This definitions section establishes the terminology used throughout Alabama's Chapter 580-9-44, which governs licensing and operational standards for substance use disorder treatment programs across multiple levels of care — from early intervention and outpatient through intensive outpatient, partial hospitalization, ambulatory detoxification, and residential treatment for both adults and adolescents. Facility operators must apply these definitions when interpreting and complying with the substantive requirements in the chapter's other sections. Key terms cover clinical concepts (e.g., ASAM placement criteria, co-occurring disorders, detoxification), service types, personnel roles, and documentation standards.
View official sourceAla. Admin. Code r. 580-9-44-.01 - Definitions
State Regulations
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(1)
Abstinence -
Non-use of any addictive psychoactive substance.
(2)
Abuse - The willful infliction of
physical pain, injury, or mental anguish or the willful deprivation of services
necessary to maintain mental and physical health.
(3)
Activity - The execution of a task or
action (a group or individual session) by an individual.
(4)
Activity Therapy - Structured,
object-oriented music, dance, art, social, or play therapeutic activities
conducted, not for recreational purposes, by a qualified substance abuse
professional to assist a client in developing or enhancing psychosocial
competencies, to alleviate emotional disturbances, to change maladaptive
patterns of behavior, and/or to assist in restoring the individual to a level
of functioning capable of supporting and sustaining recovery.
(5)
Addiction - A primary, chronic
neurobiological disease, with genetic, psychosocial and environmental factors
influencing its development and manifestations. It is characterized by
behaviors that include one or more of the following: impaired control over drug
use, compulsive use, continued use despite harm, and craving.
(6)
Administer - The direct application of a
prescription drug by ingestion or any other means to the body of a client by a
licensed practitioner, or by the client at the direction of, or in the presence
of, a practitioner.
(7)
Admission -
That point in an individual's relationship with an organized treatment service
when the placement assessment process has been completed and the individual
placed in a level of care of the treatment program.
(8)
Adolescent - An individual aged 13-18.
The term also frequently applies to young adults aged 18-21, whose needs
dictate admissions to adolescent programs.
(9)
Advocacy - To advocate for, protect and
advance the legal, human and service rights of people.
(10)
Aftercare - The component of a treatment
program which assures the provision of continued contact with the client
following the termination of services from a primary care modality, designed to
support and to increase the gains made to date in the treatment process.
Aftercare plan development should start prior to discharge, but is not
implemented until discharge.
(11)
Aftercare Plan - A written plan that specifies goals to be achieved by a client
and/or family involved in the aftercare of the client.
(12)
Alcoholism - A general but diagnostic
term, usually used to describe alcohol dependence, but sometimes used more
broadly to describe a variety of problems related to the use of beverage
alcohol.
(13)
Ambulatory
Detoxification - Detoxification that is medically monitored but that does not
require admission to an inpatient medically or clinically monitored or managed
setting.
(14)
Ancillary Services -
Non-substance use related services such as legal, vocational, employment,
public assistance, childcare and transportation that may either be essential or
incidental to a client's recovery.
(15)
ASAM Placement Criteria - ASAM Placement
criteria means the most current edition/set of placement criteria for substance
abuse patient/clients published by the American Society of Addiction
Medicine.
(16)
Assertive Community
Treatment (ACT) - Active outreach to persons, usually with serious and
persistent mental illness, who need a support system that facilitates living
and functioning adequately in the community. ACT involves comprehensive
services designed to engage and retain patients in treatment and assist them in
managing daily living, obtaining work, building and strengthening family and
friendship networks, managing symptoms and crises and preventing
relapse.
(17)
Basic Living Skills -
Scheduled interventions conducted under the supervision of a qualified
substance abuse professional to train and assist a client in reestablishing the
ability to perform and manage fundamental tasks required for daily
living.
(18)
Behavioral Health
Field - A broad array of mental health, substance use, habilitation and
rehabilitation services that are utilized to individuals with substance use
disorders. The field includes the areas of psychology, social work, counseling
and psychiatric nursing.
(19)
Behavioral Health Screening - A structured interview process conducted by a
qualified substance abuse professional, utilizing the DMH/SASD uniform
assessment tool, for the purpose of identifying an individual's presenting
needs and establishing a corresponding recommendation for placement in an
appropriate level of care.
(20)
Case Management - The activities guided by a client's service plan which brings
agencies, resources and people together within a planned framework of action
toward the achievement of established treatment goals.
(21)
Central Registry - A system which is
used by two (2) or more providers to share information about clients who are
applying for or presently involved in detoxification or maintenance treatment
using methadone or other opiate replacements, for the purpose of preventing the
concurrent enrollment of clients with more than one OMT provider.
(22)
Certification - The process by which DMH
or SASD determines that a provider is qualified to provide treatment or
prevention services under applicable State and Federal standards.
(23)
Chemical Dependency - A generic term
relating to psychological or physical dependency, or both, on one or more
psychoactive substances.
(24)
Chemical Restraint - Is the use of any drug to manage a client's behavior in a
way that reduces the safety risk to the client or others or to temporarily
restrict the client's freedom of movement and is not a standard treatment
dosage for the client's medical or psychiatric condition.
(25)
Child/Adolescent - The period of life of
an individual up to the age at which one is legally recognized as an adult
according to state or provincial law. (CARF)
(26)
Child Sitting Services - Care provided
for children of clients in treatment during the same time period as the
specific occurrence of the parent's treatment.
(27)
Client - An individual who receives
treatment for alcohol or other drug problems. The terms "client" and "patient"
sometimes are used interchangeably, although staff in medical settings more
commonly use "patient" while staff of non-medical residential or outpatient
settings refer to "clients".
(28)
Clinically Managed Services - Services directed by non-physician addiction
specialists rather than medical personnel. They are appropriate for individuals
whose primary problems involve emotional, behavioral or cognitive concerns,
readiness to change, relapse, or recovery environment and whose problems with
intoxication/withdrawal or biomedical are minimal or can be managed through
separate arrangements for medical services.
(29)
Clinical Supervision - Intermittent
face-to-face contact, provided on or off the site of a service, between a
clinical supervisor and treatment staff to ensure that each client has an
individualized counseling plan and is receiving quality care.
(30)
Consultation - A discussion of the
aspects of a particular client's circumstance with other professionals to
ensure comprehensive and quality care for the client that is consistent with
the objectives of the client's treatment plan, or is used to make adjustments
to the client's treatment plan.
(31)
Continuous Assessment - The term
includes but is not limited to review of the individual service plan, client
progress reports, etc. The information gained from continuous assessment is
used to match an individuals' need with the appropriate setting, care level and
intensity. It is also used to determine an individuals' need for continued
stay, discharge, or transfer to another level of care.
(32)
Continuing Care - A course of treatment
identified in a service plan designed to support the process of recovery that
is provided at a frequency sufficient to maintain recovery. The treatment
provided is flexible and tailored to the shifting needs of the client and his
and her level of readiness to change.
(33)
Co-Occurring Disorders - Concurrent
substance use and mental health disorder found in a single individual. Both
conditions are such that they may also exist alone but there is no implication
as to one disorder being primary. Other terms used to describe COD include:
dual diagnosis, dual disorders, mentally ill chemically addicted (MICA),
chemically addicted mentally ill (CAMI), mentally ill substance abusers (MISA),
mentally ill chemically dependent (MICD), coexisting disorders, co-morbid
disorders, and individuals with co-occurring psychiatric and substance
symptomatology (ICOPSS).
(34)
Continued Stay, Transfer, and Discharge Criteria -Criteria used after the
initial assessment to monitor progress during a treatment episode and decide on
Level of Care.
(35)
Counselor - A
member of the clinical staff working in a program who is licensed or certified
and whose primary duties consist of conducting and documenting services such as
counseling, psycho-educational groups, psychosocial assessment, treatment
planning and case management.
(36)
Crisis Intervention - Services that respond to a client's needs during acute
episodes that may involve physical distress, imminent relapse and danger to
self and others.
(37)
Crisis
Planning - A process of developing necessary resources to appropriately address
and respond to acute needs of a client to include assessing for suicide and
homicide ideations or plans.
(38)
Criteria - Written rules, measures, or factors that help assessors determine
where to place a client in care.
(39)
Dependence - Used in three different
ways:
(a)
physical dependence is a state of
adaptation that is manifested by a drug class specific withdrawal syndrome that
can be produced by abrupt cessation, rapid dose reduction, decreasing blood
level of the drug, and/or administration of an antagonist;
(b)
psychological dependence is a subjective
sense of need for a specific psychoactive substance, either for its positive
effects or to avoid negative effects associated with its abstinence; and
(c)
one category of psychoactive
substance use disorder.
(40)
Detoxification - The deliberate
withdrawal of a person from a specific physiological addicting substance in a
safe and effective manner.
(41)
Detoxification Rating Scales - As needed documentation. For example: clinical
institution, withdrawal, assessment (CIWA); clinical opiates withdrawal scale
(COWS), etc.
(42)
Developmental
Delay, Prevention Activities, Dependent Child - Structured activities provided
by an appropriately credentialed professional for children of clients in
treatment, during the same time period as the specific occurrence of the
parent's treatment. These services function to foster healthy psychological,
emotional, social and intellectual development of the child.
(43)
Diagnostic Criteria - Prevailing
standards which are used to determine a client's mental and physical condition
relative to their need for substance abuse services, such as those which are
described in the current Diagnostic and Statistical Manual of Mental
Disorders.
(44)
Didactic Group -
Groups that are designed to teach or lecture.
(4
5)
Discharge Planning - The process, beginning at admission of
determining a client's continued need for treatment services and developing a
plan to address ongoing client recovery needs once the client has been
discharged from a level of care.
(46)
Discharge Summary - A written narrative
of the client's treatment record describing the client's accomplishments and
problems during treatment, reasons for discharge and recommendations for
further services.
(47)
Discharge/Transfer Criteria - During client assessment, problems and priorities
are identified as justifying treatment at a particular level of care.
Discharge/Transfer Criteria describe the degree of resolution of those problems
and priorities and are used to determine when a client can be treated at a
different level of care or discharged from treatment. The appearance of new
problems may require services that can be provided effectively only at a more
or less intensive level of care. This level of function and clinical severity
of a client's status in each of the six dimensions is considered in determining
the need for discharge or transfer.
(48)
Documentation - Provisions of written,
dated and authenticated evidence (signed by person's name and title) to
substantiate compliance with standards (e.g. minutes of meetings, memoranda,
schedules, notices, announcement).
(49)
Drug Intoxication - Dysfunctional
changes in physiological functioning, psychological functioning, mood state,
cognitive process, or all of these, as a consequence of consumption of a
psychoactive substance; usually disruptive, and often stemming from central
nervous system impairment.
(50)
DSM
- The most current edition of the Diagnostic and Statistical Manual of Mental
Disorders, published by the American Psychiatric Association. References to DSM
may be construed to mean the most current edition of the International
Classification of Diseases (ICD-10) when appropriate.
(51)
Dual Diagnosis - Refers to the client
who has signs and symptoms of concurrent substance-related and mental
disorders. Other terms used to describe such co-occurring disorders include,
co-occurring disorders, dual disorders, mentally ill chemically addicted
(MICA), chemically addicted mentally ill (CAMI), mentally ill substance abusers
(MISA), mentally ill chemically dependent (MICD), coexisting disorders,
comorbid disorders, and individuals with co-occurring psychiatric and substance
symptomatology (ICOPSS).
(52)
Dual
Diagnosis Capable (DDC) - Treatment programs that address co-occurring mental
and substance-related disorders in their policies and procedures, assessment,
treatment planning, program content and discharge planning are described as
"Dual Diagnosis Capable" DDC. Such programs have arrangements in place for
coordination and collaboration with mental health services. They can provide
psychopharmacologic monitoring and psychological assessment and consultation,
either on site or through coordinated consultation with off site providers.
Program staff are able to address the interaction between mental and substance
related disorders and their effect on the client's readiness to change- as well
as relapse and recovery environment issues-through individual and group program
content. Nevertheless, the primary focus of DDC programs is the treatment of
substance-related disorders.
(53)
Dual Diagnosis Enhanced (DDE) - Describes treatment programs that incorporate
policies, procedures, assessments, treatment and discharge planning processes
that accommodate patients who have co-occurring mental and substance related
disorders. Mental health symptom management groups are incorporated into
addiction treatment. Motivational enhancement therapies specifically designed
for those with co-occurring mental and substance-related disorders are more
likely to be available (particularly in out-patient settings) and, there is
close collaboration or integration with a mental health program that provides
crisis backup services and access to mental health case management and
continuing care. In contrast to Dual Diagnosis Capable services. Dual Diagnosis
Enhanced services place their primary focus on the integration of services for
mental and substance-related disorders in their staffing, services and program
content.
(54)
Early Intervention -
Services that explore and address any problems or risk factors that appear to
be related to the use of alcohol and other drugs and that help the client to
recognize the harmful consequences of inappropriate use. Such individuals may
not appear to meet the diagnostic criteria for a substance use disorder, but
require early intervention for education and further assessment.
(55)
Emergency Service - A network of
services that provides all persons having acute problems related to alcohol and
other drug use and abuse readily available diagnosis and care, as well as
appropriate referral for continuing care after emergency treatment.
(56)
Exploitation - An unjust or improper use
of another person or their resources for one's own profit or advantage or for
the profit or advantage of another person.
(57)
Evidence-Based Practice - An approach to
mental health care practice in which the clinician is aware of the evidence
that bears on his/her clinical practice, and the strength of that
evidence.
(58)
Failure (as in a
treatment failure) - Lack of progress and/or regression at any given level of
care. These situations warrant a reassessment of the treatment plan, with
modifications of the treatment approach. Such situations may require changes in
the treatment plan at the same level of care or transfer to a different (more
or less intensive) level of care to achieve a better therapeutic response.
Sometimes used to describe relapse after a single treatment episode- an
inappropriate construct in describing a chronic disease or disorder.
(59)
Family - Individuals as defined by law,
or significant others that claim relationship to the client. A person's
immediate relatives and/or significant others. A term used to describe a
person's parents, spouse, siblings, extended family, guardians, legally
authorized representatives, or significant others as identified by the person
served. (CARF)
(60)
Family
Counseling - A treatment plan focused on intervention involving a client,
his/her family unit and/or significant others, and a mental health/substance
abuse professional. Treatment is designed to maximize strengths and to reduce
behavior problems and/or functional deficits stemming from the existence of a
mental disorder that interferes with a client's personal, familial, vocational,
and/or community adjustment.
(61)
Flow Sheets - A term usually associated with the field of nursing;
Documentation that is required for a patient that assesses their entire day.
Components of a flow sheet include:
(a)
The
Master Treatment Problem (MTP Problem).
(b)
Risk Assessment.
(c)
Medication Compliance and
Response.
(d)
Subjective &
Objective Data.
(e)
Physical
Assessment- Review of Systems.
(f)
Pain Assessment.
(g)
Intervention/Education.
(h)
Response to Intervention.
(i)
Additional Information.
(62)
Follow-up - A process used by a
treatment provider that will periodically assess the progress of a client who
has completed treatment services.
(63)
Governing Authority - The individuals or
group that provides direction, guidance, and oversight, approves decisions
specific to the organization and its services. The chief executive or agency
director reports to this authority.
(64)
Grievance - A written expression of
dissatisfaction which may or may not be the result of an unresolved
complaint.
(65)
Group Counseling -
The application of counseling techniques which involve interaction among
members of a group consisting of at least three (3) clients but not more than
fifteen (15) with a minimum of one (1) counselor for every fifteen (15)
clients.
(66)
Health Education - A
service prescribed to modify assessed alcohol and/or drug use, cognitive,
behavioral, emotional, social, and/or psycho-physiological factors relevant to
and affecting the client's physical health problems. This service is provided
for individuals who have established illnesses or symptoms.
(67)
HIV Early Intervention Services -
Appropriate pretest counseling for HIV and AIDS. Testing individuals with
respect to such disease, including tests to confirm the presence of the
disease, tests to diagnose the extent of the deficiency in the immune system,
and tests to provide information on appropriate therapeutic measures for
preventing and treating the deterioration of the immune system and for
preventing and treating conditions arising from the disease. Also, appropriate
post-test counseling and therapeutic measures.
(68)
Human Service Needs Assessment (HSNA) -
An assessment of specific human service needs of a client. The systematic
determination of the specific needs of each client. Its' purpose is to
comprehensively define the scope of services and the client's functional levels
to develop an individualized case management case plan. It clearly describes
the client's strengths and problem areas. The following key elements make up
the HSNA: family relationship, housing, vocational/educational, recreational,
transportation, social support, physical, financial and spiritual.
(69)
Individualized Counseling - Counseling
designed to meet a particular client's needs, guided by a treatment plan that
is directly related to a specific, unique client assessment.
(70)
Individualized Service Plan - The
ongoing process by which a clinician and the client identify and rank problems,
establish agreed upon goals and decide on the treatment process and resources
to be utilized.
(71)
Intake - The
process of collecting and assessing information to facilitate admission of an
individual into a substance abuse treatment program.
(72)
Intake Service - A structured interview
process conducted by a trained clinician for the purpose of identifying and
evaluating a client's continued need for treatment or care after diagnostic
interview examination, admission and implementation of the initial treatment
plan, in a specific level of care.
(73)
Intensive Case Management - A
comprehensive community service that includes evaluation, outreach and support
services, usually provided on an outpatient basis. The case manager (management
team) advocates for the client with community agencies and arranges services
and supports. The case manager may also teach community living and
problem-solving skills, model productive behaviors and the client becomes
self-sufficient.
(74)
Intensive
Outpatient Treatment - An organized service delivered by addiction
professionals or addiction-credentialed clinicians, which provides a planned
regimen of treatment, consisting of regularly scheduled sessions within a
structured program, for a minimum of nine (9) hours of treatment per week for
adults and six (6) hours of treatment per week for adolescents.
(75)
Interdisciplinary Staff - A group of
clinicians trained in different professions, disciplines, or service areas
(such as physicians, counselors, psychologists, social workers, nurses and
certified substance abuse counselors), who function interactively and
interdependently in conducting a client's diagnostic interview examination,
service plan and treatment services. There must be close interaction and
integration among the disciplines to ensure that all members of the team
interact to achieve team goals.
(76)
Intervention - A planned interaction
with an individual who may be dependent on one or more psychoactive substances,
with the aim of making a full assessment, overcoming denial, interrupting
drug-taking behavior, or inducing the individual to initiate treatment.
Includes activities and strategies that are used to prevent or impede the
development or progression of substance abuse problems.
(77)
Length of Service - The number of days
for inpatient care or units/visits for outpatient of service provided to a
patient, from admission to discharge, at a particular level of care.
(78)
Level of Care - The term refers to broad
categories of patient placement, which encompass a range of clinical services
such as early intervention, detoxification, or Opioid Maintenance Therapy
services and levels of care such as intensive outpatient treatment or
clinically managed medium intensity residential treatment.
(79)
Level of Function - An individual's
relative degree of health and freedom from specific signs and symptoms of a
mental or substance-related disorder, which determine whether the individual
requires treatment.
(80)
Licensed
Independent Practitioner - An individual permitted by law and by the
organization to provide care and services, without direction or supervision,
within the scope of the individual's license and consistent with individually
granted clinical privileges. In Alabama such individuals include: MD, DO,
licensed psychologist, licensed professional counselor, licensed certified
social worker, licensed marriage and family therapist. Master's level nurse in
psychiatric nursing, certified registered nurse practitioner, and physician
assistant.
(81)
Linkage -
Established connections and networks with a variety of agencies, companies and
persons in the community that provides linkage that is facilitated between the
client and service provider. (CARF)
(82)
Long-term Detoxification Treatment
-Detoxification treatment for a period of more than thirty (30) days but less
than one-hundred eighty (180) days.
(83)
Medical Director - A physician licensed
under Alabama law who has been designated to oversee all medical services of a
provider and has been given the authority and responsibility for medical care
delivered by a provider. This includes ensuring the program is in compliance
with all federal, state and local laws and regulations regarding the medical
treatment of addiction to an Opioid drug.
(84)
Medically Managed Treatment - Services
that involve daily medical care, where diagnostic and treatment services are
directly provided and/or managed by an appropriately trained and licensed
physician.
(85)
Medically Monitored
Treatment - Services that are provided by an interdisciplinary staff of nurses,
counselors, social workers, addiction specialists and other health care
professionals and technical personnel, under the direction of a licensed
physician. Medical monitoring is provided through an appropriate mix of direct
patient contact, review of records, team meetings, twenty-four (24) hour
coverage by a physician, and quality assurance programs.
(86)
Medical Monitoring - Evaluation, care
and treatment by medical personnel who are licensed for clients whose substance
abuse and related problems are severe enough to require intensive inpatient
treatment using an interdisciplinary team approach.
(87)
Medical Necessity - Services by a
provider to identify or treat an illness that has been diagnosed or suspected.
The services are consistent with:
(a)
The
diagnosis and treatment of a condition.
(b)
The standards of good medical
practice.
(c)
Required for other
than convenience.
(d)
The most
appropriate supply or level of service.
When applied to inpatient care, the term means: that the needed
care can only be safely given on an inpatient basis.
(88)
Medically Managed Service -
Services provided or directly managed by a physician.
(89)
Medically Monitored Service - Services
provided under the direction and supervision of a physician. The physician may
or may not directly administer care to the client.
(90)
Medication Administration - The direct
administration of prescribed medication, as according to assessed needs
stipulated in a client's service plan, and observation of the client's intake
of the medication by mouth.
(91)
Medication Assistant Certified Worker (MAC Worker) - Unlicensed worker that
performs basic strategies in assisting with the medication administration
process. Must have successfully completed the twenty-four (24) hour MAC 1 &
2 educational program and received a score of ninety (90) or above on the MAC
test.
(92)
Medication Assistant
Supervisor Nurse (MAC Nurse) - A registered nurse (RN) or licensed practical
nurse (LPN) with a valid Alabama license and employed or contracted by an
agency/program certified by the ADMH. Must complete the seven (7) hours
training program for MAS nurses and receive a score of ninety (90) or above on
the MAS test.
(93)
Medication
Assistance Train-the-Trainer Registered Nurse (MATT RN) - Must be a MAS
registered nurse with at least one (1) year of community service. Must also
receive additional training beyond the MAS requirement and receive a score of
ninety (90) or above on the MATT test.
(94)
Medication Destruction Record - What it
is and what is contained in it.
(95)
Medication Management - The practice of
prescribing and/or dispensing medication by qualified personnel.
(CARF)
(96)
Medication Monitoring -
Face-to-face contact between the client and rehabilitative services, or a child
and adolescent services/adult protective services professional, pharmacist, RN,
or LPN for the purpose of reviewing the overt physiological effects of
psychotropic medications; monitoring compliance with dosage instructions;
instructing the client and/or caregivers of expected effects of psychotropic
medications; assessing the client's need to see the physician; and recommending
changes in the psychotropic medication regimen.
(97)
Mental Health Consultation - A service
aimed at assisting other service agency providers or independent practitioners
in providing appropriate services to an identified Medicaid client by providing
clinical consultation. Key service functions include written or oral
interaction in a clinical capacity in order to assist another provider to meet
the specific treatment needs of an individual client and to assure continuity
of care to another setting.
(98)
Modality - A specific type of treatment (technique, method, or procedure) that
is used to relieve symptoms or induce behavior change. Modalities of addiction
treatment include, for example, detoxification or antagonist medication,
motivational interviewing, cognitive behavioral therapy, group therapy, social
skills training, vocational counseling and self/mutual help groups.
(99)
Monitoring - The interaction between the
area authority or county program and a provider of public services regarding
the functions set forth in the standards.
(100)
Motivational Enhancement and Engagement
Strategies - A patient-centered counseling approach for initiating behavior
change by helping patients to resolve ambivalence about engaging in treatment
and stopping substance use. This approach employs strategies to evoke rapid and
internally motivated change in the patient, rather than guiding the patient
stepwise through the recovery process. (Adopted from Principles of Drug
Addiction Treatment-A Research Based Guide, National Institute on Drug Abuse,
1999).
(101)
Neglect - The willful
act of withholding or inadequately providing shelter, food, hydration,
clothing, medical care and good hygiene.
(102)
Non-Violent Crisis Intervention - A
process of interrupting an action or behavior that is harmful to an individual
through the use of techniques that require limited force or action.
(103)
Nurse Delegation Program (NDP) - A
general term that refers to the entire system that allows non-licensed persons
to assist licensed nursing professionals in the administration of medications
in a residential treatment setting.
(104)
Opioid Agonist Treatment Medication - A
prescription medication, such as methadone, Buprenorphine or other substance
scheduled as a narcotic under the Federal Controlled Substances Act
(21 U.S.C.
Section
811
) that is approved by the U.S.
Food and Drug Administration for use in the treatment of opiate addiction or
dependence.
(105)
Opioid
Maintenance - The dispensing of methadone for more than one-hundred eighty
(180) days in the treatment of an individual for dependence on
opiates.
(106)
Outpatient Service -
An organized non-residential service, delivered in a variety of settings, in
which addiction treatment personnel provide professionally directed evaluation
and treatment of substance-related disorders. Usually fewer than nine (9)
hours.
(107)
Overdose - The
inadvertent or deliberate consumption of a dose much larger than that either
habitually used by the individual or ordinarily used for treatment of an
illness, and likely to result in a serious toxic reaction or death.
(108)
Parenting Skills Development - A
structured face-to-face encounter facilitated by a trained clinician for the
purpose of enhancing the parenting competency of individuals who are parents of
dependent children, and who have a substance use disorder. This service may
include interactive activities involving the parents' children.
(109)
Partial Hospitalization - A generic
term encompassing day, night, evening and weekend treatment programs that
employ an integrated, comprehensive and complementary schedule of recognized
treatments. Commonly referred to as "day treatment." A partial hospitalization
program does not need to be attached to a licensed hospital.
(110)
Patient - An individual receiving
alcohol/other drug treatment. The terms "client", "patient" and "client"
sometimes are used interchangeably and refer to the individual who has
completed the screening, behavioral health screening and diagnostic interview
examination process and is receiving substance abuse treatment
services.
(111)
Peer Counseling
Services - The provision of scheduled interventions by a certified peer
counselor, who is in recovery from a substance use or co-occurring substance
use and mental illness disorder, to assist a client in the acquisition and
exercise of skills needed to support recovery. Services may include activities
that assist clients in accessing and/or engaging in treatment and in symptom
management, promote socialization, recovery, and self-advocacy, and provide
guidance in the development of natural community supports and basic daily
living skills.
(112)
Performance
Improvement - A formal method of evaluating the quality of care rendered by a
provider and is used to promote and maintain an efficient and effective service
delivery system. Performance improvement includes the use of a quality
assurance process to ensure that problems, when they occur are corrected
appropriately and in a timely manner.
(113)
Pharmacotherapy - Any treatment of
persons served with medications, including methadone or opiate replacement
therapies.
(114)
Physical Restraint
- The direct application of physical force to a client without the client's
permission to restrict his or her freedom of movement.
(115)
Placement Assessment - An interview
with the person served to collect information related to his/her history and
needs, preferences, strengths and abilities in order to determine the
diagnosis, appropriate services and/or referral. (Modified CARF)
(116)
Prevention - Social, economic, legal,
medical and/or psychological measures aimed at minimizing the use of
potentially addicting substances, lowering the dependence risk in susceptible
individuals, or minimizing other adverse consequences of psychoactive substance
use. Primary prevention consists of attempts to reduce the incidence of
addictive diseases and related problems in a general population. Secondary
prevention aims to achieve early detection, diagnosis and treatment of affected
individuals. Tertiary prevention seeks to diminish the incidence of
complications of addictive diseases.
(117)
Program - A generalized term for an
organized system of services designed to address the treatment needs of
patients.
(118)
Progress Note -
Written entries made by clinical staff in the client record that document
progress or lack thereof toward meeting treatment plan objectives, and which
generally address the provision of services, the client's response to those
services, and significant events. Progress notes also include documentation of
those events and activities related to the client's treatment.
(119)
Psychiatric Seclusion - The involuntary
confinement of a client alone in a room, from which the client is prevented
from leaving for a prescribed period of time in order to control or limit
his/her dangerous behavior.
(120)
Psychoeducation - Individualized instruction and training of the persons served
to increase their knowledge and understanding of their psychiatric diagnoses,
prognoses, treatment and rehabilitation in order to enhance their acceptance of
these psychiatric disabilities, increase their cooperation and collaboration
with treatment and rehabilitation, improve their coping skills, and favorably
affect their outcomes. Such education should be consistent with the individual
plans and be provided with the knowledge and support of the interdisciplinary
teams. (CARF)
(121)
Qualified Case
Manager - An individual that possesses a Bachelor of Science degree in a
behavioral health field or in nursing and have successfully completed training
in a case management curriculum approved by DMH to provide case management
services to the identified population being served.
(122)
Qualified Interpreter:
(a)
Spoken Language Interpreters must be able
to interpret expressively and receptively using specialized vocabularies
between two persons speaking two languages.
(b)
Sign Language Interpreters must meet the
expectations of the Spoken Language Interpreter plus be eligible to work in
Alabama as specified in Section 34, Chapter 16 of the Code of Alabama, i.e.
they must obtain Interpreter licensure.
(123)
Qualified Person - Any person qualified
under applicable law or professional requirement where they exist to perform
any function authorized under these rules. Where professional qualifications
are not imposed under other law, these rules may permit persons to act as
specifically authorized.
(124)
Qualified Physician - Is a Psychiatrist or a licensed physician who has been
granted privileges to order seclusion or restraint.
(125)
Qualified Registered Nurse - Is one who
has successfully completed a DMH approved psychiatric management course and who
as at least one (1) year psychiatric nursing experience. A Registered Nurse who
has been granted privileges to implement seclusion or restraint.
(126)
Qualified Substance Abuse Professional
I (QSAP I) - An individual licensed in the State of Alabama as a Professional
Counselor, Certified Social Worker, Psychiatric Clinical Nurse Specialist,
Psychiatric Nurse Practitioner, Marriage and Family Therapist, Clinical
Psychologist, Physician's Assistant, Physician and meets the other
qualifications as specified in the standards themselves.
(127)
Qualified Substance Abuse Professional
II (QSAP II) - An individual who holds a master's or bachelor's degree from an
accredited college or university in Psychology, Social Work, Community
Rehabilitation, Pastoral Counseling, Family Therapy, or other behavioral health
areas that requires equivalent clinical course work and who meets the other
qualifications as specified in the standards themselves.
(128)
Qualified Substance Abuse Professional
III (QSAP III) - An individual who has a bachelor's degree from an accredited
college or university in Psychology, Social Work, Community Rehabilitation,
Pastoral Counseling, Family Therapy, or other behavioral health area that
requires equivalent clinical course work and; who has a minimum of two (2)
years full-time paid employment experience providing direct treatment or care
for individuals who have substance-related disorders, under the supervision of
a QSAP I, and holds a substance abuse counselor certification.
(129)
Readiness to Change - An individual's
emotional and cognitive awareness of the need to change, coupled with a
commitment to change. When applied to addiction treatment it describes the
patient's degree of awareness of the relationship between his/her alcohol or
other drug use or mental health problems and the adverse consequences of such
use, as well as the presence of specific readiness to change personal patterns
of alcohol and other drug use.
(130)
Recovery Support Services - A range of
non-clinical services provided to facilitate the process of recovery from
substance use disorders and to promote wellness. These services may be provided
prior to, during and after treatment for individuals and their families who
have been assessed as having a need for such.
(131)
Referral - The establishment of a link
between a client and another service by providing client authorized
documentation to the other service of the client's need and recommendations for
treatment services, and includes follow-up within a given time span as to the
disposition of the recommendations.
(132)
Relapse - Recurrence of psychoactive
substance-dependent behavior in an individual who has previously achieved and
maintained abstinence for a significant period of time beyond
withdrawal.
(133)
Relapse
Prevention - Services designed to support the recovery of the individual and to
prevent the recurrence of substance abuse.
(134)
Resident - A patient in one of the
clinically managed, residential levels of care.
(135)
Residential Detoxification -
Detoxification that is medically monitored and requires admission to a
Clinically Managed or Medically Monitored Detoxification Program.
(136)
Restraint:
(a)
Any manual method used or physical or
mechanical device, material, or equipment attached or adjacent to a client's
body that he or she cannot easily remove or that restricts freedom of movement
or normal access to one's body.
(b)
A drug used to control a client's behavior when that drug is not a standard
treatment for the client's condition.
(c)
The use of physical, mechanical,
chemical, or other means to temporarily subdue an individual or otherwise limit
a person's freedom of movement. (CARF)
(137)
Seclusion - The use of a secure,
private room designed to isolate a client who has been determined by a
physician to pose an immediate threat of physical harm to self or others.
Seclusion refers to the placement of a client alone in any room from which the
client is physically prevented from leaving.
(138)
Screening - A process involving a brief
review of a person's presenting problem to determine the person's
appropriateness and eligibility for substance abuse services and the possible
level of services require.
(139)
Sentinel Event - Is an unexpected occurrence involving a child/adolescent
receiving treatment for a psychological or psychiatric illness that results in
serious physical injury, psychological injury, or death (or risk thereof).
Serious Incident/Critical Incident - The occurrence or set of
events inconsistent with the routine operation of an approved treatment
facility, or the routine care of a client. Serious incidents, sometimes
referred to as critical incidents, include but are not necessarily limited to
the following:
(a)
Adverse drug
events.
(b)
Self destructive
behavior.
(c)
Deaths and injuries
(including automobile accidents) to the client, client family, staff, and
visitors.
(d)
Medication
errors.
(e)
Neglect or abuse of a
client.
(f)
Fire.
(g)
Unauthorized disclosure of
information.
(h)
Damage to or theft
of property belonging to a client or an approved treatment facility.
(i)
Other unexpected occurrences.
(j)
Or events potentially subject to
litigation.
A serious incident may involve multiple individuals or
results.
(141)
Service Plan - A written plan of services, developed by the clinician in
conjunction with the client, that addresses the individualized needs of the
client through devising plans for services that offer reasonable promise of
success and are consistent with the abilities and circumstances of the client.
The Service Plan is reviewed regularly by the clinician and client to assess
its continued viability and effectiveness while respecting the client's input
and freedom of choice.
(142)
Setting - A specific place in which treatment is delivered. Settings for
alcohol/other drug treatment include hospitals, methadone clinics, community
mental health centers and prisons or jails.
(143)
Severity of Illness - Specific signs
and symptoms for which a patient requires treatment, including the degree of
impairment and the extent of a patient's support networks.
(144)
Short-term Detoxification Treatment
-Detoxification treatment for a period not in excess of thirty (30)
days.
(145)
Sign Language
Interpreter - The provision of sign language or interpreter services for
clients enrolled in a specified level of care by appropriately credentialed
professionals.
(146)
Smoking
Cessation - A structured face-to-face encounter provided by trained personnel
to assist individuals enrolled in a specific level of care in efforts to stop
smoking.
(147)
Staffing/Case Review
- A regularly scheduled review of client's treatment goals which involve the
client's primary clinical staff person and other persons involved in the
implementation of the treatment plan.
(148)
Staff Member - A person who is directly
employed by an organization on either a full- or part-time basis.
(CARF)
(149)
Stages of Change -
This refers principally to the work of Prochaska and DiClemente, who described
how individuals progress and regress through various levels of awareness of a
problem, as well as the degree of activity involved in behavior. While their
original work studied individuals who changed from smokers to non-smokers, the
concept of stages of change subsequently has been applied to a variety of
behaviors.
(150)
Standards -
Specifications representing the minimal characteristics of an alcohol and other
drug abuse treatment program, which are acceptable for the licensing of a
program.
(151)
State Opioid
Treatment Authority - The Director, or designee, of the State of Alabama DMH
Substance Abuse Division's Treatment Services or its successor.
(152)
Substance Abuse - Harmful use of a
specific psychoactive substance. The term also applies to one category of
psychoactive substance-related disorders. While recognizing that "abuse" is
part of present diagnostic terminology, ASAM recommends that an alternative
term be found for this purpose because of the pejorative connotations of the
word "abuse".
(153)
Substance Abuse
Service Provider - Any entity or person. A public agency, a private for-profit
or not-for-profit agency, a person who is in private practice and a hospital
either licensed or exempt from licensure that has obtained certification
through DMH/SASD to provide substance abuse services at any of the SASD
approved levels of care.
(154)
Substance Dependence - Marked by a cluster of cognitive, behavioral and
psychological symptoms indicating that the individual continues to use alcohol
or other drugs despite significant related problems. The cluster of symptoms
can include tolerance, withdrawal or use of a substance in larger amounts or
over a longer period of time than intended; persistent desire or unsuccessful
efforts to cut down or control substance use; a great deal of time spent in
activities related to obtaining or using substances or to recover from their
effects; relinquishing important social, occupational or recreational
activities because of substance use; and continuing alcohol or drug use despite
knowledge of having a persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by such use.
(155)
Substance Use Disorders - Include
Substance Dependence and Substance Abuse, according to the specific diagnostic
criteria given in DSM IV. Substance Use Disorders are one of two subgroups
('substance dependence' and 'substance abuse') of the broader diagnostic
category of Substance-Related Disorders. In the ASAM PPC-2R, the specific
subgroup or disorder is used in the diagnostic criteria for admission to
certain levels of care.
(156)
Supportive Counseling - Not considered therapy but is provided to clients, or
victims, to help them discuss feelings relating to domestic violence, sexual
assault or abuse, and other issues that maybe negatively affecting their
well-being. It is used to help them identify their strengths and to re-develop
feelings of self-worth. The client's spouse, parents, or other family members
may also receive supportive counseling which provides them with an outlet to
verbalize their feelings and to develop viable plans for action.
(157)
Support Services - Those readily
available to the program through affiliation, contract or because of their
availability to the community at large (example: 911). They are used to provide
services beyond the capacity of the staff of the program and which will not be
needed by patients on a routine basis or to augment the services provided by
staff.
(158)
The Levels of Care:
(a)
Level 0.5: Early Intervention: A service
for a group of individuals who, for a known reason, are at risk of developing
substance-related problems, or for those for whom there is not yet sufficient
information to document a substance use disorder. (ASAM PPC-2R).
(b)
Level I: Outpatient Treatment: Organized
services that may be delivered in a variety of settings. Includes
professionally directed services provided by addiction or mental health
personnel that include evaluation, treatment and recovery services. These
services are provided in regularly scheduled sessions and follow a defined set
of policies and procedures or medical protocols. (ASAM PPC-2R)
(c)
Level II: Intensive Outpatient
Treatment/Partial Hospitalization: An organized outpatient service that
delivers treatment services during the day, before or after work or school, in
the evenings, or on the weekends. Includes programs that essentially provide
education and treatment components while allowing clients to apply their newly
acquired skills within "real world" environments. These programs have the
capacity to arrange for medical and psychiatric consultation,
psychopharmacological consultation, medication management and 24-hour crisis
services. (ASAM PPC-2R)
(d)
Level
III: Residential/Inpatient Treatment: Encompasses organized services provided
by addiction and mental health personnel who provide a planned regimen of care
in a twenty-four (24) hour live-in setting. Such services adhere to defined
policies and procedures. They are located in permanent facilities where clients
reside safely. They are staffed for twenty-four (24) hour coverage and
self-help groups are available on-site. There are five types of programs
located at this level:
1.
Level III.01:
Transitional Residential Program
2.
Level III.1: Clinically Managed Low Intensity Residential Treatment
3.
Level III.3: Clinically Managed Medium
Intensity Residential Treatment
4.
Level III.5: Clinically Managed High Intensity Residential Treatment
5.
Level III.7: Medically Monitored Inpatient
Treatment (ASAM PPC-2R)
(e)
Level IV: Medically Managed Intensive
Inpatient Treatment: These programs provide a planned regimen of twenty-four
(24) hour medically directed evaluation, care and treatment of mental and
substance-related disorders in an acute care inpatient setting. They are
staffed by addiction-credentialed physicians, psychiatrists and clinicians.
Services at this level are delivered under a defined set of policies and
procedures and have permanent facilities that include inpatient beds. Level
four programs provide care to clients whose mental and substance-related
problems are so severe that they require primary biomedical, psychiatric and
nursing care. Treatment is provided twenty-four (24) hours a day and the full
resources of a general acute care hospital or psychiatric hospital are
available. Treatment is specific to SA or MI disorders but the skills of the
interdisciplinary team and the availability of support services allow the
conjoint treatment of any co-occurring biomedical condition that needs to be
addressed. (ASAM PPC-2R)
(159)
Timeout - The restriction of a client
for a period of time to a designated area from which the client is not
physically prevented from leaving for the purpose of providing the client an
opportunity to regain self-control.
(160)
Tolerance - A stage of adaptation in
which exposure to a drug induces changes that result in diminution of one or
more of the drug's effects over time.
(161)
Transfer - Movement of the client from
one level of service to another, within the continuum of care. The change may
take place at the same location or by physically moving the client to a
different site for the new level of care.
(162)
Transfer Summary - A written
justification of the circumstances of the transfer of a client from one
component to another or from one provider to another.
(163)
Transitional Hold - A brief physical
restraint of an individual that may be face-down for the purpose of quickly and
effectively gaining physical control of that individual, or prior to transport
to enable the individual to be transported safely.
(164)
Transitional Residential Treatment -
Services directed by persons who specialize in addictions treatment. They are
appropriate for persons whose primary problems involve emotional, behavioral or
cognitive concerns, readiness to change, relapse potential and recovery
environment dictates that these issues can be addressed through arrangements
for clinical/medical services with the appropriate living situation.
(165)
Transportation - Agency provided
non-emergency services utilized to transport a client to and from treatment or
care, and to and from community-based organizations and activities during the
course of treatment or care, as identified in the individual's service
plan.
(166)
Treatment - The
application of professional planned, merged, administered, and/or monitored
evidenced-based/best practices and procedures to identify, stabilize, minimize,
or alleviate the harmful consequences of substance related disorders and to
restore impaired health and functionality relative to the disorders.
(167)
Treatment Program - Any program that
delivers alcohol and/other drug abuse treatment services to a defined client
population.
(168)
Treatment Staff -
The group of personnel of the alcohol and other drug abuse treatment program,
which is directly involved in client care or treatment.
(169)
Waiver - The voluntary relinquishment
or surrender of some known right or privilege. Waivers are given in writing,
listing clearly and unambiguously the full knowledge of what is being waived.
They are developed specifically for a particular right, duty, or privilege and
cannot be used or applied to other essential functions of a job or activity.
All waivers are signed by the appropriate authority.
(170)
Youth - A person between six (6) and
eighteen years (18) of age. (CARF)
(171)
Meaning of the verbs in the Standards:
Attention is drawn to the use of the words "shall", "should", and "may" in the
SASD Standards:
(a)
"Shall" is the term used
to indicate a mandatory statement, the only acceptable method under these
present standards.
(b)
"Should" is
the term used to reflect the most preferable procedure, yet allowing for the
use of effective alternatives.
(c)
"May" is the term used to reflect an acceptable method that is recognized but
not necessarily preferred.
Notes
Ala. Admin. Code
r.
580-9-44-.01
New: Filed: July 22, 1992.
Extended: September 30, 1992. Extended: December 31, 1992. Certified: March 30,
1993. Effective May 5, 1993. Repealed and New Rule: Filed November 19, 2003;
effective December 24, 2003. Repealed and New Rule: Filed January 26, 2012;
effective March 1, 2012.
Author:
Substance Abuse Services Division
Statutory Authority:
Code of Ala.
1975
, §
22-50-11
.
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