Statutes, codes, and regulations
Delaware Administrative Code
Title 16 - Health and SafetyDepartment of Health and Social ServicesDivision of Substance Abuse and Mental HealthSubstance Abuse Facility Licensing Standards
Part III - Provisions Regarding Modalities
Section 6001-III-16.0 - Co-Occurring Treatment

16 Del. Admin. Code § 6001-III-16.0

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Current through Register Vol. 28, No. 7, January 1, 2025
Section 6001-III-16.0 - Co-Occurring Treatment
16.1 In addition to the requirements applicable to all programs and § 15.0 of these standards, a Co-Occurring Treatment program shall provide a cadre of staff and services to meet the psychiatric and substance use disorder needs of clients. Staffing shall be flexible and meet the changing needs of the population served.
16.2 Staffing
16.2.1 Qualifications for the Position of Medical Director
16.2.1.1 Each Medical Director shall be a person with a Medical Degree or Doctor of Osteopathy degree; licensed to practice medicine in the state of Delaware and has completed (or is enrolled in) an accredited residency training program in psychiatry, internal medicine or family practice.
16.2.2 Qualifications for the Position of Qualified Psychiatric Practitioner
16.2.2.1 Qualified Psychiatric Practitioners shall meet the criteria for Qualified Medical Personnel as defined in § 3.0 of these standards; AND
16.2.2.2 Have a minimum of three (3) years of documented clinical experience in the field of mental health.
16.2.3 Qualifications for the Position of Clinical Director
16.2.3.1 Each individual hired or promoted to provide clinical supervision on or after the date these regulations become effective shall, at a minimum, meet the following criteria:
16.2.3.1.1 A master's degree with a major in psychology, social work, counseling, nursing or a related field of study and six (6) years of clinical experience in human services, three (3) of which shall be in substance abuse treatment services; OR
16.2.3.1.2 A master's degree from an accredited college or university with a major in chemical dependency, psychology, social work, counseling, nursing or a related field of study and full certification as a Certified Co-Occurring Disorders Professional in the state of Delaware (CCDP); OR
16.2.3.1.3 A master's degree from an accredited college or university with a major in chemical dependency, psychology, social work, counseling, nursing or a related field of study and full certification as a Certified Co-Occurring Disorders Professional by a nationally recognized body.
16.2.3.2 Clinical supervisor as defined in § 6.1.3 will not meet the criteria for Clinical supervisor for a co-occurring treatment program.
16.2.4 Qualifications for the Position of Mental Health Clinician
16.2.4.1 Each individual hired or promoted to the position of Mental Health Clinician on or after the date these regulations become effective shall meet the following criteria at a minimum:
16.2.4.1.1 A master's degree in psychology, counseling, social work, nursing, rehabilitation or related field of study from an accredited college or university.
16.2.5 Qualifications for the Position of Associate Mental Health Clinician:
16.2.5.1 Each individual hired or promoted to the position of Associate Mental Health Clinician on or after the date these regulations become effective shall, at a minimum, meet the following criteria:
16.2.5.1.1 Full certification as a Certified Co-Occurring Disorders Professional in the state of Delaware (CCDP); OR
16.2.5.1.2 Full certification as a Certified Co-Occurring Disorders Professional by a nationally recognized body; OR
16.2.5.1.3 A bachelor's degree from an accredited college or university in psychology, social work, counseling, or nursing and five (5) years of documented clinical experience working in the field of mental health
16.2.6 Qualifications for the position of Case Manager
16.2.6.1 Co-occurring treatment programs that employ Case Managers shall hire or promote staff on or after the date these regulations become effective that meet the following criteria:
16.2.6.1.1 A bachelor's degree from an accredited college or university in chemical dependency, psychology, social work, counseling, or nursing and five (5) years of documented clinical experience working in the field of mental health and/or addictions counseling.
16.2.6.2 Qualifications for the position of Assistant Clinician:
16.2.6.2.1 Each individual hired or promoted to the position of Assistant Clinician on or after the date these regulations become effective shall meet the following criteria:
16.2.6.2.1.1 A bachelor's degree from an accredited college or university in psychology, social work, counseling or nurse with less than five (5) years of documented clinical experience working in the field of mental health counseling; OR
16.2.6.2.1.2 The individual is a student enrolled in a course of study while completing a practicum or internship.
16.2.7 Programs may employ staff that dually meets the staffing requirements in § 6.0 and § 16.1 of these standards with the exception of § 16.1.3: Clinical supervisor.
16.3 Staff Training
16.3.1 In addition to staff training and development in § 5.1.7 of these standards, co-occurring treatment programs shall include:
16.3.1.1 At orientation:
16.3.1.1.1 Training in the relationship between substance use disorders and mental health disorders;
16.3.1.1.2 Training in the use of medication with co-occurring disorder clients including the use of buphrenorphine, and other Opioid antagonist medications; and
16.3.1.1.3 Training in DSM five (5) Axis Diagnosis.
16.3.1.2 Annually thereafter:
16.3.1.2.1 Ten (10) hours of training specific to the treatment of clients with co-occurring mental health and substance use disorders.
16.3.1.2.2 Ongoing training specific to co-occurring disorder treatment as part of the staff member's individualized training plan required in § 5.1.7.2 of these standards.
16.4 Clinical Supervision
16.4.1 Staff who meet the criteria for Assistant Clinician in § 16.1.6.2 of these standards shall receive clinical supervision in accordance with § 6.1.5.2 and § 6.1.5.3 of these standards.
16.5 Services
16.5.1 Qualified Psychiatric Practitioner
16.5.1.1 Qualified Psychiatric Practitioners shall be available to staff at all times.
16.5.1.2 Qualified Psychiatric Practitioners shall conduct a psychiatric evaluation within thirty (30) days of admission to the co-occurring treatment program to include:
16.5.1.2.1 Psychiatric history;
16.5.1.2.2 Medication history ;
16.5.1.2.3 Mental Status; AND
16.5.1.2.4 DSM five (5) Axis Diagnosis.
16.5.1.3 Qualified Psychiatric Practitioners shall meet with consumers for regularly scheduled appointments at intervals determined to be most beneficial for the consumer, but no less than every six months.
16.5.2 Medication monitoring
16.5.2.1 A Qualified Psychiatric Practitioner will explain to the consumer the rationale for each medication prescribed as well as the medication's risks/benefits.
16.5.2.1.1 Informed consent shall be obtained for each medication prescribed at the time it is prescribed.
16.5.2.1.2 Informed consent shall be updated, at a minimum, annually in concert with the annual psychiatric evaluation.
16.5.2.2 Rationale for all changes in medication orders shall be documented in the Qualified Psychiatric Practitioner's notes.
16.5.2.3 All medication orders in the consumer's case record shall include:
16.5.2.3.1 Name of the medication;
16.5.2.3.2 Dosage;
16.5.2.3.3 Route of administration;
16.5.2.3.4 Frequency of administration;
16.5.2.3.5 Signature of the Qualified Psychiatric Practitioner prescribing the medication; and
16.5.2.3.6 All known allergies.
16.5.2.4 Medication orders shall be documented on a medication order form and include:
16.5.2.4.1 Date of initiation;
16.5.2.4.2 Date of discontinuance;
16.5.2.4.3 Name of medication;
16.5.2.4.4 Route of administration;
16.5.2.4.5 Frequency of administration; AND
16.5.2.4.6 Signature of the person documenting the orders.
16.5.2.5 All medication orders shall be reviewed at each face-to-face meeting with the consumer and the review shall be reflected in the progress notes written by a Qualified Psychiatric Practitioner at the time of the consumer's visit.
16.5.3 A Qualified Psychiatric Practitioner's progress note shall be completed after each meeting with a consumer and include but not be limited to:
16.5.3.1 The consumer's report of progress;
16.5.3.2 The content of the meeting;
16.5.3.3 The Qualified Psychiatric Practitioner opinion of the consumer's status;
16.5.3.4 Current DSM five (5) Axis Diagnosis; AND
16.5.3.5 Continuation of the plan of treatment in conjunction with the consumer's treatment plan.
16.5.4 Annual review by Qualified Psychiatric Practitioner
16.5.4.1 Qualified Psychiatric Practitioner shall review each consumer's record annually and provide documentation of:
16.5.4.1.1 A clinical review of the consumer's progress over the year;
16.5.4.1.2 Any changes noted;
16.5.4.1.3 Mental status exam;
16.5.4.1.4 Observations;
16.5.4.1.5 Impressions;
16.5.4.1.6 DSM five (5) Axis Diagnosis; AND
16.5.4.1.7 Plan.
16.5.5 Staff shall monitor and document consumer tolerance, compliance in following prescribed medication treatment and medication side effects to include the following:
16.5.5.1 Laboratory studies for all medications which require laboratory monitoring as recommended in the most current Physician's Desk Reference.
16.5.5.1.1 Laboratory studies shall be reviewed and signed by a Qualified Psychiatric Practitioner or RN within two (2) days of receipt.
16.5.5.1.2 Results of laboratory studies shall be documented in the consumer's chart within thirty (30) days.
16.5.5.2 AIMS (Abnormal Involuntary Movement Scale) shall be performed no less than annually for consumers whose medication includes Tardive Dyskinesia as possible side effects of the medication.
16.5.5.3 Monitoring of vital signs at each visit with a Qualified Psychiatric Practitioner shall include:
16.5.5.3.1 Temperature;
16.5.5.3.2 Blood pressure;
16.5.5.3.3 Pulse; and
16.5.5.3.4 Respiration.
16.5.6 Screening and Assessment
16.5.6.1 Co-Occurring treatment programs will utilize a screening tool approved by DSAMH to screen all consumers for substance use disorders and mental health symptoms at intake, and annually thereafter.
16.5.6.2 Based on the screening results:
16.5.6.2.1 Assessment will be conducted using tools approved by DSAMH; AND
16.5.6.2.2 Clients will be placed in appropriate levels of care to meet their substance use and mental health needs.
16.5.7 Case Management
16.5.7.1 Based on the needs of the client, case management coordination shall include:
16.5.7.1.1 Coordination of medical services with the consumer's primary care physician when needed;
16.5.7.1.2 Linkage to medical services when a primary care physician has not been identified;
16.5.7.1.3 Coordination of crisis intervention and stabilization services as appropriate;
16.5.7.1.4 Assistance with achieving goals for independence as defined by the consumer;
16.5.7.1.5 Linkage to resources and opportunities through:
16.5.7.1.5.1 Support groups including but not limited to:
16.5.7.1.5.1.1 Sober support groups that meet the needs of co-occurring consumers;
16.5.7.1.5.1.2 Peer support/peer mentoring networks;
16.5.7.1.5.1.3 Social support networks;
16.5.7.1.5.1.4 Social skills training networks;
16.5.7.1.5.1.5 Family support networks; and
16.5.7.1.5.1.6 Other community services as needed.
16.5.7.1.6 Safe/decentffordable housing when needed;
16.5.7.1.7 Entitlements;
16.5.7.1.8 Education and vocational services;
16.5.7.1.9 Transportation to and from the program; and
16.5.7.1.10 Other activities carried out in collaboration with the consumer.
16.5.7.2. When a Case Manager meeting the criteria of § 16.2.6 of these standards is the sole provider of case management services, case loads shall not exceed a one to forty (1:40) staff: consumer ratio.
16.5.8 Psycho-Education and Counseling
16.5.8.1 Programs shall provide psycho-education for all consumers and family members on:
16.5.8.1.1 The efficacy of medications used for mental health diagnosis and the effects of substances on these medications; and
16.5.8.1.2 The treatment and maintenance of co-occurring disorders.
16.5.8.2 When appropriate, programs shall provide counseling that includes:
16.5.8.2.1 Group therapy that will support maintenance and stability of the consumer's psychiatric and substance use disorder;
16.5.8.2.2 Individual therapy to address all therapeutic issues that will support maintenance and stability of the consumer's psychiatric and substance use disorder; and
16.5.8.2.3 Family therapy to address therapeutic issues within the family that will support maintenance and stability of a consumer's psychiatric and substance use disorder.
16.5.8.3 Co-occurring treatment programs shall offer ample opportunity to consumers to attend community support groups that will enhance treatment for both mental health diagnosis and substance use disorders. Groups shall include but not be limited to:
16.5.8.3.1 In-house support groups provided by the co-occurring treatment program; and/or
16.5.8.3.2 Linkage to-12 step groups that support dual recovery for mental health diagnosis and substance use disorders (e.g. "Double Trouble"); and/or
16.5.8.3.3 Linkage to faith-based or other community networks including education programs, physical fitness programs, etc. that support dual recovery for mental health diagnosis and substance use disorders.

16 Del. Admin. Code § 6001-III-16.0

14 DE Reg. 471 (11/01/10)