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Iowa Administrative Rules (Last Updated: December 07, 2016) |
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Department 441. Human Services Department |
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Chapter 24. ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, INTELLECTUAL DISABILITIES, OR DEVELOPMENTAL DISABILITIES |
Section 441.24.4. Standards for services.
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Providers for the services set forth in subrules 24.4(9) through 24.4(13) shall meet the standards in subrules 24.4(1) through 24.4(8) in addition to the standards for the specific service. Providers of outpatient psychotherapy and counseling services shall also meet standards in subrules 24.4(1), 24.4(2), 24.4(4), 24.4(6), 24.4(7), and 24.4(8). Providers of emergency services or evaluation services shall meet the benchmark for the services they provide.
24.4(1) Social history.
a. Performance benchmark. The organization completes a social history for each individual served.
b. Performance indicators.
(1) The organization collects and documents relevant historical information and organizes the information in one distinct document in a narrative format.
(2) The social history includes:
1. Relevant information regarding the onset of disability.
2. Family, physical, psychosocial, behavioral, cultural, environmental, and legal history.
3. Developmental history for children.
4. Any history of substance abuse, domestic violence, or physical, emotional, or sexual abuse.
(3) Staff review and update the social history at least annually.
24.4(2) Assessment.
a. Performance benchmark. The organization develops a written assessment for each individual served. The assessment is the basis for the services provided to the individuals.
b. Performance indicators.
(1) The assessment includes information about the individual’s current situation, diagnosis, needs, problems, wants, abilities and desired results, gathered with the individual’s involvement.
(2) Staff solicit collateral provider information as appropriate to the individual situation in order to compile a comprehensive and full assessment.
(3) Staff develop and complete the assessment in a narrative format.
(4) Staff base decisions regarding the level, type and immediacy of services to be provided, or the need for further assessment or evaluation, upon the analysis of the information gathered in the assessment.
(5) Staff complete an annual reassessment for each individual using the service and document the reassessment in a written format.
(6) Documentation supporting the diagnosis is contained in the individual’s record. A diagnosis of mental retardation is supported by a psychological evaluation conducted by a qualified professional. A diagnosis of developmental disability is supported by professional documentation. A determination of chronic mental illness is supported by a psychiatric or psychological evaluation conducted by a qualified professional.
24.4(3) Individual service plan.
a. Performance benchmark. Individualized, planned, and appropriate services are guided by an individual-specific service plan developed in collaboration with the individual using the service, staff, and significantly involved others as appropriate. Services are planned for and directed to where the individuals live, learn, work, and socialize.
b. Performance indicators.
(1) The service plan is based on the current assessment.
(2) The service plan identifies observable or measurable individual goals and action steps to meet the goals.
(3) The service plan includes interventions and supports needed to meet those goals with incremental action steps, as appropriate.
(4) The service plan includes the staff, people, or organizations responsible for carrying out the interventions or supports.
(5) Services defined in the service plan are appropriate to the severity level of problems and specific needs or disabilities.
(6) The plan reflects desired individual outcomes.
(7) Activities identified in the service plan encourage the ability and right of the individual using the service to make choices, to experience a sense of achievement, and to modify or continue participation in the treatment process.
(8) Staff monitor the service plan with review occurring regularly. At least annually, staff assess and revise the service plan to determine achievement, continued need, or change in goals or intervention methods. The review includes the individual using the service, with the involvement of significant others as appropriate.
(9) Staff develop a separate, individualized, anticipated discharge plan as part of the service plan that is specific to each service the individual receives.
(10) The service plan includes documentation of any rights restrictions, why there is a need for the restriction, and a plan to restore those rights or a reason why a plan is not necessary or appropriate.
24.4(4) Documentation of service provision.
a. Performance benchmark. Individualized and appropriate intervention services and treatments are provided in ways that support the needs, desires, and goals identified in the service plan, and that respect the rights and choices of the individual using the service.
b. Performance indicators.
(1) Staff document in the narrative the individual’s participation in the treatment process.
(2) Responsible staff document the individual’s progress toward goals, the provision of staff intervention, and the individual’s response to those interventions.
(3) Documentation of service provision is in a written, legible, narrative format in accordance with organizational policies and procedures.
24.4(5) Incident reports.
a. Performance benchmark. The organization completes an incident report when organization staff first become aware that an incident has occurred.
b. Performance indicators.
(1) The organization documents the following information:
1. The name of the individual served who was involved in the incident.
2. The date and time the incident occurred.
3. A description of the incident.
4. The names of all organization staff and others who were present or responded at the time of the incident. (For confidentiality reasons, other individuals who receive services should be identified by initials or some other accepted means.)
5. The action the organization staff took to handle the situation.
6. The resolution of or follow-up to the incident.
(2) The staff who were directly involved at the time of the incident or who first became aware of the incident prepare and sign the incident report before forwarding it to the supervisor.
(3) Staff file a copy of the completed incident report in a centralized location and make a notation in the individual’s file.
(4) Staff send a copy of the incident report to the individual’s Medicaid targeted case manager or county case worker who is involved in funding the service and notify the individual’s legal guardian within 72 hours of the incident.
24.4(6) Confidentiality and legal status.
a. Performance benchmark. Staff release medical and mental health information only when properly authorized.
b. Performance indicators.
(1) The organization obtains voluntary written authorization from the individual using the service, the individual’s legal guardian, or other people authorized by law before releasing personal identifying information, medical records, mental health records, or any other confidential information.
(2) Staff complete voluntary written authorization forms in accordance with existing federal and state laws, rules, and regulations and maintain them in each individual file.
(3) Documentation regarding restrictions on the individual, such as guardianship, power of attorney, conservatorship, mental health commitments, or other court orders, is placed in the individual’s record, if applicable.
24.4(7) Service systems.
a. Performance benchmark. The organization develops a clear description of each of the services offered. The organization develops an admission and discharge system of services. Staff coordinate services with other settings and providers.
b. Performance indicators.
(1) The organization has established and documented the necessary admission information to determine each individual’s eligibility for participation in the service.
(2) Staff include verification in each individual’s file that a service description was provided to the individual using the service and, when appropriate, to family or significant others.
(3) Continuity of services occurs through coordination among the staff and professionals providing services. Coordination of services through linkages with other settings and providers has occurred, as appropriate.
(4) Staff include a written discharge summary in each individual record at the time of discharge.
24.4(8) Respect for individual rights.
a. Performance benchmark. Each individual using the service is recognized and respected in the provision of services, in accordance with basic human, civil, and statutory rights.
b. Performance indicators.
(1) Staff provide services in ways that respect and enhance the individual’s sense of autonomy, privacy, dignity, self-esteem, and involvement in the individual’s own treatment. Staff take language barriers, cultural differences, and cognitive deficits into consideration and make provisions to facilitate meaningful individual participation.
(2) Staff inform individuals using the service and, when appropriate, family and significant others of their rights, choices, and responsibilities.
(3) The organization has a procedure established to protect the individuals using the service during any activities, procedure or research that requires informed consent.
(4) The organization verifies that individuals using the service and their guardians are informed of the process to express questions, concerns, complaints, or grievances about any aspect of the individual’s service, including the appeal process.
(5) The organization provides the individuals and their guardians the right to appeal the application of policies, procedures, or any staff action that affects the individual using the service. The organization has established written appeal procedures and a method to ensure that the procedures and appeal process are available to individuals using the service.
(6) All individuals using the service, their legal representatives, and other people authorized by law have access to the records of the individual using the service in accordance with state and federal laws and regulations.
24.4(9) Case management services. “Case management services” means those services established pursuant to Iowa Code section 225C.20.
a. Performance benchmark. Case management services link individuals using the service to service agencies and support systems responsible for providing the necessary direct service activities and coordinate and monitor those services.
b. Performance indicators.
(1) Staff clearly define the need for case management and document it annually.
(2) At a minimum, the team is composed of the individual using the service, the case manager, and providers or natural supports relevant to the individual’s service needs. The team may also include family members, at the discretion of the individual using the service.
(3) The team works with the individual using the service to establish the service plan that guides and coordinates the delivery of the services.
(4) The case manager advocates for the individual using the service.
(5) The case manager coordinates and monitors the services provided to the individual using the service.
(6) Documentation of contacts includes the date, the name of the individual using the service, the name of the case manager, and the place of service.
(7) The case manager holds individual face-to-face meetings at least quarterly with the individual using the service.
(8) Case managers do not provide direct services. Individuals using the service are linked to appropriate resources, which provide necessary direct services and natural supports.
(9) Individuals using the service participate in developing an individualized crisis intervention plan that includes natural supports and self-help methods.
(10) Documentation shows that individuals using the service are informed about their choice of providers as provided in the county management plan.
(11) Within an accredited case management program, the average caseload is no more than 45 individuals per each full-time case manager. The average caseload of children with serious emotional disturbance is no more than 15 children per full-time case manager.
(12) The case manager communicates with the team and then documents in the individual’s file a quarterly review of the individual’s progress toward achieving the goals.
24.4(10) Day treatment services. “Day treatment” means an individualized service emphasizing mental health treatment and intensive psychosocial rehabilitation activities designed to increase the individual’s ability to function independently or facilitate transition from residential placement. Staff use individual and group treatment and rehabilitation services based on individual needs and identified behavioral or mental health issues.
a. Performance benchmark. Individuals using the service who are experiencing a significantly reduced ability to function in the community are stabilized and improved by the receipt of psychosocial rehabilitation, mental health treatment services, and in-home support services, and the need for residential or inpatient placement is alleviated.
b. Performance indicators.
(1) Individuals using the service participate with the organizational staff in identifying the problem areas to be addressed and the goals to be achieved that are based on the individual’s need for services.
(2) Individuals using the service receive individualized services designed to focus on those identified mental health or behavioral issues that are causing significant impairment in their day-to-day functioning.
(3) Individuals who receive intensive outpatient and day treatment services receive a comprehensive and integrated schedule of recognized individual and group treatment and rehabilitation services.
(4) Individuals using the service and staff review their progress in resolving problems and achieving goals on a frequent and regular basis.
(5) Individuals using the service receive services appropriate to defined needs and current risk factors.
(6) Individuals using the service receive services from staff who are appropriately qualified and trained to provide the range and intensity of services required by the individual’s specific problems or disabilities. A mental health professional provides or directly supervises the provision of treatment services.
(7) Individuals using the service participate in discharge planning that focuses on coordinating and integrating individual, family, and community and organization resources.
(8) Family members of individuals using the service are involved in the planning and provision of services, as appropriate and as desired by the individual.
(9) Individuals using the service participate in developing a detailed psychiatric crisis intervention plan that includes natural supports and self-help methods.
24.4(11) Intensive psychiatric rehabilitation services. “Intensive psychiatric rehabilitation services” means services designed to restore, improve, or maximize level of functioning, self-care, responsibility, independence, and quality of life; to minimize impairments, disabilities, and disadvantages of people who have a disabling mental illness; and to prevent or reduce the need for services in a hospital or residential setting. Services focus on improving personal capabilities while reducing the harmful effects of psychiatric disability, resulting in an individual’s recovering the ability to perform a valued role in society.
a. Performance benchmark. Individuals using the service who are experiencing a significantly reduced ability to function in the community due to a disability are stabilized and experience role recovery by the receipt of intensive psychiatric rehabilitation services.
b. Performance indicators.
(1) Individuals using the service receive services from staff who meet the definition of intensive psychiatric rehabilitation practitioner. The intensive psychiatric rehabilitation supervisor has at least a bachelor’s degree in a human services field and 60 hours of training in intensive psychiatric rehabilitation.
(2) Individuals using the service receive four to ten hours per week of recognized psychiatric rehabilitation services. All services are provided for an identified period.
(3) Whenever possible, intensive psychiatric rehabilitative services are provided in natural settings where individuals using the service live, learn, work, and socialize.
(4) Significantly involved others participate in the planning and provision of services as appropriate and as desired by the individual using the service.
(5) Individuals using the service participate in developing a detailed psychiatric crisis intervention plan that includes natural supports and self-help methods.
(6) A readiness assessment is initially completed with staff to assist the individual in choosing a valued role and environment. The readiness assessment culminates in a score that documents the individual’s motivational readiness.
(7) During the readiness development phase, staff document monthly in the individual’s file changes in the individual’s motivational readiness to choose valued roles and environments.
(8) During the goal-choosing phase, staff and the individual identify personal criteria, describe alternative environments, and choose the goal. These activities are documented in the individual’s file.
(9) During the goal-achieving phase, the functional assessment and resource assessment are completed. Skill programming or skill teaching takes place. These activities are documented in the individual’s file.
(10) During goal keeping, individuals using the service participate in discharge planning that focuses on coordinating and integrating individual, family, community, and organization resources for successful community tenure and the anticipated end of psychiatric rehabilitation services. Staff document increases in skill acquisition and skill competency.
(11) Staff document any positive changes in environmental status, such as moving to a more independent living arrangement, enrolling in an education program, getting a job, or joining a community group.
(12) On an ongoing basis and at discharge, staff or the individual using the service documents the level of individual satisfaction with intensive psychiatric rehabilitation services in each individual’s file.
24.4(12) Supported community living services. “Supported community living services” means those services provided to individuals with a mental illness, mental retardation, or developmental disability to enable them to develop supports and learn skills that will allow them to live, learn, work and socialize in the community. Services are individualized, need- and abilities-focused, and organized according to the following components: outreach to appropriate support or treatment services; assistance and referral in meeting basic human needs; assistance in housing and living arrangements; crisis intervention and assistance; social and vocational assistance; the provision of or arrangement for personal, environmental, family, and community supports; facilitation of the individual’s identification and development of natural support systems; support, assistance, and education to the individual’s family and to the community; protection and advocacy; and service coordination.
These services are to be provided by organizational staff or through linkages with other resources and are intended to be provided in the individual’s home or other natural community environment where the skills are learned or used. Supported community living is not part of an organized mental health support or treatment group, drop-in center, or clubhouse. Skill training groups may be one of the activities in the service plan and part of supported community living. Skill training groups cannot stand alone as a supported community living service.
a. Performance benchmark. Individuals using the service live, learn, work, and socialize in the community.
b. Performance indicators.
(1) Individuals receive services within their home and community setting where the skills are learned or used.
(2) At intake, the individuals using the service participate in a functional assessment to assist in defining areas of service need and establishing a service plan. Staff summarize the findings of the functional assessment in a narrative that describes the individual’s current level of functioning in the areas of living, learning, working, and socialization. Staff review functional assessments on a regular basis to determine progress.
(3) Individuals using the service receive skill training and support services directed to enabling them to regain or attain higher levels of functioning or to maximize functioning in the current goal areas.
(4) Services are delivered on an individualized basis in the place where the individual using the service lives or works.
(5) Documentation that steps have been taken to encourage the use of natural supports and develop new ones is in the individual file.
(6) Individuals using the service participate in developing a detailed individualized crisis intervention plan that includes natural supports and self-help methods.
24.4(13) Partial hospitalization services. “Partial hospitalization services” means an active treatment program providing intensive group and individual clinical services within a structured therapeutic environment for individuals who are exhibiting psychiatric symptoms of sufficient severity to cause significant impairment in day-to-day functioning. Short-term outpatient crisis stabilization and rehabilitation services are provided to avert hospitalization or to transition from an acute care setting. Services are supervised and managed by a mental health professional, and psychiatric consultation is routinely available. Clinical services are provided by a mental health professional.
a. Performance benchmark. Individuals who are experiencing serious impairment in day-to-day functioning due to severe psychiatric distress are enabled to remain in their community living situation through the receipt of therapeutically intensive milieu services.
b. Performance indicators.
(1) Individuals using the service and staff mutually develop an individualized service plan that focuses on the behavioral and mental health issues and problems identified at admission. Goals are based on the individual’s need for services.
(2) Individuals using the service receive clinical services that are provided and supervised by mental health professionals. A licensed and qualified psychiatrist provides psychiatric consultation and medication services.
(3) Individuals using the service receive a comprehensive schedule of active, planned, and integrated psychotherapeutic and rehabilitation services provided by qualified professional staff.
(4) Individuals using the service receive group and individual treatment services that are designed to increase their ability to function independently.
(5) Individuals using the service are involved in the development of an anticipated discharge plan that includes linkages to family, provider, and community resources and services.
(6) Individuals using the service have sufficient staff available to ensure their safety, to be responsive to crisis or individual need, and to provide active treatment services.
(7) Individuals using the service receive services commensurate with current identified risk and need factors.
(8) Support systems identified by individuals using the service are involved in the planning and provision of services and treatments as appropriate and desired by the individual using the service.
(9) Individuals using the service participate in developing a detailed psychiatric crisis intervention plan that includes natural supports and self-help methods.
24.4(14) Outpatient psychotherapy and counseling services. “Outpatient psychotherapy and counseling services” means a dynamic process in which the therapist uses professional skills, knowledge and training to enable individuals using the service to realize and mobilize their strengths and abilities, take charge of their lives, and resolve their issues and problems. Psychotherapy services may be individual, group, or family, and are provided by a person meeting the criteria of a mental health professional or by a person with a master’s degree or an intern working on a master’s degree in a mental health field who is directly supervised by a mental health professional.
a. Performance benchmark. Individuals using the service realize and mobilize their own strengths and abilities to take control of their lives in the areas where they live, learn, work, and socialize.
b. Performance indicators.
(1) Individuals using the service are prepared for their role as partners in the therapeutic process at intake where they define their situations and evaluate those factors that affect their situations.
(2) Individuals using the service establish desired problem resolution at intake during the initial assessment.
(3) Psychiatric services other than psychopharmacological services are available from the organization as needed by the individual using the service.
(4) Psychopharmacological services are available from the organization as needed.
(5) Staff document mutually agreed-upon treatment goals during or after each session. A distinct service plan document is not required.
(6) Staff document mutually agreed-upon supports and interventions during or after each session. A distinct service plan document is not required.
(7) Staff document in the progress notes the individual’s status at each visit and the reasons for continuing or discontinuing services. A distinct discharge summary document is not required.
(8) Any assignment of activities to occur between sessions is documented in the following session’s documentation.
(9) Individuals using the service who have a chronic mental illness participate in developing a detailed psychiatric crisis intervention plan that includes natural supports and self-help methods.
(10) The record documents that the organization follows up on individuals who miss appointments.
24.4(15) Emergency services. “Emergency services” means crisis services that provide a focused assessment and rapid stabilization of acute symptoms of mental illness or emotional distress and are available and accessible, by telephone or face-to-face, on a 24-hour basis. The clinical assessment and psychotherapeutic services are provided by a person who has training in emergency services and who is a mental health professional or has access to a mental health professional, at least by telephone.
Services may be provided by a person who holds a master’s degree in a mental health field including, but not limited to, psychology, counseling and guidance, psychiatric nursing, psychiatric rehabilitation, or social work; or a person who holds a bachelor’s degree in a human service discipline with five years’ experience providing mental health services or human services; or a psychiatric nurse who has three years of clinical experience in mental health. A comprehensive social history is not required for this treatment.
a. Performance benchmark. Individuals using the service receive emergency services when needed that provide a focused assessment and rapid stabilization of acute symptoms of mental illness or emotional distress.
b. Performance indicators.
(1) Individuals using the service can access 24-hour emergency services by telephone or in person.
(2) Information about how to access emergency services is publicized to facilitate availability of services to individuals using the service, family members, and the public.
(3) Individuals using the service receive assessments and services from either a mental health professional or from personnel who meet the requirements above and are supervised by a mental health professional. Psychiatric consultation is available, if needed.
(4) Individuals using the service receive intervention commensurate with current identified risk factors.
(5) Significantly involved others are involved as necessary and appropriate to the situation and as desired by the individual using the service.
(6) Individuals using the service are involved in the development of postemergency service planning and resource identification and coordination.
(7) Staff document contacts in a narrative format and maintain them in a central location that will allow timely response to the problems presented by the individual using the service.
(8) Timely coordination of contacts with relevant professionals is made.
24.4(16) Evaluation services. “Evaluation services” means screening, diagnosis and assessment of individual and family functioning needs, abilities, and disabilities, and determining current status and functioning in the areas of living, learning, working, and socializing.
a. Performance benchmark. Individuals using the service receive comprehensive evaluation services that include screening, diagnosis, and assessment of individual or family functioning, needs and disabilities.
b. Performance indicators.
(1) Evaluations include screening, diagnosis, and assessment of individual or family functioning, needs, abilities, and disabilities.
(2) Evaluations consider the emotional, behavioral, cognitive, psychosocial, and physical information as appropriate and necessary.
(3) Evaluations includes recommendations for services and need for further evaluations.
(4) Mental health evaluations are completed by a person who meets the criteria of a mental health professional, or a person with a master’s degree who is license-eligible and supervised by a mental health professional, or an intern of a master’s or doctorate program who is supervised by a mental health professional.