Virginia Administrative Code › Title 12 - HEALTH › Agency 35 - DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES › Chapter 46 - REGULATIONS FOR CHILDREN'S RESIDENTIAL FACILITIES › Part I - General Provisions › Section 12VAC35-46-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
					 shall have the following meanings unless the context clearly indicates
					 otherwise.
"Allegation" means an accusation that a facility is
					 operating without a license or receiving public funds for services it is not
					 certified to provide.
"Allied health professional" means a professional who is
					 involved with the delivery of health or related services pertaining to the
					 identification, evaluation, and prevention of diseases and disorders, such as a
					 certified substance abuse counselor, certified substance abuse counseling
					 assistant, peer recovery support specialist, certified nurse aide, or
					 occupational therapist.
"Annual" means within 13 months of the previous event or
					 occurrence.
"Applicable state regulation" means any regulation that the
					 department determines applies to the facility. The term includes, but is not
					 necessarily limited to, regulations promulgated by the Departments of
					 Education, Health, Housing and Community Development, or other state
					 agencies.
"Applicant" means the person, corporation, partnership,
					 association, or public agency that has applied for a license.
"ASAM" means the American Society of Addiction
					 Medicine.
"Aversive stimuli" means the physical forces (e.g., sound,
					 electricity, heat, cold, light, water, or noise) or substances (e.g., hot
					 pepper sauce or pepper spray) measurable in duration and intensity that when
					 applied to a resident are noxious or painful to the resident but in no case
					 shall the term "aversive stimuli" include striking or hitting the individual
					 with any part of the body or with an implement or pinching, pulling, or shaking
					 the resident.
"Behavior support" means those principles and methods
					 employed by a provider to help a child achieve positive behavior and to address
					 and correct a child's inappropriate behavior in a constructive and safe manner
					 in accordance with written policies and procedures governing program
					 expectations, treatment goals, child and staff safety and security, and the
					 child's individualized service plan.
"Behavior support assessment" means identification of a
					 resident's behavior triggers, successful intervention strategies, anger and
					 anxiety management options for calming, techniques for self-management, and
					 specific goals that address the targeted behaviors that lead to emergency
					 safety interventions.
"Body cavity search" means any examination of a resident's
					 rectal or vaginal cavities, except the performance of medical procedures by
					 medical personnel.
"Brain injury" means any injury to the brain that occurs
					 after birth, but before age 65, that is acquired through traumatic or
					 nontraumatic insults. Nontraumatic insults may include anoxia, hypoxia,
					 aneurysm, toxic exposure, encephalopathy, surgical interventions, tumor, and
					 stroke. Brain injury does not include hereditary, congenital, or degenerative
					 brain disorders, or injuries induced by birth trauma.
"Brain Injury Waiver" means a Virginia Medicaid home and
					 community-based waiver for persons with brain injury approved by the Centers
					 for Medicare and Medicaid Services.
"Care" or "treatment" means a set of individually planned
					 interventions, training, habilitation, or supports that help a resident obtain
					 or maintain an optimal level of functioning, reduce the effects of disability
					 or discomfort, or ameliorate symptoms, undesirable changes, or conditions
					 specific to physical, mental, behavioral, or social functioning.
"Child" means any person legally defined as a child under
					 state law. The term includes residents and other children coming into contact
					 with the resident or facility (e.g., visitors). When the term is used, the
					 requirement applies to every child at the facility regardless of whether the
					 child has been admitted to the facility for care (e.g., staff to child ratios
					 apply to all children present even though some may not be residents).
"Child-placing agency" means any person licensed to place
					 children in foster homes or adoptive homes or a local board of social services
					 authorized to place children in foster homes or adoptive homes.
"Children's residential facility" or "facility" means a
					 publicly or privately operated facility, other than a private family home,
					 where 24-hour per day care is provided to children separated from their legal
					 guardians and is required to be licensed or certified by the Code of Virginia
					 except:
1. Any facility licensed by
				  the Department of Social Services as a child-caring institution as of January
				  1, 1987, and that receives public funds; and
2. Acute-care private psychiatric hospitals
				  serving children that are licensed by the Department of Behavioral Health and
				  Developmental Services under the Rules and Regulations for Licensing Providers
				  by the Department of Behavioral Health and Developmental Services, 12VAC35-105.
"Clinically managed, low-intensity residential care" or
					 "Level of care 3.1" means providing an ongoing therapeutic environment for
					 children requiring some structured support in which treatment is directed
					 toward applying recovery skills; preventing relapse; improving emotional
					 functioning; promoting personal responsibility; reintegrating the child into
					 work, education, and family environments; and strengthening adaptive skills
					 that may not have been achieved or have been diminished during the child's
					 active addiction. A clinically managed, low-intensity residential care is also
					 designed for the child suffering from chronic, long-term alcoholism or drug
					 addiction and affords an extended period of time to establish sound recovery
					 and a solid support system.
"Clinically managed, medium-intensity residential care" or
					 "Level of care 3.5" means a substance use treatment program that offers 24-hour
					 supportive treatment of children with significant psychological and social
					 problems by credentialed addiction treatment professionals in an
					 interdisciplinary treatment approach. The children served by clinically
					 managed, medium-intensity residential care are children who are not
					 sufficiently stable to benefit from outpatient treatment regardless of
					 intensity of service.
"Commissioner" means the Commissioner of the Department of
					 Behavioral Health and Developmental Services or his authorized agent.
"Complaint" means an accusation against a licensed facility
					 regarding an alleged violation of regulations or law.
"Contraband" means any item prohibited by law or by the
					 rules and regulations of the department, or any item that conflicts with the
					 program or safety and security of the facility or individual residents.
"Corporal punishment" means punishment administered through
					 the intentional inflicting of pain and discomfort to the body through actions
					 such as, but not limited to (i) striking or hitting with any part of the body
					 or with an implement; or (ii) any similar action that normally inflicts pain or
					 discomfort.
"Counseling" means certain formal treatment interventions
					 such as individual, family, and group modalities that provide for support and
					 problem solving. Such interventions take place between provider staff and
					 resident families or groups and are aimed at enhancing appropriate psychosocial
					 functioning or personal sense of well-being.
"Corrective action plan" means the provider's pledged
					 corrective action in response to cited areas of noncompliance documented by the
					 department. A corrective action plan must be completed within a specified
					 time.
"Crisis" means any acute emotional disturbance in which a
					 resident presents an immediate danger to self or others or is at risk of
					 serious mental or physical health deterioration caused by acute mental
					 distress, behavioral or situational factors, or acute substance abuse related
					 problems.
"Crisis intervention" means those activities aimed at the
					 rapid management of a crisis.
"Day" means calendar day unless the context clearly
					 indicates otherwise.
"Department" or "DBHDS" means the Department of Behavioral
					 Health and Developmental Services.
"Developmental disability" means a severe, chronic
					 disability of an individual that (i) is attributable to a mental or physical
					 impairment or a combination of mental and physical impairments other than a
					 sole diagnosis of mental illness; (ii) is manifested before the individual
					 reaches 22 years of age; (iii) is likely to continue indefinitely; (iv) results
					 in substantial functional limitations in three or more of the following areas
					 of major life activity: self-care, receptive and expressive language, learning,
					 mobility, self-direction, capacity for independent living, or economic
					 self-sufficiency; and (v) reflects the individual's need for a combination and
					 sequence of special interdisciplinary or generic services, individualized
					 supports, or other forms of assistance that are of lifelong or extended
					 duration and are individually planned and coordinated. An individual from birth
					 to nine years of age, inclusive, who has a substantial developmental delay or
					 specific congenital or acquired condition may be considered to have a
					 developmental disability without meeting three or more of the criteria
					 described in clauses (i) through (v) if the individual without services and
					 supports has a high probability of meeting those criteria later in life.
"Diagnostic and Statistical Manual of Mental Disorders" or
					 "DSM" means the Diagnostic and Statistical Manual of Mental Disorders, 5th
					 Edition, DSM-5, of the American Psychiatric Association.
"DOE" means the Department of Education.
"Emergency" means a sudden, generally unexpected occurrence
					 or set of circumstances demanding immediate action. Emergency does not include
					 regularly scheduled time off for permanent staff or other situations that
					 should reasonably be anticipated.
"Emergency admission" means the sudden, unplanned,
					 unexpected admittance of a child who needs immediate care or a court-ordered
					 placement.
"Goal" means expected results or conditions that usually
					 involve a long period of time and that are written in behavioral terms in a
					 statement of relatively broad scope. Goals provide guidance in establishing
					 specific short-term objectives directed toward the attainment of the
					 goal.
"Good character and reputation" means findings have been
					 established and knowledgeable and objective people agree that the individual
					 maintains business or professional, family, and community relationships that
					 are characterized by honesty, fairness, truthfulness, and dependability, and
					 has a history or pattern of behavior that demonstrates that the individual is
					 suitable and able to care for, supervise, and protect children. Relatives by
					 blood or marriage, and persons who are not knowledgeable of the individual,
					 such as recent acquaintances, shall not be considered objective
					 references.
"Group home" means a children's residential facility that
					 is a community-based, homelike single dwelling, or its acceptable equivalent,
					 other than the private home of the operator, and serves up to 12.
"Health record" means the file maintained by the provider
					 that contains personal health information.
"Human research" means any systematic investigation
					 including research development, testing, and evaluation, utilizing human
					 subjects, that is designed to develop or contribute to generalized knowledge.
					 Human research shall not include research exempt from federal research
					 regulations pursuant to 45
					 CFR 46.101(b).
"Immediately" means directly without delay.
"Independent living program" means a competency-based
					 program that is specifically approved by the department to provide the
					 opportunity for the residents to develop the skills necessary to live
					 successfully on their own following completion of the program.
"Individualized service plan" means a written plan of
					 action developed and modified at intervals to meet the needs of a specific
					 resident. It specifies measurable short and long-term goals, objectives,
					 strategies, and time frames for reaching the goals and the individuals
					 responsible for carrying out the plan.
"Intellectual disability" means a disability originating
					 before 18 years of age, characterized concurrently by (i) significant
					 subaverage intellectual functioning as demonstrated by performance on a
					 standardized measure of intellectual functioning administered in conformity
					 with accepted professional practice that is at least two standard deviations
					 below the mean and (ii) significant limitations in adaptive behavior as
					 expressed in conceptual, social, and practical adaptive skills.
"Legal guardian" means the natural or adoptive parents or
					 other person, agency, or institution that has legal custody of a child.
"License" means a document verifying approval to operate a
					 children's residential facility and that indicates the status of the facility
					 regarding compliance with applicable state regulations.
"Live-in staff" means staff who are required to be on duty
					 for a period of 24 consecutive hours or more during each work week.
"Living unit" means the space in which a particular group
					 of children in care of a residential facility reside. A living unit contains
					 sleeping areas, bath and toilet facilities, and a living room or its equivalent
					 for use by the residents of the unit. Depending upon its design, a building may
					 contain one living unit or several separate living units.
"Mechanical restraint" means the use of a mechanical device
					 that cannot be removed by the individual to restrict the freedom of movement or
					 functioning of a limb or a portion of an individual's body when that behavior
					 places him or others at imminent risk.
"Medication" means prescribed and over-the-counter
					 drugs.
"Medication administration" means the direct application of
					 medications by injection, inhalation, or ingestion or any other means to a
					 resident by (i) persons legally permitted to administer medications; or (ii)
					 the resident at the direction and in the presence of persons legally permitted
					 to administer medications.
"Medication assisted treatment" or "MAT" means the use of
					 U.S. Food and Drug Administration-approved medications in combination with
					 counseling and behavioral therapies to provide treatment of substance use
					 disorders.
"Medication error" means an error made in administering a
					 medication to a resident including the following:
(i) the wrong medication is given to the
				  resident;
(ii) the wrong resident
				  is given the medication;
(iii) the
				  wrong dosage is given to a resident;
(iv) medication is given to a resident at the
				  wrong time or not at all; and
(v)
				  the proper method is not used to give the medication to the resident. A
				  medication error does not include a resident's refusal of offered medication.
"Motivational enhancement" means a person-centered approach
					 that is collaborative, employs strategies to strengthen motivation for change,
					 increases engagement in substance use services, resolves ambivalence about
					 changing substance use behaviors, and supports individuals to set goals to
					 change their substance use.
"Neurobehavioral services" means the assessment,
					 evaluation, and treatment of cognitive, perceptual, behavioral, and other
					 impairments caused by brain injury, that affect an individual's ability to
					 function successfully in the community.
"Objective" means expected short-term results or conditions
					 that must be met in order to attain a goal. Objectives are stated in
					 measurable, behavioral terms and have a specified time for achievement.
"On-duty" means that period of time during which a staff
					 person is responsible for the supervision of one or more children.
"On-site" means services that are delivered by the provider
					 and are an integrated part of the overall service delivery system.
"Parent" means a natural or adoptive parent or surrogate
					 parent appointed pursuant to DOE's regulations governing special education
					 programs for students with disabilities. "Parent" means either parent unless
					 the facility has been provided documentation that there is a legally binding
					 instrument, a state law, or court order governing such matters as divorce,
					 separation, or custody, that provides to the contrary.
"Pat down" means a thorough external body search of a
					 clothed resident.
"Personal health information" means oral, written, or
					 otherwise recorded information that is created or received by an entity
					 relating to either an individual's physical or mental health or the provision
					 of or payment for health care to an individual.
"Placement" means an activity by any person that provides
					 assistance to a parent or legal guardian in locating and effecting the movement
					 of a child to a foster home, adoptive home, or children's residential
					 facility.
"Premises" means the tracts of land on which any part of a
					 residential facility for children is located and any buildings on such tracts
					 of land.
"Provider" means any person, entity, or organization,
					 excluding an agency of the federal government by whatever name or designation,
					 that delivers (i) residential services to children with mental illness,
					 developmental disability, or substance abuse; or (ii) residential services for
					 persons with brain injury.
"Record" means up-to-date written or automated information
					 relating to one resident. This information includes social data, agreements,
					 all correspondence relating to the care of the resident, service plans with
					 periodic revisions, aftercare plans and discharge summary, and any other data
					 related to the resident.
"Resident" means a person admitted to a children's
					 residential facility for supervision, care, training, or treatment on a 24-hour
					 per day basis.
"Residential treatment program" means 24-hour, supervised,
					 medically necessary, out-of-home programs designed to provide necessary support
					 and address mental health, behavioral, substance abuse, cognitive, or training
					 needs of a child or adolescent in order to prevent or minimize the need for
					 more intensive inpatient treatment. Services include, but shall not be limited
					 to, assessment and evaluation, medical treatment (including medication),
					 individual and group counseling, neurobehavioral services, and family therapy
					 necessary to treat the child. The service provides active treatment or training
					 beginning at admission related to the resident's principle diagnosis and
					 admitting symptoms. These services do not include interventions and activities
					 designed only to meet the supportive nonmental health special needs including
					 personal care, habilitation, or academic educational needs of the
					 resident.
"Respite care facility" means a facility that is
					 specifically approved to provide short-term, periodic residential care to
					 children accepted into its program in order to give the parents or legal
					 guardians temporary relief from responsibility for their direct care.
"Rest day" means a period of not less than 24 consecutive
					 hours during which a staff person has no responsibility to perform duties
					 related to the facility.