Direct services

1. Inpatient care. a. Principle. The inpatient care component shall provide twenty-four hour supervised therapeutic care under the direction of a physician in a hospital. This service should be utilized only when, and for so long as, other services of the center are not appropriate. The goal of the inpatient care component is to provide appropriate and effective treatment to facilitate the patient's earliest return to the community. b. Standards. (1) The inpatient care component shall have a written statement describing its philosophy and objectives in the provision of care to patients with emotional problems. (a) This written statement shall include a statement of the primary diagnostic and treatment modalities utilized. (b) This written statement shall delineate the interrelationship of the inpatient care component and its personnel with other components. (2) The inpatient care component shall provide an intensive treatment program in a therapeutic environment. There shall be documentation that an evaluation of the needs of the patient has been conducted within twenty-four hours of the patient's entry into the inpatient care component. (a) This evaluation shall be carried out by or under the supervision of a qualified physician. (b) The process and results of this evaluation shall be documented in the patient's inpatient record. (3) There shall be a written, individualized treatment plan based on the diagnostic assessment of the patient's needs. (a) Any mental health professional may be involved in the patient's treatment under the supervision of a physician. (b) The treatment plan shall be aimed at moving the patient from the inpatient care component into another care component of the center, or into the community as soon as the patient is sufficiently improved. (4) The inpatient care component shall be reasonably accessible and immediately available. (a) Patients who need inpatient care shall be hospitalized without delay. (b) In the event that all inpatient care beds are filled, the center has the responsibility for arranging a suitable place for the patient's care. (5) Whenever possible, a person shall be admitted voluntarily to the inpatient care component. However, the center shall be prepared to receive clients who are committed to the inpatient care component through legal action. (6) The inpatient care component shall be structurally suitable to assure the patient of privacy when the patient desires it, and to encourage therapeutic interaction between patients and staff members. (7) Hospital inpatient care facilities, staffing, records, procedures, and programs shall meet the requirements for licensure by the state of North Dakota and, if appropriate, meet the requirements for accreditation by the joint commission on accreditation of hospitals. 2. Partial care. a. Principle. The partial care component shall be designed to provide a therapeutic program for those persons who require less than twenty-four hour a day care, but more than outpatient care. Partial care is an effective alternative to inpatient care. Partial care can serve as an effective transition between full-time care and return to the community. When so utilized, partial care can appreciably shorten the duration of a person's inpatient stay. b. Standards. (1) The partial care component shall have a written plan describing its treatment philosophy, objectives, and organization. (a) The written plan shall define the roles and responsibilities of the partial care personnel and the lines of authority. (b) The written plan shall delineate the interrelationship of the partial care component and its personnel with other center care components. (2) The partial care component shall have at least a day and night care program. (3) There shall be trained staff and supporting personnel to perform the services of the partial care component. (a) Performance of the services of the partial care component shall be verified by documentation of the implementation of individualized treatment plans and attainment of treatment objectives. (b) There shall be a written plan for the training of all partial care personnel. (4) The physical facility shall be appropriate for the partial care component. (a) The day care program may take place at the center in a designated area or in the community utilizing available resources, or both. (b) The night care program usually takes place in a hospital setting where appropriate bed space shall be provided. (c) The center shall employ facilities for the partial care component which contribute to the ease and effectiveness of the program, such as encouraging communication with staff and patients. (5) The partial care component shall be accessible to the community and be conveniently available by way of public or center-arranged transportation. 3. Outpatient care. a. Principle. The outpatient care component shall be designed to provide the necessary treatment modalities for patients who need to spend relatively little time at the center on both a scheduled basis and a nonscheduled basis. b. Standards. (1) The outpatient care component shall have a written plan describing its treatment philosophy, objectives, and organization. (a) The treatment philosophy shall include a justification of the primary diagnostic and treatment modalities utilized. (b) The plan shall include a description of the objectives of the outpatient care component. The description of the objectives shall demonstrate the indicators used to measure progress toward attainment of the objectives. (c) The written plan shall define the roles and responsibilities of the outpatient care personnel and the lines of authority. (d) The written plan shall delineate the interrelationship of the outpatient care component and its personnel with other center care components. (e) The written plan shall include a mechanism and assurances for the care of patients who may require treatment services unavailable in the outpatient care component. (2) The outpatient care component, including intake and treatment, shall be promptly available during normal center working hours. (a) A patient has a right to seek and receive timely help at the center without being placed on a "waiting list". (b) The center shall find ways and means of handling new intakes swiftly and effectively, and to get the patient started in a suitable treatment program without delay. (3) There shall be a written, individualized treatment plan that is based upon the psychiatric/psychological/social evaluation. (a) The treatment plan shall specify those services planned for meeting the patient's needs. (b) The treatment plan shall include referrals for services not provided by the outpatient care component. (c) There shall be documentation verifying that the treatment plan is reviewed and updated at least monthly. (4) There shall be trained staff and supporting personnel to perform the services of the outpatient care component. (a) Performance of the services of the outpatient care component shall be verified by documentation of the implementation of individualized treatment plans and the attainment of treatment objectives. (b) There shall be a written plan for the training of all outpatient care personnel. 4. Emergency care. a. Principle. The emergency care component shall provide immediate mental health care for persons in a crisis on a twenty-four hour a day, seven-day a week basis. The emergency care component shall include adequate provision for effective handling of special situations, including violent, criminal and suicidal clients and persons brought to the service through legal or police action. b. Standards. (1) The emergency care component shall have a written plan describing its treatment philosophy, objectives, and organization. (a) The written plan shall include the emergency component's philosophy toward emergency services and their delivery. (b) The written plan shall define the roles and responsibilities of the emergency care personnel and the lines of authority. (c) The written plan shall delineate the interrelationship of the component and its personnel with other center care components. (d) The written plan shall delineate the methods by which the emergency care component, upon contact with an emergency, determines the level of the emergency and the appropriate services to be performed. (2) The emergency care component shall maintain a twenty-four hour telephone service. The telephone emergency service shall be publicized adequately by such means as brochures, newsletters, or the mass media. (3) The emergency care component available on a twenty-four hour basis shall include but not be limited to (a) the determination by trained staff of whether each person should receive a medical, psychological or social evaluation; (b) treatment of acute and potentially life threatening disorders and (c) supervision of medically ill persons by trained medical staff. (a) Medical services shall be available to the emergency care component at all times. (b) The emergency care component shall have the capability of providing evaluation and treatment services outside the center facility as necessary such as in homes, jails, schools, general hospitals and any other location where emergencies are likely to happen. (4) The emergency care component shall be available to assist other center staff in handling emergencies, crises or unusual situations as requested. (5) The emergency care component shall keep a record for each emergency telephone call involving suicidal threats and other serious problems or situations, including records of referrals made and the response of agencies or persons to whom a patient has been referred. (a) These records shall be available to all staff members carrying out emergency duties and to the other center clinical staff as needed. (b) There shall be assurance that patients receiving emergency care can be readily transferred to other services of the center, as their need dictates. (6) There shall be a written plan for the training of all emergency care personnel. This training plan shall be updated at least annually for adjustment to changing needs.