Sarah Johnson is the health information manager for the Columbus County Alcohol and Drug Treatment Center, a CARF-accredited, publicly funded treatment facility. As a member of the quality improvement (QI) committee, Sarah has been reviewing client records and focusing on written clinical assessments and treatment plans. The QI committee is interested in evaluating how consistently the clinicians document appropriate treatment goals based on the information found in the clinical assessment.

One of the records that Sarah reviewed is an outpatient record for Ann Wilson, a 24-year-old female client enrolled in the center's women's program.

Based on the summaries of Ms. Wilson's clinical assessment and treatment plan (see below).

Clinical Assessment

Presenting Problem: The 24-year-old, white female with a history of alcohol and cannabis abuse was referred by the county inpatient alcohol and drug treatment program. She is in need of continuing treatment for her longstanding problem with alcohol and drugs.

Health/Medical History: No current health problems. Client has two children, aged 2 years and 4 years. Other than childbirth and her recent substance abuse treatment, this client has not had any previous hospitalizations.

Family/Social Interaction: Client was raised in a physically abusive environment by her mother and alcoholic stepfather. Natural father was killed in a nightclub when the client was 10 years old. Client indicates that her natural father was also an alcoholic. She is currently living in public housing with her two children. She has little family or other emotional support. Her boyfriend of several years (father of her 2-year-old child) recently moved in with another woman.

Psychoactive Substance Use History

Drug Used	Age at First Use	Frequency (last 6 mo)	Quantity	Last Use	How
Alcohol	11	Daily	Pint of bourbon per day	1 month ago	Oral
Cocaine	18	Once in the last year	Unknown	6 months ago	Smoked
Cannabis	15	Weekly	Two per week	1 month ago	Smoked

DSM- V Diagnoses

Axis I Alcohol Dependence

Cannabis Abuse

Cocaine Use

Axis II Diagnosis deferred

Axis III None currently

Clinical Impression: This client recently completed a 28-day inpatient rehabilitation program. Client realizes she has a problem and is ready to seek treatment on a voluntary basis. Client feels relapse risks are high due to her lack of support. She will be admitted to the women's program so her children can benefit from the day care services and she can benefit from the support network. Anticipated level of care is weekly individual counselling sessions, as well as participating in group therapy twice a week.

Answer the questions:

1. What specific feedback should Sarah give to the committee?
2. Do the treatment goals and objectives relate to the person's goals?
3. Are they written in measurable terms?
4. Do they specify treatment interventions and their frequency?
5. Explain the different arguments for and against the use of contracted health services and privately operated correctional facilities.
6. Describe how correctional institutions are affected by the Health Insurance Portability and Accountability Act of 1996. In what ways do HIPAA rules apply differently to the correctional setting?