Licensing: Intensive Residential Treatment Programs (IRTP)

(1) Adolescent Intensive Residential Treatment Program. An adolescent Intensive Residential Treatment Program (IRTP) is a residential mental health program which provides comprehensive treatment and education in a secure setting to adolescents with serious emotional disturbance or mental illness and which has the capacity to admit such adolescents pursuant to the provisions of M.G.L. c. 123, §§ 7, 8, 10 and 11. IRTPs may not receive a Class VIII license to administer electroconvulsive treatment. (2) Eligibility. Only individuals who meet the following criteria may be eligible for admission to an IRTP: (a) The individual shall be 13 through 18 years of age. An individual already admitted to an IRTP who turns 19 years old may, upon approval of the Commissioner or designee, remain there to complete his or her course of treatment; (b) The individual has been determined to require continuing care and treatment in a secure residential setting; (c) Failure to place the individual in a secure treatment setting would create a likelihood of serious harm by reason of mental illness; and (d) There is no appropriate, less restrictive setting available. (3) Admission. Individuals who meet the IRTP eligibility criteria may be admitted to and retained in an IRTP only in accordance with the provisions of M.G.L. c. 123, §§ 7 and 8 or 10 and 11, and the applicable provisions of 104 CMR 27.00. For IRTPs operated by or under contract with the Department, individuals may only be admitted upon approval of the Department. Referrals for admission to an IRTP operated by or under contract with the Department shall be made through an admissions process, as designated by the Department, and shall contain such clinical information and documentation as the Department may require. (4) Location. If an IRTP is located on the grounds of a state hospital or in the same building as an inpatient mental health unit, it shall have program, kitchen and eating facilities separate from those of the state hospital or inpatient unit. (5) Staffing. Each IRTP shall be staffed at a level sufficient to meet the clinical needs of the patients, as well as the administrative and ancillary services necessary to the operation of the IRTP, consistent with the requirements of Joint Commission or other accreditation agency approved by the Department. Among the clinical staff shall be persons in appropriate disciplines qualified to provide services which shall include, but are not limited to: psychiatric and psychological intervention; individual, group and family therapy; nursing care; milieu support; medication administration; discharge planning; education; rehabilitation services; recreation; and peer and family support. (a) Each IRTP shall have sufficient full-time senior management to provide adequate oversight of program, clinical and psychiatric operations. Senior managers with responsibility for clinical matters shall be mental health professionals, licensed as independent practitioners in their field of training and expertise. At least one member of senior management shall be a licensed mental health professional who is, by training or experience, a specialist in the treatment of adolescents. (b) Each IRTP shall have a psychiatrist, who is board certified or eligible in child and adolescent psychiatry, available for consultation and shall have a psychiatrist on-site or on- call, 24 hours per day, for psychiatric emergencies. (c) Each IRTP shall have sufficient qualified registered nurses on each shift for the administration of regularly prescribed medications, as well as for administration of pro renata (PRN) and emergency medication and conducting examinations pursuant to 104 CMR 27.12. (d) Each IRTP shall have a sufficient number of independently licensed mental health professionals such that the primary individual and family therapist for each adolescent shall be so licensed. (e) Provision shall be made to ensure that sufficient back-up personnel are available to respond within a reasonable time in emergency situations. (6) General Physical Requirements. (a) Each IRTP shall provide outdoor recreational and indoor space that is safe, comfortable, well-lit, well-ventilated, adequate in size and of sufficient quality to be utilized in a manner consistent with the overall philosophy and treatment goals of the IRTP. (b) Each IRTP shall provide sufficient security features to enable the staff to prevent physical harm to patients and to staff, including the capacity to lock the IRTP. SUBPART C: OPERATIONAL STANDARDS FOR MENTAL HEALTH FACILITIES