This chapter establishes licensing and operating standards for crisis intervention service providers in Louisiana, administered by the Department of Social Services. Operators must obtain and maintain a license, meet organizational and administrative requirements, follow program and service standards (including crisis assessment, de-escalation, and prohibited restraint practices), meet personnel qualifications and training requirements, and uphold client rights and grievance procedures. The regulations govern crisis care providers offering assessment, de-escalation, one-to-one intervention, and referral services to individuals in emotional or behavioral crisis.
View official sourceChapter 89.Crisis Intervention §8901.Purpose A.The overall purpose of these regulations is the protection of the health, safety and well-being of persons served by crisis care providers. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1261 (November 1995). §8903.Procedures A.Initial Application. Before beginning operation, it is mandatory to obtain a license from the Department of Social Services. To do so, the following steps should be followed: 1.Secure an application form issued by: Department of Social Services Bureau of Licensing, P. O. Box 3078, Baton Rouge, LA 70821-3078. Phone: (504) 922-0015 2.A license will be issued on an initial application when the licensure inspection verifying compliance is completed and verification is received by the Bureau of Licensing. 3.When a Provider changes location, it is mandatory to notify the Bureau of Licensing and program offices as appropriate. Additionally the provider must submit the processing fee to the bureau. 4.When a provider changes ownership, a new application and fee are required. 5.A license is valid for the period for which it is issued but may be revoked if the provider falls below minimum standards. 6.The department is authorized to determine the period during which the license shall be effective. A license is not transferable to another person or location. 7.If a director or member of his immediate family has had a previous license revoked or refused, upon re-application, applicant shall provide satisfactory evidence that the reason for such revocation no longer exists. B.Fees 1.An application processing fee of $25 is required to be submitted with all initial applications. This fee is to be paid by all providers. All fees are nonrefundable. 2.Other licensure fees: a.$25 replacement fee for any provider replacing a license when changes are requested by the provider, i.e. change in provider location, name change, age range change. b.$5 processing fee for issuing a duplicate provider license with no changes. C.Relicensing. The relicensing survey is similar to the original licensing inspection. The provider will have an opportunity to review any licensing deficiencies with the licensing specialist before it is submitted to the State Office. 1.A license is issued for a period of no more than one year. Provider is totally responsible for applying for license renewal on an annual basis. Failure to reapply will result in nonrenewal of license. 2.If the licensure inspection reveals that the provider is not substantially meeting minimum requirements, a new license may not be issued. 3.The Department of Social Services shall be notified before changes are made which might have an effect upon the license (for example, changes in age range, changes in location). D.Inspections 1.It shall be the duty of the Department of Social Services through its duly authorized agents, to inspect at regular intervals not to exceed one year, or as deemed necessary by the department, and without previous notice, all crisis care/intervention service providers. 2.Whenever the department is advised or has reason to believe that any person or agency or organization is operating a crisis intervention service without a license, the department shall make an investigation to ascertain the facts. E.Waivers 1.The office of the Secretary of the Department of Social Services shall have the authority to waive any of these standards for just cause provided the health and safety of the clients and/or staff are not in jeopardy. If it is determined that the provider or agency is meeting or exceeding the intent of a standard or regulation, the standard or regulation may be deemed to be met. F.Denial, Revocation, or Nonrenewal of License 1.An application for a license may be denied for any of the following reasons: a.failure to meet any of the minimum standards for licensure. b.conviction of a felony, as shown by a certified copy of the record of the court of conviction of the applicant; i.or if the applicant is a firm or corporation, of any of its members or officers; ii.or of any staff providing the crisis intervention or supervision of the clients. 2.A license may be revoked, or renewal thereof, denied, for any of the following reasons: a.cruelty or indifference to the welfare of the children and adults; b.violation of any provision of the minimum standards, rules, regulations, or orders of the Department of Social Services promulgated thereunder; c.disapproval from any agency whose approval is required for licensure; d.non payment of application processing fee or failure to submit a licensure application; e.any validated instance of client abuse, corporal punishment, physical punishment, cruel, severe, or unusual punishment may result in revocation, denial or nonrenewal of the license if the owner is responsible or if the staff member who is responsible remains in the employment of the provider. G.Appeal Procedure. If the license is refused or revoked because the provider does not meet minimum requirements for licensure, the procedure is as follows: 1.the Department of Social Services, by certified letter, shall advise the provider of the reasons for denial or revocation, and its right of appeal; 2.the provider/owner may appeal this decision by submitting a written request with the reasons to the Secretary of the Department of Social Services. Write to Department of Social Services, Appeals Section, P.O. Box 2994, Baton Rouge, LA 70821-9118. This written request must be post-marked within 30 days of the director/owner's receipt of the above notification in 8903.G.1; 3.the Appeals Bureau of the Department of Social Services shall set a hearing; 4.an appeal hearing officer of the Department of Social Services shall conduct the hearing. The Department of Social Services shall advise the appellant by certified letter of the decision, either affirming or reversing the original decision. If the license is denied or revoked, the provider shall terminate operation immediately; 5.if the provider continues to operate without a license, the Department of Social Services may file suit in the district court in the parish in which the provider is located for injunctive relief. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1261 (November 1995). §8905.Organization and Administration A.General Requirements 1.A provider shall allow designated representatives of DSS in the performance of their mandated duties to inspect all aspects of a provider's functioning which impact on clients and to interview any staff member or client (if the client agrees to said interview). 2.A provider shall make any information which the Provider is required to have under the present requirements and any information reasonably related to assessment of compliance with these requirements available to DSS. B.Governing Body 1.A provider shall have an identifiable governing body with responsibility for and authority over the policies and activities of the program/agency. 2.A provider shall have documents identifying all officers and members of the governing body, their addresses, and terms of membership. 3.When the governing body of a provider is comprised of more than one person, the governing body shall hold formal meetings at least twice a year. 4.When the governing body is composed of more than one person, a provider shall have written minutes of all formal meetings of the governing body and by-laws specifying frequency of meetings and quorum requirements. C.Responsibilities of a Governing Body. The governing body of a provider shall: 1.ensure the provider's compliance and conformity with the provider's charter; 2.ensure the provider's continual compliance and conformity with all relevant federal, state, local, and municipal laws and regulations; 3.ensure that the provider is adequately funded and fiscally sound; 4.review and approve the provider's annual budget; 5.ensure the review and approval of an annual external audit; 6.designate a person to act as chief administrator and delegate sufficient authority to this person to manage the provider agency; 7.formulate and annually review, in consultation with the chief administrator, written policies concerning the provider's philosophy, goals, current services, personnel practices, job descriptions and fiscal management; 8.annually evaluate the chief administrator's performance; 9.have the authority to dismiss the chief administrator; 10.meet with designated representatives of DSS whenever required to do so; 11.inform designated representatives of DSS prior to initiating any substantial changes in the services provided by the provider. D.Accessibility of Executive. The chief administrator or a person authorized to act on behalf of the chief administrator shall be accessible to staff and designated representatives of DSS at all times. E.Documentation of Authority to Operate. A private provider shall have documentation of its authority to operate under state law. F.Administrative File. A provider shall have an administrative file including: 1.documents identifying the governing body; 2.list of members and officers of the governing body and their addresses and terms of membership; 3.minutes of formal meetings and by-laws of the governing body, if applicable; 4.documentation of the provider's authority to operate under state law; 5. organizational chart of the provider; 6.all leases, contracts and purchase-of-service agreements to which the provider is a party; 7.insurance policies: every provider shall maintain in force at all times a comprehensive general liability insurance policy. this policy shall be in addition to any professional liability policies maintained by the provider and shall extend coverage to any staff member who provides transportation for any client in the course and scope of his/her employment; 8.annual budgets and audit reports; 9.master list of all contractors used by the provider. G.Accounting 1.A provider shall establish a system of business management and staffing to assure maintenance of complete and accurate accounts, books and records, in keeping with generally accepted accounting principles. 2.A provider shall demonstrate fiscal accountability through regular recording of its finances and annual external audit. 3.A provider shall not permit public funds to be paid, or committed to be paid, to any person or organization to which any of the members of the governing body, administrative personnel, or members of the immediate families of members of the governing body or administrative personnel have any direct or indirect financial relationship or interest, or in which any of these persons serve as an officer or employee, unless the services or goods involved are provided at a competitive cost or under terms favorable to the provider. The provider shall have a written disclosure of any financial transaction between the provider and other business entities in which a member of the governing body, administrative personnel, or his/her immediate family is involved. H.Confidentiality and Security of Files 1.A provider shall have written procedures for the maintenance, security, and confidentiality of records. This shall include specifying who shall supervise the maintenance of records, and who shall have custody of records. This procedure shall also state to whom records can be released and the procedure for doing so. Records, including client as well as administrative, shall be the property of the provider and the provider, as custodian, shall secure records against loss, tampering, or unauthorized use. 2.Staff members of the provider shall not disclose or knowingly permit the disclosure of any information concerning the agency, the clients or his/her family, directly or indirectly, to any unauthorized person. 3.When the client is of majority age and noninterdicted, a Provider shall obtain the client's written, informed permission prior to releasing any information from which the client or his/her family might be identified. 4.When a client is a minor or is interdicted, a provider shall obtain written, informed consent from the legally responsible person prior to releasing any information from which the client or his/her family might be identified. 5.A provider shall, upon written authorization from the client or his legal representative, make available information in the case record to the client, his counsel, or the client's legally responsible person. If, the provider reasonably concludes that knowledge of the information contained in the record would be injurious to the health or welfare of the client, or could reasonably be expected to endanger the life or safety of any other person, that provider may deny access to the record. The provider may charge a reasonable fee for copying the records. 6.A provider may use material from case records for teaching or research purposes, development of the governing body's understanding and knowledge of the provider's services, or similar educational purposes, provided that names are deleted and other similar identifying information is disguised or deleted. 7.A provider shall not release a personnel file without the staff member's written permission except in accordance with state law. I.Records - Administrative and Client 1.A provider shall ensure that all entries in records are legible, signed by the person making the entry and accompanied by the date on which the entry was made. 2.All records shall be maintained in an accessible, standardized order and format and shall be retained and disposed of in accordance with state laws and requirements of the funding sources. 3.A provider shall have sufficient space, facilities and supplies for providing effective record keeping services. 4.A provider shall have a written record for each client which shall include: a.The name, sex, race, birth date of the client, home address, address of crisis location. b.Other identification data including court status and/or legal status, name of parent or legal guardian, as appropriate. c.The names, addresses and phone numbers of other persons or providers involved with the client's plan/case. This shall include the client's physician. d.A provider shall document: i.client's presenting problem, any known DSM IV diagnosis and medications; ii.any other known serious health condition and medication. e.information and documentation of interventions used and case disposition, including progress notes as required in 8907.D.1.b. f.information and documentation concerning any injuries (regardless of cause), any violations of client safeguards, any suspected incidents of abuse/mistreatment/neglect, or any client grievances. 5.A provider shall have a written record for each staff member which includes: a.the application for employment and/or resume's; b.references (three); c.any required medical examinations; d.all required documentation of appropriate status which includes: i.valid driver's license for operating provider vehicles or transporting clients; ii.professional credentials/certification required to hold the position. e.periodic, at least annual, performance evaluations; f.staff member's starting and termination dates along with salary paid; g.staff member shall have reasonable access to his/her file and shall be allowed to add any written statement he/she wishes to make to the file at any time; h.documentation of criminal records check; i.any reports or internal investigations concerning the staff member's involvement in any suspected abuse/mistreatment/neglect, violation of client safeguards, or violation of client rights. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1262 (November 1995). §8907.Program and Services A.Program Description 1.A provider shall have a written program description describing: a.the overall philosophy of the provider; b.the long-term and short-term goals of the provider; c.the types of clients best served by the provider; d.there shall be written eligibility criteria for each of the services/programs provided; e.the services provided directly or through subcontract by the provider; f.a schedule for any fees for services which will be charged the client. 2.A provider shall make every effort to ensure that service and program planning for each client is a comprehensive process involving appropriate provider staff, representatives of other agencies, the client, and where appropriate the legally responsible person, and any other person(s) significantly involved in the client's care on an ongoing basis. 3.A provider shall perform crisis assessments to determine, as a minimum, the mental status of the individual and their danger to self or others. Appropriate short term follow-up shall be included as part of the intervention. Documentation of this intervention shall be kept in the client's record. 4.There shall be written policies and procedures to assure the following client care safeguards: a.crisis workers shall not participate in discipline or punishment procedures; b.crisis workers shall not subject clients to verbal remarks which belittle or ridicule them, their families, or others; c.seclusion, defined as the placement of a client alone in a locked room, shall not be employed; d.passive physical restraint shall be employed only as a therapeutic intervention to protect the client from physical injury to self or others; e.restraining devices shall not be used in crisis interventions. 5.The provider shall have written policies and procedures to assure that any suspected violations of these safeguards are internally investigated and, where abuse or neglect is suspected, that immediate reports are made to the public agency statutorily authorized to investigate such alleged incidents. B.Transportation 1.A provider shall ensure and document that any vehicle used by provider staff to transport clients is inspected and licensed according to state laws and carries a sufficient amount of current liability insurance. 2.Any staff member or the provider using a vehicle to transport clients shall be properly licensed to operate that vehicle according to state laws. C.External Professional Service. A provider shall have a written policy which mandates that, when necessary, clients be given assistance in obtaining any required professional services not available from staff members of the provider. D.Organizational Communication 1.A provider shall establish procedures to assure adequate communication among staff to provide continuity of services to the client, including: a.establishing procedures to assure periodic staff meetings with supervisory staff, professional staff, and direct line workers; b.crisis workers doing one-to-one monitoring with a client will keep progress notes every half hour detailing the behavior of the client subsequent to the last entry. Progress notes will become part of the client's record. The client's record will be shared with the client's treating clinician, if applicable; c.establishing a mechanism to assure the crisis worker's access to emergency services and/or an agency supervisor. 2.A provider shall establish procedures which facilitate participation and feedback from clients and families. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1263 (November 1995). §8909.Personnel A.Staff Plan. A provider shall have a written plan for recruitment, screening, orientation, ongoing training, development, supervision, and performance evaluation of staff members. B.Nondiscrimination. A provider shall have a written policy to prevent discrimination and shall comply with all state and federal employment and service delivery laws and regulations pertaining to nondiscrimination. C.Recruitment. A provider shall actively recruit and, whenever possible, employ qualified persons of both sexes representative of the cultural and racial groups served by the provider. This shall include the hiring of qualified persons with disabilities. D.Education and Experience Requirements. Provider shall establish requisite education and experience qualifications for the crisis worker doing one-to-one Intervention, which shall include: 1.a bachelor's degree in a human service related field (social work, psychology, counseling, criminal justice, education) and one year successful paid work experience with clients with emotional disorders; or, 2.a high school diploma with two years successful paid work experience with clients with emotional disorders; however, 3.the provider may elect to permit applicants who are parents of children with emotional disorders to substitute their year(s) of successful parenting experience for the requisite years of work experience. 4.provider shall establish requisite education and experience qualifications for crisis workers responsible for mental health assessments, which shall include: a.A bachelor's degree in a human service related field (social work, psychology, counseling, criminal justice, education); and b.two years successful paid work experience with clients with emotional disorders. 5.provider shall establish requisite education and experience qualifications for crisis workers responsible for clinical supervision of staff which shall include: a.a valid Louisiana license in a mental health/counseling profession (board certified social worker, licensed professional counselor, licensed psychologist, physician, registered nurse); and b.successful work experience with clients with emotional disorders. E.Screening 1.Provider shall maintain documentation of satisfactory criminal record check, as required by R.S. 15:587.1, or documentation that an application for criminal record check has been made if no response has been received. A criminal records check shall be requested by the Provider prior to the employment of any person who will have supervisory or disciplinary authority over clients. 2.Provider shall have a résumé or a record of employment history on each staff member. 3.Prior to employing any person, and upon obtaining a signed release and the names of the references from the applicant, a provider shall obtain three written references for each prospective staff member or telephone notes from contact with said references. 4.A provider's screening procedures shall address the prospective staff member's qualifications, ability, related experience, health, character, emotional stability and social skills as related to the appropriate job description. Documentation shall be maintained in the personnel file. F.Orientation. A provider's orientation shall provide a minimum of 18 hours of training for all crisis workers before direct contact with clients will begin. The training will include: 1.Twelve hours of training in crisis de-escalation and management of aggressive behavior, including passive physical restraints and acceptable and prohibited responses. Documentation of pre-service crisis training shall consist of a signed statement of the date(s), hours, method and content of curriculum trained and confirmation of the staff member's participation. 2.Six hours of orientation in provider's emergency and safety procedures, universal precautions, state law on client abuse and client rights, and provider's policies and procedures, including prohibited disciplinary responses. Documentation shall consist of a signed statement of the date(s), hours, and topics of the orientation and confirmation of the staff member's participation. G.Training 1.A provider shall ensure that each crisis worker completes at least 40 hours of training per year. Orientation may be considered in meeting this requirement during the staff member's first year of employment. Routine supervision shall not be considered for meeting this requirement. This requirement may be fulfilled through documented individual consultation as well as group training sessions. 2.Direct service delivery staff members' annual training shall be documented by signed statements consisting of the dates, hours and content of the training, and confirmation of the staff members' participation. Curricula shall include: a.crisis de-escalation and aggression control management, including physical restraint; b.signs and symptoms of reactions to medication, especially psychotropic medication; c.psychotropic medications; d.major mental disorders of population served by program; description of disorders and treatment; e.universal precautions, HIV, and Hepatitis B; f.CPR course appropriate to client population, or yearly recertification in same; g.first aid and emergency medical procedures; h.client rights, mental health law, orders for protective custody, judicial commitments; i.mandated reporting of child/adult abuse per state law. H.Evaluation. A provider's performance evaluation procedures shall address the nature, quality and effectiveness of a crisis worker's interactions with clients, family and other providers. Evaluations shall be completed at least annually. I.Personnel Practices 1.A provider shall have written personnel practices and written job descriptions for each staff position including volunteers. 2.A provider shall have an employee grievance procedure which complies with federal and state law. J.Abuse Reporting. A provider shall have abuse reporting procedures which require all staff members to report any incidents of suspected abuse or mistreatment whether that abuse or mistreatment is done by another staff member or professional, family member, the client, or any other person. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1264 (November 1995). §8911.Client Rights and Grievance Procedure A.A provider shall ensure that clients are provided all rights available to them, be they interdicted or not, and shall document same. B.A provider shall make every effort to ensure that a client understands his/her rights in matters such as access to services, appeal, grievance, and protection from abuse. C.A provider shall have a written grievance procedure for clients designed to allow clients to make complaints without fear of retaliation. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1265 (November 1995). §8913.Glossary of Terms Crisis—the subjective reaction to a stressful life experience that compromises the individual's and/or family's stability and ability to cope or function. Crisis Assessment—exploration of the precipitating factors, description of current manifestations, identification of available resources, and development of a crisis response plan. Crisis De-escalation—techniques for reduction in crisis manifestations and implementation of the crisis response plan. Crisis Intervention—treatment which alleviates the impact of a crisis and helps mobilize the resources and improve the coping skills of those affected. Crisis Intervention Service—services which provide assessment, de-escalation and referrals to those in emotional/behavioral crisis. This may include one-to-one intervention to prevent harm to self or others. These services may be available 24 hours a day, seven days a week and are usually staffed by crisis clinicians, social workers, and trained paraprofessionals. Crisis Worker—professional or paraprofessional worker engaged in direct services delivery or in supervision of direct services delivery. DSM IV—fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. One-to-one Intervention—provision of staff, trained in verbal de-escalation and passive physical restraint, to a person in crisis characterized by continuous visual contact, at a minimum, for a specified amount of time, for the purpose of preventing harm to self or others. These staff do not function as alternative care givers or supplant the existing care giver relationships. Passive Physical Restraint—the least amount of direct physical contact required on the part of a staff member to prevent a client from harming self or others, and specifically excludes use of restraining devices. Staff Member—staff members include the wage and hourly workers (consistent with Department of Labor guidelines) and independent contractors paid by the provider. Staff may be either administrative and clerical support workers or professional and paraprofessional workers engaged in direct service delivery. Due to the unpredictable nature of the demand for crisis services, crisis providers may need to employ independent contractors as staff members on an as-needed basis. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:51. HISTORICAL NOTE:Promulgated by Department of Social Services, Office of the Secretary, LR 21:1265 (November 1995).