Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 193 - OFFICE OF ADULT MENTAL HEALTH › Chapter 6 - MENTAL HEALTH LICENSING REGULATIONS › CRISIS RESIDENTIAL SERVICE STANDARDS

Current through 2024-29, July 17, 2024
These standards, in addition to the core standards, are
				  applied to agencies providing crisis residential services.
Assessment
CRS.1 An assessment of the client is completed within 24
				  hours of admission to the crisis residential program.
CRS. 1. A. The assessment minimally addresses the
				  following:
CRS. 1. A.1 the client's strengths and weaknesses;
CRS. 1. A.2 the client's perception of his or her
				  needs;
CRS. 1. A.3 the family/guardian's input and perception of the
				  client's needs when appropriate, and with the client's consent;
CRS. 1. A.4 a personal, family, and social history;
CRS. 1. A.5 the client's emotional, psychiatric and
				  psychological strengths and needs;
CRS. 1. A.6 a physical health status and history, including
				  current prescribed and over-the-counter medication use;
CRS. 1. A.7 past and current drug/alcohol use;
CRS. 1. A.8 a developmental history;
CRS. 1. A.9 possible sources of assistance and support in
				  meeting the needs expressed by the client or legally responsible party,
				  including state and federal entitlement programs;
CRS. 1. A.10 physical and environmental barriers that may
				  impede the client and families ability to obtain services;
CRS. 1. A.11 history of physical and/or sexual abuse;
CRS. 1. A.12 housing and financial needs; and
CRS. 1. A.13 the client's general need for crisis
				  services;
CRS. 1. A.14 the client's vocational, educational, social,
				  living; leisure/recreational and medical needs;
CRS. 1. A.15 the status of the Individualized Support Plan;
				  and
CRS. 1. A.16 the signature of the person who performed the
				  assessment.
Interpretive Guideline for CRS.1.A through CRS.1.A.13
The Division of Licensing recognized that in some cases not
				  all of the information requested in these standards will be able to be
				  obtained. The Division also recognized that the level of detail required will
				  vary given a variety of factors (the client's level of cooperation, the
				  integrity of the information sources, the length of services or treatment, the
				  condition being addressed, the practitioner's training, etc.). Although the
				  Division will attempt to be sensitive to these factors and flexible in
				  surveying this area, the agency should assure that assessments that do not
				  address all these standards have accompanying documentation that justifies
				  abbreviated or absent information.
CRS. 1. B. The agency will establish policies and procedures
				  establishing criteria for the performance of the following assessments:
CRS. 1. B.1 a nutritional assessment;
CRS. 1. B.2 a cognitive functioning assessment;
Interpretive Guideline for CRS.1.B.2
The client's cognitive functioning assessment should include
				  assessment of the following functions: problem solving, decision making,
				  organization, self-direction, system negotiation skills, concentration, and
				  abstract reasoning. For individuals over 60 years of age, this assessment
				  should also include memory, language orientation, and visuo-spatial
				  abilities.
CRS. 1. B.3 an assessment of the client's capacity; CRS.1.B.4
				  a neurological assessment.
CRS. 1. C. The assessment shall be obtained from -the client,
				  legally responsible party, community service agencies, and to the extent
				  possible, from other individuals in the community as authorized by the client
				  or legally responsible party.
CRS. 1. C.1. In instances in which the client receives
				  community support services and/or has an Individualized Support Plan, the
				  agency will, subject to the client's consent, shall coordinate the assessment
				  and subsequent service planning with the community support provider.
CRS. 1. C.1.a. Services provided to these clients will be
				  consistent with the targets and objectives of the Individualized Support
				  Plan.
CRS. 1. C.1.b. Services provided to these clients will be
				  delivered pursuant to a service agreement negotiated with the community support
				  worker.
CRS. 1. D. The client record contains a summary evaluation of
				  the data collected in the assessment.
Interpretive Guideline for CRS.1.B through CRS.1.B.4
These assessments do necessarily have to be performed in the
				  agency or by agency staff. The intent of these standards are to assure that the
				  agency has mechanisms by which to evaluate the need for these assessments and
				  to perform or refer for assessment those clients whose symptomatology suggest
				  such need.
Service Planning
CRS.2. A service plan is developed for each client, with the
				  client's consent, within 24 hours of admission to the crisis residential
				  program.
CRS. 2. A. The service plan minimally contains the
				  following:
CRS. 2. A.1 problem statements;
CRS. 2. A.2 goals related to the projected length of stay and
				  based upon client needs;
CRS. 2. A.3 objectives stated in terms which allow objective
				  measurement of progress;
CRS. 2. A.4 specification of treatment responsibilities and
				  methods;
CRS. 2. A.5 client input and signature;
CRS. 2. A.6 signatures of all people participating in the
				  development of the plan;
CRS. 2. A.7 a description of any physical handicap and any
				  accommodations necessary to provide the same or equal services and benefits as
				  those afforded non-disabled individuals:
CRS. 2. A.8 criteria for discharge.
Interpretive Guideline for CRS.2.A.7 through CRS.2.A.8
These elements may be addressed within service plan goals.
CRS.3 The service plan is designed so that the client's
				  progress towards service plan goals can be monitored and evaluated.
Discharge Planning
CRS.4 A discharge summary is entered in the client record
				  within 24 hours -of discharge and includes the client's course of treatment and
				  ongoing needs at discharge.
CRS. 4. A. Each discharge minimally addresses, but need not
				  be limited to, the following:
CRS. 4. A.1 the reasons for termination of service;
CRS. 4. A.2 the final assessment, including general
				  observations and significant findings of the client's condition initially,
				  while services were being provided and at discharge;
CRS. 4. A.3 the course and progress of the client with regard
				  to each identified problem; and
CRS. 4. A.4 the recommendation & and arrangements for
				  further continued service needs.
CRS.5 The agency will have a discharge protocol that protects
				  the client from summary discharge and allows the agency to maintain program
				  integrity.
CRS. 5. A. The agency has a policy and procedure for
				  discharging clients that includes the terms upon which a client may be
				  discharged serious infractions of the policies required to maintain the
				  privacy, comfort and safety of residents, under-utilization of the
				  program).
CRS. 5. B. Agencies will not summarily discharge clients. All
				  substantiated complaints will be assessed for the seriousness of the violation
				  and actions taken to achieve compliance.
Physical Plant
CRS.6 A secure and readily accessible storage area of
				  adequate size is available to accommodate client belongings.
CRS. 6. A The agency has a policy and procedure related to
				  what personal belongings may be brought to the agency.
Crisis Residential Services
CRS.7 All agencies will have personal emergency paging
				  systems or will have staff back-up assistance immediately available.
CRS. 7. A. Agencies that do not have a personal emergency
				  paging system will have policies and procedures assuring the immediate
				  availability of staff back-up assistance.
CRS.8 In addition to the orientation and training required in
				  the core staff development standards, crisis residential staff shall:
CRS. 8. A. "shadow" an experienced staff member for an
				  appropriate period (determined by the agency in policy and procedure);
CRS. 8.B. receive nationally recognized training in managing
				  people who act out aggressively (e.g. MANDT, Nappi);
CRS. 8. . C. receive training in crisis stabilization;
CRS. 8. D. receive training in residential/milieu
				  management.
Health
CRS.9 If food services are provided, the facilities for the
				  preparation and serving of food shall be inspected and approved by the
				  Department of Human Services.
CRS. 9. A. If food is either prepared or served at the
				  facility, then the agency shall either obtain a DHS Eating Establishment
				  license or show written evidence from DHS indicating that they need no such
				  license.
CRS. 9. B. When the agency requires a DHS license, the
				  agency's Eating Establishment license is current.
CRS.10 The agency shall have methods for obtaining on- or
				  off-site medical services for all clients.
CRS. 10. A The agency defines in policy and procedure those
				  medical services delivered on-site. For those medical services not provided
				  on-site, letters of agreement and/or procedures for accessing medical service
				  provider(s) are in effect.