Section 29-2334. SERVICES AND SUPPORTS -- PATIENT ASSESSMENT AND PLACEMENT CRITERIA

 

2334.1 To determine placement of an applicant in the appropriate level of care in a substance abuse treatment facility or program, qualified program staff shall complete a comprehensive assessment that establishes the condition of the applicant within each of the six dimensions presented in §2331 LEVEL OF CARE STANDARDS. The assessment shall address:

 

(a) Current medical, substance abuse, and mental status, including a complete physical or documentation of complete physical examination within the past six months. Even if documentation is available from a prior physical, assessment of patient’s current condition shall be sufficient to rule out the need for admission to Level III care, based on criteria presented in §2331.6;

 

(b) Evaluation of medical needs and physical health, including nutritional needs, current medications, ability to take medications as prescribed, medication allergies, chronic and current medical problems, history of medical conditions and treatment;

 

(c) Substance abuse assessment that includes present and historical use patterns by type of substance, including alcohol, indicating frequency of use, quantity used, and route of use; current pattern and history of alcohol use, drug use, and mental illness among immediate and distant family members; history of treatment to include when, where and whether or not the treatment was court-ordered; current status of involvement in AA/NA to include for how long and on what frequency; and, the degree of importance that the applicant places on receiving treatment now;

 

(d) The substance abuse assessment shall also include information on prior substance abuse if available that identifies the place, date, length of stay, response to treatment, and factors contributing to relapse; history of suicide or homicide attempts and whether they occurred while under the influence; history of aggressive behavior; and/or history of injurious actions to others;

 

(e) Mental health assessment to minimally include current and historical information on condition and prior treatment related to the type of problem; the presence of hallucinations, delusional thoughts, anxiety, memory loss, poor sleep patterns, loss of appetite, poor personal care habits, depression, suicidal or homicidal thoughts or attempts, violent behavior; and the relationship of these things to the applicant’s use or abuse of alcohol and/or drugs; current pattern and history of alcohol and/or drug use, and mental illness among immediate and distant family members. In the event that the applicant appears to have considerable mental illness, a licensed psychiatric social worker, licensed psychiatric nurse, licensed psychologist or psychiatrist shall be available to complete the assessment;

 

(f) Employment status and history; impact of addiction on work history; training and education level achieved; importance to individual of receiving counseling to address employment problems;

 

(g) Physical examination;

 

(h) History and current status of family and social relations including relationship to others in household, satisfaction status of current living arrangements, number of dependent children, history of lost custody, information on status of current foster care cases, impact of custodial children or other dependents on complying with treatment requirements, impact of addiction on financial status, history of emotional, physical and/or sexual abuse, alcohol/drug use habits of others in household;

 

(i) Legal issues and their impact on treatment to include present or past criminal justice involvement due to alcohol or drug use, or for other reasons; current probation/parole/trial/sentencing status; whether or not applicant was referred for treatment by the criminal justice system;

 

(j) Complete financial assessment and determination of financial status with payment arrangements for receiving treatment; and

 

(k) Current use of community resources.

 

2334.2 In the event that the applicant is intoxicated, severely impaired by drugs, or is experiencing mental decompensation at the time of the assessment, sufficient information shall be collected to support admission to an appropriate level of care, with a full assessment to be completed within ten (10) days after admission or no later than two (2) days prior to discharge if the length of stay is projected to be less than ten (10) days.

 

2334.3 An interdisciplinary team shall participate in reviewing and completing the pre-admission comprehensive assessment for the purpose of formulating a preliminary diagnosis, making a level of care placement decision, and developing a preliminary rehabilitation service plan for a patient.

 

2334.4 An interdisciplinary team shall consist of an addiction counselor and one or more of the following: a Licensed Independent Clinical Social Worker (LICSW), a licensed nurse practitioner or a registered nurse with a specialty in psychiatry or chemical dependency, a licensed psychologist, or a licensed physician.

 

2334.5 A final diagnostic formulation shall be made by the interdisciplinary team using the most recent edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) including diagnosis, degree of severity for dependency, and a review of substance use patterns, within five (5) calendar days after admission.

 

2334.6 Input from the interdisciplinary team members shall be used to make specific recommendations for further evaluation, continuing care, and specific services based on the completed assessment, diagnosis and team intervention.

 

2334.7 The facility or program shall have written policies and procedures governing patient assessments, placement, referral, and orientation and shall include but is not limited to:

 

(a) Staff designated to conduct assessments and make placement decisions;

 

(b) Protocol for crisis triage and intervention; and

 

(c) Protocol for referral and follow up.

 

 

source

Final Rulemaking published at 47 DCR 9341 (November 24, 2000), adopting Emergency and Proposed Rulemaking published at 47 DCR 7708, 7755 (September 22, 2000).