65E-12.108. Minimum Standards for Short-Term Residential Treatment Programs (SRT)

In addition to Rules 65E-12.104, 65E-12.105, and 65E-12.106, F.A.C., above, these standards apply to SRT programs.

(1) Admission Criteria.

(a) Referral Required. People may be admitted to an SRT only following a psychiatric or psychological evaluation and referral from a CSU, inpatient unit, or a designated public or private receiving facility.

(b) Admission. All individuals shall be admitted pursuant to Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C., and only on the order of a physician or psychiatrist.

(2) Nursing Assessment and Physical Examination. All persons shall be given a nursing assessment and shall be given a physical examination within 24 hours of admission. The physical examination shall include a complete medical history and documentation of significant medical problems. It must contain specific descriptive terms and not the phrase, “within normal limits.” If the person received a physical examination at an inpatient program or CSU prior to transfer to the SRT, no further physical examination will be necessary unless clinically indicated or it does not meet the requirements of this section. General findings must be written in the individual's clinical record within 24 hours.

(3) Emotional and Behavioral Assessment. For all individuals who are admitted to an SRT an emotional and behavioral assessment shall be completed and entered into the individual’s clinical record within 72 hours. The assessment shall be made by a mental health professional or other unit staff under the supervision of a mental health professional. If the individual received an assessment at an inpatient program or CSU prior to transfer to the SRT, another assessment is not required unless clinically necessary or it does not meet the requirements of this section. The assessment shall include the following.

(a) A history of previous emotional, behavioral, and substance abuse problems and treatment.

(b) A social assessment to include a determination of the need for participation of family members or significant others in the person’s treatment; the social, peer group, and environmental setting from which the person comes; family circumstances; current living situation; employment history; social, ethnic, cultural factors; and childhood history.

(c) A direct psychiatric evaluation to be completed by a physician or psychiatrist to include a mental status examination which includes behavioral descriptions, including symptoms, not summary conclusions, and concise evaluation of cognitive functioning. A diagnosis, made by the physician or psychiatrist, shall be recorded in the individual’s clinical record, with a minimum of Axes I, II, and III, from the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised, Washington, DC, American Psychiatric Association, 1994.

(d) When indicated, a psychological assessment including intellectual, projective, and personality testing. The assessment shall also include specifications of the behaviors that will be demonstrated in order for the individual to return to a less restrictive setting and recommended intervention strategies.

(e) When indicated, other functional evaluations of language, self-care, and social-affective and visual-motor functioning.

(4) Medical Care.

(a) The development of medical care policies and procedures shall be the responsibility of the psychiatrist or physician. The policies and procedures for medical care shall include the procedures that may be initiated by a registered nurse in order to alleviate a life threatening situation. Medication or medical treatment shall be administered upon direct order from a physician or psychiatrist, and orders for medications and treatments shall be written and signed by the physician or psychiatrist.

(b) There shall be no standing orders for any medication used primarily for the treatment of mental illness.

(c) Every order given by telephone shall be received and recorded immediately only by a registered nurse with the physician’s or psychiatrist’s name, and signed by the physician or psychiatrist within 24 hours. Such telephone orders shall include a progress note that an order was made by telephone, the content of the order, justification, time, and date.

(5) Comprehensive Service and Implementation Plans. At the time of admission to the SRT the previously completed comprehensive service plan shall be reviewed and revised as needed with the person’s service plan manager. The SRT shall develop a service implementation plan which has objectives and action steps written for the person in behavioral terms. The objectives shall be related directly to one or more goals in the person’s comprehensive service plan. The service implementation plan shall be initiated with documented input from the person receiving services and signed by the responsible physician or psychiatrist or a staff member privileged by policies and procedures within 24 hours of admission. The service implementation plan shall be fully developed within 5 days of admission and must contain short-term treatment objectives stated in behavioral terms, relative to the long-term view and goals in the comprehensive service plan, and a description of the type and frequency of services to be provided in relation to treatment objectives. The plan shall be reviewed and updated at least every 30 days. A copy of the plan shall be signed by and provided to the individual and his guardian as provided by law. A new aftercare plan shall be developed prior to discharge from the SRT.

(6) Previous Record. For individuals who enter the SRT as a continuation of care, transfer from an inpatient program or CSU, the previously completed intake interview, physical examination, medication log, progress notes, discharge or aftercare plan, and forms under Chapter 65E-5, F.A.C., shall be made a part of the SRT clinical record.

(7) Required SRT Services.

(a) Services. Each SRT shall provide the following services on a 24-hour-a-day, 7-day-a-week basis:

1. Twenty-four hour supervision;

2. Individual, group, and family counseling services directed toward alleviating the crisis or symptomatic behavior which required admission to an SRT;

3. Medical or psychiatric treatment;

4. Social and recreational activities, inside and outside the context of the facility;

5. Referral to other less restrictive, nonresidential treatment services, when appropriate. Each SRT shall have access to the CSU, if one exists in the area, and to hospital emergency services in the event of a crisis that cannot be managed within the facility; and

6. Each SRT shall provide or have access to transportation in order to accomplish emergency transfers and to meet the service needs of persons served.

(b) Routine Activities. Basic routine activities for persons admitted to an SRT shall be delineated in program policies and procedures which shall be available to all personnel. The daily activities shall be planned to provide a consistent, well structured, yet flexible, framework for daily living and shall be periodically reviewed and revised as the needs of individuals or the group change. Basic daily routine shall be coordinated with special requirements of each service implementation plan. A schedule of daily activities shall be posted or otherwise available to all persons receiving services.

(c) Laboratory Services.

1. Requirement. Every SRT shall provide or contract for licensed laboratory services commensurate with the individual’s needs.

a. Emergency. Provision shall be made for the availability of emergency licensed laboratory services on a 24-hour-a-day, 7-day-a-week basis including holidays.

b. Orders. All laboratory tests and services shall be ordered by a physician or psychiatrist.

c. Record. All laboratory reports shall be filed in the individual's clinical record.

d. Specimens. Each SRT shall have written policies and procedures governing the collection, preservation and transportation of specimens to assure adequate stability of specimens.

2. Contracts. Where the SRT depends on an outside laboratory for services, there shall be a written contract detailing the conditions, procedures and availability of work performed. The contract shall be reviewed and approved by the SRT director or administrator.

(d) Continuity of Care.

1. Discharge Preparation. Prior to discharge or departure from the SRT, the staff with the individual’s consent shall work with the individual’s support system including family, friends, employers and case manager, as appropriate, to assure that all efforts are made to prepare the individual for returning to a less restrictive setting.

2. Referral Services. All SRT facilities shall develop and maintain written referral agreements.

(e) Each SRT shall have access to a hospital inpatient unit to assure that referred persons are admitted as soon as necessary.

(8) Space. Each person receiving services shall be provided a minimum of 175 square feet of usable client space within the SRT. Bedrooms shall be spacious and attractive, and activity rooms or space shall be provided.

(9) Access and Egress. Each SRT shall provide reasonable control over access to and egress from the unit and recreational area.

Specific Authority 394.879(1), (2) FS. Law Implemented 394.875 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.108, Amended 9-1-98.