Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.18 - Level II.5: Partial Hospitalization Treatment Program

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule Compliance. Each Level II.5 Partial
			 Hospitalization Program shall comply with the following rules and the rules
			 specified in this chapter: (List applicable rules found throughout the
			 standards)
(a) Program Description. The entity
			 shall develop, maintain and implement a written program description that
			 defines the Level II.5 Partial Hospitalization 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 Level II.5 Partial Hospitalization
			 Services shall be provided. Services may be provided in any appropriate setting
			 that protects the client's right to privacy, confidentiality, safety and meets
			 DMH facility certification criteria.
2. Admission Criteria. The entity shall
			 develop, maintain and implement written criteria for admission to its Level
			 II.5 Partial Hospitalization 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 II.5 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 unstable
			 mental and/or physical health problems.
(II) Who have unstable or dysfunctional, but
			 adequate living arrangements.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to receive
			 Level II.5 Partial Hospitalization 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.
(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.5
			 Partial Hospitalization 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 individual admitted to receive Level II.5 Partial
			 Hospitalization 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.
(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.5 Partial Hospitalization Services in a Women and Dependent Children
			 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) 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.5 Partial
			 Hospitalization 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.5 Partial
			 Hospitalization Program shall 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. 5 Partial Hospitalization Program shall document the capacity to
			 provide each of the core services to include the following services:
(I) Activity therapy.
(II) Academic or vocational
			 services.
(iii)
			 Co-occurring Disorders Program Specific Criteria: Each Level II.5 Partial
			 Hospitalization 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) Activity therapy.
(IV) Intensive case
			 management.
(iv) Women
			 and Dependent Children Program Specific Criteria: Each Level II.5 Women and
			 Dependent Children Partial Hospitalization 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 II.5 Partial Hospitalization 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) Medication
			 administration and monitoring.
(VII) Family education.
(X) Gender responsive
			 treatment.
(ii)
			 Adolescent Program Specific Criteria: Each Level II. 5 Adolescent Partial
			 Hospitalization Program shall document the capacity to provide the service
			 strategies to include 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.5 Co-occurring
			 Enhanced Partial Hospitalization Program shall document the capacity to provide
			 the service strategies to include 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.5 Women and
			 Dependent Children Partial Hospitalization Program shall document the capacity
			 to provide the service strategies and/or arrange for 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
			 resources and planning.
(X) Family
			 planning services.
5. Documentation: For each day in attendance
			 an individual progress note shall be recorded to reflect services provided in
			 Level II.5 Partial Hospitalization.
6. Support Systems. Each Level II.5 Partial
			 Hospitalization Program shall develop, maintain and document implementation of
			 written policies and procedures that 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 forty-eight (48) 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.5 Partial
			 Hospitalization 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.5
			 Partial Hospitalization 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.5 Partial
			 Hospitalization 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.5
			 Partial Hospitalization 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.5 Adolescent
			 Partial Hospitalization 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.
(II) 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.
(III) 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.5 Co-occurring Enhanced Partial Hospitalization Program shall be
			 qualified, as a qualified paraprofessional to provide the specific services
			 delineated in the entity's operational procedures for this level of
			 care.
(VI) The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level II.5
			 Co-occurring Enhanced Partial Hospitalization Program as delineated in its
			 operational procedures.
(VII) The
			 entity shall maintain an adequate number of support personnel to sustain the
			 program's administrative functions.
(VIII) Every client in a Level II.5
			 Co-occurring Enhanced Partial Hospitalization 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.5 Women and Dependent Children Partial Hospitalization 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.5 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 twenty (20) clients
			 with active cases at any one time.
8. Training. The entity shall provide written
			 documentation that all Level II.5 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 II.5 Partial Hospitalization
			 Services are established on the basis of the unique needs of each client served
			 and shall be available a minimum of twenty (20) hours each week.
10. Length of Service: The entity shall
			 provide written documentation that the duration of treatment in each Level II.5
			 Partial Hospitalization 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.5 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
			 II.5 Partial Hospitalization 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.