Iowa Admin. Code r. 441-24.4 - Standards for services
Providers for the services set forth in subrules 24.4(9) through 24.4(13) shall meet the standards in subrules 24.4(1) through 24.4(8) in addition to the standards for the specific service. Providers of outpatient psychotherapy and counseling services shall also meet standards in subrules 24.4(1), 24.4(2), 24.4(4), 24.4(6), 24.4(7), and 24.4(8). Providers of emergency services or evaluation services shall meet the benchmark for the services they provide.
(1)
Social history.
a.
Performance benchmark. The organization completes a social
history for each individual served.
b.
Performance indicators .
(1) The organization collects and documents
relevant historical information and organizes the information in one distinct
document.
(2) The social history
includes:
1. Relevant information regarding
the onset of disability.
2. Family,
physical, psychosocial, behavioral, cultural, environmental, and legal
history.
3. Developmental history
for children.
4. Any history of
substance abuse, domestic violence, or physical, emotional, or sexual
abuse.
(3) Staff review
and update the social history at least annually.
(2)
Assessment .
a.
Performance benchmark.
The organization develops a written assessment for each individual served. The
assessment is the basis for the services provided to the individuals.
b.
Performance indicators .
(1) The assessment includes information about
the individual's current situation, diagnosis, needs, problems, wants,
abilities and desired results, gathered with the individual's
involvement.
(2) Staff solicit
collateral provider information as appropriate to the individual situation in
order to compile a comprehensive and full assessment .
(3) Staff base decisions regarding the level,
type and immediacy of services to be provided, or the need for further
assessment or evaluation, upon the analysis of the information gathered in the
assessment .
(4) Staff complete an
annual reassessment for each individual using the service and document the
reassessment.
(5) Documentation
supporting the diagnosis is contained in the individual's record. A diagnosis
of intellectual disability is supported by a psychological evaluation conducted
by a qualified professional. A diagnosis of developmental disability is
supported by professional documentation. A determination of chronic mental
illness is supported by a psychiatric or psychological evaluation conducted by
a qualified professional.
(3)
Individual service plan .
a.
Performance benchmark.
Individualized, planned, and appropriate services are guided by an
individual-specific service plan developed in collaboration with the individual
using the service, staff , and significantly involved others as appropriate .
Services are planned for and directed to where the individuals live, learn,
work, and socialize.
b.
Performance indicators .
(1)
The service plan is based on the current assessment .
(2) The service plan identifies observable or
measurable individual goals and action steps to meet the goals.
(3) The service plan includes interventions
and supports needed to meet those goals with incremental action steps, as
appropriate .
(4) The service plan
includes the staff , people, or organizations responsible for carrying out the
interventions or supports.
(5)
Services defined in the service plan are appropriate to the severity level of
problems and specific needs or disabilities.
(6) The plan reflects desired individual
outcomes.
(7) Activities identified
in the service plan encourage the ability and right of the individual using the
service to make choices, to experience a sense of achievement, and to modify or
continue participation in the treatment process.
(8) Staff monitor the service plan with
review occurring regularly. At least annually, staff assess and revise the
service plan to determine achievement, continued need, or change in goals or
intervention methods. The review includes the individual using the service,
with the involvement of significant others as appropriate .
(9) Staff develop a separate, individualized,
anticipated discharge plan as part of the service plan that is specific to each
service the individual receives.
(10) The service plan includes documentation
of any rights restrictions, why there is a need for the restriction, and a plan
to restore those rights or a reason why a plan is not necessary or
appropriate .
(4)
Documentation of service
provision.
a.
Performance
benchmark. Individualized and appropriate intervention services and
treatments are provided in ways that support the needs, desires, and goals
identified in the service plan , and that respect the rights and choices of the
individual using the service.
b.
Performance indicators .
(1)
Staff document in the narrative the individual's participation in the treatment
process.
(2) Responsible staff
document the individual's progress toward goals, the provision of staff
intervention, and the individual's response to those interventions.
(3) Documentation of service provision is in
a legible, written format in accordance with organizational policies and
procedures .
(5)
Incident reports.
a.
Performance benchmark.
The organization completes an incident report when organization staff first
become aware that an incident has occurred.
b.
Performance indicators .
(1) The organization documents the following
information:
1. The name of the individual
served who was involved in the incident .
2. The date and time the incident
occurred.
3. A description of the
incident .
4. The names of all
organization staff and others who were present or responded at the time of the
incident . (For confidentiality reasons, other individuals who receive services
should be identified by initials or some other accepted means.)
5. The action the organization staff took to
handle the situation.
6. The
resolution of or follow-up to the incident .
(2) The staff who were directly involved at
the time of the incident or who first became aware of the incident prepare and
sign the incident report before forwarding it to the supervisor.
(3) Staff file a copy of the completed
incident report in a centralized location and make a notation in the
individual's file.
(4) Staff send a
copy of the incident report to the individual's Medicaid targeted case manager
or county case worker who is involved in funding the service and notify the
individual's legal guardian within 72 hours of the incident .
(6)
Confidentiality and legal status.
a.
Performance benchmark.
Staff release medical and mental health information only when properly
authorized.
b.
Performance
indicators .
(1) The organization
obtains voluntary written authorization from the individual using the service,
the individual's legal guardian, or other people authorized by law before
releasing personal identifying information, medical records, mental health
records, or any other confidential information.
(2) Staff complete voluntary written
authorization forms in accordance with existing federal and state laws, rules,
and regulations and maintain them in each individual file.
(3) Documentation regarding restrictions on
the individual, such as guardianship, power of attorney, conservatorship,
mental health commitments, or other court orders, is placed in the individual's
record, if applicable.
(7)
Service systems.
a.
Performance benchmark.
The organization develops a clear description of each of the services offered.
The organization develops an admission and discharge system of services. Staff
coordinate services with other settings and providers.
b.
Performance indicators .
(1) The organization has established and
documented the necessary admission information to determine each individual's
eligibility for participation in the service.
(2) Staff include verification in each
individual's file that a service description was provided to the individual
using the service and, when appropriate , to family or significant
others.
(3) Continuity of services
occurs through coordination among the staff and professionals providing
services. Coordination of services through linkages with other settings and
providers has occurred, as appropriate .
(4) Staff include a written discharge summary
in each individual record at the time of discharge.
(8)
Respect for individual
rights.
a.
Performance
benchmark. Each individual using the service is recognized and
respected in the provision of services, in accordance with basic human, civil,
and statutory rights.
b.
Performance indicators .
(1)
Staff provide services in ways that respect and enhance the individual's sense
of autonomy, privacy, dignity, self-esteem, and involvement in the individual's
own treatment. Staff take language barriers, cultural differences, and
cognitive deficits into consideration and make provisions to facilitate
meaningful individual participation.
(2) Staff inform individuals using the
service and, when appropriate , family and significant others of their rights,
choices, and responsibilities.
(3)
The organization has a procedure established to protect the individuals using
the service during any activities, procedure or research that requires informed
consent .
(4) The organization
verifies that individuals using the service and their guardians are informed of
the process to express questions, concerns, complaints, or grievances about any
aspect of the individual's service, including the appeal process.
(5) The organization provides the individuals
and their guardians the right to appeal the application of policies ,
procedures , or any staff action that affects the individual using the service.
The organization has established written appeal procedures and a method to
ensure that the procedures and appeal process are available to individuals
using the service.
(6) All
individuals using the service, their legal representatives, and other people
authorized by law have access to the records of the individual using the
service in accordance with state and federal laws and regulations.
(9)
Case
management services. "Case management services" means those services
established pursuant to Iowa Code section
225C.20.
a.
Performance benchmark.
Case management services link individuals using the service to service agencies
and support systems responsible for providing the necessary direct service
activities and coordinate and monitor those services.
b.
Performance indicators .
(1) Staff clearly define the need for case
management and document it annually.
(2) At a minimum, the team is composed of the
individual using the service, the case manager, and providers or natural
supports relevant to the individual's service needs. The team may also include
family members, at the discretion of the individual using the
service.
(3) The team works with
the individual using the service to establish the service plan that guides and
coordinates the delivery of the services.
(4) The case manager advocates for the
individual using the service.
(5)
The case manager coordinates and monitors the services provided to the
individual using the service.
(6)
Documentation of contacts includes the date, the name of the individual using
the service, the name of the case manager, and the place of service.
(7) The case manager holds individual
face-to-face meetings at least quarterly with the individual using the
service.
(8) Case managers do not
provide direct services . Individuals using the service are linked to
appropriate resources, which provide necessary direct services and natural
supports .
(9) Individuals using the
service participate in developing an individualized crisis intervention plan
that includes natural supports and self-help methods.
(10) Documentation shows that individuals
using the service are informed about their choice of providers as provided in
the county management plan.
(11)
Within an accredited case management program , the average caseload is no more
than 45 individuals per each full-time case manager. The average caseload of
children with serious emotional disturbance is no more than 15 children per
full-time case manager.
(12) The
case manager communicates with the team and then documents in the individual's
file a quarterly review of the individual's progress toward achieving the
goals.
(10)
Day treatment services. "Day treatment" means an
individualized service emphasizing mental health treatment and intensive
psychosocial rehabilitation activities designed to increase the individual's
ability to function independently or facilitate transition from residential
placement. Staff use individual and group treatment and rehabilitation services
based on individual needs and identified behavioral or mental health issues.
a.
Performance benchmark.
Individuals using the service who are experiencing a significantly reduced
ability to function in the community are stabilized and improved by the receipt
of psychosocial rehabilitation, mental health treatment services, and in-home
support services, and the need for residential or inpatient placement is
alleviated.
b.
Performance
indicators .
(1) Individuals using
the service participate with the organizational staff in identifying the
problem areas to be addressed and the goals to be achieved that are based on
the individual's need for services.
(2) Individuals using the service receive
individualized services designed to focus on those identified mental health or
behavioral issues that are causing significant impairment in their day-to-day
functioning.
(3) Individuals who
receive intensive outpatient and day treatment services receive a comprehensive
and integrated schedule of recognized individual and group treatment and
rehabilitation services .
(4)
Individuals using the service and staff review their progress in resolving
problems and achieving goals on a frequent and regular basis.
(5) Individuals using the service receive
services appropriate to defined needs and current risk factors.
(6) Individuals using the service receive
services from staff who are appropriately qualified and trained to provide the
range and intensity of services required by the individual's specific problems
or disabilities. A mental health professional provides or directly supervises
the provision of treatment services.
(7) Individuals using the service participate
in discharge planning that focuses on coordinating and integrating individual,
family, and community and organization resources.
(8) Family members of individuals using the
service are involved in the planning and provision of services, as appropriate
and as desired by the individual.
(9) Individuals using the service participate
in developing a detailed psychiatric crisis intervention plan that includes
natural supports and self-help methods.
(11)
Intensive psychiatric
rehabilitation services . "Intensive psychiatric rehabilitation
services " means services designed to restore, improve, or maximize level of
functioning, self-care, responsibility, independence, and quality of life; to
minimize impairments, disabilities, and disadvantages of people who have a
disabling mental illness; and to prevent or reduce the need for services in a
hospital or residential setting. Services focus on improving personal
capabilities while reducing the harmful effects of psychiatric disability,
resulting in an individual's recovering the ability to perform a valued role in
society.
a.
Performance
benchmark. Individuals using the service who are experiencing a
significantly reduced ability to function in the community due to a disability
are stabilized and experience role recovery by the receipt of intensive
psychiatric rehabilitation services .
b.
Performance indicators .
(1) Individuals using the service receive
services from staff who meet the definition of intensive psychiatric
rehabilitation practitioner . The intensive psychiatric rehabilitation
supervisor has at least a bachelor's degree in a human services field and 60
hours of training in intensive psychiatric rehabilitation.
(2) Individuals using the service receive
four to ten hours per week of recognized psychiatric rehabilitation services .
All services are provided for an identified period.
(3) Whenever possible, intensive psychiatric
rehabilitative services are provided in natural settings where individuals
using the service live, learn, work, and socialize.
(4) Significantly involved others participate
in the planning and provision of services as appropriate and as desired by the
individual using the service.
(5)
Individuals using the service participate in developing a detailed psychiatric
crisis intervention plan that includes natural supports and self-help
methods.
(6) A readiness assessment
is initially completed with staff to assist the individual in choosing a valued
role and environment. The readiness assessment culminates in a score that
documents the individual's motivational readiness.
(7) During the readiness development phase,
staff document monthly in the individual's file changes in the individual's
motivational readiness to choose valued roles and environments.
(8) During the goal-choosing phase, staff and
the individual identify personal criteria, describe alternative environments,
and choose the goal. These activities are documented in the individual's
file.
(9) During the goal-achieving
phase, the functional assessment and resource assessment are completed. Skill
programming or skill teaching takes place. These activities are documented in
the individual's file.
(10) During
goal keeping , individuals using the service participate in discharge planning
that focuses on coordinating and integrating individual, family, community , and
organization resources for successful community tenure and the anticipated end
of psychiatric rehabilitation services . Staff document increases in skill
acquisition and skill competency.
(11) Staff document any positive changes in
environmental status, such as moving to a more independent living arrangement,
enrolling in an education program , getting a job, or joining a community
group.
(12) On an ongoing basis and
at discharge, staff or the individual using the service documents the level of
individual satisfaction with intensive psychiatric rehabilitation services in
each individual's file.
(12)
Supported community living
services. "Supported community living services" means those services
provided to individuals with a mental illness, mental retardation, or
developmental disability to enable them to develop supports and learn skills
that will allow them to live, learn, work and socialize in the community .
Services are individualized, need- and abilities-focused, and organized
according to the following components: outreach to appropriate support or
treatment services; assistance and referral in meeting basic human needs;
assistance in housing and living arrangements; crisis intervention and
assistance; social and vocational assistance; the provision of or arrangement
for personal, environmental, family, and community supports; facilitation of
the individual's identification and development of natural support systems;
support, assistance, and education to the individual's family and to the
community ; protection and advocacy; and service coordination.
These services are to be provided by organizational
a.
Performance benchmark. Individuals using the service live,
learn, work, and socialize in the community .
b.
Performance indicators .
(1) Individuals receive services within their
home and community setting where the skills are learned or used.
(2) At intake, the individuals using the
service participate in a functional assessment to assist in defining areas of
service need and establishing a service plan . Staff summarize the findings of
the functional assessment in a narrative that describes the individual's
current level of functioning in the areas of living, learning, working, and
socialization. Staff review functional assessments on a regular basis to
determine progress.
(3) Individuals
using the service receive skill training and support services directed to
enabling them to regain or attain higher levels of functioning or to maximize
functioning in the current goal areas.
(4) Services are delivered on an
individualized basis in the place where the individual using the service lives
or works.
(5) Documentation that
steps have been taken to encourage the use of natural supports and develop new
ones is in the individual file.
(6)
Individuals using the service participate in developing a detailed
individualized crisis intervention plan that includes natural supports and
self-help methods.
(13)
Partial hospitalization
services. "Partial hospitalization services" means an active treatment
program providing intensive group and individual clinical services within a
structured therapeutic environment for individuals who are exhibiting
psychiatric symptoms of sufficient severity to cause significant impairment in
day-to-day functioning. Short-term outpatient crisis stabilization and
rehabilitation services are provided to avert hospitalization or to transition
from an acute care setting. Services are supervised and managed by a mental
health professional , and psychiatric consultation is routinely available.
Clinical services are provided by a mental health professional .
a.
Performance benchmark.
Individuals who are experiencing serious impairment in day-to-day functioning
due to severe psychiatric distress are enabled to remain in their community
living situation through the receipt of therapeutically intensive milieu
services.
b.
Performance
indicators .
(1) Individuals using
the service and staff mutually develop an individualized service plan that
focuses on the behavioral and mental health issues and problems identified at
admission. Goals are based on the individual's need for services.
(2) Individuals using the service receive
clinical services that are provided and supervised by mental health
professionals. A licensed and qualified psychiatrist provides psychiatric
consultation and medication services.
(3) Individuals using the service receive a
comprehensive schedule of active, planned, and integrated psychotherapeutic and
rehabilitation services provided by qualified professional staff .
(4) Individuals using the service receive
group and individual treatment services that are designed to increase their
ability to function independently.
(5) Individuals using the service are
involved in the development of an anticipated discharge plan that includes
linkages to family, provider, and community resources and services.
(6) Individuals using the service have
sufficient staff available to ensure their safety, to be responsive to crisis
or individual need, and to provide active treatment services.
(7) Individuals using the service receive
services commensurate with current identified risk and need factors.
(8) Support systems identified by individuals
using the service are involved in the planning and provision of services and
treatments as appropriate and desired by the individual using the
service.
(9) Individuals using the
service participate in developing a detailed psychiatric crisis intervention
plan that includes natural supports and self-help methods.
(14)
Outpatient
psychotherapy and counseling services. "Outpatient psychotherapy and
counseling services" means a dynamic process in which the therapist uses
professional skills, knowledge and training to enable individuals using the
service to realize and mobilize their strengths and abilities, take charge of
their lives, and resolve their issues and problems. Psychotherapy services may
be individual, group, or family, and are provided by a person meeting the
criteria of a mental health professional or by a person with a master's degree
or an intern working on a master's degree in a mental health field who is
directly supervised by a mental health professional .
a.
Performance benchmark.
Individuals using the service realize and mobilize their own strengths and
abilities to take control of their lives in the areas where they live, learn,
work, and socialize.
b.
Performance indicators .
(1)
Individuals using the service are prepared for their role as partners in the
therapeutic process at intake where they define their situations and evaluate
those factors that affect their situations.
(2) Individuals using the service establish
desired problem resolution at intake during the initial assessment .
(3) Psychiatric services other than
psychopharmacological services are available from the organization as needed by
the individual using the service.
(4) Psychopharmacological services are
available from the organization as needed.
(5) Any assignment of activities to occur
between sessions is documented in the following session's
documentation.
(6) Individuals
using the service who have a chronic mental illness participate in developing a
detailed psychiatric crisis intervention plan that includes natural supports
and self-help methods.
(7) The
record documents that the organization follows up on individuals who miss
appointments.
(8) Treatment
planning is based on the assessment .
(9) Individuals using the service participate
with the organizational staff in identifying the assessed needs to be
addressed.
(10) The treatment plan
identifies measurable goals, desired outcomes and time frames for achieving
them.
(11) The treatment plan
includes interventions and supports to be provided.
(12) Individuals using the service review
their progress in resolving problems and achieving goals on a frequent and
regular basis with organizational staff . The treatment plan is revised as
appropriate to the individual's needs and priorities.
(13) Individuals using the service
participate in transition/discharge planning that includes linkages to family,
provider, and community resources and services.
(14) Significantly involved others of
individuals using the service are involved in the planning and provision of
services, as appropriate and as desired by the individual.
(15)
Emergency
services. "Emergency services" means crisis services that provide a
focused assessment and rapid stabilization of acute symptoms of mental illness
or emotional distress and are available and accessible, by telephone or
face-to-face , on a 24-hour basis. The clinical assessment and psychotherapeutic
services are provided by a person who has training in emergency services and
who is a mental health professional or has access to a mental health
professional , at least by telephone.
Services may be provided by a person who holds a master's
degree in a mental health field including, but not limited to, psychology,
counseling and guidance, psychiatric nursing, psychiatric rehabilitation, or
social work; or a person who holds a bachelor's degree in a human service
discipline with five years' experience providing mental health services or
human services; or a
a.
Performance
benchmark. Individuals using the service receive emergency services
when needed that provide a focused assessment and rapid stabilization of acute
symptoms of mental illness or emotional distress.
b.
Performance indicators .
(1) Individuals using the service can access
24-hour emergency services by telephone or in person.
(2) Information about how to access emergency
services is publicized to facilitate availability of services to individuals
using the service, family members, and the public.
(3) Individuals using the service receive
assessments and services from either a mental health professional or from
personnel who meet the requirements above and are supervised by a mental health
professional . Psychiatric consultation is available, if needed.
(4) Individuals using the service receive
intervention commensurate with current identified risk factors.
(5) Significantly involved others are
involved as necessary and appropriate to the situation and as desired by the
individual using the service.
(6)
Individuals using the service are involved in the development of postemergency
service planning and resource identification and coordination.
(7) Staff document contacts in a narrative
format and maintain them in a central location that will allow timely response
to the problems presented by the individual using the service.
(8) Timely coordination of contacts with
relevant professionals is made.
(16)
Evaluation services.
"Evaluation services" means screening, diagnosis and assessment of individual
and family functioning needs, abilities, and disabilities, and determining
current status and functioning in the areas of living, learning, working, and
socializing.
a.
Performance
benchmark. Individuals using the service receive comprehensive
evaluation services that include screening, diagnosis, and assessment of
individual or family functioning, needs and disabilities.
b.
Performance indicators .
(1) Evaluations include screening, diagnosis,
and assessment of individual or family functioning, needs, abilities, and
disabilities.
(2) Evaluations
consider the emotional, behavioral, cognitive, psychosocial, and physical
information as appropriate and necessary.
(3) Evaluations includes recommendations for
services and need for further evaluations.
(4) Mental health evaluations are completed
by a person who meets the criteria of a mental health professional , or a person
with a master's degree who is license-eligible and supervised by a mental
health professional , or an intern of a master's or doctorate program who is
supervised by a mental health professional .
Notes
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.