3793:2-1-05 Clinical management.

(A) The purpose of this rule is to state the minimum clinical management requirements that a program must meet in order to be certified by the Ohio department of alcohol and drug addiction services as an alcohol and drug addiction outpatient treatment program, residential treatment program, ambulatory or sub-acute detoxification program or licensed as an opioid agonist program.

(B) The provisions of this rule are applicable to all of the following Ohio alcohol and drug treatment programs, public and private, regardless of whether they receive any public funds or funds that originate and/or pass through the Ohio department of alcohol and drug addiction services in accordance with division (A) of section 3793.06 of the Revised Code.

(1) Alcohol and drug addiction outpatient treatment programs.

(2) Alcohol and drug addiction residential treatment programs.

(3) Opioid agonist programs.

(4) Alcohol and drug addiction ambulatory detoxification programs.

(C) The provisions of this rule are not applicable to the following programs:

(1) Alcohol and drug prevention programs.

(2) Alcohol and drug addiction sub-acute detoxification and acute hospital detoxification programs.

(3) Criminal justice therapeutic community programs.

(4) Treatment alternatives to street crime programs.

(5) Driver intervention programs.

(D) Each program shall be abstinence-based.

(E) Clinical organization:

The admission, continued stay and discharge/referral to each level of care based on the Ohio department of alcohol and drug addiction services' protocols for levels of care (youth and adult) for publicly-funded clients shall be predicated upon the following factors:

(1) A substance related disorder diagnosis based on the current "Diagnostic and Statistical Manual of Mental Disorders" for adult clients admitted to levels I-IV and levels I-III for youth.

(2) The degree of severity for the following dimensions:

(a) Intoxication or withdrawal potential.

(b) Biomedical conditions and complications.

(c) Emotional/behavioral/cognitive conditions and complications.

(d) Treatment acceptance/resistance.

(e) Relapse potential.

(f) Recovery environment.

(g) Family or care giver functioning (for youth).

(F) The admission, continued stay and discharge/referral to each level of care for non-publicly-funded clients shall be based on the Ohio department of alcohol and drug addiction services' protocol or other objective placement criteria.

(G) Each alcohol and drug treatment program shall have written policies and/or procedures that include, but are not limited to:

(1) Admission criteria including criteria for financial eligibility and for determining appropriateness of services.

(2) Admission procedures.

(3) Procedures to follow when an individual has been determined to be inappropriate for admission to the program.

(4) Procedures for transferring clients to a different treatment program within the same agency.

(5) Identification and description of the alcohol and drug addiction services provided under each level of care.

(6) Procedures for making a referral to other organizations, including a determination of the appropriateness of the referral, referral when the appropriate level of care is not provided by the program and provisions for obtaining a properly completed release form.

(7) Procedures for transporting clients to other organizations, when necessary that include, but are not limited to:

(a) A hospital.

(b) A mental health facility for individuals who present a danger to self and/or others.

(8) Procedures for terminating client services, including terminating against the advice of the program.

(9) Procedures for the release of client information.

(10) Procedures for obtaining an assessment for each client admitted or re-admitted to the program, including acceptance of an assessment performed by another program certified by the department or an assessment containing comparable elements of assessment per rule 3793:2-1-08 of the Administrative Code that has been performed within one year of the admission or re-admission date of a client. A copy of the assessment shall be filed in the client's record and updated, signed and dated by a staff member of the admitting program authorized to conduct an assessment pursuant to agency 3793 of the Administrative Code.

(11) Procedures for developing an individualized treatment plan that addresses problems identified in the client's assessment.

(12) Procedures for reporting suspected child abuse and/or neglect, consistent with sections 2151.42.1 and 2151.421 of the Revised Code, rule 5101:2-34-06 of the Administrative Code and rule 3793:2-1-03 of the Administrative Code.

(13) All programs certified by the Ohio department of alcohol and drug addiction services shall have a policy on client behavioral interventions that includes, but is not limited to, the following:

(a) A statement that the use of all cruel and unusual punishments and practices including, but not limited to physical or verbal abuse is prohibited:

(b) Statement indicating what types of interventions shall be employed.

(c) Statement that isolation in a locked, unmonitored room shall not occur.

(d) Statement that behavioral intervention shall only be administered by the program director, clinical director or program employees with direct care responsibilities who have been trained in the program's approved behavioral interventions policy and procedures.

(14) Policy/procedure for referring or providing client education on exposure to, and the transmission of, tuberculosis, hepatitis type B and C, and HIV disease for each client admitted to the program. Documentation shall appear in the client record.

(H) Dietary services:

(1) Each program shall operate its dietary services in accordance with laws, regulations and/or ordinances of the Ohio board of dietetics, Ohio department of health and/or local health department.

(a) Each program shall have policies and procedures for planning menus, preparing and serving food, procurement and storage of food, sanitation and waste disposal.

(b) Halfway house treatment programs and residential treatment programs shall make provisions for three nutritionally balanced meals daily for each client.

(2) Each program that prepares and/or serves meals as part of its daily scheduled activities, shall follow written dietary policies and/or procedures that include, but are not limited to, the following:

(a) Planning menus that meet the nutritional needs of clients in accordance with the current recommended daily allowance established by the national academy of science.

(b) Provisions for preparing and serving meals for persons with special dietary needs.

(c) Procurement, storage, preparation and serving of food.

(d) Maintaining the food service areas and storage areas in a sanitary condition.

(e) Waste disposal.

(3) Each program that prepares and/or serves food shall have documentation to reflect that a dietician, who is licensed by the Ohio board of dietetics, has reviewed, signed, dated and approved:

(a) The program's dietary policies and procedures.

(b) The program's menus.

(c) Special diets.

(I) Pharmaceutical services:

(1) Each program that dispenses, administers and/or prescribes medications, shall have a license for the terminal distribution of dangerous drugs from the Ohio board of pharmacy.

(a) "Administer" means the direct application of a drug to a person, whether by injection, ingestion or any other means.

(b) "Dispense" means the final association of a drug with a particular client pursuant to the prescription, drug order or other lawful order of a prescriber and the professional judgment of and the responsibility for: interpreting, preparing, compounding, labeling and packaging a specific drug.

(2) Each program that dispenses, prescribes and/or administers medications shall have written policies and/or procedures for pharmaceutical services, that include, at a minimum, the following in accordance with 21 C.F.R. 1305m, 21 C.F.R. 1307 and Chapter 4729. of the Revised Code:

(a) Individuals who can dispense, prescribe and/or administer over-the-counter and prescription medications for the program.

(b) Ordering, receiving and storing prescription and over-the-counter medications.

(c) Administering medications.

(d) Dispensing and labeling medications.

(e) Procedures for disposal of all medications.

(f) Procedures for reporting theft or loss of prescription or over-the counter medications..

(3) Each program that permits clients to medicate themselves shall have written policies and/or procedures that include, but are not limited to, the following:

(a) Procedures for storing medications in a locked cabinet.

(b) Procedures for self-medication.

(c) Procedures for accounting for medications that are kept for the client while she/he is at the program site.

(d) Policy prohibiting clients from having unsecured prescription medications in their possession at the alcohol/drug program site or while involved in program activities off site unless required for medical necessity.

(e) Procedures for obtaining and for accounting for medications (prescription and over-the-counter) from clients at the time of admission to or upon entering the program site and return of same, as appropriate, at the time of the discharge/departure.

(4) Clients shall not be denied admission to a program due solely to their use of prescribed psychotropic medication(s).

(J) Each program certified by the Ohio department of alcohol and drug addiction services shall have a clinical director (this title may be referred to as clinical coordinator, etc.) who has demonstrated experience and/or education in substance abuse treatment and holds one or more of the following credentials from a professional regulatory board in Ohio:

(1) Physician who is licensed to practice medicine in Ohio by the Ohio state medical board.

(2) Psychologist who is licensed by the Ohio state board of psychology.

(3) Professional clinical counselor who is licensed by the state of Ohio counselor, a social worker and marriage and family therapist board and whose declaration statement includes substance abuse assessment and counseling and supervision.

(4) Licensed independent social worker who is licensed by the state of Ohio counselor, social worker and marriage and family therapist board and whose declaration statement includes substance abuse assessment and counseling.

(5) Registered nurse with the Ohio board of nursing who has demonstrated experience and/or education in substance use disorder treatment.

(6) Certified chemical dependency counselor III-E, or licensed independent chemical dependency counselor, who is licensed by the chemical dependency professionals board.

(7) Licensed independent marriage and family therapist who is licensed by the state of Ohio counselor, social worker & marriage and family therapist board and whose declaration statement includes substance abuse assessment and counseling and supervision.

(K) Individuals qualified to be alcohol and drug treatment services supervisors pursuant to rule 3793:2-1-08 of the Administrative Code shall:

(1) Conduct regularly scheduled individual and/or group supervision sessions.

(2) Develop written goals and methods for supervision that are agreed upon with the supervisee.

(3) Document what occurred during supervision sessions and progress with supervision goals.

Effective: 02/14/2011
R.C. 119.032 review dates: 11/10/2010 and 07/15/2015
Promulgated Under: 119.03
Statutory Authority: 3793.02(D) , 3793.06 , 3793.11
Rule Amplifies: 3793.06 . 3793.11
Prior Effective Dates: 7/1/91, 7/1/01, 6/13/04, 11/17/05