(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).
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