Current through Register Vol. 24-18, September 15, 2024
(1) Agencies
certified for behavioral health residential and inpatient services provide
behavioral health intervention, assessment and treatment services in a
residential treatment facility or hospital. Residential and inpatient services
under this certification include:
(a) In
accordance with the service standards in WAC
246-341-1108:
(i) Adult residential and inpatient substance
use disorder treatment; and
(ii)
Youth residential and inpatient substance use disorder treatment;
(b) In accordance with the service
standards in WAC
246-341-1118:
(i) Adult residential and inpatient mental
health treatment; and
(ii) Youth
residential and inpatient mental health
treatment.
(2)
Agencies certified for behavioral health residential and in-patient services
must:
(a) Be a facility licensed by the
department as:
(i) A hospital licensed under
chapter 70.41 RCW;
(ii) A private
psychiatric hospital licensed under chapter 71.12 RCW;
(iii) A private alcohol and substance use
disorder hospital licensed under chapter 71.12 RCW; or
(iv) A residential treatment facility
licensed under chapter 71.12 RCW;
(b) Ensure access to necessary medical
treatment, including emergency life-sustaining treatment and
medication;
(c) Review the
individual's crisis or recovery plan, if applicable and available;
(d) Determine the individual's risk of harm
to self, others, or property;
(e)
Coordinate with the individual's current treatment provider, if applicable, to
assure continuity of care during admission and upon discharge;
(f) Develop and provide to the individual a
discharge summary that must include:
(i) A
continuing care recommendation; and
(ii) Scheduled follow-up appointments,
including the time and date of the appointment(s), when possible.
(3) If providing
services to adults and minors, an agency must ensure that a minor who is at
least age 13 but not yet age 18 is served with adults only if the minor's
individual service record contains:
(a)
Documentation that justifies such placement;
(b) A professional judgment that placement in
an inpatient facility that serves adults will not harm the minor; and
(c) Ensure the following for individuals who
share a room:
(i) An individual 15 years of
age or younger must not room with an individual 18 years of age or
older;
(ii) Anyone under 13 years
of age must be evaluated for clinical appropriateness before being placed in a
room with an individual 13 to 16 years of age; and
(iii) An individual 16 or 17 years of age
must be evaluated for clinical appropriateness before being placed in a room
with an individual 18 years of age or older.
(4) An agency providing residential or
inpatient mental health or substance use disorder services to youth must follow
these additional requirements:
(a) Allow
communication between the youth and the youth's parent, or if applicable, a
legal guardian, and facilitate the communication when clinically
appropriate.
(b) Notify the parent
or legal guardian within two hours of any significant decrease in the
behavioral or physical health status of the youth and document all notification
and attempts of notification in the individual service record.
(c) Discharge the youth to the care of the
youth's parent, or if applicable, legal guardian. For an unplanned discharge
and when the parent or legal guardian is not available, the agency must contact
the relevant state's child protective services.
(d) Ensure a staff member who demonstrates
knowledge of adolescent development and substance use disorders is available at
the agency or available by phone.
(e) Ensure staff members are trained in safe
and therapeutic techniques for dealing with a youth's behavior and emotional
crisis, including:
(i) Verbal de-escalation;
(ii) Crisis intervention;
(iii) Emotional regulation;
(iv) Suicide assessment and
intervention;
(v) Conflict
management and problem solving skills;
(vi) Management of assaultive behavior;
(vii) Proper use of therapeutic
physical intervention techniques; and
(viii) Emergency procedures.
(f) Unless otherwise advised by
the treatment provider:
(i) Provide group
meetings to promote social and emotional growth.
(ii) Provide leisure and other therapy or
related activities.
(iii) Provide
seven or more hours of structured recreation each week, that is led or
supervised by staff members.
(iv)
For each youth who is unable to attend school for an estimated period of four
weeks or more during the academic school year, the agency must work with the
school district in which the youth is enrolled or the youth's educational
provider to assure the academic needs of the youth are met.
(g) Conduct random and regular
room checks when an individual is in their room, and more often when clinically
indicated.
(h) Ensure each
individual's individual service record:
(i)
Contains any consent or release forms signed by the youth and their parent or
legal guardian;
(ii) Contains the
parent's or other referring person's agreement to participate in the treatment
process, as appropriate, and if possible; and
(iii) Documents any problems identified in
specific youth assessment, including any referrals to school and community
support services, on the individual service plan.
(5) An agency that provides
services to youth may continue to provide services to a youth who turns 18
years old while admitted, so long as it is documented that it is in the best
interest of the individual and the agency meets the requirements in subsection
(4)(h) of this section.
(6) An
agency certified for behavioral health residential and in-patient intervention,
assessment and treatment services may choose to provide services to individuals
on a less restrictive alternative order in accordance with the requirements in
WAC 246-341-0805.
