Ala. Admin. Code r. 580-9-44-.17 - Level II.1: Intensive Outpatient Treatment

(1) Rule Compliance. Each Level II.1 Intensive Outpatient Program shall comply with the following rules and the rules specified in this chapter.

(a) Program Description. The entity shall develop, maintain and implement a written program description that defines the Level II.1 Intensive Outpatient Program it provides to include the following specifications:

1. Location. The entity shall specifically identify and describe the setting in which Level II.1 Intensive Outpatient Services shall be provided. Services may be provided in any appropriate setting that protects the client's right to privacy, confidentiality, safety and meets the DMH facility certification standards.

2. Admission Criteria. The entity shall develop, maintain and implement written criteria for admission to its Level II.1 Outpatient Program and the following specifications:

(i) The entity's admission criteria shall specify the target population for the Level II.1 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) Individuals who have fairly stable to stable mental and/or physical health problems; and

(II) Who have supportive living arrangements.

(ii) The entity shall provide written documentation in individual case records that each client admitted to receive Level II.1 Intensive Outpatient Services meets:

(I) The diagnostic criteria for a substance dependence disorder as defined in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders; and

(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 II.1 Intensive 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 II.1 Intensive Outpatient Services in a Co-occurring Enhanced Treatment Program meets:

(I) The diagnostic criteria for a substance dependence and mental illness disorder as defined in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders; and

(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 II.1 Intensive Outpatient Services in a Women and Children Program:

(I) Meets the diagnostic criteria for a substance dependence disorder as defined in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders.

(II) Meets 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 II.1 Intensive 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 Level II.1 Intensive Outpatient Program shall directly or by referral provide the following core services:

(I) Placement assessment.

(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 II. 1 Adolescent Intensive Outpatient Program shall document the capacity to provide each of the core services to include the following services:

(I) Activity therapy.

(II) Academic and vocational services.

(III) Vocational services.

(iii) Co-occurring Disorders Program Specific Criteria: Each level II.1 Co-occurring Disorders Intensive Outpatient Program shall document the capacity to provide each of the core services to include the following services:

(I) Basic living skills.

(II) Crisis intervention services.

(III) Intensive case management.

(IV) Academic and vocational services.

(iv) Women and Dependent Children Program Specific Criteria: Each Level II.1 Women and Dependent Children Intensive 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/or 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 II.1 Intensive Outpatient Program shall include, at a minimum:

(I) Implementation of individualized counseling plan strategies.

(II) Ongoing individualized assessment.

(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) Medication administration and monitoring.

(IX) Gender responsive treatment.

(ii) Adolescent Program Specific Criteria: Each Level II. 1 Adolescent Intensive 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.

(V) Academic or vocational services.

(iii) Co-occurring Disorders Program Specific Criteria: Each Level II.1 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) Intensive Case Management.

(iv) Women and Dependent Children Program Specific Criteria: Each Level II.1 Women and Dependent Children Intensive 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.

(VIII) Academic and vocational services.

(IX) Financial resource development and planning.

(X) Family planning services.

5. Documentation: For each day in attendance, an individualized progress note shall be recorded to reflect services provided in Level II.1.

6. Support Systems. Each Level II.1 Intensive 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 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 seventy-two (72) hours.

(iii) Direct affiliation with or coordination through referral to more and less intensive levels of care and supportive housing services.

(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 II.1 Intensive 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) Direct Care Personnel. All direct care personnel shall be qualified as a qualified paraprofessional to provide the specific services delineated in the entity's operational procedures for this level of care.

(ii) Clinical Personnel. The entity shall maintain an adequate number of clinical personnel to sustain the Level II.1 Intensive Outpatient Program as delineated in its operational procedures.

(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 II.1 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.

(vi) Adolescent Program Specific Criteria.

(I) Direct Care Personnel. All direct care personnel shall be qualified, as 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 II.1 Adolescent Intensive 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 II.1 Adolescent Intensive Outpatient 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.

(vii) Co-occurring Disorders Program Specific Criteria.

(I) The Level II.5 Co-occurring Enhanced Partial Hospitalization 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.

(III) Treatment organization/agency shall have access to an Alabama licensed physician, full time, part time, or on contract, who shall be available to the program for client care and shall assume liability for the medical aspects of the program.

(VI) Treatment staff that provide therapy and ongoing clinical assessment services to individuals diagnosed with co-occurring disorders shall have, at a minimum:

I. A master's degree in a behavioral health related field with a minimum of two (2) years' work experience with individuals who have co-occurring disorders, mental health or substance use disorders.

II. Specialized training to work with individuals who have co-occurring disorders.

(V) All other direct care personnel in a Level II.1 Co-occurring Enhanced Intensive Outpatient Program shall be qualified as a qualified paraprofessional to provide the specific services delineated in the entity's operational plan for this level of care.

(VI) Clinical Personnel. The entity shall maintain an adequate number of clinical personnel to sustain the Level II.1 Co-occurring Enhanced Outpatient Program as delineated in its operational plan.

(VII) Administrative Support Personnel. The entity shall maintain an adequate number of support personnel to sustain the program's administrative functions.

(VIII) Every client in a Level II.1 Co-occurring Intensive Outpatient Program shall be assigned to a specific primary counselor for care management.

(IX) Each primary counselor shall maintain a case load not to exceed twenty (20) clients with active cases at any one time.

(viii) Women and Dependent Children Program Specific Criteria:

(I) Direct Care Personnel. All direct care personnel shall be qualified as 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 II.1 Women and Dependent Children Intensive 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 II.1 Women and Dependent Children Program shall be assigned to a specific primary counselor for case management.

(V) Each primary counselor shall maintain a case load not to exceed twenty (20) clients with active cases at any one time.

8. Training. The entity shall provide written documentation that all Level II.1 Program personnel satisfy the competency and training requirements as specified in Rule 580-9-44-.02(3).

9. Service Intensity.

(i) The entity shall document that the amount and frequency of Level II.1 Intensive Outpatient Services are established on the basis of the unique needs of each client served and shall be available a minimum of nine (9) hours but no greater than nineteen (19) hours each week.

(ii) Adolescent Program Specific Criteria. The entity shall document that the amount and frequency of Level II.1 Intensive Outpatient Services for adolescents are established on the basis of the unique needs of each client served and shall be available a minimum of six (6) hours but no greater than nineteen (19) hours each week.

10. Length of Service: The entity shall provide written documentation that the duration of treatment in each Level II.1 Intensive 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.

(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 II.1 service 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 II.1 Intensive 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

Ala. Admin. Code r. 580-9-44-.17

New Rule: Filed January 26, 2012; effective March 1, 2012. Amended by Alabama Administrative Monthly Volume XLI, Issue No. 04, January 31, 2023, eff. 3/17/2023.

Author: Substance Abuse Services Division

Statutory Authority: Code of Ala. 1975, § 22-50-11.