415-050-0125 Personnel Records (1) Providers must maintain personnel records for each program staff and withdrawal management technician that contains, at a minimum, all of the following documentation: (a) The results of national and state-wide criminal records check processes applicable to the current position or title for personnel who render substance use disorder treatment services or have access to substance use disorder protected health information such as service records or billing information; (b) A current position description that includes applicable qualifications, including credentials and competencies; (c) When applicable to the position, copies of relevant licensure or certification, diploma, or certified transcripts from an accredited college, indicating that the personnel meets applicable qualifications; (d) Copies of any action on the credentials as reported by the certification or Licensing Board or body; (e) Periodic performance appraisals that, when deficiencies are noted, contain a performance improvement and training plan, including completion of any required training(s) and resolution of the performance plan; (f) Orientations and trainings required in OAR 415-050; (g) Disciplinary documentation; (h) Active First Aid and CPR certification for each non-medical personnel; and (i) Results of a Tuberculosis screening as per OAR 333-071-0057. (2) Providers must ensure each program staff receives training applicable to the specific population for whom services are planned, delivered, or supervised. The program must document orientation training for each program staff or individual providing services within 30 days of the hire date. At minimum, orientation training for all program staff must include, but not be limited to: (a) A review of crisis prevention and response procedures; (b) A review of emergency evacuation procedures; (c) A review of program policies and procedures; (d) A review of rights for patients receiving services and supports; (e) A review of mandatory abuse reporting procedures; (f) A review of confidentiality policies and procedures; (g) A review of Fraud, Waste and Abuse policies and procedures; (h) A review of care coordination procedures; (i) A review and agreement to abide by the Code of conduct; (j) Training in de-escalation; and (k) Training in motivational enhancement. (3) Providers must ensure that withdrawal management technician staff receive the following trainings. The program must document orientation training for each withdrawal management staff within 30 days of the hire date. At minimum, orientation training for all program staff must include but not be limited to: (a) A review of crisis prevention and response procedures; (b) A review of emergency evacuation procedures; (c) A review of program policies and procedures; (d) A review of rights for patients receiving services and supports; (e) A review of mandatory abuse reporting procedures; (f) A review of confidentiality policies and procedures; (g) A review and agreement to abide by the Code of conduct; (h) Training in de-escalation; and (i) Training in motivational enhancement. (4) Medical treatment staff rendering or assisting with medical interventions, including applicable interns, must have the following trainings documented within one week of active employment in such a role: (a) Medical protocols; (b) Use of COWS, CIWA-AR and other evidence-based screening tools. (5) Non-medical program staff must be certified for first aid/ CPR within 6 weeks of active employment. (6) Supervision: all staff who are responsible for the delivery of services or supports must receive documented supervision and oversight by a qualified supervisor or manager, as applicable and as defined in OAR 415-050. Individual face-to face contact may include real time, two-way audio or audio-visual conferencing. Part time program staff must receive supervision prorated to reflect the average number of hours worked. (a) Supervision must be related to the development of the staff and the services, and the implementation and outcome of the services. Supervision must be provided to assist staff to: (A) Increase their skills within their scope of practice; (B) Improve quality of services or supports to patients; and (C) Ensure understanding and application of the code of conduct and program policies and procedures. (b) Documentation must include the date, amount of time per session and a brief description of the topics addressed and must demonstrate the following minimum amount of supervision occurred: (A) One hour per month of documented group supervision and consultation to medical treatment staff, non-medical treatment staff, withdrawal management technician, substance use disorder treatment staff, peer support or wellness specialist, and volunteer who is responsible for the delivery of services or supports; and (B) Interns and student interns must receive one-hour of individual clinical supervision per week. (c) Supervision must assist supervisees to ensure safety, increase their skills, improve quality of services to patients, and address understanding of and adherence to program protocols, policies, procedures and code of conduct; (d) When available, a qualified Peer-delivered Services Supervisor must provide the required monthly supervision to program staff providing direct Peer-delivered Services. Otherwise, supervision must be provided by a qualified supervisor; (e) Interns and student interns must render services and supports under the active supervision of a qualified supervisor; and (f) Individualized non-clinical supervision must be utilized as needed and documented. Statutory/Other Authority: ORS 413.042 & ORS 430.256 Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375 History: ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023