Ala. Admin. Code r. 580-9-44-.15

Level I: Outpatient Treatment

This rule establishes operating standards for Level I Outpatient Treatment programs licensed by the Alabama Department of Mental Health under its substance use disorder continuum. Operators must develop written operational plans, apply ASAM-based admission criteria, provide specified core services (counseling, case management, medication management, etc.), and maintain appropriate staffing ratios and training. The rule includes program-specific requirements for adolescent, co-occurring disorders, and women-with-dependent-children populations.

Ala. Admin. Code r. 580-9-44-.15 - Level I: Outpatient Treatment 

 State Regulations 

 Compare

(1)
 Rule Compliance. Each Level I Outpatient
 Program shall comply with the following rules and the rules specified in this
 chapter. 
(a)
 Program Description. The entity
 shall develop, maintain and document implementation of a written operational
 plan that defines its Level I Outpatient Program. The program description shall
 comply with all of the requirements specified in
 
580-9-44-.13
. 
 
1.
 Location. The entity shall specifically
 identify and describe the setting in which Level I Outpatient Services shall be
 provided. Services may be provided in any appropriate setting that protects the
 client's right to privacy, confidentiality and safety, including but not
 limited to, traditional clinical offices and behavioral health sites,
 residences, schools, shelters, work sites, community centers and other
 locations as pre-authorized by DMH.

2.
 Admission Criteria: The entity shall
 develop, maintain and implement written criteria for admission to its Level I
 Outpatient Program in compliance with the requirements of
 
580-9-44-.13
(9)
 
 and the following specifications:
(i)
 The
 entity's admission criteria shall specify the target population for the Level I
 Program, which shall include, at a minimum, individuals whose assessed severity
 of illness initially warrants this level of care, including but not limited to:
 
(I)
 Whose progress in a more intensive level
 of care warrants a step-down to a less intensive level of care.

(II)
 Who are in the early stages of change
 and who are not yet ready to commit to full recovery.

(III)
 Who are experiencing increased
 conflict, demonstrating passive compliance or considering leaving
 treatment.

(ii)
 The
 entity shall provide written documentation in individual case records that each
 client admitted to receive Level I Outpatient Services meets: 
 
(I)
 The diagnostic criteria for a substance
 use disorder as defined in the most recent edition of the Diagnostic and
 Statistical Manual for Mental Disorders.

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(iii)
 Adolescent
 Program Specific Criteria: The entity shall provide written documentation in
 individual case records that each adolescent admitted to receive Level I
 Outpatient Services meets:
(I)
 The diagnostic
 criteria for a substance use disorder as defined in the most recent edition of
 the Diagnostic and Statistical Manual for Mental Disorders.

(II)
 The adolescent dimensional criteria for
 admission to this level of care as defined in the most recent edition of the
 ASAM PPC-2R.

(iv)

 Co-occurring Disorders Program Specific Criteria: 
 
The entity shall provide written documentation in individual
 case records that each client admitted to receive Level I Outpatient Services
 in a Co-occurring Enhanced Treatment Program meets:

(I)
 The diagnostic criteria for a substance
 use and mental illness disorder as defined in the most recent edition of the
 Diagnostic and Statistical Manual for Mental Disorders.

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(v)
 Women and
 Dependent Children Program Specific Criteria: The entity shall provide written
 documentation in individual case records that each client admitted to receive
 Level I Outpatient Services in a Women and Children Program: 
 
(I)
 Meets the diagnostic criteria for a
 substance use disorder as defined in the most recent edition Diagnostic and
 Statistical Manual for Mental Disorders.

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(III)
 Is pregnant;
 or

(IV)
 Has care and custody of
 dependent children; or

(V)
 Has lost
 custody of dependent children and has the potential for family
 reunification.

3.
 Core Services. Each Level I Outpatient
 Program shall demonstrate the capacity to provide a basic level of skilled
 treatment services appropriate to the needs of its clientele. 
 
(i)
 At a minimum, the entity shall directly
 or by referral provide the following core services: 
 
(I)
 Behavioral Health Screening.

(II)
 Individual counseling.

(III)
 Group counseling.

(IV)
 Family counseling.

(V)
 Psychoeducation.

(VI)
 Mental health consultation.

(VII)
 Recovery support services.

(VIII)
 Peer counseling services.

(IX)
 Medication management.

(X)
 Alcohol and/or drug
 screening/testing.

(XI)
 Smoking
 cessation.

(XII)
 Sign language
 interpreter services.

(XIII)
 HIV
 early intervention services.

(XIV)

 Case management:
I.
 Case planning.

II.
 Linkage.

III.
 Advocacy.

IV.
 Monitoring.

(ii)
 Adolescent Program Specific Criteria:
 Each Level I Adolescent Outpatient Program shall document the capacity to
 provide each of the core services and to include activity therapy. 
 
(I)
 Activity therapy.

(iii)
 Co-occurring Disorders Program Specific
 Criteria: Each level I Co-occurring Disorders Outpatient Program shall document
 the capacity to provide each of the core services to include basic living
 skills, crisis intervention services, and intensive case management.

(iv)
 Women and Dependent Children Program
 Specific Criteria: Each Level I Women and Dependent Children Outpatient Program
 shall document the capacity to provide each of the core services and/or arrange
 for the following services: 
(I)

 Transportation.

(II)
 Child sitting
 services.

(III)
 Developmental delay
 and prevention services.

(IV)

 Activity therapy.

(V)
 Parenting
 skills development.

4.
 Therapeutic Component Implementation. The
 entity shall document implementation of regularly scheduled treatment sessions
 that are provided in an amount, frequency and intensity appropriate to the
 client's assessed needs and expressed desires for care. 
 
(i)
 Service strategies for each Level I
 Outpatient Program shall include, at a minimum: 
 
(I)
 Implementation of individualized
 counseling plan strategies.

(II)

 Ongoing individualized assessment services.

(III)
 Motivational enhancement and engagement
 strategies.

(IV)
 Relapse prevention
 strategies.

(V)
 Interpersonal
 choice/decision-making skill development.

(VI)
 Health education.

(VII)
 Random drug screening.

(VIII)
 Family education.

(IX)
 Gender responsive
 treatment.

(ii)

 Adolescent Program Specific Criteria: Each Level I Adolescent Outpatient
 Program shall document the capacity to provide the service strategies and the
 following therapeutic components: 
(I)

 Adolescent specific evidence based therapeutic interventions.

(II)
 Client education on key adolescent
 development issues, including but not limited to, adolescent brain development
 and the impact of substance use, emotional and social influence on behavior,
 value system development, puberty/physical development, sexuality and
 self-esteem.

(III)
 Recreation and
 leisure time skills training.

(IV)

 Family, community and school reintegration services.

(iii)
 Co-occurring Disorders Program Specific
 Criteria: Each Level I Co-occurring Disorders Outpatient Program shall document
 the capacity to provide the service strategies and the following therapeutic
 components:
(I)
 Groups and classes that
 address the signs and symptoms of mental health and substance use
 disorders.

(II)
 Groups, classes,
 and training to assist clients in becoming aware of cues or triggers that
 enhance the likelihood of alcohol and drug use or psychiatric decompensation
 and to aid in development of alternative coping responses to those
 cues.

(III)
 Dual recovery groups
 that provide a forum for discussion of the interactions of and interrelations
 between substance use and mental health disorders.

(iv)
 Women and Dependent Children Program
 Specific Criteria: Each Level I Women and Dependent Children Outpatient Program
 shall document the capacity to provide the service strategies and the following
 therapeutic components:
(I)
 Specific services
 which address issues of relationships, parenting, abuse, and trauma.

(II)
 Primary medical care, including prenatal
 care.

(III)
 Primary pediatric care
 for children.

(IV)
 Therapeutic
 interventions for children which address their developmental needs and issues
 of sexual abuse and neglect.

(V)

 Outreach to inform pregnant women of the services and priorities.

(VI)
 Interim services while awaiting
 admission to this level of care.

(VII)
 Recreation and leisure time skills
 training.

5.

 Documentation: An individual progress note shall be recorded for each
 respective service provided in Level I.

6.
 Support Systems. Each Level I Outpatient
 Program shall develop, maintain and document implementation of written policies
 and procedures which govern the process used to provide client access to
 support services on site, or through consultation or referral, which shall
 minimally include:
(i)
 Medical, psychiatric,
 psychological, laboratory and toxicology services.

(ii)
 Medical and psychiatric consultation
 shall be available within twenty-four (24) hours by telephone or if in person,
 within a timeframe appropriate to the severity and urgency of the consultation
 requested.

(iii)
 Direct affiliation
 with or coordination through referral to more intensive levels of care and
 medication management.

(iv)

 Emergency services shall be available by telephone twenty-four (24) hours a
 day, seven (7) days a week.

(v)

 Mutual self-help groups that are tailored to the needs of the specific client
 population.

(vi)
 Referral for other
 services as according to the client's assessed needs.

7.
 Program Personnel. Each level I Outpatient
 Program shall employ an adequate number of qualified individuals to provide
 personalized care for its clientele and to meet the program's goals and
 objectives.
(i)
 Clinical Personnel. The entity
 shall maintain an adequate number of clinical personnel to sustain the Level I
 Outpatient program as delineated in its operational plan.

(ii)
 Administrative Support Personnel. The
 entity shall maintain an adequate number of support personnel to sustain the
 program's administrative functions.

(iii)
 Every client in a Level I program shall
 be assigned to a specific Primary Counselor for care management.

(iv)
 Each primary counselor shall maintain a
 case load not to exceed forty (40) clients with active cases at any one
 time.

(v)
 Adolescent Program
 Specific Criteria Adolescent Program Specific Criteria: 
 
(I)
 Clinical Personnel. The entity shall
 maintain an adequate number of clinical personnel to sustain the Level I
 Adolescent Outpatient program as delineated in its operational plan.

(II)
 Administrative Support Personnel. The
 entity shall maintain an adequate number of support personnel to sustain the
 program's administrative functions.

(III)
 Every client in a Level I adolescent
 program shall be assigned to a specific Primary Counselor for care
 management.

(IV)
 Each primary
 counselor shall maintain a case load not to exceed thirty (30) clients with
 active cases at any one time.

(vi)
 Co-occurring Disorders Program Specific
 Criteria:
(I)
 The Level I Co-occurring
 Enhanced Outpatient Program shall have access to psychiatric services (led by a
 qualified psychiatrist or nurse practitioner) that are fully capable of
 evaluating, diagnosing, and prescribing medications to clients with
 co-occurring disorders. On-call psychiatric services shall be available
 twenty-four (24) hours a day, seven (7) days a week.

(II)
 Treatment staff that provide therapy and
 ongoing clinical assessment services to individuals diagnosed with co-occurring
 disorders.

(III)
 Every client in a
 Level I Enhanced Co-occurring Outpatient Program shall be assigned to a
 specific Primary Counselor for care management.

(IV)
 Each primary counselor shall maintain a
 case load not to exceed thirty (30) clients with active cases at any one
 time.

(vii)
 Women and
 Dependent Children Program Specific Criteria: 
 
(I)
 Direct Care Personnel. All direct care
 personnel shall be a qualified paraprofessional to provide the specific
 services delineated in the entity's operational plan for this level of
 care.

(II)
 Clinical Personnel. The
 entity shall maintain an adequate number of clinical personnel to sustain the
 Level I Women and Dependent Children Outpatient Program as delineated in its
 operational plan.

(III)

 Administrative Support Personnel. The entity shall maintain an adequate number
 of support personnel to sustain the program's administrative
 functions.

(IV)
 Every client in a
 Level I Women and Dependent Children Program shall be assigned to a specific
 primary counselor for care management.

(V)
 Each primary counselor shall maintain a
 case load not to exceed thirty (30) clients with active cases at any one
 time.

8.

 Training. The entity shall provide written documentation that all Level I
 Program personnel satisfy the competency and training requirements as specified
 in Rule 
580-9-44-.02
(3)
.

9.
 Service Intensity. The entity shall
 document that the amount and frequency of Level I Outpatient services are
 established on the basis of the unique needs of each client served, not to
 exceed eight (8) contact hours weekly.

10.
 Length of Service. The entity shall
 provide written documentation that the duration of treatment in each Level I
 Outpatient Program shall vary as determined by: 
 
(i)
 The severity of the client's
 illness.

(ii)
 The client's ability
 to comprehend the information provided and use that information to implement
 treatment strategies and attain treatment goals; or

(iii)
 The appearance of new problems that
 require another level of care; or

(iv)
 The availability of services at an
 assessed level of need when Level I services have been utilized as interim
 services.

11.
 Service
 Availability: The entity shall provide written documentation describing the
 process utilized to establish the hours of service availability for its Level I
 Outpatient Programs. At a minimum, this process shall: 
 
(i)
 Include consideration of the needs of the
 target population, including work, school and parenting
 responsibilities.

(ii)
 Include
 consideration of transportation accessibility.

(iii)
 Not be based solely on standard eight
 (8) to five (5), Monday through Friday office
 hours.

Notes

Ala. Admin. Code
 r. 
580-9-44-.15

New Rule: Filed January 26,
 2012; effective March 1, 2012.

Amended by
 
Alabama
 Administrative Monthly Volume XLI, Issue No. 04, January 31,
 2023
, eff. 
3/17/2023
.

Author:
 Substance Abuse Services Division

Statutory Authority:

Code of Ala.
 1975
, §
 
22-50-11
.

State regulations are updated quarterly; we currently have two versions available.
 Below is a 
comparison between our most recent version and the prior quarterly release.

 More comparison features will be added as we have more versions to compare.

 No prior version found.

 State Regulations Toolbox