Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment updates staff qualifications
for the ITCD program.
(1) ITCD
is integrating substance use disorder treatment with community psychiatric
rehabilitation for individuals with co-occurring psychiatric and substance use
disorders. ITCD is a practice based on evidence and research for individuals
with serious mental illness and substance use disorders.
(2) Organizations certified or deemed
certified by the department as CPR programs may offer further specialized
treatment for co-occurring psychiatric and substance use disorders and shall
use the Integrated Treatment for Co-Occurring Disorders: The Evidence resource
KIT published in 2010 by the U. S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Center for Mental
Health Services, Publication No. SMA-08-4366, Rockville, MD 20009. This
publication may be downloaded at
https://store.samhsa.gov/product/Integrated-Treatment-for-Co-Occurring-Disorders-Evidence-Based-Practices-EBP-KIT/SMA08-4367.
The resource KIT incorporated by reference with this rulemaking does not
include any later amendments or additions.
(3) The agency shall have policies approved
by the governing body as defined in
9 CSR
10-7.090 that are consistent with the provision of
effective evidence-based interventions to guide the co-occurring services and
be consistent with the ITCD model of treatment.
(4) Admission Criteria. Persons meeting
criteria for ITCD must meet admission criteria as defined in
9 CSR
30-4.005 and must have a co-occurring substance use
disorder
(A) Individuals shall receive
screening for both mental health and substance use disorders.
(B) If individuals present with both mental
health and substance use identified service needs, the individuals shall
receive an integrated assessment identifying service needs as well as stage of
readiness for change.
(5)
Personnel and Staff Development. ITCD shall be delivered by a multidisciplinary
team responsible for coordinating a comprehensive array of services available
to the individual through CPR with the amount and frequency of service
commensurate with the individual's assessed need.
(A) The multidisciplinary team shall include,
but is not limited to, the following:
1. A
physician/physician extender (physician extender includes licensed assistant
physician, physician assistant, psychiatric resident, psychiatric pharmacist,
and advanced practice registered nurse (APRN);
2. A registered professional nurse
(RN);
3. A qualified mental health
professional (QMHP);
4. Additional
staff sufficient to provide community support and retain the responsibility for
acquisition of appropriate housing and employment services;
5. A qualified co-occurring disorders
specialist is defined as a person who demonstrates substantial knowledge and
skill regarding substance use disorders by being one (1) of the following:
A. A physician or QMHP in Missouri or an
individual who meets the applicable training and credentialing required by the
Missouri Credentialing Board for any of the following accreditations (Qualified
Addiction Professional):
(I) Certified
Alcohol and Drug Counselor (CADC);
(II) Certified Reciprocal Alcohol and Drug
Counselor (CRADC);
(III) Certified
Reciprocal Advanced Alcohol and Drug Counselor (CRAADC);
(IV) Certified Criminal Justice Addictions
Professional (CCJP);
(V) Registered
Alcohol Drug Counselor-Provisional (RADC-P);
(VI) Registered Alcohol Drug Counselor
(RADC);
(VII) Co-Occurring
Disorders Professional (CCDP); or
(VIII) Co-Occurring Disorders
Professional-Diplomat (CCDP-D); and
B. The QMHP or QAP shall also have one (1)
year of training or supervised experience in substance use disorder treatment.
If they have less than one (1) year of experience in providing co-occurring
disorder treatment, they shall be actively acquiring twenty-four (24) hours of
training in co-occurring disorders content and receive supervision from
experienced cooccurring disorders staff as approved by the department.
(B) The
multidisciplinary treatment team shall meet regularly to discuss each
individual's progress and goals and provide insights and advice to one
another
(C) Multidisciplinary team
members shall receive ongoing training in ITCD and have a training plan that
addresses specific ITCD criteria, including co-occurring disorders,
motivational interviewing, stage-wise treatment, cognitive behavioral
interventions, and substance use disorders treatment.
(D) The number of integrated treatment teams
is determined by the needs and number of individuals being supported.
(E) Only qualified staff shall provide
integrated treatment for cooccurring disorder services. Qualified staff for
each service are-
1. Individual counseling,
group counseling, and assessment, a QMHP, or a QAP who meets the co-occurring
counselor competency requirements established by the department; and
2. Group psychosocial rehabilitation
services, eligible providers shall have documented education and experience
related to the topic presented and either be, or be supervised by, a QMHP or
QAP who meets co-occurring counselor competency requirements established by the
department.
(6) Treatment.
(A) ITCD shall be delivered according to the
ITCD model and criteria specified by the department. Services are time
unlimited with the intensity modified according to level of need and degree of
recovery; include outreach efforts and interventions to promote physical
health, especially related to substance use; and target specific services to
individuals who do not respond to treatment.
(B) In addition to eligible CPR services,
integrated treatment for co-occurring disorder services include the following:
1. Co-occurring individual counseling. A
structured goal-oriented therapeutic process in which an individual interacts
with a counselor in accordance with the individual's treatment plan in order to
resolve problems related to the individual's documented mental and substance
use disorders that interfere with functioning. Individual co-occurring
counseling involves the use of practices such as motivational interviewing,
cognitive behavioral therapy, harm reduction, and relapse prevention.
Individual co-occurring counseling may include interaction with one (1) or more
members of the individual's family or other natural supports for the purpose of
assessment or supporting the individual's recovery;
2. Co-occurring group counseling.
Goal-oriented therapeutic interaction among a counselor and two (2) or more
individuals as specified in individual treatment plans designed to promote
individual self-understanding, selfesteem, and resolution of personal problems
related to the individual's documented mental disorders and substance use
disorders through personal disclosure and interpersonal interaction among group
members. Group size shall not exceed ten (10) individuals;
3. Co-occurring group psychosocial
rehabilitation services. Informational and experiential services designed to
assist individuals, family members, and others identified by the individual as
a primary natural support, in the management of the substance use and mental
health disorders. Services are delivered through systematic, structured,
didactic methods to increase knowledge of mental illnesses and substance use
disorders. This includes integrating affective and cognitive aspects in order
to enable the individuals receiving services, family members, and other natural
supports to cope with the illness and understand the importance of their
individual plan of care. The primary goal is to restore lost functioning and
promote reintegration and recovery through knowledge of one's disease,
symptoms, understanding of the precursors to crisis, crisis planning, community
resources, recovery management, and medication action, interaction, and side
effects. Group size shall not exceed twenty (20) individuals;
4. Co-occurring assessment supplement.
Individuals who present with both substance use and mental health identified
service needs must receive additional assessments to document the co-occurring
disorders and assess the interaction of the co-occurring disorders over
time;
5. The agency shall arrange
for referrals for withdrawal manage-ment/detoxification or hospitalization
services when appropriate;
6. The
agency shall provide housing and vocational services consistent with the ITCD
model; and
7. Other services as
appropriate.
(C) Staff
shall help individuals in the engagement and persuasion stages recognize the
consequences of their substance use, resolve ambivalence related to their
addiction, and introduce them to self-help principles. Individuals in the
active treatment or relapse prevention stage shall receive co-occurring
individual and/or group counseling and be assisted in connecting with self-help
programs in the community.
(D)
Families and other natural supports shall receive education and, as
appropriate, be involved in counseling.
(7) Records.
(A) An integrated treatment plan shall be
developed by the multi-disciplinary team, including input from the integrated
treatment specialist, and shall include participation of the individual
receiving services.
(B) The
treatment plan shall address mental health and substance use disorder treatment
strategies that involve building both skills and supports for
recovery.
(C) Interventions shall
be consistent with, and determined by, the individual's identified stage of
treatment.
(8)
Performance Improvement. The agency's performance improvement plan shall
include monitoring its compliance with the ITCD program model and identifying
and measuring satisfaction and outcomes of individuals served. Fidelity
improvement shall be included as part of the agency's overall performance
improvement efforts.
(9) The team
shall participate in fidelity reviews and fidelity improvement activities
conducted by the department.
*Original authority: 630.050, RSMo 1980, amended 1993,
1995, 2008; 630.655, RSMo 1980; and 632.050, RSMo
1980.
