Each chemical dependency service provider must have and adhere to a clinical manual containing patient care policies and procedures, including:
(1) How the provider meets WAC 388-805-305
(2) How the provider will meet applicable certified service standards for the level of program service requirements:
Allowance of up to twenty percent of education time to consist of film or video presentations.
(3) Identification of resources and referral options so staff can make referrals required by law and as indicated by patient needs.
(4) Assurance that there is an identified clinical supervisor who:
(a) Is a chemical dependency professional (CDP);
(b) Has documented competency in clinical supervision;
(c) Reviews and documents a sample of patient records of each CDP semi-annually;
(d) Ensures implementation of assessment, treatment, continuing care, transfer and discharge plans in accord with WAC 388-805-315
(e) Ensures continued competency of each CDP in assessment, treatment, continuing care, transfer, and discharge plans in accord with WAC 388-805-310
(5) Patient admission, continued service, and discharge criteria using PPC.
(6) Policies and procedures to implement the following requirements:
(a) The administrator must not admit or retain a person unless the person's treatment needs can be met;
(b) A chemical dependency professional (CDP), or a CDP trainee under supervision of a CDP, must assess and refer each patient to the appropriate treatment service; and
(c) A person needing detoxification must immediately be referred to a detoxification provider, unless the person needs acute care in a hospital.
(7) Additional requirements for opiate substitution treatment programs:
(a) A program physician must ensure that a person is currently addicted to an opioid drug and that the person became addicted at least one year before admission to treatment;
(b) A program physician must ensure that each patient voluntarily chooses maintenance treatment and provides informed written consent to treatment;
(c) A program physician must ensure that all relevant facts concerning the use of the opioid drug are clearly and adequately explained to the patient;
(d) A person under eighteen years of age needing opiate substitution treatment is required to have had two documented attempts at short-term detoxification or drug-free treatment within a twelve-month period. A waiting period of no less than seven days is required between the first and second short-term detoxification treatment;
(e) No person under eighteen years of age may be admitted to maintenance treatment unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to treatment;
(f) A program physician may waive the requirement of a one year history of addiction under subsection (7)(a) of this section, for patients released from penal institutions (within six months after release), for pregnant patients (program physician must certify pregnancy), and for previously treated patients (up to two years after discharge);
(g) Documentation in each patient's record that the service provider made a good faith effort to review if the patient is enrolled in any other opiate substitution treatment service;
(h) When the medical director or program physician of an opiate substitution treatment program provider in which the patient is enrolled determines that exceptional circumstances exist, the patient may be granted permission to seek concurrent treatment at another opiate substitution treatment program provider. The justification for finding exceptional circumstances for double enrollment must be documented in the patient's record at both treatment program providers.
(8) Tuberculosis screening for prevention and control of TB in all detox, residential, and outpatient programs, including:
(a) Obtaining a history of preventive or curative therapy;
(b) Screening and related procedures for coordinating with the local health department; and
(c) Implementing TB control as provided by the department of health TB control program.
(9) HIV/AIDS information, brief risk intervention, and referral.
(10) Limitation of group counseling sessions to twelve or fewer patients.
(11) Counseling sessions with nine to twelve youths to include a second adult staff member.
(12) Provision of education to each patient on:
(a) Alcohol, other drugs, and chemical dependency;
(b) Relapse prevention; and
(c) HIV/AIDS, hepatitis, and TB.
(13) Provision of education or information to each patient on:
(a) The impact of chemical use during pregnancy, risks to the fetus, and the importance of informing medical practitioners of chemical use during pregnancy;
(b) Emotional, physical, and sexual abuse; and
(c) Nicotine addiction.
(14) An outline of each lecture and education session included in the service, sufficient in detail for another trained staff person to deliver the session in the absence of the regular instructor.
(15) Assigning of work to a patient by a CDP when the assignment:
(a) Is part of the treatment program; and
(b) Has therapeutic value.
(16) Use of self-help groups.
(17) Patient rules and responsibilities, including disciplinary sanctions for noncomplying patients.
(18) If youth are admitted, a policy and procedure for assessing the need for referral to child welfare services.
(19) Implementation of the deferred prosecution program.
(20) Reporting status of persons convicted under chapter 46.61
RCW to the department of licensing.
(21) Asking at intake or next counseling session if the patient has been court ordered to chemical dependency or mental health treatment and is under supervision by the department of corrections, and documenting the patient's response in the clinical record.
(22) For patients that are court ordered to receive chemical dependency or mental health treatment and under department of corrections supervision, the provider must request:
(a) Authorizations to share information with the department of corrections, the county designated chemical dependency specialist and any other court ordered treatment provider; or
(b) A copy of the court order that exempts the patient from the reporting requirements with the department of corrections and mental health provider.
(c) If a patient refuses to sign a release, document attempt in the patient record.
(23) Nonresidential providers must have policies and procedures on:
(a) Medical emergencies;
(b) Suicidal and mentally ill patients;
(c) Laboratory tests, including UA's and drug testing;
(d) Services and resources for pregnant women:
(i) A pregnant woman who is not seen by a private physician must be referred to a physician or the local first steps maternity care program for determination of prenatal care needs; and
(ii) Services include discussion of pregnancy specific issues and resources.
[Statutory Authority: RCW 70.96A.040, chapter 70.96A RCW, and 42 C.F.R. Part 8. 08-24-083, § 388-805-300, filed 12/1/08, effective 1/1/09. Statutory Authority: RCW 70.96A.090, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-300, filed 5/17/06, effective 6/17/06. Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-300, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-300, filed 11/21/00, effective 1/1/01.]