Current through Register Vol. XLI, No. 38, September 20, 2024
24.1
Compliance.
A psychiatric residential treatment facility for persons
under 21 is a freestanding or physically distinct part of a psychiatric
inpatient organization that provides services and treatment to children who do
not need acute care but require intensive and coordinated services in a
residential setting in a manner consistent with federal requirements. A
psychiatric residential treatment facility provides a continually, medically
supervised interdisciplinary program of behavioral health treatment.
24.2. Accreditation Requirements.
A psychiatric residential treatment facility shall be
appropriately accredited as required by federal standards. Where differing
accreditation, certification or licensing standards exist, the more stringent
standard applies.
24.3.
Employee Ratios.
24.3.1. The average
employee-to-patient ratio for a psychiatric residential treatment facility
shall be 1-to-4 during day and evening hours (one employee whose primary
responsibility is providing direct care for every four children during the day
and evening). During nighttime sleeping hours, the ratio shall be 1-to-8.
During all hours there shall be capability to increase employee-to-patient
ratio in response to acuity, extending to the provision of 1-to-1 care when
necessary. Employees assigned to work a defined unit and providing care to the
children on that unit including nursing, teachers, and activity therapists may
be included in the employee-to-client ratio. Employees assigned to supervisory
duties or whose duties cause them to be away from the unit (nursing supervisor)
may not be included in the count.
24.3.2. The nursing coverage shall include a
registered nurse during day and evening shifts with, at minimum, a licensed,
practical nurse overnight.
24.3.3.
There shall be a supervisor present on all shifts and employees shall have
access to other administrative employees at all times.
24.4. Employee Training and Credentials.
24.4.1. All direct care employees shall have
a minimum of a high school diploma or GED and professional employees shall have
appropriate education and certification consistent with professional licensing
standards.
24.4.2. In addition to
the requirements for employee training prescribed in section 11 of this rule,
direct care employees shall receive refresher training in emergency safety
interventions twice a year that shall include both didactic and experiential
activities.
24.5.
Treatment Services.
The residential treatment facility shall provide the
following clinical services:
24.5.1. A
physician shall be available 24 hours a day, seven days a week to respond to
medical and psychiatric emergencies;
24.5.2. A physician licensed in the state of
West Virginia and board certified in psychiatry shall perform observation and
assessment at least weekly; and
24.5.3. Routine assessments shall be
performed by the physician to effectively coordinate all treatment, manage
medication trials or adjustments, or both, minimize serious side effects, and
provide medical management of all psychiatric and medical problems.
24.6. Assessments.
24.6.1. A comprehensive assessment process
shall include evaluation of:
24.6.1.a.
Psychiatric health;
24.6.1.b.
Physical health;
24.6.1.c. Ability
to self-medicate with supervision;
24.6.1.d. Psychosocial history;
24.6.1.e. Recreational activities;
24.6.1.f. Spiritual and cultural preferences
and interests;
24.6.1.g. Behavioral
and adaptive living skills, both strengths and deficits; and
24.6.1.h. Educational functioning.
24.6.2. An additional diagnostic
assessment shall be provided as needed, either onsite or by using community
providers.
24.6.3. All required
clinical assessments shall be completed prior to the development of the plan of
care. Assessments conducted within 30 days prior to admission by qualified
professionals may be used if reviewed and approved for treatment planning by
the responsible psychiatrist and Interdisciplinary Treatment Team.
24.6.4. A psychiatric evaluation shall be
completed within 24 hours of admission and shall include:
24.6.4.a. The reason for admission;
24.6.4.b. The current clinical
presentation;
24.6.4.c.
Psychosocial stressors related to the recent illness;
24.6.4.d. A current or potential risk to self
or others;
24.6.4.e. A history of
the present illness;
24.6.4.f. A
past psychiatric history;
24.6.4.g.
A developmental assessment;
24.6.4.h. The presence or absence of physical
disorders or conditions affecting the presenting problem;
24.6.4.i. An alcohol or drug history;
and
24.6.4.j. A mental status
examination.
24.6.5. A
diagnosis on all five axes shall be given, based on the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM).
24.6.6. A physical health examination shall
be provided within 24 hours of admission.
24.6.7. A Registered Nurse practitioner shall
provide a health assessment within 24 hours of admission. The assessment shall
document:
24.6.7.a. A general history of the
patient's and family's health;
24.6.7.b. The patient's current
medications;
24.6.7.c. Allergies;
24.6.7.d. Pertinent medical
problems requiring nursing attention;
24.6.7.e. Current risk and safety
factors;
24.6.7.f. Nutritional
status;
24.6.7.g. Immunization
status; and
24.6.7.h. Sleep
patterns.
24.7. Plan of Care.
24.7.1. A preliminary plan of care shall be
developed within 72 hours of admission.
24.7.2. The interdisciplinary team shall have
30 days to complete all assessments while providing any immediately necessary
psychiatric and therapeutic treatment. Prior to the end of the 30-day period or
when all initial assessments are completed, whichever comes first, the team
shall complete a plan of care.
24.7.3. The plan of care shall be reviewed by
the interdisciplinary team for effectiveness and shall be revised when major
changes in treatment occur, or at least every 30 days.
24.8. Transfer Agreement.
The organization shall have a written transfer agreement with
one or more hospitals that ensures that an individual can be transferred to an
appropriate setting in a timely manner when transfer is necessary for more
intensive psychiatric care or for emergency or specialized medical care.
24.9. Transitioning Adults.
The psychiatric residential treatment facility may serve
individuals aged 18 to 21 so long as the transitioning adult is court ordered,
voluntary or committed under the requirements of Chapter 27 of the West
Virginia Code.
24.10.
Restrictive Behavior Management.
Restrictive Behavior Management techniques shall conform to
all federal guidelines for psychiatric residential treatment
facilities.
