North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 28 - MENTAL HEALTH, STATE OPERATED FACILITIES AND SERVICES › Subchapter A - COMMITTEES AND PROCEDURES › Section .0100 - SCOPE AND DEFINITIONS › Section 28A .0102 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) In addition to
				  the definitions contained in this Rule, the terms defined in
				  G.S.
				  122C-3,
				  122C-4 and
				  122C-53(f) also
				  apply to all rules in Subchapters 28A, 28B, 28C, and 28D of this
				  Chapter.
(b) As used in the rules
				  in Subchapters 28A, 28B, 28C, and 28D of this Chapter, the following terms have
				  the meanings specified:
(1) "Abuse" means the
				  same as defined in 42 CFR Part 488 Subpart E, which is incorporated by
				  reference, including subsequent amendments. The Code of Federal Regulations is
				  available free of charge at
https://www.govinfo.gov/app/collection/CFR
.
(2) "Associate Professional (AP)" within the
				  mental health, developmental disabilities and substance abuse services
				  (mh/dd/sas) system of care means an individual who is either a:
(A) graduate of a college or university with
				  a Masters degree in a human service field with less than one year of full-time,
				  post-graduate degree accumulated mh/dd/sa experience with the population
				  served, or a substance abuse professional with less than one year of full-time,
				  post-graduate degree accumulated supervised experience in alcoholism and drug
				  abuse counseling. Upon hiring, an individualized supervision plan shall be
				  developed and supervision shall be provided by a qualified professional with
				  the population served until the individual meets one year of
				  experience;
(B) graduate of a
				  college or university with a bachelor's degree in a human service field with
				  less than two years of full-time, post-bachelor's degree accumulated mh/dd/sa
				  experience with the population served, or a substance abuse professional with
				  less than two years of full-time, post-bachelor's degree accumulated supervised
				  experience in alcoholism and drug abuse counseling. Upon hiring, an
				  individualized supervision plan shall be developed and reviewed annually.
				  Supervision shall be provided by a qualified professional with the population
				  served until the individual meets two years of experience;
(C) graduate of a college or university with
				  a bachelor's degree in a field other than human services with less than four
				  years of full-time, post bachelor's degree accumulated mh/dd/sa experience with
				  the population served, or a substance abuse professional with less than four
				  years of full-time, post-bachelor's degree accumulated supervised experience in
				  alcoholism and drug abuse counseling. Upon hiring, an individualized
				  supervision plan shall be developed and reviewed annually. Supervision shall be
				  provided by a qualified professional with the population served until the
				  individual meets four years of experience; or
(D) registered nurse who is licensed to
				  practice in the State of North Carolina by the North Carolina Board of Nursing
				  with less than four years of full-time accumulated experience in mh/dd/sa with
				  the population served. Upon hiring, an individualized supervision plan shall be
				  developed and reviewed annually. Supervision shall be provided by a qualified
				  professional with the population served until the individual meets four years
				  of experience.
(3) "Basic
				  necessities" mean the essential items or substances needed to support life and
				  health which include, but are not limited to, a nutritionally sound diet
				  balanced during three meals per day, access to water and bathroom facilities at
				  frequent intervals, seasonable clothing, medications to control seizures,
				  diabetes and other like physical health conditions, and access to social
				  contacts.
(4) "Certified clinical
				  supervisor (CCS)" means an individual who is certified as such by the North
				  Carolina Addictions Specialist Professional Practice Board.
(5) "Certified alcohol and drug counselor"
				  means an individual who is certified as such by the North Carolina Addictions
				  Specialist Professional Practice Board.
(6) "Client" has the same meaning assigned in
				  G.S.
				  133C-3. "Client" may also be referred to as a
				  patient or resident.
(7) "Client
				  record" means any record made of confidential information as defined
				  G.S.
				  122C-3.
(8) "Clinical Director" means Medical
				  Director, Director of Medical Services or such person acting in the position of
				  Clinical Director, or his designee.
(9) "Clinically competent" means
				  authorization by the State Facility Director for a qualified professional to
				  provide specific treatment or habilitation services to clients based on the
				  professional's education, training, experience, competence and
				  judgment.
(10) "Consent" means
				  concurrence by a client or his legally responsible person following receipt of
				  information from the qualified professional who will administer the proposed
				  treatment or procedure. Informed consent implies that the client or his legally
				  responsible person was provided with information concerning proposed treatment,
				  including both benefits and risks, in order to make an educated decision with
				  regard to such treatment.
(11)
				  "Dangerous articles or substances" mean, but are not limited to, any weapon or
				  potential weapon, heavy blunt object, sharp objects, potentially harmful
				  chemicals, or drugs of any sort, including alcohol.
(12) "Division" means the Division of State
				  Operated Healthcare Facilities.
(13) "Division Director" means the Director
				  of the Division or his designee.
(14) "Emergency" means a situation in a state
				  facility in which a client is in imminent danger of causing abuse or injury to
				  self or others, or when substantial property damage is occurring as a result of
				  unexpected and severe forms of inappropriate behavior, and rapid intervention
				  by the staff is needed.
(15)
				  "Emergency surgery" means an operation or surgery performed in a medical
				  emergency, as defined in Subparagraph (b)(28) of this Rule, where informed
				  consent cannot be obtained from an authorized person, as specified in
				  G.S.
				  90-21.13, because the delay would worsen the
				  physical condition or endanger the life of the client.
(16) "Exclusionary time-out" means the
				  removal of a client to a separate area or room from which exit is not barred
				  for the purpose of modifying behavior.
(17) "Exploitation" means the same as defined
				  in 42 CFR Part 483 Subpart B, which is incorporated by reference, including
				  subsequent amendments. The Code of Federal Regulations is available free of
				  charge at
https://www.govinfo.gov/app/collection/CFR
.
(18) "Forensic Division" means the units at
				  any State hospital designated in accordance with
				  G.S.
				  122C-252 which serves clients who are:
(A) admitted for the purpose of evaluation
				  for capacity to proceed to trial;
(B) found not guilty by reason of
				  insanity;
(C) determined incapable
				  of proceeding to trial.
(19) "Grievance" means a verbal or written
				  complaint by or on behalf of a client concerning a situation that occurred
				  within the state facility. A grievance does not include complaints that can be
				  resolved without delay by staff present. A complaint that is not resolved shall
				  be filed and processed in accordance with the requirements of
				  10A NCAC
				  28B .0203.
(20) "Human Rights Committee" means a
				  committee, appointed by the Secretary, to act in a capacity regarding the
				  protection of client rights.
(21)
				  "Independent psychiatric consultant" means a licensed psychiatrist not on the
				  staff of the state facility in which the client is being treated. The
				  psychiatrist may be in private practice, be employed by another state facility,
				  or be employed by a facility other than a state facility as defined in
				  G.S.
				  122C-3(14).
(22) "Interpreter services" means specialized
				  communication services provided for the hearing impaired by interpreters
				  certified by the National Registry of Interpreters for the Deaf or the National
				  Association of the Deaf.
(23)
				  "Involuntary client" means a person admitted to any regional psychiatric
				  hospital or alcohol and drug abuse treatment center under the provisions of
				  Article 5, Parts 7, 8 or 9 of G.S. 122C and includes, but is not limited to,
				  clients detained pending a district court hearing and clients involuntarily
				  committed after a district court hearing. This term shall also include
				  individuals who are defendants in criminal actions and are being evaluated in a
				  state facility for mental responsibility or mental competency as a part of such
				  criminal proceedings as specified in
				  G.S.
				  15A-1002, unless a valid order providing
				  otherwise is issued from a court of competent jurisdiction, and the civil
				  commitment of defendants found not guilty by reason of insanity as specified in
				  G.S.
				  15A-1321.
(24) "Isolation time-out" means the removal
				  of a client to a separate room from which exit is barred where there is direct,
				  uninterrupted supervision by staff for the purpose of modifying behavior.
				  "Isolation time-out" does not include precautions intended to prevent
				  transmission of a communicable disease.
(25) "Licensed Clinical Addiction Specialist
				  (LCAS)" means an individual who is certified as such by the North Carolina
				  Addictions Specialist Professional Practice Board.
(26) "Licensed Clinical Mental health
				  (LCMHC)" means a counselor who is licensed as such by the North Carolina Board
				  of Licensed Clinical Mental Health Counselors.
(27) "Major physical injury" means damage
				  caused to the body resulting in profuse bleeding or contusion of tissues;
				  fracture of a bone; damage to internal organs; loss of consciousness; loss of
				  normal neurological function (inability to move or coordinate movement); or any
				  other painful condition caused by such injury.
(28) "Medical emergency" means a situation
				  where the client is unconscious, ill, or injured, and the circumstances require
				  immediate medical or other health care related decisions and actions to prevent
				  the worsening of the physical condition, or endanger the life, of the
				  client.
(29) "Minimal risk
				  research" means that the risks of harm anticipated in the proposed research are
				  not greater, considering probability and magnitude, than those encountered in
				  daily life or during the performance of routine physical or psychological
				  examinations or tests.
(30) "Minor
				  client" means a person under 18 years of age who:
(A) has not been married; or
(B) has not been emancipated by a decree
				  issued by a court of competent jurisdiction; or
(C) is not a member of the armed
				  forces.
(31)
				  "Misappropriation of resident property" means the same as defined by 42 CFR
				  Part 488 Subpart E, incorporated by reference, including subsequent amendments.
				  The Code of Federal Regulations is available free of charge at
https://www.govinfo.gov/app/collection/CFR
.
(32) "Neglect" means the same as defined by
				  42 CFR Part 488 Subpart E, incorporated by reference, including subsequent
				  amendments. The Code of Federal Regulations is available free of charge at
https://www.govinfo.gov/app/collection/CFR
.
(33) "Normalization" means the principle of
				  helping the client to obtain an existence as close to normal as possible,
				  taking into consideration the client's disabilities and potential, by making
				  available to him patterns and conditions of everyday life that are as close as
				  possible to the norms and patterns of the mainstream of society.
(34) "Paraprofessional" within the mh/dd/sa
				  system of care means an individual who, with the exception of staff providing
				  respite services or personal care services, has a GED or high school diploma;
				  an individual employed prior to November 1, 2001 to provide a mh/dd/sa service
				  is not required to have a GED or high school diploma. Upon hiring, an
				  individualized supervision plan shall be developed and supervision shall be
				  provided by a qualified professional or associate professional with the
				  population served.
(35) "Person
				  standing in loco parentis" means one who has put himself in the place of a
				  lawful parent by assuming the rights and obligations of a parent without formal
				  adoption.
(36) "Physical Restraint"
				  means the application or use of any manual method of restraint that restricts
				  freedom of movement, or the application or use of any physical or mechanical
				  device that restricts freedom of movement or normal access to one's body,
				  including material or equipment attached or adjacent to the client's body that
				  he or she cannot easily remove. Holding a client in a therapeutic hold or any
				  other manner that restricts his or her movement constitutes manual restraint
				  for that client. Mechanical devices may restrain a client to a bed or chair, or
				  may be used as ambulatory restraints. Examples of mechanical devices include
				  cuffs, ankle straps, sheets or restraining shirts, arm splints, mittens and
				  helmets. Excluded from this definition of physical restraint are physical
				  guidance, gentle physical prompting techniques, escorting and therapeutic holds
				  used solely for the purpose of escorting a client who is walking, soft ties
				  used solely to prevent a medically ill client from removing intravenous tubes,
				  indwelling catheters, cardiac monitor electrodes or similar medical devices,
				  and prosthetic devices or assistive technology which are designed and used to
				  increase client adaptive skills. Escorting means the temporary touching or
				  holding of the hand, wrist, arm, shoulder or back for the purpose of inducing a
				  client to walk to a safe location.
(37) "Protective devices" means an
				  intervention that provides support for clients or enhances the safety of
				  clients with specific medical or behavioral needs. Such devices may include
				  posey vests, geri-chairs or table top chairs to provide support and safety for
				  clients with physical disabilities; devices such as helmets and mittens for
				  self-injurious behaviors; or devices such as soft ties used to prevent
				  medically ill clients from removing intravenous tubes, indwelling catheters,
				  cardiac monitor electrodes or similar medical devices. As provided in Rule
				  .0207 of Subchapter 28D, the use of a protective device for behavioral control
				  shall comply with the requirements specified in Rule .0203 of Subchapter
				  28D.
(38) "Psychotropic medication"
				  means medication with the primary function of treating mental illness,
				  personality or behavior disorders. It includes, but is not limited to,
				  antipsychotics, antidepressants, antianxiety agents and mood
				  stabilizers.
(39) "Qualified
				  professional" means, within the mh/dd/sas system of care, an individual who is
				  either:
(A) an individual who holds a license,
				  provisional license, or certificate issued by the governing board regulating a
				  human service profession, including a registered nurse who is licensed to
				  practice in the State of North Carolina by the North Carolina Board of Nursing
				  who also has four years of full-time accumulated experience in mh/dd/sa with
				  the population served;
(B) a
				  graduate of a college or university with a Masters degree in a human service
				  field and has one year of full-time, pre- or post-graduate degree accumulated
				  supervised mh/dd/sa experience with the population served, or a substance abuse
				  professional who has one-year of full-time, pre- or post-graduate degree
				  accumulated supervised experience in alcoholism and drug abuse
				  counseling;
(C) a graduate of a
				  college or university with a bachelor's degree in a human service field and has
				  two years of full-time, pre- or post-bachelor's degree accumulated supervised
				  mh/dd/sa experience with the population served, or a substance abuse
				  professional who has two years of full-time, pre- or post-bachelor's degree
				  accumulated supervised experience in alcoholism and drug abuse counseling;
				  or
(D) a graduate of a college or
				  university with a bachelor's degree in a field other than human services and
				  has four years of full-time, pre- or post-bachelor's degree accumulated
				  mh/dd/sa experience with the population served, or a substance abuse
				  professional who has four years of full-time, pre- or post-bachelor's degree
				  accumulated supervised experience in alcoholism and drug abuse
				  counseling.
(40)
				  "Regional alcohol and drug abuse treatment center" means a state facility for
				  persons with a substance abuse disorder as specified in
				  G.S.
				  122C-181(a)(3).
(41) "Regional developmental disability
				  center" means a state facility for the developmentally disabled as specified in
				  G.S.
				  122C-181(a)(2).
(42) "Regional psychiatric hospital" means a
				  state facility for the mentally ill as specified in
				  G.S.
				  122C-181(a)(1).
(43) "Representative payee" means the person,
				  group, or facility designated by a funding source, such as Supplemental
				  Security Income (SSI), to receive and handle funds according to the guidelines
				  of the source on behalf of a client.
(44) "Research" means inquiry involving a
				  trial or observation made under conditions determined by the investigator to
				  confirm or disprove an hypothesis or to explicate some principle or
				  effect.
(45) "Respite client" means
				  a client admitted to a developmental disability center or a neuromedical
				  treatment center for a short-term period, not to exceed 30 days. The primary
				  purpose of such admission is to provide a temporary interval of rest or relief
				  for the client's regular caretaker.
(46) "Responsible professional" shall have
				  the meaning as specified in
				  G.S.
				  122C-3; the "responsible professional" shall
				  also be a qualified professional as defined in Subparagraph (b)(39) of this
				  Rule.
(47) "Seclusion" means
				  isolating a client in a separate locked room for the purpose of managing a
				  client's behavior. "Seclusion" does not include precautions intended to prevent
				  transmission of a communicable disease. In the Forensic Service, Pretrial
				  Evaluation Unit and the Forensic Treatment Program Maximum Security Ward in the
				  Central Regional Hospital, the use of locked rooms is not considered seclusion
				  for clients with criminal charges who are:
(A)
				  undergoing pretrial evaluations ordered by a criminal court;
(B) in treatment for restoration of capacity
				  to proceed;
(C) in treatment to
				  reduce violence risk; or
(D)
				  considered to be an escape risk.
(48) "State Facility Director" means the
				  chief administrative officer or manager of a state facility or his
				  designee.
(49) "Strike" means, but
				  is not limited to, hitting, kicking, slapping or beating whether done with a
				  part of one's body or with an object.
(50) "Timeout" means the removal of a client
				  from other clients to another space within the same activity area for the
				  purpose of modifying behavior.
(51)
				  "Treatment" means the act, method, or manner of habilitating or rehabilitating,
				  caring for or managing a client's physical or mental problems.
(52) "Treatment plan" means a written
				  individual plan of treatment or habilitation for each client to be undertaken
				  by the treatment team and includes any documentation of restriction of client's
				  rights.
(53) "Treatment team" means
				  an interdisciplinary group of qualified professionals sufficient in number and
				  variety by discipline to assess and address the identified needs of the
				  client.
(54) "Unit" means an
				  integral component of a state facility established for the delivery of one or
				  more elements of service to which specific staff and space are assigned, and
				  for which responsibility has been assigned to a director, supervisor,
				  administrator, or manager.
(55)
				  "Voluntary client" means a person admitted to a state facility under the
				  provisions of Article 5, Parts 2, 3, 4 or 5 of G.S. 122C.