SECTION 450:18-13-161. Residential treatment for adolescents

(a)   Residential treatment for adolescents shall provide a planned regimen of twenty-four (24) hour, seven (7) days a week, professionally directed evaluation, care, and treatment for chemically dependent adolescents, under written policies and procedures in a permanent facility. Adolescents not attending academic training shall participate in at least twenty-one (21) substance use disorder treatment related hours per week. Adolescents attending academic training shall participate in at least fifteen (15) hours of substance use disorder treatment related hours per week. At a minimum, ten (10) hours shall be devoted to therapeutic treatment services including, but not limited to, group, individual, and family therapy provided by a qualified service provider. The remaining hours shall be devoted to life skills, prosocial skills, and recreational activities. Other activities such as self help support groups, meetings, and religious participation shall be in addition to required hours.

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

(1)   Environment:

(A)   The facility shall maintain an environment which is supportive of physical and emotional growth and development which is appropriate to the needs of adolescents;

(B)   The facility shall provide space, both indoor and outdoor, for the recreational and social needs of adolescents;

(C)   The facility shall group consumers appropriately by age, developmental level, gender, and treatment needs;

(D)   The program may provide transportation to activities in the community as appropriate. Vehicles used for transportation should not be labeled in any way that calls attention to the facility or the vehicle's occupants;

(E)   The program shall provide study areas within the facility and shall provide ancillary study materials such as encyclopedias, dictionaries, and educational resource texts and materials; and

(F)   The facility shall provide a safe, welcoming, and culturally/age appropriate environment.

(2)   Support systems:

(A)   The facility shall make available a licensed physician by telephone twenty-four (24) hours per day, seven (7) days per week;

(B)   The facility shall have specialized professional consultation or supervision available;

(C)   The facility shall provide clinically appropriate public educational services in compliance with applicable Oklahoma laws; and

(D)   The facility shall provide emergency services and crisis interventions.

(3)   Staff:

(A)   The facility shall document that service providers are knowledgeable regarding the biopsychsocial aspects of substance use disorder, cultural, gender, and age specific issues, co-occurring disorder issues, child and adolescent development and, evidenced based practices.

(B)   Maintain documentation that service providers are knowledgeable regarding the identification of violence and domestic violence, spousal or partner abuse, child abuse and neglect, parent and sibling abuse, normal and abnormal adolescent development, and family dynamics;

(C)   Ensure at least two (2) staff members are awake and on duty twenty-four (24) hours a day, seven (7) days a week;

(D)   If educational services are provided, the facility shall maintain documentation to verify that providing staff meets all state requirements for education or special education;

(E)   Staff shall be knowledgeable regarding the facility required education, and training requirements and policies;

(F)   Staff shall be least eighteen (18) years of age; and

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

(4)   Treatment services:

(A)   A multidisciplinary team approach shall be utilized in providing daily substance use disorder treatment services to assess and address the individual needs of each adolescent;

(B)   Services shall include, but not be limited to:

(i)   Therapy. Therapy must be provided by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate who must use and document a clinical approach generally accepted as reliable in the relevant clinical community, 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 all children under the age of eighteen, the total group size is limited to six.

(ii)   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). This service 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. The maximum staffing ratio for group rehabilitation services is eight to one for children under the age of eighteen.

(iii)   Educational groups. Education groups must be conducted by a LBHP, Licensure Candidate, CADC, CM II or Peer Recovery Support Specialist (PRSS).

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

(v)   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 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.

(C)   Services shall be provided in appropriate groups according to age, gender, developmental level, treatment status, and individual needs;

(D)   The facility shall provide clinically appropriate public educational services in compliance with applicable Oklahoma law;

(E)   Consumers shall participate in educational programs within the community, when clinically indicated, including extracurricular activities; and

(F)   Service providers shall confer on a regular basis with school personnel, including the provision of necessary information, when appropriate, on the educational progress of the consumer, and shall assess and respond to the needs for changes in the educational plans.

(5)   Assessments:

(A)   A physical examination shall be conducted by a licensed physician, to include physical assessment, health history, immunization status, and evaluation of motor development and function, speech, hearing, visual, and language functioning; and

(B)   The facility shall facilitate and document the involvement and participation of family members or significant others in the assessment, treatment, rehabilitation, and continuing treatment needs of each consumer;

(6)   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 that each consumer receives a minimum of twenty-one (21) hours of treatment-related hours each week or fifteen (15) or more treatment-related hours if participating in academic training.

(7)   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 450:18-13-161 may be determined by a review of the following:

(1)   Licenses;

(2)   Policies and procedures;

(3)   Treatment and service protocols;

(4)   Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service training(s);

(5)   Treatment records;

(6)   Interviews with staff and consumers; and

(7)   Other facility documentation.

[Source: Amended and renumbered from 450:18-3-161 at 23 Ok Reg 1953, eff 7-1-06; Amended at 24 Ok Reg 2580, eff 7-12-07; Amended at 27 Ok Reg 2237, eff 7-11-10; Amended 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]