Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.15 - Level I: Outpatient Treatment

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule
			 Compliance. Each Level I Outpatient Program shall comply with the following
			 rules and the rules specified in this chapter.
(a) Program Description. The entity shall
			 develop, maintain and document implementation of a written operational plan
			 that defines its Level I Outpatient Program. The program description shall
			 comply with all of the requirements specified in 580-9-44-.13.
1. Location. The entity shall specifically
			 identify and describe the setting in which Level I Outpatient Services shall be
			 provided. Services may be provided in any appropriate setting that protects the
			 client's right to privacy, confidentiality and safety, including but not
			 limited to, traditional clinical offices and behavioral health sites,
			 residences, schools, shelters, work sites, community centers and other
			 locations as pre-authorized by DMH.
2. Admission Criteria: The entity shall
			 develop, maintain and implement written criteria for admission to its Level I
			 Outpatient Program in compliance with the requirements of 580-9-44-.13(9) and
			 the following specifications:
(i) The entity's
			 admission criteria shall specify the target population for the Level I 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) Whose progress in a more intensive level
			 of care warrants a step-down to a less intensive level of care.
(II) Who are in the early stages of change
			 and who are not yet ready to commit to full recovery.
(III) Who are experiencing increased
			 conflict, demonstrating passive compliance or considering leaving
			 treatment.
(ii) The
			 entity shall provide written documentation in individual case records that each
			 client admitted to receive Level I 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 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 I
			 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 I Outpatient Services
				in a Co-occurring Enhanced Treatment Program meets:
(I) The diagnostic criteria for a substance
			 use and mental illness disorder as defined in the most recent edition of the
			 Diagnostic and Statistical Manual for Mental Disorders.
(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 I Outpatient Services in a Women and Children Program:
(I) Meets the diagnostic criteria for a
			 substance use disorder as defined in the most recent edition Diagnostic and
			 Statistical Manual for Mental Disorders.
(II) 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 I 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 entity shall directly
			 or by referral provide the following core services:
(I) Behavioral Health Screening.
(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 I Adolescent Outpatient Program shall document the capacity to
			 provide each of the core services and to include activity therapy.
(I) Activity therapy.
(iii) Co-occurring Disorders Program Specific
			 Criteria: Each level I Co-occurring Disorders Outpatient Program shall document
			 the capacity to provide each of the core services to include basic living
			 skills, crisis intervention services, and intensive case management.
(iv) Women and Dependent Children Program
			 Specific Criteria: Each Level I Women and Dependent Children 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 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 I
			 Outpatient Program shall include, at a minimum:
(I) Implementation of individualized
			 counseling plan strategies.
(II)
			 Ongoing individualized assessment services.
(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) Family education.
(IX) Gender responsive
			 treatment.
(ii)
			 Adolescent Program Specific Criteria: Each Level I Adolescent 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.
(iii) Co-occurring Disorders Program Specific
			 Criteria: Each Level I 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) Women and Dependent Children Program
			 Specific Criteria: Each Level I Women and Dependent Children 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.
5.
			 Documentation: An individual progress note shall be recorded for each
			 respective service provided in Level I.
6. Support Systems. Each Level I 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
			 minimally 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 a timeframe appropriate to the severity and urgency of the consultation
			 requested.
(iii) Direct affiliation
			 with or coordination through referral to more intensive levels of care and
			 medication management.
(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 I 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) Clinical Personnel. The entity
			 shall maintain an adequate number of clinical personnel to sustain the Level I
			 Outpatient program as delineated in its operational plan.
(ii) Administrative Support Personnel. The
			 entity shall maintain an adequate number of support personnel to sustain the
			 program's administrative functions.
(iii) Every client in a Level I program shall
			 be assigned to a specific Primary Counselor for care management.
(iv) Each primary counselor shall maintain a
			 case load not to exceed forty (40) clients with active cases at any one
			 time.
(v) Adolescent Program
			 Specific Criteria Adolescent Program Specific Criteria:
(I) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level I
			 Adolescent Outpatient program as delineated in its operational plan.
(II) Administrative Support Personnel. The
			 entity shall maintain an adequate number of support personnel to sustain the
			 program's administrative functions.
(III) Every client in a Level I adolescent
			 program shall be assigned to a specific Primary Counselor for care
			 management.
(IV) Each primary
			 counselor shall maintain a case load not to exceed thirty (30) clients with
			 active cases at any one time.
(vi) Co-occurring Disorders Program Specific
			 Criteria:
(I) The Level I Co-occurring
			 Enhanced Outpatient 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.
(II) Treatment staff that provide therapy and
			 ongoing clinical assessment services to individuals diagnosed with co-occurring
			 disorders.
(III) Every client in a
			 Level I Enhanced Co-occurring Outpatient Program shall be assigned to a
			 specific Primary Counselor for care management.
(IV) Each primary counselor shall maintain a
			 case load not to exceed thirty (30) clients with active cases at any one
			 time.
(vii) Women and
			 Dependent Children Program Specific Criteria:
(I) Direct Care Personnel. All direct care
			 personnel shall be 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 I Women and Dependent Children 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 I Women and Dependent Children 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.
8.
			 Training. The entity shall provide written documentation that all Level I
			 Program personnel satisfy the competency and training requirements as specified
			 in Rule 580-9-44-.02(3).
9. Service
			 Intensity. The entity shall document that the amount and frequency of Level I
			 Outpatient services are established on the basis of the unique needs of each
			 client served, not to exceed eight (8) contact hours weekly.
10. Length of Service. The entity shall
			 provide written documentation that the duration of treatment in each Level I
			 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; or
(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 I services 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 I
			 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.