DAR File No. 39864

Human Services, Substance Abuse and Mental Health

Rule R523-4

Screening, Assessment, Prevention, Treatment and Recovery Support Standards for Adults Required to Participate in Services by the Criminal Justice System

Notice of Proposed Rule

(New Rule)

DAR File No.: 39864
Filed: 10/27/2015 10:03:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In response to the requirement in H.B. 348 passed during the 2015 General Session, this rule prescribes the standards for mental health and substance use disorder screening, assessment, prevention, treatment, education and recovery supports services for adult individuals required to participate in treatment by the court or the Board of Pardons and Parole.

Summary of the rule or change:

This rule provides guidance on: 1) standards for criminogenic risk screening and assessment; 2) standards for substance use disorder and mental health screenings; 3) standards for mental health and substance use disorder assessments; 4) standards for providers of educational or prevention series; 5) standards for community-based treatment programs; 6) standards for jail or prison treatment programs; 7) documentation standards for community and jail/prison based treatment services; 8) certification procedures for educational series and treatment providers; 9) grounds for denial, corrective action, suspension, and revocation of educational series or treatment providers; 10) corrective action; 11) suspension and revocation; 12) procedure for denial, suspension, or revocation; and 13) posting of certified providers.

State statutory or constitutional authorization for this rule:

• Section 63G-4-203
• Subsection 62A-15-103(h)
• 42 CFR Part 2

Anticipated cost or savings to:

the state budget:

This rule will have no impact on the state budget. Justice Reinvestment Initiative (JRI) funds will be contracted primarily to county government. The Division of Substance Abuse and Mental Health (DSAMH) will provide oversight within existing resources. The Utah Department of Corrections (UDC) will also have no financial impact. Programs operated by UDC 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 will be 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 chose to change business practice to meet 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 jhjonesrobbins@utah.gov
• 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 raywinger@utah.gov

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.

R523-4. Screening, Assessment, Prevention, Treatment and Recovery Support Standards for Adults Required to Participate in Services by the Criminal Justice System.

R523-4-1. Authority.

This rule is authorized by Section 62A-15-103(h) requiring the Division of Substance Abuse and Mental Health (Division) to establish by rule, in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, minimum standards and requirements for the provision of substance use disorder and mental health treatment to individuals who are required to participate in treatment by the court or the Board of Pardons and Parole, or who are incarcerated.

 

R523-4-2. Purpose.

This rule prescribes the standards for mental health and substance use disorder screening, assessment, prevention, treatment, education and recovery supports services for adults required to participate in treatment by the court or the Board of Pardons and Parole, or who are incarcerated.

 

R523-4-3. Definitions.

(1) "Assessment" means an in-depth clinical interview with a licensed mental health therapist, used to:

(a) Determine if an individual is in need of:

(i) Mental health or substance use disorder treatment services;

(ii) Educational or Prevention series;

(iii) Recovery support services;

(iv) Services to reduce criminogenic risk factors; or

(v) A combination of Subsection R523-4-3(1)(a)(i) through Subsection R523-4-3(1)(a)(iv).

(b) Recommend a needed level of care or array of services.

(2) "Criminogenic Risk" means offender characteristics that are directly related to researched causation of crime.

(3) "Criminogenic Need" means dynamic or changeable attributes of offenders that are directly linked to criminal behavior that should be targeted to develop a comprehensive treatment plan.

(4) "Educational or Prevention Series" means a court-ordered and evidence-based instructional series for individuals 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.

(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 an individual's mental health issues.

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

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

(8) "Screening" means a preliminary appraisal of an individual to determine if further assessment of mental health, substance use or criminogenic needs is needed.

(9) "Treatment" means the array of therapeutic services, including individual, family, group services, medications and interventions designed to improve and enhance social or psychological functioning and reduce criminogenic risk for individuals identified as having either mental health or substance use disorders. The ultimate goal of treatment services is to engage the individual in a process of recovery.

 

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

(1) Prior to participating in educational, preventative or treatment services adults shall be given a brief, validated, risk and needs screen to determine whether the adult is of low, moderate, or high risk to re-offend.

(a) For individuals over the age of eighteen (18), 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) Screenings shall:

(a) Be conducted by an individual that has completed training recommended by the developer of the specific instrument being used and/or approved by the Division;

(b) 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 or moderate likelihood of re-offending the adult shall be given an in-depth assessment of criminogenic risk and need.

(a) The Level of Service/Risk, Need, Responsivity (LS/RNR) shall be used for males.

(b) The Women's Risk Needs Assessment (WRNA) shall be used for females.

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

 

R523-4-5. Standards for Substance Use and Mental Health Disorder Screenings.

(1) Adults shall be screened using an instrument(s) that has been evaluated and found reliable and valid by the scientific community to determine whether the adult is in need of a comprehensive assessment.

(2) Screenings shall be:

(a) Conducted by an individual that has completed training recommended by the developer of the specific instrument being used and/or approved by the Division;

(b) Trauma-sensitive, developmentally appropriate, culturally sensitive, short, simple, and easy to administer and interpret by a wide variety of professionals who work with adults.

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

(4) Screenings shall not be used to determine diagnosis but may assist in determining the need for further assessment.

 

R523-4-6. Standards for and Substance Use and Mental Health Disorder Assessments.

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

(2) Assessments shall identify the individual's need for Substance Use Disorder or Mental Health services in the following modified ASAM Patient Placement Criteria dimensions:

(a) Risk of acute psychosis, intoxication/withdrawal;

(b) Biomedical conditions or complications;

(c) Emotional, behavioral, or cognitive conditions;

(d) Readiness to change;

(e) Relapse, continued use or continued problem potential; and

(f) Recovery environment.

(3) The assessment shall include relevant information on:

(a) The individual's psychosocial function, substance use including tobacco/nicotine, mental and physical health, and other factors, such as educational experiences, trauma history, cultural issues, legal involvement, risk to criminally re-offend and family relationships that are relevant to the purpose of the assessment;

(b) Strengths, resiliencies, natural supports, interests of the individual, and an evaluation of the individual's unique abilities;

(c) Developmental and functional levels, social, emotional, communication abilities and strengths, and independent living skills;

(d) Cognitive, social, and affective development; family, peer, and intimate relationships; trauma; current or past emotional, physical or sexual abuse; suicidality; and safety;

(e) Collateral information from other sources that are relevant to the individual's situation and provides insight into the issues in Subsection R523-4-6(2)(a) through (2)(d).

(4) The assessment will include a diagnosis when clinically indicated.

(5) Based on the screening and the assessment, the assessor shall make recommendations regarding the needed level of care and services to address the identified clinical and criminogenic needs.

(6) The level of care and array of services shall be based on the ASAM or equivalent Mental Health criteria.

 

R523-4-7. Standards for Providers of Educational or Prevention Series.

(1) Entities wishing to provide an intervention, program, activity or curriculum to fulfill the legal requirements of court-referred individuals set forth in Subsection 62A-15-103(h) shall:

(a) Obtain and maintain an outpatient or residential facility license from the Department of Human Services, Office of Licensing.

(b) Submit an application to the Division for review that includes a description of how their proposed intervention, activity, or curriculum:

(i) Meets the requirements for listing on Utah's registry of evidence-based practices identified in Section R523-9;

(ii) Addresses the substance use, mental health and criminogenic needs of the targeted population;

(iii) Meets the requirements set forth in Subsection 62A-15-103(h) and Subsection R523-4-7(1)(b) through 1(f).

(c) Not implement any educational programs until approved by the Division.

(d) Maintain records documenting the individual's attendance and course completion or failure to attend and/or complete.

(e) Shall not include minors in adult groups.

(f) Serve low criminogenic risk individuals and high criminogenic risk individuals separately.

(g) Provide accurate information and be designed to promote compliance with Utah laws.

 

R523-4-8. Standards for Community-based Treatment Programs.

(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) Individuals with high risk and individuals with low risk to re-offend shall be treated separately.

(5) Programs shall coordinate and communicate with Adult Probation and Parole, county sheriff's offices, or other necessary criminal justice agencies on a regular and consistent basis as agreed.

(6) Programs shall provide multi-dimensional treatment that targets the validated criminogenic risk factors.

(7) Treatment participation and length shall be of sufficient dosage/duration to affect stable behavioral change.

(8) Treatment intensity, duration and modality shall be based on the current ASAM or comparable mental health criteria and medical necessity determined by the ongoing assessment process.

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

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

(a) Treatment programs shall coordinate or refer individuals 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 adults.

(11) Treatment programs shall:

(a) First assess level of motivation for treatment and implement strategies to increase engagement;

(b) Assess individuals for mental health, substance use disorder and other criminogenic risks using validated instruments and protocols;

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

(d) Develop an individualized treatment plan that identifies a comprehensive set of tools and strategies that address the client's identifiable strengths as well as her or his problems and deficits;

(e) Provide comprehensive treatment services;

(f) As appropriate and with consent, involve families and support persons in the treatment and recovery process;

(g) Use developmentally appropriate and informed treatments;

(h) Monitor drug use through drug testing and other means;

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

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

(i) Have qualified staff licensed and capable of assessing individuals for both mental health and substance use disorders;

(j) Recognize gender, cultural, linguistic, and other individual differences in their treatment approach;

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

(l) Ensure all individuals with alcohol and/or opioid disorders shall be educated and screened for the potential use of medication-assisted treatment; and

(m) Develop strategies to screen for, prevent, and refer to treatment adults with serious chronic conditions such as HIV/AIDS, Hepatitis B and C, and tuberculosis.

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

(12) Treatment programs shall work with individuals to identify needed and desired recovery supports.

(a) Participation in recovery support shall be voluntary.

(b) Whenever possible, individuals shall be encouraged and given a choice of potential recovery support services and a choice of programs.

(c) Services such as case management, housing, employment training, transportation, childcare, healthcare, and peer support may be provided before, during or after the completion of acute treatment services.

 

R523-4-9. Standards for Jail or Prison Treatment Programs.

(1) Individuals should be screened for criminogenic risk, mental health, substance use disorders and substance withdrawal syndromes.

(2) Individuals with signs and symptoms of withdrawal should receive timely medical care or a transfer to a more appropriate facility that can provide standard detoxification services.

(3) Jail or prison-based treatment service providers shall coordinate care with community-based treatment providers so that individuals may transition to treatment services in the community.

(4) Treatment programs shall:

(a) First assess level of motivation for treatment and implement strategies to increase engagement;

(b) Assess individuals for mental health, substance use disorders and criminogenic risk using scientifically validated instruments and protocols;

(c) Diagnose and treat or ensure treatment for co-occurring conditions;

(d) Provide comprehensive treatment services;

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

(f) Use developmentally appropriate and informed treatments;

(g) Monitor drug use through drug testing and other means;

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

(h) Have qualified staff licensed and capable of assessing individuals for both mental health and substance use disorders.

(i) Recognize gender, cultural, linguistic, and other individual differences in their treatment approach;

(j) Provide ongoing chronic disease management, recovery support, monitoring and link to needed community supports

(k) All individuals with alcohol and/or opioid disorders shall be educated and screened for the potential use of medication-assisted treatment.

(l) Treatment providers shall develop strategies to screen for, prevent, and refer to treatment adults with serious chronic conditions such as HIV/AIDS, Hepatitis B and C, and tuberculosis.

(m) Work with individuals to identify needed and desired recovery supports.

(i) Recovery supports may include preparation/planning for housing, employment, healthcare, peer support or other services upon release.

(ii) Recovery supports may be provided before, during or after the completion of acute treatment services.

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

 

R523-4-10. Documentation Standards for Community and Jail/Prison Based Treatment Services.

(1) A complete and accurate record of all clinical services shall be kept for each individual 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 individual 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, and shall be signed and dated by the patient.

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

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

(a) The assessment/engagement session identifies presenting problems, individual goals and http://useonlyasdirected.org/get-help-now/initial diagnosis.

(b) The assessment/engagement session includes a statement of the individual'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 individual's current situation and presenting problem.

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

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

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

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

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

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

(4) Any and all screenings and assessments shall be documented in the individual 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 level of care is being substituted.

(b) Assessment dimensions are current and are updated as new information is received, new goals are identified, and as the individual 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 the individual's participation in development of the plan;

(d) Evidence that the plan is based on the individual'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 individual 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 individual file shall include documentation of the individual's status throughout the individual record including:

(a) Changes in types, schedule, duration and frequency of therapeutic interventions to facilitate individual progress as well as changes in individual 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 individual's goals as well as the clinician's assessment of the individual'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 or home visits shall be documented;

(h) Individual and group notes shall be specific and document progress towards achievement of the objectives identified in the recovery 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 individual's recovery support plan.

 

R523-4-11. Certification Procedures for Educational Series and Treatment Providers.

(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 in writing 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.

 

R523-4-12. Corrective Action.

(1) When the Division becomes aware that a provider is in violation of this rule the Division shall:

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

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

(2) The provider shall submit a written plan for achieving compliance within 30 days of notification of noncompliance.

 

R523-4-13. Suspension and Revocation.

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

(a) Respond in writing to areas of noncompliance identified in writing by the Division within the defined period;

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

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

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

(a) Continues to provide the educational series 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 Administrative Office of the Courts, the Utah Department of Corrections, the Department of Human Services, Office of Licensing and county local authorities when a certification is suspended or revoked.

 

R523-4-14. 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 provider, the Division shall notify the applicant or provider 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 provider may request a meeting with the Director or their designee 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 provider or applicant in writing of the decision of the Director or Designee of the Division.

 

R523-4-15. Posting of Certified Providers.

(1) The Division shall maintain and make public a list of all certified educational or prevention series and treatment programs.

(2) The list shall include agency contact information, service location address, target population, information on cost and reimbursement policies, and a brief description of the program.

 

KEY: offender substance abuse screenings, offender substance abuse assessments, offender substance abuse education series, offender substance abuse treatments

Date of Enactment or Last Substantive Amendment: 2015

Authorizing, and Implemented or Interpreted Law: 62A-15-103(h); 42 CFR Part 2