Ala. Admin. Code r. 580-9-44-.15 - Level I: Outpatient Treatment
(1) Rule Compliance. Each Level I Outpatient
Program shall comply with the following rules and the rules specified in this
chapter.
(a) Program Description. The entity
shall develop, maintain and document implementation of a written operational
plan that defines its Level I Outpatient Program. The program description shall
comply with all of the requirements specified in
580-9-44-.13.
1. Location. The entity shall specifically
identify and describe the setting in which Level I Outpatient Services shall be
provided. Services may be provided in any appropriate setting that protects the
client's right to privacy, confidentiality and safety, including but not
limited to, traditional clinical offices and behavioral health sites,
residences, schools, shelters, work sites, community centers and other
locations as pre-authorized by DMH.
2. Admission Criteria: The entity shall
develop, maintain and implement written criteria for admission to its Level I
Outpatient Program in compliance with the requirements of
580-9-44-.13(9)
and the following specifications:
(i) The
entity's admission criteria shall specify the target population for the Level I
Program, which shall include, at a minimum, individuals whose assessed severity
of illness initially warrants this level of care, including but not limited to:
(I) Whose progress in a more intensive level
of care warrants a step-down to a less intensive level of care.
(II) Who are in the early stages of change
and who are not yet ready to commit to full recovery.
(III) Who are experiencing increased
conflict, demonstrating passive compliance or considering leaving
treatment.
(ii) The
entity shall provide written documentation in individual case records that each
client admitted to receive Level I Outpatient Services meets:
(I) The diagnostic criteria for a substance
use disorder as defined in the most recent edition of the Diagnostic and
Statistical Manual for Mental Disorders.
(II) The dimensional criteria for admission
to this level of care as defined in the most recent edition of the ASAM
PPC-2R.
(iii) Adolescent
Program Specific Criteria: The entity shall provide written documentation in
individual case records that each adolescent admitted to receive Level I
Outpatient Services meets:
(I) The diagnostic
criteria for a substance use disorder as defined in the most recent edition of
the Diagnostic and Statistical Manual for Mental Disorders.
(II) The adolescent dimensional criteria for
admission to this level of care as defined in the most recent edition of the
ASAM PPC-2R.
(iv)
Co-occurring Disorders Program Specific Criteria:
The entity shall provide written documentation in individual case records that each client admitted to receive Level I Outpatient Services in a Co-occurring Enhanced Treatment Program meets:
(I) The diagnostic criteria for a substance
use and mental illness disorder as defined in the most recent edition of the
Diagnostic and Statistical Manual for Mental Disorders.
(II) The dimensional criteria for admission
to this level of care as defined in the most recent edition of the ASAM
PPC-2R.
(v) Women and
Dependent Children Program Specific Criteria: The entity shall provide written
documentation in individual case records that each client admitted to receive
Level I Outpatient Services in a Women and Children Program:
(I) Meets the diagnostic criteria for a
substance use disorder as defined in the most recent edition Diagnostic and
Statistical Manual for Mental Disorders.
(II) The dimensional criteria for admission
to this level of care as defined in the most recent edition of the ASAM
PPC-2R.
(III) Is pregnant;
or
(IV) Has care and custody of
dependent children; or
(V) Has lost
custody of dependent children and has the potential for family
reunification.
3. Core Services. Each Level I Outpatient
Program shall demonstrate the capacity to provide a basic level of skilled
treatment services appropriate to the needs of its clientele.
(i) At a minimum, the entity shall directly
or by referral provide the following core services:
(I) Behavioral Health Screening.
(II) Individual counseling.
(III) Group counseling.
(IV) Family counseling.
(V) Psychoeducation.
(VI) Mental health consultation.
(VII) Recovery support services.
(VIII) Peer counseling services.
(IX) Medication management.
(X) Alcohol and/or drug
screening/testing.
(XI) Smoking
cessation.
(XII) Sign language
interpreter services.
(XIII) HIV
early intervention services.
(XIV)
Case management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Adolescent Program Specific Criteria:
Each Level I Adolescent Outpatient Program shall document the capacity to
provide each of the core services and to include activity therapy.
(I) Activity therapy.
(iii) Co-occurring Disorders Program Specific
Criteria: Each level I Co-occurring Disorders Outpatient Program shall document
the capacity to provide each of the core services to include basic living
skills, crisis intervention services, and intensive case management.
(iv) Women and Dependent Children Program
Specific Criteria: Each Level I Women and Dependent Children Outpatient Program
shall document the capacity to provide each of the core services and/or arrange
for the following services:
(I)
Transportation.
(II) Child sitting
services.
(III) Developmental delay
and prevention services.
(IV)
Activity therapy.
(V) Parenting
skills development.
4. Therapeutic Component Implementation. The
entity shall document implementation of regularly scheduled treatment sessions
that are provided in an amount, frequency and intensity appropriate to the
client's assessed needs and expressed desires for care.
(i) Service strategies for each Level I
Outpatient Program shall include, at a minimum:
(I) Implementation of individualized
counseling plan strategies.
(II)
Ongoing individualized assessment services.
(III) Motivational enhancement and engagement
strategies.
(IV) Relapse prevention
strategies.
(V) Interpersonal
choice/decision-making skill development.
(VI) Health education.
(VII) Random drug screening.
(VIII) Family education.
(IX) Gender responsive
treatment.
(ii)
Adolescent Program Specific Criteria: Each Level I Adolescent Outpatient
Program shall document the capacity to provide the service strategies and the
following therapeutic components:
(I)
Adolescent specific evidence based therapeutic interventions.
(II) Client education on key adolescent
development issues, including but not limited to, adolescent brain development
and the impact of substance use, emotional and social influence on behavior,
value system development, puberty/physical development, sexuality and
self-esteem.
(III) Recreation and
leisure time skills training.
(IV)
Family, community and school reintegration services.
(iii) Co-occurring Disorders Program Specific
Criteria: Each Level I Co-occurring Disorders Outpatient Program shall document
the capacity to provide the service strategies and the following therapeutic
components:
(I) Groups and classes that
address the signs and symptoms of mental health and substance use
disorders.
(II) Groups, classes,
and training to assist clients in becoming aware of cues or triggers that
enhance the likelihood of alcohol and drug use or psychiatric decompensation
and to aid in development of alternative coping responses to those
cues.
(III) Dual recovery groups
that provide a forum for discussion of the interactions of and interrelations
between substance use and mental health disorders.
(iv) Women and Dependent Children Program
Specific Criteria: Each Level I Women and Dependent Children Outpatient Program
shall document the capacity to provide the service strategies and the following
therapeutic components:
(I) Specific services
which address issues of relationships, parenting, abuse, and trauma.
(II) Primary medical care, including prenatal
care.
(III) Primary pediatric care
for children.
(IV) Therapeutic
interventions for children which address their developmental needs and issues
of sexual abuse and neglect.
(V)
Outreach to inform pregnant women of the services and priorities.
(VI) Interim services while awaiting
admission to this level of care.
(VII) Recreation and leisure time skills
training.
5.
Documentation: An individual progress note shall be recorded for each
respective service provided in Level I.
6. Support Systems. Each Level I Outpatient
Program shall develop, maintain and document implementation of written policies
and procedures which govern the process used to provide client access to
support services on site, or through consultation or referral, which shall
minimally include:
(i) Medical, psychiatric,
psychological, laboratory and toxicology services.
(ii) Medical and psychiatric consultation
shall be available within twenty-four (24) hours by telephone or if in person,
within a timeframe appropriate to the severity and urgency of the consultation
requested.
(iii) Direct affiliation
with or coordination through referral to more intensive levels of care and
medication management.
(iv)
Emergency services shall be available by telephone twenty-four (24) hours a
day, seven (7) days a week.
(v)
Mutual self-help groups that are tailored to the needs of the specific client
population.
(vi) Referral for other
services as according to the client's assessed needs.
7. Program Personnel. Each level I Outpatient
Program shall employ an adequate number of qualified individuals to provide
personalized care for its clientele and to meet the program's goals and
objectives.
(i) Clinical Personnel. The entity
shall maintain an adequate number of clinical personnel to sustain the Level I
Outpatient program as delineated in its operational plan.
(ii) Administrative Support Personnel. The
entity shall maintain an adequate number of support personnel to sustain the
program's administrative functions.
(iii) Every client in a Level I program shall
be assigned to a specific Primary Counselor for care management.
(iv) Each primary counselor shall maintain a
case load not to exceed forty (40) clients with active cases at any one
time.
(v) Adolescent Program
Specific Criteria Adolescent Program Specific Criteria:
(I) Clinical Personnel. The entity shall
maintain an adequate number of clinical personnel to sustain the Level I
Adolescent Outpatient program as delineated in its operational plan.
(II) Administrative Support Personnel. The
entity shall maintain an adequate number of support personnel to sustain the
program's administrative functions.
(III) Every client in a Level I adolescent
program shall be assigned to a specific Primary Counselor for care
management.
(IV) Each primary
counselor shall maintain a case load not to exceed thirty (30) clients with
active cases at any one time.
(vi) Co-occurring Disorders Program Specific
Criteria:
(I) The Level I Co-occurring
Enhanced Outpatient Program shall have access to psychiatric services (led by a
qualified psychiatrist or nurse practitioner) that are fully capable of
evaluating, diagnosing, and prescribing medications to clients with
co-occurring disorders. On-call psychiatric services shall be available
twenty-four (24) hours a day, seven (7) days a week.
(II) Treatment staff that provide therapy and
ongoing clinical assessment services to individuals diagnosed with co-occurring
disorders.
(III) Every client in a
Level I Enhanced Co-occurring Outpatient Program shall be assigned to a
specific Primary Counselor for care management.
(IV) Each primary counselor shall maintain a
case load not to exceed thirty (30) clients with active cases at any one
time.
(vii) Women and
Dependent Children Program Specific Criteria:
(I) Direct Care Personnel. All direct care
personnel shall be a qualified paraprofessional to provide the specific
services delineated in the entity's operational plan for this level of
care.
(II) Clinical Personnel. The
entity shall maintain an adequate number of clinical personnel to sustain the
Level I Women and Dependent Children Outpatient Program as delineated in its
operational plan.
(III)
Administrative Support Personnel. The entity shall maintain an adequate number
of support personnel to sustain the program's administrative
functions.
(IV) Every client in a
Level I Women and Dependent Children Program shall be assigned to a specific
primary counselor for care management.
(V) Each primary counselor shall maintain a
case load not to exceed thirty (30) clients with active cases at any one
time.
8.
Training. The entity shall provide written documentation that all Level I
Program personnel satisfy the competency and training requirements as specified
in Rule 580-9-44-.02(3).
9. Service Intensity. The entity shall
document that the amount and frequency of Level I Outpatient services are
established on the basis of the unique needs of each client served, not to
exceed eight (8) contact hours weekly.
10. Length of Service. The entity shall
provide written documentation that the duration of treatment in each Level I
Outpatient Program shall vary as determined by:
(i) The severity of the client's
illness.
(ii) The client's ability
to comprehend the information provided and use that information to implement
treatment strategies and attain treatment goals; or
(iii) The appearance of new problems that
require another level of care; or
(iv) The availability of services at an
assessed level of need when Level I services have been utilized as interim
services.
11. Service
Availability: The entity shall provide written documentation describing the
process utilized to establish the hours of service availability for its Level I
Outpatient Programs. At a minimum, this process shall:
(i) Include consideration of the needs of the
target population, including work, school and parenting
responsibilities.
(ii) Include
consideration of transportation accessibility.
(iii) Not be based solely on standard eight
(8) to five (5), Monday through Friday office
hours.
Notes
Author: Substance Abuse Services Division
Statutory Authority: Code of Ala. 1975, ยง 22-50-11.
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