Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule describes the levels of outpatient
care that may be certified and the goals, eligibility criteria, and available
services. Discharge criteria and performance indicators for outpatient programs
are also identified.
(1)
Available Services. An array of services shall be available on an outpatient
basis to persons with substance abuse problems and their family members. The
program shall provide all services and comply with the functions required under
9 CSR
30-3.110.
(2) Certified Levels of Care. Outpatient
services shall be organized and certified according to levels of care. Each of
the levels of care shall vary in the intensity and duration of services
offered.
(A) The levels of care may include
1. Community based primary treatment. This
level of care is the most structured, intensive, and short-term service
delivery option with services offered on a frequent, almost daily
basis;
2. Intensive outpatient
rehabilitation. This level of care provides intermediate structure, intensity
and duration of treatment and rehabilitation, with services offered on multiple
occasions per week;
3. Supported
recovery. This level of care provides treatment and rehabilitation on a
regularly scheduled basis, with services offered on approximately a weekly
basis unless other scheduling is clinically indicated.
(B) All outpatient services and levels of
care offered by an organization shall be certified in accordance with this
rule. An organization shall be certified as providing one of the following
methods of outpatient service delivery:
1.
Supported recovery;
2. Intensive
outpatient rehabilitation and supported recovery; or
3. Community based primary treatment,
intensive outpatient rehabilitation and supported recovery.
(C) Outpatient services shall be
provided in a coordinated manner responsive to each person's needs, progress
and outcomes.
1. The organization shall
ensure that individuals can access an appropriate level of care.
A. If all three (3) outpatient levels of care
are not offered, the organization shall demonstrate that it effectively helps
persons to access other levels of care that may be available in the local
geographic area, as needed.
B. The
organization must demonstrate that it effectively helps persons to access
detoxification and residential treatment services, as needed.
2. An organization with multiple
service sites shall not be required to offer its certified levels of care at
every site, if it can demonstrate that an individual has reasonable access to
its levels of care through coordinated service delivery.
3. A light meal shall be served at a site to
those individuals who receive services for a period of more than four (4)
consecutive hours. Additional meals shall be provided, if warranted by the
program's hours of operation.
(3) Individualized Treatment Options. The
levels of care shall be used in a manner that provides individualized treatment
options and offers service intensity in accordance with the needs, progress and
outcomes of each person served.
(A) A person
may enter treatment at any level of care in accordance with eligibility
criteria.
(B) A person can move
from one level of care to another over time in accordance with symptoms,
progress, outcomes and other clinical factors.
1. The duration of each level of care shall
be time limited and tailored to the individual's needs.
2. A person may be transferred to a more
intensive level of care if there is a continuing inability to make progress
toward treatment and rehabilitation goals.
(4) Community Based Primary Treatment. This
level of care is the most structured, intensive, and short term service
delivery option. Structured services shall be offered at least five (5) days
per week and should approximate the service intensity of residential treatment.
(A) Eligibility for primary treatment shall
be based on
1. Evidence that the person
cannot achieve abstinence without close monitoring and structured support;
and
2. Need for frequent, almost
daily services and supervision.
(B) Expected outcomes for primary treatment
are to
1. Interrupt a significant pattern of
substance abuse;
2. Achieve a
period of abstinence;
3. Enhance
motivation for recovery; and
4.
Stabilize emotional and behavioral functioning.
(C) The program shall offer an intensive
array of services each week.
1. Each person
shall participate in at least twenty-five (25) hours of service per week,
unless contraindicated by the individual's medical, emotional, legal, and/or
family circumstances, and unless residential support is provided.
2. Where residential support is provided,
each person shall be offered additional structured therapeutic activities in
accordance with residential treatment standards.
3. Each person shall participate in at least
one (1) hour per week of individual counseling. Additional individual
counseling shall be provided, in accordance with the individual's
needs.
4. For community based
primary treatment that is funded by the department or provided through a
service network authorized by the department, day treatment may be specified as
the applicable service for this level of care.
(5) Intensive Outpatient Rehabilitation. This
level of care offers an intermediate intensity and duration of treatment.
Services should be offered on multiple occasions during each week.
(A) Eligibility for intensive outpatient
rehabilitation shall be based on
1. Ability
to limit substance use and remain abstinent without close monitoring and
structured support;
2. Absence of
crisis that cannot be resolved by community support services;
3. Evidence of willingness to participate in
the program, keep appointments, participate in self help, etc.; and
4. Willingness, as clinically appropriate, to
involve significant others in the treatment process, such as family, employer,
probation officer, etc.
(B) Expected outcomes for intensive
outpatient rehabilitation are to
1. Establish
and/or maintain sobriety;
2.
Improve emotional and behavioral functioning; and
3. Develop recovery supports in the family
and community.
(C) The
program shall offer at least ten (10) hours of service per week.
1. Each person shall be expected to
participate in at least ten (10) hours of service per week, unless
contraindicated by the individual's medical, emotional, legal, and/or family
circumstances.
2. Each person shall
participate in at least one (1) hour per week of individual
counseling.
(6) Supported Recovery. This level of care
offers treatment on a regularly scheduled basis, while allowing for a temporary
increase in services to address a crisis, relapse, or imminent risk of relapse.
Services should be offered on approximately a weekly basis, unless other
scheduling is clinically indicated.
(A)
Eligibility for supported recovery shall be based on
1. Lack of need for structured or intensive
treatment;
2. Presence of adequate
resources to support oneself in the community;
3. Absence of crisis that cannot be resolved
by community support services;
4.
Willingness to participate in the program, keep appointments, participate in
self help, etc.;
5. Evidence of a
desire to maintain a drug free lifestyle;
6. Involvement in the community, such as
family, church, employer, etc.; and
7. Presence of recovery supports in the
family and/or community.
(B) Expected outcomes for supported recovery
are to
1. Maintain sobriety and minimize the
risk of relapse;
2. Improve family
and social relationships;
3.
Promote vocational/educational functioning; and
4. Further develop recovery supports in the
community.
(C) The
program shall offer at least three (3) hours of service per week. Each person
shall be expected to participate in any combination of services determined to
be clinically necessary.
(7) Continued Services. The treatment episode
or level of care shall be reviewed for the appropriateness of continued
services if the person presents repeated relapse incidents, a pattern of
noncompliance or poor attendance, threats or aggression toward staff or other
clients, or failure to comply with basic program rules.
(8) Discharge Criteria. Each person's length
of stay in outpatient services shall be individualized, based on the person's
needs and progress in achieving treatment goals.
(A) An individual should be considered for
successful completion and discharge from outpatient services upon
1. Recognizing and understanding his/her
substance abuse problem and its impacts;
2. Achieving a continuous period of
sobriety;
3. Absence of immediate
or recurring crisis that poses a substantial risk of relapse;
4. Stabilizing emotional problems, when
applicable (for example, not experiencing serious psychiatric symptoms, taking
psychotropic medication as prescribed, etc.);
5. Demonstrating independent living
skills;
6. Implementing a relapse
prevention plan; and
7. Developing
family and/or social networks which support recovery and a continuing recovery
plan.
(B) A person may
be discharged from outpatient services before accomplishing these goals if
1. Commitment to continuing services is not
demonstrated by the client; or
2.
No further progress is imminent or likely to occur.
*Original authority: 630.050, RSMo 1980, amended 1993,
1995; 630.655, RSMo 1980; and 631.010, RSMo
1980.
