Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 75 COMMUNITY SUBSTANCE ABUSE SERVICE STANDARDS
Date:
08/31/2009
Document:
DHS 75.14 Transitional residential treatment service.
(1) SERVICE DESCRIPTION. A transitional residential treatment service is a clinically supervised, peer-supported therapeutic environment with clinical involvement. The service provides substance abuse treatment in the form of counseling for 3 to 11 hours per patient weekly, immediate access to peer support through the environment and intensive case management which may include direct education and monitoring in the areas of personal health and hygiene, community socialization, job readiness, problem resolution counseling, housekeeping and financial planning.
(2) REQUIREMENTS. To receive certification from the department under this chapter, a transitional residential treatment service shall comply with all requirements included in s. DHS 75.03 that apply to a transitional residential treatment service, as shown in Table 75.03, and, in addition, a transitional residential treatment service shall comply with the requirements of this section. If a requirement in this section conflicts with an applicable requirement in s. DHS 75.03, the requirement in this section shall be followed.
(3) ORGANIZATIONAL REQUIREMENTS. Before operating or expanding a transitional residential treatment service, a facility shall be approved under ch. DHS 124 as a hospital, licensed under ch. DHS 83 as a community-based residential facility, certified under ch. DHS 82 or licensed under ch. DHS 88 as an adult family home.
(4) REQUIRED PERSONNEL. (a) A transitional residential treatment service shall have the following personnel:
1. A director responsible for the overall operation of the service, including the therapeutic design and delivery of services.
2. A physician available to provide medical supervision and clinical consultation as either an employee of the service or under a written contract with the service.
3. At least one full-time substance abuse counselor for every 15 patients or fraction thereof.
4. At least one clinical supervisor on staff to provide ongoing clinical supervision of the counseling staff, or a person outside the agency who is a clinical supervisor and who by a written agreement will provide ongoing clinical supervision of the counseling staff.
5. A mental health professional available either as an employee of the service or through written agreement to provide joint and concurrent services for the treatment of dually diagnosed patients.
(b) A certified clinical supervisor who meets the requirements of a substance abuse counselor may provide direct counseling services in addition to his or her supervisory responsibilities.
(5) CLINICAL SUPERVISION. (a) A transitional residential treatment service shall provide for ongoing clinical supervision of the counseling staff. Ongoing clinical supervision shall be provided as required in s. RL 162.01.
Note: Section RL 162.01 (1) states that a clinical supervisor shall provide a minimum of:
1. Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
2. Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
3. One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
4. One in person meeting each calendar month with a substance abuse counselor-in-training, substance abuse counselor, or clinical substance abuse counselor. This meeting may fulfill a part of the requirements above.
(b) The clinical supervisor shall provide supervision and performance evaluation of substance abuse counselors in the areas identified in s. RL 162.01 (5).
Note: Section RL 162.01 (5) states that the goals of clinical supervision are to provide the opportunity to develop competency in the transdisciplinary foundations, practice dimensions and care functions, provide a context for professional growth and development and ensure a continuance of quality patient care.
(6) SERVICE OPERATIONS. (a) Medical screening. 1. A physician, registered nurse or physician assistant shall conduct medical screening of a patient no later than 7 working days after the person's admission to identify health problems and to screen for communicable diseases unless there is documentation that screening was completed within 90 days prior to admission.
2. A patient continuing in treatment shall receive an annual follow-up medical screening unless the patient is being seen regularly by a personal physician.
(b) Medical service needs. A service shall arrange for services for a patient with medical needs unless otherwise arranged for by the patient.
(c) Intake. A service shall complete intake within 24 hours of a person's admission to the service except that the initial assessment and initial treatment plan shall be completed within 4 working days of admission.
(d) Hours of operation. A service shall operate 24 hours per day and 7 days per week.
(e) Policies and procedures manual. A service shall have a written policy and procedures manual that includes all of the following:
1. The service philosophy and objectives.
2. The service's patient capacity.
3. A statement concerning the type and physical condition of patients appropriate for the service.
4. Admission policy, including:
a. Target group served, if any.
b. Limitations on admission.
5. Procedures for screening for communicable disease.
6. Service goals and services defined and justified in terms of patient needs, including:
a. Staff assignments to accomplish service goals.
b. Description of community resources available to assist in meeting the service's treatment goals.
(f) Documentation of review. 1. A service shall maintain documentation that the governing body, director and representatives of the administrative and direct service staffs have annually revised, updated as necessary and approved the policy and procedures manual, including the service philosophy and objectives.
2. The service shall maintain documentation to verify that each staff member has reviewed a copy of the policy and procedures manual.
(g) Emergency medical care. A service shall have a written agreement with a hospital or clinic for the hospital or clinic to provide emergency medical care to patients.
(h) Emergency transportation. A service shall have arrangements for emergency transportation, when needed, of patients to emergency medical care services.
(i) Treatment plan. The service's treatment staff shall prepare a written treatment plan for each patient referred from prior treatment service, which is designed to establish continuing contact for the support of the patient. A patient's treatment plan shall include information, unmet goals and objectives from the patient's prior treatment experience and treatment staff shall review and update the treatment plan every 30 days.
(j) Support services. A service shall provide support services that promote self-care by the patient, which shall include all of the following:
1. Planned activities of daily living.
2. Planned development of social skills to promote personal adjustment to society upon discharge.
(k) Employment related services. A service shall make job readiness counseling, problem-resolution counseling and pre-vocational and vocational training activities available to patients.
(L) Recreational services. A service shall have planned recreational services for patients, which shall include all of the following:
1. Emphasis on recreation skills in independent living situations.
2. Use of both internal and community recreational resources.
(7) ADMISSION. Admission to a transitional residential treatment service is appropriate only for one of the following reasons:
(a) The person was admitted to and discharged from one or more services under s. DHS 75.10, 75.11, 75.12 or 75.13 within the past 12 months or is currently being served under either s. DHS 75.12 or 75.13.
(b) The person has an extensive lifetime treatment history and has experienced at least two detoxification episodes during the past 12 months, and one of the following conditions is met:
1. The person to be admitted is determined appropriate for placement in this level of care by the application of approved placement criteria.
2. The person to be admitted is determined appropriate for this level of care through the alternative placement recommendations of WI-UPC or other approved placement criteria.
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