Ala. Admin. Code r. 580-9-44-.18

Level II.5: Partial Hospitalization Treatment Program

This regulation establishes operating standards for Level II.5 Substance Use Partial Hospitalization Programs (ASAM 2.5) certified by the Alabama Department of Mental Health. Operators must develop written program descriptions, admission criteria, core service arrays, staffing plans, and documentation requirements for each client. Specific sub-program tracks are addressed for adolescents, individuals with co-occurring disorders, and women with dependent children. Services must be available a minimum of 20 hours per week, with 24/7 emergency telephone access and medical/psychiatric consultation available within 24–48 hours.

Ala. Admin. Code r. 580-9-44-.18 - Level II.5: Partial Hospitalization Treatment Program 

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(1)
 Rule
 Compliance. Each Level II.5 Partial Hospitalization Program shall comply with
 the following rules and the rules specified in this chapter: (List applicable
 rules found throughout the standards)
(a)

 Program Description. The entity shall develop, maintain and implement a written
 program description that defines the Level II.5 Partial Hospitalization Program
 it provides, as according to Rule
 
580-9-44-.13
 and the following
 specifications: 
1.
 Location. The entity shall
 specifically identify and describe the setting in which Level II.5 Partial
 Hospitalization Services shall be provided. Services may be provided in any
 appropriate setting that protects the client's right to privacy,
 confidentiality, safety and meets DMH facility certification
 criteria.

2.
 Admission Criteria.
 The entity shall develop, maintain and implement written criteria for admission
 to its Level II.5 Partial Hospitalization Program, in compliance with the
 requirements of Rule
 
580-9-44-.13
(9)
,
 and the following specifications: 
(i)
 The
 entity's admission criteria shall specify the target population for the Level
 II.5 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)
 Individuals who have fairly
 unstable mental and/or physical health problems.

(II)
 Who have unstable or dysfunctional, but
 adequate living arrangements.

(ii)
 The entity shall provide written
 documentation in individual case records that each client admitted to receive
 Level II.5 Partial Hospitalization Services meets: 
 
(I)
 The diagnostic criteria for a substance
 dependence 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 II.5
 Partial Hospitalization 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 individual admitted to receive Level II.5 Partial
 Hospitalization Services in a Co-occurring Enhanced Treatment Program meets: 
 
(I)
 The diagnostic criteria for a substance
 dependence 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 II.5 Partial Hospitalization Services in a Women and Dependent Children
 Program meets: 
(I)
 The diagnostic criteria
 for a substance dependence 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)
 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 II.5 Partial
 Hospitalization 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 Level II.5 Partial
 Hospitalization Program shall provide the following core services: 
 
(I)
 Placement assessment.

(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 II. 5 Partial Hospitalization Program shall document the capacity to
 provide each of the core services to include the following services: 
 
(I)
 Activity therapy.

(II)
 Academic or vocational
 services.

(iii)

 Co-occurring Disorders Program Specific Criteria: Each Level II.5 Partial
 Hospitalization Program shall document the capacity to provide each of the core
 services to include the following services: 
 
(I)
 Basic living skills.

(II)
 Crisis intervention services.

(III)
 Activity therapy.

(IV)
 Intensive case
 management.

(iv)
 Women
 and Dependent Children Program Specific Criteria: Each Level II.5 Women and
 Dependent Children Partial Hospitalization 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 II.5 Partial Hospitalization 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)
 Medication
 administration and monitoring.

(VII)
 Family education.

(X)
 Gender responsive
 treatment.

(ii)

 Adolescent Program Specific Criteria: Each Level II. 5 Adolescent Partial
 Hospitalization Program shall document the capacity to provide the service
 strategies to include 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.

(V)
 Academic or vocational
 services

(iii)

 Co-occurring Disorders Program Specific Criteria: Each Level II.5 Co-occurring
 Enhanced Partial Hospitalization Program shall document the capacity to provide
 the service strategies to include 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)
 Intensive case
 management.

(iv)
 Women
 and Dependent Children Program Specific Criteria: Each Level II.5 Women and
 Dependent Children Partial Hospitalization Program shall document the capacity
 to provide the service strategies and/or arrange for 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.

(VIII)
 Academic and
 vocational services.

(IX)
 Financial
 resources and planning.

(X)
 Family
 planning services.

5.
 Documentation: For each day in attendance
 an individual progress note shall be recorded to reflect services provided in
 Level II.5 Partial Hospitalization.

6.
 Support Systems. Each Level II.5 Partial
 Hospitalization Program shall develop, maintain and document implementation of
 written policies and procedures that 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 forty-eight (48) hours.

(iii)
 Direct affiliation with, or
 coordination through referral to more and less intensive levels of care and
 supportive housing services.

(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 II.5 Partial
 Hospitalization 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)
 Direct
 Care Personnel. All direct care personnel shall be qualified as a qualified
 paraprofessional to provide the specific services delineated in the entity's
 operational procedures for this level of care.

(ii)
 Clinical Personnel. The entity shall
 maintain an adequate number of clinical personnel to sustain the Level II.5
 Partial Hospitalization Program as delineated in its operational
 procedures.

(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 II.5 Partial
 Hospitalization 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.

(vi)

 Adolescent Program Specific Criteria.
(I)

 Direct Care Personnel. All direct care personnel shall be qualified as 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 II.5
 Partial Hospitalization 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 II.5 Adolescent
 Partial Hospitalization 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.

(vii)
 Co-occurring Disorders Program Specific
 Criteria.
(I)
 The Level II.5 Co-occurring
 Enhanced Partial Hospitalization 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)
 The treatment organization/agency shall
 have access to an Alabama licensed physician, full time, part time, or on
 contract, who shall be available to the program for client care and shall
 assume liability for the medical aspects of the program.

(III)
 Treatment staff that provide therapy
 and ongoing clinical assessment services to individuals diagnosed with
 co-occurring disorders, shall have, at a minimum: 
 
I.
 A master's degree in a behavioral health
 related field with a minimum of two (2) years' work experience with individuals
 who have co-occurring disorders, mental health or substance use
 disorders.

II.
 Specialized training
 to work with individuals who have co-occurring disorders.

(V)
 All other direct care personnel in a
 Level II.5 Co-occurring Enhanced Partial Hospitalization Program shall be
 qualified, as a qualified paraprofessional to provide the specific services
 delineated in the entity's operational procedures for this level of
 care.

(VI)
 The entity shall
 maintain an adequate number of clinical personnel to sustain the Level II.5
 Co-occurring Enhanced Partial Hospitalization Program as delineated in its
 operational procedures.

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

(VIII)
 Every client in a Level II.5
 Co-occurring Enhanced Partial Hospitalization Program shall be assigned to a
 specific primary counselor for care management.

(IX)
 Each primary counselor shall maintain a
 case load not to exceed twenty (20) clients with active cases at any one
 time.

(viii)
 Women and
 Dependent Children Program Specific Criteria: 
 
(I)
 Direct Care Personnel. All direct care
 personnel shall be qualified, as 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 II.5 Women and Dependent Children Partial Hospitalization 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 II.5 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 twenty (20) clients
 with active cases at any one time.

8.
 Training. The entity shall provide written
 documentation that all Level II.5 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 II.5 Partial Hospitalization
 Services are established on the basis of the unique needs of each client served
 and shall be available a minimum of twenty (20) hours each week.

10.
 Length of Service: The entity shall
 provide written documentation that the duration of treatment in each Level II.5
 Partial Hospitalization 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.

(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 II.5 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
 II.5 Partial Hospitalization Program. 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-.18

 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
.

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