Current through Reg. 50, No. 187; September 24, 2024
In addition to Rules
65E-12.104,
65E-12.105, and
65E-12.106, F.A.C., above, these
standards apply to SRT programs.
(1)
Admission Criteria.
(a) Referral Required.
People may be admitted to an SRT only following a psychiatric or psychological
evaluation and referral from a CSU, inpatient unit, or a designated public or
private receiving facility.
(b)
Admission. All individuals shall be admitted pursuant to Chapter 394, Part I,
F.S., and Chapter 65E-5, F.A.C., and only on the order of a physician or
psychiatrist.
(2) Nursing
Assessment and Physical Examination. All persons shall be given a nursing
assessment and shall be given a physical examination within 24 hours of
admission. The physical examination shall include a complete medical history
and documentation of significant medical problems. It must contain specific
descriptive terms and not the phrase, "within normal limits." If the person
received a physical examination at an inpatient program or CSU prior to
transfer to the SRT, no further physical examination will be necessary unless
clinically indicated or it does not meet the requirements of this section.
General findings must be written in the individual's clinical record within 24
hours.
(3) Emotional and Behavioral
Assessment. For all individuals who are admitted to an SRT an emotional and
behavioral assessment shall be completed and entered into the individual's
clinical record within 72 hours. The assessment shall be made by a mental
health professional or other unit staff under the supervision of a mental
health professional. If the individual received an assessment at an inpatient
program or CSU prior to transfer to the SRT, another assessment is not required
unless clinically necessary or it does not meet the requirements of this
section. The assessment shall include the following.
(a) A history of previous emotional,
behavioral, and substance abuse problems and treatment.
(b) A social assessment to include a
determination of the need for participation of family members or significant
others in the person's treatment; the social, peer group, and environmental
setting from which the person comes; family circumstances; current living
situation; employment history; social, ethnic, cultural factors; and childhood
history.
(c) A direct psychiatric
evaluation to be completed by a physician or psychiatrist to include a mental
status examination which includes behavioral descriptions, including symptoms,
not summary conclusions, and concise evaluation of cognitive functioning. A
diagnosis, made by the physician or psychiatrist, shall be recorded in the
individual's clinical record, with a minimum of Axes I, II, and III, from the
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Revised, Washington, DC, American Psychiatric
Association, 1994.
(d) When
indicated, a psychological assessment including intellectual, projective, and
personality testing. The assessment shall also include specifications of the
behaviors that will be demonstrated in order for the individual to return to a
less restrictive setting and recommended intervention strategies.
(e) When indicated, other functional
evaluations of language, self-care, and social-affective and visual-motor
functioning.
(4) Medical
Care.
(a) The development of medical care
policies and procedures shall be the responsibility of the psychiatrist or
physician. The policies and procedures for medical care shall include the
procedures that may be initiated by a registered nurse in order to alleviate a
life threatening situation. Medication or medical treatment shall be
administered upon direct order from a physician or psychiatrist, and orders for
medications and treatments shall be written and signed by the physician or
psychiatrist.
(b) There shall be no
standing orders for any medication used primarily for the treatment of mental
illness.
(c) Every order given by
telephone shall be received and recorded immediately only by a registered nurse
with the physician's or psychiatrist's name, and signed by the physician or
psychiatrist within 24 hours. Such telephone orders shall include a progress
note that an order was made by telephone, the content of the order,
justification, time, and date.
(5) Comprehensive Service and Implementation
Plans. At the time of admission to the SRT the previously completed
comprehensive service plan shall be reviewed and revised as needed with the
person's service plan manager. The SRT shall develop a service implementation
plan which has objectives and action steps written for the person in behavioral
terms. The objectives shall be related directly to one or more goals in the
person's comprehensive service plan. The service implementation plan shall be
initiated with documented input from the person receiving services and signed
by the responsible physician or psychiatrist or a staff member privileged by
policies and procedures within 24 hours of admission. The service
implementation plan shall be fully developed within 5 days of admission and
must contain short-term treatment objectives stated in behavioral terms,
relative to the long-term view and goals in the comprehensive service plan, and
a description of the type and frequency of services to be provided in relation
to treatment objectives. The plan shall be reviewed and updated at least every
30 days. A copy of the plan shall be signed by and provided to the individual
and his guardian as provided by law. A new aftercare plan shall be developed
prior to discharge from the SRT.
(6) Previous Record. For individuals who
enter the SRT as a continuation of care, transfer from an inpatient program or
CSU, the previously completed intake interview, physical examination,
medication log, progress notes, discharge or aftercare plan, and forms under
Chapter 65E-5, F.A.C., shall be made a part of the SRT clinical
record.
(7) Required SRT Services.
(a) Services. Each SRT shall provide the
following services on a 24-hour-a-day, 7-day-a-week basis:
1. Twenty-four hour supervision,
2. Individual, group, and family counseling
services directed toward alleviating the crisis or symptomatic behavior which
required admission to an SRT,
3.
Medical or psychiatric treatment,
4. Social and recreational activities, inside
and outside the context of the facility,
5. Referral to other less restrictive,
nonresidential treatment services, when appropriate. Each SRT shall have access
to the CSU, if one exists in the area, and to hospital emergency services in
the event of a crisis that cannot be managed within the facility; and,
6. Each SRT shall provide or have
access to transportation in order to accomplish emergency transfers and to meet
the service needs of persons served.
(b) Routine Activities. Basic routine
activities for persons admitted to an SRT shall be delineated in program
policies and procedures which shall be available to all personnel. The daily
activities shall be planned to provide a consistent, well structured, yet
flexible, framework for daily living and shall be periodically reviewed and
revised as the needs of individuals or the group change. Basic daily routine
shall be coordinated with special requirements of each service implementation
plan. A schedule of daily activities shall be posted or otherwise available to
all persons receiving services.
(c)
Laboratory Services.
1. Requirement. Every SRT
shall provide or contract for licensed laboratory services commensurate with
the individual's needs.
a. Emergency.
Provision shall be made for the availability of emergency licensed laboratory
services on a 24-hour-a-day, 7-day-a-week basis including holidays.
b. Orders. All laboratory tests and services
shall be ordered by a physician or psychiatrist.
c. Record. All laboratory reports shall be
filed in the individual's clinical record.
d. Specimens. Each SRT shall have written
policies and procedures governing the collection, preservation and
transportation of specimens to assure adequate stability of
specimens.
2. Contracts.
Where the SRT depends on an outside laboratory for services, there shall be a
written contract detailing the conditions, procedures and availability of work
performed. The contract shall be reviewed and approved by the SRT director or
administrator.
(d)
Continuity of Care.
1. Discharge Preparation.
Prior to discharge or departure from the SRT, the staff with the individual's
consent shall work with the individual's support system including family,
friends, employers and case manager, as appropriate, to assure that all efforts
are made to prepare the individual for returning to a less restrictive
setting.
2. Referral Services. All
SRT facilities shall develop and maintain written referral
agreements.
(e) Each SRT
shall have access to a hospital inpatient unit to assure that referred persons
are admitted as soon as necessary.
(8) Space. Each person receiving services
shall be provided a minimum of 175 square feet of usable client space within
the SRT. Bedrooms shall be spacious and attractive, and activity rooms or space
shall be provided.
(9) Access and
Egress. Each SRT shall provide reasonable control over access to and egress
from the unit and recreational area.
Rulemaking Authority
394.879(1), (2)
FS. Law Implemented 394.875
FS.
New 2-27-86, Amended 7-14-92, Formerly 10E-12.108, Amended
9-1-98.
