65D-30.007. Standards for Residential Treatment

In addition to rule 65D-30.004, F.A.C., the following standards apply to residential treatment.

(1) Residential treatment is a service provided in a structured and supervised live-in environment within a nonhospital or free-standing setting 24 hours-per-day, 7 days-per-week, and is intended for individuals who meet the placement criteria for this component. For the purpose of these rules, there are four (4) levels of residential treatment that vary according to the type, frequency, and duration of services provided.

(2) Facilities Not Required to be Licensed as Residential Treatment. Licensure as residential treatment, as defined in paragraph 65D-30.002(16)(d), F.A.C., shall not apply to facilities that only provide housing, meals, or housing and meals to individuals who are substance use impaired or in recovery. These facilities do not provide clinical services; however, they may arrange for or provide support groups such as Alcoholics Anonymous and Narcotics Anonymous. All other facilities providing services to individuals as described in subsections 65D-30.007(2) and (3), F.A.C., either at the facility or at alternate locations, must be licensed under this rule.

(3) Levels of Residential Treatment. For the purpose of this rule, there are four levels of residential treatment. In each level, treatment shall be structured to serve individuals who need a safe and stable living environment in order to develop sufficient recovery skills for the transition to a less restrictive level of care or reintegration into the general community in accordance with placement criteria. Treatment shall also include a schedule of services provided within a positive environment that reinforce the resident’s recovery. Individuals will be placed in a level of residential treatment that is based upon their treatment needs and circumstances. Because treatment plans should be specific to the individual, length of stay and duration of treatment shall be dependent upon the individual’s: a) severity of illness or disorder, b) level of functioning, and c) clinical progress in treatment and outcomes based on individualized treatment goals for all levels of residential treatment.

(a) Level 1 programs offer organized treatment services that feature a planned and structured regimen of care in a 24-hour residential setting. These programs are more than a 24-hour supported living environment (like those in level 4), and are a 24-hour treatment setting. There are two (2) categories of treatment under this level of care.

1. Adult Level 1 programs are appropriate for adults age 18 years and older with a substance use disorder or a co-occurring mental health and substance use disorder who have sub-acute biomedical, behavioral, emotional, or cognitive conditions severe enough that they require treatment in a Level 1 program, but do not need the full resources of an acute care general hospital or a medically managed inpatient treatment program. This level includes programs that provide services on a short-term basis. The emphasis is on an intensive regimen of clinical services using a multidisciplinary team approach. Services may include some medical services based on the needs of the individual.

2. Adolescent Level 1 programs are appropriate for adolescents under the age of 18 years with a substance use disorder or who have a co-occurring substance use and mental health disorders or symptoms. This level is often necessary to help change negative patterns of behavior, thinking, and feeling that predispose one to substance use and to develop skills to maintain a substance-free life. Services should take into account the different developmental needs based on the age of the adolescent and address any deficits in behavioral, cognitive, and social-emotional development often associated with substance use during the adolescent period. Seventeen-year-olds who turn 18 while completing treatment shall be allowed to stay only if it is clinically indicated, there is one-on-one supervision, and they have separate bedrooms.

(b) Level 2 programs are structured rehabilitation-oriented group facilities that serve persons with a substance use disorder or a co-occurring mental health and substance use disorder who have significant deficits in independent living skills and need extensive support and supervision. Programs include those referred to as therapeutic communities or some variation of therapeutic communities and are longer term than Level 1. There are two (2) categories of treatment under this level of care.

1. Adult Level 2 programs are appropriate for adults age 18 years and older with a substance use disorder or a co-occurring mental health and substance use disorder who have multi-dimensional needs of such severity that they cannot safely be treated in less intensive levels of care. This level is appropriate for adults who may experience significant social and psychological deficits, such as chaotic, and often abusive, interpersonal relationships; criminal justice involvement; prior treatment in less restrictive levels of care; inconsistent work histories and educational experiences; homelessness or inadequate housing; or anti-social behavior. In addition to clinical services, considerable emphasis is placed on services that address the individual’s educational and vocational needs, socially dysfunctional behavior, and need for stable housing upon discharge. It also includes services that promote continued abstinence from substance use upon the individual’s return to the community.

2. Adolescent Level 2 programs are appropriate for adolescents under the age of 18 with a substance use disorder or a co-occuring mental health and substance use disorder who have impaired functioning across a comprehensive range of psychosocial domains. This is characterized as having unpredictable fluctuations in mood, and developmental or cognitive difficulties related to mental health symptoms or disorders. In addition to providing clinical services, as defined in rule 65D-30.002, F.A.C., this level of care provides services to improve  interpersonal relationships, conflict resolution skills, impulse control problems and to reduce social inhibition or withdrawal. For these adolescents, treatment must occur in a structured environment conducive to teaching and practicing prosocial behavior to facilitate healthy reintegration into the community.

(c) Level 3 programs are appropriate for adults age 18 years and older with a substance use disorder or a co-occurring mental health and substance use disorder whose cognitive functioning has been severely impaired from the chronic use of substances, either temporarily or permanently. This would include individuals who have varying degrees of organic brain disorder or brain injury or other problems that require extended care. The emphasis is on providing services that work on cognitive problems and activities of daily living, socialization, and specific skills to restore and maintain independent living. Typically, services are slower paced, more concrete and repetitive. This level excludes adolescent programs.

(d) Level 4 programs are appropriate for adults or adolescents with a substance use disorder or a co-occurring mental health and substance abuse use disorder and provide services on a short-term basis. This level is appropriate for individuals who have completed other levels of residential treatment, particularly levels 2 and 3. This includes individuals who have functional limitations in application of recovery skills, self-efficacy, or a lack of connection to the community systems of work, education, or family life. Although clinical services are provided, the emphasis is on services that are low-intensity and emphasize a supportive environment. This includes services that focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into work, education, and family life.

(4) Services. Each individual shall receive services each week, including counseling, as provided for in subsection 65D-30.007(6), F.A.C. Each provider shall be capable of providing or arranging for the services listed below. With the exception of counseling, as defined in rule 65D-30.002, F.A.C., it is not intended that all services listed below be provided. For individuals participating under subsection 65D-30.0037(15) and rule 65D-30.0048, F.A.C., services shall be provided in accordance with the terms and conditions of the Department of Corrections’ contract with the provider. Juvenile Justice Commitment Programs and detention facilities operated by or under contract with the Department of Juvenile Justice are exempt from the requirements of this subsection, but shall provide such services as required in the policies, standards, and contractual terms and conditions established by the Department of Juvenile Justice. Otherwise, services shall be provided in accordance with the needs of the individual as identified in the treatment plan as follows:

(a) Individual counseling;

(b) Group counseling;

(c) Counseling with family members or members of the individual’s support system;

(d) Substance related/recovery-oriented education, such as strategies for avoiding substance use or relapse, health problems related to substance use, and motivational enhancement and strategies for achieving a substance-free lifestyle;

(e) Life skills training such as anger management, communication skills, employability skills, problem solving, relapse prevention, recovery training, decision-making, relationship skills, and symptom management;

(f) Expressive therapies, such as recreation therapy, art therapy, music therapy, or dance (movement) therapy to provide the individual with alternative means of self-expression and problem resolution, and other therapies such as evidence-based practices and interventions for substance use or co-occurring conditions;

(g) Training or education in health and medical issues;

(h) Employment or educational support services to assist individuals in becoming financially independent; and

(i) Mental health services for the purpose of:

1. Managing individuals with disorders who are stabilized;

2. Evaluating individuals’ needs for in-depth mental health assessment;

3. Training individuals to manage symptoms; and

4. If the provider is not staffed to address primary mental health problems that may arise during treatment, the provider should initiate a timely referral to an appropriate provider for mental health crises or the emergence of a primary mental health disorder, according to the provider’s policies and procedures.

(5) Education. As provided for in subsection 397.501(6), F.S., in addition to the services required for all programs, education and training must be coordinated or provided to an adolescent, appropriate to his or her needs, in order to maintain his or her educational and intellectual development.

(6) Required Hours of Services.

(a) For level 1, each individual shall receive services each week in accordance with subsection 65D-30.007(4), F.A.C., including at least 14 hours of counseling.

(b) For level 2, each individual shall receive services each week in accordance with subsection 65D-30.007(4), F.A.C., including at least 10 hours of counseling.

(c) For level 3, each individual shall receive services each week in accordance with subsection 65D-30.007(4), F.A.C., including at least 4 hours of counseling.

(d) For level 4, each individual shall receive services each week in accordance with subsection 65D-30.007(4), F.A.C., including at least 2 hours of counseling.

In instances in which it is determined that an individual requires fewer hours of counseling in any of the levels of residential treatment, this shall be described and justified in the individual’s treatment plan and approved by the qualified professional.

(7) Transportation. Each provider shall arrange for or provide transportation services to individuals who are involved in activities or in need of services, such as mental health, dental, public health, and social services, that are provided at other facilities.

(8) Staff Coverage. For all levels of residential treatment, each provider shall maintain awake, paid staff coverage 24 hours-per-day, 7 days per week.

(9) Caseload. No primary counselor may have a caseload that exceeds 15 currently participating individuals.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311(26), 397.321, 397.4014, 397.410 FS. History–New 5-25-00, Amended 4-3-03, 8-29-19.