STATE OF CALIFORNIA STANDARDS FOR DRUG TREATMENT PROGRAMS OCTOBER 21, 1981

STATE OF CALIFORNIA STANDARDS FOR DRUG TREATMENT PROGRAMS OCTOBER 21, 1981 (REVISED SEPTEMBER 1982) TABLE OF CONTENTS

E PAG INTRODUCTION 1 I. GENERAL MANAGEMENT 2 A. Gverning Bdy 2 B. Chief Executive Officer 2 C. Persnnel Plicies 2 D. Fiscal Management 4 E. Vlunteer Services 5 II. PROGRAM MANAGEMENT 5 A. Admissin r Readmissin 5 1. Criteria 5 2. Intake 6 3. Medical Assessment 6 B. Services 7 1. Staffing 7 2. Hurs f Operatin 7 3. Cunseling and Other Therapeutic Services 7 4. Referral Services 8 5. Medical Services 8 C. Case Management 9 1. Establishment and Cntrl f Recrds 9 2. Cntents f Recrds 9 D. Quality Assurance 11 1. Cntinuity f Care 11 2. Case Review and Treatment Plan Revisin 12 3. Prgram Evaluatin 13 4. Fllw-up 13 5. Staff Develpment 13 6. Utilizatin Review 13 7. Facility Management 13

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TABLE OF CONTENTS PAGE E. Client Rights 13 1. Dcument 13 2. Cnfidentiality 14 3. Cnsent t Treatment 4. Cnsent fr Fllw-up 14 5. Research 14 F. Discharge 14 1. Criteria 14 2. Summary 15 III. GENERAL PROVISIONS 15 A. Prtcl 15 B. Exceptins 15 DEFINITIONS 16

-ii- INTRODUCTION The Standards included in this dcument identify minimal requirements fr Drug Treatment Prgrams within the State f Califrnia. They apply t all prgrams designated as treatment services in each Cunty Plan and funded whlly r in part thrugh the Department f Alchl and Drug Prgrams (ADP). Only thse plicies and prcedures cnsidered abslutely essential are specifically identified in these minimal standards. Requirements identified elsewhere - such as Cnfidentiality Regulatins (42 CFR Part 2), Methadne Regulatins (Title 9), "Prpsed Shrt-Dyle Medi-Cal Certificatin Standards", and Shrt-Dyle Cmmunity Services Systems Manual are nt repeated in this dcument. In case f cnflicts the mst restrictive requirement shall apply. The funding surce(s) decide whether these standards apply when it first apprves a prgram prtcl.

I. GENERAL MANAGEMENT A. Gverning Bdy Each prgram shall have a gverning bdy which has full legal authrity fr perating the prgram. The gverning bdy shall meet at least quarterly. Minutes f all meetings shall be kept and be available t the public. Names and addresses f all gverning bard members shall be available. The bylaws, and rules f the prgram shall fllw applicable legal requirements. Public rganizatins shall prvide an rganizatin chart which reflects the prgram's placement within a gvernment agency. Private rganizatins shall prvide dcumentatin f the legal authrity fr the frmatin f the agency. B. Chief Executive Officer Fr private rganizatins prviding drug abuse services, the gverning bdy shall appint a chief fficer(s). The majr duties, authrity, and qualificatins f the fficer(s) shall be defined in the rganizatin's bylaws r rules. Here is a suggested list f duties fr chief fficer(s) - t be included in the bylaws r rules. A chief fficer shuld: a) plan activities; C. Persnnel Plicies b) reprt prgram's peratins; c) reprt prgram's finances, including develping the annual peratin budget; and d) develp prgram's rules, including persnnel plicies. 1. Persnnel plicies shall be established and maintained which: a) are written and revised as needed and are apprved by the gverning bdy; 2

b) are applicable t all emplyees and are available t and reviewed with new emplyees; c) cmply with applicable lcal, state, and federal emplyment practice laws; and d) cntain infrmatin abut the fllwing: recruitment, hiring prcess, evaluatin, prmtin, disciplinary actin and terminatin; equal emplyment pprtunity, nndiscriminatin, and affirmative actin plicies as applicable; emplyee benefits, (vacatin, sick leave), training and develpment, grievance prcedures; salary schedule, merit adjustment, severance pay, emplyee rules f cnduct; emplyee safety and injuries; and physical health status as required. 2. Persnnel files shall be maintained n all emplyees and shall cntain: a. applicatin fr emplyment and resume; b. emplyment cnfirmatin statement; c. salary schedule and salary adjustment infrmatin; d. emplyee's evaluatins; e. health recrds as required; and f. ther persnnel actins (e.g., cmmendatins, discipline, status change, emplyment incidents and/r injuries). 3. Prcedures shall be established fr access t and cnfidentiality f persnnel recrds. 3

4. Jb descriptins shall be develped, revised as needed, and apprved by the gverning bdy. The jb descriptins shall include: a. psitin title and classificatin; b. duties and respnsibilities; c. lines f supervisin; and d. educatin, training, wrk experience and ther qualificatins fr the psitin. 5. A written cde f cnduct fr emplyees and vlunteers shall be established which addresses at least the fllwing: a. use f drug and/r alchl; b. relatinship between staff-client; c. prhibitin f sexual cntact with clients; and d. cnflict f interest. D. Fiscal Management 1. Each prgram shall have an annual written budget which includes expected incme and expenses, and that: a. lists all incme by surce; and b. lists all expenses by prgram cmpnent r type f service. 2. Each prgram shall use the Unifrm Methd f Determining Ability t Pay (UMDAP) as the fee schedule fr cllecting fees. 3. Each prgram shall develp a reprting mechanism which indicates the relatin f the budget t actual incme and expenses t date. 4. Each prgram shall maintain written plicies and prcedures that gvern the fiscal management system (e.g., purchasing authrity, accunts receivable, cash, billings and cst allcatin). 4

5. Prgram persnnel respnsible fr signing checks and perfrming ther accunting activities shall be bnded. 6. The fiscal management system shall prvide fr an audit f the financial peratins f the prgram at least every tw years, either by a public accuntant wh is nt a staff r Bard member r by the funding agency. E. Vlunteer Services If a prgram utilizes the services f vlunteers, it shuld develp and implement plicies and prcedures which addresses vlunteers: a. recruitment; b. screening; c. selectin; d. training and rientatin; e. duties and assignments; f. supervisin; g. evaluatin; and h. prtectin f client cnfidentiality. II. PROGRAM MANAGEMENT A. Admissin r Readmissin 1. Criteria Each prgram shall include in its prtcl written admissin and readmissin criteria fr determining clients' eligibility and suitability fr treatment. These criteria shall include, at minimum: a. identificatin f drugs f abuse; b. dcumentatin f scial, psychlgical, physical and/r behaviral 5

2. Intake prblems related t drug abuse; and c. statement f nndiscriminatin. a. An initial interview shall determine whether r nt a client meets the admissin criteria. b. If a ptential client des nt meet the admissin criteria, the client shall be referred elsewhere fr treatment. c. All client's admitted shall meet the admissin criteria and this shall be dcumented in the client's recrd. d. If a client is apprpriate fr treatment, the fllwing infrmatin shall be gathered at minimum: scial, ecnmic and family backgrund; educatin; vcatinal achievements; criminal histry, legal status; medical histry; drug histry; and previus treatment. e. Only upn cmpletin f this prcess and the signing f the cnsent frm, shall the client be admitted t treatment. 3. Medical Assessment A cmplete medical and drug histry shall be taken. The prgram shall take reasnable steps t prtect the clients frm spread f infectius disease(s). An assessment f the physical cnditins f the client shall be made within 30 days frm admissin and dcumented in the client recrd in ne f the 6

fllwing ways: a. A physical examinatin by a physician, registered nurse practitiner r physician's assistant accrding t prcedures prescribed by State Law. b. Upn the review f the medical histry and ther apprpriate material, a determinatin must be made by a licensed physician f the need fr physical and labratry examinatins. Any recmmended examinatin must be made available either directly by the prgram r by referral. B. Services 1. Staffing Each prgram shall be staffed t ensure adequate delivery f required and prvided services as apprved in the prgram prtcl. 2. Hurs f Operatin Each prgram shuld prvide sufficient scheduled hurs f service t meet the needs f the clients. The hurs shall be s distributed that clients can utilize the services withut undue incnvenience. When nt pen, the prgram shuld prvide infrmatin cncerning the availability f shrt-term emergency cunseling r referral services, including, but nt limited t, emergency telephne services. 3. Cunseling and Other Therapeutic Services a. Frequency f Services Outpatient. Each client shuld be seen weekly r mre ften, depending n his/her need and treatment plan. At minimum, all clients shall receive tw cunseling sessins per 30 day perid r be subject t discharge. Residential. A minimum f twenty hurs per week f cunseling and/r structured therapeutic activities shall be prvided fr each client. Day Treatment. A minimum f ten hurs per week f 7

cunseling and/r structured therapeutic activities shall be prvided fr each client. Exceptins t abve frequency f services may be made fr individual clients where it is determined by prgram staff that fewer cntacts are clinically apprpriate and that prgress tward treatment gals is being maintained. Such exceptins shall be nted in the case file. b. Type f Services The need fr the fllwing minimum services must be assessed and, when needed, shall be prvided directly r by referral t an ancillary service. These services include, but are nt limited t: educatin pprtunity; vcatinal cunseling and training; jb referral and placement; legal services; medical services, dental services; scial/recreatinal services; and individual cunseling and grup cunseling fr clients, spuses, parents and ther significant peple. 4. Referral Services T the maximum extent pssible, prgrams shall prvide and utilize cmmunity resurces and dcument referrals in client recrds. If during the curse f treatment it is judged that a client is nt apprpriate fr treatment, r is in need f ther services, the prgram shall prvide the client with a referral t apprpriate alternative services. Prgram plicies and prcedures shall identify the cnditins under which referrals are made, the prcedures fr making and fllwing-up the referrals, and the agencies t which referrals may be made. 8

5. Medical Services a. Emergency. Each prgram shall make prvisins fr emergency medical services fr its clients. b. Cnsulting. Each prgram shall have available, either directly r by referral, a qualified medical cnsultant t ensure quality f medical services. c. Medical Detxificatin. When deemed apprpriate, each prgram shall prvide r refer a client fr medical detxificatin. C. Case Management 1. Establishment, Cntrl and Lcatin f Recrds a. A case file (client recrd) must be established fr each client admitted t the prgram. b. All client recrds are t be maintained and infrmatin released nly in accrdance with 42 CFR, Part 2. 2. Cntents f Recrds All recrds must cntain the fllwing, at minimum: a. Demgraphic and Identifying Data: client identifier (i.e. name, number, etc...); date f birth; sex; race/ethnic backgrund; address; telephne number; next f kin, r emergency cntact (include phne number); cnsent t treatment; 9

referral surce and reasn fr referral; date f admissin; and type f admissin (i.e., new, etc...). b. Intake Data All data gathered during intake (see Sectin II.A.2.) shall appear in the client's recrd. c. Treatment Plan Each client shall have an individual written treatment plan which is based upn the infrmatin btained in the intake and assessment prcesses. The treatment plan shall be develped within 30 days frm the client's admissin. There shall be peridic review and update f the treatment plan at least every 90 days. At minimum, the treatment plan shall include the fllwing: statement f prblems t be addressed in treatment; statement f gal(s) t be reached which address the prblem(s); actin steps which will be taken by prgram and/r client t accmplish gal(s); and target date(s) fr accmplishment f actin step(s), gal(s), and when pssible, reslutin f prblem(s). d. Urine Surveillance Fr thse situatins where drug screening by urinalysis is deemed apprpriate and necessary by the prgram directr, r supervising physician, the prgram shall: establish prcedures which prtect against the falsificatin and/r cntaminatin f any urine sample; dcument urinalysis results in the client's files. 10

e. Other infrmatin required The dcumentatin f all services which shw the relatinship f services t treatment plans (see Sectin II.B.3.). The dcumentatin f quality assurance prcedures (see Sectin II.D.). The dcumentatin f required discharge infrmatin (see Sectin II.F.). Prgress ntes which state clients' prgress tward reaching gal(s). f. Other requirements Client recrd shall be written legibly in ink r typewritten. All entries shall be signed and dated. All significant infrmatin pertaining t a client shall be included in the client's recrd. A standard frmat shall be used fr all recrds. These recrds shall be easily accessible t staff prviding services t the clients. g. Dispsal and Maintenance f Recrds Clsed prgrams - In the case f a prgram clsing, all client recrds shall be stred in an apprpriate cnfidential manner by the Cunty Drug Prgram Administratr fr nt less than fur years. Clsed cases - There shall be a written plicy in all prgrams regarding the maintenance and dispsal f client recrds. All recrds shall be stred in an apprpriate cnfidential manner fr nt less than fur years frm the date they are fficially clsed. D. Quality Assurance Each prgram shall maintain written plicies and prcedures fr quality assurance. The prcedures must include the fllwing: 11

1. Cntinuity f Care The prgram shall prvide fr a staff persn (r persns) respnsible fr the client's cntinuity f care and assurance that, at least, the fllwing activities take place: a. a treatment plan is develped at the earliest practical time after admissin, nt t exceed 30 days; b. the services required are prvided and dcumented in the client recrd; c. failure f the client t keep scheduled appintments is discussed with the client and ther actin taken as apprpriate; d. prgress in achieving the gals and bjectives identified in the treatment plan assessed and dcumented n a cntinuus basis; e. the treatment plan is peridically reviewed and updated, at least 90 days; f. the client's recrd cntains all required dcuments (e.g., crrespndence, authrizatin t release infrmatin, cnsent fr treatment, etc...); and g. if feasible, the client is fllwed-up after treatment as scheduled in the discharge summary. 2. Case and Treatment Plan Reviews a. Case Reviews At minimum, case reviews shall ccur at intake, when treatment plan revisin is apprpriate, and at discharge. The purpse f the dcumented case review is t ensue that: the treatment plan is relevant t the stated prblem(s); the services delivered are relevant t the treatment plan; and recrdkeeping is adequate. 12

b. Treatment Plan Review The treatment plan review shall: assess prgress t date; reassess needs and services; and identify additinal prblem areas and frmulate new gals, when apprpriate. 3. Prgram Evaluatin Each prgram shall have written self-evaluatin prcedures fr management decisin-making, which shall be included in the prgram prtcl. 4. Fllw-up Each prgram shuld have fllw-up prcedures fr clients wh remain in the cmmunity after discharge. 5. Staff Develpment Each prgram shall have a written plan fr training needs f staff. All training events shall be dcumented. 6. Utilizatin Review Each prgram shall have written prcedures fr utilizatin review. 7. Facility Management E. Client Rights Each prgram's facility shall cmply with all applicable lcal, state and federal laws and regulatins. Prcedures shall be develped t ensure that the facility will be maintained in a clean, safe, sanitary, and drug free cnditin. 1. A dcument shall be prepared which shall include the fllwing: a. a statement f nndiscriminatin by race, religin, sex, ethnicity, age, disability, sexual preference, and ability t pay; 13

b. client rights; c. grievance prcedures; d. appeal prcess fr discharge; e. prgram rules and regulatins; f. client fees; and g. access t treatment files in accrdance with Executive Order #B-22/76. A cpy f the dcument shall be prvided t each client upn admissin r psted in a prminent place, accessible t clients. 2. Cnfidentiality - All prgrams shall cmply with 42 CFR, Part 2 and Article 7 (cmmencing with Sectin 5325) f Subchapter 2, Part 1 f Divisin 5 f the Welfare and Institutin Cde. In additin, all methadne prgrams shall cmply with Sectins 11875-11882 f the Health and Safety Cde. 3. Cnsent t Treatment - Each prgram shall develp a cnsent t treatment (r admissin agreement) frm, which shall be read and signed by client upn admissin. This frm shall advise clients f his/her bligatins as well as thse f the prgram. 4. Cnsent fr Fllw-up - The fllw-up after discharge can nt ccur withut a written cnsent frm the client. 5. Research - Any prgram cnducting research using clients s subjects shall cmply with all standards f the Califrnia Research Advisry Panel and the federal regulatins fr prtectin f human subjects (45 CFR 46). F. Discharge Each prgram shall have written prcedures regarding client discharge. These prcedures shall cntain the fllwing. 1. Written criteria fr discharge defining: a. successful cmpletin f prgram; b. unsuccessful discharge; 14

c. invluntary discharge; and d. transfers and referrals. 2. A discharge summary which includes: a. descriptin f treatment episde; b. current drug usage; c. vcatinal/educatinal achievements; d. criminal activity; e. reasn fr discharge; f. clients' discharge plan; and g. referrals. III. GENERAL PROVISIONS A. Each prgram shall develp a written prtcl indicating cmpliance with all f the standards cntained herein which shall be apprved by the apprpriate funding surce(s). B. Request fr exceptins t the standards shall be submitted t the apprpriate funding surce(s) with a full explanatin and justificatin. These exceptins shall be granted nly if the quality f treatment is nt significantly reduced r when applicatin f these standards makes the prgram cst ineffective. 15

Definitins Actin Steps - Specific time limited, verifiable actins f client and/r services, which leads t the accmplishment f treatment plan gals. Admissin - At this pint, the prgram determines that the client meets the admissin criteria and the client signs a cnsent t treatment frm. Appeal Prcess - A written prcedure by which client may appeal discharge. Assessment - The prcess f evaluating a client's prblems, needs, strengths, and weaknesses, s that a treatment plan may be develped r revised. Client/Patient - An individual wh has a drug abuse prblem, fr whm intake prcedures have been cmpleted, and has been admitted t the prgram. Hwever, fr cnfidentiality reasns, a persn becmes a client upn applying fr treatment. Client Recrd - The file established fr each client upn admissin t a prgram which cntains the required infrmatin. Cunseling - A prcess based n a face-t-face client/cunselr cntact r grup/family cunselr interactin fr the purpse f identifying client's prblems and needs, setting gals and interventins, and practicing new behavirs. Cunselr - An individual wh, by virtue f educatin, training, and/r experience, prvide services which may include advice, pinin, r instructin t an individual r grup t allw clients an pprtunity t explre prblems related t directly r indirectly t substance abuse. Day Treatment - A ten-hur, five-day, nn-residential, structured, supervised envirnment t further an individual's ability t live and wrk in the cmmunity. Dcumentatin - Written evidence f cmpliance. 16

Drug Abuse - The use f drugs, licit r illicit, which results in an individual's physical, mental, emtinal, and/r scial impairment. Fllw-up - Prcess fr determining the status f an individual wh has been discharged frm a prgram. Funding Surce - The Cunty (Drug Prgram Administratr) fr prgrams perated thrugh cntracts, with the Cunty, and the State fr prgrams perated by the Cunty r by private rganizatins directly funded by the State. Gverning Bdy - In a gvernment perated prgram it is defined, fr example, as Bard f Supervisrs, City Cuncil; and in a private perated prgram it is defined as Bard f Directrs. Grievance Prcedure - A written prcedure by which a client may prtest alleged vilatin f rights. Intake - The prcess f cllecting and evaluating infrmatin t determine the apprpriateness f a prspective client fr the drug abuse prgram. May - Reflects an acceptable methd that is recgnized but nt necessarily preferred r mandatry. Outpatient Mdality - A nnresidential prgram ffering treatment services. Prgram - An rganized service system which addresses treatment needs f clients. Prgram Evaluatin - A dcumented prcess by which a prgram peridically assesses the quality f treatment services using measurable criteria. Prtcl - A dcument which describes the prgram's prcedures fr cmpliance with these standards as well as ther applicable laws and regulatins. Qualified Medical - A licensed physician r nurse practitiner r a physician Cnsultant assistant perating under the supervisin f a licensed physician. 17