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Rules, Rules, Rules'

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Title: Rules, Rules, Rules'


1
Rules, Rules, Rules.
  • September 2004
  • Texas Commission on Alcohol and Drug Abuse
  • 144, 147, 148
  • Rhonda G. Patrick, LMSW, MPA
  • Blue Basin, Inc.

2
Schedule
  • 830 am - 845 am Introductions
  • 845 am - 900 am Overview of New TCADA
    Rules Structure
  • 900 am 1015 am Chapter 144
  • 1015 am 1030 am Break
  • 1030 am 1200 pm Chapter 147
  • 1200 pm 100 pm Lunch
  • 100 pm 230 pm Chapter 148
  • 230 pm 245 pm Break
  • 245 pm 400 pm Chapter 148
  • 400 pm 430 pm Questions and Answers

3
Course Objectives
  • Participants will be able to understand the
    purpose of TCADA regulations.
  • Participant will be able to identify the changes
    made in the rule revisions and their impact on
    organization processes.
  • Participants will understand TCADA Chapter 144
    Contract Management rules and their application
    on contracting with TCADA.
  • Participants will understand TCADA Chapter 147
    Contract Program Requirements rules and their
    application to prevention, intervention and other
    specialized programs.
  • Participants will understand TCADA Chapter 148
    Standards of Care rules and their application
    to all treatment providers.
  • Participants will understand how changes at the
    State level will impact rule interpretation and
    program oversight.

4
Overview Of New Rules Structure
  • Delineation of rules by function and activity
  • TCADA General Activities
  • Investigations
  • General Contracting
  • Prevention and Intervention Contracting
  • Standards of Care
  • Counselor s
  • Peer Assistance Programs
  • Offender education Programs

5
Eating
  • If you bite your tongue while eating, it is
    because you have recently told a lie.

6
Overview Of New Rules Structure
  • What is changed in the structure?
  • 141 General Provisions- Revised 2/1/04
  • 142 Investigations Hearings- Revised 2/1/04
  • 144 Contract Requirements- Repealed ABCD on
    2/1/04 and EF 9/1/04 and Replaced with 144
    Contract Administration Requirements
  • 145 Faith-Based Repealed 9/1/04 and Part of 148
    after 9/1/04
  • 147 Contract Program Requirements- New addition
    effective 9/1/04
  • 148 Licensure Requirements- Repealed 9/1/04 and
    Replaced with Standards of Care effective 9/1/04.
  • 150 Counselor Licensure- Revised 2/1/04
  • 151 Peer Assistance Programs- No Changes
  • 153 Offender Education Programs- Revised 2/1/04

7
Overview Of New Rules Structure
  • What are we actually left with and who does it
    apply too?
  • 141 General Provisions- Applies to TCADA
  • 142 Investigations Hearings- Applies to
    Facilities
  • 144 Contract Administrative Requirements- Applies
    to funded
  • 147 Contract Program Requirements- Applies to
    funded
  • 148 Standards of Care- Applies to all treatment,
    intervention and prevention programs
  • 150 Counselor Licensure- Applies to all
    counselors and counselor interns
  • 151 Peer Assistance Programs- Applies to all peer
    assistance programs
  • 153 Offender Education Programs- Applies to all
    offender education programs

8
Chapter 144Overview Application
  • Applies to all substance abuse programs funded by
    the commission.
  • Careful not to say TCADA, but Commission
  • Covers
  • Funding
  • Contracting Organization
  • Contract Administration
  • Contract Oversight

9
Old Wives Tales
  • If you cut an apple in half and count how many
    seeds are inside, you will also know how many
    children you will have.

10
Chapter 144
  • 144.301 General Requirements
  • 144.302 Organizational Structure
  • 144.303 Policies Procedures
  • 144.305 Personnel Requirements Documentation
  • 144.401 Contract Provisions
  • 144.404 Program Income

11
Chapter 144
  • 144.405 Indirect Costs
  • 144.406 Prior Approval
  • 144.407 Equipment and Supplies
  • 144.408 Minor Remodeling
  • 144.409 Subcontracting
  • 144.411 Procurement
  • 144.412 Travel
  • 144.413 Financial Eligibility

12
Chapter 144
  • 144.415 Cost Reimbursement
  • 144.416 Billing for Treatment Services
  • 144.417 BHIPS
  • 144.418 Reporting
  • 144.419 Obligating
  • 144.420 Contract Closeout

13
Try this one.
  • To prevent an unwelcome guest from returning,
    sweep out the room they stayed in immediately
    after they leave.

14
Chapter 147Overview Application
  • Completely New Chapter
  • Only applies to funded
  • Involves Prevention, Intervention and Special
    Programs
  • Moved from old 144
  • Most significant changes occur in OSAR
  • Builds in definitions to rules rather than
    separate them out

15
Chapter 147Prevention and Intervention
  • 147.103 Program Design
  • 147.110 Problem Identification and Referral
  • 147.112 Environmental and Social Policy
  • 147.113 Intervention Services
  • 147.114 Community Coalitions
  • 147.116 Pregnant Parenting Adult
    Adolescent Female Prevention Services

16
Chapter 147 HIV Programming
  • 147.202 HIV Required Services
  • 147.203 Minimum Operational Requirements-HIV
  • 147.204 Minimum Operational Requirements- HEI

17
Chapter 147 Narcotic Treatment Programs
  • 147.303 Required Services
  • 147.304 Minimum Operational Requirements

18
Off to the Chapel
  • If a single woman sleeps with a piece of wedding
    cake under her pillow, she will dream of her
    future husband.

19
Chapter 147 OSAR Services
  • 147.402 Standards
  • Screening
  • Motivational Interviewing
  • Stages of Change
  • Resource Directory
  • Coordinate Client Care
  • Outreach

20
Chapter 147Performance Standards
  • Performance Definitions
  • Completion
  • Abstinence
  • Follow-Up
  • Referral

21
Chapter 147Pregnant Post Partum Women
  • 147.604 Individualized Plan of Services
  • Service plan
  • Service Requirements
  • Counseling
  • Services for children
  • Employment
  • CPS Involvement
  • Service Coordination
  • Outreach

22
Feeling a little sick
  • To cure a cough take a hair from the coughing
    person's head, put it between two slices of
    buttered bread, feed it to a dog, and say, "Eat
    well you hound, may you be sick and I be sound."

23
Chapter 148 Overview Application
  • No longer Licensure rules
  • Now standards of care that apply to all who
    provide substance abuse services.
  • All substance abuse service providers must comply
    with section B
  • All treatment providers must comply with B, D-N
  • All prevention or interventions providers must
    comply with B and C

24
Chapter 148 Required of All Programs
  • 148.201. General Standard.
  • The provider shall provide adequate and
    appropriate services consistent with best
    practices and industry standards. The provider
    shall maintain objectivity. The provider shall
    respect each individual's dignity, and shall not
    engage in any action that may cause injury and
    shall always act with integrity in providing
    services.
  • 148.202. Scope of Practice.
  • The provider shall recognize the limitations of
    their ability and shall not offer services
    outside the provider's scope of practice or use
    techniques that exceed their professional
    competence.
  • 148.203. Competence and Due Care.
  • Providers shall plan, supervise adequately, and
    evaluate any activity for which they are
    responsible. Providers shall render services
    carefully and promptly. Providers shall follow
    the technical and ethical standards related to
    the provision of services, strive continually to
    improve personal competence and quality of
    service delivery, and discharge their
    professional responsibility to the best of their
    abilities. Providers are responsible for
    assessing the adequacy of their own competence
    for the responsibility to be assumed. Services
    shall be designed and administered as to do no
    harm to recipients. The provider shall always
    act in the best interest of the individual being
    served. The provider shall terminate any
    professional relationship that is not beneficial,
    or is in any way detrimental, to the individual
    being served.

25
Chapter 148 Required of All Programs
  • 148.204. Appropriate Services.
  • Services should be appropriate for the
    individual's needs and circumstances, including
    age and developmental level, and should be
    culturally sensitive.
  • 148.205. Accuracy.
  • The provider shall report information fairly,
    professionally, and accurately when providing
    services and when communicating with other
    professionals, the Commission, and the general
    public. Each provider shall document and assign
    credit to all contributing sources used in
    published material or public statements.
  • 148.206. Documentation.
  • The provider shall maintain required
    documentation of services provided and related
    transactions including financial records.
  • 148.207. Discrimination.
  • The provider shall not discriminate against any
    individual on the basis of gender, race,
    religion, age, national origin, disability
    (physical or mental), sexual orientation, medical
    condition, including HIV diagnosis or because an
    individual is perceived as being HIV infected.
    The provider may consider economic condition and
    financial resources in admission criteria, but
    economic condition shall not affect the services
    once an individual is admitted.

26
Chapter 148 Required of All Programs
  • 148.208. Access to Services.
  • The provider shall provide access to services,
    including providing information about other
    services and alternative providers, taking into
    account an individual's financial constraints and
    special needs.
  • 148.209. Location.
  • The provider shall not offer or provide services
    in settings or locations that are inappropriate
    or harmful to individuals served or others.
  • 148.210. Confidentiality.
  • The provider shall protect the privacy of
    individuals served and shall not disclose
    confidential information without express written
    consent, except as permitted by law. The
    provider shall remain knowledgeable of, and obey,
    all State and Federal laws and regulations
    relating to confidentiality of records relating
    to the provision of services. The provider shall
    not discuss or divulge information obtained in
    clinical or consulting relationships except in
    appropriate settings and for professional
    purposes that demonstrably relate to the case.
    Confidential information acquired during delivery
    of services shall be safeguarded from illegal or
    inappropriate use, access and disclosure or from
    loss, destruction or tampering. These safeguards
    shall protect against verbal disclosure, prevent
    unsecured maintenance of records, or recording of
    an activity or presentation without appropriate
    releases.
  • 148.211. Environment.
  • The provider shall provide an appropriate, safe,
    clean, and well-maintained environment.

27
Chapter 148 Required of All Programs
  • 148.212. Communications.
  • The provider shall inform the individual
    receiving services about all relevant and
    important aspects of the service relationship.
  • 148.213. Exploitation.
  • The provider shall not exploit relationships
    with individuals receiving services for personal
    or financial gain of the provider or its
    personnel. The provider shall not charge
    exorbitant or unreasonable fees for any service.
    The provider shall not pay or receive any
    commission, consideration, or benefit of any kind
    related to the referral of an individual for
    services.
  • 148.214. Duty to Report.
  • When a provider or its personnel have knowledge
    of unethical conduct or practice on the part of a
    person or provider, they have a responsibility to
    report the conduct or practices to appropriate
    funding or regulatory bodies or to the public.
    Any provider or provider personnel who receive an
    allegation or have reason to suspect that an
    individual has been, is, or will be subject to
    abuse, neglect or exploitation by any provider
    shall immediately inform TCADA's investigations
    division. The provider shall also take immediate
    action to prevent or stop the abuse, neglect, or
    exploitation and provide appropriate care and
    treatment. The provider shall report allegations
    of child abuse or neglect to the Texas Department
    of Protective and Regulatory Services as required
    by the Tex. Fam. Code Ann. 261.101 (Vernon 2002
    Supp. 2004). The provider shall report
    allegations of abuse, neglect or exploitation of
    elderly or disabled individuals to the Texas
    Department of Protective and Regulatory Services
    as required by the Tex. Hum. Res. Code Ann.
    48.051 (Vernon 2001 Supp. 2004). If the
    allegation involves sexual exploitation, the
    service provider shall comply with reporting
    requirements listed in the Tex. Civ. Prac. Rem.
    Code Ann. 81.006 (Vernon 1997 Supp. 2004).

28
Chapter 148 Required of All Programs
  • 148.215. Impaired Providers.
  • Providers should recognize the effect of
    impairment on professional performance and should
    be willing to seek needed treatment. Where there
    is evidence of impairment in a colleague, a
    provider should be supportive of assistance or
    treatment. An employer shall provide access to
    information regarding available services to
    impaired employees.
  • 148.216. Ethics.
  • Providers shall adhere to established
    professional codes of ethics. These codes of
    ethics define the professional context within
    which the provider works, in order to maintain
    professional standards and safeguard the client
    or participant. Provider and all of its
    personnel shall protect consumers and act in an
    ethical manner at all times.

29
Chapter 148 Required of All Programs
  • 148.217. Specific Acts Prohibited.
  • Providers shall not enter into a personal or
    business relationship of any type with an
    individual receiving services until at least two
    years after the last date an individual receives
    services from the provider.
  • Providers shall not allow unqualified persons or
    entities to provide services.
  • Provider shall not hire or utilize known sex
    offenders in adolescent programs or programs that
    house children.
  • Providers shall prohibit adolescent clients and
    participants from using tobacco products on the
    program site. Staff and other adults (volunteers,
    clients, participants and visitors) shall not use
    tobacco products in the presence of adolescent
    clients or participants.

30
Chapter 148 Required of All Programs
  • 148.218. Standards of Conduct.
  • The facility and all of its personnel shall
    protect clients' rights and provide competent
    services.
  • Any person associated with the facility that
    receives an allegation or has reason to suspect
    that a person associated with the facility has
    been, is, or will be engaged in illegal,
    unethical, or unprofessional conduct shall
    immediately inform the Commission's
    investigations division and the facility's chief
    executive officer or designee. If the allegation
    involves the chief executive officer, it shall be
    reported to the Commission and the facility's
    governing body.
  • The facility and its personnel shall comply with
    Tex. Health Safety Code Ann. ch. 164 (Vernon
    2001 Supp. 2003)(relating to Treatment
    Facilities Marketing and Admission Practices).
  • The facility shall have written policies on
    staff conduct that complies with this section.

31
Chapter 148 Prevention Requirements
  • What evidenced based programs that addresses the
    listed criteria.
  • Want family included
  • Want input from stakeholders
  • Want program evaluation

32
Chapter 148Licensure Information
  • For new applicants must submit
  • Application
  • Operational Plan
  • Policies and Procedures
  • Proof of Liability Insurance
  • Inspection will occur within 45 days
  • Applying 60 days for inactive status- no services
    for 60 days retire license- can request inactive
    status, but only good for 60 days

33
Chapter 148 Facility Requirements
  • 148.502 Operational Plan, Policies Procedures
  • The facility shall operate according to an
    operational plan. The operational plan shall
    reflect
  • program purpose or mission statement
  • services and how they are provided
  • description of the population to be served and
  • goals and objectives of the program.
  • The facility shall adopt and implement written
    policies and procedures as deemed necessary by
    the facility and as required herein. The
    policies and procedures shall contain sufficient
    detail to ensure compliance with all applicable
    Commission rules.
  • The policy and procedure manual shall be current,
    consistent with program practices, individualized
    to the program, and easily accessible to all
    staff at all times.

34
Chapter 148 Facility Requirements
  • 148.503. Reporting Measures
  • Facilities shall submit the following information
    annually, electronically or in paper form, in a
    format provided by the Commission, unless a
    current contract with TCADA is in effect
  • total number of clients served by diagnosis
  • gender of clients served
  • ethnicity of clients served
  • ages of clients served
  • primary and secondary drug at admission
  • discharge reason per treatment episode, including
    length of stay at time of discharge and
  • average percent of occupancy for each residential
    program.

35
Chapter 148 Facility Requirements
  • 148.504. Quality Management.
  • The facility shall develop procedures and
    implement a quality management process. The
    procedures shall address at a minimum
  • goals and objectives that relate to the program
    purpose or mission statements
  • methods to review the progress toward the goals
    and a documented process to implement corrections
    or changes
  • a mechanism to review and analyze incident
    reports, monitor compliance with rules and other
    requirements, identify areas where quality is not
    optimal and procedures to analyze identified
    issues, implement corrections, and evaluate and
    monitor their ongoing effectiveness
  • methods of utilization review to ensure
    appropriate client placement, adequacy of
    services provided and length of stay and
  • documentation of the activities of the quality
    management process.

36
Dream a little Dream
  • For a woman to dream of going to a hairdresser
    shows she will soon be entangled in some family
    scandal concerning the morals of a member of her
    family. Should she have her hair dyed, she will
    narrowly escape imprisonment.
  • For a man to dream of a hairdresser will presage
    much gossip or a need to dominate a beautiful
    woman.

37
Chapter 148 Facility Requirements
  • 148.505. General Environment.
  • The facility shall have a certificate of
    occupancy from the local authority that reflects
    the current use by the occupant or documentation
    that the locality does not issue occupancy
    certificates.
  • 148.507. General Documentation Requirements.
  • Authentication of electronic records shall be by
    a digital authentication key.
  • 148.508. Client Records.
  • The facility shall protect all client records
    and other client-identifying information from
    destruction, loss, tampering, and unauthorized
    access, use or disclosure.
  • (1) All active client records shall be stored
    at the facility. Inactive records, if stored
    off-site, shall be fully protected. All
    original client records shall be maintained in
    the State of Texas.
  • (2) Information that identifies those seeking
    services shall be protected to the same degree
    as information that identifies clients.
  • (3) Electronic client information shall be
    protected to the same degree as paper records
    and shall have a reliable backup system.
  • Client records shall be maintained for at least
    six years. Records of adolescent clients shall be
    maintained for at least five years after the
    client turns 18.

38
Chapter 148 Facility Requirements
  • 148.509. Incident Reporting
  • All incident reports shall be stored in a
    single, separate file.
  • The facility shall have a designated individual
    responsible for reviewing incident reports and
    all incidents should be evaluated through the
    quality management process to determine
    opportunities to improve or address program and
    staff performance.

39
Chapter 148 Personnel Practices
  • 148.601. Hiring Practices.
  • A facility whose personnel includes counselor
    interns shall be registered with the Commission
    as a clinical training institution and comply
    with all applicable requirements.
  • The facility shall verify by Internet, telephone
    or letter and document the current status of all
    required credentials with the credentialing
    authority.
  • The facility shall be aware of its obligations
    under Tex. Civ. Prac. Rem. Code Ann. 81.003.
    Reference Checks
  • The facility shall obtain and assess the results
    of a criminal background check from the
    Department of Public Safety on all staff within
    four weeks of the hiring date. Individuals hired
    may not have any client contact until the results
    of the criminal background check are assessed.
    The facility shall use the criteria listed in
    Tex. Occ. Code Ann. 53.022, 53.023 (Vernon
    2004) to evaluate criminal history reports and
    make related employment decisions.
  • The facility shall not hire an individual who has
    not passed a pre-employment drug test that meets
    criteria established by the Commission. The
    facility shall develop a job description which
    outlines job duties and minimum qualifications
    for all personnel.
  • The facility shall maintain a personnel file for
    each employee, and all contractors, students and
    volunteers with any direct client contact which
    contains documentation demonstrating compliance
    with this section.

40
Chapter 148 Personnel Practices
  • 148.603. Training.
  • Prior to performing their duties and
    responsibilities, the facility shall provide
    orientation to staff, volunteers, and students.
    This orientation shall include information
    addressing
  • TCADA rules
  • facility policies and procedures
  • client rights
  • client grievance procedures
  • confidentiality of client-identifying information
    (42 C.F.R. pt. 2 HIPAA)
  • standards of conduct and
  • emergency and evacuation procedures.

41
Chapter 148 Personnel Practices
  • Training Continued
  • The following initial training must be received
    within the first 90 days of employment and must
    be completed before the employee can perform a
    function to which the specific training is
    applicable. Subsequent training must be
    completed as specified.
  • (1) Abuse, Neglect, and Exploitation.
  • (2) HIV, Hepatitis B and C, Tuberculosis and
    Sexually Transmitted Diseases.
  • (3) Cardio Pulmonary Resuscitation (CPR)
  • (4) Nonviolent Crisis Intervention.
  • (5) Restraint and/or Seclusion.
  • (6) Intake, Screening and Admission
    Authorization.
  • (7) Self-administration of Medication.

42
More dreams.
  • To dream of a monkey denotes that you have
    deceitful friends who will flatter you to advance
    their own interests.

43
Chapter 148 Client Rights
  • 148.701 Bill of Rights
  • Revised and includes residential
  • No changes to Client Grievance
  • No changes to Abuse, Neglect Exploitation
  • No change to Program Rules
  • 148.705 Client Labor
  • No client labor allowed, falls under
    relationships clause
  • No Changes to Restraint and Seclusion
  • No changes to Responding to Emergencies
  • 148.708 Searches
  • Clarified that must be documented in client file.

44
Chapter 148 Screening Assessment
  • 148.801 Screening
  • DSM-IV
  • TDI Placement Criteria
  • Financial Resources Insurance
  • Validated Assessment Instruments
  • Documentation to Justify-Supported
  • LVN can do detox screening w/ conditions

45
Chapter 148 Screening Assessment
  • 148.802 Admission Consent
  • Consolidation of consent and orientation

46
Chapter 148 Screening Assessment
  • 148.803 Assessment
  • Comprehensive Psychosocial Assessment

47
Chapter 148 Screening Assessment
  • 148.804 Treatment Planning
  • Discharge on TP, use TDI criteria, but
    individualize
  • Projected length of stay
  • No change to reviews
  • Transfers must be justified
  • No change to progress notes

48
Chapter 148 Screening Assessment
  • 148.805 Discharge
  • Individualized discharge plan
  • Updated as client progresses through treatment
  • Address continuity of services
  • No changes to written plan design
  • Clarification on follow-up, no sooner than 60 and
    no later than 90 upon DC from FACILITY, not
    program.

49
Chapter 148 Treatment Program Services
  • 148.901 Requirements for All Treatment Providers
  • Follow written curriculum
  • Education must include client participation
  • Education related to HIV, STD, TB Hep
  • Education related to nicotine addition and
    tobacco
  • Access to screening and testing and referral if
    positive
  • Maintain and adequate number of staff
  • Residential- one counselor 8 hours, six days a
    week
  • Director QCC, 2 years post licensure experience
  • 148.902 Requirements for Detoxification Programs
  • Medical Director or designee shall approve all
    medical policies, guideline, tools and medical
    content of all forms
  • Detox training requirements
  • Screening instrument recommendation
  • Specifies required counseling
  • Documentation requirement for crisis
    stabilization

50
Chapter 148 Treatment Program Services
  • 148.903 Requirements for Residential Programs
  • Intensive Residential- 30 hours of counseling (10
    CD counseling, 10additional counseling 10
    planned, structured activities monitored by
    staff.)
  • 116 day and 132 night
  • Counselor caseloads can not exceed ten
  • Supportive Residential- 6 hours per week ( three
    CD counseling- one individual per month and three
    of additional counseling)
  • 120 day and 150 night
  • Program sets caseload limit
  • 148.904 Requirements for Outpatient Programs
  • Ensure access to full continuum of care
  • Intensity appropriate to client needs

51
Chapter 148 Treatment Program Services
  • 148.905 Requirements for Adolescent Programs
  • Provide education within 3 days if admission
    expected to last beyond 14 days.
  • 15 hours of planned structured activities
    (includes school)
  • 18 day and 116 night
  • Involve family
  • Training requirement

52
Chapter 148 COSPD
  • 148.906 Access to services
  • May not include the following in determining
    eligibility for any service
  • Mental Illness
  • Medications
  • Presumption of inability to benefit
  • Success of prior episodes
  • If a client refuses a service, this can not
    preclude them from accessing other MH and CD
    services
  • Establish and implement procedures to ensure
    continuity between screening, assessment,
    treatment and referral services.

53
Chapter 148 COSPD
  • 148.907 Additional requirements for programs
  • Address both MH and CD
  • Best Practices
  • Facilitate accessing services they need and
    choose
  • Provided by competent staff (as defined in
    148.908)
  • 148.909 Competencies for staff
  • Staff must demonstrate competencies within 90
    days
  • Knowledge Competencies
  • Technical Competencies
  • Interpersonal Competencies

54
Chapter 148 COSPD
  • 148.909 Treatment Planning
  • Identify services
  • Measurable outcomes
  • Family members need for education and support
    services
  • Facilitation of families education and support
    services
  • Client and family (if requested) get a copy of
    treatment plan

55
Chapter 148 Women and Children
  • 148.910 Treatment Services for Women and Children
  • Has been significantly condensed
  • Requirements related to minimum standards for
    child care centers (www.tdprs.state.tx.us)
  • Adoption of rules related to child care

56
Chapter 148 Electronic Services (Internet
Therapy)
  • 148.911 Treatment Services Provided by Electronic
    Means
  • May only be outpatient services
  • Adults only
  • QCC Only
  • Verification of client required
  • Security as detailed in HIPAA required
  • Transfer of info using 128 bit-encryption
  • No e-mail with client identification
  • Toll-free number for technical support

57
Chapter 148 Electronic Services (Internet
Therapy)
  • Contingency plan for problems
  • Description of all services
  • Referral for those who do not meet criteria
  • Grievance procedure
  • Provide potential risks to client
  • Emergency contact for client
  • Program reside and performed in Texas
  • Make ADA accommodation

58
Chapter 148 Food and Nutrition
  • No significant changes
  • Each dose of prescription and OTC medication must
    be recorded in client record

59
Chapter 148 Food and Nutrition
  • No significant changes

60
Chapter 148 Physical Plant
  • 148.1202 Inspections
  • annual inspection by the local certified fire
    inspector or the State fire marshal
  • annual inspection of the alarm system by the fire
    marshal or an inspector authorized to install and
    inspect such systems
  • annual kitchen inspection by the local health
    authority or the Texas Department of Health
  • gas pipe pressure test once every three years by
    the local gas company or a licensed plumber
  • annual inspection and maintenance of fire
    extinguishers by personnel licensed or certified
    to perform those duties and
  • annual inspection of liquefied petroleum gas
    systems by an inspector certified by the Texas
    Railroad Commission.

61
Chapter 148 Physical Plant
  • 148.1205 Space, Furniture and Supplies
  • 80 usable square feet per individual in
    single-occupancy rooms
  • 60 usable square feet per individual in
    multiple-occupancy rooms (or 50 square feet per
    individual if bunk beds are used) and
  • 40 usable square feet for each child 18 months
    and older and 30 usable square feet per infant
    under 18 months.
  • 148.1206 Fire Systems
  • A fire detection, alarm, and communication system
    required for life safety shall be installed,
    tested, and maintained in accordance with the
    facility's occupancy and capacity
    classifications.

62
Chapter 148 Court Commitment
  • No significant changes to this section

63
Chapter 148 Therapeutic Communities
  • A TC methodology to treatment is distinguished
    from other models of care by the following
  • TCs are highly structured residential programs
    intended to treat criminal and antisocial
    behaviors occurring with substance abuse or
    dependence.
  • This model views recovery from these disorders as
    a developmental learning process in which the
    social and psychological characteristics of the
    client must be changed to one of "right living"
    and the client must adopt appropriate morals and
    values promoted by the program as opposed to
    solely recovering from an illness.
  • The model utilizes the community itself and TC
    specific group-type meetings as the primary
    modality of change. Confrontation amongst clients
    regarding their behaviors, a carefully
    orchestrated consequence-reward system and
    hierarchical privilege system are the primary
    approaches utilized instead of the counseling and
    therapy utilized in other models of treatment.
  • Counselors act primarily as role models and
    rational authorities rather than as counselors or
    therapists.
  • The model expects the client length of stay to be
    a minimum of 90 days in order to achieve positive
    outcomes.
  • The program is divided into 3 phases The
    Orientation Phase (Information Dissemination),
    Primary Treatment Phase (Personal Application),
    and Re-Entry/Relapse Prevention Phase (Social
    Application).

64
Chapter 148 Therapeutic Communities
  • Treatment programs using the TC methodology are
    required to comply with Screening and Assessment
  • If the comprehensive psychosocial assessment
    identifies a potential mental health problem, the
    program shall arrange for the client to obtain a
    mental health evaluation by a Qualified Mental
    Health Professional.
  • If the mental health evaluation reflects the
    client currently has a diagnosis, or has been
    diagnosed during the last year with an Axis I
    diagnosis or post traumatic stress disorder,
    and/or moderate to severe mental retardation, the
    program shall obtain written authorization from a
    licensed psychiatrist or licensed physician
    experienced in treating chemical dependency, for
    the client to receive TC treatment services prior
    to providing TC program services.
  • A QCC, with at least one year documented
    experience in treating individuals with mental
    illness, shall act as the primary counselor and
    confer at least monthly with the authorizing
    psychiatrist or physician.
  • The client shall voluntarily agree to participate
    in the TC program.
  • If the client is pregnant at the time of
    admission, the program shall obtain written
    authorization from a licensed physician for the
    client to receive TC treatment services prior to
    providing TC program services. If the pregnancy
    is determined after admission, the program shall
    obtain written authorization from a licensed
    physician for the client to receive TC treatment
    services.
  • A physician or physician assistant shall monitor
    the pregnant clients response to treatment at
    least monthly or more often as needed.

65
Chapter 148 Therapeutic Communities
  • The TC Program shall ensure that all staff
    receive training in the TC methodology. All
    staff members shall receive 16 hours of training
    in TC theory, TC methods, and TC intervention
    techniques. This training is in addition to the
    applicable training requirements outlined in
    148.603 of this title (relating to Training),
    and must take place within the first ninety days
    of employment.
  • Intensive residential TC programs shall provide a
    minimum of 20 hours of services per week, which
    shall include
  • Six hours of counseling (which shall include two
    hours of individual counseling per month)
  • Six hours of additional counseling, CD education,
    and life skills training and
  • Eight hours of TC groups, such as cognitive
    restructuring, AM/PM development, and
    encounter-confrontation groups. A counselor
    shall be present to supervise or monitor the
    activity and maintain structure in the TC groups.
  • In addition to the 20 hours outlined above, the
    program shall provide ten additional hours of
    peer driven activities, such as community
    meetings, house meetings, peer support,
    recreation, seminars, and self help groups.
  • Attendance shall be documented for peer driven
    activities. Documentation shall contain date,
    duration and type of activity. There is no size
    limitation or staffing requirement for peer
    driven activities.
  • Ten hours of the above services shall be in
    provided in the evenings and on weekends.

66
Chapter 148 Therapeutic Communities
  • Adult Supportive TC Residential Programs shall
    provide at least six hours of treatment services
    per week for each client, comprised of at least
  • two hours of chemical dependency counseling (one
    hour per month of which shall be individual
    counseling)
  • two hours of additional counseling, chemical
    dependency education, and life skills training
    and
  • two hours of TC groups such as cognitive
    restructuring, AM/PM development, and encounter-
    confrontation groups. A counselor shall be
    present to supervise or monitor the activity and
    maintain structure in the TC groups.
  • Group counseling size is limited to 16 clients.
    Chemical dependency education and life skills
    classes are limited to 35 clients.
  • The TC program shall set limits on counselor
    caseload size that ensures effective,
    individualized treatment. The TC program shall
    justify the caseload size in writing based on the
    program design, characteristics and needs of the
    population served, and the minimum client service
    hours as indicated in this section.

67
Chapter 148 Therapeutic Communities
  • In intensive residential TC programs the direct
    care staff to client ratio shall be 116 while
    awake and 132 during sleeping hours.
  • In supportive residential TC programs the direct
    care staff to client ratio shall be 120 while
    awake and 150 during sleeping hours.
  • In addition to the other requirements of this
    subchapter, the TC programs policy and procedure
    manual shall contain the following
  • written program description explaining how the
    therapeutic community functions
  • program structure, including rules, methods, and
    service schedule
  • overview of the TC treatment process
  • description of consequences and rewards system
    and
  • policy stating that interventions are not used as
    punishment and that access to medical and
    psychiatric care will not be denied.

68
Chapter 148 Faith Based Programs
  • No significant changes other than moved from its
    own chapter to Standards of Care.

69
September 2004
  • Welcome State Health Services
  • Licensing
  • Audit
  • Investigation

70
HHSC Organizational Chart6/15/2004
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