OMH-09-09-00004-A Operation of Licensed Housing Programs for Children and Adolescents with Serious Emotional Disturbances

5/20/09 N.Y. St. Reg. OMH-09-09-00004-A

NEW YORK STATE REGISTER

VOLUME XXXI, ISSUE 20

May 20, 2009

RULE MAKING ACTIVITIES

OFFICE OF MENTAL HEALTH

NOTICE OF ADOPTION

 

I.D No. OMH-09-09-00004-A

Filing No. 497

Filing Date. May. 05, 2009

Effective Date. May. 20, 2009

Operation of Licensed Housing Programs for Children and Adolescents with Serious Emotional Disturbances

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Action taken:

Amendment of Part 594 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 7.09 and 31.04

Subject:

Operation of Licensed Housing Programs for Children and Adolescents with Serious Emotional Disturbances.

Purpose:

To amend Part 594 to include a new class of community residences for treatment of eating disorders.

Substance of final rule:

Summary

This rule will amend 14 NYCRR Part 594, Operation of Licensed Housing Programs for Children and Adolescents with Serious Emotional Disturbances, by establishing a new sub-class of community residence for children and adolescents who have been diagnosed as having an eating disorder such as anorexia nervosa, bulimia, binge eating disorder, or other eating disorder identified as such in generally accepted medical or mental health diagnostic references.

Overview

The new category of community residences will be known as Community Residences for Eating Disorder Integrated Treatment (CREDIT), and will address the needs of individuals who have reached at least the 12th birthday but not the 19th, who have been referred by a provider who is a participant in a Comprehensive Care Center for Eating Disorders (CCCED) designated by the State Department of Health or by the individual's primary care physician or mental health provider, and whose individual treatment issues preclude being served in a family setting or other less restrictive residential alternative.

Requirements

CREDIT programs will be required to have written affiliation agreements with CCCED providers, which must include referral and admission procedures, as well as procedures for crisis clinical back-up. The agreements will be subject to approval by the Office of Mental Health, and will be required to assure continuity and integration of care with the CCCED. The agreements will provide, at a minimum, for the following:

• The performance of a psychiatric assessment;

• The development of an integrated service plan;

• The performance of a medical examination;

• The supervision of meal, bathroom and exercise time;

• Family participation, as appropriate;

• Coordination of residents' educational needs with residents' school districts.

CREDIT programs will be required to have sufficient staff to meet the special needs of children and adolescents residing in a community residence who have been diagnosed with an eating disorder. Services will be required to be provided pursuant to an initial service plan developed by program staff with the resident and family and/or any collateral identified for participation within three days of admission, and a more extensive plan to be developed within four weeks of admission. The service plan will be required to be reviewed weekly. The CREDIT program will be required to complete progress notes weekly.

Revisions Regarding Children's Residences other than CREDIT Program

Part 594 is also being amended to include several technical amendments concerning the operation of licensed housing programs for children and adolescents. Included in these amendments is utilization of "person first" language and an emphasis on family-centered community-based treatment, resilience and recovery. In addition, each licensed housing program will be required to submit a staffing plan which includes at least one full-time employee who is a registered nurse for each eight-bed community residence and for each 12-bed teaching family home.

Non-substantive changes to previous rulemaking

The non-substantive changes in the final version of the rulemaking serve to clarify certain definitions. "Behavioral support" is also known as "behavior management training" and "family-based treatment program (FBTP)" families are also known as "professional" families. Further, in the definition section of the rulemaking, the word "family" was removed from "Counseling services" to ensure consistency with other Parts in Title 14 NYCRR.

Final rule as compared with last published rule:

Nonsubstantive changes were made in sections 594.4(a), (b), 594.6(b), 594.8(f), (g), 594.10(c), (d) and 594.11(j), (k).

Text of rule and any required statements and analyses may be obtained from:

Joyce Donohue, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, [phone], email: [e-mail]

Revised Regulatory Impact Statement

A revised regulatory impact statement is not submitted with this notice because the changes to the final version of the rulemaking are non-substantive. These changes provide definition clarification and assure consistency with other Parts of Title 14 NYCRR regarding "counseling services".

Revised Regulatory Flexibility Analysis

The changes to the final version of the rulemaking provide definition clarification and assure consistency with other Parts of Title 14 NYCRR regarding "counseling services". As there is no adverse economic impact on small businesses or local governments as a result of these non-substantive changes, a regulatory flexibility analysis is not submitted with this notice.

Revised Rural Area Flexibility Analysis

A Rural Area Flexibility Analysis is not submitted with this notice because the changes to the final version of the rulemaking are non-substantive. These changes merely serve to clarify definitions and assure consistency with other Parts of Title 14 NYCRR.

Revised Job Impact Statement

A Job Impact Statement is not submitted with this notice because the changes to the final version of the rulemaking are non-substantive. These changes merely serve to clarify definitions and assure consistency with other Parts of Title 14 NYCRR.

Assessment of Public Comment

The agency received two letters in support of the adoption of Part 594 of Title 14 NYCRR. The letters stated that eating disorders can have severe effects on a patient's physical and mental health, and effective treatment requires an integrated team approach involving a physician, mental health provider, dietitian and supportive therapies. In addition, the rate of eating disorders among all age groups continues to rise both in New York State and throughout the country, and some patients require more than outpatient services to manage their eating disorder. A structured treatment program offered in a residential setting may be needed to facilitate recovery, and since a residential component for the treatment of eating disorders has not previously been available in New York State, many patients are forced to go out of state to access this level of care. The CREDIT program will help to alleviate this problem and allow therapeutic work to be done with the patient and his/her family.