Discharge and Aftercare
Comprehensive Discharge Planning
Preparing patients for successful reintegration to work, family and home life depends on continued recovery and accountability at a lower level of care.
Case managers strive to connect patients with culturally competent health care providers who understand the demands of the fire service. With patient permission, discharge treatment recommendations are shared with the patient’s outpatient clinician and fire department physician.
Discharge plans use the Wellness Recovery Action Plan (WRAP) model and include the minimum following components, including the first behavioral health appointment within seven days:
- Referral to clinically indicated level of care (intensive outpatient or outpatient)
- Individual therapist appointment
- Psychiatrist/prescriber appointment, if indicated
- Primary care appointment
- List of local resources for self-help support (AA, NA, SMART recovery groups, etc.)
Commitment to Aftercare
The Center of Excellence is dedicated to understanding treatment efficacy, which is why we provide continuous aftercare support and monitoring for 18 months post-discharge. Patients who choose to participate in aftercare monitoring are surveyed at repeated intervals to measure symptom stabilization, aftercare compliance, treatment recidivism, and social and occupational functioning.
The 18-month aftercare process provides ongoing support following a patient’s discharge to include discharge surveys and wellness checks (via phone) at the following intervals:
- Monthly for the first 3 months following discharge
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months