SECTION 450:18-13-101.1. Intensive residential treatment for adults

(a)   Intensive substance use disorder treatment in a residential setting shall provide a planned regimen of twenty four (24) hours a day, seven (7) days a week of professionally directed evaluation, care, and treatment in a permanent program location. Consumers shall participate in at least thirty-seven (37) treatment hours of substance use disorder treatment services per week. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment.

(b)   The facility shall maintain written programmatic descriptions and operational methods addressing the following:

(1)   Support system:

(A)   A licensed physician shall be available, at least by telephone, twenty-four (24) hours per day, seven (7) days per week;

(B)   The facility shall maintain written policy and procedures for handling medical emergencies; and an emergency medical number shall be conspicuously posted for staff use; and

(C)   The facility shall maintain written policies and procedures for the handling of clinical issues during times in which clinical staff are not at the facility.

(2)   Staff:

(A)   The facility shall maintain documentation that service providers are knowledgeable regarding the biopsychosocial dimensions of substance use disorders, evidenced-based practices, cultural, age, and gender specific issues, and co-occurring disorder issues.

(B)   Staff shall be at least eighteen (18) years of age.

(C)   The facility shall document in personnel records all education, training, and experience stated above prior to the provision of direct care services.

(D)   The facility shall have staff members on site twenty-four (24) hours per day, seven (7) days per week.

(3)   Treatment services. Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder treatment services shall be provided to assess and address individual needs of each consumer. Services shall include, but are not limited to:

(A)   Therapy. Therapy must be provided by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate who must use and document a generally accepted clinical approach to treatment such as cognitive behavioral treatment, narrative therapy, solution focused brief therapy or another widely accepted theoretical framework for treatment. The therapy must be goal directed utilizing techniques appropriate to the individual consumer's service plan and the consumer's developmental and cognitive abilities. This service does not include social skill development or daily living skill activities. For adults, group therapy is limited to a total of eight adult individuals. For all children under the age of eighteen, the total group size is limited to six. Therapy must be provided at least four (4) hour per week.

(B)   Rehabilitation services. Rehabilitation services must be provided by a LBHP, Licensure Candidate, Certified Alcohol and Drug Counselor (CADC) or Certified Behavioral Health Case Manager II (CM II). These services includes educational and supportive services regarding independent living, self-care, social skills regarding development, lifestyle changes and recovery principles and practices (including relapse prevention). Services provided typically take the form of curriculum based education and skills practice, and should be goal specific in accordance with an individualized service plan. Rehabilitation services must be provided at least seven (7) hours per week. The maximum staffing ratio for group rehabilitation services is fourteen members for each qualified provider for adults and eight to one for children under the age of eighteen.

(C)   Educational groups. Only eleven (11) hours per week of education group may be counted toward the required treatment hours. Education groups may include but are not limited to learning experiences regarding living skills, budgeting, educational/vocational skills, etc.

(D)   Case Management. Case management must be provided by a LBHP, Licensure Candidate, CADC, CM II or CM I as clinically indicated.

(E)   Crisis Intervention. Crisis intervention services must be provided by a LBHP or Licensure Candidate. Crisis intervention services are provided as needed for the purpose of responding to acute behavioral or emotional dysfunction as evidenced by psychotic, suicidal, homicidal severe psychiatric distress, and/or imminent danger of substance relapse. The crisis situation including the symptoms exhibited and the resulting intervention or recommendations must be clearly documented in the consumer's record.

(4)   Treatment documentation:

(A)   All documentation for therapy, case management and crisis intervention must be documented in an individual note and reflect the content of each session provided. Documentation must include, at a minimum, the following:

(i)   Date;

(ii)   start and stop time for each session;

(iii)   Specific problems, goals, and objectives addressed;

(iv)   type of service and method(s) used to address problems;

(v)   Summary of progress made toward goals and objectives, or lack of;

(vi)   Consumer response to overall treatment services;

(vii)   Any new problems, goals, or objectives identified during the week;

(viii)   Dated signature and credentials of the service provider completing the documentation; and

(ix)   Consumer's name.

(B)   Documentation for rehabilitation services and education groups must include daily member sign-in/sign-out record of member attendance (including date, time, type of service and service focus), and a daily progress note or a summary progress note weekly.

(C)   Documentation shall reflect each consumer has received a minimum of thirty-seven (37) hours of treatment services each week, including the treatment services required in 18-13-101.1(b)(3), in addition to life skills, recreational, and self-help supportive meetings.

(5)   The program provides documentation of the following community living components:

(A)   A written daily schedule of activities.

(B)   Quarterly meetings between consumers and the program personnel.

(C)   Recreational activities to be utilized on personal time.

(D)   Personal space for privacy.

(E)   Security of consumer's property.

(F)   A clean, inviting, and comfortable setting.

(G)   Evidence of individual possessions and decorations.

(H)   Daily access to nutritious meals and snacks.

(I)   Policy addressing separate sleeping areas for the consumers based on:

(i)   Gender;

(ii)   Age; and

(iii)   Needs.

(c)   Compliance with 450:18-13-101.1 may be determined by a review of the following:

(1)   Licenses;

(2)   Policies and procedures;

(3)   Treatment protocols;

(4)   Personnel record, documentation of professional licensure or certification, documentation of professional work experience, and ongoing in-service trainings;

(5)   Treatment records; and

(6)   Interviews with staff and consumers.

[Source: Added at 31 Ok Reg 2004, eff 10-1-14; Amended at 32 Ok Reg 2091, eff 9-15-15; Added at 35 Ok Reg 1821, eff 10-1-18]