C.M.R. 14, 193, ch. 6, CRISIS RESIDENTIAL SERVICE STANDARDS
These standards, in addition to the core standards, are applied to agencies providing crisis residential services.
Assessment
CRS.1 An assessment of the client is completed within 24 hours of admission to the crisis residential program.
CRS. 1. A. The assessment minimally addresses the following:
CRS. 1. A.1 the client's strengths and weaknesses;
CRS. 1. A.2 the client's perception of his or her needs;
CRS. 1. A.3 the family/guardian's input and perception of the client's needs when appropriate, and with the client's consent;
CRS. 1. A.4 a personal, family, and social history;
CRS. 1. A.5 the client's emotional, psychiatric and psychological strengths and needs;
CRS. 1. A.6 a physical health status and history, including current prescribed and over-the-counter medication use;
CRS. 1. A.7 past and current drug/alcohol use;
CRS. 1. A.8 a developmental history;
CRS. 1. A.9 possible sources of assistance and support in meeting the needs expressed by the client or legally responsible party, including state and federal entitlement programs;
CRS. 1. A.10 physical and environmental barriers that may impede the client and families ability to obtain services;
CRS. 1. A.11 history of physical and/or sexual abuse;
CRS. 1. A.12 housing and financial needs; and
CRS. 1. A.13 the client's general need for crisis services;
CRS. 1. A.14 the client's vocational, educational, social, living; leisure/recreational and medical needs;
CRS. 1. A.15 the status of the Individualized Support Plan; and
CRS. 1. A.16 the signature of the person who performed the assessment.
Interpretive Guideline for CRS.1.A through CRS.1.A.13
The Division of Licensing recognized that in some cases not all of the information requested in these standards will be able to be obtained. The Division also recognized that the level of detail required will vary given a variety of factors (the client's level of cooperation, the integrity of the information sources, the length of services or treatment, the condition being addressed, the practitioner's training, etc.). Although the Division will attempt to be sensitive to these factors and flexible in surveying this area, the agency should assure that assessments that do not address all these standards have accompanying documentation that justifies abbreviated or absent information.
CRS. 1. B. The agency will establish policies and procedures establishing criteria for the performance of the following assessments:
CRS. 1. B.1 a nutritional assessment;
CRS. 1. B.2 a cognitive functioning assessment;
Interpretive Guideline for CRS.1.B.2
The client's cognitive functioning assessment should include assessment of the following functions: problem solving, decision making, organization, self-direction, system negotiation skills, concentration, and abstract reasoning. For individuals over 60 years of age, this assessment should also include memory, language orientation, and visuo-spatial abilities.
CRS. 1. B.3 an assessment of the client's capacity; CRS.1.B.4 a neurological assessment.
CRS. 1. C. The assessment shall be obtained from -the client, legally responsible party, community service agencies, and to the extent possible, from other individuals in the community as authorized by the client or legally responsible party.
CRS. 1. C.1. In instances in which the client receives community support services and/or has an Individualized Support Plan, the agency will, subject to the client's consent, shall coordinate the assessment and subsequent service planning with the community support provider.
CRS. 1. C.1.a. Services provided to these clients will be consistent with the targets and objectives of the Individualized Support Plan.
CRS. 1. C.1.b. Services provided to these clients will be delivered pursuant to a service agreement negotiated with the community support worker.
CRS. 1. D. The client record contains a summary evaluation of the data collected in the assessment.
Interpretive Guideline for CRS.1.B through CRS.1.B.4
These assessments do necessarily have to be performed in the agency or by agency staff. The intent of these standards are to assure that the agency has mechanisms by which to evaluate the need for these assessments and to perform or refer for assessment those clients whose symptomatology suggest such need.
Service Planning
CRS.2. A service plan is developed for each client, with the client's consent, within 24 hours of admission to the crisis residential program.
CRS. 2. A. The service plan minimally contains the following:
CRS. 2. A.1 problem statements;
CRS. 2. A.2 goals related to the projected length of stay and based upon client needs;
CRS. 2. A.3 objectives stated in terms which allow objective measurement of progress;
CRS. 2. A.4 specification of treatment responsibilities and methods;
CRS. 2. A.5 client input and signature;
CRS. 2. A.6 signatures of all people participating in the development of the plan;
CRS. 2. A.7 a description of any physical handicap and any accommodations necessary to provide the same or equal services and benefits as those afforded non-disabled individuals:
CRS. 2. A.8 criteria for discharge.
Interpretive Guideline for CRS.2.A.7 through CRS.2.A.8
These elements may be addressed within service plan goals.
CRS.3 The service plan is designed so that the client's progress towards service plan goals can be monitored and evaluated.
Discharge Planning
CRS.4 A discharge summary is entered in the client record within 24 hours -of discharge and includes the client's course of treatment and ongoing needs at discharge.
CRS. 4. A. Each discharge minimally addresses, but need not be limited to, the following:
CRS. 4. A.1 the reasons for termination of service;
CRS. 4. A.2 the final assessment, including general observations and significant findings of the client's condition initially, while services were being provided and at discharge;
CRS. 4. A.3 the course and progress of the client with regard to each identified problem; and
CRS. 4. A.4 the recommendation & and arrangements for further continued service needs.
CRS.5 The agency will have a discharge protocol that protects the client from summary discharge and allows the agency to maintain program integrity.
CRS. 5. A. The agency has a policy and procedure for discharging clients that includes the terms upon which a client may be discharged serious infractions of the policies required to maintain the privacy, comfort and safety of residents, under-utilization of the program).
CRS. 5. B. Agencies will not summarily discharge clients. All substantiated complaints will be assessed for the seriousness of the violation and actions taken to achieve compliance.
Physical Plant
CRS.6 A secure and readily accessible storage area of adequate size is available to accommodate client belongings.
CRS. 6. A The agency has a policy and procedure related to what personal belongings may be brought to the agency.
Crisis Residential Services
CRS.7 All agencies will have personal emergency paging systems or will have staff back-up assistance immediately available.
CRS. 7. A. Agencies that do not have a personal emergency paging system will have policies and procedures assuring the immediate availability of staff back-up assistance.
CRS.8 In addition to the orientation and training required in the core staff development standards, crisis residential staff shall:
CRS. 8. A. "shadow" an experienced staff member for an appropriate period (determined by the agency in policy and procedure);
CRS. 8.B. receive nationally recognized training in managing people who act out aggressively (e.g. MANDT, Nappi);
CRS. 8. . C. receive training in crisis stabilization;
CRS. 8. D. receive training in residential/milieu management.
Health
CRS.9 If food services are provided, the facilities for the preparation and serving of food shall be inspected and approved by the Department of Human Services.
CRS. 9. A. If food is either prepared or served at the facility, then the agency shall either obtain a DHS Eating Establishment license or show written evidence from DHS indicating that they need no such license.
CRS. 9. B. When the agency requires a DHS license, the agency's Eating Establishment license is current.
CRS.10 The agency shall have methods for obtaining on- or off-site medical services for all clients.
CRS. 10. A The agency defines in policy and procedure those medical services delivered on-site. For those medical services not provided on-site, letters of agreement and/or procedures for accessing medical service provider(s) are in effect.
C.M.R. 14, 193, ch. 6, CRISIS RESIDENTIAL SERVICE STANDARDS