Current through Register Vol. 18, September 20, 2024
(1) In addition
to policies required throughout this rule, a SUDF licensed to serve adolescents
must have written policies and procedures that address:
(a) limiting admission to adolescents 17
years of age or younger or adolescents 18, 19, and 20 years of age if a client
is enrolled in certified secondary school, and the assessment completed by a
LAC or mental health professional with substance use in the scope of their
license determines their appropriateness for adolescent treatment;
(b) age-appropriate treatment;
(c) separation of adolescents from adults in
all characteristics of the treatment process;
(d) separation of adolescents from adults in
all non-treatment aspects including eating, sleeping, bathing, and recreation
activities; and
(e) staffing
patterns to ensure staff members of the same sex as clients are present at all
times.
(2) The SUDF must
maintain the minimum client to direct care staff ratios:
(a) from 7:00 a.m. to 11:00 p.m.: eight
adolescents to one direct care staff;
(b) from 11:00 p.m. to 7:00 a.m.: 12
adolescents to one direct care staff; and
(c) programs must have at least one awake
night staff in each building or unit housing adolescents.
(3) The SUDF must:
(a) allow communication between the
adolescent and the adolescent's parent or legal guardian a minimum of one time
per week and facilitate the communication when clinically
appropriate;
(b) provide family
therapy as indicated in the individualized treatment plan or document reasons
why family therapy may not be provided;
(c) notify the parent or legal guardian
within two hours of any serious incident as defined in ARM
37.106.1413 involving
the adolescent;
(d) discharge the
adolescent to the care of the adolescent's parent or legal guardian. For
emergency discharge and when the parent or legal guardian is not available, the
program must contact the appropriate authority; and
(e) only admit adolescents with the written
consent of the adolescent's parent or legal guardian.
(4) The SUDF must have protocols for
evaluating the treatment implications and safety concerns for determining
whether being placed in a room with another specific adolescent is
appropriate.
(5) In no
circumstances should adolescents of more than three years age difference be
placed in the same room.
(6)
Adolescent facilities utilizing physical restraints must have written policies
and procedures governing the appropriate use of crisis intervention and
physical restraint strategies including:
(a)
training for all staff in crisis intervention, de-escalation, and physical
restraint by a state approved or nationally recognized program;
(b) that crisis prevention and de-escalation
techniques are the preferred methods and must be used first to manage
behavior;
(c) physical restraint
must only be used to safely control an adolescent until the adolescent can
regain control of the adolescent's own behavior;
(d) prohibit the use of physical restraint if
an adolescent has a documented physical condition that would contradict its use
unless a health care professional has previously and specifically authorized
its use in writing. Documentation must be maintained in the adolescent's client
record; and
(e) prohibiting the use
of prone physical restraints.
(7) Physical restraint must only be used in
the following circumstances:
(a) when the
adolescent has failed to respond to de-escalation techniques, and it is
necessary to prevent harm to the adolescent or others; or
(b) when an adolescent's behavior puts
themselves or others at substantial risk of harm and the adolescent must be
forcibly moved.
(8)
Physical restraint must be used only by staff members who are specifically
trained and certified in physical restraint techniques.
(9) The SUDF must document the following for
each physical restraint:
(a) adolescent's
behavior which required the physical restraint;
(b) specific attempts to de-escalate the
situation before using physical restraint;
(c) length of time the physical restraint was
applied, including documentation of the time the restraint began and
ended;
(d) identity of specific
staff member(s) involved in administering the physical restraint;
(e) type of physical restraint
used;
(f) any injuries to the
adolescent resulting from the physical restraint; and
(g) a face-to-face debriefing completed
within 24 hours of the restraint, including:
(i) the staff member(s) and adolescent
involved in the physical restraint;
(ii) providing the adolescent and staff
involved the opportunity to discuss the circumstances resulting in the use of
the restraint; and
(iii) strategies
that could be used by the staff, the adolescent, and/or others that could
prevent the future use of restraint.
(10) The SUDF must provide access to an
educational program appropriate to the needs of the youth and comply with state
school attendance laws, as provided in Title 20, chapter 5, MCA.
(11) Group counseling sessions must be
provided by a licensed addiction counselor or mental health professional and
must not exceed eight adolescents to one adult staff member.
(12) All staff members working directly with
adolescents must be at least 21 years of age.
(13) The SUDF must not employ any staff
member that has a substantiation of child abuse or neglect.
AUTH:
50-5-103,
MCA; IMP:
50-5-103,
MCA