ALCOHOL AND DRUG SAFETY ACTION PROGRAM STANDARDS MANUAL

ALCOHOL AND DRUG SAFETY ACTION PROGRAM STANDARDS MANUAL SEPTEMBER 2010

TABLE OF CONTENTS Introduction... 2 Chapter I: Certification of Program... 3 Chapter II: Client Entry Into Program... 8 Chapter III: Client Fees... 10 Chapter IV: Assessment and Treatment Planning... 12 Chapter V: Intervention and Treatment Services... 14 Chapter VI: Termination and Transfers... 18 Chapter VII: Appeals Procedures... 21 Chapter VIII: Confidentiality... 23 Chapter IX: Interstate Services... 24 Chapter X: Operational Guidelines... 27 Chapter XI: Termination... 34 Chapter XII: Laws Related to Driving Under the Influence... 36 Chapter XIII: Sample Letters and Forms... 44 1

INTRODUCTION The South Carolina Alcohol and Drug Safety Action Program (ADSAP) provides assessment, education, intervention and treatment services mandated by Section 56-5-2990 of the Code of Law of South Carolina 1976, as amended. State law requires successful completion of a certified ADSAP by all individuals who are convicted of driving under the influence (DUI) or driving with an unlawful alcohol concentration (a blood alcohol concentration of.08 percent or greater); are referred by the South Carolina Department of Natural Resources (SCDNR) for boating under the influence (BUI); or have their licenses suspended through the state s Administrative License Revocation (ALR) procedure. (This includes drivers charged under the provisions known as zero tolerance [which targets drivers under age 21] or.15 [which is in addition to a charge of DUI or driving with an unlawful alcohol concentration for drivers who operate a vehicle with a BAC of.15 percent or greater]. An individual also is subject to ALR if he refuses to take a blood, breath, or urine test for the presence of alcohol or other drugs). These individuals must successfully complete ADSAP before they can be eligible for relicensing by the South Carolina Department of Motor Vehicles or reinstatement of their boating privileges by the SCDNR. Upon entering ADSAP, a person is assessed by a privileged ADSAP professional using a clinical assessment to determine the degree of impairment and the risk for another DUI. On the basis of the assessment, a treatment plan is developed. Educational and/or therapeutic services designed to address the goals set forth in the treatment plan are provided by the certified ADSAP. At the conclusion of those services or at the end of the legally imposed participation period, the client s progress toward achieving his/her goals is evaluated. If the goals are successfully achieved, the person is given a successful completion from the ADSAP. If, at the end of the program, there is no evidence that the person has achieved his/her goals, or if there is evidence of continuing highrisk behaviors, the person may be terminated from ADSAP as an unsuccessful completion. The ADSAP immediately informs the unsuccessful participant of this decision and the procedures by which this decision may be appealed. This manual will explain the minimum standards that facilitate the operations of a certified ADSAP. It is designed to provide the privileged ADSAP professional with a framework for reference when providing the services and making decisions involved in this management process. ADSAP staff must keep in mind that the manual delineates basic requirements and recommendations that should be implemented with all ADSAP clients. Certified ADSAPs are encouraged to develop additional procedures that may enhance their individual programming within the framework of these standards. All terms, acronyms, etc., are defined in the text of the manual. In addition, the manual s appendices contain additional information on operational guidelines, termination criteria and laws related to DUI, as well as sample letters and forms. 2

CHAPTER I CERTIFICATION OF PROGRAM Standard 1.1 Each agency providing services under Section 56-5-2990 and Section 56-1-1330 of the 1976 South Carolina Code of Laws, as amended, will be certified as an Alcohol and Drug Safety Action Program (ADSAP) by the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS). 1.1 This standard requires that the agency complete and maintain certification issued by DAODAS. letter of certification DAODAS Block Grant to a county alcohol and drug abuse authority Standard 1.2 Each agency certified as an ADSAP provider will offer a continuum of care in accordance with American Society of Addiction Medicine (ASAM) Levels of Care. The required minimum services to be provided through the continuum of care are the PRIME FOR LIFE curriculum (Level 0.5); Individual and Group Counseling (Level I); Intensive Outpatient Services (Level II); and referral linkages to higher levels of care. Any provider to which an ADSAP client is referred for a higher level of care must meet Standard 1.3 and Standard 1.4. All clients are required to receive a DUI risk assessment and/or clinical biopsychosocial assessment for placement in the appropriate level of care. 1.2 The DUI risk assessment and/or the biopsychosocial assessment will provide the basis for diagnostic classification according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV); placement in the PRIME FOR LIFE curriculum (ASAM Level 0.5), Individual and Group Counseling (Level I); and/or Intensive Outpatient Services (Level II) offered by a certified ADSAP provider; or referral to a higher level of care within the network of county alcohol and drug abuse authorities. certification of services by DAODAS policies and procedures documenting the services that are offered ADSAP client records documenting placement in appropriate levels of care 3

Standard 1.3 Each agency certified as an ADSAP provider in South Carolina is required to have a current license issued by the South Carolina Department of Health and Environmental Control (DHEC) as an addictions treatment program. In addition, each agency certified as an ADSAP provider is required to obtain and maintain current national accreditation either by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the CARF: The Rehabilitation Accreditation Commission for direct client addictions treatment services. 1.3 Each agency must be currently licensed by DHEC and have a current national accreditation for the provision of addictions treatment services by JCAHO or CARF. current DHEC license current certificate of accreditation from JCAHO or CARF Standard 1.4 Each agency operating a certified ADSAP must meet all the requirements in the DAODAS Block Grant to the county alcohol and drug abuse authorities. Certified ADSAP providers must meet all conditions of personnel and programming quality set forth in the official DAODAS Block Grant and documents that contain policies, standards and regulations. 1.4 This standard requires all certified ADSAP providers to comply with all requirements in the DAODAS Block Grant to the county alcohol and drug abuse authorities. Certified ADSAP providers must comply with all ADSAP Standards and program deliverables outlined in the ADSAP Performance Standards and DAODAS Block Grant. current DAODAS Block Grant monitoring report(s) survey report(s) personnel policy training records privileging records evidence of program accessibility for all available levels of care 4

Standard 1.5 Each certified ADSAP provider will use only the DAODAS-designated curriculum and other services within the provider s continuum of care as outlined in each county alcohol and drug abuse authority s DAODAS Block Grant. 1.5 The agency should demonstrate a policy and/or written procedures regarding ADSAP that include the above requirements and those outlined in the county authority s DAODAS Block Grant. Community self-help resources, private facilities or other external services cannot be identified as mandatory requirements for ADSAP completion. agency s ADSAP policy and/or procedures ADSAP client records Standard 1.6 Each certified ADSAP provider will ensure that only certified or in-process group leaders who meet the qualifications designated by DAODAS and have successfully completed the ADSAP group leader certification training will deliver the designated ADSAP curriculum. 1.6 This standard requires that the certified provider demonstrate that all ADSAP group leaders meet the minimum education requirement of a bachelor s degree or possess or have application on file for certification as a Certified Addictions Counselor (CAC). Each inprocess group leader must also complete a minimum of one co-leading experience with a certified ADSAP group leader mentor to complete certification requirements unless the group leader mentor identifies additional practice teaching. The standard will also permit in-process group leaders to deliver the curriculum independent of a co-leader upon satisfactory completion of the mentor co-leader experience. The agency will maintain a copy of the current certificate for all certified group leaders or a copy of the group leader evaluation form for all in-process group leaders. DAODAS ADSAP group leader application copy of group leader certification group leader certificate 5

Standard 1.7 Each certified ADSAP provider will ensure that all certified curriculum (ASAM Level of Care 0.5) group leaders maintain active certification to conduct ADSAP education services. Each certified ADSAP provider will ensure that clinical counselors providing ASAM Level I services (or higher) are credentialed or in process. 1.7 All candidates for group leader re-certification must attend one re-certification training event every two years and conduct three groups using the PRIME FOR LIFE curriculum during that two-year period. If an individual allows his/her group leader certification to expire, he/she must return to in-process status, co-lead one PRIME FOR LIFE group under the supervision of a group leader certified by Prevention Research Institute (PRI), and complete a PRI re-certification training within one year from the date that he/she returns to in-process status. All personnel providing treatment services must maintain active certification as an addictions counselor or be in the process of earning certification. To complete the certification process, a newly trained PRI group leader must co-teach his/her first 16-hour group under the supervision of a staff member from his/her agency. (The supervising individual must have at least two years experience as a certified PRI group leader and must have conducted a complete group using Version 8 of PRIME FOR LIFE.) Prior to certification, a new group leader must also be under clinical supervision at his/her agency. For agencies that do not have an experienced certified group leader who meets the stated requirements, the agency s ADSAP coordinator must select a mentor for the new group leader from the mentoring list certified by PRI. Under these conditions, the mentor will observe the first four sessions conducted by the new group leader. copy of recertification letter or certificate Standard 1.8 Each certified ADSAP provider will maintain records of personnel, privileging/certification and supervision for personnel involved in the delivery of services to ADSAP clients. 1.8 Minimum requirements for group leader records should include an employment and certification application, job description, certification/recertification documentation and evidence of supervision. Records of personnel, privileging and supervision for other program personnel should be up to date and include a job description and qualifications, applicable certification or credentialing, and supervision by staff with advanced knowledge of ADSAP critical functions. personnel, privileging files and supervision records 6

Standard 1.9 All staff providing direct treatment services (ASAM Level I or higher) to ADSAP clients are required to meet the certification and licensing requirements as stated in the DAODAS Block Grant. 1.9 All personnel providing direct treatment services (ASAM Level I or higher) to ADSAP clients will meet the required standards of the DAODAS Block Grant for certification and be privileged by the certified ADSAP provider to provide these services. personnel privileging files Standard 1.10 Each certified ADSAP provider will develop and maintain current operational procedures that guide the delivery of services and compliance with the current performance standards. agency s policy and procedures Standard 1.11 Each certified ADSAP provider will ensure a functional system of case management for ADSAP client records. 1.11 This standard requires that the agency demonstrate a documented system of case management review and monitoring for ADSAP clients. Policy and procedure documents should identify case management protocol, including frequency of reviews. agency s ADSAP and treatment program policy and procedures client records 7

CHAPTER II CLIENT ENTRY INTO PROGRAM Standard 2.1 An initial intake will be conducted with each applicant to determine the eligibility of the applicant to participate in ADSAP. 2.1 Client records should also contain a completed Preliminary Client Record Form, documentation of eligibility or mandate to services by another state, and/or other admission forms. 10-year driving record, a letter of suspension, and court referral form (A copy of the traffic ticket is optional.) interstate referral /interstate documentation of eligibility South Carolina Department of Motor Vehicles Notice of Suspension form Standard 2.1.1 Each applicant must provide proof of one of the following to be eligible for admission to ADSAP services: 1) conviction of driving under the influence (DUI); 2) referral from the South Carolina Department of Natural Resources (SCDNR) for boating under the influence (BUI); or 3) suspension of a driver s license through the state s Administrative License Revocation (ALR) procedure for zero tolerance (which targets drivers under the age of 21), a blood alcohol concentration (BAC) of.15 (which is in addition to a charge of DUI for drivers of any age who operate a vehicle with a BAC of.15 percent or greater), or refusal to take a blood, breath or urine test for the presence of alcohol or other drugs. 2.1.1 Individuals who are South Carolina licensed drivers with a DUI conviction, a BUI suspension, an ALR suspension that occurred in South Carolina, or a DUI violation occurring in another state on a South Carolina driver s license are required to enroll in and complete ADSAP. (NOTE: Applicants who may be declared a habitual offender [offenses that include at least one DUI]; may be declared as forever barred from driving in South Carolina; or have a felony DUI conviction are required to complete ADSAP to be relicensed in South Carolina.) Individuals who physically reside in South Carolina must enroll in services with a certified in-state ADSAP provider or provide evidence of eligibility for interstate ADSAP enrollment (Chapter IX). 10-year driving record, a letter of suspension, and court referral form (A copy of the traffic ticket is optional.) receipt of fine payment 8

SCDNR notice of suspension for BUI DMV Notice of Suspension form client records Standard 2.1.2 Enrollment in and completion of ADSAP will be reported to DAODAS to ensure client compliance with South Carolina relicensing requirements. 2.1.2 The client record should include documentation of DUI conviction or BUI suspension. intake documentation DAODAS management information system (MIS) records Standard 2.2 Each applicant will be informed of the legal requirements to enter and complete ADSAP. 2.2 The agency should conduct an orientation with each client to include information regarding the legal requirements to successfully complete ADSAP and client and program responsibilities related to fees, refunds and other agency-specific requirements for successful completion of the program. Documentation of the activity should be signed by the client acknowledging receipt of orientation activity and related documents. written documentation of orientation activity and orientation documents given to client Standard 2.3 The ADSAP assessment will be conducted within 20 days of the date of intake. 2.3 The ADSAP assessment may be conducted concurrently with the orientation activity but will not exceed 20 days from the date of intake with the agency to enroll in ADSAP. Any client request to delay assessment services should be documented in the clinical record to demonstrate agency compliance with the standard. intake documentation clinical assessment documentation 9

CHAPTER III CLIENT FEES Standard 3.1 Each certified provider will set fees for services rendered by ADSAP in accordance with fees identified by DAODAS and the South Carolina Code of Laws. 3.1 The cost for ADSAP services will not exceed: $75 (seventy-five dollars) for the Driver Risk Inventory-II (DRI-II) and focused interview; $160 (one hundred and sixty dollars) for the DRI-II and biopsychosocial assessment; $500 (five hundred dollars) for education services (including the DRI-II and biopsychosocial assessment); $2,000 (two thousand dollars) for treatment services (including the DRI-II and biopsychosocial assessment; or $2,500 (two thousand and five hundred dollars) for both education and treatment services. policy and procedures client fee agreement billing records Standard 3.2 Each person admitted to an ADSAP in South Carolina will bear the cost of assessment, treatment and/or educational services provided by the certified program or perform community service in lieu of payment as set forth in DUI statutory provisions. 3.2 Each certified ADSAP provider should demonstrate written policy and procedures regarding the assessment and collection of fees related to ADSAP services and procedures to ensure client performance of community service when it is determined that a client is unable to pay for services. Each ADSAP provider will keep a record of all community service hours performed and fees offset by fiscal year. The report will be forwarded to DAODAS by July 31 annually. agency policy regarding fees written fee-assessment and collection procedures client fee agreement fiscal year community services report 10

Standard 3.3 No applicant will be denied access to ADSAP services due to inability to pay for those services. 3.3 A policy developed by the administering agency or the certified ADSAP program should indicate services are not denied due to a client s inability to pay, and this information should be communicated to all clients. agency or program policy community service in lieu of payment report financial assessment Standard 3.4 Each certified provider will ensure completion of a financial assessment to determine client ability to pay for services upon a client s request for a negotiated financial arrangement. 3.4 The certified ADSAP provider will use an approved financial assessment and will ensure service accessibility when inability to pay is reported or determined. The certified ADSAP provider must ensure development of a fee agreement for clients who are unable to pay program costs in accordance with the agency s fee-collection procedures (including initial payment) and must also ensure and provide evidence of a financial assessment for clients who report inability to pay.. financial assessment client fee agreement Standard 3.5 Each program will develop written procedures regarding the refunding of fees associated with ADSAP services and will communicate these procedures to clients during ADSAP orientation. 3.5 The certified ADSAP provider will develop and implement procedures for the refunding of ADSAP fees as appropriate. Communication of refund information should be documented at orientation and should include any refund exceptions as well as the rights and responsibilities of each party. written refund procedures written documentation that the refund procedures information was provided to clients 11

CHAPTER IV ASSESSMENT AND TREATMENT PLANNING Standard 4.1 Each ADSAP client will be assessed by a person who is privileged to determine the extent and nature of an alcohol and other drug abuse problem and services necessary to successfully complete treatment and/or educational services recommended by the ADSAP. 4.1 The DUI risk assessment and clinical assessment should be provided by staff knowledgeable in the diagnostic classifications of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Society of Addiction Medicine (ASAM) placement, and use and interpretation of the approved DUI risk assessment instrument, DUI laws and ADSAP standards, as well as the ability to determine and execute a plan of services necessary for successful completion. privileging files client records Standard 4.1.1 Each client will be administered an objective assessment instrument approved by DAODAS. 4.1.1 The use of the objective assessment instrument may be waived for clients with reading or language comprehension problems (e.g., inability to speak and/or understand English). testing instrument clinical notes Standard 4.2 A service contract or individualized treatment plan will be developed for each client admitted to the ADSAP. 4.2 The service contract must be completed for all clients referred into the educational curriculum to outline all conditions for successful completion when education independent of further services is identified as necessary for risk reduction. An individualized treatment plan must be developed for all clients referred into an ASAM Level I or higher level-of-care placement and will include objective criteria by which achievement or non-achievement of goals can be 12

verified. The goals of the Individualized Treatment Plan should address problems and action needed for DUI risk reduction including completion of the education placement if education and treatment are identified by the assessment. service contract treatment plan clinical service notes ADSAP group note Standard 4.3 The service contract or treatment plan will be signed by the client and staff privileged to deliver ADSAP services. signed service contract signed treatment plan Standard 4.4 Any modification(s) to the ADSAP service contract or treatment plan will be made only during consultation with the client. The client s acknowledgement of the changes made in the service contract or treatment plan will be documented on the contract or treatment plan by the client s signature and date. 4.4 The clinical service note should be used to document the activity and identify interaction with the client related to changes made in the service contract or treatment plan. clinical service notes treatment plan service contract 13

CHAPTER V INTERVENTION AND TREATMENT SERVICES Standard 5.1 Services provided to ADSAP clients will be designed to meet each client s specific DUI offender education and/or treatment needs in the service modality(ies) identified as appropriate by the assessment. 5.1 A client may be exempted from ADSAP participation by a certified ADSAP provider only if the DUI risk assessment and/or clinical assessment and supporting documentation provide information that clearly demonstrates and documents that the client has reduced his risk for DUI and supports the recommendation that no further education, intervention or treatment is warranted. The client file should document, at a minimum: a 10-year driver record; diagnostic information consistent with perceivable DUI risk reduction; no elevation in any of the six ASAM dimensions (if a multiaxial assessment is provided); and no evidence of ASAM continued-stay criteria. If a diagnosis of dependence is established, the documentation should also include current uncomplicated remission, a developed support system, relapse prevention and DUI risk awareness. DUI risk or clinical assessment transfer document(s) from referring state case consultation note Standard 5.2 The education curriculum designated by DAODAS is mandatory for all ADSAP clients recommended for placement in ASAM Level 0.5. All ADSAP clients assessed as needing placement in ASAM Level I or higher may be placed directly in those services, or completion of the education curriculum (ASAM Level 0.5) may be required prior to placement in a higher level of care. for successful completion of ADSAP must be demonstrated through risk reduction. 5.2 The DAODAS-designated curriculum is mandatory for all ADSAP clients recommended for education intervention as the plan for risk reduction, unless special circumstances are identified and documented. All ADSAP clients assessed as needing higher levels of care (ASAM Level I or above) may be placed in those services following the assessment or following completion of the education curriculum (ASAM Level 0.5). All ADSAP clients must demonstrate risk reduction for successful completion. client record 14

Standard 5.3 A client may be removed from any existing ADSAP placement and referred to a placement in a higher level of care if the ADSAP group progress note or any other form of documentation indicates continuous high-risk behaviors, an active substance-dependence diagnosis or other needs that warrant additional services or placement in a higher level of care. 5.3 The client file (including ADSAP curriculum progress note) should document, at a minimum, a substance-dependence diagnosis consistent with substance intoxication, withdrawal or dependence in combination with continuous maladaptive use patterns, unsatisfactory progress in the existing placement, evidence of continuous risk for DUI, and treatment team recommendation. client record staffing notes Standard 5.4 The ADSAP educational curriculum will be delivered in eight sequential sessions and in accordance with the requirements of the DAODAS Block Grant to each county alcohol and drug abuse authority. 5.4 This standard establishes that the number of sessions per week cannot exceed two and that the maximum duration for each session will not exceed two hours of actual group instruction time (excluding breaks). Curriculum delivery will also meet all other conditions outlined in the DAODAS Block Grant related to group size, course content, certification and distribution of participant handbooks. client records Standard 5.5 The ADSAP group note will be used to document and evaluate participation, performance and curriculum-completion status for clients referred into the educational placement. client records 15

Standard 5.5.1 The ADSAP group note will be signed by all group leaders involved in the delivery of the ADSAP education curriculum. client records Standard 5.6 The clinical service note will be used to document and reflect the degree of progress made toward achievement of treatment-plan goal(s) for clients referred into an ASAM Level I or higher level-of-care placement. treatment plan clinical service notes Standard 5.7 The alcohol and other drug testing protocol utilized for assessing use with individual ADSAP clients will be documented in the certified ADSAP agency s policies and procedures. agency s policies and procedures clinical record documentation Standard 5.8 Case management in response to an identified problem will be documented and documentation placed in the clinical record in a timely manner so that corrective action may be taken when problems exist. 5.8 Clients will be informed of problems noted and provided opportunity for corrective action if identified problems jeopardize a successful completion. clinical service notes 16

Standard 5.9 Each certified ADSAP provider will ensure that face-to-face case management contact is made or attempted with clients who have been inactive in program services for 30 days. 5.9 Program inactivity is defined as a period of client non-involvement or non-compliance with program recommendations or requirements. clinical service notes client correspondence Standard 5.10 Each certified ADSAP provider will notify DAODAS using the ADSAP Termination Report Form when there is evidence or information to support that a client holding a provisional driver s license poses a significant threat to public safety while enrolled in ADSAP. The termination decision must then be communicated to the client in writing. 5.10 The determination of a significant threat to public safety will be based on the treatment team consultation or consultation with the state ADSAP coordinator. case consultation note client record ADSAP Termination Report Form correspondence to client Standard 5.11 All ADSAP client records will meet DAODAS Uniform Clinical Record guidelines. administering agency or program policies and procedures client records 17

CHAPTER VI TERMINATION AND TRANSFERS Standard 6.1 Each client will be terminated from ADSAP within 12 months of the date of enrollment in the program. 6.1 The intent of this standard is to ensure that no client enrollment exceeds the enrollment period defined in the DUI statutes. dated ADSAP Enrollment Form ADSAP Termination Report Form Standard 6.1.1 All termination actions will be reported to DAODAS within 10 days of the termination. dated ADSAP Termination Report Form clinical record ADSAP MIS records Standard 6.1.2 A client may be terminated at any time during the enrollment period with sufficient evidence of program non-compliance. 6.1.2 This standard will permit the termination of clients at any time during the program enrollment with sufficient evidence of program non-compliance as identified in the termination criteria (Chapter XI) and is applicable to provisional or relicensing clients. clinical service notes correspondence to client client notification (See Chapter XIII Sample Letter #1) termination criteria (See Chapter XI) 18

Standard 6.2 All ADSAP unsuccessful termination decisions will be made by a treatment team employed by the administrating agency and will be communicated to the client in writing within 10 working days of the termination action. 6.2 At a minimum, the staffing of unsuccessful termination decisions should include the designated ADSAP staff and at least one clinical staff member. Client notification should specify reason(s) for the unsuccessful completion and information on the appeals process. clinical service notes treatment team/staffing notes correspondence to client Standard 6.3 The termination status for each ADSAP participant will be determined from the ADSAP group notes, progress on treatment-plan goal(s) or ADSAP assessment findings. 6.3 Termination status will be based upon the client s DUI risk profile and the client s progress toward reduction of risk-contributing behaviors. Although family-member or significantother participation and community self-help involvement may be therapeutically beneficial, such participation will not be a required condition of the client s successful completion. treatment plan clinical service notes pre- and post-tests ADSAP Termination Report Form Standard 6.3.1 Each certified provider will use the following discharge criteria to determine successful completion of ADSAP: successful completion of the recommended education or treatment service; evidence of reduced risk for re-arrest in areas targeted in the DUI risk assessment and treatment plan; no evidence of DUI arrest or conviction during the course of program participation; and resolution of program fees for the current enrollment. 19

6.3.1 Successful completion of ADSAP will be based upon a determination that every reasonable effort to ensure public safety has been made and that the welfare of the client will not be appreciably endangered by the recommendation for reinstatement of full driving privileges to the client. Standard 6.4 Each certified provider must conduct an exit (post-service) interview with each client referred into an ASAM Level 0.5 (education service) placement to determine discharge status and/or need for further treatment or continuing-care services. Providers may also conduct an exit interview with each client referred into an ASAM Level I or higher level-of-care placement. 6.4 The exit interview may be waived for Level 0.5 (education service) placements, unless the ADSAP group note identifies the need for post-group review or the record reflects client inactivity of 90 days from the final group activity. The exit interview for ASAM Level I or higher placement should consist of face-to-face contact and will be documented in the clinical record. clinical service notes Standard 6.5 Each certified provider will offer and provide continuing care to ADSAP clients as appropriate, regardless of completion status. continuing care plan clinical service notes Standard 6.6 Each certified provider will forward transferring record information to an identified certified ADSAP within 10 working days of the date that the transfer request is made. If the ADSAP provider making the transfer has submitted an ADSAP Enrollment Form to DAODAS for the client, the enrollment will remain open until the client completes ADSAP services with the ADSAP provider to which the transfer was made. The ADSAP provider to whom the transfer was made will complete an ADSAP Termination Report Form and submit it to DAODAS. 20

CHAPTER VII APPEALS PROCEDURES Standard 7.1 Each certified ADSAP provider will develop and follow a policy and/or written procedures concerning the appeals process in accordance with the DAODAS appeals procedures. 7.1 The appeals procedures should include provisions to inform the clients of the procedures, procedures for filing, level of review, timeframes for decision-making, written notification procedures, and the rights and responsibilities of each party. administering agency or certified program s appeals policy and/or written procedures Standard 7.2 Each certified ADSAP provider will inform clients of the right to appeal an unsuccessfulcompletion decision in accordance with the administering agency s or the certified program s appeals policy and procedures as required in Standard 7.1. 7.2 All clients enrolled in a South Carolina ADSAP will be afforded the opportunity to appeal an unsuccessful-completion decision. The appeals process for provisional driver s license enrollees will be offered when the client declines the re-enrollment option and the unsuccessful completion decision is entered in the clinical record. A client may waive the mandated appeal hearing and request an administrative review instead, but must complete a written waiver statement. The administrative review is less formal than the appeals hearing, but there should also be documentation of findings and reason(s) for the decision resulting from the review. client notification of appeals (See Chapter XIII Sample Letter #1) client notification of hearing (See Chapter XIII Sample Letter #2) or client notification of administrative review (See Chapter XIII Sample Letter #3) hearing waiver statement hearing panel or administrative review panel report 21

Standard 7.3 Each certified ADSAP provider will use a hearing and/or administrative review panel to review all ADSAP appeal requests. 7.3 It is recommended that the hearing panel consist of agency staff or other individuals with no conflict of interest or direct program involvement (e.g., director of treatment, a board member, the agency s attorney). hearing panel report (See Chapter XIII Sample Form #1) or review panel report (See Chapter XIII Sample Form #2) Standard 7.4 Each certified ADSAP provider will provide the client with written notification of the outcome of the hearing or administrative-review panel decision. 7.4 Written minutes or taped recording of the hearing or administrative-review proceeding will be maintained by the certified ADSAP and an official report completed (See Chapter XIII Sample Forms #1 and #2). The report is should be housed separately from the clinical records and maintained in the agency or program s official records. The client will be notified in writing of the decision of the hearing or administrative review. client notification of hearing or administrative-review panel decision (See Chapter XIII Sample Letters #4-7) Standard 7.5 An ADSAP client will waive the right to appeal an unsuccessful-completion decision if the client does not request an appeal hearing or administrative review in writing from the certified ADSAP within 30 days of the date of termination. 7.5 The client will be given 30 days from the unsuccessful completion notification date to request an appeal hearing or administrative review. If the appeal or administrative review is not requested within this time, the right to appeal the unsuccessful completion is waived. The client must be notified using Sample Letter #1. client notification of appeals (See Chapter XIII Sample Letter #1) client correspondence 22

CHAPTER VIII CONFIDENTIALITY Standard 8.1 Information gathered pertaining to a client s participation in ADSAP is confidential and will not be released without the client s prior written consent. Consent for the Release of Confidential Information Standard 8.2 The procedures for the communication of information pertaining to a client will be consistent with the confidentiality laws of South Carolina and the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-19 Consent for the Release of Confidential Information 23

CHAPTER IX INTERSTATE SERVICES Standard 9.1 The Interstate ADSAP Office will process all enrollments and terminations for non-residents charged with DUI and BUI violations. Non-residents eligible for processing through the Interstate ADSAP Office include: 1) South Carolina-licensed drivers who have been convicted of DUI or BUI in South Carolina or another state and who reside in another state and meet the out-of-state residency requirements (ADSAP Standard 9.4); and 2) drivers licensed in other states and who reside in other states who are charged with DUI or BUI in South Carolina. 9.1 The Interstate ADSAP Office is the only certified program authorized to process non- transfer interstate ADSAP enrollment and terminations for clients who physically reside in other states. proof of DAODAS Interstate DUI contract monitoring report client record Standard 9.2 The Interstate ADSAP Office will develop and maintain a system of documentation for all admissions and terminations supervised as a result of interstate administrative processing and case management. 9.2 Documentation will include, at a minimum: DUI offender data information; correspondence to and in regard to the identified client; ADSAP enrollment/termination forms; and relevant fee information. Administrative processing for interstate enrollment will consist of intake (initial contact and determination of eligibility for interstate processing), establishing a case file, review of all documentation submitted by or on behalf of the client, and correspondence with the out-of-state client and/or other professionals involved in the delivery of services to the client. Interstate ADSAP Office policies and procedures case file documentation 24

Standard 9.3 The fee for the administrative processing of out-of-state cases will not exceed $125 for interstate enrollment. The administrative fee will be non-refundable after eligibility has been determined and the client has been formally accepted into the Interstate ADSAP. Clients who are not eligible for services will receive a refund within 30 days of a determination of ineligibility. 9.3 The administrative processing fee covers the services/activities provided by the designated Interstate ADSAP Office as stated in Standard 9.1. client records Interstate ADSAP Office policies and procedures Standard 9.4 Only individuals with permanent residence in another state or clients with out-of-state geographical preference due to work or other special circumstance are eligible for interstate administrative processing. 9.4 Clients must provide proof of residence, college attendance, extended work assignment or other special circumstances to justify the interstate-processing request. The program should evaluate location, distance and time before granting an interstate processing. client record a form of verification, inclusive of residence, student or employment eligibility Standard 9.5 The Interstate ADSAP Office will verify client compliance with South Carolina ADSAP requirements for a face-to-face clinical DUI assessment by a state-certified DUI evaluator, licensed or certified substance abuse counselor, or other qualified mental health professional, as well as client completion of education/treatment recommendations from the assessment. Service placement of interstate ADSAP clients will be based on information obtained during the face-toface clinical DUI assessment. Services received by interstate ADSAP clients must meet the requirements in Chapter V. 9.5 Upon contact by an interstate ADSAP client, the Interstate ADSAP Office representative will complete an initial contact form and forward a letter of instruction and application packet. The out-of-state offender will be instructed to complete an application packet. The application packet will include: a request for a current, official 10-year South Carolina 25

driving record and re-instatement requirements from the SCDMV, along with a South Carolina driving record, a release-of-information form to communicate with DAODAS and the SCDMV, a request for proof of residency and a $125 processing fee. The Interstate ADSAP Office representative will notify the client of his/her eligibility status within 10 working days of the date that the packet is received by the Interstate ADSAP Office. The representative will provide contact information for a county ADSAP authority for clients who are ineligible due to residency status. Eligible interstate ADSAP clients will receive an acceptance letter with instructions for completing services, a referral letter indicating the date of the DUI offense(s) and other substance violations, minimum requirements, and the Recommendation for Relicensing (R4R) form. The receiving agency will complete the R4R form when the client has completed all services and return it to the Interstate ADSAP Office. The Interstate ADSAP Office will notify the client of the completion status within 10 working days from receipt of the R4R form. DAODAS will be notified of the completion status within 10 working days of the completion of interstate ADSAP requirements. client record client correspondence enrollment and termination forms Standard 9.6 The Interstate ADSAP Office will only use assessment and discharge documentation by an outof-state provider completed within 12 months of the date of the interstate ADSAP enrollment. 9.6 Only current recommendations for relicensing (those within a 12-month period) will be accepted and credited for ADSAP completion by the Interstate ADSAP Office or any certified ADSAP provider. After the 12-month period, a new assessment is required. dated Recommendation for Relicensing form or letter from qualified out-of-state service provider client record ADSAP Enrollment and Termination Report 26

CHAPTER X OPERATIONAL GUIDELINES The following guidelines have been developed to assist Alcohol and Drug Safety Action Program (ADSAP) personnel with some of the procedural issues involved in the operation of a certified ADSAP. If there are additional questions and/or concerns, please consult the ADSAP Standards or contact the State ADSAP Coordinator. CHAPTER I Program Certification Each agency providing ADSAP services under Section 56-5-2990 and Section 56-1-1330 of the 1976 South Carolina Code of Laws, as amended, must be certified by the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS). Each agency certified as an ADSAP provider will offer a continuum of care in accordance with the American Society of Addiction Medicine (ASAM) Levels of Care. The required minimum services to be provided through the continuum of care are the PRIME FOR LIFE curriculum (Level 0.5); Individual and Group Counseling (Level I); Intensive Outpatient Services (Level II); and referral linkages to higher levels of care. Any provider to which an ADSAP client is referred for a higher level of care must meet Standard 1.3 and Standard 1.4. All clients are required to receive a DUI risk assessment and/or clinical biopsychosocial assessment for placement in the appropriate level of care. Each agency certified as an ADSAP provider in South Carolina is required to have a current license issued by the South Carolina Department of Health and Environmental Control (DHEC) as an addictions treatment program. In addition, each agency certified as an ADSAP provider is required to obtain and maintain current national accreditation for direct client addictions treatment services, either from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or CARF: The Rehabilitation Accreditation Commission. Each agency operating a certified ADSAP must meet all the requirements in the DAODAS Block Grant to the county alcohol and drug abuse authorities. Certified ADSAP providers must meet all conditions of personnel and programming quality set forth in the official DAODAS Block Grant and documents that contain policies, standards, and regulations. Each certified ADSAP provider must comply with all ADSAP-related deliverables outlined in the DAODAS Block Grant and the standards outlined in this manual. All certified ADSAP providers must use the DAODAS-designated curriculum and other services provided in the agency s continuum of care outlined in the DAODAS Block Grant as the only service requirements for ADSAP completion. Each certified ADSAP provider will ensure that only certified or in-process group leaders who meet the qualifications designated by DAODAS and have successfully completed the ADSAP group leader certification training will deliver the designated ADSAP curriculum. 27

Each certified ADSAP provider will ensure that all certified curriculum (ASAM Level of Care 0.5) group leaders maintain active certification to conduct ADSAP education services. Each certified ADSAP provider will ensure that clinical counselors providing ASAM Level I services (or higher) are credentialed or in process. Each certified ADSAP provider will maintain records of personnel, privileging/certification and supervision for personnel involved in the delivery of services to ADSAP clients. All staff providing direct treatment services (ASAM Level I or higher) to ADSAP clients are required to meet the certification and licensing requirements as stated in the DAODAS Block Grant. Each certified ADSAP provider will develop and maintain current operational procedures that guide the delivery of services and compliance with the current performance standards. Each certified ADSAP provider will demonstrate a system of regular and ongoing case management to: 1) review the progress of clients enrolled in ADSAP; 2) provide intervention when problems are identified; and 3) engage clients in services necessary to meet risk reduction. The agency s policy or procedure documents should outline its case-management system. Case management may be carried out by: 1) record review; 2) face-to-face client contact; and/or 3) service-provider or collateral contact. Case-management actions should be documented in the clinical record in a timely manner and communicated to appropriate program staff. CHAPTER II Client Entry Into ADSAP All personnel assigned to handle inquiries about ADSAP must be trained in ADSAP eligibility requirements, intake methods (including fee requirements), and procedures for completion of the ADSAP Enrollment and Termination Form. Only individuals licensed in this state and convicted or charged in another state while possessing a South Carolina driver s license or individuals charged or convicted in this state while licensed in another state are required to complete a South Carolina ADSAP as a result of: 1) a driving under the influence (DUI) violation; 2) a Boating Under the Influence (BUI) violation; or 3) an ALR suspension. (Note: Applicants who may be declared habitual offenders [past offenses that include at least one DUI], declared forever barred, or have a felony DUI conviction are required to complete ADSAP to be relicensed in South Carolina.) Individuals referred by other states to complete a DUI offender program for DUI or related violations that do not involve South Carolina will be placed into ADSAP or the appropriate level of care pending authorization from the licensing state. However, completion of the ADSAP Enrollment and Termination Form is not required. An applicant must have one of the following to meet ADSAP eligibility: 1) conviction for DUI in South Carolina or conviction for DUI in another state while licensed by South Carolina; 2) suspension of driving privileges resulting from violation of the South Carolina Zero Tolerance law, refusal to submit to breath or urine test, or registering a blood alcohol concentration (BAC) 28

of.15% or greater; or 3) suspension of boating privileges resulting from conviction for BUI. Any proof of the suspension or conviction may be used. Enrollment in ADSAP must occur after an orientation activity has been conducted to inform clients, at a minimum, of the legal requirements to enroll and successfully complete ADSAP. Prepayment of fees is not a requirement for ADSAP intake or enrollment. Each applicant will be informed of the legal requirements to enter and complete ADSAP. Enrollment in and completion of ADSAP will be reported to DAODAS to ensure client compliance with South Carolina relicensing requirements. The ADSAP assessment will be conducted within 20 days of the date that the client requests services. CHAPTER III Client Fees The cost of ADSAP services cannot exceed $500 for education services or $2,000 for treatment services and cannot exceed $2,500 in total for all services in accordance with the law. The fees for education and treatment include the DUI risk assessment. Charges for the clinical assessment must be billed at the approved rate and applied to clients who receive a clinical assessment for treatment or assessment to support exemption of program services. The education-group cost also includes the participant s study guide used with the curriculum. Fees for rescheduling of the curriculum group are prohibited. Each certified ADSAP provider must conduct a financial assessment upon client notification of inability to meet contracted fees or establish a payment plan. No client will be denied services due to inability to pay. Community service will be assigned when a client demonstrates inability to pay in accordance with DUI statutory provisions. Refund policies must be communicated during orientations and must address all applicable conditions. Prorated refunds must detail the method for prorating and must adhere to the agency s refund policy and procedures distributed during orientation. CHAPTER IV Assessment and Treatment Planning Each ADSAP client must be assessed by agency personnel privileged to provide the DUI risk assessment or clinical assessment. Staff may be privileged to provide the DUI risk assessment upon completion of the minimum training requirements outlined below; however, all biopsychosocial assessments must be provided by credentialed staff. Each certified ADSAP provider must use the DAODAS-approved assessment instrument and must ensure that all personnel involved in the administration of the instrument receive training in the use of the assessment instrument. 29