N.Y. Comp. Codes R. & Regs. tit. 14 § 595.4

Current through Register Vol. 46, No. 43, October 23, 2024

Section 595.4 - Definitions

For purposes of this Part:

(a) General definitions.

(1) Admission criteria are those factors which are identified by the provider of service for use in determining an individual's eligibility for admission to a residential services program.

(2) Clinical assessment means an evaluation which shall include, at a minimum, a patient history, mental status determination, diagnosis and identification of individual treatment needs and recommendations.

(3) Community Residence for Eating Disorder Integrated Treatment Program (CREDIT Program) for adults is a subclass of community residence for individuals over the age of 18 who have been diagnosed with an eating disorder as defined in section 2799-e of the Public Health Law, whose individual treatment issues preclude family settings or other less restrictive alternatives.

(4) Designated mental illness diagnosis means that an individual is 18 years of age or older and currently meets the criteria for a psychiatric diagnosis in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), or has a diagnosis of an eating disorder as defined in this section, but excluding alcohol or drug disorders, dementias and other disorders due to general medical conditions, developmental disabilities or social conditions (V-codes). ICD-9-CM categories and codes that do not have an equivalent in DSM-IV are also not included as designated mental illness diagnosis.

(5) Discharge planning means the process of planning for termination of services from a residential program through the identification of residential and other resources and supports needed for the transition of the resident to another residential option and making the necessary referrals, including linkages for treatment, rehabilitative and support services.

(6) Eating disorder means an eating disorder as such term is defined in section 2799-e of the Public Health Law and shall include, but not be limited to, conditions such as anorexia nervosa, bulimia and binge eating disorder, identified as such in the most current edition of the International Classification of Disease or the most current edition of the Diagnostic and Statistical Manual of Mental Disorders, or other medical and mental health diagnostic references generally accepted for standard use by the medical and mental health fields.

(7) Extended impairment in functioning means an individual has met subparagraph (i) or (ii) of this paragraph:

(i) experienced two of the following four functional limitations due to a designated mental illness over the past 12 months on a continuous or intermittent basis:

(a) marked difficulties in self-care such as personal hygiene, diet, clothing, avoiding injuries, securing health care or complying with medical advice;

(b) marked restrictions of activities of daily living such as maintaining a residence, using transportation, day-to-day money management or accessing community service;

(c) marked difficulties in maintaining social functioning such as establishing and maintaining social relationships, interpersonal interactions with primary partners, children and other family members, friends, or neighbors, social skills, compliance with social norms or appropriate use of leisure time;

(d) frequent deficiencies of concentration, persistence or pace resulting in failure to complete tasks in a timely manner in work, home or school setting. Individuals may exhibit limitations in these areas when they repeatedly are unable to complete simple tasks within an established time period, make frequent errors in tasks, or require assistance in the completion of tasks; or

(ii) met criteria for rating of 50 or less on the Global Assessment of Functioning Scale (Axis V of DSM-IV) due to a designated mental illness over the past 12 months on a continuous or intermittent basis.

(8) On-site services means those services which are provided either on a 24- hour basis in a congregate or service enriched single room occupancy program or through periodic visits and on an as-needed basis within an apartment program.

(9) Provider of service means the entity which is responsible for the operation of a program. Such entity may be an individual partnership, association or corporation.

(10) Qualified mental health staff person means:

(i) a physician who is currently licensed as a physician by the New York State Education Department;

(ii) a psychologist who is currently licensed as a psychologist by the New York State Education Department;

(iii) a social worker who is either currently licensed as a licensed master social worker or as a licensed clinical social worker by the New York State Education Department or has a master's degree in social work from a program approved by the New York State Education Department;

(iv) a registered nurse who is currently licensed as a registered professional nurse by the New York State Education Department;

(v) a creative arts therapist who is currently licensed as a creative arts therapist by the New York State Education Department;

(vi) a marriage and family therapist who is currently licensed as a marriage and family therapist by the New York State Education Department;

(vii) a mental health counselor who is currently licensed as a mental health counselor by the New York State Education Department;

(viii) a psychoanalyst who is currently licensed as a psychoanalyst by the New York State Education Department;

(ix) a nurse practitioner who is currently certified as a nurse practitioner by the New York State Education Department;

(x) an individual having education, experience and demonstrated competence, as defined below:

(a) a master's or bachelor's degree in a human services related field;

(b) an associate's degree in a human services related field and three years experience in human services;

(c) a high school degree and five years experience in human services; or

(xi) for purposes of a CREDIT program, a registered dietitian who is currently licensed by the New York State Education Department; or

(xii) other professional disciplines which receive the written approval of the Office of Mental Health.

(11) Reliance on psychiatric treatment, rehabilitation and supports means that a documented history shows that the individual, at some prior time, met the threshold for extended impairment in functioning, but symptoms and/or functioning problems are currently attenuated by medication or psychiatric rehabilitation and supports. Medication refers to psychotropic medications which may control certain primary manifestations of mental disorder, but may or may not affect functional limitations imposed by the mental disorder. Psychiatric rehabilitation and supports refers to a highly structured and supportive setting which may greatly reduce the demands placed on the individual and, thereby, minimize overt symptoms and signs of the underlying mental disorder.

(12) Site means the type of structure in which a residential program is located. Structural types are defined to delineate differences in premises, capacity and safety requirements and may include:

(i) Apartment which means a unit organized as a self-contained entity requiring staff support appropriate to the needs of the residents.

(ii) Congregate which means a program which is a group living design, requiring staff on-site, 24 hours per day.

(iii) Service enriched single room occupancy which means a program providing support services for persons who require assistance to improve or maintain their daily living and socialization skills, in residences with private living units and supportive services available on site. Such programs provide 24 hour on-site staff coverage and are designed to enable residents to live as independently as possible in stable community-based housing.

(13) Support residential program means a residential program which provides supportive services designed to improve or maintain an individual's ability to live as independently as possible and eventually access generic housing. For an individual who is not ready for full participation in services and activities, there may be an extended period of engagement consistent with the individual's desire, tolerance and capacity to participate in such services.

(14) Treatment residential program means a rehabilitation-oriented residential program which focuses upon interventions necessary to address an individual's specific functional and behavior deficits which must be resolved in order to access generic housing. The engagement of an individual in services and activities shall be consistent with the individual's desire, tolerance and capacity to participate in such initiatives.

(15) As used in this Part to describe the duties or obligations of the provider of service, the word ensure shall not affect the standard of liability in damages of a provider of service beyond the standard set forth in statutory and/or case law applicable in this State.

(b) Service definitions.

(1) Assertiveness/self-advocacy training means training which is designed to promote the individual's ability to assess his or her needs to make a life status change and to increase self awareness about his or her values and preferences. Training will also increase an individual's ability to respond to medical, safety and other personal problems. Activities are also intended to improve communication skills and facilitate appropriate interpersonal behavior.

(2) Community integration services/resource development means activities which are designed to help individuals identify skills and community supports necessary for specific environments, assess their skills, strengths and deficits in relation to environmental demands, assess available resources, and develop a natural support system by accessing social, educational and recreational opportunities.

(3) Daily living skills training means activities which focus on the acquisition of skills and capabilities to maintain primary activities of daily life. Services are provided by addressing areas of functioning in categories such as: dressing, personal hygiene and grooming, selection and/or preparation of food, cleaning and washing of clothes, maintenance of environment, budgeting and money management. Training is intended to increase those competencies needed by the individual to live in his or her goal environment.

(4) Health services means training to maximize independence in personal health care by increasing the individual's awareness of his or her physical health status and the resources required to maintain physical health, including regular medical and dental appointments, basic first aid skill and basic knowledge of proper nutritional habits and family planning. Also included is training on topics such as AIDS awareness. In the CREDIT program, health services may also include assistance and monitoring of the individual's activities relating to food, meals, and weight management.

(5) Medication management and training means training regarding the storage, monitoring, recordkeeping and supervision associated with the self-administration of medication. This does not include prescribing, but does include a certain degree of reviewing the appropriateness of the residents' existing regimen with his or her physician. Activities which focus on educating residents about the role and effects of medication in treating symptoms of mental illness and training in the skill of self-medication are also included.

(6) Parenting training means structured activities intended to promote positive family functioning and enable residents to assume parenting responsibilities. Activities include peer support groups to foster skills around effective parenting, assistance in selecting and obtaining housing appropriate for families, and linkage with the children's service system. Psycho-education programs on parenting skills, single parenting issues, child care and the nature of mental illness and its effect on the family are also included.

(7) Rehabilitation counseling means a therapeutic modality which includes assisting the individual in clarifying future directions and the potential to achieve rehabilitation goals, identifying and specifying behaviors that impede goal setting, improving awareness of the influence of environmental stress, and helping an individual to generalize newly learned behaviors to housing and other situations outside the program structure.

(8) Skill development services means activities which assist clients to gain and utilize the skills necessary to undertake employment or pursue educational opportunities. This may include skills related to securing appropriate clothing, scheduling, work related symptom management, and work readiness training.

(9) Socialization means activities which are intended to diminish tendencies toward isolation and withdrawal by assisting residents in the acquisition or development of social and interpersonal skills. It is an activity meant to improve or maintain a resident's capacity for social involvement by providing opportunities for application of social skills. This occurs through resident and staff interaction in the program and through exposure with staff to opportunities in the community. Modalities used in socialization include individual and group counseling and behavior intervention.

(10) Substance abuse services means services provided to increase the individual's awareness of alcohol and substance abuse and reduction or elimination of its use: such services shall include verbal and medication therapies, psycho-educational approaches and prevention and relapse prevention techniques.

(11) Symptom management for the purpose of this Part, means activities which are intended to achieve a maximum reduction of psychiatric symptoms and increased functioning. This includes the ongoing monitoring of residents' mental illness symptoms and response to treatment, interventions designed to help residents manage their symptoms and assisting residents to develop coping strategies to deal with internal and external stressors. Activities range from providing guidance around everyday life situations to addressing acute emotional distress through crisis management and behavior intervention techniques.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 595.4