N.Y. Comp. Codes R. & Regs. tit. 14 § 512.5

Current through Register Vol. 46, No. 43, October 23, 2024

Section 512.5 - Service categories and requirements

Each of the following services, offered by PROS providers in accordance with their certification category, are provided face-to-face by PROS staff members for the purpose of assisting individuals to overcome the barriers caused by their mental illness that are preventing them from achieving their chosen goals.

(a) Assessment is a service designed to review and determine an individual's level of functioning, the past benefits of participating in mental health services, and his or her ability to function in specific life roles. In addition, the assessment service should identify the individual's strengths as well as challenges and barriers encountered as a result of his or her psychiatric condition. The assessment service involves a comprehensive and continuous process, conducted within the context of the individual's self-identified needs, goals, and ethnic, religious and cultural identities. Each assessment must result in a summary of findings, within the context of the specific assessment focus, that addresses the individual's strengths, talents, and abilities, as well as the challenges and barriers presented by the individual's mental illness.

(b) Basic living skills training is a service designed to improve an individual's ability to perform the basic skills necessary to achieve maximum independence and acceptable community behaviors that are critical to his or her recovery. This service focuses on the acquisition of skills, as well as strategies for appropriate use of the skill, utilizing teaching interventions such as motivational, educational and cognitive-behavioral techniques. The service may include opportunities to practice, observe, reinforce and improve the individual's skill performance. The topics which may be covered include, but are not limited to: grooming and personal hygiene, nutrition, homemaking, building relationships, childcare, transportation, use of community resources, and engaging in social interactions.

(c) Benefits and financial management is a service designed to support an individual's functioning in the community through understanding and skill in handling his or her financial resources. The instruction may include counseling on budgeting, income and benefits, including incentives for returning to work as well as basic counseling on income maintenance, eligibility for benefits from relevant sources, and determination of the need for plans for additional support and assistance in managing personal finances.

(d) Clinical counseling and therapy is a service designed to provide goal-oriented verbal counseling or therapy, including individual, group and family counseling or therapy, for the purpose of addressing the emotional, cognitive and behavioral symptoms of a mental health disorder or for engaging, motivating and stabilizing persons with a co-occurring mental health and substance abuse (including alcohol) disorder, and the related effects on role functioning. Such service may also include cognitive behavioral therapy.

(e) Cognitive remediation is a set of techniques and interventions, such as drills, activities and exercises, designed to improve an individual's functioning by improving the cognitive skill that is the target of the remediation task. These skills include, but are not limited to: the ability to pay attention, remember, process information, solve problems, organize and reorganize information, communicate and act upon information. Cognitive remediation techniques work to improve mental capabilities necessary to learn academic subject matter, and more generally to function in daily life. Cognitive remediation is an optional PROS service, subject to prior review and written approval of the office.

(f) Community living exploration is a service designed to help an individual understand the demands of specific community life roles, in order to make decisions regarding participation in those roles. Community living exploration services can also be used to help motivate individuals who are not yet exhibiting active interest in more integrated community life roles, by increasing their knowledge of opportunities available in the community. Topics may include, but are not limited to: options for satisfactory experiences with living environments, work or career opportunities, educational opportunities, opportunities to connect to culturally-based community services, and resources for use of leisure time. It is expected that, to the extent possible, these services will be developed in natural community environments.

(g) Crisis intervention is a service designed to safely and respectfully de-escalate situations of acute distress or agitation which require immediate attention. Such service may include, but is not limited to, calming techniques to interrupt escalating behavior.

(h) Engagement is a service designed to reach out to individuals over time for the purpose of fostering a commitment on the part of an individual to enter into therapeutic relationships supportive of the individual's recovery. This service may include, but is not limited to, activities such as initial contacts with potential program participants, as well as ongoing efforts to engage individuals to participate in program services.

(i) Family psychoeducation/intensive family support is an intensive rehabilitation (IR) service designed to provide information, clinical guidance and support to collaterals and PROS participants when desired and appropriate, for the purpose of assisting and enhancing the capacity of a collateral to facilitate an individual's recovery. Specific examples of family psychoeducation/intensive family support include consumer-centered family consultation (CCFC), psychoeducational multiple family groups (MFGs), and behavioral family therapy.

(j) Health assessment is a service designed to gather data concerning an individual's medical history and any current signs and symptoms, and assess such data to determine his or her physical health status and need for referral. The assessment of the data shall be done by a nurse practitioner, psychiatric nurse practitioner, physician, physician's assistant, psychiatrist or registered professional nurse. Where indicated, this service shall include screening for metabolic syndrome, diabetes, and hypertension on a periodic basis.

(k) Individualized recovery planning is a continuous, dynamic process that engages each person as an active partner in developing, reviewing and modifying a course of care that supports his or her progress towards recovery. The course of care is based on an assessment process and the individual's personal preferences and desired life roles. The course of care is reflected in an individualized recovery plan (IRP), which includes the identification of medically necessary services and which supports the individual's goals and desires. The individualized recovery planning process also includes the development of a relapse prevention plan by the individual in partnership with the PROS practitioner and, when appropriate, an advance directive. The service may also involve activities designed to help identify and develop compensatory supports necessary to assist an individual during his or her recovery process.

(l) Information and education regarding self-help is a service designed to encourage individuals to participate in self-help and mutual aid groups. The service is designed to help an individual understand what self-help resources are available in the community and how to benefit from participating in them. The service may be conducted by people who have common experiences, and is intended to help the individual to learn how to share personal experiences with others who have had a common experience, to learn about the variety of available self-help groups, and to aid the individual in accessing the self-help options of his or her choice.

(m) Integrated treatment for dual disorders (IDDT) is an evidence-based practice designed to address the mental health and substance abuse needs of persons with co-occurring disorders simultaneously. Such service includes, but is not limited to, motivational, cognitive-behavioral and harm reduction approaches, wherein practitioners coordinate care with appropriate substance abuse providers when it is determined that the co-occurring disorder is acute or serious, and the recipient is ready to accept related treatment.

(n) Intensive rehabilitation goal acquisition is a service designed to assist an individual in identifying, attaining and retaining personally meaningful goals that will help the person to resume normal functioning in adult life roles. This service should be used to provide active support once an individual has made a commitment to achieving a new role, such as returning to work or school, returning to adult care giving or parenting roles, resuming roles as a spouse or significant other, obtaining a desired housing arrangement, and resuming a role as a community volunteer. Due to the urgency associated with the individual's readiness to attain and maintain a preferred life role, this service is not normally a long-term intervention.

(o) Intensive relapse prevention is a service designed to address an exacerbation of acute symptoms, or manage existing symptoms that are not responsive to the current service formulation. This may include the provision of targeted, intensive interventions necessary to address immediate risks such as relapse, hospitalization, loss of housing, or involvement with the criminal justice system. This service may also include the execution of a series of predetermined steps identified in the relapse prevention plan.

(p) Medication management is a service designed to prescribe or administer medication with the highest efficacy and lowest toxicity in treating the primary symptoms of an individual's psychiatric condition. This service is intended to include medication trials which are adequate in dose and duration, as well as assessments of the appropriateness of the individual's existing medication regimen through record reviews, ongoing monitoring, and consultation with the PROS participant and/or collateral. The purpose of such consultation is to determine personal preferences, as well as past and present experiences with medication, including related efficacy, side effects and compliance. Medication management may includes monitoring the side effects of prescribed medications, including, but not limited to, extrapyramidal, cardiac and metabolic side effects, and may include providing individuals with information concerning the effects, benefits, risks and possible side effects of a proposed course of medication.

(q) Ongoing rehabilitation and support is a service designed to provide ongoing counseling, mentoring, advocacy and support for the purpose of sustaining an individual's role in competitive, integrated employment. Such service does not include task-specific job training.

(r) Pre-admission screening is a service designed to include the initial process of contacting, engaging, interviewing and evaluating an individual to determine his or her need and desire for PROS services. The result of pre-admission screening is a determination of the individual's desire to participate in services and the program's appropriateness to meet the needs of the individual.

(s) Psychiatric assessment is a service designed to gather data concerning an individual's psychiatric history and current mental health symptoms, assess such data for determination of the individual's current mental health status, and identify the need for clinical treatment services. Assessment of the data shall be done by a psychiatrist or psychiatric nurse practitioner.

(t) Structured skill development and support is a service designed to assist individuals in developing instrumental skills for performing normative life roles associated with group membership, work, education, parenting or living environments. The focus of structured skill development is to develop skills through a process of teaching, practice, and feedback in community environments replicated at the program site. The modality for teaching these skills is a combination of individual, group and structured activities. It is often provided in structured club-like settings such as a work-ordered day or an activity-center format, where staff employ supportive counseling, mentoring and skill development techniques to assist the individual in completion of essential tasks.

(u) Symptom monitoring is a service designed to identify the ongoing effects of an individual's course of care. This service involves the continuous process of monitoring a recipient's symptoms of mental illness, as identified in his or her individualized recovery plan, and his or her response to treatment, within the context of other support and rehabilitation services. Such service may include consultation with identified collaterals. If this service is provided by a staff person other than a psychiatrist, nurse or nurse practitioner, it must include communication of observed symptoms and treatment responses to the physician or nurse.

(v) Wellness self-management (also known as illness management and recovery) is a service designed to develop or improve personal coping strategies, prevent relapse, and promote recovery. Such services may be provided to recipients and/or collaterals, and may include, but are not limited to:

(1) coping skills training which means teaching individuals strategies to address symptoms, manage stress and reduce exposure and vulnerability to stress;

(2) disability education which means instruction on the facts concerning mental illness and the potential for recovery. The intent of this service is to give individuals admitted to PROS programs and collaterals hope as well as practical information on prevention and recovery practices, including evidence-based practices;

(3) dual disorder education which means providing individuals admitted to PROS programs and/or collaterals with basic information on the nature of substance abuse disorders and how they relate to the symptoms and experiences of mental illness;

(4) medication education and self-management which means providing individuals admitted to PROS programs or collaterals with information on the individual's medications, including related efficacy, side effects and compliance issues. Individuals are supported in managing their medications and in learning about the effects of the medication on their mental health condition and in managing the side effects of medication through healthy life style changes such as smoking cessation, nutrition, and weight loss;

(5) problem-solving skills training which means a series of learning activities designed to assist individuals admitted to PROS programs and collaterals develop effective solutions for stressful responses to routine life situations. These activities may include, but are not limited to: role playing exercises, homework assignments or the mastery of specific principles and techniques; and

(6) relapse prevention planning which means a process to engage individuals admitted to PROS programs and collaterals in understanding factors which may trigger a recurrence of severe symptoms of mental illness and ways to cope with the potential for recurrence. Planning activities may include the development of an advance directives document and specific instructions on what steps need to be taken in the event of a relapse.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 512.5