Section 441.24.39. Crisis stabilization residential services (CSRS).

Crisis stabilization residential services are short-term services provided in facility-based settings of no more than 16 beds. The goal of CSRS is to stabilize and reintegrate the individual back into the community. Crisis stabilization residential services are designed for voluntary individuals who are in need of a safe, secure environment less intensive and restrictive than an inpatient hospital. Crisis stabilization residential services have the capacity to serve more than two individuals at a time. Crisis stabilization residential services can be for youth aged 18 and younger or adults aged 18 and older. Youth and adults cannot be housed in the same facility setting. Facilities licensed by the department of inspections and appeals for other services would have to comply with the provisions of Iowa Administrative Code rule 481—57.50(135C) for operating another business or activity in the facility.

         24.39(1) Eligibility. To be eligible, an individual must:

            a.               Be an adult aged 18 or older or a youth aged 18 or under.

            b.               Be determined appropriate for the service by a mental health assessment; and

            c.               Be determined to not need inpatient acute hospital psychiatric services.

         24.39(2) Staffing requirements.

            a.               A designated director or administrator is responsible for the management and operation of the CSRS of no more than 16 beds.

            b.               At least one licensed mental health professional is available for consultation 24 hours a day, 365 days a year.

            c.               Crisis stabilization residential services are provided by a mental health professional with expertise appropriate to the individual’s needs.

            d.               Each individual has contact with a mental health professional at least one time a day.

            e.               Each individual has a minimum of one hour per day of additional services provided by crisis response staff including, but not limited to, skill building, peer support or family support peer services; or other therapeutic programming.

            f.                Awake and attentive staffing 24 hours a day, 365 days a year is provided.

         24.39(3) Performance benchmark. The individual is provided safe, secure and structured crisis stabilization services in the least restrictive location meeting the individual’s needs.

         24.39(4) Performance indicators.

            a.               Individual’s consent is documented, and treatment providers, family members and other natural supports are contacted within 24 hours of admission.

            b.               A comprehensive mental health assessment is completed within 24 hours of admission.

            c.               Daily crisis stabilization includes, at minimum, daily contact with a mental health professional and one hour of additional crisis stabilization service.

            d.               The length of stay is expected to be less than five days.

            e.               The number of days an individual receives crisis stabilization services is documented. The documentation records specific reasons for lengths of stay beyond five days.

            f.                Records include:

             (1)             Stabilization plan.

             (2)             Medication record.

             (3)             Treatment summary.

             (4)             Daily contact with a mental health professional.

            g.               Additional services provided include, but are not limited to, skill building, peer support or family support peer services.

            h.               Individual choice is verified including, but not limited to, treatment participation and discharge plan options.

            i.                Data of readmission is tracked including an analysis of data trends, looking at effectiveness, and appropriate corrective action. The information is documented in the performance improvement system.

            j.                Documentation tracks that the youth’s education needs are met with educational services received in the CSRS, and an action plan is in place to return the youth to school upon discharge.

         24.39(5) Crisis stabilization incident reporting.

            a.                Performance benchmark. An incident report is completed when staff are notified an incident has occurred.

            b.                Performance indicators.

             (1)             The incident report documents:

            1.      The name of the individual who was involved in the incident.

            2.      Date and time of occurrence of the incident.

            3.      A description of the incident.

            4.      Names and signatures of all staff present at the time of the incident.

            5.      The action staff took to handle the situation.

            6.      The resolution or follow-up to the incident.

             (2)             A copy of the incident report is maintained in a centralized file and a copy given to the individual, the mental health and disability services region, and the parent or guardian when appropriate.

         24.39(6) Service requirements.

            a.                Stabilization plan. The individual is involved collaboratively in all aspects of crisis stabilization services including, but not limited to, admission, treatment planning, intervention, and discharge. The involvement of family members and others is encouraged.

Within 24 hours of admission to CSRS, a written short-term stabilization plan is developed, with the involvement and consent of the individual, and reviewed frequently to assess the need for continued placement in CSRS. At a minimum, this plan includes:

             (1)             Criteria for discharge, including referrals and linkages to appropriate services and coordination with other systems.

             (2)             Description of any physical disability and accommodations necessary to provide the same or equal services and benefits as those afforded nondisabled individuals.

             (3)             Evidence of input by the individual, including the individual’s signature.

             (4)             Goal statement.

             (5)             Goals consistent with needs and projected length of stay.

             (6)             Objectives that are built on strengths and allow measurement of progress.

             (7)             Rights restrictions.

             (8)             Signatures of all participating in the development of the plan.

             (9)             Specification of treatment responsibilities and methods.

            b.                Performance benchmark. A stabilization plan is completed within 24 hours of admittance.

            c.                Performance indicators.

             (1)             Records include a written short-term stabilization plan developed with the involvement and consent of the individual within 24 hours of admission and is reviewed frequently to assess the need for continued placement in CSRS.

             (2)             Records indicating a stabilization plan has been completed within the 24-hour time frame are maintained.

             (3)             Reasons the stabilization plan does not meet the criteria is documented.

             (4)             A follow-up appointment with the individual’s preferred provider will be made, and crisis response staff will follow up with the individual and document contact or attempt to contact on a periodic basis until the appointment takes place.

         24.39(7) Treatment summary. Prior to discharge, a treatment summary is provided and a copy shared with the individual and treatment team as appropriate.

            a.                Contents. At a minimum, this treatment summary includes:

             (1)             Course and progress regarding each identified problem.

             (2)             Documentation of daily contact with a mental health professional.

             (3)             Impact on placement and support decisions.

             (4)             Assessment.

             (5)             Action plan.

             (6)             Stabilization plan.

             (7)             Treatment interventions.

             (8)             Reasons for termination of service.

             (9)             Signature of the mental health professional.

            b.                Performance benchmark. A treatment summary is completed during the individual’s length of stay in CSRS.

            c.                Performance indicators.

             (1)             Records include a written treatment summary developed with the involvement and consent of the individual.

             (2)             An individual receives a copy of the treatment summary upon discharge.

             (3)             Corrective action steps are documented when treatment plans are not completed within the length of stay.

         24.39(8) Health and safety.

            a.                Performance benchmarks.

             (1)             Emergency preparedness policies and procedures include health and safety measures.

             (2)             Crisis stabilization services meet all applicable local, state and federal regulations.

             (3)             Medication administration and documentation standards in rule 441—24.40(225C) are documented.

            b.                Performance indicators.

             (1)             Health and fire safety inspections.

            1.      Documentation includes Iowa fire marshal rules and fire ordinances, local health, fire, occupancy code, and safety regulations.

            2.      Standards for public facilities guide food and beverage safety, nutrition standards, and safe storage of all consumable products.

            3.      Crisis stabilization residential services comply with rule 441—24.40(225C).

             (2)             Emergency preparedness. Emergency preparedness policies are designed to provide effective utilization of available resources for continuation during a disaster event, including, but not limited to, cases of severe weather or fire.

             (3)             The facility is safe, clean, well-ventilated, and a properly heated environment in good repair and free from vermin.

             (4)             Bedrooms include:

            1.      A sturdily constructed bed.

            2.      A sanitized mattress protected with a clean mattress pad.

            3.      A designated space in proximity to the sleeping area for personal possessions including clothing.

            4.      Curtains or window blinds on bedroom windows.

            5.      Available clean linens.

             (5)             Sleeping areas include:

            1.      Doors for privacy.

            2.      Partitioning and placement of furniture to provide privacy.

            3.      Rooms accommodate no more than two per room. Single room dimensions are at least 80 square feet not including closets. Dual occupancy rooms are at least 120 square feet not including closets.

            4.      Personal belongings and personal touches in the rooms are defined within CSRS policy.

            5.      Respect by staff for an individual’s right to privacy.

             (6)             Personal hygiene and privacy tools are provided:

            1.      A safe supply of hot and cold running water which is potable.

            2.      Clean towels, electric hand dryers or paper towel dispensers, and an available supply of toilet paper and soap.

            3.      Natural or mechanical ventilation capable of removing odors.

            4.      Tubs or showers with slip-proof surfaces.

            5.      Partitions with doors which provide privacy if a bathroom has multiple toilet stools.

            6.      Toilets, wash basins, and other plumbing or sanitary facilities are in good operating condition.

            7.      Privacy in bathrooms for male and female individuals.

             (7)             Federal laws regarding smoking on property are recognized and followed.

             (8)             The following is provided:

            1.      Areas in which an individual may be alone when appropriate.

            2.      Areas for private conversations with others.

            3.      A secure space for personal belongings.

            c.                Housekeeping. Maintenance of living quarters and day-to-day housekeeping activities are clearly defined in writing and a part of the orientation. Staff assistance and equipment are provided as needed.

            d.                Clothing.

             (1)             Personal clothing is allowed in accordance with CSRS policy.

             (2)             Clothing may be washed with provided laundry mechanisms.

            e.                Religion/culture. Rights to religion and culture include:

             (1)             The opportunity to participate in religious activities and services in accordance with the individual’s faith or of a minor individual’s parent(s) or guardian.

             (2)             Arrange for transportation to religious activities when appropriate per CSRS policy.

            f.                 Smoking. The smokefree air Act, Iowa Code chapter 142D, is included in the CSRS policy.

[ARC 1660C, IAB 10/15/14, effective 12/1/14]