Residential Treatment

PURPOSE: This rule describes the goals, eligibility and discharge criteria, available services, and performance indicators for residential treatment. (1) Treatment Goals. Residential treatment shall offer an intensive set of services in a structured alcohol- and drug-free setting. Services shall be organized and directed toward the primary goals of— (A) Stabilizing a crisis situation, where applicable; (B) Interrupting a pattern of extensive or severe substance abuse; (C) Restoring physical, mental and emotional functioning; (D) Promoting the individual’s recognition of a substance abuse problem and its effects on his/her life; (E) Developing recovery skills, including an action plan for continuing sobriety and recovery; and (F) Promoting the individual’s support systems and community reintegration. (2) Eligibility Criteria. In order to fully participate in and benefit from the intensive set of services offered in residential treatment, a person must meet the following admission and eligibility criteria: (A) Does not demonstrate symptoms of intoxication, impairment or withdrawal that would hinder or prohibit full participation in treatment services. A screening instrument, that includes vital signs, must be used with all prospective clients to identify symptoms of intoxication, impairment, or withdrawal and, when indicated, detoxification services must be provided or arranged; (B) Needs an alternative, supervised living environment to ensure safety and protection from harm; (C) Meets the general treatment eligibility requirement of a current diagnosis of substance abuse or dependence and, in addition, demonstrates one or more of the following— 1. Recent patterns of extensive or severe substance abuse; 2. Inability to establish a period of sobriety without continuous supervision and structure; 3. Presence of significant resistance or denial of an identified substance abuse problem; or 4. Limited recovery skills and/or support system; and (D) A client may qualify for transfer from outpatient to residential treatment if the person— 1. Has been unable to establish a period of sobriety despite active participation in the most intensive set of services available on an outpatient basis; or 2. Presents imminent risk of serious consequences associated with substance abuse. (3) Safety and Supervision. The residential setting shall ensure the safety and well-being of persons served. (A) Staff coverage shall ensure the continuous supervision and safety of clients. 1. There shall be an adequate number of paid staff on duty (awake and dressed) at all times. At least two (2) staff shall be on duty, unless otherwise stipulated in these rules or authorized in writing by the department through the exceptions process. Additional staff shall be required, if warranted by the size of the program and the responsibilities and duties of the staff members. 2. Clients shall be supervised at all times by a staff member with current certification in first aid and cardiopulmonary resuscitation. (B) The program shall immediately and effectively address any untoward or critical incident including, but not limited to, any incident of alcohol or drug use by a client on its premises. (4) Intensive Services with Individualized Scheduling. Services shall be responsive to the needs of persons served. (A) There shall be a current schedule of program activities that offers a minimum of fifty (50) hours of structured, therapeutic activity per week. 1. Therapeutic activities shall be provided seven (7) days per week. 2. Group education and group counseling must constitute at least twenty (20) of the required hours of therapeutic activity per week. (B) At least one (1) hour of individual counseling per week shall be provided to each client. Additional individual counseling shall be provided, in accordance with the individual’s needs. (5) Discharge Criteria. Each client’s length of stay in residential treatment shall be individualized, based on the person’s needs and progress in achieving treatment goals. (A) To qualify for successful completion and discharge from residential treatment, the person should— 1. Demonstrate a recognition and understanding of his/her substance abuse problem and its impacts; 2. Achieve an initial period of sobriety and accept the need for continued care; 3. Develop a plan for continuing sobriety and recovery; and 4. Take initial steps to mobilize supports in the community for continuing recovery. (B) A person may be discharged before accomplishing these goals if maximum benefit has been achieved and— 1. No further progress is imminent or likely to occur; 2. Clinically appropriate therapeutic efforts have been made by staff; and 3. Commitment to continuing care and recovery is not demonstrated by the client. (6) The program handles applications for continued civil detention in accordance with sections 631.140, 631.145 and 631.150, RSMo 2000. AUTHORITY: sections 630.050, 630.655 and 631.010, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. Amended: Filed Oct. 15, 2001, effective April 30, 2002. Amended: Filed April 15, 2002, effective Nov. 30, 2002. *Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.655, RSMo 1980; and 631.010, RSMo 1980.