Detoxification, also known as "withdrawal under medical care", is often considered a precursor to or a first stage of treatment, and it is designed to treat the physiological effects of acute and potentially fatal interruption of the use of drugs. 

Phase detoxification refers to the initial period of medical treatment-drug that is administered to the patient, these drugs allow you to move from using, not using drugs, in a comfortable, without suffering from symptoms of withdrawal.  

Procedures detoxification may or may not involve the administration of medication support.

Successful treatment consists of several steps:

1. Detoxification.

2. Medication (for opioid addiction, tobacco or alcohol)

3. Evaluation and treatment of problems of concurrent mental health, such as depression and anxiety.

4. Residential treatment and behavioral Counseling.

5. Long-term monitoring to prevent relapse.

All the team of professional interdisciplinary the Clinical Detoxification, that part in the treatment and rehabilitation of people with mental disorders and/or addiction issues to substance abuse and alcohol, will be governed by the procedures set forth in this Protocol.  Such Protocol it is framed under the best guides for the practice of proper treatment and recovery of mental disorders, substance abuse, and alcohol and best practices for the comprehensive treatment of individuals diagnosed with concurrent (mental Disorder, more addiction). The treatment that will be offered in the Clinic detox is a component based on Christian values and faith, complemented with scientific methodology. This phase of detoxification physiological, is approved with the process of “host”, conceptualized within the framework of treatment Therapeutic Community, motivation process needed to prepare for and facilitate the entry of the client/patient to the phase of residential treatment.

The average time of detoxification treatment for patients with dependence on substances or Diagnostic Concurrent, may be 10 days, according to the study of the individual case (Diagnosis), which will determine the Individualized Treatment Plan (“PITRA”).

Identifying the stage of change in which the patient is diagnosed, it sets the PITRA fit the person, in order to meet fully the needs of the client that is to say, the aspect of biological, psychological, social, and spiritual.

Emphasis is placed on the total abstinence from drug and alcohol use and the clarification of goals, so that the person can operate with relative success in the Therapeutic Community, once the detoxification phase.

III. PROTOCOLS

A. Admission Process

The process of admission begins when the participant is referred by any entity or individual to our Center. You will be greeted by the Interdisciplinary Committee of Admissions and Treatment, taking into account the clinical information obtained by the psychologist, the social worker, the nurse, the physician, the psychiatrist, and the other members of the team that will intervene in the treatment; this committee is coordinated by the intake officer assigned by the Center, who will make the initial interview and the recommendation for admission.

B. social Assessment

After the presentation of the document referred to, and the recommendation of the admission, the (the) social worker (Case Manager and Administrator of Record Clinical) will proceed to open the file, you will conduct an intake interview that included demographic information and the social history of the participant and shall direct the person on the documents informed consent you must sign, including in connection with the law “’HIPPA’ and 42 CFR. The first three days will be focused on medical treatment, after this, will start the phase of “Welcoming” during this phase, you will be directed to the participant or patient and will explain about the operation of the Residential Program, your rights, the rules of good coexistence and programmes of activities. The family member that will accompany the candidate to treatment will be focused on the same aspects in order to maintain their commitment, active participation and support in the whole process of therapeutic intervention to the participant. The social worker will design the plan of social services that will be provided to the participant.

(See Attachment A “Form of socio-demographic Information”.

C. Medical Evaluation, Medical History and Tests*

Once you have completed the interview for social and completed the process of documentation that is relevant to your admission, the candidate will be taken to the area of nursing* where a(a) enfermero(a) measure and report vital signs, height and weight of the participant initiating the nursing services, this information shall be noted on the part of the Medical History of your file.

The doctor will complement all the relevant information to the medical history of the participant. At the time of admission the patient should bring the results of the following tests:

• Drug test

• Urine test (OT)

• CBS

• U/A

• Metabolic Comprensive Panell

• VDRL

• P. P. D (Chest Plate)

• Test of COVID-19

*Medical treatment and medicines will be pre-paid by the patient Plan (or health insurance), and are not included in the payment of the monthly payment.

IV. DETOXIFICATION

After obtaining the results of the tests ordered by the physician, the participant will have a second evaluation with the medical clinician to analyze the results of laboratory tests. The clinician will establish a medical diagnosis based on the results of laboratory and medical evaluation. Find any physical illness, the candidate will be referred to your primary care physician for treatment of the condition encountered. No other health impairment, the physician clinical will begin with the treatment of drug-therapeutic established for the management of the withdrawal syndrome that occurs during the detoxification phase. Another drug that could be used for this purpose is Buprenorphine, this has properties agonist and opioid antagonists, it has also been shown to be effective to suppress the withdrawal symptoms, reduce cravings, block the euphoric effects of opioids; this would be done in coordination with one of the health Centers authorized to formulate Buprenorphine. In the stabilization phase will be used anxiolytics are not controlled. As part of its responsibilities, the doctor will develop a treatment plan for each individual participant, which will be regularly reviewed. Documented in the records of the participants, all the interventions and follow-up plans that serve as a frame of reference to make recommendations and referrals to the rest of the interdisciplinary team.

 (See: Annex B “The protocol and functions of the nursing service”.

          Annex C “The protocol and functions of the clinician”.

D. Psychological Evaluation and Treatment       The psychologist will conduct a psychological evaluation during the first 3 to 5 business days after the date of admission to the program. The purpose of the evaluation is to make a discernment of the psychological state and emotional of the participant and to establish a diagnostic impression, based on the Diagnostic and Statistical Manual of Mental disorders, Revised (DSM-V), the results were obtained diagnostics to proceed with the establishment of the plan of psychotherapy and/or counseling, according to the mode of therapy most appropriate and fit the behavioural needs of the participant (individual therapy, group therapy, family therapy, or therapy of marriage). The psychologist will progress notes in the file and the same can be discussed, consent signed by the participant or patient, during the meetings with the interdisciplinary team to assess the progress of the same.

See attached D1 “Clinical Interview”,

D2 “Plan of treatment”,

        D3 “Progress Notes”.

E. And Treatment

Find the psychologist is a mental health condition that warrants it, the participant will be referred to a medical facility or provider of services to the patient, for the participant to receive treatment with psychotropic drugs apply. The psychiatrist is an important part of the therapeutic team, interdisciplinary, monitored by changes in expected and unexpected behavior of the participants consequential psychiatric treatment. The pharmacological treatment formulated by the psychiatrist will be supervised by the nurse on duty.

F. Spiritual Plan/Discipleship (Days 4 to 10)

            We offer the service of assistance and spiritual counseling to the participant voluntarily agrees to it. In addition you will be offered lectures and readings with the aim of strengthening spiritual.

Spiritual integration along the approach to Bio-Psycho-Social approach is very effective in the rehabilitation of the participant and in reducing relapses.

G. Inventory of Interests, recreation Plan and Laborterapia(Days 4 to 10)

The inventory of interests and plans of recreation and laborterapia, when applicable, will be performed by the operators's therapeutic program, according to the individual characteristics of the patient and to the possibilities of the program.

V. TERMINATION OF TREATMENT AND FOLLOW-up

The Board's Evaluation of the clinical detoxification will make the corresponding evaluation of the progress and improvement of each participant at the end of the treatment and will make the determination of the end. The social worker shall communicate in writing the decision to the Entity referred the case to the participant and to the parents or family members where applicable. In written communication it will indicate the intention on the part of the program to offer a follow-up treatment for the space of a year. The participant must have met the following criteria for high:

1. Withdrawal - Have been out of the use of drugs during the treatment.

2. Social functioning - The participant submits a conduct adjustment and responsibility to their roles both at home and in the community.

3. Have a plan of goals for the future and short-term, designed during his recovery, in the phase of reintegration to the community.

4. Once you have completed the assessment and treatment plan detox, the interdisciplinary committee of admissions and treatment, will meet to discuss the

options that will be presented to the patient to enter one of the Centers of Teen Challenge of PR. If the patient agrees, we will proceed to make the processing and transfer to the treatment Center, which will be referred to.

VI. CLINICAL RECORD

The clinical record of the participant will be one organized, updated and readable in such a way that allows for the communication of the therapeutic team, interdisciplinary, ensuring the continuity and the holistic development of the treatment provided to the participant*.

See Attachment F “Protocol for the management of the Clinical records”.

VII. ABANDONMENT IS NOT AUTHORIZED BY THE PROGRAM.

When the patient abandonare without authorization the physical facilities of the clinic, a time known for his absence without authorization, we will communicate this fact as soon as possible to the patient's family members, and/or the relevant authorities.

If, after this, the patient is persuaded to continue the treatment, you will be re - evaluated by the psychologist, to set the stage of change that will be placed on your re-entry.

Angel Roque: Director of Admissions |Therapeutic Adiction Counseling III

Dr. Hernán Plaza: Clinical Director and Psychologist

Lic Johana Velez: Psychologist

Lic Yanira Perez:  Counselor-Professional

Lic Celinda Cuts: Nurse

Lic Rosa Rodriguez: Clinical Social Worker

Lic Dr. Miguel Rodriguez: General Practitioner

Lic Albert Rodriguez: Case management/Chaplain