Ala. Admin. Code r. 580-2-20-.13

MI Residential Services

This regulation establishes operating standards for Mental Illness (MI) Residential Services programs certified by the Alabama Department of Mental Health. Operators must develop a program description covering staffing patterns, bed capacity, admission and exclusionary criteria, and the full range of services to be provided or arranged for residents. Requirements address 24/7 on-site staffing, medication storage and management, meal provision, physical environment, program rules, and special accommodations for recipients who are deaf. Specific staffing and qualification standards are set out for distinct residential program types, including Adult Small Capacity (3-bed) homes and Adult Residential Care Homes with Specialized Basic Services, and provisions are included for child/adolescent residential programs and crisis respite use of residential beds.

Ala. Admin. Code r. 580-2-20-.13 - MI Residential Services 

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The agency shall have a program description for MI Residential
 services/programs. Residential setting applies to settings that provide
 congregate living and dining to recipients. 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)
 Staffing pattern of the home consistent
 with staffing requirements for each type of residential program
 certified.

(2)
 Type of the program
 to include:
(a)
 The number of beds.

(b)
 Services to be provided.

(c)
 Serious mental illness (SMI) or serious
 emotionally disturbed (SED) population served.

(d)
 Age range.

(e)
 Expected length of stay.

(f)
 Expected outcomes.

(3)
 Staff qualifications consistent with
 requirements for each type of residential program certified.

(4)
 Service area for the program.

(5)
 Admission criteria shall include the
 following inclusionary criteria:
(a)
 Require
 the recipient's willingness to participate in daily structured
 activities.

(b)
 Require a principal
 psychiatric diagnosis.

(c)
 Require
 a setting that has staff on the premises twenty-four (24) hours/day when
 recipients are present and a combination of the following criteria, whose
 severity would preclude treatment in a less restrictive environment: 
 
1.
 Impaired contact with reality manifested
 by hallucinations, delusions, or ideas of reference.

2.
 Withdrawal, regression, or confusion not
 warranting inpatient hospitalization.

3.
 Moderate to severe disabling
 depression.

4.
 Moderate to severe
 disabling anxiety.

5.
 Disabling
 somatic symptoms.

6.
 Poor
 medication compliance.

7.
 Inpatient
 care is not warranted.

8.
 Poor
 socialization skills.

9.

 Inappropriate attention-seeking behaviors.

10.
 Poor interpersonal skills.

11.
 Inadequate problem-solving
 skills.

(6)

 Discharge/transfer criteria and procedures.

(7)
 Exclusionary criteria must include the
 following:
(a)
 Primary diagnosis of the
 following:
1.
 "Z" Code.

2.
 Substance Use Disorder.

3.
 Autism Spectrum Disorder.

4.
 Developmental/Intellectual
 Disability.

5.
 Organic Mental
 Disorder.

6.
 Traumatic Brain
 Injury.

7.
 Primary physical
 disorder (serious illness requiring hospital care, nursing care, home health
 care, or impaired mobility that prohibits participation in program
 services).

(8)
 The program description should indicate
 that the following services, at a minimum, should be either provided in-house
 or arranged for by the residential staff, depending upon the needs of the
 individual recipient:
(a)
 Assistance in
 applying for benefits.

(b)

 Assistance in improving social and communication skills.

(c)
 Assistance with medication
 management.

(d)
 Assistance in the
 development of basic living skills (money management, laundering, meal
 preparation, shopping, transportation, house cleaning, personal hygiene,
 nutrition, and health and safety).

(e)
 Vocational services.

(f)
 Community orientation.

(g)
 Recreation and activities.

(h)
 Assistance in locating long term
 community placement in least restrictive setting.

(i)
 Transportation to and from necessary
 community services and supports.

(j)
 Education about psychiatric
 illness.

(k)
 Family support and
 education.

(l)
 The program
 description for a child/adolescent residential program must include a
 description of how the child/ adolescent shall continue to receive appropriate
 education while in the program.

(9)
 The program description addresses a
 procedure for referral to the appropriate resource (DHR, Probate Court, etc.)
 for those recipients who may need a legal guardian/lawful representative while
 residing in the program.

(10)

 Residential facilities shall demonstrate on-site staff coverage twenty-four
 (24) hours a day, seven (7) days per week as indicated by staff duty
 rosters.

(11)
 The personnel records
 of all residential staff have current certification for First Aid and CPR from
 an authorized certifying agency. Staff are trained prior to working alone with
 recipients.

(12)
 There is
 documentation that all residential staff who transport recipients have a
 current valid driver's license. The license shall be appropriate for the type
 of vehicle operated by the driver.

(13)
 The majority of residential staff of a
 residential program serving primarily recipients who are deaf shall hold at
 least Intermediate Plus level proficiency in American Sign Language as measured
 by the Sign Language Proficiency Interview (SLPI) with at least one proficient
 person per shift. Staff providing clinical services shall have an Advanced Plus
 fluency or use a qualified interpreter. Non-signing staff will engage in
 on-the-job training to learn American Sign Language.

(14)
 Programming will be modified to provide
 effective participation for all recipients who are deaf.

(15)
 Residential programs shall provide or
 arrange access to a wide range of services. The following services, at a
 minimum, shall be either provided in-house or arranged for by the residential
 staff, depending upon the needs of the individual recipient: 
 
(a)
 Assistance in applying for
 benefits.

(b)
 Assistance in
 improving social and communication skills.

(c)
 Assistance with medication
 management.

(d)
 Assistance in the
 development of basic living skills (money management, laundering, meal
 preparation, shopping, transportation, house cleaning, personal hygiene,
 nutrition, and health and safety).

(e)
 Vocational services.

(f)
 Community orientation.

(g)
 Recreation and activities.

(h)
 Assistance in locating long term
 community placement in least restrictive setting.

(i)
 Transportation to and from necessary
 community services and supports.

(j)
 Education about psychiatric
 illness.

(k)
 Family support and
 education.

(l)
 Monthly/weekly
 schedule of activities and recipient/ staff member interview confirm that the
 appropriate services are being accessed or provided to recipients of
 residential services.

(m)
 The
 recipients' records indicate that the required services are being
 provided.

(n)
 The recipients'
 records indicate that the provision of communication access for people who are
 deaf is consistent with programming offered by the home.

(16)
 There are policies and procedures
 designed to assure that meals are nutritious, offer a variety of foods, and
 reflect recipient preferences to the extent possible. Agency policies and
 procedures shall include, at a minimum, the following: 
 
(a)
 Provide each recipient a variety of three
 (3) nutritious meals plus snacks per day seven (7) days per week as evidenced
 by weekly menus. (Exception: Recipients served a meal at another
 location).

(b)
 Assure that
 recipients who are involved in activities outside of the home during mealtimes
 get a meal.

(c)
 Provision of
 special diets based on recipient needs.

(17)
 There is a policy stating that staff
 shall not serve as the legal guardian for recipients of the residential
 facility.

(18)
 All filled
 prescriptions controlled by staff of residential facilities shall be stored in
 a locked cabinet or other substantially constructed storage area that precludes
 unauthorized entry. There shall be a written policy that medication cabinets be
 locked when not in use.

(19)
 There
 shall be a written policies and procedures regarding disposition of all
 medications in residential programs in accordance with ADMH Nurse Delegation
 Guidelines, Alabama Board of Pharmacy and Drug Enforcement Agency
 (DEA).

(20)
 There must be written
 procedures for handling the disruptive behavior of recipients. Staff shall be
 trained in these procedures. Such procedures shall include: 
 
(a)
 Access to agency backup staff and
 appropriate community personnel.

(b)
 If incarceration is necessary, the
 following procedures are required, or documentation of why, in an individual
 case, they could not be implemented:
1.

 Face-to-face contact by a mental health professional either prior to or within
 two (2) hours of incarceration.

2.

 A staff member informs the jail/detention center of the recipient's medication
 and offer to bring medication to the jail/detention center.

3.
 Regular visits by a staff member during
 incarceration unless it is considered to be non-therapeutic or is not permitted
 by the jail/detention center and is so documented in the recipient's
 record.

4.
 If the recipient is on
 temporary visit status, the state hospital will be notified within twenty-four
 (24) hours.

5.
 The emergency
 contact will be notified within twenty-four (24) hours.

(21)
 There is a policy that
 recipients will not be discharged solely on the basis of one positive urine
 analysis showing the presence of alcohol, illegal drugs, or medication not
 prescribed.

(22)
 At the time of
 admission, the provider will secure a written agreement with the recipient,
 family member, lawful representative, placing agency, or significant other
 indicating who will be responsible for medical and dental expenses.

(23)
 All residential programs must
 demonstrate their recipient's accessibility to a local licensed hospital for
 the purpose of providing emergency hospital care.

(24)
 Residential programs will assist
 recipients in obtaining necessary medical care.

(25)
 First aid supplies in the type and
 quantity approved by a registered nurse or a pharmacist shall be kept in a
 readily accessible location for all shifts and will be restocked upon
 use.

(26)
 There shall be adequate
 room for private visits with relatives and friends, for small group activities,
 and for social events and recreational activities.

(27)
 In residential programs occupied by
 recipients who are deaf, an adaptive telecommunication device must be present
 in order to allow the recipient to make and receive telephone calls.

(28)
 Radios, televisions, books, current
 magazines and newspapers, games, etc. shall be available for recipients. In
 homes occupied by deaf recipients, televisions will have closed-caption turned
 on.

(29)
 In the case of death, the
 provider shall:
(a)
 Follow the most recent
 ADMH Incident Management Plan for all deaths.

(b)
 Follow all local, state and federal
 guidelines/laws regarding reporting deaths

(30)
 If the provider uses residential beds
 for respite services (also known as crisis respite), the following criteria
 shall be met:
(a)
 There are written admission,
 expected length of stay, and continued stay criteria.

(b)
 There is a written screening/referral
 protocol.

(c)
 Services provided and
 documented must be appropriate to meet the identified needs of each person
 admitted for crisis respite services.

(d)
 The beds must be in a certified
 residential program.

(31)
 The capacity of each type of residential
 program shall not exceed ten (10) except in cases where a waiver is recommended
 by the Associate Commissioner for Mental Health and Substance Abuse Services
 (MHSAS) and approved by the ADMH Commissioner based upon the presence of a
 compensating advantage to the residents in increased privacy and personal
 space. Programs in excess of a capacity of ten (10) and/or that have more than
 two (2) residents per bedroom that have been previously certified are eligible
 to continue to be certified at the existing capacity and bedroom occupancy at
 the existing location so long as compliance with all applicable administrative
 codes are maintained. If a previously certified program with a capacity greater
 than ten (10) and/or with more than two (2) residents per bedroom changes
 location, the new location cannot exceed a capacity of ten (10) and cannot have
 more than two (2) residents per bedroom unless a waiver of this administrative
 code, applied for in writing, is granted by the ADMH Commissioner.

(32)
 There shall be written program rules
 developed in accordance with the following principles: 
 
(a)
 Be developed with documented active
 participation of recipients and staff.

(b)
 Promote individual responsibility and
 prohibit rules for staff convenience and rules based on one person's
 behavior.

(c)
 Be based on the
 Rights Protection and Advocacy guidelines for recipient rights and
 responsibilities.

(d)
 Address the
 following areas, at a minimum. 
1.
 Visitation
 hours.

2.
 Sign in/out
 requirements.

3.
 Curfew.

4.
 Sexual contact on provider/facility
 property which respect recipient's dignity, privacy, and need for social
 interaction with others.

5.

 Supervised access to the kitchen for health and safety reasons.

6.
 Possession and consumption of legal and
 illegal substances.

7.
 Possession
 of weapons.

(e)
 Provide
 for resolution of disputes on an individual basis. When necessary, adjustments
 should be made to the treatment plan.

(f)
 Make clear the consequences when rules
 are not followed.

(g)
 Limit chores
 to those necessary to maintain personal and treatment areas and prohibit using
 recipients for other duties unless the recipient chooses to perform those
 duties and is compensated fairly.

(h)
 Application of the rules and consequences
 will be fair, consistent, and recognize extenuating circumstances.

(33)

An Adult
 Small Capacity (3-bed) Residential Home shall meet the following
 criteria:

(a)
 The program
 coordinator shall have one of the following: 
 
1.
 A bachelor's degree in a mental health
 service-related field with one (1) year experience in a direct mental health
 service-related field.

2.
 A
 bachelor's degree not in a mental health service-related field with two (2)
 years of experience in a direct mental health service-related field.

3.
 No degree or high school diploma/GED with
 three (3) years of experience working directly in a mental health residential
 setting(s).

(b)
 All
 staff shall receive initial training related to the special needs of the
 population served.

(c)
 The program
 has the following staffing pattern:
1.
 Day
 Shift - one (1) Program Coordinator (5 days per week) and one (1) Mental Health
 Worker (2 days per week).

2.

 Evening Shift - one (1) Mental Health Worker (7 days per week).

3.
 Night Shift - one (1) Mental Health Worker
 (7 days per week, awake).

(d)
 The program shall provide specialized
 services that are based on the admission criteria contained in the program
 description.

(34)

An Adult Residential Care Home with Specialized Basic
 Services
 shall meet the following criteria: 
 
(a)
 The program coordinator shall have one of
 the following:
1.
 A bachelor's degree in a
 mental health service-related field with one (1) year experience in a direct
 service-related field.

2.
 A
 bachelor's degree not in a mental health service-related field with two (2)
 years of experience in a direct mental health service-related field.

3.
 No degree or high school diploma/GED with
 three (3) years of experience working directly in a mental health residential
 setting(s).

(b)
 All
 staff shall receive initial training related to the special needs of the
 population served.

(c)
 The program
 shall provide specialized services that are based on the admission criteria
 contained in the program description.

(d)
 The program has the following staffing
 pattern for a four (4) to ten (10) bed home: 
 
1.
 Day shift - one (1) Program Coordinator (5
 days per week), and 1 Mental Health Worker (2 days per week).

2.
 Evening shift - one (1) Mental Health
 Worker (7 days per week).

3.
 Night
 shift - one (1) Mental Health Worker (7 days per week, awake).

(e)
 The program has the following
 staffing pattern for an eleven (11) to sixteen (16) bed home: 
 
1.
 Day Shift - one (1) Program Coordinator (5
 days/ week), 1 Mental Health Worker (7 days/week).

2.
 Evening Shift - one (1) Mental Health
 Worker (7 days/week).

3.
 Night
 Shift - one (1) Mental Health Worker (7 days/ week, awake).

(35)

An Adult Residential Care Home with Specialized Behavioral
 Services
 shall meet the following criteria: 
 
(a)
 The program coordinator shall have one of
 the following: 
1.
 A bachelor's degree in a
 mental health service-related field with one (1) year experience in a direct
 mental health service-related field.

2.
 A bachelor's degree not in a mental health
 service-related field with two (2) years of experience in a direct mental
 health service-related field.

3.
 No
 degree or high school diploma/GED with three (3) years of experience working
 directly in a mental health residential setting(s).

(b)
 All staff shall receive initial training
 related to the special needs of the population served.

(c)
 The program shall provide specialized
 services that are based on the admission criteria contained in the program
 description.

(d)
 The program has
 the following staffing pattern for a four (4) to ten (10) bed home: 
 
1.
 Day shift - 1 Program Coordinator (5 days
 per week), one (1) Mental Health Worker five (5) days per week, and two (2)
 Mental Health Worker (2 days per week).

2.
 Evening shift - two (2) Mental Health
 Workers (7 days per week).

3.
 Night
 shift - one (1) Mental Health Workers (7 days per week, awake).

(e)
 The program has the following
 staffing pattern for an eleven (11) to sixteen (16) bed home: 
 
1.
 Day Shift - 1 Program Coordinator
 (5day/week), one (1) Mental Health Worker 5 days/week, and two (2) Mental
 Health Workers (2 days/week).

2.

 Evening Shift - two (2) Mental Health Workers (7days/week).

3.
 Night Shift - two (2) Mental Health
 Workers (7 days/ week, a minimum of one (1) awake).

(36)

An Adult
 Residential Care Home with Specialized Medical Services

 shall meet the following criteria: 
(a)
 The
 program coordinator shall be a registered nurse.

(b)
 All staff shall receive initial training
 related to the special needs of the population served.

(c)
 The program shall provide specialized
 services that are based on the admission criteria contained in the program
 description.

(d)
 The program has
 the following staffing pattern for a four (4) to ten (10) bed home: 
 
1.
 Day shift - one (1) registered nurse (7
 days per week), and one (1) Mental Health Worker (7 days per week).

2.
 Evening shift - one (1) licensed practical
 nurse and one (1) Mental Health Worker (7 days per week).

3.
 Night shift - one (1) licensed practical
 nurse and one (1) Mental Health Worker (both 7 days per week, both
 awake).

(e)
 The program
 has the following staffing pattern for an eleven (11) to sixteen (16) bed home:
 
1.
 Day Shift - one (1) Registered Nurse (7
 days/week), two (2) Mental Health Worker (7days/week).

2.
 Evening Shift - one (1) Licensed Practical
 Nurse and two (2) Mental Health Workers (7 days/week).

3.
 Night Shift - one (1) Licensed Practical
 Nurse and one (1) Mental Health Worker (7 days/week, both awake).

(37)

A Crisis Residential Unit (CRU)
 program
 shall meet the following criteria:
(a)
 The
 program coordinator shall have a master's degree in a mental health
 service-related field and one (1) year post master's experience in a direct
 mental health service-related or be a registered nurse with one (1) year in a
 mental health service-related field.

(b)
 The program shall provide specialized
 services that are based on the admission criteria contained in the program
 description.

(c)
 All staff shall
 receive initial training related to the special needs of the population
 served.

(d)
 A psychiatrist, a
 certified registered nurse practioner (CRNP) or physician assistant (PA) shall
 make rounds at a minimum of two (2) non-consecutive days per week and shall be
 on call seven (7) days per week.

(e)
 The expected length of stay is based on
 an ADMH approved program description, not to exceed six (6) to twelve (12)
 months. Extensions of LOS clearly document reasons consistent with the
 continued stay criteria, specify a period of time not to exceed three (3)
 months, specify clinical objectives to be achieved during the extension, and
 are approved by a qualified staff member.

(f)
 Intensive Case Management shall be
 available within the organization to facilitate discharge planning and
 diversion from hospitalization in a state hospital.

(g)
 The program has the following staffing
 pattern for a maximum of ten (10) beds or less: 
 
1.
 Day shift - .10 psychiatrist/CRNP/PA, 1 MA
 (5 days per week), 1 RN or LPN (7 days per week), one (1) Mental Health Worker
 (7 days per week), where the MA position or the RN may be the program
 coordinator.

2.
 Evening shift -one
 (1) RN or LPN (7 days per week) and 1 Mental Health Worker (7 days per
 week).

3.
 Night shift - one (1) RN
 or LPN and 1 Mental Health Worker (both 7 days per week).

(h)
 The program has the following staffing
 pattern for eleven (11) to sixteen (16) beds: 
 
1.
 Day Shift - .15 psychiatrist/CRNP/PA
 (includes on-call time), one (1) MA (5 days/week), one (1) RN or LPN (7
 days/week), one (1) BA, CPS-Adult, or Mental Health Worker (7 days/week), and
 one (1) Mental Health Worker (7 days/week) where either the MA position or the
 RN may be the program coordinator.

2.
 Evening Shift - one (1) RN or LPN and two
 (2) Mental Health Workers (7 days/week).

3.
 Night Shift - one (1) RN or LPN and two
 (2) Mental Health Workers (7 days/week, all awake).

(38)

The
 Transitional Age Residential Care Program (age 17-25)
 shall
 meet the following criteria: 
(a)
 The Program
 Coordinator shall have either a bachelor's degree in a mental health
 service-related field or be a Registered Nurse. The Program Coordinator shall
 have at least one (1) year post-degree direct service experience with
 adolescents/youth.

(b)
 Recipients
 shall continue to receive educational services while in the residential
 program, if deemed appropriate based upon an assessment of educational needs
 and age. School-age recipients shall receive the required educational elements
 as outlined by the Alabama State Department of Education, unless modified by an
 Individual Education Program (IEP). If the educational program is provided by
 the residential program, it must be registered with the Alabama State
 Department of Education. If the program is receiving special education funds,
 the program must agree to meet the minimum assurance statements set forth by
 the Alabama State Department of Education.

(c)
 The recipient's IEP shall be followed and
 updated as needed while in residential care, including providing access to
 special needs services. The recipient and/or lawful representative shall be
 informed of any meeting regarding an update or alteration in the recipient's
 IEP.

(d)
 All staff shall receive
 initial training (before working alone with recipients) and 20 hours of annual
 training related to the target population with 2 of those hours involving the
 perspective of families and recipients with regard to residential
 treatment.

(e)
 The program shall
 provide specialized services that are based on the essential service components
 and the admission criteria contained in the program description. Custody must
 be verified through the admission process, if applicable.

(f)
 The frequency and intensity of treatment
 interventions must be specified in the individual treatment plans. Individual
 service elements must meet the applicable criteria in the Outpatient Service
 standards.

(g)
 The treatment plans
 are consistent with the admission criteria.

(h)
 The recipients shall receive at least one
 (1) hour of individual therapy and one (1) hour of group therapy each week.
 There is documentation that there are no more than 10 recipients in each group
 therapy session.

(i)
 The clinical
 backgrounds of the recipients should be considered when room assignments are
 made.

(j)
 Within ninety (90) to one
 hundred-eighty (180) days prior to discharge the residential facility will
 begin coordinating recommended transitional services.

(k)
 Within fourteen (14) days prior to
 discharge, with the permission of the recipient and/or lawful representative/
 legal guardian, the program shall set up appointments for the recipient for all
 recommended follow-up services.

(l)

 Upon discharge, the recipient and/or lawful representative/legal guardian will
 be given a list of all medications given during the residential stay and an
 explanation for why they were prescribed and the reason for discontinuation, if
 applicable.

(m)
 The program has the
 following staffing pattern for sixteen (16) beds: 
 
1.
 Day Shift - one (1) Program Coordinator (5
 days per week), 1 BA Care Coordinator/Case Manager (7 days per week), and 1
 Mental Health Worker (7 days per week).

2.
 Evening Shift - two (2) Mental Health
 Workers (7 days per week).

3.
 Night
 Shift - two (2) Mental Health Workers (7 days per week with at least one (1)
 awake)

(n)
 Admissions
 will be drawn primarily from persons referred from state psychiatric
 hospitals.

(39)

A Child/Adolescent Residential
 program
 must meet the following criteria: 
(a)
 The
 program coordinator shall have a master's degree in a mental health
 service-related field and shall have at least two (2) years post master's
 experience in a direct service functional area. One of the two years post
 master's experience must be with children/adolescents.

(b)
 Children/adolescents shall continue to
 receive an appropriate education while in the residential program. Children and
 adolescents shall receive the required educational elements as outlined by the
 Alabama State Department of Education, modified by an Individual Education
 Program (IEP). If the educational program is provided by the residential
 program, it must be registered with the Alabama State Department of Education.
 If the program is receiving special education funds, the program must agree to
 meet the minimum assurance statements set forth by the Alabama State Department
 of Education.

(c)
 Staffing pattern
 shall be outlined in the program description and approved by ADMH. The staffing
 pattern shall reflect the number of children/adolescents being served, staff to
 recipient ratio, and the acuity of the treatment needs of those being
 served.

(d)
 All staff shall receive
 initial (before working alone with recipients) and twenty (20) hours of annual
 training related to the target population with two (2) of those twenty (20)
 hours involving the perspective of families and recipients with regard to
 residential treatment.

(e)
 The
 frequency and intensity of treatment interventions shall be specified in the
 individual treatment plans. Individual service elements shall meet the
 applicable criteria in the Outpatient Service standards.

(f)
 The treatment plans are consistent with
 the admission criteria.

(g)
 The
 child/adolescent shall be assessed for special education services. Once
 assessed, if the child/adolescent is determined to qualify for Special
 Education services, an Individualized Education Plan (IEP) is developed, and a
 copy is placed in the clinical record.

(h)
 If a child/adolescent has an IEP, it
 shall be followed while in residential care including any updates. The lawful
 representative/legal guardian shall be informed of any meeting regarding an
 update or alteration in the child/ adolescent's IEP.

(i)
 Children/adolescents shall receive at
 least one (1) hour of individual therapy and one (1) hour of group therapy each
 week. There is documentation that there are no more than ten (10) recipients in
 each group therapy session.

(j)
 The
 clinical backgrounds of the children and adolescents shall be considered when
 room assignments are made.

(k)

 Within ninety (90) to one hundred-eighty (180) prior to discharge, the
 residential facility will begin coordinating recommended transitional
 services.

(l)
 Within fourteen (14)
 days prior to discharge, with the permission of the lawful representative/legal
 guardian, the facility will set up appointments for the child/adolescent for
 all recommended follow-up services.

(m)
 Upon discharge, the lawful
 representative/legal guardian will be given a list of all medications given
 during the residential stay and an explanation for why they were prescribed and
 the reason for discontinuation, if applicable.

(40)

A
 Medication/Observation/Meals (MOM)
 program is exempt from
 the following general residential standards in this section (5) (a), (15) (l)
 and (m), (16) (a) (b) (c), (18), (28), (31), and (32) (a-H), and must meet the
 following criteria:
(a)
 The program
 coordinator shall have one of the following: 
 
1.
 A bachelor's degree in a mental health
 service-related field with one (1) 2 year of experience in a direct mental
 health service-related field.

2.
 A
 bachelor's degree not in a mental health service-related field with two (2)
 years of experience in a direct mental health service-related field.

3.
 No degree or high school diploma/GED with
 three (3) years of experience working directly in a mental health residential
 setting(s).

(b)
 All
 staff shall receive initial related to the special needs of the population
 served.

(c)
 The program shall
 provide specialized services that are based on the admission criteria contained
 in the program description. The program description shall specifically address
 provisions for the following core services: meals, observation, and
 medication.

(d)
 Residents shall be
 provided choice to what degree, if any, they wish to participate in on-site
 activities.

(e)
 Outpatient Services
 such as psychiatry, nursing, and therapy services shall be delivered on-site or
 staff shall arrange services offsite, to include transportation as clinically
 appropriate.

(f)
 Living units shall
 be exclusively for the target population and shall be communally located with
 24/7 on-site awake staff.

(g)
 The
 number of living units located at one site shall not exceed 30 unless approved
 by the Department of Mental Health.

(h)
 The program has the following staffing
 pattern for a twenty (20) bed location: 
1.

 Day shift - 1 Program Coordinator (5 days per week), .10 full-time equivalent
 psychiatrist, .10 full-time equivalent MA therapist, and .10 full-time
 equivalent registered nurse, and 1 Mental Health Worker or Certified Peer
 Specialist- Adult (7 days per week).

2.
 Evening shift - 1 Mental Health Worker or
 Certified Peer Specialist - Adult (7 days per week).

3.
 Night Shift - 1 Mental Health Worker or
 Certified Peer Specialist - Adult (7 days per week, awake).

(i)
 The program has the following
 staffing pattern for a twenty-one (21) to thirty (30) bed per location: 
 
1.
 Day shift - one (1) Program Coordinator (5
 days per week),.10 full-time equivalent psychiatrist, .10 full-time equivalent
 MA therapist, and .10 full-time equivalent registered nurse, one (1) Mental
 Health Workers or Certified Peer Specialist- Adult (7 days per week) and one
 (1) Mental Health Worker or Certified Peer Specialist - Adult (2 days per
 week).

2.
 Evening shift - two (2)
 Mental Health Workers or Certified Peer Specialist - Adult (7 days per
 week).

3.
 Night Shift - 2 Mental
 Health Workers or Certified Peer Specialist - Adult (7 days per week,
 awake).

Notes

Ala. Admin. Code
 r. 
580-2-20-.13

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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