Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.27 - Level III.7: Medically Monitored High Intensity Residential Treatment Program For Adolescents

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.7 Medically Monitored High Intensity Residential
			 Treatment Program for Adolescents 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.7 Adolescent Medically Monitored High
			 Intensity Residential Treatment 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.7 Adolescent Program shall be 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.7 Adolescent 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.7 Adolescent Services, which
			 shall include, at a minimum, individuals:
(I)
			 Who are less than nineteen (19) years old and:
(II) Whose assessed severity of illness
			 warrants this level of care, including but not limited to adolescents whose
			 sub-acute biomedical and emotional, behavioral, or cognitive problems are so
			 severe that they require medically monitored treatment but do not need the full
			 resources of an acute care general hospital.
(III) For whom treatment for identified
			 problems has been rendered ineffective at less intensive levels of
			 care.
(ii) The entity
			 shall provide written documentation in individual case records that each client
			 admitted to a Level III.7 Adolescent Program meets:
(I) The diagnostic criteria for a substance
			 related 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 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.7 Adolescent Co-occurring
			 Enhanced Treatment Program meets:
(I) The
			 diagnostic criteria for a substance related 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.7 Adolescent Program for
			 Women and Dependent Children:
(I) Meets the
			 diagnostic criteria for a substance related 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 III.7 Adolescent
			 High Intensity Residential Program shall demonstrate the capacity to provide a
			 basic regimen of treatment services appropriate to the adolescent's
			 developmental and cognitive levels and other assessed needs.
(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) Medication administration.
(XI) Alcohol and/or drug
			 screening/testing.
(XII)
			 Transportation.
(XIII) Activity
			 therapy.
(XIX) Case management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. The entity shall
			 implement procedures for the provision of medical services as according to
			 protocols established in compliance with Rule 580-9-44-.13(24).
(I) 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.7 Adolescent Co-occurring Disorders High 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) Intensive case
			 management.
(vi) Women
			 and Dependent Children Program Specific Criteria: Each Level III.7 Adolescent
			 Women and Dependent Children High 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)
			 Parenting skills development.
(IV)
			 Academic and vocational services.
(V) Financial resource development and
			 planning.
(VI) Family planning
			 services.
4.
			 Therapeutic Component Implementation. The entity shall document the
			 implementation of a planned regimen of professionally directed program
			 activities for adolescents and their families. Evaluation, treatment and care
			 shall be 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 III.7
			 Adolescent 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) Clients 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. Development
			 and application of recovery skills including relapse prevention.
III. Interpersonal choice/decision making
			 skill development.
IV. Enhancement
			 of the understanding of addiction.
V. Development of a social network supportive
			 of recovery.
VI. Random drug
			 screening.
VII. Health
			 education.
VIII. Medication
			 administration and monitoring.
IX.
			 Promotion of successful involvement in regular productive daily activity, such
			 as school or work.
X. Enhancement
			 of personal responsibility, developmental maturity and prosocial
			 values.
XI. Educational services in
			 accordance with state and local regulations.
XII. Opportunities to remedy educational
			 deficits created by involvement with alcohol and other drugs.
XIII. Supervised therapeutic recreational
			 activities.
(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.
5.
			 Documentation: Each Level III.7 Adolescent 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.
6. Support Systems. Each Level III.7
			 Adolescent 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) The availability
			 of a physician or physician extender to assess each adolescent in person within
			 twenty-four (24) hours of admission and thereafter as medically
			 necessary.
(ii) Emergency
			 consultation with a physician available twenty-four (24) hours a day seven (7)
			 days a week.
(iii) Telephone or in
			 person consultation with emergency services twenty-four (24) hours a day seven
			 (7) days a week.
(iv) The
			 availability of a MAS Registered Nurse to conduct a nursing assessment at the
			 time of admission, monitor the client's progress during treatment and manage
			 medication administration.
(v)
			 Telephone or in person consultation with a MAS Nurse twenty-four (24) hours a
			 day, seven (7) days a week.
(vi)
			 Indicated laboratory and toxicology testing.
(vii) Indicated medical procedures.
(viii) Medical treatment.
(ix) Psychological and psychiatric
			 treatment.
(x) Community based
			 services assessed as needed but not provided by the entity.
(xix) Direct affiliation with or coordination
			 through referral to more and less intensive levels of care including
			 detoxification services.
7. Program Personnel. Each Level III.7
			 Adolescent 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)
			 Nursing Personnel. MAS Registered Nurses or Licensed Practical Nurses shall be
			 available for primary nursing care and observation twenty-four (24) hours a
			 day.
(ii) 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.
(iii) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level III.7
			 Program as delineated in its operational procedures.
(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.7 Adolescent
			 Program shall be assigned to a specific primary counselor for care management
			 whose principal responsibilities shall include, but not limited to:
(I) Development and implementation of the
			 individualized service plan.
(II)
			 Ensuring service delivery and coordination of service delivery as delineated in
			 the plan.
(III) Evaluation of the
			 client's overall progress in treatment and preparation of staffing
			 reports.
(IV) Discharge and
			 continuing care planning and implementation.
(vii) Each primary counselor shall maintain a
			 case load not to exceed ten (10) clients with active cases at any one
			 time.
(viii) Co-occurring Disorders
			 Program Specific Criteria.
(I) Each Level
			 III.7 Adolescent 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
			 supervised experience in a direct service area treating adolescent clients with
			 co-occurring disorders.
(II) Each
			 Level III.7 Adolescent Co-occurring Enhanced High Intensity Residential 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 responsibility 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.7 Adolescent Co-occurring Enhanced High Intensity Residential 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.7
			 Adolescent Co-occurring Enhanced 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.7 Adolescent Residential Program shall be assigned to a specific
			 primary counselor for care management as a qualified
			 paraprofessional.
(viii)
			 Women and Dependent Children Program Specific Criteria.
(I) Direct Care Personnel. All direct care
			 personnel shall be qualified as 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 III.7 Adolescent High Intensity Women and Dependent Children Residential
			 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 III.7 Adolescent
			 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 ten (10)
			 clients with active cases at any one time.
8. Training. The entity shall provide written
			 documentation that all Level III.7 Adolescent 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 III.7 Adolescent High Intensity Residential
			 Treatment Services are established on the basis of the unique needs of each
			 client served. To assist in addressing these needs, the entity shall ensure the
			 availability of no less than twenty (20) hours of structured services each
			 week.
(ii) The entity shall provide
			 written documentation describing the procedures utilized to ensure the
			 provision of services appropriate to the client's developmental stage and level
			 of comprehension including any necessary adaptations.
10. Length of Service: The entity shall
			 provide written documentation that the duration of treatment in each Level
			 III.7 Adolescent High Intensity Residential 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 a Level III.7 Adolescent Residential Program has
			 been utilized to provide interim services.
11. Service Availability: The entity shall
			 provide written documentation describing the process utilized to establish
			 hours of availability for Behavioral Health Screening and Diagnostic Interview
			 Examination Services at its Level III.7 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.