Crisis stabilization residential services are short-term
services provided in facility-based settings of no more than 16 beds. The goal
of CSRS is to stabilize and reintegrate the individual back into the community.
Crisis stabilization residential services are designed for voluntary
individuals who are in need of a safe, secure environment less intensive and
restrictive than an inpatient hospital. Crisis stabilization residential
services have the capacity to serve more than two individuals at a time. Crisis
stabilization residential services can be for youth aged 18 and younger or
adults aged 18 and older. Youth and adults cannot be housed in the same
facility setting. Facilities licensed by the department of inspections and
appeals for other services would have to comply with the provisions of Iowa
Administrative Code rule
481-57.50
(135C) for operating another business or activity in the facility.
(1) Eligibility. To be eligible, an
individual must:
a. Be an adult aged 18 or
older or a youth aged 18 or under.
b. Be determined appropriate for the service
by a mental health assessment; and
c. Be determined to not need inpatient acute
hospital psychiatric services.
(2) Staffing requirements.
a. A designated director or administrator is
responsible for the management and operation of the CSRS of no more than 16
beds.
b. At least one licensed
mental health professional is available for consultation 24 hours a day, 365
days a year.
c. Crisis
stabilization residential services are provided by a mental health professional
with expertise appropriate to the individual's needs.
d. Each individual has contact with a mental
health professional at least one time a day.
e. Each individual has a minimum of one hour
per day of additional services provided by crisis response staff including, but
not limited to, skill building, peer support or family support peer services;
or other therapeutic programming.
f. Awake and attentive staffing 24 hours a
day, 365 days a year is provided.
(3) Performance benchmark. The individual is
provided safe, secure and structured crisis stabilization services in the least
restrictive location meeting the individual's needs.
(4) Performance indicators.
a. Individual's consent is documented, and
treatment providers, family members and other natural supports are contacted
within 24 hours of admission.
b. A
comprehensive mental health assessment is completed within 24 hours of
admission.
c. Daily crisis
stabilization includes, at minimum, daily contact with a mental health
professional and one hour of additional crisis stabilization service.
d. The length of stay is expected to be less
than five days.
e. The number of
days an individual receives crisis stabilization services is documented. The
documentation records specific reasons for lengths of stay beyond five
days.
f. Records include:
(1) Stabilization plan.
(2) Medication record.
(3) Treatment summary.
(4) Daily contact with a mental health
professional.
g.
Additional services provided include, but are not limited to, skill building,
peer support or family support peer services.
h. Individual choice is verified including,
but not limited to, treatment participation and discharge plan
options.
i. Data of readmission is
tracked including an analysis of data trends, looking at effectiveness, and
appropriate corrective action. The information is documented in the performance
improvement system.
j.
Documentation tracks that the youth's education needs are met with educational
services received in the CSRS, and an action plan is in place to return the
youth to school upon discharge.
(5) Crisis stabilization incident reporting.
a. Performance benchmark. An incident report
is completed when staff are notified an incident has occurred.
b. Performance indicators.
(1) The incident report documents:
1. The name of the individual who was
involved in the incident.
2. Date
and time of occurrence of the incident.
3. A description of the incident.
4. Names and signatures of all staff present
at the time of the incident.
5. The
action staff took to handle the situation.
6. The resolution or follow-up to the
incident.
(2) A copy of
the incident report is maintained in a centralized file and a copy given to the
individual, the mental health and disability services region, and the parent or
guardian when appropriate.
(6) Service requirements,
a. Stabilization plan. The individual is
involved collaboratively in all aspects of crisis stabilization services
including, but not limited to, admission, treatment planning, intervention, and
discharge. The involvement of family members and others is encouraged.
Within 24 hours of admission to CSRS, a written short-term
stabilization plan is developed, with the involvement and consent of the
individual, and reviewed frequently to assess the need for continued placement
in CSRS. At a minimum, this plan includes:
(1) Criteria for discharge, including
referrals and linkages to appropriate services and coordination with other
systems.
(2) Description of any
physical disability and accommodations necessary to provide the same or equal
services and benefits as those afforded nondisabled individuals.
(3) Evidence of input by the individual,
including the individual's signature.
(4) Goal statement.
(5) Goals consistent with needs and projected
length of stay.
(6) Objectives that
are built on strengths and allow measurement of progress.
(7) Rights restrictions.
(8) Signatures of all participating in the
development of the plan.
(9)
Specification of treatment responsibilities and methods.
b. Performance benchmark. A stabilization
plan is completed within 24 hours of admittance.
c. Performance indicators.
(1) Records include a written short-term
stabilization plan developed with the involvement and consent of the individual
within 24 hours of admission and is reviewed frequently to assess the need for
continued placement in CSRS.
(2)
Records indicating a stabilization plan has been completed within the 24-hour
time frame are maintained.
(3)
Reasons the stabilization plan does not meet the criteria is
documented.
(4) A follow-up
appointment with the individual's preferred provider will be made, and crisis
response staff will follow up with the individual and document contact or
attempt to contact on a periodic basis until the appointment takes
place.
(7)
Treatment summary. Prior to discharge, a treatment summary is provided and a
copy shared with the individual and treatment team as appropriate.
a. Contents. At a minimum, this treatment
summary includes:
(1) Course and progress
regarding each identified problem.
(2) Documentation of daily contact with a
mental health professional.
(3)
Impact on placement and support decisions.
(4) Assessment.
(5) Action plan.
(6) Stabilization plan.
(7) Treatment interventions.
(8) Reasons for termination of
service.
(9) Signature of the
mental health professional.
b. Performance benchmark. A treatment summary
is completed during the individual's length of stay in CSRS.
c. Performance indicators.
(1) Records include a written treatment
summary developed with the involvement and consent of the individual.
(2) An individual receives a copy of the
treatment summary upon discharge.
(3) Corrective action steps are documented
when treatment plans are not completed within the length of stay.
(8) Health and safety.
a. Performance benchmarks.
(1) Emergency preparedness policies and
procedures include health and safety measures.
(2) Crisis stabilization services meet all
applicable local, state and federal regulations.
(3) Medication administration and
documentation standards in rule
441-24.40
(225C) are documented.
b. Performance indicators.
(1) Health and fire safety inspections.
1. Documentation includes Iowa fire marshal
rules and fire ordinances, local health, fire, occupancy code, and safety
regulations.
2. Standards for
public facilities guide food and beverage safety, nutrition standards, and safe
storage of all consumable products.
3. Crisis stabilization residential services
comply with rule
441-24.40
(225C).
(2) Emergency
preparedness. Emergency preparedness policies are designed to provide effective
utilization of available resources for continuation during a disaster event,
including, but not limited to, cases of severe weather or fire.
(3) The facility is safe, clean,
well-ventilated, and a properly heated environment in good repair and free from
vermin.
(4) Bedrooms include:
1. A sturdily constructed bed.
2. A sanitized mattress protected with a
clean mattress pad.
3. A designated
space in proximity to the sleeping area for personal possessions including
clothing.
4. Curtains or window
blinds on bedroom windows.
5.
Available clean linens.
(5) Sleeping areas include:
1. Doors for privacy.
2. Partitioning and placement of furniture to
provide privacy.
3. Rooms
accommodate no more than two per room. Single room dimensions are at least 80
square feet not including closets. Dual occupancy rooms are at least 120 square
feet not including closets.
4.
Personal belongings and personal touches in the rooms are defined within CSRS
policy.
5. Respect by staff for an
individual's right to privacy.
(6) Personal hygiene and privacy tools are
provided:
1. A safe supply of hot and cold
running water which is potable.
2.
Clean towels, electric hand dryers or paper towel dispensers, and an available
supply of toilet paper and soap.
3.
Natural or mechanical ventilation capable of removing odors.
4. Tubs or showers with slip-proof
surfaces.
5. Partitions with doors
which provide privacy if a bathroom has multiple toilet stools.
6. Toilets, wash basins, and other plumbing
or sanitary facilities are in good operating condition.
7. Privacy in bathrooms for male and female
individuals.
(7) Federal
laws regarding smoking on property are recognized and followed.
(8) The following is provided:
1. Areas in which an individual may be alone
when appropriate.
2. Areas for
private conversations with others.
3. A secure space for personal belongings.
c.
Housekeeping. Maintenance of living quarters and day-to-day housekeeping
activities are clearly defined in writing and a part of the orientation. Staff
assistance and equipment are provided as needed.
d. Clothing.
(1) Personal clothing is allowed in
accordance with CSRS policy.
(2)
Clothing may be washed with provided laundry mechanisms.
e. Religion/culture. Rights to religion and
culture include:
(1) The opportunity to
participate in religious activities and services in accordance with the
individual's faith or of a minor individual's parent(s) or guardian.
(2) Arrange for transportation to religious
activities when appropriate per CSRS policy.
f. Smoking. The smokefree air Act, Iowa Code
chapter 142D, is included in the CSRS policy.