Ala. Admin. Code r. 580-9-44-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 580-9-44-.01 - Definitions

(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.

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.