Ala. Admin. Code r. 580-9-44-.18 - Level II.5: Partial Hospitalization Treatment Program
(1) Rule
Compliance. Each Level II.5 Partial Hospitalization Program shall comply with
the following rules and the rules specified in this chapter: (List applicable
rules found throughout the standards)
(a)
Program Description. The entity shall develop, maintain and implement a written
program description that defines the Level II.5 Partial Hospitalization Program
it provides, as according to Rule
580-9-44-.13 and the following
specifications:
1. Location. The entity shall
specifically identify and describe the setting in which Level II.5 Partial
Hospitalization Services shall be provided. Services may be provided in any
appropriate setting that protects the client's right to privacy,
confidentiality, safety and meets DMH facility certification
criteria.
2. Admission Criteria.
The entity shall develop, maintain and implement written criteria for admission
to its Level II.5 Partial Hospitalization Program, in compliance with the
requirements of Rule
580-9-44-.13(9),
and the following specifications:
(i) The
entity's admission criteria shall specify the target population for the Level
II.5 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
unstable mental and/or physical health problems.
(II) Who have unstable or dysfunctional, but
adequate living arrangements.
(ii) The entity shall provide written
documentation in individual case records that each client admitted to receive
Level II.5 Partial Hospitalization 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.
(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.5
Partial Hospitalization 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 individual admitted to receive Level II.5 Partial
Hospitalization 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.
(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.5 Partial Hospitalization Services in a Women and Dependent Children
Program 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.
(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 II.5 Partial
Hospitalization 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.5 Partial
Hospitalization Program shall 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. 5 Partial Hospitalization Program shall document the capacity to
provide each of the core services to include the following services:
(I) Activity therapy.
(II) Academic or vocational
services.
(iii)
Co-occurring Disorders Program Specific Criteria: Each Level II.5 Partial
Hospitalization 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) Activity therapy.
(IV) Intensive case
management.
(iv) Women
and Dependent Children Program Specific Criteria: Each Level II.5 Women and
Dependent Children Partial Hospitalization 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 II.5 Partial Hospitalization 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) Medication
administration and monitoring.
(VII) Family education.
(X) Gender responsive
treatment.
(ii)
Adolescent Program Specific Criteria: Each Level II. 5 Adolescent Partial
Hospitalization Program shall document the capacity to provide the service
strategies to include 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.5 Co-occurring
Enhanced Partial Hospitalization Program shall document the capacity to provide
the service strategies to include 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.5 Women and
Dependent Children Partial Hospitalization Program shall document the capacity
to provide the service strategies and/or arrange for 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
resources and planning.
(X) Family
planning services.
5. Documentation: For each day in attendance
an individual progress note shall be recorded to reflect services provided in
Level II.5 Partial Hospitalization.
6. Support Systems. Each Level II.5 Partial
Hospitalization Program shall develop, maintain and document implementation of
written policies and procedures that 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 forty-eight (48) 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.5 Partial
Hospitalization 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.5
Partial Hospitalization 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.5 Partial
Hospitalization 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.5
Partial Hospitalization 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.5 Adolescent
Partial Hospitalization 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.
(II) The 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.
(III) 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.5 Co-occurring Enhanced Partial Hospitalization Program shall be
qualified, as a qualified paraprofessional to provide the specific services
delineated in the entity's operational procedures for this level of
care.
(VI) The entity shall
maintain an adequate number of clinical personnel to sustain the Level II.5
Co-occurring Enhanced Partial Hospitalization Program as delineated in its
operational procedures.
(VII) The
entity shall maintain an adequate number of support personnel to sustain the
program's administrative functions.
(VIII) Every client in a Level II.5
Co-occurring Enhanced Partial Hospitalization 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.5 Women and Dependent Children Partial Hospitalization 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.5 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 twenty (20) clients
with active cases at any one time.
8. Training. The entity shall provide written
documentation that all Level II.5 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 II.5 Partial Hospitalization
Services are established on the basis of the unique needs of each client served
and shall be available a minimum of twenty (20) hours each week.
10. Length of Service: The entity shall
provide written documentation that the duration of treatment in each Level II.5
Partial Hospitalization 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.5 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
II.5 Partial Hospitalization Program. 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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