Current through Register Vol. 24-18, September 15, 2024
A behavioral health agency may provide competency
evaluation and restoration treatment services to individuals under chapter
10.77 RCW when the department certifies the services.
(1) In addition to meeting the agency
licensure, certification, administration, personnel, and clinical requirements
in WAC 246-341-0100 through
246-341-0640 and the inpatient
services requirements in WAC
246-341-1105 and applicable
requirements in WAC
246-341-1131, an agency providing
competency evaluation and restoration services must be licensed by the
department as:
(a) A residential treatment
facility consistent with chapter 246-337 WAC;
(b) A hospital consistent with chapter
246-320 WAC;
(c) A private
psychiatric hospital consistent with chapter 246-322 WAC; or
(d) An inpatient evaluation and treatment
facility as provided in WAC
246-341-1133 and consistent with
chapter 246-337 WAC.
(2)
The administrative policies and procedures must include:
(a) Designation of a psychiatrist as the
professional person in charge of clinical services at the agency;
(b) Procedures to assure the protection of
individual participant rights in WAC
246-341-1156; and
(c) Procedures to assure that seclusion and
restraint are used only to the extent necessary to ensure the safety of the
individual see WAC
246-341-1158.
(3) The individual service record must
include all of the following:
(a) A copy of
the court order and charging documents. If the order is for competency
restoration treatment and the competency evaluation was provided by a qualified
expert or professional person who was not designated by the secretary, a copy
of all previous court orders related to competency or criminal insanity
provided by the state and a copy of any evaluation reports must be
included.
(b) A copy of the
discovery materials, including, at a minimum, a statement of the individual's
criminal history.
(c) A copy of the
individual's medical clearance information.
(d) All diagnostic and therapeutic services
prescribed by the attending clinical staff members.
(e) Specific targets and strategies for
restoring competency to include periodic assessments of gains on these
targets.
(f) Participation of a
multidisciplinary team that includes at a minimum:
(i) A physician, advanced registered nurse
practitioner (ARNP), or physician assistant certified (PA-C);
(ii) A nurse, if the person in (f)(i) of this
subsection is not an ARNP; and
(iii) A mental health professional.
(g) Participation of other
multidisciplinary team members, which may include a psychologist and chemical
dependency professional.
(h) All
assessments and justification for the use of seclusion or restraint.
(4) The initial assessment must
include:
(a) The individual's:
(i) Identifying information;
(ii) Specific barriers to
competence;
(iii) Medical
provider's name or medical providers' names;
(iv) Medical concerns;
(v) Medications currently taken;
(vi) Brief mental health history;
and
(vii) Brief substance use
history, including tobacco use.
(b) The identification of any risk of harm to
self and others, including suicide and homicide; and
(c) Treatment recommendations or
recommendations for additional program-specific assessment.
(5) To determine the nature of the
disorder and the treatment necessary, the agency must ensure that the
individual receives the following assessments and document in the client's
record the date provided:
(a) A health
assessment of the individual's physical condition to determine if the
individual needs to be transferred to an appropriate hospital for
treatment;
(b) An examination and
medical evaluation within 24 hours by a physician, advanced registered nurse
practitioner, or physician assistant;
(c) A psychosocial evaluation by a mental
health professional; and
(d) A
competency to stand trial evaluation conducted by a licensed psychologist, or a
copy of a competency to stand trial evaluation using the most recent competency
evaluation, if an evaluation has already been conducted.
(6) If a state hospital transfers an
individual to an agency for competency restoration treatment, the agency must
review the individual's completed admission assessment from the state hospital
to assure it meets the requirements of subsection (3) of this section for
initial assessments. The agency must update the assessment as needed. If the
state hospital has not completed or has only partially completed an assessment
for the individual, the agency must complete the assessment according to the
requirements in subsections (2) and (3) of this section.
(7) The agency must ensure the individual
service plan is completed within seven days of admission and is updated every
90 days.
