SECTION 450:18-13-190. Adolescent halfway house services

(a)   Adolescent halfway house treatment shall provide low intensity substance use disorder treatment in a supportive living environment to facilitate reintegration into the home or community. Emphasis shall be on applying recovery skills, relapse prevention, independent living skills, and educational and vocational skills. Consumers shall participate in at least six (6) hours of structured substance use disorder treatment and rehabilitation services weekly. Self-help meetings are not included in the required hours.

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

(1)   Environment:

(A)   The facility shall be a freestanding facility or portion of a related healthcare facility having at least one (1) each of toilet, lavatory, and bathing facilities for each eight (8) residents;

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

(C)   The facility shall provide space, both indoor and outdoor. In co-ed treatment, the facility shall maintain separate sleeping quarters for males and females;

(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;

(F)   The facility shall be licensed by the Oklahoma State Department of Human Services (OKDHS) as a "Residential Child Care Facility"; and

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

(2)   Support systems:

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

(B)   Specialized professional consultation or supervision, emergency services, and crisis intervention shall be available;

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

(D)   The facility shall have a written plan for emergency procedures and staff shall have access to supplies as designated in this plan.

(3)   Staff:

(A)   Service providers shall be knowledgeable regarding the biopsychsocial aspects of substance use disorders, evidenced based practices, co-occurring disorder issues, child and adolescent development issues, and gender, cultural, and age-specific issues.

(B)   Service providers shall be 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)   The facility shall have staff members on duty twenty-four (24) hours per day, seven (7) days a week;

(D)   Staff shall be knowledgeable about emergency procedures as specified in the emergency procedures plan;

(E)   If educational services are provided, documentation shall be maintained to verify providing staff meet all state requirements for education or special education;

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

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

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

(4)   Treatment services:

(A)   The facility shall provide substance use disorder treatment services to assess and address the individual needs of each adolescent, to 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 clinically 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 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.

(B)   The facility shall provide services in appropriate groups according to age, gender, developmental level, and individual needs;

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

(D)   Consumers may participate in educational programs in the community, when clinically indicated, including extracurricular activities; and

(E)   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)   Assessment;

(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 functioning, speech, hearing, visual and language functioning, if no records are available on admission reflecting such examination within the previous year; and

(B)   The facility shall facilitate 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)   Compliance with the above may be determined by a review of the following:

(1)   Licenses;

(2)   Policies and procedures;

(3)   Treatment 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 trainings;

(5)   Treatment records;

(6)   Interviews with staff and consumers; and

(7)   Other facility records.

[Source: Amended and renumbered from 450:18-3-190 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]