Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.20 - Level III.01: Transitional Residential Program

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule Compliance. Each Level III.01
			 Transitional Residential Program shall comply with the following rules and the
			 rules specified in this chapter.
(a) Program
			 Description. The entity shall develop, maintain, and implement a written
			 program description that defines the Level III.01 Transitional Residential
			 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.01
			 Transitional Residential 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.01 Transitional Residential 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.01 Services, which shall
			 include, at a minimum:
(I) Individuals whose
			 assessed severity of illness warrants this level of care.
(II) Individuals who have a need for support
			 in a twenty-four (24) hour drug-free environment in order to reintegrate into
			 the community after treatment in 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.01 Program meets the following diagnostic and modified
			 ASAM PPC2R dimensional criteria for this level of care:
(I) The client shall meet the criteria for a
			 substance use disorder, as according to the specific diagnostic criteria given
			 in the most recent edition of the Diagnostic and Statistical Manual of Mental
			 Disorders of the American Psychiatric Association.
(II) Acute Intoxication and/or Withdrawal:
I. The client shall not report experiencing
			 or display any signs or symptoms of alcohol or other drug
			 withdrawal.
(III)
			 Biomedical Conditions and Complications:
I.
			 The client's biomedical problems, if any, shall be stable, and shall not
			 require medical or nurse monitoring by the transitional program.
II. The client shall be capable of
			 self-administering any prescribed or required over the counter
			 medication.
(IV)
			 Emotional, Behavioral, or Cognitive Conditions and Complications:
I. The client shall not report or display
			 symptoms of a co-occurring psychiatric, emotional, behavioral, or behavioral
			 condition; or
II. The client's
			 co-occurring psychiatric, emotional, behavioral, or cognitive disorder shall
			 be:
A. Stable.
B. Self-manageable.
C. Addressed concurrently through appropriate
			 psychiatric services.
III. The client shall be assessed as not
			 posing a risk of harm to self or others.
(V) Readiness to Change:
I. The client shall acknowledge the existence
			 of a substance use disorder, or a co-occurring substance use and psychiatric,
			 emotional, behavioral, or cognitive disorder and expresses and demonstrates a
			 desire to make needed changes to support recovery.
(VI) Relapse, Continued Use, or Continued
			 Problem Potential:
I. The client's history
			 indicates a high risk of relapse in a less structured level of care;
			 or
II. The client needs regimented
			 support to maintain engagement in a recovery focused process on community
			 reintegration.
(VII)
			 Recovery Environment:
I. The client has
			 insufficient resources and skills to maintain a recovery-oriented lifestyle
			 outside of a twenty-four (24) hour supportive
			 environment.
3. Core Services: Each Level III.01
			 Transitional 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) Psychoeducation.
(III) Peer support.
(IV) Daily living skills.
(V) Alcohol and/or drug
			 screening/testing.
(VI)
			 Transportation.
(VII) Case
			 Management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV.
			 Monitoring.
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.01
			 Transitional Residential Program shall include, at a minimum:
(I) Maintenance of an alcohol and illicit
			 drug free environment.
(II)
			 Implementation of individualized service 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.01 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 recovery support services and activities that shall, at a minimum,
			 include:
I. Motivational strategies.
II. Relapse prevention counseling.
III. Interpersonal choices/decision making
			 skills development.
IV. Development
			 of a social network supportive of recovery.
V. Daily living and recovery skills
			 development.
VI. Random drug
			 screening.
VII. Health
			 education.
5. Documentation. Individualized progress
			 notes shall be recorded each day for each respective service provided in Level
			 III.01 Services.
6. Support
			 Systems. Each level III.01 Transitional Residential Program shall develop,
			 maintain and document implementation of written policies and procedures that
			 govern the process used to provide client access to support services at the
			 Level III.01 Program site, or through consultation or referral, which shall
			 minimally include:
(i) Telephone or in person
			 consultation with emergency services twenty-four (24) hours a day, seven (7)
			 days a week.
(ii) Telephone or in
			 person consultation with a Registered Nurse 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.01 Transitional 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.
(iii)
			 Administrative Support Personnel: The entity shall maintain an adequate number
			 of support personnel to sustain the program's administrative
			 functions.
(iii) Every client in a
			 Level III.01 Transitional Residential Program shall be assigned to a specific
			 primary counselor for care management.
8. Training. The entity shall provide written
			 documentation that all Level III.01 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.01 Services are established
			 on the basis of the unique needs of each client served.
10. Length of Service. The entity shall
			 provide written documentation that the duration of treatment in its Level
			 III.01 Program is variable 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 meet
			 treatment goals and strategies; or
(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.01 Transitional Residential Program
			 has been utilized as an interim level of care.
11. Service Availability: The entity shall
			 provide written documentation describing the process utilized to establish
			 hours of availability for screening, assessment and intake services, admission
			 and counseling services at its Level III.01 Transitional 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.