Webinar of Treatment Standard Changes

John R. Kasich, Governor Orman Hall, Director Webinar of Treatment Standard Changes

Presenters • Nicholas S. Humenay, M.S. Ed., LICDC, PC • (614) 752-8717 • humenay@ada.ohio.gov • Barbara L. Dietz, LICDC, OCPS I • (614) 644-8424 • bdietz@ada.ohio.gov • Patty Heffner, LICDC • (614) 466-9002 • pheffner@ada.ohio.gov • Tony Johnson, BS, LCDC III • (614) 644-8412 • tjohnson@ada.ohio.gov

Please Save all questions for the end of the presentation Please mute all phones so that all who are a part of the presentation can hear.

Deemed Status3793:2-1-01.1 Accrediting Bodies: What is needed: The Joint Commission (JC) The Commission on Accreditation of Rehabilitation Facilities (CARF) The Council on Accreditation for Children and Family Services (COA) Send a copy of the certificate or license to ODADAS. Send a copy of the most recent survey to ODADAS ODADAS will review report and confirm certification status If the survey report indicates that agency has been issued a conditional or provisional license the agency must submit a copy of the Corrective Action Plan.

Standards Exempt from Deemed Certification Employee policies related to programs responsible for the direct care or supervision of children and/or adolescents. OAC 3793:2-1-03(R). Employee policies related to programs that operate residential and/or halfway house programs for adults that include childcare. OAC 3793:2-1-03(S). Reporting of major unusual incidents – OAC 3793: 2-1-04(G).

Standards exempt from Deemed Certification Con’t. Policies related to admission, continued stay and discharge/referral to each level of care based on the Ohio Department of Alcohol and Drug Addiction Services’ protocols for levels of care – 3793:2-1-05(F) and (G). Procedures for reporting suspected child abuse/neglect – 3793:2-1-05(H)(12). Standards related to the application of 42 CFR Part 2 confidentiality of alcohol and drug abuse patient records

Detoxification Programs Programs that provide detox services are not broken down into ambulatory, sub acute or acute hospital detoxification. They are just detoxification programs. OAC 3793:2-2-1-01(B)(4)

Program Certification/Licensure for New Programs Applicants must submit an application to the Ohio Department of Alcohol and Drug Addiction Services. Applicants should also send copies of their occupancy permit, most recent fire inspection report, secretary of state license and food service license if applicable. (Application cannot be processed until all appropriate documents are received.) Copies of policies and procedures (please send copies only. Originals will not be returned until day of inspection).

Program Certification/Licensurefor New Programs cont’d • Upon receipt of an application, ODADAS shall: • Notify the applicable alcohol and drug addiction services board or alcohol, drug addiction and mental health services board of program’s intent to open a program. • Review the application to determine if it is complete. • If the application is incomplete, the department shall notify the applicant of corrections or additions needed and/or may return the material to the applicant with further instructions. (return of the materials or failure of the department to take further action shall not constitute denial of an application for certification or licensure) • If the application is complete, ODADAS will continue with the certification process. • The department will need to review the program’s policies and procedure and schedule an on-site inspection. If the • When the application has met all requirements to become a certified program, ODADAS will grant the program full or conditional certification status. • If conditional status is granted, the certification will be valid for 90 days to allow the agency to correct any deficiencies.

Renewal Process for Currently Certified Programs • Outpatient, residential and detox programs will be certified for a period of three years. • Programs that have deemed certification status pursuant to section 3793:2-1-01(1) of the Administrative Code, will be certified for the period of their national accreditation not to exceed three years. • ODADAS will send each owner an assurance statement for each certified site and for programs that have obtained deemed certification. • The assurance statement must be signed and dated by the executive director, CEO or president of the organization and president of the governing authority.

Renewal Process for Currently Certified Programs Con’t • By signing the assurance statement, the program is agreeing to comply with the certification standards as established by department rules for each certified location for the duration of its three-year certification period. • All assurance statements must be received by the department within 30 days of the beginning of the new certification period and must include: • Any changes to the information supplied by the department regarding the program. Changes include but are not limited to names, addresses, telephone and fax numbers, email addresses, program business hours and the number of beds. • The program certification or license will be considered invalid if the program fails to follow the procedures for renewing the program certification, moves to another location, goes out of business or is sold or otherwise conveyed to another entity.

Variance Requests • Programs requesting a variance for one or more of the program certification/licensure standards shall include a copy of the request with the program certification/licensure application. • Each variance request shall be prepared and submitted in accordance with this rule. • Failure to comply with the requirement of (G)(3) within the specified time frame shall result in the program being placed on conditional status. • If a program was granted a variance in the previous certification period a new request must be made for the new period and be included with the assurance statement.

Program Administration • Each alcohol and drug addiction program serving children and/or adolescents as well as halfway house and residential programs for adults that include child care shall have a policy which states the following:“ a prospective employee, volunteer or student intern that has not pled guilty to nor have been convicted of any of the offenses listed in paragraph (I) of OAC 5101:2-5-09 may be hired by an agency if the conditions as provided by OAC 5101:2-5-09 (H) have been met.”

Client Records • An individualized treatment plan shall be written for each client within seven days of completion of the assessment or at the time of the first face-to-face contact following the assessment. • Individualized treatment plans shall be based on the assessment and include at a minimum, the following: • Problem(s) to be addressed including but not limited to diagnosis or diagnoses and other primary problems based upon clinician recommendations.

Client Records Con’t • Daily or weekly progress notes shall include, at a minimum, the following and may include checklists: • Client Identification (Name and/or Identification Number) • Daily Progress Notes – the date of the progress note • Weekly Progress Notes – The Weekly Period of the Progress Note (must be a continuous 7 day period) • Overall summary of the client’s treatment progress during the period • Date, original signature and credential (registration and /or license) of the staff member writing the daily or weekly progress note. (The staff member must be qualified in accordance with rule 3793:2-1-08 of the Administrative Code, to provide all the services documented in the daily or weekly service log)

Client Records Cont’d • Client records utilizing daily or weekly progress notes pursuant to section (P) of this rule must contain a service log that includes, at a minimum, the following which may include checklists: • Date of service for each service provided during the day or week • Type of service (for example, case management, individual counseling, group counseling, crisis intervention, etc.) provided during the day or week • Length of time of each service contact or service delivery (calculated by the number of hours, minutes and/or start and ending time of each service delivery) • The signature and license of each clinician who provided services during the day or week

Client Records Con’t • A termination summary shall be prepared when there have been no services provided for thirty (30) calendar days. (treatment has been terminated when no treatment services have been provided or upon documentation of last communication or attempted communication with the client) • Services must be documented in the client’s chart in order to establish the timeline governing the preparation of the termination summary. (Termination Summaries require all the same elements of the previous rule.) • A termination summary extension shall be permitted for extenuating circumstances that prohibit the client’s attendance within thirty (30) calendar days and shall not exceed a period of sixty (60) calendar days. • Extenuating circumstances include but are not limited to: • Hospitalization • Incarceration • Known travel • Documentation shall exist in the client’s chart detailing the extenuating circumstance that support the termination summary extension.

Detoxification Programs • Each detoxification program is required to have an affiliation agreement with at least one alcohol and drug addiction services treatment program that is currently certified by ODADAS for the purpose of referrals to less intensive levels of care. • Each program shall have written policies and procedures to ensure its referral process is appropriately implemented and managed and shall include, at a minimum, the following: • Telephone contact with client and program to which client is referred to follow up on the referral. These contacts shall be documented in the client’s record.

Treatment Services A crisis intervention services is a face-to-face interaction with a client that is in response to a crisis or emergency situation experienced by themselves, a family member and/or significant other. It begins with an evaluation of what happened during the crisis and the individual’s response to it. An individual’s reaction to a crisis can include emotional reactions (such as difficulty concentrating, confusion, nightmares), physical reactions (such as headaches, dizziness, fatigue, stomach problems) and behavioral reactions (sleep and appetite problems, isolation, restlessness). Information about the individual’s strengths, coping skills and social support network is also obtained. Crisis intervention services can be provided at a program site certified by ODADAS or in the client’s natural environment.

Treatment Services Con’t Individuals who have unstable psychiatric problems shall be referred to a psychiatric facility. Individuals who are experiencing withdrawal symptoms from use of alcohol and/or other drugs shall be referred to a person and/or entity that can provide the appropriate level of detoxification services.

Treatment Services Con’t • A licensed independent marriage and family therapist licensed by the state of Ohio Counselor, Social Worker, Marriage and Family Therapist Board and whose professional disclosure statement includes substance abuse assessment and counseling can supervise (except twenty-three hour observation bed) and provide the following treatment services: • Assessment, including diagnosis. • Registered Candidate has changed to Chemical Dependency Counselor Assistant and can do all the same tasks. • Certified Chemical Dependency Counselor I is no longer a recognized credential in the state of Ohio.

Treatment Services Continued • Intensive outpatient services shall include, but are not limited to, the following services: • Assessment • Individual Counseling • Group Counseling • Crisis Intervention as needed • Case Management

References http://codes.ohio.gov/oac/5101%3A2-5-09

Questions?

Webinar of Treatment Standard Changes