Original Notice.

     Preproposal statement of inquiry was filed as WSR 09-03-098.

     Title of Rule and Other Identifying Information: The department is amending WAC 388-865-0245 Administration of the Involuntary Treatment Act, 388-865-0275 Management information system, 388-865-0405 Competency requirements for staff, 388-865-0452 Emergency crisis intervention services -- Additional standards, 388-865-0456 Case management services -- Additional standards, 388-865-0466 Community support outpatient certification -- Additional standards, and 388-865-0468 Emergency crisis intervention services certification -- Additional standards.

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on August 25, 2009, at 10:00 a.m.

     Date of Intended Adoption: Not sooner than August 26, 2009.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on August 25, 2009.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by August 11, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Chapter 360, Laws of 2007 (SHB 1456) established certain safety requirements for mental health professionals who conduct home visits to stabilize persons in crisis. The purpose of this rule-making action is to codify those requirements.

     Reasons Supporting Proposal: To comply with state law.

     Statutory Authority for Adoption: RCW 71.05.560, 71.05.700, 71.05.705, 71.05.710, 71.05.715, 71.05.720, and 71.24.035.

     Statute Being Implemented: RCW 71.05.560, 71.05.700, 71.05.705, 71.05.710, 71.05.715, 71.05.720, and 71.24.035.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1344; Implementation: David Kludt, P.O. Box 45320, Olympia, WA 98504-5320, (360) 902-0786; and Enforcement: Pete Marburger, P.O. Box 45320, Olympia, WA 98504-5320, (360) 902-0837.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Per RCW 19.85.025(3), no statement is required for rules incorporating state statutes by reference without material change.

     A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 (5)(b)(iii) exempts rules that are incorporating by reference Washington state statute.

July 10, 2009

Stephanie E. Schiller

Rules Coordinator

     (1) Designating mental health professionals to perform the duties of involuntary investigation and detention in accordance with the requirements of chapters 71.05 and 71.34 RCW.

     (2) Documenting consumer compliance with the conditions of less restrictive alternative court orders by:

     (a) Ensuring periodic evaluation of each committed consumer for release from or continuation of an involuntary treatment order. Evaluations must be recorded in the clinical record, and must occur at least monthly for ninety and one hundred eighty-day commitments.

     (b) Notifying the designated mental health professional if noncompliance with the less restrictive order impairs the individual sufficiently to warrant detention or evaluation for detention and petitioning for revocation of the less restrictive alternative court order.

     (3) Ensuring that when a peace officer or designated mental health professional escorts a consumer to a facility, the designated mental health professional must take reasonable precautions to safeguard the consumer's property including:

     (a) Safeguarding the consumer's property in the immediate vicinity of the point of apprehension;

     (b) Safeguarding belongings not in the immediate vicinity if there may be possible danger to those belongings;

     (c) Taking reasonable precautions to lock and otherwise secure the consumer's home or other property as soon as possible after the consumer's initial detention.

     (4) Ensuring that the requirements of RCW 71.05.700 through 71.05.715 are met.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0245, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0245, filed 5/31/01, effective 7/1/01.]

     (1) Operate an information system and ensure that information about consumers who receive publicly funded mental health services is reported to the state mental health information system according to mental health division guidelines.

     (2) Ensure that the information reported is:

     (a) Sufficient to produce accurate regional support network reports; and

     (b) Adequate to locate case managers in the event that a consumer requires treatment by a service provider that would not normally have access to treatment information about the consumer.

     (3) Ensure that information about consumers is shared or released between service providers only in compliance with state statutes (see chapters 70.02, 71.05, and 71.34 RCW) and this chapter. Information about consumers and their individualized crisis plans must ((be available)):

     (a) Be available twenty-four hours a day, seven days a week to designated mental health professionals and inpatient evaluation and treatment facilities, as consistent with confidentiality statutes; ((and))

     (b) Be available to the state and regional support network staff as required for management information and program review; and

     (c) Comply with the requirements of RCW 71.05.715.

     (4) Maintain on file a statement signed by regional support network, county or service provider staff having access to the mental health information systems acknowledging that they understand the rules on confidentiality and will follow the rules.

     (5) Take appropriate action if a subcontractor or regional support network employee willfully releases confidential information, as required by chapter 71.05 RCW.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0275, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0275, filed 5/31/01, effective 7/1/01.]

     (1) All staff have a current Washington state department of health license or certificate or registration as may be required for their position;

     (2) Washington state patrol background checks are conducted for employees in contact with consumers consistent with RCW 43.43.830;

     (3) Mental health services are provided by a mental health professional, or under the clinical supervision of a mental health professional;

     (4) Staff performing mental health services (not including crisis telephone) must have access to consultation with a psychiatrist or a physician with at least one year's experience in the direct treatment of persons who have a mental or emotional disorder;

     (5) Mental health services to children, older adults, ethnic minorities or persons with disabilities must be provided by, under the supervision of, or with consultation from the appropriate mental health specialist(s) when the consumer:

     (a) Is a child as defined in WAC ((866-865-0150 [388-865-0150])) 388-865-0150;

     (b) Is or becomes an older person as defined in WAC 388-865-0150;

     (c) Is a member of a racial/ethnic group as defined in WAC ((866-865-0105)) 388-865-0105 and as reported:

     (i) In the consumer's demographic data; or

     (ii) By the consumer or others who provide active support to the consumer; or

     (iii) Through other means.

     (d) Is disabled as defined in WAC 388-865-0150 and as reported:

     (i) In the consumer's demographic data; or

     (ii) By the consumer or others who provide active support to the consumer; or

     (iii) Through other means.

     (6) Staff receive regular supervision and an annual performance evaluation; and

     (7) An individualized annual training plan must be implemented for each direct service staff person and supervisor ((in)), to include at a minimum:

     (a) The skills he or she needs for his/her job description and the population served; and

     (b) The requirements of RCW 71.05.720.

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0405, filed 5/31/01, effective 7/1/01.]

     (c) Voluntary and involuntary inpatient evaluation and treatment facilities.

     (2) Consumer information must be available to the state and regional support network staff as required for management information, quality management and program review.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0440, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0440, filed 5/31/01, effective 7/1/01.]

     (1) Availability of staff to respond to crises twenty-four hours a day, seven days a week, including:

     (a) Bringing services to the person in crisis when clinically indicated;

     (b) Requiring that staff remain with the consumer in crisis to stabilize and support him/her until the crisis is resolved or a referral to another service is accomplished;

     (c) Resolving the crisis in the least restrictive manner possible;

     (d) A process to include family members, significant others, and other relevant treatment providers as necessary to provide support to the person in crisis((; and)).

     (((e))) (2) Written procedures for managing assaultive and/or self-injurious patient behavior.

     (((2))) (3) Written procedures for visits to homes and other private locations in accordance with the requirements of RCW 71.05.700 through 71.05.715.

     (4) Crisis telephone screening;

     (((3))) (5) Mobile outreach and stabilization services with trained staff available to provide in-home or in-community stabilization services, including flexible supports to the person where he/she lives.

     (((4))) (6) Provide access to necessary services including:

     (a) Medical services, which means at least emergency services, preliminary screening for organic disorders, prescription services, and medication administration;

     (b) Interpretive services to enable staff to communicate with consumers who have limited ability to communicate in English, or have sensory disabilities;

     (c) Mental health specialists for children, elderly, ethnic minorities or consumers who are deaf or developmentally disabled;

     (d) Voluntary and involuntary inpatient evaluation and treatment services, including a written protocol to assure that consumers who require involuntary inpatient services are transported in a safe and timely manner;

     (e) Investigation and detention to involuntary services under chapter 71.05 RCW for adults and chapter 71.34 RCW for children who are thirteen years of age or older, including written protocols for contacting the designated mental health professional.

     (((5))) (7) Document all telephone and face-to-face crisis response contacts, including:

     (a) Source of referral;

     (b) Nature of crisis;

     (c) Time elapsed from the initial contact to face-to-face response; and

     (d) Outcomes, including basis for decision not to respond in person, follow-up contacts made, and referrals made.

     (((6))) (8) The provider must have a written protocol for referring consumers to a voluntary or involuntary inpatient evaluation and treatment facility for admission on a seven-day-a-week, twenty-four-hour-a-day basis, including arrangements for contacting the designated mental health professional and transporting consumers.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0452, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0452, filed 5/31/01, effective 7/1/01.]

     (1) Assist consumers to achieve the goals stated in their individualized service plan;

     (2) Support consumer employment, education or participation in other daily activities appropriate to their age and culture;

     (3) Make referrals to other needed services and supports, including treatment for co-occurring disorders and health care;

     (4) Assist consumers to resolve crises in least-restrictive settings;

     (5) Provide information and education about the consumer's illness so the consumer and family and natural supports are engaged to help consumers manage the consumer's symptoms;

     (6) Include, as necessary, flexible application of funds, such as rent subsidies, rent deposits, and in-home care to enable stable community living; and

     (7) Maintain written procedures for home visits in accordance with the requirements of RCW 71.05.700 through 71.05.715.

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0456, filed 5/31/01, effective 7/1/01.]

     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.
AMENDATORY SECTION(Amending WSR 06-17-114, filed 8/18/06, effective 9/18/06)

WAC 388-865-0466   Community support outpatient certification -- Additional standards.   In order to provide services to consumers on a less restrictive alternative court order, providers must be licensed to provide the psychiatric and medical service component of community support services and be certified by the mental health division to provide involuntary treatment services consistent with WAC 388-865-0484. In addition, the provider must:

     (1) Document in the consumer clinical record and otherwise ensure:

     (a) Detained and committed consumers are advised of their rights under chapter 71.05 or 71.34 RCW and as follows:

     (i) To receive adequate care and individualized treatment;

     (ii) To make an informed decision regarding the use of antipsychotic medication and to refuse medication beginning twenty-four hours before any court proceeding that the consumer has the right to attend;

     (iii) To maintain the right to be presumed competent and not lose any civil rights as a consequence of receiving evaluation and treatment for a mental disorder;

     (iv) Of access to attorneys, courts, and other legal redress;

     (v) To have the right to be told statements the consumer makes may be used in the involuntary proceedings; and

     (vi) To have the right to have all information and records compiled, obtained, or maintained in the course of treatment kept confidential as defined in chapters 71.05 and 71.34 RCW.

     (b) A copy of the less restrictive alternative court order and any subsequent modifications are included in the clinical record;

     (c) Development and implementation of an individual service plan which addresses the conditions of the less restrictive alternative court order and a plan for transition to voluntary treatment;

     (d) That the consumer receives psychiatric treatment including medication management for the assessment and prescription of psychotropic medications appropriate to the needs of the consumer. Such services must be provided:

     (i) At least weekly during the fourteen-day period;

     (ii) Monthly during the ninety-day and one-hundred eighty day periods of involuntary treatment unless the attending physician determines another schedule is more appropriate, and they record the new schedule and the reasons for it in the consumer's clinical record.

     (2) Maintain written procedures for managing assaultive and/or self-destructive patient behavior, and provide training to staff in these interventions;

     (3) Have a written protocol for referring consumers to an inpatient evaluation and treatment facility for admission on a seven-day-a-week, twenty-four-hour-a-day basis;

     (4) For consumers who require involuntary detention the protocol must also include procedures for:

     (a) Contacting the designated mental health professional regarding revocations and extension of less restrictive alternatives, and

     (b) Transporting consumers.

     (5) Maintain written procedures for home visits in accordance with the requirements of RCW 71.05.700 through 71.05.715

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0466, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0466, filed 5/31/01, effective 7/1/01.]

     (1) Be available seven-days-a-week, twenty-four-hours-per-day;

     (2) Follow a written protocol for holding a consumer and contacting the designated mental health professional;

     (3) Provide or have access to necessary medical services;

     (4) Have a written agreement with a certified inpatient evaluation and treatment facility for admission on a seven day a week, twenty-four hour per day basis; ((and))

     (5) Follow a written protocol for transporting individuals to inpatient evaluation and treatment facilities; and

     (6) Maintain written procedures for home visits in accordance with the requirements of RCW 71.05.700 through 71.05.715.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, § 388-865-0468, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0468, filed 5/31/01, effective 7/1/01.]

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