DAR File No. 39863

Human Services, Substance Abuse and Mental Health

Rule R523-3

Screening, Assessment, Education and Treatment Standards for Court-referred Youth Under the Age of 21

Notice of Proposed Rule

(New Rule)

DAR File No.: 39863
Filed: 10/27/2015 09:51:48 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is required by H.B. 348 passed during the 2015 General Session. This rule prescribes the standards for substance use disorder screening, assessment, treatment, and required educational series for court-referred youth (hereinafter youth) under the age of 21 found in violation of: 1) Section 41-6a-502 driving under the influence of alcohol, drugs or a combination of both; 2) Section 53-3-231 person under 21 may not operate a vehicle or motorboat with detectable alcohol in body; 3) Section 41-6a-517 driving with any measurable controlled substance in the body; 4) Section 41-6a-520 blood alcohol test refusal; 5) Section 32B-4-409 unlawful purchase, possession, consumption of alcohol; 6) Section 32B-4-410 unlawful admittance or attempt to gain admittance; 7) Section 76-9-701 intoxication; and/or 8) Section 32B-4-411 unlawful use of proof of age. Under the age of 18 is in violation of: 1) Section 58-37-8; 2) Title 58, Chapter 37a, Utah Drug Paraphernalia Act; and 3) Title 58, Chapter 37b, Imitation Controlled Substances Act.

Summary of the rule or change:

This rule provides guidance on the following: 1) standards for criminogenic risk screening and assessment; 2) standards for substance use disorder and mental health screenings; 3) standards for substance use disorder assessments; 4) standards for educational series; 5) standards for substance use disorder treatment; 6) documentation standards for substance use disorder treatment; 7) certification procedures for educational series and treatment programs; 8) corrective action; 9) suspension and revocation; 10) procedure for denial, suspension, or revocation; and 11) posting of certified programs.

State statutory or constitutional authorization for this rule:

• Section 58-37-8
• Section 53-3-231
• 42 CFR Part 2
• Title 58, Chapter 37a
• Section 63G-4-203
• Subsection 62A-15-105(6)
• Title 58, Chapter 37b
• Section 76-9-701
• Section 32B-4-409
• Section 32B-4-410
• Section 32B-4-411
• Section 41-6a-517
• Section 41-6a-502
• Section 41-6a-501
• Section 41-6a-520

Anticipated cost or savings to:

the state budget:

This rule will have no impact on the state budget. Funds will be contracted primarily to the county governments. The Division of Substance Abuse and Mental Health (DSAMH) will provide oversight within existing resources. The juvenile court already screens juveniles for criminogenic need. Some state programs will need to meet the standards outlined in this rule. This may result in fewer individuals served. However, this rule does not mandate or require additional funds for treatment services.

local governments:

Treatment funds are contracted by DSAMH to county governments. Funds do not create an entitlement for individuals involved in the justice system but strengthen the existing safety net. Meeting the standards may require higher expenditures per client. However, services will only be provided within appropriation.

small businesses:

Small business will not be impacted by this rule. Private treatment providers may choose to change business practice to meet new standards. If they choose to change business practice to meet the new standards, this will likely result in additional revenue from the criminal justice system.

persons other than small businesses, businesses, or local governmental entities:

DSAMH does not anticipate increased costs to this class of persons. If persons in this class that are private treatment providers choose to change business practice to meet the new standards, this will likely result in additional revenue from the criminal justice system.

Compliance costs for affected persons:

DSAMH does not anticipate that there will be a compliance cost for affected persons because these services will be provided within the funding of the legislative appropriation.

Comments by the department head on the fiscal impact the rule may have on businesses:

The Department of Human Services does not anticipate a fiscal impact on businesses because these programs will be provided within the funding allocations provided by the legislative appropriations.

Ann Silverberg Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
195 N 1950 W
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Julene Robbins at the above address, by phone at 801-538-4521, by FAX at 801-538-3942, or by Internet E-mail at [email protected]
• L Ray Winger at the above address, by phone at 801-538-4319, by FAX at 801-538-9892, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/15/2015

This rule may become effective on:

12/22/2015

Authorized by:

Doug Thomas, Director

R523. Human Services, Substance Abuse and Mental Health.

R523-3. Screening, Assessment, Education and Treatment Standards for Court-referred Youth Under the Age of 21.

R523-3-1. Authority.

This rule is authorized by Subsection 62A-15-105(6) requiring the Division of Substance Abuse and Mental Health (Division) to provide form and content of screening, assessment, education and treatment as defined in Section 41-6a-501.

 

R523-3-2. Purpose.

(1) This rule prescribes the standards for substance use disorder screening, assessment, treatment, and required educational series for court-referred youth (hereinafter youth):

(a) Under the age of 21 found in violation of:

(i) Section 41-6a-502 driving under the influence of alcohol, drugs or a combination of both;

(ii) Section 53-3-231 person under 21 may not operate a vehicle or motorboat with detectable alcohol in body;

(iii) Section 41-6a-517 driving with any measurable controlled substance in the body;

(iv) Section 41-6a-520 blood alcohol test refusal;

(v) Section 32B-4-409 unlawful purchase, possession, consumption of alcohol;

(vi) Section 32B-4-410 unlawful admittance or attempt to gain admittance;

(vii) Section 76-9-701 intoxication; and/or

(viii) Section 32B-4-411 unlawful use of proof of age; or

(b) Under the age of 18 is in violation of:

(i) Section 58-37-8;

(ii) Title 58, Chapter 37a, Utah Drug Paraphernalia Act;

(iii) Title 58, Chapter 37b, Imitation Controlled Substances Act;

 

R523-3-3. Definitions.

(1) "Assessment" means an in-depth clinical interview with a licensed mental health therapist used to determine if a youth is in need of:

(a) Substance use disorder treatment that is obtained at a substance use disorder program;

(b) An educational series; or

(c) A combination of Subsection R523-3-3(1)(a)and Subsection R523-3-3(1)(b).

(2) "Educational series" means a court-ordered and evidence-based instructional series for youth with low criminogenic risk obtained at a substance use disorder program that is approved by the Division of Substance Abuse and Mental Health in accordance with Section 62A-15-105 designed to prevent the onset of substance use and/or mental health disorders and reduce criminogenic risk. (3) "Criminogenic Risk" means youth characteristics that are directly related to researched causation of delinquency.

(4) "Criminogenic Need" means dynamic or changeable attributes of youth that are directly linked to delinquency that should be targeted to develop a comprehensive treatment plan.

(5) "Level of Care" means the intensity of either substance use disorder services needed as defined by the American Society of Addiction Medicine (ASAM) or the array of services needed to address a youth's mental health issues.

(6) "Recovery" means a process of change through which youth improve their health and wellness, live a self-directed life, and strive to reach their full potential.

(7) "Recovery Support" means services or activities provided before, during or after completion of acute treatment services to enhance a youth's ability to either attain or retain their recovery from either mental health or substance use disorders.

(8) "Screening" means a preliminary appraisal of a youth used to determine:

(a) Criminogenic risk, and;

(b) If the youth is in need of further assessment.

(9) "Youth" for purposes of this rule are defined as any person under the age of twenty-one years of age.

 

R523-3-4. Standards for Criminogenic Risk Screening and Assessment.

(1) Prior to referral to a certified educational series or treatment program, all youth shall be given a brief, validated, risk and needs screen in the preliminary stages of involvement with the justice system to determine whether the youth is of low, moderate, or high risk to re-offend.

(a) For youth under the age of eighteen (18) years of age, the screening instrument to be used shall be the most current version of the Pre-Screen Risk Assessment (PSRA) or other instrument currently approved by the Juvenile Court.

(b) For youth between the ages of eighteen (18) and twenty-one (21), the screening instrument to be used shall be the most current version of the Level of Service Inventory-Revised: Screening Version (LSI-R:SV).

(2) The screen shall collect information about behaviors and characteristics known to predict re-offending including delinquency history, social history, and attitudes/behaviors.

(3) If the screen indicates a high likelihood of re-offending, the youth shall be given an in-depth assessment of criminogenic risk and need.

(a) For youth under the age of eighteen (18) years of age, the assessment instrument to be used shall be the most current version of the Protective and Risk Assessment (PRA).

(b) For youth between the ages of eighteen (18) and twenty-one (21), the assessment instrument to be used if a criminogenic risk assessment is necessary shall be the Level of Service/Risk, Need, Responsivity (LS/RNR).

(4) The criminogenic assessment shall examine a wide variety of factors related to the youth's strengths and challenges including: delinquency history, school, employment, relationships, environment, current living arrangements, alcohol and drugs, mental health, attitudes and behaviors, and skills.

(5) The criminogenic assessment shall also identify protective factors that are related to the reduced likelihood of re-offending and risk factors that are related to the increased likelihood of re-offending.

 

R523-3-5. Standards for Substance Use and Co-occurring Mental Health Disorder Screenings.

(1) A court may order a Substance Use and Mental Health Disorder Screening for a youth upon a first violation of the offenses in Section R523-3-2.

(2) A court shall order a Substance Use and Mental Health Disorder Screening for second or subsequent violation of the offenses in Section R523-3-2.

(3) Youth shall be screened using an instrument(s) that has been evaluated and found reliable and valid by the scientific community to determine whether youth are in need of comprehensive assessment.

(4) Screenings shall be:

(a) Conducted by a person that has completed all training recommended by the developer of the specific instrument being used; and

(b) Trauma-informed developmentally appropriate, short, simple, and easy to administer and interpret by a wide variety of professionals who work with youth;

(5) The youth shall be referred for an assessment if the screening identifies a potential substance use and/or mental health disorder.

(6) Screenings shall not be used to determine diagnosis.

(7) Examples of validated substance use disorder screening instruments for youth include but are not limited to the Substance Abuse Subtle Screening Inventory (SASSI); the Problem Oriented Screening Instrument for Teenagers (POSIT), the Personal Experience Screening Questionnaire(PESQ)and the CRAFFT Screening Tool recommended by the American Academy of Pediatrics' Committee on Substance Abuse.

 

R523-3-6. Standards for Substance Use Disorder and Co-occurring Mental Health Assessments.

(1) Assessments shall be conducted by a licensed mental health therapist using a standardized instrument(s) and process that has been evaluated by the scientific community and determined to be reliable and valid for the purpose of assessing youth.

(2) Assessments shall identify: relevant information to the youth's use of substances that will assist in determining the need for placement in services based on the ASAM Dimensions as outlined in the ASAM Criteria, 2013 Edition, or most current ASAMH criteria.

(3) Assessments shall focus on the youth's substance use severity, mental health status, legal problems, physical condition, educational functioning, living situation and the criminogenic risk factors that predict the likelihood of re-offense.

(4) Based on the screening and the assessment, the assessor shall recommend needed services, and supervision requirements that address the youth's clinical and criminogenic needs.

(5) Examples of validated substance use disorder assessment instruments for youth include but are not limited to: The Global Appraisal of Youth Needs (GAIN), Teen Addiction Severity Index (T-ASI) and the Personal Experience Inventory (PEI).

 

R523-3-7. Standards for Educational Series.

(1) Applicants wishing to certify an intervention, program, activity or curriculum for approval to fulfill the legal requirements of court-referred youth as set forth in Section 41-6a-501 shall submit an application to the Division for review that shows the ability to:

(a) Meet the requirements for listing on Utah's registry of evidence-based programs identified in Section R523-9;

(b) Maintain records documenting the location, fees collected, date(s)of service, attendance and course completion or failure to complete;

(c) Serve youth in settings that are segregated from adults;

(d) Serve low risk youth and high risk youth in separate groups.

(e) Provide accurate information about the harms of underage drinking and drug use and be designed to promote compliance with Utah laws.

(4) All individuals working with youth shall complete a background check that meets the standards for working with vulnerable populations. This must be completed before engaging in or participating in youth programs or activities under this rule.

 

R523-3-8. Standards for Substance Use Disorder Treatment.

(1) All programs shall maintain the appropriate license from the Department of Human Services, Office of Licensing for the services being provided.

(2) All programs shall submit Treatment Episode Data (TEDs) admission and discharge data as outlined in the Division's most current Division Directives.

(3) Programs shall evaluate all participants for criminogenic risk and need, and deliver services that target the specific risk and needs identified.

(4) Youth with high risk and youth with low risk to reoffend shall be treated separately.

(5) Programs shall coordinate and communicate with the Juvenile Court, Juvenile Justice Services, the State Office of Education, and other necessary agencies on a regular and consistent basis as agreed.

(6) Programs shall provide multi-dimensional services that target the validated criminogenic risk factors. (7) Treatment participation and length shall be of sufficient dosage/duration to affect stable behavioral change.

(7) The appropriateness of treatment intensity, duration and modality shall be adjusted based on medical necessity using the current ASAM or comparable mental health criteria and ongoing assessment process.

(a) The Division shall develop performance metrics that evaluate the ability of programs to engage and retain individuals in the appropriate intensity and modality of service.

(8) Treatment programs shall ensure that public funds are the payor of last resort.

(a) Treatment programs shall coordinate or refer youth and families to the Department of Workforce Services or healthcare navigators for assistance with eligibility for public or private insurance plans.

(b) Treatment programs may negotiate and assess usual and customary fees to youth.

(9) Youth treatment programs shall:

(a) Assess youth for substance use and mental health disorders and motivation to seek treatment using validated instruments and protocols;

(b) Identify barriers to treatment participation and develop specific strategies to address each barrier as early as possible;

(c) Diagnose, treat or ensure treatment for co-occurring mental illness;

(d) Provide comprehensive treatment services;

(e) As appropriate and with consent, involve families in the treatment process;

(f) Use developmentally appropriate and informed treatments;

(g) Have qualified, and licensed staff trained to work with youth with substance use disorders and mental illness;

(h) Recognize gender, cultural, and youth differences;

(i) Provide or link to ongoing chronic disease management, recovery supports, monitoring and aftercare services;

(j) Ensure that low risk youth and high risk youth are treated in separate groups;

(k) Use specific evidence-based or evidence-informed clinical interventions, strategies, and procedures to achieve specific treatment goals and objectives;

(l) Youth testing positive for drugs or alcohol shall not be denied entry or removed from treatment from a program solely for positive drug tests.

(m) Programs shall comply with all Division Directives for Drug testing as published in the annual DSAMH Division Directives.

(n) Conduct program evaluation and ongoing process improvement activities;

(o) Agree to allow the Division to perform qualitative review and audits;

(p) Agree to allow program information to be published in the Division's Online Guide to Adolescent Substance Use Disorder Treatment programs in Utah;

(q) Complete and submit the National Survey on Substance Abuse Treatment Services (N-SATTS); and

(r) All individuals working with youth shall complete a background check that meets the standards for working with vulnerable populations prior to beginning employment.

 

R523-3-9. Documentation Standards for Substance Use Disorder and Co-occurring Treatment.

(1) A complete and accurate record of all clinical services shall be kept for each youth served that contains the following information:

(a) Any and all screenings and assessments completed;

(b) Any and all consent forms or required disclosures;

(c) A comprehensive treatment plan;

(d) Progress notes;

(e) Continuing recovery recommendations upon discharge; and

(f) Record reflects cultural and gender specificity in treatment.

(2) The youth record is maintained in a manner so as to protect confidentiality and comply with 42 CFR Part 2 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) documentation/privacy standards. The record is organized, clear, complete, current and legible.

(a) Consent forms for any release of information shall be found in the file.

(b) Consent forms shall be complete, and contain a statement that consent is subject to revocation, shall be signed and dated by the patient, and guardian if the patient is a minor.

(c) Each file shall contain a signed and witnessed Acknowledgement of Receipt of Privacy statement.

(3) The youth record shall contain documentation of the initial assessment/engagement session.

(a) The assessment/engagement identifies presenting problem(s), youth goals and identifies the initial diagnosis.

(b) The assessment/engagement includes a statement of the youth's presenting problem(s) and:

(i) Identification and documentation of acute psychosis, intoxication/withdrawal relevant to the presenting problem;

(ii) Identification and documentation of biomedical conditions and complications relevant to the presenting problem;

(iii) Identification and documentation of emotional; behavioral, cognitive conditions and or complications relevant to the youth's current situation and the presenting problem;

(iv) Identification, evaluation and documentation of the readiness to change relevant to the presenting problem;

(v) Identification and documentation of relapse, or continued problem potential relevant to the presenting problem;

(vi) Identification and documentation of the youth's recovery environment relative to the presenting problem;

(vii) Identification of recovery support services needed relevant to the presenting problem;

(viii) An assessment/engagement summary includes recommendations for level of care and intensity of services needed; and

(ix) Documentation of an assignment for the youth to complete for their next session.

(4) Any and all screenings and assessments shall be documented in the youth file.

(a) The assessment information is current and includes the justification for the assessed level of care and array of services, as well as justification if the level of care is being substituted.

(b) Assessment dimensions are current and are updated as new information is received, new goals are identified and youth progresses or regresses.

(c) Assessment process is ongoing and changes to assessment information are reflected throughout the record.

(d) Level of care and intensity of services are supported by ongoing assessment information, or difference is clinically justified.

(e) Assessment shall be signed and include the title of a person licensed in the State of Utah to diagnose, assess and treat people with mental health and substance use disorders.

(5) A treatment plan that contains the following:

(a) Specific individualized long range goals;

(b) Behaviorally measurable short-term objectives that support long range goals;

(c) Evidence of youth's participation in development of the plan;

(d) Evidence that the plan is based on the youth's goals and other needs identified in the screening and assessments;

(e) Objectives that are measurable, achievable within a specified time frame and reflect developmentally appropriate activities that support progress towards achievement of youth goals;

(f) Substance use disorder treatment plans should be based on the six ASAM Patient Placement Dimensions and shall address critical areas identified in each dimension. Mental Health Recovery Plans shall be organized in a similar manner;

(g) Interventions designed to help the patient complete the objectives; and

(h) Signature and title of a person licensed in the State of Utah to diagnose, assess and treat people with mental health and substance use disorders.

(6) The youth file shall include documentation of the youth's status throughout the youth record including:

(a) Changes in types, schedule, duration and frequency of therapeutic interventions to facilitate youth progress as well as changes in youth objectives and goals;

(b) Each contact shall be documented in a timely manner:

(c) Progress notes shall be kept that identify the date, duration and type of intervention;

(d) Progress notes shall document progress or lack of progress on the youth's goals as well as the clinician's assessment of the youth's changes in behaviors, attitudes and beliefs;

(e) Progress notes shall reflect clinician's assessment of the effectiveness of the therapeutic interventions and plans for future interventions;

(f) Notes shall be legible and signed by a qualified staff indicating appropriate credentials;

(g) No-shows, cancellations or gaps in service such as vacation, incarceration, home visits shall be documented;

(h) Youth and group notes shall be specific and document progress towards achievement of the objectives identified in the treatment plan and as each objective is completed, identify a new objective;

(i) Lack of progress toward treatment/recovery plan goals and resulting adjustments to the recovery plan shall also be documented;

(j) Notes shall reflect behavioral changes as well as changes in attitudes and beliefs;

(k) Other group activities such as psychoeducation, life skills, case management, and recreation may be summarized and dated with the date the activity occurred;

(l) Recovery support services are documented to the extent required for clinical continuity and in order to meet financial requirements;

(m) Changes in assessment information, current level of care and treatment plan; and

(n) Upon discharge, recommendations for ongoing services include the extent to which established goals and objectives were achieved, what ongoing services are recommended, and a description of the youth's recovery support plan.

 

R523-3-10. Certification Procedures for Educational Series and Treatment Programs.

(1) Programs seeking first-time approval or re-approval shall make application to the Division at least 60 days prior to delivering services.

(2) All application forms shall be reviewed by the Division.

(3) The Division shall determine if the application is complete and demonstrates compliance with this rule.

(4) The Division approves the application and determines the program has met all other requirements, the Division shall certify the program for a period of two years.

(5) The Division shall notify all applicants within 30 days of submission of an application, whether the application is:

(a) Approved,

(b) Denied; or

(c) Requires additional information.

(6) If an application for re-approval requires additional information, a previously certified program may continue to provide services for 30 days from the date of notification unless notified by the Department of Human Services to cease and desist.

 

R523-3-11. Corrective Action.

(1) The Division shall notify the Department of Human Services, Office of Licensing immediately if the Division becomes aware of an issue that may affect the imminent health, safety, or well-being of youth.

(2) When the Division becomes aware that a program is in violation of this rule but the violation does likely not affect the imminent health, safety, or well-being of youth, the Division shall:

(a) Identify in writing the specific areas in which the program is not in compliance, and;

(b) Send written notice to the program within 30 days after becoming aware of the violation.

(3) The program shall submit a written plan for achieving compliance within thirty (30) days of notification of noncompliance.

 

R523-3-12. Suspension and Revocation.

(1) The Division may suspend the approval of a program when a program fails to:

(a) Respond in writing to areas of noncompliance identified in writing by the Division within the thirty (30) days.

(b) Comply with the corrective action plan in its written response to the Division; or

(c) Allow the Division access to information or records necessary to determine the program's compliance under this rule.

(2) The Division may revoke approval if a program:

(a) Continues to provide the educational series or treatment services after suspension;

(b) Fails to comply with corrective action while under a suspension; or

(c) Commits a second violation which constitutes grounds for suspension when a previous violation resulted in a suspension during the last 24 months.

(3) The Division shall notify the Juvenile Court, the Division of Juvenile Justice Services, the State Office of Education, the Department of Human Services, Office of Licensing and county local authorities when a certification is suspended or revoked.

 

R523-3-13. Procedure for Denial, Suspension, or Revocation.

(1) If the Division has grounds for action under this rule and intends to deny, suspend or revoke approval of a program, the Division shall notify the applicant or program of the action to be taken.

(2) A notice to suspend or revoke approval shall contain the reasons for the action, to include all statutory or rule violations, and a date when the action shall become effective.

(3) The program may request a meeting with the Director or designee of the Division within ten calendar days of receipt of notification.

(4) A request for a meeting for this purpose shall be in writing.

(5) Within ten days following the close of the meeting, the Division shall inform the program or applicant in writing of the decision of the Division Director or Designee.

 

R523-3-14. Posting of Certified Programs.

(1) The Division shall maintain a current list of certified educational series and treatment programs on its website.

(2) The list of Educational Series programs shall include the contact information for the program, the program's business location, information on the cost of services, the number of hours required to complete the educational series and a short description of the series.

(3) The list of treatment programs shall include the contact information for the programs, the program's business location, and information on the cost of services.

 

KEY: youth adolescent treatment standards, youth offender substance use screening or assessments, youth offender substance use education series, youth offender substance use treatments

Date of Enactment or Last Substantive Amendment: 2015

Authorizing, and Implemented or Interpreted Law: 32B-4-409; 32B-4-410; 32B-4-411; 41-6a-501; 41-6a-502; 41-6a-517; 41-6a-520; 53-3-231; 58-37-8; 58-37a; 58-37b; 62A-15-105(6); 76-9-701; 42CFR Part 2