No. 40930 (Repeal and Reenact): Rule R501-21. Outpatient Treatment Programs

(Repeal and Reenact)

DAR File No.: 40930
Filed: 11/01/2016 06:20:36 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this repeal and reenactment is to update and clarify outpatient treatment requirements for the Department of Human Services (DHS) licensure with the Office of Licensing.

Summary of the rule or change:

This rule defines outpatient treatment program per H.B. 259 from the 2016 General Session. It also sets expectations and requirements for outpatient treatment licensure with DHS Office of Licensing.

Statutory or constitutional authorization for this rule:

• Title 62A, Chapter 2

Anticipated cost or savings to:

the state budget:

It is anticipated that more programs will be identified as needing licensure, based on the new definition of outpatient treatment program. This will be neither a cost or savings to the state as the fees should about cover the added state efforts.

local governments:

It is not anticipated that this will increase the costs to local government. It is possible that a local government could be required to license when they previously were not required to, but it is more likely any local government that requires this license already has it. In fact, the requirements are lessened in this new rule from the previous rule because outpatient treatment licenses will no longer be held to the standards of Rule R501-2. Costs related to CPR certification and other administrative aspects of Rule R501-2 have been replaced with easier-to-meet regulations that, in general, will cost less. It is possible that some providers providing medication-assisted treatment will have a few more requirements, but they are likely offset by other changes in the rule.

small businesses:

It is not anticipated that this will increase the costs to small businesses. It is possible that small businesses could be required to license when they previously were not required to. For that business, the increased cost will be the licensing fee of $900 for the first year and $300 in subsequent years, plus any individualized cost of meeting compliance requirements which would vary greatly across providers. Most small business providers that need to be licensed are likely already are. For those already licensed, the requirements are lessened in this new rule from the previous rule because outpatient treatment licenses will no longer be held to the standards of Rule R501-2. Costs related to CPR certification and other administrative aspects of Rule R501-2 have been replaced with easier-to-meet regulations that in general will cost less and are available online for free. It is possible that some providers providing medication-assisted treatment will have a few more requirements, but they are likely offset by other changes in the rule. So, for providers that are now captured by the new definition of outpatient treatment program, there will be increased costs related to initial licensing. However, most outpatient treatment providers are likely already licensed, and for those providers, compliance should, on the whole, be made even easier than previous rule.

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

It is not anticipated that persons other than small businesses, businesses, or local government entities would be affected by this rule change. Any individual affected would be captured under small businesses above and the same information would apply.

Compliance costs for affected persons:

The compliance costs for programs that were not previously licensed for outpatient treatment but now will be required to will essentially be the licensing fees of $900 for an initial license and $300 yearly after that for renewal, as well as any costs required to actually comply with the regulations. Those costs are thought to be minimal since most people providing these services will likely already be in compliance with the bulk of these basic health and safety standards. Individual persons are not required to license as this license type is for programs. It is important to note that there are exclusions both in statute and in rule to limit who needs to license under the outpatient treatment program definition.

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

This rule expands the definition of outpatient treatment program to include some entities that were not previously licensed and would now be required to pay fees and come in compliance with licensure. This expansion is a direct result of H.B. 259 (2016) in order to address substance abuse fraud and establish basic health and safety standards across providers. However, it also reduces the requirements of the license for most currently licensed outpatient treatment providers. So, some providers may experience some minimal cost savings.

Ann Williamson, Executive Director

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

Human Services
Administration, Administrative Services, Licensing
195 N 1950 W 1ST FLR
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 [e-mail]
• Diane Moore at the above address, by phone at 801-538-4235, by FAX at 801-538-4553, or by Internet E-mail at [e-mail]

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:

12/15/2016

This rule may become effective on:

12/22/2016

Authorized by:

Diane Moore, Director

RULE TEXT

R501. Human Services, Administration, Administrative Services, Licensing.

[R501-21. Outpatient Treatment Programs.

R501-21-1. Authority.

Pursuant to Section 62A-2-101 et seq., the Office of Licensing, shall license outpatient treatment programs according to the following rules.

 

R501-21-2. Purpose.

Outpatient treatment programs shall serve consumers who require less structure than offered in day treatment or residential treatment programs. Consumers are provided treatment as often as determined and noted in the treatment plan.

 

R501-21-3. Definition.

Outpatient treatment program means individual, family, or group therapy or counseling designed to improve and enhance social or psychological functioning for those whose physical and emotional status allows them to continue functioning in their usual living environment in accordance with Subsection 62A-2-101(12).

 

R501-21-4. Administration.

A. In addition to the following rules, all Outpatient Treatment Programs shall comply with R501-2, Core Standards.

B. A current list of enrollment of all registered consumers shall be on-site at all times.

 

R501-21-5. Staffing.

Professional staff shall include at least one of the following individuals who has received training in the specific area listed below:

A. Mental Health

1. a licensed physician, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. If unlicensed staff are used, they shall not supervise clinical programs. Unlicensed staff shall be trained to work with psychiatric consumers and be supervised by a licensed clinical professional.

B. Substance Abuse

1. a licensed physician, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. A licensed substance abuse counselor or unlicensed staff who work with substance abusers shall be supervised by a licensed clinical professional.

6. Opioid outpatient treatment programs shall have a licensed physician who is an American Society of Addiction Medicine certified physician or who can document specific training in methadone treatment for opioid addictions or who can document specific training or experience in methadone treatment for opioid addictions. Physicians prescribing buprenorphine must show proof of completion of federally required physician training.

C. Children and Youth

1. a licensed psychiatrist, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. If the following individuals are used they shall not supervise clinical programs: A person with a graduate degree in counseling, psychiatric nursing, marriage and family therapy, social work or psychology who is working toward a clinical license, and has been approved by the Division of Occupational and Professional Licensing for the appropriate supervision, or a second year graduate student training for one of the above degrees.

D. Domestic Violence

1. a licensed psychiatrist, or

2. a licensed psychologist, or

3. a licensed clinical social worker, or

4. a licensed marriage and family therapist, or

5. a licensed professional counselor, or

6. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist, or

7. a person with a graduate degree in counseling, psychiatric nursing, marriage and family therapy, social work or psychology who is working toward a clinical license, and has been approved by the Division of Occupational and Professional Licensing for the appropriate supervision, or

8. a second year graduate student in training for one of the above degrees, or

9. a licensed social services worker with at least three years of continual, full time, related experience, when practicing under the direction and supervision of a licensed clinical professional.

10. Individuals from categories 7. and 8. above shall not supervise clinical programs. Individuals in category 9 above shall not supervise clinical programs, and may only co-facilitate group therapy sessions with a person qualified per paragraphs 1. through 6. above.

 

R501-21-6. Direct Service.

A. Treatment plans shall be developed based on assessment and evaluation of individual consumer needs. The treatment may be consultive and may include medication management.

B. Treatment plans shall be reviewed and signed by a licensed clinical professional as frequently as determined in the treatment plan.

C. Except for Domestic Violence, individual, group, couple, or family counseling sessions shall be provided to the consumer as frequently as determined in the treatment plan. In the consumer's record and in the progress notes, the date of the session and the provider shall be documented. Treatment sessions may be provided less frequently than once a month if approved by the clinical supervisor and justified in the consumer record.

D. Domestic violence treatment programs shall comply with generally accepted practices in the current domestic violence literature and the following requirements:

1. Maintain and document cooperative working relationships with domestic violence shelters, treatment programs, referring agencies, custodial parents when the consumer is a minor and local domestic violence coalitions. If the consumer is a perpetrator, contact with victims, current partner, and the criminal justice referring agencies is also required, as appropriate.

2. Treatment sessions for each perpetrator, not including orientation and assessment interviews, shall be provided for at least one hour per week for a minimum of sixteen weeks. Treatment sessions for children and victims shall offer a minimum of 10 sessions for each consumer not including intake or orientation.

3. Staff to Consumer Ratio:

a. The staff to consumer ratio in adult treatment groups shall be one to eight for a one hour long group or one to ten for an hour and a half long group. The maximum group size shall not exceed sixteen.

b. Child victim or child witness groups shall have a ratio of one staff to eight children when the consumers are under twelve years of age, and a one staff to ten children ratio when the consumers are twelve years of age or older.

c. When any consumer enters a treatment program the staff shall conduct an in-depth, face to face interview and assessment to determine the consumer's clinical profile and treatment needs. For perpetrator consumers, additional information shall be obtained from the police incident report, perpetrator's criminal history, prior treatment providers, and the victim. When appropriate, additional information for child consumers shall be obtained from parents, prior treatment providers, schools and Child Protective Services. When any of the above information cannot be obtained the reason shall be documented. The assessment shall include the following:

1) a profile of the frequency, severity and duration of the domestic violence behavior, which includes a summary of psychological violence,

2) documentation of any homicidal, suicidal ideation and intentions as well as abusive behavior toward children,

3) a clinical diagnosis and a referral for evaluation to determine the need for medication if indicated,

4) documentation of safety planning when the consumer is an adult victim, child victim, or child witness, and that they have contact with the perpetrator. For victims who choose not to become treatment consumers, safety planning shall be addressed when they are contacted, and

5) documentation that appropriate measures have been taken to protect children from harm.

4. Consumers deemed appropriate for a domestic violence treatment program shall have an individualized treatment plan, which addresses all relevant treatment issues. Consumers who are not deemed appropriate for domestic violence programs shall be referred to the appropriate resource, with the reasons for referral documented and notification given to the referring agency. Domestic violence counseling shall be provided when appropriate, concurrently with or after other necessary treatment.

5. Conjoint or group therapy sessions with victims and perpetrators together or with both co-perpetrators shall not be provided until a comprehensive assessment has been completed to determine that the violence has stopped and that conjoint treatment is appropriate. The perpetrator must complete a minimum of 12 domestic violence treatment sessions prior to implementing conjoint therapy.

6. A written procedure shall be implemented to facilitate the following in an efficient and timely manner:

a. entry of the court ordered defendant into treatment,

b. notification of consumer compliance, participation or completion,

c. disposition of non-compliant consumers,

d. notification of the recurrence of violence, and

e. notification of factors which may exacerbate an individual's potential for violence.

7. Comply with the "Duty to Warn," Section 78B-3-502.

8. Document specialized training in domestic violence assessment and treatment practices including 24 hours of pre-service training within the last two years and 16 hours of training annually thereafter for all individuals providing treatment services.

9. Clinical supervision for treatment staff who are not clinically licensed shall consist of a minimum of an hour a week to discuss clinical dynamics of cases.

E. Opioid outpatient treatment programs shall:

1. Admit consumers to the program and dispense medications only after the completion of a face to face visit with a licensed practitioner having authority to prescribe controlled substances who confirms the opioid dependence. A licensed practitioner having authority to prescribe controlled substances must approve every subsequent dose increase prior to the change.

2. Assure all consumers see the physician at least once yearly.

3. Require all consumers admitted to the program to participate in random, drug testing. Drug testing will be performed by the program minimally, 2 times per month for the first 3 months of treatment, and monthly thereafter, except for a consumer whose lack of progress shall require more frequent drug testing for a longer period of time.

4. Require consumers to participate in counseling sessions at least 1 hour per week for the first 90 days. Upon successful completion of this phase of treatment, consumers shall be required to participate in counseling 2 hours per month for the next 6 months. Upon successful completion of 9 months of treatment, consumers shall be seen at least monthly thereafter until discharge. Exceptions to this requirement must be approved in writing by the Division of Substance Abuse and Mental Health.

5. Maintain a staff to consumer ratio of:

a. 1 counselor to every 50 consumers.

b. 1 hour of physician time at the program site each month for every 10 consumers enrolled.

c. 1 FTE nurse to dispense medications for every 150 consumers dosing on an average daily basis.

6. Comply with R523-21-1 Rules Governing Methadone Providers.

 

R501-21-7. Physical Environment.

A. The program shall provide written documentation of compliance with the following:

1. local zoning ordinances,

2. local business license requirements,

3. local building codes,

4. local fire safety regulations, and

5. local health codes.

B. Building and Grounds

1. The program shall ensure that the appearance and cleanliness of the building and grounds are maintained.

2. The program shall take reasonable measures to ensure a safe physical environment for consumers and staff.

 

R501-21-8. Physical Facility.

A. Space shall be provided for private and group counseling sessions.

B. The program shall have storage for the following:

1. locked storage for medications, and

2. locked storage for hazardous chemicals and materials, according to the direction of the local fire authorities.

C. Equipment

1. Furniture and equipment shall be of sufficient quantity, variety, and quality to meet program and consumer plans.

2. All furniture and equipment shall be maintained in a clean and safe condition.

D. Bathrooms

1. Bathrooms shall accommodate physically disabled consumers.

2. Each bathroom shall be maintained in good operating order and be properly equipped with toilet paper, towels, and soap.

3. Bathrooms shall be ventilated by mechanical means or equipped with a screened window that opens.]

R501-21. Outpatient Treatment Programs.

R501-21-1. Authority.

(1) Pursuant to Section Title 62A Chapter 2, the Office of Licensing shall license outpatient treatment programs according to the following rules.

 

R501-21-2. Purpose.

(1) Outpatient treatment programs shall serve consumers who require less structure than offered in day treatment or residential treatment programs.

 

R501-21-3. Definition.

(1) "Outpatient Treatment Programs" means two or more individuals, at least one of whom provides outpatient treatment and also meets one or more of the following criteria:

(a) allows agents, contractors, persons with a financial interest, staff, volunteers, or individuals who are not excluded under R501-21-3-2 to either:

(i) provide direct client services, including case management, transportation, assessment, screening, education, or peer support services. Direct client services do not include office tasks unrelated to client treatment, such as: billing, scheduling, standard correspondence and payroll; or

(ii) manage or direct program operations, including intake, admissions or discharge, setting of fees, or hiring of staff.

(b) Offers outpatient treatment services to satisfy criminal court requirements.

(c) Is required by DHS contract to be licensed for outpatient treatment.

(d) Provides services requiring DUI Education Certification, or Justice Certification by the Division of Substance Abuse and Mental Health as authorized in 62A-15-103 and described in R523-4 and R523-11.

(2) The following individuals are excluded from subsection (1) above:

(a) individuals who are exempt from individual professional licensure under Utah Code 58-1-307;

(b) individuals who are licensed, certified, or authorized under Utah Code 58, Chapters 60, 61, 67, 68; and

(c) entities that are excluded under 62A-2-110.

 

R501-21-4. Administration and Direct Services.

(1) In addition to the following rules, all outpatient treatment programs shall comply with R501-1 General Provisions and R501-14 Background Screening Rules.

(2) Programs shall have current program information readily available to the Office and the public, including a description of:

(a) program services;

(b) the client population served;

(c) program requirements and expectations;

(d) information regarding any non-clinical services offered;

(e) costs, fees, and expenses that may be assessed, including any non-refundable costs, fees or expenses; and

(f) complaint reporting and resolution processes.

(3) The Program shall:

(a) provide outpatient and/or intensive outpatient treatment services not to exceed nineteen hours per week, as clinically recommended and documented;

(b) identify and provide to the Office the organizational structure of the program including:

(i) names and titles of owners, directors and individuals responsible for implementing all aspects of the program, and

(ii) a job description, duties and qualifications for each job title;

(c) identify a director or qualified designee who shall be immediately available at all times that the program is in operation;

(d) ensure at least one CPR/First Aid trained or certified staff member is present at all times with clients;

(e) disclose any potential conflicts of interest to the Office;

(f) ensure that staff are licensed or certified in good standing as required and that unlicensed individuals providing direct client services shall do so only in accordance with the Mental Health Professional Practices Act;

(g) train and monitor staff compliance regarding:

(i) program policy and procedures;

(ii) the needs of the program's consumers;

(iii) Office of Licensing rule 501-21 and annual training on the Licensing Code of Conduct and client rights as outlined in R501-1-12;

(iv) emergency procedures;

(h) create and maintain personnel files for each staff member to include:

(i) applicable qualifications, experience, certifications and licenses;

(ii) approved and current Office of Licensing background screening except as excluded in 501-14-17; and

(iii) training records with date completed, topic and employee signature(s) verifying completion.

(i) comply with Office rules and all local, state and federal laws;

(j) maintain proof of financial viability of the program;

(k) maintain general liability insurance, professional liability insurance that covers all program staff, vehicle insurance for transport of clients, fire insurance and any additional insurance required to cover all program activities; and

(l) maintain proof of completion of the National Mental Health Services Survey (NMHSS) annually if providing mental health services; and

(m) ensure that all programs and individuals involved with the prescription, administration or dispensing of controlled substances shall do so per state and federal law, including maintenance of DEA registration numbers for:

(a) all prescribing physicians; and

(b) the specifics site where the controlled substances are being prescribed, as required.

(5) The program shall develop, implement and comply with policies and procedures sufficient to ensure the health and safety and meet the needs of the client population served. Policies and procedures shall address:

(a) client eligibility;

(b) intake and discharge process;

(c) client rights as outlined in R501-1-12;

(d) staff and client grievance procedures;

(e) behavior management;

(f) medication management;

(g) critical incident reporting as outlined in R501-1-2-6 and R501-1-10-2d;

(h) emergency procedures;

(i) transportation of clients to include requirement of insurance, valid driver license, driver and client safety and vehicle maintenance;

(j) firearms;

(k) client safety including any unique circumstances regarding physical facility, supervision, community safety and mixing populations; and

(l) provision of client meals, administration of required medications, maximum group sizes, and sufficient physical environment providing for the comfort of clients when clients are present for six or more consecutive hours.

(6) Programs shall maintain client files to include the following:

(a) client name, home address, email address, phone numbers, date of birth and gender;

(b) legal guardian and emergency contact names, address, email address and phone numbers;

(c) all information that could affect the health, safety or well-being of the client including all medications, allergies, chronic conditions or communicable diseases;

(d) intake assessment;

(e) treatment plan signed by the clinical professional or service plan for non-clinical services;

(f) detailed documentation of all clinical and non-clinical services provided with date and signature of staff completing each entry;

(g) signed disclosure statement including Medicaid number, insurance information and identification of any other entities that are billed for the client's services;

(h) client or guardian signed consent or court order of commitment to services in lieu of signed consent, for all treatment and non-clinical services; and

(i) grievance and complaint documentation.

(7) Programs shall document a plan detailing how all program, staff, and client files shall be maintained and remain available for the Office and other legally authorized access, for seven years, regardless of whether or not the program remains licensed.

(8) The program shall ensure that assessment, treatment and service planning practices are clinically appropriate, updated as needed, timely, individualized, and involve the participation of the client or guardian.

(9) Programs shall maintain documentation of all critical incidents; critical incident reports shall contain:

(a) time of incident;

(b) summary of incident;

(c) individuals involved; and

(d) program response to the incident.

 

R501-21-5. Physical Facility.

(1) Space shall be adequate to meet service needs and ensure client confidentiality and comfort.

(2) The program shall maintain potentially hazardous items on-site lawfully, responsibly and with consideration of the safety and risk level of the population(s) served.

(3) All furniture and equipment shall be maintained in a clean and safe condition.

(4) Programs offering supplemental services or activities in addition to outpatient treatment shall:

(a) remain publically transparent in the use of the equipment, practices and purposes;

(b) ensure the health and safety of the consumer;

(c) gain informed consent for participation in supplemental services or activities; and

(d) provide verification of all trainings or certifications as required for the operation and use of any supplemental equipment.

(5) The program shall post the following documents where they are clearly visible by clients, staff, and visitors:

(a) Civil Rights and anti-discrimination laws;

(b) program license;

(c) current or pending Notices of Agency Action;

(d) abuse and neglect reporting laws; and

(e) client rights and grievance process.

(6) The program site shall provide access to a toilet and lavatory sink in a manner that ensures basic privacy, and shall be:

(a) stocked with toilet paper, soap, and paper towels/dryer; and

(b) maintained in good operating order and kept in a clean and safe condition.

(7) The program shall ensure that the physical environment is safe for consumers and staff and that the appearance and cleanliness of the building and grounds are maintained.

 

R501-21-6. Substance Use Disorder Treatment Programs.

(1) All substance use disorder treatment programs shall develop and implement a plan on how to support opioid overdose reversal.

(2) Maintain proof of completion of the National Survey of Substance Abuse Treatment Services (NSSATS) annually.

(3) Medication-assisted treatment (MAT) in substance use disorder programs shall:

(a) maintain a program-wide counselor to MAT consumer ratio of: 1:50;

(b) assure all consumers see a licensed practitioner that is authorized to prescribe controlled substances at least once yearly;

(c) show proof of completion of federally required physician training for physicians prescribing buprenorphine;

(d) admit consumers to the program and prescribe, administer or dispense medications only after the completion of a face-to-face visit with a licensed practitioner having authority to prescribe controlled substances who confirms opioid dependence. A licensed practitioner having authority to prescribe controlled substances must approve every subsequent dose increase prior to the change;

(e) require all consumers admitted to the program to participate in random drug testing. Drug testing will be performed by the program a minimum of two times per month for the first three months of treatment, and monthly thereafter; except for a consumer whose documented lack of progress shall require more frequent drug testing for a longer period of time;

(f) require that consumers participate in at least one counseling session per week for the first 90 days. Upon documented successful completion of this phase of treatment, consumers shall be required to participate in counseling sessions at least twice monthly for the next six months. Upon documented successful completion of nine months of treatment, consumers shall be seen by a licensed counselor at least monthly thereafter until discharge; and

(g) require one hour of prescribing practitioner time at the program site each month for every ten MAT consumers enrolled.

(4) MAT Programs prescribing, administering or dispensing Methadone (Opioid Treatment Programs) shall:

(a) maintain Substance Abuse and Mental Health Services Administration (SAMHSA) certification and accreditation as an opioid treatment program.

(b) comply with DSAMH Rule R523-10 Governing Methadone and other opioid treatment service providers;

(c) employ a:

(i) licensed physician who is an American Society of Addiction Medicine certified physician; or

(ii) prescribing licensed practitioner who can document specific training in current industry standards regarding methadone treatment for opioid addictions; or

(iii) prescribing licensed practitioner who can document specific training or experience in methadone treatment for opioid addictions; and

(d) provide one nurse to dispense or administer medications for every 150 Methadone consumers dosing on an average daily basis.

(5) Certified DUI Education Programs

(a) Only programs certified with the Division of Substance Abuse and Mental Health (DSAMH) to provide Prime for Life education in accordance with R523-4 and R523-11 shall provide court ordered DUI education.

(b) Certified DUI education programs shall:

(i) complete and maintain a substance use screening for each participant prior to providing the education course;

(A) screenings may be shared between providers with client written consent.;

(ii) provide a workbook to each participant to keep upon completion of the course;

(iii) ensure at least 16 hours of course education; and

(iv) provide separate classes for adults and youth.

(c) Any violations of this rule section will be reported to DSAMH for evaluation of certification.

(6) Justice Reform Initiative (JRI) Certified Programs

(a) JRI certified programs shall maintain a criminogenic screen/risk assessment for each justice involved client and separate clients into treatment groups according to level of risk assessed.

(b) Providers shall complete screenings that assess both substance abuse and mental health comorbidity.

(c) JRI programs shall treat, or refer to other DHS licensed programs that have obtained a justice certification from the DSAMH to treat the array of disorders noted in screenings.

(d) Any violations of this rule section shall be reported to DSAMH for evaluation of certification.

 

R501-21-7. Domestic Violence.

(1) Domestic Violence (DV) treatment programs shall comply with generally accepted and current practices in domestic violence treatment, and shall meet the following requirements:

(a) maintain and document cooperative working relationships with domestic violence shelters, treatment programs, referring agencies, custodial parents when the consumer is a minor, and local domestic violence coalitions;

(i) treatment sessions for children and victims shall offer a minimum of ten sessions for each consumer, not including intake or orientation;

(b) if the consumer is a perpetrator, program contact with the victims, current partner, and the criminal justice referring agencies is also required, as appropriate;

(i) treatment sessions for each perpetrator, not including orientation and assessment interviews shall be provided for at least one hour per week, for a minimum of 16 weeks.

(2) Staff to Consumer Ratio

(a) The staff to consumer ratio in adult treatment groups shall be one staff to eight consumers, for a one hour long group; or one staff to ten consumers for an hour and a half long group. The maximum group size shall not exceed 16.

(b) Child victim, or child witness groups shall have a ratio of one staff to eight children, when the consumers are under 12 years of age; and a ratio of one staff to ten children when the consumers are 12 years of age and older.

(3) Client Intake and Safety

(a) When any consumer enters a treatment program, the staff shall conduct an in-depth, face-to-face interview and assessment to determine the consumer's clinical profile and treatment needs.

(b) For perpetrator consumers, additional information shall be obtained from the police incident report, perpetrator's criminal history, prior treatment providers, and the victim.

(c) When appropriate, additional information for child consumers shall be obtained from parents, prior treatment providers, schools, and Child Protective Services.

(d) When any of the above cannot be obtained, the reason shall be documented.

(e) The assessment shall include the following:

(i) a profile of the frequency, severity, and duration of the domestic violence behavior, which includes a summary of psychological violence;

(ii) documentation of any homicidal, suicidal ideation and intentions, as well as abusive behavior towards children;

(iii) a clinical diagnosis and a referral for evaluation to determine the need for medication, if indicated;

(iv) documentation of safety planning when the consumer is an adult victim, child victim, or child witness; and that they have contact with the perpetrator;

(A) for victims who choose not to become treatment consumers, safety planning shall be addressed when they are contacted; and

(v) documentation that appropriate measures have been taken to protect children from harm.

(4) Treatment Procedures

(a) Consumers deemed appropriate for a domestic violence treatment program shall have an individualized treatment plan, which addresses all relevant treatment issues.

(b) Consumers who are not deemed appropriate for domestic violence programs shall be referred to the appropriate resource, with the reasons for referral documented, and notification given to the referring agency.

(c) Domestic violence counseling shall be provided concurrently with, or after other necessary treatment, when appropriate.

(d) Conjoint or group therapy sessions with victims and perpetrators together, or with both co-perpetrators, shall not be provided until a comprehensive assessment has been completed to determine that the violence has stopped, and that conjoint treatment is appropriate.

(e) The perpetrator must complete a minimum of 12 domestic violence treatment sessions prior to the provider implementing conjoint therapy.

(f) A written procedure shall be implemented to facilitate the following, in an efficient and timely manner:

(i) entry of the court ordered defendant into treatment;

(ii) notification of consumer compliance, participation, or completion;

(iii) disposition of non-compliant consumers;

(iv) notification of the recurrence of violence; and

(v) notification of factors which may exacerbate an individual's potential for violence.

(g) The program shall comply with the "Duty to Warn," Section 78B-3-502.

(h) The program shall document specialized training in domestic violence assessment and treatment practices, including 24 hours of pre-service training, within the last two years; and 16 hours annual training thereafter for all individuals providing treatment service.

(i) Clinical supervision for treatment staff that are not clinically licensed shall consist of a minimum of one hour per week to discuss clinical dynamics of cases.

(5) Training

(a) Training that is documented and approved by the designated Utah DHS DV Specialist Regarding assessment and treatment practices for treating:

(i) DV victims; and

(ii) DV perpetrators.

(6) Programs must disclose all current DHS contracts and actions against the contract to the Office.

(7) Programs must disclose all current Accreditations and actions against accredited status to the Office.

 

R501-21-8 Compliance.

(1) A licensee that is in operation on the effective date of this rule, shall be given 30 days to achieve compliance with this rule.

 

KEY: human services, licensing, outpatient treatment programs, substance abuse

Date of Enactment or Last Substantive Amendment: [November 3, 2014]2016

Notice of Continuation: April 1, 2015

Authorizing, and Implemented or Interpreted Law: 62A-2-101 et seq.

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