La. Admin. Code tit. 48 § I-6249

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-6249 - Personnel Qualifications and Responsibilities

A. Professional Staffing Standards. The following are the minimum staffing requirements for TGHs.

1. Supervising Practitioner

a. A supervising practitioner shall be one of the following:

i. a physician with an unrestricted license to practice in Louisiana and who meets all of the following qualifications:

(a). an unrestricted drug enforcement agency (DEA) and Louisiana controlled substance license;

(b). if the physician holds an additional license(s) in another state or jurisdiction, that license(s) shall be unrestricted and be documented in the employment record;

(c). board-certification in general psychiatry; and

(d). satisfactory completion of a specialized psychiatric residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME), as evidenced by a copy of the certificate of training or a letter of verification of training from the training director, which includes the exact dates of training and verification that all ACGME requirements have been satisfactorily met. If training was completed in a psychiatric residency program not accredited by the ACGME, the physician shall demonstrate that he/she meets the most current requirements as set forth in the American Board of Psychiatry and Neurologys Board policies, rules and regulations regarding information for applicants for initial certification in psychiatry;

ii. a psychologist/medical psychologist shall have the following:

(a). an unrestricted license to practice psychology in Louisiana issued by the Louisiana State Board of Examiners of Psychologists under R.S. 37:2351 et seq., or an unrestricted license to practice medical psychology issued by the Louisiana State Board of Medical Examiners under R.S. 37.1360.51 et seq.;

(b). unrestricted DEA and Louisiana controlled substance licenses, if the supervising practitioner is a medical psychologist;

(c). demonstrated competence and experience in the assessment, diagnosis, and treatment of children and adolescents who have mental and emotional disorders or disabilities, alcoholism and substance abuse.Acceptable competence/experience is specialized training at the internship or post-doctoral level before licensure and/or being in the independent practice of child/adolescent psychology in private practice, as a consultant, or within an outpatient or inpatient treatment facility for a period of at least two years post-licensure.

b. The house managers responsibilities include, but are not limited to the following:

i. supervising the activities of the TGH when the professional staff is on call, but not on duty;

ii. assuming accountability to direct the care of the client at the time of admission and during the entire TGH stay;

iii. supervising the development of a comprehensive treatment plan in the seven days following admission.

iv. providing clinical direction in the development of the comprehensive treatment plan;

v. at least every 28 days or more often as necessary, providing:

(a). a face-to-face assessment/service to the client;

(b). a review of the need for continued care; and

(c). continued supervision of the comprehensive treatment plan;

vi. providing crisis management including supervision and direction to the staff to resolve any crisis of the client's condition;

vii. monitoring and supervising an aggressive plan to transition the client from the program into less intensive treatment services as medically necessary;

viii. providing 24-hour on call coverage, seven days a week;

ix. assuming professional responsibility for the services provided and assure that the services are medically appropriate.

2. Clinical Director

a. A clinical director shall be an LMHP.

b. The clinical director shall have the appropriate qualifications to meet the responsibilities of the clinical director and the needs of the TGHs clients. A clinical director may not practice beyond his/her scope of practice license.

c. If the TGH treats clients with both mental health and substance abuse conditions, then the clinical director shall have the training and experience necessary to practice in both fields.

d. Practitioners who meet the criteria of the clinical director may also serve as the TGH's therapist.

e. The responsibilities of a clinical director include, but are not limited to:

i. overseeing, implementing, and coordinating treatment services;

ii. continually incorporating new clinical information and best practices into the program to assure program effectiveness and viability;

iii. overseeing the process to identify, respond to, and report crisis situations on a 24-hour per day, 7 day per week basis;

iv. clinical management for the program in conjunction with and consultation with the supervising practitioner;

v. assuring confidentiality and quality organization and management of clinical records and other program documentation; and

vi. applying and supervising the gathering of outcome data and determining the effectiveness of the program.

3. TGH Therapist

a. A TGH therapist shall be an LMHP or an individual with a Master's degree in social work, counseling, psychology or a related human services field.

b. The role and the responsibilities of the TGH Therapist include but are not limited to:

i. reporting to the clinical director and supervising practitioner for clinical and non-clinical guidance and direction;

ii. communicating treatment issues to the clinical director and to the supervising practitioner as needed;

iii. providing individual, group, family, psychotherapy and/or substance abuse counseling;

iv. assisting in developing/updating treatment plans for clients in TGH care in conjunction with the other multidisciplinary team members;

v. providing assistance to direct care staff and implementing the treatment plan when directed by the clinical director;

vi. providing clinical information to the multidisciplinary team and attending treatment team meetings; and

vii. providing continuous and ongoing assessments to assure clinical needs of clients and parents(s)/caregivers(s) are met.

4. Nursing Services

a. The TGH shall have a licensed registered nurse who shall supervise the nursing services of the TGH. He or she shall be operating within his/her scope of practice and have documented experience and training in the treatment of children or adolescents.

b. All nursing services shall be furnished by licensed nurses. All nursing services furnished in the TGH shall be provided in accordance with acceptable nursing professional practice standards.

c. The responsibilities of the registered nurse include, but are not limited to:

i. providing a nursing assessment within 24 hours of admission for each client;

ii. establishing a system of operation for the administration and supervision of the clients' medication and medical needs;

iii. training staff regarding the potential side effects of medications, including psychotropic drugs;

iv. coordinating psychiatric and medical care per physician's direction; and

v. monitoring and supervising all staff providing nursing care and services to clients.

d. The responsibilities of all licensed nurses include, but are not limited to:

i. reporting to the clinical director for programmatic guidance;

ii. reporting to the supervising practitioner as necessary regarding medical, psychiatric, and physical treatment issues;

iii. reviewing all medical treatment orders and implementing orders as directed;

iv. serving as a member of the multidisciplinary treatment team;

v. administering medications and monitoring the clients' responses to medications;

vi. providing education on medication and other health issues as needed;

vii. abiding by all state and federal laws, rules, and regulations; and

viii. identifying and assessing the clients for dental and medical needs.

5. House Manager

a. The house manager shall have the following qualifications:

i. be at least 21 years of age and at least 3 years older than the oldest client; and

ii. possess one of the following:

(a). a Bachelor's degree in a human services field and one year of documented employment with a health care provider that treats clients with mental illness; or

(b). two years of course work toward a Bachelor's degree in a human services field and two years of documented employment with a health care provider that treats clients with mental illness.

b. The house manager's responsibilities include, but are not limited to the following:

i. supervising the activities of the facility when the professional staff is on call, but not on duty;

ii. identifying, respond to, and report any crisis situation to the clinical director on a 24-hour, seven day per week basis;

iii. reporting incidents of abuse, neglect and misappropriation to the clinical director;

iv. assessing situations related to relapse;

v. coordinating and consulting with the clinical director as needed; and

vi. providing access to appropriate medical care when needed.

6. Direct Care Staff

a. All direct care staff shall have at least the following qualifications:

i. a high school diploma or equivalent;

ii. at least 18 years of age, but shall also be at least three years older than all clients under the age of 18;

iii. a minimum of two years of experience working with clients of the population served, be equivalently qualified by education in the human services field, or have a combination of work experience and education with one year of education substituting for one year of experience;

iv. not have a finding on the Louisiana State Nurse Aide Registry and the Louisiana Direct Service Worker Registry against him/her;

v. be certified in crisis prevention/management (example: CPI, Mandt, etc.); and

vi. be proficient in de-escalation techniques.

vii. Repealed.

b. The responsibilities of direct care staff include, but are not limited to:

i. completing the required program orientation and training, and demonstrating competency prior to being assigned to direct care;

ii. having a clear understanding of the treatment plan;

iii. assisting clients in developing social, recreational, and other independent living skills as appropriate;

iv. being aware of safety issues and providing safety intervention within the milieu;

v. reporting all crisis or emergency situations to the clinical director or his/her designee in the absence of the clinical director;

vi. reporting to the therapist or clinical director as necessary regarding treatment issues;

vii. understanding the program philosophy regarding behavior management and applying this philosophy in daily interactions with clients in TGH care; and

viii. having the ability to effectively implement de-escalation techniques.

La. Admin. Code tit. 48, § I-6249

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:414 (February 2012), Amended LR 411294 (7/1/2015), Amended by the Department of Health, Bureau of Health Services Financing, LR 44779 (4/1/2018).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2009.