AHC
WSR 97-03-062
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(General Provisions)
[Filed January 13, 1997, 11:28 a.m.]
Date of Adoption: January 13, 1997.
Purpose: Adopts standards for certified chemical dependency treatment providers for behavior management and temporary protective holding of chemically dependent youth who present a danger to themselves or others.
Citation of Existing Rules Affected by this Order: Amending WAC 440-22-005.
Statutory Authority for Adoption: RCW 70.96A.090.
Adopted under notice filed as WSR 96-09-078 on April 16, 1996, and supplemental notice WSR 96-14-055 on June 27, 1996.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 1, amended 1, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, amended 0, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 1, amended 1, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 0, repealed 0.
Effective Date of Rule: Thirty-one days after filing.
January 13, 1997
Philip A. Wozniak, Director
Administrative Services Division
AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-005 Definitions. Unless the context clearly indicates otherwise, the definitions in this section apply throughout this chapter:
(1) "Administrator" means the person designated responsible for the operation of the certified treatment service;
(2) "Adult" means a person eighteen years of age or older. "Young adult" means an adult who is not yet twenty-one years of age;
(3) "Alcoholic" means a person who has the disease of alcoholism;
(4) "Alcoholism" means a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic;
(5) "Authenticated" means written, permanent verification of an entry in a patient treatment record by means of an original signature including first initial, last name, and professional designation or job title, or initials of the name if the file includes an authentication record, and the date of the entry;
(6) "Authentication record" means a document which is part of a patient's treatment record, with legible identification of all persons initialing entries in the treatment record, and includes:
(a) Full printed name;
(b) Signature including the first initial and last name; and
(c) Initials and abbreviations indicating professional designation or job title.
(7) "Bloodborne pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans. The pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV);
(8) "Branch service site" means a physically separate certified unit where qualified staff provide a certified treatment service and are governed by a parent organization;
(9) "Certified treatment service" means a discrete program of chemical dependency treatment offered by a service provider who has a certificate of approval from the department of social and health services, as evidence the provider meets the standards of chapter 440-22 WAC;
(10) "Chemical dependency" means a person's alcoholism or drug addiction or both;
(11) "Chemical dependency counseling" means face-to-face individual or group contact using therapeutic techniques and:
(a) Led by a chemical dependency counselor (CDC) or a CDC intern under direct CDC supervision;
(b) Directed toward patients and others who are harmfully affected by the use of mood-altering chemicals or are chemically dependent; and
(c) Directed toward a goal of abstinence for chemically dependent persons.
(12) "Chemical dependency counselor (CDC)" means a person registered, certified, or exempted by the state department of health, and qualified as a CDC as described under WAC 440-22-240. Categories of chemical dependency counselors include:
(a) "Assessment officer" which means a person employed at a certified district or municipal court treatment program who meets WAC 440-22-225 requirements or is grandparented as meeting those requirements;
(b) "Youth chemical dependency counselor" which means a person who meets WAC 440-22-230 requirements.
(13) "Chemical dependency counselor (CDC) intern" means a person who meets the standards for CDC interns described under WAC 440-22-200 and 440-22-220, and is supervised by a CDC in a certified treatment agency, as described under WAC 440-22-210;
(14) "Child" means a person less than eighteen years of age, also known as adolescent, juvenile, or minor;
(15) "County coordinator" means the person designated by the chief executive officer of a county to carry out administrative and oversight responsibilities of the county chemical dependency program;
(16) "Criminal background check" means a search by the Washington state patrol for any record of convictions or civil adjudication related to crimes against children or other persons, including developmentally disabled and vulnerable adults, per RCW 43.43.830 through 43.43.842 relating to the Washington state patrol;
(17) "Danger to self or others," for purposes of WAC 440-22-406, means a youth residing in a chemical dependency treatment agency who creates a risk of serious harm to the health, safety, or welfare to self or others. Behaviors considered a danger to self or others include:
(a) Suicide threat or attempt;
(b) Assault or threat of assault; or
(c) Attempt to run from treatment, potentially resulting in a dangerous or life-threatening situation.
(18) "Department" means the Washington state department of social and health services;
(((18))) (19) "Detoxification" or "detox" means care and treatment
of a person while the person recovers from the transitory effects of
acute or chronic intoxication or withdrawal from alcohol or other drugs;
(((19)) (20) "Disability, person with a" means a person who:
(a) Has a physical or mental impairment that substantially limits one or more major life activities of the person;
(b) Has a record of such an impairment; or
(c) Is regarded as having such an impairment.
(((20))) (21) "Discrete treatment service" means a chemical
dependency treatment service that:
(a) Provides distinct chemical dependency supervision and treatment separate from other services provided within the facility;
(b) Provides a separate treatment area for ensuring confidentiality of chemical dependency treatment services; and
(c) Has separate accounting records and documents identifying the provider's funding sources and expenditures of all funds received for the provision of chemical dependency services.
(((21))) (22) "Domestic violence" means:
(a) Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury, or assault between family or household members; or
(b) Sexual assault of one family or household member by another.
(((22))) (23) "Drug addiction" means a primary, chronic disease with
genetic, psychosocial, and environmental factors influencing its
development and manifestations. The disease is often progressive and
fatal. Drug addiction is characterized by impaired control over use of
drugs, preoccupation with drugs, use of a drug despite adverse
consequences, and distortions in thinking, most notably denial. Each of
these symptoms may be continuous or periodic;
(((23))) (24) "First Steps" means a program available across the
state for low-income pregnant women and their infants. First Steps
provides maternal and child health care and support services;
(((24))) (25) "Governing body" means the legal entity responsible
for the operation of the chemical dependency treatment service;
(((25))) (26) "HIV/AIDS brief risk intervention (BRI)" means an
individual face-to-face interview with a client or patient, to help that
person assess personal risk for HIV/AIDS infection and discuss methods
to reduce infection transmission;
(((26))) (27) "HIV/AIDS education" means education, in addition to
the brief risk intervention, designed to provide a person with
information regarding HIV/AIDS risk factors, HIV antibody testing, HIV
infection prevention techniques, the impact of alcohol and other drug use
on risks and the disease process, and trends in the spread of the
disease;
(((27))) (28) "Medical practitioner" means a physician, certified
nurse practitioner, or certified physician's assistant. Nurse
practitioners and midwives with prescriptive authority may perform
practitioner functions related only to indicated specialty services;
(((28))) (29) "Misuse" means use of alcohol or other drugs by a
person in:
(a) Violation of any law; or
(b) Breach of agency policies relating to the drug-free work place.
(((29))) (30) "Off-site treatment" means provision of treatment by
a certified provider at a location where treatment is not the primary
purpose of the site;
(((30))) (31) "Opiate dependency treatment agency" means an
organization that administers or dispenses an approved drug as specified
in 212 CFR Part 291 for treatment or detoxification of opiate dependency.
The agency is:
(a) Approved by the Federal Food and Drug Administration;
(b) Registered with the Federal Drug Enforcement Administration;
(c) Licensed by the county in which it operates; and
(d) Certified as an "opiate dependency treatment agency" by the department.
(((31))) (32) "Patient" is a person receiving chemical dependency
treatment services from a certified program;
(((32))) (33) "Patient contact" means counselor time spent with a
client or patient to do assessments, individual or group counseling, or
education;
(((33))) (34) "Probation assessment service" means a certified
assessment service offered by a misdemeanant probation department or unit
within a county or municipality;
(((34))) (35) "Progress notes" are a permanent record of ongoing
assessments of a patient's participation in and response to treatment,
and progress in recovery;
(((35))) (36) "Restraint," for purposes of WAC 440-22-406, means the
use of methods, by a trained staff person, to prevent or limit free body
movement in the event of out-of-control behavior. "Restraint" includes:
(a) Containment or seclusion in an unlocked quiet room;
(b) Physical restraint, meaning a person physically holds or restricts another person in a safe manner for a short time in an immediate crisis; or
(c) Use of a safe and humane apparatus which the person cannot release by oneself.
(37) "Service provider" or "provider" means a legally operated entity certified by the department to provide chemical dependency treatment services. The components of a service provider are:
(a) Legal entity/owner;
(b) Facility; and
(c) Staff and services.
(((36))) (38) "Sexual abuse" means sexual assault, incest, or sexual
exploitation;
(((37))) (39) "Sexual harassment" means unwelcome sexual advances,
requests for sexual favors, and other verbal or physical conduct when:
(a) Submission to such conduct is made explicitly or implicitly a term or condition of employment or treatment;
(b) Such conduct interferes with work performance or creates an intimidating, hostile, or offensive work or treatment environment.
(((38))) (40) "Substance abuse" means a recurring pattern of alcohol
or other drug use which substantially impairs a person's functioning in
one or more important life areas, such as familial, vocational,
psychological, physical, or social;
(((39))) (41) "Summary suspension" means an immediate suspension of
certification, per RCW 34.05.422(4), by the department pending
administrative proceedings for suspension, revocation, or other actions
deemed necessary by the department;
(((40))) (42) "Supervision" means:
(a) Regular monitoring of the administrative, clinical, or clerical work performance of a staff member, intern, student, volunteer, or employee on contract by a person with the authority to give directions and require change; and
(b) "Direct supervision" means the supervisor is on the premises and available for immediate consultation.
(((41))) (43) "Suspend" means termination of the department's
certification of a provider's treatment services for a specified period
or until specific conditions have been met and the department notifies
the provider of reinstatement;
(((42))) (44) "Treatment services" means the broad range of
emergency, detoxification, residential, and outpatient services and care.
Treatment services include diagnostic evaluation, chemical dependency
education, individual and group counseling, medical, psychiatric,
psychological, and social services, vocational rehabilitation and career
counseling which may be extended to alcoholics and other drug addicts and
their families, persons incapacitated by alcohol or other drugs, and
intoxicated persons;
(((43))) (45) "Urinalysis" means analysis of a patient's urine
sample for the presence of alcohol or controlled substances by a licensed
laboratory or a provider who is exempted from licensure by the department
of health:
(a) "Negative urine" is a urine sample in which the lab does not detect specific levels of alcohol or other specified drugs; and
(b) "Positive urine" is a urine sample in which the lab confirms specific levels of alcohol or other specified drugs.
(((44))) (46) "Vulnerable adult" means a person sixty years of age
or older who has the functional, mental, or physical inability to care
for oneself.
(((45))) (47) "Youth" means a person seventeen years of age or
younger.
[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672),
440-22-005, filed 12/22/93, effective 2/1/94.]
Reviser's note: The typographical error in the above section
occurred in the copy filed by the agency and appears in the Register
pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 440-22-406 Behavior management. (1) Upon application for a youth's admission, a provider shall:
(a) Advise the youth's parent and other referring persons of the programmatic and physical plant capabilities and constraints in regard to providing treatment with or without a youth's consent;
(b) Obtain the parent's or other referring person's agreement to participate in the treatment process as appropriate and possible; and
(c) Obtain the parent's or other referring person's agreement to return and take custody of the youth as necessary and appropriate on discharge or transfer.
(2) The administrator shall ensure policies and procedures are written and implemented which detail least to increasingly restrictive practices used by the provider to stabilize and protect youth who are a danger to self or others, including:
(a) Obtaining signed behavioral contracts from the youth, at admission and updated as necessary;
(b) Acknowledging positive behavior and fostering dignity and self respect;
(c) Supporting self-control and the rights of others;
(d) Increased individual counseling;
(e) Increased staff monitoring;
(f) Verbal de-escalation;
(g) Use of unlocked room for containment or seclusion;
(h) Use of restraints; and
(i) Emergency procedures, including notification of the parent, guardian or other referring person, and, when appropriate, law enforcement.
(3) The provider shall ensure staff are trained in safe and therapeutic techniques for dealing with a youth's behavioral and emotional crises, including:
(a) Verbal de-escalation;
(b) Crisis intervention;
(c) Anger management;
(d) Suicide assessment and intervention;
(e) Conflict management and problem solving skills;
(f) Management of assaultive behavior;
(g) Proper use of restraint; and
(h) Emergency procedures.
(4) To prevent a youth's unauthorized exit from the residential treatment site, the provider may have:
(a) An unlocked room for containment or seclusion;
(b) A secure perimeter, such as a nonscalable fence with locked gates; and
(c) Locked windows and exterior doors.
(5) Providers using holding mechanisms in subsection (4) of this section shall meet 1994 Uniform Building Code requirements or its successor, which include fire safety and special egress control devices, such as alarms and automatic releases.
(6) When less-restrictive measures are not sufficient to de-escalate a behavioral crisis, clinical staff may contain or seclude a youth in a quiet unlocked room which has a window for observation and:
(a) The clinical supervisor shall be notified immediately of the staff person's use of a quiet room for a youth, and shall determine its appropriateness;
(b) A chemical dependency counselor shall consult with the youth immediately and at least every ten minutes, for counseling, assistance, and to maintain direct communication; and
(c) The clinical supervisor or designated alternate shall evaluate the youth and determine the need for mental health consultation.
(7) Youth who demonstrate continuing refusal to participate in treatment or continuing to exhibit behaviors that present health and safety risks to self, other patients, or staff may be discharged or transferred to more appropriate care after:
(a) Interventions appropriate to the situation from those listed in subsection (2) of this section have been attempted without success;
(b) The person has been informed of the consequences and return options;
(c) The parents, guardian, or other referring person has been notified of the emergency and need to transfer or discharge the person; and
(d) Arrangements are made for the physical transfer of the person into the custody of the youth's parent, guardian, or other appropriate person or program.
(8) Involved staff shall document the circumstances surrounding each incident requiring intervention in the youth's record and include:
(a) The precipitating circumstances;
(b) Measures taken to resolve the incident;
(c) Final resolution; and
(d) Record of notification of appropriate others.
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