Ala. Admin. Code r. 660-5-52-.03

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

Section 660-5-52-.03 - Referral And Admission

(1) The ISP team shall be fully involved when assessing the need for, and appropriateness of, inpatient services even though child welfare staff and supervisors have primary responsibility for completing the referral and admission process. The referral and admission process includes assessing a child's need for inpatient services; confirming the need with a qualified professional; and obtaining SDHR consultation and approval for service delivery.

(2) A qualified professional must be a physician licensed under Alabama law to practice medicine; or a master's level psychologist or a psychological technician licensed under Alabama law; or a master's level professional counselor licensed under Alabama law; or a master's level social worker (non-DHR employee) licensed under Alabama law or who has specialized training in psychiatric care; or a registered nurse who has completed a master's degree in psychiatric nursing.

(3) Assessing The Needs For Inpatient Services - Inpatient services shall only be considered when a child cannot be safely evaluated and/or treated on an outpatient basis or in a less restrictive setting. The provision of supportive services shall always be considered prior to inpatient referral. ISP team members shall assess information gathered about behavioral indicators and prior services and treatment interventions.

(4) Confirming The Need For Inpatient Services - Once the ISP team has determined that the child is unable to be served in a less restrictive setting and that inpatient services appear to be needed, that need must be confirmed by a qualified professional prior to contact with SDHR for placement approval. The qualified professional shall not be on staff at the hospital setting where inpatient services will be sought. The qualified professional shall personally assess the child, and as appropriate, the child's family members and other caregivers. The qualified professional shall obtain and document information regarding specific needs related to exhibited behaviors; risk of harm to self or others; diagnosis; clear evidence that the child's needs can not be met on an outpatient basis or in a less restrictive setting with supportive services being provided; and whether services require an inpatient setting, and, if so, the anticipated length of the hospital stay. Confirmation by the qualified professional may be provided in an ISP meeting, a case staffing with the professional and other appropriate child and family planning team members in attendance, or it may be provided to the child and family planning team in writing.

(5) If a service provider recommends inpatient services and the ISP team is not in agreement, a second opinion may be sought. If deemed necessary, the second opinion shall be provided by a qualified professional not on staff at the hospital where services will be sought. The child welfare staff are responsible for contacting that professional to obtain confirmation that inpatient services are necessary.

(6) State DHR Consultation And Approval - Inpatient psychiatric services require State Office approval prior to the child's admission. The SDHR consultant having responsibility for providing consultation and approval for child welfare services shall be contacted during the assessment process to assist the ISP team in determining both the need for, and appropriateness of, inpatient services. When a qualified professional has confirmed the need for inpatient services, the consultant shall be contacted for placement approval. If it is necessary to hospitalize a child for inpatient psychiatric services on the weekend or after office hours, the supervisor must notify the SDHR consultant of the child's hospitalization on the next working day.

(a) Extensions - When inpatient services are needed beyond 14 days, extensions are considered on a case-by-case basis. Information required for extensions includes child's current status; a description of the progress made during hospitalization; barriers which are impeding progress toward discharge; supportive services offered and delivered to address the barriers; a description of efforts made to develop supportive services which will facilitate the child's safe placement in a less restrictive setting; and documentation supporting the need for an extension (i.e., treating physician or therapist's statement), estimated length of the extension, and if a second (2nd) opinion is considered necessary. Prior approvals for extensions also require the SDHR consultant's approval.

Author: Jerome Webb

Ala. Admin. Code r. 660-5-52-.03

New Rule: Filed October 7, 2003; effective November 11, 2003.

Statutory Authority:R.C. v. Fuller case (R.C. v. Hornsby, No. 88-H-1170-N, Consent Decree) (M.D. Ala. Approved December 18, 1991)