Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.22 - Level III.2-D: Clinically Managed Residential Detoxification

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule Compliance. In addition to
			 compliance with the rules as specified in this chapter, each Level III.2-D
			 Clinically Managed Residential Detoxification 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 its
			 Level III.2-D Program, 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.2-D
			 Program is provided. Services may 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.2-D 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 the Level III.2-D Program,
			 which shall include, at a minimum, individuals who:
(I) Are experiencing signs and symptoms of
			 withdrawal, or there is evidence based on history of substance intake, age,
			 gender, previous withdrawal history, present symptoms, physical condition
			 and/or emotional behavioral or cognitive condition that withdrawal syndrome is
			 imminent.
(II) Assessed as not
			 being at risk of severe withdrawal syndrome and moderate withdrawal is safely
			 manageable at this level.
(III)
			 Have a history of insufficient skills and supports to complete detoxification
			 at a less intense level of care.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to receive
			 Level III.2-D services meets:
(I) The
			 diagnostic criteria for Substance Induced Disorder as defined in the most
			 recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
			 the American Psychiatric Association.
(II) The dimensional criteria for admission
			 to this level of care as defined in the ASAM
			 PPC-2R.
3. Core
			 Services: At a minimum, the Level III.2-D Program shall document the capacity
			 to provide the following core services:
(i)
			 Placement assessment.
(ii)
			 Individual counseling.
(iii) Group
			 counseling.
(iv)
			 Psychoeducation.
(v) Family
			 counseling.
(vi) Peer
			 support.
(vii) Medical and somatic
			 services.
(viii) Medication
			 administration.
(ix) Medication
			 monitoring.
(x) Alcohol and/or drug
			 screening/testing.
(xi) Case
			 management:
(I) Case planning.
(II) Linkage.
(III) Advocacy.
(IV)
			 Monitoring.
4.
			 Therapeutic Component Implementation: The entity shall document implementation
			 of medical and other clinical services organized to enhance the client's
			 understanding of addiction, support completion of the detoxification process
			 and initiate transfer to an appropriate level of care for continued treatment.
			 The entity's Level III.2-D Program shall, at a minimum, consist of the
			 following components:
(i) Completion of a
			 comprehensive medical history and physical examination of the client at
			 admission.
(ii) Protocols and/or
			 standing orders, established by the entity's medical director, for management
			 of detoxification from each major drug category of abused drugs that are
			 consistent with guidelines published by nationally recognized organizations
			 (e.g., SAMHSA, ASAM, American Academy of Addiction Psychology).
(I) Level III.2-D Programs that utilize
			 benzodiazepines in the detoxification protocol:
I. Shall have written protocols and
			 procedures to show that all doses or amounts of benzodiazepines are carefully
			 monitored and are slowly reduced as appropriate.
II. Shall have written longer-term
			 detoxification protocols and procedures that adhere to general principles of
			 management, including clear indications of benzodiazepine dependence, clear
			 intermediate treatment goals and strategies, regular review and methods to
			 prevent diversion from the plan.
(iii) On duty awake staff shall provide
			 supervision for each client's health, welfare and safety twenty-four (24) hours
			 a day, seven (7) days a week.
(iv)
			 On-site physician care and phone availability twenty-four (24) hours a day,
			 seven (7) days a week.
(v)
			 Credentialed personnel who are trained and competent to implement physician
			 approved protocols for client observation and supervision, determination of
			 appropriate level of care and facilitation of the client's transitioning to
			 continuing care.
(vi) Services
			 designed explicitly to safely detoxify clients without the need for ready
			 on-site access to medical and nursing personnel.
(vii) Medical evaluation and consultation
			 available twenty-four (24) hours a day in accordance with practice
			 guidelines.
(viii) Clinicians who
			 assess and treat clients are able to obtain and interpret information regarding
			 the needs of the client to include the signs and symptoms of alcohol and other
			 drug intoxification and withdrawal, as well as, the appropriate treatment and
			 monitoring of these conditions.
(ix) Medication administration and monitoring
			 services, including specific procedures for pregnant women.
(x) Continuous assessment.
(xi) Planned counseling and other therapeutic
			 interventions.
(xii) Motivational
			 enhancement therapy.
(xiii) Direct
			 affiliation with other levels of care.
5. Documentation: Level III.2-D Programs
			 shall provide the following clinical record documentation:
(i) Documentation of each
			 clinical/therapeutic intervention provided.
(ii) Daily assessment of progress, through
			 detoxification, including response to medication, which also notes any
			 treatment changes.
(iii) Monitoring
			 of vital signs, at a minimum, every eight (8) hours until discharge.
(iv) The use of detoxification rating scale
			 tables and flow sheets.
6. Support Systems: The Level III.2-D Program
			 shall develop, maintain and document implementation of written policies and
			 procedures utilized to provide client access to support services on site, or
			 through consultation or referral, which shall minimally include availability
			 to:
(i) Specialized clinical consultation for
			 biomedical, emotional, behavioral and cognitive problems.
(ii) Appropriate laboratory and toxicology
			 testing.
(iii) Psychological and
			 psychiatric services.
(iv)
			 Transportation.
(v) Twenty-four
			 (24) hour emergency medical services.
7. Staff Requirements.
(i) Medical Director. The Level III.2-D
			 Program shall have a medical director who is a physician licensed to practice
			 in the State of Alabama, with a minimum of one (1) year experience treating
			 persons with substance induced disorders. The medical director shall be
			 responsible for admission, diagnosis, medication management and client
			 care.
(ii) Nursing Services
			 Director. The Level III.2-D Program shall have a nursing services director who
			 shall be a Registered Nurse licensed according to Alabama law, with training
			 and work experience in behavioral health.
(iii) There shall be a Registered Nurse (RN)
			 or Licensed Practical Nurse (LPN) on site during all hours of the Level III.2-D
			 Program's operation.
(iv) Direct
			 Care Personnel. All direct care personnel shall have the qualifications as a
			 qualified paraprofessional to provide the specific services delineated in the
			 entity's program description for this level of care.
(v) The entity shall maintain an adequate
			 number of personnel, including physicians, nurses, counselors and case managers
			 to sustain the Level III.2-D Program as delineated in its operational
			 plan.
(vi) Administrative Support
			 Personnel. The entity shall maintain an adequate number of support personnel to
			 sustain the program's administrative functions.
8. Training: The entity shall provide written
			 documentation that:
(i) All Level III.2-D
			 Program personnel satisfy the requirements of the core training curriculum, as
			 specified in Rule 580-9-44-.02(3).
(ii) All clinical and medical services staff
			 in a Level III.2-D Program shall receive training during the initial twelve
			 (12) months employment and develop basic competencies in the following areas:
(I) Biopsychosocial dimensions of alcohol and
			 other drug dependence, including:
I. The signs
			 and symptoms of alcohol and other drug intoxication and withdrawal.
II. Evidence-based treatment and monitoring
			 strategies for alcohol and other drug intoxication and withdrawal.
III. Continuing care motivational and
			 engagement strategies.
(II) Pharmacotherapy.
(III) ASAM Patient Placement
			 Criteria.
(IV) Assessment of and
			 service planning to address biopsychosocial
			 needs.
9.
			 Service Intensity: The entity shall document in the clinical record that the
			 intensity of Level III.2-D Services is established on the basis of the unique
			 needs of each client served.
10.
			 Length of Service: The entity shall provide written documentation in the
			 clinical record that the duration of treatment in a Level III.2-D Program
			 varies as determined by the client's assessed needs, and that the client
			 continues in treatment until:
(i) Withdrawal
			 signs and symptoms are sufficiently resolved; or
(ii) Withdrawal signs and symptoms have
			 failed to respond to treatment and have intensified warranting a transfer to a
			 more intense level of care; or
(iii) The client is, otherwise, unable to
			 complete detoxification at this level of
			 care.