Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.21 - Level III.1: Clinically Managed Low Intensity Residential Treatment Program

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.1
			 Clinically Managed Low 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.1 Clinically Managed Low 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.1 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.1 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.1 Services, which shall
			 include, at a minimum, individuals:
(I) Whose
			 assessed severity of illness warrants this level of care including, but not
			 limited to:
I. Individuals who have a need for
			 structure and support in a twenty-four (24) hour drug-free environment in order
			 to:
A. Engage in treatment.
B. Sustain participation in regular
			 productive, daily activities or current treatment for physical or mental
			 disorders.
C. Develop, integrate
			 and practice recovery and coping skills.
D. Continue treatment for a substance use
			 disorder as a step-down from a more intense level of
			 care.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to a Level
			 III.1 Program 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 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 a Level III.1 Program
			 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 a Level III.1 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 a Level
			 III.1 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; 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) 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.1 Low
			 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) Daily living skills.
(VIII) Medication management.
(IX) Alcohol and/or drug
			 screening/testing.
(X)
			 Transportation.
(XI) Case
			 management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. Medical services,
			 including a physical examination, shall be provided as specified by the
			 entity's medical protocols established as required by Rule
			 580-9-44-.13(24).
(iii) Adolescent
			 Program Specific Criteria: Each Level III.1 Adolescent Low Intensity
			 Residential Treatment Program shall document the capacity to provide each of
			 the core services and the following services:
(I) Activity therapy.
(II) Academic or vocational
			 services.
(iv)
			 Co-occurring Disorders Program Specific Criteria: Each Level III.1 Co-occurring
			 Disorders Low Intensity Residential Treatment Program shall document the
			 capacity to provide each of the core services and the following services:
(I) Basic living skills.
(II) Crisis intervention services.
(III) Activity therapy.
(IV) Intensive case
			 management.
(v) Women and
			 Dependent Children Program Specific Criteria: Each Level III.1 Women and
			 Dependent Children Low Intensity Residential Treatment Program shall document
			 the capacity to provide each of the core services and 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 III.1 Residential Program shall include, at a
			 minimum:
(I) Maintenance of an alcohol and
			 illicit drug-free residential environment.
(II) Implementation of individualized
			 counseling plan strategies.
(III)
			 On duty, awake staff shall provide supervision of client's health, welfare and
			 safety twenty-four (24) hours a day.
(IV) All clients enrolled in Level III.1
			 Programs shall have access to clinical services twenty-four (24) hours a day,
			 seven (7) days a week.
(V) The
			 entity shall document the provision of planned counseling and recovery support
			 services and activities that shall, at a minimum, include:
I. Motivational and engagement
			 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 management and
			 administration.
(ii) Adolescent Program Specific Criteria:
			 Each Level III. 1 Adolescent Low Intensity Residential Treatment Program shall
			 document the capacity to provide the service strategies and the following
			 therapeutic components:
(I) 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.
(II)
			 Recreation and leisure time skills training.
(III) Gender specific treatment.
(IV) Family, community and school
			 reintegration services.
(V)
			 Academic or vocational services.
(iii) Co-occurring Disorders Program Specific
			 Criteria: Each Level III.1 Co-occurring Disorders Low Intensity Residential
			 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.
(iv) Women
			 and Dependent Children Program Specific Criteria: Each Level III.1 Low
			 Intensity Residential Treatment 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 or
			 vocational services.
(IX) Financial
			 resource development and planning.
(X) Family planning
			 services.
5.
			 Documentation: Each Level III.1 Intensive Outpatient 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.1
			 Services.
6. Support
			 Systems. Each Level III.1 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) Direct
			 affiliation with, or coordination through referral to more and less intensive
			 levels of care.
(iv) Direct
			 affiliation with, or coordination through referral to supportive services,
			 including vocational rehabilitation, literacy training and adult
			 education.
(v) Mutual self-help
			 groups which are tailored to the needs of the specific client
			 population.
7. Program
			 Personnel. Each level III.1 Low 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) Program Coordinator. Each Level III.1 Low
			 Intensity Residential Treatment Program shall have a full-time program
			 coordinator or manager who shall have a minimum of three (3) years' work
			 experience in a direct service area treating clients with substance use or
			 co-occurring mental health and substance use disorders, plus other
			 qualifications and credentials as designated in writing by the governing
			 authority.
(ii) Direct Care
			 Personnel. All direct care personnel shall have the qualifications as specified
			 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.1 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.1 program
			 shall be assigned to a specific primary counselor for care
			 management.
(vi) Each primary
			 counselor shall maintain a case load not to exceed fifteen (15) clients with
			 active cases at any one time.
(vii)
			 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 III.1
			 Low Intensity 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.1 Adolescent
			 Low Intensity Residential Treatment Program shall be assigned to a specific
			 primary counselor for care management.
(V) Each primary counselor shall maintain a
			 case load not to exceed fifteen (15) clients with active cases at any one
			 time.
(viii) Co-occurring
			 Disorders Program Specific Criteria.
(I) Each
			 Level III.1 Co-occurring Enhanced Low 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 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 III.1 Co-occurring Enhanced Low 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.
(VI) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level III.1
			 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.1
			 Residential 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.
(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 III.1 Low 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.1 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.1 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 III.1 Low 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 five (5) hours of structured services each
			 week.
10. Length of Service: The
			 entity shall provide written documentation that the duration of treatment in
			 each Level III.1 Low 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.1 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 service, and
			 counseling services at its Level III.1 Low 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.