This Oklahoma regulation (OAC 450:18) establishes certification standards and criteria for facilities and organizations providing substance-related and addictive disorder treatment services under the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). Facility operators must comply with ASAM levels of care criteria for placement, continued stay, and discharge decisions across all SUD treatment settings, from outpatient through residential and medically monitored inpatient levels. Operators must also meet requirements related to consumer assessment, care planning, discharge planning, co-occurring disorder capability, and documentation. The chapter covers the full continuum of SUD services including outpatient, intensive outpatient, partial hospitalization, and all residential levels (ASAM 3.1, 3.3, 3.5, 3.7).
View official sourceThis chapter sets forth the standards and criteria used in the certification of facilities and organizations providing treatment services for consumers with substance-related and addictive disorders and implements 43A O.S. §§ 3-403, 3-415, 3-416, 3-417, 3-417.1, 3-601, 3-602 and 3-603. The rules regarding the certification processes, including, but not limited to, the application process, fees, and administrative sanctions are found in OAC 450:1, Subchapters 5 and 9. Rules outlining general certification qualifications applicable to facilities and organizations certified under this Chapter are found in OAC 450:1-9-5 through OAC 450:1-9-5.6. The following words or terms, when used in this chapter, shall have the following meaning, unless the context clearly indicates otherwise: "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a consumer by a staff responsible for the consumer's health, safety, or welfare, including but not limited to: non-accidental physical injury or mental anguish; sexual abuse; sexual exploitation; use of mechanical restraints without proper authority; the intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or deprivation of food, clothing, shelter, or healthcare by a staff responsible for providing these services to a consumer. "Acute intoxication or withdrawal potential" means one dimension to be considered in consumer placement, continued stay, and discharge and is an evaluation of the consumer's withdrawal patterns and current level of intoxication and potential for withdrawal complications as it impacts level of care decision making. "Admission" means the acceptance of a consumer by a treatment program to receive services at that program. "Admission criteria" means those criteria which shall be met for admission of a consumer for services. "Adult" means any individual eighteen (18) years of age or older. "ASAM" means the American Society of Addiction Medicine. "ASAM levels of care" means the different options for treatment as described in the current edition of the ASAM criteria that vary according to the intensity of the services offered. Each treatment option is a level of care. "ASAM criteria" means the most current edition of the American Society of Addiction Medicine's published criteria for admission to treatment, continued services, and discharge. "ASAM level 1" means Outpatient Services for adolescents and adults. This level of care typically consists of less than nine (9) hours of services per week for adults or less than six (6) hours of services per week for adolescents. Services may be delivered in a wide variety of settings. "ASAM level 3" means residential and inpatient services and encompasses ASAM levels 3.1, 3.3, 3.5 and 3.7. "ASAM level 3.1" means Clinically Managed Low-Intensity Residential Services for adolescents and adults. This level of care typically provides at least five (5) hours of clinical services a week and provides a twenty-four (24) hour living support and structure with trained personnel. The corresponding service description for this level of care is Halfway House Services. "ASAM level 3.3" means Clinically Managed Population-Specific High-Intensity Residential Services. This level of care is for adults only and typically offers twenty-four (24) hour care with trained personnel and is designed to accommodate individuals with cognitive or other impairments, including co-occurring disorders. The corresponding service description for this level of care is Residential Treatment for Adults with Co-Occurring Disorders. "ASAM level 3.5" means Clinically Managed Medium-Intensity Residential Services for adolescents and Clinically Managed High-Intensity Residential Services for adults. This level of care provides twenty-four (24) hour care and offers a wide range of therapeutic services. The corresponding service descriptions for this level of care are Residential Treatment and Intensive Residential Treatment. "ASAM level 3.7" means Medically Monitored High-Intensity Inpatient Services for adolescents and Medically Monitored Intensive Inpatient Withdrawal Management for adults. This level of care is provided by a physician, Advanced Practice Registered Nurse, or Physician Assistant either on-site or on-call with twenty-four (24) hour care by a Registered Nurse on-site for supervision and medication availability. This level of care is appropriate for individuals withdrawing from alcohol or other drugs with subacute biomedical and emotional, behavioral, or cognitive problems severe enough to require inpatient treatment but for whom hospitalization is not necessary. The corresponding service description for this level of care is Medically Supervised Withdrawal Management. "Assessment" means those procedures by which a program provides an on-going evaluation process with the consumer as outlined in applicable rules throughout OAC 450 to collect pertinent information needed as prescribed in applicable rules and statutes to determine courses of actions or services to be provided on behalf of the consumer. Assessment may be synonymous with the term evaluation. "Behavioral health services" means a wide range of diagnostic, therapeutic, and rehabilitative services used in the treatment of mental illness, substance use disorders, and co-occurring disorders. "Biomedical condition and complications" means one dimension to be considered in placement, continued stay, and discharge and is an evaluation of the consumer's current physical condition and history of medical and physical functioning as it impacts level of care decision making. "Biopsychsocial assessment" means face-to-face interviews conducted by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate designed to elicit historical and current information regarding the behaviors, experiences, and support systems of a consumer, and identify the consumer's strengths, needs, abilities, and preferences for the purpose of guiding the consumer's recovery plan. "Care management" means a type of case management in residential substance use disorder (ASAM Level 3) treatment settings that includes assessment, development of a care plan, and referral and linkage to community supports and community-based or lower level of care services to promote continued recovery after the individual discharges from the treatment facility. "Case management" means planned referral, linkage, monitoring, support, and advocacy provided in partnership with a consumer to assist that consumer with self-sufficiency and community tenure and take place in the individual's home, in the community, or in the facility, in accordance with a service plan developed with and approved by the consumer and qualified staff. "Child" or "Children" means any individuals under eighteen (18) years of age. "Client" See "Consumer. "Community-based Structured Crisis Center" or "CBSCC" means a program of non-hospital emergency services for mental health and substance use disorder crisis stabilization as authorized by 43A O.S. §3-317 including, but not limited to, observation, evaluation, emergency treatment, and referral, when necessary, for inpatient psychiatric or substance use disorder treatment services. This service is limited to CMHCs who are certified by the Department of Mental Health and Substance Abuse Services or facilities operated by the Department of Mental of Substance Abuse Services. "Community mental health center" or "CMHC" means a facility offering a comprehensive array of community-based mental health services including, but not limited to, inpatient treatment, outpatient treatment, partial hospitalization, emergency care, consultation and education, and certain services at the option of the center including, but not limited to, prescreening, rehabilitation services, pre-care and aftercare, training programs, and research and evaluation. "Consultation" means the act of providing information or technical assistance to a particular group or individual seeking resolution of specific problems. A documented process of interaction between staff members or between facility staff and unrelated individuals, groups, or agencies for the purpose of problem solving or enhancing their capacities to manage consumers or facilities. "Consumer" means an individual, adult, adolescent, or child, who has applied for, is receiving or has received evaluation or treatment services from a facility operated or certified by ODMHSAS or with which ODMHSAS contracts and includes all persons referred to in OAC Title 450 as client(s) or patient(s) or resident(s) or a combination thereof. "Consumer advocacy" means all activities on behalf of the consumer to assist with or facilitate resolution of problems in the acquisition of resources or services needed by the consumer. "Consumer record" means the collection of written information about a consumer's evaluation or treatment that includes the admission data, evaluation, treatment or service plan, description of treatment or services provided, continuing care plan, and discharge information on an individual consumer. "Continuing care" means providing a specific period of structured therapeutic involvement designed to enhance, facilitate, and promote transition from a current level of services to support ongoing recovery. "Contract" means a document adopted by the governing authority of a treatment facility and any other organization, facility, or individual, which specifies services, personnel, or space to be provided by the program, as well as the monies to be expended in exchange. "Co-occurring disorder" (COD) means any combination of mental health symptoms and substance use disorder symptoms or diagnoses that affect a consumer and are typically determined by the current Diagnostic and Statistical Manual of Mental Disorders. "Co-occurring disorder capability" means the organized capacity within any type of program to routinely screen, identify, assess, and provide properly matched interventions to consumer's with co-occurring disorders. "Correctional institution" means any penal or correctional facility, jail, reformatory, detention center, work farm, halfway house, or residential community program operated by, or under contract to, the United States, a state, a territory, a political subdivision of a state or territory, or an Indian tribe, for the confinement or rehabilitation of persons charged with or convicted of a criminal offense, or other persons held in lawful custody. Other persons held in lawful custody include juvenile offenders adjudicated delinquent, aliens detained awaiting deportation, persons committed to mental institutions through the criminal justice system, witnesses, or others awaiting charges or trial. Programs which are providing treatment services within a correctional facility may be exempt from certain services described in this chapter which cannot be provided due to circumstance. "Crisis Diversion" means an unanticipated, unscheduled situation requiring supportive assistance, face-to-face or telephone, to resolve immediate problems before they become overwhelming and severely impair the individual's ability to function or maintain in the community. "Crisis intervention" means actions taken and services provided to address emergency psychological, physiological, and safety aspects of alcohol, drug-related, and mental health crises. "Cultural competency" means the ability to recognize, respect, and address the unique needs, worth, thoughts, communications, actions, customs, beliefs, and values that reflect an individual's racial, ethnic, religious, sexual orientation, and/or social group. "Day school" means the provision of therapeutic and accredited academic services on a regularly scheduled basis. "Department" or "ODMHSAS" means the Oklahoma Department of Mental Health and Substance Abuse Services. "Detoxification" means the process of eliminating the toxic effects of drugs and alcohol from the body. Supervised detoxification methods include social detoxification and medical monitoring or medical management and are intended to avoid withdrawal complications. "DHS" or "OKDHS" means the Oklahoma Department of Human Services. "Diagnosis" means the determination of a disorder as defined by current DSM criteria and in accordance with commonly accepted professional practice standards. "Dietitian" or "Dietician" means an individual trained and licensed in the development, monitoring, and maintenance of food and nutrition in accordance with the Oklahoma State Board of Medical Licensure and Supervision. "Discharge criteria" means individualized measures by which a program and the consumer determine readiness for discharge or transition from services being provided by that facility. These may reference general guidelines as specified in facility policies or procedures and/or in published guidelines including, but not limited to, the current ASAM criteria for individuals with substance use disorders, but should be individualized for each consumer and articulated in terms of consumer behaviors, resolutions of specific problems, and attainment of goals developed in partnership with the participant and the provider. "Discharge planning" or "transition planning" means the process, begun at admission, of determining a consumer's continued need for treatment services and of developing a plan to address ongoing consumer post-treatment and recovery needs. Discharge planning may or may not include a document identified as a discharge plan. "Discharge summary"summary" means a clinical document in the treatment record summarizing the consumer's progress during treatment, with goals reached, continuing needs, and other pertinent information including documentation of linkage to aftercare. "DOC" or "ODOC" means the Oklahoma Department of Corrections. "Documentation" means the provision of written, dated, and authenticated evidence to substantiate compliance with standards, e.g., minutes of meetings, memoranda, schedules, notices, logs, records, policies, procedures, and announcements. "DSM" means the most current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. "Education" means the dissemination of relevant information specifically focused on increasing the awareness of the community and the receptivity and sensitivity of the community concerning mental health, substance-related and addictive disorders, or other related problems and services related to the specific focus of treatment. "Emergency services" means a twenty-four (24) hour capability for assessment, intervention, and resolution of a consumer's crisis or emergency provided in response to unanticipated, unscheduled emergencies requiring prompt intervention to resolve immediate, overwhelming problems that severely impair the individual's ability to function or remain in the community and may include placement of the individual in a protective environment, withdrawal management, individual and group consultation, and medical assessment. "Emotional, behavioral or cognitive conditions and complications" means one dimension to be considered in consumer placement, continued stay, and discharge and is an evaluation of the consumer's historical and current emotional, behavioral, or cognitive status including the presence and severity of any diagnosed mental illnesses, as well as, the level of anxiety, depression, impulsivity, guilt, and behavior that accompanies or follows these emotional states and historical information, as it impacts on level of care decision making. "Evaluation" See "Assessment." "Evidence based practice" means programs or practices that are supported by research methodology and have produced consistently positive patterns of results when replicated within the intent of the published guidance. "Executive director" means the person hired by the governing authority to direct all the activities of the organization; may be used synonymously with administrative director, administrator, chief executive officer, and director. "Face-To-Face" for the purposes of the delivery of behavioral health care, means a face-to-face physical contact and in-person encounter between the health care provider and the consumer, including the initial visit. The use of telemedicine shall be considered a face-to-face encounter. "Facilities" or "facility" means entities as described in Title 43A O.S. § 1-103(7), community mental health centers, residential mental health facilities, community-based structured crisis centers, certified services for the alcohol and drug dependent, programs of assertive community treatment, eating disorder treatment, gambling disorder treatment, and narcotic treatment programs. "Family" means the parents, brothers, sisters, other relatives, foster parents, guardians, and others who perform the roles and functions of family members in the lives of consumers. "Follow-up" means the organized method of systematically determining the status of consumers after they have been discharged to determine post-treatment outcomes and utilization of post-treatment referrals. "Gambling disorder treatment services" means treatment activities for consumers by a gambling treatment professional that include, but are not limited to, the following: (A) Assessment and diagnostic impression, ongoing; (B) Treatment planning and revision, as necessary; (C) Individual, group and family therapy; (D) Case management; (E) Psychosocial rehabilitation; and (E) Discharge planning. "Goals" means broad general statements of purpose or intent that indicates the general effect the facility or service is intended to have. "Guardian" means an individual who has been given the legal authority for managing the affairs of another individual. "Halfway house" means low intensity substance use disorder treatment in a supportive living environment to facilitate the individual's reintegration into the community, most often following completion of primary treatment. Corresponding ASAM Treatment Level: Level III.1, Clinically managed Low Intensity Residential Services. "Halfway house for persons with children" means a halfway house that includes services for the recovering person's children who will reside with him or her in the house. Corresponding ASAM Treatment Level: Level III.1, Clinically managed Low Intensity Residential Services. "Infant" means any child from birth up to 3 years of age. "Initial contact" means a person's first contact with the facility, e.g., a request for information or service by telephone or in person. "Inpatient services" means the process of providing care to persons who require twenty-four (24) hour supervision in a hospital or other suitably equipped medical setting as a result of acute or chronic medical or psychiatric illnesses and professional staff providing medical care according to a treatment plan based on documentation of need. "Intervention" means a process or technique intended to facilitate behavior change. "Licensed Behavioral Health Professional" or "LBHP" means: (A) An Allopathic or Osteopathic Physician with a current license and board certification in psychiatry or board eligible in the state in which services are provided, or a current resident in psychiatry; (B) An Advanced Practice Registered Nurse licensed as a registered nurse with a current certification of recognition from the board of nursing in the state in which services are provided and certified in a psychiatric mental health specialty; (C) A Clinical Psychologist who is duly licensed to practice by the State Board of Examiners of Psychologists; (D) A Physician Assistant who is licensed in good standing in Oklahoma and has received specific training for and is experienced in performing mental health therapeutic, diagnostic, or counseling functions; (E) A practitioner with a license to practice in the state in which services are provided by one of the following licensing boards: (i) Social Work (clinical specialty only); (ii) Professional Counselor; (iii) Marriage and Family Therapist; (iv) Behavioral Practitioner; or (v) Alcohol and Drug Counselor. "Licensed physician" means an individual with an M.D. or D.O. degree who is licensed in the State of Oklahoma to practice medicine. "Licensed practical nurse" means an individual who is a graduate of an approved school of nursing and is licensed in the State of Oklahoma to provide practical nursing services. "Licensure" means the process by which an agency of government grants permission to persons or health facilities meeting qualifications to engage in a given occupation or business or use a particular title. "Licensure Candidate" means practitioners actively and regularly receiving board approved supervision, and extended supervision by a fully licensed clinician if board's supervision requirement is met but the individual is not yet licensed, to become licensed by one of the following licensing boards: (A) Psychology; (B) Social Work (clinical specialty only); (C) Professional Counselor; (D) Marriage and Family Therapist; (E) Behavioral Practitioner; or (F) Alcohol and Drug Counselor. "Life skills" means abilities and techniques necessary to function independently in society. "Medical care" means those diagnostic and treatment services which, under the laws of the jurisdiction in which the facility is located, can only be provided or supervised by a licensed physician. "Medical withdrawal management" means diagnostic and treatment services performed by licensed facilities for acute alcohol or drug intoxication, delirium tremens, and physical and neurological complications resulting from acute intoxication. Medical withdrawal management includes the services of a physician and attendant medical personnel including nurses, interns, and emergency room personnel, the administration of a medical examination and a medical history, the use of an emergency room and emergency medical equipment if warranted, a general diet of three meals each day, the administration of appropriate laboratory tests, and supervision by properly trained personnel until the person is no longer medically incapacitated by the effects of alcohol or drugs. [43 A O.S. § 3-403(5)] It is an organized service delivered by medical and nursing professionals that provides for twenty-four (24)-hour medically directed evaluation and withdrawal management in an acute care inpatient setting. Services are delivered under a defined set of physician-approved policies and physician-managed procedures or medical protocols. Corresponding ASAM Service Level: Level 4-WM, Medically Managed Intensive Inpatient Withdrawal Management. "Medical services" means the administration of medical procedures by a physician, registered nurse, nurse practitioner, physician's assistant, or dentist and in accordance with a documented treatment plan and medical supervision available to provide the consumer with the service necessitated by the prevalent problem identified and includes physical examinations, withdrawal management from alcohol or drugs, methadone maintenance, dental services, or pharmacy services, etc. "Medically supervised withdrawal management" means withdrawal management outside of a medical setting, directed by a physician who has attendant medical personnel including nurses for intoxicated consumers, and consumer's withdrawing from alcohol and other drugs, presenting with no apparent medical or neurological symptoms as a result of their use of substances that would require hospitalization as determined by an examining physician. Corresponding ASAM Service Level: Level 3.7-WM, Medically Monitored Inpatient Withdrawal Management. Withdrawal management is intended to stabilize and prepare consumers in accessing treatment. "Medication" means any prescription or over-the-counter drug that is taken orally, injected, inserted, applied topically, or otherwise administered by staff or self- administered by the consumer for the appropriate treatment or prevention of medical or psychiatric issues. "Medication assisted treatment" means the use of medications, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders. "Medication-self administration" means the consumers administer their own medication to themselves, or their children, with staff observation. "Neglect" means: (A) the failure of staff to provide adequate food, clothing, shelter, medical care or supervision which includes, but is not limited to, lack of appropriate supervision that results in harm to a consumer; (B) the failure of staff to provide special care made necessary by the physical or mental condition of the consumer; (C) the knowing failure of staff to provide protection for a consumer who is unable to protect his or her own interest; or (D) staff knowingly causing or permitting harm or threatened harm through action or inaction that has resulted or may result in physical or mental injury. "Non-medical withdrawal management" means withdrawal management services for intoxicated consumers and consumers withdrawing from alcohol or other drugs presenting with no apparent medical or neurological symptoms as a result of their use of substances. Corresponding ASAM Service Level: Level 3.2-WM, Clinically managed Residential Withdrawal Management Withdrawal management is intended to stabilize and prepare consumers in accessing treatment. "Objectives" means a specific statement of planned accomplishments or results that are specific, measurable, attainable, realistic, and time-limited. "ODMHSAS" means the Oklahoma Department of Mental Health and Substance Abuse Services. "Oklahoma Administrative Code" or "OAC" means the publication authorized by 75 O.S. § 256 known as The Oklahoma Administrative Code or, prior to its publication, the compilation of codified rules authorized by 75 O.S. § 256(A)(1)(a) and maintained in the Office of Administrative Rules. "OSDH" means the Oklahoma State Department of Health. "Outpatient services" means an organized, nonresidential treatment service in regularly scheduled sessions intended for individuals not requiring a more intensive level of care or those who require continuing services following more intensive treatment regimens. For substance use disorder treatment services, the corresponding ASAM Treatment Level is Level I, Outpatient Treatment. "Peer Recovery Support Specialist" or "PRSS" means an individual who meets the qualifications and is certified as a PRSS pursuant to OAC 450:53. "Performance Improvement" or "PI" means an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of consumers and others. Synonyms, and near synonyms, include continuous quality improvement, continuous improvement, organization-wide quality improvement, and total quality management. "Personnel record" means a chart or file containing the employment history and actions relevant to individual employee or volunteer activities within an organization and may contain application, evaluation, salary data, job description, citations, credentials, etc. "PICIS" is a comprehensive management information system based on national standards for mental health and substance abuse databases. It is a repository of diverse data elements that provide information about organizational concepts, staffing patterns, consumer profiles, program or treatment focus, and many other topics of interest to clinicians, administrators, and consumers. It includes unique identifiers for agencies, staff, and consumers that provide the ability to monitor the course of consumer services throughout the statewide ODMHSAS network. PICIS collects data from hospitals, community mental health centers, substance abuse agencies, community residential mental health facilities, prevention programs, and centers for the homeless which are operated or funded in part by ODMHSAS. "Play therapy" means a form of action therapy that uses, but is not limited to, sand play, fairy tales, art and puppetry to encourage communication in children who have inadequate or immature verbalization skills or who verbalize excessively due to defensiveness. "Policy" means statements of facility intent, strategy, principle, or rules in the provision of services; a course of action leading to the effective and ethical provision of services. "Prevention" means the assessment, development, and implementation of strategies designed to prevent the adverse effects of mental illness, substance use disorders, addiction, and trauma. "Procedures" means the written methods by which policies are implemented. "Process" means information about what a program is implementing and the extent to which the program is being implemented as planned. "Program" means a structured set of activities designed and structured to achieve specific objectives relative to the needs of the consumers or patients. "Progress notes" means a chronological written description of services provided to a consumer, resident, client, or patient that documents, utilizing acceptable documentation practices, the consumer's response related to the intervention plan or services provided. "Psychiatrist" means a licensed physician who specializes in the assessment and treatment of individuals having psychiatric disorders and who is fully licensed to practice medicine in the state in which he or she practices and is certified in psychiatry by the American Board of Psychiatry and Neurology or has equivalent training or experience. "Psychotherapy" or "Therapy" means a goal directed process using generally accepted clinical approaches provided face-to-face by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate with consumers in individual, group, or family settings to promote positive, emotional, or behavioral change. "Readiness to change" means one dimension to be considered in consumer placement, continued stay, and transition and is an evaluation of the consumer's current emotional and cognitive awareness of the need to change, coupled with a commitment to change. "Recovery" means an ongoing process of discovery and/or rediscovery that must be self-defined, individualized, and may contain some, if not all, of the fundamental components of recovery as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA). "Recovery/living environment" means one dimension to be considered in consumer placement, continued stay, and discharge and is an evaluation of the consumer's current recovery environment, current relationships, degree of support for recovery, current housing, employment situation, availability of alternatives, and historical information as it impacts on level of care decision making. "Registered nurse" means an individual who is a graduate of an approved school of nursing and is licensed in the State of Oklahoma to practice as a registered nurse. "Rehabilitation services" means face-to-face individual or group services provided by qualified staff to develop skills necessary to perform activities of daily living and successful integration into community life. Rehabilitation services for substance use disorders are also referred to as skill development services. "Relapse" means the process which may result in the return to the use of substances after a period of abstinence. "Relapse potential, continued use, or continued problem potential" means one dimension to be considered in consumer placement, continued stay, and discharge and is an evaluation of the consumer's attitudes, knowledge, and coping skills, as well as the likelihood that the consumer will relapse from a previously achieved and maintained abstinence and/or stable and healthy mental health function. If an individual has not yet achieved abstinence and/or stable and healthy mental health function, this dimension assesses the likelihood that the individual will continue to use alcohol or other drugs and/or continue to have mental health problems. "Residential treatment-substance abuse" means treatment for a consumer in a live-in setting which provides a regimen consisting of twenty-four (24) treatment hours per week. This level of care should correspond with the ASAM Service Level: Level 3.5, Clinically managed High-Intensity Residential Services. "Residential treatment for persons with children-substance abuse" means a residential treatment facility that includes services for the recovering person's children who will reside with him or her in the residential facility. Corresponding ASAM Service Level (Parent Only): Level 3.5 Clinically Managed High-Intensity Residential Services. "Screening" means the process to determine whether the person seeking assistance needs further comprehensive assessment. "Service plan" or "Treatment plan" means the document used during the process by which a LBHP or a Licensure Candidate and the consumer together and jointly identify and rank problems, establish agreed-upon immediate short-term and long-term goals, and decide on the treatment process and resources to be utilized. "Service Provider" means a person who is allowed to provide treatment services within the regulation and scope of their certification level or license. "Significant others" means those individuals who are, or have been, significantly involved in the life of the consumer. "Socialization" means all activities, which encourage interaction and the development of communication, interpersonal, social, and recreational skills and can include consumer education. "Substance-related and addictive disorders" means a substance-related disorder involving problems related to the use of ten distinct classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics and anxiolytics; stimulants; tobacco; and other (unknown) substances. Substance-related disorders fall into one of two categories, substance use disorders and substance induced disorders. A substance use disorder is a cluster of cognitive, behavioral and physiological symptoms indicating the consumer continues using the substance(s) despite significant substance-related problems. A substance-induced disorder is a reversible substance-specific syndrome due to the recent ingestion of a substance. Addictive disorders involve repetitive clusters of behaviors that activate reward systems similar to those activated by drugs and create behavioral symptoms comparable to those produced by substance use disorders such as compulsive gambling. "Substance use disorder treatment services" means the coordination of treatment activities for consumers by service provider that includes, but is not limited to, the following: (A) Screening, diagnostic impression, and assessment. (B) Treatment planning and revision, as necessary. (C) Continuing care review to assure continuing stay and discharge criteria are met. (D) Case management services. (E) Reports and record keeping of consumer related data. (F) Consultation that facilitates necessary communication in regard to consumers. (G) Discharge planning that assists consumers in developing continuing care plans and facilitates transition into post-treatment recovery. (H) Individual, group, and family therapy. (I) Rehabilitation services. (J) Peer recovery support services. (K) Crisis intervention services. "Substance-use disorders" means alcohol or drug dependence or psychoactive substance use disorder as defined by current DSM criteria or by other standardized and widely accepted criteria. "Substance withdrawal" means a state of being in which a group of symptoms of variable clustering and degree of severity occur on cessation or reduction of use of a psychoactive substance that has been taken repeatedly, usually for a prolonged period and/or in high doses. The syndrome may be accompanied by signs of physiological disturbance. Onset and course of the withdrawal state are time-limited and are related to the type of substance and the dose being used immediately before abstinence. "Supportive services" refers to assistance with the development of problem-solving and decision making skills to maintain or achieve optimal functioning within the community and can include consumer education. "Therapeutic hour(s)" means the amount of time in which the consumer is engaged with a service provider identifying, addressing, and/or resolving issues that are related to the consumer's treatment plan. "Tobacco" means any nicotine delivery product or device that is not approved by the U.S. Food and Drug Administration (FDA) for the purpose of nicotine dependence treatment, including, but not limited to cigarettes, cigars, snuff, chewing tobacco, electronic cigarettes and vaping devices. "Trauma informed capability" means the capacity for a facility and all its programs to recognize and respond accordingly to the presence of the effects of past and current traumatic experiences in the lives of its consumers. "Treatment" means the broad range of emergency, inpatient, intermediate and outpatient services and care including diagnostic evaluation, medical, psychiatric, psychological and social service care, vocational rehabilitation, and career counseling. [43A O.S. § 3-403(11)]. "Treatment hours - residential" means the structured hours in which a consumer is involved in receiving professional services to assist in achieving recovery. "Treatment session-outpatient" means each face-to-face contact with a consumer in a therapeutic setting whether individually or in a group. "Volunteer" means any person who is not on the program's payroll, but provides services and fulfills a defined role within the program and includes interns and practicum students. "Wellness" means the condition of good physical, mental, and emotional health, especially when maintained by an appropriate diet, exercise, and other lifestyle modifications. "Withdrawal Management" means the process of eliminating the toxic effects of substances from the body. Withdrawal management methods include social detoxification and medical monitoring or medical management and are intended to avoid withdrawal complications. The attention of the facility is drawn to the distinction between the use of the words "shall," "should," and "may" in this chapter: (1) "Shall" is the term used to indicate a mandatory statement, the only acceptable method under the present standards. (2) "Should" is the term used to reflect the most preferable procedure, yet allowing for the use of effective alternatives. (3) "May" is the term used to reflect an acceptable method that is recognized but not necessarily preferred. This chapter is applicable to all substance-related and addictive disorder treatment facilities and organizations providing treatment, therapy, rehabilitation services, and substance-related and addictive disorder treatment services which are statutorily required to be certified by the ODMHSAS. A portion of these standards may be suspended during a specific time frame to allow the certified provider the opportunity to engage in performance improvement activities in partnership with ODMHSAS. Suspension may be granted after the provider has submitted a formal written request to the Commissioner, or designee, of the Department of Mental Health and Substance Abuse Services and a letter of approval from the Commissioner, or designee of the Department of Mental Health and Substance Abuse Services, has been received. The Commissioner, or a designee, shall respond within thirty (30) days of receipt of the written request. The purpose of this subchapter is to set forth rules regulating program requirements, activities, and services which are not specific to levels of care. The rules set forth in this subchapter are applicable only to those facilities providing substance-related and addictive disorder treatment services. The following shall be applicable to all residential facilities and to any outpatient facilities which provide an on-premise meal service. (1) Storage, preparation, dishwashing, and serving of food and ice shall be in compliance with the requirements of the OSDH regulations governing public feeding establishments. (2) Each facility shall have an annual inspection completed by the OSDH free from any pending violations. (a) Any facility which provides twenty-four (24) hour per day care shall have a written plan describing the organization and delivery of dietetic services (either directly or through contract) to meet the dietary needs of consumers. (b) Menus for meals provided by the facility shall be reviewed annually and as needed for consumer's with special dietary needs (diabetes, pregnancy, religious requirements, etc.). This review shall be made by an Oklahoma Registered Dietician. Approval of the review shall be documented by the dietician's signature, American Dietetic Association (AA) Registration Number (RD#), Oklahoma License Number (DL#), and date of the review. (c) Dietetic services, including health policy and procedures for food service staff, other staff, and consumers performing food service duties as a part of their treatment plan, shall be in compliance with all applicable federal, state, and local statutes and regulations, and shall be so noted in facility policy and procedure. All programs preparing meals provided to consumers shall document, on an annual basis, compliance with OSDH rules and regulations pertaining to kitchen facilities. (d) Food shall be served in an appetizing and attractive manner, at realistically planned mealtimes, and in a congenial and relaxed atmosphere. (e) Information pertinent to special dietetic needs of consumers shall be entered into the consumers' treatment records, and when medically indicated, forwarded to parties having permission to receive information regarding consumers' treatment. (f) Compliance with 450:18-5-4 may be determined by a review of the following: (1) Facility policy and procedures; (2) Written plan for dietetic services; (3) Menus; (4) Menu approvals; (5) OSHD reports; and (6) Any other supporting facility documentation. (a) Facilities providing pharmacy services either as a part of their regular business operation, through a sub-corporation, or other related business entity shall comply with all federal and state statutes and regulations regarding drugs and pharmacies including, but not limited to, OAC, Title 535. Facility policy and procedure shall indicate such compliance. (b) For services neither provided in a licensed hospital nor as a part of a licensed hospital's services, the facility shall have written policies and procedures including, but not limited to, the following: (1) Staff not licensed to dispense or administer medication shall not dispense or administer medication; (2) Medication shall not be withheld from a consumer for whom the medication was prescribed for non-medical reasons; (3) Prescription medications shall be stored in a non-residential area under lock, with the exception of those medications which may be needed by a consumer on a medical emergency basis; and (4) Staff shall keep a log of all self-administered medications (prescribed or over-the-counter). (c) Compliance with 450:18-5-5 may be determined by a review of policy and procedure, consumer records, interviews with staff and consumers, and any other supporting facility documentation. Providers of residential treatment, medically supervised withdrawal management, or halfway house services shall provide access to medication assisted treatment (MAT) medications to all consumers for whom MAT is determined to be appropriate. Access to MAT medications shall be provided either directly from the residential treatment, medically supervised withdrawal management, or halfway house provider; or provided through a formal agreement with a separate MAT provider. (a) Facilities providing a day school (i.e., an academic formal educational program) either as a primary focus of their services or as an ancillary service, shall be in compliance with all applicable rules and regulations of the Oklahoma State Department of Education (OSDE) and of the local school district in which the day school is located. (b) In addition, the facility shall provide the following documentation: (1) Academic services provided are accredited by the local school district or the OSDE; (2) All teachers shall have a valid license or certificate from the OSDE for the teaching position they are employed to fill; (3) Therapeutic units are provided by staff trained in the issues of substance use disorders; (4) Each student shall have a home school; and (5) Each student shall have a daily activity schedule and individualized treatment plan based on assessment of need and formulated for both educational and therapy needs. (c) Compliance with 450:18-5-6 may be determined by a review of facility policy and procedures, relevant personnel records, other facility supporting documentation, and interviews with staff and consumers . (a) Providers of residential treatment services (ASAM Level 3.3 and ASAM Level 3.5) shall provide non-medical withdrawal management as part of their regular service delivery program and facility environment. (b) Non-medical withdrawal management shall be provided for intoxicated consumers and consumers withdrawing from alcohol and other drugs who present with no apparent medical or neurological symptoms as a result of their substance use disorder. (c) The facility shall maintain written programmatic descriptions and policy and procedures addressing the following: (1) Environment: The facility shall monitor and document vital signs, and food and liquids intake. (2) Staff: (A) Staff providing non-medical withdrawal management shall be knowledgeable about the physical signs of withdrawal, the taking of vital signs, the implication of those vital signs, and emergency procedures. Service providers shall be trained and competent to implement physician-approved protocols for consumer observation and supervision, determination of appropriate level of care, and facilitation of the consumer's transition to continuing care. (B) The facility shall document in personnel records all education, training, and experience stated in (A) above prior to staff providing direct care services. (3) Treatment services: Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder withdrawal management treatment services shall be provided, to include oral intake of fluids, three (3) meals a day, and the taking of vital signs (temperature, pulse, respiration rate, blood pressure), and fluid and food intake a minimum of one (1) time every six (6) hours or more often as indicated by the consumer's condition. (a) All facilities shall complete a face-to-face screening with each individual to determine appropriateness of further assessment. (b) The facility shall maintain written screening policies and procedures that, at a minimum include: (1) how the screening is to be conducted; (2) that the screening conducted is an integrated screening to identify both immediate and ongoing needs, which includes screening for whether the consumer is a risk to self or others, including suicide risk factors; and (3) how the consumer is assisted with admission for services, and/or with accessing other appropriate services. (c) All facilities shall assess each consumer for appropriateness of admission to the treatment program. Each presenting consumer for substance use disorder treatment shall be assessed to determine a clinically appropriate placement in the least restrictive level of care. Facilities must ensure that a consumer's refusal of a particular service does not preclude the consumer from accessing other needed mental health or substance-related or addictive disorder treatment services. Should the service provider determine the consumer's needs cannot be met within the facility, clinical assessments and referrals for the consumer shall be documented. (d) Any consumer seeking admission to inpatient or residential services, including medically-supervised withdrawal management, while under the influence or undergoing withdrawal of alcohol or drugs, shall be assessed prior to admission for medical needs. The written criteria to be used for medical needs assessment of persons under the influence or undergoing withdrawal of alcohol or drugs, and the protocols for determining when physician review of the assessment is needed, shall be approved by the facility's consulting physician. (e) Compliance with 450:18-7-21 may be determined by a review of the following: (1) Policies and procedures; (2) Intake protocols; (3) assessment instruments; (4) Treatment records; (5) Interviews with staff and consumers; and (6) Other facility documentation. (a) Written policies and procedures governing the screening and assessment process shall specify the following: (1) The information to be obtained on all applicants or referrals for admission; (2) The procedures for accepting referrals from outside agencies or organizations; (3) The records to be kept on all applicants; (4) Any prospective consumer data to be recorded during the admission process; and (5) The procedures to be followed when an applicant or a referral is found ineligible for admission. (b) Facilities shall have written policies and procedures for the purpose of admitting and assessing persons with special needs. (c) Compliance with 450:18-7-22 may be determined by a review of the following: (1) Policies and procedures; (2) Admission protocols; (3) Screening and assessment instruments; (4) Treatment records; (5) Interviews with staff and consumers; and (6) Other facility documentation. (a) All programs shall complete a biopsychsocial assessment that gathers sufficient information to assist the consumer in developing an individualized service plan and utilizes standardized tools such as the Addiction Severity Index (ASI) for adults or the Teen Addiction Severity Index (T-ASI) for adolescents. The assessment must also list the client's past and current psychiatric medications, if applicable. The assessment must be completed by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate. Licensure candidate signatures must be co-signed by a fully-licensed LBHP in good standing. (b) Compliance with 450:18-7-23 may be determined by a review of the following: (1) Policy and procedures; (2) Biopsychsocial assessment instruments; (3) Consumer records; (4) Case management assessments; (5) Interviews with staff and consumers; and (6) Other facility documentation. (a) The facility shall have policies and procedures which delineate the process, protocols, and timeframes by which on-going clinical assessments occur. (b) Compliance with 450:18-7-27 shall be determined by a review of the clinical records and agency policies and procedures. (a) Case management efforts shall empower consumers to access and use needed services and meet self-determined goals. These services include resource skills development and consumer advocacy provided in various settings based on consumer need. (b) As allowed per Title 43A O.S. Section 3-318, case management services shall be offered to all adults and children who have substance-related disorders, and to their family members, if applicable, to ensure access to needed services. (c) Case management shall be co-occurring disorder capable. (d) Case management services shall be planned referral, linkage, monitoring and support, and advocacy assistance provided in partnership with a consumer to support that consumer in self sufficiency and community tenure. Activities include: (1) Completion of strengths based assessment for the purpose of individual plan of care development; (2) Development of case management care plan which can be reflected as a part of the comprehensive service plan; (3) Referral, linkage and advocacy to assist with gaining access to appropriate community resources; (4) Contacts with other individuals and organizations that influence the recipient's relationship with the community, i.e., family members, law enforcement personnel, landlords, etc.; (5) Monitoring and support related to the individual plan of care to reassess goals and objectives and assess progress and or barriers to progress; (6) Follow-up contact with the consumer if they miss any scheduled appointments (including physician/medication, therapy, rehabilitation, or other supportive service appointments as delineated on the service plan); and (7) Crisis diversion (unanticipated, unscheduled situation requiring supportive assistance, face-to-face or telephone, to resolve immediate problems before they become overwhelming and severely impair the individual's ability to function or maintain in the community) to assist consumer(s) from progression to a higher level of care. (e) Compliance with 450:18-7-61 shall be determined by on-site observation and a review of the clinical records and written policies and procedures. (a) Case management services shall be provided within community settings; the residence of the consumer; or any other appropriate settings, based on the individual needs of the consumer. Contact with consumers shall be made on at least a monthly basis unless otherwise specified in the service plan. (b) Compliance with 450:18-7-62 shall be determined by a review of the following: Case managers shall contact each consumer at least once a month, unless otherwise specified in the service plan, to monitor progress or provide case management services. Inability to make face-to-face contact shall be documented. Contact was made with consumers as specified in the service plan. (a) Case managers from the outpatient facilities to which the consumer will be discharged shall assist the consumer and withdrawal management/residential/halfway house facility, psychiatric inpatient unit, and/or CBSCC, with discharge planning for consumer returning to the community. (b) Consumers discharging from a withdrawal management/residential/halfway house facility shall be offered case management and other supportive services. This shall occur as soon as possible, but shall be offered no later than one (1) week post-discharge. (c) Compliance with 450:18-7-63 shall be determined by a review of the clinical records; staff interviews; and information from ODMHSAS withdrawal management/residential/halfway house facilities, operated psychiatric inpatient unit, and CBSCC facilities. (a) Individuals providing case management services shall be an LBHP, Licensure Candidate, CADC or certified as a behavioral health case manager pursuant to OAC, Title 450, Chapter 50. (b) Compliance with 450:18-7-65 shall be determined by a review of the facility personnel records and credentialing files. (a) A service plan shall be completed for each adult and child consumer, including dependent children receiving services from a residential or halfway house facility. The service plan is performed with the active participation of the consumer and a support person or advocate, if requested by the consumer. In the case of children under the age of sixteen (16), it is performed with the participation of the parent or guardian, if allowed by law, and the child as age and developmentally appropriate. The service plan shall provide the formation of measurable service objectives and reflect ongoing changes in goals and objectives based upon consumer's progress or preference or the identification of new needs, challenges, and problems. The service plan shall be completed by a LBHP or Licensure Candidate. (b) The service plan is developed after and based on information obtained in the assessment and includes the evaluation of the assessment information by the clinician and the consumer. (c) The service plan must have an overall general focus on recovery which, for adults, may include goals like employment, independent living, volunteer work, or training, and for children, may include areas like school and educational concerns and assisting the family in caring for the child in the least restrictive level of care. (d) Service plan updates should occur at a minimum of every six (6) months while outpatient services are provided. Service plan updates shall occur at a minimum of once every thirty (30) days while halfway house, residential, or medically supervised withdrawal management services are provided. (e) Service plans, both comprehensive and update, must include dated signatures of the consumer (if age fourteen [14] or older), the parent/guardian (if required by law), and the LBHP or Licensure Candidate. If a minor is eligible to self-consent to treatment pursuant to state law, a parent/guardian signature is not required. Licensure candidate signatures must be co-signed by a fully-licensed LBHP in good standing. Signatures must be obtained after the service plan is completed. (f) Compliance with 450:18-7-81 shall be determined by a review of the clinical records, interviews with staff and consumers, and other facility documentation. (a) Medically supervised withdrawal management facilities shall complete medical service plans to address the medical stabilization treatment and service needs of each consumer within three (3) hours of admission. Service plans shall be completed by a license d physician, Advanced Practice Registered Nurs e (APRN), Physician Assistant (PA) , or Registered Nurse (RN) . A Licensed Practical Nurse (LPN) may assist with the service plan . LPN signatures must be co-signed by a physician, APRN, PA or RN at the time the service plan is completed . (b) Compliance with 450:18-7-84 may be determined by a review of the following: (1) Policies and procedures; (2) Treatment protocols; (3) Clinical services manuals; (4) Service plan forms; (5) Consumer records; (6) Interviews with staff and consumers; and (7) Other facility documentation. (a) Progress notes shall chronologically describe the services provided by date and, for timed treatment sessions, time of service, and the consumer's progress in treatment. (b) Progress notes must include the consumer's name, be signed by the service provider, and include the service provider's credentials. (c) Outpatient staff must document each visit or transaction, except for assessment completion or service plan development, including missed appointments. (d) Compliance with 450:18-7-101 may be determined by a review of the following: (1) Policies and procedures; (2) Consumer records; (3) Progress notes; (4) Interviews with staff; and (5) Other facility documentation. (a) All facilities shall assess each consumer for appropriateness of discharge from a treatment program. (b) Compliance with 450:18-7-121 may be determined by a review of the following: (1) Policies and procedures; (2) Continuing care plans; (3) Discharge assessments; (4) Discharge summaries; (5) Progress notes; (6) Consumer records; (7) Interviews with staff and consumers; and (8) Other facility documentation. (a) The facility shall assist the consumer to obtain services that are needed, but not available within the facility, and/or in transitioning from one level of care to another, and/or discharging from a facility. Transition/discharge plans shall be developed with the knowledge and cooperation of the consumer. (b) A written plan of recommendations and specific referrals for implementation of continuing care services, including medications, shall be prepared for each consumer. Development of the transition/discharge plan shall begin no later than two (2) weeks after admission into residential/inpatient level of care (ASAM Level 3) service settings. (c) The transition/discharge plan shall be included in the discharge summary. (d) Compliance with 450:18-7-122 may be determined by a review of the following: (1) Policies and procedures; (2) Continuing care plans; (3) Discharge assessments; (4) Discharge summaries; (5) Progress notes; (6) Consumer records; (7) Interviews with staff and consumers; and (8) Other facility information. (a) The consumer record shall contain copies of all consultation reports concerning the consumer. (b) Compliance with 450:18-7-141 may be determined by a review of policies and procedures, consumer records, progress notes, interviews with staff, and other facility documentation. (a) When psychometric or psychological testing is done, the consumer record shall contain a copy of a written report describing the test results and implications or recommendations for treatment. (b) Compliance with 450:18-7-142 may be determined by a review of policies and procedures; consumer records; progress notes; interviews with staff; and other facility documentation. (a) The consumer record shall contain any additional information relating to the consumer, which has been secured from sources outside the treatment facility. The information obtained shall be confidential and privileged and may not be released except as allowed by applicable state and federal laws. (b) Compliance with 450:18-7-143 may be determined by a review of policies and procedures, consumer records, progress notes, interviews with staff, and other facility documentation. (a) A medication record shall be maintained on all consumers who receive medications or prescriptions through facility services and shall be a concise and accurate record of the medications the consumer is receiving or prescribed. (b) The consumer record shall contain a medication record with the following information on all medications that are self-administered, administered, dispensed, or prescribed by licensed medical staff: (1) Type of medication; (2) Dosage; (3) Frequency of administration or prescribed change; (4) Route of administration; and (5) Staff member who administered, dispensed, or monitored self-administration of each dose, prescribing licensed medical staff when applicable, and consumer's signature when self-administered. (c) A record of pertinent information regarding adverse reactions to drugs, drug allergies, or sensitivities during admission, updated when required by virtue of new information, and kept in a highly visible location in or on the record. (d) Compliance with 450:18-7-144 may be determined by a review of policies and procedures, consumer records, progress notes, interviews with staff, and other facility documentation. All treatment facilities shall comply with applicable rules in Title 450, Chapter 15. Consumer Rights. Those programs which are providing services within a correctional facility should detail the following due to circumstance: (1) The provider shall document provisions of 450:15-3-2 (a), (b), and (d). (2) The provider shall provide written grievance policy and procedure including time frames for the grievance process. (3) The provider shall describe the procedure used when the grievance is against a staff. This policy may refer to DOC mandated policy and procedure. (4) The provider shall describe the facility's responsibility for evaluation, review, and resolution should the allegation be substantiated. Each treatment facility shall comply with applicable rules in Title 450, Chapter 15. Consumer Rights. The ODMHSAS Advocate General and Inspector General, in any investigation regarding consumer rights shall have access to consumers' facility records, and facility staff as set forth in Title 450, Chapter 15. Facilities shall document the provision of one or more of the following levels of care and/or optional programs in policies and procedures. All facilities shall include the requirements found in Subchapter 7, Facility Clinical Records. (1) Outpatient services, ASAM Level 1 (2) Residential services, ASAM Level 3 (A) Halfway house services, ASAM Level 3.1, which includes: (i) Adult halfway house services; (ii) Halfway house services for persons with dependent children and pregnant women; and (iii) Adolescent halfway house services. (B) Residential treatment services for adults with co-occurring disorders, ASAM Level 3.3 (C) Residential treatment services, ASAM Level 3.5, which includes: (i) Residential treatment for adults; (ii) Intensive residential treatment for adults; (iii) Residential treatment for persons with dependent children and pregnant women; (iv) Intensive residential treatment for persons with dependent children and pregnant women; (v) Residential treatment for adolescents; and (vi) Intensive residential treatment for adolescents. (D) Medically supervised withdrawal management, ASAM Level 3.7 (a) Every facility shall provide or refer for Human Immunodeficiency Virus (HIV), Sexually Transmitted Diseases (STD), and Acquired Immunodeficiency Syndrome (AIDS) education, testing, and counseling services for drug dependent persons, and every facility shall: (1) Provide or refer for educational sessions regarding HIV/STD/AIDS) to consumers and the significant other(s) of the consumer; (2) Provide or refer all drug dependent persons, and their identified significant others for HIV/STD/AIDS testing and counseling; (3) Provide documentation of services described in (1) and (2) above, including refusal of these services; and (4) Maintain all test results in the confidential manner prescribed by applicable state or federal statutes or regulations. (b) Compliance with 450:18-13-2 shall be determined by a review of the following: written policies and procedures; consumer records; and other supporting facility records and documentation. (a) Outpatient services shall be organized non-residential services with scheduled treatment sessions that accommodate employed and parenting consumers' schedules and offer treatment services during the day, evening, or weekends. Services shall be designed to provide a variety of professional diagnostic and primary substance-related and/or addictive disorder treatment services for consumers their families, and significant others, whose emotional and physical statuses allows them to function in their usual environments. (b) The program shall maintain written programmatic descriptions and operational methods that address the following: (1) Environment: (A) The facility shall be publicly accessible and accommodate office space, individual and group space, secure record storage, protect consumer confidentiality, and provide a safe, welcoming, culturally, and age appropriate environment. (B) Hours of operation shall be during regularly scheduled times in which services are accessible to consumers and the general public, including those employed between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday. (C) For facilities that do not provide twenty-four (24) hour services, the facilities' hours of operation shall be conspicuously displayed on the outside of the building. For facilities in multi-office buildings, the hours shall be posted either on the building directory or the facility's office door. (2) Support system: (A) The facility shall maintain written policies and procedures for handling medical emergencies and an emergency medical number shall be posted for use by staff; and (B) The facility shall have available specialized professional consultation or professional supervision. (3) Staff: (A) The facility shall maintain documentation that service providers are knowledgeable regarding biopsychsocial dimensions of substance-related and addictive disorders, evidenced based practices, cultural, age, and gender specific issues, and co-occurring disorder issues. (B) The facility shall document in personnel records all education, training, and experience stated above prior to service providers providing direct care services. (4) Treatment services: (A) Substance-related and addictive disorders treatment services shall be provided to assess and address the individual needs of each consumer. These services shall include, but not be limited to, therapy, rehabilitation services, case management services, and crisis intervention: (i) Therapy. Therapy, including individual, family, and group therapy, must be provided by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate who must use and document a generally accepted clinical approach to treatment such as cognitive behavioral treatment, narrative therapy, solution focused brief therapy or another widely accepted theoretical framework for treatment. The therapy must be goal directed utilizing techniques appropriate to the individual consumer's service plan and the consumer's developmental and cognitive abilities. (ii) Rehabilitation services. Rehabilitation services must be provided by a LBHP, Licensure Candidate, or Certified Alcohol and Drug Counselor (CADC) or Certified Behavioral Health Case Manager II (CM II). These services include educational and supportive services regarding independent living, self-care, social skills regarding development, lifestyle changes and recovery principles and practices (including relapse prevention). Services provided typically take the form of curriculum based education and skills practice, and should be goal specific in accordance with an individualized service plan. (iii) Peer Recovery Support Services. Peer recovery support services must be provided by Peer Recovery Support Specialists. Services shall be provided in accordance with OAC 450:18-13-221. (iv) Case Management. Case management must be provided by a LBHP, Licensure Candidate, CADC, CM II or CM I as clinically indicated. These services include planned referral, linkage, monitoring, support, and advocacy provided in partnership with a consumer to assist that consumer with self-sufficiency and community tenure. (v) Crisis Intervention. Crisis intervention services must be provided by a LBHP or Licensure Candidate. Crisis intervention services are provided as needed for the purpose of responding to acute behavioral or emotional dysfunction as evidenced by psychotic, suicidal, homicidal severe psychiatric distress, and/or imminent danger of substance relapse. The crisis situation including the symptoms exhibited and the resulting intervention or recommendations must be clearly documented in the consumer's record. (B) Frequency of services shall be determined by mutual agreement between the service provider and the consumer; (C) When appropriate, and with the consumer's consent in accordance with state and federal laws, guidelines, and standards, the treatment program coordinates with other treatment providers that the consumer is currently utilizing; and (D) Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, case management services and, if appropriate, crisis intervention services. (c) Compliance with 450:18-13-21 may be determined by a review of the following: (1) Policies and procedures; (2) Licenses; (3) Treatment protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff and consumers; and (7) Other supporting facility records. (a) Medically supervised withdrawal management shall be provided outside a medical facility, but under the direction of a licensed physician , Advanced Practice Registered Nurse, or Physician Assistant and a licensed registered nurse supervisor, for consumers who are withdrawing or are intoxicated from alcohol or other drugs. Presenting consumers shall be assessed as currently experiencing no apparent medical or neurological symptoms as a result of their substance use that would require hospitalization. (b) The facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: The facility shall provide for beds, food service, monitoring/documenting vital signs, food, and liquids. The facility shall provide a safe, welcoming, and culturally/age appropriate environment. If the facility provides services to consumers under the age of eighteen (18), it shall be licensed by the Oklahoma State Department of Human Services (OKDHS) as a "Residential Child Care Facility". (2) Support system: (A) A licensed physician , Advanced Practice Registered Nurse, or Physician Assistant providing supervision of withdrawal management shall be on site or on call twenty-four (24) hours per day, seven (7) days per week; (B) The facility shall maintain a written plan for emergency procedures which shall be approved by a licensed physician; and (C) The facility shall have supplies, as designated in the written emergency procedures, which shall be accessible to the staff. (3) Staff: (A) Staff members shall be knowledgeable about the physical signs of withdrawal, the taking of vital signs, the implication of those vital signs, and emergency procedures. (B) A Registered Nurse shall provide twenty-four (24) hour on-site supervision and monitoring, and statutorily approved personnel shall administer medications in accordance with physician's orders; (C) Staff shall be knowledgeable regarding facility-required education, evidenced based practices, training, and policies; and (D) The facility shall document in personnel records all education, training, and experience stated in (A), (B), and (C) above prior to staff providing direct care services. (E) The facility shall have a minimum of two (2) staff members on site twenty-four (24) hours per day, seven (7) days per week. If consumers under eighteen (18) are on site, staffing ratios shall not exceed those specified in OAC 340:110-3-153.2. (4) Treatment services: (A) Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder withdrawal management treatment services shall be provided which shall include, but are not limited to, oral intake of fluids, three (3) meals a day, taking of vital signs (temperature, pulse, respiration rate, blood pressure), documentation of fluid and food intake a minimum of one (1) time every six (6) hours or more often as indicated by the consumer's condition. (B) Medications are to be prescribed if needed during withdrawal management. The medications are to include those needed for physical health issues and mental impairment if acquired during the withdrawal process. (5) Assessment: (A) An individualized case management plan shall be developed for each consumer prior to discharge; (B) A medical assessment for appropriateness of placement shall be completed and documented by a licensed physician, Advanced Practice Registered Nurse (APRN) , or Physician Assistant (PA) during the admission process to the program. A Registered Nurse (RN) may assist with the assessment. RN signatures must be co-signed by a physician, APRN or PA at the time the assessment is completed and must include a dated signature(s) of each practitioner. (C) All assessments shall be signed by a licensed physician within twenty-four (24) hours of admission, with the physician as the admitting practitioner of record. (c) Compliance with 450:18-13-61 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, and ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff; and (7) Other supporting facility documentation (a) Substance use disorder treatment in a residential setting shall provide a planned regimen of twenty-four (24) hours a day, seven (7) days a week of professionally directed evaluation, care, and treatment in a permanent program location. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (b) The facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Support system: (A) A licensed physician shall be available, at least by telephone, twenty-four (24) hours per day, seven (7) days per week; (B) The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed physician; and an emergency medical number shall be conspicuously posted for staff use; and (C) The facility shall maintain written policies and procedures for the handling of clinical issues during times in which clinical staff are not at the facility. (2) Staff: (A) The facility shall maintain documentation that service providers are knowledgeable regarding the biopsychosocial dimensions of substance use disorders, evidenced-based practices, culture, age, and gender related issues, and co-occurring disorder issues. (B) The facility shall document in personnel records all education, training, and experience stated above prior to the provision of direct care services. (C) The facility shall have staff members on site twenty-four (24) hours per day, seven (7) days per week. (3) Treatment services. Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder treatment services shall be provided to assess and address individual needs of each consumer. Services shall include, but are not limited to: (A) Therapy. Therapy, including individual, family, and group therapy, must be provided by a Licensed Behavioral Health Professional (LBHP) or Licensure Candidate who must use and document a generally accepted clinical approach to treatment such as cognitive behavioral treatment, narrative therapy, solution focused brief therapy or another widely accepted theoretical framework for treatment. The therapy must be goal directed utilizing techniques appropriate to the individual consumer's service plan and the consumer's developmental and cognitive abilities. This service does not include social skill development or daily living skill activities. (B) Rehabilitation services. Rehabilitation services must be provided by a LBHP, Licensure Candidate, or Certified Alcohol and Drug Counselor (CADC) or Certified Behavioral Health Case Manager II (CM II). These services include educational and supportive services regarding independent living, self-care, social skills regarding development, lifestyle changes and recovery principles and practices (including relapse prevention). Services provided typically take the form of curriculum based education and skills practice, and should be goal specific in accordance with an individualized service plan. (C) Peer Recovery Support Services. Peer recovery support services must be provided by Peer Recovery Support Specialists. Services shall be provided in accordance with OAC 450:18-13-221. (D) Care Management. Care management must be provided by a LBHP, Licensure Candidate, CADC, CM II or CM I as clinically indicated. Care management is case management provided in residential settings that includes assessment, development of a care plan, and referral and linkage to community supports and community-based or lower level of care services to promote continued recovery after the individual discharges from the treatment facility. (E) Crisis Intervention. Crisis intervention services must be provided by a LBHP or Licensure Candidate. Crisis intervention services are provided as needed for the purpose of responding to acute behavioral or emotional dysfunction as evidenced by psychotic, suicidal, homicidal severe psychiatric distress, and/or imminent danger of substance relapse. The crisis situation including the symptoms exhibited and the resulting intervention or recommendations must be clearly documented in the consumer's record. (F) Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (4) The program provides documentation of the following community living components: (A) A written daily schedule of activities. (B) Quarterly meetings between consumers and the program personnel. (C) Recreational activities to be utilized on personal time. (D) Personal space for privacy. (E) Security of consumer's property. (F) A clean, inviting, and comfortable setting. (G) Evidence of individual possessions and decorations. (H) Daily access to nutritious meals and snacks. (I) Policy addressing separate sleeping areas for the consumers based on: (i) Gender; (ii) Age; and (iii) Needs. (c) Compliance with 450:18-13-101 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel record, documentation of professional licensure or certification, documentation of professional work experience, and ongoing in-service trainings; (5) Treatment records; and (6) Interviews with staff and consumers. (a) Substance use disorder treatment shall be provided in a residential setting offering a planned regimen of twenty-four (24) hours a day, seven (7) days a week of professionally directed evaluation, care, and treatment in a permanent setting and under a defined set of policies and procedures. (b) Each facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: The facility shall provide family-style living arrangements, indoor recreational space for children and families, and safe, protected outdoor recreational and leisure space. The facility shall provide for materials and space appropriate for ages and development of children receiving services. (43A O.S. §3-417). The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (2) Support system: (A) A licensed physician shall be available, at least by telephone, twenty-four (24) hours per day, seven (7) days per week. (B) The facility shall promote and facilitate children's access to the fullest possible range of medical services available such as health screening, well-child health care, screening in speech, language, hearing, and vision, and verify immunization records. (C) Access to emergency health care shall be provided as necessary. The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed physician, and an emergency medical number shall be conspicuously posted for staff use. (D) The facility shall have access to public schools for school age children, and facilitation of the child's receiving the benefits of Public Laws 99-142; and (E) The facility staff shall document a liaison with the local Oklahoma Department of Human Service (OKDHS) offices to: (i) Promote preservation of families; (ii) In cases of investigation of abuse, provide instruction in positive parenting behavior, if requested by the Oklahoma Department of Human Services (OKDHS) and with parental consent, provide daily observations of parent-child interaction; (iii) Expedite investigations in a timely manner; and (iv) Ensure prompt facility response to situations which require immediate intervention. (3) Staff: (A) The facility shall maintain documentation that service providers are knowledgeable regarding biopsychsocial dimensions of substance use disorder, evidenced based practices, culture, age and gender related issues, co-occurring disorder issues and treatment of infants, toddlers, preschool children, and school-age children. (B) The facility shall document that service providers have training in the following: (i) trauma issues, identification of domestic violence, spousal or partner abuse, and child abuse and neglect, with special emphasis on failure to thrive, and sexual abuse of children; (ii) child development and age appropriate behaviors; (iii) parenting skills appropriate to infants, toddlers, preschool, and school age children; and (iv) the impact of substances and substance use disorders on parenting and family units. (C) The facility shall document that staff working with children shall have ongoing training in the following and demonstrate job appropriate functional comprehension of: (i) the impact of prenatal drug and alcohol exposure on child development; (ii) the effect of substance use disorders on parenting children and families; (iii) parenting skills appropriate to infants, toddlers, preschool, and school age children; (iv) common children's behavioral and developmental problems; (v) appropriate play activities according to developmental stage; (vi) recognition of sexual acting-out behavior; and (vii) the substance use disorder recovery process, especially as related to family units. (D) The facility shall document that staff are knowledgeable regarding facility-required education, and training requirements and policies; (E) The facility shall have staff on site twenty-four (24) hours a day; and (F) The facility shall document in personnel records, all education, training, and experience stated above prior to the provision of services. (4) Treatment services: (A) The facility shall provide (twenty-four [24] hours a day, seven [7] days a week) substance use disorder treatment services to assess and address individual needs of each consumer. Treatment services, shall include, but are not limited to those specified in 450:18-13-101(b)(3). Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (B) Services may be provided to dependent children by providers certified under this Chapter when provided to address the impacts related to the parent's addiction; however, compliance with separate provider qualifications may be required for treatment services provided to dependent children, in accordance with OAC 450 and Title 43A of the Oklahoma Statutes. The facility shall provide treatment services for children ages four (4) to twelve (12) years in accordance with the child's service plan, including, but not limited to, assessment and age appropriate individual, family and group therapy (topics can include, but are not limited to, poor impulse control, anger management, peer interaction, understanding feelings, problem/conflict resolution), according to the development of the child. Special attention shall be given to the high risk of sexual abuse, sexual acting-out by children, suicide risk, and the treatment of toddlers and preschool children; and (C) Children's services, excluding infants, shall address the significant issues and needs documented in the child's and/or parent's assessment utilizing both structured and unstructured therapeutic activity. Services shall create and enhance positive self-image and feelings of self-worth, promote family unity, teach personal body safety, and positive school interactions, and to prevent alcohol, tobacco, and other drug use; and (D) Services for infants (ages birth to three [3] years of age) shall include, at a minimum, developmentally appropriate parent-child interactive bonding activities and developmentally appropriate structured activities that promote and nurture the growth and well being of the infant; and (E) Case management services for each adult and each child that include assessment of and planning and arranging for recovery needs. (5) The program provides documentation of the following community living components: (A) A written daily schedule of activities. (B) Quarterly meetings between consumer and the program personnel. (C) Recreational activities to be utilized on personal time. (D) Personal space for privacy. (E) Security of consumer's property. (F) A clean, inviting, and comfortable setting. (G) Evidence of individual possessions and decorations. (H) Daily access to nutritious meals and snacks. (I) Policy addressing separate sleeping areas for the consumers based on: (i) Gender; (ii) Age; and (iii) Needs. (c) Compliance with 450:18-13-121 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel record, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service trainings; (5) Records; (6) Interviews with staff; and (7) Other facility documentation. (a) Substance use disorder and mental health treatment shall be provided in a residential setting offering a planned regimen of twenty-four (24) hour structured evaluation, care, and treatment, under a defined set of policy and procedures, and shall have a permanent setting. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (b) The facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Support system: (A) The facility shall maintain availability of a licensed physician, who is knowledgeable in substance use disorders and mental health issues to provide evaluation, treatment and follow-up; and a licensed psychiatrist will be available by telephone twenty-four (24) hours per day, seven (7) days per week; (B) The facility shall make available medication evaluation, administration, or monitoring, and staff shall be available to monitor medications as needed; and (C) The facility shall provide case management services. (D) The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed psychiatrist, and an emergency medical number shall be conspicuously posted for staff use. (2) Staff: (A) Service providers shall be knowledgeable regarding substance use disorders, mental health, evidenced based practices, co-occurring issues, culture, age, and gender related issues. (B) All staff shall be knowledgeable regarding facility-required education, training, and policies; and (C) The facility shall document in personnel records, prior to the provision of treatment services, all education, training, and experience stated above. (3) Treatment services: (A) Daily treatment service shall be provided to assess and address individual needs of each consumer. These services shall include those specified at 450:18-13-101(b)(3). (B) Psychiatric and/or psychological and/or mental health evaluations shall be completed on all consumers. (C) Medication monitoring shall be provided. (4) Treatment documentation: (A) The service plan shall address the consumer's mental health needs and related medications. The consumer's medications shall be re-assessed a minimum of once every thirty (30) days. (B) Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (5) The program provides documentation of the following community living components: (A) A written daily schedule of activities. (B) Quarterly meetings between consumers and the program personnel. (C) Recreational activities to be utilized on personal time. (D) Personal space for privacy. (E) Security of consumer's property. (F) A clean, inviting, and comfortable setting. (G) Evidence of individual possessions and decorations. (H) Daily access to nutritious meals and snacks. (I) Policy addressing separate sleeping areas for the consumers based on: (i) Gender; (ii) Age; and (iii) Needs. (c) Compliance with 450:18-13-141 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel record, documentation of professional licensure or certification, documentation of professional work experience and ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff; and (7) Other facility documentation. (a) Residential treatment for adolescents ages thirteen (13) to seventeen (17) shall provide a planned regimen of twenty-four (24) hour, seven (7) days a week, professionally directed evaluation, care, and treatment for chemically dependent adolescents, under written policies and procedures in a permanent facility. Adolescents not attending academic training shall participate in at least twenty-four (24) substance use disorder treatment related hours per week. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (b) The residential treatment program shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: (A) The facility shall maintain an environment which is supportive of physical and emotional growth and development which is appropriate to the needs of adolescents; (B) The facility shall provide space, both indoor and outdoor, for the recreational and social needs of adolescents; (C) The facility shall group consumers appropriately by age, developmental level, gender, and treatment needs; (D) The program may provide transportation to activities in the community as appropriate. Vehicles used for transportation should not be labeled in any way that calls attention to the facility or the vehicle's occupants; (E) The program shall provide study areas within the facility and shall provide ancillary study materials such as encyclopedias, dictionaries, and educational resource texts and materials; and (F) The facility shall be licensed by the Oklahoma State Department of Human Services (OKDHS) as a "Residential Child Care Facility". (2) Support systems: (A) The facility shall make available a licensed physician by telephone twenty-four (24) hours per day, seven (7) days per week; (B) The facility shall have specialized professional consultation or supervision available; (C) The facility shall provide clinically appropriate public educational services in compliance with applicable Oklahoma laws; and (D) The facility shall provide emergency services and crisis interventions. (E) The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed physician, and an emergency medical number shall be conspicuously posted for staff use. (3) Staff: (A) The facility shall document that service providers are knowledgeable regarding the biopsychsocial aspects of substance use disorder, cultural, gender, and age specific issues, co-occurring disorder issues, child and adolescent development and, evidenced based practices. (B) Maintain documentation that service providers are knowledgeable regarding the identification of violence and domestic violence, spousal or partner abuse, child abuse and neglect, parent and sibling abuse, normal and abnormal adolescent development, and family dynamics; (C) Ensure at least two (2) staff members are awake and on duty twenty-four (24) hours a day, seven (7) days a week. Staffing ratios shall not exceed those specified in OAC 340:110-3-153.2. (D) If educational services are provided, the facility shall maintain documentation to verify that providing staff meets all state requirements for education or special education; (E) Staff shall be knowledgeable regarding the facility required education, and training requirements and policies; and (F) The facility shall document in personnel records all education training and experience stated in above prior to the provision of direct care service. (4) Treatment services: (A) A multidisciplinary team approach shall be utilized in providing daily substance use disorder treatment services to assess and address the individual needs of each adolescent; (B) Services shall include, but not be limited to, those specified at 450:18-13-101(b)(3). (C) Services shall be provided in appropriate groups according to age, gender, developmental level, treatment status, and individual needs; (D) The facility shall provide clinically appropriate public educational services in compliance with applicable Oklahoma law; (E) Consumers shall participate in educational programs within the community, when clinically indicated, including extracurricular activities; and (F) Service providers shall confer on a regular basis with school personnel, including the provision of necessary information, when appropriate, on the educational progress of the consumer, and shall assess and respond to the needs for changes in the educational plans. (G) Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (5) Assessments: (A) A physical examination shall be conducted by a licensed physician, to include physical assessment, health history, immunization status, and evaluation of motor development and function, speech, hearing, visual, and language functioning; and (B) The facility shall facilitate and document the involvement and participation of family members or significant others in the assessment, treatment, rehabilitation, and continuing treatment needs of each consumer; (6) Documentation of the following community living components: (A) A written daily schedule of activities. (B) Quarterly meetings between consumers and the program personnel. (C) Recreational activities to be utilized on personal time. (D) Personal space for privacy. (E) Security of consumer's property. (F) A clean, inviting, and comfortable setting. (G) Evidence of individual possessions and decorations. (H) Daily access to nutritious meals and snacks. (I) Policy addressing separate sleeping areas for the consumers based on: (i) Gender; (ii) Age; and (iii) Needs. (c) Compliance with 450:18-13-161 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment and service protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service training(s); (5) Treatment records; (6) Interviews with staff and consumers; and (7) Other facility documentation. (a) Halfway house services shall provide low intensity treatment in a supportive living environment to facilitate reintegration into the community. Major emphasis shall be on continuing substance use disorder care and follow-up, and community ancillary services in an environment supporting continued abstinence. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (b) Each facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: The facility shall be a freestanding facility or portion of a related healthcare facility having at least one (1) each of toilet, lavatory, and bathing facilities for each eight (8) residents. The facility shall provide a safe, welcoming, and culturally/age appropriate environment. (2) Support system: (A) A licensed physician shall be available, by telephone twenty-four (24) hours a day, seven (7) days a week; (B) The facility shall have a written plan for emergency procedures, approved by a licensed physician; (C) The facility shall have supplies, as designated by the written emergency procedures plan, which shall be accessible to staff at all times; and (D) Specialized professional consultation or professional supervision shall be available. (3) Staff: (A) Service providers shall be knowledgeable regarding biopsychsocial dimensions of substance use disorders, evidenced based practices, culture, age, and gender related issues, and co-occurring disorder issues; (B) Staff shall be knowledgeable regarding facility-required education, training, and policies; (C) Staff shall be knowledgeable about emergency procedures as specified in the emergency procedures plan; (D) The facility shall have staff members on site twenty-four (24) hours per day, seven (7) days per week; and (D) The facility shall document in personnel records all education, training, and experience stated above prior to the provision of direct care services. (4) Treatment services. The facility shall have scheduled rehabilitation services to assess and address the individual needs of each consumer. Such services shall include, but not be limited to those specified at 450:18-13-101(b)(3). Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (c) Compliance with 450:18-13-181 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff and consumers; and (7) Other facility records. (a) Halfway house treatment for adolescents ages thirteen (13) to seventeen (17) shall provide low intensity substance use disorder treatment in a supportive living environment to facilitate reintegration into the home or community. Emphasis shall be on applying recovery skills, relapse prevention, independent living skills, and educational and vocational skills. The facility shall provide beds, food service, and a safe, welcoming, and culturally/age appropriate environment. (b) Each facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: (A) The facility shall maintain an environment which is supportive of physical and emotional growth and development which is appropriate to the needs of adolescents; (B) The facility shall provide space, both indoor and outdoor, for the recreational and social needs of adolescents; (C) The facility shall group consumers appropriately by age, developmental level, gender, and treatment needs; (D) The program may provide transportation to activities in the community as appropriate. Vehicles used for transportation should not be labeled in any way that calls attention to the facility or the vehicle's occupants; (E) The program shall provide study areas within the facility and shall provide ancillary study materials such as encyclopedias, dictionaries, and educational resource texts and materials; and (F) The facility shall be licensed by the Oklahoma State Department of Human Services (OKDHS) as a "Residential Child Care Facility". (2) Support systems: (A) A licensed physician shall be available by telephone twenty-four (24) hours per day, seven (7) days a week; (B) The facility shall have specialized professional consultation or supervision available; (C) The facility shall provide clinically appropriate public educational services in compliance with applicable Oklahoma laws; and (D) The facility shall provide emergency services and crisis interventions. (E) The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed physician, and an emergency medical number shall be conspicuously posted for staff use. (3) Staff: (A) Service providers shall be knowledgeable regarding the biopsychsocial aspects of substance use disorders, evidenced based practices, co-occurring disorder issues, child and adolescent development issues, and culture, age, and gender related issues. (B) Service providers shall be knowledgeable regarding the identification of violence and domestic violence, spousal or partner abuse, child abuse and neglect, parent and sibling abuse, normal and abnormal adolescent development, and family dynamics; (C) The facility shall have a minimum of two (2) staff members on duty twenty-four (24) hours per day, seven (7) days a week. Staffing ratios shall not exceed those specified in OAC 340:110-3-153.2. (D) Staff shall be knowledgeable about emergency procedures as specified in the emergency procedures plan; (E) If educational services are provided, documentation shall be maintained to verify providing staff meet all state requirements for education or special education; (F) Staff shall be knowledgeable regarding the facility-required education, training requirements, and policies; and (G) The facility shall document in personnel records all education, training, and experience stated above prior to the provision of direct care services. (4) Treatment services: (A) The facility shall provide substance use disorder treatment services to assess and address the individual needs of each adolescent, to include, but not be limited to those specified at 450:18-13-101(b)(3).Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (B) The facility shall provide services in appropriate groups according to age, gender, developmental level, and individual needs; (C) The facility shall provide for clinically appropriate public educational services in compliance with applicable Oklahoma law; (D) Consumers may participate in educational programs in the community, when clinically indicated, including extracurricular activities; and (E) Service providers shall confer on a regular basis with school personnel, including the provision of necessary information when appropriate, on the educational progress of the consumer and shall assess and respond to the needs for changes in the educational plans. (5) Assessment; (A) A physical examination shall be conducted by a licensed physician to include physical assessment, health history, immunization status, and evaluation of motor development and functioning, speech, hearing, visual and language functioning; and (B) The facility shall facilitate involvement and participation of family members or significant others in the assessment, treatment, rehabilitation, and continuing treatment needs of each consumer. (c) Compliance with the above may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff and consumers; and (7) Other facility records. (a) Halfway house services for persons with dependent children and pregnant women shall provide substance use disorder treatment services in a residential setting and shall include a planned regimen of twenty-four (24) hour, seven (7) days a week, supervised living arrangements, to include professionally directed evaluation, care, and treatment, under a defined set of policy and procedures, in a permanent setting. (b) Each facility shall maintain written programmatic descriptions and operational methods addressing the following: (1) Environment: The facility shall be a freestanding facility providing family-style living arrangements, indoor recreational space for children and families, and safe, protected outdoor recreational space. The facility shall provide materials and space appropriate for ages of children receiving services. The facility shall provide a safe, welcoming, and culturally/age appropriate environment. (2) Support system: (A) A licensed physician shall be available by telephone twenty-four (24) hours per day, seven (7) days a week; (B) The facility shall ensure children's access to the fullest possible range of medical services available, such as health screening, well-child health care, screening in speech, language, hearing, and vision, and verification of immunization records; (C) The facility shall have access to emergency health care provided as necessary. The facility shall maintain written policy and procedures for handling medical emergencies which are approved by the licensed physician, and an emergency medical number shall be conspicuously posted for staff use; (D) The facility shall have access to public schools for school age children, and facilitation of the child's receiving the benefits of Public Laws 99-142; and (E) The facility staff shall document a liaison with the local Oklahoma Department of Human Service (OKDHS) offices to: (i) Promote preservation of families; (ii) In cases of investigation of abuse, provide instruction in positive parenting behavior, if requested by the Oklahoma Department of Human Services (OKDHS) and with parental consent, provide daily observations of parent-child interaction; (iii) Expedite investigations in a timely manner; and (iv) Ensure prompt facility response to situations which require immediate intervention. (3) Staff: (A) Service providers shall be knowledgeable regarding Biopsychsocial dimensions of substance use disorder, evidenced-based practices, culture, age, and gender related issues, co-occurring disorder issues, and services for infants, toddlers, preschool, and school-age children. (B) Service providers are minimally trained in: (i) Trauma issues, identification of domestic violence, spousal or partner abuse, and child abuse and neglect, with special emphasis on failure to thrive and sexual abuse of children. (ii) Child development and age appropriate behaviors. (iii) Parenting skills appropriate to infants, toddlers, pre-school, and school age children. (iv) The impact of substances and substance use disorders on parenting and family units. (C) Service providers working with children shall be knowledgeable and demonstrate job appropriate functional comprehension of: (i) The impact of prenatal drug and alcohol exposure on child development. (ii) The effect of substance use disorders on parenting, children, and families. (iii) Parenting skills appropriate to infants, toddlers, pre-school, and school age children. (iv) Common child behavioral and developmental problems. (v) Appropriate play activities according to developmental stage. (vi) Recognition of sexual acting out behavior. (vii) The substance use disorder recovery process, especially as related to family units. (D) The facility shall have staff members on site and awake twenty-four (24)hours per day, seven (7) days per week; (E) Staff shall be knowledgeable regarding facility-required education and training requirements and policies; and (F) The facility shall document in personnel records all education, training, and experience stated above prior to the provision of direct care services. (4) Treatment services: (A) Daily (twenty-four [24] hours a day, seven [7] days a week) substance use disorder services shall be provided to assess and address individual needs of each consumer. Services shall include, but are not limited to, those specified at 450:18-13-101(b)(3). Documentation shall reflect each consumer received and/or was offered, at minimum, individual, group, and/or family therapy, rehabilitation services, care management services and, if appropriate, peer recovery support services and crisis intervention services. (B) Services may be provided to dependent children by providers certified under this Chapter when provided to address the impacts related to the parent's addiction; however, compliance with separate provider qualifications may be required for treatment services provided to dependent children, in accordance with OAC 450 and Title 43A of the Oklahoma Statutes. Services for children shall be provided in accordance with the child's service plan consisting of, but not limited to, assessment and therapy, according to the development of the child. Documentation of all needs identified for each child shall be identified on that child's case management service plan and/or service plan. (C) Children's services, excluding infants, shall be provided which address the significant issues and needs documented in either or both the child's and the parent's assessment and shall utilize both structured and unstructured therapeutic activity. Services shall address the significant issues and needs documented in the parent's or child's assessment and create and enhance positive self image and feelings of self-worth, promote family unity, teach personal body safety and positive school interactions, and to prevent alcohol, tobacco, and other drug use; (D) Infant services, ages birth to three (3) years of age, shall be provided and shall consist, at a minimum, of developmentally appropriate parent-child bonding (interactive) activities and play therapy as determined by mother's service plan; and (E) Case management services for each adult and each child shall be provided, which include the assessment of and planning and arranging for recovery needs. (c) Compliance with 450:18-13-201 may be determined by review and/or observation of facility documentation and operations, including but not limited to the following: (1) Licenses; (2) Policies and procedures; (3) Treatment protocols; (4) Personnel records, documentation of professional licensure, certification or licensure as an alcohol and drug counselor, documentation of professional work experience, and ongoing in-service trainings; (5) Treatment records; (6) Interviews with staff and consumers; and (7) Other facility documentation. (a) Peer recovery support services are provided as a program integrated within the overall structure of substance-related and addictive disorders agency services and may be offered to consumers age sixteen (16) and older with substance use disorders, including co-occurring disorders. (b) Peer recovery support services may be offered to other consumers of the agency and their families. (c) These services shall: (1) Be based on an individualized, recovery-focused service philosophy that allows individuals the opportunity to learn to manage their own recovery and advocacy process; (2) Recognize the unique value of services being provided by persons with lived experience who are able to demonstrate their own hopefulness and recovery; (3) Enhance the development of natural supports, coping skills, and other skills necessary to function as independently as possible in the community, including, but not limited to, assisting re-entry into the community after a hospitalization or other residential setting; (4) Have written policies specific to these services; and, (5) Be provided by Recovery Support Specialists as defined by OAC 450:18-13-222. (d) Each agency shall have in place provisions for direct supervision and other supports for staff providing this service. (e) Compliance with 450:18-13-221 shall be determined by a review of documentation of linkage activities and agreements, clinical records, PICIS reporting data, and policies and procedures. (a) Peer Recovery Support Services shall be provided only by Peer Recovery Support Specialists meeting the requirements and certified pursuant to OAC 450:53. (b) Each agency shall document and maintain records to verify current credentialing of each provider of this service. (c) Compliance for 450:17-3-192 shall be determined by a review of the facility personnel records and ODMHSAS credentialing files. (a) Peer Recovery Support services can be provided in any location. The majority of contacts should be face-to-face, however, services may be provided over the telephone as necessary to help the consumer achieve his or her goals. (b) Compliance for 450:18-13-223 shall be determined by a review of the agency policies and procedures, PICIS, consumer records, consumer interviews, and observation.