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RULE §306.317Psychosocial Rehabilitative Services

(a) Description. Psychosocial rehabilitative services are social, behavioral, and cognitive interventions provided by members of an individual's therapeutic team that build on strengths and focus on restoring the individual's ability to develop and maintain social relationships, occupational or educational achievement, and other independent living skills that are affected by or the result of a serious mental illness in adults. Psychosocial rehabilitative services may also address the impact of co-occurring disorders upon the individual's ability to reduce symptomology and increase daily functioning. Psychosocial rehabilitative services that include, but are not limited to, the following component services:

  (1) independent living services;

  (2) coordination services;

  (3) employment related services;

  (4) housing related services;

  (5) medication related services; and

  (6) crisis related services.

(b) Conditions.

  (1) Psychosocial rehabilitative services:

    (A) may only be provided to an eligible adult;

    (B) may be provided individually or in a group;

    (C) may be provided on site or in vivo;

    (D) must be provided by a member of the individual's therapeutic team; and

    (E) may not be provided to an individual who is currently admitted to a CSU.

  (2) The therapeutic team must be constituted and organized in a manner that ensures that:

    (A) the team includes a sufficient number of staff to adequately address the rehabilitative needs of individuals assigned to the team;

    (B) team members are appropriately credentialed to provide the full array of component services;

    (C) team members have regularly scheduled team meetings either in person or by teleconference; and

    (D) every member of the team is knowledgeable of the needs and of the services available to the specific individuals assigned to the team.

  (3) Independent living services, coordination services, employment related services, and housing related services, as described in subsection (c)(1) - (4) of this section, must be provided by:

    (A) a QMHP-CS;

    (B) a CSSP; or

    (C) a peer provider.

  (4) Medication related services, as described in subsection (c)(5) of this section, must be provided by licensed medical personnel.

  (5) Crisis related services, as described in subsection (c)(6) of this section, must be provided by a QMHP-CS.

  (6) As part of providing the coordination services described in subsection (c)(2) of this section, a QMHP-CS must conduct the uniform assessment at intervals specified by the department to determine the type, amount, and duration of MH rehabilitative services.

(c) Components of psychosocial rehabilitative services. Psychosocial rehabilitative services include, but are not limited to, the following.

  (1) Independent living services assist an individual in acquiring the most immediate, fundamental functional skills needed to enable the individual to reside in the community and avoid more restrictive levels of treatment or reducing behaviors or symptoms that prevent successful functioning in the individual's environment of choice. Such services include training in symptom management, personal hygiene, nutrition, food preparation, exercise, money management and community integration activities.

  (2) Coordination services are training activities that assist an individual in improving his or her ability to gain and coordinate access to necessary care and services appropriate to the needs of the individual. Coordination services include, but are not limited to, instruction and guidance in such areas as:

    (A) assessment--identifying strengths and areas of need across life domains;

    (B) recovery planning--prioritizing needs and establishing life and treatment goals, selecting interventions, developing and revising recovery plans that include wellness, relapse prevention, and crisis plans;

    (C) access--identifying potential service providers and support systems across all life domains (e.g., medical, social, educational, substance use), initiating contact with providers and support systems including advocacy groups;

    (D) coordination--setting appointments, arranging transportation, facilitating communication between providers; and

    (E) advocacy--

      (i) asserting treatment needs, requesting special accommodations, evaluating provider effectiveness and compliance with the agreed upon recovery plan; and

      (ii) requesting improvements and modifications to ensure maximum benefit from the services and supports.

  (3) Employment related services provide supports and skills training that are not job-specific and focus on developing skills to reduce or manage the symptoms of serious mental illness that interfere with an individual's ability to make vocational choices or obtain or retain employment. Such services consist of:

    (A) instruction in dress, grooming, socially and culturally appropriate behaviors, and etiquette necessary to obtain and retain employment;

    (B) training in task focus, maintaining concentration, task completion, and planning and managing activities to achieve outcomes;

    (C) instruction in obtaining appropriate clothing, arranging transportation, utilizing public transportation, accessing and utilizing available resources related to obtaining employment, and accessing employment-related programs and benefits (e.g., unemployment, workers' compensation, and Social Security);

    (D) interventions or supports provided on or off the job site to reduce behaviors or symptoms of serious mental illness that interfere with job performance or that interfere with the development of skills that would enable the individual to obtain or retain employment; and

    (E) interventions designed to develop natural supports on or off the job site to compensate for skill deficits that interfere with job performance.

  (4) Housing related services develop an individual's strengths and abilities to manage the symptoms of the individual's serious mental illness that interfere with the individual's capacity to obtain or maintain tenure in independent integrated housing. Such services consist of:

    (A) skills training related to:

      (i) home maintenance and cleanliness;

      (ii) problem-solving with the individual's landlord and neighbors, mortgage lender, or homeowners association; and

      (iii) maintaining appropriate interpersonal boundaries; and

    (B) supportive contacts with the individual to reduce or manage the behaviors or symptoms related to the individual's serious mental illness that interfere with maintaining independent integrated housing.

  (5) Medication related services provide training regarding an individual's medication adherence. Such services consist of training in:

    (A) the importance of the individual taking the medications as prescribed;

    (B) the self-administration of the individual's medication;

    (C) determining the effectiveness of the individual's medications;

    (D) identifying side-effects of the individual's medications; and

    (E) contraindications for medications prescribed.

  (6) Crisis related services respond to an individual in crisis in order to reduce symptoms of serious mental illness or SED and to prevent admission of the individual to a more restrictive environment.

(d) Frequency and duration. The provision of psychosocial rehabilitative services must be in accordance with the amount and duration for which the provider has obtained authorization in accordance with §416.6 of this title (relating to Service Authorization and Recovery Plan).

Source Note: The provisions of this §306.317 adopted to be effective January 22, 2014, 39 TexReg 299; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1239

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