist them in this process if asked.
Confidentiality (HIPAA & 42 CFR Part 2): You cannot share PHI without a valid Release of Information. 42 CFR Part 2 provides *extra* protection for substance use records.

Mandated Reporting & Safety

You are a Mandated Reporter. This is not optional. If you have *any suspicion* of child abuse or neglect, you must call the CPS Central Registry.
Home Visit Safety: Always be aware of your surroundings. Have your phone charged. Notify your supervisor of your schedule. If you arrive and a situation feels unsafe (e.g., unexpected angry visitors, signs of intoxication), **do not enter.** Call your supervisor from your car.

Crisis Intervention Techniques: A 3-Phase Approach

When a client is in crisis, your first job is to manage the situation safely. Follow these steps.

Phase 1: Assess (Triage)

You must quickly assess the level of risk. A simple model is:

Ideation: Are they thinking about suicide or harming others?
Plan: Do they have a specific plan (how, where, when)? A plan = higher risk.
Intent: Do they intend to act on their plan? Intent = high risk.
Means: Do they have access to their planned method? Access = imminent risk.

Also, check for protective factors (e.g., "I'd never leave my dog") and other risks (e.g., substance use, access to weapons).

Phase 2: Verbally De-escalate

Your self-regulation is key. You cannot de-escalate someone else if you are escalated.

Stay Calm: Your voice tone and body language are your most important tools. Stay relaxed, speak slowly, and give them space.
Active Listening: Listen to *understand*, not to reply.
Validate, Validate, Validate: Validation is **not** agreement. It's acknowledging their feeling as real. "I can see how incredibly angry you are." "It makes sense you would feel hopeless right now."
Set Limits: Be clear and non-threatening. "I'm here to help, but I can't let you hurt yourself." "I need you to keep your voice down so I can understand."
Offer Choices: This gives them back a sense of control. "Do you want to go to a quieter room, or would you rather get a cold drink of water?"

Phase 3: Act & Escalate

If verbal de-escalation fails or the risk is imminent, you must escalate.

IMMEDIATELY CALL YOUR SUPERVISOR. This is your first call. You are a QMHP/E, not an independent clinician. You will make the next-step plan *with* your supervisor.
Review the Safety Plan: Pull out the client's safety plan. Start at Step 1. "Who is on your list to call for help?"
Contact Guardian: The guardian must be notified of any significant risk.
Contact Crisis Services: If the plan fails, you and your supervisor will engage crisis services (e.g., 988, Regional Mobile Crisis/REACH).
911 / Emergency Room: This is the highest level of care. If a client is an immediate danger to self or others and refuses to go, 911 is the last resort to ensure safety.

Module 5: Competency Test

Please answer the following questions to demonstrate your understanding of the material. 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. Complete a psychological evaluation.

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

A brand of software used for billing. The concept that all documentation (CCA, ISP, SOAP) is linked and supports medical necessity. A policy that states notes must be written in gold ink. The wire that connects your computer to the internet.

3. You are a QMHPC/Intern and you suspect a client's parent has been neglecting them. What must you do?

Wait until you have concrete proof before doing anything. Ask the client to report it themselves. Call the CPS hotline immediately (within 24 hours) as you are a mandated reporter. Discuss it with your friends to see what they think.

4. Which of these is a "Prohibited Activity" for an Intern or QMHP?

Transporting a client to a doctor's appointment in your personal car. Teaching a client a coping skill from the treatment plan. Writing a SOAP note for supervisor review. Calling your supervisor to report a crisis.

5. A client's rights, under DBHDS regulations, can be restricted:

Never, under any circumstances. If the client is being rude to you. Only if their behavior poses a danger, with a formal plan, and it's the least restrictive option. If the guardian requests it, regardless of the reason.

6. A client's school counselor calls you for an update. What must you have before speaking to them?

A signed, valid Release of Information (ROI) from the client/guardian. Nothing, school counselors are part of the team. Verbal permission from the client is good enough. Your supervisor's permission.

7. Which law provides *extra* protection for substance use records?

HIPAA 42 CFR Part 2 The Mandated Reporter Act The Safety Plan Act

8. A client tells you they are upset and want to file a grievance. You should:

Tell them it's not a good idea and will make things worse. Respect their right, inform them they cannot be retaliated against, and provide them with the grievance form and Human Rights Advocate's contact info. Tell them you'll file it for them but never actually do it. Ignore the request and change the subject.

9. What is the *most* important part of the "A" (Assessment) in a SOAP note?

Describing what the client was wearing. Stating your personal opinion about the client's parent. Assessing the client's progress toward their specific ISP goal and justifying the service. Copying and pasting the same thing from last week's note.

10. A client reports active SI with a plan and intent. Your *first* call is to:

911, always. Your LMHP Supervisor to co-develop the safety response. The client's school. The client's best friend.

11. A "passive" and non-billable note would say:

"Worker utilized a CBT worksheet to challenge cognitive distortions." "Worker observed client while they watched TV." "Worker modeled 3-part 'I feel' statements for the family." "Worker coached client through a distress tolerance skill (TIPP)."

12. The "T.I.P.P." skill taught in DBT is a:

Long-term problem-solving strategy. Way to ask for things interpersonally. Crisis survival / Distress Tolerance skill. Psychoeducation worksheet.

13. The "Trauma Narrative" is a key component of which EBP model?

TF-CBT DBT IFS Mandated Reporting

14. What is the *first* step in verbal de-escalation?

Telling the client to "calm down" immediately. Calling 911. Managing your *own* emotional state (staying calm). Setting a firm boundary.

15. You arrive for a home visit and hear adults yelling and throwing things inside. You should:

Go inside and try to de-escalate the adults. Enter and find the client to see if they are safe. Call 911 immediately. Do not enter. Return to your car, call your supervisor, and report the situation.

Module 6: Training Attestation

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

By checking the box below, you certify that you have completed this online orientation, understand all the material presented, and agree to abide by all agency policies and procedures.

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.