Section 29-4603. STAFFING AND ADMINISTRATION

 

4603.1Each MCOTT Program shall have as Program Director, a person who (1) is a licensed Psychiatrist, credentialed to practice in the District of Columbia, or a Master's Degree level clinician in social work, nursing, psychology, counseling or other human service discipline and (2) has at least three years of experience in working with seriously and persistently mentally ill adults, including one year of program management or supervisory experience sufficient to administer the MCOTT Program.

 

4603.2Each MCOTT Program shall employ an assistant director who is a supervisory nurse with a Master's degree in nursing and at least three years experience in working with seriously and persistently mentally ill adults, including one year of program management or supervisory experience sufficient to administer the MCOTT Program.

 

4603.3During hours during which the MCOTT office facility is not open, each MCOTT Program shall be staffed by professionals who are experienced in the MCOTT Program services, skilled in crisis intervention procedures, who are on call and available to respond to MCOTT clients by telephone and in person, as needed.

 

4603.4Each MCOTT Program shall be staffed with individuals who are qualified to provide the Program Services described in this chapter including, but not limited to, the following: case management; crisis assessment and intervention; symptom assessment, management, and supportive counseling; education; administration of medication, monitoring, and documentation; assistance to clients in obtaining the basic necessities of daily living including: assistance to clients in structuring and performing basic daily activities; development and support of social activities and relationships; substance abuse treatment; criminal justice liaison; assisting clients to find and maintain employment; and provision of support to the client's family and significant others.

 

4603.5Each MCOTT Program shall employ the minimum number of staff persons, except a psychiatrist and a clerical office manager, as specified in this section.

 

4603.6Each MCOTT Program shall employ an office manager responsible for organizing, coordinating and monitoring all non-clinical operations of the MCOTT Program, including medical records management; operating and coordinating the computer systems; maintaining accounting and budget records for client and program expenditures; and provision of clerical and receptionist services.

 

4603.7Each MCOTT Program shall employ one full-time and one part-time psychiatrist to provide comprehensive psychiatric services. The comprehensive psychiatric services shall include face-to-face contact with clients, consultation with Provider staff and participation in regularly scheduled daily organizational staff meetings and treatment planning meetings.

 

4603.8Each MCOTT Program shall employ a minimum of five (5) full-time registered nurses. A Program Director with a Master's degree in nursing or the assistant director who is the nurse supervisor shall not replace one of these five full-time nurses.

 

4603.9Each MCOTT Program shall employ a minimum of two (2) full-time vocational rehabilitation specialists with Master's degrees in rehabilitation counseling or related field and at least one year of supervisory experience in providing individualized job development and supported employment on behalf of persons with physical or mental disabilities, or at least one year of vocational rehabilitation experience with individuals having a persistent mental illness which interferes with their ability to perform in normal work settings.

 

4603.10Each MCOTT Program shall employ a minimum of two (2) full-time Master's degree social workers licensed in the District as Licensed Independent Clinical Social Workers (LICSW) and/or Licensed Graduate Social Workers (LGSW).

 

4603.11Each MCOTT Program shall employ a minimum of two (2) full-time Mental Health Specialists. The minimum qualifications for this position are a Bachelor's degree and/or Master's degree in mental health or allied professions.

 

4603.12Each MCOTT Program shall ensure that at least one (1) full-time staff person shall be registered as an addiction counselor under Title 17 of the DCMR, Chapter 73, to provide substance abuse services.

 

4603.13The MCOTT Program Director shall assign a staff person to be the Shift Manager who shall be in charge of developing and implementing the daily MCOTT assignment schedule as well as making all daily assignments, ensuring that all daily assignments are completed or rescheduled, and for handling all emergencies or crises that arise during the course of the day in consultation with the MCOTT Program Director, assistant program director, or psychiatrist.

 

4603.14MCOTT Program staff shall:

 

(a)Document and notify all other staff of all changes in the client's mental or social status;

 

(b)Provide any of the primary case management functions, as assigned, on behalf of, or in place of, the Primary Case Manager; and

 

(c)Provide emergency services when a client is in crisis.

 

4603.15Each MCOTT Program shall have a written policy for clinical supervision of staff providing treatment, rehabilitation, and support services to MCOTT clients.

 

4603.16The Program Director and/or the clinical staff designee shall assume responsibility for supervising and directing all MCOTT staff activities, including:

 

(a)Regular meetings held at least once a month with individual staff to review cases, assess performance, and give feedback;

 

(b)Individual, side-by-side sessions in which the supervisor accompanies an individual staff member to meet with clients in regularly, but not less than quarterly, scheduled or crisis meetings to enable the supervisor to assess performance, give feedback, and/or model alternative treatment approaches; and

 

(c)Participation with team members in daily organizational staff and treatment planning meetings to review and assess staff performance and provide staff direction regarding individual clients. Clinical supervision provided to staff shall be documented in writing.

 

4603.17The MCOTT Program shall have daily organizational staff meetings at regularly scheduled times established by the Program Director.

 

4603.18The daily organizational staff meetings shall be recorded in writing in a Daily Log or electronic record.

 

4603.19The Daily Log shall include, but is not limited to, the following information:

 

(a)A roster of clients in the MCOTT Program; and

 

(b)Brief documentation of any daily treatment, services and/or contacts; and

 

(c)A concise description of each client's daily behavioral status.

 

4603.20The MCOTT Program shall maintain a Daily Team Assignment Schedule which shall be a written, daily timetable summarizing all client treatment and service contacts to be divided and shared by staff working on that day. The daily team assignment schedule shall be developed from a central file of all weekly client contact schedules.

 

4603.21The MCOTT Program Director shall use the staff meeting to do a daily evaluation of each client in terms of treatment contacts received.

 

4603.22The Program Director or designee shall maintain a weekly client contact schedule for each MCOTT client, which shall be maintained in a central file.

 

4603.23The Program Director or shift manager designee shall develop a daily team assignment schedule from the central file of all weekly client contact schedules.

 

4603.24The Program Director, Primary Case Manager and the MCOTT psychiatrist shall conduct treatment-planning meetings to develop each client's Individual Treatment Plan (ITP) which shall be reviewed every three (3) months and rewritten every six (6) months.

 

4603.25At regularly, at least quarterly, scheduled times, per a written schedule maintained by the Program Director, the MCOTT Program shall hold treatment planning meetings under the supervision of the Program Director and psychiatrist to assess individual client needs/problems; to establish measurable long- and short-term treatment goals; to plan treatment and service interventions and to assign staff persons responsible for providing the services.

 

4603.26Each MCOTT Program shall provide a maximum staff-to-client ratio of one staff to ten clients for each full time clinical staff person, except psychiatrists.

 

4603.27Each MCOTT Program shall maintain written personnel policies and procedures and shall maintain personnel files which shall contain each employee's application, credentials, job description, annual performance appraisal, job title, training, orientation, salary and a statement signed by the employee that the employee understands the obligation to maintain the confidentiality of client records under applicable local and federal law.

 

4603.28Each MCOTT Program shall have a current organizational chart that clearly defines the MCOTT Program's structure, staff responsibilities, and lines of authority.

 

4603.29Each MCOTT Program's organizational chart shall show relationships between the MCOTT Program and other entities, such as the following:

 

(a)The Board of Directors, if applicable;

 

(b)Advisory boards;

 

(c)The parent Provider organization, if applicable; and

 

(d)Health or service affiliations.

 

4603.30Each MCOTT Program shall have available to all staff a current MCOTT Program Manual which sets forth all of its policies and procedures.

 

4603.31Each MCOTT Program Manual shall include, but not be limited to, the following information:

 

(a)A statement reflecting the goals and missions of the MCOTT Program;

 

(b)A description of the services to be provided;

 

(c)The reimbursement methodology and/or fee schedules;

 

(d)Operational schedules;

 

(e)A description of the population to be served;

 

(f)Clinic policies, and quality assurance standards;

 

(g)Financial and record-keeping procedures;

 

(h)A statement of client's rights;

 

(i)Admission criteria;

 

(j)Discharge and referral criteria;

 

(k)Written policies and procedures for emergency care;

 

(l)A description of staff and personnel policies, which shall be reviewed annually, revised as necessary and dated at time of review;

 

(m)A description of each staff position, procedures for employee hiring, evaluations, grievances, and in-service training;

 

(n)A description of in-service training of a meaningful nature for all non-professional staff and identification of the supervisor responsible for providing and facilitating that training; and

 

(o)An up-to-date listing of professional staff licensure and registration information.

 

4603.32Each MCOTT Program shall participate in the CMHS Organizational Performance Program, CMHS Policy 50000.115.IF, CMHS Performance Plan.

 

4603.33Each MCOTT Program shall be monitored through the Organizational Performance Plan. The Provider shall report the required data and findings quarterly as specified in the Organizational Performance Plan to the CMHS Adult Services Administration Quality Assessment Coordinator and to MAA staff on a quarterly basis.

 

4603.34Each MCOTT Program shall comply with the reporting requirements of the CMHS Policy 50000.480.1C, "Reporting Unusual Incidents", by reporting such incidents to appropriate staff of MAA and CMHS by telephone within 24 hours and in writing within five (5) days of any unusual incident. Unusual incident means an event affecting MCOTT staff or clients which is significantly different from the regular routine or varies from established procedures which shall include, but are not limited to:

 

(a)Death;

 

(b)Injury;

 

(c)Unexplained absence of the client from the program or his/her residence;

 

(d)Physical, sexual or verbal abuse of a client by staff or client(s);

 

(e)Staff negligence;

 

(f)Fire;

 

(g)Theft;

 

(h)Destruction of property;

 

(i)Sudden serious problems with the physical plant;

 

(j)Complaints from families or visitors of clients; and

 

(k)Requests for information from the press, attorneys or government officials outside of the Department of Human Services and the Department of Health.

 

source

Final Rulemaking published at 46 DCR 6122 (July 23, 1999).