Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65D - Substance Abuse Program › Chapter 65D-30 - SUBSTANCE ABUSE SERVICES OFFICE › Section 65D-30.007 - Standards for Residential Treatment

Current through Reg. 50, No. 138; July 16, 2024
In addition to rule
				   65D-30.004, F.A.C., the
				  following standards apply to residential treatment.
(1) Residential treatment is a service
				provided in a structured and supervised live-in environment within a
				nonhospital or free-standing setting 24 hours-per-day, 7 days-per-week, and is
				intended for individuals who meet the placement criteria for this component.
				For the purpose of these rules, there are four (4) levels of residential
				treatment that vary according to the type, frequency, and duration of services
				provided.
(2) Facilities Not
				Required to be Licensed as Residential Treatment. Licensure as residential
				treatment, as defined in paragraph
				 65D-30.002(16)(d),
				F.A.C., shall not apply to facilities that only provide housing, meals, or
				housing and meals to individuals who are substance use impaired or in recovery.
				These facilities do not provide clinical services; however, they may arrange
				for or provide support groups such as Alcoholics Anonymous and Narcotics
				Anonymous. All other facilities providing services to individuals as described
				in subsections  65D-30.007(2) and
				(3), F.A.C., either at the facility or at
				alternate locations, must be licensed under this rule.
(3) Levels of Residential Treatment. For the
				purpose of this rule, there are four levels of residential treatment. In each
				level, treatment shall be structured to serve individuals who need a safe and
				stable living environment in order to develop sufficient recovery skills for
				the transition to a less restrictive level of care or reintegration into the
				general community in accordance with placement criteria. Treatment shall also
				include a schedule of services provided within a positive environment that
				reinforce the resident's recovery. Individuals will be placed in a level of
				residential treatment that is based upon their treatment needs and
				circumstances. Because treatment plans should be specific to the individual,
				length of stay and duration of treatment shall be dependent upon the
				individual's:
a) severity of illness or
				disorder,
b) level of functioning,
				and
c) clinical progress in
				treatment and outcomes based on individualized treatment goals for all levels
				of residential treatment.
(a) Level 1
				programs offer organized treatment services that feature a planned and
				structured regimen of care in a 24-hour residential setting. These programs are
				more than a 24-hour supported living environment (like those in level 4), and
				are a 24-hour treatment setting. There are two (2) categories of treatment
				under this level of care.
1. Adult Level 1
				programs are appropriate for adults age 18 years and older with a substance use
				disorder or a co-occurring mental health and substance use disorder who have
				sub-acute biomedical, behavioral, emotional, or cognitive conditions severe
				enough that they require treatment in a Level 1 program, but do not need the
				full resources of an acute care general hospital or a medically managed
				inpatient treatment program. This level includes programs that provide services
				on a short-term basis. The emphasis is on an intensive regimen of clinical
				services using a multidisciplinary team approach. Services may include some
				medical services based on the needs of the individual.
2. Adolescent Level 1 programs are
				appropriate for adolescents under the age of 18 years with a substance use
				disorder or who have a co-occurring substance use and mental health disorders
				or symptoms. This level is often necessary to help change negative patterns of
				behavior, thinking, and feeling that predispose one to substance use and to
				develop skills to maintain a substance-free life. Services should take into
				account the different developmental needs based on the age of the adolescent
				and address any deficits in behavioral, cognitive, and social-emotional
				development often associated with substance use during the adolescent period.
				Seventeen-year-olds who turn 18 while completing treatment shall be allowed to
				stay only if it is clinically indicated, there is one-on-one supervision, and
				they have separate bedrooms.
(b) Level 2 programs are structured
				rehabilitation-oriented group facilities that serve persons with a substance
				use disorder or a co-occurring mental health and substance use disorder who
				have significant deficits in independent living skills and need extensive
				support and supervision. Programs include those referred to as therapeutic
				communities or some variation of therapeutic communities and are longer term
				than Level 1. There are two (2) categories of treatment under this level of
				care.
1. Adult Level 2 programs are
				appropriate for adults age 18 years and older with a substance use disorder or
				a co-occurring mental health and substance use disorder who have
				multi-dimensional needs of such severity that they cannot safely be treated in
				less intensive levels of care. This level is appropriate for adults who may
				experience significant social and psychological deficits, such as chaotic, and
				often abusive, interpersonal relationships; criminal justice involvement; prior
				treatment in less restrictive levels of care; inconsistent work histories and
				educational experiences; homelessness or inadequate housing; or anti-social
				behavior. In addition to clinical services, considerable emphasis is placed on
				services that address the individual's educational and vocational needs,
				socially dysfunctional behavior, and need for stable housing upon discharge. It
				also includes services that promote continued abstinence from substance use
				upon the individual's return to the community.
2. Adolescent Level 2 programs are
				appropriate for adolescents under the age of 18 with a substance use disorder
				or a co-occuring mental health and substance use disorder who have impaired
				functioning across a comprehensive range of psychosocial domains. This is
				characterized as having unpredictable fluctuations in mood, and developmental
				or cognitive difficulties related to mental health symptoms or disorders. In
				addition to providing clinical services, as defined in rule
				 65D-30.002, F.A.C., this level
				of care provides services to improve interpersonal relationships, conflict
				resolution skills, impulse control problems and to reduce social inhibition or
				withdrawal. For these adolescents, treatment must occur in a structured
				environment conducive to teaching and practicing prosocial behavior to
				facilitate healthy reintegration into the community.
(c) Level 3 programs are appropriate for
				adults age 18 years and older with a substance use disorder or a co-occurring
				mental health and substance use disorder whose cognitive functioning has been
				severely impaired from the chronic use of substances, either temporarily or
				permanently. This would include individuals who have varying degrees of organic
				brain disorder or brain injury or other problems that require extended care.
				The emphasis is on providing services that work on cognitive problems and
				activities of daily living, socialization, and specific skills to restore and
				maintain independent living. Typically, services are slower paced, more
				concrete and repetitive. This level excludes adolescent programs.
(d) Level 4 programs are appropriate for
				adults or adolescents with a substance use disorder or a co-occurring mental
				health and substance abuse use disorder and provide services on a short-term
				basis. This level is appropriate for individuals who have completed other
				levels of residential treatment, particularly levels 2 and 3. This includes
				individuals who have functional limitations in application of recovery skills,
				self-efficacy, or a lack of connection to the community systems of work,
				education, or family life. Although clinical services are provided, the
				emphasis is on services that are low-intensity and emphasize a supportive
				environment. This includes services that focus on recovery skills, preventing
				relapse, improving emotional functioning, promoting personal responsibility and
				reintegrating the individual into work, education, and family
				life.