Ala. Admin. Code r. 580-9-44-.25 - Level III.5: Clinically Managed High Intensity Residential Treatment Program For Adults
(1) Rule
Compliance. In addition to compliance with the rules as specified in this
chapter, each Level III.5 Clinically Managed High Intensity Residential
Treatment 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 the Level III.5 Clinically Managed High Intensity Residential Treatment
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 the Level III.5 Program
shall be provided. Services shall 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.5 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 its Level
III.5 Services, which shall include, at a minimum, individuals who have been
assessed to have multiple, significant social and psychological functional
deficits that cannot be adequately addressed on an outpatient basis.
(ii) The entity shall provide written
documentation in individual case records that each client admitted to a Level
III.5 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) Co-occurring Disorders Program Specific
Criteria. The entity shall provide written documentation in individual case
records that each individual admitted to a Level III.5 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.
(iv) Women and Dependent Children Program
Specific Criteria: The entity shall provide written documentation in individual
case records that each client admitted to a Level III.5 Program for Women and
Dependent Children:
(I) Meets the diagnostic
criteria for a substance dependence 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 III.5 High
Intensity Residential Program shall demonstrate the capacity to provide a basic
level of treatment services appropriate to the needs of its clientele.
(i) At a minimum, the entity shall
demonstrate and document its capacity to provide a twenty-four (24) hour
structured residential treatment environment with the following core services:
(I) Placement assessment.
(II) Individual counseling.
(III) Group counseling.
(IV) Family counseling.
(V) Psychoeducation.
(VI) Peer support.
(VII) Medical and somatic services.
(VIII) Daily living skills.
(IX) Medication management.
(X) Alcohol and/or drug
screening/testing.
(XI)
Transportation.
(XII) Case
Management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. Medical Services shall
be provided as specified by the entity's medical protocols established as
required by Rule
580-9-44-.13(24).
(I) Clients who have not had a physical
examination within the last twelve (12) months shall be provided a physical
examination within two (2) weeks of admission.
(II) Pregnant clients who are not receiving
routine prenatal care, shall be seen by physician within two (2) weeks of
admission.
(iii) Mental
Health Services. The entity shall develop, maintain and document implementation
of written policies and procedures to ensure that each client's mental health
needs are identified through the assessment service process and access to
appropriate care for these needs is provided concurrently with treatment for
assessed substance related disorders.
(iv) Family Support. The entity shall
initiate and document in the client record continuous efforts to involve the
client's family and other natural supports in the treatment process.
(v) Co-occurring Disorders Program Specific
Criteria: Each Level III.5 Co-occurring Disorders Low Intensity Residential
Treatment Program shall document the capacity to provide each of the core
services and the following services:
(I)
Mental health consultation.
(II)
Crisis intervention services.
(III)
Activity therapy.
(IV) Intensive
case management.
(vi)
Women and Dependent Children Program Specific Criteria: Each Level III.5 Women
and Dependent Children Medium Intensity Residential Treatment Program shall
document the capacity to provide each of the core services and the following
services:
(I) Child sitting
services.
(II) Developmental delay
and prevention services.
(III)
Activity therapy.
(IV) Parenting
skills development.
(V) Academic
and vocational services.
(VI)
Financial resource development and planning.
(VII) Family planning
services.
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 each client's assessed needs and
expressed desires for care.
(i) Service
strategies for each Level III.5 Residential Program shall include, at a
minimum:
(I) On duty awake staff shall
provide supervision of client's health, welfare and safety twenty-four (24)
hours a day.
(II) Client shall have
access to clinical services personnel twenty-four (24) hours a day, seven (7)
days a week.
(III) Daily clinical
services to improve the client's ability to structure and reorganize the tasks
of daily living and recovery.
(IV)
The provision of daily scheduled treatment and recovery support services and
activities that shall, at a minimum, include those that address:
I. Implementation of individualized service
plan strategies.
II. Relapse
prevention.
III. Interpersonal
choice/decision making skill development.
IV. Development of a social network
supportive of recovery.
V. Daily
living and recovery skills development.
VI. Random drug screening.
VII. Health education.
VIII. Medication administration and
monitoring.
(ii) The entity shall actively promote and
provide referrals and/or access to community support services.
(iii) All services shall be organized and
provided according to evidence-based and best practice standards and
guidelines.
(iv) Co-occurring
Disorders Program Specific Criteria: Each Level III.5 Co-occurring Enhanced
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.
5.
Documentation: Each Level III.5 High Intensity Residential Program shall
provide the following documentation in each client record:
(i) Individualized progress notes shall be
recorded each day for each respective service provided in Level III.5
Services.
6. Support
Systems. Each Level III.5 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)
Telephone or in person consultation with a physician available twenty-four (24)
hours a day, seven (7) days a week.
(ii) Telephone or in person consultation with
emergency services twenty-four (24) hours a day, seven (7) days a
week.
(iii) Telephone or in person
consultation with a registered nurse twenty-four (24) hours a day, seven (7)
days a week.
(iv) Direct
affiliation with, or coordination through referral to more and less intensive
levels of care.
(v) Direct
affiliation with, or coordination through referral to supportive services,
including vocational rehabilitation, literacy training and adult
education.
(vi) Mutual self-help
groups which are tailored to the needs of the specific client
population.
(vii) Appropriate
laboratory and toxicology testing.
(viii) Psychological and psychiatric
services.
(ix) Direct affiliation
with or coordination through referral to more and less intensive levels of
care.
(x) Co-occurring Disorders
Program Specific Criteria: In addition to compliance with the criteria, each
Level III.5 Co-occurring Enhanced High Intensity Residential Program shall
provide client access to intensive case management services.
(xi) Women and Dependent Children's Program
Specific Criteria: In addition to compliance with the criteria, the each Level
III.5 High Intensity Residential Treatment Program for Women and Dependent
Children shall provide client access to the following support services:
(I) Academic and vocational
services.
(II) Financial resource
development and planning.
(III)
Family planning services.
7. Program Personnel. Each level III.5 High
Intensity Residential 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 III.5
High Intensity Residential 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 III.5 Program
shall be assigned to a specific primary counselor for care
management.
(v) Each primary
counselor shall maintain a case load not to exceed sixteen (16) clients with
active cases at any one time.
(vi)
Co-occurring Disorders Program Specific Criteria.
(I) The Level III.5 Co-occurring Enhanced
High Intensity Residential Program shall be coordinated by a full-time member
of the staff who has the minimum of a master's degree in a mental health
related field and at least two (2) years post master's supervised experience in
a direct service area treating clients with co-occurring disorders.
(II) The Level III.5 Co-occurring Enhanced
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) 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.
(IV) 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 III.5 Co-occurring Enhanced Program shall be qualified 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 III.5 Enhanced High Intensity Residential 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 III.5 Co-occurring Program shall be assigned to a specific primary
counselor for care management.
(IX)
Each primary counselor shall maintain a case load not to exceed sixteen (16)
clients with active cases at any one time.
(vii) Women and Dependent Children Program
Specific Criteria:
(I) Each Level III.5 Women
and Dependent Children High Intensity Residential Program shall be coordinated
by a full-time member of the staff who has a minimum of a master's degree in a
behavioral health related field and at least two (2) years post master's
supervised experience in a direct service area treating women who have
substance use, mental health or co-occurring mental health and substance use
disorders.
(II) 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.
(III) Clinical Personnel. The entity shall
maintain an adequate number of clinical personnel to sustain the Level III.5
Women and Dependent Children Program as delineated in its operational
plan.
(IV) Administrative Support
Personnel. The entity shall maintain an adequate number of support personnel to
sustain the program's administrative functions.
(V) Every client in a Level III.5 Women and
Dependent Children Program shall be assigned to a specific primary counselor
for care management.
(VI) Each
primary counselor shall maintain a case load not to exceed ten (10) clients
with active cases at any one time.
8. Training. The entity shall provide written
documentation that all Level III.5 Program personnel satisfy the competency and
training requirements as specified in Rule
580-9-44-.02(3).
9. Service Intensity: The entity shall
develop, maintain and document implementation of policies and procedures in
regard to service intensity for its Level III.5 Residential Program, which
shall at a minimum specify:
(i) The amount and
frequency of Level III.5 Services are established on the basis of the unique
needs of each client served.
(ii)
The program has the capacity to provide a minimum of twenty-five (25) contact
hours of clinical services weekly for each client.
10. Length of Service: The entity shall
provide written documentation that the duration of treatment in its Level III.5
Program is variable 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 meet treatment goals and
strategies; 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 a Level III.5 High Intensity Residential Program
has been utilized as an interim level of care.
11. Service Availability: The entity shall
provide written documentation describing the process utilized to establish
hours of availability for screening, assessment and intake service, admission
and counseling services at its Level III.5 High Intensity Residential 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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