Current through Register Vol. XLI, No. 42, October 18, 2024
Section 78-3-24 - Psychiatric Residential Treatment Facility24.1 Compliance. A psychiatric residential treatment facility for persons under 21 is a freestanding or physically distinct part of a psychiatric inpatient organization that provides services and treatment to children who do not need acute care but require intensive and coordinated services in a residential setting in a manner consistent with federal requirements. A psychiatric residential treatment facility provides a continually, medically supervised interdisciplinary program of behavioral health treatment.
24.2. Accreditation Requirements. A psychiatric residential treatment facility shall be appropriately accredited as required by federal standards. Where differing accreditation, certification or licensing standards exist, the more stringent standard applies.
24.3. Employee Ratios.24.3.1. The average employee-to-patient ratio for a psychiatric residential treatment facility shall be 1-to-4 during day and evening hours (one employee whose primary responsibility is providing direct care for every four children during the day and evening). During nighttime sleeping hours, the ratio shall be 1-to-8. During all hours there shall be capability to increase employee-to-patient ratio in response to acuity, extending to the provision of 1-to-1 care when necessary. Employees assigned to work a defined unit and providing care to the children on that unit including nursing, teachers, and activity therapists may be included in the employee-to-client ratio. Employees assigned to supervisory duties or whose duties cause them to be away from the unit (nursing supervisor) may not be included in the count.24.3.2. The nursing coverage shall include a registered nurse during day and evening shifts with, at minimum, a licensed, practical nurse overnight.24.3.3. There shall be a supervisor present on all shifts and employees shall have access to other administrative employees at all times.24.4. Employee Training and Credentials. 24.4.1. All direct care employees shall have a minimum of a high school diploma or GED and professional employees shall have appropriate education and certification consistent with professional licensing standards.24.4.2. In addition to the requirements for employee training prescribed in section 11 of this rule, direct care employees shall receive refresher training in emergency safety interventions twice a year that shall include both didactic and experiential activities.24.5. Treatment Services. The residential treatment facility shall provide the following clinical services:
24.5.1. A physician shall be available 24 hours a day, seven days a week to respond to medical and psychiatric emergencies;24.5.2. A physician licensed in the state of West Virginia and board certified in psychiatry shall perform observation and assessment at least weekly; and24.5.3. Routine assessments shall be performed by the physician to effectively coordinate all treatment, manage medication trials or adjustments, or both, minimize serious side effects, and provide medical management of all psychiatric and medical problems.24.6. Assessments. 24.6.1. A comprehensive assessment process shall include evaluation of: 24.6.1.a. Psychiatric health;24.6.1.b. Physical health;24.6.1.c. Ability to self-medicate with supervision;24.6.1.d. Psychosocial history;24.6.1.e. Recreational activities;24.6.1.f. Spiritual and cultural preferences and interests;24.6.1.g. Behavioral and adaptive living skills, both strengths and deficits; and24.6.1.h. Educational functioning.24.6.2. An additional diagnostic assessment shall be provided as needed, either onsite or by using community providers.24.6.3. All required clinical assessments shall be completed prior to the development of the plan of care. Assessments conducted within 30 days prior to admission by qualified professionals may be used if reviewed and approved for treatment planning by the responsible psychiatrist and Interdisciplinary Treatment Team.24.6.4. A psychiatric evaluation shall be completed within 24 hours of admission and shall include: 24.6.4.a. The reason for admission;24.6.4.b. The current clinical presentation;24.6.4.c. Psychosocial stressors related to the recent illness;24.6.4.d. A current or potential risk to self or others;24.6.4.e. A history of the present illness;24.6.4.f. A past psychiatric history;24.6.4.g. A developmental assessment;24.6.4.h. The presence or absence of physical disorders or conditions affecting the presenting problem;24.6.4.i. An alcohol or drug history; and24.6.4.j. A mental status examination.24.6.5. A diagnosis on all five axes shall be given, based on the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).24.6.6. A physical health examination shall be provided within 24 hours of admission.24.6.7. A Registered Nurse practitioner shall provide a health assessment within 24 hours of admission. The assessment shall document:24.6.7.a. A general history of the patient's and family's health;24.6.7.b. The patient's current medications;24.6.7.d. Pertinent medical problems requiring nursing attention;24.6.7.e. Current risk and safety factors;24.6.7.f. Nutritional status;24.6.7.g. Immunization status; and24.6.7.h. Sleep patterns.24.7. Plan of Care. 24.7.1. A preliminary plan of care shall be developed within 72 hours of admission.24.7.2. The interdisciplinary team shall have 30 days to complete all assessments while providing any immediately necessary psychiatric and therapeutic treatment. Prior to the end of the 30-day period or when all initial assessments are completed, whichever comes first, the team shall complete a plan of care.24.7.3. The plan of care shall be reviewed by the interdisciplinary team for effectiveness and shall be revised when major changes in treatment occur, or at least every 30 days.24.8. Transfer Agreement. The organization shall have a written transfer agreement with one or more hospitals that ensures that an individual can be transferred to an appropriate setting in a timely manner when transfer is necessary for more intensive psychiatric care or for emergency or specialized medical care.
24.9. Transitioning Adults. The psychiatric residential treatment facility may serve individuals aged 18 to 21 so long as the transitioning adult is court ordered, voluntary or committed under the requirements of Chapter 27 of the West Virginia Code.
24.10. Restrictive Behavior Management. Restrictive Behavior Management techniques shall conform to all federal guidelines for psychiatric residential treatment facilities.