Ohio Administrative Code
Title 5122 - Department of Mental Health and Addiction Services
Chapter 5122-29 - Requirements and Procedures for Mental Health Services Provided by Agencies
Section 5122-29-20 - Prevention services
Universal Citation: OH Admin Code 5122-29-20
Current through all regulations passed and filed through September 16, 2024
(A) As used in this rule:
(1)
"Adverse childhood experiences" or "ACES" mean potentially
traumatic events that occur during childhood (ages zero to seventeen years of
age). "Adverse childhood experiences" include physical and emotional abuse,
neglect, caregiver mental illness, and household violence.
(2)
"Brief
intervention" means a time-limited, structured behavioral health intervention
using techniques such as motivational engagement that are personalized to
reduce risk and encourage behavior change.
(3)
"Coalition" means
a group of diverse organizations and constituent groups working together, using
a comprehensive public health approach and data driven planning process, toward
a common goal of reducing the local incidence, prevalence, and consequences of
mental, emotional, and behavioral (MEB) disorders.
(4)
"Culturally
relevant" means the service delivery system response to the cultural,
linguistic, beliefs, and practices of the community as demonstrated through
readiness, resource, and needs assessment activities; capacity development
efforts; engaging stakeholders in planning; sound implementation science; and
evaluation, quality improvement, and sustainability activities.
(5)
"Direct services"
mean interactive prevention interventions that require personal contact with
individuals or groups to influence individual-level change. "Direct services"
include classroom-based programming, parent programs, training, and coalition
building.
(6)
"Early intervention" means an integral part of the
continuum of prevention services that includes providing early services and
supports after serious risk factors have been identified. These interventions
are implemented to halt or slow the impact of those risks and indicators of MEB
disorders in the earliest stages.
(7)
"Evidenced-based"
means a program, practice, policy, strategy, or intervention that has been
identified as effective by a nationally-recognized organization, a federal
agency, or agency of this state and has produced a consistent, positive pattern
of results on the majority of the intended recipients or target
population.
(8)
"Evidence-informed" means practices, strategies,
policies, or interventions that were developed based on the best research
available in the field. These activities have a strong scientific basis for
their use and there is confidence from recognized institutions that these will
have a consistent positive pattern of results or fit within prevention
best-practice frameworks.
(9)
"Indirect services" mean population-based prevention
interventions that require sharing resources and collaborating to contribute to
community-level change. "Indirect services" include compliance checks, media
campaigns, advocacy, and resource development.
(10)
"Mental,
emotional, and behavioral health (MEB) development" or "MEB development" means
a product of complex neurobiological processes that interact with
characteristics of the physical and social environment, beginning before
conception and continuing through and beyond adolescence.
(11)
"Mental,
emotional, and behavioral health disorders" or "MEB disorders" mean a number of
conditions that exist on a continuum, including mental and substance use
disorders, while including a broader range of concerns associated with problem
behaviors in youth.
(12)
"Mental health promotion" means actions supporting the
development of protective factors and healthy behaviors that can help promote
healthy MEB development and prevent or reduce risk factors that could lead to
the development of a diagnosable MEB disorder.
(13)
"Prevention
services" means a planned sequence of culturally relevant, evidence-based
strategies designed to reduce the likelihood of or delay the onset of MEB
disorders. "Prevention services" include direct services and indirect
services.
(14)
"Protective factor" means a characteristic at the
biological, psychological, family, or community level that is associated with a
lower likelihood of problem outcomes or that reduce the negative impact of a
risk factor on problem outcomes.
(15)
"Public health
approach" means a model that attempts to prevent or reduce a particular illness
or social problem in a population by identifying risk factors and implementing
strategies to improve conditions.
(16)
"Resiliency"
means the ability to adapt and grow in response to adversity, stress, or
trauma. Building resiliency includes a focus on strategies that mitigate risk
and build protections in individuals and communities that prevent adverse
childhood experiences and other risks that contribute to MEB
disorders.
(17)
"Risk factor" means a characteristic at the biological,
psychological, family, community, or cultural level that precedes and is
associated with a higher likelihood of problem outcomes.
(18)
"Screening"
means a process that identifies risk factors or early behaviors that make MEB
disorders more likely and can be carried out at the individual, group, and
community level. Screening segments a portion of those screened who could
benefit from additional interventions, including a referral for a diagnostic
assessment.
(19)
"Social determinants of health" mean conditions in
places where people live, learn, work, and play that affect a wide range of
health risks and outcomes. "Social determinants of health" include economic
stability, education, health and healthcare, neighborhood and built
environment, and social and community context.
(20)
"Trauma-informed" means a program, organization, or system
that does all of the following:
(a)
realizes the widespread impact of trauma and
understands potential paths for recovery;
(b)
recognizes the
signs and symptoms of trauma in clients, families, staff, and others involved
with the system;
(c)
responds by fully integrating knowledge about trauma
into policies, procedures, and practices; and
(d)
seeks to actively
resist re-traumatization.
(21)
"Workforce
development" means learning opportunities designed to increase knowledge,
skills, and abilities of the workforce and includes training, conferences,
virtual learning webinars, and communities of practice.
(B) Prevention services involve a continuum of coordinated efforts developed within a comprehensive public health approach combining the use of the following evidence-based strategies in appropriate proportions. Mental health promotion and early intervention are part of this continuum and use a combination of the approaches and methods described in paragraphs (B)(2) and (B)(3) of this rule.
(1)
Evidence-based prevention strategies
(a)
Education: This
strategy increases knowledge and skills, as well as influences attitude or
behavior. This strategy does not include education provided as a component of
treatment services.
(b)
Environmental: This strategy seeks to establish or
change standards or policies that will reduce the incidence and prevalence of
behavioral health problems in a population.
(c)
Community-based
process: This strategy focuses on enhancing the ability of the community to
provide prevention services through organizing, training, planning, interagency
collaboration, coalition building, or networking. This strategy is essential to
effectively implementing environmental strategies that will impact social
determinants of health.
(d)
Alternatives: This strategy focuses on providing
opportunities for positive behavioral support that reduce risk taking behavior
and reinforce protective factors achieved through attachment and bonding to
families, schools, communities, and peers. The opportunities are to be provided
as part of a larger comprehensive prevention effort.
(e)
Information
dissemination: This strategy builds knowledge and awareness of the nature and
extent of risk and protective factors related to MEB disorders and their
effects on individuals, families, and communities.
(f)
Problem
identification and referral: This strategy focuses on identifying individuals
who exhibit behavior or risk indicators and referring them for prevention
interventions, clinical assessment, or services. An example of this strategy is
universal screening in a school.
(2)
Mental health
promotion involves the use of one or both of the following approaches:
(a)
Universal efforts
to enhance an individual's ability to achieve developmentally appropriate tasks
and a positive sense of self-esteem, mastery, well-being, and social inclusion,
as well as strengthening their ability to cope with adversity by targeting
skills (such as self-regulation, self-efficacy, goal setting, and building
positive relationships) that build resiliency;
(b)
Actions to
strengthen the policy environment and use of strategic communication for
network building, stakeholder engagement, enhanced mental health literacy, and
behavior change.
(3)
Early
intervention involves the use of both of the following methods:
(a)
A comprehensive
developmental approach that is collaborative, culturally relevant, and geared
toward skill development or increasing protective factors; and
(b)
Services and
supports that are provided to individuals and families prior to receiving a
clinical diagnosis, are usually included in the indicated category, and most
often use education and problem identification and referral strategies, such as
screening and brief interventions.
(C) Subject to paragraph (D) and except as provided in paragraph (G) of this rule, a provider that seeks to receive the government funds described in division (B) of section 5119.36 of the Revised Code for its prevention services is to have those services certified by the department of mental health and addiction services by meeting all of the following standards:
(1)
The provider uses at least one of the following
evidence-based prevention strategies described in paragraph (B)(1)(a),
(B)(1)(b), or (B)(1)(c) of this rule: education, environmental, or
community-based process.
(2)
All prevention interventions used by the provider are
evidence-based or evidence-informed by prevention science as demonstrated by
one of the following:
(a)
A theory of change that is documented in a logic or
conceptual model;
(b)
A description of the intervention in a national
registry or peer-reviewed journal;
(c)
Documentation
that the intervention has been implemented showing a consistent pattern of
positive results; or
(d)
Documentation that the intervention has been reviewed
and found appropriate by a panel of informed prevention experts or key
community leaders that includes a description of each reviewer's
qualifications.
(3)
The provider is
implementing interventions that are targeted to various populations based on
the following levels of risk:
(a)
Universal: targeted to the general public or a whole
population group that has not been identified on the basis of individual
risk.
(b)
Selective: targeted to individuals or a subgroup of the
population whose risk of developing mental, emotional, or behavioral disorders
is significantly higher than average.
(c)
Indicated:
targeted to high-risk individuals who are identified as having minimal but
detectable signs or symptoms that foreshadow an MEB disorder, as well as
biological markers that indicate a predisposition in a person for such disorder
prior to a clinical diagnosis.
(4)
Within a targeted
population, the provider is implementing interventions by considering all of
the following:
(a)
Conceptual fit addressing identified risk and
protective factor priorities;
(b)
Cultural
relevance and support from key prevention stakeholders;
(c)
Adverse childhood
experiences and trauma-informed implications; and
(d)
Age and gender
appropriateness.
(5)
The provider
employs or contracts with either or both of the following to provide prevention
interventions:
(a)
Licensed or certified individuals, consistent with
paragraph (B) of rule
5122-29-30 of the Administrative
Code, who are able to show (i) prevention competency within the professional
scope of practice of the appropriate license, certification, or registration
issued by a regulatory board of this state and (ii) compliance with the
supervisory and ethical requirements identified by such regulatory
board.
(b)
Prevention specialist assistants, prevention
specialists, or prevention consultants certified under Chapter 4758. of the
Revised Code who are working within their professional scope of practice and
are supervised in accordance with rules
4758-6-08,
4758-6-09, and
4758-6-10 of the Administrative
Code.
(6)
The provider has a process to ensure volunteers
assisting with prevention interventions are supervised by one or more
individuals who are eligible, in accordance with rule
5122-29-30 of the Administrative
Code, to supervise within the applicable professional scope of
practice.
(7)
The provider has a procedure for prevention service
providers to document their workforce development and continuing education
hours for purposes of staying current with the latest developments in
prevention science.
(8)
The provider has a procedure for referring individuals
participating in prevention services to all of the following when a need is
identified:
(a)
Substance use, problem gambling, or other mental health
disorder treatment and primary care health services;
(b)
Social services;
and
(c)
Community resources.
(9)
The provider has
a plan for evaluating the effectiveness of the prevention services it provides
and its workforce development approaches.
(10)
The provider has
a plan to maintain, in accordance with paragraph (E)(3) of rule
5122-27-01 of the Administrative
Code, documentation for the prevention services it provides.
(D) A provider that is a coalition is not subject to the certification requirement in paragraph (C) of this rule until July 1, 2025.
The applicability of paragraph (C) on providers that are coalitions, beginning July 1, 2025, does not prohibit a board of alcohol, drug addiction, or mental health services from doing any of the following:
(1)
Participating as a member or convener of a
coalition;
(2)
Serving as a fiscal or administrative agent for a
coalition;
(3)
Providing staff support for a
coalition;
(4)
Submitting an application for certification on a
coalition's behalf, as long as the board indicates the coalition's name in the
space designated for the provider's "doing business as" name and all other
information the board submits as part of the application is about the coalition
as the provider.
As provided in section 340.037 of the Revised Code, a board of alcohol, drug addiction, or mental health services is not permitted to provide prevention services except as permitted under that section.
(E) A provider that is a coalition, and that is not requesting deemed status according to rule 5122-25-02 of the Administrative Code, is to file an application according to the procedure in rule 5122-25-03 of the Administrative Code except that the coalition is only required to submit as part of the application all of the following:
(1)
The items specified in paragraphs (A)(1)(a)(i),
(A)(1)(a)(iii) to (A)(1)(a)(ix), (A)(1)(a) (xi), (A)(1)(a)(xii), and
(A)(1)(a)(xiv) of rule
5122-25-03 of the Administrative
Code;
(2)
The address and telephone number the coalition uses for
legal notice and correspondence;
(3)
A written
description of the coalition's governance structure and a written table of
organization or organization chart;
(4)
Upon request of
the department and if applicable, the corporate information specified in
paragraph (A)(1)(b) of rule
5122-25-03 of the Administrative
Code.
(F) A provider that is a coalition and that is seeking certification under this rule is exempt from the certification fee for prevention services specified in rule 5122-25-08 of the Administrative Code.
(G) All of the following are not subject to the certification requirement in paragraph (C) of this rule, although each may attain certification on a voluntary basis:
(1)
An educational
entity under the jurisdiction of the Ohio department of education or Ohio
department of higher education;
(2)
A board of health
of a general or city health district or the authority having the duties of a
board of health under section
3709.05 of the Revised Code that
has received accreditation from the public health accreditation
board;
(3)
A faith-based organization that is actively working
with a provider certified under this rule, as verified in writing by that
provider;
(4)
A county family and children first council established
under division (B)(1) of section
121.37 of the Revised
Code.
(H) A provider whose prevention services have been certified pursuant to this rule is not required to keep records of individuals who receive prevention services. Any records which are kept, however, are to be kept in compliance with the requirements of 42 C.F.R. part 2 and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, 45 C.F.R. part 160 and subparts A and E of part 164.
Replaces: 5122-29-20
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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