Ala. Admin. Code r. 580-9-44-.20

Level III.01: Transitional Residential Program

This regulation establishes operating standards for Level III.01 Transitional Residential Programs under Alabama's Department of Mental Health, which provide 24-hour structured residential support for individuals with substance use disorders who are reintegrating into the community after more intensive treatment. Operators must develop written program descriptions, admission criteria based on ASAM dimensions, and document core services including case management, psychoeducation, peer support, and relapse prevention. Staffing, training, documentation, and service availability requirements are also specified.

Ala. Admin. Code r. 580-9-44-.20 - Level III.01: Transitional Residential Program 

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(1)
 Rule Compliance. Each Level III.01
 Transitional Residential Program shall comply with the following rules and the
 rules specified in this chapter.
(a)
 Program
 Description. The entity shall develop, maintain, and implement a written
 program description that defines the Level III.01 Transitional Residential
 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 the Level III.01
 Transitional Residential Program shall be provided. Services shall be provided
 in any facility that meets all applicable federal, state and local
 certification, licensure, building, life-safety, fire, health and zoning
 regulations including the DMH facility certification standards.

2.
 Admission Criteria: The entity shall
 develop, maintain and document implementation of written criteria for admission
 to its Level III.01 Transitional Residential 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 its Level
 III.01 Services, which shall include, at a minimum:
 
(I)
 Individuals whose assessed severity of
 illness warrants this level of care.

(II)
 Individuals who have a need for support
 in a twenty-four (24) hour drug-free environment in order to reintegrate into
 the community after treatment in a more intense level of
 care.

(ii)
 The entity
 shall provide written documentation in individual case records that each client
 admitted to a Level III.01 Program meets the following diagnostic and modified
 ASAM PPC2R dimensional criteria for this level of care: 
 
(I)
 The client shall meet the criteria for a
 substance use disorder, as according to the specific diagnostic criteria given
 in the most recent edition of the Diagnostic and Statistical Manual of Mental
 Disorders of the American Psychiatric Association.

(II)
 Acute Intoxication and/or Withdrawal: 
 
I.
 The client shall not report experiencing
 or display any signs or symptoms of alcohol or other drug
 withdrawal.

(III)

 Biomedical Conditions and Complications:
I.

 The client's biomedical problems, if any, shall be stable, and shall not
 require medical or nurse monitoring by the transitional program.

II.
 The client shall be capable of
 self-administering any prescribed or required over the counter
 medication.

(IV)

 Emotional, Behavioral, or Cognitive Conditions and Complications: 
 
I.
 The client shall not report or display
 symptoms of a co-occurring psychiatric, emotional, behavioral, or behavioral
 condition; or

II.
 The client's
 co-occurring psychiatric, emotional, behavioral, or cognitive disorder shall
 be:
A.
 Stable.

B.
 Self-manageable.

C.
 Addressed concurrently through appropriate
 psychiatric services.

III.
 The client shall be assessed as not
 posing a risk of harm to self or others.

(V)
 Readiness to Change: 
 
I.
 The client shall acknowledge the existence
 of a substance use disorder, or a co-occurring substance use and psychiatric,
 emotional, behavioral, or cognitive disorder and expresses and demonstrates a
 desire to make needed changes to support recovery.

(VI)
 Relapse, Continued Use, or Continued
 Problem Potential:
I.
 The client's history
 indicates a high risk of relapse in a less structured level of care;
 or

II.
 The client needs regimented
 support to maintain engagement in a recovery focused process on community
 reintegration.

(VII)

 Recovery Environment:
I.
 The client has
 insufficient resources and skills to maintain a recovery-oriented lifestyle
 outside of a twenty-four (24) hour supportive
 environment.

3.
 Core Services: Each Level III.01
 Transitional Residential Program shall demonstrate the capacity to provide a
 basic level of treatment services appropriate to the needs of its clientele. 
 
(i)
 At a minimum, the entity shall
 demonstrate and document its capacity to provide a twenty-four (24) hour
 structured residential treatment environment with the following core services: 
 
(I)
 Placement assessment.

(II)
 Psychoeducation.

(III)
 Peer support.

(IV)
 Daily living skills.

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

(VI)

 Transportation.

(VII)
 Case
 Management:
I.
 Case planning.

II.
 Linkage.

III.
 Advocacy.

IV.

 Monitoring.

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 III.01
 Transitional Residential Program shall include, at a minimum: 
 
(I)
 Maintenance of an alcohol and illicit
 drug free environment.

(II)

 Implementation of individualized service plan strategies.

(III)
 On duty, awake staff shall provide
 supervision of client's health, welfare and safety twenty-four (24) hours a
 day.

(IV)
 All clients enrolled in
 Level III.01 Programs shall have access to clinical services twenty-four (24)
 hours a day, seven (7) days a week.

(V)
 The entity shall document the provision
 of planned recovery support services and activities that shall, at a minimum,
 include:
I.
 Motivational strategies.

II.
 Relapse prevention counseling.

III.
 Interpersonal choices/decision making
 skills development.

IV.
 Development
 of a social network supportive of recovery.

V.
 Daily living and recovery skills
 development.

VI.
 Random drug
 screening.

VII.
 Health
 education.

5.
 Documentation. Individualized progress
 notes shall be recorded each day for each respective service provided in Level
 III.01 Services.

6.
 Support
 Systems. Each level III.01 Transitional Residential Program shall develop,
 maintain and document implementation of written policies and procedures that
 govern the process used to provide client access to support services at the
 Level III.01 Program site, or through consultation or referral, which shall
 minimally include:
(i)
 Telephone or in person
 consultation with emergency services twenty-four (24) hours a day, seven (7)
 days a week.

(ii)
 Telephone or in
 person consultation with a Registered Nurse twenty-four (24) hours a day, seven
 (7) days a week.

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

(iv)
 Direct
 affiliation with or coordination through referral to supportive services,
 including vocational rehabilitation, literacy training and adult
 education.

(v)
 Mutual self-help
 groups which are tailored to the needs of the specific client
 population.

7.
 Program
 Personnel. Each Level III.01 Transitional Residential 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 have the qualifications as a qualified paraprofessional to
 provide the specific services delineated in the entity's program description
 for this level of care.

(iii)

 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 III.01 Transitional Residential Program shall be assigned to a specific
 primary counselor for care management.

8.
 Training. The entity shall provide written
 documentation that all Level III.01 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 III.01 Services are established
 on the basis of the unique needs of each client served.

10.
 Length of Service. The entity shall
 provide written documentation that the duration of treatment in its Level
 III.01 Program is variable 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 meet
 treatment goals and strategies; 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 a Level III.01 Transitional Residential Program
 has been utilized as an interim level of care.

11.
 Service Availability: The entity shall
 provide written documentation describing the process utilized to establish
 hours of availability for screening, assessment and intake services, admission
 and counseling services at its Level III.01 Transitional Residential 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-.20

 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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