Ala. Admin. Code r. 580-2-20-.12

MI Day Programs

This regulation establishes program description and operational requirements for three Alabama Department of Mental Health MI Day Programs: the Adult Rehabilitative Day Program (RDP), Adult Intensive Day Treatment (AIDT), and Partial Hospitalization Program (PHP). Operators must document admission, discharge, and exclusionary criteria; maintain specified staff-to-recipient ratios; provide individualized treatment plans; and ensure communication access for deaf or limited-English-proficient recipients. Each program type has distinct staffing qualifications, minimum hours of operation, and length-of-stay expectations that facilities must meet and document in recipient records.

Ala. Admin. Code r. 580-2-20-.12 - MI Day Programs 

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The agency shall have a program description for MI Day
 Treatment service/program. The program description shall include all
 requirements per
 
580-2-20-.09
(2)
 
 (a-e) General Clinical Practice and the program(s) criteria as follows:

(1)

Adult Rehabilitation
 Day Program (RDP).
 The program description is consistent
 with the provisions of this section and defines Rehabilitative Day Program
 (RDP) as an identifiable and distinct program that provides long-term recovery
 services with the goals of improving functioning, facilitating recovery,
 achieving personal life goals, regaining self-worth, optimizing illness
 management, and helping recipients to become productive participants in family
 and community life. The program description shall include all of the following
 components: 
(a)
 A description of the target
 population of serious mental illness (SMI).

(b)
 Age range.

(c)
 Nature and scope of the program, as
 indicated by individual recipient needs and preferences.

(d)
 Location of the geographic service area
 for the program.

(e)
 Specifies that
 the program is staffed by qualified individuals whose primary job function is
 specific to Rehabilitative Day Program.

(f)
 Admission criteria shall address
 inclusionary criteria as follows: 
1.
 Presence
 of a psychiatric diagnosis.

2.
 Mild
 to moderate persistent, chronic, and/or refractory symptoms and impairments in
 one (1) or more areas of living (e.g. difficulty attaining & sustaining
 life goals and/or community integration).

3.
 Does not meet admission or continued stay
 criteria for more intensive levels of care such as PHP or AIDT but requires the
 daily structure and services of a recovery oriented rehabilitative milieu to
 improve or maintain level of functioning, achieve personal life goals, and
 sustain a positive quality of life.

4.
 RDP services are reasonably expected to
 improve the individual's functional level, increase quality of life, and
 facilitate attainment of personal life goals.

5.
 Be approved by a qualified staff
 member.

(g)

 Discharge/transfer criteria shall include the following: 
 
1.
 Rehabilitative goals have been met and the
 individual no longer needs this type of service.

2.
 Less intensive levels of care can
 reasonably be expected to improve or maintain the individual's level of symptom
 remission, condition, functional level, quality of life, attainment of life
 goals, and recovery; or the degree of impairment, severity of symptoms, and/or
 level of functioning necessitates admission to a more intensive level of
 care.

3.
 The individual primarily
 needs support, activities, socialization, or custodial care that could be
 provided in other less intensive settings (e.g. peer support group, drop in
 center, or senior citizen's center).

4.
 The individual chooses not to
 participate.

(h)

 Exclusionary criteria must include the following: 
 
1.
 The person's level of functioning requires
 a more intensive level of care.

2.

 The individual is not experiencing mild or moderate persistent, chronic
 symptoms, impairments in one (1) or more areas of daily life, difficulty
 attaining and sustaining life goals and/or problems with community
 integration.

(i)
 The RDP
 constitutes active structured, rehabilitative interventions that specifically
 address the individual's life goals, builds on personal strengths and assets,
 improves functioning, increases skills, promotes a positive quality of life,
 and develops support networks. The RDP should include an initial screening and
 an individualized treatment plan. Based on the specific focus of the program
 and the needs and preferences of recipients, the adult RDP shall provide the
 following:
1.
 Initial screening to evaluate
 the appropriateness of the recipient's participation in the program.

2.
 Development of an individualized program
 plan.

3.
 As well as at least one
 (1) more service from the following based on the needs and preferences of
 recipient's participation in the program: 
(i)

 Psychoeducational services

(ii)

 Basis Living Skills

(iii)
 Coping
 skills training closely related to presenting problems (e.g., stress
 management, symptom management, assertiveness training, and problem
 solving)

(iv)
 Utilization of
 community resources.

(j)
 The program coordinator must have at a
 minimum a bachelor's degree in a mental health related field and at least one
 (1) year of direct service experience in a mental health setting or be a
 registered nurse with at least one (1) year of mental health
 experience.

(k)
 The overall staff
 present to recipient ratio cannot exceed one to twenty (1:20). If a program has
 a capacity of twenty (20) or less, an additional staff person should be present
 during the hours of operation to permit individualized treatment.

(l)
 Records document that recipients admitted
 to the RDP meet the admission criteria.

(m)
 Records document that the recipients
 admitted to the RDP do not meet the exclusionary criteria.

(n)
 Rehabilitative Day Programs shall be
 scheduled at least four (4) hours per day one (1) day per week.

(o)
 Recipients who are deaf or who have
 limited English proficiency shall have effective communication access provided
 by staff proficient in the recipients' preferred language, or by a qualified
 interpreter. Proficient in American Sign Language is defined as having at least
 an Intermediate Plus level in the Sign Language Proficiency
 Interview.

(p)
 Documentation that
 communication access has been provided for recipients who are deaf or who have
 limited English proficiency.

(q)

 The use of family members to interpret is discouraged due to the possibility of
 conflicts of interest. If family members are used to interpret, this shall be
 noted on the waiver. Family members under the age of eighteen (18) cannot be
 used as interpreters.

(r)

 Programming will be modified to provide effective participation for all
 recipients who are deaf.

(s)

 Recipients are scheduled to attend RDP at least once a week based on individual
 goals, preferences, needs and circumstances.

(t)
 The record documents that the treatment
 plan for rehabilitative day services is evaluated at least every three (3)
 months to assure that continued participation in RDP is clinically
 indicated.

(2)

Adult Intensive Day Treatment (AIDT)
.
 The
 program description is consistent with the provisions of this section and
 defines Intensive Day Treatment (AIDT) as an identifiable and distinct program
 that provides highly structured services designed to bridge acute treatment and
 less intensive services such as rehabilitative and outpatient with the goals of
 community living skills acquisition/enhancement, increased level of
 functioning, and enhanced community integration. The program description shall
 include all of the following components:
(a)
 A
 description of the target population of SMI.

(b)
 Age range.

(c)
 Nature and scope of the program, as
 indicated by individual recipient needs and preferences.

(d)
 Location of the geographic service area
 for the program.

(e)
 Specifies that
 the program is staffed by qualified individuals whose primary job function is
 specific to Adult Intensive Day Program.

(f)
 Admission shall include address
 inclusionary criteria as follows: 
1.
 Presence
 of a psychiatric diagnosis.

2.

 Moderately disabling persistent, chronic, and/or refractory symptoms with no
 significant clinical progress made or expected in a less intensive level of
 care.

3.
 Symptoms that do not meet
 admission criteria for more intensive levels of care but do require the daily
 structure and supervision of a treatment oriented therapeutic milieu.

4.
 AIDT can be reasonably expected to improve
 the recipient's symptoms, condition, or functional level sufficient to permit
 transition to a less intensive level of care.

5.
 Be approved by a qualified
 staff.

(g)

 Discharge/transfer criteria shall include the following: 
 
1.
 Treatment plan goals and objectives have
 been substantially attained and continued treatment can be provided in less
 intensive levels of care.

2.

 Recipient's degree of impairment, severity of symptoms, and level of
 functioning have improved enough to resume normal activities or to receive less
 intensive services (e.g., rehabilitative day program, case management, standard
 outpatient services).

3.

 Recipient's degree of impairment, severity of symptoms, and/or level of
 functioning necessitates admission to a more intensive level of care.

4.
 Recipient is unwilling or unable to
 participate in/ benefit from the program due to severity of symptoms,
 functional impairment, behavioral problems, personal choice, or cognitive
 limitations despite repeated documented efforts to engage the
 recipient.

(h)

 Exclusionary criteria shall address the following: 
 
1.
 The recipient's degree of impairment,
 severity of symptoms, and level of functioning require a more intensive level
 of care.

2.
 The recipient is
 experiencing mild persistent, chronic symptoms without acute exacerbation and
 less intensive levels of care can reasonably be expected to improve the
 recipient's symptoms, condition, and functional level.

(i)
 The program description defines the
 expected length of stay (LOS) as intermediate term, not to exceed six (6)
 months unless clinically justified.

(j)
 The program description shall state the
 procedure for extending a recipient past the expected LOS and must require at
 least one (1) of the following continued stay criteria: 
 
1.
 Goals and objectives specified on the
 treatment plan have not been substantially attained or new problems have
 emerged, and further treatment can be reasonably expected to result in progress
 toward goals and objectives and/or continued stability.

2.
 Continued treatment cannot be provided in
 less intensive levels of care (e.g., rehabilitative day program, case
 management, standard outpatient services) due to a reasonable risk of relapse
 and/or hospitalization based on documented clinical judgment or failed attempts
 to transition the recipient to a less intensive level of care.

3.
 Be approved by a qualified staff
 member.

(k)
 The
 following services shall be available within the program as indicated by
 individual recipient needs:
1.
 Initial
 screening to evaluate the appropriateness of the recipient's participation in
 the program.

2.
 Development of an
 individualized treatment plan.

3.

 Individual, group, and family therapy.

4.
 Coping skills training (e.g. stress
 management, symptom management, problem solving).

5.
 Utilization of community
 resources.

6.
 Family education
 closely related to the presenting problems such as diagnosis, symptoms,
 medication, coping skills, etc.

7.

 Basic living skills

8.
 Recipient
 education closely related to presenting problems such as diagnosis, symptoms,
 medication, etc. rather than academic training.

(l)
 The program coordinator must have a
 master's degree in a mental health related field and one (1) year of
 post-master's direct mental illness experience.

(m)
 The overall staff present to recipient
 ratio cannot exceed one to sixteen (1:16). If a program has a capacity of
 sixteen (16) or less, an additional staff person shall be present during the
 hours of operation to permit individualized treatment.

(n)
 The program is operated a minimum of four
 (4) hours per day and at least four (4) days per week.

(o)
 Recipient records document that the
 recipient received a minimum of one (1) hour of individual or group therapy
 weekly.

(p)
 There is documentation
 in the recipient record that group therapy size does not exceed sixteen (16) in
 each group.

(q)
 The AIDT program's
 length of stay (LOS) is an intermediate term, not to exceed six (6) months
 unless clinically justified.

(r)

 Extensions of LOS clearly document reasons consistent with the continued stay
 criteria, specify a period not to exceed three (3) months, specify clinical
 objectives to be achieved during the extension, and are approved by a staff
 member.

(s)
 Each recipient in an
 Intensive Day Treatment program shall have a counselor/therapist.

(t)
 Program statistics document that
 recipients are scheduled to attend three to five (3 to 5) days per week and at
 least four (4) hours per day. If a recipient is scheduled less frequently, it
 is clearly documented that the recipient is in a brief transition period, not
 to exceed three (3) months.

(u)

 Recipients who are deaf or limited English proficient shall have effective
 communication access provided by staff proficient in the recipient's preferred
 language, or by a qualified interpreter. Proficient in American Sign Language
 is defined as having at least an Intermediate Plus level on the Sign Language
 Proficiency Interview.

(v)

 Documentation that communication access has been provided for recipients who
 are deaf or who have limited English proficiency.

(w)
 The use of family members to interpret is
 discouraged due to the possibility of conflicts of interest. If family members
 are used to interpret, this shall be noted on the waiver. Family members under
 the age of eighteen (18) cannot be used as interpreters.

(x)
 Programming will be modified to provide
 effective participation for all recipients who are deaf.

(3)

Partial Hospitalization
 Program (PHP).
 The program description is consistent with
 the provisions of this section and defines the Partial Hospitalization Program
 (PHP) as an identifiable and distinct organizational unit that provides
 intensive, structured, active, clinical treatment with the goal of acute
 symptom remission, hospital avoidance, and/or reduction of inpatient length of
 stay. The program description shall include all of the following components: 
 
(a)
 A description of the target population of
 SMI.

(b)
 Age range.

(c)
 Nature and scope of the program, as
 indicated by individual recipient needs and preferences.

(d)
 Location of the geographic service area
 for the program.

(e)
 Specifies that
 the program is staffed by qualified individuals whose primary job function is
 specific to Partial Hospitalization Program.

(f)
 Admission criteria shall include the
 following inclusionary criteria: 
1.
 Presence
 of a psychiatric diagnosis.

2.

 Acute psychiatric symptoms resulting in marked or severe impairment in multiple
 areas of daily life sufficient to make hospitalization very likely without
 admission to PHP.

3.
 Admission is
 an alternative to continued hospitalization.

4.
 Severe persistent symptoms without acute
 exacerbation where significant clinical progress has not been made in a less
 intensive treatment setting and where PHP services are reasonably expected to
 improve the recipient's symptoms, condition, or functional level.

(g)
 Discharge/transfer criteria
 shall include the following:
1.
 Treatment plan
 goals and objectives have been substantially attained and continued treatment
 can be provided in less intensive levels of care.

2.
 Recipient's degree of impairment, severity
 of symptoms, and level of functioning have improved enough to resume normal
 activities (school, work, home) or to receive less intensive services (e.g.
 intensive day treatment, rehabilitative day program, standard outpatient
 services, case management, etc.).

3.
 Recipient's degree of impairment, severity
 of symptoms, and/or level of functioning necessitates admission to a more
 intensive level of care.

4.

 Recipient is unwilling or unable to participate in/ benefit from the program
 due to severity of symptoms, functional impairment, behavioral problems,
 personal choice, or cognitive limitations despite repeated documented efforts
 to engage the patient.

5.
 Recipient
 primarily needs support, activities, socialization, custodial, respite, or
 recreational care that could be provided in other less intensive settings (e.g.
 drop-in center, senior center, peer support group.)

(h)
 Exclusionary criteria shall address the
 following:
1.
 The recipient requires a more
 intensive level of care.

2.
 The
 recipient is experiencing mild to moderate symptoms without an acute
 exacerbation.

3.
 Less intensive
 levels of treatment can reasonably be expected to improve the recipient's
 symptoms, condition, and functional level.

(i)
 The program description clearly
 identifies the PHP as a time-limited program with the expected length of stay
 (LOS) not to exceed three (3) months, unless clinically justified, but not more
 than six (6) months per admission.

(j)
 The program description shall state the
 procedure for extending a recipient past the expected LOS. The psychiatrist,
 certified nurse practitioner, or physician assistant certifies the need to
 extend the length of stay for a specified period of time not to exceed three
 (3) one (1) month extensions to achieve clearly articulated clinical
 objectives. An extension in LOS shall have at least one (1) of the following
 criteria for continued stay: 
1.
 Goals and
 objectives specified on the treatment plan have not been substantially attained
 or new problems have emerged, and further treatment can be reasonably expected
 to result in progress toward goals and objectives and/or continued
 stability.

2.
 Continued treatment
 cannot be provided in less intensive levels of care due to a reasonable risk of
 relapse and/ or hospitalization based on documented clinical judgment or failed
 attempts to transition the recipient to a less intensive level of
 care.

(k)
 The following
 services shall be available and provided as indicated by the initial screening:
 
1.
 Medication evaluation and medication
 management.

2.
 Individual, group,
 and family therapy.

3.
 Coping
 skills training closely related to presenting problems e.g. stress management,
 symptom management, assertiveness training, and problem solving as opposed to
 basic living skills such as money management, cooking, etc.

4.
 Activity therapy closely related to the
 presenting problems that necessitated admission (e.g. aerobics, maintaining a
 recovery diary, creative expression (art, poetry, drama) pertaining to the
 recovery process).

5.
 Medication
 administration.

6.
 Medication
 monitoring.

7.
 Family education
 closely related to the presenting problems such as diagnosis, symptoms,
 medication, coping skills, etc.

8.

 Recipient education closely related to presenting problems such as diagnosis,
 symptoms, medication, etc. rather than academic training.

9.
 Documentation of daily services attended
 must be in each recipient's record.

(l)
 Partial Hospitalization Programs shall
 have a multi-disciplinary treatment team under the direction of a psychiatrist,
 certified registered nurse practitioner, or physician's assistant. The team may
 include social workers, counselors, psychologists, nurses, certified peer
 specialists, bachelor level staff, occupational therapists, recreational
 therapists, activity therapists, substance use disorder counselors, and other
 staff trained to work with psychiatric patients. At a minimum, the treatment
 team shall include a psychiatrist or certified nurse practitioner or
 physician's assistant, master's level clinician, a licensed practical nurse,
 and at least one (1) other trained professional and/or para-professional. The
 clinician, nurse, and other staff member will each be present during the hours
 of program operation.

(m)
 A
 qualified interpreter will be present at all team meetings when a recipient who
 is deaf or who has limited English proficiency is present.

(n)
 There shall be a sufficient number of
 staff for the daily census of the program with a minimum staff to recipient
 ratio of one to ten (1:10).

(o)
 The
 program coordinator must have a master's degree in a mental health related
 field and at least two (2) years of post-master's direct mental illness service
 experience or be a registered nurse with a minimum of two (2) years of
 psychiatric experience.

(p)
 A
 psychiatrist, certified nurse practitioner, or physician's assistant shall be
 responsible for providing and documenting the following services: 
 
1.
 Order for admission.

2.
 Initial psychiatric evaluation.

3.
 Initial approval and monthly review of the
 treatment plan.

4.
 Medication
 evaluation and management services.

5.
 Evaluation of readiness for discharge and
 discharge order.

6.
 At least
 monthly face-to-face assessment of the recipient and as
 medically/psychiatrically indicated.

7.
 Face-to-face evaluation and certification
 of need for continued stay on at least a monthly basis.

(q)
 Each patient in a Partial Hospitalization
 Program shall have a qualified counselor/therapist.

(r)
 The PHP Program shall be scheduled at
 least four (4) hours per day, five (5) days per week for day programs and a
 minimum of sixteen (16) hours over at least four (4) days per week for evening
 programs.

(s)
 Recipient records
 document that the recipient received at a minimum one (1) hour of individual or
 group therapy weekly unless clinically contraindicated and
 documented.

(t)
 Group size (all
 types of groups with the exception of activity therapy) shall not exceed
 sixteen (16).

(u)
 Recipients in a
 PHP shall be scheduled at least four (4) hours per day, three to five (3-5)
 days per week based on individual clinical needs, preferences, and
 circumstances. When clinically indicated, less frequent attendance may be
 utilized during a brief period of transition to less intensive levels of
 care.

(v)
 The PHP is a time-limited
 program with the length of stay (LOS) not to exceed three (3) months, unless
 clinically justified, but not more than six (6) months per admission.

(w)
 Extensions of Length of Stay clearly
 document reasons consistent with the continued stay criteria, specify a period
 of time not to exceed one (1) month, specify clinical objectives to be achieved
 during the extension, are certified by a psychiatrist, a certified nurse
 practitioner, or licensed physician's assistant, and do not exceed three (3)
 extensions.

(x)
 Recipients who are
 deaf or limited English proficient shall have effective communication access to
 these services provided by staff proficient in the recipient's preferred
 language, o or by a qualified interpreter. Proficient in American Sign Language
 is defined as having at least an Intermediate Plus level on the Sign Language
 Proficiency Interview.

(y)

 Documentation that communication access has been provided for recipients who
 are deaf or who have limited English proficiency.

(z)
 The use of family members to interpret is
 discouraged due to the possibility of conflicts of interest. If family members
 are used to interpret, this shall be noted on the waiver. Family members under
 the age of eighteen (18) cannot be used as interpreters.

(aa)
 Programming will be modified to provide
 effective participation for all recipients who are deaf.

(4)

Child and Adolescent
 Day Treatment
.
 The program description is consistent with
 the provisions of this section. The program description shall include all of
 the following components: 
(a)
 A description
 of the target population of SED.

(b)
 Age range.

(c)
 Nature and scope of the program, as
 indicated by individual recipient needs and preferences.

(d)
 Location of the geographic service area
 for the program.

(e)
 Specifies that
 the program is staffed by qualified individuals whose primary job function is
 specific to Child and Adolescent Day Treatment.

(f)
 Admission criteria shall be comprehensive
 enough to justify a recipient's treatment in Child and Adolescent Day Treatment
 and shall include the following:
1.
 Presence
 of a psychiatric diagnosis.

2.

 Presence of a combination of at least five (5) of the following inclusionary
 criteria, whose severity would prevent treatment in a less intensive
 environment or for a temporary, clinically justified period of more intensive
 services to prevent regression: 
(i)
 Poor
 self-control.

(ii)
 Cruelty to
 animals.

(iii)
 Inappropriate
 aggressive behavior.

(iv)

 Angry/hostile temper tantrums.

(v)

 Hyperactivity.

(vi)

 Withdrawn.

(vii)
 Running
 away.

(viii)

 Destructiveness.

(ix)
 Poor school
 performance.

(x)
 Truancy.

(xi)
 Defiance of authority.

(xii)
 Manipulative behavior.

(xiii)
 Sexual maladjustment.

(xiv)
 Assaultive behavior.

(xv)
 Child abuse victim.

(xvi)
 Depression.

(xvii)
 Anxiety.

(xviii)
 Homicidal/suicidal
 ideation.

(xix)
 Drug
 experimentation.

(xx)
 Sexual
 abuse.

(xxi)
 Irrational
 fears.

(xxii)
 Attention seeking
 behavior.

(xxiii)

 Encopretic/enuretic.

(xxiv)
 Low
 frustration tolerance.

(xxv)

 Inadequate social skills.

(xxvi)

 Dysfunctional family relationships.

(g)
 Admission is approved by Licensed
 Independent Practitioners.

(h)

 Recipient shall have documented moderately disabling persistent, chronic,
 and/or refractory symptoms with no significant clinical progress made or
 expected in a less intensive level of care.

(i)
 The program can be reasonably expected to
 improve the recipient's symptoms, condition, or functional level sufficient to
 permit transition to a less intensive level of care.

(j)
 The program description shall state the
 expected length of stay (LOS) which should not exceed one (1) academic
 year.

(k)
 The program description
 shall state the procedure for extending a recipient past the expected LOS and
 shall include the following continued stay criteria: 
 
1.
 Goals and objectives specified on the
 treatment plan have not been substantially attained or new problems have
 emerged.

2.
 Further treatment can
 be reasonably expected to result in progress toward goals and objectives and/or
 continued stability.

3.
 Documented
 clinical judgment indicates that continued treatment cannot be provided in less
 intensive levels of care due to reasonable risk of relapse and/or
 hospitalization.

4.
 Documented
 clinical judgment indicates that an attempt to transition the recipient to a
 less intensive level of care is reasonably expected to result in the
 re-emergence of symptoms sufficient to meet admission criteria.

5.
 A qualified staff member approves
 extending the length of stay of a specified period of time not to exceed four
 (4) months per extension to achieve clearly articulated clinical
 objective.

(l)

 Discharge/transfer criteria shall include the following: 
 
1.
 Treatment plan goals and objectives have
 been substantially attained and continued treatment can be provided in less
 intensive levels of care.

2.

 Recipient's degree of impairment, severity of symptoms, and level of
 functioning have improved enough or resume normal activities or to receive less
 intensive services.

3.
 Recipient's
 degree of impairment, severity of symptoms, and/or level of functioning
 necessitate admission to a more intensive level of care.

4.
 Recipient is unwilling or unable to
 participate in/benefit from the program due to severity of symptoms, functional
 impairment, behavioral problems, personal choice, or cognitive limitation
 despite repeated documented efforts to engage the recipient.

(m)
 Exclusionary criteria shall
 address the following:
1.
 The recipient's
 degree of impairment, severity of symptoms, and level of functioning require a
 more intensive level of care.

2.

 The recipient is experiencing mild persistent, chronic symptoms without acute
 exacerbation and less intensive levels of care can reasonably be expected to
 improve the recipient's symptoms, condition, and functional level.

(n)
 The Child and Adolescent Day
 Treatment shall constitute active, intensive treatment that specifically
 addresses the presenting problems that necessitate admission. The daily
 schedule of services attended must be in each recipient's record, and
 recipient/staff interviews confirm that the required services are provided.
 Recipient records document an initial screening, an individualized treatment
 plan to include documentation of the recipient's participation in the program
 and the development of the treatment plan, and verify an active, intensive
 treatment program. Key service functions include, at a minimum, the following
 services:
1.
 Initial screening to evaluate the
 appropriateness of the recipient's participation in the program.

2.
 Development of an individualized program
 plan.

3.
 Individual, group, and
 family therapy.

4.

 Psychoeducational services.

5.

 Basic Living Skills.

6.
 Coping
 skills training closely related to presenting problems (e.g., stress
 management, assertiveness training, and problem solving).

7.
 Education services for children who are
 attending Day Treatment instead of a local school.

(o)
 The program coordinator must have a
 master's degree in a mental health related field and one (1) year of direct
 mental illness service experience, six (6) months of which must be in services
 for children and adolescents

(p)

 The overall staff present to recipient ratio cannot exceed one to ten (1:10).
 In a program that has only ten (10) recipients, there must be at least one (1)
 other staff member present during hours of operation.

(q)
 Programs with an educational component
 must be in operation five (5) days per week with a minimum of two (2) hours
 treatment/non-educational service per day. Programs that do not have an
 educational component must be in operation a minimum of three (3) days per week
 and have a minimum of three (3) hours of service each day with the exception of
 pre-school and after-school programs which must operate a minimum of two (2)
 hours per day.

(r)
 Recipient's
 records document that the recipient received at a minimum one (1) hour of group
 therapy per week and one (1) hour of individual or family therapy at least once
 a month. The minimum services may be met in more than one (1) session of less
 than one (1) hour each. The time requirements for pre-school day treatment are
 one (1) half hour of group therapy per week and one (1) half hour individual or
 family therapy at least once a month.

(s)
 There is documentation that group therapy
 size does not exceed ten (10) in each session.

(t)
 Recipient records document that group and
 individual therapy address clinical issues identified in the recipient's
 treatment plans.

(u)
 Extensions of
 length of stay clearly document:
1.
 Clinical
 reasons for extension.

2.
 Specify a
 period of time not to exceed four (4) months.

3.
 Specify clinical objectives to be achieved
 during the extension and are approved by a qualified staff member.

4.
 Recipient records indicate that extensions
 of length of stay are consistent with procedures for extending length of stay
 as stated in the program description.

(v)
 Child and Adolescent Day Treatment
 programs that children attend instead of a Local Educational Agency (LEA) must
 be registered with the Alabama State Department of Education. The program must
 agree to meet the minimum assurance statements and guidelines set forth by the
 Alabama State Department of Education.

(w)
 All Child and Adolescent Day Treatment
 Programs that serve school-age children with an educational component must
 provide an educational curriculum or document coordination with the Local
 Education Agency.

(x)
 Recipients
 who are deaf or limited English proficiency shall have effective communication
 access to these services provided by staff proficient in the recipient's
 preferred language or a qualified interpreter. Proficient in American Sign
 Language is defined as having at least an Intermediate Plus level on the Sign
 Language Proficiency Interview.

(y)

 Documentation that communication access has been provided for recipients who
 are deaf or who have limited English proficiency.

(z)
 The use of family members to interpret is
 discouraged due to the possibility of conflicts of interest. If family members
 are used to interpret, this shall be noted on the waiver. Family members under
 the age of eighteen (18) cannot be used as interpreters.

(aa)
 Programming will be modified to provide
 effective participation for all recipients who are deaf.

Notes

Ala. Admin. Code
 r. 
580-2-20-.12

Adopted by
 
Alabama
 Administrative Monthly Volume XLI, Issue No. 07, April 28, 2023
,
 eff. 
6/12/2023
.

Author:
 Division of Mental Health and Substance
 Use Services, ADMH

Statutory Authority:

Code of Alabama
 1975
, §
 
22-50-11

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