37 TAC §163.40
The Texas Board of Criminal Justice proposes to amend §163.40,
concerning Substance Abuse Treatment. The purpose of the amendments is to
implement the legislative mandate in H.B. 2668 (78th Legislature, R.S.) for
best practices targeting the substance abuse offender population under community
supervision. The Substance Abuse Treatment Standards, as amended, will emphasize
enhancement of cognitive programs targeting anti-social thinking and more
intensive supervision for high-risk offenders. Community supervision and corrections
departments (CSCDs) are already required to utilize valid assessments to assure
proper levels of supervision and program placements. Treatment providers will
continue to be evaluated to determine outcomes and impact on participants.
However, the revised Standards are not more intrusive than the current Department
of State Health Services (formerly Texas Commission on Alcohol and Drug Abuse)
rules under which treatment providers are currently operating.
Significant amendments are summarized as follows. Definitions were added
in subsection (a) to include the terms "Best Practices," "Criminogenic Risks/Needs,"
"Life Skills Training," "Responsivity," and "Treatment Team," among others.
Program time frames have been amended to better correspond to the current
Department of State Health Services (formerly Texas Commission on Alcohol
and Drug Abuse Commission) rules. Subsection (d) is amended to provide that
offenders who are removed from treatment as "ineligible" are not to be counted
as "discharged." In subsection (e), the intake process is required to include
eligibility, and to be completed within ten working days. Subsection (g),
dealing with assessments, is amended to require responsivity analysis. Treatment
planning is required to include criteria for discharge based on achievement
of treatment plan goals, in subsection (m), and in subsection (o) is a similar
requirement for changes in treatment stages; amended subsection (o) also requires
that the treatment team meet if the offender is subject to a major setback,
and prior to discharge. New subsection (r) requires a discharge summary for
all offenders who do not leave the program successfully, while amended subsection
(q) requires a discharge plan for those who leave successfully. Subsection
(s) limits the number of offenders in group counseling, life skills, and group
education classes; provides credentialing requirements for such services;
requires a counselor on duty during normal business hours; and requires CSCDs
to incorporate certain components of "best practices" in treatment programs.
Subsection (u) is amended to delete references to the detoxification stage
of treatment, as CSCDs do not offer this stage of treatment. In subsection
(w), caseloads for Supportive Residential Treatment are permitted to increase
from 16 to 20 offenders per counselor, with further increases permissible
based on research-based evidence.
Brad Livingston, Executive Director for TDCJ, has determined that for the
first five years, the legislation upon which the rule is based will have fiscal
implications for CSCDs, consistent with the Legislative Budget Board's Fiscal
note for H.B. 2668. That document indicated that local governments would incur
additional costs because additional persons would be diverted to community
supervision from the Texas Department of Criminal Justice, but did not quantify
those costs, or quantify the costs, if any, of the implementation of "Best
Practices." Mr. Livingston is not able to predict or quantify whether the
various amendments would have a positive or negative fiscal impact, in part
because any impact would depend on each individual CSCD's current level of
service. The proposed amendments were conveyed to all CSCDs on October 4,
2004, with a request for comments by October 25, 2004, and the proposed amendments
were revised in light of CSCD comments.
Mr. Livingston also has determined that for each year of the first five
years the section is in effect the public benefit anticipated as a result
of enforcing the section will be to enhance and assist in the targeting of
appropriate strategies for the supervision and treatment of substance abusing
offenders. Evidence-Based Practices have a strong emphasis on outcome measures,
specifically reduction in recidivism. These practices have been proven through
research to be effective, allowing the use of scarce resources more effectively
and to target the appropriate offenders for each program. Mr. Livingston has
determined that there will be no economic costs to persons who are required
to comply with the section as amended, and that there will be no fiscal impact
on small businesses.
Questions about the content of the proposal may be directed to John Hill
at (512) 305-9327 in the TDCJ Community Justice Assistance Division. Written
comments should be directed to Carl Reynolds, General Counsel, Texas Department
of Criminal Justice, P.O. Box 13084, Austin, Texas 78711, or to Carl.Reynolds@tdcj.state.tx.us.
Written comments from the general public should be received within 30 days
of the publication of this proposal in the
Texas
Register
.
The amendments are proposed under Texas Government Code, §509.015.
Cross Reference to Statutes: Texas Government Code, §509.015.
§163.40.Substance Abuse Treatment.
(a)
Definitions. The following words and terms, when used in
this section, shall have the following meanings, unless the context clearly
indicates otherwise.
(1)
Admission--The administrative process and procedure performed
to accept an offender into a treatment program or facility.
(2)
Aftercare--Counseling and community based support
services that are designed to provide continued support for treatment delivered
in a residential or outpatient program
[
Assessment--a process using
a structured or semi-structured interview to determine the nature and extent
of a client's chemical dependency.
]
(3)
Aftercare Caseloads--Supervision and support services
for offenders who have completed a substance abuse treatment program.
[
Chemical Dependency Counselor--A qualified, credentialed counselor intern
working under a direct supervision.
]
(4)
Assessment--A process conducted by a qualified credential
counselor (QCC) trained to administer a structured interview to determine
the nature and extent of an offender's chemical abuse, dependency or addiction,
to assist in making an appropriate referral. Other criminogenic risks/needs
will be assessed and incorporated into the individual treatment plan.
[
Continuum of Care--A system which provides for the uninterrupted provision
of essential services to offenders entering, exiting, and within the system.
]
(5)
Best Practices--In these standards, Best Practices
are evidence-based substance abuse treatment programs that address concepts
such as criminogenic risks/needs, responsivity, and cognitive-behavioral treatment,
and programs that possess the following hallmarks:
[
Counseling--Face-to-face
interactions between offenders and counselors to help offenders identify,
understand, and resolve their personal issues and problems related to their
substance abuse or chemical dependency. Counseling may take place in groups
or in individual meetings.
]
(A)
validated treatment assessments
that include criminogenic risks/need factors;
(B)
a treatment regimen that focuses
on changing criminogenic risks/needs, behaviors, and thinking patterns;
(C)
a treatment regimen that includes
a specific, cognitive-behavioral program that has been recognized in professional
criminal justice journals;
(D)
responsivity in addressing
offenders' needs and employment of qualified staff; and
(E)
measurable outcomes to reduce
substance abuse, dependency or addiction and other criminogenic risks/needs.
(6)
Chemical Dependency--Substance-related disorders as
that term is used in the most recent published edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM).
[
Counselor Intern--A
person pursuing a course of training in chemical dependency counseling at
a regionally accredited institution of higher education or a registered clinical
training institution who has been designated as a counselor. The activities
of a counselor intern shall be performed under the direct supervision of a
qualified, credentialed counselor in accordance with rules adopted by the
Texas Commission on Alcohol and Drug Abuse.
]
(7)
Continuum of Care--A system that provides for the
uninterrupted provision of essential services from initial assessment through
completion of treatment.
[
Detoxification--Chemical dependency treatment
designed to systematically reduce the amount of alcohol and other toxic chemicals
in an offender's body, manage withdrawal symptoms, and encourage the offender
to continue ongoing treatment for chemical dependency.
]
(8)
Counseling--Face-to-face interactions between offenders
and counselors to help offenders identify, understand, and resolve their personal
issues and problems related to their substance abuse or chemical dependency.
Counseling may take place in groups or in individual meetings.
[
Direct Care Staff--The staff responsible for providing treatment, care, supervision,
or other offender services that involve a significant amount of direct contact.
(Clerical support staff are not considered direct care staff.)
]
(9)
Counselor--A qualified credentialed counselor, graduate
or counselor intern working towards licensure that would qualify them to be
a qualified credentialed counselor (QCC).
[
Discharge--The time
when an offender leaves a program or facility and will no longer be receiving
chemical dependency treatment from that program or facility.
]
(10)
Counselor Intern--An advanced student or graduate
in a professional field gaining supervised professional experience.
[
Discharge Summary--A recapitulation of the offender's progress and participation
while in either primary, residential, or outpatient treatment.
]
(11)
Criminogenic Risk/Needs--Dynamic risk factors that
are directly related to crime production, such as antisocial peers; antisocial
beliefs, values and attitudes; substance abuse, dependency or addiction; anger/hostility;
poor self-management skills; inadequate social skills; poor attitude toward
work/school; and poor family dynamics.
[
Education--Educational
instruction; a planned, structured presentation of information which is related
to substance abuse or chemical dependency.
]
(12)
Detoxification--Chemical dependency treatment designed
to systematically reduce the amount of alcohol and other toxic chemicals in
an offender's body, manage withdrawal symptoms, and encourage the offender
to continue ongoing treatment for chemical dependency.
[
Emergency--A
situation requiring immediate attention and action to treat or prevent physical,
emotional, or mental threat, harm, injury, or illness.
]
(13)
Direct Care Staff--Staff responsible for providing
treatment, care, supervision, or other direct client services that involve
face-to-face contact with an offender.
[
Facility--The physical
location of the treatment program operated by, for, or with funding from the
TDCJ-CJAD. Some locations may be locked facilities for in-patient treatment;
other programs may be offered at locations as outpatient treatment.
]
(14)
Discharge--Formal, documented termination of services.
[
Grievance--A formal complaint limited to matters affecting the
complaining offender personally and limited to matters for which the facility/program
has the authority to remedy through the grievance process.
]
(15)
Discharge Summary--A written report of the offender's
progress and participation while in treatment, including a discharge plan
that provides an aftercare/supervision plan designed to sustain progress for
offenders successfully completing treatment.
[
Primary Counselor--An
individual working directly with and being responsible for the treatment of
the offender.
]
(16)
Education--Educational instruction; a planned, structured
presentation of information which is related to substance abuse or chemical
dependency. Education is not considered counseling.
[
Qualified,
Credentialed Counselor (QCC)--A licensed chemical dependency counselor (LCDC)
or one of the following professionals:
]
[
(A)
licensed professional counselor
(LPC); ]
[
(B)
licensed master social worker
(LMSW); ]
[
(C)
licensed marriage and family
therapist (LMFT);]
[
(D)
licensed psychologist; ]
[
(E)
licensed physician (MD or
DO);]
[
(F)
certified addictions registered
nurse (CARN);]
[
(G)
licensed psychological associate;
and ]
[
(H)
advance practice nurse recognized
by the Board of Nurse Examiners as a clinical nurse specialist or nurse practitioner
with specialty in psyche-mental health (APN-P/MH). ]
(17)
Emergency--A situation requiring immediate attention
and action to treat or prevent physical or emotional harm or illness.
[
Screening Instrument--a written device administered to an offender to determine
the possible existence of chemical dependency.
]
(18)
Evaluation--A process conducted by a CSO trained
to administer the TDCJ-CJAD Substance Abuse Evaluation (SAE) instrument to
determine the nature and extent of an offender's chemical abuse, dependency
or addiction to assist in making an appropriate referral. Other criminogenic
risk/needs will be assessed and incorporated into the individual treatment
plan.
[
Senior Counselor/Unit Manager/Unit Supervisor--A supervisory
staff member who directs, monitors, and oversees the work performance of subordinate
staff members.
]
(19)
Facility--The physical location of the treatment
program operated by, for, or with funding from the TDCJ-CJAD. Some locations
may be secured facilities for in-patient treatment; other programs may be
offered at locations as outpatient treatment.
[
Special Needs Populations--Offenders
who have significant problems in the areas of mental health, diminished intellectual
capacity, or medical needs.
]
(20)
Graduate--A counselor intern who has successfully
completed education and work experience requirements prior to licensure by
the Texas Department of State Health Services (formerly Texas Commission on
Alcohol and Drug Abuse).
[
Treatment--A planned, structured, and
organized program designed to initiate and promote a person's chemical-free
status or to maintain the person free of illegal drugs. It includes, but is
not limited to, the application of planned procedures to identify and change
patterns of behavior related to or resulting from chemical dependency that
are maladaptive, destructive, or injurious to health, or to restore appropriate
levels of physical, psychological, or social functioning lost due to chemical
dependency.
]
(21)
Grievance--A formal complaint limited to matters
affecting the complaining offender personally and limited to matters that
the facility/program has the authority to remedy.
[
Use of Force--Graduated
levels of use of physical strength or weapons necessary to gain physical compliance
and control of an offender whose actions otherwise pose a danger to self or
others.
]
(22)
Intake--The process of gathering
information to determine if an offender is eligible and appropriate for services,
and providing information to the offender about a program's services and rules.
(23)
Life Skills Training--A structured
program of training, based upon a written curriculum and provided by qualified
staff designed to help offenders with social competencies, such as communication
and social interaction, stress management, problem solving, decision making,
and management of daily responsibilities.
(24)
Primary Counselor--An individual
working directly with and being responsible for the treatment of the offender.
(25)
Qualified, Credentialed Counselor
(QCC)--A licensed chemical dependency counselor (LCDC) or one of the following
professionals:
(A)
licensed professional counselor (LPC);
(B)
licensed master social worker (LMSW);
(C)
licensed marriage and family therapist (LMFT);
(D)
licensed psychologist;
(E)
licensed physician (MD or DO);
(F)
licensed physician's assistant;
(G)
certified addictions registered nurse (CARN);
or
(H)
licensed psychological associate; and
(I)
nurse practitioner recognized by the Board of
Nurse Examiners as a clinical nurse specialist or nurse practitioner with
specialty in psyche-mental health (APN-P/MH).
(26)
Responsivity--Matching the
characteristics of the offender with the program modality, and the knowledge,
skills, and abilities of the staff. It includes offender's learning style
and readiness for treatment; the quality of the treatment relationship; and
the staff's therapeutic approach, cultural competency, use of reinforcement,
and modeling.
(27)
Screening--The initial stage
of a process in which it is determined if an offender has a chemical dependency
problem that may require further assessment or evaluation.
(28)
Senior Counselor/Unit Manager/Unit
Supervisor--A supervisory staff member who directs, monitors, and oversees
the work performance of subordinate staff members.
(29)
Special Needs Populations--Offenders
who have significant problems in the areas of mental health, diminished intellectual
capacity, or medical needs.
(30)
Structured Activity--A planned,
interactive, scheduled event that is overseen by staff in which participants
actively take part in an activity related to recovery, health, life skills,
or interpersonal skills.
(31)
Treatment--A planned, structured,
and organized program, either residential or non-residential, designed to
initiate and promote an offender's chemical-free status or to maintain the
offender free of illegal drugs. It includes, but is not limited to, the application
of planned procedures to identify and change patterns of behavior related
to or resulting from chemical dependency that are maladaptive, destructive,
or injurious to health, or to restore appropriate levels of physical, psychological,
or social functioning lost due to chemical dependency.
(32)
Treatment Team--The treatment
team shall consist of at least the offender, the offender's counselor, a CSO
and/or residential CSO (when appropriate).
(b)
Compliance. Compliance with TDCJ-CJAD substance abuse treatment
standards is required of all programs that provide substance abuse treatment
and are funded
directly or indirectly
or managed by TDCJ-CJAD.
Programs and facilities providing only substance abuse education are not subject
to these standards.
(c)
Personnel & Staff Development/Accreditation. The employer
shall ensure that employees acquire
and maintain
any credentials,
licensing, certifications, or continuing education required to perform their
duties
, with copies kept in their personnel files
. [
Personnel
files for employees shall be maintained to display copies of required documents.
Programs that are not clinical training institutions as defined by the Texas
Commission on Alcohol and Drug Abuse must inform all non-credentialed staff
of this fact
]
(d)
Admissions
and Removals
. [
There shall be
documentation of specific admission criteria and procedures. Offenders are
eligible for substance abuse treatment programs:
]
(1)
Eligibility--Programs shall have written eligibility
criteria specific to the services and mission of the program. Offenders may
be admitted into a program only by order of the court and only if they meet
the minimum eligibility criteria as outlined in the program policies, licensure
or CJAD approved program design. Offenders found to be ineligible for admission
within 10 days of arrival at the program shall not be counted in program admissions.
[
if the offender's needs are met by the treatment services provided
by the program,
]
(2)
There shall be documentation of specific admission
criteria and procedures. Offenders are eligible for substance abuse treatment
programs if:
[
if a court orders the offender into the program and
the subsequent assessment indicates the need for treatment services; or
]
(A)
there is responsivity between
the treatment services provided by the program and the offender's criminogenic
risks/needs;
(B)
a court orders the offender
into the program and the subsequent assessment indicates the need for treatment
services; or
(C)
the program allows readmissions
and the offender meets the admission criteria.
(3)
For offenders who are placed in treatment programs
who do not meet admission or eligibility criteria, a mechanism or procedure
shall be developed for offender removal. A review and justification explaining
the reason the offender does not meet admission criteria shall be required
with copies kept in the offender's file. Offenders who do not meet eligibility
criteria will be considered ineligible and shall not be counted as "discharged."
[
if the program allows readmissions and the offender meets the
admission criteria. For offenders who are placed in treatment programs who
do not meet admission criteria, a mechanism or procedure shall be developed
for offender removal. A review and justification explaining the reason the
offender does not meet admission criteria shall be required.
]
(e)
Intake. There shall be written policies and procedures
establishing an intake process
to determine eligibility
for offenders
entering a substance abuse treatment program.
The intake process must
be completed within ten working days of an offender's arrival in a program.
(f)
Initial Assessment Procedures. Acceptable and recognized
assessment tools [
(tests and measurements)
] shall be used in all
substance abuse treatment programs within ten (10) working days from date
of admission. Assessment policies and procedures shall require the use of
approved clinical measurements and screening tests. If the screening identifies
a potential mental health problem, the facility shall obtain a mental health
assessment and seek appropriate mental health services when resources for
mental health assessments and services are available internally or through
referral at no additional cost to the program. Assessment procedures shall
include the following:
(1)
identification of strengths, abilities, needs and substance
preferences of the
offender
[
offenders served
];
(2)
summarization and evaluation of each offender to develop
individual treatment plans;
(3)
assessments completed by a [
Qualified Credentialed
Counselor (
]QCC[
)
], or if the assessor is a Counselor Intern,
then the documentation must be reviewed and signed by a QCC.
(g)
Assessments. The assessment shall include:
(1)
a summary of the offender's alcohol or drug abuse history
including substances used, date of last use, date of first use, patterns and
consequences of use, types of and responses to previous treatment, and periods
of sobriety;
(2)
family information, including substance use and abuse by
family members and supportive or dysfunctional relationships;
(3)
vocational and employment status, including skills or trades
learned, work record, and current vocational plans;
(4)
health information, including medical conditions that present
a problem or that might interfere with treatment;
(5)
emotional or behavioral problems, including a history of
psychiatric treatment;
(6)
educational achievement level;
(7)
intellectual functioning level; [
and
]
(8)
responsivity analysis; and
[
a diagnostic
summary signed and dated by a Qualified Credentialed Counselor (QCC).
]
(9)
a diagnostic summary signed
and dated by a QCC.
(h)
Orientation. Each program shall establish written policies
and procedures for the orientation process. Orientation shall be provided
at the onset of treatment and in accordance with the level of treatment to
be provided. The orientation shall relay information concerning program rules,
the grievance procedure, and the steps necessary for offenders to complete
treatment successfully.
(i)
Offender Rights. The offender's basic rights shall be respected
and protected, free from abuse, neglect, exploitation, and discrimination.
Each provider shall have written policy and procedure to ensure protection
of the offender's rights according to federal and state guidelines.
(j)
Release of Information. There shall be written policies
and procedures for protecting and releasing offender information that conforms
to federal and state confidentiality laws. The staff shall follow written
policies and procedures for responding to oral and written requests for offender-identifying
information.
(k)
Offender Records. There shall be written policies and procedures
regarding the content of offender treatment records. Residential programs
shall maintain separate individual treatment records for defendants. Case
records, whether residential or outpatient, shall include the following information
at a minimum:
(1)
court order placing the offender into the program;
[
initial intake information form;
]
(2)
initial intake information form;
[
referral
documentation;
]
(3)
referral documentation;
[
case information
from referral source, if applicable;
]
(4)
case information from referral source, if applicable;
[
release of information forms;
]
(5)
release of information forms;
[
relevant
medical information;
]
(6)
relevant medical information;
[
case history
and assessment including risk and needs assessment and Strategies for Case
Supervision if required;
]
(7)
case history and assessment including risk and needs
assessment and Strategies for Case Supervision if required;
[
individual
treatment plan;
]
(8)
individual treatment plan;
[
evaluation and
progress reports;
]
(9)
evaluation and progress reports; and
[
discharge summary; and
(10)
discharge summary.
[
court order placing
the offender into the program.
]
(l)
Offender Records Review Policy. There shall be written
policies
[
policy
] and procedures to govern the access of
offenders to their own substance abuse treatment records in accordance with
Texas Health & Safety Code and 42 CFR part 2
(Code of Federal Regulations)
. This access does not apply to criminal justice records. Restrictions
to access [
to
] treatment records shall be specified and explained
to offenders upon request. Exceptions must involve the potential for harm
to the offender or others.
(m)
Treatment Planning and Review. Initial individual Treatment
Plans will be completed
by the counselor collaborating with the offender
within ten [
(10)
] working days from the date of an offender's
admission to a
Community Corrections Facility (
CCF
)
,
County Correctional Center (
CCC
)
or any other substance abuse
treatment program or through a similar process approved by the
Community
Supervision and Corrections Department (
CSCD
)
. Substance
abuse treatment shall be based on
substance abuse, chemical dependency
or addiction and other criminogenic risks/
needs identified through assessments
and revised according to the offender's
successful resolution of those
substance abuse, chemical dependency or addiction and other criminogenic risks/needs
[
success or lack of progress
].[
,
] Treatment plans
shall
include criteria for discharge that are based on the achievement
of treatment plan goals and shall
be reviewed at timely intervals
with
[
at
] a minimum of once each month or when major changes
occur (e.g., change in
stage
[
phase
])
. The treatment
planning and review process
[
and
] shall ensure
that
:
(1)
[
that
] the primary counselor meets with the
offender as needed to review the treatment plan, evaluating goal progress
and revisions; [
and
]
(2)
[
that
] all revised treatment plans
are
[
be
] signed and dated by the counselor and the offender
; and
[
.
]
(3)
results of the review are documented
and placed in the treatment file, with a copy to the CSO.
(n)
Treatment Progress Notes. There shall be written policies
and procedures to require all programs to record and maintain progress notes
on all offender case records, document counseling sessions, and to summarize
significant events that occur throughout the treatment process. Progress notes
shall be documented at a minimum of once each week.
(o)
Changes in Treatment
Stages
[
Levels
].
Each treatment program shall develop written criteria
based on achievement
of treatment plan goals
for an offender to advance or regress from a
stage
[
level
] of treatment. An offender must meet the criteria
for a change in the
stage
[
level
] of treatment before
such a change or a discharge is implemented.
The treatment team shall
confer when the offender is subject to a major setback in the program and
prior to discharge
[
Justification for level changes must be documented
].
(p)
Discharges from Treatment. Discharge from a program shall
be
according to one of
[
based on
] the following criteria:
(1)
Successful Discharge--
the offender has made
sufficient progress towards meeting the objectives of the
Treatment Plan,
including addressing criminogenic risks/needs
[
supervision plan
] and program requirements;
(2)
Administrative Discharge--
the offender has satisfied
a period of placement as a condition of community supervision
, the offender
is removed by order of the court, or the offender is removed by operation
of law for conduct occurring prior to admission into the program
;
(3)
Unsuccessful Discharge--
the offender has demonstrated
non-compliance with the program criteria or court order
, including absconding
from the program; or
[
;
]
(4)
Medical Discharge--
the offender manifests a
medical
or psychological
problem
, including death,
that
prohibits participation or completion of the program requirements
.
[
;
]
[
(5)
the offender displays symptoms
of a psychological disorder that prohibits participation or completion of
the program requirements; or]
[
(6)
the offender is identified
as inappropriate or ineligible for participation in the program as defined
by facility eligibility criteria, statute, or standard.]
(q)
Discharge
Plan
[
Summary
].
The
treatment team shall adopt a
[
A
] discharge
plan
[
summary shall be prepared by the primary counselor
] for each offender
prior to
successful discharge
[
leaving any substance abuse
program
]. The discharge
plan
[
summary
] shall be
sent to the
offender's
[
defendant's
] supervision officer
within seven [
(7)
] days
after
[
of
] discharge
and provide a
summary
[
summation
] of:
(1)
clinical problems at the onset of treatment and original
diagnosis;
(2)
the problems or needs and strengths or weaknesses identified
on the master treatment plan;
(3)
the goals and objectives established;
(4)
the course of treatment;
(5)
the outcomes achieved; and
(6)
a continuum of care/relapse plan for aftercare treatment,
which must be prepared with the offender and a family member or significant
other, if appropriate and available.
[
a continuum of care plan/aftercare
treatment plan, which must be prepared with the offender prior to discharge.
]
(r)
Discharge Summary. A Discharge
Summary shall be prepared for all offenders who leave the program as an unsuccessful,
administrative or medical discharge. The summary shall include elements (1)
- (6) of the Discharge Plan.
(s)
[
(r)
] General Program Services Provisions.
Specific services shall be required of all substance abuse treatment programs.
Written
policies
[
policy
] and procedures shall ensure
the following
standards are met
:
(1)
All substance abuse services shall be delivered according
to a written treatment plan
that has been developed from the offender's
assessment
;
(2)
Group counseling sessions are
limited to a maximum of sixteen offenders. Group education and life skills
training sessions are limited to a maximum of thirty-five offenders. These
limits do not apply to multi-family educational groups, seminars, outside
speakers, or other events designed for a large audience.
(3)
[
(2)
] All programs shall employ a
QCC.
[
Qualified Credentialed Counselor as the Program Director,
Clinical Director, Senior Counselor, or the counselor in a similar supervisory
position;
]
(4)
All counselor interns shall
work under the direct supervision of a QCC.
(5)
Chemical dependency counseling
must be provided by a QCC, graduate or counselor who has the specialized education,
training, or expertise in the subject matter to be delivered. Chemical dependency
education shall be provided by counselors or individuals who have the specialized
education, training, or expertise in the subject matter to be delivered.
(6)
Direct care staff shall be
awake and alert on site during all hours of program operation.
(7)
Residential programs shall
have at least one counselor on duty at least eight hours a day, five days
a week.
(8)
Offenders in residential programs
shall have an opportunity for eight continuous hours of sleep each night.
Staff shall conduct and document at least three checks while offenders are
sleeping.
(9)
[
(3)
] The program shall include
a
culturally diverse curriculum applicable to the population served
and shall be evidenced through demonstrated, appropriate counseling and instructional
materials.
(10)
[
(4)
] Members of the offender treatment
team shall demonstrate effective communications and coordination, as evidenced
in staffing, treatment planning and case-management documentation.
(11)
[
(5)
] There shall be written policies
and procedures regarding the delivery and administration of prescription and
nonprescription medication which provide for:
(A)
conformity with state regulations; and
(B)
documentation of the administration of medications, medication
errors, and drug reactions.
(12)
[
(6)
] Chemical dependency education
and life skills training
shall follow a course outline that identifies
lecture topics and major points to be discussed
. All educational sessions
shall include offender participation and discussion of the material presented.
[
;
]
(13)
[
(7)
] The program shall provide
education about the health risks of tobacco products and nicotine addiction
.
[
;
]
(14)
[
(8)
] The program shall provide
HIV, Hepatitis B and C and Tuberculosis education based on the Model Workplace
Guidelines for Direct Service Providers developed by the Texas Department
of
State
Health
Services.
[
;
]
(15)
[
(9)
] Offenders shall have access
to HIV counseling and testing services directly or through referral
,
as follows:
[
;
]
(A)
HIV services shall be voluntary, anonymous, and not limited
by ability to pay.
(B)
counseling shall be based on the model protocol developed
by the Texas Department of
State
Health
Services
.
(C)
in all TDCJ-CJAD funded facilities, testing, as well as
pre- and post-test counseling, is to be provided by the medical department
or contracted medical provider. [
In all facilities, service shall be
provided either directly or through referral.
]
(16)
[
(10)
] The program shall make testing
and information, for tuberculosis and sexually transmitted diseases available
to all offenders, unless the program has access to test results obtained during
the past year
, as follows:
[
;
]
(A)
services may be made available directly or through referral.
(B)
if an offender tests positive for tuberculosis or a sexually
transmitted disease, the program shall refer the offender to an appropriate
health care provider and take appropriate steps to protect offenders and staff.
(C)
a community corrections facility shall report to the local
health department the release of an offender who is receiving treatment for
tuberculosis.
(17)
[
(11)
] The program shall:
(A)
refer pregnant offenders who are not receiving prenatal
care to an appropriate health care provider and monitor follow-through; and
(B)
refer offenders to ancillary services
(such as mental
health services)
necessary to meet treatment goals.
(18)
CSCDs that contract for services
shall give preference to available programs that include the following elements
of "Best Practices" in criminal justice treatment. CSCDs that conduct their
own programs are required to incorporate the following elements of "Best Practices"
in criminal justice treatment:
(A)
validated treatment assessments that include
substance abuse, dependency or addiction and other criminogenic risks/needs
factors;
(B)
a treatment regimen that focuses on changing
substance abuse, dependency or addiction and other criminogenic risks/needs,
behaviors, and thinking patterns;
(C)
a treatment regimen that includes a specific,
cognitive-behavioral program that has been recognized in professional criminal
justice journals; and
(D)
responsivity in addressing offenders' needs
and in employment of qualified staff.
(19)
CSCDs that place offenders
in substance abuse treatment programs shall ensure that offenders are referred
to available aftercare services, giving preference to programs that incorporate
"Best Practice" elements.
(t)
[
(s)
]
Stages
[
Levels
] of Treatment. All CCFs providing substance abuse treatment shall designate
in the current facility's Community Justice Plan (CJP) program proposal stages
[
levels
] of treatment to be provided as described in
subsections
(v)
[
sections (t)
] through
(y)
[
(x)
] below. [
Beginning in fiscal year 2004, level II and level
III treatment programs must include a cognitive-behavioral component for medium
and high-risk offenders.
]
(u)
[
(t) Level I (
]Detoxification[
)
].
Offenders being referred to detoxification services must be
referred to appropriately licensed service providers.
[
Written
policies and procedures shall ensure the following:
]
[
(1)
All offenders admitted to
Level I (Detoxification) programs shall need detoxification.]
[
(2)
Every offender shall have
a completed medical history and physical.]
[
(A)
Residential offenders shall have a completed
physical and medical history and a physical within 24 hours of admission.
If the facility cannot meet this deadline because of exceptional circumstances,
the circumstances shall be documented in the offender record. Until an offender's
medical history and physical is complete, staff shall observe offenders closely
(no less than every 15 minutes) and monitor vital signs (no less than once
each hour).]
[
(B)
Outpatient offenders shall have the medical
history and physical completed before admission.]
[
(3)
The program shall provide
continuous supervision for offenders.]
[
(A)
In residential programs, direct care staff
shall be awake and on site 24 hours a day.]
[
(i)
During day and evening hours, at least two
awake staff shall be on duty for the first 12 offenders, with one more person
on duty for each additional one to 16 offenders.]
[
(ii)
At night, at least one awake staff member
shall be on duty for the first 12 offenders, with one more person on duty
for each additional one to 16 offenders.]
[
(B)
In outpatient programs, direct care staff shall
be awake and on site whenever an offender is on site. Offenders shall have
access to on-call staff 24 hours a day.]
[
(4)
If the program accepts offenders
with acute detoxification symptoms or a history of acute detoxification symptoms,
the program shall have:]
[
(A)
a licensed vocational nurse or registered nurse
on duty during all hours of operation;]
[
(B)
a physician on-call 24 hours a day.]
[
(5)
Level of observation shall
be based on medical recommendations and program design, or not less than that
described in (2)(A) above.]
[
(6)
A physician shall approve
all medical policies, procedures, guidelines, tools, and forms, which shall
include:]
[
(A)
screening instruments (including a medical
risk assessment) and procedures;]
[
(B)
treatment protocol or standing orders for each
chemical the program is prepared to address in detoxification; and ]
[
(C)
emergency procedures.]
[
(7)
The clinical supervisor shall
be a physician, physician assistant, advanced practice nurse, or registered
nurse.]
[
(8)
The program shall:]
[
(A)
ensure continuous access to emergency medical
care;]
[
(B)
provide offenders access to mental health evaluation
and linkage with mental health services when indicated;]
[
(C)
use written procedures to encourage offenders
to seek appropriate treatment after detoxification.]
[
(9)
Direct care staff shall complete
detoxification training provided by a physician, physician assistant, advanced
practice nurse, or registered nurse that includes instruction in the following
areas:]
[
(A)
signs of withdrawal;]
[
(B)
pregnancy-related complications (if the program
admits females of child-bearing age);]
[
(C)
observation and monitoring procedures;]
[
(D)
appropriate intervention; and]
[
(E)
complications requiring transfer.]
[
(10)
Staff shall assist each offender
in developing an individualized post-detoxification plan that includes appropriate
referrals.]
(v)
[
(u) Level II (Relapse/
]Intensive
Residential Treatment[
)
]. Written policies and procedures shall
ensure the following:
(1)
All offenders admitted to [
Level II (Relapse/
]Intensive
Residential Treatment[
)
] shall
have written justification
to support their admission,
be medically stable, and able to participate
in treatment.
(2)
The program shall provide adequate staff for close supervision
and individualized treatment with counselor caseloads not to exceed
ten
[
(10)
] offenders.
(3)
There shall be direct care staff alert and on site during
all hours of operation. There shall be an appropriate number of direct care
staff to provide all required program services, maintain an environment that
is conducive to treatment, and ensure the safety and security of the offenders,
according to the design of the facility and with the approval of the funding
source.
(4)
Program
[
For programs 90 days or less
]
counselors shall complete a comprehensive offender assessment and individual
treatment plan within
ten
[
five (5)
] working days of
admission. [
All other programs shall complete a comprehensive offender
assessment and individual treatment plan within ten (10) working days.
]
(5)
The facility shall deliver not less than
twenty-five
[
twenty (20)
] hours of structured activities per week for
each offender, including:
(A)
ten [
(10)
] hours of chemical dependency counseling
using
[
with
] a cognitive-behavioral approach with no less
than one hour of individual counseling;
(B)
ten
[
seven (7)
] hours additional
education, counseling, life skills, or rehabilitation activities; and
(C)
five
[
three (3)
] hours of structured
social or recreational activities.
(6)
Counseling and education schedules shall be submitted to
the funding entity for approval.
(7)
Each offender shall have an opportunity to participate
in physical recreation at least weekly.
(8)
Program staff shall offer chemical dependency education
or services to identified significant others.
(9)
The program shall provide each offender with opportunities
to apply knowledge and practice skills in a structured, supportive environment.
Cognitive behavioral programs shall have a published curriculum identified
by the authors to contain cognitive, social and behavioral elements. Anyone
facilitating a cognitive curriculum must be trained in that specific curriculum.
All
direct care
staff must receive training on the principles of
a cognitive behavioral model as it relates to their job duties. This curriculum
shall be approved by TDCJ-CJAD and implemented as designed. Components of
the cognitive program shall at
a
minimum include:
(A)
ways to identify thinking patterns; and
(B)
a
social skills training component.
(w)
[
(v)
]
Supportive
[
Level III (Community
] Residential Treatment[
)
]. Written policies
and procedures shall ensure the following:
(1)
All offenders admitted to [
level III (Community
]
Supportive
Residential Treatment[
)
] shall
have written
justification to support their admission,
be medically stable,
and
able to function with limited supervision and support, and be able
to participate in work release or community service/restitution programs.
(2)
The program shall have adequate staff to meet treatment
needs within the context of the program description, with counselor caseloads
not to exceed
twenty
[
sixteen (16)
] offenders
,
unless the program can provide research-based evidence in writing to justify
a higher caseload size based on the program design, characteristics, and needs
of the population served, and any other relevant factors
.
(3)
There shall be direct care staff alert and on site during
all hours of operation. There shall be an appropriate number of direct care
staff to provide for the safety and security of the offenders, according to
the design of the facility and with the approval of the funding
source
.
(4)
Counselors shall complete a comprehensive offender assessment
and individualized treatment plan within ten [
(10)
] working days
of admission for all offenders.
(5)
The
program
[
facility
] shall deliver
no less than
six
[
ten (10)
] hours [
of structured
activities
] per week
of chemical dependency counseling with a cognitive-behavioral
approach (one hour per month of which shall be individual counseling)
for
each offender, [
including at least five (5) hours of chemical dependency
counseling with a cognitive-behavioral approach.
]
(6)
Counseling and education schedules shall be submitted to
the funding entity for approval.
(7)
The program design and application shall include increasing
levels of responsibility for offenders and frequent opportunities for offenders
to apply knowledge and practice skills in structured and unstructured settings.
Cognitive behavioral programs shall have a published curriculum identified
by the authors to contain cognitive, social and behavioral elements. This
curriculum shall be approved by TDCJ-CJAD and implemented as designed. Anyone
facilitating a cognitive curriculum must be trained in that specific curriculum.
All staff must receive training on the principles of a cognitive behavioral
model as it relates to their job duties. Components of the cognitive program
shall at minimum include:
(A)
ways to identify thinking patterns; and
(B)
a social skills training component
[
Social
Skills Training Component
].
(x)
[
(w) Level IV (
] Outpatient Treatment[
)
]. Written policies and procedures shall ensure the following:
(1)
All offenders admitted to [
Level IV (
]Outpatient
treatment[
)
] programs shall be medically stable, and have appropriate
support systems in the community to live independently with minimal structure.
(2)
The program shall have adequate staff to provide offenders
support and guidance to ensure effective service delivery, safety, and security.
Staffing patterns shall be submitted to the funding entity.
(3)
The program shall set limits on counselor caseload size
to ensure effective, individualized treatment and rehabilitation. Criteria
used to set the caseload size shall be documented and approved by the funding
entity.
(4)
Didactic groups shall not exceed
thirty-five
[
35
] offenders in a group.
(5)
Therapeutic groups shall not exceed
sixteen
[
16
] offenders in a group.
(6)
For offenders in supportive outpatient programs, counselors
shall complete a comprehensive offender assessment within thirty [
(30)
] calendar days of admission for all offenders.
(7)
For offenders in intensive outpatient programs, counselors
shall complete a comprehensive offender assessment within ten [
(10)
]
calendar days of admission for all offenders.
(8)
Intensive outpatient programs shall deliver no less than
six
[
ten (10) hours of structured activities per week for each
offender, including at least five (5)
] hours
per week
of
chemical dependency counseling
with a cognitive behavioral approach
.
(9)
Supportive outpatient programs shall deliver no less than
two [
(2)
] hours
per week
[
of structured activities
per week for each offender, including at least one (1) hour
] of chemical
dependency counseling.
(10)
Counseling and education schedules shall be submitted
to the funding entity for approval.
(11)
The program design and application shall include increasing
levels of responsibility for offenders and frequent opportunities for offenders
to apply knowledge and practice skills in structured and unstructured settings.
(12)
The outpatient treatment
stages
[
levels
] may be utilized for residents in the work release phase of any residential
substance abuse treatment program.
(y)
[
(x)
] Special
Needs
Populations.
Written policies and procedures shall ensure the following:
(1)
Programs that address the special mental health, intellectual
capacity, or medical needs of offenders must provide appropriate treatment
either by program staff or through contracted services.
(2)
Admission to a special needs program must be based on a
documented mental health, intellectual capacity, or medical need.
(3)
When the assessment process indicates that the offender
has coexisting disabilities/disorders, the Treatment Plan shall specifically
address those issues that might impact treatment, recovery, relapse, and/or
recidivism.
(4)
Personnel [
shall be available who are
] qualified
in the treatment of coexisting disabilities/disorders
shall be available
.
(5)
Within ninety-six [
(96)
] hours of admission
to a special needs residential program, offenders shall be administered a
medical and psychological evaluation.
(6)
Within ten [
(10)
] days of admission to a residential
program for special needs offenders, the program administrator or designee
shall contact the Texas
Correctional Office on Offenders
[
Council on Offenders
] with
Medical or
Mental Impairments
(TCOOMMI)
[
(TCOMI)
] regarding the offender's status. As soon
as discharge date is projected,
TCOOMMI
[
TCOMI
] shall
be notified in writing of plans for a continuum of care after discharge, regardless
of whether or not the discharge is for successful completion of the program.
(7)
Residential facilities providing services for special needs
populations shall have procedures to provide access to health care services,
including medical, dental, and mental health services, under the control of
a designated health authority. When this authority is other than a physician,
final medical judgments must rest with a single designated responsible physician
licensed by the state.
(A)
Services/treatment shall be directed toward maximizing
the functioning and reducing the symptoms of offenders.
(B)
There shall be written policies and procedures regarding
the delivery and administration of prescription and nonprescription medication
which provide for:
(i)
conformity with state regulations;
(ii)
documentation of the rationale for use and goals of service/treatment
consistent with the individual plan of treatment;
(iii)
documentation of the administration of medications, medication
errors, and drug reactions; and
(iv)
procedures to follow in case of emergencies.
(8)
There shall be procedures for documenting that the offender
has been informed of medication management procedures.
(9)
Offenders shall be actively involved in decisions related
to their medications.
(10)
Programs for special needs offenders must follow the same
staffing for treatment levels as the levels for other offenders, except all
residential programs shall maintain caseloads of no greater than sixteen [
(16)
] offenders for each counselor.
(11)
Programs operating in residential facilities shall ensure
that offenders will have no less than ten [
(10)
] days of appropriate
medication for use after discharge.
(z)
Use of Force. The CSCD director
and Facility director shall ensure that a residential treatment program has
written policies, procedures, and practices that restrict the use of physical
force to instances of self-protection, protection of offenders or others,
or prevention of property damage. In no event is the use of physical force
against an offender justifiable as punishment. A written report shall be prepared
following all uses of force, and all such written reports shall be promptly
submitted to the CSCD director and Facility director for review and follow-up.
The application of restraining devices, aerosol sprays, chemical agents, etc.
shall only be accomplished by an individual who is properly trained in the
use of such devices and only in an emergency by any individual in self-protection,
protection of others or other circumstances as described previously.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on January 28, 2005.
TRD-200500414
Carl Reynolds
General Counsel
Texas Department of Criminal Justice
Earliest possible date of adoption: March 13, 2005
For further information, please call: (512) 463-0422