Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.24 - Level III.5: Clinically Managed Medium 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. 5 Clinically Managed Medium 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.5 Adolescent Clinically Managed Medium
			 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.5
			 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.5 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.5 Adolescent Services which shall include, at a minimum, individuals:
(I) Who are less than nineteen (19) years
			 old.
(II) Whose assessed severity
			 of illness warrants this level of care including but not limited to individuals
			 who have impaired functioning across a broad range of psychosocial domains that
			 may be expressed as:
I. Disruptive
			 behaviors.
II. Delinquency and
			 juvenile justice involvement.
III.
			 Educational difficulties.
IV.
			 Family conflicts and chaotic home situations.
V. Developmental immaturity and/or
VI. Psychological
			 problems.
(III) Who do
			 not require significant medical, psychiatric, or nurse monitoring or
			 interventions.
(IV) 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.5 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 for Mental Disorders;
			 and
(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 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.5 Adolescent Program for Women and Dependent Children:
(I) Meets the diagnostic criteria for a
			 substance related 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 Adolescent
			 Medium 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 accessibility to 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) Clients who have not had a physical
			 examination within the last twelve (12) months shall be scheduled 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 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 Adolescent
			 Co-occurring Disorders Medium 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.
(vi) Women and Dependent Children Program
			 Specific Criteria: Each Level III. 5 Adolescent 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) Parenting skills
			 development.
4.
			 Therapeutic Component Implementation. The entity shall document the
			 implementation of a planned regimen of twenty-four (24) hour 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.5
			 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, recovery support services and other
			 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.
(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 Adolescent 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.
(IV) Intensive case
			 management.
(v) Women and
			 Dependent Children Program Specific Criteria: Each Level III. 5. Adolescent
			 Women and Dependent Children Program shall document the capacity to provide the
			 service strategies and the following therapeutic components:
(I) Gender 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) Family
			 planning services.
5. Documentation: Each Level III.5 Adolescent
			 Medium 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.5 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) Emergency 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 MAS nurse twenty-four (24) hours a day, seven (7) days a
			 week.
(iv) Indicated laboratory and
			 toxicology testing.
(v) Indicated
			 medical procedures.
(vi) Medical
			 treatment.
(vii) Psychological and
			 psychiatric treatment.
(viii)
			 Direct affiliation with or coordination through referral to more and less
			 intensive levels of care, including detoxification
			 services.
7. Program
			 Personnel. Each Level III. 5 Adolescent Medium 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 have the qualifications, as a qualified
			 paraprofessional to provide the specific services delineated in the entity's
			 program description for this level of care.
(ii) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level III. 5
			 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) Each primary counselor shall maintain a
			 case load not to exceed ten (10) clients with active cases at any one
			 time.
(v) Co-occurring Disorders
			 Program Specific Criteria.
(I) Each Level
			 III.5 Adolescent Co-occurring Enhanced Medium 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.
(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 responsibility for the medical aspects of the
			 program.
(III) All other direct
			 care personnel in a Level III.5 Adolescent Co-occurring Enhanced Medium
			 Intensity Residential Program shall be qualified, as a qualified
			 paraprofessional to provide the specific services delineated in the entity's
			 operational plan for this level of care.
(IV) Every client in a Level III.5 Adolescent
			 Residential 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) 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 III. 5 Adolescent Medium 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. 5
			 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.5
			 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.5 Adolescent Medium 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 fifteen (15) 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.
			 5 Adolescent Medium 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.5 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 screening assessment and intake services at its Level
			 III.5 Medium Intensity Adolescent 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.