Current through Register Vol. 63, No. 9, September 1, 2024
(1) To be eligible
for ECS/ECOS, an individual shall:
(a) Be APD
service eligible;
(b) Meet the
diagnostic criteria of severe mental illness with complex behaviors or be
approved by the enhanced care services team;
(c) Require intensive community mental health
services to transition to a lower level of care;
(d) Have a history of multiple APD placements
due to complex behaviors; and
(e)
Be currently or have been a patient at the Oregon State Hospital or have
received inpatient services in an acute psychiatric unit for over 14 days and
have been referred to non-enhanced APD facilities and denied admission due to
severe mental illness with complex behaviors and be currently exhibiting two or
more of the following: self-endangering behavior, aggressive behavior,
intrusive behavior, intractable psychiatric symptoms, complex medication needs,
sexually inappropriate behavior, and elopement behavior.
(2) ECS/ECOS providers shall:
(a) For ECS, provide a minimum of four hours
per day or additional hours as required to support the needs of the enhanced
care facility, seven days per week of mental health staffing provided or
arranged for by the contracted mental health provider;
(b) Coordinate interdisciplinary team
meetings (IDT) to develop the service plan, review the behavior support plan,
and to coordinate care planning with the Department of Human Services
(Department) licensed provider staff, APD case manager, QMHP, prescriber and
related professionals such as the Department licensed facility or program
direct care staff, the Department licensed facility RN, and facility
administrator. IDTs in ECS programs shall be held weekly and at least quarterly
for ECOS;
(c) Coordinate quarterly
behavioral health trainings for Department-licensed providers and related
program staff providing services to ECS and ECOS recipients; and
(d) Ensure the availability of consultation
and crisis services staffed by a QMHP or the local CMHP available to the ECS
and ECOS provider and the Department licensed facility direct care staff
24-hours per day.
(3)
Behavior support services shall be designed to facilitate positive alternatives
to challenging behavior and to assist the individual in developing adaptive and
functional living skills. Providers shall:
(a) Develop and implement individual behavior
support strategies based on a functional or other clinically appropriate
assessment of challenging behavior;
(b) Document the behavior support strategies
and measures for tracking progress as a behavior support plan in the service
plan;
(c) Establish a framework
that ensures individualized positive behavior support practices throughout the
program and articulates a rationale consistent with the philosophies supported
by the Division, including the Division's trauma-informed services
policy;
(d) Obtain informed consent
from the individual or guardian, if one is appointed, in the use of behavior
support strategies and communicate both verbally and in writing the information
to the individual or guardian, in a language understood;
(e) Establish outcome-based tracking methods
to measure the effectiveness of behavior support strategies in:
(A) The use of least restrictive
interventions possible; and
(B)
Increasing positive behavior.
(f) Require all program staff to receive
quarterly mental health in-service training in evidence-based practices to
promote positive behavior support and related to needs of each individual;
and
(g) Review and update behavior
support policies, procedures, and practices annually.
(4) Providers shall develop a transition plan
for each individual as part of the initial assessment process. Each
individual's mental health service plan shall reflect their transition goal and
the supports necessary to achieve transition.
(5) Staffing requirements include:
(a) Each ECS and ECOS program shall have a
minimum of one FTE QMHP for programs serving five or more individuals who is
responsible for coordinating entries, transitions, and required IDT's; assuring
the completion of individual assessments, mental health service, and behavior
support plans; providing supervision of QMHP's and QMHA's; and coordinating
services and trainings with facility staff;
(b) Each ECS and ECOS program shall have
psychiatric consultation available. For ECS programs serving more than ten
individuals, the psychiatrist shall participate.
(6) In ECS programs, the CMHP and the
Department licensed provider shall develop a written collaborative agreement
that addresses at a minimum: risk management, census management, staff levels,
training, treatment and activity programs, entry and transition procedures, a
process for reporting and evaluating critical incidents, record keeping, policy
and procedure manuals, dispute resolution, and service coordination.
Statutory/Other Authority: ORS
161.390,
413.042,
430.640 &
443.450
Statutes/Other Implemented: ORS
161.390 -
161.400,
428.205 -
428.270,
430.010,
430.205 -
430.210,
430.254 -
430.640,
430.850 -
430.955 &
743A.168
