DHS Addictions and Mental Health Division: Mental Health Services_309

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The Oregon Administrative Rules contain OARs filed through January 15, 2010

DEPARTMENT OF HUMAN SERVICES, ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

DIVISION 32

COMMUNITY TREATMENT AND SUPPORT SERVICES

309-032-0001

Standards for Inpatient Psychiatric Services

(1) Purpose. This rule prescribes standards for programs which, as alternatives to state hospitalization, provide inpatient psychiatric services as part of a community mental health program.

(2) Statutory Authority and Procedures. This rule carries out and is authorized by ORS 430.610 to 430.670.

(3) Application for Approval. A community mental health program may be approved by the Division to provide, as alternatives to state hospitalization, inpatient psychiatric services only upon its written application and in accordance with OAR 309-012-0010 (Letters of Approval).

(4) Standards for Approval. In order to be approved by the Division for funding of inpatient psychiatric services, a community mental health program shall:

(a) Have an ongoing utilization review system which shall be applied to patients receiving services under this rule;

(b) Have a contract with the community hospital providing the inpatient service. The contract shall be approved by the appropriate regional Assistant Administrator of the Division and shall at least specify:

(A) The procedure by which the community mental health program will pay for hospital services;

(B) The criteria for a patient's eligibility to participate in the program;

(C) The method by which the community mental health program director approves a patient for participation in the program;

(D) The types of services the community hospital will provide;

(E) That charges by the community hospital under the contract shall be the same as charges by the community hospital to private patients;

(F) The total maximum amount of payments by the community mental health program to the community hospital under the contract;

(G) The community hospital's utilization review system applicable to patients in the program.

(5) Patient Eligibility:

(a) Eligibility criteria. To be eligible for inpatient services under this rule a patient shall:

(A) Be in need of 24-hour-a-day medical supervision, treatment and care;

(B) Be at a substantial risk of requiring hospitalization in a state mental hospital;

(D) Require 12 days or less hospitalization; and

(E) Be determined by the community hospital with the approval of the community mental health program director or his designee not to have financial resources available to pay for hospitalization. To determine a patient's financial resources, the community mental health program director and the community hospital shall consider:

(i) The patient's gross income;

(ii) The number of the patient's dependents;

(iii) The patient's employment status;

(iv) The patient's debts;

(v) The degree of the patient's disability;

(vi) Third-party resources available for the benefit of the patient, including medicare, medicaid or private insurance.

(b) Funds provided by the Division to a county may not be used to purchase community inpatient services under this rule unless, and only to the extent that, other resources, including personal resources of the patient, private insurance, and medicare, are insufficient to pay the costs of the inpatient services. However, funds provided by the Division may not be used for a patient in whose behalf payments are made under Title XIX of the Social Security Act;

(c) No funds provided by the Division to a county for a program approved under this rule may be used to pay the costs of holding an allegedly mentally ill person against whom civil commitment proceedings have been instituted;

(d) Funds provided by the Division to a county for a program approved under this rule may be used to pay the costs of up to seven days of hospitalization, except that an additional five days of hospitalization may be paid for under this rule if a utilization review committee determines additional hospitalization is needed. If more than 12 days hospitalization are necessary, a patient who is certified for services under this rule may be transferred to the appropriate state hospital.

(6) State Financial Participation:

(a) The Division shall reimburse a county whose community mental health program has been approved under this rule for community inpatient services up to the maximum amount agreed upon with the county as stated in the contract between the Division and the county;

(b) Certification of Eligibility. The community mental health program director or his designee shall certify which patients are eligible for community inpatient services under this rule.

[Publications: Publication referenced are available from the agency.]

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 33, f. 9-5-75, ef. 9-26-75

Sexual Offender Treatment Program

309-032-0070

Purpose and Statutory Authority

(1) Purpose. These rules prescribe the standards of the Mental Health and Developmental Disability Services Division for the operation of a community mental health program utilizing medication for the treatment of sexual deviation (hereinafter "the program").

(2) Statutory Authority. These rules are authorized by ORS 430.041 and carry out the provisions of ORS 135.930 through 135.950.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0075

Definitions

As used in these rules:

(1) "Adjunctive Therapy" means any course of education and/or treatment deemed necessary by program staff for successful completion of the program by a program client. The need for adjunctive therapy may be either identified during the evaluation of an applicant for the program or while a client is participating in the program.

(2) "Applicant" means a person who has given informed consent to be evaluated for the program.

(3) "Client" means a person receiving services under these rules.

(4) "Community Mental Health Program" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, mental retardation or other develop-mental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Mental Health and Developmental Disability Services Division.

(5) "Department of Corrections" means the Department of Corrections of the Department of Human Services, or its designee(s). Designees of the Department of Corrections may be a county operated corrections program, or any other person or agency designated by the Administrator of the Department of Corrections.

(6) "Division" means the Mental Health and Developmental Disability Services Division of the Department of Human Services.

(7) "Evaluation" means an assessment of an individual to determine the existence of a sexual deviation, whether the individual is medically suitable and psychologically suitable to participate in the program, and to document the need for adjunctive therapy should the applicant be accepted for the program.

(8) "Forcible Compulsion" means physical force that overcomes earnest resistance; or a threat, express or implied, that places a person in fear of immediate or future death or physical injury to self or another person, or in fear that the person or another person will immediately or in the future be kidnapped (ORS 163.305(2)).

(9) "Informed Consent" means the applicant has been informed by the treating physician about the program, possible side effects of medications or other treatment, possible benefits from participation in the program, procedures for determining if the applicant is medically and psychologically suitable for the program, and program rules the applicant agrees to follow if accepted for the program. Informed consent exists when the applicant signs a program application that documents that the above information has been explained to the applicant, the applicant has had an opportunity to ask questions about the program, and the applicant requests evaluation for the program.

(10) "Medically Suitable" means the applicant has been examined by a physician licensed to practice medicine in the State of Oregon and no present medical condition has been found that would prohibit the applicant from receiving treatment in the program. Documentation that the client is medically suitable will be included in the applicant's file before treatment begins.

(11) "Medication" means a drug prescribed by a program physician as part of a treatment program designed to eliminate deviant sexual behavior.

(12) "Board of Parole and Post-Prison Supervision" means the State Board of Parole created by ORS 144.005 which may authorize any inmate, who is committed to the legal and physical custody of the Department of Corrections, to go upon parole.

(13) "Program Staff" means the program will either have or contract for staff with the following qualifications:

(a) A physician, licensed to practice medicine in the State of Oregon;

(b) A psychiatrist licensed to practice medicine in the State of Oregon or a clinical psychologist licensed to practice psychology in the State of Oregon;

(d) A behavioral therapist approved by the Division to use psycho-physiological instruments that measure sexual arousal including, but not limited to, the penileplethysmograph; and

(e) Other staff experienced in providing adjunctive therapy as necessary.

(14) "Psychologically Suitable" means the applicant has been assessed by a psychiatrist or licensed psychologist to determine the existence of a sexual deviation that is treatable.

(15) "Treatment Plan" means the prescribed course of activities of each client in the program. At a minimum, the treatment plans shall include:

(a) The specific treatment to be administered and the prescribed dates and times of treatment;

(b) The prescribed course of any adjunctive therapy the client will follow; and

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0080

Program Approval

A program for the treatment of sexual deviation shall:

(1) Meet the standards set forth in these rules, those provisions of OAR 309-014-0000 through 309-014-0040 that are applicable, and any other Division administrative rules applicable to the program. A letter of approval issued to the program under OAR 309-012-0010 shall be effective for two years from the date of issue and may be renewed or revoked by the Division as set forth in OAR 309-012-0010; and

(2) Submit to the Division a plan for program organization and administration. The plan will include:

(a) An organization chart showing the lines of authority for the program including any parts of the program that are subcontracted by the community mental health program;

(b) A description of which program staff will provide the functions as described in OAR 309-032-0085 through 309-032-0100.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0085

Eligibility for Treatment

To be eligible for treatment by the program, the person must reside or intend to reside in a county having a program and must meet one of the following eligibility criteria:

(1) The person has been convicted of committing, or attempting to commit, a sexual crime involving forcible compulsion, is not appealing the conviction, or the conviction has been sustained upon appeal, and the Court makes participation in the program a condition of probation following a court ordered evaluation by the Division; or

(2) The Board of Parole and Post-Prison Supervision orders an evaluation by the Division of the person currently imprisoned for a sexual crime involving forcible compulsion and the Division finds the person to be medically suitable and likely to benefit from the program; or

(3) The person is currently on probation or parole, was convicted of a sexual crime, and voluntarily applies to the program for evaluation; or

(4) The person has not been convicted of a sexual crime and voluntarily applies to the program for evaluation.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0090

Eligibility for Acceptance into the Program

To be accepted as a client in the program, the individual must:

(1) Meet the eligibility criteria for evaluation as outlined in OAR 309-032-0085;

(2) Give informed consent to participate in the program; and

(3) Be evaluated by the Division or it's designee and be found to be medically and psychologically suitable for the program.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0095

Evaluation for the Program

(1) Initial Interview. Upon receipt of a request for an evaluation program staff will interview the person. At a minimum, the staff person will:

(a) Assess whether the person has the proper legal status to be eligible for evaluation;

(b) Assess whether the person resides or intends to reside in the county where the program is located;

(d) Obtain intake information;

(e) Obtain signed release of information forms, if necessary;

(f) Obtain a signed fee agreement, if appropriate;

(g) Obtain a signed post-treatment assessment agreement; and

(h) Arrange for a medical and psychological evaluation to complete the evaluation process.

(2) Medical Evaluation. Program staff will insure that each applicant receives a medical examination before acceptance in the program. The evaluation will include:

(a) Lab testing to determine the pre-treatment serum testosterone level, sperm count, and sperm morphology;

(b) Other laboratory tests deemed necessary by the examining physician;

(c) Screening for a history of high blood pressure, diabetes, migraine headaches, gall bladder disease, and any physical signs of alcoholism, or other substance abuse; and

(d) A written report from the examining physician indicating the applicant is or is not medically suitable for the program.

(3) Psychological Evaluation. If the applicant is found to be medically suitable for the program, he will be evaluated by a psychiatrist or a licensed psychologist to determine if he is psychologically suitable for the program. At a minimum, the evaluation will include:

(a) A complete clinical interview including a detailed sexual history, any indications of alcoholism or other substance abuse, and an assessment of the client's willingness and ability to participate in and benefit from treatment;

(b) An arousal assessment, utilizing the penileplethysmograph, which may be administered by a behavioral therapist;

(d) Recommendations for adjunctive therapy and any additional requirements thought necessary for the client to successfully complete the program; and

(e) A written report indicating whether the applicant is or is not psychologically suitable for the program including the existence of any conditions which might prohibit the applicant from successfully completing the program.

(4) Program staff will convene a pre-treatment client staffing. The pre-treatment staffing will:

(a) Inform the client of the results of the evaluation;

(b) Obtain a signed release of information form for each person/agency providing service to the client;

(d) Review program policies and procedures to insure the client understands what is necessary for successful completion of the program and under what conditions the client may be terminated from the program.

(5) Following the pre-treatment staffing, the physician, together with other program staff as appropriate, will obtain a signed informed consent from the client and document it in the clinical record.

(6) If the Court or Board of Parole and Post-Prison Supervision has ordered the evaluation, the results and recommendations from the evaluation will be forwarded to them:

(a) At a minimum the report to the Court or Board of Parole and Post-Prison Supervision will include:

(A) A statement by the physician that the applicant is or is not medically suitable for the program;

(B) A statement that the applicant is or is not psychologically suitable for the program; and

(b) If the recommendation is that the applicant should be allowed to participate in the program, the report will also include:

(A) A specific medication schedule indicating the times and places for treatment; and

(B) A schedule for adjunctive therapy.

(c) The program may recommend that additional requirements be imposed on the applicant. They may include, but are not limited to requirements that the applicant:

(A) Participate in alcoholism or other substance abuse treatment;

(B) Submit to urine surveillance;

(D) Be restricted to a specific living arrangement or place of employment in order to reduce potential risk to the community.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0100

Client Treatment

(1) Each applicant who is recommended and accepted for treatment becomes a client of the program. Each client shall be assigned a specifically designated case manager who shall monitor and evaluate all treatment and assess the effects of treatment and client compliance.

(2) The case manager shall be responsible for maintaining a complete client file on each client. Each client file shall contain the following:

(a) Client identifying information;

(b) A copy of the informed consent document;

(d) The initial interview report;

(e) A copy of all evaluation reports and other assessments;

(f) A copy of all informed consent statements;

(g) A copy of all Court or Board of Parole and Post-Prison Supervision orders, and all other required conditions;

(h) Signed and dated notations of client participation in the program, including:

(A) All medications received or missed;

(B) All adjunctive therapy sessions attended or missed;

(C) Monthly progress notes that include an assessment of the client's progress or lack of progress toward treatment plan objectives;

(D) Any side effects of taking medications along with any recommendations or actions taken to control or eliminate those side effects; and

(E) Any client staffings held regarding the client.

(i) All post-treatment assessments; and

(j) Other information the program deems necessary or is required by other Division administrative rules.

(3) If participation in the program is a condition of parole or probation, the case manager will report to the Court, Board of Parole and Post-Prison Supervision and/or the Department of Corrections when each of the following occur:

(a) Upon acceptance of the applicant as a client in the program; and

(b) Upon request of the Court, Board of Parole and Post-Prison Supervision or the Department of Corrections for periodic reports to monitor client participation in the program; and

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0105

Termination from the Program

A client of the program may be terminated from the program if the client:

(1) Withdraws content for further participation in the program;

(2) Develops a medical condition that precludes further treatment;

(3) Has been determined to be psychologically unsuitable for further participation in the program;

(4) Has achieved maximum benefit from treatment;

(5) Has violated program rules;

(6) Commits a new offense, including a sexual offense, which makes the client unsuitable for community supervision;

(7) Threatens the security or safety of the program or program participants;

(8) Fails to keep scheduled appointments for medication and/or adjunctive therapy;

(9) Refuses treatment deemed necessary by program staff for a diagnosed substance abuse problem (whether the diagnosis is made before or after entry into the program); or

(10) Violates any requirements of the Court or Board of Parole and Post-Prison Supervision.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0110

Post-Treatment Follow-Up

(1) As a requirement of program participation, the client will agree to post-treatment assessments six months after the client leaves the treatment program. These assessments will include:

(a) Laboratory tests for serum testosterone level, sperm count, and sperm morphology; and

(b) Interviews which shall document:

(A) The present/absence of any deviant sexual fantasies. This will be documented through the use of the penileplethysmograph;

(B) The presence/absence of any medical side effects which could be the result of treatment;

(C) The presence/absence of any psychological side effects which could be a result of participation in the program or adjunctive therapy.

(2) The program will monitor the post-treatment activity of program clients by performing law enforcement data system (LEDS) checks on former program clients. These checks will be at six month intervals for a period of three years post treatment.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

309-032-0115

Variances

A variance from these rules may be granted to a program in the following manner:

(1) A program requesting a variance shall submit, in writing, through the Office of Programs for Mental or Emotional Disturbances:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(e) Signed documentation from the local mental health authority indicating its position on the proposed variance.

(2) The assistant administrator of the Office of Programs for Mental or Emotional Disturbances shall approve or deny the request for variance.

(3) The program office shall notify the community mental health program of the decision. The community mental health program will forward the decision and reasons therefor to the program requesting the variance. This notice shall be given the program within 30 days of receipt of the request by the program or administrative office with a copy to other relevant sections of the Division.

(4) Appeal of the denial of a variance request shall be to the Administrator of the Division, whose decision shall be final.

(5) A variance granted by the Division shall be attached to, and become part of, the contract for that year.

Stat. Auth.: ORS 135 & ORS 430
Stats. Implemented:
Hist.: MHD 6-1984(Temp), f. & ef. 9-19-84; MHD 8-1984, f. & ef. 11-26-84

Standards for Community Mental Health Services for the Homeless Mentally Ill

309-032-0175

Purpose and Statutory Authority

(1) Purpose. These rules prescribe the standards for community-based programs that serve homeless individuals with a chronic mental illness.

(2) Statutory Authority. These rules are authorized by ORS 430.041 and 430.140 and carry out the provisions of ORS 430.610 through 430.685.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0180

Definitions

As used in these rules:

(1) "Chronically Mentally Ill Person" means a person who is 18 years of age or older and who satisfies both of the following criteria:

(a) Has been diagnosed by a psychiatrist, by a licensed clinical psychologist or by an examiner certified by the Mental Health and Developmental Disability Services Division as having chronic schizophrenia, a chronic major mood disorder, chronic paranoid disorder (DSM-111-R diagnoses of 295.12, .22, .32, .40, .63, .70, .92; 296.2, .3, .4, .5, .6; 297.1, .3), or another chronic psychotic disorder other than those caused by substance abuse; and

(b) Demonstrates impaired role functioning in at least two of the following areas:

(A) Social role: an inability to function independently in the role of worker, student, or homemaker;

(B) Daily living skills: an inability to engage independently in personal care (grooming, personal hygiene, etc.) or community living activities (handling personal finances, using community resources, performing household chores, etc.); or

(c) Social acceptability: an inability to exhibit appropriate social behavior, which results in demand for intervention by the mental health and/or the judicial system.

(2) "Client" means a person receiving services under these rules.

(3) "Community Mental Health Program (CMHP)" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, mental retardation or other developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Mental Health and Developmental Disability Services Division.

(4) "Division" means the Mental Health and Developmental Disability Services Division, of the Department of Human Services, of the State of Oregon.

(5) "Homeless Individual" means a person who has no fixed place of residence or resides in temporary housing such as a hotel or shelter.

(6) "Local Mental Health Authority" means an entity operating under an intergovernmental agreement or a direct contract with the Mental Health and Developmental Disability Services Division to administer a community mental health program in a specific geographic area of the state.

(7) "Outreach" means the delivery of mental health services, referral services and case management services in non-traditional settings, such as shelters, streets, transitional housing sites, drop-in centers or single room occupancy hotels.

(8) "Qualified Mental Health Associate" means any person delivering services under the direct supervision of a qualified mental health professional and meeting the following minimum qualifications:

(a) A bachelor's degree in a mental health related field; or

(b) A combination of at least one year's work experience and two years education, training or work experience in mental health.

(9) "Qualified Mental Health Professional" means any person meeting the following minimum qualifications:

(a) Psychiatrist licensed to practice in the State of Oregon;

(b) Physician licensed to practice in the State of Oregon;

(d) Graduate degree in Social Work;

(e) Graduate degree in Psychiatric Nursing and Licensed in the State of Oregon;

(f) Graduate degree in another mental health related field;

(g) Registration as an Occupational Therapist; or

(h) Graduate degree in Recreational Therapy.

[Publications: The publication(s) referred to or incorporated by reference in this rule are available from the agency.]

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0185

Services to be Provided

The following community mental health services for homeless individuals with a chronic mental illness shall be available:

(1) Case management to include:

(a) Identifying, screening and evaluating potential clients to determine their eligibility for services;

(b) Preparing individualized service plans meeting the record requirements of this rule for each client accepted for service. To the extent possible, the plans shall be prepared with the participation of the client and, as appropriate, significant others in the client's life. Plans shall be updated as appropriate, but not less than every three months;

(c) Assistance in applying for benefits to which the client is entitled. Staff shall routinely help clients secure resources such as Social Security benefits, General Assistance, food stamps, vocational rehabilitation, and housing assistance. When needed, staff shall accompany clients to help them apply for benefits;

(d) Provision of representative payee services in accordance with Section 1631 (a)(2) of the Social Security Act, when appropriate;

(e) Coordinating services with other agencies and resources, organizing and conducting case staffings as needed;

(f) Providing emotional support and counseling to clients throughout the provision of all other services listed in these rules; and

(g) Assuring that clients are informed about services that are available through community mental health programs.

(2) Outreach services to help clients gain access to needed services.

(3) Diagnostic services.

(4) Crisis intervention services.

(5) Purchase of temporary shelter, food, clothing, hygiene supplies and medications as may be necessary to engage a client in mental health services.

(6) Daily structure, support, supervision and skill training in shelter and other temporary residential settings. Skill training shall include household skills, money management, personal hygiene, and self-management of medications, as needed to increase independent living skills and the likelihood of securing stable housing.

(7) Referral to other agencies as appropriate for needed medication management for primary health services, hospital services and substance abuse services.

(8) Training to staff members of other agencies that provide services to homeless individuals with a chronic mental illness, including persons working in shelters, mental health clinics, and other places where homeless individuals receive services. Such training shall include training with respect to:

(a) Identifying individuals who are chronically mentally ill; and

(b) Referring individuals to services available to the mentally ill.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0190

Client Eligibility

(1) Community mental health services for the homeless shall enroll and serve individuals who:

(a) Are homeless or subject to a significant probability of becoming homeless; and

(b) Are chronically mentally ill.

(2) Community mental health services for the homeless may also serve individuals who are believed to be eligible when insufficient information exists to clearly establish eligibility:

(a) A client's eligibility shall be determined and documented at the earliest possible date; and

(b) Individuals determined to be ineligible shall be referred to other appropriate services or agencies.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0195

Staff Qualifications and Training Standards

(1) Staff delivering case management and outreach services to clients enrolled in a community mental health program for homeless individuals who have a chronic mental illness shall be qualified mental health professionals or qualified mental health associates and have demonstrated ability to:

(a) Identify individuals who are chronically mentally ill;

(b) Refer individuals to services available to the mentally ill including substance abuse programs, vocational rehabilitation programs, literacy programs, health programs and community mental health programs.

(2) All staff delivering community mental health services to homeless individuals with a chronic mental illness shall have training and qualifications appropriate to the services they are responsible for providing to clients. All staff shall operate under the supervision of a qualified mental health professional.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0200

Client Rights

Programs operating under provisions of this rule shall have written procedures to assure client rights as follows:

(1) Protection of client privacy and dignity;

(2) Confidentiality of records consistent with state statutes and federal statutes and regulations;

(3) Involvement of the client in planning the service through the provision of information, presented in terms understood by the general public, which explains the following:

(a) The service to be provided;

(b) Alternative services available;

(d) The client's right to refuse the service; and

(e) The client's grievance procedure.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0205

Record Requirements

(1) A record shall be maintained for each client who enrolled under this rule. The record shall contain:

(a) A description of the client;

(b) An assessment of the client's needs including strengths, weaknesses, presenting problem, and diagnosis;

(d) Progress notes that provide an on-going account of client contacts, a description of service delivered, and monitoring of service objectives; and

(e) A termination summary describing reasons for the client no longer being involved in service.

(2) A record shall be maintained for individuals served but not yet enrolled under the provisions of OAR 309-032-0190(2) of this rule. The record shall contain:

(a) A description of the client;

(b) A preliminary assessment of the client's need based on available information; and

(3) Records shall be confidential in accordance with ORS 179.505, 45 CFR Part 2, Mental Health and Developmental Disability Services Division administrative rules pertaining to client records, and the current edition of the Mental Health and Developmental Disability Services Division Handbook on Confidentiality.

[Publications: The publication(s) referred to or incorporated by reference in this rule are available from the agency.]

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

309-032-0210

Variances

A variance from these rules may be granted to a service provider in the following manner:

(1) A written request shall be submitted through the community mental health program to the Program Office for Mental or Emotional Disturbances stating:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance, if appropriate, with the section of the rule from which the variance is sought; and

(e) In writing, a signed document from the local mental health authority indicating its position on the proposed variance.

(2) The Assistant Administrator of the Program Office for Mental or Emotional Disturbances shall approve or deny the request for variance.

(3) The program Office for Mental or Emotional Disturbances shall notify the community mental health program of the decision. The community mental health program will forward the decision and reasons therefor to the program requesting the variance. This notice shall be given the program within 30 days of receipt of the request by the Program Office for Mental or Emotional Disturbances with a copy to other relevant sections of the Division.

(4) Appeal of the denial of a variance request shall be to the Administrator of the Division, whose decision shall be final.

(5) A variance granted by the Division shall be attached to, and become part of, the contract for that year.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 1-1988(Temp), f. & cert. ef. 2-16-88; MHD 4-1988, f. & cert. ef. 4-29-88

Standards for Supported Employment Services

309-032-0220

Purpose and Statutory Authority

(1) Purpose. These rules prescribe standards and procedures for operation of supported employment services approved by the Mental Health and Developmental Disability Services Division.

(2) Statutory Authority. These rules are authorized by ORS 430.041 and 430.1240 and carry out provisions of ORS 430.610 through 430.685.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0225

Definitions

(1) "Chronically Mentally Ill Person" means a person who is 18 years of age or older and who satisfies both of the following criteria:

(a) Severe mental disorder as identified by a psychiatrist, by a licensed clinical psychologist or by a non-medical examiner certified by the Mental Health and Developmental Disability Services Division. Must be diagnosed as having a Schizophrenic, Major Affective or Paranoid Disorder (DSM-III-R diagnosis of 295.1, .2, .3, .4, .6, .7, .9; 296.2, .3, .4, .5, .6; or 297.1, .3), or another severe mental disorder with a documented history of persistent psychotic symptoms other than those caused by substance abuse; and

(b) Impaired role functioning, consisting of at least two of the following:

(A) Social role: An inability to function independently in the role of worker, student, or homemaker;

(B) Daily living skills: An inability to engage independently in personal care (grooming, personal hygiene, etc.) or community living activities (handling personal finances, using community resources, performing household chores, etc.); or

(C) Social acceptability: An inability to exhibit appropriate social behavior, which results in demand for intervention by the mental health and/or judicial system.

(2) "Client" means a person receiving services under these rules.

(3) "Community Mental Health Program" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, mental retardation or other developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Mental Health and Developmental Disability Services Division.

(4) "Community Support Unit" means the organization of community support services in a community mental health program.

(5) " Competitive Work" work that is performed on a full-time basis or on a part-time basis averaging at least 20 hours per week for each pay period and for which an individual is compensated in accordance with the Fair Labor Standards Act.

(6) "Division" means the Mental Health and Developmental Disability Services Division of the Department of Human Services.

(7) "DSM III-R" means "Diagnostic and Statistical Manual of Mental Disorders," Third Edition Revised, American Psychiatric Association, 1987.

(8) "Integrated Work Setting" means job sites where most co-workers are not handicapped and individuals with handicaps are not part of a work group of other individuals with handicaps; or individuals with handicaps are part of a small work group of not more than eight individuals with handicaps; or individuals with handicaps have regular contact with non-handicapped individuals other than personnel providing support services in the immediate work setting.

(9) "Local Mental Health Authority" means an entity operating under an intergovernmental agreement or a direct contract with the Mental Health and Developmental Disability Services Division to administer a community mental health program in a specific geographic area of the state.

(10) "Ongoing Support" means continuous or periodic job skill training or support services provided at least twice monthly at, or away from the work site, throughout the term of employment to enable the individual to perform the work.

(11) "Supported Employment" means paid employment averaging at least 20 hours per week accompanied by ongoing support which occurs individually, or in groups of no more than eight workers with disabilities, in a variety of integrated work settings.

(12) "Transitional Employment" means competitive work in an integrated work setting for individuals with chronic mental illness who may need support services but not necessarily job skills training services to perform the work. Such services may be provided either at the work site or away from the work site. The job placement may not necessarily be a permanent employment outcome for the individual.

[Publications: The publication(s) referred to or incorporated by reference in this rule are available from the agency.]

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0230

Client Eligibility

Supported Employment Services shall enroll and serve only persons who:

(1) Are chronically mentally ill;

(2) Are enrolled in and actively served by a Community Support Unit;

(3) Have completed Vocational Rehabilitation Division evaluation or training;

(4) Require ongoing support by the program due to one or more of the following problems:

(a) Repeated failure to maintain employment;

(b) Poor ability to generalize skills from pre-employment training;

(d) Poor communication skills;

(e) Difficulty getting along with co-workers or supervisors;

(f) Inability to organize one's self to get to work regularly and on time; or

(g) Inability to deal with job stress.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0235

Services to be Provided

Supported Employment Services shall provide either Supported Employment or Transitional Employment services to each client. Formal counseling services shall be provided through the Community Support Unit. The following employment related services shall be provided:

(1) Assessment of the supportive services needed by the client to succeed in a work environment.

(2) Ongoing support services which shall:

(a) Be individualized and based on the assessment of client need;

(b) Be described in the rehabilitation plan; and

(A) Supervision and job training of client;

(B) On the job visits to provide support;

(D) Job coaching with the client, at and away from site;

(E) Emotional support;

(F) Coordination with professionals and family;

(G) Transportation;

(H) Individual social support activities; and

(I) Group social support activities.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0240

Staff Qualifications

Supported Employment Services shall maintain position descriptions for all supported employment positions. The position descriptions shall require staff to be experienced in one or more of the following areas at the time of hire with the goal being for staff to acquire proficiency in all areas:

(1) Vocational training;

(2) Job coaching;

(3) Job Development of Placement; or

(4) Working with persons with chronic mental illness.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0245

Case Record

Supported Employment Services shall maintain an individual case record for each client receiving services. The Supported Employment Services record may be a part of the Community Support Services record. The record shall:

(1) Contain an Intake Form prescribed by the Division;

(2) Contain a functional assessment of the client's strengths and deficits related to the client's ability to work;

(3) Contain relevant information from the client's participation in Community Support services;

(4) Contain an individual rehabilitation plan which outlines the ongoing support services to be provided;

(5) Contain progress notes documenting the client's movement toward specified rehabilitation goals. Progress notes shall be recorded when significant events occur and at least every other week;

(6) Contain monthly client progress summary forms prescribed by the Division;

(7) Contain periodic reviews of the rehabilitation plan identifying any changes in the services needed to allow the client to succeed in the work environment. Reviews of the rehabilitation plan shall be conducted every 90 days or more frequently if required by the client's condition;

(8) Be kept confidential in accordance with ORS 179.505, 45 CFR 204.50, 42 CFR Part 2 and current edition of the Division's Handbook in Confidentiality;

(9) Be stored securely and retained in accordance with applicable Oregon Revised Statutes, Oregon Administrative Rules and Division policies;

(10) Contain a copy of a CPMS enrollment form completed and submitted a the time Vocational Rehabilitation Division training ends and the client enters Supported Employment services; and

(11) Contain a CPMS termination form and discharge summary within 30 days of the client's termination from Supported Employment Services.

[Publications: The publication(s) referred to or incorporated by reference in this rule are available from the agency.]

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

309-032-0250

Variances

A variance from these rules may be granted to an agency in the following manner:

(1) An agency requesting a variance shall submit, in writing, through the community mental health program to the appropriate program or administrative office:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(e) Signed documentation from the local mental health authority indicating its position on the proposed variance.

(2) The assistant administrator of the program or administrative office shall approve or deny the request for variance.

(3) The program or administrative office shall notify the community mental health program of the decision. The community mental health program will forward the decision and reasons therefore to the program requesting the variance. This notice shall be given the program within 30 days of receipt of the request by the program or administrative office with a copy to other relevant sections of the Division.

(4) Appeal of the denial of a variance request shall be to the Administrator of the Division, whose decision shall be final.

(5) A variance granted by the Division shall be attached to, and become part of, the contract for that year.

Stat. Auth.: ORS 430
Stats. Implemented:
Hist.: MHD 7-1988, f. & cert. ef. 6-28-88

Standards for Community Treatment and Supervision of Persons
Under the Jurisdiction of the Psychiatric Security Review Board (PSRB)

309-032-0455

Definitions

As used in these rules:

(1) "Case Number" means the unique identification number assigned to each client by the provider. No more than one such number shall be assigned to the client, and that number shall be identical for both the client's treatment record and CPMS enrollment. Once assigned, the case number must be retained for all subsequent admissions or periods of service for the client.

(2) "Client" means a person who is under the jurisdiction of the PSRB and receiving services under these rules.

(3) "Client Identifying Information" means specific personal, biographical, and demographic information about the client.

(4) "Community Mental Health Program" or "CMHP" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, and operated in a specific geographic area of the state under an omnibus contract with the Division.

(5) "Conditional Release" means placement by a court or the PSRB, of a person who has been found eligible under ORS 161.327(b) or 161.336, for supervision and treatment in a community setting.

(6) "CPMS" or "Client Process Monitoring System", means an automated client data system maintained by the Division. "CPMS" shall also mean any subsequent modification or change to this system.

(7) "Data Base" means that collection of client information obtained through the mental health assessment process. It includes, but is not limited to: Identifying information, behavioral description, presenting problem(s), psychosocial and medical histories, developmental history, mental status, and current health information.

(8) "Diagnosis" means a DSM diagnosis determined through the mental health assessment and any examinations, tests, procedures, or consultations suggested by the assessment.

(9) "DSM" means the current edition of the "Diagnostic and Statistical Manual of Mental Disorders," published by the American Psychiatric Association.

(10) "Division" means the Addictions and Mental Health Division of the Department of Human Services.

(11) "Goal" means the broad aspirations or more final objectives toward which the client is striving, and toward which all services are intended to assist the client.

(12) "Health History" means a review of the client's current and past state of health as reported by the client, including:

(a) History of any significant illnesses, injuries, allergies, or drug sensitivities; and

(b) History of any significant medical treatments, including hospitalizations and major medical procedures.

(13) "Informed Consent" means the client or guardian understands a specific diagnosis and consents to service procedures and is informed of the risks or benefits, alternative services and procedures and the consequences of not receiving a specific service or procedure.

(14) "Licensed Medical Professional" means a medically trained person who is licensed to practice in the State of Oregon and has one of the following degrees: MD (Medical Doctor); DO (Doctor of Osteopathy); NP (Nurse Practitioner); PA (Physician's Assistant); or RN (Registered Nurse).

(15) "Local Mental Health Authority", as described in ORS 430.620, means the county court or board of county commissioners or one or more counties who choose to operate a community mental health program, or in the case of a Native American reservation, the tribal council, or if the county declines to operate or contract for all or part of a community mental health program, the board of directors of a public or private corporation.

(16) "Medication Use Record" means information kept in the client's treatment record which documents medications and/or agents prescribed or recommended by the provider's employed or contracted licensed medical professional who has prescriptive privileges, and includes medication progress notes as applicable.

(17) "Mental Health Assessment" means a process in which the client's need for mental health services is determined through evaluation of the client's strengths, goals, needs, and current level of functioning.

(18) "Mental Status Examination" means an overall assessment of a person's mental functioning that includes descriptions of appearance, behavior, speech, mood and affect, suicidal/homicidal ideation, thought processes and content, and perceptual difficulties including hallucinations and delusions. Cognitive abilities are also assessed and include orientation, concentration, general knowledge, abstraction abilities, judgment, and insight.

(19) "Objective" means an interim level of progress or a component step that is necessary or helpful in moving toward a goal.

(20) "Progress Note" means a written summary of how the client is progressing with respect to the client's treatment plan.

(21) "Provider" means:

(a) An organizational entity which is operated by, or contractually affiliated with, a community mental health program, and is responsible for the direct delivery of mental health services to clients; or

(b) A public agency or private corporation or an individual, as provided for in ORS 161.390. Notwithstanding the conditions of certification in OAR Chapter 309, the Division may contract directly with a community mental health and developmental disabilities program, other public agency or private corporation or an individual to provide supervision and treatment for a conditionally released person.

(22) "Psychiatric Evaluation" means an assessment performed by a licensed medical professional with prescriptive privileges who is a qualified mental health professional.

(23) "Qualified Mental Health Associate" (QMHA) means a person who delivers services under the direct supervision of a qualified mental health professional, and who meets the following minimum qualifications:

(a) Has a bachelor's degree in a mental health related field; or

(b) Has a combination of at least one year's work experience and two years education, training or work experience in mental health.

(24) "Qualified Mental Health Professional" (QMHP) means a person who meets all of the following minimum qualifications:

(a) Fits one of these categories:

(A) Psychiatrist or physician, licensed to practice in the State of Oregon; graduate degree in psychology, social work, or other mental health related field; graduate degree in psychiatric nursing, licensed in the State of Oregon; registration as an occupational therapist; graduate degree in recreational therapy; or

(B) Any other person whose education and experience meet, in a determination process approved by the Division, a level of competence consistent with the standards established for qualified mental health professionals.

(b) Has demonstrated competence to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social, and work relationships; conduct a mental status assessment; document a DSM diagnosis; write and supervise a treatment plan; and provide individual, family, and/or group therapy.

(25) "Qualified Person" means a person who is a qualified mental health professional, or a qualified mental health associate, is identified by the PSRB in the Conditional Release Order and who is designated by the provider to deliver and/or arrange and monitor the provision of required reports and services in this rule.

(26) "Treatment plan" means an individualized, written plan defining specific treatment objectives and proposed service interventions derived from the client's mental health assessment, and the Conditional Release Order.

(27) "Treatment Record" means a separate file established and maintained under these rules for each client.

(28) "Service Supervisor" means a person who has two years of experience as a qualified mental health professional and who, in accordance with OAR 309-032-0505, reviews the services provided to clients by qualified persons.

(29) "Setting" means the location at which a service is provided, and includes, but is not limited to: CMHP office, client's residence, or other identified location.

(30) "Significant Procedure" means a diagnostic or service modality which may have a substantial adverse effect on the client's psychological or physical health, such as administration of medications which have serious side effects.

(31) "Supervision" means monitoring of client's compliance with Conditional Release Orders, Agreement to Conditional Release, the treatment plan requirements, and any additional monitoring and reporting requirements stipulated by the PSRB, the courts, or the Division, not otherwise specified in these rules.

(32) "Termination Summary" means a summary of client progress toward treatment objectives from the time of admission to the termination of services.

(33) "Utilization Review" means a process in which client treatment records are examined by a review committee to evaluate the need for, and appropriateness of services, as well as completeness of the record.

[Publication: Publications referenced are available from the agency.]

Stat. Auth.: ORS 409.050
Stats. Implemented: ORS 161.295 - 161.430, 428.205 - 428.270
Hist.: MHD 2-1991, f. 1-30-91, cert. ef. 2-1-91; MHD 3-2006(Temp), f. & cert. ef. 11-1-06 thru 4-25-07; MHS 1-2007, f. & cert. ef. 4-24-07; MHS 11-2007(Temp), f. & cert. ef. 8-31-07 thru 2-27-08; MHS 16-2007, f. & cert. ef. 12-11-07

309-032-0460

General Standards

Providers of mental health evaluations and services under Orders for Evaluation and/or Orders of Conditional Release shall provide all reports and notifications ordered by the PSRB, under ORS 161.295 through 161.430, or otherwise required in this rule and other law. These responsibilities do not conflict with adherence to client rights under this rule and other Oregon statutes.

309-032-0465

Order for Evaluation

Following the receipt of an Order for Evaluation from the PSRB, the provider will:

(1) Within 15 days of receipt of the Order, schedule an interview with the client for the purpose of initiating or conducting the evaluation;

(2) Appoint a qualified mental health professional to conduct the evaluation and to provide an evaluation report to the PSRB;

(3) Within 30 days of the evaluation interview, submit the evaluation report to the PSRB responding to the questions asked in the Order for Evaluation; and

(4) If supervision by the provider is recommended, notify the PSRB of the name of the person designated to serve as the client's Qualified Person, who will be primarily responsible for delivering or arranging for the delivery of services and the submission of reports under these rules.

309-032-0470

Periodic and Special Circumstance Reports to the PSRB

The service provider, acting through the designated Qualified Person, shall submit reports to the PSRB as follows:

(1) Monthly reports. Monthly reports consistent with PSRB reporting requirements as specified in the Conditional Release Order that summarize the client's adherence to Conditional Release requirements and general progress in treatment. Reports are to be received by the PSRB by the tenth day of the month following the reporting period;

(2) Interim reports. Prompt interim reports, including immediate reports by phone, if necessary, to ensure the public's or client's safety including:

(a) At the time of any significant change in the client's clinical, legal, employment or other status which may affect compliance with Conditional Release orders;

(b) Upon noting major symptoms of a psychiatric decompensation requiring psychiatric stabilization or hospitalization or any other major change in the client's treatment plan;

(d) At any other time when, in the opinion of the Qualified Person, such an interim report is needed to assist or protect the client or to protect public safety.

309-032-0475

Minimum Treatment Services

Treatment services shall include all appropriate services determined necessary by the Community Mental Health Program or the Provider to assist the client in maintaining community placement and which are consistent with Conditional Release Orders and the Agreement to Conditional Release. Treatment shall include:

(1) Medication management and monitoring;

(2) Substance abuse treatment or referral;

(3) Group, family, and individual counseling services;

(4) Health care services. The providers shall directly provide, or refer for, available health care services to the extent they are necessary for continuation of conditional release;

(5) Life skills training; and

(6) Hospital services. The provider shall directly provide or arrange for psychiatric hospital services, if needed as follows:

(a) Voluntary psychiatric hospitalization. At the discretion of the Qualified Person, and in consultation with the PSRB Executive Office, clients may be returned to psychiatric hospitalization on a voluntary basis. These returns may be prompted by a deterioration in mental status, violations of Conditional Release Orders, or at the request of the Qualified Person or the client;

(b) Conditional release revocation. If a client requires involuntary return to a State Psychiatric Hospital or center, revocation procedures shall be initiated through the PSRB. If the CMHP or the provider is unable to consult immediately with the PSRB when it is necessary to hospitalize a client involuntarily, the PSRB Executive Office shall be notified of actions taken by the next working day.

309-032-0480

Policies and Procedures

Each provider shall have written policies and procedures governing the following:

(1) Establishment, maintenance, and contents of treatment records;

(2) Confidentiality of treatment records;

(3) Safety, storage, and retention of treatment records;

(4) Client rights specific to services received, and client appeal process and grievance procedures;

(5) Client participation in treatment and termination planning;

(6) Assessment, evaluation, and planning for client treatment needs;

(7) Performance and documentation of medical services;

(8) Establishment and maintenance of medication use record;

(9) Performance and documentation of staff supervision;

(10) Performance and documentation of utilization review; and

(11) Client Revocation of the client's community placement when the client requires involuntary hospitalization and/or fails to comply with Conditional Release Orders.

309-032-0485

Consumer Rights Specific to Services Received

In addition to client rights delineated in applicable Oregon Revised Statutes, Oregon Administrative Rules, and elsewhere in these rules, the following shall be required specific to services received:

(1) Notification of rights. At the time of enrollment, the provider shall make available to the client or guardian a document that describes the client's rights and responsibilities.

(2) Services refusal. The client shall have the right to refuse service, including any specific procedure, unless ordered by a court or the PSRB.

(3) Grievances. The client shall have the right to lodge a grievance.

(4) Access to records. The client shall have the right to access the client's own treatment records in accordance with state and federal law, including ORS 179.505, 192.505, 45 CFR 205.50, 42 CFR Part 2.

(5) Informed participation in treatment planning. The client shall be afforded the opportunity participate in an informed way in planning his or her treatment unless this participation would jeopardize the client's treatment.

[Publication: Publications referenced are available from the agency.]

309-032-0490

Establishment and Maintenance of Treatment Record

(1) Individuality of records and maintenance. A separate, individual treatment record shall be opened and maintained for each eligible and enrolled PSRB client receiving services from the provider, including the instance in which more than one eligible and enrolled member of a family receives services from the same provider.

(2) Organization of records. Each treatment record shall be maintained to assure accessibility, uniform organization, and completeness of all components required by these rules.

(3) Signature of authors. All documentation required in this rule must be signed by the staff providing the service and making the entry. Where required, the entry must be signed by the supervisor signifying approval of the material. Each staff and supervisor signature must include the person's academic degree or professional status and the date signed.

(4) Documentation of client consent. All procedures in these rules requiring client consent shall be documented in the record on forms describing what the client has been asked to consent to, and signed and dated by the client or client representative.

(5) Error corrections. Errors in the record shall be corrected by lining out the incorrect data with a single line in ink, and then adding the correct information, the date corrected, and the initials of the person making the correction.

(6) Confidentiality of other clients. References to other clients, when included in the individual client's record, shall preserve the confidentiality of the other clients.

(7) Security. Treatment records shall be secured, safeguarded, stored, and retained in accordance with applicable Oregon Revised Statutes and Oregon Administrative Rules. The PSRB shall provide copies of all reports to the client and to the client's counsel as required by ORS 161.336(4)(d).

(8) Confidentiality of treatment records. All individuals' records are confidential except as otherwise indicated by applicable rule or laws:

(a) For the purpose of disclosure from individual medical records under these rules, service providers under these rules shall be considered "providers" as defined in ORS 179.505 and 179.506(1) shall be applicable;

(b) For the purposes of disclosure from non-medical individual records, both the general prohibition against disclosure of "information of a personal nature" and limitations to the prohibition in ORS 192.502(2) shall be applicable;

(c) This does not restrict the provider from submitting reports required in this rule to the court or the PSRB without a client's signed release of information.

309-032-0495

Documentation of Protection of Client Rights

Treatment records shall document adherence to the client's rights:

(1) Client consent to enrollment in treatment services. At the time of enrollment, the client or guardian shall sign a document or documents which verifies the client has been informed of all client rights referred to in OAR 309-032-0485 Client; and that the client consents to evaluation and services prior to development of the treatment plan.

(2) Consent to specific treatment services. At the time of treatment plan development the qualified mental health professional responsible for development of the treatment plan shall obtain client or guardian signed consent to the treatment approaches recommended, and include this documentation in the service record.

(3) Consent to significant procedures. Whenever a significant procedure is proposed, the client's or guardian's signature verifying informed consent to the procedure shall be obtained and included in the treatment record.

(4) Refusal to consent. If the client refuses recommended treatment services, or refuses to consent to a procedure as required in these rules, the client's refusal shall be documented in the service record and the PSRB notified. The reasons for refusal and efforts to obtain the client's signature shall be documented in the client's treatment record.

(5) Documentation of disclosure of fee policy. The service record shall include documentation signed by the client verifying that fees the client will be asked to pay have been described.

(6) Authorization to release information. The service record must include documentation signed by the client authorizing any release of information by the type of information and the recipient of information.

309-032-0500

Client Identification and Documentation of Service Needs and Delivery

Treatment records shall document the gathering of information, conduct of assessments, planning, reviews, and the provision of services as follows:

(1) Client identifying information. Client identifying information must be obtained by a QMHA OR QMHP. The information must be readily identifiable and accessible in the client's record, and include the following:

(a) The unique case number assigned to the client;

(b) The client's name;

(d) The client's phone number and address;

(e) Who to contact in case of an emergency and the phone or address at which contact may be made;

(f) A copy of the CPMS enrollment form(s).

(2) Conditional release orders. A copy of the Order of Conditional Release and the Agreement to Conditional Release shall be included in the client's record.

(3) Mental health assessment. A mental health assessment shall be completed for each client within 60 days of enrollment and prior to the initial review of the treatment plan. The assessment must be completed by a QMHP who shall sign and date the final page of the assessment. The service supervisor, a psychiatrist, or a physician who is a QMHP shall review, sign and date the assessment within 60 days of the client's enrollment. The assessment must include the following elements that must be readily accessible and identifiable in the record:

(a) A statement of the client's initial goal(s) in seeking or entering treatment services and a description of events precipitating enrollment, and their related history;

(b) Historical information shall be obtained from the client, or other sources when appropriate, including but not necessarily limited to:

(A) Mental health history;

(B) Health history;

(D) Developmental history;

(E) Social history, including family and interpersonal history;

(F) Educational, vocational, and employment history; and

(G) Legal history.

(c) A determination of the client's functional strengths and deficits including, but not necessarily limited to daily living, social and vocational skills, and current support system;

(d) A mental status examination;

(e) A summary of significant and pertinent data from the mental health assessment including client strengths and deficits;

(f) A DSM diagnosis, supported by data obtained in the assessment;

(g) Preliminary recommendations for treatment services, including psychosocial and medical interventions, additional examinations, tests, and evaluations that are needed; and

(h) A disposition statement about how the client will be served by the provider, and/or referred elsewhere, and if referred, the reasons for referral.

(4) Treatment goal identification. The treatment goals including those articulated by the client shall be recorded in the treatment record so as to be readily identifiable and accessible. Each goal must derive from the mental health assessment, and be updated as follows:

(a) To reflect significant changes in the client's status which may affect goal pursuit; and

(b) When significant new goals are identified.

(5) Treatment plan and the PSRB Order of Release. An individualized treatment plan, developed from the mental health assessment, and the client's goals so far as possible, must be completed, signed and dated by a QMHP within 60 days of the client's enrollment. The plan must be readily identifiable and accessible within the treatment record and be written at a level of specificity that will permit its subsequent implementation to be efficiently monitored and reviewed. The recorded plan shall contain the following minimum components:

(a) Specific objectives that clearly state in language understandable to the client, the component steps, or outcomes for each treatment goal, and the criteria for determining when each objective or outcome is attained;

(b) The specific services or interventions to be used to achieve each objective;

(d) Specific efforts to be undertaken by the clients both:

(A) As a participant in services being offered by the provider; and

(B) Those to be undertaken by the client personally in their daily or ongoing living activities.

(e) Identification of the qualified person assigned to the client who is responsible for coordinating services.

(6) Client participation in treatment planning. The QMHP responsible for providing services to the client must document in the client's treatment record that:

(a) The treatment goals including the client's goals for seeking services, as noted in the assessment, have been discussed with the client and consented to;

(b) The proposed treatment activities and service approaches have been discussed with the client and consented to;

(c) The provider is exempt from complying with subsection (a) or (b) of this section if the QMHP documents in the treatment record that the client is unable to participate as required in subsection (a) or (b) of this section; or, that such participation would jeopardize the client's treatment;

(d) When and if the circumstances which prevented the completion of one or more actions required by subsection (a) or (b) of this section change, such that client participation and consent can occur, the client must be afforded the opportunity to participate in the activities, and that participation must be documented in the treatment record.

(7) Medical services. Psychiatric evaluation services, and within resources specifically allocated for the purpose, other medical screening services, shall be provided. Delivery of any such services must be documented so as to be readily accessible and identifiable in the client's record, and must meet the following standards:

(a) Psychiatric evaluations shall be performed by a medical professional who is a psychiatrist, other physician, or licensed medical professional with prescriptive privileges, any of whom must be a QMHP:

(A) If the evaluation is performed by the provider's employed or contracted medical professional, it must be completed within 60 days of the client's enrollment, unless a similar evaluation was performed within 180 days prior to the enrollment. A psychiatric evaluation must be performed at least once annually. The evaluation must contain pertinent psychiatric history and information, a psychiatric diagnostic statement, and identification of medications recommended for the client's psychiatric condition;

(B) If the evaluation is performed by a medical professional not employed by, or under contract to, the provider, a summary of the evaluation must be obtained in a timely manner and include a diagnostic statement and medications recommended.

(b) If resources have been allocated for the purpose, medical screenings as follows will be provided to determine whether the client has organic diseases or conditions that cause or exacerbate the client's mental or emotional disturbance:

(A) A comprehensive health history;

(B) A physical examination;

(D) Other laboratory, radiological, or diagnostic tests that may be indicated by history and physical examination.

(c) Medical screening shall be ordered within 60 days after enrollment of the client, unless a screening was performed within 180 days prior to enrollment. The data collected from the medical screening must be reviewed by a licensed medical professional, and the findings and interpretation(s), along with the licensed medical professional's recommendations for further medical tests, evaluations and treatment, filed in the treatment record;

(d) All orders for medication, laboratory and other medical procedures issued by medical staff of the provider shall be recorded in the treatment record in conformance with standard medical practice. Such orders, whether written or verbal, shall be initiated and authenticated by a licensed medical professional with prescriptive privileges. Relevant medical orders issued by medical personnel not employed by, or under contract to, the provider shall be documented through periodic consultation or exchange of information;

(e) A medication use record documenting all medications or agents prescribed or recommended for the client shall be signed by the provider's licensed medical professional having prescriptive privileges and shall be maintained so as to be readily identifiable and accessible in the treatment record. Documentation for each medication or agent prescribed or recommended shall include the following:

(A) Name of medication or agent;

(B) Dosage and method of administration;

(D) If administered by provider staff, the dates administered, and the signature and identification of the staff person(s) administering the medication; and

(E) Observed affects and side effects, including laboratory findings and corrective actions taken for side effects.

(8) Progress notes. Progress notes, documenting client progress toward meeting treatment plan objectives, must be recorded so as to be readily identifiable and accessible within the client's treatment record, and must meet the following requirements:

(a) A progress note shall be recorded and signed by the qualified person providing the service each time a service is provided; or at any time a significant change occurs in the client's condition;

(b) Each progress note shall specify the service(s) provided, the date provided, and the amount of time it took to delivery each service. As appropriate, progress notes shall document:

(A) Periodic discussions with the client concerning progress or difficulty in meeting objectives identified in the treatment plan;

(B) Significant changes in the client's condition including, at a minimum, documentation of changes in the client's mental status;

(D) Description of modifications to the treatment plan that are necessary due to paragraphs (A), (B), and (C) of this subsection; and

(E) Description of services provided that depart from the treatment plan.

(9) Periodic review of assessment and plan. A review and update of each client's mental health assessment and treatment plan shall occur at least annually, unless greater frequency is required by client needs, OAR 309-0160080, or the PSRB. A copy of the review and update shall be submitted to the PSRB. Reviews and updates must be recorded so as to be readily identifiable and accessible within the treatment record and must be signed by the QMHP providing services and by supervisory personnel:

(a) The Mental Health Assessment review and update must include:

(A) An interim history, including significant changes in the client's environment, functioning, and mental status;

(B) A summary of treatment interventions used and client response; and

(b) The Treatment Plan review shall summarize client's progress toward meeting treatment objectives and shall include updates of, or modifications to, the treatment plan objectives.

(10) Services termination summary. A services termination summary shall be completed for each client for whom the provider no longer assumes treatment responsibility. The summary must be prepared and signed by the QMHP responsible for the provision of services to the client, and be readily identifiable and accessible within the client's treatment record. The summary must be formulated and written and the client's record closed no later than 90 days after the last treatment service contact with the client, unless otherwise specified in the treatment plan. This requirement for closure of the client's treatment record is independent of, and unrelated to, requirements for CPMS termination:

(a) The services termination summary shall include the following minimum information:

(A) The date of termination, including the date of last contact with the client;

(B) Reasons for termination;

(D) Summary of client's status and level of functioning, including goals not accomplished; and

(E) Prognosis and recommendations for further services.

(b) In the case of a client's discharge from PSRB jurisdiction, the client, to the extent able, and family members or significant others, to the extent appropriate, shall participate in services termination planning. Such participation shall be documented;

(c) Client non-appearance. When treatment responsibility is terminated for a client who no longer appears for services, the provider must document efforts made to locate or contact the client, and, for any client remaining under PSRB jurisdiction, immediately notify the PSRB.

309-032-0505

Service Supervision

Except as provided for by section (2) of this rule, any staff providing services to a client shall be supervised:

(1) Approval of treatment plan. The service supervisor, or a psychiatrist, or a physician who is a QMHP shall review and approve by signature, the treatment plan and each periodic plan update for each client. The review(s) shall determine the appropriateness of the relationship between client needs, proposed services, services provided, and intended results. Reviews shall, at minimum, include reviewing the client's case with the qualified person(s) providing services to the client or by examining the client's treatment record.

(2) Service supervision exceptions. Notwithstanding the supervision requirements above, the provider may modify the requirements specified in these rules for supervision of staff:

(a) Who are licensed under Oregon Revised Statutes to conduct private practice without supervision (such as a physician, psychologist, or social worker); and

(b) Who are qualified mental health professionals; and

(d) Who are supervisors not under supervision of another supervisor, and whose activities are not required to be supervised by OAR 309-016-0075, and 309-016-0080.

309-032-0510

Utilization Review

Utilization reviews shall be conducted quarterly in accordance with applicable administrative rules and must include at least the following components:

(1) Completeness review. Consumer records shall undergo a completeness review to determine that all entries necessary to document services are present, that the records are accurate, and that the records contain all information, forms, and signatures required by these rules. The completeness review shall be conducted every quarter on a random sample of at least three percent of all active PSRB cases with no fewer than three of those cases not subject to reviews required by OAR 309-016-0090 . If fewer than three PSRB service consumers are enrolled, the completeness review must include each consumer's record.

(2) Content review. The content of consumer records shall be examined by a committee consisting of at least the following members:

(a) A qualified mental health professional on the staff of the provider;

(b) A qualified mental health professional not on the staff of the provider; and

(c) A licensed medical professional who is a qualified mental health professional and, when necessary, meets additional requirements set by OAR 309-016-0090 concerning Utilization Review Requirements;

(d) The content review shall be conducted on a random sample of at least three percent of all active cases, with no fewer than three cases selected for the sample, or all PSRB service consumers if fewer than three persons are enrolled. The review shall meet any additional sampling requirements set by OAR 309-016-0090 concerning Utilization Review Requirements.

(3) Utilization review summary. Upon completion of each quarterly utilization review a summary shall be written of both the content review and the completeness review findings, presented to the provider director or designee, and retained in the provider's administrative files. The summary shall include recommended corrective action(s), if any. Documentation of corrective actions taken shall be filed in the appropriate administrative file.

(4) Utilization review records access. Utilization reviews of consumer records shall be available for examination by appropriate local, state, and federal agency representatives.

Stat. Auth.: ORS 409.050
Stats. Implemented: ORS 161.295 - 161.430, 428.205 - 428.270
Hist.: MHD 2-1991, f. 1-30-91, cert. ef. 2-1-91; MHD 3-2006(Temp), f. & cert. ef. 11-1-06 thru 4-25-07

309-032-0515

Variances

(1) Criteria for a variance. Variances may be granted to a CMHP or a provider if there is a lack of resources to implement the standards required in this rule or if implementation of the proposed alternative services, methods, concepts or procedures would result in services or systems that meet or exceed the standards in these rules.

(2) Variance application. The CMHP or provider requesting a variance shall submit, in writing, an application to the Division that contains the following:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A description of the individual's opinion and participation in requesting the variance;

(e) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(f) Signed documentation from the CMHP or the provider indicating its position on the proposed variance.

(3) Division review. The Assistant Director or designee of the Division shall approve or deny the request for a variance.

(4) Notification. The Division shall notify the CMHP or the provider of the decision. This notice shall be given to the CMHP or the provider within 30 days of the receipt of the request by the Division with a copy to other relevant sections of the Division.

(5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Assistant Director of the Division, whose decision shall be final.

(6) Written approval. The CMHP or the provider may implement a variance only after written approval from the Division. The intergovernmental Agreement shall be amended to the extent that the variance changes a term in that agreement.

(7) Duration of variance. A variance shall be reviewed by the Division at least every two years.

Standards for Adult Mental Health Services

309-032-0525

Purpose and Statutory Authority

(1) Purpose. These rules prescribe standards and procedures for community mental health rehabilitation services for adults. All adult mental health services provided under this rule will endeavor to promote recovery, independence and successful community living, by or through:

(a) Communication of hope, and promotion of emotional, behavioral and psychological growth through persistent efforts to attain individual goals;

(b) The promotion of skills and knowledge to help individuals effectively manage their mental health concerns and develop a sense of hope and sense of self that is not illness dominated; and

(2) Statutory Authority. These rules are authorized by ORS 430.041 and 430.640(1)(h) to carry out the provisions of ORS 426.490 through 426.500 and 430.630.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0535

Definitions

As used in these rules:

(1) "Abuse" means one or more of the following:

(a) Any death caused by other than accidental or natural means.

(b) Any physical injury caused by other than accidental means, or that appears to be at variance with the explanation given of the injury.

(d) Sexual harassment or exploitation, including but nor limited to any sexual contact between and employee of a facility or community program and an adult.

(2) "Adult" means and individual 18 years of age or older.

(3) "Case Management" means services provided by a QMHP or QMHA to a consumer who requires access to benefits and services from local, regional or state allied agencies or other service providers. Case management includes advocating for the consumer's treatment needs, providing assistance in obtaining entitlements based on mental or emotional disability, accessing housing or residential programs, coordinating services including mental health treatment, educational or vocational activities, and arranging alternatives to inpatient hospital services.

(4) "Client Process Monitoring System" or "CPMS", means the automated consumer data system maintained by the Division.

(5) "Clinical Formulation" means the documentation of the clinical judgments which lead to decisions in regard to diagnosis, prognosis, the priority and sequences of treatment goals and to the type and intensity of clinical interventions described in the treatment plan.

(6) "Clinical Record" means a collection of all documentation regarding a consumer's mental health treatment and related services. It is a document and provides the basis by which the provider manages service delivery and quality management. For the purpose of confidentiality, it is considered a medical record as defined in ORS Chapter 179.

(7) "Community Mental Health Program" or "CMHP" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, and operated in a specific geographic area of the state under an omnibus contract with the Division.

(8) "Consumer" means an adult who receives or is eligible to receive mental health services from a provider funded and authorized through the Division.

(9) "Declaration for Mental Health Treatment" means a document that states the consumer's preferences or instructions regarding mental health treatment as defined by ORS 127.000 through 127.737.

(10) "Diagnosis" means the principal mental disorder(s) identified in a five axis diagnosis listed in the most recently published edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, that constitutes the medically appropriate reason for clinical care and the main focus of treatment for a consumer. The diagnosis is determined through the mental health assessment and any examinations, tests, procedures, or consultation suggested by the assessment.

(11) "Discharge" means the conclusion of the planned course of services described in the individualized treatment plan, regardless of outcome or attainment of goals described in the individualized treatment plan.

(12) "Discharge Summary" means a written description of consumer status and progress related to goals and objectives listed in the treatment plan form the time of admission to the termination of services.

(13) "Division" means the Mental Health and Developmental Disability Services Division of the Oregon Department of Human Services.

(14) "Goal" means an expected result or condition to be achieved that provides a guideline for the direction of care, is reasonable and realistic, and is related to an identified need or problem in the treatment plan. It also identifies what the consumer wishes to achieve.

(15) "Informed Consent" means the consumer and, if appropriate, guardian, after being provided with a description of the proposed services and information concerning potential risks and benefits of service procedures, has voluntarily agreed to participate in the services. This includes his/her right to participate in the development and periodic review of an individualized treatment plan, to be informed of his/her diagnosis (after the mental health assessment has been conducted), and an explanation of the purpose of any prescribed medication and potential side effects. The consumer is also informed of his/her right to withdraw consent and file a grievance at any time.

(16) "Licensed Medical Practitioner" or "LMP" means a person who meets the following minimum qualifications as documented by the LMHA or designee:

(a) Holds at least one of the following educational degrees and a valid license:

(A) Physician licensed to practice in the State of Oregon;

(B) Nurse practitioner licensed to practice in the State of Oregon; or

(b) Whose training, experience and competence demonstrate the ability to conduct a mental health assessment and provide medication management; and

(c) When the LMP is not a psychiatrist, the LMP is required to have access to consultation services provided by a psychiatrist, either through directs employment by the provider or through written contract between the LMP and the consulting psychiatrist.

(17) "Local Mental Health Authority" (LMHA means the county court or board of county commissioners of one or more counties who choose to operate a community mental health program, or in the case of a Native American reservation, the tribal council, or if the county declines to operate or contract for all or part of a community mental health program, the board of directors of a public or private corporation which contracts with the Division to operate a CMHP for that county.

(18) "Medication use record" means information kept in the consumer's clinical record which documents medications and/or agents prescribed or recommended by, a LMP and includes medication progress notes as applicable.

(19) "Mental Health Assessment" means a process in which the consumer's need for mental health services is determined through evaluation of the consumer's strengths, goals, needs, and current level of functioning.

(20) "Objective" means the written statement of an expected result or condition that is related to the attainment of a stated or specified goal. The objective is stated in measurable terms and has a specified time for accomplishment. This also means a step identified in order for a consumer to attain his/her individual goal.

(21) "Outreach" means the delivery of mental health services, referral services and case management services in non-traditional settings, such as, but not limited to, the consumer's residence, shelters, streets, jails, transitional housing sites, drop-in centers or single room occupancy hotels.

(22) "Personal Care Plan" means a written plan which a case manager or other designated person develops for persons with mental illness after assessing an individual and considering the individual's physician orders if any. The plan is developed jointly among the consumer, case manager, and residential caregiver, and identifies the care and services to be provided by the caregiver.

(23) "Persons Diagnosed with Serious Mental Illness" means an individual who is:

(a) Diagnosed by a QMHP as suffering from a chronic mental disorder as defined by ORS 426.495(2)(b) which includes, but is not limited to, conditions such as schizophrenia, serious affective and paranoid disorders, and other disorders which manifest symptoms that are not solely a result of mental retardation or other developmental disabilities, epilepsy, drug abuse, or alcoholism; which continue for more than one year, or on the basis of a specific diagnosis, are likely to continue for more than one year; and

(b) Is impaired to an extent which substantially limits the person's consistent functioning in one or more of the following areas:

(A) Home environment: independently attending to shelter needs, personal hygiene, nutritional needs and home maintenance;

(B) Community negotiation: independently and appropriately utilizing community resources for shopping, recreation and other needs;

(D) Vocational: maintaining employment sufficient to meet personal living expenses or engaging in other age appropriate activities.

(24) "Program" means an organization or other entity certified in accordance with this rule to provide community mental health services to adults.

(25) "Progress Note" means a written summary of how treatment modalities are implemented as described in the consumer's treatment plan.

(26) "Provider" means an organizational entity, agency or individual certified and/or authorized by the Division or its contractors to deliver mental health services to consumers.

(27) "Qualified Mental Health Associate" or "QMHA" means a person who delivers services under the supervision of a QMHP, and who meets the following minimum qualifications as documented by the LMHA or designee:

(a) Has a bachelor's degree in a behavioral sciences field, or a combination of at least three year's work, education, training or experience; and

(b) Has the competencies necessary to:

(A) Communicate effectively;

(B) Understand mental health assessment, treatment and service terminology and to apply the concepts;

(D) Implement interventions prescribed on a treatment plan.

(28) "Qualified Mental Health Professional" or "QMHP" means any person designated by the LMHA as a QMHP prior to the adoption of this rule, a LMP, or any other person meeting the following minimum qualifications as documented by the LMHA or designee:

(a) Possess one of the following education degrees:

(A) Graduate degree in psychology;

(B) Bachelor's degree in nursing and licensed by the State of Oregon;

(D) Graduate degree in a behavioral science(s) field;

(E) Graduate degree in recreational art, or music therapy; or

(F) Bachelor's degree in occupational therapy and licensed by the State of Oregon; and

(b) Whose education and experience demonstrates the competencies to identify precipitating events; gather histories of mental, emotional and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social, and work relationships; conduct a mental status assessment; document a multiaxial DSM diagnosis; write and implement or supervise implementation of a treatment plan; conduct and document a mental health assessment; and provide mental health treatment and rehabilitative services within the scope of his or her practice.

(29) "Recovery" means the process of a person regaining his/her health, safety, and independence following a diagnosis of a psychiatric disorder.

(30) "Supervisor" means a QMHP who has two years of postgraduate experience providing mental health services to adults and who, in accordance with this rule, reviews and oversees the services provided to consumers.

(31) "Treatment plan" means an individualized, written plan developed by a QMHP with consumer involvement which is based on the consumer's mental health assessment and defines specific service and treatment goals and objectives and the proposed interventions.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & ORS 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0545

Adult Mental Health Services

(1) In accordance with ORS 426 and ORS 430 the following services shall be provided:

(a) Crisis services shall be readily available and include the following:

(A) 24 hours, seven days per week telephone or face-to-face screening to determine a person's need for immediate community mental health services; and

(B) Development of a written initial crisis plan which includes a provisional diagnosis and a brief description of the services necessary to help the individual effectively manage his/her mental health crisis.

(b) Mental health assessment and treatment planning;

(d) Medication management as identified in the consumer's individualized treatment plan;

(e) Individual, family and group therapies and other community-based services identified in the consumer's individualized treatment plan.

(2) In addition to the services listed in OAR 309-032-0545(1) case management services shall be made available to persons diagnosed with serious mental illness in accordance with ORS 426.500(3) and include the following:

(a) Assistance in applying for benefits to which the consumer is entitled. Staff shall routinely help consumers secure resources such as Social Security benefits, General Assistance, food stamps, vocational rehabilitation, and housing assistance. When needed, staff shall accompany consumers to help them apply for benefits.

(b) Assistance in helping the consumer complete and update a personal crisis plan or a declaration for mental health treatment with the consumer's participation and informed consent.

(d) Symptom-management efforts directed to help each consumer identify the symptoms and occurrence patterns of his or her mental illness and develop methods (internal, behavioral, or adaptive) to help lessen their effects;

(e) Promote linkages to work-related services that help the consumer find and maintain employment in community-based job sites;

(f) When a consumer resides in a Residential Treatment Home or Residential Treatment Facility, the case manager will collaborate with the facility to arrange the necessary treatment services and coordinate residential and nonresidential treatment;

(g) When a consumer is placed in an Adult Foster Home, the case manager will assist in development of the Personal Care Plan. Additionally, the case manager shall evaluate the appropriateness of services in relation to the consumers assessed need and review the Personal Care Plan every 180 days;

(h) When a consumer is admitted to a hospital or nonhospital facility for psychiatric reasons, the case manager shall make contact in person or by telephone with the consumer within one working day of admission. The consumer's case manager shall be actively involved with discharge planning from the hospital or nonhospital facility;

(i) If a consumer is hospitalized in a state psychiatric hospital, the case manager shall, from the point of admission, be actively involved with discharging the consumer from long term care; and

(j) Monitoring health and safety needs for consumers who reside in community settings including residential programs licensed by the Department of Human Services. Where significant health and safety concerns are identified, the case manager shall assure that necessary services or actions occur to address the identified health and safety needs for the consumer.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0555

Consumer Rights

In addition to consumer rights in applicable Oregon Revised Statutes, Oregon Administrative Rules, and elsewhere in these rules, the following is required specific to services received:

(1) Notification of rights. The provider shall make available to the consumer and, if appropriate, guardian a document which describes the consumers' rights and responsibilities, including, at a minimum, freedom from abuse as defined in ORS 430.735 by an employee of the provider. Information and material shall be provided to the consumers in written form or in alternative format or language appropriate to the consumers' need, upon request. The rights, responsibilities, and how to exercise them, shall be explained to the consumer, and if appropriate, guardian at the beginning of each episode of treatment. The specification of rights and responsibilities shall also be posted visibly in an area frequented by consumers.

(2) The consumer shall have a humane service environment that affords reasonable protection from harm and affords reasonable privacy.

(3) The consumer shall be provided services in a setting under conditions that are least restrictive to the person's liberty, that are least intrusive to the person and that provide for the greatest degree of independence.

(4) The consumer shall receive no services without informed voluntary written consent except as permitted by law.

(5) The consumer and others of the consumer's choice shall be afforded the opportunity to participate in the planning and provision of services with the consumer's consent.

(6) The consumer shall have the right to refuse services, including any specific procedure without suffering punitive consequences. If adverse consequences are expected to result from such refusal, that fact must be explained verbally to the consumer and, if appropriate, guardian.

(7) The consumer shall not be involuntarily terminated or transferred from services without prior notice, notification of available sources of necessary continued services and exercise of a grievance procedure.

(8) The consumer shall have access to and communicate privately with any public or private rights protection program or rights advocate.

(9) Grievance policy: The consumer shall have the right to file a grievance or complaint, free from retaliation, and receive assistance when needed in submitting a grievance or complaint. The program shall develop, implement, and fully inform consumers of policies and procedures that provide for:

(a) Receipt of oral and written grievances from consumer and, if appropriate, guardian acting on his/her behalf;

(b) Investigation of the facts pertaining to the grievance;

(d) Documentation in the consumer's record of the receipt, investigation, and action taken regarding the grievance.

(10) Declaration of mental health treatment. The consumers shall be informed of their right to execute a declaration of mental health treatment.

(11) Informed consent to fee-for-service. The amount and schedule of payment of any fees to be charged must be disclosed in writing and agreed to by the consumer and, if appropriate, guardian.

(12) Respect and dignity. A provider shall maintain written policies and procedures with regard to a consumer's rights. The policies and procedures shall assure that the consumer's right to be treated with respect and dignity is safeguarded.

(13) Alternative format. Information and materials shall be provided to the consumer in written form or in an alternative format or language appropriate to the consumer's needs.

(14) Cultural Competence. A provider shall ensure that the provision of care is culturally appropriate by demonstrating both awareness of and sensitivity to cultural differences.

(15) Gender Specific. A provider shall ensure that the provision of care is gender appropriate by demonstrating both awareness of and sensitivity to gender differences.

(16) Mandatory abuse reporting. All providers are required to report incidents of abuse when the provider comes in contact with and has reasonable cause to believe that a consumer has suffered abuse.

(17) Prohibition of discrimination. All providers shall make reasonable modifications in policies, practices, and procedures to avoid discrimination.

(18) American with Disabilities Act (ADA). Providers shall comply with the ADA.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 - ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0565

Clinical Record

(1) An individualized clinical record shall be maintained for each consumer that includes the following:

(a) Basic identifying information:

(A) CPMS enrollment data where required;

(B) Identifying data including the consumer's name, address, telephone number, date of birth, gender and marital status;

(C) Name, address, and telephone number of legal guardian and family members or other persons to contact in case of an emergency as authorized by the consumer; and

(D) Name, address and telephone number of the consumer's physician;

(b) Written documentation that the consumer and, if appropriate, guardian consents voluntarily to services after being provided with a description of the proposed services and information concerning potential risks and benefits of service procedures. This includes his/her right to participate in the development and periodic review of an individualized treatment plan, to be informed of his/her diagnosis (after the mental health assessment has been completed), and the purpose of any prescribed medication and potential side effects. The consumer is also informed of his/her right to withdraw consent and file a grievance or request a hearing at any time.

(c) If the consumer has a validly executed declaration for mental health treatment, a copy of the declaration for mental health treatment as set forth in ORS 127.736 shall be placed in the clinical record in accordance with ORS 127.703(1)(b).

(2) Each program shall:

(a) Maintain the consumer clinical record for a minimum of seven years after the consumer has been discharged form services.

(b) Permit inspection of consumer clinical records upon request by the Division to determine compliance with these rules.

(c) Not falsify, alter, or destroy any consumer information required by these rules to be maintained in the clinical record.

(d) Maintain each clinical record to assure permanency, timely completion of documentation, identification, accessibility, uniform organization, and completeness of all components required by these rules. Errors in the permanent clinical record shall be corrected by lining out the incorrect data with a single line in ink, adding the correct information, and dating and initialing the correction. Errors may not be corrected by removal or obliteration through the use of correction fluid or tape so they cannot be read.

(e) Comply with state and federal laws and pertaining to confidentiality of consumer records and shall have authentication protocols for electronic consumer records to ensure the safety and integrity of confidentiality.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0575

Documentation of Clinical Services

All providers shall develop and maintain an individual, legible, clinical record for each consumer served under these rules which is completed in a timely manner. Documentation of clinical services shall include the following:

(1) Mental health assessment. The mental health assessment shall be conducted by a QMHP for all consumers receiving community mental health services and include a determination of the consumer's mental status and other documentation to support the determination of a DSM 5-Axis diagnosis and a written clinical formulation. The clinical formulation shall provide a description of the following:

(a) Presenting problems and/or concerns;

(b) Important biological, cultural, psychological and social factors which are a priority for intervention;

(d) Consumer/family expectations for recovery;

(e) Issues/concerns to be addressed in the consumer's treatment plan which warrant treatment and or management;

(f) Justification for treatment services and prognosis;

(g) For consumers with a diagnosed co-occurring substance use or abuse problem or condition the following shall also be included in the clinical formulation:

(A) Acute intoxication and/or withdrawal potential;

(B) Biomedical conditions or complications;

(D) Readiness to change including treatment acceptance or resistance;

(E) Relapse/continued use potential; and

(F) Recovery environment and social supports.

(h) The mental health assessment shall be updated annually to include, at a minimum, the charges in the consumer's mental status, social support system, level of functioning, and shall document the consumer's participation in treatment planning.

(2) Treatment plan. An individualized treatment plan shall be developed no later than 45 calendar days after the date of initiation of services and include the following:

(a) Identify problems to be addressed based upon the needs identified in the mental health assessment and the consumer's readiness for treatment services;

(b) Include goals and objectives that are individualized, recovery-oriented, measurable, timely, and appropriate to the identified service needs;

(A) Services and activities to achieve identified goal(s) and objectives;

(B) Estimated frequency and duration of each service activity, or where flexible service delivery methods are identified as the treatment method of choice, a description of the flexible services to be provided to the consumer;

(D) Documentation indicting the consumer and/or guardian (and family, where appropriate) was involved in treatment planning to the degree the consumer and/or guardian and family were capable of assisting;

(d) Documentation indicating that the treatment plan has been updated at least annually or in response to changes in the consumer's condition or relationships, such as changes in place of residence, employment status, divorce, homelessness, or improved or worsening symptomology.

(3) Progress notes shall meet the following requirements:

(a) A progress note shall be recorded and legible and signed by the person providing the service each time a service is provided and at any time a significant change occurs in the consumer's condition. However, a two week summary progress note may be done to record the delivery of Daily Structure and Support, and Skills Training, provided the number, dates of delivery, and time taken to provide the services are recorded;

(b) Each progress note shall specify the type of service(s) provided, the date provided, and the setting in which service was provided. Progress notes shall also document:

(A) Consumer/Family involvement in accomplishing goals as planned;

(B) Periodic discussions with the consumer concerning progress toward meeting goals identified in the treatment plan;

(D) Description of other significant problems or events as they occur and their effect on the consumer; and

(E) Contacts with other agencies providing services to the consumer or for the purpose of referral.

(4) Medical services. Medical services shall be provided and documented in a legible manner consistent with professional and community standards of care and shall include the following:

(a) Orders for medication, laboratory and other medical procedures shall be recorded in the clinical record in conformance with standard medical practice. Such orders, whether written or verbal, shall be initiated and authenticated by a LMP. Consultation and/or exchange of information with other medical personnel who are not employed by, or under contract to, the provider shall be documented in the clinical record.

(b) Written documentation of medications prescribed for the consumer by a LMP shall maintained in the clinical record. Documentation for each medication prescribed shall include the following:

(A) A copy or detailed written description of the signed prescription order;

(B) The name of medication prescribed;

(D) The date medications were prescribed, reviewed, or renewed;

(E) The date, the signature and credentials of staff administering and/or prescribing medications; and

(F) Medication use record which contain:

(a) Observed side effects including laboratory findings;

(b) Medication allergies and adverse reaction; and

(c) Documentation that the consumer was asked about possible adverse effects of medications, including sexual dysfunction, and evaluation for tardive dyskinesia when appropriate.

(5) A discharge summary shall include the following:

(a) Written documentation of the last service contact with the consumer, the diagnosis at admission and a summary statement that describes the effectiveness of treatment modalities and progress relative to goals listed in the treatment plan while in service;

(b) The reason(s) for discharge, changes in diagnosis during the course of treatment, current diagnosis and level of functioning, and prognosis and recommendations for further treatment. Discharge summaries shall be completed within 30 calendar days after a planned discharge and within 45 calendar days after an unplanned discharge.

(d) When participation in services is terminated for a consumer who no longer appears for services, the provider shall document efforts made to locate or contact the consumer, or document the reason why such efforts were not made.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0585

Service Supervision

Except as provided for by section (2) of this rule, any staff providing services to a consumer shall be supervised.

(1) Employees of programs certified in accordance with this rule and other contracted persons providing services to consumers shall receive supervision by a qualified supervisor in regard to the development and implementation of the treatment plan and in monitoring the effectiveness of services.

(2) Service supervision exceptions. Notwithstanding the supervision requirements above, the provider may modify the requirements specified in these rules for supervision of independent contractors who are QMHPs and are licensed under existing Oregon Revised Statutes to conduct independent practice without supervision.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0595

Quality Management Requirements

Providers shall develop and implement a planned, systematic and ongoing process for monitoring, evaluating, and improving the quality and appropriateness of services provided to adults. The quality management system shall include a quality management committee and a quality management plan which together implement a continuous cycle of measurement, assessment and improvement of clinical outcomes based on input from other service providers and consumers.

(1) The quality management committee shall develop and implement the quality management plan and shall be a catalyst for improvement in the organization's clinical outcomes. The quality management committee shall be composed of:

(a) One or more QMHPs, including an LMP, who are representative of the scope of services delivered;

(b) A representative or representatives of the adults served. Additionally the organization shall invite and support representatives of family members of consumers to participate as members of the quality management committee;

(c) Other persons who have the ability to identify, design, measure, assess and implement clinical and organizational changes; and

(d) Other persons as deemed necessary to assure the provision of culturally competent and non-discriminatory service delivery.

(2) The quality management committee duties shall:

(a) Identify indicators of quality;

(b) Identify measurable and time-specific performance objectives;

(d) Develop a process to systematically collect outcome data and identify staff who will collect and analyze data;

(e) Oversee the data collection process;

(f) Analyze the information collected and measure progress toward performance objectives;

(g) Identify clinical and operational changes necessary to achieve performance objectives;

(h) Implement clinical or operational changes that are indicated by the achievement or non-achievement of performance objectives; and

(i) Reassess and, if necessary, revise objectives and methods to measure performance on an ongoing basis.

(3) The quality management committee shall meet at least quarterly.

(4) The written quality management plan shall describe the implementation and ongoing operation of the functions performed by the quality management committee. The quality management plan shall include:

(a) A description of the quality management committee's authority to identify and implement clinical and organizational changes;

(b) The composition and tenure of the quality management committee;

(d) The policies and procedures for identifying measurable performance objectives;

(e) The policy and procedures for identifying and using data sources;

(f) The indicators of quality in the following domains:

(A) Access to services;

(B) Quality of care;

(D) Outreach and prevention.

(g) The policies and procedures for reporting, tracking, investigating, and analyzing reports of critical incidents;

(h) The policies and procedures for both reviewing documentation and determining that the staff have the required competencies and credentials to perform assigned duties and meet the provider's performance objectives;

(i) The policies and procedures to manage utilization of services;

(j) The policies and procedures for reviewing and responding to complaint and grievance information; and

(k) The policies and procedures for conducting clinical record reviews.

(5) A written summary of the pertinent facts and conclusions of each quality management committee meeting will be maintained and be available for review.

(6) The quality management committee shall evaluate the quality management plan at least annually and update the quality management plan as necessary.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

309-032-0605

Variances

(1) Criteria for a variance. Variances may be granted to a CMHP or provider if there is a lack of resources to implement the standards required in this rule or if implementation of the proposed alternative services, methods, concepts or procedures would result in services or systems that meet or exceed the standards in these rules.

(2) Variance application. The CMHP or provider requesting a variance shall submit, in writing, an application to the Division which contains the following:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(e) Signed documentation from the LMHA or designee recommending approval for the proposed variance.

(3) Office of Mental Health Services review. The Assistant Administrator or designee of the Office of Mental Health Services shall approve or deny the request for a variance.

(4) Notification. The Office of Mental Health Services shall notify the CMHP and/or provider in writing of the decision to approve or deny the requested variance. This notice shall be given to the CMHP and provider within 30 days of the receipt of the request by the Office of Mental Health Services.

(5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Administrator of the Division, whose decision shall be final.

(6) Written approval. The CMHP or provider may implement a variance only after written approval from the Division.

(7) Duration of variance. A variance to these rules shall be valid for a period of no more than two years. A variance may be reissued through written application for a variance from the CMHP or provider, as described above, and upon written approval by the Office of Mental Health Services.

Stat. Auth.: ORS 430.041 & ORS 430.640
Stats. Implemented: OAR 426.490 – ORS 426.500 & 430.630
Hist.: MHD 7-1992, f. & cert. ef. 9-30-92; MHD 6-2001, f. 7-26-01, cert. ef. 7-27-01

Standards for Enhanced Care Services

309-032-0720

Purpose and Statutory Authority

(1) Purpose. These rules prescribe standards and procedures for the delivery of mental health services designed to treat eligible persons with severe mental illness residing in selected Senior and Disabled Services Division licensed facilities.

(2) Statutory Authority. These rules are authorized by ORS 430.041 and 430.640(1)(h) to carry out the provisions of ORS 426.490 through 426.500 and 430.630.

Stat. Auth.: ORS 426.500, ORS 430.041, ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0730

Definitions

As used in these rules:

(1) "Activities" refers to rehabilitative services or recreational events developed by the treatment team to address a resident's needs.

(2) "Aids" refers to Certified Nursing Assistants in nursing homes and non-certified aides in residential care facilities who meet requirements set forth in section (14) of this rule.

(3) "Behavioral program" is a component of an individual treatment plan that addresses behavioral dysfunctions.

(4) "Care plan" refers to the individual plan developed by Senior and Disabled Services Division contractors under OAR 411-086-0060, Comprehensive Assessment and Care Plan. The care plan may reference or include the mental health treatment plan described in section (15) of this rule.

(5) "Client Process Monitoring System (CPMS)" means the automated client data system maintained by the Division.

(6) "Community mental health program (CMHP)" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, and operated in a specific geographic area of the state under an omnibus contract with the Mental Health and Developmental Disability Services Division.

(7) "County of origin" means the county having psychiatric hospitalization responsibility for an individual prior to placement in the Enhanced Care Services program.

(8) "Day treatment" means direct mental health or rehabilitative services provided to the resident by CMHP staff as defined in the treatment plan.

(9) "Division" means the Mental Health and Developmental Disability Services Division of the Department of Human Services of the State of Oregon.

(10) "Enhanced Care Services (ECS)" means services which enable eligible residents in designated Senior and Disabled Services Division facilities to control or decrease identified behavior problems, manage psychiatric symptoms, and maintain, improve or minimize deterioration in their psycho-social and functional status.

(11) "Enhanced Care Services Coordinator" means a qualified mental health professional employed by the Division or its subcontractor who is responsible for providing administrative and clinical support to Senior and Disabled Services Division (SDSD) staff, SDSD providers, CMHP and hospital staff serving clients who receive Enhanced Care Services.

(12) "Mental health aide" is a qualified mental health associate or a designated certified nursing assistant who implements programs described in an individual treatment plan under the supervision of a QMHP.

(13) "Provider" means an organizational entity which is licensed by the Senior and Disabled Services Division and is responsible for the direct delivery of adult foster home, residential care or nursing facility services.

(14) "Qualified mental health associate (QMHA)" means a mental health staff with qualifications defined in OAR 309-016-0005(22), Medicaid Payment for Community Mental Health Services.

(15) "Qualified mental health professional (QMHP)" means a mental health practitioner employed by the Division or its subcontractor with qualifications defined in OAR 309-016-0005(23), Medicaid Payment for Community Mental Health Services.

(16) "Resident" as used in these rules means, an individual who resides in a Senior and Disabled Services facility and receives Enhanced Care Services.

(17) "Senior and Disabled Services Division (SDSD)" means the Department of Human Services agency responsible for the provision of community based care and nursing facility services to eligible persons as specified in OAR Chapter 411; Division 50, Adult Foster Homes; Division 55, Residential Care Facilities; Division 65, Specialized Living Facilities; Division 70, Title XIX Long-Term Care Facilities; Division 85, Nursing Facilities, Generally; Division 86, Administration and Services; Division 87, Physical Environment; Division 88, Transfer Rules; and Division 89, Complaints, Inspection Sanctions.

(18) "Treatment plan" means the mental health plan developed by CMHP staff in conjunction with provider staff required by OAR 309-016-0005(28), Medicaid Payment for Community Mental Health Services. This plan will be included or referenced in the providers care plan, in section (3) of this rule.

(19) "Treatment team" means the resident or legal representative, supervising QMHP, nurse practitioner or physician providing psychiatric services, and QMHA or activities aide, who meet weekly with provider staff (section (10) of this rule) to coordinate and develop the treatment plan.

Stat. Auth.: ORS 426.500, ORS 430.041 & ORS 430.630
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0740

Services to be Provided

(1) Standards. Enhanced Care Services shall be provided consistent with OAR 309-016-0000 through 309-016-0130, Medicaid Payment for Community Mental Health Services.

(2) Services. Enhanced Care Services shall include:

(a) A day treatment program or an individualized treatment program supervised by a QMHP and offered either off-site or at the SDSD licensed facility;

(b) 12 hours-a-week of activities available during evening and weekend shifts provided or arranged by the CMHP staff;

(c) Weekly treatment team meetings to review behavior programs, develop treatment plans, and coordinate care planning with provider staff and related professionals;

(d) A crisis service staffed by a QMHP or the local CMHP available to the provider and direct care staff 24 hours a day;

(e) Quarterly mental health inservice trainings delivered to the provider and related personnel working with recipients of the Enhanced Care Services.

Stat. Auth.: ORS 426.500, ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0750

Staffing

The CMHP shall ensure, through development of contracts between the CMHP and provider, that staff time will be designated as follows:

(1) QMHP responsibilities. A QMHP to coordinate admissions, discharges and weekly treatment team meetings; develop resident assessment, treatment and behavioral plans; provide on-site supervision of QMHAs and to coordinate services and trainings with facility personnel.

(2) Psychiatric consultation. On-site psychiatric consultation by a nurse practitioner or physician to include attendance at weekly treatment team meetings.

(3) QMHA responsibilities. An on-site QMHA or mental health aide to coordinate or implement day treatment, activity and behavioral programs as specified in individual treatment plans.

(4) Aide responsibilities. Aide staff assigned 24 hours-a-day to implement activities programs, behavior plans and risk management procedures designated in individual treatment plans and unit policy and procedures.

Stat. Auth.: ORS 426.500, ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0760

Eligibility Requirements

(1) Screenings. In order to be eligible for Enhanced Care Services, a person shall be determined by SDSD staff to be eligible for a nursing facility or community-based care services as defined in OAR 411-015-0100 and be determined by either the Oregon State Hospital gero-psychiatric outreach team or the Enhanced Care Services Coordinator as appropriate for Enhanced Care Services.

(2) Symptoms. An eligible person must exhibit two or more of the following: Self endangering behaviors, aggressive behaviors, intrusive behaviors, intractable psychiatric symptoms, problematic medication needs, sexually inappropriate behaviors, or elopement behaviors.

(3) Placement history. An eligible person must have a history of failed community placements or a length of stay at a psychiatric hospital of greater than 30 days and be currently ineligible for placement in a nonenhanced setting.

Stat. Auth.: ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0770

Admission Requirements

(1) Evaluation. All persons seeking Enhanced Care Services shall be evaluated by the CMHP provider and local SDSD staff prior to placement in a specific facility.

(2) Placement plan. The CMHPs and referring facility staff shall develop a 30 day consultation agreement and an alternative placement plan to be utilized in the event that the placement is unsuccessful.

(3) Release of information. All residents or their legal guardians shall be asked to sign a release of information form designating the Senior and Disabled Services Division and its licensed providers as recipients of treatment information.

(4) County of origin. The county of origin shall retain responsibility for public sector psychiatric inpatient services of residents receiving Enhanced Care Services.

Stat. Auth.: ORS 426.500 & ORS 430.630
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0780

Discharge Requirements

(1) Notification. The CMHP shall notify the Division or its designee, within three working days, of any change in a resident's medical or psychiatric condition which jeopardizes the placement.

(2) Review. The Division or its designee shall review a permanent discharge of a resident prior to transfer or within three working days after an emergency transfer or hospitalization.

Stat. Auth.: ORS 426.500 & ORS 430.630
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0790

Administrative Requirements

(1) Written agreements. The CMHP shall develop written agreements or contracts with providers which address: supervision of on-site CMHP and provider staff, risk management, census management, aide staffing levels, training, activities program, admission and discharge procedures, critical incidents, record keeping, developments of policy and procedure manuals and other service coordination issues.

(2) Team meetings. CMHP staff shall inform related professionals, such as SDSD case managers, the nurse or physician responsible for medical care, and the provider of all treatment team meetings and shall schedule meetings at times that encourage full participation.

(3) SDSD standards. All CMHP staff working in an SDSD licensed facility will comply with applicable requirements specified in OAR 309-032-0730(14).

(4) Data collection. The CMHP shall ensure that all persons receiving Enhanced Care Services are enrolled in the Division's Client Process Monitoring System (CPMS), and terminated when services are discontinued.

Stat. Auth.: ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0800

Environment

A CMHP shall provide Enhanced Care Services in SDSD licensed facilities that provide a multipurpose room, an area for residents requiring an environment with low stimulation, an accessible outdoor space with a covered area, a refrigerator and microwave conveniently located for program activities, space for staff meetings, and mental health treatment and storage of records and security doors. A minimum of one private room will be required in facilities opened after January 1, 1994.

Stat. Auth.: ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0810

Records

(1) Requirements. All Enhanced Care Services shall comply with OAR 309-016-0000 through 309-016-0130, Medicaid Payment for Community Mental Health Services; regarding documentation and record keeping.

(2) Confidentiality. CMHPs providing Enhanced Care Service shall comply with the confidentiality requirements of ORS 179.505 through 179.507, Inspection, Disclosure or Release of Patient Records by Provider.

(3) Documentation. Documentation of mental health services shall be kept in the resident's facility chart, shall be available to provider staff, and shall include the treatment plan and reviews, problem list, mental health assessment, psychiatric consultation notes, case notes and an annual review of the individual's need for a locked facility.

(4) Behavior programs. A treatment plan that addresses a behavioral dysfunction through the use of interventions such as but not limited to: soft restraints, chair devices, time out, personal holds, show of force, level systems or negative reinforcement shall include a behavioral program. The behavioral program shall:

(a) Analyze the behavior to be modified in order to develop a measurable description of the behavior which includes factors such as predictors, frequency, duration, intensity and severity;

(b) Include a description of procedures, including staff roles, which will be used in a consistent manner, to alter the problem behavior and reinforce alternative behavior;

(c) Include documentation that the resident and/or guardian and members of the treatment team are fully aware of and consent to the behavioral program;

(d) Emphasize the development of alternative behaviors, positive approaches and positive behavior intervention;

(e) Use the least restrictive intervention possible;

(f) Ensure that locked seclusion, locked restraints, abusive or demeaning intervention shall not be used; and

(g) Be evaluated by the treatment team through a weekly review of data that addresses progress toward measurable outcomes.

(5) Record access. The CMHP will ensure through agreement with providers, that staff of the CMHP shall have access to relevant resident records including medication sheets, doctor's orders, lab reports, assessments and care plans.

Stat. Auth.: ORS 430.041, ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0820

Rights

Enhanced Care Services shall operate under standards specified in OAR 309-016-0000 through 309-016-0130, Medicaid Payment for Community Mental Health Services

Stat. Auth.: ORS 430.630 & ORS 430.640(1)(h)
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

309-032-0830

Variances

A variance from these rules may be granted to an agency in the following manner:

(1) Description. An agency requesting a variance shall submit, in writing, through the community mental health program to the appropriate program or administrative office:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(e) Signed documentation from the local mental health authority indicating its support of the proposed variance.

(2) Review. The assistant administrator of the program or administrative office shall approve or deny the request for variance.

(3) Notification. The program or administrative office shall notify the community mental health program of the decision. The community mental health program shall forward the decision and reasons therefore to the program requesting the variance. This notice shall be given the program within 30 days of receipt of the request by the program or administrative office with a copy to other relevant sections of the Division and SDSD.

(4) Appeal. Appeals of the denial of a variance request shall be to the Administrator of the Division, whose decision shall be final.

(5) Duration. A variance granted by the Division shall be attached to, and become part of, the Intergovernmental Agreement for that year.

Stat. Auth.: ORS 430.041
Stats. Implemented:
Hist.: MHD 1-1995, f. & cert. ef. 4-6-95

Community Treatment and Support Services

309-032-0850

Standards for Regional Acute Care Psychiatric Services for Adults

(1) Purpose: These rules prescribe standards and procedures for regional acute care psychiatric services for adults.

(2) Statutory Authority: These rules are authorized by ORS 430.041 and ORS 430.640(1)(h) to carry out the provisions of ORS 426.490 through 426.500 and 430.630(3).

Stat. Auth.: ORS 426.490 – ORS 426.500 & ORS 430.630(3)
Stats. Implemented:
Hist. MHD 8-1994, f. & cert. ef. 11-28-94

309-032-0860

Definitions

As used in these rules:

(l) "Adult" means a person age 18 years or older.

(2) "Clinical record" means a separate file established and maintained under these rules for each patient.

(3) "Community mental health program" or "CMHP" means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, and operated in a specific geographic area of the state under an omnibus contract with the Mental Health and Developmental Disability Services Division.

(4) "Council" means an organization of persons, with a mission statement and by-laws, comprised of representatives of the regional acute care psychiatric service, state hospital, community mental health programs served, consumers, and family members. The Council is advisory to the regional acute care facility for adults.

(5) "Diagnosis" means a DSM diagnosis determined through the mental health assessment and any examinations, laboratory, medical or psychological tests, procedures, or consultations suggested by the assessment.

(6) "Division" means the Mental Health and Developmental Disability Services Division of the Department of Human Services.

(7) "DSM" means the current edition of the "Diagnostic and Statistical Manual of Mental Disorders," published by the American Psychiatric Association.

(8) "Goal" means the broad aspirations or outcomes toward which the patient is striving, and toward which all services are intended to assist the patient.

(9) "Guardian" means a person appointed by a court of law to act as a guardian of a legally incapacitated person.

(10) "Independent medical practitioner" means a medically trained person who is licensed to practice independently in the State of Oregon and has one of the following degrees: MD (Medical Doctor), DO (Doctor of Osteopathy), or NP (Nurse Practitioner).

(11) "Legally incapacitated" means having been found by a court of law under ORS 126.103 or 426.295 to be unable, without assistance, to properly manage or take care of one's personal affairs.

(12) "Linkage agreement" means a written agreement between the regional acute care psychiatric services, the local community mental health programs, and state hospitals which describes the roles and responsibilities each assumes in order to assure that the goals of the regional acute care psychiatric services are achieved.

(13) "Medical director" means a board eligible psychiatrist who oversees the patient care program. The medical director shall have the final authority concerning inpatient medical care including admissions, continuing care, and discharges.

(14) "Medical history" means a review of the patient's current and past state of health as reported by the patient or other reliable sources, including, but not limited to:

(a) History of any significant illnesses, injuries, allergies, or drug sensitivities; and

(b) History of any significant medical treatments, including hospitalizations and major medical procedures.

(15) "Mental health assessment" means a process in which the person's need for mental health services is determined through evaluation of the patient's strengths, goals, needs, and current level of functioning.

(16) "Mental status examination" means an overall assessment of a person's mental functioning that includes descriptions of appearance, behavior, speech, mood and affect, suicidal/homicidal ideation, thought processes and content, and perceptual difficulties including hallucinations and delusions. Cognitive abilities are also assessed and include orientation, memory, concentration, general knowledge, abstraction abilities, judgment, and insight.

(17) "Objective" means an interim level of progress or a component step the specification of which is necessary or helpful in moving toward a goal.

(18) "Office" means the Office of Mental Health Services of the Mental Health and Developmental Disability Services Division.

(19) "OPRCS" means the Oregon Patient/Resident Care System. OPRCS is a Division operated, on-line computerized information system which accepts, stores and returns information about patients from state operated institutions and other designated inpatient services.

(20) "Patient" means a person who is receiving care and treatment in a regional acute care psychiatric service.

(21) "Person committed to the Division" means a patient committed under ORS 161.327 or 426.130.

(22) "Program administrator" means a person, with appropriate professional qualifications and experience, appointed by the governing body to manage the operation of the regional acute care psychiatric services.

(23) "Psychiatrist" means a physician licensed as provided pursuant to ORS 677.010 to 677.450 by the Board of Medical Examiners for the State of Oregon and who has completed an approved residency training program in psychiatry.

(24) "Qualified mental health professional" or "QMHP" means a person who is one of the following:

(a) Psychiatrist or physician, licensed to practice in the State of Oregon; an individual with a graduate degree in psychology, social work, or other mental health related field; a registered nurse with a graduate degree in psychiatric nursing, licensed in the State of Oregon; an individual with registration as an occupational therapist; an individual with a graduate degree in recreational therapy; or

(b) Any other person whose education, experience, and competence have been documented by the CMHP director or designee as able to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social, and work relationships, conduct a mental status assessment; document a DSM diagnosis; write and supervise a rehabilitation plan; and provide individual, family, and/or group therapy.

(25) "Regional acute care psychiatric service" or "service" means a Division funded service provided under contract with the Division or county, and operated in cooperation with a regional or local council. A regional acute care psychiatric service must include 24 hour-a-day psychiatric, multi-disciplinary, inpatient or residential stabilization, care and treatment, for adults ages 18 and older with severe psychiatric disabilities in a designated region of the State. For the purpose of these rules, a state hospital is not a regional acute care psychiatric service. The goal of a regional acute care service is the stabilization, control and/or amelioration of acute dysfunctional symptoms or behaviors that result in the earliest possible return of the person to a less restrictive environment.

(26) "Supervisor" means a person who has two years of experience as a qualified mental health professional and who, in accordance with Section 309-032-0870 of these rules, reviews the services provided to patients by qualified persons.

(27) "Treatment plan" means an individualized, written plan defining specific rehabilitation objectives and proposed service interventions derived from the patient's mental health assessment.

Stat. Auth.: ORS 430.630(3)
Stats. Implemented:
Hist. MHD 8-1994, f. & cert. ef. 11-28-94

309-032-0870

Standards for Approval of Regional Acute Care Psychiatric Service

(1) State approvals and licenses. The facility in which a regional acute care psychiatric service is provided shall maintain state approvals and licenses as required by Oregon law for the health, safety, and welfare of the persons served. Non-hospital facilities shall be licensed by the Division as required by ORS 443.410. The facility must also be approved under OAR 309-033-0530 Approval of Hospitals and Nonhospital Facilities that Provide Services to Committed Persons and to Persons in Custody or on Diversion and OAR 309-033-0540, Administrative Requirements for Hospitals and Nonhospital Facilities Approved to Provide Services to Persons in Custody, Psychiatric Hold or Certified for 14 Days of Intensive Treatment.

(2) Clinical record management. A regional acute care psychiatric service shall maintain clinical records as follows:

(a) Clinical records are confidential, as set forth in ORS 179.505 and 192.502 and any other applicable state or federal law, except as otherwise indicated by applicable rule or law. For the purposes of disclosure from non-medical individual records, both the general prohibition against disclosure of "information of a personal nature" and limitations to the prohibition in ORS 192.502(2) shall be applicable.

(b) Clinical records shall be secured, safeguarded, stored, and retained in accordance with OAR 166-030-1015.

(c) Clinical record entries required by these rules must be signed by the staff providing the service and making the entry. Each signature must include the person's academic degree or professional status and the date signed.

(3) Clinical record content. The clinical record shall contain:

(a) Identifying demographic information, including, if available, who to contact in an emergency and the names of persons who encompass the support system of the patient.

(b) Consent to release information and explanation of fee policies. At the time of admission staff shall present the patient with forms for obtaining consent so that information may be shared with family and others. An explanation of fee policies shall also be provided in written form at the earliest time possible. The patient shall be asked to sign each. If the patient is unwilling or unable to sign, staff shall record that the person is unable or unwilling to do so.

(c) Admitting mental health assessment. An admitting mental health assessment shall be completed, by or under the supervision of an independent medical practitioner with supervised training or experience in a mental health related setting, within 24 hours of admission. The admitting mental health assessment shall include a description of the presenting problem(s), a mental status examination, an initial DSM diagnosis, and an assessment of the resources currently available to the person. The assessment shall result in a plan for the initial services to be provided. The admitting mental health assessment shall also include documentation that a medical history and physical examination of the person has been performed within 24 hours after admission by a physician, physician assistant, or nurse practitioner. If the independent medical practitioner believes a new medical history and physical examination are not necessary, and if within 30 days of admission a complete physical history has been recorded and a complete physical examination has been performed, the signed report of the history and examination may be placed in the clinical record and may be considered to constitute an appropriate physical health assessment.

(d) Psycho-social assessment. A psycho-social assessment shall be completed for each patient within 72 hours of admission. If the patient stays less than 72 hours, a psycho-social assessment need not be written. The assessment must be completed by a qualified mental health professional or supervisor. The assessment does not need to be a single document but must include the following elements:

(A) A description of events precipitating admission and any goal(s) of the patient in seeking or entering services.

(B) When relevant to the patient's service needs, historical information including: mental health history; medical history; substance use and abuse history; developmental history; social history, including family and interpersonal history; sexual and other abuse history; educational, vocational, employment history; and legal history.

(C) An identification of the patient's need for assistance in maintaining financial support, employment, housing, and other support needs.

(D) Recommendations for discharge planning and any additional services, interventions, additional examinations, tests, and evaluations that are needed.

(e) Treatment plan. A treatment plan, individually developed with the patient from the findings of the admitting mental health assessment and psycho-social assessment, must be completed by a QMHP or supervisor within 72 hours of the person's admission. The plan must be written at a level of specificity that will permit its subsequent implementation to be efficiently monitored and reviewed. The recorded plan shall contain the following components:

(A) The rehabilitation and other goals, including those articulated by the patient.

(B) Specific objectives, including discharge objectives, and the measurable or observable criteria for determining when each objective is attained;

(D) The projected frequency and duration of services;

(E) Identification of the QMHP or supervisor assigned to the patient who is responsible for coordinating services;

(F) The signature of the patient indicating he/she has participated in the development of the plan to the degree possible. If the patient is unwilling or unable to sign the plan, staff shall record on the plan that the patient is unable or unwilling to do so.

(G) The plan must be reviewed weekly and updated with the participation of the patient when needed to reflect significant changes in the patient's status, and when significant new goals are identified.

(f) Progress notes. Progress notes shall document observations, treatment rendered. response to treatment, and changes in the patient's condition, and other significant information relating to the patient. All entries involving subjective interpretation of the patient's progress shall be supplemented by a description of the actual behavior observed.

(g) Reports of medication administration, medical treatments, and diagnostic procedures.

(h) Telephone communications about the patient, releases of information, and reports from other sources.

(i) The record shall contain medical and mental health advance directives or note that the patient has been provided this information.

(j) The record shall contain documentation that the person has been provided information on patient rights, grievance procedure, and abuse reporting.

(k) The record shall contain documentation including physician's orders and reasons for all restraint and seclusion episodes.

(l) Discharge plan. The discharge planning shall begin at the time of admission with the participation of the patient and, when indicated, the family, guardian and significant others. The discharge plan shall include the results of the admitting mental health assessment; DSM diagnoses; summary of the course of treatment, including prescribed medications; final assessment of the person's condition; recommendations and arrangements for further treatment including prescribed medications and continuing care; and documentation of the planning for, and securing of appropriate living arrangements.

(4) Patient data management. The regional acute care psychiatric service shall supply to the Division, using the Division's on-line Oregon Patient/Resident Client System (OPRCS), via computer and modem, information about persons admitted to and discharged from the service. Such information shall include the patient's name, DSM diagnosis, admission date, discharge date, legal status, Medicaid eligibility, Medicaid Prime Number and various patient demographics. Such information shall be entered on the day of admission and updated on the day of discharge.

(5) Professional staff standards. The regional acute care psychiatric service shall:

(a) Have sufficient appropriately qualified professional, administrative and support staff to assess and address the identified clinical needs of persons served, provide needed services, and coordinate the services provided.

(b) Designate a program administrator to oversee the administration of the services and carry out these rules.

(c) Designate a medical director to oversee the patient care program. The medical director shall have the final authority concerning inpatient medical care including admissions, continuing care, and discharges.

(d) Designate an individual responsible for maintaining, controlling and supervising medical records and be responsible for maintaining the quality of clinical records.

(e) Designate an individual responsible for the development, implementation and monitoring of a written safety management plan and program, who shall keep records of identified concerns and problems and actions taken to resolve them.

(f) Designate an individual responsible for the development, implementation and monitoring of a written infection control plan and program, who shall keep records of identified concerns and problems and action taken to resolve them.

(g) Designate, or contract with, a licensed pharmacist to be responsible for the development of pharmacy policies and procedures, and to assure that the service adheres to standards of practice and applicable state and federal laws and regulations.

(h) Maintain a schedule of unit staffing which shall be readily available to the Division for a period of at least the three previous years.

(i) Have on duty at least one registered nurse at all times.

(j) Maintain a personnel file for each patient care staff which includes a written job description; the minimum level of education or training required for the position; copies of applicable licenses, certifications, or degrees granted; annual performance appraisals; a biennial, individualized staff development plan signed by the staff; documentation of CPR training; documentation of annual training and certification in managing aggressive behavior, including seclusion and restraint; and other staff development and/or skill training received.

(k) A physician must be available, at least on-call, at all times.

(6) Policies and procedures manual. The regional acute care psychiatric service shall have a policy and procedure manual. The policy and procedure manual must be made available to any person upon request. The manual shall describe:

(a) The following policies and procedures:

(A) Governance and management, including: a table of organization describing the agency structure and lines of authority; a plan for professional services; and a plan for financial management and accountability.

(B) Procedures for the management of disasters, fire, and other emergencies.

(C) Policies and procedures required under OAR 309-033-0700 through 309-033-0740, Standards for the Approval of Community Hospitals and Nonhospital Facilities to Provide Seclusion and Restraint to Committed Persons and to Persons in Custody or on Diversion addressing seclusion and restraint.

(D) Patient rights, including informed consent, access to records, and grievance procedure. The manual shall assure rights guaranteed by ORS 426.380 to 426.395 for committed persons and ORS 430.205 to 430.210 for those not committed. The grievance procedure must be in writing and include written responses, time limits for responses, use of a neutral party and a method of appeal. Programs shall post copies of the rights and grievance procedures in places accessible to all persons. Programs shall provide written copies of the rights and grievance procedure upon request.

(E) Abuse reporting for mentally ill or developmentally disabled as required by ORS 430.735 through 430.765, and 179.040, and OAR 309-040-0200 through 309-040-0290, Abuse Reporting and Protective Services in Community Programs and Community Facilities.

(F) Clinical record content and management policies and procedures, including the requirements of these rules.

(G) Psychiatric, medical, and dental emergency services policies and procedures.

(H) Pharmacy services policies and procedures approved by a licensed pharmacist.

(I) Quality assessment and improvement processes.

(J) Procedures for documenting privileges granted by the service in personnel records or other records.

(K) Policies and procedures for transfer of patients to other hospitals.

(b) The following policies and procedures, developed and amended in consultation with the council:

(A) Patient admission and discharge criteria. Unless the service has a policy and procedure recommended by the council and approved by the Division, the service shall only admit persons age 18 and older.

(B) Quality assessment and improvement processes relating to regional admissions and discharges.

(C) Patient admission, discharge and aftercare planning; including scheduling and planning for transportation of patients to the service by the referring county and from the service to the county of residence.

(D) Procedures for admission and discharge of geropsychiatric patients and persons with physical disabilities, including designation of a county or regional geropsychiatric liaison staff member.

(E) Linkage agreements with community mental health programs it serves and state hospitals.

(F) Medical and emergency care procedures, approved by the Division.

(G) Criteria for accepting pre-admission medical screening.

(H) Billing and collecting reimbursement from patients and third-party payors.

(7) Holding allegedly mentally ill persons. The service shall have an adequate number of hold rooms but at least one holding room and hold a current Certificate of Approval to hold and treat persons who are alleged to be mentally ill under OAR 309-033-0500 through 309-033-0540, Approval of Hospital and Nonhospital Facilities that Provide Services to Committed Persons or to Persons in Custody or on Diversion.

(8) Federal rules and regulations. The facility in which a service is operated shall comply with all applicable federal rules and regulations.

(9) Medical care. If the facility in which the regional acute care psychiatric service is operated is not in a general hospital, it shall have a letter of agreement with a general hospital for both emergency and medical care, which shall be renewed every two years.

(10) Quality assessment and improvement. The regional acute care psychiatric service shall have an ongoing quality assessment and improvement program to objectively and systematically monitor and evaluate the quality of care provided to patients served, pursue opportunities to improve care and correct identified problems. The program shall include:

(a) Policies and procedures that describes the quality assessment and improvement program's objectives, organization, scope, and mechanisms for improving services.

(b) A written annual plan to monitor and evaluate services. The written plan shall result in reports of findings, conclusions, and recommendations. Reports shall address:

(A) The care of patients served, including admission and discharge planning;

(B) Resource utilization, including the appropriateness and clinical necessity of admissions and continued stay, services provided, staffing levels, space, and support services;

(D) Medication usage, including records, adverse reactions, and medication errors;

(E) Accidents, injuries, safety of patients, and safety hazards; and

(F) Uses of seclusion and restraint.

(A) Findings and conclusions from studies;

(B) Recommendations, action taken, and results of the action taken; and

(C) An assessment of the effectiveness of the quality assessment and improvement program; including a review of the program's objectives, scope, organization and effectiveness.

(11) Council. The regional acute care psychiatric service shall have a council to ensure appropriate and effective care and treatment. The council shall meet to assess and collaboratively plan for improving care and treatment to patients, including patient transitions into and out of the service.

Stat. Auth.: ORS 179.010, ORS 179.505, ORS 192.502, ORS 426.380 – ORS 426.395, ORS 426.490 – ORS 426.500, ORS 430.041, ORS 430.205 – ORS 430.210, ORS 430.630(3) & ORS 443.410
Stats. Implemented:
Hist. MHD 8-1994, f. & cert. ef. 11-28-94

309-032-0890

Variances

(1) Criteria for a variance. Variances may be granted to a regional acute care psychiatric service if implementation of the proposed alternative services, methods, concepts or procedures would result in service or system that meet or exceeds the standards in these rules.

(2) Variance application. The service requesting a variance shall submit, in writing, an application to the Division which contains the following:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(e) Signed documentation from the council indicating its position on the proposed variance.

(3) Office of Mental Health Services review. The Assistant Administrator or designee of the Office shall approve or deny the request for a variance.

(4) Notification. The Office shall notify the regional acute care psychiatric service of the decision. This notice shall be given to the service, with a copy to the council, within 30 days of the receipt of the request by the Office.

(5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Administrator of the Division, whose decision shall be final.

(6) Written approval. The regional acute care psychiatric service may implement a variance only after written approval from the Division. The Intergovernmental Agreement shall be amended to the extent that the variance changes a term in that agreement.

(7) Duration of variance. A variance shall be reviewed by the Division at least every 2 years.

Stat. Auth.: ORS 426.490 – ORS 426.500 & ORS 430.630(3)
Stats. Implemented:
Hist. MHD 8-1994, f. & cert. ef. 11-28-94

Alternatives to State Hospitalization
Standards for Community Treatment Services for Children

309-032-0950

Purpose and Statutory Authority

(1) Purpose. These rules prescribe standards and procedures for community mental health treatment services for children within a comprehensive system of care. The system of care shall be child-centered and community-based with the needs of the child and family dictating the types and mix of services provided. These services may be as intensive, frequent and individualized as is medically necessary to sustain the child in treatment in the community. The provision of community mental health treatment services may require the treatment provider to work outside the clinic setting.

(2) Statutory Authority. These rules are authorized by ORS 430.041, ORS 743.556 and ORS 430.640(1)(h) to carry out the provisions of ORS 430.630.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-0960

Definitions

As used in these rules:

(1) "Admission criteria" means the standards to be met for a child to be enrolled in and receive community treatment services.

(2) "Biopsychosocial" means the combination of biological, psychological and sociocultural factors that influence the child's development and/or functioning.

(3) "Case number" means the unique identification number assigned to each child. No more than one such number shall be assigned to the child and the number shall be identical for both the treatment record and Client Process Monitoring System enrollment. Once assigned, the case number must be retained for all subsequent admissions or periods of service for the child.

(4) "Child" or "Children" means a person or persons under the age of 18, or for those with Medicaid eligibility, under the age of 21.

(5) "Children's Global Assessment Scale" or "CGAS" means a scale used to measure and condense different aspects of a child's biopsychosocial functioning into a single clinically meaningful index of severity. The CGAS is an adaptation of the Diagnostic and Statistical Manual Global Assessment Scale for adults by the Department of Child Psychiatry, Columbia University, published in November 1982. The CGAS is recommended for use with children aged 4 through 16. The CGAS score is numerically quantified on Axis Five of the DSM multiaxial diagnosis.

(6) "Client Process Monitoring System" or "CPMS" means an automated data system maintained by the MHDDSD.

(7) "Clinical record" means the collection of all documentation regarding a child's mental health treatment. The record is a legal document. The clinical record provides the basis by which the provider manages service delivery and quality assurance.

(8) "Clinical services coordination" means coordinating the access to, and provision of, services from multiple agencies according to the child's treatment plan; establishing crisis service linkages; advocating for the child's treatment needs; and providing assistance in obtaining entitlements based on a mental or emotional disability. To be eligible for Clinical Services Coordination, the enrolled child:

(a) Must have a severe and persistent mental disorder, which is not the result of conduct, substance abuse or mental retardation or other developmental disability, diagnosed on Axis I of a 5-Axes diagnosis;

(b) Must have documented mental or emotional symptoms that have been evident for one year or more, or are likely to continue for more than a year;

(c) Must have symptoms which have resulted in substantial functional limitations on two or more of the following areas of age appropriate development: role and task performance; cognition and communication; behavior toward self and others; and mood and emotions;

(d) Must have symptoms which result in a level of functioning of 49 or lower as scored on the CGAS or Global Assessment of Functioning Scale (GAF); and

(e) Must be at immediate risk of removal from home for mental health treatment or is returning home from a psychiatric inpatient or JCAHO accredited residential psychiatric treatment program.

(9) "Clinical supervision" means the documented oversight by a Qualified Mental Health Professional of mental health treatment services provided by a Qualified Mental Health Professional or Qualified Mental Health Associate. Clinical Supervision includes evaluating the effectiveness of the mental health treatment services provided. Clinical Supervision is performed on a regular, routine basis either individually or in a group setting at least once every three months.

(10) "Clinical supervisor" means a Qualified Mental Health Professional with two years post-graduate clinical experience in a mental health treatment setting who follows a professional code of ethics. The Clinical Supervisor, as documented by the Local Mental Health Authority, demonstrates the competency to oversee and evaluate the mental health treatment services provided by the Qualified Mental Health Professional or Qualified Mental Health Associate.

(11) "Community crisis services" means a system of urgent and emergency services of limited duration including screening, mental health assessment, and stabilization provided by every CMHP or its designated subcontractors 24 hours-a-day, seven days-a-week to respond to, and stabilize, children in mental health crisis.

(12) "Community Mental Health Program" or "CMHP" means the entity providing the services described in ORS 430.620 and ORS 430.630(3) for persons with mental or emotional disorders, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, and operated in a specific geographic area of the state under an omnibus contract with the MHDDSD.

(13) "Community treatment services" means the full range of children's mental health services, except inpatient care, defined in ORS 430.630(3) and 743.556.

(14) "Comprehensive mental health assessment" means a mental status exam and a biopsychosocial evaluation of a child's functioning in the following domains: emotional, cognitive, family, developmental, behavioral, social, physical, nutritional, school or vocational, substance abuse, cultural and legal, completed by a Qualified Mental Health Professional. The Comprehensive Mental Health Assessment concludes with a completed DSM five axes diagnosis followed by a clinical formulation and a comprehensive treatment plan. The Comprehensive Mental Health Assessment is revised and updated annually.

(15) "Consent to treatment" means the written agreement between the child's custodial parent or guardian, or by the child if age 14 or older, and the provider of mental health services, for the child to receive community mental health treatment services.

(16) "Consultation" is the planned professional advice about an enrolled child given by the Qualified Mental Health Professional to another professional involved in the child's treatment. Consultation is specific to goals and objectives in the child's treatment plan and is documented in the progress notes.

(17) "Continued stay criteria" means the standards to be met for a child to remain in community mental health treatment.

(18) "Crisis" means either an urgent or emergency situation that occurs when a child's mental or emotional stability or functioning is disturbed by a critical event in the child's environment and there is an immediate need to resolve the situation to prevent a serious deterioration in the child's condition.

(19) "Crisis stabilization" means the provision of appropriate child and family, psychological, and psychiatric and other medical interventions in the most normative setting possible for the child, and any placements necessary to protect and stabilize the child as quickly as possible.

(20) "Critical incident" means an incident as a result of staff action or inaction that punishes, endangers or otherwise harms a child enrolled in a community mental health program service.

(21) "Custodial parent" means the parent or parents having legal custody of the child.

(22) "Custody" means the legal care and supervision of the child by the person, agency or institution having the authority to authorize ordinary medical, psychiatric, psychological and other remedial care and treatment for the child. Under ORS 418.312, custodial parents are not required to transfer legal custody of a child to the State Office for Services to Children and Families (SCF) in order to have the child placed in an SCF-contracted foster home, group home, residential or other institutional child care setting when the sole reason for the placement is the need to obtain services for the child's emotional, behavioral or mental disorder.

(23) "Diagnosis" means the principal mental disorder listed in the DSM, that is the medically necessary reason for clinical care and the main focus of treatment. The principal diagnosis is determined through the mental health assessment and any examinations, tests, procedures, or consultations suggested by the assessment. A DSM "V" code condition, substance use disorder or mental retardation is not considered the principal diagnosis although these conditions or disorders may co-occur with the diagnosable mental disorder.

(24) "Direct supervision" means the directing and coordinating by the QMHP of interventions performed by the Qualified Mental Health Associate (QMHA). Direct supervision also means reviewing and evaluating the documentation of all interventions performed by the QMHA. Direct supervision is performed on a regular, routine basis either individually or in a group setting.

(25) "Discharge criteria" means the standards to be met to complete service provision.

(26) "Discharge summary" means written documentation of the last service contact with the child, the diagnosis at enrollment, a summary statement that describes the effectiveness of treatment modalities and progress, or lack of progress, toward treatment objectives while in service. The discharge summary also includes the reason for discharge, changes in diagnosis during treatment, current level of functioning and prognosis and recommendations for further treatment. Discharge summaries are completed no later than 30 calendar days following a planned discharge and 45 calendar days following an unplanned discharge.

(27) "DSM" means the fourth edition of the "Diagnostic and Statistical Manual of Mental Disorders," published by the American Psychiatric Association.

(28) "Early and Periodic Screening, Diagnosis and Treatment" or "EPSDT" means the preventive and remedial medical care program for eligible persons under 21 years of age who are enrolled in the state's Medicaid program.

(29) "Emergency" means the sudden onset of acute psychiatric symptoms requiring attention within 24 hours to prevent a serious deterioration in a child's mental condition.

(30) "Enrollment" means, for a CMHP or CMHP subcontractor, the act of opening a clinical record for a child who is not currently receiving services. The date of enrollment is the first face to face treatment session with the child or the child's family. Enrollment documentation includes the completed CPMS enrollment form. For children eligible to receive services from a Fully Capitated Health Plan or Mental Health Organization, enrollment means signing on with a fully capitated health plan or mental health organization under contract with the MHDDSD.

(31) "Five axes diagnosis" means the multiaxial system of evaluation in the DSM organized to provide a biopsychosocial approach to assessment and to ascertain that all of the information necessary for planning treatment and predicting outcomes for the child is recorded on each of five axes. The principal diagnosis is recorded on Axis I, any description of mental retardation or personality features on Axis II, physical disorders or conditions on Axis III, severity of psychosocial stressors on Axis IV, and the global assessment of functioning on Axis V.

(32) "Fully Capitated Health Plan" or "FCHP" means a prepaid health plan under contract with the MHDDSD and Office of Medical Assistance Programs to provide capitated physical and mental health services.

(33) "Global Assessment of Functioning Scale" or "GAF" means a scale in the DSM used to measure and condense different aspects of biopsychosocial functioning in adolescents 17 and older and adults into a single clinically meaningful index of severity of disorder. The GAF score is numerically quantified on Axis Five of the DSM multiaxial diagnosis.

(34) "Goal" means an expected result or condition to be achieved, is specified in a statement of relatively broad scope, provides a guideline for the direction of care and is related to an identified clinical problem.

(35) "Guardian" means a parent, other person or agency legally in charge of the affairs of a minor child and having the authority to make decisions of substantial legal significance concerning the child.

(36) "Informed consent to treatment" means that the information about a specific diagnosis and the risks or benefits of treatment options and the consequences of not receiving a specific treatment are understood by the child, if able, and the parent or guardian, if involved. The person consenting to treatment voluntarily agrees in writing, as required in ORS 430.210(d), to a prescribed treatment for the specific diagnosis.

(37) "Level of care" means the range of available mental health services provided from the least restrictive and least intensive in a community-based setting to the most restrictive and most intensive in an inpatient setting. As required in ORS 430.210(a), children are to be served in the most normative, least restrictive, least intrusive level of care appropriate to their treatment history, degree of impairment, current symptoms and the extent of family or other supports.

(38) "Level of functioning" means the description and numeric quantification on Axis V of a DSM diagnosis of the effectiveness of a child's ability to achieve or maintain developmentally appropriate behavior in one or more of the following areas: role and task performance, cognition and communication, behavior toward self and others, and mood and emotions as measured against age appropriate norms.

(39) "Licensed Medical Practitioner" means any person who meets the following minimum qualifications as documented by the Local Mental Health Authority or designee:

(a) Holds at least one of the following educational degrees and valid licensures:

(A) Physician licensed to practice in the State of Oregon;

(B) Nurse Practitioner licensed to practice in the State of Oregon;

(b) Whose training, experience and competence demonstrates the ability to conduct a Comprehensive Mental Health Assessment and provide medication management.

(c) When the LMP is not a psychiatrist, the LMP shall have access to consultation services provided by a psychiatrist, preferably a child psychiatrist, either through direct employment by the provider or through written contract between the provider and the consulting psychiatrist.

(40) "Local Mental Health Authority" or "LMHA" means the county court or board of county commissioners of one or more counties who choose to operate a county mental health program or choose to operate an MHO; or, in the case of a Native American reservation, the tribal council; or, if the county declines to operate or contract for all or part of a community mental health program, the board of directors of a public or private corporation which contracts with the MHDDSD to operate a CMHP or MHO for that county.

(41) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to poor and indigent persons. Medical assistance programs cover both health and mental health care for children and adults. Some services, such as EPSDT, are required to be provided by the state. Other services, such as case management, are optional.

(42) "Medicaid Authorization Specialist" or "MAS" means the Qualified Mental Health Professional designated at the county or regional level to determine the mental health needs of children requesting services, or for whom services are requested, and to authorize the provision of mental health services identified in the Service Authorization Form for Medicaid-eligible children.

(43) "Medical necessity" means the determination by a Licensed Medical Practitioner operating within the scope of his or her license, training and experience, that a service is reasonably necessary to diagnose, correct, cure, alleviate, rehabilitate or prevent the worsening of a disabling mental disorder. Medically necessary services must be consistent with standards of good practice, generally recognized by the professional community as effective, and there must also be no other equally effective, more conservative, or less costly course of treatment available or suitable for the person requesting the service.

(44) "Medication service record" means the documentation of written or verbal orders for medication, laboratory, and other medical procedures issued by a Licensed Medical Practitioner employed by, or under contract with, the provider and acting within the scope of his or her license. The provision of medication services is documented in written progress notes and placed in the client's record.

(45) "Mental Health and Developmental Disability Services Division" or "MHDDSD" means the Department of Human Services Agency responsible for the administration of state mental health and developmental disabilities programs and the mental health and developmental disabilities laws of the state.

(46) "Mental health assessment" means the documentation by a QMHP of the child's presenting mental health problem(s) and relevant child and family history, mental status examination and DSM five axis diagnosis or provisional diagnosis.

(47) "Mental Health Organization" or "MHO" means an entity under a risk bearing contract with the MHDDSD to provide mental health services on a prepaid, capitated basis.

(48) "Mental status examination" means the face-to-face assessment by a QMHP of a child's mental functioning within a developmental and cultural context that includes descriptions of appearance, behavior, speech, language, mood and affect, suicidal or homicidal ideation, thought processes and content, and perceptual difficulties including hallucinations and delusions. Cognitive abilities are also assessed and include orientation, concentration, general knowledge, intellectual ability, abstraction abilities, judgment, and insight appropriate to the age of the child.

(49) "Minor child" means an unmarried person under the age of 18.

(50) "Non-custodial parent" means a parent whose custodial responsibilities have been removed by the court by divorce decree. Under ORS 107.154, and unless otherwise ordered by the court, non-custodial parents have the same rights to consult with any person who may provide care and treatment for the child and to inspect and receive the child's medical and psychological records to the same extent as the custodial parent. The non-custodial parent may also authorize emergency medical, psychological and psychiatric or other health care if the custodial parent is unavailable.

(51) "Nurse Practitioner" means a Registered Nurse who has a graduate degree in nursing and is certified by the Oregon State Board of Nursing as qualified to practice as a Psychiatric/Mental Health Nurse Practitioner.

(52) "Objective" means the written statement of an expected result or condition that is related to the attainment of a goal. The objective is stated in measurable terms, has a specified time for accomplishment, and describes what services or activities are needed, how frequently they are needed and the primary Qualified Mental Health Professional who will be coordinating them.

(53) "Physician" means a Medical Doctor or a Doctor of Osteopathy licensed to practice in Oregon. For these rules, a physician is preferably a Board-Certified Child Psychiatrist.

(54) "Plan of correction" means a written document which specifies actions that a provider will take to come into compliance with these rules.

(55) "Progress note" means the written documentation of the clinical course of treatment. Progress notes become the basis for review and revision of the treatment plan and the treatment provided. Progress notes shall document the specific treatment service rendered, the child's response to the specific treatment service, the date the service was provided, the setting, who performed the service, who was present, and the amount of time taken to provide the service. A progress note concludes with the signature, educational credentials of the person providing the service, and the date the note was signed.

(56) "Provider" means a CMHP, CMHP subcontractor, FCHP or MHO which is contractually affiliated with the MHDDSD and is responsible for the direct delivery of children's mental health services, or an agency providing services under ORS 743.556.

(57) "Provisional diagnosis" means a statement on Axis I of a DSM diagnosis when there is a strong presumption that the full criteria for the diagnosis will ultimately be met.

(58) "Psychiatrist" means a physician who is Board-Eligible or Board-Certified in psychiatry and licensed in the State of Oregon.

(59) "Qualified Mental Health Associate" or "QMHA" means a person who delivers services under the direct supervision of a Qualified Mental Health Professional and who meets the following minimum qualifications as documented by the Local Mental Health Authority or designee:

(a) Has a bachelor's degree in a behavioral sciences field, or a combination of at least three years work, education, training or experience; and

(b) Has the competencies necessary to:

(A) Communicate effectively;

(B) Understand mental health assessment, treatment and service terminology and to apply the concepts;

(D) Implement interventions prescribed on a treatment plan.

(60) "Qualified Mental Health Professional" or "QMHP" means a Licensed Medical Practitioner or any other person who meets the following minimum qualifications as documented by the Local Mental Health Authority or designee:

(a) Holds any of the following educational degrees:

(A) Graduate degree in psychology;

(B) Bachelor's degree in nursing and licensed by the State of Oregon;

(D) Graduate degree in a behavioral science field;

(E) Graduate degree in recreational, music, or art therapy;

(F) Bachelor's degree in occupational therapy and licensed by the State of Oregon; and

(b) Whose education and experience demonstrates the competencies to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social and work relationships; conduct a mental status examination; document a multiaxial DSM diagnosis; write and supervise a treatment plan; conduct a Comprehensive Mental Health Assessment and provide individual, family and/or group therapy within the scope of their training.

(61) "Quality assurance" means the structured, internal monitoring and evaluation process to:

(a) Identify aspects of quality care;

(b) Use indicators and clinical criteria to continually and systematically monitor these aspects of care;

(d) Take action to correct problems and improve substandard care;

(e) Assess the effectiveness of the actions; and

(f) Document the improvements in care.

(62) "Service coordination plan" means the written record of the services provided for children with a severe and persistent mental disorder by the social service agencies serving the child.

(63) "Severe and persistent disorder" means an emotional, mental, and/or neurobiological impairment which is manifested by emotional or behavioral symptoms that are not solely a result of mental retardation or other developmental disabilities, epilepsy, drug abuse, or alcoholism and which continues for more than one year, or on the basis of a specific diagnosis is likely to continue for more than one year.

(64) "Setting" means the location at which community-based mental health treatment services are provided and includes the CMHP office, the child's residence or other identified location.

(65) "Substantial compliance" means a level of adherence to MHDDSD rules applicable to the operation of a service that warrants certification by the MHDDSD as set forth in OAR 309-012-0000 through 309-012-0220.

(66) "System of care" means the comprehensive array of mental health and other necessary services which are organized to meet the multiple and changing needs of children with mental disorders.

(67) "Treatment" means the planned, medically necessary, individualized program of medical, psychological, and/or rehabilitative procedures, experiences and activities for a child designed to remediate symptoms of a principal mental or emotional disorder diagnosed on Axis I of a five-axes DSM diagnosis. The principal disorder and the child's level of functioning are the reasons for treatment and the focus of the clinical interventions provided. The need for treatment is determined by a mental health assessment. Treatment is provided by a QMHP or QMHA.

(68) "Treatment plan" means the written documentation of the child's individualized treatment goal(s), measurable objectives and treatment services to be provided. The treatment plan is developed jointly by the QMHP and the child with his or her parent(s) or guardian, if appropriate. The treatment plan also includes the frequency and duration of the services and the QMHP who is coordinating the services.

(69) "Urgent" means the onset of psychiatric symptoms requiring attention within 72 hours to prevent a serious deterioration in a child's mental condition.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-0970

General Provisions of the System of Care for Children's Community Mental Health Services

The Local Mental Health Authority or designee shall have in place a system of care for children's community mental health services. The Local Mental Health Authority or designee shall:

(1) Establish and maintain comprehensive mental health services for children as defined in ORS 430.630(3);

(2) Assure that mental health services are provided under clinical supervision;

(3) Hold a valid Certificate of Approval issued by the MHDDSD to provide Community Mental Health Treatment Services for Children;

(4) Demonstrate fiscally responsible practices;

(5) Manage the costs of mental health services as required by the MHDDSD;

(6) Assure each subcontractor is in compliance with standards and procedures prescribed in these rules;

(7) Monitor quality assurance and utilization review findings;

(8) Inform the MHDDSD by telephone and in writing within one working day of any critical incident affecting a child and propose the course of action to be taken by the CMHP to investigate or otherwise resolve the incident;

(9) Report suspected child abuse per ORS 419B.010;

(10) Assist children in obtaining and retaining benefits to which they are entitled, including Medicaid and Supplemental Security Income (SSI);

(11) Enroll children in the Client Process Monitoring System when the child's mental health services are funded all or in part by MHDDSD funds, unless the specific service the child receives is provided by an FCHP or MHO whose contract with the MHDDSD does not require enrollment;

(12) Operate programs that value diversity, cultural competence, and have the capacity for cultural self-assessment;

(13) Encourage family involvement in the child's treatment and advocacy on the child's behalf; and

(14) Provide community treatment services for children in a smoke free environment.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-0980

Community Treatment Services

Community treatment services are rehabilitative in nature and may be provided to children outside the clinic setting. Treatment services must be based on sound clinical theory and recognized and widely accepted as clinically appropriate methods of treatment by qualified professionals in the mental health field. At a minimum, the LMHA or designee shall make the following services available in accordance with ORS 430.630:

(1) Community Crisis Services. At a minimum, children's community crisis services shall consist of:

(a) 24 hour, seven days per week face-to-face or telephone screening to determine the need for immediate services for any child requesting assistance or for whom assistance is requested;

(b) 24 hour, seven days per week capability to conduct, by or under the supervision of a QMHP, a mental health status examination to determine the child's condition and the interventions necessary to stabilize the child;

(c) A mental health assessment concluding with written recommendations by the QMHP regarding the need for further treatment;

(d) Provision of appropriate child and family, psychological, and psychiatric services necessary to stabilize the child as quickly as possible;

(e) Referral to the appropriate level of care and linkage to other medical interventions necessary to protect and stabilize the child as quickly as possible; and

(f) Linkage to appropriate social services.

(2) Mental health assessment.

(3) Individual, family and group therapies.

(4) Individual and group psychosocial skill development.

(5) Consultation with professionals involved with the child's treatment.

(6) Psychiatric services as needed for each child.

(7) Medication management and monitoring.

(8) Service planning and coordination.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-0990

Children's Community Treatment Services Admission Criteria

Admission to community treatment services shall be prioritized as follows:

(1) For mental health crisis services:

(a) Any child whose level of functioning indicates an emergency psychiatric condition;

(b) Any child whose level of functioning indicates an urgent psychiatric condition.

(2) For community based mental health treatment services:

(a) Children who, in accordance with the assessment of professionals in the mental health field:

(A) Are at immediate risk of psychiatric hospitalization or removal from home due to a mental or emotional disorder;

(B) Exhibit behavior which indicates high risk of developing disorders of a severe or persistent nature; or

(b) Any other child who is experiencing mental or emotional disorders which significantly affect the child's ability to function in everyday life, but not requiring hospitalization or removal from home in the near future.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1000

Levels of Care Criteria

Children shall be served in the least restrictive, least intensive setting appropriate to their treatment history, degree of impairment, current symptoms and the extent of family and other supports. The QMHP must recommend the appropriate level of care to the child and parent or guardian when a more restrictive or less restrictive level of care is determined to be medically necessary. The following criteria are to be used to determine the appropriate level of care:

(1) Community based outpatient services. These services may be provided in clinic, home, school, or other settings familiar to and comfortable for the child.

(a) Admission.

(A) Child has a principal diagnosis on Axis I of a completed five-Axes DSM diagnosis; and

(B) Child does not immediately require more restrictive or intensive services.

(b) Continued Stay. At least one of the following is met:

(A) Child is making observed progress toward identified treatment goals as documented in the treatment plan, but treatment goals have not been reached.

(B) Child made no documented progress toward treatment goals, but the treatment plan has been modified based on a clarification of the nature of the identified problems and a re-evaluation of the child's treatment needs.

(C) Child exhibits new symptoms which can be safely and effectively treated at an outpatient level of care. The treatment plan has been revised accordingly.

(A) Child's targeted symptoms have abated as documented by the attainment of goals in the treatment plan; or

(B) Child exhibits new symptoms which may not be safely or effectively treated at an outpatient level of care; and

(D) Child is not benefitting from treatment and made no progress toward treatment goals in the last three months, even though appropriate treatment plan reviews and revisions were conducted.

(2) Community based treatment in residential settings. These services may be provided in settings such as Oregon Youth Authority or State Office for Services to Children and Families (SCF) contracted proctor care, therapeutic group homes, treatment foster care and residential facilities co-managed by MHDDSD.

(a) Admission.

(A) Child has a principal diagnosis on Axis I of a completed 5-Axes DSM diagnosis; and

(B) Child's condition is not manageable in the child's current living situation; or

(D) Child needs treatment provided in a structured, supervised setting; and

(E) Less restrictive or less intensive services are not adequate to meet the child's treatment needs based on:

(i) Documented lack of response to prior treatment; or

(ii) The clinical judgment of the Medicaid Authorization Specialist (MAS) or the CMHP-designated QMHP and the treatment team working with the child.

(b) Continued Stay. At least one of the following is met:

(A) Child is making observed progress toward identified treatment goals as documented in the treatment plan, but treatment goals have not been reached.

(B) Child made no documented progress toward treatment goals, but the treatment plan has been reviewed and modified in order to reevaluate the child's treatment needs, clarify the nature of the identified problems, and/or to initiate new therapeutic interventions; or

(C) Child exhibits new symptoms or maladaptive behaviors that justify continuation and can be safely and effectively treated at an outpatient level of care. The treatment plan has been revised accordingly; and

(D) Child's continued stay has been reviewed and approved by the MAS or designated QMHP every three months.

(A) Child's targeted symptoms and maladaptive behaviors have abated to the baseline level as documented by the attainment of goals in the treatment plan; or

(B) Child exhibits new symptoms and maladaptive behaviors which may not be treated safely or effectively at a community based residential level of care; or

(C) Child is not benefitting from treatment and made no progress toward treatment goals in the last six months even though appropriate treatment plan reviews and revisions were conducted.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630

Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1010

Medical Involvement

(1) A comprehensive mental health assessment shall be provided for:

(a) Children with a severe and persistent mental disorder for whom Service Coordination Plans have been developed and who receive Clinical Services Coordination; and

(b) Children who remain in service for at least one year.

(2) The comprehensive mental health assessment shall be maintained in the child's clinical record and shall be updated annually.

(3) A Licensed Medical Practitioner who is either a nurse practitioner or a physician will review and approve each comprehensive mental health assessment and treatment plan required by OAR 309-032-1010(1). The Licensed Medical Practitioner's approval indicates the Medical Necessity of the services.

(4) Children with a severe and persistent mental disorder for whom Service Coordination Plans have been developed and who receive Clinical Services Coordination shall have additional consultation with a Licensed Medical Practitioner who is either a nurse practitioner or a physician within six months of the comprehensive mental health assessment. The consultation documentation shall indicate the Medical Necessity of the continuing services and include one of the following:

(a) A written summary of a consultation between a Licensed Medical Practitioner who is either a nurse practitioner or a physician and the QMHP covering the following criteria:

(A) Symptoms or behaviors persist at a level of severity documented upon admission and the projected time frame for attainment of treatment goals has not been reached as documented in the treatment plan; or

(B) The child's and/or family's progress toward identified treatment goals for this level of care has been documented but not all treatment goals have been reached; or

(C) No progress toward treatment goals has been documented and the treatment plan has been modified to introduce further evaluation in order to clarify the nature of the identified problems and/or new therapeutic interventions have been initiated; or

(D) New symptoms or maladaptive behaviors have appeared while the child is in treatment. Treatment of these symptoms and behaviors has been incorporated into a revised treatment plan. The new symptoms and/or maladaptive behaviors justify continuation of treatment and may be treated safely and effectively with this level of care; or

(b) A written summary of a face-to-face psychiatric or clinical mental health assessment performed by a Licensed Medical Practitioner who is either a nurse practitioner or a physician.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1020

Service Coordination Plan

A Service Coordination Plan shall be developed by the provider for any child with a severe and persistent mental disorder who receives Clinical Services Coordination. The Service Coordination Plan shall include:

(1) A listing of any other providers of the child's mental health services along with the amount, duration, and scope of each provider's services; and

(2) A brief description of the child's service planning in the following domains: legal, education, family, physical health, and social.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1030

Children's Rights

Children and their families receiving mental health care under these rules are entitled to all rights in applicable Oregon Revised Statutes and Oregon Administrative Rules. The rights listed below shall be visibly posted and shall be explained, both verbally and in writing, by the provider to the person legally giving consent to treatment of the child at the time of enrollment.

(1) Consent to treatment. A custodial parent or legal guardian, or a minor child under conditions described below, must give written informed consent to diagnosis and treatment.

(a) Minor children can give informed consent in the following circumstances:

(A) Under age 18 and lawfully married.

(B) Age 16 or older and legally emancipated by the court.

(C) Age 14 or older for outpatient diagnosis and treatment for a mental or emotional disorder. For purposes of informed consent, outpatient treatment does not include treatment provided in residential facilities or in day or partial hospitalization programs.

(b) If the child is initially served in a crisis situation, these rights shall be explained as soon as clinically practical, but not more than five working days from the initiation of services if the child who received the crisis service remains in service.

(2) The custodial parent or legal guardian of any minor, age 14 or older who has consented to outpatient treatment or diagnosis, shall be involved before the end of treatment unless:

(a) The parents refuse;

(b) There are clear clinical indications to the contrary;

(d) The child has been legally emancipated by the court or has been self sustaining for 90 days prior to obtaining treatment. As required in ORS 109.675, such refusal or the reasons for exclusion must be documented in the child's clinical record.

(3) Services refusal. The person giving consent to treatment has the right to refuse service, including any specific treatment procedure. If serious consequences may result from refusing a service, the consequences must be explained verbally and in writing by the provider to the custodial parent, guardian or child who is refusing service. Service refusal shall be documented in the clinical record.

(4) Grievances. The child or the person consenting to the child's treatment has the right to lodge an oral or written complaint or file a grievance with the entity providing treatment services. All service providers will:

(a) Have written procedures for accepting, processing and responding to oral or written complaints and grievances. The procedures must include:

(A) The process for registering an oral or written complaint or grievance;

(B) The time lines for processing an oral or written complaint or grievance; and

(C) Notification of the appeals process, including time lines for an oral or written complaint or grievance and the provision of the appropriate appeal forms.

(b) Designate a staff person to receive complaint or grievance information and enter the information into a log. The log will identify, at a minimum, the person lodging the complaint or grievance, the date of the complaint or grievance, the nature of the complaint or grievance, the resolution and the date of the resolution.

(c) Have written procedures for informing children and their legal guardian(s) orally and in writing about the provider's complaint or grievance procedures.

(d) Have written procedures for processing an expedited complaint request if it is believed that the child's health is at risk. A request for expedited complaint must be filed by the child or the person consenting to the child's treatment and must include the following:

(A) A statement that this is a request for an expedited complaint;

(B) An explanation of the urgency of resolving the issue; and

(5) Service denial. The child or the person consenting to treatment on behalf of the child, has the right to appeal when a service has been denied. All providers must have written procedures as described in OAR 309-032-1030(4) for accepting, processing and responding to service denial complaints. In addition to the procedures described in OAR 309-032-1030(4), providers must respond in writing to the complaint within five working days of the complaint. The written response must include:

(a) The service requested;

(b) A statement of service denial;

(d) Notification of the appeals process including the required time frame to file an appeal and provision of the appropriate appeal forms.

(6) Hearing request. All providers must include in their written appeals process the right of the Medicaid-eligible child, or the person consenting to treatment for the child, to file a request for hearing as a result of a denial of service or an adverse finding against a complainant in accordance with OAR 309-016-0140 through 309-016-0210.

(7) Access to clinical records. The person consenting to treatment, usually the custodial parent or guardian, has the right of access to the child's clinical record. A copy of the record is to be provided within five working days of requesting it. The person requesting the record is responsible for payment for the cost of duplication.

(8) Informed participation in treatment planning. The child, if appropriate, and the custodial parent or legal guardian and others of their choosing, shall have the opportunity to participate in an informed way in the treatment planning process for the child, and in the review, at least every three months, of the child's progress toward treatment goals and objectives. At a minimum, the following information should be discussed:

(a) Treatment and other interventions to be undertaken;

(b) Alternative treatments or interventions available, if any;

(d) Benefits which can reasonably be expected; and

(e) Risks that may be involved in treatment, if any.

(9) Confidentiality. No records or information regarding the child which are made confidential by ORS 179.505, 45 CFR 205.50, 42 CFR Part 2 or any other applicable confidentiality law shall be disclosed except as permitted by the applicable law.

(10) Informed consent to fees for services. The amount and payment schedule of any fees to be charged must be disclosed in writing and agreed to by the person consenting to treatment.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1040

Establishment and Maintenance of Clinical Records

(1) Individuality and maintenance of clinical records. A separate, individualized clinical record shall be opened and maintained for each child served by a provider.

(2) Organization of clinical records. Each clinical record shall be uniform in organization, readily identifiable and accessible, and contain all of the components required by these rules in a current and complete manner.

(3) Signature of authors. All documentation required in this rule must be signed by the staff providing the service and making the entry. Signature must include the person's academic degree or professional credential and the date signed.

(4) Documentation of informed consent. All procedures in these rules requiring consent and the provision of such information to the consenting custodial parent or guardian or where appropriate, the child, shall be documented in the clinical record on forms describing what the child or adult giving consent has been informed of, and asked to consent to, and signed and dated by the consenting person. If the provider does not obtain the required documentation, the reasons must be specified in the clinical record and signed by the qualified supervisor of the person responsible for provision of treatment services to the child.

(5) Error corrections. Errors in the clinical record shall be corrected by lining out the incorrect data with a single line in ink, and then adding the correct information, the date corrected, and the initials of the person making the correction. Errors may not be corrected by removal or obliteration.

(6) Confidentiality of other clients. References to other persons being treated by the CMHP, CMHP subcontractors, FCHP or MHO when included in the child's clinical record shall preserve the confidentiality of the other clients.

(7) Security. Clinical records shall be secured, safeguarded, stored, and retained in accordance with applicable Oregon Revised Statutes and Oregon Administrative Rules.

(8) Confidentiality of records. All clinical records are confidential to the extent provided for in 309-032-1030(9).

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1050

Clinical Record Documentation Requirements

The child's clinical record shall contain adequate written information which is readily accessible and uniformly placed in the clinical record to document the diagnosed mental disorder and the child's need for treatment for the diagnosis. The documentation shall include:

(1) CPMS enrollment data if required by OAR 309-032-0960(30);

(2) Identifying data including child's name, date of birth, sex, address, phone number, and name of parent(s) or legal guardian including an address and phone number if different.

(3) A mental health assessment;

(4) An individualized treatment plan;

(5) Written discharge criteria;

(6) A comprehensive mental health assessment as required in OAR 309-032-1010.

(7) A Service Coordination Plan as required by OAR 309-032-1020.

(8) Written progress notes for each service provided;

(9) A written discharge summary; and

(10) A medication service record if medication is prescribed on the treatment plan.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1060

Quality Assurance Requirements

Providers will have a planned, systematic and ongoing process for monitoring, evaluating, and improving the quality and appropriateness of services provided to children and families. Providers will implement a Quality Assurance system which will assure compliance with the provisions of OAR 309-032-0950 through 309-032-1080. The Quality Assurance system shall include a Quality Assurance Committee and a Quality Assurance Plan which together implement a continuous cycle of measurement, assessment and improvement of clinical outcomes based on input from service providers and representatives of the children and families served.

(1) The Quality Assurance Committee shall carry out the Quality Assurance Plan and shall be the catalyst for improvement in the organization's clinical outcomes. The Quality Assurance Committee shall be composed of:

(a) One or more QMHPs, including an LMP who is preferably a child psychiatrist, who are representative of the scope of services delivered;

(b) A representative or representatives of the children and families served;

(c) Other persons who have the ability to identify, design, measure, assess and implement clinical and organizational changes.

(2) The Quality Assurance Committee duties shall:

(a) Identify indicators of quality;

(b) Identify measurable and time-specific performance objectives;

(d) Develop a process to systematically collect outcome data and identify staff who will collect and analyze data;

(e) Oversee the data collection process;

(f) Analyze the information collected and measure progress toward performance objectives;

(g) Identify clinical and operational changes necessary to achieve performance objectives;

(h) Implement clinical or operational changes that are indicated by the achievement or non-achievement of performance objectives; and

(i) Reassess and, if necessary, revise objectives and methods to measure performance on an ongoing basis.

(3) The Quality Assurance Committee shall meet at least quarterly.

(4) The written Quality Assurance Plan shall describe the implementation and ongoing operation of the functions performed by the Quality Assurance Committee. The Quality Assurance Plan shall include:

(a) A description of the Quality Assurance Committee's authority to identify and implement clinical and organizational changes;

(b) The composition and tenure of the Quality Assurance Committee;

(d) The policies and procedures for identifying and using objective and measurable performance objectives.

(e) The policy and procedures for identifying and using data sources;

(f) The indicators of quality in the following domains:

(A) Access to services;

(B) Quality of care;

(D) Outreach and prevention.

(g) The policies and procedures for reporting, tracking, investigating, and analyzing reports of critical incidents;

(i) The policies and procedures to manage utilization of services;

(j) The policies and procedures for reviewing complaint and grievance information; and

(k) The policies and procedures for clinical record reviews.

(5) A written summary of the pertinent facts and conclusions of each Quality Assurance Committee meeting will be maintained and be available for review by the MHDDSD, CMHP, MHO or FCHP.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1070

Certificate of Approval to Provide Community Based Mental Health Treatment Services

Providers of community mental health outpatient children's mental health services and providers operating under ORS 743.556 must be in compliance with OAR 309-032-0950 through 309-032-1080 and must hold a valid Certificate of Approval to provide Community Mental Health Treatment Services for Children from the MHD DSD as described in OAR 309-012-0130 through 309-012-0220. The Certificates will be issued as follows:

(1) A provider who is determined by the MHDDSD to be in substantial compliance with applicable rules will receive a three year Certificate of Approval.

(2) A provider who is determined by the MHDDSD to not be in substantial compliance with applicable rules may, at the discretion of the MHD DSD, have conditions placed on the Certificate of Approval.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1080

Sanctions for Non-Compliance

(1) Programs or services not in substantial compliance. When the MHDDSD determines, pursuant to this rule that a provider is not in substantial compliance with these rules, the MHDDSD may, at its discretion, require the provider to file a Plan of Correction within a period of time specified by the MHDDSD.

(2) MHDDSD authority. The MHDDSD may accept, reject, or modify the Plan of Correction or require the provider to comply with a Plan of Correction as directed and approved by the MHDDSD.

(3) Sanctions. Sanctions may include, at the discretion of the MHDDSD, elimination of the service or program, termination of the Certificate of Approval to provide Community Mental Health Treatment Services for Children, merger with an approved CMHP, or if applicable, withholding of funds.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist: MHD 6-1996, f. & cert. ef. 10-1-96

309-032-1095

Variances

(a) CMHP's and other providers may submit their variance request directly with the Division; and

(b) Providers, who hold Certificates of Approval jointly with CMHP's and the Division, shall submit their variance requests to the CMHP's. The CMHP may then submit the variance request, along with the CMHP's written support of the variance, to the Division.

(2) Variance application. The CMHP or provider requesting a variance shall submit, in writing, an application to the Deputy Assistant Director of the Division or designee, which contains the following:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought; and

(3) Division review. The Deputy Assistant Director shall approve or deny the request for a variance.

(4) Notification. The Division shall notify the CMHP and/or provider in writing of the decision to approve or deny the requested variance. The written notification shall include the specific alternative practice, service, method, concept or procedure that is approved and the duration of the approval.

(5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Assistant Director of the Division, whose decision shall be final.

(6) Written approval. The CMHP or provider may implement a variance only after written approval from the Division.

(7) Duration of variance. It is the responsibility of the CMHP or the provider to submit a request to extend a variance in writing prior to a variance expiring. A variance may be reissued through written application for a variance from the CMHP or provider, as described above, and upon written approval by the Division.

Stat. Auth.: ORS 409.050
Stats. Implemented: ORS 409.010 & 430.630
Hist.: MHS 3-2008, f. & cert. ef. 4-15-08

Standards for Children's Intensive Mental Health Treatment Services

309-032-1100

Purpose and Statutory Authority

(1) Purpose. These rules prescribe standards and procedures for intensive mental health treatment services for children within a comprehensive system of care. The goal of these services is to maintain the child in the community in the least restrictive treatment setting appropriate to the acuity of the child's disorder. The system of care shall be child and family-centered and community-based with the needs of the child and family determining the types and mix of services provided. These services may be as intensive, frequent and individualized as is medically appropriate to sustain the child in treatment in the community.

(2) Statutory Authority. These rules are authorized by ORS 430.041, 430.640(1)(h), and 743.556 to carry out the provisions of ORS 430.630.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1110

Definitions

As used in these rules:

(1) "Accreditation" means official notification given a provider of compliance to standards established by an accrediting organization approved by the Health Care Financing Administration to accredit providers of Medicaid reimbursed "inpatient under 21."

(2) "Active treatment" means implementation of a professionally developed and supervised individual plan of care to improve a child's condition.

(3) "Acute care" means short term psychiatric treatment in a hospital or other equivalent level of care.

(4) "Admission criteria" means the behavioral and diagnostic requirements to be met for a child to be admitted to intensive mental health treatment services.

(5) "Assessment and Evaluation Program" means a service designed for children who need non-hospital level psychiatric assessment, evaluation and brief treatment in a staff or facility secure program.

(6) "Behavior management policy" means the written policies and procedures adopted by the provider that describe the behavioral interventions to be used by the provider to manage maladaptive or problem behavior of an admitted child.

(7) "Case management" means the service provided to children and families to link and coordinate segments of the service delivery system of a single provider or of several providers to ensure that the most effective means of meeting the child's needs for care are used. Case management functions for children with intensive treatment needs include planning specific treatment goals and services needed to achieve goals; linking the child to appropriate services delineated in the care plan; monitoring and ongoing contact with the child to ensure that services are being delivered appropriately; and advocating for the child's clinical needs.

(8) "Certification" means official approval given by the Division to an appropriately licensed and/or accredited provider to deliver intensive treatment services.

(9) "Chemical restraint" means the administration of medication for the acute management of uncontrolled behavior. Chemical restraint is different from the use of medication for treatment of symptoms of severe emotional disturbances and/or disorders. Chemical restraint of children is prohibited.

(10) "Child" or "Children" means a person or persons under the age of 18, or for those with Medicaid eligibility under the age of 21, who receives ITS services.

(11) "CHIP" means the Child Health Insurance Program federal grant-in-aid program to states under Title XXI of the Social Security Act.

(12) "Client Process Monitoring System" or "CPMS" means the Division's client information system for community based services.

(13) "Clinical record" means the collection of all documentation regarding a child's mental health treatment. The record is a legal document. The clinical record provides the foundation for managing and tracking the provision and quality of services.

(14) "Clinical supervision" means the documented oversight by a Clinical Supervisor of mental health treatment services provided by Qualified Mental Health Professionals or Qualified Mental Health Associates.

(15) "Clinical supervisor" means a Qualified Mental Health Professional with two years post-graduate clinical experience in a mental health treatment setting. The clinical supervisor, as documented by the provider, operates within the scope of his or her practice or licensure, and demonstrates the competency to oversee and evaluate the mental health treatment services provided by other Qualified Mental Health Professionals or Qualified Mental Health Associates.

(16) "Comprehensive mental health assessment" means the written documentation by a QMHP of the child's presenting mental health problem(s) and mental status; and emotional, cognitive, family, substance use, behavioral, social, physical, nutritional, school or vocational, recreational and cultural functioning; and developmental, medical and legal history. A comprehensive mental health assessment is collected through interview with the child, family and other relevant persons; review of previous treatment records; observation; and psychological and neuropsychological testing when indicated. The comprehensive mental health assessment concludes with a completed DSM five axis diagnosis, clinical formulation, prognosis for treatment, and treatment recommendations. The comprehensive mental health assessment is used to document the need for mental health services and to develop or update the child's individual plan of care.

(17) "Consent to treatment" means the informed, voluntary, written agreement as required in ORS 430.210(d) between the provider and the child's custodial parent or guardian, or the child if legally emancipated, for the child to receive prescribed treatment for a specific diagnosis.

(18) "Consultation" means professional advice or explanation given concerning a specific child to others involved in the treatment process, including family members, staff members of other human service agencies and care providers.

(19) "Contractor" means a CMHP, MHO or other entity approved by the Division for contracting or subcontracting to purchase intensive mental health treatment services for children. A contractor is responsible for assuring that the provider of contracted services meets the requirements established in this rule including applicable licensing, certification and accreditation standards and holds a valid Certificate of Approval issued by the Division.

(20) "Continued stay criteria" means the diagnostic, behavioral and functional indicators documented in the child's plan of care by the interdisciplinary team to provide the clinical rationale for a child to remain in an intensive mental health treatment service.

(21) "Crisis" means either an urgent or emergency situation that occurs when a child's mental status, emotional stability, or functioning evidences a rapid deterioration and there is an immediate need to address the situation to prevent further deterioration in the child's condition.

(22) "Custodial parent" means the parent(s) or guardians having legal custody of the child.

(23) "Custody" means the legal care and supervision of the child by the person, agency or institution having the authority to authorize ordinary, urgent or emergent medical, psychiatric, psychological and other remedial care and treatment for the child. The custodial parent(s) is not required to relinquish custody of the child to receive mental health treatment services.

(24) "Diagnosis" means the primary mental disorder listed in the most recently published edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), that is the medically appropriate reason for clinical care and the main focus of treatment. The primary diagnosis is determined through the mental health assessment and any examinations, tests, procedures or consultations suggested by the assessment. A DSM "V" code condition, substance use disorder or mental retardation is not considered the primary diagnosis covered under these rules although these conditions or disorders may co-occur with the diagnosable mental disorder.

(25) "Direct supervision" means the oversight and coordination by a QMHP of interventions described in the individual plan of care performed by a Qualified Mental Health Associate (QMHA) and other direct care staff. Direct supervision also includes reviewing and evaluating the documentation of interventions directed by the individual plan of care performed by a QMHA or other direct care staff. Direct supervision is performed on a regular, routine basis in an individual or group setting.

(26) "Direction of the psychiatrist" means medical oversight of the clinical aspects of care required of accredited "inpatient under 21" providers by the Health Care Financing Administration (HCFA). Medical oversight includes participation on the interdisciplinary team, prescribing treatment on individual plans of care by signature, prescribing and/or monitoring medications and reviewing special treatment procedures.

(27) "Discharge criteria" means the diagnostic, behavioral and functional indicators the child and/or family will meet to move to the next level of service.

(28) "Discharge instructions" means a brief document which transmits information about the child's ongoing care and treatment needs. Discharge instructions include current medication and medical information, diagnosis and current treatment intervention strategies to manage the child prior to receiving a discharge summary. Discharge instructions shall be part of the information given to the parent or guardian upon or prior to discharge.

(29) "Discharge summary" means written documentation of the last service contact with the child; the diagnosis at admission; and a summary statement that describes the effectiveness of treatment modalities and progress, or lack of progress, toward treatment objectives while in service. The discharge summary also includes the reason for discharge, changes in diagnosis during treatment, current level of functioning and prognosis and recommendations for further treatment.

(30) "Division" means the Department of Human Services Agency responsible for the administration of mental health and developmental disabilities programs and laws of the state.

(31) "DSM" means the current edition of the "Diagnostic and Statistical Manual of Mental Disorders" published by the American Psychiatric Association.

(32) "Enrollment" means the assignment of Oregon Health Plan clients to Mental Health Organizations (MHOs), Oregon Health Plan Managed Care Enrollment Requirements.

(33) "Family" means the parent(s), legal guardian, siblings, grandparents, spouse and other primary relations of the child whether by blood, adoption, legal or social relationship.

(34) "Five-axis diagnosis" means the multiaxial system of evaluation in the DSM organized to provide a comprehensive approach to psychiatric assessment and to ascertain that all of the information necessary for planning treatment and predicting treatment outcomes for children is recorded on each of five axis.

(35) "Formal complaint" means the expression in a manner appropriate to the child or family/guardian of dissatisfaction or concern about the provision or denial of services that is the responsibility of the provider under these rules. The formal complaint can be expressed by a child or by the child's representative.

(36) "Fully Capitated Health Plan" or "FCHP" means a prepaid health plan under contract with the Office of Medical Assistance Programs to provide capitated physical health and chemical dependency services under the Oregon Health Plan. Some FCHPs also serve as Mental Health Organizations.

(37) "Goal" means an expected result or condition to be achieved, which is specified in a statement of relatively broad scope, provides a guideline for the direction of care and is related to an identified clinical problem.

(38) "Guardian" means a parent, other person or agency legally in charge of the affairs of a minor child and having the authority to make decisions of substantial legal significance concerning the child.

(39) "Indicators of progress" means the diagnostic, behavioral, or functional measures used by the provider to demonstrate the degree to which a child and family have made functional or behavioral improvement in the areas being measured.

(40) "Individual plan of care" means the written plan developed by a QMHP for active treatment for each child admitted to an intensive treatment service program. The individual plan of care specifies the DSM diagnosis, goals, measurable objectives, and specific treatment modalities and is based on a completed mental health assessment or comprehensive mental health assessment of the child's functioning and the acuity and severity of psychiatric symptoms.

(41) "Individuals with Disabilities Education Act" or "IDEA" means the federal law requiring that a free and appropriate education be provided to all children with mental and physical handicapping conditions. The education provided must include all educational and related services necessary for the child to learn.

(42) "Initial plan of care" means the written plan developed by a QMHP for active treatment based on the mental health assessment completed at admission. The initial plan of care specifies assessment and treatment modalities before completing the individual plan of care.

(43) "Intensive treatment services" or "ITS" means the range of service components in the system of care inclusive of treatment foster care, therapeutic group homes, psychiatric day treatment, partial hospitalization, residential psychiatric treatment, sub-acute care or other services as determined by the Division that provides active psychiatric treatment for children with severe emotional disorders and their families.

(44) "Interdisciplinary team" means a team of qualified treatment and education professionals including a child and adolescent psychiatrist or LMP and the child's parent or guardian responsible for assessment and evaluation, the development and oversight of individual plans of care, and the provision of treatment for children admitted to an intensive treatment services program.

(45) "Isolation" means the staff-directed placement of a child in a room or other space in which the child is alone and without ongoing verbal or visual contact with others. Periodic visual or verbal contact by staff does not prevent the child from being considered to be in isolation. A child who is placed in his or her bedroom at the child's normal bedtime or otherwise has a routine separation unrelated to behavior or conduct is not considered to be isolation.

(46) "Level of care" means the relative amount and intensity of mental health services provided from the least restrictive and least intensive in a community-based setting to the most restrictive and most intensive in an inpatient setting. As required in ORS 430.210(a), children are to be served in the most normative, least restrictive, least intrusive level of care appropriate to their treatment history, degree of impairment, current symptoms and the extent of family or other supports.

(47) "Level of functioning" means the description and numeric quantification on Axis V of a DSM diagnosis of the effectiveness of a child's ability to achieve or maintain developmentally appropriate behavior in one or more of the following areas: role and task performance, cognition and communication, behavior toward self and others, and mood and emotions as measured against age appropriate norms.

(48) "Licensed Medical Practitioner" or "LMP" means any person who meets the following minimum qualifications as documented by the provider:

(a) Holds at least one of the following educational degrees and valid licensure:

(A) Physician licensed to practice in the State of Oregon;

(B) Nurse Practitioner licensed to practice in the State of Oregon;

(b) A Licensed Medical Practitioner contracting or employed for the first time with a provider under these rules after July 1, 2000, shall be a board-certified or board-eligible child and adolescent psychiatrist licensed to practice in the State of Oregon.

(49) "Manual restraint" means the act of involuntarily restricting a child's movement by holding the whole or a portion of a child's body in order to protect the child or others from injury. The momentary periods of physical restriction by direct contact with the child, without the aid of material or mechanical devices, accomplished with limited force, that prevent the child from completing an act that would result in potential physical harm to the child or others are not considered to be restraint.

(50) "Mechanical restraint" means the use of any physical device to involuntarily restrain the movement of all or a portion of a child's body as a means of controlling his or her physical activities in order to protect the child or other persons from injury. Mechanical restraint shall only be used by Sub-Acute providers specifically authorized in writing to use mechanical restraint by the Division. Mechanical restraint does not apply to movement restrictions stemming from physical medicine, dental, diagnostic or surgical procedures which are based on widely accepted, clinically appropriate methods of treatment by qualified professionals operating within the scope of their licensure.

(51) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to poor and indigent persons under Title XIX of the Social Security Act.

(52) "Medically appropriate" means services which are required for prevention (including preventing a relapse), diagnosis or treatment of mental health conditions and which are appropriate and consistent with the diagnosis; consistent with treating the symptoms of a mental illness or treatment of a mental condition; appropriate with regard to standards of good practice and generally recognized by the relevant scientific community as effective; not solely for the convenience of the provider of the services, child or family; and the most cost effective of the alternative levels of medically appropriate services which can be safely and effectively provided to the child and family in the LMP's judgement.

(53) "Medication service record" means the documentation of written or verbal orders for medication, laboratory and other medical procedures issued by a Licensed Medical Practitioner employed by, or under contract with, the provider and acting within the scope of his or her license. The provision of medication services is documented in written progress notes and/or medication administration records and placed in the client's record.

(54) "Mental health assessment" means the written documentation by a QMHP of the child's presenting mental health problem(s) and relevant child and family history, mental status examination and DSM 5-axis diagnosis or provisional diagnosis.

(55) "Mental Health Information System" means the information system of the Division that includes the Client Process Monitoring System for non-hospital services, the Medicaid Management Information System for the Medicaid eligible population and billable services delivered, and the Oregon Patient Resident Care System for inpatient and acute services. It provides a statewide client registry for tracking services utilization and contractor capacity.

(56) "Mental Health Organization" or "MHO" means a prepaid health plan under contract with the Division to provide covered services under the Oregon Health Plan.

(57) "Mental status examination" means the face-to-face assessment by a QMHP of a child's mental functioning within a developmental and cultural context that includes descriptions of appearance, behavior, speech, language, mood and affect, suicidal or homicidal ideation, thought processes and content, and perceptual difficulties including hallucinations and delusions. Cognitive abilities are also assessed and include orientation, concentration, general knowledge, intellectual ability, abstraction abilities, judgment, and insight appropriate to the age of the child.

(58) "Milieu" means the daily environment of structure and therapy, education, recreation and socialization interactions with staff and peers for children in treatment.

(59) "Minor child" means an unmarried person under the age of 18.

(60) "Non-custodial parent" means a parent whose custodial responsibilities have been removed by the court by divorce decree. Under ORS 107.154, and unless otherwise ordered by the court, non-custodial parents have the same rights to consult with any person who may provide care and treatment for the child and to inspect and receive the child's medical and psychological records to the same extent as the custodial parent.

(61) "Objective" means a quantifiable statement of a desired future state or condition which is related to the attainment of a goal within a stated deadline for achievement.

(62) "Oregon Youth Authority (OYA)" means the department of state government created by the 1995 Legislative Assembly that is charged with the management and administration of youth correction facilities, state parole and probation services, and other functions related to state programs for youth corrections.

(63) "Partial hospitalization program" means a comprehensive interdisciplinary day treatment program certified under this rule to provide psychiatric services, therapy, education and therapeutic activities as an alternative to hospitalization which meets Health Care Financing Administration accreditation standards.

(64) "Plan of correction" means a written document which specifies actions that a provider will take to come into compliance with these rules.

(65) "Progress note" means the written documentation of the clinical course of treatment.

(66) "Provider" means an organization or agency certified by the Division to provide intensive mental health treatment services for children.

(67) "Provisional diagnosis" means a statement on Axis I of a DSM diagnosis when there is a strong presumption that the full criteria for the diagnosis will ultimately be met.

(68) "Psychiatric Day Treatment" means the comprehensive, interdisciplinary, non-residential community based program certified under this rule consisting of psychiatric treatment, family treatment and therapeutic activities integrated with an accredited education program.

(69) "Psychiatric Residential Treatment Facility" or "PRTF" means the behavioral health care programs certified under this rule to provide 24-hour, seven days per week active mental health treatment under the direction of a psychiatrist for children under age 21. These services are associated with a Residential Psychiatric Treatment Program for children who can benefit from a less restrictive residential psychiatric environment.

(70) "Psychiatrist" means a Licensed Medical Practitioner who is board-eligible or board-certified in child and adolescent psychiatry and licensed to practice in the State of Oregon.

(71) "Qualified Mental Health Associate" or "QMHA" means a person who delivers services under the direct supervision of a Qualified Mental Health Professional and who meets the following minimum qualifications as documented by the provider:

(a) Has a bachelor's degree in a behavioral sciences field, or a combination of at least three years work, education, training or experience; and

(b) Has the competency necessary to:

(A) Communicate effectively;

(B) Understand mental health assessment, treatment and service terminology and to apply the concepts;

(D) Implement interventions as assigned on an individual plan of care.

(72) "Qualified Mental Health Professional" or "QMHP" means a Licensed Medical Practitioner or any other person who meets the following minimum qualifications as documented by the provider:

(a) Holds any of the following educational degrees:

(A) Graduate degree in psychology;

(B) Bachelor's degree in nursing and licensed by the State of Oregon;

(D) Graduate degree in a behavioral science field;

(E) Graduate degree in recreational, music, or art therapy;

(F) Bachelor's degree in occupational therapy and licensed by the State of Oregon; and

(b) Whose education and experience demonstrate the competency to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social and work relationships; conduct a mental status examination; document a multiaxial DSM diagnosis; write and supervise an individual plan of care; conduct a Comprehensive Mental Health Assessment and provide individual, family and/or group therapy within the scope of their training.

(73) "Quality Management" means a continuous process to simultaneously promote consistency of performance and to promote meaningful change in measurable objectives. The process is used to improve a provider's performance and adjust measurable objectives and benchmarks.

(74) "Quality of care" means the degree to which services are consistent with best practices and produce desired and satisfactory mental health outcomes for the child.

(75) "Reportable incident" means an event in which an admitted child while in the program is believed to have been abused, endangered or significantly harmed. This may include, but is not limited to, incidents as a result of staff action or inaction, incidents between children, incidents that occur on passes, or incidents of self-harm where medical attention is necessary.

(76) "Residential Psychiatric Treatment Program" means the behavioral health care programs certified under this rule to provide 24-hour, seven days per week active mental health treatment under the direction of a psychiatrist for children under age 21.

(77) "Seclusion" means the involuntary confinement of a child alone in a specifically designed room from which the child is physically prevented from leaving.

(78) "Severe emotional disorder" means an emotional, mental, and/or neurobiological impairment which is manifested by emotional or behavioral symptoms that are not solely a result of mental retardation or other developmental disabilities, epilepsy, drug abuse, or alcoholism and which continue for more than one year, or on the basis of a specific diagnosis is likely to continue for more than one year.

(79) "Special treatment procedures" means seclusion; manual restraint; staff directed isolation for more than five hours in five days or a single episode of two hours; and experimental practices and research projects that involve risk to a child.

(80) "Special Treatment Procedures Committee" means the committee established or designated by the provider to review special treatment procedures.

(81) "State Office for Services to Children and Families (SOSCF) or (SCF)" means the Division serving as Oregon's child welfare agency.

(82) "Sub-Acute Psychiatric Care" means mental health treatment under the clinical direction of a psychiatrist as an alternative to hospitalization certified under this rule for children who are not in the most acute phase of a mental condition but who require a level of care higher than that provided in a residential psychiatric treatment setting.

(83) "System of care" means the comprehensive array of mental health and other necessary services which are organized to meet the multiple and changing needs of children with severe emotional disorders and their families.

(84) "Therapeutic group home" means mental health treatment settings certified under this rule for children in group care homes of eight or fewer children in SCF-licensed homes where the home parents are employed or contracted by the supervising agency to provide in-home psychosocial skills development for each child.

(85) "Treatment foster care" means mental health treatment settings certified under this rule for children residing in SCF certified homes where the home parents are employed or contracted by the supervising agency to provide in-home psychosocial skills development for each child.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1120

General Conditions of Participation for Children's Intensive Mental Health Treatment Services Providers

Providers delivering children's intensive mental health services shall:

(1)(a) Hold, and/or assure that subcontractors hold, a valid Certificate of Approval issued by the Division and, if applicable, accreditation approved by the Division and the Health Care Financing Administration and appropriate license or certification from the State Office for Services to Children and Families;

(b) Providers that are not required to have accreditation approved by the Health Care Financing Administration may use alternative standards for the organization of their services;

(A) Alternative standards include the Day and Residential Treatment Services (DARTS) Standards or others approved by the Division;

(B) In the event of a conflict between this rule and voluntary standards, the standards and procedures outlined in this rule will supercede all alternative standards.

(2) Maintain the organizational capacity and interdisciplinary treatment capability to deliver clinically and developmentally appropriate services in the medically appropriate amount, intensity and duration for each admitted child specific to the child's diagnosis, level of functioning and the acuity and severity of the child's psychiatric symptoms;

(3) Maintain 24 hour, seven days per week treatment responsibility for admitted children. Non-residential programs shall maintain on-call capability at all times to respond directly or by referral to the treatment needs of admitted children including crises 24 hours per day, seven days per week;

(4) Deliver active psychiatric treatment in the least restrictive, least intensive setting appropriate to each admitted child's treatment history, diagnosis, development, level of functioning and degree of impairment, current symptoms and the extent of family and other supports;

(5) Use treatment methods appropriate for children with severe emotional disorders that are based on sound clinical theory and professional standards of care and widely accepted by qualified professionals in the mental health field;

(6) Demonstrate family involvement and participation in all phases of assessment, treatment planning and the child's treatment by documentation in the clinical record;

(7) Report suspected child abuse as required in ORS 419B.010;

(8) Maintain reportable incident files including:

(a) Child abuse reports made by the provider to law enforcement or the State Office for Services to Children and Families child protective services documenting the dates of the incident the persons involved and, if known, the outcome of such reports; and

(b) Reportable incident information documenting the date of the incident, the persons involved, the quality and performance actions taken to initiate investigation of the incident, and correct any identified deficiencies.

(9) Inform the Division and the legal guardian within one working day of reportable incidents.

(10) Enroll children in the Mental Health Information System when the child's mental health services are funded all or in part by Division funds, unless the Division contract does not require enrollment;

(11) Maintain policies and practices prohibiting on- or off-site non-professional relationships and activities between employees and admitted children and their families unless the activities are approved by the provider and interdisciplinary team and identified as clinically appropriate services in the child's individual plan of care;

(12) Provide services for children in a smoke free environment in accordance with Public Law 103.277, the Pro-Child Act;

(13) Establish systematic and objective methods to accomplish the following:

(a) Periodically monitor and evaluate access to, and provision of, children's intensive mental health treatment services;

(b) Identify and seek to resolve problems in access to, or provision of, services; and

(c) Improve access and services using reliable and valid performance measures; and to periodically report pertinent data and information as directed by the Division.

(14) Demonstrate education service integration in all phases of assessment, treatment planning, active treatment, and discharge planning by documentation in the clinical record; and

(15) Maintain policies and procedures to ensure the safety and emergency needs of children, families, staff and visitors including:

(a) First aid and cardiopulmonary resuscitation training for staff who are assigned to provide direct service to children;

(b) Off campus activities;

(d) Facility and environmental emergencies.

(16) Demonstrate cultural competency, gender responsiveness and language appropriateness in the delivery of services to clients.

(17) Demonstrate operation by a governing body whose membership reflects diverse community interests and whose organization and operation shall be set out in writing.

(18) Develop and publish a comprehensive document which describes the mission statement, treatment philosophy, programmatic descriptions, admission criteria, and the policies and procedures for operation of the program.

(19) Develop policies and procedures for orientation of the incoming child and family that consider pre-admission orientation times convenient for the family and that facilitate adequate staff program and child and family preparation prior to admission.

(20) Develop policies and procedures prohibiting firearms and outlining the management of other potentially dangerous objects.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1130

General Treatment Requirements

(1) Admission. Providers shall plan admissions, help the child and family understand the reason for admission, give admission consideration to children that realistically allows the child's family to participate in treatment, and advise the family on transportation arrangements when needed.

(2) Prior to admission for planned admissions or within 14 days following an emergency admission, providers shall determine that a child is eligible for intensive treatment services. Admissions shall be based on the provider's clinical review of the child's functioning, of the severity and acuity of the child's psychiatric symptoms, and of documentation of the following:

(a) A completed five-axis diagnosis current within 60 days of the admission date;

(b) Pertinent biological, psychological and sociocultural factors influencing the child's development and functioning;

(d) The child's functioning as scored on measures established by the Division; and

(e) Attempts to effectively treat the child in a less restrictive level of care.

(3) Assessment.

(a) On admission the child shall have an initial plan of care based on a mental health assessment completed by a QMHP.

(b) A comprehensive mental health assessment shall be conducted by the provider's interdisciplinary team and be completed within 30 treatment days after admission.

(4) Active Treatment and Individual Plans of Care.

(a) Providers shall fully inform the child in developmentally appropriate language and obtain informed consent from the child's parent(s) or guardian about the proposed care and shall document in the child's clinical record that the following information has been reviewed, discussed, and agreed to by the participants:

(A) Active treatment and other interventions to be undertaken;

(B) Alternative treatments or interventions available, if any;

(D) Indicators by which progress will be measured;

(E) Benefits which can reasonably be expected;

(F) Risks of treatment, if any;

(G) Prognosis for treatment; and

(H) Discharge plan.

(b) The individual plan of care shall clinically support the level of care to be provided and shall:

(A) Be developed and implemented no later than 14 treatment days after admission by an interdisciplinary team in consultation with the child, the parent(s) or guardian and the provider to which the child will be discharged;

(B) Be based on a mental health assessment of the child's functioning, the acuity and severity of the child's psychiatric symptoms, diagnosis, and the biological, medical, psychological and sociocultural factors that influence the child's development and functioning;

(D) Prescribe an integrated program of therapies, activities, interventions and experiences designed to meet the goals;

(E) Include a discharge plan to ensure continuity of care with the child's family, school, and community upon discharge; and

(F) Be signed and dated by the psychiatrist and other members of the interdisciplinary team including the child's guardian, and when appropriate the child.

(5) Individual Plan of Care Review. A written summary of each individual plan of care review shall be filed in the child's clinical record. Revisions shall be implemented as necessary based on each child's individualized response to the treatment interventions.

(a) The review in nationally accredited sub-acute, assessment and evaluation programs and residential psychiatric treatment programs shall be conducted every 30 days by the interdisciplinary team.

(b) In other programs, the review shall be conducted every 30 days by the child's interdisciplinary team. The psychiatrist shall participate in the review at least every 90 days.

(6) Discharge Planning and Coordination.

(a) Providers shall establish written policies and practices for identifying, planning and coordinating discharge to after-care resources. At a minimum, the provider's interdisciplinary team shall:

(A) Integrate discharge planning into ongoing treatment planning and documentation from the time of admission, and specify the discharge criteria that will indicate resolution of the symptoms and behaviors that justified the admission;

(B) Review and, if needed, modify the discharge plan every 30 days;

(C) Include the parent, guardian and provider to which the child will be discharged in discharge planning and reflect their needs and desires to the extent clinically indicated;

(D) Finalize the discharge plan prior to discharge and identify in the plan the continuum of services and the type and frequency of follow-up contacts recommended by the provider to assist in the child's successful transition to the next appropriate level of care; and

(E) Assure that appropriate medical care and medication management will be provided to clients who leave through a planned discharge. The discharging provider's interdisciplinary team shall identify the medical personnel who will provide continuing care and shall also arrange an initial appointment with that provider.

(b) Providers shall give written discharge instructions to the child's parent(s) or guardian, or the provider of the next level of care on the date of discharge.

(c) Providers shall notify the child's parent(s) or guardian and the provider to which the child will be discharged of the anticipated discharge dates at the time of admission and when the discharge plan is changed.

(d) Providers shall not discharge a child from an intensive treatment service unless the interdisciplinary team, in consultation with the child's parent(s) or guardian or the provider of the next level of care, determines that the child requires a more or less, restrictive level of care. If the determination is to admit the child to acute care, the provider shall not discharge the child from the program during the acute care stay unless the interdisciplinary team, in consultation with the child's parent(s) or guardian or the provider of the next level of care determines that the child requires a more or less restrictive level of care.

(e) A discharge summary reflecting the active course of treatment shall be completed and placed in the chart within 15 treatment days following discharge.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1140

General Staffing and Personnel Requirements

(1) Providers of children's intensive mental health treatment services shall have the clinical leadership and sufficient QMHP, QMHA and other staff to meet the 24-hour, seven days per week treatment needs of admitted children and shall establish policies, contracts and practices to assure:

(a) Availability of psychiatric services to meet the following requirements:

(A) Provide medical oversight of the clinical aspects of care in nationally accredited sub-acute, assessment and evaluation programs and residential psychiatric treatment programs and provide 24-hour, seven days per week psychiatric on-call coverage; or consult on clinical care and treatment in psychiatric day treatment, partial hospitalization, therapeutic group homes and treatment foster care programs;

(B) Assess each child's medication and treatment needs, prescribe medicine or otherwise assure that case management and consultation services are provided to obtain prescriptions, and prescribe therapeutic modalities to achieve the child's individual plan of care goals; and

(b) An executive director or clinical director who meets the following minimum qualifications:

(A) Masters degree in a human service-related field from an accredited school;

(B) Five years experience in a human services program;

(D) Subscribes to a professional code of ethics.

(2) Providers of children's intensive mental health services shall have adequate numbers of QMHP, QMHA and other staff whose care specialization is consistent with the duties and requirements of the specific level of care. Professional staff shall operate within the scope of their training and licensure.

(3) Providers shall assure through documentation in personnel files that all supervisory and clinical staff meet all applicable professional licensing and/or certification, and QMHP or QMHA competencies.

(4) Providers shall maintain a personnel file for each employee, that contains:

(a) The employment application;

(b) Verification of a criminal history check as required by ORS 181.536 - 181.537;

(d) Documentation and copies of relevant licensure and/or certification that the employee meets applicable professional standards;

(e) Annual performance appraisals;

(f) Annual staff development and training activities;

(g) Employee incident reports;

(h) Disciplinary actions;

(i) Commendations; and

(j) Reference checks.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1150

System of Care

(1) General Requirements. All ITS providers described in this section shall meet the following general requirements:

(a) Active psychiatric treatment and education services shall be functionally integrated in a therapeutic milieu designed to promote achievement of goals and treatment objectives developed in each child's individual plan of care.

(b) ITS facilities shall meet all applicable licensing, certification and accreditation/or standards for plant technology, safety management, professional staffing, therapeutic environment, performance measurement, quality management and utilization review.

(c) ITS providers shall maintain linkages with primary care physicians, CMHPs and MHOs and the child's parent(s) or guardian to plan for necessary continuing care resources for the child.

(d) ITS providers shall maintain linkages with the applicable education service district or school district to coordinate and provide the necessary educational services for the children.

(e) When treatment services interrupt the child's day to day educational environment, the program provides or makes arrangements for the continuity of the child's education.

(f) ITS providers shall ensure that the following services be available and accessible through direct service, contract or by referral:

(A) Psychiatric and psychological assessment and treatment;

(B) Individual, group and family therapies;

(D) Pre-vocational/vocational rehabilitation;

(E) Therapies supporting speech, language and hearing rehabilitation;

(F) Individual and group psychosocial skills development;

(G) Behavior management;

(H) Activity and recreational therapies;

(I) Nutrition;

(J) Physical health care services or coordination; and

(K) Case management, treatment planning and coordination, and consultation.

(g) Family therapy shall be provided by a Qualified Mental Health Professional. The family therapist to child ratio shall be at least one family therapist for each 12 children.

(h) There shall be a clinical supervisory ratio of at least one QMHP clinical supervisor for each nine staff.

(i) Providers of ITS shall measure individual active treatment outcomes for children in treatment with the provider. Measurement of active treatment outcomes shall include, but are not limited to:

(A) Stabilization of the acuity and severity of symptoms;

(B) Reduction of danger to self or others;

(D) Stabilization of behavior and conduct; and

(E) Development of new adaptive coping skills.

(2) In addition to the general requirements for all ITS providers listed in 309-032-1150(1), the following service specific requirements shall be met.

(3) Psychiatric Residential Treatment Services. These services are structured treatment environments with daily 24-hour supervision and active psychiatric treatment. It includes Sub-Acute Psychiatric Care, Assessment and Evaluation Programs, Residential Psychiatric Treatment Programs, and Psychiatric Residential Treatment Facilities. Psychiatric Residential Treatment Services are provided by nationally accredited providers certified under these rules for children who require active treatment for a diagnosed mental disorder in a 24-hour residential setting. An education program provided and admitted children shall have, or have been screened for, an Individual Education Plan, Personal Education Plan, and/or an Individual Family Service Plan.

(a) Providers of Psychiatric Residential Treatment Services shall maintain one or more linkages with acute care hospitals and/or MHOs to coordinate necessary inpatient care.

(b) Psychiatric residential clinical care and treatment shall be under the direction of a medical director who is a psychiatrist as defined in these rules and delivered by an interdisciplinary team of board-certified or board-eligible child and adolescent psychiatrists, registered nurses, psychologists, other qualified mental health professionals, and other relevant program staff. A psychiatrist shall be available to the unit 24-hours per day, seven days per week.

(c) Psychiatric Residential Treatment Services shall be staffed to the acuity and severity of admitted children at a staffing ratio of not less than one staff for three children during the day and evening shifts. At least one staff for every three staff members during the day and evening shifts shall be a Qualified Mental Health Professional or Qualified Mental Health Associate. For overnight staff there shall be a staffing ratio of at least one staff for six children with one being a Qualified Mental Health Associate. For units that by this ratio have one overnight staff, there shall be additional staff immediately available within the facility or on the premises. At least one Qualified Mental Health Professional shall be on site or on call at all times. At least one staff with designated clinical leadership responsibilities shall be on site at all times.

(4) Sub-Acute Psychiatric Care. These are services provided by nationally accredited providers certified under these rules for children who need 24-hour intensive mental health treatment in a secure setting to assess, evaluate and stabilize or resolve the symptoms of an acute episode that occurred as the result of the diagnosed mental disorder. In addition to the requirements provided in 309-032-1150(1)–(3) Sub-Acute Psychiatric Care providers shall:

(a) Provide psychiatric nursing staffing at least 16 hours per day;

(b) Establish policies and practices to meet the following admission and continued stay criteria:

(A) Admission:

(i) The child is admitted by physician order for a period up to 14 days to determine through assessment and evaluation the existence of a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis that shall be the basis for the development of a plan to guide the child's treatment; or

(ii) The child has a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis; and

(iii) The child needs treatment 24-hours each day in a secure setting under the direction of a psychiatrist to stabilize or resolve symptoms or behaviors which were identified as the reason for admission and which are consistent with the DSM diagnosis;

(iv) The admitting and referring physicians have consulted and agree on the admission;

(v) Proposed treatments for the DSM diagnosis require close nursing supervision and monitoring and psychiatric supervision at least one to three times per week; and

(vi) Less restrictive or less intensive services cannot be expected to improve the child's condition or prevent further regression so that Sub-Acute services will no longer be needed.

(B) Continued Stay:

(i) Children shall remain in Sub-Acute Psychiatric Care only as long as necessary to provide brief treatment to stabilize the child. Continued stays of more than 30 days shall be approved at 30-day intervals up to 90 days by the Division or its designated external review organization.

(ii) Children may continue to receive Sub-Acute Psychiatric Care services for more than 90 days only by authorization of the attending psychiatrist or the interdisciplinary team and approval by the Division or its designated external review organization.

(c) Mechanical restraint shall be used only by Sub-Acute providers specifically authorized by the Division in writing to use mechanical restraint.

(5) Assessment and Evaluation Programs. Assessment and Evaluation Programs shall provide services for children who need up to 90 days of 24-hour comprehensive mental health assessment to diagnose a mental disorder and to stabilize assessed symptoms and behavior that affect the child's functioning. In addition to the requirements provided in 309-032-1150(1) and (2) providers of assessment and evaluation program services shall establish policies and practices to meet the following admission and continued stay criteria:

(a) Admission:

(A) The child is admitted by physician order for a period up to 30 days to assess, evaluate and make written recommendations for continuing services. If the child is determined to have a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis that shall be the basis to guide the child's treatment; or

(B) The child has a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis; and

(C) The child needs additional assessment and brief active treatment 24 hours each day under the direction of a psychiatrist to stabilize or resolve symptoms or behaviors which were identified as reason for admission and which are consistent with the DSM diagnosis; and

(D) Less restrictive or less intensive services cannot be expected to improve the child's condition or prevent further regression so that residential assessment and evaluation services will no longer be needed.

(b) Continued Stay:

(A) Children shall remain in an Assessment and Evaluation program only for the period of time needed to complete the necessary battery of assessments and provide brief treatment to stabilize the child.

(B) Continued stays of more than 30 days shall be approved at 30-day intervals up to 90 days by the Division or its designated external review organization.

(C) Children may continue to receive Assessment and Evaluation services for more than 90 days only by authorization of the attending psychiatrist or the interdisciplinary team and approval by the Division or its designated external review organization.

(c) Assessment and Evaluation programs shall provide the referring source with written discharge instructions, a comprehensive written assessment and recommendations for continuing care at the conclusion of the assessment period.

(6) Residential Psychiatric Treatment Program. Services shall include 24-hour supervision for children who have a serious psychiatric, emotional and/or acute behavioral health issues which require intensive therapeutic counseling and activity, intensive staff supervision, support and assistance. In addition to the requirements provided in 309-032-1150(1)–(3) a Residential Psychiatric Treatment Program shall establish policies and practices to meet the following admission and continued stay criteria:

(a) Admission:

(A) A psychiatric or psychological evaluation including a completed 5-axis diagnosis current within 60 days of the application date. The child shall have a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis. The referral information shall have been reviewed by an independent psychiatric review process established by the Division to certify the need for services based on the following criteria:

(B) Ambulatory resources available in the community do not meet the child's treatment needs;

(C) Proper treatment of the child's psychiatric condition requires services on a 24-hour intensive treatment basis under the direction of a psychiatrist;

(D) The services can reasonably be expected to improve the child's condition or prevent further regression so that the current level of care is no longer necessary;

(E) Providers shall accept an emergency admission only under unusual and extreme circumstances. Emergency admissions shall be retrospectively reviewed by the Division or its designated external review organization.

(b) Continued Stay:

(A) Children shall remain in a 24-hour Residential Psychiatric Treatment Program only for the period of time determined to be medically appropriate to treat the psychiatric condition(s) identified on the child's individual plan of care.

(B) Continued stays shall be approved by the Division or its designated external review organization at 90-day intervals.

(C) Continued stays that exceed one year and at an annual basis thereafter shall be approved by the Division or a designated external psychiatric review process.

(7) Psychiatric Residential Treatment Facility. Services shall include 24-hour supervision for children who have a serious psychiatric, emotional and/or behavioral health issues which require intensive therapeutic counseling and activity, staff supervision, support and assistance. These services are associated with a Psychiatric Residential Treatment Program for children who can benefit from a less restrictive residential environment. In addition to the requirements provided in 309-032-1150(1)–(3) a Psychiatric Residential Treatment Facility shall:

(a) Be staffed to the acuity and severity of admitted children and have sufficient QMHP staff to ensure delivery of the appropriate mix and frequency of sound clinical treatment services. There shall be no less than one QMHP for the first five children enrolled. For each additional group of five, or any part thereof, a QMHP or QMHA will be added to the treatment staff ratio. At least one staff per every five staff members shall be a QMHP. For overnight staff there shall be a staffing ratio of at least one staff for six children with one being a QMHA. For units that by this ratio have one overnight staff, there shall be additional staff immediately available within the facility or on the premises. At least one QMHP shall be on site or on call at all times. At least one staff with designated clinical leadership responsibilities shall be on site at all times.

(b) Admission criteria:

(A) The admission decision shall be the responsibility of the interdisciplinary team based on referral information current within the last 60 days;

(B) The referral information shall have been reviewed by an independent psychiatric review process established by the Division to certify the need for services based on the following criteria:

(i) Ambulatory resources available in the community do not meet the child's treatment needs;

(ii) Proper treatment of the child's psychiatric condition requires services on a 24-hour intensive treatment basis under the direction of a psychiatrist but is less severe than the need for Residential Psychiatric Treatment Program level of care;

(iii) The services can reasonably be expected to improve the child's condition or prevent further regression so that the current level of care is no longer necessary.

(A) Children shall remain in a 24-hour Psychiatric Residential Treatment Facility only for the period of time determined to be medically appropriate to treat the psychiatric condition(s) identified on the child's individual plan of care.

(B) Continued stays shall be approved by the Division or its designated external review organization at 90-day intervals.

(C) Continued stays that exceed one year and at an annual basis thereafter shall be approved by the Division or a designated external psychiatric review process.

(8) Partial Hospitalization Programs. Partial Hospitalization services shall be delivered by nationally accredited providers certified under these rules to provide day hospital services. Partial Hospitalization services shall be provided to children who can be maintained at home by a parent, guardian or foster parent by qualified mental health professionals and qualified mental health associates under the direction of a psychiatrist.

(a) Partial Hospitalization services providers shall maintain one or more contracts with acute care hospitals and/or MHOs to coordinate necessary inpatient care with the MHOs and their contracted hospitals. Partial Hospitalization providers shall maintain linkages with primary care physicians, CMHPs and MHOs, and the child's parent(s) or guardian to plan for necessary continuing care resources for the child.

(b) Partial Hospitalization programs shall be staffed to the acuity and severity of admitted children at a clinical staffing ratio of at least one Qualified Mental Health Professional or Qualified Mental Health Associate for up to three children. And have the 24-hour on-call availability of at least one Qualified Mental Health Professional during hours the program is not open.

(c) Providers of Partial Hospitalization services shall establish policies and practices to meet the following admission, continued stay and discharge criteria:

(A) Admission:

(i) The admission decision shall be the responsibility of the interdisciplinary team. The admission shall be based on referral information current within the last 60 days.

(ii) The child shall have a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis and the referral information shall have been reviewed by a psychiatric review process established by the Division to certify the need for services based on the following criteria:

(I) Partial Hospitalization level of care is appropriate to meet the child's treatment needs;

(II) Proper treatment of the child's psychiatric condition requires intensive treatment services under the direction of a psychiatrist; and

(III) The services can reasonably be expected to improve the child's condition or prevent further regression so that the current level of care is no longer necessary.

(B) Continued Stay:

(i) Children shall remain in a Partial Hospitalization program only for the period of time determined to be medically appropriate to treat the psychiatric conditions identified on the child's individual plan of care.

(ii) Continued stays shall be reviewed by the interdisciplinary team and approved every 30 days by a Division approved process.

(9) Psychiatric Day Treatment. Psychiatric Day Treatment services are delivered by providers certified by the Division under these rules to provide Psychiatric Day Treatment services. Psychiatric Day Treatment services shall be provided to children who can be maintained at home by a parent, guardian or foster parent by qualified mental health professionals and qualified mental health associates in consultation with the psychiatrist. An education program is provided and admitted children shall have, or have been screened for, an Individual Education Plan, Personal Education Plan or Individual Family Service Plan.

(a) Psychiatric Day Treatment programs shall be staffed to the acuity and severity of admitted children at a clinical staffing ratio of at least one Qualified Mental Health Professional or Qualified Mental Health Associate for three children.

(b) Providers of Psychiatric Day Treatment services shall establish policies and practices to meet the following admission, and continued stay criteria:

(A) Admission:

(i) The admission decision shall be the responsibility of the interdisciplinary team. The admission shall be based on referral information current within the last 60 days.

(ii) The child shall have a primary diagnosis on Axis I of a completed 5-Axis DSM diagnosis and the referral information shall have been reviewed by a review process approved by the Division to certify the need for services based on the following criteria:

(I) Psychiatric Day Treatment level of care is appropriate to meet the child's treatment needs;

(II) Proper treatment of the child's psychiatric condition requires intensive treatment services in consultation with a psychiatrist; and

(III) The services can reasonably be expected to improve the child's condition or prevent further regression so that the current level of care is no longer necessary.

(B) Continued Stay:

(i) Children shall remain in a psychiatric day treatment program only for the period of time determined to be medically appropriate to treat the psychiatric conditions identified on the child's individual plan of care.

(ii) Continued stay shall be reviewed by the interdisciplinary team and approved every 90 days by a review process approved by the Division.

(10) Substitute Care Settings. Providers of community-based intensive mental health treatment services in substitute care settings shall be certified under these rules. These services include therapeutic group homes and treatment foster care homes. The provider delivers active mental health treatment focused on the behavior, feelings and perceptions the child presents in the treatment/living milieu through regularly scheduled group and individual skills training. Active treatment is based on a mental health assessment of the child's developmental level, behavior, functioning and the severity and acuity of psychiatric symptoms.

(a) Treatment services provided in therapeutic group home and treatment foster care settings shall be delivered by QMHPs and QMHAs with experience and training in psychosocial skills development and milieu therapy under the direction of a qualified mental health professional in consultation with an psychiatrist. The treatment staffing ratio shall be one staff for every eight children.

(b) Providers of therapeutic group home and treatment foster care services shall maintain linkages with primary care physicians, applicable education agencies, CMHPs and MHOs, SCF or OYA representatives, and the child's parent(s) or guardian to coordinate related services and aftercare resources for the child.

(c) Therapeutic group home and treatment foster care and other individualized intensive treatment services provided in substitute care settings shall be staffed to the acuity and severity of admitted children according to the treatment prescribed in each child's individual plan of care. The provision of these services shall be supervised by a Qualified Mental Health Professional.

(d) Providers shall establish policies and practices to meet the following admission and continued stay criteria:

(A) Admission shall be based on referral information current within the last 60 days and include a written assessment by a Qualified Mental Health Professional of the child's primary diagnosis on Axis I of a 5-Axis diagnosis supporting the following criteria:

(i) Therapeutic group or treatment foster care home mental health treatment level of care is appropriate to meet the child's treatment needs; and

(ii) The services can reasonably be expected to improve the child's condition or prevent further regression so that the current level of care is no longer necessary.

(B) Continued stay in a therapeutic group or treatment foster care home shall be based upon determination by an LMP of the medical appropriateness of the setting treating the psychiatric conditions identified in the child's individual plan of care.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1160

Establishing and Maintaining Clinical Records

(1) Individual record. A single, separate and individualized clinical record shall be maintained for each child served by the provider.

(2) Terminology. All documentation entries in the clinical record shall be written in commonly accepted clinical terms in standard, understandable English.

(3) Error corrections. Errors in the clinical record shall be corrected by lining out the incorrect data with a single line in ink, and then adding the correct information, the date corrected, and the initials of the person making the correction. Errors may not be corrected by removal or obliteration.

(4) Signature of authors. All documentation required in this rule must be signed by the person providing the service and making the entry. Signature must include the person's academic degree or professional credential and the date signed. Documentation that is dictated shall also include the date of dictation and date signed.

(5) Organization of clinical records. Each clinical record shall be uniform in organization, readily identifiable and accessible, and contain all of the content required by these rules in a current and complete manner within required timelines.

(6) Providers shall insure that each clinical record includes the following documentation:

(a) MHOs, FCHP, or other third party insurance enrollment information;

(b) Identifying data including child's name, date of birth, gender, address, phone number and name of parent(s) or legal guardian including an address and phone number if different;

(d) An individualized plan of care developed by the interdisciplinary team or professional;

(e) Written discharge criteria;

(f) Completed medical history including current prescribed medications and allergies;

(g) Emergency medical and dental resources and primary care physician;

(h) A medication service record of all medications administered;

(i) Documentation by the interdisciplinary team that the child's individual plan of care has been reviewed, the services provided are medically appropriate for the specific level of care, and changes in the plan recommended by the interdisciplinary team as indicated by the child's treatment needs have been implemented;

(j) Progress notes documenting specific treatments, interventions, and activities related to the individual plan of care or have treatment planning implications, and the child's response to the specific treatment or activities;

(k) Special treatment procedures notations in a separate section or in a separate format documenting each incident of manual restraint, seclusion, or mechanical, signed and dated by the staff directing the intervention and if required by the psychiatrist and/or clinical supervisor authorizing the intervention;

(l) Written discharge instructions and discharge summary; and

(m) The clinical documentation received from the referral source.

(7) The child's parent or guardian, or the child if legally emancipated, must give informed consent in writing to treatment including specific informed consent to the initial administration of any medication, or to a subsequent change in the class of the medication. Each informed consent shall state the information in writing, signed and dated by the person giving consent, and placed in the child's clinical record.

(8) The child's parent or guardian, or the child if legally emancipated, has the right to refuse treatment services including those generally accepted such as medication. The consequences of this service refusal shall be explained verbally and in writing by the provider to the child and parent or guardian, or the child if legally emancipated. A refusal of service shall be documented in the child's record.

(9) The child's clinical record shall be secured, safeguarded, stored and retained in accordance with applicable Oregon Revised Statutes and Oregon Administrative Rules.

(10) The child has the right to confidentiality when referenced in another child's clinical record.

(11) Providers that use electronic clinical record systems shall establish written policies and procedures to ensure confidentiality in accordance with ORS 179.505 through 179.507. The policies and procedures shall assure the following:

(a) The capacity to regularly provide printed documentation of all content incorporated within the clinical record;

(b) The verification of authentication of the individual making an entry including name, degree and date entered; and

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1170

Child and Family Rights

Providers shall establish written policies and procedures pertaining to child and family rights. The written statement of rights shall be posted prominently in simple, easy to understand language on a form devised by the provider or the Division. This form shall be given by the provider to the person legally giving consent to treatment of the child, at the time of admission. In addition, these rights shall be explained orally at the time of admission to the person giving consent to treatment and to the child, in a manner appropriate to the child's developmental level. If the child is initially served in a crisis situation, these rights shall be explained as soon as clinically practical, but not more than five working days from the initiation of services if the child who received the crisis service remains in service. Statement of Rights shall include the following:

(1) Right to provide consent to treatment in accordance with ORS 109.640 and ORS 109.675.

(2) Right to refuse services.

(3) Right to confidentiality in accordance with ORS 179.505, 107.154, and 418.312.

(4) Right to immediate inspection of the clinical record in accordance with ORS 179.505.

(a) The child, if able, and the custodial parent(s) or guardian of a minor child has the right to immediate inspection of the record.

(b) A copy of the record is to be provided within five working days of a request for it. The person requesting the record is responsible for payment for the cost of duplication, after the first copy.

(c) Identifying and clinical information about the child shall be protected in provider publications such as newsletters and brochures.

(5) Right to humane treatment in the least restrictive environment.

(6) Right to receive services in a humane environment that provides the child with protection from harm and protects the dignity of the child and his or her family.

(7) Right to participate in treatment planning. The child, to the extent of his or her capability, and the child's parent or guardian, shall have the right to participate in the planning of services, including the right to participate in the development and periodic revision of the child's individual plan of care. The child's attorney or other representative shall also have the right to participate in the planning process, including attending individual plan of care development and review meetings, upon the request of the child or child's parent or guardian.

(8) Right to private and uncensored communications by mail, telephone and visitation.

(a) This right may be restricted only if the treatment provider documents in the child's record that, in the absence of this restriction, significant physical or clinical harm will result to the child or others. The nature of the harm shall be specified in reasonable detail, and any restriction of the right to communicate shall be no broader than necessary to prevent this harm.

(b) The parent or guardian and the child, in a developmentally appropriate manner, shall be given specific written notice of each restriction of the child's right to communicate. The treatment provider shall ensure that correspondence can be conveniently received and mailed, that telephones are reasonably accessible and allow for confidential communication, and that space is available for visits. Reasonable times for the use of telephones and visits may be established in writing by the treatment provider.

(c) A child shall have the right to uncensored communication with licensed attorneys at law and the state protection and advocacy agency.

(d) The state protection and advocacy agency shall be permitted access to a child and the child's records consistent with federal and state statutes and regulations governing such access. The child's juvenile court attorney and court appointed special advocate (CASA), if any, shall have access to the child and the child's records in accordance with applicable statutes and administrative rules.

(9) Right to personal possessions.

(a) A child shall have the right to wear his or her own clothing and to keep personal possessions. The provider must provide the child with a reasonable amount of storage space for this purpose.

(b) Possession and use, including reasonable restriction of the time and place of use, of certain classes of property may be restricted by the treatment provider if necessary to prevent the child or others from harm, provided that notice of this restriction is given to all children and their families upon the child's admission.

(c) An individual item not subject to general restriction but substantially likely to cause significant physical or clinical harm to a particular child or others due to the child's individual clinical condition may be restricted if the harm that would be likely to result is specifically documented in the child's record. The parent or guardian and the child, in a developmentally appropriate manner, shall be given specific written notice of each such restriction.

(10) Right to receive educational services in the least restrictive environment. Including, if the child is eligible, a free appropriate public education under the Individuals with Disabilities Education Act, 20 USC, Secs. 1401 et seq. Section 504 of the Rehabilitation Act of 1973, 29 USC Sec. 794, and related federal and state statutes and regulations.

(11) Right to refuse to perform routine labor tasks for the provider and to receive reasonable compensation for all work performed other than personal housekeeping duties or chores.

(12) Right to be free from unusual or hazardous treatment procedures and to not participate in experimental treatment procedures without voluntary informed consent.

(13) Right to be free from seclusion or restraint unless used in compliance with all applicable statutes and administrative rules.

(14) Right to freely exercise recognized and accepted religious beliefs and other civil rights.

(15) Right to be thoroughly informed of the provider's rules and regulations.

(16) Right to participate regularly in developmentally appropriate indoor and outdoor play and recreation.

(17) Right to make informed consent to fees for services. The amount and payment schedule of any fees to be charged must be disclosed in writing and agreed to by the person consenting to treatment.

(18) Right to consent to disclosure of clinical records. The person consenting to treatment, usually the custodial parent or guardian, has the right to authorize disclosure of the child's clinical record in accordance with ORS 179.505. When a child is admitted for treatment under a voluntary placement agreement with SCF, the parent(s) or guardian shall have the right to authorize disclosure.

(19) Right of assertion of rights. The rights contained in this section may be asserted and exercised by the child (except where the law requires that only the parent or guardian may exercise a particular right), the child's parent or guardian, or any representative of the child.

(20) Right of formal complaint. The child, parent or guardian or child's representative shall have the right to assert formal complaints concerning denial of any rights contained in this section in a fair, timely and impartial formal complaint procedure. There shall be no retaliation or punishment for exercise of any rights contained in this section.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1180

Behavior Management

(1) Providers shall have a written behavior management policy specifying which behavior management practices and restrictions may be used by staff and the circumstances under which they may be used. The behavior management policy shall:

(a) Establish a framework, which assures consistent behavior management practices throughout the program and articulates a rationale consistent with the provider's philosophy of treatment;

(b) Require the provider to obtain informed consent upon admission from the parent(s) or guardian in the use of behavior management practices and communicate both verbally and in writing the information to the parent(s) or guardian and the child in a developmentally appropriate manner;

(c) Establish thresholds and tracking mechanisms of behavior management interventions that will activate clinical review and which shall be relevant to the acuity and severity of symptoms, and developmental functioning of the population served by the provider;

(d) Require that when thresholds established in the policy are exceeded that the child's individual plan of care be reviewed and revised if necessary within no more than 24 hours and specifies the individual(s) in the program with designated clinical leadership responsibilities who must participate in the review, and specify that the review be documented in the child's clinical record;

(e) Describe the manner and regime in which all staff will be trained to manage aggressive, assaultive, maladaptive, or problem behavior and de-escalate volatile situations through a Division approved crisis intervention training program, and require that such training shall occur annually; and

(f) Require that the provider review and update behavior management policies, procedures, and practices, minimally annually.

(2) Individual behavior management interventions will be developed, implemented, and reviewed for each child, review shall occur minimally at each individual plan of care review.

(3) Each staff directed behavior management intervention that isolates a child for more than 15 minutes shall be noted in the child's clinical record:

(a) The cumulative data shall be reviewed by the child's interdisciplinary team and be reported in the next required individual plan of care review summary;

(b) The individual plan of care shall outline use of this procedure, therapeutic alternatives, and methods to reduce its use; and

(c) Assure that when incidents of isolation for more than five hours in five days or a single episode of two hours the psychiatrist or designee shall within 24 working hours convene by phone or in person individual(s) in the program with designated clinical leadership responsibilities to review the child's individual plan of care and behavior management interventions and make necessary adjustments. This information shall be documented in the child's clinical record and referred to the Special Treatment Procedures Committee.

Stat. Auth.: ORS 430.041, 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1190

Special Treatment Procedures

(1) Providers shall have policies and procedures and a quality management system to:

(a) Monitor the use of special treatment procedures to assure that children are safeguarded and their rights are always protected; and

(b) Review and approve experimental practices other than medications that are outside usual and customary clinical practices and research projects. Experimental practices and research require review and approval by the Division Institutional Review Board.

(c) Report the number of seclusions, the number of restraints, and the total number of patient days to the Division within 30 days of the end of each calendar quarter.

(2) Chemical restraint shall not be used. Medication shall not be used as a restraint, but shall be prescribed and administered according to acceptable nursing, medical, and pharmaceutical practices to treat symptoms of serious emotional disorders.

(3) Mechanical restraint shall be used only in a Sub-Acute program specifically authorized for such use in writing by the Division. Sub-Acute programs that are authorized to use mechanical restraint shall adhere to the standards for special treatment procedures as described in this section and other specific conditions as required by the Division.

(4) The provider shall establish a Special Treatment Procedures Committee or designate this function to an already established Quality Management Committee. Committee membership shall minimally include a staff person with designated clinical leadership responsibilities, the person responsible for staff training in crisis intervention procedures, and other clinical personnel not directly responsible for authorizing the use of special treatment procedures with individual children. The committee shall:

(a) Meet at least monthly and shall report in writing to the provider's Quality Management Committee at least quarterly regarding the committee's activities, findings and recommendations;

(b) Conduct individual and aggregate review of incidents of seclusion and manual restraint;

(c) Conduct individual and aggregate review of incidents of isolation for more than five hours in five days or a single episode of two hours;

(d) Analyze special treatment procedures to determine opportunities to reduce their use, increase the use of alternatives, improve the quality of care of children receiving services, and recommend whether follow up action is needed; and

(e) Review and update special treatment procedures policies and procedures minimally annually.

(5) Obtain informed consent upon admission from the parent(s) or guardian in the use of special treatment procedures. Communicate both verbally and in writing the information to the parent(s) or guardian and the child in a developmentally appropriate manner.

(6) General Conditions of Manual Restraint and Seclusion.

(a) There shall be a systematic approach, documented in written policies and procedures to the treatment of children which employs individualized, preplanned alternatives to manual restraint and seclusion;

(b) Manual restraint and seclusion shall only be used in an emergency to prevent immediate injury to a child who is in danger of physically harming him or her self or others in situations such as the occurrence of, or serious threat of violence, personal injury or attempted suicide;

(d) A child shall be manually restrained or secluded only when clinically indicated and alternatives are not sufficient to protect the child or others as determined by the interdisciplinary team responsible for the child's individual care plan;

(e) The use of manual restraint and seclusion shall be directly related to the child's individual symptoms and behaviors and the acuity of the symptoms and behaviors. Manual restraint and seclusion shall not be used as punishment, discipline, or for the convenience of staff;

(f) Manual restraint and seclusion shall only be used for the length of time necessary for the child to resume self-control and prevent harm to the child or others;

(g) If manual restraint and seclusion are considered as part of the child's individualized safety needs, then alternatives to manual restraint and seclusion shall be identified and made a part of the child's individual plan of care. The individual plan of care shall outline use of this procedure, and goals addressing therapeutic alternatives and interventions to reduce its use; and

(h) Each incident of manual restraint and seclusion shall be referred to the Special Treatment Procedures Committee.

(A) Manual Restraint:

(i) Each incident of manual restraint shall be documented in the clinical record. The documentation shall specify less restrictive methods attempted prior to the manual restraint, the required authorization, length of time the manual restraint was used, the events precipitating the manual restraint, assessment of appropriateness of the manual restraint based on threat of harm to self or others, assessment of physical injury, and the child's response to the intervention;

(ii) A minimum of two staff shall implement a manual restraint. If in the event of an emergency a single staff manual restraint has occurred, the provider's on-call administrator shall immediately review the intervention;

(iii) A manual restraint intervention that exceeds 30 minutes shall require a documented review and authorization by a QMHP, interventions which exceed one hour shall require a documented review and authorization by a psychiatrist or designee; and

(iv) A designated individual with clinical leadership responsibilities shall review the manual restraint documentation prior to the end of the shift in which the intervention occurred.

(v) If incidents of manual restraint used with an individual child cumulatively exceed five hours in five days or a single episode of one hour, the psychiatrist or designee shall within 24 hours convene by phone or in person individual(s) in the program with designated clinical leadership responsibilities to review the child's individual plan of care and/or behavior management interventions and make necessary adjustments. This information shall be documented in the child's clinical record and referred to the Special Treatment Procedures Committee.

(B) Seclusion:

(i) Each episode of seclusion shall be authorized immediately after initiation of the episode in the child's clinical record by the psychiatrist. A general order for the use of seclusion is not sufficient. The psychiatrist may delegate the authority to authorize seclusion to QMHP staff who have satisfactorily completed a Division-approved crisis intervention training program;

(ii) Written orders for seclusion are limited to two hours for children age nine and older and one hour for children under age nine. The psychiatrist may extend the original order for one additional hour for children under age nine to two hours total, and the original order for two hours for children age nine and older up to six hours total;

(iii) Visual monitoring of a child in seclusion shall occur and be documented at least every fifteen minutes or more often as clinically indicated;

(iv) The child's right to retain personal possessions and personal articles of clothing may be suspended during a seclusion only when necessary to ensure the safety of the child or others. Articles that a child might use to inflict self-injury must be removed;

(v) The child shall have regular meals, bathing, and use of the bathroom during seclusion and their provision shall be documented in the child's clinical record;

(vi) Each incident of seclusion shall be documented in the child's clinical record. The documentation shall include the clinical justification for use, the written order by the authorized individual, the less restrictive methods attempted, length of time the seclusion was used, the precipitating events, assessment of appropriateness of the intervention based on threat of harm to self or others, assessment of physical injury, and the child's response to the intervention; and

(vii) If incidents of seclusion used with an individual child cumulatively exceed five hours in five days or a single episode of more than two hours for children age nine and older and more than one hour for children under age nine, the psychiatrist or designee shall within 24 hours convene by phone or in person individual(s) in the program with designated clinical leadership responsibilities to review the child's individual plan of care and/or behavior management interventions and make necessary adjustments. This information shall be documented in the child's clinical record and referred to the Special Treatment Procedures Committee.

(7) Application for the use of seclusion. Any facility or program in which the use of seclusion occurs shall be authorized by the Division for this purpose and shall meet the following requirements:

(a) A facility or program seeking authorization shall submit a written application to the Division;

(b) Application shall include a comprehensive plan for the need for and use of seclusion of admitted children and copies of the facility's policies and procedures for the utilization and monitoring of seclusion including a statistical analysis of the facility's actual use of seclusion, physical space, staff training, staff authorization, record keeping and quality management practices;

(c) The Division shall review the application and, after a determination that the written application is complete and satisfies all applicable requirements, shall provide for a review of the facility by authorized Division staff;

(d) The Division shall have access to the records of the facility's clients, the physical plant of the facility, the employees of the facility, the professional credentials of employees, and shall have the opportunity to observe fully the treatment and seclusion practices employed by the facility;

(e) After the review, the Assistant Administrator or designee shall approve or disapprove the facility's application and if, approved, shall certify the facility based on the determination of the facility's compliance with all applicable requirements for the seclusion of children;

(f) If disapproved the facility shall be provided with specific recommendations and have the right of appeal to the Division; and

(g) Certification of a facility shall be effective for a maximum of three years and may be renewed thereafter upon approval of a renewal application.

(8) Structural and physical requirements for seclusion. Any facility or program in which the use of seclusion occurs shall be certified by the Division for this purpose. A provider seeking this certification under these rules shall have available at least one room that meets the following specifications and requirements:

(a) The room must be of adequate size to permit three adults to move freely and allows for one adult to lie down. Any newly constructed room shall be no less than 64 square feet;

(b) The door must open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside;

(d) The room shall contain no furniture. A fireproof mattress or mat shall be available for comfort;

(e) Any windows shall be made of unbreakable or shatterproof glass, or plastic. Non-shatterproof glass shall be protected by adequate climb-proof screening;

(f) There shall be no exposed pipes or electrical wiring in the room. Electrical outlets shall be permanently capped or covered with a metal shield secured by tamper-proof screws. Ceiling and wall lights shall be recessed and covered with safety glass or unbreakable plastic. Any cover, cap or shield shall be secured by tamper-proof screws;

(g) The room shall meet State Fire Marshal fire, safety, and health standards. If sprinklers are installed, they shall be recessed and covered with fine mesh screening. If pop-down type, sprinklers must have breakaway strength of under 80 pounds. In lieu of sprinklers, combined smoke and heat detector shall be used with similar protective design or installation;

(h) The room shall be ventilated, kept at a temperature no less than 64°F and no more than 85°F. Heating and cooling vents shall be secure and out of reach;

(i) The room shall be designed and equipped in a manner that would not allow a child to climb off the ground;

(j) Walls, floor and ceiling shall be solidly and smoothly constructed, to be cleaned easily, and have no rough or jagged portions; and

(k) Adequate and safe bathrooms shall be available.

Stat. Auth.: ORS 430.041, 430.640(1)(h) & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00; MHS 17-2007(Temp), f. 12-28-07, cert. ef. 1-1-08 thru 6-29-08; MHS 5-2008, f. & cert. ef. 6-27-08

309-032-1200

Quality Management

Providers shall have a planned, systematic and ongoing process for monitoring, evaluating and improving the quality and appropriateness of services provided to children and families. The Quality Management system shall include a Quality Management Committee and a Quality Management Plan which together implement a continuous cycle of assessment and improvement of clinical outcomes based on measurement and input from service providers and representatives of the children and families served.

(1) Providers shall have a continuous quality management process that:

(a) Establishes and reviews expectations about quality and outcomes; and

(b) Seeks to correct any observed deficiencies identified through its quality management process.

(2) The overall scope of the Quality Management process is described in a written plan which identifies mechanisms, committees or other means of assigning responsibility for carrying out and coordinating the Quality Management process activities, and which includes:

(a) Indicators of quality;

(b) Methods of monitoring;

(d) Follow-up mechanisms.

(3) The written Quality Management Plan shall describe the implementation and ongoing operation of the functions performed by the Quality Management Committee.

(a) The plan shall be reviewed and revised annually; and

(b) The provider's board shall review the annual Quality Management report and approve the annual Quality Management plan.

(4) The Quality Management Plan shall include:

(a) A description of the Quality Management Committee's authority to identify and implement clinical and organizational changes;

(b) The composition and tenure of the Quality Management Committee;

(d) Provisions which require activities to evaluate and recommend improvements as necessary in the following domains:

(A) Quality of care provided to children and families;

(B) Integration and coordination of services between the provider and other entities associated with the child and family;

(D) Clinical outcomes.

(e) The requirements that the following review activities are conducted and integrated into the overall Quality Management process:

(A) Review of the use of special treatment procedures;

(B) Review of grievances, formal complaints, incidents or accidents; and

(5) The provider shall have a Quality Management Committee that meets at least quarterly. The Quality Management Committee shall be composed of:

(a) One or more qualified mental health professionals who are representative of the scope of services delivered;

(b) A representative or representatives of the children and families served;

(c) Other persons who have the ability to identify, design, measure, assess and implement clinical and organizational changes; and

(d) A representative of external agencies.

(6) Quality Management activities are conducted with representation of those who have knowledge or ability to effect continuous quality improvement.

(7) The Quality Management process is conducted with input from children, families, and community stakeholders.

(8) The provider has a participatory process whereby all personnel contribute to and recommend changes in the Quality Management process.

(9) The provider assures that the psychiatrist participates and is involved in quality management activities and is recognized within the staff organization as a member of the quality management committee with responsibilities described in the provider's quality management plan.

(10) Quality Management activities are conducted in accord with the applicable Oregon Revised Statutes, Oregon Administrative Rules and the provider's policies and procedures with regard to confidentiality.

(11) Documentation of the pertinent facts and conclusions of each Quality Management Committee meeting shall be maintained and be available for review by the Division.

(12) An annual report of Quality Management activities and data shall be available for review by the Division.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1210

Formal Complaints

(1) The child, or the person consenting to the child's treatment, has the right to file an oral or written formal complaint with the entity providing services and receive a timely response. All providers will:

(a) Have written procedures for accepting, processing and responding to oral or written formal complaints. The written procedures must include:

(A) The process for registering an oral or written formal complaint;

(B) The time lines for processing an oral or written formal complaint; and

(C) Notification of the appeals process, including time lines for a formal complaint and the provision of the appropriate appeal forms.

(b) Designate a staff person to coordinate formal complaint information, receive formal complaint information, assist any person who needs assistance with the process, and enter the information into a log. The log will identify, at a minimum, the person lodging the formal complaint, the date of the formal complaint, the nature of the formal complaint, the resolution and the date of the resolution.

(c) Have written procedures for informing children and their legal guardian orally and in writing about the provider's formal complaint procedures.

(d) Have written procedures for processing an expedited formal complaint request if it is believed the child's health is at risk. A request for expedited formal complaint must be filed by the child or the person consenting to the child's treatment and must include the following:

(A) A statement requesting an expedited formal complaint;

(B) An explanation of the urgency of resolving the issue; and

(2) Service denial. The child, or the person consenting to treatment on behalf of the child, has the right to appeal when a service has been denied. All providers shall have written policies and procedures in compliance with applicable Oregon Medical Assistance Program Administrative Rules for accepting, processing and responding in writing within five working days to service denial complaints. The written response must include:

(a) The service requested;

(b) A statement of service denial;

(d) Notification of the appeals process including the required time frame to file an appeal and provision of the appropriate appeal forms.

(3) Hearing request for Medicaid and CHIP eligible children. In accordance with applicable Oregon Administrative Rules, providers shall have a written appeals process whereby a Medicaid or CHIP eligible child, or the person consenting to treatment for the child, can assert his or her right to file a request for hearing as a result of a denial of service or an adverse finding against the complainant.

(4) Hearing request for children who are not Medicaid or CHIP eligible. Providers shall have a written appeals process for non-Medicaid, non-CHIP eligible children with at least one level of appeal at the provider level. The appeals process must culminate in a hearing by the Division Administrator or designee if the complaint cannot be satisfactorily resolved at the provider level.

Stat. Auth.: ORS 430.041, ORS 430.640(1)(h) & ORS 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1220

Certificate of Approval

(1) Providers shall be in compliance with these rules and hold a valid Certificate of Approval issued by the Division to provide children's intensive mental health treatment services as described in these rules.

(2) A provider who is determined by the Division to be in substantial compliance with these rules may receive a Certificate of Approval valid for up to three years.

(3) A provider who is determined by the Division to be not in substantial compliance with these rules may, at the discretion of the Division, receive a time-limited Certificate of Approval of less than three years and may have conditions for compliance placed on the Certificate of Approval.

(4) The Division may require a provider who is not in compliance with these rules to develop a Plan of Correction within a time period specified by the Division. The Division may accept, reject, or modify the Plan of Correction or require the provider to comply with a Plan of Correction directed and approved by the Division.

(5) The Division at its discretion may terminate the provider's Certificate of Approval to provide children's intensive mental health treatment services, withhold funds, or apply other applicable sanctions allowable in rule and statute for failure to comply with these rules.

Stat. Auth.: ORS 430.041, ORS 743.556 & ORS 430.640(1)(h)
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

309-032-1230

Variance

A variance from portions of these rules that are not derived from federal regulations or the Office of Medical Assistance Program (OMAP) General Rules may be granted for a period of up to one year or a time period specified on the provider's Certificate of Approval in the following manner:

(1) The provider shall submit to the Assistant Administrator of the Division a written request which includes:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought.

(2) The Assistant Administrator of the Division shall approve or deny the request for variance in writing.

(3) The Division shall notify the provider of the decision in writing within 30 days of the receipt of the request.

(4) Appeal of the denial of a variance request shall be to the Administrator of the Division whose decision shall be final.

(5) All variances must be reapplied for as directed by the Division.

Stat. Auth.: ORS 430.041, ORS 743.556 & ORS 430.640(1)(h)
Stats. Implemented: ORS 430.630
Hist.: MHD 6-2000, f. & cert. ef. 2-15-00

Standards for Children's Intensive Community-Based
Treatment and Support Services

309-032-1240

Purpose

These rules prescribe standards and procedures for providers of intensive community-based treatment and support services within the continuum of mental health care for children with serious mental, emotional, and behavioral disorders and their families. These rules apply to any certified provider of Community Mental Health Treatment Services for Children and to any certified provider of Children's Intensive Mental Health Treatment Services who are also certified as providers of Intensive Community-Based Treatment and Support Services. Children will be referred to providers certified under these rules based on a Level of Need Determination. The planning and provision of intensive community-based treatment and support services must promote collaboration between families as equal partners with providers and community resources in determining how best to meet the mental health needs of the child and family. These rules set standards for the provision of intensive psychiatric and mental health services and supports that are individualized, comprehensive, coordinated, child-centered, family-driven and culturally competent. The planning and provision of intensive community-based treatment and support services must ensure that the child and family are served in the most natural setting possible and disruptions to the child's school and home life are minimized. The goals of the service planning process are to build on child and family strengths in providing services that are directed toward successful home, school, and community functioning. Service planning must be flexible and responsive to the type, intensity, location, and duration of psychiatric and mental health services and supports that would benefit the child and family.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1245

Definitions

Definitions as used in these rules:

(1) "Behavior support plan" means the individualized strategies and techniques that are used by the family and providers to facilitate positive behavioral change in the child.

(2) "Behavior support policy" means the written policies and procedures adopted by the provider that describe the behavioral interventions and practices that may be used by the provider to support a child who is receiving services from the provider to manage his or her maladaptive or problem behavior.

(3) "Care coordination" means a process oriented activity that provides ongoing communication and collaboration with children and families with multiple needs. Care coordination includes: facilitating communication between the family, natural supports, community resources, and involved child-serving providers and agencies; organizing, facilitating and participating in team meetings at which strengths and needs are identified and safety planning occurs; and providing for continuity of care by creating linkages to and managing transitions between levels of care and transitions for older youth to the adult service system.

(4) "Case management" means a goal oriented activity that assists children, youth, and families. Case management includes: identifying strengths and needs; identifying, brokering and linking to community services and resources; assisting in obtaining entitlements; advocating on behalf of families; providing support and consultation to families; facilitating access to intensive services; and providing crisis planning, prevention, and intervention services.

(5) "Child" or "Children" means a person or persons under the age of 18, or for those with Medicaid eligibility under the age of 21, who receives ICTS services.

(6) "Child and family team" means those individuals who are responsible for creating, implementing, reviewing, and revising a service coordination plan. At minimum the team must be comprised of the family, care coordinator, and child when appropriate. The team should also include any involved child-serving providers and agencies and any other natural, formal, and informal supports as identified by the family.

(7) "Clinical supervision" means the documented oversight by a Clinical Supervisor of mental health treatment services provided by Qualified Mental Health Professionals, Qualified Mental Health Associates, or mental health paraprofessionals. Clinical Supervision includes evaluating the effectiveness of the mental health treatment services provided. Clinical Supervision is performed on a regular, routine basis.

(8) "Clinical Supervisor" means a Qualified Mental Health Professional with two years post-graduate clinical experience in a mental health treatment setting. The clinical supervisor, as documented by the provider, operates within the scope of his or her practice or licensure, and demonstrates the competency to oversee and evaluate the mental health treatment services provided by other Qualified Mental Health Professionals, Qualified Mental Health Associates, or mental health paraprofessionals.

(9) "Community Mental Health Program" or "CMHP" means an organization that provides all services for persons with mental or emotional disorders, drug abuse problems, developmental disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, as provided in ORS 430.630(10) or a local public health authority as provided in ORS 431.375, and operated in a specific geographic area of the state under an omnibus contract with the Department of Human Services.

(10) "Comprehensive mental health assessment" means the written documentation by a QMHP of the child's presenting mental health problem(s) and mental status, and evaluation of the child's functioning in the following domains: emotional, cognitive, family, developmental, behavioral, social, physical health, nutritional, school or vocational, substance use, cultural, spiritual, recreational, and legal. A comprehensive mental health assessment is collected through interview with the child, family and other relevant persons; review of previous treatment records; observation; and psychological and neuropsychological testing when indicated. The comprehensive mental health assessment concludes with a completed DSM five axis diagnosis, clinical formulation, prognosis for treatment, and treatment recommendations. The comprehensive mental health assessment is used to document the need for mental health services and to develop or update the child's treatment plan.

(11) "Comprehensive mental health assessment update" means the written documentation by a QMHP of the most current information related to all domains of a Comprehensive Mental Health Assessment.

(12) "Department" means the Department of Human Services.

(13) "Discharge criteria" means the diagnostic, behavioral, and functional indicators that, when met, means that service is complete. Discharge criteria must be documented in the child's mental health treatment plan.

(14) "Discharge summary" means written documentation of the last service contact with the child. Documentation must include the diagnosis at enrollment, and a summary statement that describes the effectiveness of treatment modalities and progress, or lack of progress, toward treatment objectives as documented in the mental health treatment plan. The discharge summary also includes the reason for discharge, changes in diagnosis during treatment, current level of functioning, prognosis, and recommendations for further treatment. Discharge summaries are completed no later than 30 calendar days following a planned discharge and 45 calendar days following an unplanned discharge.

(15) "DSM" means the text revision of the 4th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR) published by the American Psychiatric Association.

(16) "Evidence-based practice" or "EBP" means clinical and preventive mental health services that are based on the most current information from generally accepted scientific research and approved by OMHAS.

(17) "Family" means the biological or legal parents, siblings, other relatives, foster parents, legal guardians, caregivers and other primary relations to the child whether by blood, adoption, legal or social relationship.

(18) "Family support" means the provision of supportive services. It includes: support to caregivers at community meetings; assistance to families in system navigation and managing multiple appointments; supportive home visits; peer support, parent mentoring and coaching; advocacy; and furthering efforts to develop natural and informal community supports.

(19) "Guardian" means a parent, other person or agency legally in charge of the affairs of a minor child and having the authority to make decisions of substantial legal significance concerning the child.

(20) "ICTS discharge criteria" means the written diagnostic, behavioral, and functional indicators the child and family will meet to transition out of ICTS services as documented in a child's service coordination plan.

(21) "ICTS discharge summary" means a written document developed by the child and family team that is completed prior to discharge from intensive community-based treatment and support services that is based on the service coordination plan. It includes: a review of service coordination planning; type and duration of services, supports, and levels of care utilized; concerns that arose during the planning process; and significant child and family accomplishments. The summary will also include recommendations about and planning to coordinate access to ongoing services and supports that would benefit the child and family as well as any other transition planning that will ensure continuity of care.

(22) "Informed consent to treatment" means that the information about a specific diagnosis and the risks or benefits of treatment options and the consequences of not receiving a specific treatment are understood by the child, if able, and the parent or guardian, if involved. The person consenting to treatment voluntarily agrees in writing, as required in ORS 430.210(d), to a prescribed treatment for the specific diagnosis.

(23) "Intensive community-based treatment and support services" or "ICTS" means a specialized set of in-home and community-based supports and mental health treatment services that are delivered in the most normative, least restrictive setting. Intensive community-based treatment and support services include, but are not limited to: crisis prevention and intervention; care coordination; case management; individual, group and family therapy; psychiatric services; skills training; family support; respite care; and team-driven service coordination planning.

(24) "Intensive treatment services" or "ITS" means a specific range of service components in the system of care. Intensive treatment services include treatment foster care, therapeutic group homes, psychiatric day treatment, partial hospitalization, psychiatric residential treatment, sub-acute care or other services as determined by OMHAS that provide active psychiatric and mental health treatment for children with severe emotional disorders and their families.

(25) "Level of care" means the relative amount and intensity of mental health services provided from the least restrictive and least intensive in a community-based setting to the most restrictive and most intensive in an inpatient setting. Children are to be served in the most normative, least restrictive, least intrusive level of care appropriate to their treatment history, degree of impairment, current symptoms and the extent of family or other supportive involvement.

(26) "Level of need determination" means the OMHAS approved process by which children are assessed for medically appropriate mental health treatment.

(27) "Licensed Medical Practitioner" or "LMP" means a board-certified or board-eligible child and adolescent psychiatrist licensed to practice in the State of Oregon.

(28) "Local Mental Health Authority" or "LMHA" means one of the following entities:

(a) The board of county commissioners of one or more counties that establishes or operates a community mental health and developmental disabilities program;

(b) The tribal council, in the case of a federally recognized tribe of Native Americans, that elects to enter into an agreement to provide mental health services; or

(29) "Medically appropriate" means services, which are required for prevention (including preventing a relapse), diagnosis or treatment of mental health conditions. Services are appropriate and consistent with the diagnosis; consistent with treating the symptoms of a mental illness or treatment of a mental condition; appropriate with regard to standards of good practice; and generally recognized by the relevant scientific community as effective. Services are not solely for the convenience of the provider of the services, child or family; and are the most cost effective of the alternative levels of services, which can be safely and effectively provided to the child and family.

(30) "Mental Health Organization" or "MHO" means an entity under a risk-bearing contract with OMHAS to provide mental health services on a prepaid, capitated basis.

(31) "Mental status exam" means the face-to-face assessment by a QMHP of a child's mental functioning within a developmental and cultural context. It includes descriptions of appearance, behavior, speech, language, mood and affect, suicidal or homicidal ideation, thought processes and content and perceptual difficulties including hallucinations and delusions. Cognitive abilities are also assessed and include orientation, concentration, general knowledge, intellectual ability, abstraction abilities, judgment, and insight appropriate to the age of the child.

(32) "Office of Mental Health and Addiction Services" or "OMHAS" means the program office of the Department of Human Services responsible for the administration of mental health and addiction services for the State of Oregon.

(33) "Paraprofessional" means a family member, peer, natural support, or other person whose education, experience, and competence are adequate to permit them to provide direct mental health services such as family support and respite care to children, youth, and families under the supervision of a QMHP.

(34) "Qualified Mental Health Associate" or "QMHA" means a person who delivers services under the direct supervision of a Qualified Mental Health Professional and who meets the following minimum qualifications as documented by the provider:

(a) Has a bachelor's degree in a behavioral sciences field, or a combination of at least three years work, education, training or experience; and

(b) Has the competency necessary to:

(A) Communicate effectively;

(B) Understand mental health assessment, treatment and service terminology and to apply the concepts;

(D) Implement interventions as assigned on a treatment plan.

(35) "Qualified Mental Health Professional" or "QMHP" means a Licensed Medical Practitioner or any other person who meets the following minimum qualifications as documented by the provider:

(a) Holds any of the following educational degrees:

(A) Graduate degree in psychology;

(B) Bachelor's degree in nursing and licensed by the State of Oregon;

(D) Graduate degree in a behavioral science field;

(E) Graduate degree in recreational, music, or art therapy;

(F) Bachelor's degree in occupational therapy and licensed by the State of Oregon.

(b) Whose education and experience demonstrate the competency to: identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social and work relationships; conduct a mental status examination; document a multiaxial DSM diagnosis; write and supervise a treatment plan; conduct a Comprehensive Mental Health Assessment; and provide individual, family and/or group therapy within the scope of their training.

(36) "Respite care" means planned and emergency interventions designed to provide temporary relief from care giving in order to maintain a stable and safe living environment. Respite care can be provided in or out of the home and includes supervision of and behavioral support for the child.

(37) "Service coordination plan" means a written summary document that incorporates and supports the relevant plans, services, and supports that are being provided to the child and family by the providers, agencies, and others who comprise the child and family team as well as defining roles and responsibilities of each party. The service coordination plan is formulated by the team and approved by the family.

(38) "Service intensity" means the relative amount, frequency, intensity, and duration of mental health services provided to a child and family that is based on the assessed needs of the child and family specific to the child's diagnosis, level of functioning, and the acuity and severity of the child's psychiatric symptoms.

(39) "Skills training" means providing parenting information and behavior support training and planning to parents or caregivers as well as skills development for children and transitional youth. It may include developing and strengthening competencies that include but are not limited to areas such as anger management, stress reduction, conflict resolution, self-esteem, parent-child interactions, peer relations, drug and alcohol awareness, behavior support, managing symptoms, and adapting the home and other settings to mitigate triggers to maladaptive behavior. The goal of this service is to maintain a stable living environment, positive interpersonal relationships, and participation in developmentally appropriate activities.

(40) "Treatment plan" means the written plan developed jointly by the QMHP and the child with his or her family, if appropriate. The treatment plan specifies the DSM diagnosis, goals, measurable objectives, specific treatment modalities and evidence-based practices. It is based on a completed comprehensive mental health assessment or assessment update of the child's functioning and the acuity and severity of psychiatric symptoms.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1250

General Conditions of Participation for Children's Intensive Community-Based Treatment and Support Services Providers

Providers delivering or ensuring the provision of children's intensive community-based treatment and support services must:

(1) Hold a valid Certificate of Approval issued by the Office of Mental Health and Addiction Services (OMHAS) to deliver intensive community-based treatment and support services, and, when applicable, a license or certification from the Department of Human Services, State Office for Children, Adults, and Families;

(2) Maintain the organizational capacity and interdisciplinary treatment capability to deliver or ensure the provision of medically appropriate services to meet the assessed needs for treatment in the amount, intensity, and duration for each child specific to the child's diagnosis, level of functioning and the acuity and severity of the child's psychiatric symptoms;

(3) Use evidence-based treatment methods appropriate for children with severe mental, emotional, or behavioral disorders and professional standards of care;

(4) Assure that mental health services are provided under clinical supervision;

(5) Maintain policies describing procedures for admission, transition, and discharge;

(6) Demonstrate family involvement and participation in all phases of assessment, service planning and the child's treatment by documentation in the child's clinical record. At a minimum there must be documentation that all completed assessments have been reviewed and explained to the family or youth of legal age and to the child in a developmentally appropriate fashion;

(7) Maintain a formal relationship with a family organization for the purpose of assuring that family voice is part of all decision making and planning for the development of services, quality assurance, and use of resources. The formal relationship includes the following:

(a) The relationship is defined in a written agreement; and

(b) Family representation is included on governing and advisory bodies in numbers that result in meaningful participation.

(8) Develop a policy on family involvement that includes specific supports to family members that address and prevent barriers to family involvement;

(9) Report suspected child abuse as required in ORS 419B.010;

(10) Enroll children in Client Process Monitoring System when the child's mental health services are funded all or in part by OMHAS funds;

(11) Maintain policies and procedures prohibiting on- or off-site non-professional relationships and activities between employees and children and their families unless the activities are approved by the provider and interdisciplinary team and identified as clinically appropriate services in the child's service plan;

(12) Provide services for children in a smoke free environment in accordance with Public Law 103.277, the Pro-Child Act;

(13) Demonstrate education service integration in all phases of assessment, service planning, active treatment, and transition and discharge planning by documentation in the child's clinical record;

(14) Maintain policies and procedures to ensure safety and provide for the emergency needs of children, families, and staff including:

(a) Medical emergencies; and

(b) Facility and environmental emergencies.

(15) Demonstrate cultural competency, gender responsiveness and language appropriateness in the delivery of services to clients and their families;

(16) Demonstrate oversight by a governing body whose membership reflects diverse community interests and whose organization and operation must be set out in writing;

(17) Develop and publish a comprehensive document which describes the mission statement, treatment philosophy, including research or evidence basis for treatment models used, and program descriptions for the provision of intensive community-based treatment and support services; and

(18) Develop policies and procedures for orientation of children and families that consider orientation times convenient for the family and that provide for adequate child and family preparation.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1255

Award and Applicability of Certificates of Approval to Provide Children's Intensive Community-Based Treatment and Support Services

Certificates of Approval to provide children's intensive community-based treatment and support services may be applied for by a mental health services provider as defined in OAR 309-012-0140. The mental health services provider must either hold a valid Certificate of Approval issued by OMHAS to provide Children's Intensive Mental Health Treatment Services or a Certificate of Approval issued jointly by OMHAS and a CMHP to provide Community Mental Health Treatment Services for Children.

(1) Mental health services providers who hold a current and valid Certificate of Approval to provide children's intensive mental health treatment services may apply to OMHAS for a Certificate of Approval to provide intensive community-based treatment and support services. Applications must include evidence that the Local Mental Health Authority has been notified and has been given an opportunity to comment about the ITS provider's efforts to become ICTS certified and about the ITS provider's potential to serve children from the child's LMHA area. Certification of an ICTS provider can be effective for a maximum of three years and may be renewed thereafter by OMHAS.

(2) Mental health services providers who hold a current and valid Certificate of Approval to provide community treatment services for children may apply to the CMHPs to recommend that OMHAS issue a Certificate of Approval to provide intensive community-based treatment and support services. Certification of an ICTS provider can be effective for a maximum of three years and may be renewed thereafter by OMHAS.

(3) Following the completion of the application process, and any reviews deemed necessary by OMHAS or the CMHP, one of the following determinations will be made by OMHAS:

(a) That the applicant may be awarded a Certificate of Approval based on demonstration of its capacity and willingness to operate in compliance with applicable administrative rules;

(b) That the applicant will not be awarded a Certificate of Approval because it has not demonstrated that it will comply with applicable administrative rules; or

(c) That the applicant may be awarded a Certificate of Approval with specified conditions as described in OAR 309-012-0200 and at the discretion of OMHAS, receive a time-limited Certificate of Approval of less than three years and may have conditions for compliance placed on the Certificate of Approval to provide intensive community-based treatment and support services.

(4) OMHAS may require a provider who is not in compliance with these rules to develop a Plan of Correction within a time period specified by OMHAS. OMHAS may accept, reject, or modify the Plan of Correction or require the provider to comply with a Plan of Correction directed and approved by OMHAS.

(5) OMHAS, at its discretion, may terminate the provider's Certificate of Approval to provide intensive community-based treatment and support services, withhold funds, or apply other applicable sanctions allowable in rule and statute for failure to comply with these rules.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1260

Service Coordination Planning

ICTS providers must ensure that children and families referred to them through the level of need determination process receive care coordination when supported by the family. Providers must ensure that:

(1) A child and family team is identified and organized jointly with the family;

(2) A child and family team meeting is convened and an initial Service Coordination Plan, including any necessary crisis prevention and intervention planning, is developed no later than 14 calendar days from the date the provider receives an authorized request for ICTS services;

(3) The Service Coordination Plan is completed within 30 calendar days from the date the provider receives an authorized request for ICTS services. The plan is reviewed and revised quarterly, and when changes in service coordination planning occur, by the child and family team. It includes:

(a) A strengths and needs assessment that includes all relevant domains of the comprehensive mental health assessment;

(b) Short- and long-term goals related to identified needs across domains;

(c) Planning that utilizes a combination of existing or modified formal services; newly created services; informal, formal and natural supports and community resources; and documentation of the individuals responsible for providing these services and supports;

(d) A proactive safety/crisis plan that utilizes professional and natural supports to provide 24 hours, seven days per week flexible response and is reflective of strategies to avert potential crises without placement disruptions and provide appropriate interventions when crises occur; and

(e) ICTS discharge criteria as well as transition planning and coordination of the child's discharge from intensive community-based treatment and support services.

(4) The child receives medically appropriate mental health services and supports that include evidence-based practices, at the appropriate level of care, as determined by the ongoing service coordination planning by the child and family team; and

(5) Services and supports are documented in the child's clinical record.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1265

Intensive Community-Based Treatment and Support Services

ICTS providers must ensure that intensive community-based treatment and support services are made available to children and families referred to them through the level of need determination process. Services and supports must be provided by qualified individuals. Intensive community-based treatment and support services may be delivered at a clinic, facility, home, school, other provider/allied agency location or other setting as identified by the child and family team. Intensive community-based treatment and support services include but are not limited to:

(1) Providing or ensuring the provision of children's crisis services, which includes:

(a) 24 hours, seven days per week face-to-face or telephone screening to determine the need for immediate services for any child requesting assistance or for whom assistance is requested;

(b) 24 hours, seven days per week capability to conduct, by or under the supervision of a QMHP, a mental health status examination to determine the child's condition and the interventions necessary to stabilize the child;

(c) Provision of medically appropriate child and family, psychological, and psychiatric services necessary to stabilize the child;

(d) Referral to the appropriate level of care and linkage to other medically appropriate interventions necessary to protect and stabilize the child; and

(e) Linkage to appropriate social services.

(2) Comprehensive mental health assessment or assessment update.

(3) Psychiatric services provided by a Licensed Medical Practitioner.

(4) Medication management and monitoring.

(5) Individual, group and family therapy provided by a QMHP who has a child and adolescent mental health background and experience providing community-based, intensive services to families.

(6) Care coordination provided by a QMHP or QMHA supervised by a QMHP who has:

(a) Demonstrated competencies in child and adolescent mental health and experience providing intensive services to families;

(b) Extensive knowledge about services and resources available to children and families in the community;

(d) Experience facilitating crisis prevention and intervention services.

(7) Case management provided by a QMHP or QMHA supervised by a QMHP who has:

(a) Demonstrated competencies in child and adolescent mental health and experience providing intensive services to families;

(b) Extensive knowledge about services and resources available to children and families in the community; and

(8) Skills training provided by a QMHP or QMHA supervised by a QMHP who has:

(a) Demonstrated competency in child development, serious emotional and behavioral disorders and parenting-behavioral management;

(b) Extensive knowledge of community recreational, social and supportive resources; and

(9) Family support and respite care provided by paraprofessionals who have:

(a) Specialized knowledge and experience that enables them to provide supportive services to families; and

(b) Received training that enables them to implement supportive services interventions to children and families coping with developmental, physical, medical, emotional and behavioral disorders.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1270

Staffing Requirements

(1) ICTS providers must have the clinical leadership and sufficient QMHP, QMHA and other staff to meet the 24-hours, seven days per week treatment needs of children served. The provider must establish policies and practices to assure:

(a) Availability of a LMP to meet the following requirements:

(A) Provide medical oversight of the clinical aspects of care and consult on clinical care;

(B) Prescribe medicine or otherwise assure that case management and consultation services are provided to obtain prescriptions, and prescribe therapeutic modalities to achieve the child's treatment and service coordination goals; and

(b) An executive director or clinical director who meets the following minimum qualifications:

(A) Masters degree in a human service-related field from an accredited school;

(B) Five years experience in a human services program;

(D) Subscribes to a professional code of ethics.

(2) ICTS providers must have adequate numbers of QMHP, QMHA and other staff whose care specialization is consistent with the duties and requirements of the specific level of service intensity. Professional staff must operate within the scope of their training and licensure.

(3) Staffing must be adequate to provide timely response to crises, potential crises, and other urgent and non-urgent child and family service needs 24 hours a day, seven days per week for the clients they serve.

(4) Providers must have adequate numbers of qualified supervisory staff to oversee service delivery in community settings by QMHP, QMHA, and other staff.

(5) Providers must document in personnel files that all supervisory and clinical staff meet all applicable professional licensing and/or certification, and QMHP or QMHA competencies.

(6) Providers must document in personnel files that supervisory and clinical staff are qualified and meet competencies to provide ICTS services as defined by these rules.

(7) Providers must maintain a personnel file for each employee that contains:

(a) The employment application;

(b) Verification of a criminal history check as required by ORS 181.536-181.537;

(d) Documentation and copies of relevant licensure and/or certification that the employee meets applicable professional standards;

(e) Annual performance appraisals;

(f) Annual staff development and training activities;

(g) Employee incident reports;

(h) Disciplinary actions;

(i) Commendations; and

(j) Reference checks.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1275

Behavior Support

Providers must have a written behavior support policy specifying which behavior support practices may be used by the provider, the circumstances under which they may be used, and how the practices will be clinically reviewed. Manual restraint, mechanical restraint, and seclusion may only be used by providers who are certified by OMHAS to use restraint and seclusion as outlined in OAR 309-032-1100 through 309-032-1230. To ensure that providers are administering and documenting well defined responses of planned and therapeutic interventions to specific target behaviors, the provider's behavior support policy must:

(1) Outline behavior support techniques and treatment interventions used in accordance with a process established by care, treatment, and service leaders;

(2) Require that the selection of interventions considers clinical appropriateness and minimizes restrictiveness of interventions;

(3) Specify that a behavior support plan that outlines individualized behavior support techniques and interventions will be developed, implemented, and reviewed for each child. The policy must specify that each child must have thresholds of behavior support interventions that will activate a clinical review. The review must occur when thresholds have been surpassed and at each service coordination plan review;

(4) Establish a framework, which assures that the child, family, and others who comprise the child and family team have involvement with the child's behavior support plan, and that families are educated about and consent to the plan and treatment interventions, and are involved in the monitoring and updating of the plan;

(5) Describe the manner in which staff, paraprofessionals, or others identified in the behavior support plan will be trained to maintain the child's behavior support plan and manage aggressive, assaultive, or other problem behaviors and de-escalate volatile situations through a crisis intervention training program;

(6) Specify behavior support interventions and procedures that are prohibited including:

(a) Procedures that are implemented by another client or unauthorized person;

(b) Procedures that deny basic needs such as diet, water, shelter, or essential clothing; and

(7) Require that the provider review and update the behavior support policies, procedures, and practices annually; and

(8) Be reviewed and approved by the provider's clinical leaders.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1280

Establishment and Maintenance of Clinical Records

(1) A separate, individualized clinical record must be opened and maintained for each child served by an ICTS provider. If the ICTS provider is also the outpatient or ITS provider or both, the clinical record will include documentation of outpatient, ITS, and ICTS services.

(2) Each clinical record must be uniform in organization, readily identifiable and accessible, and contain all of the components required by this rule in a current and complete manner.

(3) All documentation required in this rule must be signed by the staff providing the service and making the entry. Signature must include the person's academic degree or professional credential and the date signed.

(4) All procedures in this rule requiring consent and the provision of such information to the consenting custodial parent or guardian or where appropriate, the child, must be documented in the clinical record on forms describing what the child or adult giving consent has been informed of, and asked to consent to, and signed and dated by the consenting person. If the provider does not obtain the required documentation, the reasons must be specified in the clinical record and signed by the qualified supervisor of the person responsible for provision of treatment services to the child.

(5) Errors in the clinical record must be corrected by lining out the incorrect data with a single line in ink, and then adding the correct information, the date corrected, and the initials of the person making the correction. Errors in paper or electronic health records may not be corrected by removal or obliteration.

(6) References to other persons being treated by the CMHP, CMHP subcontractors, or other providers when included in the child's clinical record must preserve the confidentiality of the other clients.

(7) Clinical records must be secured, safeguarded, stored, and retained in accordance with applicable Oregon Revised Statutes and Oregon Administrative Rules.

(8) All clinical records are confidential to the extent provided for in OAR 309-032-1030(9) and other state and federal laws, rules, or regulations.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1285

Clinical Record Documentation Requirements

The child's clinical record must contain adequate written information that is readily accessible and uniformly placed in the clinical record to include:

(1) Identifying data including the child's name, date of birth, sex, address, phone number, and name of parent(s) or legal guardian including an address and phone number if different;

(2) Level of need determination documentation;

(3) A comprehensive mental health assessment or assessment update to be completed within 14 calendar days from the date the provider receives an authorized request for ICTS services. An assessment update must include the most current information related to all domains of the Comprehensive Mental Health Assessment. Comprehensive mental health assessments and assessment updates are updated annually and reviewed and approved by the LMP;

(4) An individualized treatment plan to be completed within 30 calendar days from the date the provider receives an authorized request for ICTS services. The treatment plan is reviewed and revised quarterly and when changes in treatment planning occur and is approved by the LMP;

(5) A service coordination plan to be completed within 30 calendar days from the date the provider receives an authorized request for ICTS services. The plan is reviewed and revised quarterly, and when changes in service coordination planning occur, by the child and family team;

(6) Documentation of child and family team meetings;

(7) Documentation of the services recommended by the child and family team;

(8) Progress notes documenting specific treatments, interventions, and activities related to the implementation of the service coordination plan and the treatment plan;

(9) In addition to OAR 309-032-1285(7), monthly summary progress notes by the care coordinator that document that the child and family team has discussed progress with treatment and service coordination planning and if necessary convened a child and family team meeting to facilitate timely and appropriate service coordination planning;

(10) Written ICTS discharge criteria as documented in the service coordination plan;

(11) A written ICTS discharge summary related to the service coordination plan;

(12) Written discharge criteria as documented in the treatment plan;

(13) A written discharge summary related to the treatment plan; and

(14) A medication service record if medication is prescribed on the treatment plan.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1290

Child & Family Rights

Providers must establish written policies and procedures pertaining to child and family rights. The written statement of rights must be posted prominently in simple, easy to understand language on a form devised by the provider or the OMHAS. Written information must be provided in the non-English languages of the clients served. Information about rights must be available in alternate formats, taking into consideration the special needs of children and families. At the time of admission the provider must give this form to the person legally giving consent to treatment of the child. In addition, these rights must be explained orally at the time of admission to the person giving consent to treatment and to the child, in a manner appropriate to the child's developmental level. Statement of Rights must include the following:

(1) The right to consent to treatment in accordance with ORS 109.640 and 109.675. A custodial parent or legal guardian, or a minor child under conditions described below, must give written informed consent to diagnosis and treatment.

(a) Minor children can give informed consent for outpatient diagnosis and treatment for a mental or emotional disorder in the following circumstances:

(A) Under age 18 and lawfully married.

(B) Age 14 or older.

(b) If the child is initially served in a crisis situation, these rights must be explained as soon as clinically practical, but not more than five working days from the initiation of services if the child who received the crisis service remains in service.

(c) The custodial parent or legal guardian of any minor, age 14 or older who has consented to outpatient treatment or diagnosis, must be involved before the end of treatment unless:

(A) The parents refuse;

(B) There are clear clinical indications to the contrary;

(D) The child has been legally emancipated by the court, or has been self sustaining for 90 days prior to obtaining treatment. As required in ORS 109.675, such refusal or the reasons for exclusion must be documented in the child's clinical record.

(2) The right to refuse services. The person giving consent to treatment has the right to refuse service, including any specific treatment procedure. If serious consequences may result from refusing a service, the provider must explain the consequences verbally or in writing to the custodial parent, the guardian, or the child who is refusing service. Service refusal must be documented in the clinical record.

(3) The right to confidentiality in accordance with ORS 179.505, 107.154, 418.312, and any other applicable state and federal regulation.

(4) The right to consent to disclosure of clinical records. The person consenting to treatment, usually the custodial parent or guardian, has the right to authorize disclosure of the child's clinical record in accordance with ORS 179.505 and any other applicable state and federal regulation.

(5) The right to immediate inspection of the clinical record unless access is restricted in accordance with ORS 179.505.

(a) The child, if able, and the custodial parent(s) or guardian of a minor child has the right to immediate inspection of the record.

(b) A copy of the record is to be provided within five working days of a request for it. The person requesting the record is responsible for payment for the cost of duplication, after the first copy.

(c) Identifying and clinical information about the child must be protected in provider publications such as newsletters and brochures.

(6) The right to participate in treatment planning and service coordination. The child, if appropriate, and the custodial parent(s) or legal guardian and others of their choosing, must have the opportunity to participate in an informed way in the treatment planning and service coordination process for the child, and in the review, at least every three months, of the child's progress toward treatment goals and objectives. At a minimum, the following information should be discussed:

(a) Treatment and other interventions to be undertaken;

(b) Alternative treatments or interventions available, if any;

(d) Benefits which can reasonably be expected; and

(e) Risks that may be involved in treatment, if any.

(7) The right to make informed consent to fees for services. The amount and payment schedule of any fees to be charged must be disclosed in writing and agreed to by the person consenting to treatment.

(8) The rights contained in this section may be asserted and exercised by the child (except where the law requires that only the parent or guardian may exercise a particular right), the child's parent or guardian, or any representative of the child.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1295

Quality Management

Providers must have a planned, systematic and ongoing process for monitoring, evaluating and improving the quality and appropriateness of services provided to children and families. Rules related to Quality Management and Quality Assurance as set forth in OAR 309-032-1060 are applicable to ICTS providers who are certified as providers of Community Mental Health Treatment Services for Children. Rules related to Quality Management and Quality Assurance as set forth in OAR 309-032-1295 are applicable to ICTS providers who are certified as providers of Children's Intensive Mental Health Treatment Services and providers of both Children's Intensive Mental Health Treatment Services and Community Mental Health Treatment Services for Children. Providers will implement a Quality Assurance system, which will assure compliance with the provisions of OAR 309-032-1240 through 309-032-1305.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1300

Grievances and Complaints

Rules related to grievances, complaints, service denials, appeals, and hearing requests as set forth in OAR 309-032-1030(4)-(6) are applicable to ICTS providers who are certified as providers of Community Mental Health Treatment Services for Children. Rules related to complaints, service denials, appeals, and hearing requests as set forth in OAR 309-032-1210 are applicable to ICTS providers who are certified as providers of Children's Intensive Mental Health Treatment Services and providers of both Children's Intensive Mental Health Treatment Services and Community Mental Health Treatment Services for Children.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

309-032-1305

Variance

(1) The provider must submit a written request to the Assistant Administrator of OMHAS, which includes:

(a) The section of the rule from which the variance is sought;

(b) The reason for the proposed variance;

(d) A plan and timetable for compliance with the section of the rule from which the variance is sought.

(2) The Assistant Administrator of OMHAS must approve or deny the request for variance in writing.

(3) OMHAS will notify the provider of the decision in writing within 30 days of the receipt of the request.

(4) Appeal of the denial of a variance request must be to the Administrator of OMHAS whose decision will be final.

(5) All variances must be reapplied for as directed by OMHAS.

Stat. Auth.: ORS 430.640 & 743.556
Stats. Implemented: ORS 430.630
Hist.: MHD 1-2005(Temp), f. & cert. ef. 1-3-05 thru 7-1-05; MHD 6-2005, f. 6-24-05, cert. ef. 7-1-05

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