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Opioid Treatment Definition
Purpose
Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.Definition
Note:Please see PA-OTP 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 OTP Crosswalk.
Opioid Treatment (PA-OTP) 1: Person-Centered Logic Model
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 1.01
- needs the program will address;
- available human, financial, agency, and community resources (i.e. inputs);
- program activities intended to bring about desired results;
- program outputs (i.e. the size and scope of services delivered);
- desired outcomes (i.e. the changes you expect to see in persons served); and
- expected long-term impact on the agency, community, and/or system.
Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to:
- needs assessments and periodic reassessments; and
- the best available evidence of service effectiveness.
PA-OTP 1.02
- change in clinical status;
- change in functional status;
- health, welfare, and safety;
- permanency of life situation;
- quality of life;
- achievement of individual service goals; and
- other outcomes as appropriate to the program or service population.
Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PA-PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes.
Opioid Treatment (PA-OTP) 2: Personnel
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 2.01
- an advanced degree in social work, medicine, psychology, pastoral counseling, marriage and family counseling, mental health or substance use counseling, or psychiatric nursing, and in-service or other training in the treatment of substance use conditions;
- a bachelor’s degree in social work or a related human service field with specialized training and experience in the area of substance use treatment;
- certification by the designated authority when the state has a mechanism for certifying addiction counselors;
- personal experience with drug use recovery and specialized training and demonstrated skills in the area of substance use treatment; or
- specific and relevant training in the treatment of substance use and a minimum of two years’ work experience in a substance use treatment service.
PA-OTP 2.02
- practitioners licensed and registered under the appropriate federal and state laws; or
- supervised by a licensed practitioner.
PA-OTP 2.03
- an advanced degree in a human service field and a minimum of two years’ post-graduate professional experience;
- specialized training and experience in substance use diagnosis and treatment and additional training in supervision; and/or
- certification by the designated authority in their state as an approved addiction counseling supervisor.
PA-OTP 2.04
PA-OTP 2.05
- are on staff or available through formal agreement to provide services and support needed to meet the needs of individuals; and
- make level of care, treatment, and termination-of-service decisions with service recipients.
PA-OTP 2.06
PA-OTP 2.07
PA-OTP 2.08
- the concept of addiction as a disease;
- the goals of opioid treatment in regard to other drug use;
- the latest information, theories, and techniques in identification, diagnosis, and treatment of alcohol and other drug problems, including the harm reduction model;
- relapse prevention;
- recognition of co-occurring health and mental health conditions and integrated services available to meet them;
- management of drug overdose;
- special treatment needs of women;
- criminal justice issues, as appropriate;
- the benefits and limitations of tests that screen for drug use; and
- HIV/AIDS symptoms, risk-reduction and infection control guidelines, testing, and counseling.
PA-OTP 2.09
PA-OTP 2.10
- assigning a worker at intake or early in the contact; and
- avoiding the arbitrary or indiscriminate reassignment of direct service personnel.
PA-OTP 2.11
- the qualifications, competencies, and experience of the worker, including the level of supervision needed;
- the work and time required to accomplish assigned tasks and job responsibilities; and
- service volume, accounting for assessed level of needs of persons served.
Opioid Treatment (PA-OTP) 3: Access to Service
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 3.01
- during hours that are based on the needs of the service population; and
- 24 hours a day, seven days a week for emergencies.
PA-OTP 3.02
PA-OTP 3.03
- results of a review to determine if the person is enrolled in another OTP; and
- justification of extenuating circumstances as determined by the medical director or physician, when they exist.
PA-OTP 3.04
- has been dependent on opiates for at least one year before admission, except in extenuating circumstances set forth in federal, state, and local law or regulation; and/or
- is physically dependent upon a narcotic drug, using accepted medical criteria, such as those listed in the Diagnostic and Statistical Manual for Mental Disorders.
PA-OTP 3.05
Opioid Treatment (PA-OTP) 4: Intake and Assessment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 4.01
- how well their request matches the agency's services; and
- what services will be available and when.
PA-OTP 4.02
- gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
- give priority to pregnant women, and individuals with urgent needs and emergency medical or psychiatric situations;
- facilitate the identification of individuals and families with co-occurring conditions and multiple needs;
- support timely initiation of services; and
- provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.
PA-OTP 4.03
- completed within established timeframes;
- updated as needed based on the needs of persons served; and
- 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.
PA-OTP 4.04
- medical history, including history of narcotic dependence;
- evidence of current physical dependence;
- laboratory examinations, including a serological test for syphilis, a tuberculin skin test, and a toxicology test to analyze drug dependence;
- determination of the presence of infectious diseases or organ abnormalities; and
- determination of vital signs, general appearance.
PA-OTP 4.05
- high-risk behaviors related to HIV/AIDS, sexually transmitted diseases, multi drug-resistant tuberculosis, and other infectious diseases;
- patterns of other drug use, including Benzodiazepines;
- presence of co-occurring health and mental health conditions; and
- issues related to criminal activities.
Interpretation: Individuals identified as having mental health needs should receive integrated treatment directly or through referral to a cooperating service provider.
Opioid Treatment (PA-OTP) 5: Service Planning and Monitoring
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 5.01
- agreed upon goals, including education, vocational, and employment goals, desired outcomes, and timeframes for achieving them;
- recommendations for medical, psychosocial, economic, legal, or other support services and by whom they will be provided;
- possibilities for maintaining and strengthening family relationships and other informal social networks;
- procedures for expedited service planning when crisis or urgent need is identified; and
- the individual’s signature.
PA-OTP 5.02
- assume a service coordination role, as appropriate, when the need has been identified and no other agency has assumed that responsibility;
- ensure that they receive appropriate advocacy support;
- assist with access to the full array of services to which they are eligible; and
- mediate barriers to services within the service delivery system.
PA-OTP 5.03
- service plan implementation;
- progress toward achieving goals and desired outcomes; and
- the continuing appropriateness of the agreed upon service goals.
PA-OTP 5.04
- review progress toward achievement of agreed upon goals; and
- sign revisions to service goals and plans.
Opioid Treatment (PA-OTP) 6: Community Services
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 6.01
- educates the public about the value of opioid treatment;
- builds community support; and
- provides information about the agency.
PA-OTP 6.02
- serves as a community resource for substance use and related health, mental health, and social issues;
- establishes mechanisms to hear community views and issues about opioid treatment and the agency's presence in the community; and
- aims to address and resolve community concerns.
Opioid Treatment (PA-OTP) 7: Service Elements
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 7.01
- substance use counseling that is coordinated with other counseling and services;
- access to physicians with knowledge of appropriate prescribing practices for individuals with addiction;
- activities that address the importance of drug and alcohol-free lifestyles and de-emphasize the role of intoxicants; and
- activities that address issues of particular concern to women, including intimacy, intimate partner violence, physical trauma, sexual trauma, prevention of exposure to and transmission of HIV/AIDS and other STDs, child care, pregnancy, and family planning.
PA-OTP 7.02
- program guidelines, rules, and regulations;
- the nature of addictive disorders;
- signs and symptoms of overdose and when to seek emergency assistance;
- the dangers of cross-tolerance;
- dependency substitution and self-medication;
- therapeutic effects of opioid treatment medication;
- common myths about opioid treatment medication;
- the benefits of treatment and the recovery process;
- dispensing medication; and
- toxicology testing procedures.
PA-OTP 7.03
- infectious disease prevention and risk reduction information and education;
- counseling on the importance of treatment adherence and honest communication with the provider;
- counseling on HIV infection and other infectious diseases and referral for testing;
- intensive clinical support for continued active use of alcohol and other drugs, including tobacco;
- supplemental psychotherapy services or referrals for co-occurring mental health disorders;
- support, information, and referral when seeking alternative therapies;
- access to vocational rehabilitation, evaluation, education, and training services;
- access to parenting workshops;
- access to support and specialized recovery groups if the person and his/her family is affected by HIV/AIDS; and
- noncompliance and discharge procedures.
PA-OTP 7.04
- person-centered;
- strengths-based;
- culturally-responsive;
- facilitative and self-directed;
- supported by formal and informal resources; and
- ongoing.
PA-OTP 7.05
PA-OTP 7.06
PA-OTP 7.07
PA-OTP 7.08
Opioid Treatment (PA-OTP) 8: Medical Services
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 8.01
PA-OTP 8.02
PA-OTP 8.03
PA-OTP 8.04
PA-OTP 8.05
PA-OTP 8.06
- prior to initiating dosing for new patients;
- at clinical decision points, such as ordering take home medication; and
- routinely for all patients.
Opioid Treatment (PA-OTP) 9: Toxicology Testing for Continued Drug Use
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 9.01
PA-OTP 9.02
- with respect for individual privacy; and
- in a safe treatment atmosphere.
PA-OTP 9.03
- at least eight random drug tests per service recipient, per year;
- at least one initial and two subsequent tests for individuals in interim maintenance treatment; and
- tests, as appropriate, during medically supervised and other types of withdrawal.
PA-OTP 9.04
- informing persons served about how specimens are collected and of their responsibility to provide a specimen when asked;
- discussing positive toxicology results with the individual;
- providing counseling, medical review, and other interventions if the person continues to test positive for illegal substance use;
- methods to minimize falsification during the drug testing sample collection;
- a process for reviewing false-positive and false-negative results; and
- documenting results in the case record along with the person’s response.
PA-OTP 9.05
- evaluates negative reports for opioid treatment medication and related metabolites;
- reviews dosage when positive toxicology reports for drugs are received;
- investigates the possibility of false positive results when persons served deny drug use;
- rapidly responds if the individual is found to be in danger of relapse; and
- uses the results to determine the need for additional interventions.
PA-OTP 9.06
Opioid Treatment (PA-OTP) 10: Take-Home Privileges for Unsupervised Use of Medication
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 10.01
PA-OTP 10.02
- length of time in treatment;
- consistency of clinic attendance;
- clinical status;
- progress in rehabilitation;
- medical necessity;
- behavioral factors;
- geographic considerations;
- employment schedules that create hardship for an individual to meet limited clinic hours;
- results of toxicology tests; and
- other special needs.
Interpretation: Time in treatment should not be a factor for patients prescribed buprenorphine for take-home use.
PA-OTP 10.03
- schedules toxicology tests to ensure he or she consumes the opioid treatment medication provided and remains free of substance use;
- implements measures to help avoid diversion of controlled substances;
- has a physician review his or her status at least every 90 days, or more frequently if clinically indicated; and
- periodically reviews the benefits and drawbacks of continued take-home privileges.
PA-OTP 10.04
- signs or symptoms of withdrawal;
- evidence of continued alcohol and drug use;
- the absence of laboratory evidence of the opioid treatment medication in toxicology samples;
- participation in short-term detoxification or interim maintenance treatment programs;
- potential complications from concurrent disorders;
- ongoing criminal behavior; and
- absence of stable social relationships or a stable home environment.
PA-OTP 10.05
Opioid Treatment (PA-OTP) 11: Dosage Requirements
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 11.01
- a physician makes all dosage decisions within the medically accepted dosage range for effective treatment;
- conditions for use are documented in the person’s case record;
- medications are administered and dispensed in accordance with approved product labeling;
- the initial dose of methadone does not exceed 30 milligrams, and 40 milligrams as a total dose for the first day; and
- methadone is dispensed in oral form.
PA-OTP 11.02
- one dose per week in the first 90 days of treatment;
- two doses per week in the second 90 days of treatment;
- three doses per week in the third 90 days of treatment;
- a six-day supply in the remaining months of the year;
- a two-week supply after one year of continuous treatment; and
- a one-month supply after two years of continuous treatment.
PA-OTP 11.03
Opioid Treatment (PA-OTP) 12: Detoxification Treatment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 12.01
PA-OTP 12.02
- evaluation;
- stabilization; and
- preparation for entry into substance use treatment.
PA-OTP 12.03
PA-OTP 12.04
PA-OTP 12.05
PA-OTP 12.06
PA-OTP 12.07
- providing personal accommodations for individuals that are age, developmentally, gender, and culturally appropriate;
- providing private areas for bathing, toileting, and personal hygiene;
- allocating rooms for occasional on-site services, as needed;
- ensuring accommodations for informal gathering of persons served, including during inclement weather;
- having adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage; and
- being maintained in good, clean condition.
PA-OTP 12.08
- implementing and communicating policies for searches of individuals or their property;
- prohibiting the use of surveillance cameras or listening devices of persons in bedrooms;
- maintaining doors on sleeping areas and bathroom enclosures;
- providing one- or two-person rooms to individuals who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
- requiring employees to knock before entering a service recipient’s room unless there is a safety or clinical concern.
Sensitivity should be taken to ensure that all persons served, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated.
Opioid Treatment (PA-OTP) 13: Interim Maintenance Treatment
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A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 13.01
- when the person cannot be placed in a comprehensive treatment program within 14 days of application;
- within a reasonable geographic area; and
- for a maximum of 120 days in any 12 month period.
PA-OTP 13.02
PA-OTP 13.03
PA-OTP 13.04
Opioid Treatment (PA-OTP) 14: Opioid Treatment During Pregnancy
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 14.01
- maintenance at the pre-pregnancy medication dose for women who become pregnant during treatment;
- dosing protocols for newly admitted pregnant women that are equivalent to those used for all other persons served;
- carefully monitoring the methadone dose, especially during the third trimester of pregnancy; and
- provision of treatment services for pregnant women with concurrent HIV infection.
PA-OTP 14.02
PA-OTP 14.03
- the effects of treatment on unborn children;
- continued use of drugs; and
- withdrawal from opioid treatment medication during pregnancy.
PA-OTP 14.04
- is conducted under the supervision of a physician;
- takes place, when possible, in a prenatal unit equipped with fetal monitoring equipment and with regular fetal assessments; and
- is not initiated before 14 weeks, nor after 32 weeks, gestation.
PA-OTP 14.05
- healthy mother-infant interactions;
- signs, symptoms, and effects of neonatal abstinence syndrome; and
- resources to treat neonatal abstinence syndrome.
PA-OTP 14.06
Opioid Treatment (PA-OTP) 15: Withdrawal
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 15.01
- a voluntary and therapeutic process planned for by the individual and a physician; or
- conducted in response to an individual's request, but against medical advice (AMA).
PA-OTP 15.02
- dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
- periodic assessments of mental status;
- an assessment for pregnancy for women of childbearing age;
- availability of counseling and other support services; and
- discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.
PA-OTP 15.03
- are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
- can be readmitted to the program within 30 days without repeating the initial assessment; and
- are considered for maintenance treatment when withdrawal fails.
Interpretation: Reason for seeking discharge and steps taken to avoid discharge should be noted in the case record.
PA-OTP 15.04
- a humane withdrawal schedule based on sound clinical judgement; and
- referral or transfer to a suitable, alternative treatment program, whenever possible.
Interpretation: A suggested schedule for medically supervised administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical factors. Since administrative withdrawal is conducted over a short timeframe and associated with poor prognosis connecting individuals to alternative treatment programs is critical.
Opioid Treatment (PA-OTP) 16: Case Closing and Aftercare
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 16.01
- is a clearly defined process that includes assignment of staff responsibility;
- begins at intake; and
- involves the worker, persons served and others, as appropriate to the needs and wishes of the individual.
PA-OTP 16.02
PA-OTP 16.03
- identifies short- and long-term needs and goals; and
- facilitates the initiation or continuation of needed supports and services.
PA-OTP 16.04
Opioid Treatment (PA-OTP) 17: Diversion Control
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 17.01
- measures to reduce the possibility of diversion of controlled substances;
- specific responsibilities assigned to personnel for plan implementation;
- mechanisms for surveillance and continuous monitoring; and
- a process for corrective action when problems are identified.
PA-OTP 17.02
Opioid Treatment (PA-OTP) 18: Program Administration
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-OTP 18.01
PA-OTP 18.02
- documents and monitors client care in conformity with all federal and state reporting requirements relevant to opioid treatment;
- complies with the approved central registry system, when available; and
- supports provision of PDMP reports, when applicable.