Ala. Admin. Code r. 580-9-44-.22 - Level III.2-D: Clinically Managed Residential Detoxification
(1) Rule
Compliance. In addition to compliance with the rules as specified in this
chapter, each Level III.2-D Clinically Managed Residential Detoxification
Program shall comply with the rules as specified in the following chapters.
(a) Program Description. The entity shall
develop, maintain and implement a written program description that defines its
Level III.2-D Program, 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 the Level III.2-D
Program is provided. Services may be provided in any facility that meets all
applicable federal, state and local certification, licensure, building,
life-safety, fire, health and zoning regulations including the DMH facility
certification standards.
2.
Admission Criteria: The entity shall develop, maintain and document
implementation of written criteria for admission to its Level III.2-D 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
III.2-D Program, which shall include, at a minimum, individuals who:
(I) Are experiencing signs and symptoms of
withdrawal, or there is evidence based on history of substance intake, age,
gender, previous withdrawal history, present symptoms, physical condition
and/or emotional behavioral or cognitive condition that withdrawal syndrome is
imminent.
(II) Assessed as not
being at risk of severe withdrawal syndrome and moderate withdrawal is safely
manageable at this level.
(III)
Have a history of insufficient skills and supports to complete detoxification
at a less intense level of care.
(ii) The entity shall provide written
documentation in individual case records that each client admitted to receive
Level III.2-D services meets:
(I) The
diagnostic criteria for Substance Induced Disorder as defined in the most
recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.
(II) The dimensional criteria for admission
to this level of care as defined in the ASAM
PPC-2R.
3. Core
Services: At a minimum, the Level III.2-D Program shall document the capacity
to provide the following core services:
(i)
Placement assessment.
(ii)
Individual counseling.
(iii) Group
counseling.
(iv)
Psychoeducation.
(v) Family
counseling.
(vi) Peer
support.
(vii) Medical and somatic
services.
(viii) Medication
administration.
(ix) Medication
monitoring.
(x) Alcohol and/or drug
screening/testing.
(xi) Case
management:
(I) Case planning.
(II) Linkage.
(III) Advocacy.
(IV)
Monitoring.
4.
Therapeutic Component Implementation: The entity shall document implementation
of medical and other clinical services organized to enhance the client's
understanding of addiction, support completion of the detoxification process
and initiate transfer to an appropriate level of care for continued treatment.
The entity's Level III.2-D Program shall, at a minimum, consist of the
following components:
(i) Completion of a
comprehensive medical history and physical examination of the client at
admission.
(ii) Protocols and/or
standing orders, established by the entity's medical director, for management
of detoxification from each major drug category of abused drugs that are
consistent with guidelines published by nationally recognized organizations
(e.g., SAMHSA, ASAM, American Academy of Addiction Psychology).
(I) Level III.2-D Programs that utilize
benzodiazepines in the detoxification protocol:
I. Shall have written protocols and
procedures to show that all doses or amounts of benzodiazepines are carefully
monitored and are slowly reduced as appropriate.
II. Shall have written longer-term
detoxification protocols and procedures that adhere to general principles of
management, including clear indications of benzodiazepine dependence, clear
intermediate treatment goals and strategies, regular review and methods to
prevent diversion from the plan.
(iii) On duty awake staff shall provide
supervision for each client's health, welfare and safety twenty-four (24) hours
a day, seven (7) days a week.
(iv)
On-site physician care and phone availability twenty-four (24) hours a day,
seven (7) days a week.
(v)
Credentialed personnel who are trained and competent to implement physician
approved protocols for client observation and supervision, determination of
appropriate level of care and facilitation of the client's transitioning to
continuing care.
(vi) Services
designed explicitly to safely detoxify clients without the need for ready
on-site access to medical and nursing personnel.
(vii) Medical evaluation and consultation
available twenty-four (24) hours a day in accordance with practice
guidelines.
(viii) Clinicians who
assess and treat clients are able to obtain and interpret information regarding
the needs of the client to include the signs and symptoms of alcohol and other
drug intoxification and withdrawal, as well as, the appropriate treatment and
monitoring of these conditions.
(ix) Medication administration and monitoring
services, including specific procedures for pregnant women.
(x) Continuous assessment.
(xi) Planned counseling and other therapeutic
interventions.
(xii) Motivational
enhancement therapy.
(xiii) Direct
affiliation with other levels of care.
5. Documentation: Level III.2-D Programs
shall provide the following clinical record documentation:
(i) Documentation of each
clinical/therapeutic intervention provided.
(ii) Daily assessment of progress, through
detoxification, including response to medication, which also notes any
treatment changes.
(iii) Monitoring
of vital signs, at a minimum, every eight (8) hours until discharge.
(iv) The use of detoxification rating scale
tables and flow sheets.
6. Support Systems: The Level III.2-D Program
shall develop, maintain and document implementation of written policies and
procedures utilized to provide client access to support services on site, or
through consultation or referral, which shall minimally include availability
to:
(i) Specialized clinical consultation for
biomedical, emotional, behavioral and cognitive problems.
(ii) Appropriate laboratory and toxicology
testing.
(iii) Psychological and
psychiatric services.
(iv)
Transportation.
(v) Twenty-four
(24) hour emergency medical services.
7. Staff Requirements.
(i) Medical Director. The Level III.2-D
Program shall have a medical director who is a physician licensed to practice
in the State of Alabama, with a minimum of one (1) year experience treating
persons with substance induced disorders. The medical director shall be
responsible for admission, diagnosis, medication management and client
care.
(ii) Nursing Services
Director. The Level III.2-D Program shall have a nursing services director who
shall be a Registered Nurse licensed according to Alabama law, with training
and work experience in behavioral health.
(iii) There shall be a Registered Nurse (RN)
or Licensed Practical Nurse (LPN) on site during all hours of the Level III.2-D
Program's operation.
(iv) Direct
Care Personnel. All direct care personnel shall have the qualifications as a
qualified paraprofessional to provide the specific services delineated in the
entity's program description for this level of care.
(v) The entity shall maintain an adequate
number of personnel, including physicians, nurses, counselors and case managers
to sustain the Level III.2-D Program as delineated in its operational
plan.
(vi) Administrative Support
Personnel. The entity shall maintain an adequate number of support personnel to
sustain the program's administrative functions.
8. Training: The entity shall provide written
documentation that:
(i) All Level III.2-D
Program personnel satisfy the requirements of the core training curriculum, as
specified in Rule
580-9-44-.02(3).
(ii) All clinical and medical services staff
in a Level III.2-D Program shall receive training during the initial twelve
(12) months employment and develop basic competencies in the following areas:
(I) Biopsychosocial dimensions of alcohol and
other drug dependence, including:
I. The signs
and symptoms of alcohol and other drug intoxication and withdrawal.
II. Evidence-based treatment and monitoring
strategies for alcohol and other drug intoxication and withdrawal.
III. Continuing care motivational and
engagement strategies.
(II) Pharmacotherapy.
(III) ASAM Patient Placement
Criteria.
(IV) Assessment of and
service planning to address biopsychosocial
needs.
9.
Service Intensity: The entity shall document in the clinical record that the
intensity of Level III.2-D Services is established on the basis of the unique
needs of each client served.
10.
Length of Service: The entity shall provide written documentation in the
clinical record that the duration of treatment in a Level III.2-D Program
varies as determined by the client's assessed needs, and that the client
continues in treatment until:
(i) Withdrawal
signs and symptoms are sufficiently resolved; or
(ii) Withdrawal signs and symptoms have
failed to respond to treatment and have intensified warranting a transfer to a
more intense level of care; or
(iii) The client is, otherwise, unable to
complete detoxification at this level of
care.
Notes
Author: Substance Abuse Services Division
Statutory Authority: Code of Ala. 1975, ยง 22-50-11.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.