Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.25 - Level III.5: Clinically Managed High Intensity Residential Treatment Program For Adults

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.5 Clinically Managed High Intensity Residential
			 Treatment 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 the Level III.5 Clinically Managed High Intensity Residential Treatment
			 Program it provides, 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.5 Program
			 shall be provided. Services shall 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.5 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 its Level III.5 Services,
			 which shall include, at a minimum, individuals who have been assessed to have
			 multiple, significant social and psychological functional deficits that cannot
			 be adequately addressed on an outpatient basis.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to a Level
			 III.5 Program 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.
(II) The dimensional
			 criteria for admission to this level of care as defined in the most recent
			 edition of the ASAM PPC-2R.
(iii) Co-occurring Disorders Program Specific
			 Criteria. The entity shall provide written documentation in individual case
			 records that each individual admitted to a Level III.5 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.
(II) The dimensional
			 criteria for admission to this level of care as defined in the most recent
			 edition of the ASAM PPC-2R.
(iv) Women and Dependent Children Program
			 Specific Criteria: The entity shall provide written documentation in individual
			 case records that each client admitted to a Level III.5 Program for Women and
			 Dependent Children:
(I) Meets the diagnostic
			 criteria for a substance dependence 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 III.5 High
			 Intensity Residential Program shall demonstrate the capacity to provide a basic
			 level of treatment services appropriate to the needs of its clientele.
(i) At a minimum, the entity shall
			 demonstrate and document its capacity to provide a twenty-four (24) hour
			 structured residential treatment environment with the following core services:
(I) Placement assessment.
(II) Individual counseling.
(III) Group counseling.
(IV) Family counseling.
(V) Psychoeducation.
(VI) Peer support.
(VII) Medical and somatic services.
(VIII) Daily living skills.
(IX) Medication management.
(X) Alcohol and/or drug
			 screening/testing.
(XI)
			 Transportation.
(XII) Case
			 Management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. Medical Services shall
			 be provided as specified by the entity's medical protocols established as
			 required by Rule 580-9-44-.13(24).
(I)
			 Clients who have not had a physical examination within the last twelve (12)
			 months shall be provided a physical examination within two (2) weeks of
			 admission.
(II) Pregnant clients
			 who are not receiving routine prenatal care, shall be seen by physician within
			 two (2) weeks of admission.
(iii) Mental Health Services. The entity
			 shall develop, maintain and document implementation of written policies and
			 procedures to ensure that each client's mental health needs are identified
			 through the assessment service process and access to appropriate care for these
			 needs is provided concurrently with treatment for assessed substance related
			 disorders.
(iv) Family Support. The
			 entity shall initiate and document in the client record continuous efforts to
			 involve the client's family and other natural supports in the treatment
			 process.
(v) Co-occurring Disorders
			 Program Specific Criteria: Each Level III.5 Co-occurring Disorders Low
			 Intensity Residential Treatment Program shall document the capacity to provide
			 each of the core services and the following services:
(I) Mental health consultation.
(II) Crisis intervention services.
(III) Activity therapy.
(IV) Intensive case
			 management.
(vi) Women
			 and Dependent Children Program Specific Criteria: Each Level III.5 Women and
			 Dependent Children Medium Intensity Residential Treatment Program shall
			 document the capacity to provide each of the core services and the following
			 services:
(I) Child sitting
			 services.
(II) Developmental delay
			 and prevention services.
(III)
			 Activity therapy.
(IV) Parenting
			 skills development.
(V) Academic
			 and vocational services.
(VI)
			 Financial resource development and planning.
(VII) Family planning
			 services.
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 each client's assessed needs and
			 expressed desires for care.
(i) Service
			 strategies for each Level III.5 Residential Program shall include, at a
			 minimum:
(I) On duty awake staff shall
			 provide supervision of client's health, welfare and safety twenty-four (24)
			 hours a day.
(II) Client shall have
			 access to clinical services personnel twenty-four (24) hours a day, seven (7)
			 days a week.
(III) Daily clinical
			 services to improve the client's ability to structure and reorganize the tasks
			 of daily living and recovery.
(IV)
			 The provision of daily scheduled treatment and recovery support services and
			 activities that shall, at a minimum, include those that address:
I. Implementation of individualized service
			 plan strategies.
II. Relapse
			 prevention.
III. Interpersonal
			 choice/decision making skill development.
IV. Development of a social network
			 supportive of recovery.
V. Daily
			 living and recovery skills development.
VI. Random drug screening.
VII. Health education.
VIII. Medication administration and
			 monitoring.
(ii) The entity shall actively promote and
			 provide referrals and/or access to community support services.
(iii) All services shall be organized and
			 provided according to evidence-based and best practice standards and
			 guidelines.
(iv) Co-occurring
			 Disorders Program Specific Criteria: Each Level III.5 Co-occurring Enhanced
			 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.
5.
			 Documentation: Each Level III.5 High Intensity Residential Program shall
			 provide the following documentation in each client record:
(i) Individualized progress notes shall be
			 recorded each day for each respective service provided in Level III.5
			 Services.
6. Support
			 Systems. Each Level III.5 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)
			 Telephone or in person consultation with a physician available twenty-four (24)
			 hours a day, seven (7) days a week.
(ii) Telephone or in person consultation with
			 emergency services twenty-four (24) hours a day, seven (7) days a
			 week.
(iii) Telephone or in person
			 consultation with a registered nurse twenty-four (24) hours a day, seven (7)
			 days a week.
(iv) Direct
			 affiliation with, or coordination through referral to more and less intensive
			 levels of care.
(v) Direct
			 affiliation with, or coordination through referral to supportive services,
			 including vocational rehabilitation, literacy training and adult
			 education.
(vi) Mutual self-help
			 groups which are tailored to the needs of the specific client
			 population.
(vii) Appropriate
			 laboratory and toxicology testing.
(viii) Psychological and psychiatric
			 services.
(ix) Direct affiliation
			 with or coordination through referral to more and less intensive levels of
			 care.
(x) Co-occurring Disorders
			 Program Specific Criteria: In addition to compliance with the criteria, each
			 Level III.5 Co-occurring Enhanced High Intensity Residential Program shall
			 provide client access to intensive case management services.
(xi) Women and Dependent Children's Program
			 Specific Criteria: In addition to compliance with the criteria, the each Level
			 III.5 High Intensity Residential Treatment Program for Women and Dependent
			 Children shall provide client access to the following support services:
(I) Academic and vocational
			 services.
(II) Financial resource
			 development and planning.
(III)
			 Family planning services.
7. Program Personnel. Each level III.5 High
			 Intensity Residential 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 III.5
			 High Intensity Residential 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 III.5 Program
			 shall be assigned to a specific primary counselor for care
			 management.
(v) Each primary
			 counselor shall maintain a case load not to exceed sixteen (16) clients with
			 active cases at any one time.
(vi)
			 Co-occurring Disorders Program Specific Criteria.
(I) The Level III.5 Co-occurring Enhanced
			 High Intensity Residential Program shall be coordinated by a full-time member
			 of the staff who has the minimum of a master's degree in a mental health
			 related field and at least two (2) years post master's supervised experience in
			 a direct service area treating clients with co-occurring disorders.
(II) The Level III.5 Co-occurring Enhanced
			 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) The
			 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.
(IV) 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 III.5 Co-occurring Enhanced Program shall be qualified 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 III.5 Enhanced High Intensity Residential 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 III.5 Co-occurring Program shall be assigned to a specific primary
			 counselor for care management.
(IX)
			 Each primary counselor shall maintain a case load not to exceed sixteen (16)
			 clients with active cases at any one time.
(vii) Women and Dependent Children Program
			 Specific Criteria:
(I) Each Level III.5 Women
			 and Dependent Children High Intensity Residential Program shall be coordinated
			 by a full-time member of the staff who has a minimum of a master's degree in a
			 behavioral health related field and at least two (2) years post master's
			 supervised experience in a direct service area treating women who have
			 substance use, mental health or co-occurring mental health and substance use
			 disorders.
(II) 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.
(III) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level III.5
			 Women and Dependent Children Program as delineated in its operational
			 plan.
(IV) Administrative Support
			 Personnel. The entity shall maintain an adequate number of support personnel to
			 sustain the program's administrative functions.
(V) Every client in a Level III.5 Women and
			 Dependent Children Program shall be assigned to a specific primary counselor
			 for care management.
(VI) Each
			 primary counselor shall maintain a case load not to exceed ten (10) clients
			 with active cases at any one time.
8. Training. The entity shall provide written
			 documentation that all Level III.5 Program personnel satisfy the competency and
			 training requirements as specified in Rule 580-9-44-.02(3).
9. Service Intensity: The entity shall
			 develop, maintain and document implementation of policies and procedures in
			 regard to service intensity for its Level III.5 Residential Program, which
			 shall at a minimum specify:
(i) The amount and
			 frequency of Level III.5 Services are established on the basis of the unique
			 needs of each client served.
(ii)
			 The program has the capacity to provide a minimum of twenty-five (25) contact
			 hours of clinical services weekly for each client.
10. Length of Service: The entity shall
			 provide written documentation that the duration of treatment in its Level III.5
			 Program is variable 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 meet treatment goals and
			 strategies; 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 a Level III.5 High Intensity Residential Program
			 has been utilized as an interim level of care.
11. Service Availability: The entity shall
			 provide written documentation describing the process utilized to establish
			 hours of availability for screening, assessment and intake service, admission
			 and counseling services at its Level III.5 High Intensity Residential Program.
			 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.