Current through Reg. 50, No. 187; September 24, 2024
In addition to rule
65D-30.004, F.A.C., the
following standards apply to residential treatment.
(1) Residential treatment is a service
provided in a structured and supervised live-in environment within a
nonhospital or free-standing setting 24 hours-per-day, 7 days-per-week, and is
intended for individuals who meet the placement criteria for this component.
For the purpose of these rules, there are four (4) levels of residential
treatment that vary according to the type, frequency, and duration of services
provided.
(2) Facilities Not
Required to be Licensed as Residential Treatment. Licensure as residential
treatment, as defined in paragraph
65D-30.002(16)(d),
F.A.C., shall not apply to facilities that only provide housing, meals, or
housing and meals to individuals who are substance use impaired or in recovery.
These facilities do not provide clinical services; however, they may arrange
for or provide support groups such as Alcoholics Anonymous and Narcotics
Anonymous. All other facilities providing services to individuals as described
in subsections 65D-30.007(2) and
(3), F.A.C., either at the facility or at
alternate locations, must be licensed under this rule.
(3) Levels of Residential Treatment. For the
purpose of this rule, there are four levels of residential treatment. In each
level, treatment shall be structured to serve individuals who need a safe and
stable living environment in order to develop sufficient recovery skills for
the transition to a less restrictive level of care or reintegration into the
general community in accordance with placement criteria. Treatment shall also
include a schedule of services provided within a positive environment that
reinforce the resident's recovery. Individuals will be placed in a level of
residential treatment that is based upon their treatment needs and
circumstances. Because treatment plans should be specific to the individual,
length of stay and duration of treatment shall be dependent upon the
individual's:
a) severity of illness or
disorder,
b) level of functioning,
and
c) clinical progress in
treatment and outcomes based on individualized treatment goals for all levels
of residential treatment.
(a) Level 1
programs offer organized treatment services that feature a planned and
structured regimen of care in a 24-hour residential setting. These programs are
more than a 24-hour supported living environment (like those in level 4), and
are a 24-hour treatment setting. There are two (2) categories of treatment
under this level of care.
1. Adult Level 1
programs are appropriate for adults age 18 years and older with a substance use
disorder or a co-occurring mental health and substance use disorder who have
sub-acute biomedical, behavioral, emotional, or cognitive conditions severe
enough that they require treatment in a Level 1 program, but do not need the
full resources of an acute care general hospital or a medically managed
inpatient treatment program. This level includes programs that provide services
on a short-term basis. The emphasis is on an intensive regimen of clinical
services using a multidisciplinary team approach. Services may include some
medical services based on the needs of the individual.
2. Adolescent Level 1 programs are
appropriate for adolescents under the age of 18 years with a substance use
disorder or who have a co-occurring substance use and mental health disorders
or symptoms. This level is often necessary to help change negative patterns of
behavior, thinking, and feeling that predispose one to substance use and to
develop skills to maintain a substance-free life. Services should take into
account the different developmental needs based on the age of the adolescent
and address any deficits in behavioral, cognitive, and social-emotional
development often associated with substance use during the adolescent period.
Seventeen-year-olds who turn 18 while completing treatment shall be allowed to
stay only if it is clinically indicated, there is one-on-one supervision, and
they have separate bedrooms.
(b) Level 2 programs are structured
rehabilitation-oriented group facilities that serve persons with a substance
use disorder or a co-occurring mental health and substance use disorder who
have significant deficits in independent living skills and need extensive
support and supervision. Programs include those referred to as therapeutic
communities or some variation of therapeutic communities and are longer term
than Level 1. There are two (2) categories of treatment under this level of
care.
1. Adult Level 2 programs are
appropriate for adults age 18 years and older with a substance use disorder or
a co-occurring mental health and substance use disorder who have
multi-dimensional needs of such severity that they cannot safely be treated in
less intensive levels of care. This level is appropriate for adults who may
experience significant social and psychological deficits, such as chaotic, and
often abusive, interpersonal relationships; criminal justice involvement; prior
treatment in less restrictive levels of care; inconsistent work histories and
educational experiences; homelessness or inadequate housing; or anti-social
behavior. In addition to clinical services, considerable emphasis is placed on
services that address the individual's educational and vocational needs,
socially dysfunctional behavior, and need for stable housing upon discharge. It
also includes services that promote continued abstinence from substance use
upon the individual's return to the community.
2. Adolescent Level 2 programs are
appropriate for adolescents under the age of 18 with a substance use disorder
or a co-occuring mental health and substance use disorder who have impaired
functioning across a comprehensive range of psychosocial domains. This is
characterized as having unpredictable fluctuations in mood, and developmental
or cognitive difficulties related to mental health symptoms or disorders. In
addition to providing clinical services, as defined in rule
65D-30.002, F.A.C., this level
of care provides services to improve interpersonal relationships, conflict
resolution skills, impulse control problems and to reduce social inhibition or
withdrawal. For these adolescents, treatment must occur in a structured
environment conducive to teaching and practicing prosocial behavior to
facilitate healthy reintegration into the community.
(c) Level 3 programs are appropriate for
adults age 18 years and older with a substance use disorder or a co-occurring
mental health and substance use disorder whose cognitive functioning has been
severely impaired from the chronic use of substances, either temporarily or
permanently. This would include individuals who have varying degrees of organic
brain disorder or brain injury or other problems that require extended care.
The emphasis is on providing services that work on cognitive problems and
activities of daily living, socialization, and specific skills to restore and
maintain independent living. Typically, services are slower paced, more
concrete and repetitive. This level excludes adolescent programs.
(d) Level 4 programs are appropriate for
adults or adolescents with a substance use disorder or a co-occurring mental
health and substance abuse use disorder and provide services on a short-term
basis. This level is appropriate for individuals who have completed other
levels of residential treatment, particularly levels 2 and 3. This includes
individuals who have functional limitations in application of recovery skills,
self-efficacy, or a lack of connection to the community systems of work,
education, or family life. Although clinical services are provided, the
emphasis is on services that are low-intensity and emphasize a supportive
environment. This includes services that focus on recovery skills, preventing
relapse, improving emotional functioning, promoting personal responsibility and
reintegrating the individual into work, education, and family
life.
(4)
Services. Each individual shall receive services each week, including
counseling, as provided for in subsection
65D-30.007(6),
F.A.C. Each provider shall be capable of providing or arranging for the
services listed below. With the exception of counseling, as defined in rule
65D-30.002, F.A.C., it is not
intended that all services listed below be provided. For individuals
participating under subsection
65D-30.0037(15)
and rule 65D-30.0048, F.A.C., services
shall be provided in accordance with the terms and conditions of the Department
of Corrections' contract with the provider. Juvenile Justice Commitment
Programs and detention facilities operated by or under contract with the
Department of Juvenile Justice are exempt from the requirements of this
subsection, but shall provide such services as required in the policies,
standards, and contractual terms and conditions established by the Department
of Juvenile Justice. Otherwise, services shall be provided in accordance with
the needs of the individual as identified in the treatment plan as follows:
(a) Individual counseling;
(b) Group counseling;
(c) Counseling with family members or members
of the individual's support system;
(d) Substance related/recovery-oriented
education, such as strategies for avoiding substance use or relapse, health
problems related to substance use, and motivational enhancement and strategies
for achieving a substance-free lifestyle;
(e) Life skills training such as anger
management, communication skills, employability skills, problem solving,
relapse prevention, recovery training, decision-making, relationship skills,
and symptom management;
(f)
Expressive therapies, such as recreation therapy, art therapy, music therapy,
or dance (movement) therapy to provide the individual with alternative means of
self-expression and problem resolution, and other therapies such as
evidence-based practices and interventions for substance use or co-occurring
conditions;
(g) Training or
education in health and medical issues;
(h) Employment or educational support
services to assist individuals in becoming financially independent;
and
(i) Mental health services for
the purpose of:
1. Managing individuals with
disorders who are stabilized;
2.
Evaluating individuals' needs for in-depth mental health assessment;
3. Training individuals to manage symptoms;
and
4. If the provider is not
staffed to address primary mental health problems that may arise during
treatment, the provider should initiate a timely referral to an appropriate
provider for mental health crises or the emergence of a primary mental health
disorder, according to the provider's policies and
procedures.
(5)
Education. As provided for in subsection
397.501(6),
F.S., in addition to the services required for all programs, education and
training must be coordinated or provided to an adolescent, appropriate to his
or her needs, in order to maintain his or her educational and intellectual
development.
(6) Required Hours of
Services.
(a) For level 1, each individual
shall receive services each week in accordance with subsection
65D-30.007(4),
F.A.C., including at least 14 hours of counseling.
(b) For level 2, each individual shall
receive services each week in accordance with subsection
65D-30.007(4),
F.A.C., including at least 10 hours of counseling.
(c) For level 3, each individual shall
receive services each week in accordance with subsection
65D-30.007(4),
F.A.C., including at least 4 hours of counseling.
(d) For level 4, each individual shall
receive services each week in accordance with subsection
65D-30.007(4),
F.A.C., including at least 2 hours of counseling.
In instances in which it is determined that an individual
requires fewer hours of counseling in any of the levels of residential
treatment, this shall be described and justified in the individual's treatment
plan and approved by the qualified professional.
(7) Transportation. Each provider shall
arrange for or provide transportation services to individuals who are involved
in activities or in need of services, such as mental health, dental, public
health, and social services, that are provided at other facilities.
(8) Staff Coverage. For all levels of
residential treatment, each provider shall maintain awake, paid staff coverage
24 hours-per-day, 7 days per week.
(9) Caseload. No primary counselor may have a
caseload that exceeds 15 currently participating
individuals.
Rulemaking Authority
397.321(5) FS.
Law Implemented 397.311(26),
397.321,
397.4014,
397.410
FS.
New 5-25-00, Amended 4-3-03,
8-29-19.
