Header:
CODE OF MARYLAND REGULATIONS
TITLE 10. DEPARTMENT OF HEALTH AND MENTAL HYGIENE
SUBTITLE 47. ALCOHOL AND DRUG ABUSE ADMINISTRATION
CHAPTER 01. REQUIREMENTS
Date:
08/31/2009
Document:
.26 Outpatient Care Program.
A. Scope of Service. The outpatient care program shall be designed to provide a variety of diagnostic and therapeutic treatment services in a non-residential setting for persons suffering from alcoholism or exhibiting symptoms of alcohol abuse. Outpatient care programs shall provide these services to clients whose physical and emotional status allows them to function in their usual environment. On the basis of individual client assessments, the outpatient program will offer a variety of treatment services including individual and group counseling, therapy, alcohol education groups, family counseling and access to support organizations such as Alcoholics Anonymous and Al-Anon.
B. Plan for Service.
(1) The program shall develop a written plan for service which describes both the program's treatment philosophy and objectives. The plan shall include the following components:
(a) A statement describing and justifying the primary diagnostic and treatment modalities utilized within the program;
(b) A statement of organizational objectives consistent with the program's philosophy;
(c) A description of the criteria used to measure progress towards attainment of the program's objectives;
(d) A description of alternative resources which may be used to provide diagnostic, treatment or support services that the outpatient care program does not provide directly; and
(e) A description of procedures used to insure continuity of care for clients who are referred to outside treatment facilities.
(2) The program shall develop a written plan describing its organization which shall include a description of:
(a) The interrelationship of the outpatient care program and any other services provided by the facility;
(b) An organizational chart showing the relationship between and the function of all program staff and administrators; and
(c) A written rationale for the proposed program staffing.
(3) The program shall maintain documentation demonstrating that the program's governing authority, executive director, clinical and administrative staff have annually updated and approved the program's plan for service and organizational plan.
(4) The program shall maintain documentation verifying that each administrative and clinical staff member of the outpatient care program has reviewed a copy of the plan for service as part of their orientation process.
C. Minimum Physical Facility Requirements.
(1) The outpatient care program shall be located and designed so as to provide adequate and appropriate facilities for private counseling sessions and client interview rooms. In addition, the programs shall have appropriate space for group activities and educational programs.
(2) The program shall be designed, located, constructed and equipped so as to promote the effective operation of its programs and to protect the health and safety of its clients and staff.
(3) The program shall maintain a written evacuation plan to be used in the case of fire or other disaster. Programs are not eligible for any form of certification unless a written certificate of compliance is obtained from the local fire marshal indicating that all applicable fire and safety code requirements have been satisfied by the program.
D. Staffing. The amount of staff required for the outpatient care program will vary with the complexity of the service provided and the number of clients enrolled in the program. The following standards establish minimum staffing patterns for an outpatient care program:
(1) One physician shall provide consultation services on an as needed basis.
(2) A clinical director shall be designated to supervise the therapeutic and rehabilitative components of the program. The clinical director shall be a certified alcoholism counselor or a person who has a level of training and experience equivalent to that required for certification as an alcoholism counselor and may be trained in any acceptable clinical discipline, such as psychology, nursing, social work, counseling. The clinical director may serve in a consultant capacity to the program.
(3) At least one full time (35 or more hours per week) counselor shall be employed for every 35 clients enrolled in the program. All programs which employ three or more clinical staff shall insure that at least one of these staff members is a certified alcoholism counselor or a person who has a level of training and experience equivalent to that required for certification as an alcoholism counselor. When clinical supervision is provided by a person other than the clinical director, each supervisor shall be a certified alcoholism counselor or a person who has documented experience and advanced training in alcoholism treatment and clinical supervision. Clinical supervisors shall carry caseloads at the discretion of the executive director of the program.
E. Intake.
(1) The program shall maintain documentation verifying that program staff have initiated a psycho-social assessment within 10 working days of every client's initial admission to the program. The psycho-social assessment shall be completed before the time that the client's individual treatment plan is developed and implemented. A new psycho-social assessment shall be prepared for each subsequent admission to the program.
(2) The outpatient care program shall develop written procedures for obtaining psychiatric, psychological or medical examinations on behalf of clients when these services are not provided by the program. The program shall maintain documentation regarding the results of the examination.
F. Treatment Plans.
(1) The program shall develop a written, individualized treatment plan on behalf of every client. The treatment plan shall be based on the psycho-social evaluation and any other psychiatric or psychological assessments which have been performed on behalf of the client. In those instances where medical examination of the patient has been obtained, pertinent findings from the examination shall be included in the treatment plan.
(2) The client shall be encouraged to participate in the development of the individualized treatment plan. The nature of this participation shall be described in the client's record. The program shall maintain documentation indicating the client has been informed of and had assented to the treatment plan and has been afforded an opportunity to assist in the development of treatment goals and objectives.
(3) Within 15 working days of the client's admission to the program, a written individualized treatment plan shall be included in the client's record. If the program is unable to develop a treatment plan within the 15 working day period, the clinical director, or the clinical supervisor shall determine why there is a delay in development of a treatment plan and shall insure that a treatment plan is immediately developed. They shall also insure that all treatment plans are updated and reviewed at least every 90 days after the client's admission to the program.
(4) Progress notes about the client shall be documented in the client's treatment record. There shall be a note documenting each contact.
G. Family Services. The outpatient care program shall provide education and support services to families of alcoholics in accordance with the confidentiality provisions of 42 CFR 2.1 et seq. The program shall maintain a written policy governing the provision of family services. The program shall provide the services directly or by referring individuals to other programs or agencies involved in the treatment of alcoholics. The family service plan shall include the following components:
(1) Procedures for obtaining an assessment of the treatment needs of the client's family;
(2) A method which provides for the treatment needs of the family members or friends and describes how they will be involved in the client's treatment process;
(3) Informational and educational programs that are family oriented to meet the needs of family members or friends which shall be offered on a regularly scheduled basis;
(4) Procedures for on-going active participation by the client's family or friends in support activities such as Al-Anon and Alateen; and
(5) Individuals who provide family counseling shall have documented formal training in family therapy.
H. Services to Adolescents.
(1) Outpatient care programs which provide treatment services to primary clients, ages 12--17 inclusive, shall adhere to all the requirements in Sec. A--G.
(2) A written treatment protocol shall be established and maintained that provides for the special developmental needs of adolescents and emphasizes the use of family counseling procedures.
(3) Activities and identified treatment needs for adolescents shall be fully documented in the client's treatment plan progress notes and aftercare plan.
(4) Admission criteria for persons between 12 and 17 years old shall allow for admission if primary diagnosis is drug abuse.
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