Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Governing Body or Sponsor: The Crisis Stabilization Center shall identify a
Governing Body or Sponsor (Governing Body) which shall have overall
responsibility for the operation of the Center. The Governing Body may delegate
responsibility for the day-to-day management of the Center to appropriate staff
in accordance with the organizational plan approved by the Office. No
individual shall serve as both a member of the Governing Body and as paid staff
of the Crisis Stabilization Center without prior approval of the
Office.
(b) For hospital-based
Crisis Stabilization Centers, the Governing Body of the hospital shall be
responsible for the overall operation and management of the Crisis
Stabilization Center. The Governing Body may delegate responsibility for the
day-to-day management of the Center to appropriate staff pursuant to an
organizational plan approved by the Office. No individual shall serve as both
member of the Governing Body and of the paid staff of the Crisis Stabilization
Center without prior approval of the Office.
(c) For Crisis Stabilization Centers, the
Governing Body shall delegate responsibility for the day-to-day management of
the Crisis Stabilization Center in accordance with the written plan of
organization provided for in paragraph (e)(2) of this section.
(1) Onsite direction shall be delegated to an
individual who shall be known as the Program Director and who shall meet the
qualifications specified in section
600.11(f) of this
Part.
(2) The Program Director
shall be employed by the Crisis Stabilization Center as a full-time
employee.
(3) Overall
administrative direction may be the responsibility of the Program Director or
may be delegated by the Governing Body to an individual who shall meet
qualifications that are acceptable to the Office.
(d) The Governing Body shall comply with all
requirements set forth in 10 NYCRR Part 405 .2 as well as requirements
established by appropriate local, State and Federal standard-setting
bodies.
(e) The Governing Body shall
be responsible for the following duties:
(1)
to develop an organizational plan which indicates lines of accountability and
the qualifications required for staff positions. Such plan may include the
delegation of the responsibility for the day- to-day management of the program
to a Program Director who shall be a member of the professional staff employed
by the Crisis Stabilization Center. Where such Crisis Stabilization Center is
hospital-based, the Program Director shall report to the Director of Psychiatry
or Medical Director of the host hospital.
(2) to develop written personnel policies
which shall prohibit discrimination on the basis of race or ethnicity,
religion, disability, gender identity or sexual orientation, marital status,
age, documentation status, or national origin, as well as, written policies on
affirmative action which are consistent with the affirmative action and equal
employment opportunity obligations imposed by title VII of the Civil Rights
Act, Federal Executive Order 11246, the Rehabilitation Act of 1973, section
504, as amended, and the Vietnam Era Veteran's Readjustment Act;
(f) The Governing Body shall
develop, approve, periodically review and revise as appropriate all
programmatic and administrative policies and procedures. Such policies and
procedures shall include, but are not limited to the following:
(1) policies that guide efforts to reduce
disparities in access, quality of care and treatment outcomes for
underserved/unserved and/or marginalized populations, including but not limited
to: people of color, members of the LBGTQ+ community, older adults, pregnant
persons, Veterans, individuals who are hearing impaired, individuals with
limited English proficiency, immigrants, individuals with
intellectual/developmental disabilities and all justice system-involved
populations;
(2) policies that
ensure that efforts are made to employ staff that are proficient in the most
prevalent languages spoken by service Recipient;
(3) policies and procedures governing
Recipient records which ensure confidentiality consistent with the Mental
Hygiene Law, sections
33.13,
33.14 and
33.16,
45 C.F.R. parts
160 and
164 and which provide for
appropriate retention of such records pursuant to section
590.12 of this Title;
(4) policies regarding the confidentiality of
substance use disorder treatment records in accordance with state and federal
law including 42 CFR Part 2 and HIPAA;
(5) policies that ensure the protection of
Recipients' rights;
(i) At a minimum these
policies shall establish and describe a Recipient's grievance
procedure.
(ii) The Crisis
Stabilization Center shall post a statement of Recipients' rights in a
conspicuous location easily accessible to the public and provide a copy to
service Recipients.
(6)
policies for training staff to recognize the signs and symptoms of severe
reactions to or overdose on substances including but not limited to alcohol,
sedative-hypnotics, opioids, stimulants, cannabis and synthetic cannabinoids,
and the appropriate interventions when overdose occurs in accordance with
guidance from the Office
(i) Training on these
interventions shall include but not be limited to education about the use of
naloxone overdose prevention kits.
(ii) Centers must develop and implement a
plan to have staff trained in the use of a naloxone overdose prevention kit and
must ensure that such kit and appropriately trained staff are available during
all program hours of operation.
(iii) Staff should be trained that overdose
risk can exist with any illicit substance use, not limited to known opioid use
or intended substance of choice.
(7) policies for the provision of overdose
prevention education and training and availability of overdose prevention kits
or prescriptions for service Recipients and their collaterals.
(g) Cultural and linguistic
competency.
(1) Crisis Stabilization Centers
shall review demographic data for the Crisis Stabilization Center's Catchment
Area to determine the cultural and linguistic needs of the population as well
as disparities in access to treatment. Staff shall be trained to be aware and
respond appropriately to the cultural and linguistic needs of the Catchment
Area and develop a plan to address disparities in treatment access.
(2) Crisis Stabilization Centers shall ensure
provision of language assistance services at no cost to the Recipient and/or
their family/collaterals and shall make all necessary documents available in
the Recipient's preferred language. Language access services will be made
available in such a way that assessment or treatment activities will not be
delayed. Crisis Stabilization Centers are responsible for ensuring the
competence of individuals providing language assistance, recognizing that the
use of untrained individuals and/or minors as interpreters should be
avoided.
(3) Crisis Stabilization
Centers shall provide easy-to-understand print and multimedia materials and
signage in the languages commonly used by the populations in the service area,
with a focus on the varied literacy levels among the service user
population.
(h) County
planning.
(1) Crisis Stabilization Centers
shall participate in county and community planning activities annually, and as
additionally needed, to ensure, maintain, improve or develop community services
that demonstrate recovery outcomes. These outcomes include, but are not limited
to, quality of life, socio-economic status, entitlement status, social
networking, coping skills and reduction in use of crisis services.
(i) Incidents.
(1) The Crisis Stabilization Center shall
ensure the timely reporting, investigation, review, monitoring and
documentation of incidents pursuant to the Mental Hygiene Law and 14 NYCRR Part
524.
(i) The Crisis Stabilization Center
shall utilize New York Incident Management Reporting System reports or other
available incident/data analysis reports to assist in risk management
activities and compile and analyze incident data for the purpose of identifying
and addressing possible patterns and trends to improve service
delivery.
(2) Incident
Training.
(i) All new staff shall receive
training which must include at a minimum, the definition of incidents,
reporting procedures, an overview of the review process, and the role of risk
management.
(ii) Refresher incident
reporting training shall be conducted at least annually for all staff and
evidence of such training must be recorded in the staff personnel
file.
(3) For
hospital-based Centers, the hospital's incident review committee shall review
incidents, make recommendations and ensure implementation of action plans with
the Crisis Stabilization Center's Program Director.
(j) Non-discrimination. No Recipient that
meets the criteria for treatment may be denied a based solely on the
Recipient's:
(1) prior treatment
history;
(2) referral
source;
(3) pregnancy;
(4) history of contact with the criminal
justice system;
(5) HIV and AIDS
status;
(6) physical or mental
disability;
(7) lack of cooperation
by collaterals in the treatment process;
(8) toxicology test results;
(9) use of any illicit or prescribed
substances, including but not limited to, benzodiazepines;
(10) use of medications for substance use
disorder prescribed and monitored by a physician, physician's assistant or
nurse practitioner;
(11)
age;
(12) actual or perceived
gender;
(13) national
origin;
(14) race/color;
(15) actual or perceived sexual
orientation;
(16) marital
status;
(17) military
status;
(18) familial status;
or
(19) religion.
(k) Posting notices. The Crisis
Stabilization Center shall ensure the posting of notices displaying the
availability of on-site peer counseling/mutual-aid services and the address and
telephone number of local off-site peer counseling/mutual aid
services.
(l) The Crisis
Stabilization Center will have memorandums of understanding (MOUs) with any
available crisis residential services or comparable services for Recipients
determined to need crisis stabilization beyond 23 hours and 59
minutes.
(m) Crisis Stabilization
Centers shall develop policies and procedures describing Recipient drop off
from law enforcement, emergency medical services, mobile crisis and other
outreach and treatment teams.
(n)
Supportive Crisis Stabilization Centers shall develop policies and procedures
describing how Recipients will access services identified in screening and
assessment that are not provided by the Crisis Stabilization Center and
follow-up to ensure such services are accessed.
(o) The Commissioners or their designee may
prevent new presentations to the Crisis Stabilization Center emanating from
emergency medical services, ambulance services and law enforcement if a
conclusion is reached that the ability of the Crisis Stabilization Center to
deliver quality service would be jeopardized.
(1) The Commissioners or their designee shall
review the continued necessity for such prevention at least once every
twenty-four hours according to a mutually developed plan.
(2) The Crisis Stabilization Center shall
develop a contingency plan with other local affiliated hospitals, emergency
medical services and law enforcement for the prevention of new presentations
during periods of high demand and overcrowding.
(3) Where a Crisis Stabilization Center
prevents new presentations pursuant to this paragraph, the Crisis Stabilization
Center must notify the appropriate OMH Field Office and OASAS Regional Office
according to a mutually developed plan.
