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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 448STANDARD OF CARE
SUBCHAPTER NTHERAPEUTIC COMMUNITIES
RULE §448.1401Therapeutic Communities

(a) Programs that conduct adult residential treatment services using the therapeutic community (TC) methodology are required to comply with this section in addition to all other rules regarding health, safety and physical plant requirements in this chapter. This section of the rules does not apply to those programs serving adolescents. Adolescent programs shall follow the minimum service and staffing requirements in the other sections of this chapter.

(b) A TC methodology to treatment is distinguished from other models of care by the following:

  (1) TCs are highly structured residential programs intended to treat criminal and antisocial behaviors occurring with substance abuse or dependence.

  (2) This model views recovery from these disorders as a developmental learning process in which the social and psychological characteristics of the client must be changed to one of "right living" and the client must adopt appropriate morals and values promoted by the program as opposed to solely recovering from an illness.

  (3) The model utilizes the community itself and TC specific group-type meetings as the primary modality of change. Confrontation amongst clients regarding their behaviors, a carefully orchestrated consequence-reward system and hierarchical privilege system are the primary approaches utilized instead of the counseling and therapy utilized in other models of treatment.

  (4) Counselors act primarily as role models and rational authorities rather than as counselors or therapists.

  (5) The model expects the client length of stay to be a minimum of 90 days in order to achieve positive outcomes.

  (6) The program is divided into 3 phases: The Orientation Phase (Information Dissemination), Primary Treatment Phase (Personal Application), and Re-Entry/Relapse Prevention Phase (Social Application).

(c) Treatment programs using the TC methodology are required to comply with Subchapter H. of this title (relating to Screening and Assessment).

(d) If the comprehensive psychosocial assessment identifies a potential mental health problem, the program shall arrange for the client to obtain a mental health evaluation by a Qualified Mental Health Professional.

  (1) If the mental health evaluation reflects the client currently has a diagnosis, or has been diagnosed during the last year with an Axis I diagnosis or post traumatic stress disorder, and/or moderate to severe mental retardation, the program shall obtain written authorization from a licensed psychiatrist or licensed physician experienced in treating chemical dependency, for the client to receive TC treatment services prior to providing TC program services.

  (2) A QCC, with at least one year documented experience in treating individuals with mental illness, shall act as the primary counselor and confer at least monthly with the authorizing psychiatrist or physician.

(e) The admission authorization process shall follow the rules as outlined in §148.802 of this title (relating to Admission Authority and Consent to Treatment). In addition to the elements outlined in §148.802(b)(1)-(16), the consent to treatment form shall contain the information in (b)(1)-(6), above. The client shall voluntarily agree to participate in the TC program.

  (1) If the client is pregnant at the time of admission, the program shall obtain written authorization from a licensed physician for the client to receive TC treatment services prior to providing TC program services. If the pregnancy is determined after admission, the program shall obtain written authorization from a licensed physician for the client to receive TC treatment services.

  (2) A physician or physician assistant shall monitor the client's response to treatment at least monthly or more often as needed.

(f) The TC Program shall ensure that all staff receive training in the TC methodology. All staff members shall receive 16 hours of training in TC theory, TC methods, and TC intervention techniques. This training is in addition to the applicable training requirements outlined in §148.603 of this title (relating to Training), and must take place within the first ninety days of employment.

(g) Intensive residential TC programs shall provide a minimum of 20 hours of services per week, which shall include:

  (1) Six hours of counseling (which shall include two hours of individual counseling per month);

  (2) Six hours of additional counseling, CD education, and life skills training; and

  (3) Eight hours of TC groups, such as cognitive restructuring, AM/PM development, and encounter-confrontation groups. A counselor shall be present to supervise or monitor the activity and maintain structure in the TC groups.

(h) In addition to the 20 hours outlined above, the program shall provide ten additional hours of peer driven activities, such as community meetings, house meetings, peer support, recreation, seminars, and self help groups.

(i) Attendance shall be documented for peer driven activities. Documentation shall contain date, duration and type of activity. There is no size limitation or staffing requirement for peer driven activities.

(j) Ten hours of the above services shall be in provided in the evenings and on weekends.

(k) Adult Supportive TC Residential Programs shall provide at least six hours of treatment services per week for each client, comprised of at least:

  (1) two hours of chemical dependency counseling (one hour per month of which shall be individual counseling);

  (2) two hours of additional counseling, chemical dependency education, and life skills training; and

  (3) two hours of TC groups such as cognitive restructuring, AM/PM development, and encounter-confrontation groups. A counselor shall be present to supervise or monitor the activity and maintain structure in the TC groups.

(l) Group counseling size is limited to 16 clients. Chemical dependency education and life skills classes are limited to 35 clients.

(m) The TC program shall set limits on counselor caseload size that ensures effective, individualized treatment. The TC program shall justify the caseload size in writing based on the program design, characteristics and needs of the population served, and the minimum client service hours as indicated in this section.

(n) In intensive residential TC programs the direct care staff to client ratio shall be 1:16 while awake and 1:32 during sleeping hours.

(o) In supportive residential TC programs the direct care staff to client ratio shall be 1:20 while awake and 1:50 during sleeping hours.

(p) In addition to the other requirements of this subchapter, the TC program's policy and procedure manual shall contain the following:

  (1) written program description explaining how the therapeutic community functions;

  (2) program structure, including rules, methods, and service schedule;

  (3) overview of the TC treatment process;

  (4) a description of consequences and rewards system; and

  (5) policy stating that interventions are not used as punishment and that access to medical and psychiatric care will not be denied.


Source Note: The provisions of this §448.1401 adopted to be effective September 1, 2004, 29 TexReg 2020; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842

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