Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 23 - Behavioral Health Services
Rule 016.23.10-003 - Licensure Standards for Alcohol and Other Drug Abuse Treatment Programs

(1) Procedures for Licensure

(2) Licensure Types

(3) Substance Abuse Treatment Standards

(4) Application for Licensure

The Procedures for Licensure explains the licensure process for treatment programs, the Standards Review Team and other issues regarding licensure.

The Application for Licensure must be completed by all programs seeking licensure as an alcohol and/or other drug abuse treatment program in Arkansas prior to the on-site initial review.

An alcohol and other drug abuse treatment program must be in compliance with all applicable Standards in order for a program to obtain a one year or a three year license.

Questions concerning the licensure of alcohol and other drug abuse treatment programs in Arkansas may be directed to:

Department of Human Services Physical Address:

Division of Behavioral Health Services 4800 West Seventh Street

The Office of Alcohol and Drug Abuse Prevention Little Rock, AR 72205

Director, Program Compliance and Outcome Monitoring 305 South Palm Street, Administration Little Rock, Arkansas 72205

Phone: 501-686-9866 Fax: 501-686-9396

http://www.arkansas.gov/dhhs/dmhs/

PROCEDURES FOR LICENSURE

Licensure is required of any individual, partnership, association or corporation operating or seeking to operate a substance abuse treatment program in the State of Arkansas. Upon promulgation of revisions to the standards, OADAP will provide to each of the programs known to be operating within Arkansas, a copy of the newly issued Licensure Standards for Alcohol and other Drug Abuse Treatment Programs manual.

A schedule for the licensure process for each treatment program with the participation of the program under review will be developed by OADAP. The entire licensure process for a program is shown below, with explanatory comments following.

Step 1

Step 2 Receipt by OADAP of the program's completed application for licensure. First time applicants shall submit a non-refundable $75.00 application fee. All licensed programs are billed annually by OADAP for a $75.00 renewal fee.

Step 3 OADAP staff shall develop the schedule and requirements for the review of the program.

Step 4 OADAP will provide written confirmation and notification to the program to include:

Step 5 Formal on-site reviews by the OADAP Standards Review Team.

Step 6 Report by the OADAP Standards Review Team and recommendations to the Director of Program Compliance and Outcome Monitoring, Alcohol and Drug Abuse Prevention.

Step 7 Formal report to the program including findings and recommendations of the OADAP Standards Review Team with the type of license awarded.

Step 8 When applicable, responses to the program's appeal and/or scheduling of a follow-up Licensure Review.

Step 9 Submission to OADAP, by the program, of a $1,500.00 non-refundable licensure review fee (for first time applicants only) due after the review.

NOTE: The formal license will only be issued upon receipt of payment of the licensure review fee.

APPLICATION PROCESS FOR OPIOID TREATMENT PROGRAMS (OTP)

An OTP shall not operate in the State of Arkansas prior to completion of the application process. The following criteria must be met:

1. Governing Board Authority and Procedures

2. Program Planning and Evaluation Processes

3. Employment and Personnel Practices

4. Program Services (to include applicable specialized services applied for)

5. Inspection of the Physical Plant

6. Articles of Incorporation/By Laws on file with the Arkansas Secretary of State

7. Board Minutes on file

8. Insurance Documentation

9. Evidence of current valid certifications of building, fire, safety and health inspections.

10. Policies and Procedures Manual

11. Client Handbook

Prior to expiration of the six (6) month operational permit, a formal review, with a Standards Review Team (SRT) will be performed to determine the program's level of compliance with all applicable standards. If the program under review is found to be in full compliance with all applicable standards, then the SRT shall recommend a one (1) year license.

STANDARDS REVIEW TEAM

The members of the Standards Review Team (SRT) for each program will consist of members who participate in the formal on-site review. OADAP reserves the right to adjust the size of the SRT as appropriate to conform to the size and complexity of the program under review. The SRT ordinarily will be composed of representatives from:

The appeal must contain:

GB1 There shall be a governing body which has the ultimate authority for the overall operation of a program, which is one of the following as verified by the program's articles of incorporation:

GB3 Each program shall retain written documentation that describes the means by which the governing body shall maintain written documentation for all of the following:

GB4 The governing body shall hold meetings and keep minutes that include:

GB5 The governing body for the organization shall:

GB6 The governing body shall:

PP&E1 A program plan will be developed and approved by the governing body which addresses outcome measures and includes:

PP&E2 The Governing Body will evaluate the plan annually based on the goals and objectives of the program. This includes operational definitions of the criteria to be applied in determining achievements of established goals, objectives and a mechanism for:

FM1 The Governing Body shall ensure that the program has liability insurance that provides for the protection of the physical and financial resources of the program:

AO1 Ownership Change. The program shall provide written notification to OADAP at least thirty (30) calendar days prior to any change of name, ownership, location, control of the facility, or make major programmatic changes using the OADAP form (see Addendum 1).

AO2 Access Policy. The program has a policy defining the program's areas that may be accessed by clients and visitors that includes medication areas, dispensing and food preparation areas.

AO3 Directory. The program shall maintain a log of all visitors to the program to protect client confidentiality in accordance with 42 CFR Part 2.

AO4 Tobacco Products. The program shall have a written policy and procedure prohibiting the use of any tobacco products within the facility in accordance with the Arkansas Clean Indoor Act of 2006. If the program provides a designated smoking area it shall be located a minimum of 25 feet from any entrance to the facility and shall not be in a common area that non-smoking individuals must transverse to gain access into the facility. In addition the program shall prohibit the use of alcohol, tobacco and illicit drugs by staff which includes:

AO5 HIV/AIDS. The Program shall implement a written policy that states the

Program shall not deny treatment to a person based on his or her actual or perceived sero status, HIV related condition or AIDS.

AO6 Advertising. The Program shall not use incentives or rewards or unethical advertising practices to attract new clients. This shall not forbid the Program from rewarding clients that maintain exemplary compliance with program rules and their individualized treatment plans.

AO7 Privacy. The private counseling area used provides sufficient privacy to maintain confidentiality of the communication between counselor and client. A private meeting area shall be available for clients to meet with their legal representatives, service providers, family members or persons providing assistance in attaining treatment goals.

AO8 Emergency/Natural Disaster. The program shall develop written policies and procedures for continued safety and treatment of clients in the event of an emergency or natural disaster. Emergency policy and procedures are readily available to all staff; the program has a written internal disaster plan which includes the training of staff in disaster and evacuation procedures, a list of alternate resources and the monthly rehearsal of various disastrous scenarios of the procedure are documented.

AO9 Critical Care Referral. The program will have policies and procedures for referring clients for services needed at a critical care facility.

AO10 Workforce Safety. The program has implemented work practice controls and provided personal protective equipment to reduce exposure to bodily fluids through the normal performance of their duties.

AO11 Infection Control. The Program shall have written policies for infection control, which are in compliance with the Center for Disease Control and Prevention. Guidelines.

AO12 STD Control. The program shall have policies and procedures describing the programs services for HIV/AIDS, Sexually Transmitted Diseases (STDs), Tuberculosis (TB) and Hepatitis to include:

AO13 Client Handbook. The Client Handbook shall clearly state that the program shall not be held responsible for any medical costs incurred by clients or children occupying the program and transported to medical appointments. The provider's responsibility is limited to arranging for the clients to access these services and providing transportation for them.

AO14 Grievance Policy. The Program shall have a grievance policy which states that there is a reasonable, specific deadline for completing the grievance process. At the program level, once received, client grievances must be reviewed and a decision reached in accordance of the program's policies and procedures. Grievances to be reviewed by the governing board shall be heard no later than the board's next scheduled meeting.

AO15 The program will maintain a publicly listed or local telephone number.

AO16 Hours of operation are scheduled to make services accessible to clients and the general public.

AO17 There shall be no less than one (1) staff on duty at all times per twenty-five (25) clients, per physical site. (Not Applicable to Criminal Justice System).

AO18 There shall be no less than one (1) treatment staff per twenty (20) clients during scheduled treatment activities.

AO19 A counselor's caseload shall not exceed the 25 to one (1) client/counselor ratio.

AO20 The program has at least one staff person present during operating hours who maintains a valid certification in First Aid, Cardio-Pulmonary Resuscitation (CPR) and Non-violent Crisis Prevention and Intervention (NCPI). All Specialized Women Services programs will have at least one staff person who is certified in child and infant CPR. This documentation will be verified by the staff member's personnel record.

AO21 The program has procured an agreement with a mental health provider licensed or certified in the State of Arkansas to provide consulting services for dually diagnosed treatment applicants or clients. The agreement must be updated every two years.

AO22 The program maintains a comprehensive resource directory (updated every 2 years) of local community and government agencies within the service area which contains at least:

AO23 Documenting outreach and referral activities necessary to educate judges, prosecuting attorneys, law enforcement personnel, community service providers, substance abuse treatment programs, and the public as to the operations of the program.

AO24 The program will provide written referral to or coordinate introduction of available resources and services through community and government agencies that will assist with specialized needs to maintain a continuum of client care. These agreements shall include:

AO25 Services are available to provide a variety of diagnostic and primary substance abuse treatment on both a scheduled and non-scheduled basis. Services provided by the program include, but are not necessarily limited to the following:

AO26 Residential services are provided seven (7) days per week, 24 hours per day and provide;

AO27 Partial day treatment programs provide services at a minimum of four (4) hours per day and at least five (5) days per week.

AO28 Protocol for administrative discharge to include: threats of violence or actual bodily harm, disruptive behavior, sexual misconduct, loitering, sale, purchase or use of drugs or alcohol, continued unexcused absences from counseling.

AO29 When a program determines to administratively discharge a client, the program shall provide a written statement containing:

HR1 Ensure compliance with all legal, ethical, and regulatory codes in accordance with Title VI/Title VII of the 1964 Civil Rights Law, Equal Employment Opportunities Commission (EEOC) (race, color, sex, religion, national origin, age or disability).

HR2 Prohibiting harassment of any nature including that of race, color, religion, age, sexual orientation, physical or mental disability and unwanted sexual advances.

HR3 The program shall designate an employee who will monitor the programs compliance with the Americans with Disability Act (ADA), and educate all staff.

HR4 Consequences for unethical conduct and violations of the harassment policy will include:

HR5 Background investigations shall be required for all staff that have direct contact with clients or client records.

HR6 A program cannot employ any person currently receiving substance abuse treatment services. This also prohibits the use of clients to monitor the program.

HR7 Former substance abuse clients shall not provide direct treatment services for 12 months after their discharge from substance abuse treatment.

HR8 An employee assistance program or provisions for referral to such services must be available.

HR9 Employee grievance protocol which is reviewed, updated and approved annually by the governing body. Documentation of employee grievances shall be confidential and shall be stored separately from personnel records.

HR10 Personnel shall meet all local, state, or federal legal requirements for their position. (e.g. licensing and certification)

HR11 All non-certified or non-licensed staff, including volunteers, providing counseling and treatment related services, shall be registered with the Arkansas Substance Abuse Certification Board (ASACB). An exception is granted for those staff involved in an internship or practicum from another human services or behavioral discipline.

HR12 Students or interns shall be supervised by a paid staff member and shall not be used to supplant direct treatment service employees.

HR13 A Counselor in Training (CIT) shall provide evidence that a minimum of thirty (30) clock hours of continuing education is obtained per year toward the certification process.

HR14 CITs providing direct treatment services must be receive at least one hour of individual supervision or ninety minutes of group supervision weekly. Such supervision must be documented and must be performed by persons authorized to approve treatment plans, as specified in this manual.

HR15 Policy includes a specific process for completion of a comprehensive evaluation of personnel performance on at least an annual basis for all staff.

HR16 The process for evaluation of personnel performance requires a written report and requires documentation that the evaluation is reviewed with the employee.

HR17 The program has established an appropriate staff development plan for all employees and volunteers. The plan is to include:

HR18 Personnel records will be kept on all employees, volunteers and professionals contracted to provide direct treatment services that contain at least:

HR19 Employee records are stored in a secure and confidential place.

CP1 The Program shall comply with state and federal regulations governing confidentiality of alcohol and drug abuse client records and other client identifying information. Existing federal regulation include the Health Insurance Portability and Accountability Act and 42 CFR, Part 2. Both regulations provide for safeguarding files or other client identifying information from disclosure or access by unauthorized individuals, and require that records be maintained in a secure manner. OADAP shall review records for the purpose of monitoring execution of the policies and standards required by these regulations.

CP2 Documentation shall not contain slang, technical jargon, or abstract terms.

CP3 Errors in the treatment chart should never be corrected with "white-out" or Marker, by pasting paper over the error or by any other method, which would obliterate the original words. When an error is corrected, the original text must remain readable. A single line is to be drawn through the error, the correct information added with the date and initials of the person making the correction.

CP4 No documentation shall be signed and dated prior to completion;

CP5 The program's treatment services, lectures, and written material shall be appropriate to the clients served, age-appropriate and easily understood by clients.

CP6 There is documentation of planned programs, consistent with the needs of the clients, for social, educational, and recreational activities for all clients for daytime, evenings and weekends.

CP7 The program shall retain all documentation for at least six (6) years and shall ensure that all individual client records are disposed of in a secure manner. The written policies and procedures shall ensure:

CP8 The program has standardized screening protocol to determine applicants eligibility and appropriateness for admission to treatment.

CP9 The program has a uniform intake process and documentation shall include:

CP10 A client handbook is made available to all clients and a receipt must be in the client record. The client handbook shall include the following:

CP11 Personal Property Inventory shall be taken upon admission to a residential environment. Items of value shall be securely stored by the program at the request of the client. The inventory list will include the stored items, date received and returned, and signatures of staff and client.

CP12 The program shall provide a specialized plan for treatment by assessment and then addressing the specialized needs of each client of the program.

CM1 Arranging and facilitating for the provision of all services as documented in the treatment plan.

CM2 Holding regular, and as needed, meetings with the client to monitor and reevaluate the individualized comprehensive plan.

CM3 Holding regular, and as needed, meetings with the program staff and others involved in the delivery of services to the client to monitor and evaluate progress.

CM4 Maintaining records of other documentation of all services delivered to the client.

CM5 Developing an aftercare plan with the client prior to discharge.

SA1 A pre-admission screening shall be used to determine a client's eligibility and appropriateness. It is to include:

SA2 Documentation of client information and history is to include:

SA3 An assessment to determine severity and environment placement to include a completed Addiction Severity Index (ASI) for adults or an equivalent assessment tool for adolescents is to be completed within 72 hours of admission. When applicable, results of other tests or standardized assessments, including the ASAM patient placement criteria or other nationally recognized placement tool must also to be included.

INITIAL TREATMENT PLAN - The initial treatment plan is to be developed and implemented within twenty-four (24) hours, based on assessments that determined all immediate problems and needs such as; medical condition, nutrition, clothing, personal hygiene, legal issues and emergency contacts and the actions taken to meet those needs.

CTP1 The comprehensive treatment plan is to be developed and implemented no later than seven (7) days from admission to residential services and partial day treatment and no later than twenty-one (21) days from admission to outpatient services and is to include:

CTP2 All comprehensive treatment plans are reviewed and approved by one of the following, as licensed or certified in the State of Arkansas:

CTP3 The client's progress in meeting treatment plan goals is reviewed no later than every seven (7) days in the residential environment (unless clinically contra-indicated) and every ninety (90) days in an outpatient environment. The review must be approved by an individual specified in "CTP2" above; (Not Applicable to Criminal Justice System).

CTP4 The client's progress in meeting treatment plan goals will be assessed at the time of discharge.

PN1 Progress notes shall contain: the date and time the session ended: the purpose of the session; topics discussed; client behavior and response to the treatment provided during the session; significant events; and the name, signature and title of the staff person conducting the session.

PN2 Group and individual treatment sessions progress shall be documented per session.

PN3 Outpatient treatment is documented per session.

PN4 Partial day treatment notes contain information required by but may be compressed into a single note that addresses treatment provided on a per day basis.

PN5 Residential treatment shall be documented at least daily.

PN6 The client's progress in meeting treatment plan goals will be assessed at the time of discharge.

PN7 Significant client events that fall within the provisions of the "Incident

Reporting Policy" shall be documented as soon as possible after the event. The administration of first aid to a client shall be documented as soon as possible. Any client behavior that could lead to a disciplinary action shall be documented as soon as possible. Any other event, that could effect the client's treatment, shall be documented as soon as possible.

PN8 When a client refuses to divulge information and/or follow the recommended course of treatment, this refusal is noted in the case client record.

PN9 When a client transfers from one program to another, the transferring program shall send copies of the transferring client's records to the licensed receiving program prior to admission.

AFTERCARE PLAN (AP)

AP1 The aftercare plan will be written one-week prior to target date of completion.

The aftercare plan, implemented at discharge, shall minimally contain: a summary of client needs not treated; established goal(s) that address the untreated needs; and the means by which the goals will be met;

AP2 Discharge Summary shall include but not be limited to the date, time, conditions of discharge, environmental change, client's perception of treatment offered, referrals made, date and signature, and credentials of staff.

AP3 The program shall have written policy and procedure denoting protocol for discharging clients abruptly to ensure the safety and welfare of clients during discharge. Documentation for such discharges shall include:

AP4 In the case where a client is discharged against medical advice, for non- compliance or in abstentia the program shall document that the Aftercare Plan has not been developed for these specific reasons.

CC1 There are written policies and procedures for the protection of client's privacy with regard to program visitors which require:

CC2 A client's authorization shall be obtained before releasing information. A proper consent form must be in writing and contain the following items:

CC3 The program has written procedures for responding to requests for confidential client information when presented with telephone inquiries; written inquiries; subpoenas; court orders; search warrants; arrest warrants; and for reporting child abuse.

CC4 Every authorization for release of information becomes part of the client's permanent case record; and, according to HIPAA programs, must provide client with copies of all signed authorizations.

CC5 In a life-threatening situation or where an individual's condition or situation precludes the possibility of obtaining written consent, the program does allow for the release of pertinent medical information to the medical personnel responsible for the individual's care without a client or applicant's authorization, and without the authorization of the Chief Executive Officer or his or her designee, if obtaining such authorization would cause an excessive delay in delivering treatment to the individual.

CC6 In the event information has been released without the individual's authorization, the staff member responsible for the release of information enters into the individual's case record all details pertinent to the transaction, including at least: the date the information was released; persons to whom the information was released; the reason the information was released; the nature and details of the information given.

CC7 The client or applicant is informed that the confidential information was released as soon as possible after the incident occurs.

CLIENT RIGHTS (CR)

CR1 There are policies and procedures to inform all clients of their legal and human rights. At the time of admission, each client shall be informed of his or her rights in a language that he/she understands, and shall receive a written copy of these rights, which shall include:

PE1 Programs are to ensure compliance with all local, state and federal laws and regulations regarding the condition and maintenance of its facility.

PE2 Provide evidence of current valid certifications, which are maintained on site of all applicable buildings, fire and safety, health, and all other applicable inspections. All items of concern noted in these inspections shall immediately be addressed/corrected.

PE3 Private residences shall not be used to provide treatment unless:

PE4 Provides adequate physical facilities for the storage, processing and handling of client records by means of suitable locked, secured rooms or file cabinets;

PE5 Maintain a suitably stocked first aid kit(s), with contents as defined in the program's policies and procedures at all sites.

PE6 Maintain fire extinguisher(s) that are accessible, in working order and have attached documentation of annual inspection;

PE7 Evacuation routes are prominently posted throughout all facilities;

PE8 All exits must be clearly marked.

PE9 The programs telephone number(s) and actual hours of operation will be posted at all public entrances.

PE10 Conspicuous warning signs must be posted at all public entrances informing staff, volunteers, clients and visitors as to the following requirements:

PE11 A copy of compliance with law Title VI/Title VII of the 1964 Civil Rights Law shall be prominently displayed for the viewing public.

PE12 Programs must provide a safe and sanitary environment.

PE13 Residential facilities shall:

PE14 Adult clients shall remain separated from adolescent population during all times with the exception of mixed therapy sessions.

PE15 Programs will maintain this separation by any means necessary including a structural separation, continuous monitoring or any combination of efforts required to assure compliance with this standard.

PE16 Plumbing must be:

PE17 There shall be at least one toilet, one sink, and one shower or tub per every eight (8) residential clients.

PE17 Laundry facilities shall be available in the facility or on a contractual basis. When provided at the facility laundry rooms shall be kept separate from bedrooms, living areas, dining areas and kitchen.

PE19 Storage will be least twelve (12) inches above the floor.

PE20 A secure locked storage is available for client valuables when requested.

PE21 Separate storage areas are provided and designated for:

PE22 When handling soiled linen or other potentially infectious material Universal Precautions are to be followed.

PE23 Hazardous and regulated waste is disposed of in accordance with federal requirements.

PE24 Poisons, toxic materials and other potentially dangerous items shall be stored in a secured location.

MD1 The documentation of handling; administration; observation and self administration; witnessed disposal process; medication errors, adverse reactions and use of medication. Chain of custody will be maintained at all times.

MD2 Medication Errors and Adverse reactions are to be reported to OADAP following the Incident Reporting Policy. OADAP will receive follow-up reports throughout the programs process of investigation and bringing the incident to a close.

MD3 A list of prescription medications and over the counter (OTC) medications to be kept in stock on units that dispense medication shall be developed.

MD4 Both lists will be developed in conjunction with the program's physician who shall sign and date denoting his approval. Any future additions/deletions must follow the same procedure.

MD5 The medication list shall be reviewed at least annually.

MD6 Programs who do not employ or contract with a Medical Doctor shall not maintain stocked prescription medications.

MD7 The program shall use an effective inventory system to track and account for all prescription medications.

MD8 A system is in place to monitor and to dispose of all outdated medication in compliance according to the program's disposal policy.

MD9 Medication orders may be given by telephone to licensed or registered nurse.

The orders must then be signed by the authorizing physician ordering the medication within 72 hours.

MD10 Medications shall be stored at appropriate temperatures based on the manufacturer's product inserts.

MD11 Medications requiring refrigeration shall be stored in a locked compartment separate from food.

MD12 External use medications in liquid, tablet, capsule or powder form shall be stored separately from medications for internal use.

MD13 Urine or blood samples shall not be stored with food or medicines.

MD14 The program shall keep all prescriptions and non-prescription medications, syringes and needles in locked storage.

MD15 Medications, syringes and needles shall be accessible only to staff who are authorized to provide medication

MD16 Used needles and syringes shall be placed in secure, rigid, puncture proof containers and disposed of according to OSHA's Hazardous Waste Standards.

FN1 If the program prepares meals on site, the program shall have a current food establishment health inspection as required by the Arkansas Department of Health.

FN2 When meals are provided by a food service, a written contract shall be maintained and shall require the food service to have a current food establishment health inspection as required by the Arkansas Department of Health.

FN3 A licensed dietitian or certified dietary manager shall approve menus and written guidelines for substitutions in advance.

FN4 The program shall provide modified diets to residents who medically require them as determined by a licensed dietitian or certified dietary manager. Special diets shall be prepared in consultation with a licensed dietitian or certified dietary manager.

FN5 The program shall provide at least three meals daily, with no more than fourteen (14) hours between any two meals.

FN6 Clients in a Partial Day Treatment setting shall be offered a minimum of one meal per day provided by the program.

FN7 Outpatient programs shall allow a meal break after five consecutive hours of scheduled activities.

FN8 All food shall be stored, prepared, and served in a safe, healthy manner;

FN9 Non-perishable items shall not be used that contain a sell by date that has expired by more than two years.

FN10 Perishable items shall not be used once they exceed their sell by date.

FN11 Documentation of a Negative TB test (with one year) will be required for all persons working in the kitchen or meal preparation environment.

FN12 All persons working in the kitchen or meal preparation environment shall wear hairnets and gloves.

FN13 If menu planning and independent meal preparation are part of the client's treatment program, a licensed dietician or certified dietary manager shall provide training or approve a training program for staff who instruct and supervise clients in meal preparation

FN14 The program shall define duties in writing and have written instructions posted or easily accessible to clients.

FN15 Clients in detoxification treatment shall not prepare meals.

DS1 The Regional Alcohol and Drug Detoxification Program will not admit any client under 18 years of age.

DS2 While a client is in observation detoxification (with or without medical supervision), Medical Doctor(s), registered or licensed practical nurse or Regional Detoxification Specialists (RDS), must be present and specifically assigned to monitor the client on a twenty-four (24) hour basis.

DS3 Clients in detoxification services will receive three (3) meals per day, with no more than fourteen (14) hours between any two (2) meals. Their meals will be served separately from other residential clients. If eating in a common area, they will receive their meal prior to or after other clients have vacated the area.

DS4 Only an RDS, Medical Doctor, registered or licensed nurse are authorized to document progress notes, vital signs, fluid/food intake, withdrawal risk assessments and stabilization plans. All documentation is to include the authorized persons' signature and credentials.

DS5 An RDS must hold current certifications in the following;

DS6 All staff assigned to monitor detoxification clients shall know the signs and symptoms of withdrawal, the implication of those signs and symptoms; and emergency procedures, as defined in facility policy and procedure manual.

DS7 Clients in detoxification services will have their vital signs taken upon admission and documented; and at least every two (2) hours thereafter, until within normal limits for eight (8) consecutive hours.

Exception: Once vital signs are within normal limits for eight (8) consecutive hours, they will be taken no less than every six hours. At this time, blood pressure, temperature and pulse may be omitted one (1) time per twenty-four (24) hour period; observation will continue as evidenced by documentation of reason for vital sign omission, client behavior observed and respiration count. (e.g. Vital signs completed at 10:00 p.m., description of behavior client exhibiting at midnight and resume vital signs at 2:00 a.m.);

DS8 Observation detoxification, with or without medical supervision, will include:

DS9 A complete set of vital signs will include blood pressure reading (systolic and diastolic), temperature, pulse and respirations.

DS10 Once vital signs are within normal limits for eight (8) hours, they will be taken no less than every six (6) hours. There will be documentation in the client's case record verifying each vital sign taken during the client's stay in detoxification.

DS11 Oral fluids and food shall be easily accessible to clients.

DS12 There will be documentation of meals offered, consumed and/or refused; and the amount consumed or refused, every two (2) hours.

DS13 There will be documentation of consumption of oral fluids indicating amount offered, consumed, or refused, every (2) hours.

DS14 There will be documentation of reason for not offering nutrition. (e.g. client absent during meal time to see personal physician).

DS15 Medication that is prescribed to an individual for withdrawal must be documented in the withdrawal risk assessment, stabilization plan and progress notes.

DS16 A file will be maintained for each client, per admission; it will contain:

AT1 The program shall limit admissions to adolescents 13 through 17 years of age.

The policies and procedures shall specify any exceptions to this requirement, and OADAP must be notified and a waiver obtained prior to admission.

AT2 The program shall address the special needs (i.e., self-esteem, peer pressure, etc. classes) of adolescents and protect their rights.

AT3 The program shall provide separate groups and activities for adolescents.

AT4 The program shall obtain consent for admission and authorization to obtain medical treatment at the time of admission for all clients under 18 years of age, unless adjudicated as an emancipated minor.

AT5 Residential and day treatment programs shall have policies and procedures that govern access to client education as required by the Arkansas Department of Education.

AT6 The program shall allow regular communication between an adolescent client and the client's family and shall not arbitrarily restrict any communication without clear, written individualized clinical justification documented in the client record.

AT7 Program staff that plan, supervise, or provide chemical dependency education or counseling to adolescents shall have the following:

AT8 Clients shall be under direct supervision at all times.

AT9 In public places, clients shall be within eyesight at all times.

AT10 Staff shall conduct visual checks at least once every hour. Bed checks will be made and documented every four (4) hours.

AT11 All Incidents will be recorded and reported as appropriate.

AT12 The treatment plan shall address adolescent specific needs and issues.

AT13 The program shall involve the adolescent's family or an alternate support system in the treatment process or document why this is not happening.

AT14 The program shall prohibit adolescent clients from using tobacco products.

AT15 The program shall prohibit tobacco products within the confines of any program housing adolescents.

AT16 Staff employed with adolescent programs will have training specific to the clients served, such as: impact of substance abuse on children; identifying domestic violence; abuse; neglect; empowering the client and families to restore family functioning; development and age appropriate behaviors; parenting skills; self-esteem; peer pressure; and bullying.

SPECIALIZED WOMEN'S SERVICES (SWS) - Programs authorized by OADAP to provide Specialized Women's Services shall in addition to the General Standards meet the requirements of the standards listed in Specialized Women's Services sections. The program shall address the specialized needs of the parent and include services for children. These services may be provided on the premises or through written service agreements with other providers.

SWS1 Treatment shall include intensive primary treatment and clients must participate in at least thirty (30) hours of therapeutic services per week, including substance abuse group counseling, education, parenting, family reunification, and child development services.

SWS2 Job Skills:

SWS3 Parenting Skills:

SWS4 Children in the facility shall receive age appropriate therapy as needed.

SWS5 All clients with children will attend and participate in parent/child interactive education either individual or group (1 hour minimum) per week.

SWS6 The program shall assess and document parent-child interaction weekly and any identified needs shall be addressed in treatment.

SWS7 Residential programs shall not accept dependents over the age of six (6), unless the program has prior written approval from OADAP.

SWS8 The program shall inform and educate pregnant clients of the Child Abuse Prevention and Treatment Act in accordance with state and federal laws.

SWS9 Programs will provide training specific to the clients served, such as: substance abuse impact on children; identifying domestic violence; abuse; neglect; empowering the client and families to restore family functioning; child development and age appropriate behaviors; parenting skills; self-esteem; peer pressure; and bullying.

SWS10 The program shall inform and educate pregnant clients of the dangers and effects that alcohol and illicit drug use has on the fetus.

SWS11 Other education to be provided will include, but not be limited to, the topics of HIV/AIDS, STDs, TB, family planning, nutrition, sexual abuse and spousal abuse.

SWS12 Family Education and Support:

SWS13 Aftercare: Prior to discharge the program shall be responsible for establishing an aftercare plan and will encourage the client to participate in support activities.

SWS14 The program will provide access and referral to the fullest possible range of medical care for clients and children to include but not be limited to: Pre-natal and post-partum health care; emergency health care; health screening; dental; well-child health care; screening in speech/language; hearing and vision; and verification of immunization records.

SWS15 Childcare: The program shall ensure parents or qualified childcare providers directly supervise the children at all times. The program is always responsible for providing oversight and guidance to ensure children receive appropriate care, when they are supervised by clients.

SWS16 Child Care for residents with small children/day care will be provided either on the program's premises (by an authorized child care provider), or through a licensed day care center.

SWS17 Childcare shall be arranged for services delivered in the evenings, such as, an AA meeting, or for an emergency. (Clients cannot provide this service).

SWS18 The program shall have a current schedule showing who is responsible for the children at all times;

SWS19 Physical discipline by program staff is strictly prohibited.

SWS20 The program shall provide a variety of age-appropriate equipment, toys, and learning materials;

SWS21 Transportation shall be provided for any other services necessary to meet treatment goals.

SWS22 Program shall have policies and procedures that state staff shall not allow anyone except the legal guardian or a person authorized by the legal guardian to take a child away from the facility. If an individual shows documentation of legal custody, staff shall record the person's identification before releasing the child.

SWS23 The program will provide room, board and laundry services.

SWS24 Pregnant women; women with children and, children will be fed apart from other clients. If being fed in a common area they will receive their meals prior to or after other clients have vacated the area.

SWS25 The program may assess any amount for rent not to exceed the actual cost per day.

SWS26 The program staff are mandatory reporters, and program shall have a procedure to use if a parent abuses or neglects a child, including reporting, intervention and documentation.

SWS27 The program must provide a safe and sanitary environment appropriate for children, to include at a minimum:

SWS28 Neither staff nor clients will use tobacco products within twenty-five feet of any program housing children.

CJS1 Any person providing direct treatment services must receive at least four (4) hours of individual supervision or six (6) hours of group supervision monthly. Such supervision must be documented. Persons authorized to approve treatment plans, as specified in this manual, must perform this supervision.

CJS2 Provides sufficient privacy to maintain confidentiality of the communication between counselor and client.

CJS3 If the program uses space provided by another organization, there is a written agreement specifying the terms of such usage.

CJS4 The program has at least one staff person present at all times who maintains a valid certification in First Aid, CPR and NCI.

CJS5 The program shall not operate a new treatment site or make major programmatic changes at a present site without OADAP approval.

CJS6 Residential Treatment provides for a minimum of twenty (20) hours weekly (Sunday through Saturday) of structured treatment. (See Definition Section for an explanation of "structured treatment").

CJS7 A counselor's caseload shall not exceed the 25 to one (1) client/counselor ratio.

CJS8 The initial treatment plan is completed within seven (7) days of admission.

CJS9 The comprehensive treatment plan is developed and implemented no later than twenty-one (21) days from admission to residential services, thirty days (30) to outpatient services (including drug courts), and within forty-five (45) days from admission to therapeutic community (TC) programs.

CJS10 Residential treatment shall be documented at least weekly and shall minimally document: treatment provided during the week; the time frame that the note covers; the client's response to the treatment provided; significant client events that occurred; and the name, signature and title of the staff person who wrote the note. TC programs will meet this requirement using a monthly (every 30 days), treatment plan review.

CJS11 Develop and implement a written mission and philosophy that addresses the beliefs, attitudes and purpose of the Therapeutic Community (TC).

CJS12 The TC program operates within a distinct space separate from the main prison population.

CJS13 The TC shall provide a handbook or manual providing an explicit and comprehensive outline of the program, its mission, and its philosophy.

CJS14 The handbook will be given to each participant upon entering the program and each staff member upon onset of employment.

CJS15 The handbook shall provide a comprehensive section on the TC perspective on the substance abuse disorder.

CJS16 The program will ensure that confrontation and consequence tools used by the TC shall not infringe upon the clients rights as defined and posted.

CJS17 The staff member facilitating the confrontation group shall closely monitor and provide appropriate supervision

OPIOID TREATMENT (OP) - Programs seeking licensure as an Opioid Treatment program shall in addition to the General Standards meet the requirements of the standards listed in the Opioid Treatment section.

The Department of Human Services (DHS), Division of Behavioral Health Services (DBHS), Office of Alcohol and Drug Abuse Prevention (OADAP) have developed these standards specifically for the administration of Opioid Treatment Programs (OTPs) in Arkansas.

The goal of opioid treatment is total rehabilitation of the client. While eventual withdrawal from the use of drugs, including methadone/buprenorphine, may be an appropriate treatment goal, some clients may remain on opioid maintenance for relatively long periods of time. Periodic consideration of withdrawing from methadone/buprenorphine maintenance is appropriate only if it is in the individual client's interest. Such considerations are between the client and the treatment program.

The program shall be progressive in nature, addressing the client's individual need with methadone/buprenorphine as only one component of comprehensive treatment services.

The Program shall make records available to OADAP upon request. In addition, access by the CSAT and the Drug Enforcement Administration (DEA) is also allowed for determination of compliance with CSAT and DEA regulations.

APPLICANT SCREENING

OP1 Applicant screening shall be extensive and thorough and shall form the basis for effective, long-term treatment planning. It shall include a staff assessment as to appropriateness of treatment that admission is voluntary, and the client understands the risks, benefits, and options.

OP2 Prescription methadone is a highly addictive substance and entry into a Program is a critical decision for both the client and the Program. Before admitting an applicant to methadone treatment, the Program shall satisfy itself that the applicant fully understands the reasons for and ramifications of administrative detoxification and that the applicant voluntarily enters the Program with that knowledge.

OP3 The Program shall verify the applicant's name, address, date of birth and other critical identifying data.

OP4 The Program shall document a one (1) year history of addiction and current physiological dependence. A one (1) year history of addiction means a period of continuous or episodic addiction for the one (1) year period immediately prior to application for admission to the Program. Documentation may consist of the applicant's past treatment history, with presence of clinical signs of addiction, such as, old and fresh needle marks, constricted or dilated pupils, or an eroded or perforated nasal septum.

OP5 For applicants who are under the age of eighteen (18) the Program shall document two (2) unsuccessful attempts at drug-free treatment, prior to being considered for admission to a Program. Note: No person under the age of eighteen (18) years of age shall be admitted to maintenance treatment unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to such treatment.

OP6 The Program shall give admission priority to pregnant women.

OP7 The Medical Director may refuse treatment with a narcotic drug to a particular client if, in the reasonable clinical judgment of the Medical Director, the client would not benefit from such treatment. Prior to such a decision, appropriate staff may be consulted, as determined by the Medical Director.

OP8 Upon admission the Program shall:

OP9 The Program shall not require a medical examination for a client transferring to a new Program who received a medical and laboratory examination within three (3) months prior to admission to the new Program. The Program physician may request a medical and laboratory examination for a transferring client. However, the new Program physician shall have, as part of the transfer summary, a medical summary and statement from the client's previous Program that indicates a significant medical problem. The transferred record shall include copies of the previous examination prior to admission.

OP10 Conduct and complete a counseling intake interview and develop a narrative psychosocial history within twenty-one (21) days of the client's admission date. This psychosocial narrative shall form the basis for preparing future treatment plans.

OP11 Develop a written statement, signed by the Medical Director, that the applicant is competent to sign the voluntary agreement admitting them to the Program.

OP12 Verify that the client is not currently enrolled in another opioid treatment program.

OP13 Readmission to a program depends on whether a client who is seeking readmission previously withdrew from methadone on a voluntary basis or as a result of an administrative decision due to the client's violation of Program policies.

OP14 A client, treated and later voluntarily detoxified from methadone maintenance treatment, may be readmitted to the Program without evidence to support findings of current physiological dependence, up to two (2) years after discharge, if the Program attended is able to document prior opioid maintenance treatment of six (6) months or more, and the admitting physician, in his or her reasonable clinical judgment, finds readmission to opioid maintenance treatment medically justified.

OP15 Clients seeking readmission to a Program after an administrative detoxification shall at a minimum wait thirty (30) days prior to applying for readmission. If a Program administratively detoxifies a client twice in a year then the client shall wait twelve (12) months to reapply for readmission.

OP16 An applicant who has been residing in a correctional institution for one (1) month or longer may enroll in a Program within fourteen (14) days before release or discharge or within six (6) months after release from such an institution without evidence of current physiological dependence on narcotics provided that prior to his or her institutionalization the client would have met the one (1) year admission criteria.

OP17 A program shall place a pregnant applicant on a maintenance regimen if the applicant has had a documented narcotic dependency in the past and may be in direct jeopardy of returning to narcotic dependency, with its attendant dangers during pregnancy. The applicant need not show evidence of current physiological dependence on narcotic drugs if a program physician certifies the pregnancy and, in his or her reasonable clinical judgment, justifies medical treatment.

OP18 The Program shall test women of childbearing age for pregnancy at the time of admission unless medical personnel determine that the test is unnecessary.

OP19 In addition to federal laws and regulations regarding pregnant clients, the Program shall implement written policies and procedures to ensure the accessibility of services to pregnant women. The Program shall:

OP20 The Program shall inform pregnant clients of the Child Abuse Prevention and Treatment Act in accordance with state and federal laws.

OP21 The program will have specific policies and procedures developed to educate pregnant clients of the dangers and effects that alcohol and illicit drug use has on the fetus.

OP22 Conduct a special staffing with the entire treatment team to provide intensive case management for pregnant clients who are non-compliant with phase requirements. The Medical Director will develop specific protocols to ensure the safety of the fetus.

OP23 The Program shall provide the client a full range of treatment and rehabilitative services.

OP24 The absence of the use of controlled substances, except as medically prescribed; social, emotional, behavioral and vocational status; and other individual client needs shall determine the frequency and extent of the services.

OP25 The assessment and treatment team shall consist of a Medical Director, medical staff and counselors who shall assess the client's needs and, with the client's input, develop a treatment plan.

OP26 As part of developing a treatment plan, the client shall have input in establishing or adjusting dosage levels.

OP27 The assessment and treatment team shall staff each case at least once each thirty (30) days during the first ninety (90) days of treatment and at least once each ninety (90) days thereafter.

OP28 The Medical Director shall sign off on the initial treatment plan when developed and the comprehensive treatment plan on an annual basis.

OP29 Services to each client shall include individual, group and family counseling at the following minimum levels:

OP30 The Program shall conduct a special staffing to determine an appropriate response whenever a client has two (2) or more drug screenings in a one (1) year period that are positive for illicit drugs other than methadone/buprenorphine..

OP31 The Medical Director shall use test results as a guide to change treatment approaches and not as the sole criteria to force a client out of treatment.

OP32 When using test results, the Medical Director shall distinguish presumptive laboratory results from definitive laboratory results.

OP33 Clients in Phase II, Level III having a positive drug screen for illicit drugs and alcohol will be placed in Phase II, Level II to be completed in its entirety prior to moving back to Phase II, Level III.

OP34 Clients in Phase III or IV having a positive drug screen for illicit drugs and alcohol will be placed in Phase II, Level III to be completed in its entirety prior to moving back to Phase III.

OP35 Patients who are non-compliant with all requirements of their current phase level (i.e. positive toxicology screens and unexcused dosing and counseling absences) shall result in a decrease in phase level and take-home dose privileges. In addition, program staff must conduct a special staffing with the client present to determine corrective action protocol.

OP36 The Program shall implement a written policy that states the Program shall not deny treatment to a person based on his or her actual or perceived sero status, HIV related condition or AIDS.

OP37 Program staff shall receive yearly training on the subject of HIV and Hepatitis C infection and treatment of HIV and Hepatitis C infected clients.

OP38 The Program shall have written policies for infection control, which are in compliance with the Center for Disease Control and Prevention Guidelines.

OP39 The Program shall provide AIDS education to clients and shall provide or refer clients for HIV pre-test counseling and voluntary HIV testing. If the Program does test for AIDS, it shall be with the informed consent of the client. The Program shall assure the provision of pre and post-test counseling for the clients.

OP40 The Program shall provide annual medical evaluations to clients as appropriate for dose level sero status and identified medical concerns.

OP41 The Program shall provide or refer clients for tuberculosis and sexually transmitted disease (STD) testing upon admission and at least annually thereafter. However, Programs shall not require clients to receive HIV/AIDS testing.

OP42 The Program shall develop written policies and procedures for continued treatment with methadone or buprenorphine in the event of an emergency or natural disaster.

OP43 The Program shall have hours, which provide for early morning or late evening services to meet the needs of their client population.

OP44 The Program shall implement written policies and procedures to ensure positive identification of the client before methadone or buprenorphine is administered.

OP45 The Program shall develop written policies regarding the recording of client medication intake and a daily methadone/buprenorphine inventory. These policies shall comply with DEA, Arkansas State Pharmacy Board and Arkansas State Medical Board as appropriate.

OP46 The Program shall develop and implement written policies and procedures to contact other opioid treatment programs within a two hundred (200) mile radius to prevent duplication of services to an individual. The policy shall be in accordance with Federal Confidentiality Regulations (42 CFR, Part 2).

OP47 The Program shall monitor a client's progress and shall satisfy itself that the client is continuing to benefit from treatment.

OP48 The Program shall not use incentives or rewards or unethical advertising practices to attract new clients. This shall not forbid the Program from rewarding clients that maintain exemplary compliance with program rules and their individualized treatment plans.

OP49 The Program has the right to randomly schedule telephone requests to clients who have take home privileges requiring them to report to the treatment facility and to bring their remaining take-home medication with them. At least twice annually the Program shall randomly select at least five per cent (5%) of these clients who have take home privilege for this purpose.

OP50 Programs shall be responsible for contacting the previous Programs of transferring clients regarding such issues as their stability in treatment and take home status, before initiating take home privileges for these clients.

OP51 To prevent relapse, programs shall place transferring clients with take-home privileges on an increased drug screening surveillance schedule for the first thirty (30) days after admission.

OP52 Client to counselor ratios shall not exceed 40:1.

OP53 Programs shall employ at least one full-time medical doctor, as licensed to practice medicine in the State of Arkansas, for every 300 clients.

OP54 The medical director of an opioid treatment program will be ASAM certified; have documented references of working experience in an opioid treatment program, or have documented continuing education in addiction treatment.

OP55 The Medical Director will be available to the program on a continual basis, seven (7) days per week, twenty-four (24) hours per day.

OP56 Direct observation shall be used in collecting urine specimens. Observation shall be conducted professionally, ethically and in a manner, which respects clients privacy and does not damage the client-clinic relationship.

OP57 Random, periodic testing, including Breathalyzer tests for alcohol, shall be done to ascertain use of other substances, for clients with a history of abusing these substances.

OP58 The program has policies and procedures that address the dangers associated with the use of benzodiazepines when taking methadone. This will include provisions for admission/discharge protocol for illicit use and obtaining a release of information with the prescribing physician's acknowledgement that the patient is also being prescribed methadone. The patient must sign and date and informed consent of the program's policy.

OP59 When appropriate, family involvement shall be requested through a consent form to release information to family members.

OP60 Each client whose daily dose is above 100 milligrams is required to be under observation while ingesting the drug at least six (6) days per week irrespective of the length of time in treatment, unless the Program has received prior approval from the State Authority (SA).

OP61 In addition to federal reporting requirements, the program will have specific policies and procedure to report lost or stolen doses, theft and diversion, and fatalities of overdose to OADAP (incident reporting policy).

OP62 The program will have specific policies and procedures delineating staff access into the medication storage area(s).

OP63 Take home medication exceptions must be approved in writing, by the State

Authority (SA) prior to dispensing. Exceptional take homes will not normally be granted to Phase I, Phase II, Phase III, and Phase IV clients. Reasons for exceptional requests, may include, but are not limited to the following:

OP64 The dosing area(s) used will be a separate area that provides sufficient privacy to maintain confidentiality of the client's identity and communication between staff and the client.

OP65 Any client receiving l00mg or larger methadone dose shall not be allowed exceptional take-home privileges unless approved via the SMA.

OP66 All requests for methadone take-home medication exceptions must be submitted to the SMA in writing or through SAMHSA/CSATEXTRANET. Each request must document the following:

OP67 Programs are subject to Drug Enforcement Administration regulations concerning the Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances (Chapter II Parts 1301 - 1307). Clients shall be physically separated from the narcotic storage and dispensing area.

OP68 The Program shall not allow clients to congregate or loiter on the grounds or around the building(s) wherein the Program operates.

OP69 Entrances that have windows will be tinted or have coverings so the client's identity and confidentiality is protected from the view of the public.

OP70 In addition to client record criteria OTP shall also contain:

OP71 The Program shall complete an initial drug screening test or analysis for each client upon admission.

OP72 The Program shall conduct new client drug screening weekly for the first three (3) months in treatment. The Program may place a client who completes three (3) months of drug screening showing no indications of drug abuse on a monthly urine-testing schedule.

OP73 Programs shall implement procedures, including the random collection of samples, to effectively minimize the possibility of falsification of the sample.

OP74 The Program shall use drug screening as a clinical tool for the purposes of diagnosis and the development of treatment plans. After admission, the results of a single screening report shall not determine significant treatment decisions.

OP75 Clients on a monthly schedule for whom screening reports indicate positive results for drugs other than methadone shall return to a weekly schedule for a period of time clinically indicated by the physician.

OP76 The Program shall analyze each sample for opiates; methadone; amphetamines; crack/cocaine; benzodiazepines; marijuana and other drugs as may be indicated by clients use patterns.

OP77 Laboratories that perform the testing required under this regulation shall be in compliance with applicable Federal proficiency testing and licensing standards and applicable state standards.

OP78 The Medical Director may order methadone dosages in excess of 100 milligrams but less than 120 milligrams only where medically indicated. The Medical Director shall fully document the reasons for the dosage level and report such orders to the SMA.

OP79 The Medical Director shall obtain prior written approval from the SA for methadone dosage orders in excess of 120 milligrams.

OP80 The requirement of time in treatment is a minimum reference point after which a client may be eligible for take-home medication privileges. The time reference does not mean that a client in treatment for a particular time has a specific right to take-home medication. Since the use of take-home privileges creates a danger of not only diversion, but also accidental poisoning, the Medical Director must make every attempt to ensure that take-home medication is given only to clients who will benefit from it and who have demonstrated responsibility in handling methadone.

Thus, regardless of time in treatment, a Medical Director may, in his or her reasonable judgment, deny or rescind the take-home medication privileges of a client. Concurrently, the client shall provide assurance to the Program that take-home medication can be safely transported and stored by the client for the client's use only. Warning labels identifying the dangers associated with the ingestion of methadone shall be placed on every take home dose.

OP81 Clients shall have access to the Program in case of an off-hour emergency. The Program shall maintain a 24-hour Emergency Hot-Line with individuals designated as on-call to handle client emergencies.

OP82 When a client transfers from one Program to another, the transferring Program shall send copies of the transferring client's records to the licensed receiving

Program prior to admission. Transferring clients shall enter Phase I for a minimum of two (2) weeks. With successful completion of Phase I, they enter the appropriate treatment phase.

OP83 Individuals visiting the State of Arkansas, who are part of a methadone treatment, program, shall have their home program provide information to a licensed Program prior to the individual's arrival in the state.

OP84 The Arkansas program shall provide qualified visiting clients up to twenty-eight (28) days of methadone medication. However, take-home privileges shall not be greater than the privileges accorded by the home program, and in no case for longer than six (6) days.

OP85 In order to remain in the Program and to successfully move through treatment, clients shall be in compliance with Program rules or risk administrative detoxification from methadone. For the purpose of these standards, an infraction means threats of violence or actual bodily harm to staff or another client, disruptive behavior, community incidents (loitering, diversion of methadone, sale or purchase of drugs), continued unexcused absences from counseling and other serious rule violations. Clients may also be discharged for failure to benefit from the Program. When a Program determines to discharge a client, the Program shall provide a written statement containing:

OP86 A Program shall instruct clients not to cause unnecessary disruption to the community by loitering in the vicinity of the Program, or engaging in disorderly conduct or harassment.

The Program may discharge clients who cause such disruption to the community pursuant to the Standards.

OP87 Each Program shall provide the SA with a specific plan to avoid disrupting the community and the actions it shall take to assure responsiveness to community needs. The plan will include forming a committee of representative members of the community. Such committee shall meet at least once annually.

OP88 Further actions include assigning a staff member to act as community liaison, to establish an open dialog between the community and the program administration. Educational material shall be made available to the immediate community regarding the treatment of opioid addiction.

OP89 In an effort to maintain quality care, the program shall develop a training plan for personnel that foster consistency of care in accordance with rapidly evolving knowledge in the opioid treatment field.

OP90 The program shall develop a method of rapidly disseminating information about pharmacological issues and other advances in the field.

OP91 The program shall keep records and make such reports required by the DEA 1304.01 - 1304.38 of Chapter II - Drug Enforcement Administration, Department of Justice, part 1304 Records and Reports of Registrants.

OP92 The program shall adhere to record keeping and reporting requirements of the

CSAT, HHS, 291.505 (d) (13). These records shall include but not be limited to (i) Client Care, (ii) Drug Dispensing, (iii) Client's Record.

OP93 The program shall provide other reports as required by the SOTA with records as required by DEA and CSAT regulations.

OP94 The program shall provide other reports as required by the SOTA.

OP95 Decisions regarding a client's treatment by staff are subject to appeal. The program shall develop appeal procedures that allow clients to directly appeal to the SOTA.

OP96 The SOTA shall approve the procedures. In addition, procedures shall include a provision that a central file of client appeals be maintained at the program site for review by the SOTA staff.

OP97 The program shall post a list of client's rights in a conspicuous place for the public.

OP98 An entity may appeal the disapproval of an application or Program closure by the SOTA. Refer to Section 6.00 of Alcohol and Drug Abuse Prevention's Rules of Practice and Procedure for the Appeal Process for Adverse Action.

OP99 Failure of the program to adhere to CSAT/DEA regulations or Standards of the SA may result in revocation of program approval and/or licensure.

OP100 The SA shall report Programs recommended for closure to the CSAT/DEA for revocation of the right to receive shipments of narcotic drugs in accordance with 21 CFR, 291.505(h) .

DEFINITIONS

Relative to Licensure Standards for Alcohol and Other Drug Abuse Treatment Programs

Addiction Severity Index (ASI) - A semi-structured assessment instrument designed to be used with clients presenting for substance abuse treatment. It covers seven (7) important areas of a client's life: medical, employment/support, drug and alcohol use, legal, family/social, opinions about alcohol and drug use, and psychological. The instrument documents lifetime difficulties in these seven (7) areas and focuses on difficulties in the thirty (30) days prior to assessment.

Administrative Detoxification - The gradual, medically controlled withdrawal of methadone.

Admission - The point in an alcohol or drug abuser's relationship with the program at which the intake process has been completed and the individual is entitled to receive services.

Aftercare - The component of the treatment program which assures the provision of continued contact with the client following the termination of services from a primary care modality, designed to support and to increase the gains made to date in the treatment process. Aftercare plan development should start prior to discharge, but is not implemented until discharge.

Alcohol and Drug Management Information System (ADMIS) - Alcohol and Drug Management Information System (ADMIS) is the management information system for the collection and reporting of client related data prescribed by the State.

Alcohol or Drug Abuser/Addict - An abuser is a person who voluntarily uses alcohol or other drugs in such a way that their social or economic functioning is disrupted. An addict is a person who is physically and/or psychologically dependent on alcohol or other drugs and has little or no control over the amounts consumed, leading to substantial health endangerment, or social functioning disruption and economic functioning disruption.

Applicant - Any individual who has applied for admission to a treatment program, but is not yet admitted to the program.

Applicant Screening - The act of determining eligibility for treatment.

Assessment - The process of collecting sufficient data to enable evaluation of an individual's strengths, weaknesses, problems and needs so that a treatment plan can be developed.

Chief Executive Officer - The individual appointed by the governing board to set in behalf of the overall daily management of the organization.

Client - An individual who has an alcohol or other drug abuse problem, for whom intake procedures have been completed, who is admitted to the program, and remains active in the treatment provided by the program, and has not been discharged.

Counselor - An individual who, by virtue of education, training or experience, provides treatment, which includes advice, opinion, or instruction to an individual or in a group setting to allow opportunity for a person to explore their problems related directly or indirectly to alcohol and/or other drug abuse or dependence:.

Definitive Laboratory Results - Confirmatory tests conducted by a National Institute of Drug Abuse (NIDA) certified laboratory.

Detoxification - The withdrawal of a person from a physiologically addicting substance.

Detoxification Treatment for Opioid Dependence - The dispensing of a narcotic drug in decreasing doses to an individual to alleviate adverse physiological and psychological effects of withdrawal from the continuous or sustained use of a narcotic drug and as a method of bringing the individual to a narcotic drug-free state within such period.

Direct Care - Any individual who provides chemical dependency education or counseling of treatment related activities.

Documentation - Provision of written, dated and authenticated evidence (signed by person's name and title) to substantiate compliance with standards (e.g., minutes of meetings, memoranda, schedules, notices, announcement).

Emergency Admission - An admission that does not meet the intake process due to the extreme nature of the circumstances involved.

Emergency Care - A network of services that provides all persons having acute problems related to alcohol and other drug use and abuse readily available diagnosis and care, as well as appropriate referral for continuing care after emergency treatment.

Family - Individuals as defined by law, or significant others that claim relationship to the client.

Fiscal Management System - Procedures that provide management control of the financial aspects of program operations. Such procedures include cost accounting, program budgeting, materials purchasing, and client billing standards.

Governing Board - That person or persons with the ultimate authority and responsibility for the overall operation of the program.

Intake - The process of collecting and assessing information to determine the appropriateness of admitting an individual in an alcohol and drug abuse treatment program.

Licensure - The process by which the Alcohol and Drug Abuse Prevention determines if a person, partnership, association or corporation may operate an alcohol and drug abuse treatment program.

Licensure Standards for Alcohol and/or Other Drug Abuse Treatment Programs -

The standards developed by the Office of Alcohol and Drug Abuse Prevention, which licensed treatment programs shall comply with.

May - Term in the interpretation of a standard to reflect an acceptable method that is recognized, but not necessarily preferred.

Medical Director - A physician licensed to practice medicine in the State of Arkansas who assumes responsibility for the administration of medical services performed by the Program, ensuring that the Program is in compliance with federal, state and local laws and regulations. In an Opioid Treatment Program the Medical Director assumes the responsibility regarding the medical treatment of narcotic addiction with a narcotic drug.

Methadone Hydrochloride - An opioid (a synthetic opiate) that is primarily used for the treatment of narcotic addiction in detoxification or maintenance programs.

Narcotic Dependent - A narcotic dependent is an individual who physiologically needs opiate or a synthetic opiate to prevent the onset of signs of withdrawal.

NCPI - Crisis Prevention Institute's training in Non-violent Crisis Prevention and Intervention.

Observation Detoxification - Includes monitoring on a 24-hours per day basis of a client who is undergoing mild withdrawal in a residential/live in setting. Monitoring will consist of taking the client's vital signs. Vital signs will be taken by a staff member trained and certified by OADAP, a Medical Doctor, Registered Nurse, Licensed Psychiatric Technical Nurse or Licensed Practical Nurse. The facility shall establish approved emergency medical procedures. These services shall be available should the client's condition deteriorate and emergency procedures be required.

Opioid Maintenance - The dispensing of methadone for more than 180 days in the treatment of an individual for dependence on opiates.

Opioid Treatment Program - An entity that: