CA-DTX Standard. Generated 7/02/2022. ©2022 Council on Accreditation.
2022 Edition

Day Treatment Services Definition

Purpose

Individuals who receive Day Treatment Services improve psychosocial, educational, vocational, and cognitive functioning, and learn to manage their symptoms.

Definition

Day Treatment Services are daytime programs that provide integrated, comprehensive treatment; and educational, vocational, and activity services to individuals with physical or mental disabilities, emotional disorders, behavioural disorders, and/or substance use conditions. Day treatment services also include therapeutic services for their families.

Day Treatment Services are designed to prevent movement to a more intensive level of care or as transitional or maintenance services for those who have stepped down from more intensive levels of care.
Note: Please see CA-DTX Reference List for the research that informed the development of these standards.

Note: For information about changes made in the 2020 Edition, please see the DTX Crosswalk.
 
2022 Edition

Day Treatment Services (CA-DTX) 1: Person-Centered Logic Model

The organization implements a program logic model that describes how resources and program activities will support the achievement of positive outcomes.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.

Logic models have been implemented for all programs and the organization has identified at least two outcomes for all its programs.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  

  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Logic models need improvement or clarification; or
  • Logic models are still under development for some of its programs, but are completed for all high-risk programs such as protective services, foster care, residential treatment, etc.; or
  • At least one outcome has been identified for all of its programs; or
  • All but a few staff have been trained on use of therapeutic interventions and training is scheduled for the rest; or
  • With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Logic models need significant improvement; or
  • Logic models are still under development for a majority of programs; or
  • A logic model has not been developed for one or more high-risk programs; or
  • Outcomes have not been identified for one or more programs; or
  • Several staff have not been trained on the use of therapeutic interventions; or
  • There are gaps in monitoring of therapeutic interventions, as required; or
  • There is no process for identifying risks associated with use of therapeutic interventions; or
  • Policy on prohibited interventions does not include at least one of the required elements.
4

Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,

  • Logic models have not been developed or implemented; or
  • Outcomes have not been identified for any programs; or
  • There is no written policy or procedures for the use of therapeutic interventions; or 
  • Procedures are clearly inadequate or not being used; or
  • Documentation on therapeutic interventions is routinely incomplete and/or missing; or
  • There is evidence that people have been harmed by inappropriate or unmonitored use of therapeutic interventions.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • See program description completed during intake
  • Program logic model that includes a list of outcomes being measured
  • Procedures for the use of therapeutic interventions
  • Policy for prohibited interventions
  • Training curricula that addresses therapeutic interventions
  • Documentation of training and/or certification related to therapeutic interventions
  • Interviews may include:
    1. Program director
    2. Relevant personnel

 

CA-DTX 1.01

A program logic model, or equivalent framework, identifies:

  1. needs the program will address;
  2. available human, financial, organizational, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered); 
  5. desired outcomes (i.e. the changes you expect to see in persons served); and
  6. expected long-term impact on the organization, community, and/or system.
Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA’s PQI Tool Kit for more information on developing and using program logic models.

Examples: Information that may be used to inform the development of the logic model includes, but is not limited to: 
  1. needs assessments and periodic reassessments; 
  2. risks assessments conducted for specific interventions; and
  3. the best available evidence of service effectiveness.

 

CA-DTX 1.02

The logic model identifies outcomes in at least two of the following areas:

  1. change in clinical status;
  2. change in functional status;
  3. health, welfare, and safety;
  4. permanency of life situation; 
  5. quality of life; 
  6. achievement of individual service goals; and 
  7. other outcomes as appropriate to the program or service population.
Example: Outcomes data can be disaggregated by race or ethnicity to identify and monitor disparities in service provision or effectiveness.

 
Fundamental Practice

CA-DTX 1.03

The organization: 
  1. ensures that personnel are trained on therapeutic interventions and/or receive certification when it is available prior to coming in contact with the service population;
  2. monitors the use and effectiveness of therapeutic interventions;
  3. identifies potential risks associated with therapeutic interventions and takes appropriate steps to minimize risk, when necessary; and
  4. discontinues an intervention immediately if it produces adverse side effects or is deemed unacceptable according to prevailing professional standards.

 
Fundamental Practice

CA-DTX 1.04

Organization policy prohibits:
  1. corporal punishment;
  2. the use of aversive stimuli;
  3. interventions that involve withholding nutrition or hydration, or that inflict physical or psychological pain;
  4. the use of demeaning, shaming, or degrading language or activities;
  5. forced physical exercise to eliminate behaviours;
  6. unwarranted use of invasive procedures or activities as a disciplinary action;
  7. punitive work assignments;
  8. punishment by peers; and
  9. group punishment or discipline for individual behaviour.
 
2022 Edition

Day Treatment Services (CA-DTX) 2: Personnel

An interdisciplinary team of clinical and direct service personnel have the competency and support needed to provide services and meet the needs of the persons served.

Interpretation

Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Sample job descriptions from across relevant job categories
  • Documentation tracking staff completion of required trainings and/or competencies
  • Training curricula
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files

 

CA-DTX 2.01

Clinical personnel include mental health or human service professionals qualified:
  1. by an advanced degree, clinical training, and professional experience; and/or 
  2. in accordance with the requirements of their respective disciplines and any applicable legal requirements for practice.

 

CA-DTX 2.02

Direct service providers have:

  1. educational and experiential backgrounds that enable them to participate in the overall treatment program and to meet the emotional and developmental needs of persons served; and
  2. personal characteristics and temperament suitable for working with persons with special needs.

 

CA-DTX 2.03

A psychologist with appropriate credentials and experience is available to provide testing and psychological services, as necessary.

 

CA-DTX 2.04

A psychiatrist or other qualified health practitioner participates in the development and implementation of the overall treatment program, including regular case reviews, and provides medication management and other services as needed.
NA The organization provides non-psychiatric day treatment services.

 
Fundamental Practice

CA-DTX 2.05

A licensed physician is available on-call during hours of operation, or the organization has formal arrangements for health services with a local care authority.
NA All individuals have private physicians.

 

CA-DTX 2.06

Clinical personnel are trained on, or demonstrate competency in, the latest information, theories, and proven practices related to the treatment of alcohol and other drug use disorders including:  

  1. diagnostic criteria for substance use disorders and their severity; 
  2. the signs and symptoms of withdrawal; 
  3. addiction as a disease; 
  4. treatment needs of special populations including women, people experiencing homelessness, adolescents, and people with HIV/AIDS; 
  5. relapse prevention;
  6. management of drug overdose; and 
  7. harm reduction interventions or practices. 
NA The organization does not provide substance use treatment services.

 

CA-DTX 2.07

Individuals who provide peer support:  

  1. obtain certification, as defined by their province; 
  2. are willing to share their personal recovery stories; 
  3. have a job description and clearly understand the role of a peer support worker; and 
  4. have adequate supports in place and appropriate supervision, including mentoring and/or coaching from more experienced peers when indicated. 

 

Interpretation

Regarding element d, supervisors of peer support staff should be trained on recognizing and responding to signs of trauma among peer support workers. 

NA The organization does not utilize peer support workers. 


 

CA-DTX 2.08

Individuals who provide peer support receive pre- and in-service training on:  

  1. how to recognize the need for more intensive services and how to make an appropriate referral; 
  2. established ethical guidelines, including setting appropriate boundaries and protecting confidentiality and privacy; 
  3. wellness support methods, trauma-informed care practices, and recovery resources;  
  4. managing personal triggers that may occur during the course of their role as a peer support provider; and 
  5. skills, concepts, and philosophies related to recovery and peer support. 

NA The organization does not utilize peer support workers. 

Examples: Training on skills, concepts, and philosophies related to recovery can include, but are not limited to: 

  1. system navigation; 
  2. stages of change; 
  3. addiction as a disease; and 
  4. medication-assisted treatment. 

 

CA-DTX 2.09

The organization minimizes the number of staff working with the person over the course of their contact with the organization by:

  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.

 
Fundamental Practice

CA-DTX 2.10

There is at least one person on duty at each program site any time the program is in operation that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.

 

CA-DTX 2.11

The workloads of direct service personnel support the achievement of positive outcomes and are regularly reviewed.

Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.
 
2022 Edition

Day Treatment Services (CA-DTX) 3: Intake and Assessment

The organization’s intake and assessment practices ensure that individuals receive prompt and responsive access to appropriate services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • In a few rare instances, urgent needs were not prioritized; or
  • For the most part, established timeframes are met; or
  • Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation by persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Urgent needs are often not prioritized; or 
  • Services are frequently not initiated in a timely manner; or
  • Applicants are not receiving referrals, as appropriate; or 
  • Assessment and reassessment timeframes are often missed; or
  • Assessments are sometimes not sufficiently individualized; 
  • Culturally responsive assessments are not the norm, and this is not being addressed in supervision or training; or
  • Several case records are missing important information; or
  • Participation by persons served is inconsistent; or
  • Intake or assessment is done by another organization or referral source and no documentation and/or summary of required information is present in case record. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • There are no written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Screening and intake procedures
  • Assessment procedures
  • Copy of assessment tool(s)
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-DTX 3.01

Individuals are screened and informed about:

  1. how well their request matches the organization's services; and
  2. what services will be available and when.
NA Another organization is responsible for screening, as defined in a contract.

 
Fundamental Practice

CA-DTX 3.02

Prompt, responsive intake practices:

  1. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
  2. give priority to urgent needs and emergency situations;
  3. support timely initiation of services; and
  4. provide for placement on a waiting list or referral to appropriate resources when the person cannot be served or cannot be served promptly.

Examples: Regarding element b, urgent situations can include drug overdose, impairment, or severe withdrawal; pregnancy in women with opioid use disorder; people at risk of suicide; and cases where a parent has a child in the child welfare system.  


Referral providers for crisis situations may include 24-hour mobile crisis teams, emergency crisis intervention services, crisis stabilization, or 24-hour crisis hotline. 


 

CA-DTX 3.03

Persons served participate in an individualized, culturally and linguistically responsive assessment that is:
  1. completed within established timeframes; 
  2. updated as needed based on the needs of persons served; and
  3. focused on information pertinent for meeting service requests and objectives.

Interpretation

The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

 

CA-DTX 3.04

The assessment includes identification of:

  1. behavioural health needs and goals including an evaluation of mental health and substance use symptoms or disorders, their severity, and treatment history; 
  2. physical health needs and goals including a comprehensive medical history; 
  3. social, emotional, educational, and vocational needs, strengths, and goals including appropriate family goals;  
  4. barriers to change; and 
  5. a diagnosis in accordance with a standardized diagnostic tool. 

Examples: Substance use assessments may examine a variety of factors in the person’s substance use history including age at first use, routes of ingestion and history of tolerance, withdrawal, drug mixing, and overdose as well as information on current patterns of use such as which drugs the person uses, comorbid alcohol and tobacco use, and the frequency, recency, and intensity of use. 

 
2022 Edition

Day Treatment Services (CA-DTX) 4: Service Planning and Monitoring

Each person participates in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, signatures of staff or persons served are missing and/or not dated; or
  • With few exceptions, staff work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc.; or
  • Active participation by persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • In several instances, signatures of staff or persons served are missing and/or not dated; or
  • Quarterly reviews are not being done consistently; or
  • Level of care for some people is clearly inappropriate; or
  • Service planning is often done without full participation of the individual; or
  • Appropriate family involvement is not documented; or  
  • Documentation is routinely incomplete and/or missing; or
  • Individual staff members work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc., but this is the exception.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Service planning and monitoring procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-DTX 4.01

An assessment-based service plan is developed in a timely manner with the full participation of the individual, and their guardian and/or family when appropriate, and includes:

  1. agreed upon goals, desired outcomes, and timeframes for achieving them;
  2. services and supports to be provided, and by whom; 
  3. specific referrals to be made during treatment and aftercare;
  4. possibilities for maintaining and strengthening family relationships and other informal social networks; 
  5. procedures for expedited service-planning when crisis or urgent need is identified; and
  6. the person's signature.

 
Fundamental Practice

CA-DTX 4.02

The organization determines whether a crisis plan is necessary and, when indicated, engages persons served and involved family members in crisis and/or safety planning that:

  1. is individualized and centered around strengths; 
  2. identifies individualized warning signs of a crisis;
  3. identifies coping strategies and sources of support that individuals can implement during a suicidal crisis, as appropriate; and 
  4. specifies interventions that may or may not be implemented to help the person de-escalate and promote stabilization.

Interpretation

For people who have been deemed to be at high risk of suicide, a safety plan includes a prioritized written list of coping strategies and sources of support that the person can use before or during a suicidal crisis. A personalized safety plan and appropriate follow-up can help people cope with suicidal feelings in order to prevent a suicide attempt or possibly death. The safety plan should be developed once it has been determined that no immediate emergency intervention is required. 


Interpretation

“No-suicide contracts,” also known as “no-harm contracts” and other similar terms, should never be used. No-suicide contracts are based on a verbal or written agreement by the person to not engage in self-harm or suicidal acts during a specific timeframe. Research does not support this practice or show that these agreements are effective at preventing suicides, nor have they been found to provide protection against malpractice lawsuits. 

Examples: Depending on the needs of the individual, crisis plans may reference advanced mental health directives, also known as advanced psychiatric directives.


Examples: Components of a safety plan can also include: internal coping strategies, socialization strategies for distraction and support, family and social contacts for assistance, professional and agency contacts, and lethal means restriction. 

 

Examples: Warning signs for being at high risk for suicide can include a missed appointment, or significant change in status, and personnel may conduct active outreach and service engagement strategies such as phone calls, text messages, or home visits until contact is made.


 

CA-DTX 4.03

The organization works in active partnership with the individual to:
  1. assume a service coordination role, as appropriate, when the need has been identified and no other organization has assumed that responsibility;
  2. ensure that they receive appropriate advocacy support;
  3. assist with access to the full array of services to which they are eligible; and
  4. mediate barriers to services within the service delivery system.

 

CA-DTX 4.04

The worker and a supervisor, or a clinical, service, or peer team, review the case quarterly, or more frequently depending on the needs of the individual, to assess:
  1. service plan implementation;
  2. progress toward achieving service goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon service goals.

Interpretation

When experienced workers are conducting reviews of their own cases, the worker's supervisor must review a sample of the worker's evaluations as per the requirements of the standard.

Examples: People with higher level of care needs require frequent review. For example, weekly review is recommended for individuals with suicidal ideation, recent relapse, or those with a recent mental health- or substance use-related emergency room visit or hospitalization. People with acute or complex needs (e.g., individuals receiving medications for diagnosed symptoms and conditions) or those in a higher level of care such as intensive outpatient may require that their service plan be reviewed and updated every 30 days. 


 

CA-DTX 4.05

The worker, individual and/or legal guardian, and his or her family when appropriate:
  1. review progress toward achievement of agreed upon service goals; and 
  2. sign revisions to service goals and plans.
 
2022 Edition

Day Treatment Services (CA-DTX) 5: Interdisciplinary Program

Participants regularly attend an interdisciplinary program of treatment, education, and activity that fosters active participation and incorporates available social supports to the greatest extent possible given availability of appropriate resources.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation by persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Program curriculum or sample daily program schedule
  • Procedures for communication/collaboration between day and residential programs
  • Procedures for obtaining clearance to participate in athletic activities
  • Proof of accreditation, licensure, or certification for outside providers operating adventure-based activities, if applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records
  • Observe program

 

CA-DTX 5.01

The day treatment program:

  1. aids in the transition from in-patient to out-patient care;
  2. addresses needs not met by less intensive programming;
  3. offers an alternative to more restrictive care; and
  4. works with the person and other providers to ensure continuity of care.

 

CA-DTX 5.02

Participants are engaged in therapeutic activities designed to:
  1. develop and maintain a normalizing routine; 
  2. enhance personal and interpersonal skills and behaviours; and 
  3. address identified problem areas.

 

CA-DTX 5.03

The program offers the following services and adapts the structure and content of these services based on the program model and the needs of the service population:
  1. individual and group treatment;
  2. family therapy;
  3. educational programming;
  4. psychoeducational groups;
  5. medication evaluation and monitoring;
  6. expressive therapies;
  7. recreational activities;
  8. pre-vocational training;
  9. independent living skills training; and
  10. other planned, structured activities.

 

CA-DTX 5.04

When planning day treatment activities, the organization takes into account group characteristics and the individual’s:

  1. age and developmental level;
  2. emotional stability;
  3. readiness for change; 
  4. personality;
  5. skills; and
  6. gender.

 

CA-DTX 5.05

Participants are helped to develop and expand their informal support networks including connections with friends, extended family, and community members.

 

CA-DTX 5.06

Therapeutic programming provides scheduled sessions for a minimum of:
  1. nine hours per week in intensive outpatient programs; or
  2. sixteen to twenty hours per week in partial hospitalization programs.

Interpretation

Outpatient day treatment programs may operate for fewer than nine hours per week when the frequency and intensity of services is appropriate to individual needs and a rationale is provided in individual service plans.

 

CA-DTX 5.07

The organization helps individuals establish and strengthen links to needed support services including:

  1. basic needs, such as food and clothing; 
  2. supported housing;
  3. supported employment;
  4. medical care;
  5. substance use treatment;
  6. public assistance;
  7. legal services; 
  8. financial counselling; 
  9. child care;
  10. educational services;
  11. respite care; and
  12. peer support.

Interpretation

Regarding element d, people with both chronic pain and substance use disorder should receive integrated treatment from appropriate medical specialists. 


 

CA-DTX 5.08

A program that serves a mix of individuals who live in residential care and in the community ensures that:
  1. residents and non-residents receive a comprehensive program that is tailored to individual needs;
  2. mechanisms for communication between day and residential programs are in place; and
  3. responsibilities of residential and day programs are clearly delineated.
NA The organization does not serve a mixed population of residents and non-residents.

 
Fundamental Practice

CA-DTX 5.09

The organization evaluates the person's ability to participate in athletic activities and obtains:

  1. written, signed permission slips from their legal guardians;
  2. a medical records release;
  3. a signed document from a qualified medical professional stating that the person is physically capable of participating; and/or
  4. an adult waiver and release of liability.

NA The organization does not offer athletic activities to persons served.


 
Fundamental Practice

CA-DTX 5.10

Organizations that purchase services from providers that operate adventure-based activities with a significant degree of risk request proof of accreditation, licensure, or certification with a nationally recognized authority for the activity being conducted.
NA The organization does not purchase services from providers that operate adventure-based activities.
Examples: Adventure-based activities with a significant degree of risk can include white water rafting, climbing walls, or ropes courses.
 
2022 Edition

Day Treatment Services (CA-DTX) 6: Services for Families

The person, family, and organization work together to achieve an optimal level of family participation.

1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation by persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for involving the family of the primary person served
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-DTX 6.01

The organization engages the family and encourages active participation in the treatment process, including participation in family counselling, unless such involvement is contraindicated.
Examples: Examples of ways to engage family members may include demonstrating: 
  1. sensitivity to the willingness of the family to be engaged;
  2. a non-threatening manner;
  3. respect for the person’s autonomy and confidentiality;
  4. flexibility; and
  5. persistence.

 

CA-DTX 6.02

When involvement of family members or significant others is desired by the person but proves difficult to achieve, the organization:

  1. attempts to reestablish contacts and positive interactions between family members through activity and educational programs;
  2. provides individual and group counselling to family members or significant others who accept services; and
  3. aids the person in identifying ways to build and enhance a social support system.

 

CA-DTX 6.03

The families or significant others of participants are offered services including:
  1. family psycho-education;
  2. emotional support and therapy;
  3. community and support services;
  4. care coordination, as needed; and
  5. self-help referrals.
 
2022 Edition

Day Treatment Services (CA-DTX) 7: Education Services

The organization provides or arranges for individuals to receive education services and supports to help them achieve their educational and/or vocational goals.

Interpretation

Organizations that do not provide educational services on-site should coordinate with schools or community-based providers to meet the educational needs of all people. When organizations do not directly provide or arrange education services, case records should indicate that education plans are integrated into treatment plans and document advocacy for areas of unmet educational need. Education services will vary depending on the population served.

1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation of persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for developing and/or integrating education plans
  • Procedures for coordinating education services with community-based providers, if applicable
  • Proof of certification, accreditation, or registration, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-DTX 7.01

A comprehensive, coordinated education plan is developed and integrated into the service plan for any person who has educational goals, or vocational goals that include an educational component.

Interpretation

If the organization does not participate in the development of the education plan, it must still integrate each person's education plan into their service plan.


 

CA-DTX 7.02

People pursuing educational goals are enrolled in an appropriate education program on-site or in the community that is approved, certified, accredited, registered, or operated by or in conjunction with the local school district.


 

CA-DTX 7.03

The education program incorporates effective instructional practices, quality curriculum design, and educational tools and supports for diverse learning needs of children and youth.
NA The organization does not provide day treatment services to school-age children or youth.

NA The organization does not directly provide the education program or develop education plans for children or youth.
Examples: Diverse learning needs can include children who require support due to a learning disability, are learning English as an additional language, or are intellectually gifted.

 

CA-DTX 7.04

The organization provides or arranges, as needed:
  1. tutoring;
  2. preparation for a high school equivalency diploma;
  3. university preparation; 
  4. parent/teacher meetings; 
  5. vocational or continuing education opportunities; and/or 
  6. advocacy and support.
 
2022 Edition

Day Treatment Services (CA-DTX) 8: Substance Use Services

The organization provides coordinated substance use prevention, treatment, and recovery services based on the person's assessed needs and goals.

NA The organization does not provide substance use services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation of persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for communication/collaboration among team members
  • Criteria for determining the level of care

Documentation tracking staff completion of required training and/or competencies related to opioid overdose, when applicable

  • Interviews may include:
    • Clinical/Medical director
    • Relevant personnel
    • Persons served
  • Review case records
  • Observe facility

 
Fundamental Practice

CA-DTX 8.01

A qualified team of health professionals, with experience, training, and competence in engaging, diagnosing, and treating persons with substance use disorders, provide services including:

  1. administering or reviewing diagnostic, toxicological, and other health related examinations;
  2. determining the optimal level and intensity of care including clinical and community support services;
  3. evaluation for psychotropic medications and medication-assisted treatment; 
  4. prescribing and managing medication including appropriate management of pharmacotherapy for people with co-occurring conditions; 
  5. review of complicated cases where co-occurring substance use, health, and mental health conditions intersect; and
  6. coordinating care with other service providers, including primary care and mental health providers, when appropriate and with the consent of the service recipient.

 

CA-DTX 8.02

The organization directly provides a comprehensive range of prevention and treatment services including:
  1. illness management and psychoeducation interventions;
  2. clinical monitoring and drug screening; 
  3. coping skills training; 
  4. relapse prevention; 
  5. acute care; and
  6. support groups and self-help referrals.
Examples: Other services may include intensive outpatient care, medical care, psychiatric rehabilitation, and targeted case management services.

 

CA-DTX 8.03

Therapeutic services help individuals develop the knowledge, skills, and supports necessary to: 
  1. manage mental health and/or substance use disorders; 
  2. develop and practice prosocial behaviours;
  3. cultivate and sustain positive, meaningful relationships with peers, family members, and the community; 
  4. develop self-efficacy; and
  5. promote recovery, resilience, and whole-person wellness.

Examples: Recovery is a holistic process of change where people learn to overcome or manage their diagnosed symptoms and conditions in order to improve overall well-being and achieve optimal health.


 

CA-DTX 8.04

Individuals, and their families when possible, are actively connected with peer support services, either directly or by referral, appropriate to their request or need for service. 

Interpretation

Connections to outside self-help/mutual aid groups should not be limited to providing the time and location for a meeting. Organizations can support the person’s acclimation to a new group by, for example, discussing meeting protocols and what to expect prior to attending, accompanying them to their first meeting, and encouraging them to make connections with peers while at the meeting.  

Examples: Peer support refers to services provided by individuals who have shared, lived experience. Services promote resiliency and recovery and can include peer recovery groups, peer-to-peer counselling, peer mentoring or coaching, family and youth peer support, or other consumer-run services. Peer recovery groups may be specialized for particular groups of individuals or families such as individuals affected by HIV/AIDS.


 

CA-DTX 8.05

The organization maintains a supply of naloxone on-site and appropriately trained staff are available to administer this medication in the event of an overdose. 

 
2022 Edition

Day Treatment Services (CA-DTX) 9: Care and Supervision

The organization provides sufficient care and supervision to ensure participant safety and service quality.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active participation of persons served occurs to a considerable extent.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Coverage schedules for the most recent month indicating staff-to-participant ratios
  • Coverage schedules for the previous six months indicating staff-to-participant ratios
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Observe program

 

CA-DTX 9.01

Personnel-to-participant ratios are appropriate to the developmental and clinical needs of participants and:
  1. increase during emergencies, with after-hours and holiday coverage available for crisis situations; and
  2. increase to meet the special needs of individuals during busier or more stressful periods.

 
Fundamental Practice

CA-DTX 9.02

In organizations providing educational services to school-age children or youth, special education teachers and teaching or therapeutic aides provide a classroom ratio of one adult for every four participants.
NA The organization does not serve children or youth.

NA The organization does not directly provide education services to school-age children or youth.
 
2022 Edition

Day Treatment Services (CA-DTX) 10: Case Closing and Aftercare

The organization works with persons served, and family members when appropriate, to plan for case closing and, when possible, to develop aftercare plans.

1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2

Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  

  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, the organization terminated services inappropriately; or  
  • Active participation of persons served occurs to a considerable extent; or
  • A formal case closing evaluation is not consistently provided to the public authority per the requirements of the standard.
3

Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,

  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Services are frequently terminated inappropriately; or  
  • Aftercare planning is not initiated early enough to ensure orderly transitions; or
  • A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard; or  
  • Several case records are missing important information; or
  • Participation of persons served is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing. 
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Case closing procedures
  • Aftercare planning and follow-up procedures
  • Relevant portions of contract with public authority, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-DTX 10.01

Planning for case closing:
  1. is clearly defined and includes assignment of staff responsibility;
  2. begins at intake; and
  3. involves the worker, persons served, and others as appropriate to the needs and wishes of the participant.

 

CA-DTX 10.02

Upon case closing, the organization notifies any collaborating service providers, including the courts, as appropriate.

 

CA-DTX 10.03

If a person has to leave the program unexpectedly, the organization makes every effort to identify other service options and link the person with appropriate services.

Interpretation

The organization must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.

 

CA-DTX 10.04

When appropriate, the organization works with the person and their family to:

  1. develop an aftercare plan, sufficiently in advance of case closing, that identifies short- and long-term needs and goals and facilitates the initiation or continuation of needed supports and services; or
  2. conduct a formal case closing evaluation, including an assessment of unmet need, when the organization has a contract with a public authority that does not include aftercare planning or follow-up.

 

CA-DTX 10.05

The organization follows up on the aftercare plan as appropriate, when possible, and with the permission of the service recipient.
NA The organization has a contract with a public authority that prohibits or does not include aftercare planning or follow-up.
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