Office of Certification Mental Illness and Substance Abuse Services Division P.O. Box 301410

1. Office of Certification Mental Illness and Substance Abuse Services Division P.O. Box 301410 Montgomery AL 36130-1410 www.mh.alabama.gov Beth Malone, MHSAS Director of Certification 334-242-3969 Beth.Malone@mh.alabama.gov

2. To access this PowerPoint with live links visit the link below: http://www.mh.alabama.gov/Downloads/SACR/NewProviderOrientation_July2014.ppsx Or visit www.mh.alabama.gov Click on yellow SUBSTANCE icon then click Certification

3. MHSA Office of Certification Staff SITE REVIEW TEAM Cathy Anderson - Cathy.Anderson@mh.alabama.gov Marion Johnson - Marion.Johnson@mh.alabama.gov Charlene Marshall - Charlene.Marshall@mh.alabama.gov Fred McCoy - Fred.McCoy@mh.alabama.gov Charles Mitchell - Charles.Mitchell@mh.alabama.gov Shirley Stiles - Shirley.Stiles@mh.alabama.gov Makala Lane, Administrative Assistant Makala.Lane@mh.alabama.gov

4. YOU WILL RECEIVE A CERTIFICATE FOR ATTENDING THIS ORIENTATION HOWEVER, ATTENDING THIS ORIENTATION DOES NOT MEAN YOU ARE CERTIFIED TO PROVIDE SERVICES. Certificate of Attendance

5. What certification does not mean State certification does not constitute a contractual agreement between Mental Health Substance Abuse Division (MHSA) and the service provider for services.

6. Why IS CERTIFICFACTION REQUIRED? Alabama Department of Mental Health is the state agency responsible for serving Alabama citizens with mental illnesses, developmental disabilities, and substance use disorders. The department was formally established by Alabama Act 881 in 1965. ADMH’s authority is defined in Code of Alabama 1975, Section 22-50-1 thru 22-50-90. Compliance is required by LAW! 580-3-23-.02 (3) It is under this statutory authority that the Department of Mental Health requires compliance with these standards through these certification regulations by entities that hold themselves out as providers of services to persons with mental illness, developmental disabled, and/or substance abuse in the State of Alabama.

7. Exemptions TO 580‑3‑23 • General or psychiatric hospitals licensed as such by the Alabama Board of Health • Public or private educational institutions. • Qualified member of professions in their own private practice (such as licensed physicians, psychologists, psychiatrists, social workers, etc.)

8. Things to consider before you move forward on becoming a certified DMH provider: • The state is divided into regions. Each region has a mental health center responsible for conducting a needs assessment. The purpose of the needs assessments is to identify gaps in services. • First, visit the link below to see the mental health center’s needs assessment, then contact the mental health center and discuss what gaps services they have in their needs assessment. http://www.mh.alabama.gov/ADPR/310BoardStrategicPlans.aspx • You will have to work with them no matter what services you provide, mental illness or substance abuse.

9. IMPORTANT LINKS: Link to Certified Mental Health Centers and Providers http://www.mh.alabama.gov/Downloads/MI/MI_Programs_Directory.pdf Link to Certified Substance Abuse Providers http://www.mh.alabama.gov/SA/FindServices.aspx Be sure to look at the links above to see what kind of services are being offered in your county.

10. Mental illness

12. “What services do I want to provide to people suffering from mental illness?” What are the options? DEPARTMENT OF MENTAL HEALTH MENTAL ILLNESS COMMUNITY PROGRAMS ADMINISTRATIVE CODE CHAPTER 580-2-9 PROGRAM OPERATION TABLE OF CONTENTS 580-2-9.01 Type Of Certificate 580-2-9.02 Governing Authority 580-2-9.03 Mental Illness Program Staff 580-2-9.04 Consumer Protection 580-2-9.05 Reserved 580-2-9.06 Consumer Records http://www.mh.alabama.gov/downloads/SACR/SACR131105_MHSA ReportingProceduresAndForms_5-2012.pdf 580-2-9.07 Performance Improvement 580-2-9.08 General Clinical Practice All must be in policy and procedure manual

13. “What services do I want to provide to people suffering from mental illness?” What are the options? (continued) 580-2-9.09 General Outpatient 580-2-9.10 Child and Adolescent In-Home Intervention 580-2-9.11 Adult In-Home Intervention 580-2-9.12 Emergency Services 580-2-9.13 Partial Hospitalization Program 580-2-9.14 Adult Intensive Day Treatment 580-2-9.15 Adult Rehabilitative Day Program 580-2-9.16 Child and Adolescent Day Treatment 580-2-9.17 Case Management 580-2-9.18 Residential Services Choose what service you want to apply for and read the code.

14. What services do I want to provide to people suffering from mental illness?” What are the options? (continued) Choose what service you want to apply for and read the code. 580-2-9.19 Designated Mental Health Facility 580-2-9.20 Consultation and Education 580-2-9.21 Assertive Community Treatment 580-2-9.22 Program for Assertive Community Treatment 580-2-9.23 Child and Adolescent Seclusion and Restraint 580-2-9.24 Adult Seclusion and Restraint 580-2-9.25 Therapeutic Individualized Rehabilitation Services 580-2-9.26 Indigent Drug Program

15. If you apply to be a mental health center you must offer all of the following: • The provider must provide the following services as defined in the paragraph below directly through its employees: • (i) Emergency Services, • (ii) Outpatient Services, • (iii) Consultation and Education Services, and • (iv) Partial Hospitalization/Intensive Day • Treatment/Rehabilitative Day Program, and • (v) Must provide residential services either directly through • its employees or through agreement with other certified • providers.

16. If you are applying to be a mental health providers you can apply for the following: • Emergency Services Administrative Code 580-2-9.12 • Outpatient Services Administrative Code 580-2-9.09 • Consultation and Education Services • Administrative Code 580-2-9.20 • 4. Partial Hospital/Day Treatment Services • Administrative Code 580-2-9.13 • 5. Residential Services Administrative Code 580-2-9.18 • Foster Care programs must be through a contract with the mental health center.

17. What services do I want to provide to people suffering from mental illness?” What are the options? • There are three basic options for providing Mental Health services to individuals suffering from mental illness in Alabama: • Housing support (e.g. foster home) for a small number of MI clients who are receiving treatment through a local Mental Health agency • Individual programs that target specific populations and MI treatment needs in a particular area (e.g. residential services also referred to as group home) • Comprehensive MI treatment and support services for a large and diverse population of clients (e.g. Mental • Health Center)

18. Housing support/Foster Care A single site residence that provides group living for adults, three meals a day, 24/7 supervision/staff. Staff are required to have a high school education or a GED. Operated under Contractual agreement with the local Community Mental Health Center

19. Housing support/Foster Care • The foster care facility shall be monitored at least monthly by the designated CMHC to ensure compliance with the contractual agreement and these standards. • DMH only certifies foster homes that are under contract with a certified community mental health center (CMHC). • Applications for Mental Illness Foster Care must be signed by the respective CMHC that proposes to subcontract with the provider prior to being submitted.

20. Staff Qualifications Requirements • 580-2-9-.03 Mental Illness Program Staff • The executive director of a provider shall be a full-time employee and shall have at least a master’s degree in an administrative or mental health related field and at least five years of post master’s progressive managerial experience….. • There shall be a full-time Clinical Director (in addition to the Executive Director) who has full-time responsibility for the quality of clinical care and the appropriateness of clinical programs. The Clinical Director shall have as a minimum either a master’s degree in psychology, social work,…….

21. Staff qualifications consistent for each type of residential program certified • The program coordinator shall have a bachelor’s degree in a mental health service related field, shall have two years experience in a direct service area, and be trained in recovery/psychiatric rehabilitation principles…….. • The coordinator shall have three years experience in a mental illness residential setting, demonstrate the ability to communicate clearly orally and in writing, demonstrate the ability to maintain clinical records in accordance with standards……..

22. Substance abuse

24. What services do I want to provide to people suffering from substance abuse?” What are the options? ALABAMA DEPARTMENT OF MENTAL HEALTH SUBSTANCE ABUSE SERVICES ADMINISTRATIVE CODE CHAPTER 580-9-44 PROGRAM OPERATIONS TABLE OF CONTENTS 580-9-44-.01 Definitions 580-9-44-.02 Personnel 580-9-44-.03 Client Rights 580-9-44-.04 Abuse and Neglect 580-9-44-.05 Grievances, Complaints and Appeals 580-9-44-.06 Confidentiality and Privacy http://www.mh.alabama.gov/downloads/SATR/SATR71012_42CFRRegulations.pdf Required Releases: http://www.mh.alabama.gov/SACR/42CRFAndHIPAARelease.aspx All must be in policy and procedure manual

25. “What services do I want to provide to people suffering from substance abuse?” What are the options? (continued) All must be in policy and procedure manual 580-9-44-.07 Seclusion and Restraint 580-9-44-.08 Child and Adolescent Seclusion and Restraint 580-9-44-.09 Incident Reporting – procedures and forms http://www.mh.alabama.gov/downloads/SACR/SACR131105_MHSA_ReportingProceduresAndForms_5-2012.pdf All must be in policy and procedure manual 580-9-44-.10 Infection Control 580-9-44-.11 Performance Improvement 580-9-44-.12 Operational Policies and Procedures Manual 580-9-44-.13 Program Description

26. “What services do I want to provide to people suffering from substance abuse?” What are the options? (continued) Choose what service you want to apply for and read the code. 580-9-44-.14 Level 0.5: Early Intervention 580-9-44-.15 Level I: Outpatient Treatment 580-9-44-.16 Level I-D: Ambulatory Detoxification 580-9-44-.17 Level II.1: Intensive Outpatient Treatment 580-9-44-.18 Level II.5: Partial Hospitalization Treatment Program 580-9-44-.19 Level II-D: Ambulatory Detoxification With Extended On-Site Monitoring

27. “What services do I want to provide to people suffering from substance abuse?” What are the options? (continued) Choose what service you want to apply for and read the code. 580-9-44-.20 Level III.01: Transitional Residential Program 580-9-44-.21 Level III.1: Clinically Managed Low Intensity Residential Treatment Program 580-9-44-.22 Level III.2-D: Clinically Managed Residential Detoxification 580-9-44-.23 Level III.3: Clinically Managed Medium Intensity Residential Treatment Program For Adults Without Extended On-Site Monitoring

28. “What services do I want to provide to people suffering from substance abuse?” What are the options? (continued) 580-9-44-.24 Level III.5: Clinically Managed Medium Intensity Residential Treatment Program For Adolescents 580-9-44-.25 Level III.5: Clinically Managed High Intensity Residential Treatment Program For Adults 580-9-44-.26 Level III.7: Medically Monitored Intensive Residential Treatment Program For Adults 580-9-44-.27 Level III.7: Medically Monitored High Intensity Residential Treatment Program For Adolescents 580-9-44-.28 Level III.7-D: Medically Monitored Residential Detoxification 580-9-44-.29 Level I-O: Opioid Maintenance Therapy Choose what service you want to apply for and read the code.

29. Your agency is required by the Administrative Code to have: • Full-Time Executive Director • Cannot be both or any other position in your organization • Full-Time/Contract Clinical Director • Cannot be both or any other position in your organization • Program Coordinator • Substance abuse staff will need to be certified as a substance abuse professional: http://www.aadaa.us/certification-membership/ • or • http://www.naadac.org/about

30. The following must be included with your application • POLICY AND PROCEDURE MANUAL • Criminal Background Check information • Articles of Incorporation • Board by-laws including a list of Board Members • Board minutes • Program Description for each service you are applying for • Copy of most recent fiscal audit (if applicable) • Resumes of Executive Director and Board President

31. Policy and Procedure Manual Very important and required with all applications • A policy and procedures manual is a crucial tool for running a business. • It serves as a consistent source for organizational policy, which are the overall regulations that govern the business, and the procedures that define how those policies will be implemented. • A policy and procedure manual exists to answer the what and how of operations. It spells out for all employees what is expected of them and how to accomplish it. It contains instructions on how to perform a task. It ensures routine jobs get performed safely and in compliance with the Administrative Code.

32. Policy and Procedure Manual (continued) • Your procedures manual can be a three ring binder, a folder on a network share drive. What’s important is that everyone understands what constitutes your policy and procedure manual and where a policy or procedure can be found when someone needs it. • Your policy and procedure manual will be unique to your program, and should contain the required minimum policies listed in the Administrative Code. Therefore, you must be familiar with the entire Administrative Code and other laws that pertain to operating a behavior health program such as HIPPA, 42 C.F.R. Part 2, Evidence Based Practices for the population you intend to serve.

33. Policy and Procedure Manual (continued) • Procedures are really about communication. Your employees need to understand what is expected of them. Your employees need a procedures manual to reference for training. Your supervisors need a policy manual to reference for managing business processes. By documenting your procedures, you are communicating what is important for growth, quality, and customer satisfaction.

34. Writing a Policy and Procedure (continued) Your POLICYis the Administrative Code. Use the Administrative Code numbers. Your PROCEDURE is the what and how of operations. It spells out for all employees what is expected of them and how to accomplish it. It contains instructions on how to perform a task. It ensures routine jobs get performed safely and in compliance with the Administrative Code.

35. Date of Policy: January 23, 2014 Example: Administrative Code: 580-9-44-.10(2)(g) Infection Control. The entity shall develop, maintain, and document compliance with a written plan for exposure control relative to infectious diseases that shall, at a minimum, include the following requirements: (g) TB Testing for all employees prior to initiation of duties after hiring and annually thereafter. Procedure: • Prior to employment and annually thereafter all persons hired by organization shall be required to have a TB 2-step skin test. • Each employee will be required to have proof of current TB 2-step skin test results. • The test results shall be kept in the employee’s personnel file and available for review by appropriate authorities and Department of Mental Health (DMH).

36. Example: Date of Policy: January 23, 2014 Administrative Code 580-9-44.13(20)(d) (1-2) Client Records. When client records are corrected or amendments are completed using the mark through method, amendments or marked through changes must be executed as follows: 1. The information to be amended is struck out with a single line that allows the stricken information to be read. 2. The amended entry is initialed and dated. Procedure: All corrections or amendments in a client record will use a mark through method and must be executed as follows: 1. The information to be amended is struck out with a single line that allows the stricken information to be read. 2. The amended entry is initialed and dated. White out or correction fluid will not be used in a client record.

37. Nurse Delegation Program and required forms http://www.mh.alabama.gov/ADSDND/ For residential services, there shall be a registered nurse or licensed practical nurse as a full-time or part-time employee or a consultant to the provider who is responsible for supervision of delegation of medication assistance to the unlicensed personnel. Access to an on-call nurse must be available 24 hours a day, 7 days a week. Provider will implement policies and procedures approved by their Board of Directors requiring full compliance with the Alabama Board of Nursing regulation 610X7.06 Alabama Department of Mental Health Residential Community Programs.

38. Administrative Code requirements for Substance Abuse • Must be trained on the 6 dimensions of American Society of Addiction Medicine (ASAM): • http://www.mh.alabama.gov/Video/ASAMtraining.aspx • Must use the DMH Integrated Placement Assessment Tool for assessing the client needs: • http://www.mh.alabama.gov/SATR/AssessmentPlacement.aspx

39. Important links Incident Reporting Procedures http://www.mh.alabama.gov/downloads/SACR/SACR131105_MHSA_ReportingProceduresAndForms_5-2012.pdf Administrative Code for Substance Abuse http://www.mh.alabama.gov/Downloads/SACR/SA_Administrative_Code.pdf AdministrativeCode for Mental Illness http://www.mh.alabama.gov/Downloads/SACR/SA_Administrative_Code.pdf

40. Important Links FAQ on mental Illness: http://www.mh.alabama.gov/MI/FAQ.aspx?sm=b_e Administrative Code for Life Safety http://www.mh.alabama.gov/Downloads/COPP/COPP90107_580-3-22LifeSafetyMinimunStandards4PhysicalFacilities.pdf Site Visit Report Scores http://www.mh.alabama.gov/COCA/SiteVisitReports/default.aspx

41. Application/Supporting Documents All applications to the Alabama Department of Mental Health (ADMH) for certification of community programs shall be submitted in original to: Debbie Popwell DMH Office of Certification Administration 100 North Union Street P.O. Box 301410 Montgomery, Alabama 36130-1410

42. IMPORTANT!!! READ! READ! READ!