Provision of Services

(A) Admission. Prior to admission, the Licensed or Approved Provider shall determine that adolescent and transition age youth residential rehabilitation services are appropriate based upon the following criteria: (1) the resident is younger than 26 years old; and: (a) has a substance use disorder or a mental or behavioral disorder due to psychoactive substance use and is not intoxicated and is not currently at risk of experiencing withdrawal symptoms; (b) is not currently experiencing acute symptoms of physical illness or mental health conditions, and does not pose a risk to self or others; (c) meets patient placement criteria defined by the American Society of Addiction Medicine for Clinically Managed Residential Treatment for adolescents; (d) does not require intensive therapeutic intervention for a serious mental health condition as a primary diagnosis or severe emotional disturbance and/or aggressive behavior; and (e) does not require 24-hour per day nursing care. (2) residents 18 years old or older consent to treatment; (3) residents 12 through 17 years old consent to treatment by either: (a) the consent of the parent or legal guardian; or (b) without the consent of a parent or legal guardian upon a finding of two or more physicians that the minor is drug dependent. (B) Developmentally Appropriate Services. The Licensed or Approved Provider shall ensure treatment plans, facility programs and materials are tailored to adolescents and transition age youth. Program services shall address adolescent and transition age youth concerns, including education, community, juvenile justice, mental and physical health. The licensee shall ensure treatment plans, facility programs and materials recognize this unique stage of brain development, physical, social and psychological growth, and the complexity of substance use and co-occurring mental health disorders during this developmental stage. Program services shall address concerns of substance use and misuse, and their negative consequences on school performance, socialization in the community, family interaction and overall physical and mental health. (C) Assessment. Pursuant to 105 CMR 164.072(B), the Licensed or Approved Provider may initiate resident treatment prior to completion of the assessment required by 105 CMR 164.072 upon obtaining sufficient information to initiate treatment for the acute problem at the time of presentation and that the assessment is subsequently completed in a reasonable timeframe, provided that a Qualified Healthcare Professional must see such a resident prior to initiating an FDA-approved medication for treatment of addiction. In addition, the Licensed or Approved Provider shall assess the following: (1) the resident's educational status and remedial educational needs; and the resident's mental health status to determine whether a co-occurring mental health disorder is present. (D) Medical Examination. Notwithstanding the assessment required by 105 CMR 164.072, a medical and health history and physical examination shall be conducted by the program or upon referral within two weeks of admission, unless documentation of a physical examination, conducted within one year prior to admission, is provided. With resident's consent, the medical examination shall include laboratory tests for sexually transmitted diseases and, for females, pregnancy. Refusal to consent to medical examinations shall be documented, and shall not be grounds for discharge. (E) Treatment Plan. In addition to the requirements of 105 CMR 164.073, the Licensed or Approved Provider shall ensure that the treatment plan is reviewed at least every 30 calendar days, and includes: (1) a statement of the resident's educational needs and opportunities to attain them; (2) educational services to be provided; (3) projected length of stay; (4) employment readiness and skill building; (5) family reconciliation or reunification, if appropriate; and (6) skills for identifying and building healthy relationships. (F) Family Involvement in Treatment. The Licensed or Approved Provider shall ensure that services, including family therapy, are offered to parents or legal guardian and family members. The Licensed or Approved Provider shall inform parents or legal guardian of program policies and procedures, including: (1) names and telephone numbers of staff whom parents or legal guardian may contact; (2) resident manual provided pursuant to 105 CMR 164.081; and (3) criteria for discharge. (G) Treatment Services. In addition to the requirements of 105 CMR 164.074, the Licensed or Approved Provider shall provide the following: (a) individual and group psychotherapeutic counseling that addresses substance use and misuse, including safety and opioid overdose prevention; (b) educational services designed to assist the resident in maintaining or achieving participation in a developmentally appropriate school program; (c) mental health services to address co-occurring mental health disorders; (d) group programming for families of residents; (e) recreational programming; (f) exposure to support and self-help groups for adolescents; (g) opportunities for residents to participate in planning, organizing or managing non- clinical programming; (h) clinical, educational and support services designed specifically for females, separate from males, and for males, separate from females; (i) clinical and educational programming designed to address racial inequities and health disparities and meet the needs of culturally and ethnically diverse residents; and (j) a dedicated staff member to support provision of transportation services to ensure residents can obtain needed off-site services, such as medical, psychiatric and recreational services, and to support parent or legal guardian and family participation in program services and activities. (2) In addition to the requirements of 105 CMR 164.442(G)(1), the Licensed or Approved Provider shall provide the following services for Transition Age Youth: (a) assist the resident maintain or obtain participation in a developmentally appropriate school or vocational program; (b) support and self-help groups for young people; (c) skills for independent living and functioning; (d) vocational skills development; and (e) assist the resident develop and strengthen peer, family and community recovery supports. (H) Length of Stay. If the resident's length of stay exceeds 90 calendar days, the Licensed or Approved Provider shall document reasons for this extension in the resident's record. (I) Aftercare Services. The Licensed or Approved Provider shall ensure the aftercare service plan provides for continued educational services, and continued family and social support services including, but not limited to,: (1) directly connecting the resident to outpatient substance use disorder treatment services; (2) identifying self-help resources such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Al-Anon, and Alateen.