Current through Register No. 40, October 3, 2024
Residents who have medical or behavioral health needs, or
both, requiring specialized care necessitates programming that incorporates an
increased awareness of the unique needs, as well as attention, adaptation, and
accommodative measures beyond what are considered routine. For the purposes of
this section, such medical or behavioral health needs are those defined in
He-C
4001.01(bl), and which may be
congenital, developmental, or acquired through disease, trauma or environmental
causes, and which impose limitations in performing daily self-maintenance
activities or substantial limitations in a major life activity.
(a) SCPs shall comply with:
(1)
He-C 4001.01 through
He-C
4001.25 and this section; and
(2) Any other federal, state, and
professional standards related to the treatment of any medical diagnosis of any
resident.
(b) SCPs shall
develop and implement written policies and procedures governing the operation
of the program relative to the provision of services, available for review by
the department, that include the following:
(1) Intake and admissions procedures that
clearly state the criteria for the SCP population to be served;
(2) A description of the services provided
within the program to meet the special medical needs of the
residents;
(3) A description of the
professional services provided on site and in the local community that will be
contracted or accessed to ensure the special medical needs of the residents are
met;
(4) The organizational chart,
job descriptions of staff, and contracts with medical staff, clinical staff,
and consultants used to meet the special medical needs of the population being
served; and
(5) How direct care
staff will be orientated and trained to prepare to work with the population
being served.
(c) The
program director, together with relevant members of the administration,
clinical and direct-care staff, shall annually review all policies and
procedures and revise them as needed to ensure consistency with current
practice and professional standards.
(d) All clinical services provided by the
licensee shall:
(1) Focus on the residents
strengths;
(2) Be sensitive and
relevant to the diversity of the residents;
(3) Be child and family-centered;
(4) Be designed to acknowledge the impact of
violence and trauma on resident's lives, which shall be addressed in the
services provided;
(5) For
programs providing SUD services, the services shall be evidence-based by
meeting one of the following:
a. The services
shall be included as an evidence-based mental health and substance abuse
intervention on the U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration's (SAMHSA) "Evidence-Based
Practices Resource Center" available at, or as noted in Appendix A;
b. The services are published in a peer
reviewed journal and found to have positive effects; or
c. The treatment and support service provider
shall be able to document the services effectiveness based on a theoretical
model with validated research or a documented body of research generated from
similar services that indicates effectiveness; and
(6) For programs providing SUD services, the
services shall be delivered in accordance with the following:
a. The American Society of Addiction
Medicine's (ASAM), "The ASAM ", (Third edition), available as noted in Appendix
A; or
b. The U.S. Department of
Health and Human Services, Substance Abuse and Mental Health Services
Administration's (SAMHSA) "Knowledge Application Program (KAP) Resource
Documents and Manuals" (July 2020 edition), available at, or as noted in
Appendix A.
(e) The licensee shall assess and monitor the
quality of care and services it provides to residents on an ongoing
basis.
(f) SPCs providing
behavioral health services shall employ or with contract with:
(1) A clinical coordinator who shall:
a. Be a full-time employee;
b. Meet the definition of clinical staff in
He-C
4002.01(i); and
c. Have 2 years post-graduate experience in
human services; and
(2)
Clinical staff to meet the needs of the residents who shall:
a. Be a full-time employee or a part-time
employee with a minimum of 22 hours a week; and
b. Meet the criteria specified in
He-C
4002.01(j).
(g) All programs providing SUD
services shall employ or contract with:
(1) A
medical director who is:
a. A licensed
practitioner who is licensed in the state of New Hampshire; and
b. Has experience providing medical services
to residents with behavioral health or substance use disorder needs;
(2) A nurse who is currently
licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed
pursuant to the multi-state compact, and who is an RN or LPN with at least 2
year's relevant experience in substance use disorder treatment or behavioral
health services; and
(3) A
clinical services director who is a LADC or MLADC licensed by the NH board of
licensing for alcohol and other drug use professionals or an individual
licensed by the board of mental health practice and who has at least 2 year's
relevant experience in substance use disorder treatment or behavioral health
services.
(h) In
addition to (g) above, SCPs shall:
(1)
Provide administrative services that include the appointment of a full-time,
on-site program director who is responsible for the day-to-day operations of
the SPC, who meets the following qualifications:
a. For programs providing SUD services, the
program director shall be at least 21 years of age and have a minimum of one of
the following combinations of education and experience:
1. A bachelor's degree from an accredited
institution and one year of relevant experience working in a health related
field;
2. A New Hampshire license
as an RN, with at least one year relevant experience working in a health
related field;
3. An associate's
degree from an accredited institution plus 3 years relevant experience in a
health related field;
4. A MLADC
or LADC license issued by the State of New Hampshire; or
5. Licensed by the board of mental health
practice with at least one year of relevant experience working in SUD
treatment; or
b. For
SCPs not providing SUD services, the program director shall comply with the
requirements specified in
He-C
4001.19(e);
(2) Contract with or employ professional
staff to meet the needs of residents, including but not limited to clinical,
medical, and social needs; and
(3)
Employ direct care staff to implement service plans on a daily basis.
(i) The licensee shall:
(1) Assign all direct care staff and clinical
staff to a staff person who has supervisory or administrative responsibility
and experience suitable to the goals of the program and the responsibilities of
the staff supervised; and
(2)
Require direct care and clinical staff to have scheduled supervision with the
assigned supervisor regarding children's needs and methods of meeting those
needs, which shall occur a minimum of weekly or more frequently as
needed.
(j) The licensee
shall provide orientation for all new employees to acquaint them with the
program's philosophy, organization, policies, and services. No new direct care
staff shall be solely responsible for children in care until he or she has
completed the orientation.
(k)
Programs providing SUD services shall:
(1)
Ensure that all staff who perform direct care to residents or who are providing
treatment, education, and recovery support services shall be under the direct
supervision of a licensed clinical supervisor pursuant to the supervision
requirements in Alc 400;
(2)
Provide the SPC with sufficient supplies, equipment, and lighting to ensure
that the needs of residents are met;
(3) Implement any POC that has been accepted
or issued by the department;
(4)
Require that all personnel follow the orders of the licensed practitioner for
each resident and encourage the residents to follow the licensed practitioner's
orders;
(5) Employ or contract with
a nurse who is currently licensed in the state of New Hampshire pursuant to RSA
326-B, or licensed pursuant to the multi-state compact, and who is an RN or LPN
with at least 2 years relevant experience in SUD treatment or behavioral health
services;
(6) Employ or contract
with a clinical services director who is a LADC or MLADC licensed by the NH
board of licensing for alcohol and other drug use professionals or an
individual licensed by the board of mental health practice and who has at least
2 years relevant experience in treatment of SUD or behavior services;
and
(7) Require staff to obtain
continuing requirements, in accordance with Alc 400, and maintain documentation
of the training in the employee's individual personnel file for review by the
department.
(l) In
programs providing SUD services, all direct care personnel shall be at least 21
years of age unless they are:
(1) A licensed
nursing assistant working under the supervision of a nurse in accordance with
Nur 700; or
(2) Involved in an
established educational program working under the supervision of licensed
staff.
(m) An SCP that
is not able to meet the needs of any resident whom requires specialized care,
as described in this section, shall notify the department and expeditiously
seek an alternative placement, which can provide for the resident's needs on a
long-term basis and ensure that all needs are met until such time discharge can
safely occur.
(n) SCPs shall
assess each resident within 24 hours of admission to determine each resident's
needs and abilities on the following:
(1)
Walking and ambulation;
(2)
Transfers;
(3) Ability to
self-evacuate;
(4) Fall
risk;
(5) Mood and
behavior;
(6)
Communication;
(7) Nutrition and
oral health;
(8) Medications and
treatments including nebulizers and oxygen;
(9) Personal hygiene and assistance with
activities of daily living;
(10)
Whether or not safety devices, such as helmet, mittens, or safety belt, are
needed; and
(11) Nursing care and
services.
(o) The
assessment conducted in accordance with (n) above shall be:
(1) Incorporated into the resident's service
plan/treatment plan; and
(2)
Documented in the resident's file and available for review by department
staff.
(p) In addition
to the treatment plan required in
He-C
4001.21(b), SCPs shall develop a
service plan, meaning a written guide, in consultation with the resident or
guardian, agent or personal representative, if applicable, as a result of the
assessment conducted in accordance with (n) above for the provision of care and
services which shall:
(1) Be completed within
24 hours of the completion of the assessment and within 24 hours of the
completion of subsequent assessments;
(2) Identify the resident's needs;
(3) Identify the services that the SCP will
provide and the staff person responsible for providing or arranging for the
services while the child is in care;
(4) Include the following areas:
a. Educational;
b. Vocational;
c. Health, including medical, dental, and
ancillary services;
d. Behavior
management, including specific individual modifications of the restraint plan,
if necessary;
e. Life skills;
and
f. Social services, including
family work, psychological and psychiatric services, and counseling;
and
(5) Be made
available to all personnel for residents whom they assist;
(6) Be completed in consultation with the
resident and guardian or agent, if any, unless the resident and guardian or
agent are unable or unwilling to participate, it shall be documented in the
resident record; and
(7) Be
available on site for review by the department.
(q) The service plan identified in (p) above
shall include on an ongoing basis:
(1) The
date a problem or need was identified as a result of the assessment conducted
in (n) above;
(2) A description of
the problem or need;
(3) The goal
or objective of the plan;
(4) The
action or approach to be taken;
(5) The responsible person(s) or position;
and
(6) The date of reevaluation,
review, or resolution.
(r) The licensee shall explain all service
plans to all child care personnel responsible for implementing the service plan
on a daily basis, to the child's family or guardian, as appropriate, and to the
resident in a manner consistent with her or his maturity and capacity to
understand.
(s) All service plans
shall be reviewed and updated as often as necessary, but no less frequently
than every 6 months to re-assess the resident's needs and determine if:
(1) The service plan will be continued for
another 6 months;
(2) The service
plan will be revised to meet the needs of the resident; or
(3) The service plan will be discontinued
because the plan is no longer needed; and
(4) Shall be available for review by the
department.
(t) Progress
notes shall be written at least every 90 days and include, at a minimum:
(1) Service plan outcomes;
(2) The resident's physical, functional, and
mental abilities; and
(3) Changes
in behavior, such as eating habits, sleeping pattern, and
relationships.
(u) If a
resident refuses care or services that could result in a threat to their
health, safety, or well-being, or that of others, the licensee or their
designee shall:
(1) Inform the resident of
the potential results of their refusal;
(2) Notify the licensed practitioner and
guardian, if any, of the resident's refusal of care; and
(3) Document in the resident's record the
refusal of care and the resident's reason for the refusal.
(v) If a resident is non-verbal or
incapable of understanding the need for care or services as identified in (u)
above but exhibits behaviors that represent refusal of any care or services:
(1) Such behaviors shall be documented in the
resident's record; and
(2) Staff
shall consult with appropriate personnel of the SCP to determine if the care
plan requires modifications or if the needs of the resident exceed the services
that the SCP is able to provide.
(w) The licensee shall insure that medically
necessary glasses, hearing aids, prosthetic devices, corrective physical or
dental devices, or any equipment necessary or treatments prescribed by the
examining physician are provided to the resident if the resident's parent or
guardian does not provide them.
(x)
The licensee shall not require any resident to receive medical treatment or
screening when the parents of such resident object based on sincerely held
religious beliefs. However, the SPC may seek a court order for medical
treatment of a resident if it believes such medical treatment is in the
resident's best interest.
