20 CAR pt. 705 | 20 CAR Part 705 — Crisis Stabilization Unit Certification

Chapter XVII

Subchapter A

Subpart 1

20 CAR § 705-101 Purpose {#sec-20-car-705-101 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-101}

20 CAR § 705-101. Purpose.

(a) This part sets forth the standards and criteria used in the certification of crisis stabilization units by the Department of Human Services.

(b) The rules regarding the certification processes including, but not necessarily limited to, applications, requirements for, levels of, and administrative sanctions are found in this part.

20 CAR § 705-102 Applicability {#sec-20-car-705-102 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-102}

20 CAR § 705-102. Applicability.

The standards and criteria for services as subsequently set forth in this part are applicable to crisis stabilization units as stated in each section.

20 CAR § 705-103 Definitions {#sec-20-car-705-103 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-103}

20 CAR § 705-103. Definitions.

The following words or terms, when used in this part, shall have the defined meaning, unless the context clearly indicates otherwise:

(1) "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a resident by a staff responsible for the resident's health, safety, or welfare, including but not limited to:

(A) Nonaccidental physical injury or mental anguish;

(B) Sexual abuse;

(D) Use of mechanical restraints without proper authority;

(E) Intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or

(F) Deprivation of food, clothing, shelter, or health care by a staff responsible for providing these services to a resident;

(2)(A) “Adverse license action” means any:

(i) Action by a licensing authority that is related to client care;

(ii) Act or omission warranting exclusion under Participant Exclusion, 25 CAR pt. 30; or

(iii) Act or omission that imposes any restriction on the licensee’s practice privileges.

(B) The action is deemed to exist when the licensing entity imposes the adverse action except as provided in Arkansas Code § 25-15-211(c);

(3) “Certification” means a written designation, issued by the Department of Human Services, declaring that the provider has demonstrated compliance as declared within and defined by this part;

(4) “Client” means any person for whom a crisis stabilization unit furnishes, or has agreed or undertaken to furnish, services;

(5) "Clinical privileging" means an organized method for treatment facilities to authorize an individual permission to provide specific care and treatment services to clients within well-defined limits, based on the evaluation of the individual's:

(A) License;

(B) Education;

(D) Experience;

(E) Competence;

(F) Judgment; and

(G) Other credentials;

(6) “Compliance” means conformance with applicable state and federal laws, rules, and regulations including, without limitation:

(A) Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq., and implementing regulations;

(B) Other federal laws and regulations governing the delivery of health care funded in whole or in part by federal funds, for example, 42 U.S.C. § 1320c-5;

(D) Title VI of the Civil Rights Act of 1964, 42 U.S.C. § 2000d et seq., as amended, and implementing regulations;

(E) The Americans with Disabilities Act, as amended, and implementing regulations; and

(F) The Health Insurance Portability and Accountability Act (HIPAA), as amended, and implementing regulations;

(7) "Co-occurring disorder" means any combination of mental health and substance use disorder symptoms or diagnoses in a client;

(8) "Co-occurring disorder capability" means the organized capacity within any type of program to routinely screen, identify, assess, and provide properly matched interventions to individuals with co-occurring disorders;

(9) "Crisis intervention" means an immediately available service to meet the psychological, physiological, and environmental needs of individuals who are experiencing a mental health and/or substance abuse crisis;

(10) "Crisis stabilization" means emergency psychiatric and substance abuse services for the resolution of crisis situations and may include:

(A) Placement of an individual into a protective environment;

(B) Basic supportive care; and

(11)(A) "Crisis stabilization unit" means a program of emergency services for mental health and substance use disorder crisis stabilization including, but not limited to, observation, evaluation, and emergency treatment and referral, when necessary, for inpatient psychiatric or substance use disorder treatment services.

(B) Crisis stabilization units must adhere to the following:

(i) Have sixteen (16) beds or less; and

(ii) Be independently certified by the Department of Human Services;

(12)(A) "Critical incident" means an occurrence or set of events inconsistent with the routine operation of the facility or the routine care of a client.

(B) “Critical incidents” specifically include but are not necessarily limited to the following:

(i) Adverse drug events;

(ii) Self-destructive behavior;

(iii) Deaths and injuries to clients, staff, and visitors;

(iv) Medication errors;

(v) Clients who are absent without leave (AWOL);

(vi) Neglect or abuse of a client;

(vii) Fire;

(viii) Unauthorized disclosure of information;

(ix) Damage to or theft of property belonging to a client or the facility;

(x) Other unexpected occurrences; or

(xi) Events potentially subject to litigation.

(13)(A) "Emergency examination" means the examination of a person who appears to be a mentally ill person, an alcohol-dependent person, or drug-dependent person and a person requiring treatment, and whose condition is such that it appears that emergency detention may be warranted by a licensed mental health professional to determine if emergency detention of the person is warranted.

(B) The examination must occur within twelve (12) hours of being taken into protective custody;

(14) "Initial assessment" means examination of current and recent behaviors and symptoms of an individual who appears to be mentally ill or substance dependent;

(15) "Intervention plan" means a description of services to be provided in response to the presenting crisis situation that incorporates the identified problem or problems, strengths, abilities, needs, and preferences of the individual served;

(16) "Licensed mental health professional" or "LMHP" as defined;

(17) "Linkage services" means the communication and coordination with other service providers that ensure timely appropriate referrals between the crisis stabilization unit and other providers;

(18)(A) “Mental health professional” or “MHP” means a person who possesses an Arkansas license to provide clinical behavioral health care.

(B) The license must be in good standing and not subject to any adverse license action;

(19)(A) “Professionally recognized standard of care” means that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession.

(B) Conformity with Substance Abuse and Mental Health Services Administration (SAMHSA) evidence-based practice models is evidence of compliance with professionally recognized standards of care;

(20) "Progress notes" means:

(A) A chronological description of services provided to a client;

(B) The client's progress, or lack of; and

(21) “Provider” means an entity that is certified by the Department of Human Services as a crisis stabilization unit and enrolled by the Division of Medical Services as a behavioral health agency;

(22) "Psychosocial evaluations" are in-person interviews conducted by professionally trained personnel designed to elicit historical and current information regarding the behavior and experiences of an individual and are designed to provide sufficient information for problem formulation and intervention;

(23) “Qualified behavioral health provider” means a person who:

(A) Does not possess an Arkansas license to provide clinical behavioral health care;

(B) Works under the direct supervision of a mental health professional;

(C) Has successfully completed prescribed and documented courses of initial and annual training sufficient to perform all tasks assigned by a mental health professional; and

(D) Acknowledges in writing that all qualified behavioral health provider services are controlled by client care plans and provided under the direct supervision of a mental health professional;

(24)(A) "Restraint" refers to manual, mechanical, and chemical methods that are intended to restrict the movement or normal functioning of a portion of the individual's body.

(B) Mechanical restraints shall not be utilized within a certified crisis stabilization unit;

(25)(A)(i) "Sentinel event" means a type of critical incident that is an unexpected occurrence involving the death or serious physical or psychological injury to a client, or risk thereof.

(ii) Serious injury specifically includes loss of limb or function.

(iii) The phrase "or risk thereof" includes a variation in approved processes which could carry a significant chance of a serious adverse outcome to a client.

(iv) These events signal the need for immediate investigation and response.

(B) “Sentinel events” include, but are not limited to:

(i) Suicide;

(ii) Homicide;

(iii) Criminal activity;

(iv) Assault and other forms of violence, including domestic violence or sexual assault; and

(v) Adverse drug events resulting in serious injury or death;

(26) "Trauma informed" means the recognition and responsiveness to the presence of the effects of past and current traumatic experiences in the lives of all clients; and

(27) "Triage" means a dynamic process of evaluating and prioritizing the urgency of crisis intervention needed based on the nature and severity of clients' presenting situations.

History

Codification Notes: The Health Insurance Patient Affordability Act was enacted as Pub. L. No. 104-191.The Americans with Disabilities Act is codified generally at 42 U.S.C. § 12101 et seq. Authority: Arkansas Code § 20-47-813

20 CAR § 705-104 Department investigations {#sec-20-car-705-104 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-104}

20 CAR § 705-104. Department investigations.

The Department of Human Services in any investigation or program monitoring regarding client rights shall have access to:

(1) Clients;

(2) Crisis stabilization unit records; and

(3) Crisis stabilization unit staff.

Subpart 2

20 CAR § 705-201 Required service options {#sec-20-car-705-201 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-201}

20 CAR § 705-201. Required service options.

(a) Crisis stabilization units provide brief medically necessary crisis treatment services to persons age eighteen (18) and above who:

(1) Are experiencing a psychiatry-related and/or substance abuse-related crisis; and

(2) May pose an escalated risk of harm to self or others.

(b) Crisis stabilization units provide brief crisis treatment services to persons eighteen (18) years of age and over, who:

(1) Are experiencing a psychiatric or substance abuse-related crisis, or both; and

(2) May pose an escalated risk of harm to self or others.

(c) Crisis stabilization units provide hospital and jail diversion in a safe environment with mental health and substance use disorder services on-site or on call at all times, as well as on-call psychiatry, available twenty-four (24) hours a day.

(d)(1) Crisis stabilization units may provide the service of extended observation bed.

(2) This is an all-inclusive service and is paid on a per diem basis (census count at midnight and client is in the bed) that includes services such as:

(A) Evaluation;

(B) Observation;

(D) Crisis stabilization; and

(E) Social services interventions.

(e)(1) Crisis stabilization units may provide the service of short-term observation bed.

(2) This is an all-inclusive service and is paid on a per diem basis (census count at midnight and client is not in the bed) that includes services such as:

(A) Evaluation;

(B) Observation;

(D) Crisis stabilization; and

(E) Social services interventions.

(f)(1) Crisis stabilization units may provide the services of professional assessment, stabilization, and referral.

(2) These services are paid on a fee-for-service basis (census count at midnight and client is not in the bed) that includes any service described in the Counseling and Crisis Services Provider Manual, 20 CAR pt. 614.

(3) These services would be billed when a crisis stabilization unit is not providing extended observation bed nor short-term observation bed which are paid on an all-inclusive per diem basis.

(g)(1) Crisis stabilization unit services shall be provided in the least restrictive setting possible.

(2) Services should be provided within, or as close to, the community in which they reside as possible.

(h)(1) A physician shall be available at all times for the crisis stabilization unit, either on duty or on call.

(2) If the physician is on call, he or she shall respond by telephone or in person to the licensed staff on duty at the crisis unit within twenty (20) minutes.

(i) Crisis stabilization unit services shall include, but not be limited to, the following service components and each shall have written policies and procedures and each shall be co-occurring disorder capable and trauma informed, with policies and procedures that support this capability:

(1) Triage services;

(2) Co-occurring capable psychiatric crisis stabilization; and

(3) Co-occurring capable drug/alcohol crisis stabilization.

(j) The crisis stabilization unit shall have written policies and procedures addressing restraints, and these shall be in compliance with Section 503.000.

20 CAR § 705-202 Crisis stabilization — Triage {#sec-20-car-705-202 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-202}

20 CAR § 705-202. Crisis stabilization — Triage.

(a) Crisis stabilization services shall include triage services and emergency examination.

(b) Qualified staff providing triage services shall be:

(1) A mental health professional capable of providing crisis stabilization services within the scope of their individual licensure; and

(2) Knowledgeable about:

(A) Applicable laws;

(B) Department of Human Services rules;

(D) Referral sources.

(1) Immediate response, on-site and by telephone;

(2) Screening for the presence of co-occurring disorders;

(3) Integrated emergency mental health and/or substance use disorder examination on-site or via telemedicine; and

(4) Referral, linkage, or a combination of the two (2) services.

(d)(1) The crisis stabilization unit shall have written policies and procedures minimally:

(A) Providing triage crisis services;

(B) Defining methods and required content for documentation of each triage crisis response service provided; and

(C) Ensuring that individuals who present in crisis with co-occurring disorders are identified and that there are no barriers to access triage crisis response based on arbitrary alcohol or drug levels, types of diagnosis, or medications while remaining in compliance with facility certification, licensure, and medical standards.

(2) Nothing in this section requires a facility to treat a client who is not medically stable.

20 CAR § 705-203 Crisis stabilization, psychiatric, substance use disorder, and co-occurring services {#sec-20-car-705-203 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-203}

20 CAR § 705-203. Crisis stabilization, psychiatric, substance use disorder, and co-occurring services.

(a) Crisis stabilization services shall provide continuous twenty-four-hour evaluation, observation, crisis stabilization, and social services intervention seven (7) days per week for clients:

(1) Experiencing mental health or substance use disorder-related crises; or

(2) Who present with co-occurring disorders.

(b) Licensed nurses and other support staff shall be adequate in number to provide care needed by clients twenty-four (24) hours a day seven (7) days per week.

(c) Crisis stabilization services shall be provided by a co-occurring disorder capable multidisciplinary team of medical, nursing, social services, clinical, administrative, and other staff adequate to meet the clinical needs of the individuals served.

(d) Staff members assigned to a medical supervised detoxification component shall be knowledgeable about the physical signs of withdrawal, the taking of vital signs and the implication of those vital signs, and emergency procedures as well as demonstrating core competencies in addressing the needs of individuals receiving detoxification services who may have co-occurring mental health disorders and be on psychotropic medication.

(e) Services shall minimally include:

(1) Medically supervised substance use disorder and mental health screening, observation, and evaluation;

(2) Initiation and medical supervision of rapid stabilization regimen as prescribed by a physician, including medically monitored detoxification where indicated;

(3) Medically supervised and co-occurring disorder capable detoxification, in compliance with procedures outlined in the Arkansas Department of Human Services Regional Alcohol and Drug Detoxification Manual;

(4) Intensive care and intervention during acute periods of crisis stabilization;

(5) Motivational strategies to facilitate further treatment participation for mental health and/or substance abuse needs; and

(6) Providing referral, linkage, or placement as indicated by client needs.

20 CAR § 705-204 Linkage services to higher or lower levels of care or longer term placement {#sec-20-car-705-204 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-204}

20 CAR § 705-204. Linkage services to higher or lower levels of care or longer term placement.

(a) Persons needing mental health services shall be treated with the least restrictive clinically appropriate methods.

(b) In cases where clients are not able to stabilize in or are not appropriate for the crisis stabilization unit, linkage services shall be provided, including the following steps:

(1) Qualified crisis stabilization unit staff shall perform the crisis intervention and referral process to the appropriate treatment facility;

(2)(A) The referral process shall require referral to the least restrictive service to meet the needs of the client.

(B)(i) The referral shall be discussed with the client, the client's legal guardian, or both the client and legal guardian as applicable, and shall include a discussion of why a less restrictive community resource was not utilized if applicable.

(ii) This discussion shall be documented in the client's record.

(iii) If an adult client wishes to include family members in the decision-making process, appropriate releases should be obtained; and

(3)(A) Staff shall make referral to an appropriate treatment facility to include demographic and clinical information and documentation.

(B) Appropriate releases should be obtained as indicated.

(c)(1) The crisis stabilization unit shall have a written plan for addressing nonpsychiatric medical emergencies, including transfer to a general medical-surgical hospital when necessary.

(2) All emergencies must be documented and reviewed by appropriate staff.

(d) If the crisis stabilization unit is referring a client to an acute inpatient facility, the client must meet the admission criteria.

20 CAR § 705-205 Pharmacy services {#sec-20-car-705-205 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-205}

20 CAR § 705-205. Pharmacy services.

(a)(1) The crisis stabilization unit shall provide specific arrangements for pharmacy services to meet clients' needs.

(2) Provision of services may be made through agreement with another program or through a pharmacy in the community.

(b) Medical records must contain valid prescriptions for medications administered while a client is in the care of a crisis stabilization unit.

(c) The crisis stabilization unit shall have the capacity to administer medications, including injectables, twenty-four (24) hours per day.

Subpart 3

20 CAR § 705-301 Medical recordkeeping system {#sec-20-car-705-301 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-301}

20 CAR § 705-301. Medical recordkeeping system.

(a) Each crisis stabilization unit shall maintain an organized medical recordkeeping system to collect and document information appropriate to the treatment processes.

(b) This system shall be organized and easily retrievable, with usable medical records stored under confidential conditions and with planned retention and disposition.

20 CAR § 705-302 Basic requirements {#sec-20-car-705-302 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-302}

20 CAR § 705-302. Basic requirements.

The crisis stabilization unit’s policies and procedures shall:

(1) Define the content of the client’s medical record in accordance with Section 300.000 through Section 310.000 of this part;

(2) Define storage, retention, and destruction requirements for client medical records;

(3) Require client medical records be confidentially maintained in locked equipment under secure measures;

(4) Require legible entries in client medical records signed with first name or initial, last name, and dated by the person making the entry;

(5) Require the client's name be typed or written on each sheet of paper or page in the client record;

(6) Require a signed consent for treatment; and

(7) Require a signed consent for follow-up before any contact after discharge is made.

20 CAR § 705-303 Record access for clinical staff {#sec-20-car-705-303 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-303}

20 CAR § 705-303. Record access for clinical staff.

(a) The crisis stabilization unit shall ensure client records are readily accessible to the crisis stabilization unit staff directly caring for the client.

(b) Such access shall be limited to the minimum necessary to carry out the staff member’s job functions or the purpose for the use of the records.

20 CAR § 705-304 Clinical record content, intake, and assessment {#sec-20-car-705-304 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-304}

20 CAR § 705-304. Clinical record content, intake, and assessment.

(a)(1) The crisis stabilization unit shall assess each individual to determine appropriateness of admission.

(2) Initial assessments are to be completed on all clients voluntary or involuntary at time of entrance.

(b) Client intake information shall contain, but not be limited to the following identification data:

(1) Client name;

(2) Name and identifying information of the legal guardian or guardians;

(3) Home address;

(4) Telephone number;

(5) Referral source;

(6) Reason for referral;

(7) Significant other to be notified in case of emergency;

(8) Intake data core content;

(9) Presenting problem and disposition;

(10) A record of pertinent information regarding adverse reactions to drugs, drug allergies, or sensitivities shall be obtained during intake and kept in a highly visible location in or on the record; and

(11) Screening for co-occurring disorders, trauma, and medical and legal issues.

(c) Client assessment information for clients admitted to crisis stabilization units shall be completed within twelve (12) hours of client’s entrance:

(1) Integrated mental health and substance abuse psychosocial evaluation that minimally addresses:

(A) The client's strengths and abilities to be considered during community reentry;

(B) Economic, vocational, educational, social, family, and spiritual issues as indicated; and

(2) Interpretive summary of relevant assessment findings that results in the development of an intervention plan addressing mental health, substance use disorder, and other related issues contributing to the crisis; and

(3) An integrated intervention plan that minimally addresses the client's:

(A) Presenting crisis situation that incorporates the identified problem or problems;

(B) Strengths and abilities;

(D) Goals and objectives.

20 CAR § 705-305 Health, mental health, substance abuse, and drug history {#sec-20-car-705-305 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-305}

20 CAR § 705-305. Health, mental health, substance abuse, and drug history.

(a)(1) A health and drug history shall be completed for each client at the time of entrance into a crisis stabilization unit as soon as practical.

(2) The medical history shall include obtainable information regarding:

(A) Name of medication;

(B) Strength and dosage of current medication;

(D) Benefit or benefits of medication;

(E) Side effects;

(F) The prescribing medical professional, if known; and

(G) Relevant drug history of family members.

(b) A mental health history, including symptoms and safety screening, shall be completed for each client at the time of entrance into a crisis stabilization unit as soon as practical.

(c) A substance abuse history, including checklist for use, abuse, and dependence for common substances, including nicotine and caffeine, and screening for withdrawal risk and IV use shall be completed for each client at the time of entrance.

History

Codification Notes: “IV” means intravenous. Authority: Arkansas Code § 20-47-813

20 CAR § 705-306 Progress notes {#sec-20-car-705-306 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-306}

20 CAR § 705-306. Progress notes.

(a) The crisis stabilization unit shall have a policy and procedure mandating the chronological documentation of progress notes for clients admitted to crisis stabilization units.

(b) Progress notes shall minimally address the following:

(1) Person or persons to whom services were rendered;

(2) Activities and services provided and as they relate to the goals and objectives of the intervention plan, including ongoing reference to the intervention plan;

(3) Documentation of the progress or lack of progress in crisis resolution as defined in the intervention plan;

(4) Documentation of the intervention plan's implementation, including client activities and services;

(5) The client's current status;

(6) Documentation of the client's:

(A) Response to intervention services;

(B) Changes in behavior and mood; and

(7) Plans for continuing therapy or for discharge, whichever is appropriate.

(1) Intervention team shall document progress notes daily; and

(2) Nursing service shall document progress notes on each shift.

20 CAR § 705-307 Medication record {#sec-20-car-705-307 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-307}

20 CAR § 705-307. Medication record.

(a) The crisis stabilization unit shall maintain a medication record on all clients who receive medications or prescriptions in order to provide a concise and accurate record of the medications the client is receiving or has been prescribed for the client.

(b) The client medical record shall contain a medication record with information on all medications ordered or prescribed by physician staff which shall include, but not be limited to:

(1) The record of medication administered, dispensed, or prescribed shall include all of the following:

(A) Name of medication;

(B) Dosage;

(D) Route of administration; and

(E) Staff member who administered or dispensed each dose, or prescribing physician; and

(2) A record of pertinent information regarding adverse reactions to drugs, drug allergies, or sensitivities shall be:

(A) Updated when required by virtue of new information; and

(B) Kept in a highly visible location in or on the record.

20 CAR § 705-308 Aftercare and discharge summary {#sec-20-car-705-308 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-308}

20 CAR § 705-308. Aftercare and discharge summary.

The aftercare plan shall minimally include:

(1) Presenting problem at intake;

(2) Any co-occurring disorders or issues and recommended interventions for each;

(3) Physical status and ongoing physical problems;

(4) Medications prescribed at discharge;

(5) Medication and lab summary, when applicable;

(6) Names of family and significant other contacts;

(7) Any other considerations pertinent to the client's successful functioning in the community;

(8) The client’s, the client’s legal guardian, or as indicated, both the client’s and legal guardian’s comments on participation in his or her crisis resolution efforts; and

(9) The credentials of the staff members treating the client and their dated signatures.

20 CAR § 705-309 Other records’ content {#sec-20-car-705-309 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-309}

20 CAR § 705-309. Other records’ content.

(a) The client record shall contain copies of all consultation reports concerning the client.

(b) When psychometric or psychological testing is done, the client record shall contain a copy of a written report describing the test results and implications and recommendations for treatment.

(c) The client medical record shall contain any additional information relating to the client which has been secured from sources outside the crisis stabilization unit.

Subpart 4

20 CAR § 705-401 Organizational description {#sec-20-car-705-401 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-401}

20 CAR § 705-401. Organizational description.

(a) The crisis stabilization unit shall have a written organizational description which is reviewed annually by both the crisis stabilization unit and the Department of Human Services, which minimally includes:

(1) The overall target population, specifically including those individuals with co-occurring disorders, for whom services will be provided;

(2) The overall mission statement; and

(3) The annual facility goals and objectives, including the goal of continued progress for the facility in providing person-centered, culturally competent, trauma informed, and co-occurring capable services.

(b) The crisis stabilization unit’s governing body shall approve the mission statement and annual goals and objectives and document their approval.

(c) The crisis stabilization unit shall make the organizational description, mission statement, and annual goals and objectives available to staff.

(d) The crisis stabilization unit shall make the organizational description, mission statement, and annual goals and objectives available to the general public upon request.

(e) Each crisis stabilization unit shall have a written plan for professional services which shall have in writing the following:

(1) Services description and philosophy;

(2) The identification of the professional staff organization to provide these services;

(3) Written admission and exclusionary criteria to identify the type of clients for whom the services are primarily intended;

(4) Written goals and objectives; and

(5) Delineation of processes to ensure accessible, integrated, and co-occurring capable services and a plan for how each program component will address the needs of individuals with co-occurring disorders.

(f)(1) There shall be a written statement of the procedures/plans for attaining the organization's goals and objectives.

(2) These procedures/plans should:

(A) Define specific tasks, including actions regarding the organization’s co-occurring capability;

(B) Set target dates; and

20 CAR § 705-402 Information analysis and planning {#sec-20-car-705-402 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-402}

20 CAR § 705-402. Information analysis and planning.

(a) The crisis stabilization unit shall have a defined plan for conducting an organizational needs assessment that specifies the methods and data to be collected, which shall include but not be limited to information from:

(1) Clients;

(2) Governing authority;

(3) Staff;

(4) Stakeholders;

(5) Outcomes management processes; and

(6) Quality record review.

(b) The crisis stabilization unit shall have a defined system to collect data and information on a quarterly basis to manage the organization.

(d) The crisis stabilization unit shall prepare an end-of-year management report, which shall include but not be limited to:

(1) An analysis of the needs assessment process; and

(2) Performance improvement program findings.

(e) The management report shall be communicated and made available to, among others:

(1) The governing authority;

(2) Crisis stabilization unit staff; and

(3) The Department of Human Services, if and when requested.

20 CAR § 705-403 Performance improvement program {#sec-20-car-705-403 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-403}

20 CAR § 705-403. Performance improvement program.

(a) The crisis stabilization unit shall have an ongoing performance improvement program designed to objectively and systematically monitor, evaluate, and improve the quality of client care.

(b) The performance improvement program shall also address the fiscal management of the organization.

(c)(1) There shall be an annual written plan for performance improvement activities.

(2) The plan shall include, but not be limited to:

(A) Outcomes management processes specific to each program component minimally measuring:

(i) Efficiency;

(ii) Effectiveness;

(iii) Client satisfaction;

(iv) A quarterly record review to minimally assess quality of services delivered;

(v) Appropriateness of services;

(vi) Patterns of service utilization;

(vii) Clients, relevant to their:

(a) Orientation to the crisis stabilization unit and services being provided; and

(b) Active involvement in making informed choices regarding the services he or she receives;

(viii) The client assessment information thoroughness, timeliness, and completeness;

(ix) Treatment goals and objectives are based on:

(a) Assessment findings; and

(b) Client input;

(x) Services provided were related to the goals and objectives;

(xi) That services are documented as prescribed by policy; and

(xii) That the treatment plan is reviewed and updated as prescribed by policy;

(B) Clinical privileging;

(i) An annual budget that is approved by the governing authority and reviewed at least annually;

(ii) The organization's capacity to generate needed revenue to produce desired client and other outcomes; and

(iii) Monitoring client records to ensure documented dates of services provided coincide with billed service encounters; and

(D) Review of critical incident reports and client grievances or complaints.

(d)(1) The crisis stabilization unit shall monitor the implementation of the performance improvement plan on an ongoing basis and make adjustments as needed.

(2) Performance improvement findings shall be communicated and made available to, among others:

(A) The governing authority;

(B) Crisis stabilization unit staff; and

20 CAR § 705-404 Incident reporting {#sec-20-car-705-404 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-404}

20 CAR § 705-404. Incident reporting.

(a)(1) The crisis stabilization unit shall report critical incidents to the Department of Human Services in accordance with department Incident Reporting Policy 1090 that include critical incidents involving allegations constituting a sentinel event or resident abuse immediately via telephone or fax, but not less than twenty-four (24) hours of the incident.

(2) If reported by telephone, the report shall be followed with a written report within twenty-four (24) hours.

(b)(1) The crisis stabilization unit shall document and monitor internally, with a quality assurance and improvement process that will be made available for review and/or audit by an appropriate agency, the following:

(A) Critical incidents requiring medical care by a physician or nurse or follow-up attention; and

(B) Incidents requiring hospitalization or immediate off-site medical attention.

(2) These incident reports shall be delivered via fax or mail to department provider certification within twenty-four (24) hours of the incident being documented.

20 CAR § 705-405 Personnel policies and procedures {#sec-20-car-705-405 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-405}

20 CAR § 705-405. Personnel policies and procedures.

(a) The crisis stabilization unit shall have written personnel policies and procedures approved by the governing authority.

(b) All employees shall have access to personnel policies and procedures, as well as other rules and regulations governing the conditions of their employment.

(c) The crisis stabilization unit shall develop, adopt, and maintain policies and procedures to promote the objectives of the program and provide for qualified personnel during all hours of operation to support the functions of the center and provide quality care.

20 CAR § 705-406 Job descriptions {#sec-20-car-705-406 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-406}

20 CAR § 705-406. Job descriptions.

(a) The crisis stabilization unit shall have written job descriptions for all positions setting forth minimum qualifications and duties of each position.

(b) All job descriptions shall include an expectation of core competencies in relation to individuals with co-occurring disorders.

Subpart 5

20 CAR § 705-501 Staff qualifications {#sec-20-car-705-501 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-501}

20 CAR § 705-501. Staff qualifications.

(a) The crisis stabilization unit shall document the qualifications and training of staff providing crisis stabilization services which shall be in compliance with the crisis stabilization unit’s clinical privileging process.

(b) Failure to comply with this section will result in the initiation of procedures to deny, suspend, and/or revoke certification.

20 CAR § 705-502 Staff development {#sec-20-car-705-502 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-502}

20 CAR § 705-502. Staff development.

(a)(1) The crisis stabilization unit shall have a written plan for the professional growth and development of all administrative, professional, clinical, and support staff.

(2) This plan shall include but not be limited to:

(A) Orientation procedures;

(B) In-service training and education programs;

(D) Mechanisms for ensuring outside continuing educational opportunities for staff members.

(b) The results of performance improvement activities and accrediting and audit findings and recommendations shall be addressed by and documented in the staff development and clinical privileging processes.

(c) Staff competency development shall be aligned with the organization’s goals related to co-occurring capability, and incorporate a training plan, training activities, and supervision designed to improve co-occurring core competencies of all staff.

(d) Staff education and in-service training programs shall be evaluated by the crisis stabilization unit at least annually.

20 CAR § 705-503 In-service {#sec-20-car-705-503 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-503}

20 CAR § 705-503. In-service.

(a) Trainings are required annually for all employees who provide clinical services within the crisis stabilization unit program on the following topics:

(1) Fire and safety;

(2) Infection control and universal precautions;

(3) Client's rights and the constraints of the Mental Health Client's Bill of Rights;

(4) Confidentiality;

(5) Adult and Long-Term Care Facility Resident Maltreatment Act, Arkansas Code § 12-12-1701 et seq.;

(6) Facility policy and procedures;

(7) Cultural competence; and

(8) Co-occurring disorder competency and treatment principles.

(b) Trauma informed and age and developmental specific trainings. All staff providing clinical services shall have a current certification in basic first aid and in cardiopulmonary resuscitation (CPR).

(c)(1) All clinical staff shall have training in nonphysical intervention techniques and philosophies addressing appropriate nonviolent interventions for potentially physical interpersonal conflicts, staff attitudes which promote dignity and enhanced self-esteem, keys to effective communication skills, verbal and nonverbal interaction, and nonviolent intervention within thirty (30) days of being hired with annual updates thereafter.

(2) This training shall occur prior to direct patient contact.

(d)(1) The crisis stabilization unit executive director shall designate which positions and employees, including temporary employees, will be required to successfully complete physical intervention training.

(2) The employee shall successfully complete this training within thirty (30) days of being hired, with annual updates thereafter.

(3) This training shall occur prior to direct patient contact.

Subpart 6

20 CAR § 705-601 Application of standards {#sec-20-car-705-601 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-601}

20 CAR § 705-601. Application of standards.

(a) Crisis stabilization units shall apply these standards to all sites operated.

(b) The primary concern of the crisis stabilization unit should always be the safety and well-being of the clients and staff.

(d) Crisis stabilization units shall provide a safe and sanitary environment.

20 CAR § 705-602 Facility environment generally {#sec-20-car-705-602 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-602}

20 CAR § 705-602. Facility environment generally.

(a) The crisis stabilization unit shall obtain an annual fire and safety inspection from the State Fire Marshal or local authorities which documents approval for continued occupancy.

(b)(1) Crisis stabilization unit staff shall know the exact location, contents, and use of first-aid supply kits and firefighting equipment and fire detection systems.

(2) All firefighting equipment shall be annually maintained in appropriately designated areas within the facility.

(c)(1) The crisis stabilization unit shall post written plans and diagrams noting:

(A) Emergency evacuation routes in case of fire; and

(B) Shelter locations in case of severe weather.

(2) All exits must be clearly marked.

(d) Facility grounds shall be maintained in a manner which provides a safe environment for clients, personnel, and visitors.

(e) The crisis stabilization unit facility director or his or her designee shall appoint a safety officer.

(f)(1) The crisis stabilization unit shall:

(A) Have an emergency preparedness program designed to provide for the effective utilization of available resources so client care can be continued during a disaster; and

(B) Evaluate the emergency preparedness program annually and update as needed.

(2) Policies for the use and control of personal electrical equipment shall be developed and implemented.

(g) The crisis stabilization unit shall have an emergency power system to provide lighting throughout the facility.

(h)(1) The crisis stabilization unit facility director shall ensure there is a written plan to respond to internal and external disasters.

(2) External disasters include, but are not limited to, tornadoes, explosions, and chemical spills.

(i) All crisis stabilization units shall be inspected annually by designated fire and safety officials of the municipality who exercise fire/safety jurisdiction in the facility's location, which results in the facility being allowed to continue to operate.

(j) The crisis stabilization unit shall have a written infection control program and staff shall be knowledgeable of Centers for Disease Control and Prevention Guidelines for Tuberculosis and of the Blood Borne Pathogens Standard, location of spill kits, masks, and other personal protective equipment.

(k)(1) The crisis stabilization unit shall have a written hazardous communication program and staff shall be knowledgeable of:

(A) Chemicals in the workplace; and

(B) The location of material safety data sheets and personal protective equipment.

(2) Toxic or flammable substances shall be stored in approved locked storage cabinets.

(l) The crisis stabilization unit’s telephone number or numbers and actual hours of operation shall be posted at all public entrances.

(m) Signs must be posted at all public entrances informing staff, clients, and visitors as to the following requirements:

(1) No alcohol or illicit drugs are allowed in the crisis stabilization unit facility; and

(2) No firearms or other dangerous weapons are allowed in the crisis stabilization unit facility with the exception of law enforcement while in the performance of their duties.

(n) A copy of compliance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. § 2000d et seq., and Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e et seq., shall be prominently displayed within the acute crisis unit facility.

(o) Crisis stabilization units shall:

(1) Provide separate bedroom areas for males and females;

(2) Provide sufficient clean linens for clients; and

(3) Provide adequate barriers to divide clients.

(p)(1) Plumbing in crisis stabilization units shall be in working condition to avoid any health threat.

(2) All toilets, sinks, and showers shall be clean and in working order.

(q)(1) There shall be at least one (1) toilet, one (1) sink, and one (1) shower or tub per every eight (8) crisis stabilization unit beds.

(2) This means that a crisis stabilization unit shall have no less than one (1) toilet, one (1) sink, and one (1) shower or tub.

(r) A secure locked storage shall be provided for client valuables when requested.

(s) Separate storage areas are provided and designated for:

(1) Food, kitchen, and eating utensils;

(2) Clean linens;

(3) Soiled linens and soiled cleaning equipment; and

(4) Cleaning supplies and equipment.

(t)(1) When handling soiled linen or other potentially infectious material, universal precautions are to be followed and addressed in the crisis stabilization unit policies and procedures.

(2) Hazardous and regulated waste shall be disposed of in accordance with federal requirements.

(u) Poisons, toxic materials, and other potentially dangerous items shall be stored in a secured location.

20 CAR § 705-603 Medication clinic — Medication monitoring {#sec-20-car-705-603 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-603}

20 CAR § 705-603. Medication clinic — Medication monitoring.

(a) Medication administration, storage, and control and client reactions shall be continuously monitored.

(b) Crisis stabilization units shall:

(1) Ensure proper storage and control of medications;

(2) Immediately respond if incorrect doses or overdoses occur; and

(3) Have appropriate emergency supplies available if needed.

(c)(1) Written procedures for medication administration shall be available and accessible in all medication storage areas and available to all staff authorized to administer medications.

(2) All medications shall be kept in locked, nonclient-accessible areas.

(3) Factors which shall be considered in medication storage are light, moisture, sanitation, temperature, ventilation, and the segregation and safe storage of poisons, external medications, and internal medications.

(d) Telephone numbers of the state poison centers shall be immediately available in all locations where medications are prescribed, administered, or stored.

(e) A crisis stabilization unit physician shall supervise the preparation and stock of an emergency kit which shall be readily available, but accessible only to crisis stabilization unit staff.

20 CAR § 705-604 Medication error rates {#sec-20-car-705-604 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-604}

20 CAR § 705-604. Medication error rates.

The crisis stabilization unit shall have an ongoing performance improvement program that specifically, objectively, and systematically monitors medications administration or dispensing or medication orders and prescriptions to evaluate and improve the quality of client care.

20 CAR § 705-605 Technology {#sec-20-car-705-605 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-605}

20 CAR § 705-605. Technology.

(a) The crisis stabilization unit shall have a written plan regarding the use of technology and systems to support and advance effective and efficient service and business practices.

(b) The plan shall include, but not be limited to:

(1) Hardware and software;

(2) Security;

(3) Confidentiality;

(4) Backup policies;

(5) Assistive technology;

(6) Disaster recovery preparedness; and

(7) Virus protection.

20 CAR § 705-606 Food and nutrition {#sec-20-car-705-606 omnilex-key=us-ar-regs-official--title-20-part-705--20 CAR § 705-606}

20 CAR § 705-606. Food and nutrition.

(a)(1) If the crisis stabilization unit prepares meals on site, the crisis stabilization unit shall have a current food establishment health inspection as required by the Department of Health.

(2) When meals are provided by a food service, a written contract shall be maintained and shall require the food service to have a current food establishment health inspection as required by the department.

(b) Crisis stabilization units shall provide at least three (3) meals daily, with no more than fourteen (14) hours between any two (2) meals.

(d) Perishable items shall not be used once they exceed their sell by date.

20 CAR Part 705 — Crisis Stabilization Unit Certification