Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.17 - Level II.1: Intensive Outpatient Treatment

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Rule Compliance. Each Level II.1 Intensive Outpatient Program shall comply with
			 the following rules and the rules specified in this chapter.
(a) Program Description. The entity shall
			 develop, maintain and implement a written program description that defines the
			 Level II.1 Intensive Outpatient Program it provides to include the following
			 specifications:
1. Location. The entity shall
			 specifically identify and describe the setting in which Level II.1 Intensive
			 Outpatient Services shall be provided. Services may be provided in any
			 appropriate setting that protects the client's right to privacy,
			 confidentiality, safety and meets the DMH facility certification
			 standards.
2. Admission Criteria.
			 The entity shall develop, maintain and implement written criteria for admission
			 to its Level II.1 Outpatient Program and the following specifications:
(i) The entity's admission criteria shall
			 specify the target population for the Level II.1 Program which shall include,
			 at a minimum, individuals whose assessed severity of illness initially warrants
			 this level of care including but not limited to:
(I) Individuals who have fairly stable to
			 stable mental and/or physical health problems; and
(II) Who have supportive living
			 arrangements.
(ii) The
			 entity shall provide written documentation in individual case records that each
			 client admitted to receive Level II.1 Intensive Outpatient Services 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; and
(II) The dimensional criteria for admission
			 to this level of care as defined in the most recent edition of the ASAM
			 PPC-2R.
(iii) Adolescent
			 Program Specific Criteria: The entity shall provide written documentation in
			 individual case records that each adolescent admitted to receive Level II.1
			 Intensive Outpatient Services meets:
(I) The
			 diagnostic criteria for a substance use disorder as defined in the most recent
			 edition of the Diagnostic and Statistical Manual for Mental
			 Disorders.
(II) The adolescent
			 dimensional criteria for admission to this level of care as defined in the most
			 recent edition of the ASAM PPC-2R.
(iv) Co-occurring Disorders Program Specific
			 Criteria: The entity shall provide written documentation in individual case
			 records that each client admitted to receive Level II.1 Intensive Outpatient
			 Services in a 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; and
(II) The dimensional criteria for admission
			 to this level of care as defined in the most recent edition of the ASAM
			 PPC-2R.
(v) Women and
			 Dependent Children Program Specific Criteria: The entity shall provide written
			 documentation in individual case records that each client admitted to receive
			 Level II.1 Intensive Outpatient Services in a Women and Children Program:
(I) Meets 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) Meets 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 II.1 Intensive
			 Outpatient Program shall demonstrate the capacity to provide a basic level of
			 skilled treatment services appropriate to the needs of its clientele.
(i) At a minimum, the Level II.1 Intensive
			 Outpatient Program shall directly or by referral provide the following core
			 services:
(I) Placement assessment.
(II) Individual counseling.
(III) Group counseling.
(IV) Family counseling.
(V) Psychoeducation.
(VI) Mental health consultation.
(VII) Recovery support services.
(VIII) Peer counseling services.
(IX) Medication management.
(X) Alcohol and/or drug
			 screening/testing.
(XI) Smoking
			 cessation.
(XII) Sign language
			 interpreter services.
(XIII) HIV
			 early intervention services.
(XIV)
			 Case management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Adolescent Program Specific Criteria:
			 Each Level II. 1 Adolescent Intensive Outpatient Program shall document the
			 capacity to provide each of the core services to include the following
			 services:
(I) Activity therapy.
(II) Academic and vocational
			 services.
(III) Vocational
			 services.
(iii)
			 Co-occurring Disorders Program Specific Criteria: Each level II.1 Co-occurring
			 Disorders Intensive Outpatient Program shall document the capacity to provide
			 each of the core services to include the following services:
(I) Basic living skills.
(II) Crisis intervention services.
(III) Intensive case management.
(IV) Academic and vocational
			 services.
(iv) Women and
			 Dependent Children Program Specific Criteria: Each Level II.1 Women and
			 Dependent Children Intensive Outpatient Program shall document the capacity to
			 provide each of the core services and/or arrange for the following services:
(I) Transportation.
(II) Child sitting services.
(III) Developmental delay and/or prevention
			 services.
(IV) Activity
			 therapy.
(V) Parenting skills
			 development.
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 the client's assessed needs and
			 expressed desires for care.
(i) Service
			 strategies for each Level II.1 Intensive Outpatient Program shall include, at a
			 minimum:
(I) Implementation of individualized
			 counseling plan strategies.
(II)
			 Ongoing individualized assessment.
(III) Motivational enhancement and engagement
			 strategies.
(IV) Relapse prevention
			 strategies.
(V) Interpersonal
			 choice/decision-making skill development.
(VI) Health education.
(VII) Random drug screening.
(VIII) Medication administration and
			 monitoring.
(IX) Gender responsive
			 treatment.
(ii)
			 Adolescent Program Specific Criteria: Each Level II. 1 Adolescent Intensive
			 Outpatient Program shall document the capacity to provide the service
			 strategies and the following therapeutic components:
(I) Adolescent specific evidence based
			 therapeutic interventions.
(II)
			 Client education on key adolescent development issues including, but not
			 limited to, adolescent brain development and the impact of substance use,
			 emotional and social influence on behavior, value system development,
			 puberty/physical development, sexuality and self-esteem.
(III) Recreation and leisure time skills
			 training.
(IV) Family, community
			 and school reintegration services.
(V) Academic or vocational
			 services.
(iii)
			 Co-occurring Disorders Program Specific Criteria: Each Level II.1 Co-occurring
			 Disorders Outpatient 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.
(IV) Intensive Case
			 Management.
(iv) Women
			 and Dependent Children Program Specific Criteria: Each Level II.1 Women and
			 Dependent Children Intensive Outpatient Program shall document the capacity to
			 provide the service strategies and the following therapeutic components:
(I) Specific services which address issues of
			 relationships, parenting, abuse and trauma.
(II) Primary medical care, including prenatal
			 care.
(III) Primary pediatric care
			 for children.
(IV) Therapeutic
			 interventions for children which address their developmental needs and issues
			 of sexual abuse and neglect.
(V)
			 Outreach to inform pregnant women of the services and priorities.
(VI) Interim services while awaiting
			 admission to this level of care.
(VII) Recreation and leisure time skills
			 training.
(VIII) Academic and
			 vocational services.
(IX) Financial
			 resource development and planning.
(X) Family planning
			 services.
5.
			 Documentation: For each day in attendance, an individualized progress note
			 shall be recorded to reflect services provided in Level II.1.
6. Support Systems. Each Level II.1 Intensive
			 Outpatient 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 include:
(i) Medical, psychiatric,
			 psychological, laboratory and toxicology services.
(ii) Medical and psychiatric consultation
			 shall be available within twenty-four (24) hours by telephone or, if in person,
			 within seventy-two (72) hours.
(iii) Direct affiliation with or coordination
			 through referral to more and less intensive levels of care and supportive
			 housing services.
(iv) Emergency
			 services shall be available by telephone twenty-four (24) hours a day, seven
			 (7) days a week.
(v) Mutual
			 self-help groups that are tailored to the needs of the specific client
			 population.
(vi) Referral for other
			 services as according to the client's assessed needs.
7. Program Personnel. Each level II.1
			 Intensive Outpatient 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 II.1
			 Intensive Outpatient 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 II.1 Program
			 shall be assigned to a specific primary counselor for care
			 management.
(v) Each primary
			 counselor shall maintain a case load not to exceed thirty (30) clients with
			 active cases at any one time.
(vi)
			 Adolescent Program Specific Criteria.
(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 plan for this level of care.
(II) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level II.1
			 Adolescent Intensive Outpatient Program as delineated in its operational
			 plan.
(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 II.1 Adolescent
			 Intensive Outpatient Program shall be assigned to a specific primary counselor
			 for care management.
(V) Each
			 primary counselor shall maintain a case load not to exceed thirty (30) clients
			 with active cases at any one time.
(vii) Co-occurring Disorders Program Specific
			 Criteria.
(I) The Level II.5 Co-occurring
			 Enhanced Partial Hospitalization 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) 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.
(VI) 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 II.1 Co-occurring Enhanced Intensive Outpatient Program shall be
			 qualified as a qualified paraprofessional 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 II.1
			 Co-occurring Enhanced Outpatient 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 II.1
			 Co-occurring Intensive Outpatient Program shall be assigned to a specific
			 primary counselor for care management.
(IX) Each primary counselor shall maintain a
			 case load not to exceed twenty (20) clients with active cases at any one
			 time.
(viii) Women and
			 Dependent Children Program Specific Criteria:
(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 plan for this level of
			 care.
(II) Clinical Personnel. The
			 entity shall maintain an adequate number of clinical personnel to sustain the
			 Level II.1 Women and Dependent Children Intensive Outpatient Program as
			 delineated in its operational plan.
(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 II.1 Women and
			 Dependent Children Program shall be assigned to a specific primary counselor
			 for case management.
(V) Each
			 primary counselor shall maintain a case load not to exceed twenty (20) clients
			 with active cases at any one time.
8. Training. The entity shall provide written
			 documentation that all Level II.1 Program personnel satisfy the competency and
			 training requirements as specified in Rule 580-9-44-.02(3).
9. Service Intensity.
(i) The entity shall document that the amount
			 and frequency of Level II.1 Intensive Outpatient Services are established on
			 the basis of the unique needs of each client served and shall be available a
			 minimum of nine (9) hours but no greater than nineteen (19) hours each
			 week.
(ii) Adolescent Program
			 Specific Criteria. The entity shall document that the amount and frequency of
			 Level II.1 Intensive Outpatient Services for adolescents are established on the
			 basis of the unique needs of each client served and shall be available a
			 minimum of six (6) hours but no greater than nineteen (19) hours each
			 week.
10. Length of
			 Service: The entity shall provide written documentation that the duration of
			 treatment in each Level II.1 Intensive Outpatient Program shall vary 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
			 implement treatment strategies and attain treatment goals.
(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 Level II.1 service have been utilized as interim
			 services.
11. Service
			 Availability: The entity shall provide written documentation describing the
			 process utilized to establish the hours of service availability for its Level
			 II.1 Intensive Outpatient Programs. 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.