SECTION 450:18-13-201. Halfway house services for persons with dependent children

(a)   Halfway house services for persons with dependent children shall provide substance use disorder treatment services in a residential setting and shall include a planned regimen of twenty-four (24) hour, seven (7) days a week, supervised living arrangements, to include professionally directed evaluation, care, and treatment, under a defined set of policy and procedures, in a permanent setting. Consumers shall participate in at least six (6) hours of treatment, supportive services, parenting, and child development services per week for adults, and six (6) therapeutic hours of services for children, excluding infants.

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

(1)   Environment: The facility shall be a freestanding facility providing family-style living arrangements, indoor recreational space for children and families, and safe, protected outdoor recreational space. The facility shall provide materials and space appropriate for ages of children receiving services. The facility shall provide a safe, welcoming, and culturally/age appropriate environment.

(2)   Support system:

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

(B)   The facility shall ensure children's access to the fullest possible range of medical services available, such as health screening, well-child health care, screening in speech, language, hearing, and vision, and verification of immunization records;

(C)   The facility shall have access to emergency health care provided as necessary;

(D)   The facility shall have access to public schools for school age children, and facilitation of the child's receiving the benefits of Public Laws 99-142; and

(E)   The facility staff shall document a liaison with the local Oklahoma Department of Human Service (OKDHS) offices to:

(i)   Promote preservation of families;

(ii)   In cases of investigation of abuse, provide instruction in positive parenting behavior, if requested by the Oklahoma Department of Human Services (OKDHS) and with parental consent, provide daily observations of parent-child interaction;

(iii)   Expedite investigations in a timely manner; and

(iv)   Ensure prompt facility response to situations which require immediate intervention.

(3)   Staff:

(A)   Service providers shall be knowledgeable regarding Biopsychsocial dimensions of substance use disorder, evidenced-based practices, cultural, age, and gender specific issues, co-occurring disorder issues, and services for infants, toddlers, preschool, and school-age children.

(B)   Service providers are minimally trained in:

(i)   The identification of domestic violence, spousal or partner abuse, and child abuse and neglect, with special emphasis on failure to thrive and sexual abuse of children.

(ii)   Child development and age appropriate behaviors.

(iii)   Parenting skills appropriate to infants, toddlers, pre-school, and school age children.

(iv)   The impact of substances and substance use disorders on parenting and family units.

(C)   Service providers working with children shall be knowledgeable and demonstrate job appropriate functional comprehension of:

(i)   The impact of prenatal drug and alcohol exposure on child development.

(ii)   The effect of substance use disorders on parenting, children, and families.

(iii)   Parenting skills appropriate to infants, toddlers, pre-school, and school age children.

(iv)   Common child behavioral and developmental problems.

(v)   Appropriate play activities according to developmental stage.

(vi)   Recognition of sexual acting out behavior.

(vii)   The substance use disorder recovery process, especially as related to family units.

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

(E)   Staff shall be knowledgeable regarding facility-required education and training requirements and policies.

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

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

(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 fourteen members for each qualified provider for adults and 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)   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.

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

(vi)   Vocational services. Any level of provider can provide vocational services (Employment consultants, or other staff who have completed some form of job coach training, are preferred. Vocational services include the process of developing or creating appropriate employment situations for individuals who desire employment to include, but not be limited to: the identification of employment positions, conducting job analysis, matching individuals to specific jobs, facilitating job expansion or advancement and communicating with employers about training needs.

(vii)   Parenting and child development.

(B)   Services for children shall be provided and include a minimum of six (6) hours per week of therapeutic units for each child consisting of, but not limited to, assessment, therapy via art and recreational activities, etc. according to the development of the child. Documentation of all needs identified for each child shall be identified on that child's case management service plan and/or service plan.

(C)   Children's services, excluding infants, shall be provided which address the significant issues and needs documented in either or both the child's and the parent's assessment and shall utilize both structured and unstructured therapeutic activity. Services shall address the significant issues and needs documented in the parent's or child's assessment and create and enhance positive self image and feelings of self-worth, promote family unity, teach personal body safety and positive school interactions, and to prevent alcohol, tobacco, and other drug use;

(D)   Infant services, ages birth to three (3) years of age, shall be provided and shall consist, at a minimum, of developmentally appropriate parent-child bonding (interactive) activities and play therapy as determined by mother's service plan; and

(E)   Case management services for each adult and each child shall be provided, which include the assessment of and planning and arranging for recovery needs.

(5)   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, adult, and child, has received a minimum of six (6) hours of service each week addressing issues and needs indicated in the assessments (parent or child).

(c)   Compliance with 450:18-13-201 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, and ongoing in-service trainings;

(5)   Treatment records;

(6)   Interviews with staff and consumers; and

(7)   Other facility documentation.

[Source: Amended and renumbered from 450:18-3-201 at 23 Ok Reg 1953, eff 7-1-06; Amended at 24 Ok Reg 2580, eff 7-12-07; Amended at 25 Ok Reg 2532, eff 7-11-08; 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]