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Mental Health Treatment Programs

Mental Health Treatment Programs Certified by DHCS:

  • Community Residential Treatment Systems (CRTS) also know as Social Rehabilitation Programs (SRPs), which are licensed by the California Department of Social Services (CDSS);
  • Community Treatment Facilities (CTF) licensed by DSS;
  • Special Treatment Programs (STP) in Skilled Nursing Facilities (SNF/STP), licensed by the California Department of Public Health (CDPH).

CRTS/SRPs

The CRTS/SRPs are licensed by the DSS and the mental health program components are certified by the DHCS. The CRTS/SRP requirements are set forth in the California Welfare and Institutions Code (W&IC), Sections 5670, 5670.5 and 5671. The regulations for interpreting these provisions of statutes are contained in Article 3.5 (Commencing with Section 531) of Chapter 3, in Division 1, of Title 9 in the California Code of Regulations (CCR).

There are three categories of CRTS/SRPs that are defined in Sections 5670 and 5671 of the W&IC, and Sections 531 through Section 535 of Title 9 of the CCR:

  1. Short-Term Crisis Residential: Offers alternatives to acute hospitalization; provides stabilization and diagnostic services for no longer than three months.
  2. Transitional Residential: Provides an activity program that encourages utilization of community resources for no longer than 18 months.
  3. Long-Term Residential: Provides rehabilitation services for the chronically mentally ill who need long-term support and care for up to two to three years, in order to develop independent living skills.

These treatment service programs are designed to serve adults who are in need of mental health treatment and are unable to care for themselves in an independent living situation, but can be cared for in a CRTS/SRP that provides psychiatric care in a normal home environment.

CRTS/SRPs provide a wide range of alternatives to acute psychiatric hospitalization and institutional care based on the principles of residential community-based treatment. This includes a high level of care provided in a homelike setting, stringent staff requirements, 24-hour-a-day, seven-day-a-week supervision and treatment assistance and community participation at all levels.

CRTS/SRP program services include, but are not limited to: intensive diagnostic work, including learning disability assessment; full-day treatment program with an active prevocational and vocational component; special education services; outreach to develop linkages with the general social service system; and counseling to aid clients in developing the skills to move toward a less structured setting.

The CRTS/SRP, as mandated by statute and regulations, requires the DHCS to certify social rehabilitation programs in community care facilities licensed by the DSS. The program certification by the DMH is a condition of licensure by the DSS. The certification process includes a rigorous on-site review of operations, clinical practice standards, policies and procedures and treatment modalities.

Annual onsite reviews to evaluate CRTS/SRP compliance with Title 9 regulations are conducted by the certification staff. An onsite review includes, but is not limited to, interviews with staff and clients and review of clients’ charts, staff in-service training records, program staff resumes, groups/activities, outside resource contracts and agreements, all logs, documents, financial records and policies concerning regulatory practices within the facility.

Certification staff also reviews the facility requirements for qualifications of mental health treatment staffing, including training qualifications of treatment staff and treatment procedures. In addition, DHCS conducts interviews with clients as well as the staff.

At the time of the onsite surveys, clients’ charts are randomly selected and reviewed to verify that:

  • the problems for which the client was initially admitted to the CRTS/SRP are identified in the treatment/care plan;
  • the care plan consists of a synthesis of the following assessments: (1) Health and psychiatric histories; (2) Psychosocial skills; (3) Social support skills; (4) Current psychological, educational, vocational and other functional limitations; (5) Medical needs, as reported; and, (6) Meal Planning, shopping and budgeting skills;
  • the identified client population is clinically appropriate for the CRTS/SRP;
  • the profile and grouping criteria as described in the CRTS/SRP Plan have been implemented; and
  • CRTS/SRP services are being delivered as specified in DHCS approved plan.

 

Upon completion of the onsite review, the reviewer holds an exit conference with the program director and facility staff to discuss review findings. Within 30 calendar days following completion of the review, the DHCS sends both a letter of either approval or deficiencies and a copy of the completed review protocol to the facility and the DSS.

An annual CRTS certification is enclosed with a letter of approval. A letter of deficiencies will include a due date for the facility to submit a written plan of correction. Following the DHCS’s review and acceptance of the plan of correction, a certificate with a letter of approval is sent to the facility. The DHCS may conduct additional reviews to ensure that deficiencies have been corrected.

The DHCS may refuse to approve a CRTS/SRP or may withdraw approval of, or decertify, a program at any time for good cause, including but not limited to the following:

  • failure to implement or maintain the approved program plan/plan of operation;
  • substantial noncompliance with applicable regulations; or
  • revocation of the Social Rehabilitation Facility’s license by the DSS.  
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SNF/STP

SNFs/STPs operate under Title 22, California Code of Regulations (CCR), Sections 72443-72475, and DMH’s Policies and Directives.

In order for an SNF to be certified as an STP, it must meet the licensing and certification requirements of the Department of Public Health (DPH). It is necessary that the facility be licensed as a Medicaid-certified SNF.

Title 22, CCR, describes and defines programs that serve clients who have a chronic psychiatric impairment and whose adaptive functioning is moderately impaired. STP services are those therapeutic services provided to mentally disordered persons having special needs in one or more of the following areas: self-help skills, behavioral adjustment, and interpersonal relationships. They also include pre-vocational preparation and pre-release planning.

The primary focus of the DHCS survey has been and remains the structure and operation of the STP.

STPs are designed to serve clients who have a chronic psychiatric impairment and whose adaptive functioning is moderately impaired. The monitoring of SNFs/STPs occurs annually by the DHCS as stipulated by Title 22. The DHCS conducts the annual review at the facility after reviewing and approving the updated written program plan together with any written requests for modification to the previously approved program. Confirmation of program compliance is done by random review of client charts. DHCS reviewers attend groups and activities to evaluate clients’ attendance and participation. Facility records are also reviewed to ensure compliance with Title 22 in the areas of staffing coverage requirements, staff qualifications, in-service training requirements and provision of required rehabilitation services individualized to client needs. Documents such as seclusion and restraint logs, denial of patients’ rights and personnel records are  also reviewed. DPH licensing staff may be present simultaneously to conduct a facility licensing review as provided in Health and Safety Code (H&SC), Section 1422.1. Specifically, H&SC provides that

"the DPH, shall conduct, when feasible, annual licensing inspections of licensed, long-term health care facilities providing special treatment programs for the mentally disordered, concurrently with inspections conducted by the DMH for the purposes of approving the special treatment program."

STP services are those therapeutic services provided to mentally disordered persons having special needs in one or more of the following areas: self-help skills, behavioral adjustment, and interpersonal relationships. They include pre-vocational preparation and pre-release planning. Other program services include group and individual counseling; instruction on personal care and medication management; use of community and personal resources.

Program Monitoring: STPs

Program monitoring of the STP shall include, but not be limited to, a review of:

  • the approved STP Plan;
  • a sample of client charts;
  • program staff in-service training records;
  • program staff schedules and time cards;
  • Denial of Rights Log;
  • and Restraint and Seclusion records;

 

and will ensure the following:

  • each client’s treatment/care plans are appropriately addressing identified treatment needs;
  • the identified client population is clinically appropriate for the STP;
  • treatment groups are designed to address clients’ treatment needs;
  • clients are attending their scheduled programming;
  • equipment utilized for various program services is adequate for client needs and conforms to the approved STP Plan;
  • the STP’s overall integrity
  • provision for client care and welfare; and
  • investigation of complaints against the STP.

 

The DHCS reviewers will verify that:

  • The identified client population is clinically appropriate for the STP.
  • The profile and grouping criteria as described in the program plan have been implemented.
  • STP services are being delivered as specified in the DHCS-approved plan.
  • Clients are attending their scheduled programming.
  • There is at least one hour of direct program staff time for each six program hours.
  • There are sufficient program staff members, other than the Program Director, to provide the scheduled client services.  
  • The space available for the various program services is adequate for client needs and conforms to the approved STP Plan.
  • The equipment utilized for the various program services is adequate for client needs and conforms to the approved STP Plan.
  • The problems for which the client was initially admitted to the STP are identified in the treatment/care plan.
  • The client’s treatment/care plan appropriately addressees the identified problems.
  • The care plan consists of a synthesis of the following assessments:

 

    o Medical

    o Nursing

    o Dietetic

    o Social Services

    o Psychological 

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CTFs

CTFs are secured (locked) community residential treatment facilities providing mental health services to adolescents who are diagnosed as Severely Emotionally Disturbed (SED). The DMH is responsible for the development and distribution of 400 CTF beds within the five Mental Health Regions of California.

The CTF licensing category was designed to provide an alternative to state hospital or out-of-state placement and to enable children with mental health needs to receive treatment in less restrictive, more appropriate settings, closer to their families’ homes. To be licensed as a CTF, the treatment facility must have the capacity to provide "secure containment."

In order for a child to be placed in a CTF, all the following criteria must be met: (1) the child may require a period of containment to participate in and benefit from mental health treatment, and the CTF program must be reasonably expected to improve the child’s mental disorder; (2) the child must be seriously emotionally disturbed; (3) other, less restrictive interventions must have been attempted and proven insufficient, or the child is an inpatient in a psychiatric hospital, a state hospital, or an out-of-state placement; (4) the county interagency placement committee must provide certification for the child to be placed in the CTF; and (5) consent from parents, the court, or the conservator must be properly obtained.

Program Monitoring: CTFs

Program monitoring of the CTF shall include, but not be limited to, a review of:

  • a sample of client charts;
  • program staff in-service training records;
  • program staff schedules and time cards;
  • Denial of Rights Log;
  • Restraint and Seclusion records;
  • Discharge and Release Procedures;  
  • Licensed Mental Health Treatment Staffing;
  • Child and Family Involvement and Participation; and
  • Special investigations;

 

and will ensure the following:

  • each client’s treatment/care plans are appropriately addressing identified treatment needs;
  • the identified client population is clinically appropriate for the CTF;
  • treatment groups are designed to address clients’ treatment needs;
  • clients are attending their scheduled programming; and
  • provision for client care and welfare

 

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Last modified on: 3/18/2014 1:01 PM